Department of Medicine

Case Western Reserve University School of Medicine & UH Case Medical Center

WebMD – When Pain Interrupts Your Sleep

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Whether it’s from a sore lower back or throbbing tooth, pain is hard enough to deal with in the light of day. But pain at night that robs you of your much-needed sleep can be downright exhausting.

Pain affects sleep position.
Certain types of pain, such as arthritis pain and orthopedic pain, may prevent you from getting comfortable at night, says Reena Mehra, MD, of University Hospitals Case Medical Center in Cleveland. The medical director of adult sleep services says joint and muscle pain usually results in problems staying asleep (called sleep maintenance insomnia) rather than falling asleep (called sleep onset insomnia).

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New England Journal of Medicine editorial :: James Fang, MD

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A substudy of a randomized comparison of medical therapy with or without bypass surgery for ischemic heart disease in patients with LV systolic dysfunction found that overall, substantial viable myocardium evident at baseline imaging studies had no independent bearing on all-cause mortality over five years; and such viability didn’t influence the relative effectiveness of the two treatment strategies, either for all-cause mortality or the secondary end points of CV mortality and CV hospitalization.

The findings, from the Surgical Treatment for Ischemic Heart Failure trial, based on a selected cohort of about half the total trial population, don’t necessarily mean myocardial viability doesn’t have functional implications, observe the substudy authors…

After pointing out the abundant and longstanding but primarily observational support for revascularization guided by viability testing, Dr James C Fang, University Hospitals and Case Medical Center, Cleveland, OH writes in an accompanying editorial that it was “perhaps surprising” that viability didn’t predict a survival benefit from revascularization. The findings, however, “should be interpreted cautiously,” given the substudy’s limitations; for example, patients were selected for viability testing individually at the physicians’ discretion. “However, the substudy’s findings do raise reasonable questions about the most appropriate method to assess myocardial viability,” Fang writes. “The analysis is a strong reminder that in this era of cost-effectiveness, the role of expensive technologies should be accountable to a rigorous study of incremental benefit.”

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BMJ Editorial :: Cystic fibrosis & survival in patients with advanced lung disease

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Elliott Dasenbrook, MD, Assistant Professor of Medicine and Pediatrics, LeRoy W Matthews Cystic Fibrosis Center, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine wrote the following editorial for BMJ.

Cystic fibrosis and survival in patients with advanced lung disease ::
rhDNase slows progression, and is strongly recommended in treatment guidelines”

1st deployment of transcather aortic valve inplantation – TAVI

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The Division of Cardiovascular Medicine successfully deployed the first transcatheter aortic valve implantation [TAVI].

University Hospitals Case Medical Center is one of only forty sites in the U.S. and the only one in Northeast Ohio – to participate in this clinical trial.

TAVI is a state of the art, minimally invasive technique that benefits high-risk elderly patients who develop aortic stenosis.

Novel Clinical Trial Aims to Reduce Recurrence of Aggressive Breast Cancer

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Tuesday, March 08

In a first-of-its-kind clinical trial, physician-scientists at University Hospitals (UH) Case Medical Center are exploring a new method to potentially prevent recurrence of an early stage, aggressive type of breast cancer.  The pilot study, conducted by Joe Baar, MD, Director of Breast Cancer Research at UH Case Medical Center’s Seidman Cancer Center, is recruiting patients with HER-2 neu+ breast cancer.

Patients with this form of breast cancer typically have a higher recurrence rate of nearly 25% following initial treatment. This novel study aims to improve outcomes through performing bone barrow biopsies to identify if patients’ cancer has spread and adding an additional cancer-targeting drug to standard therapy.

“This study has the potential to change the standard of care for women with this type of breast cancer, which tends to spread very quickly,” says Dr. Baar, who is also Associate Professor of Medicine at Case Western Reserve University School of Medicine. “A small number of HER-2 neu+ breast cancer patients do not do well following standard therapy. We are hoping to identify these high-risk patients and stop the cancer before it progresses to other parts of the body.”

Antibiotic may become long-awaited treatment for IBS sufferers

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An antibiotic may become the first new treatment in a decade for an extremely common, and sometimes debilitating, digestive disorder. The treatment provided long-lasting relief to patients with diarrhea-predominant irritable bowel syndrome (IBS) in a large clinical trial completed at Cedars Sinai Medical Center in Los Angeles.

The results, published Wednesday in the New England Journal of Medicine, provide solid support for the theory that the symptoms of this difficult-to-treat illness are sometimes caused by excess bacteria in the small intestine.

IBS is a disorder of the lower intestinal tract that causes pain, bloating, nausea, diarrhea and constipation. It affects up to 20 percent of the population, making it one of the most commonly diagnosed disorders, according to the National Institutes of Health.

Dr. Gerard Isenberg, associate chief of gastroenterology at University Hospitals Case Medical Center, has used the therapy on his patients for the past two years as an off-label use. The drug is approved for the treatment of traveler’s diarrhea.

Many have shown dramatic improvement and seen few side effects, he says. “What’s hard about IBS is that it’s usually life-long, and you’re confronted with the question of whether you can repeat treatments of an antibiotic.”

Dr. Barbara Williams: Women’s Heart Health

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Director of the Women’s Cardiovascular Center at University Hospitals Dr. Barbara Williams discusses heart health and prevention.

Study Finds Vitamin D Decreases Swine Flu Death Risk

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Vitamin D, which plays a key role in healthy bone development, may also decrease the risk of dying from H1N1 swine flu, a study finds.

The vitamin appeared to especially benefit people in high risk groups, including people who are obese. Obesity increases the risk of dying from viral diseases. Last year’s H1N1 pandemic was especially deadly for pregnant women and people who were obese, according to health officials.

But a report, which will be published in the February 1 issue of Clinical Infectious Diseases found that vitamin D can help cut mortality rates.

The study, conducted by Janice Louie of the California Department of Public Health in Richmond, Calif., looked at 500 obese patients with a body mass index of 40 or more. It was found that these patients were three times more likely to die from viruses, like the flu, than people with a healthy BMI.

Dr. Rebecca S. Boxer, a geriatrician at University Hospitals Case Medical Center, says that vitamin D is important to the health of the immune system on a cellular level.

“Vitamin D also has a relationship to inflammation and obese patients may already have a degree of inflammation,” she told AOL Health. “One way to understand this is that the volume of distribution of vitamin D might be greater for obese people. Vitamin D is fat-soluble. So the bigger you are, the more you need for it to show up at adequate levels in your blood. It spreads throughout the fat tissue and less of it is in your blood. So it can be difficult to find obese patients with enough vitamin D because it’s sinking into their fat tissue.”

Boxer says that there has been a lot of interest in vitamin D in relation to general health and well-being but that studies have not yet shown a direct cause and effect when it comes to the swine flu. “People are getting bigger, which can contribute to lower vitamin D levels. Also people do not get enough sun exposure,” she said.

Eating foods high in vitamin D, such as fatty fish, including wild salmon, is a good way to maintain healthy levels of this vitamin, Boxer said.

“Everyone should be getting their levels checked,” said. “If anything, we know that it can help keep bones healthy. We can’t say that it will prevent the swine flu, but it’s important to make sure you’re getting enough.”

Case Western Reserve/University Hospitals join nationwide HIV vaccine clinical trial

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The Case Western Reserve University/University Hospitals AIDS Clinical Trials Unit is now screening potential participants for a nationwide HIV vaccine clinical trial (HVTN505) being conducted by the HIV Vaccine Trials Network. The HIV vaccine trial is the first of its kind in Cleveland since 2003.

The trial is testing the safety and effectiveness of a combination of two HIV vaccines to see if they will stimulate an immune response to HIV or decrease the amount of virus in the blood if a person later becomes infected. Neither vaccine can cause HIV infection. The trial, which also is open in 15 other U.S. cities, is looking to enroll 1,350 gay men and transgender women. Participants must be 18-50 years old and HIV-uninfected (negative).

“Historically, vaccines have been key to ending viral epidemics,” said Benigno Rodriguez, MD, an infectious disease physician at University Hospitals (UH) Case Medical Center and assistant professor of medicine at Case Western Reserve School of Medicine. “Even with good antiretroviral therapy, millions of people become newly infected each year. We cannot treat our way out of this epidemic.”

“Throughout the AIDS epidemic, Greater Cleveland’s gay community has consistently supported AIDS-related clinical trials. We believe that the men of Cleveland will want to stand up and learn more about HIV vaccine research. We anticipate that many will be willing to participate in this study,” continued Dr. Rodriguez.

The vaccine trial comes to Cleveland after a year of promising developments in the worldwide search for effective new tools to help stem the AIDS epidemic, now entering its third decade. Last year, clinical trials proved some level of effectiveness for two HIV prevention strategies. The CAPRISA004 study demonstrated for the first time that a microbicide – a gel used by a woman prior to sexual activity, could reduce a woman’s risk of acquiring HIV. Another clinical trial showed that antiretroviral drugs – used to treat people living with HIV – can reduce a person’s risk of acquiring HIV if used consistently prior to sexual contact.

Jim Fang, MD, discusses Dick Cheney & Heart Transplant case

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Former VP Dick Cheney has announced that he is getting by with a heart pump, which makes it awkward for him to walk … and he touched on the possibility of getting a heart transplant. Dr. James Fang shows Shepard Smith just what that pump looks like that’s keeping his heart in shape.

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