March 11, 2010 — Occasional high blood pressure readings are often dismissed as nothing to worry about, but a new study suggests this episodic high blood pressure is a strong predictor of strokes.

”We have shown that it is variations in people’s blood pressure rather than the average level that predicts stroke most powerfully,” says study lead author Peter Rothwell, MD, professor of clinical neurology at the Stroke Prevention Research Unit, John Radcliffe Hospital in Oxford, England.

The study, published in The Lancet, followed more than 2,000 patients who had a transient ischemic attack or TIA, a ”mini-stroke” predictive of a larger stroke, and validated the results with results from three other studies, in finding the link between occasional high blood pressure and stroke risk.

The researchers focused on the systolic blood pressure reading, the top number in the measurement, reflecting the pressure when the heart contracts while pumping blood. Normal blood pressure readings are below 120/80 millimeters of mercury, or mmHg.

How much variability predicts stroke risk? ”One certainly sees an increased risk of stroke when the systolic blood pressure fluctuates 40 mmHg or more (say between 120 mmHg and 160 mmHg) even when mean [or average] blood pressure is very well controlled,” Rothwell tells WebMD in an email interview.

Occasional High Blood Pressure and Stroke Risk: Study Details

Rothwell and his colleagues evaluated data from 2,435 patients who had been enrolled in the UK-TIA aspirin trial, which assigned patients with a recent TIA or ischemic stroke to take aspirin or a placebo. Rothwell’s team evaluated only the 2,006 patients from this study who had TIAs but no strokes, to avoid compromising the results due to the effect of a recent stroke on blood pressure.

Blood pressure in these patients was measured once at every four-month follow-up visit during the study, which ran from 1979 to 1985.

The results from this study were validated by Rothwell’s team with results from three other large studies, each involving more than 2,000 patients.

Occasional High Blood Pressure Predicts Stroke

Patients with the most variation in their systolic blood pressure over seven clinic visits were found six times more likely to have a stroke, Rothwell found.

The highest blood pressure readings were also associated with higher stroke risk. Those with the highest readings over the seven visits were 15 times more likely to have a stroke during the follow-up period.

Not all the patients were being treated for hypertension, Rothwell tells WebMD. “Variability was predictive of stroke in both groups,” he says, treated and untreated. “Some had stable hypertension, some had episodic hypertension and some had stable normal blood pressure. The episodic hypertension group had the highest risk of stroke.”

In one of the studies, variability in blood pressure also predicted the risk of heart attacks.

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March 11, 2010 – Some Whole Foods and Frontier Natural Products spices have been recalled due to possible salmonella contamination of pepper included in the products.

Salmonella contamination of salami products that sickened over 249 people in 44 states has been traced to red and black pepper used in the salami. But salami isn’t the only product that used the contaminated spices.

After finding salmonella in unopened pepper samples, the FDA has asked manufacturers to recall products that used certain lots of peppers from the Mincing Overseas Spice company and the Wholesome Spice Company.

Those recalls now have worked their way down to spices sold on grocery shelves. The retail products recalled today include certain lots of:

Whole Foods Asian Seafood seasoningWhole Foods Mediterranean Rotisserie seasoningWhole Foods Mediterranean Seafood seasoningWhole Foods Muchi CurryWhole Foods Southwestern Grille seasoningWhole Foods Toronto Steak Chicken seasoningFrontier Natural Products Co-op Black Pepper, coarse and fine grindFrontier Natural Products Co-op Cajun Blackened Fish Meat SeasoningFrontier Natural Products Co-op Cracked Black PepperFrontier Natural Products Co-op Curry PowderFrontier Natural Products Co-op Garlic ‘n Herb seasoningFrontier Natural Products Co-op Greek SeasoningFrontier Natural Products Co-op Muchi CurryFrontier Natural Products Co-op Oriental SeasoningFrontier Natural Products Co-op Whole Black PeppercornsFrontier Natural Products Co-op Salad SprinkleFrontier Natural Products Co-op Spaghetti SeasoningFrontier Natural Products Co-op Thai SeasoningFrontier Natural Products Co-op Toronto Steak Chicken seasoningFrontier Natural Products Co-op Veggie Pepper

The pepper recalls are not associated with the huge, ongoing recall of products containing salmonella-contaminated hydrogenated vegetable protein (HVP).

The FDA says it began an investigation of the spice industry in the spring of 2009. This “farm-to-table” risk profile “focuses on microbiological contaminants and filth issues related to spices,” according to an FDA news release.

Salmonella can cause symptoms of fever, diarrhea (which may be bloody), nausea, vomiting, and abdominal pain. In rare cases the bacteria get into the bloodstream and cause extremely serious infections. But even when this is not the case, salmonella is particularly dangerous for young children, frail or elderly people, or people with immune suppression.

People who get these symptoms after consuming Italian sausage products or any of the other recalled products should immediately seek professional health care.

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March 11, 2010 (Miami Beach, Fla.) — A moisturizing cream whose active ingredient is extract of onion can help take the redness out of new stretch marks.

New stretch marks were also softer and smoother in 54 women who used the cream for three months, says Zoe Draelos, MD, a consulting professor of dermatology at Duke University Medical Center in Durham, N.C.

“The stretch marks did not go away,” she tells WebMD. “But [after several weeks of treatment], the cream made them look and feel better,” she says.

The study, funded by Merz Pharmaceuticals, which makes the cream, was presented at the annual meeting of the American Academy of Dermatology. Draelos has served as a consultant to Merz.

Stretch Marks Affect Men, Too

Draelos estimates that up to 98% of women and 75% of men have stretch marks, which appear as wavy, linear red scars, typically on the hips, breasts, thighs, and stomach of women, and the buttocks and pectoralarea of men.

They form when the skin is rapidly stretched, such as during puberty, pregnancy, and rapid weight gain, says Joshua Zeichner, MD, director of cosmetic and clinical research at Mt. Sinai Medical Center in New York City. He was not involved with the research.

“Unfortunately, stretch marks are permanent. Exercise and diet won’t help,” he says.

They’re not harmful to your health, but many people are bothered by their appearance. The marks slowly fade and become flat on their own, but that can take years.

As a result, doctors have been looking for a product to make new stretch marks look and feel better, Draelos says.

Why Onions for Stretch Marks?

Any insult to the skin — be it a cut or wound or the rapid stretching that drives the formation of stretch marks — is accompanied by inflammation.

Onions contain flavonoids, a type of antioxidant, that have anti-inflammatory properties, Draelos says.

The new product also contains pennywort, a plant found in Asia, Africa, and the Americas that has anti-inflammatory properties and is widely used in Indian naturopathic medicine for ulcer healing, she says.

And it has sulfur, which fights bacteria and infection, and a moisturizing cream to help rehydrate the skin, Draelos says.

Onion Creams Helps Stretch Marks Look, Feel Better

The new study involved 54 women, aged 18 to 45, with new, matching stretch marks on their outer thighs.

They worked a quarter-sized amount of the cream into one of their stretch marks twice a day for 12 weeks. The other stretch mark received no treatment.

As judged by the women themselves, the treated stretch mark looked better, was less red, and was softer and smoother than the untreated stretch mark. They started to notice the difference after two weeks of treatment, and the difference persisted through all 12 weeks of the study.

The researchers also noted that the treated stretch mark looked and felt better beginning with the second week, compared with the stretch mark that was not treated. But it wasn’t until the eighth week of treatment that they noticed a substantial difference in redness.

None of the women reported any side effects.

Although the cream wasn’t tested in men, Draelos says she’d recommend it for men, too.

Zeichner says, “Doctors and patients have been looking for good treatment options for stretch marks. The use of a cream containing onion extract may be a promising option for a problem that currently has no cure.”

Called Mederma Stretch Marks Therapy, a 5.29-ounce tube retails for $39.99 at drugstores, according to a Merz spokesperson.

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March 10, 2010 — Nearly 2 million pounds of ready-to-eat beef taquito and chicken quesadilla products that may be contaminated with salmonella have been recalled, the U.S. Department of Agriculture (USDA) says.

The USDA’s Food Safety and Inspective Service said Windsor Foods, which operates in Lampasas, Texas, and Oakland, Miss., had recalled the products.

“The packages of beef taquito and chicken quesadilla products contain an ingredient of the specific hydrolyzed vegetable protein (HVP), which was recalled” March 4 by the FDA, the USDA says in a news release.

The FDA said the recall was called due to the finding that the HVP ingredient was added after salmonella prevention steps were applied.

The HVP was made by Basic Food Flavors of Las Vegas. It’s used in hot dogs, soups, salad dressings, chili, sauces, stews, gravies, chips and dips.

In addition to the beef and chicken products recalled today by Windsor Foods, Proctor & Gamble announced that it’s recalling two Pringles products that contain the HVP from Basic Food Flavors. The recalled products are Pringles Restaurant Cravers Cheeseburger potato crisps and Pringles Family Faves Taco Night potato crisps.

Last week the FDA said 56 products had been recalled, and that the list was expected to grow.

HVP tainted products have been shipped out of Las Vegas since last September, USDA said.

The USDA says each of the beef taquito cartons being recalled bear a label “EST.5590″ inside the USDA mark of inspection.

The chicken quesadilla boxes subject to recall bear the USDA mark of inspection, with the number “P-34708″ located separately on the box.

The products were sent to food service and retail establishments nationwide, USDA said.

The USDA’s Food Safety and Inspection Service says it will post the retail distribution lists as soon as possible on its web site.

So far there have been no reports of illnesses associated with the consumption of any of the products, but the USDA said it advises people who are concerned to contact a physician.

Eating foods contaminated with salmonella can cause a bacterial illness that can be life threatening, especially to people with weak immune systems, infants, the elderly, and people with HIV infections or undergoing chemotherapy.

Common symptoms include diarrhea, abdominal cramps, and fever. Other symptoms can include chills, nausea and vomiting.

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March 10, 2010 — Stromectal — a pill containing ivermectin, a drug used to prevent heartworms in dogs — kills head lice that are resistant to first-line treatment better than malathion-based lotion.

The finding comes from a clinical trial sponsored by Merck, which makes the parasite-killing pill.

When children bring home head lice, doctors usually recommend treatment with one of several brands of pyrethroid-based products, such as Elimite, Acticin, Nix,  A-200, Licide, Pronto, Pyrinyl Plus, Rid, and Tisit (although a recent study showed that a louse-smothering product called Ulesfia works well). But pyrethroid treatment fails if the head lice have become resistant to the pesticide.

What should you try next? The Merck trial pitted Stromectal against an alcohol-based product containing the powerful pesticide malathion (Prioderm Top).

The study enrolled 812 head lice-infected people from 376 households in the UK, Ireland, France, and Israel. Each household had already tried to get rid of the pests with a pyrethroid product. All the people in each household had an alcohol-based lotion applied to their heads by investigators — and each took a pill — on two occasions seven days apart.

Half the people who got the lotion got the real product and half got a sham product; half those getting pills got real Stromectal and half got an inactive placebo.

On day 15, 95% of patients assigned to Stromectal and 85% of those assigned to Prioderm Top were free of lice.

More patients preferred taking the pill to using the lotion. That isn’t surprising, as the lotion had to be left in the hair for 10 to 12 hours before washing out.

There was one serious adverse event in each group. A 7-year-old girl had a seizure six days after her first dose of Stromectal and was hospitalized, then sent home with a prescription for an epilepsy drug. An 11-year-old girl had a severe headache six days after first application of malathion lotion; she was hospitalized overnight but recovered fully.

“Ivermectin may be a good alternative to malathion when topical insecticide resistance is suspected,” conclude study researchers Olivier Chosidow, MD, PhD, of Pierre and Marie Curie University, Paris.

The Chosidow study appears in the March 11 issue of the New England Journal of Medicine.

Bad Bugs: Identifying Bugs and Their Bites

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March 10, 2010 — The U.S. is making gains on at least one war front, the “War on Cancer,” according to a new analysis of cancer death statistics.

Researchers found cancer deaths have dropped by 11% in men and 6% in women since 1971, when President Nixon signed the National Cancer Act declaring a “War on Cancer.”

Although cancer death rates rose during the first two decades of the cancer war, peaking in 1990, researchers say since then there has been a major downturn in cancer deaths, thanks largely to reductions in tobacco use, improvements in cancer screening to allow for early detection, and advances in cancer treatment.

“Contrary to the pessimistic news from the popular media, overall cancer death rates have decreased substantially in both men and women, whether measured against baseline rates in 1970/71 when the National Cancer Act was signed by President Nixon or when measured against the peak rates in 1990/91,” write researcher Ahmedin Jemal of the American Cancer Society and colleagues in PLos ONE.

Researchers say cancer death rates have been dropping steadily since the early 1990s, but some reports have declared the war on cancer a failure because of limited improvement in cancer death rates overall since 1971. But they say many of these analyses do not account for the dramatic increase in tobacco-related cancers in the latter part of the 20th century.

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Measuring Progress on the War on Cancer

In the study, researchers analyzed cancer death statistics for all cancers combined, the four most common cancers (lung, colorectal, prostate in men, and breast in women), and cancers of 15 different sites from 1970 to 2006, using the SEER*Stat database, which reports long-term cancer trends.

The results showed that for all cancers combined, cancer death rates for men increased from 249.3 deaths per 100,000 in 1970 to 279.8 in 1990 and then decreased to 221.1 in 2006, a drop of 21% since the peak year of 1990 and 11% since 1970.

In women, the cancer death rate for all cancers increased from 163.0 in 1970 to 175.3 in 1991 (the peak year) and then decreased to 153.7 in 2006, which is a decline of 12% and 6%, respectively.

Overall, the decrease in cancer death rates since 1990-1991 represent a total of 561,400 prevented cancer deaths in men and 205,700 prevented cancer deaths in women.

Researchers say the decline in cancer deaths involved all age groups and racial/ethnic groups. However, black men and women still have cancer death rates 20%-50% higher than whites.

Death rates decreased for 15 of the 19 cancer sites studied, including the four major cancers. In fact, researchers say reductions in cancer death rates from the four major cancer sites accounted for 60%-80% of the total decrease in cancer death rates since 1990-1991.

Cancer deaths increased for esophageal cancer and melanoma in men, liver cancer in men and women, and pancreatic cancer in women.

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March 10, 2010 — A large percentage of patients without known heart disease who undergo invasive cardiac catheterization to check for dangerous artery blockages do not have them, a new study suggests.

Duke University Medical Center researchers found that almost two-thirds of patients with stable chest pain who had catheterization procedures did not have significant artery disease.

The study did not include patients who were having heart attacks or those with a prior diagnosis of heart disease or unstable angina.

More than 10 million Americans experience chest pain each year and many have not been diagnosed with heart disease.

Cardiac catheterization is commonly performed in an effort to determine the cause of the pain, but the findings suggest a need for better ways to identify which of these patients will benefit from the invasive procedure, Duke University Medical Center cardiology professor Pamela S. Douglas, MD, tells WebMD.

The study appears in the March 11 issue of the New England Journal of Medicine.

“We want to be clear that if someone is having a heart attack and their doctor sends them to a cath lab, they shouldn’t argue,” she says. “But a stable patient who has not been diagnosed with heart disease and who does not need catheterization for pain control may want to ask about the risks and benefits.”

How Cardiac Catheterizations Work

Cardiac catheterization is performed to examine how well the heart and arteries are functioning. A thin plastic tube, or catheter, is inserted into a blood vessel in the arm or leg and the tube is then guided into the coronary arteries or the heart.

When dye is injected through the catheter into the coronary arteries to check for blockages, the procedure is known as coronary angiography.

In the newly published study, the researchers used a national cardiology registry to identify 2 million people who had cardiac catheterization at 663 hospitals across the U.S. between January 2004 and April 2008.

They determined that roughly 400,000 of these people, or one in five, had stable chest pain without a previous diagnosis of heart disease.

Most of these patients had undergone noninvasive cardiac testing, such as an exercise stress test or electrocardiogram, before having a coronary angiography. But only 38% ended up having significant coronary artery blockages.

“This suggests that our ability to identify disease prior to sending patients to the cardiac cath lab is not as good as it should be,” Duke assistant professor of medicine and study co-researcher Manesh R. Patel, MD, tells WebMD.

Douglas points out that the widely used noninvasive tests are not very accurate in moderate- to low-risk patients.

“These patients are more likely to have a false positive finding than a true positive finding, and end up having the invasive testing when they don’t need it,” she says.

Both researchers say more research is needed to determine how to best manage patients with stable chest pain without a diagnosis of heart disease.

Douglas is leading one of the first major trials to do this: a 10,000-patient, $5.5 million study funded by the National Heart Lung and Blood Institute that will compare traditional exercise stress testing to the noninvasive imaging procedure known as CT angiogram.

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March 10, 2010 — A dangerous diarrhea-causing germ once thought to only affect the elderly and seriously ill is now affecting a growing number of healthy children in the U.S.

A new report shows the rates of hospitalization for illness caused by the bacterium Clostridium difficile (C. difficile) in otherwise healthy children nearly doubled between 1997 and 2006.

Researchers found the number of C. difficile-related hospitalizations among children increased from 4,626 in 1997 to 8,417 in 2006, equivalent to a 9% increase each year.

“Children 1-4 years of age were as a group most likely to have a hospitalization that was [Clostridium difficile] related, and newborns were the least likely,” write researcher Marya D. Zilberberg, of the University of Massachusetts, and colleagues in Emerging Infectious Disease.

But researchers say the actual rate of C. difficile infection among newborns may be much higher because of current recommendations against testing newborns for the germ.

Diarrhea Danger Spreading

Clostridium difficile is a toxic strain of bacteria that can cause severe disease in massive outbreaks and has been associated with a growing number of hospitalizations and deaths in adults.

They say the increase in C. difficile infection among children is similar to that found among adults during the same period. But it is unclear whether the Clostridium difficile infection was present when the children were first admitted to the hospital or whether they developed the infection while hospitalized.

In any case, researchers say the pattern of C. difficile infection is changing rapidly, and a better understanding of how this germ affects children is urgently needed.

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March 10, 2010 – Hospitals and professional societies should end bans that that keep many women who’ve had a C-section from opting for a natural birth in later pregnancies, an NIH advisory panel today urged.

About 75% of women succeed in having a vaginal delivery after previous cesarean delivery, assuming that it’s not a multiple birth, that the baby is in the normal position, and that their previous C-section required only a single incision.

But women who might want to give labor a try very often don’t get a chance. That’s because of so-called “VBAC bans” — hospital policies that forbid a vaginal birth after a cesarean (VBAC) unless fully equipped and staffed surgical and anesthesia services are readily available. These policies align with current guidelines set by gynecology and anesthesia professional societies.

Not all hospitals are able to comply with this standard, so many women who have had a C-section have no choice in the matter. In fact, 30% of hospitals stopped offering women this choice after the professional-society guidelines went into effect.

The panel of experts heard three days of testimony and scientific presentations on questions surrounding VBAC. In the end, they urged the professional societies to reconsider their guidelines and urged hospitals to reconsider their policies. However, the panel has no power to force a change in policy.

Panel chairman F. Gary Cunningham, chair of obstetrics and gynecology at the University of Texas Southwestern Medical Center, noted that much more research is needed before doctors can identify the rare women who suffer VBAC complications.

While rare, the complications can be severe and even fatal. However, panel member Carol J. Rowland Hogue, PhD, MPH, director of the women’s and children’s center at Emory University, noted that VBAC isn’t the only risk for a pregnant woman.

“Pregnancy is something of a risky endeavor,” Hogue said at a news conference. “Women do suffer complications and their babies do have problems. Fortunately these are rare — but they occur irrespective of mode of delivery. The very rare experience of maternal death is higher for C-section regardless of whether it is primary or repeat. This is very important for providers to weigh.”

Hogue, Cunningham, and other panel members pointed to a research agenda set out in the panel report. They strongly suggested that professional societies and hospitals would offer women more choices if they had a better understanding of the consequences of offering — and not offering — VBAC.

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March 10, 2010 – Platelet rich plasma (PRP) — the latest, still-controversial treatment for tendon injuries — heals tennis elbow better than corticosteroid shots, a new study suggests.

Because they get very little blood, injured tendons heal notoriously slowly. Blood platelets attract healing growth factors — so the idea of PRP is to inject a patients own platelets at the site of a tendon injury.

To date, small studies suggest that PRP works for tennis elbow. However, a recent study in patients with Achilles tendon injuries yielded disappointing results.

At the same time, corticosteroid shots have been losing favor. They are great at relieving acute pain in the short term, but they don’t promote healing — and may lead to further tendon breakdown.

So what are tennis elbow sufferers supposed to do for their aching arms? A strong hint comes from Taco Gosens, MD, PhD, and colleagues at St. Elisabeth Hospital, Tilburg, Netherlands.

The researchers randomly assigned patients with chronic lateral epicondylitis — tennis elbow lasting longer than six months and pain ranking at least 5 on a 10-point scale — to get either a PRP or corticosteroid injection.

Both injections were given directly into the area of maximum tenderness and also into the tendon using a “peppering” technique in which the needle, after being passed through the skin, is inserted several times into the tendon.

What happened? Patients who got the corticosteroid had much faster pain relief. But 26 weeks after treatment, patients in the PRP arm were much more likely to have less pain and more function than those who received the corticosteroid.

And they kept getting better over the next year. By this time, PRP-treated patients reported a 64% improvement in pain and an 84% improvement in disability. Corticosteroid-treated patients reported a 24% improvement in pain and a 17% improvement in disability.

Moreover, only three of the 51 patients in the PRP group went on to get tennis-elbow surgery, and only two went back for a corticosteroid shot. Among the 49 patients in the corticosteroid group, six went on to surgery, six went back for PRP treatment, and one returned for another corticosteroid shot.

“We know that in the natural history of lateral epicondylitis 80% of patients are healed in one year, but all patients had complaints for at least six months,” Gosens and colleagues report. “In our [study], significant results were achieved only after 26 weeks [with PRP].”

Kenneth Mautner, MD, of Emory University’s sports medicine center says he gets even better results than the Dutch researchers reported. He was not involved in the Gosens study.

“Their results would have been better if they had consistently used ultrasound before treatment to show whether there really was damage to the tendon,” Mautner tells WebMD. “And they did not do PRP injections with ultrasound guidance, which I always do. If they did, they could have been in the 90% success range reported in a previous study.”

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