Bayer receives European approval for hemophilia drug Jivi, but has stiff competition ahead, says GlobalData

Germany-based pharma major Bayer has recently received the European Commission approval for its hemophilia A long-acting injectable medicine Jivi. However, since Jivi is a late entrant to the long-acting hemophilia A market segment it will struggle to compete with the established therapies, says GlobalData, a leading data and analytics company.  

The approval was based on results of the Phase II/III PROTECT VIII trial in which Jivi (a PEGylated recombinant Factor VIII) demonstrated good bleed protection in 74% of patients who were treated once weekly and 100% of patients who were treated every five days.

Jivi is the third hemophilia A treatment in Bayer's portfolio, besides Kogenate and Kovaltry. The trio boasted combined global sales of $726m by Q3 2018. GlobalData predicts sales of Jivi alone in the 7MM* to be $273m in 2026.

Tajekesa Chapman, Pharma Analyst at GlobalData, comments: “The treatment landscape is currently dominated by rFVIII replacement factors, the majority of which are short-acting. However, Jivi joins a growing market of long-acting rFVIII therapies that extend the half-life of these factors and allow for less frequent dosing, such as Bioverativ’s Elocta/Eloctate, Shire’s Adynovate/Adynovi and CSL Behring’s Afstyla.” 

Like Adynovate, Jivi uses PEGylation to achieve an extended half-life of 17.9 hours to sustain high levels of FVIII. PEGylation involves the covalent attachment of polyethylene glycol (PEG) to the protein of interest, increasing its molecular weight and size and creating a hydrophilic cloud around the molecule. These changes may alter the half-life by reducing the susceptibility of the molecule to proteolytic activity and degradation.

Chapman adds: “However, the long-term use of these products has been questioned, particularly since large PEGs are not metabolized by the human body and therefore may incur safety issues due to the longevity of PEG in the body. Further, PEGylation is thought to change the surface charge of the protein, which interferes with some receptor-mediated clearance processes.”

Experts interviewed by GlobalData expressed contrasting opinions on the PEGylation strategy, as used in Adynovate, Jivi and Novo Nordisk’s pipeline product N8-GP (turoctocog alfa pegol), but the majority suggested that they would prefer to rely more on the non-PEGylated products, such as Elocta/Eloctate, in order to avoid potential safety issues.

Chapman concludes: “Jivi is a late entrant to the long-acting hemophilia A market segment, a disadvantage for its commercial positioning. Since it does not offer a more convenient dosing schedule, it will struggle to compete with the established long-acting factors for patient share, such as Elocta/Eloctate and other non-factor replacement therapies. 

“Roche’s recently approved Hemlibra (emicizumab) is also expected to decrease the overall sales for the entire category of rFVIIIs. Bayer can soften these impacts by exploiting its presence in the hemophilia A market, with Kogenate and Kovaltry in its portfolio, to encourage uptake of Jivi among accustomed patients and gain a significant share of hemophilia A patients.”

7MM* US, France, Germany, Italy, Spain, the UK and Japan

ENDS

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Notes to Editors

• Comments provided by Tajekesa Chapman, Pharma Analyst at GlobalData
• This press release is written using data and information sourced from proprietary databases, primary and secondary research, and in-house analysis conducted by GlobalData’s team of industry experts.

About GlobalData

4,000 of the world’s largest companies, including over 70% of FTSE 100 and 60% of Fortune 100 companies, make more timely and better business decisions thanks to GlobalData’s unique data, expert analysis and innovative solutions, all in one platform. GlobalData’s mission is to help our clients decode the future to be more successful and innovative across a range of industries, including the healthcare, consumer, retail, financial, technology and professional services sectors.

SUNNIVA INC. ANNOUNCES CANNABIS TELEHEALTH SERVICE AGREEMENT BETWEEN NATURAL HEALTH SERVICES LTD AND HELLOMD TO EXPAND PATIENT REACH WITH ENHANCED MEDICAL CANNABIS SERVICES IN CANADA

VANCOUVER, BC – December 18, 2018 - Sunniva Inc. (“Sunniva”, the “Company”, “we”, “our” or “us”) (CSE:SNN) (OTCQB:SNNVF), a North American provider of cannabis products and services, announced today that its wholly owned subsidiary,  Natural Health Services Ltd. ("NHS"), will partner with HelloMD, a leading online cannabis telehealth company, to offer telemedicine services to its patients to provide more Canadian communities with convenient access to medical cannabis advice.

NHS operates a network of seven clinics specializing in medical cannabis in four provinces and has approximately 105,000 registered patients. In this joint effort, HelloMD will provide its turnkey set of white-label services to NHS, affording existing and future NHS patients the added option and convenience of an online health care practitioner consultation. In addition, NHS will have the opportunity to extend its services to areas where they do not currently have clinics, to reduce wait times, and to offer the convenience of evening and weekend consultations.

“This partnership is about both companies focusing on what they do best,” said Larry Lisser, HelloMD’s SVP of Business Development. “HelloMD’s telehealth service extends access to practitioner-led advice to more Canadians, while our integration with the NHS platform enables their patients to seamlessly benefit from the educational services NHS is so well known for. This is a win for patients all around.”

NHS patients will be first directed to a co-branded landing page on the HelloMD platform. Those patients who receive a medical document from HelloMD will be seamlessly transferred to an NHS Patient Educator who in turn helps them to understand the various options available and assists them in the selection of a Licensed Producer from which to buy medical cannabis.  

Dr. Mark Kimmins, Medical Director and Interim President of NHS commented, “Partnering with HelloMD enhances the NHS mission to improve the way Canadians access safe, regulated medical cannabis and education on how to use cannabis to improve health and quality of life. By utilizing the telehealth expertise of HelloMD, we will be able to increase our patient base and serve the needs of more Canadians.”

Neither the Canadian Securities Exchange nor its Regulation Services Provider (as that term is defined in the policies of the Canadian Securities Exchange) accepts responsibility for the adequacy or accuracy of this release.

About HelloMD: 

HelloMD has facilitated more than 100,000 virtual consults between medical cannabis patients and licensed practitioners. The company’s white-label solutions enable third parties to quickly deploy a turnkey telehealth solution, complete with the technology, practitioners and support personnel required to improve their own patient onboarding processes.

For further information about HelloMD:

Email: partners@hellomd.com

Visit: https://www.hellomd.com

About Sunniva Inc.

Sunniva, through its subsidiaries, is a vertically integrated cannabis company operating in the world’s two largest cannabis markets –California and Canada.  Our ability to leverage our large-scale, purpose-built cGMP designed greenhouses, offering better quality assurance with cannabis products free from pesticides, uniquely positions Sunniva as a leading supplier of safe, high quality products at scale. Through our strategically positioned cultivation and extraction facilities in California, we are launching Sunniva branded products in various product categories including flower, pre-rolls, vape cartridges, and ultra pure concentrates.  We have secured complaint distribution in California via our 100% ownership of LTYR Logistics, LLC that will ensure the placement of Sunniva branded products at licenced dispensaries throughout the state and we continue to aggressively pursue other upstream vertical opportunities have recently secured complaint distribution in California to assure the placement of Sunniva branded products throughout the state via 100% ownership of LTYR Logistics LLC and we continue to aggressively pursue other upstream vertical opportunities. Sunniva's management and board of directors have a proven track record for creating significant shareholder value both in the healthcare and biotech industries.

About Natural Health Services Ltd. (“NHS”)

NHS owns and operates a network of seven clinics in Canada specializing in medical cannabis under the Cannabis Act (Canada).  NHS connects patients with safe and effective medical cannabis products through Licenced Producers. NHS has in-house physicians and nurse practitioners specializing in the endocannabinoid system providing expert consultation, education, and recommendations for patients. NHS’ proprietary technology infrastructure assists physicians, patients and LPs to comply with the rules of Health Canada.  NHS currently has approximately 105,000 registered patients.

This news release includes statements containing certain "forward-looking information" within the meaning of applicable securities law ("forward-looking statements"), including, but not limited to, statements relating to the proposed benefits of the partnership between NHS and HelloMD. Forward-looking statements are frequently characterized by words such as "plan", "continue", "expect", "project", "intend", "believe", "anticipate", "estimate", "may", "will", "potential", "proposed" and other similar words, or statements that certain events or conditions "may" or "will" occur. These statements are only predictions. Various assumptions were used in drawing the conclusions or making the projections contained in the forward-looking statements throughout this news release. Forward-looking statements are based on the opinions and estimates of management at the date the statements are made and are subject to a variety of risks and uncertainties and other factors that could cause actual events or results to differ materially from those projected in the forward-looking statements. The Company is under no obligation, and expressly disclaims any intention or obligation, to update or revise any forward-looking statements, whether as a result of new information, future events or otherwise, except as expressly required by applicable law.

Cipher Pharmaceuticals Announces A-101 40% Topical Solution Accepted for Review by Health Canada

MISSISSAUGA, ON, Dec. 18, 2018 /CNW/ - Cipher Pharmaceuticals Inc. (TSX:CPH) today announced that its New Drug Submission ("NDS") for A-101 40% topical solution ("A-101 40%") for the treatment of raised seborrheic keratoses ("SKs") has been accepted for review by Health Canada. Cipher acquired the exclusive Canadian rights to distribute and commercialize A-101 40% from Aclaris Therapeutics, Inc. (NASDAQ:ACRS) ("Aclaris") in April 2018. 

A-101 40% is a U.S. Food and Drug Administration ("FDA")-approved product indicated for the treatment of raised SKs, which are commonly occurring non-cancerous skin growths that affect more than 9 million Canadian adults and can be an aesthetic skin concern. A-101 40% was approved by the FDA in December 2017 and is marketed by Aclaris in the U.S. under the tradename Eskata™.   

"This is another significant milestone for Cipher as we continue to execute on our growth strategy and diversify our commercial portfolio," said Robert Tessarolo, President and CEO of Cipher. "Upon approval, we look forward to offering A-101 40% to dermatologists and their patients as a treatment that can clear raised SKs without cutting, burning or freezing the skin."

About Seborrheic Keratoses
SKs are non-cancerous skin growths that affect an estimated 20% of the population and are most commonly seen in middle-aged and older adults. SKs vary in color from flesh-colored to pink, yellow, gray, tan, brown, or black; can range in size from a millimetre to a few centimetres wide; and typically have a slightly elevated, waxy or scaly appearance. The number and size of SKs tends to increase with advancing age. SKs frequently appear in highly visible locations, such as the face or neck, but can also appear anywhere on the body, except the palms, soles and mucous membranes.

About A-101 40% for the treatment of raised SKs
A-101 40%, marketed under the trademark ESKATA by Aclaris in the U.S., is the first and only FDA-approved medication for the treatment of raised SKs. Aclaris has submitted a Marketing Authorization Application (MAA) for ESKATA in select countries in the European Union. 

About Aclaris Therapeutics, Inc.
Aclaris Therapeutics, Inc. is a dermatologist-led biopharmaceutical company committed to identifying, developing and commercializing innovative therapies to address significant unmet needs in dermatology, both aesthetic and medical, and immunology. Aclaris' focus on market segments with no FDA-approved medications or where treatment gaps exist has resulted in the first FDA-approved treatment for the raised seborrheic keratoses and several clinical programs to develop medications for the potential treatment of common warts, alopecia areata, and vitiligo. For additional information, please visit www.aclaristx.com and follow Aclaris on LinkedIn.

About Cipher Pharmaceuticals Inc.
Cipher (TSX:CPH) is a specialty pharmaceutical company with a robust and diversified portfolio of commercial and early to late-stage products. Cipher acquires products that fulfill unmet medical needs, manages the required clinical development and regulatory approval process, and markets those products either directly in Canada or indirectly through partners in Canada, the U.S., and South America. Cipher is focused on a three-pronged growth strategy – including acquisitions, in-licensing, and selective investments in drug development – to assemble a broad portfolio of prescription products that serve unmet medical needs. For more information, visit www.cipherpharma.com. 

Forward-Looking Statements 

This press release includes forward-looking statements within the meaning of certain securities laws, including the "safe harbour" provisions of the Securities Act (Ontario) and other provincial securities law in Canada and U.S. securities laws. These forward-looking statements include, among others, statements with respect to our objectives, goals and strategies to achieve those objectives and goals, as well as statements with respect to our beliefs, plans, expectations, anticipations, estimates and intentions.  Forward-looking statements in this press release include statements with respect to the anticipated commercial launch of Trulance in late 2019, subject to the receipt of requisite regulatory approvals.    The words "may", "will", "could", "should", "would", "suspect", "outlook", "believe", "plan", "anticipate", "estimate", "expect", "intend", "forecast", "objective", "hope" and "continue" (or the negative thereof), and words and expressions of similar import, are intended to identify forward-looking statements.

By their very nature, forward-looking statements involve inherent risks and uncertainties, both general and specific, which give rise to the possibility that predictions, forecasts, projections and other forward-looking statements will not be achieved. Certain material factors or assumptions are applied in making forward-looking statements and actual results may differ materially from those expressed or implied in such statements. We caution readers not to place undue reliance on these statements as a number of important factors, many of which are beyond our control, could cause our actual results to differ materially from the beliefs, plans, objectives, expectations, anticipations, estimates and intentions expressed in such forward-looking statements. These factors include, but are not limited to, our ability to enter into in-licensing, development, manufacturing and marketing and distribution agreements with other pharmaceutical companies and keep such agreements in effect; our dependency on a limited number of products; integration difficulties and other risks if we acquire or in-license technologies or product candidates; reliance on third parties for the marketing of certain products; the product approval process is highly unpredictable; the timing of completion of clinical trials, regulatory submissions and regulatory approvals; reliance on third parties to manufacture our products and events outside of our control that could adversely impact the ability of our manufacturing partners to supply products to meet our demands; we may be subject to future product liability claims; unexpected product safety or efficacy concerns may arise; we generate license revenue from a limited number of distribution and supply agreements; the pharmaceutical industry is highly competitive; requirements for additional capital to fund future operations; dependence on key managerial personnel and external collaborators; no assurance that we will receive regulatory approvals in the U.S., Canada or any other jurisdictions; current uncertainty surrounding health care regulation in the United States; certain of our products are subject to regulation as controlled substances; limitations on reimbursement in the healthcare industry; limited reimbursement for products by government authorities and third-party payor policies; various laws pertaining to health care fraud and abuse; reliance on the success of strategic investments and partnerships; the publication of negative results of clinical trials; unpredictable development goals and projected time frames; rising insurance costs; ability to enforce covenants not to compete; risks associated with the industry in which it operates; we may be unsuccessful in evaluating material risks involved in completed and future acquisitions; we may be unable to identify, acquire or integrate acquisition targets successfully; inability to meet covenants under our long term debt arrangement; compliance with privacy and security regulation; our policies regarding returns, allowances and chargebacks may reduce revenues; certain current and future regulations could restrict our activities; additional regulatory burden and controls over financial reporting; reliance on third parties to perform certain services; general commercial litigation, class actions, other litigation claims and regulatory actions; the effects of our delisting from the NASDAQ Global Market (the "NASDAQ") and deregistration of our Common Shares under the U.S. Securities Exchange Act of 1934, as amended (the "U.S. Exchange Act"); the difficulty for shareholders to realize in the United States upon judgments of U.S. courts predicated upon civil liability of the Company and its directors and officers who are not residents of the United States; certain adverse tax rules applicable to U.S. holders of our Common Shares if we are a passive foreign investment company for U.S. federal income tax purposes; the potential violation of intellectual property rights of third parties; our efforts to obtain, protect or enforce our patents and other intellectual property rights related to our products; changes in U.S., Canadian or foreign patent laws; litigation in the pharmaceutical industry concerning the manufacture and supply of novel and generic versions of existing drugs; inability to protect our trademarks from infringement; shareholders may be further diluted if we issue securities to raise capital; volatility of our share price; the actions of a significant shareholder; we do not currently intend to pay dividends; our operating results may fluctuate significantly; our debt obligations will have priority over the Common Shares in the event of a liquidation, dissolution or winding up; and risks associated with the arrangement with Cardiome, including, among others, the failure to satisfy closing conditions and the absence of material adverse changes or other events which may give the parties a basis on which to terminate the arrangement agreement.

We caution that the foregoing list of important factors that may affect future results is not exhaustive. When reviewing our forward-looking statements, investors and others should carefully consider the foregoing factors and other uncertainties and potential events. Additional information about factors that may cause actual results to differ materially from expectations, and about material factors or assumptions applied in making forward-looking statements, may be found in the "Risk Factors" section of our Annual Information Form and in our Management's Discussion and Analysis of Operating Results and Financial Position for the year ended December 31, 2017, and elsewhere in our filings with Canadian securities regulators. Except as required by Canadian securities law, we do not undertake to update any forward-looking statements, whether written or oral, that may be made from time to time by us or on our behalf; such statements speak only as of the date made. The forward-looking statements included herein are expressly qualified in their entirety by this cautionary language.

SOURCE Cipher Pharmaceuticals Inc.

For further information:

Stefan Eftychiou, Bristol Investor Relations, (905) 326-1888 ext. 60, stefan@bristolir.com 

Today’s Children Reach Bone Maturity Earlier, Study Reveals

Findings establish “New normal” for when children reach full height 

COLUMBIA, Mo. (December 17, 2018) ― Children born in the most recent century have bones that reach full maturity earlier – by nearly 10 months in girls and nearly seven months in boys – according to anew studyfrom the University of Missouri School of Medicine.

“Our findings show there is a “new normal” for timing when kids’ skeletons will reach full maturity,” said Dana Duren, PhD, director of orthopaedic research at the Thompson Laboratory for Regenerative Orthopaedics.

The research team, led by Duren, assessed the radiographs of more than 1,000 children born between 1915 and 2006. The team evaluated radiographs of the bones in the hands and wrists to determine the precise timing of the beginning and ending of a developmental process called epiphyseal fusion.

“We focused on epiphyseal fusion because it signals the end of the growth of the bone,” said Duren, who was the principal investigator. “It begins when the growth plate, which is cartilage at the end of the bone, starts to connect the epiphysis, or bone cap, to the long bone through small calcifications. Eventually, the growth plate completely calcifies and attaches, or fuses, to the long bone. When fusion is complete, so is the growth of that bone.”

The research team used radiographs gathered in the Fels Longitudinal Study, which is the world’s only century-long study of human growth and development, to track when fusion started and when it was complete in children born as far back as 1915. The results showed that the skeletons of children born in the 1990s are reaching fusion completion, and thus skeletal maturity, faster and sooner than children born in the 1930s.

These findings directly impact the timing of the clinical care of certain pediatric orthopaedic conditions, such as leg-length differences, scoliosis and the timing of using growth hormone.

Mel Boeyer, MS, predoctoral orthopaedic research fellow and co-author of the study, works closely with pediatric orthopaedic surgeons to understand how physicians time this care.

“The timing for the treatments of these conditions is a critical component to a good outcome,” said Boeyer. “What this research shows us is physicians will need to start looking for the beginning of epiphyseal fusion sooner than they once thought.”

The study does not address what might be the cause of this new normal. However, Duren and many of her colleagues think an increase in exposure to environmental hormones and hormone mimickers could be a contributing factor.

Their study, “Early Maturity as the New Normal,” was recently published by the journal Clinical Orthopaedics and Related Research. Research reported in this publication was supported by the National Institutes of Health. In addition to Duren and Boeyer, other study authors from the University of Missouri include Richard Sherwood, PhD, in the Department of Orthopaedic Surgery, and Chelsea Deroche, PhD, in the Department of Health Management and Informatics. The authors of the study declare that they have no conflicts of interest. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.  

###

About the MU School of Medicine

The MU School of Medicine has improved health, education and research in Missouri and beyond for more than 170 years. MU physicians treat patients from every county in the state, and more Missouri physicians received their medical degrees from MU than from any other university. For more information, visit http://medicine.missouri.edu/.

For more news, visit:
http://medicine.missouri.edu/news/

MU Health Public Relations, One Hospital Drive, Columbia, MO 65212

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INSTAGRAM “HEALTH FOODS” THAT ARE SURPRISINGLY UNHEALTHY OR CALORIC

From Whole Foods to pricey health food stores, cafes, and coffee shops, certain foods and ingredients have become trendy among health and calorie counting foodies.  Who has not heard of matcha, Acai, cold-pressed juice, and gluten-free baked goods? In a perfect world, wouldn’t it be wonderful if we could find food and drinks that are delicious, healthy and not calorie laden?  While certain Instagram accounts may have you convinced these “magic foods” exist,  Dr. Niket Sonpal is a NYC gastroenterologist and assistant professor at Touro College of Osteopathic Medicine who cautions health enthusiasts to do a deeper dive into what they are eating and imbibing

Gluten-Free Baked Goods

Despite the fact that less than one percent of Americans are believed to have celiac disease, customers and food brands alike have gotten caught in the gluten-free food obsession. Dr. Sonpal explains that “To mimic the taste and texture of wheat gluten, companies will use corn, oat, and rice flours, which aren’t necessarily better for you.” One study found that participants who consumed rice-flour-based baked goods had higher levels of metals within their system than the control group, which is linked to rice’s natural arsenic and metal content.

Smoothie Bowls

Their vibrant colors and pleasant toppings give smoothie bowls the appearance of a well-balanced breakfast, but don’t be fooled: they are loaded with sugar. Unlike traditional smoothies that come in useful, portion-controlled bottles, smoothie bowls tend to be larger and have more surface area, which makes it easy to add additional toppings. For example, the Chunky Strawberry Bowl from Jamba Juice contains 590 calories and 58 grams of sugar.

Acai

Google “acai berry” and a wealth of purported benefits like weight loss and antiaging results will return. Does this trendy health food hail from Brazil really live up to the hype? Dr. Sonpal says that “While the fiber-rich fruit does tout more antioxidant properties than pomegranates and blueberries, many health claims don’t mention that it logs in 247 calories per 100 grams, 26 grams of which are carbohydrates.”  The takeaway?  Unless you are using acai at home and controlling your portions, an acai bowl could cost you almost 600 calories per serving! 

Almond milk

The fact that it’s dairy-free and low in calories has made it the default milk among many people who try to eat healthily. Dr. Sonpal explains that “though unsweetened almond milk, like dairy milk, is a good source of calcium and vitamin D, it’s really low in protein. (Just 1 or 2g protein in a one-cup serving.)

Protein Bars

Protein bars, which are sometimes also energy bars, contain numerous artificial ingredients and have as much nutritional value as a milk chocolate bar. That said, some protein bars can be healthy if they contain healthy, whole, and very few ingredients that make up the bar. Dr. Sonpal cautions, “If you see upwards of 15 ingredients in your protein bar, I would say stay away from it.”

Avocado

If you look at all the salads, grain bowls, and other healthy dishes on Instagram, you'll probably notice that the people posting them seem to be eating a great deal of avocado. "Avocados are very nutritious and packed with healthy monounsaturated fats and fiber,” says Dr. Sonpal. Many Instagrammers go overboard. "An entire medium avocado contains 250 calories and 23g fat," Sonpal says. "Keep your serving size to a quarter of a medium avocado, which would be 60 calories and 6g of fat."

Veggie Chips

The pieces of actual veggies in veggie chips are so thin and processed that most of the nutrition from the vegetable is gone. “Instead, try whole-grain pretzels, baked corn chips, crackers made with seeds and nuts, or popcorn,” Dr. Sonpal suggests. To keep from turning a bag of chips or box of crackers into a meal, divide them up into sensible portions ahead of time.

Cold-pressed juices 
Cold pressed juices have risen in popularity over the past few years, and with the hefty price tag tacked on to them (one serving of juice can be as much as $12!) one would assume guzzling some would provide you with all the nutrients you could possibly need. Unfortunately for your wallets, and your diets, that is not the case. While made of whole, raw fruits and veggies, the fiber from these foods are often stripped during the juicing process. On top of that, fruits like apples can be added to cut the bitter flavor of leafy greens, which can bump the carbohydrate content up to 20-30 grams of carbs per juice! Dr. Sonpal warns that “because there is no fiber or protein in these juices, guzzling one can cause blood sugar levels to spike too, leaving you right back where you started: hungry and craving something nutrient dense.”

Matcha Lattes

Matcha is one food trend that has taken the center stage. Some restaurants offer matcha pancakes. While matcha is packed with antioxidants and provides detox health benefits that cannot be disputed, ordering up a latte may not be the magic elixir you bargained for.  A 12-ounce matcha latte from a popular coffee chain packs 24 grams of sugar and will set you back 190 calories. 

Agave Nectar

Agave syrup is derived from the sweet nectar of the Agave tequila plant and is often perceived as a “natural” alternative to processed cane or beet sugar or other zero-calorie sweeteners. The syrup is touted by manufacturers as a safer sweetener for diabetics because it is lower on the glycemic index (a measurement of how certain foods affect blood sugar levels), Dr. Sonpal says that “no reliable human studies exist reinforcing this claim. Agave syrup is just like any other sweetener- no better, no worse”.

About Dr. Niket Sonpal is a native of Long Island NY and a graduate of the Medical University of Silesia – Hope Medical Institute in Poland. After completing his residency in Internal Medicine at Lenox Hill Hospital, he was selected to be the 2013‐2014 Chief Resident at Lenox Hill Hospital–Northshore LIJ Health System. He is an Adjunct Assistant Professor at Touro College of Osteopathic Medicine and Clinical instructor at Kingsbrook Jewish Medical Center, Brooklyn. Dr. Sonpal has completed his Fellowship in Gastroenterology & hepatology at Lenox Hill Hospital and will continue his work in the field of medical student and resident test preparation. He now serves as the associate program director for the Internal Medicine Residency Program at Brookdale University medical center. 

He is the co‐author for the best-selling Master the Boards: USMLE Step 2 CK, Master the Boards Step 3, And Master the Boards: Internal Medicine. He is also the Chief Operating Officer for Medquest Test Prep, Director of Medical Education for Picmonic Test Prep, and a recognized expert on medical test prep.

Sexercise: 7 Exercises That Can Improve Your Sex Life

How simple fitness moves can make a huge difference in the bedroom

www.vshred.com

There are many elements that go into a great sexual encounter. Some of these components include mutual attraction and self-confidence. But when the moment comes to perform you want to know you have the strength and stamina to bring your A game and enjoy a strong finale. 

“Having a body that's optimized for great sex and looking like an Instagram model are not mutually exclusive,” says Vince Sant,  co-founder and lead trainer of V Shred, the online training platform that has taken the world by storm in recent years. “Some of the smaller muscle that you didn’t even know you have sometimes make the biggest difference.”

Sant explains that there’s a logical relationship between being fit and a more enjoyable sex life. Muscle tone and cardiovascular health help us perform better and have more gratifying orgasms. Mentally, physical fitness plays a huge roll in one’s confidence which is just as much a part of sex as your partner’s attraction to you. 

For these 7 exercises, we are focusing on fortifying the stabilizing muscles in the pelvis, lower back, and core. This group of muscles is responsible for handling any position you get into with your partner and enjoy intense finales. 

High-Intensity Interval Training (H.I.I.T) 

“Your stamina and endurance are central to sex. Interval training helps increases just that. The great thing about H.I.I.T is that you can make it a part of any of your cardio and body weight routines,”  says Sant who makes H.I.I.T a fundamental part of his fitness programs. 

Lying Leg Raises

Not only does this move engage your lower abs, thighs, and glutes but it also challenges your hip flexor muscles. “The hip flexors include the psoas muscle which connects your spine to your legs. The Iliacus muscle located deep within the pelvis which helps rotate your thigh bone and is helpful in sustaining certain positions in bed, explains Sant. Other muscles engaged by this exercise are the rectus femoris (one of the four quads muscles), the pectineus muscle and the sartorius.

Crunches

A strengthened core gives you the ability to maintain pleasurable positions for increased passion. For added benefit, use a stability ball to enhance your crunches. This will work your balance and stability as well as your back which will improve your thrusting ability and help prevent back injury. 

Push-ups

If your partner likes you being on top you have to condition your upper body and core. Push-ups accomplish exactly that. Strengthening your arms, shoulders, and chest, push-ups help you to maintain a dominant thrust and increased energy. “Remember to find ways to practice progressive overload in your push-ups and other resistance training by adding weights to your exercises or increasing repetitions. Resistance training has been shown to increase the male sex hormone, Testosterone,” says Sant. 

Squats

“Squats mostly work your glutes, hamstrings, and quadriceps,” says Sant. Everything from your abs, obliques, and lower back to your calves and ankle complex are engaged in this exercise as well. The Instagram model turned fitness mogul explains that “a lot of pleasurable positions for both partners need a stronger core and lower body to sustain the positions until orgasm.” 

Stretch - The Seal Pose

People overlook stretching all the time. It is an important part of preparing for your physical activity both at the gym and in the bed. The lumbar extension aims at stretching the forward curve of the lumbar spine in your lower back. “You will be using your lower back a lot during sex and making sure the lower back is prepped for activity will prevent any pulled muscle or embarrassing moments,” says Sant

Stretch -  The Butterfly 

You want to avoid waking up next to your partner the morning after you’ve had great sex feeling sore and unable to move your legs. “The butterfly stretch helps target the groin and inner thigh. You should use this stretch after a variety of normal leg stretches to avoid overstretching the groin,” explains Sant. He maintains that this stretch is very helpful in warding off soreness in that hard-to-stretch area. 

About V Shred: 

V Shred is the fastest growing fitness and nutrition brand in the world offering online training programs designed to put the fun back into fitness and nutrition. V Shred provides a results-driven enduring lifestyle change instead of a frustrating battle that is easy to give up on. With a support network comprised of trusted accredited advisors and virtual personal trainers, people meet their fitness, nutrition, and goals. 

The company, co-founded in 2015 by Nick Daniel, Roger Crandall, Kevin Pearn, and Vince Sant, sought out to create a healthy fitness movement specifically designed to deliver profound changes in your body with the minimal amount of workout time. V Shred has created some of the world's most popular fitness and nutrition programs such as Fat Loss Extreme and Toned in 90 Days for women and men and Ripped in 90 Days for men. 

The diet that accompanies the workouts in these comprehensive fitness programs, offers plenty of healthy food options and recipes. V Shred’s supportive coaches encourage “portion empowerment” which inspires people to eat and enjoy food knowing it’s the fuel they need to achieve the results they seek. 

V Shred is based in Las Vegas, Nevada. For more information visit http://www.vshred.com

Need some Chill for the Holidays?

L’eela’s “Chill Pill” CBD Daily Supplements Provide an Assist for Health-Conscious Consumers Looking to Coast into the New Year Stress Free

DENVER (December 17, 2018)—Nearly a quarter of Americans report feeling “extreme stress” during the holiday season, according to a recent American Psychological Association poll. This prolonged season of induced anxiety may be the reason so many consumers resolve to reduce stress in the New Year. But what if there was a “Chill Pill” that helped to feel relief from this mental state?

Studies on CBD oil have concluded that the supplement is a promising treatment for numerous forms of anxiety, including social anxiety disorder, panic disorder, obsessive-compulsive disorder, generalized anxiety disorder and post-traumatic stress disorder. Additionally, recent research revealed that cannabidiol not only made participants feel better, but also changed the way their brains responded to anxiety. 

Now L’eela has added L’eela’s “Chill Pill” CBD Daily Supplements 25 mg to its product offerings, providing sustainably sourced, easy and convenient vegetarian cannabidiol (CBD) capsules meant to nourish your body from the inside. Produced with high quality Colorado CBD, the daily supplement supports calm demeanor, fights inflammation and enhances muscle and joint repair.  

“During the holidays people feel so stressed about lack of time and a hectic schedule of social obligations, but studies have found that CBD could reduce symptoms of social anxiety in people by changing blood flow to the regions of the brain linked to feelings of anxiety,” noted L’eela founder Lisa Richards.

As a formulation specialist for L’eela, Richards began investigating natural health alternatives when she developed severe allergies in her late 30s that jeopardized her fitness-rooted lifestyle as a yoga instructor. She gained an appreciation for the effectiveness of cannabidiol (CBD) and whole-plant cannabis products when she used them to aid recovery and healing from her own injuries, including three herniated discs and sacral injuries. Richards has spent several years blending her own oils using the life-balancing philosophy of Ayurveda, which is a perfect complement to the Vinyasa yoga she has taught since 2000. In her practice, she has worked with pro athletes, TV personalities, preschoolers and everyone in between. Lisa’s business partner and L’eela co-founder Amy Andrle has witnessed firsthand the power of the plant as owner of L’Eagle, a boutique dispensary and cultivation specializing in organically grown cannabis that serves medical marijuana patients suffering from conditions including PTSD, severe pain, muscle spasms, anxiety and chronic illness.

“Just as L’eela’s Vital Hydrating Oil was formulated to soothe dry skin and hair, our ‘Chill Pill’ CBD Daily Supplements can set you on the path toward calmer internal wellbeing. L’eela products are designed to support balanced beauty inside and out,” Richards concluded.

From now through Jan. 31, 2019, L’eela’s “Chill Pill” 25mg CBD Daily Supplements are 25 percent off at a sale price of $63.80 (regularly $80). Visit L’eela’s online shop at leelacbdbodycare.com. For more information or to schedule an interview, please contact media@leelabodycare.com.

L'eela CBD Body Care: Balanced Beauty Inside and Out

L’eela CBD Body Care is a line of artisan supplements and luxury body care products that feature the wellness benefits of hemp-derived cannabidiol (CBD). All L’eela products are non-psychoactive, formulated with pure and organically produced ingredients, and made with hemp that is grown and processed in the USA. L'eela puts sustainability at the forefront of its ingredient sourcing and manufacturing. For more information, visit leelacbdbodycare.com. Continue the conversation on Instagram and Facebook.

SKINCARE 911:

WHAT TO DO WHEN A SKINCARE DISASTER ERUPTS BEFORE A HOLIDAY PARTY

www.drmanishshah.com

It's something every woman fears: Waking up on the day before or day of a big holiday party with an unsightly skincare emergency. How many women have cancelled an invitation because a cold sore erupted? How about cystic acne on your chin that appears New Year’s Eve? While neither of these are "life threatening" conditions, for a woman, they might as well be. There are solutions. Dr. Manish Shah is a Denver Board Certified Plastic Surgeon. As a father to girls, he can relate to these skincare 911s and shares his expertise on what can be done to mitigate various conditions.

Problem: Cold Sore

Solution: Dr. Shah offers cortisone injections to patients who want to look better faster. "Very diluted cortisone into the cold sore, this can bring the inflammation down quite rapidly," he says. If you are afraid of needles, call your doctor and ask him/her to call in a prescription for Valtrex, Famvir, or Acylovir, Dr. Shah says. You can pick up Abreva, an over-the-counter medication. If you can't make it to the pharmacy, you can try some old-fashioned remedies: Visine will help take the red out. You can also use a cold compress and Tylenol or ibuprofen.

Problem: Allergic Reaction

Solution: The first thing you need to do is stop eating or using whatever is causing the allergic reaction. If the reaction happens a few days before an occasion, Dr. Shah recommends using hydrocortisone cream twice a day and taking Allegra, Claritin or Zyrtec which are longer acting and less sedating than Benadryl. Try a whole-milk compress for 10 minutes twice a day. For allergic reactions, use the hydrocortisone cream and then cover up redness by canceling it out entirely. The opposite of red is green, so apply green tinted concealer on the red area. The combination will create a flesh-toned hue. A good quality tinted moisturizer naturally has green/yellow undertones and also provides moisture to dry skin. "If this type of reaction is something you have never experienced before, go immediately to your dermatologist," says Dr. Shah.

Problem: Cystic Acne Breakout

There are some people who use a lancet or small knife to cut into a cyst and fish out the clogged part of the pore. "Cutting open a cyst is extremely risky. You not only run the risk of getting an infection, but you also run the risk of scarring, as in a permanent skin indentation or protrusion," says Dr. Shah. And what if you cut open a cyst but can't squeeze out the root clog? You don't know where the root is or how deep it resides inside your skin. You can't even be 100% confident that you will be able to completely remove the hardened plug of the cyst. If any remnants of the clog remain, the cyst is likely to get re-inflamed and come back even worse. It's also not exactly good to cut open skin and dig around and squeeze the wound. Doing so will only make a bloody mess, increase the chance of skin scarring, and prolong the time it takes the cyst to heal.

Solution: Here's a secret that many a supermodel or actress use: Steroid shot. Dr. Shah explains that, "when we discuss treating acne with cortisone or "steroid" shots, we are referring to the process of gently placing a very dilute quantity of a "glucocorticoid" steroid into the cyst. Glucocorticoids are a class of steroid molecules that are naturally produced by our bodies and have numerous functions including the regulation of human metabolism, immunity, and inflammation. They have very potent anti-inflammatory effects, so they are often used to treat inflammatory diseases in medicine. They can be formulated as creams to treat skin rashes or as pills to treat systemic disease. They can also be injected directly into local areas of inflammation such as in arthritic joints and inflamed acne cysts. Within one or two days of injection into a cyst, the steroid will shrink the inflammation producing relief of pain and almost immediate cosmetic improvement."

Problem: Puffy Eyes

Solution: The key to reducing the puffiness of puffy eyes is having something cool applied to them. "A cool compress or cooled cucumber slices applied for 5 to 10 minutes can constrict blood and lymph vessels," says Dr. Shah. You can also use cool tea bags, which contain tannins that will help reduce swelling. And since puffy eyes can be caused by a high salt diet or alcohol, try to cut out both before an important occasion.

Problem: Sunburn

Solution: Take a cool bath or shower. Set the water to a cool temperature that's just below lukewarm and relax for 10 to 20 minutes. The temperature will ease the pain, and the water will stop your skin from becoming as irritated. Repeat as often as you need to. Avoid using soap, bath oils, or other detergents as you bathe - they'll irritate your skin and possibly make it even worse. If you have blisters forming on your skin, take a bath instead of showering. The pressure from the shower might pop your blisters. When you get out, don't rub your skin dry with a towel. Instead, let yourself air dry, or pat the towel over your skin in small, gentle movements. Apply cold compresses to your skin. If you're not in a situation where you can bathe, or you'd just prefer not to, you can instead apply cold, wet compresses to your skin. Dampen a washcloth or other piece of fabric with cold water and lay it over the affected area for 20 to 30 minutes. Re-wet it as often as you need to. Apply aloe vera to burned skin. Using the pads of your fingers, gently apply the aloe to your sunburn. Don't "rub it in" all the way, like you might with a regular lotion. Leave it a bit goopy and moist on top of the burn - this helps prevent the skin from drying out and becoming more irritated. Reapply as often as necessary. Treat inflammation with cortisone cream (optional). Cortisone creams contain a small dose of steroids that can work to reduce inflammation to your sunburn.

Problem: Too much filler

The Solution: Dr. Shah suggests doing fillers no sooner than 1 month before a big event to allow time for healing and touch ups. One of the reasons Dr. Shah leans toward hyaluronic acid fillers such as Restylane, Juvederm and Perlane is because they are easily reversed with Hyaluronidase. This product dissolves and degrades the Restylane, Juvederm or Perlane so as to reverse the results of the initial injection. It's a great insurance policy when choosing a practitioner. Make sure yours has it at his/her disposal. Most patients find the immediate results of soft tissue filler treatments very satisfying. If an undesirable result occurs, your treatment provider should be able to discuss and carry out all of the treatment options. Removing the effects of a "filler" treatment can be difficult. This is why any filler treatment needs to be done carefully, conservatively and only by very experienced and Board -Certified Specialists. Hyaluronic Acid based dermal fillers have the additional benefit of being partially or completely reversed with time or with the injection of a commercially available enzyme known as Hyaluronidase.

About Dr. Manish Shah

Plastic Surgeon Colorado | Dr. Manish Shah, M.D. | Denver

Manish Shah, M.D., F.A.C.S. was born in Canada and raised in the Washington, D.C. area. He graduated with honors from the University of Pennsylvania, receiving a degree in biomedical engineering. He then completed his medical training at the University of Virginia, earning his Medical Doctorate. During this time he also completed a one-year fellowship in microsurgery research at the New York University School of Medicine / Institute of Reconstructive Plastic Surgery. As a prelude to his plastic surgery training, Dr. Shah completed a rigorous five-year training program in General and Trauma Surgery at Emory University and the Medical College of Georgia. His formal training in Plastic and Reconstructive Surgery was completed at the Univ. of Tennessee College of Medicine – Chattanooga Unit. After completing his plastic surgery training, he moved to New York City when he was selected for the prestigious Aesthetic Surgery Fellowship at Manhattan Eye, Ear, and Throat Hospital. He underwent extensive, advanced training in aesthetic surgery of the face, breasts, and body at the hands of some of the most renowned cosmetic surgeons in the world. This fellowship is widely considered to be the best of its kind in the world. Dr. Shah is one of only a select few plastic surgeons in the country who have undergone formal post-graduate training in aesthetic surgery.

Dr. Shah’s specialties include revision facial aesthetic surgery, rhinoplasty (“nose reshaping”), and aesthetic surgery of the breast (breast augmentation, breast lift, breast reduction). He is, however, well-trained in all areas of aesthetic surgery.

Dr. Shah’s aim is to obtain a natural appearing transformation that complements the real you!

Dr. Shah is a past Clinical Assistant Professor of Surgery at the University of Colorado Health Sciences Center based at Denver Health Medical Center, the Rocky Mountain region’s only academic Level I trauma center. He is a past Chief of Plastic Surgery at Denver Health Medical Center. He also maintains a private practice in Aesthetic and Reconstructive Plastic Surgery on the Dry Creek Medical Center campus (DTC/Denver) and up in the Aspen Valley (Basalt – in the office of MDAesthetics – Tim Kruse, M.D.).

Dr. Shah is a member of the American Society of Plastic Surgeons, the American Society of Aesthetic Plastic Surgery and the International Society of Aesthetic Plastic Surgery.

Dr. Shah is board-certified by the American Board of Plastic Surgery.

Texas A&M Health Science Center report highlights new ways forward for rural health care

BRYAN, Texas — The A&M Rural and Community Health Instituteat the Texas A&M University Health Science Centerreleased a report this week outlining new ways forward for rural Texas communities facing or experiencing a hospital closure. The Episcopal Health Foundation (EHF), Robert Wood Johnson Foundation and the T.L.L. Temple Foundation sponsored the report, titled Optimizing Rural Health: A community health care blueprint.

Through a series of focus groups and other research, a Texas A&M team, in collaboration with EHF, compared the health care needs of three communities with the current services available. What they found was that the true issue for rural health care is not necessarily the lack of a full-service hospital nearby, but instead the need to work with communities to balance needs, capacities and resources to optimize health care delivery and preserve access to health care.

            See the complete report: https://architexas.org/rural-health/images/optimizing-rural-health-a-community-healthcare-blueprint.pdf

The report includes a blueprint for each participating community based on their individual needs and circumstances. Additionally, the A&M Rural and Community Health Institute prepared community presentations to share research results and answer community members’ questions.

Although each community is unique, the commonalities discovered in this research are “lessons learned” for rural communities in Texas and across America.

“Rural communities in Texas are as unique as the residents themselves, and so there isn’t one way to optimize their residents’ health,” said  Nancy Dickey, MD, president emeritus of the Texas A&M University Health Science Center, executive director of the A&M Rural and Community Health Institute, head of the Department of Primary Careat the Texas A&M College of Medicineand lead author of the report. “Perhaps there are no right or wrong answers at all, but instead steps tailored to and supported by each community to ensure access to care.”

For example, in one community, the hospital had closed, but was in the process of reopening. Therefore, the plan for that community involved ways to make the reopening successful and involve the community in the process.

In another community, in which there was no plan to reopen their closed hospital, the blueprint suggested ways to prioritize needed services, such as mental health and sports medicine, to help advance the health of the community even without the inpatient beds that were in the now-closed hospital.

The themes of this recent research are intertwined and can increase awareness and actions toward optimized rural health care. The report notes that if communities can be aware of their hospitals’ vulnerability, they can be proactive to identify options for health care access.

“The question becomes, ‘How can we deliver care in rural areas on a high-quality basis and do so even if there is not a hospital in town?’” Dickey said. “We need to be thinking about alternatives.”

“The goal is ‘right-sizing' healthcare delivery in rural communities in a way that provides quality services for families living there,” said Elena Marks, EHF’s president and CEO. “In some areas that includes a hospital, but these blueprints show that communities may be able to find new and sometimes more effective ways of offering affordable access to the services families need the most.”

Some of those alternatives might come from the rural ‘moonshot’ announced in Novemberthat will allow the Health Science Center to identify and implement solutions for rural and underserved communities, thanks to a $10 million commitment from Blue Cross and Blue Shield of Texas.

The Rural and Community Health Institute will also be amplifying these research results from Texas to a much broader scale: the nation.

This fall, the Rural and Community Health Institute was awarded a five-year grantfrom the Vulnerable Rural Hospitals Assistance Program, funded by the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services. The grant funded the creation of the Center for Optimizing Rural Health, a technical advisory center for the nation, to actively help rural communities maintain their hospital or create other means of access to care after hospitals close.

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About Texas A&M University Health Science Center
Texas A&M University Health Science Center is transforming healththrough innovative research, education and service in dentistry, medicine, nursing, pharmacy, public health and medical sciences. As an independent state agency and academic unit of Texas A&M University, the health science center serves the state through campuses in Bryan-College Station, Dallas, Temple, Houston, Round Rock, Kingsville, Corpus Christi and McAllen. Learn more at vitalrecord.tamhsc.edu or follow @TAMHSC on Twitter.