Statins Use in Presence of Elevated Liver Enzymes: What to Do?

The beneficial role of statins in primary and secondary prevention of coronary heart disease has resulted in their frequent use in clinical practice.

However, safety concerns, especially regarding hepatotoxicity, have driven multiple trials, which have demonstrated the low incidence of statin-related hepatic adverse effects. The most commonly reported hepatic adverse effect is the phenomenon known as transaminitis, in which liver enzyme levels are elevated in the absence of proven hepatotoxicity.

"Ttransaminitis" is usually asymptomatic, reversible, and dose-related.


Lovastatin, a compound isolated from Aspergillus terreus, was the first statin to be marketed for lowering cholesterol. Image source: Wikipedia, public domain.

The increasing incidence of chronic liver diseases, including nonalcoholic fatty liver disease and hepatitis C, has created a new challenge when initiating statin treatment. These diseases result in abnormally high liver biochemistry values, discouraging statin use.

A PubMed/MEDLINE search of the literature (1994-2008) was performed for this Mayo Clinic Proceedings review. The review supports the use of statin treatment in patients with high cardiovascular risk whose elevated aminotransferase levels have no clinical relevance or are attributable to known stable chronic liver conditions.

References:
Statins in the Treatment of Dyslipidemia in the Presence of Elevated Liver Aminotransferase Levels: A Therapeutic Dilemma. Rossana M. Calderon, MD, Luigi X. Cubeddu, MD, Ronald B. Goldberg, MD and Eugene R. Schiff, MD. Mayo Clinic Proceedings April 2010 vol. 85 no. 4 349-356.

What's new in obstetrics and gynecology from UpToDate

35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page. I selected the brief excerpts below from What's new in obstetrics and gynecology:

Obstetrics

Influenza vaccination with inactivated vaccine is recommended for pregnant women, regardless of the stage of pregnancy. The 2010-2011 influenza vaccine is trivalent and includes antigens from both the 2009 pandemic H1N1 influenza virus and seasonal influenza viruses.

Use of acetaminophen during pregnancy was associated with a reduction in neural tube defects, as well as cleft lip/palate and gastroschisis. These data support the safety of acetaminophen for relief of fever and pain.

Gynecology

Like CA 125, human epididymal secretory protein E4 (HE4) is a promising biomarker for ovarian cancer. In contrast to CA 125, HE4 levels do not appear to be elevated in women with endometriosis, and thus can be useful to rule out ovarian cancer in patients with endometriosis and a pelvic mass suspected to be an endometrioma.

Sterilization does not impact sexual function. Sexual function appears to be unchanged or improved in women following tubal sterilization.

Botulinum toxin may be useful for overactive bladder syndrome (onabotulinumtoxinA, Botox®). Detrusor injection of botulinum toxin (BoNT) had a transient effect. The average time between injections was 8 to 12 months.

References:
What's new in obstetrics and gynecology. UpToDate.

Image source: Wikipedia, GNU Free Documentation License.

Stelara (ustekinumab) and Remicade (infliximab) are effective if Enbrel (etanercept) stops working in psoriasis

About 7.5 million Americans suffer from psoriasis, a lifelong disorder characterized by inflammation of skin and, often, the joints.



Stelara, Remicade, and Enbrel are all biologics -- drugs made of genetically engineered proteins -- that are generally used to treat patients who aren't responding to traditional therapies such as light therapy and methotrexate.



Remicade and Enbrel both block tumor necrosis factor-alpha (TNF-alpha), a chemical produced by immune cells that fuels inflammation, much like gas on a fire. Stelara targets two proteins, interleukin 12 and interleukin 23, that also drive the inflammatory process.



References:

Study Shows Stelara and Remicade Are Both Effective if Enbrel Stops Working. WebMD, 2010.

Ustekinumab is a Strong Option for Moderate to Severe Psoriasis - anti-IL12/23 monoclonal antibody with NNT of 2 http://goo.gl/gbXSJ

Image source: Crystal structure of human IL-12, Wikipedia, public domain.

In Adolescents, Gratitude Leads to More Success Than Materialism

Materialistic youth seem to be languishing while grateful youth seem to be flourishing.

In this study, 1,000 high school students completed measures of materialism, gratitude, academic functioning, envy, depression, life satisfaction, social integration, and absorption.

Gratitude, controlling for materialism, predicted all outcomes considered: higher grade point average, life satisfaction, social integration, and absorption, as well as lower envy and depression.

In contrast, materialism, controlling for gratitude, uniquely predicts three of the six outcomes: lower grade point average, as well as higher envy and life satisfaction.

References:
Gratitude and the Reduced Costs of Materialism in Adolescents. Jeffrey J. Froh1 , Robert A. Emmons2, Noel A. Card3, Giacomo Bono4 and Jennifer A. Wilson1. Journal of Happiness Studies, 2010.
http://www.springerlink.com/content/21616624m5621673/

Comments from Twitter:

@drjohnm RT @DrVes: In Adolescents, Gratitude Leads to More Success Than Materialism >>It also much better for the heart.

Tom Jones at 70: "I will sing as long as I possibly can. My enemy is time"

He's sold over 150 million records, but Sir Tom Jones has confessed that he dreads the day that he can no longer sing.

The 70-year-old veteran -- whose latest album 'Praise and Blame' is a meditative collection of gospel and blues songs dealing with spirituality and mortality -- was speaking to CBS News when he revealed his fear.

"I dread the day. Time is my enemy. Time will catch up with me vocally. And I dread that,' he said. "I dread to think about life without singing because I can express myself, it's a great release, it's a wonderful feeling to get on stage and pour all this stuff out and for people to go, 'Yeah!'''

From the comments on the YouTube video:

catcando75: I grew up listening to this man who belted out a song like no other & always did it in skin tight pants! His voice was clear & crisp yet deep & raspy. When you watched him you knew he loved every note because he wore it like a banner on his face. He pushed tv limits without a pause, his charisma was strong. This is a man so in love with music he knows no boundaries...

References:
Tom Jones: Time Is My Enemy. CBS.
'Time is my enemy': Tom Jones confesses to US TV network CBS that he 'dreads' the thought of retirement. Daily Mail.

Tom Jones: 'I Want to Live Forever' (video) http://goo.gl/UZ2jX

Free Medical Education Resources by the Association of American Medical Colleges (AAMC)

Head, Neck and Oral Cancer Examination

This 40-minute video is intended for practitioners of dentistry, medicine, nursing and public health who are responsible for diagnosing and referring patients with head and neck and oral cancer.

Emergency Medicine Ultrasound Simulation (U/SS) Case Scenario Package

This resource consisit of a modular package containing 5 high-fidelity full-body simulation case scenarios with supplemental bedside Emergency Department Ultrasound videos (de-identified) to assist in EM decision-making training.

Disclosing Medical Errors To Patients

This is a standardized patient case, which has been used to assess the communication skills of radiology residents when disclosing a medical error to a patient. The case content can be modified for use in other specialties. The checklist for the standardized patient and the self-evaluation checklist for the resident can be used without modification by all residencies.

Introduction to Effective Communication Skills

This PowerPoint with audio program covers the relevance and basic concepts of communication and interpersonal skills as they apply to general dentistry.

The Study Skills Workshop

The Study Skills Workshop was introduced to guide and promote 1st year Medical Students towards effective ways of learning in medicine. It is hoped that through the workshop the students are able to identify their individual learning styles and approaches. Thus they can find out self-improvement strategies to enhance their learning in medicine.

Image source: OpenClipArt.org, public domain.

What's new in endocrinology from UpToDate

35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page. I selected the brief excerpts below from What's new in endocrinology:

Osteoporosis

Denosumab (Prolia)

Denosumab is a fully human monoclonal antibody that specifically targets a ligand known as RANKL (that binds to a receptor known as RANK) which is a key mediator of osteoclast formation, function, and survival. Denosumab was approved for the treatment of postmenopausal women with osteoporosis at high risk for fracture (history of osteoporotic fracture, multiple risk factors for fracture) or patients who have failed or are intolerant of other available osteoporosis therapies. Denosumab inhibits the formation, function, and survival of osteoclasts. It decreases bone resorption, increases bone mineral density (BMD), and reduces the risk of fracture.

Teriparatide (Forteo)

Teriparatide (parathyroid hormone) did not accelerate fracture healing in postmenopausal women with distal radial fractures.

Transdermal teriparatide patch worked as well as teriparatide injection in postmenopausal women with osteoporosis.

Orlistat (Xenical, Alli) in obesity

Severe liver injury has been reported rarely with the use of orlistat (13 reports). Over the ten year period of the review, an estimated 40 million people worldwide used orlistat.

References:
What's new in endocrinology and diabetes mellitus. UpToDate.

Image source: Flickr, Creative Commons license.

Physicians as a group are leaner, fitter and live longer than average Americans

From the WSJ:

Physicians as a group are leaner, fitter and live longer than average Americans. Male physicians keep their cholesterol and blood pressure lower.

However, doctors are less likely to have their own primary care physician—and more apt to abuse prescription drugs.

Lifestyle habits

Exercise: Many physicians say they "embed" it into their lives, making it a non-negotiable part of their daily routine, often early in the morning before demands pile on. One doctor says he gets up at 4:45 a.m. virtually every morning to train for marathons he runs. "But by 8:30 at night, I have the IQ of a zucchini," he says.

Smoking: Only 2% to 4% of physicians smoke cigarettes, compared to roughly 24% of the U.S. population.

Stress: For all their good habits, it's no secret that doctors are under enormous pressure.

References:

What Patients Can Learn from the Ways Physicians Take Care of Themselves. WSJ.
Chicago doctors talk about healthy habits in their own lifestyle - not surprisingly ladies do a lot better than the guys http://goo.gl/jFf7w

Image source: OpenClipart.org, public domain.

Comments from Twitter:

@IrfanDhalla (Irfan Dhalla): Wonder if they still would be after adjusting for income? MT @DrVes: Physicians as a group are fitter and live longer goo.gl/b5C3

New CPR Guidelines - Hands Only - Use "CAB" Instead of "ABC" While Singing "Stayin' Alive"

The American Heart Association is adopting new cardiopulmonary Resuscitation (CPR) guidelines that do away with mouth to mouth resuscitation and focus on chest compressions. Do fast, forceful compressions; the beat of "Stayin' Alive" is the right pace - 100 beats per minute. Queen's "Another one bites the dust" was rejected as an alternative song choice.

Currently, this recommendation only applies to laymen CPR. The professional rescuers (EMTs, doctors, etc.) should use the previous approach with a compression-breathing (ventilation) ratio of 30:2.

However, “chest compression only” CPR is recommended if the rescuer is not trained (for example, in dispatcher assisted CPR) or is not willing to give rescue breaths. The aim is now to compress the chest to a depth of 5-6 cm (rather than 4-5 cm). This recommendation is based on several studies showing that deeper compressions were associated with improved short term outcomes.


Dr. Sanjay Gupta shows Matthew McConaughey the new way of doing CPR on Larry King Live.


Bee Gees - Stayin' Alive.

References:

New CPR is spelled C-A-B. CNN.
New international guidelines on resuscitation. BMJ, 2010.

Related reading:

Dangers of unrecognized heart disease: Husband dies while giving wife CPR (both found dead, age 60, 59) http://goo.gl/LZ39U
British Heart Foundation is urging people to forget "mouth-to-mouth" during CPR: 'no kissing, just hard CPR'. BBC, 2011.

Stereotypes in medical photographs

From BMJ:

If you search "medicine" on Google Images, you get a hundred million photographs.

The most common image is a stethoscope. The next is a bottle of pills (or, sometimes, red and black capsules). The next is a surgeon, masked and gowned, slicing skin with a scalpel.

Try "patient" and you will find lots of people in stripy pyjamas, lying obediently in bed, often with a spotty rash or a leg strung up in an orthopaedic hoist.

New images are needed to break the century-old stereotypes in medical photographs.

References:
New images needed: stereotypes in medical photographs. BMJ 2010;340:c1524.

Why doctors should use social media: it benefits their patients enormously

Wendy Sue Swanson, who blogs as Seattle Mama Doc, is a pediatrician in Seattle who recently gave a keynote at the Swedish Medical Center as part of their 2010 Health Care Symposium. See for yourself why doctors must use social media to stay uptodate and educate the public:



Link via KevinMD

Gonorrhea Getting Harder to Treat - Antibiotic Resistance Pushing Gonorrhea Toward Superbug Status

Gonorrhea is a common sexually transmitted bacterial infection. If left untreated, gonorrhea can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility in women. Treatment for gonorrhea usually consists of a single dose of one of two antibiotics, cefixime or ceftriaxone.

The current drugs of choice, ceftriaxone and cefixime, are still very effective but there are signs that resistance, particularly to cefixime, is emerging and soon these drugs may not be a good choice.

Only one remaining class of antibiotics is recommended for the treatment of gonorrhea - cephalosporins. Historically, gonorrhea has progressively developed resistance to the antibiotic drugs prescribed to treat it. Thus, it is critical to continuously monitor antibiotic resistance in Neisseria gonorrhoeae.

As a side note that highlights the prevalence of the problem, there are at least 10 songs titled "Gonorrhea" by various artists in the Amazon.com MP3 music store.



CDCStreamingHealth | April 16, 2010: This video, produced by Be Smart. Be Well., raises awareness of Sexually Transmitted Diseases (STDs): 1) What are they? 2) Why they matter? and, 3) What can I do about them? Footage courtesy of Be Smart. Be Well. http://www.besmartbewell.com, featuring CDC's Dr. John Douglas, Division of Sexually Transmitted Disease Prevention.

References:

Gonorrhea Getting Harder to Treat. WebMD.
Sex infection gonorrhea risks becoming "superbug". Reuters.
Antibiotic Resistant Gonorrhea. CDC.

Sexually Transmitted Diseases (STDs) - Diagnosis and Management Slideshow from Medscape http://goo.gl/uzwA

10 risk factors are associated with 90% of the risk of stroke

The Lancet reported that in 3000 patients with stroke (78%, with ischaemic stroke; 22%, with intracerebral haemorrhagic stroke) and 3000 controls, significant risk factors for all types of stroke were:

- history of hypertension (OR 2·64)

- current smoking (2·09)

- waist-to-hip ratio (1·65)

- diet risk score (1·35)

- regular physical activity (0·69)

- diabetes mellitus (1·36)

- alcohol intake (1·51)

- psychosocial stress (1·30)

- depression (1·35)

- cardiac causes (2·38)

- ratio of apolipoproteins B to A1 (1·89)

Collectively, these risk factors accounted for 88·1% of the PAR for all strokes. When an alternate definition of hypertension was used (history of hypertension or blood pressure higher than 160/90 mm Hg), the combined PAR was 90·3% (85·3—93·7) for all stroke.

These risk factors were all significant for ischaemic stroke, whereas hypertension, smoking, waist-to-hip ratio, diet, and alcohol intake were significant risk factors for intracerebral haemorrhagic stroke.

Ten risk factors are associated with 90% of the risk of stroke. Targeted interventions that reduce blood pressure and smoking, and promote physical activity and a healthy diet, could substantially reduce the burden of stroke.

References:

Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. The Lancet, Volume 376, Issue 9735, Pages 112 - 123, 10 July 2010

Stroke Risk Calculator http://goo.gl/elmc
Image source: BP device used for measuring arterial pressure. Wikipedia, GNU Free Documentation License.

Distracted Walking Featured in the New Windows Phone Ads

Distracted driving has gained much attention lately because of the inflated crash risk posed by drivers using cellphones to talk and text. But phones aren't just distracting drivers; they make pedestrians inattentive too.

Distracted walking combines a pedestrian, an electronic device and an unseen crack in the sidewalk, the pole of a stop sign, a toy left on the living room floor or a parked (or sometimes moving) car.

There are plenty of examples of the dangers of distracted walking in the two videos embedded in this page. These are also examples of "distracted life" in general:



References:
Forget Gum. Walking and Using Phone Is Risky. NYTimes.
Video: Stop texting while driving. Terrifying. All drivers should watch this.

Diabetic retinopathy is identified in a third of people with diabetes

Diabetic retinopathy is a common microvascular complication of diabetes, and remains the leading cause of preventable blindness in working-aged people. It is identified in a third of people with diabetes and associated with increased risk of life-threatening systemic vascular complications, including stroke, coronary heart disease, and heart failure.

Optimum control of blood glucose, blood pressure, and possibly blood lipids remains the foundation for reduction of risk of retinopathy development and progression.

Timely laser therapy is effective for preservation of sight in proliferative retinopathy and macular oedema, but its ability to reverse visual loss is poor.

Vitrectomy surgery might occasionally be needed for advanced retinopathy.

New therapies, such as intraocular injection of steroids and antivascular endothelial growth-factor agents, are less destructive to the retina than are older therapies, and could be useful in patients who respond poorly to conventional therapy.

Future treatment modalities include inhibition of other angiogenic factors, regenerative therapy, and topical therapy.

References:
Diabetic retinopathy [Seminar]. Ning Cheung, Paul Mitchell, Tien Yin Wong. Lancet, 2010.

Intensifying glucose control and adding fenofibrate to simvastatin each reduced progression of retinopathy in DM2 http://goo.gl/htHIK

Ophthalmology Self-Guided Study Activity - ACP 2011 .

The Dentist Of Jaipur (4-minute documentary)

"The Dentist Of Jaipur" - "New teeth, dentures or extractions not a problem at all for Pushkar and his old master Pyara Singh. They treat their patients in front of the train station of Jaipur, on the sidewalk under the pure sky. The short film of filmmaker Falk Peplinski, who has been living in India for three years, is an ironical image-clip for a dentist of its own kind and therefore a homage to the incredibleness of the Indian everyday life. The film had a big success at fim festivals in 2006 and 2007. India, 2006, director & editor: Falk Peplinski, photography: Karsten Hohmann, sound: Valson P.D., producer: Meera Menezes."

Warning: The video contains images that some viewers may find disturbing.


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What's new in rheumatology from UpToDate

35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page. I selected the brief excerpts below from What's new in rheumatology:

Lower dose colchicine for treatment of acute gout

A lower dose colchicine may have similar efficacy and fewer side effects than a traditional, higher dose regimen for patients with acute gouty arthritis. Colchicine given as 1.2 mg followed by one additional dose of 0.6 mg an hour later (total dose 1.8 mg) worked similarly to 1.2 mg followed by 0.6 mg every hour for up to six hours.

Nocturnal leg cramps

Quinine is no longer recommended due to the potential for serious side effects, drug interactions, and only modest benefit. Calcium channel blockers and vitamin B complex have limited effect.

Anti-CCP antibody testing in RA

Testing for anti-citrullinated peptide/protein antibodies (ACPA) has become common in the evaluation of patients for rheumatoid arthritis (RA). Second generation anti-cyclic citrullinated peptide (anti-CCP) antibodies had the highest utility, with higher specificity and similar sensitivity to rheumatoid factor (RF). Both RF and anti-CCP testing should be performed in patients suspected of having RA. Should I order an anti-CCP antibody test to diagnose rheumatoid arthritis?  http://goo.gl/L3abc - Yes. Cost of RF is $43, anti-CCP $102

Golimumab for RA

Golimumab, a neutralizing human anti-tumor necrosis factor alpha monoclonal antibody, is administered subcutaneously once monthly for the treatment of rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.

Rituximab for primary Sjogren's syndrome

Rituximab, which is used for the treatment of B cell lymphomas, rheumatoid arthritis, and other autoimmune and lymphoproliferative disorders, is a chimeric monoclonal antibody directed against the B cell antigen CD20. One course of rituximab treatment resulted in significant improvement in patients with Sjogren's syndrome (SS).

References:
What's new in rheumatology. UpToDate.

What Can You Do To Burn Calories at Work - Cleveland Clinic Video

Dr. Mike Roizen answers the question - What can you do to burm calories at work? Stay awake, have walking meetings, and go to the furthest bathroom to get some extra steps. Visit www.letsmoveit.org - Cleveland Clinic | September 23, 2010.

Short telomeres lead to chromosomal instability and increased cancer risk and mortality

Telomeres are essential to preserve the integrity of the genome. Critically short telomeres lead to replicative cell senescence and chromosomal instability and may thereby increase cancer risk.

Leukocyte telomere length was measured by quantitative polymerase chain reaction in 787 participants free of cancer at baseline in 1995 from a prospective, population-based study in Italy. The follow-up period was 10 years.

Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public domain.

11.7% of participants developed cancer (incidence rate, 13.3 per 1000 person-years).

Short telomere length at baseline was associated with incident cancer independently of cancer risk factors (hazard ratio [HR] 1.60).

Compared with participants in the longest telomere length group, the HR for incident cancer was 2.15 in the middle length group and 3.11 in the shortest length group. Furthermore, short telomere length was associated with cancer mortality and individual cancer subtypes with a high fatality rate.

There is an inverse relationship between telomere length and both cancer incidence and mortality.

References:
Telomere Length and Risk of Incident Cancer and Cancer Mortality. Peter Willeit, MD; Johann Willeit, MD; Agnes Mayr, MD; Siegfried Weger, MD; Friedrich Oberhollenzer, MD; Anita Brandstätter, PhD; Florian Kronenberg, MD; Stefan Kiechl, MD. JAMA. 2010;304(1):69-75.

From migrant worker to brain surgeon at Johns Hopkins

Dr. Alfredo Quiñones-Hinojosa is the Director of the Brain Tumor Stem Cell Laboratory at Johns Hopkins University School of Medicine.

Twenty years ago, Dr. Quinones-Hinojosa hopped a border fence from Mexico into the United States and became a migrant farm worker, living in the fields in a broken-down camper he bought for $300.

When told he would probably be a farm worker for the rest of his life, he signed up for English classes at a community college, where one of his teachers encouraged him to apply to UC-Berkeley. There, he developed a passion for science, and showed remarkable aptitude.

He went on to Harvard Medical School and graduated with honors, followed by a residency in neurosurgery at UC-San Francisco, where he completed a postdoctoral fellowship in developmental and stem cell biology.



References:
Dr. Alfredo Quinones-Hinojosa. BigThink.com.

What's new in pulmonary, critical care, and sleep medicine from UpToDate

35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page. I selected the brief excerpts below from What's new in hematology:

Asthma

When evaluating patients for occupational asthma, sputum eosinophil counts at 7 and 24 hours after specific inhalation challenge have a greater sensitivity and positive predictive value than exhaled nitric oxide (eNO).

Critical care

Proton pump inhibitors (PPIs) may be slightly more effective than histamine-2 (H2) blockers at preventing gastrointestinal (GI) bleeding in critically ill patients. However, the difference is small if real.

Idiopathic pulmonary fibrosis

Sildenafil, tyrosine kinase inhibitor imatinib, and pirfenidone, an anti-fibrotic agent, were each no more effective than placebo for treatment of idiopathic pulmonary fibrosis.

Pleural effusion

Using ultrasonography to identify a site for diagnostic thoracentesis is associated with significantly lower risk of pneumothorax, than using the physical exam for site selection.

Pulmonary embolism

PE is frequently asymptomatic. Among 5233 patients with a DVT, 32 percent had asymptomatic PE.

References:
What's new in pulmonary, critical care, and sleep medicine. UpToDate.

R U OK? Day

Hugh Jackman shows his support for R U OK?Day, a national day of action that aims to prevent suicide by encouraging people to connect with colleagues, friends and loved ones and ask: "Are you OK?".

Suicide prevention in Australia: "A conversation could save a life", link via @dreamingspires.

References:

http://ruokday.com.au
R U OK? Matt's Notes

First official antismoking campaign was launched in 1604 by James I of England

From the BMJ:

Monarchs and their heirs are not always noted for their rational medical advice. But James VI of Scotland, who became James I of England in 1603, was different.

Published anonymously in 1604 but immediately credited to the king, A Counterblaste to Tobacco flew in the face of prevailing medical opinion by outlining some of the chief health risks of smoking more than three centuries before scientists made the connection.

Possibly the first official antismoking campaign, the royal pamphlet highlighted cost and passive smoking as two of the most powerful arguments against tobacco, while it lamented that addiction, peer pressure, and fashion were among the most difficult obstacles to overcome.

A Counterblaste to Tobacco is written in Early Modern English and refers to medical theories of the time (e.g. the four humours). In it, King James I blames Native Americans for bringing tobacco in Europe, complains about passive smoking, warns of dangers to the lungs, and decries tobacco's odour as "hatefull to the nose."

James's dislike of tobacco led him to authorize an excise tax and tariff of six shillings and eight pence per pound of tobacco imported, or £1 per three pounds, a large sum of money for the time.

References:
Royal insights on smoking - Moore 340: c1408 - BMJ.

Image source: James I, VI by John de Critz, c.1606, Wikipedia, public domain.

A Counterblaste to Tobacco. Wikipedia.

Twitter comments:

@CardioNP: 400+ yrs later I still wade thru smoke to enter the hospital.

Baby carrots: 'Eat 'em like junk food'

The satirical $25 million ad campaign is launched by a new alliance of carrot growers - “a bunch of carrot farmers” - and is designed to reposition baby carrots as snacks with sass.

Timeline of the evolution of the baby carrot

Around 2,000 years ago: Carrots are first grown in what is now Afghanistan.

1700: The Dutch cultivate orange carrots. Before then, carrots were often purple or yellow.

1986: A California carrot grower invents the baby carrot to avoid throwing out some of the broken and misshaped carrots taken from the packing line.

A baby carrot is an immature carrot. A baby "cut" carrot is different - known popularly thanks to effective marketing also as a "baby carrot"- this is a mature carrot that has been cut and peeled in the "baby-cut" style.

See the rest of the ad campaign videos on YouTube.

References:
Baby carrots: 'Eat 'em like junk food'. Chicago Tribune.

Extreme Baby Carrots: An Experiment In Marketing : NPR http://goo.gl/94WX

Beyond statins: Thyromimetic eprotirome decreases LDL

Dyslipidemia increases the risk of atherosclerotic cardiovascular disease and is incompletely reversed by statin therapy alone in many patients. Thyroid hormones lower levels of serum low-density lipoprotein (LDL) cholesterol and has other potentially favorable actions on lipoprotein metabolism. Consequently, thyromimetic drugs hold promise as lipid-lowering agents if adverse effects can be avoided.

In this 12-week trial, the thyroid hormone analogue eprotirome was associated with decreases in levels of atherogenic lipoproteins in patients receiving treatment with statins.

Similar reductions were seen in levels of serum LDL, apolipoprotein B, triglycerides, and Lp(a) lipoprotein. No change in levels of serum thyrotropin or triiodothyronine was detected, although the thyroxine level decreased in patients receiving eprotirome.

References:

Use of the Thyroid Hormone Analogue Eprotirome in Statin-Treated Dyslipidemia. NEJM, 2010.

Image source: Wikipedia, public domain.

How much exercise is enough? Cleveland Clinic video

Dr. Michael Roizen, Cleveland Clinic Chief Wellness Officer, answers the question "How much exercise is enough?"

Three parts of exercise have been shown to be beneficial to health:

1. Moving the equivalent to 10,000 steps a day.
2. Resistance exercise for 30 minutes a week.
3. 20 minutes of cardiovascular exercise.

The videos are part of the Cleveland Clinic Let's Move It! program. See the CEO promoting it: