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Investigational Antibiotic Outperforms Meropenem in Treating Complicated UTI

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Image Credit: Valiantsin, Adobe Stock

This article appeared originally on our sister site, Contemporary OB/GYN.

The investigational antibiotic, Cefepime–taniborbactam, demonstrated greater efficacy for complicated urinary tract infection (UTI) treatment than meropenem, according to a recent study published in the New England Journal of Medicine. The investigational antibiotic was developed by Venatorx Pharmaceuticals, and the therapy has its FDA Prescription Drug User Fee Act (PDUFA) on February 22.

In terms of the scope of this medical issue, at least 600,000 hospitalizations are attributed to complicated UTI in the United States, and treatment can be challenging because of emerging resistance to β-lactam antibiotics. Infections are often treated using cefepime, a fourth-generation cephalosporin. However, spreading extended-spectrum β-lactamase and carbapenemase enzymes have led to increased cefepime resistance.

Taniborbactam, a β-lactamase inhibitor, can be used in combination with cefepime against carbapenem-resistant Enterobacterales species. Data has indicated in vivo efficacy from cefepime–taniborbactam against cefepime- and carbapenem-resistant Enterobacterales species, with an acceptable safety profile.

Investigators conducted a phase 3, double-blind, double-dummy, randomized, active-controlled trial to determine the safety of efficacy of cefepime-taniborbactam compared to meropenem in hospitalized patients with complicated UTI. Patients aged 18 years or older diagnosed with complicated UTI or acute pyelonephritis were included in the analysis.

What You Need to Know

Compared to meropenem, cefepime–taniborbactam demonstrates superior efficacy in treating complicated urinary tract infections (UTI), showcasing potential as an effective treatment option.

Complicated UTIs are a significant cause of hospitalizations in the United States, with challenges exacerbated by emerging resistance to β-lactam antibiotics, necessitating the exploration of alternative treatments.

Taniborbactam, a β-lactamase inhibitor, complements cefepime in combating carbapenem-resistant Enterobacterales, offering a promising strategy against resistant strains.

UTI was determined based on pyuria, at least 1 systemic sign and at least 1 local sign or symptom, and 1 or more complicating factor. Exclusion criteria included more than 24 hours of antibacterial drug therapy against UTI before randomization, meropenem-resistant infection, and nontribal system antibacterial therapy.

Participants were assigned 2:1 to the cefepime-taniborbactam and meropenem groups. Patients in the cefepime-taniborbactam group received a 2.5 g cefepime 0.5 g taniborbactam dose every 8 hours plus meropenem placebo. Patients in the meropenem group received a 1 g dose of meropenem every 8 hours plus a cefepime-taniborbactam placebo.

All randomized patients were placed into the intention-to-treat (ITT) population, and all patients who received at least 1 dose of a trial drug were included in the safety population. Patients with a positive baseline urine culture with at least 105 colony-forming units (CFU) per millimeter of a qualifying pathogen were included in the microbiologic ITT (microITT) group.

Microbiologic and clinical success in the microITT group was measured at days 19 to 23 as the primary outcome of the analysis. Investigators defined microbiologic success as, “a reduction of all gram-negative bacterial pathogens found at baseline to less than 103 CFU per millimeter.” Symptomatic resolution or return to preinfection baseline of symptoms defined clinical success.

There were 661 patients enrolled into the study, 66% of whom were in the microITT population and 99.4% in the safety population. Similar clinical and demographic characteristics were reported at baseline across treatment groups. Patients were aged a mean 56.2 years, with 38.1% aged 65 years or older.

Complicated UTI was reported in 57.8% of patients in the microITT population and acute pyelonephritis in 42.2%. Most baseline pathogens were Enterobacterales species. Trial treatment was completed by 93.9% of the cefepime-taniborbactam group and 96.4% of the meropenem group.

In the cefepime-taniboractam group, 70.6% of microITT patients reached microbiologic and clinical success on days 19 to 23, compared to 58% of the meropenem group. This indicated superiority for cefepime-taniboractam vs meropenem, with a 12.6% difference.

During follow-up, composite success and clinical success remained higher in the cefepime-taniboractam group. Composite success findings in subgroups based on age, disease severity, and infection type remained consistent with primary efficacy results.

Adverse events during treatment were reported in 35.5% of the cefepime-taniboractam group and 29% of the meropenem group. Premature discontinuation occurred in 3% and 0.9% of these groups, respectively.

Common adverse events in the cefepime-taniboractam group included headache, gastrointestinal events, and hypertension. Adverse trends were not significantly different between groups. Severe adverse events were reported in 2% of the cefepime-taniboractam group and 1.8% of the meropenem group.

These results indicated safety and improved efficacy from cefepime-taniboractam in treating complicated UTI compared to meropenem. Investigators concluded cefepime-taniboractam is a potential option for treating patients with complicated UTI and acute pyelonephritis.

Reference

Wagenlehner FM, Gasink LB, McGovern PC. Cefepime–taniborbactam in complicated urinary tract infection. N Engl J Med. 2024;390:611-622 doi:10.1056/NEJMoa2304748



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How to Use Form 1095-A, Health Insurance Marketplace® Statement

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If anyone in your household had a Marketplace plan in 2023, you should get Form 1095-A, Health Insurance Marketplace® Statement, by mail no later than mid-February. It may be available in your Marketplace account anytime from mid-January to February 1.

Notice:

You must have your Form 1095-A before you file.
Don’t file your taxes until you have an accurate 1095-A.

  • Your 1095-A includes information about Marketplace plans anyone in your household had in 2023.
  • It comes from the Marketplace, not the IRS.
  • Keep your 1095-A forms with your important tax information, like W-2 forms and other records.

How to find your 1095-A online

  1. Log in to your account.
  2. Under “Your Existing Applications,” select your 2023 application — not your 2024 application.
  3. Select “Tax Forms.”
  4. Download all 1095-As.

What’s on Form 1095-A and why you need it

  • Your 1095-A has information about Marketplace plans any member of your household had in 2023, including:
    • Premiums paid
    • Premium tax credits used
    • A figure called 
  • You’ll use information from your 1095-A to fill out tax Form 8962, Premium Tax Credit (PDF, 110 KB). This is how you’ll “” — find out if there’s any difference between the premium tax credit you used and the amount you qualify for.
  • If you had Marketplace coverage but didn’t use the .
  • Learn more about Form 1095-A from the IRS.

Check that your 1095-A is correct

  • Carefully read the instructions on the back.
  • Make sure it’s correct. If anything about your coverage or household is wrong, contact the Marketplace Call Center
  • Make sure the information about the “second lowest cost Silver Plan” (SLCSP) is correct.

How to know if your second lowest cost Silver plan information is correct

Look at Part III, column B of your 1095-A, titled “Monthly second lowest cost silver plan (SLCSP) premium.” It should show figures for each month any household member had the Marketplace plan.

The SLCSP premium is incorrect if:

  • Part III, Column B has a “0” or is blank for any month someone in your household had the Marketplace plan
  • You had changes in your household that you didn’t tell the Marketplace about — like having a baby, moving, getting married or divorced, or losing a dependent
If either applies to you, use our tax tool to get the premium for your second lowest cost Silver plan.

Use the information from your 1095-A to reconcile

Once you have an accurate 1095-A and second lowest cost Silver plan premium, you’re ready to fill out Form 8962, Premium Tax Credit.

More Answers: Form 1095-A



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Heart Risks After Pregnancy-Related High Blood Pressure in Latinas

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Monica Cantu and her husband were overjoyed to learn they were expecting twins, a boy and a girl. 

The couple couldn’t wait to meet their babies. At a doctor’s appointment, Cantu learned her baby boy was measuring small. At 23 weeks, doctors noticed something wrong with the baby’s umbilical cord. Blood wasn’t flowing properly through the cord. 

Doctors warned Cantu to expect the worst. But she held out hope for two healthy babies. 

A couple of weeks later, Cantu felt a strange tingling and numbness in her face. She and her husband rushed to the hospital. Tests showed her liver enzymes were elevated. Cantu’s blood pressure was high at first, but a second reading was normal, she says. 

When she didn’t improve after 2 days, doctors prepared Cantu for an emergency delivery. She was only 25 weeks along. 

“Panic set in,” says Cantu, who lives in Katy, TX.  “I thought, ‘These babies cannot come right now!’ My son was being estimated at just 12 ounces.” 

Cantu’s baby girl, Amelia, was born strong and screaming, she recalls. But baby Roman entered the world quietly. He clung to life but died 2 days later.   

Tests done during the ordeal revealed Cantu’s diagnosis: severe preeclampsia. High blood pressure is a defining feature of this pregnancy complication. Elevated liver enzymes and other signs of organ damage also are symptoms.   

“Losing my son was devastating,” Cantu says. “I was left with so many questions. I carried so much guilt, like my body had failed me.” 

High blood pressure during pregnancy is a growing problem for expectant moms across the U.S. and especially for Latinas. 

Hypertensive disorders of pregnancy (HDP), which include preeclampsia and gestational hypertension, more than doubled from 2007 to 2019 in the U.S., according to a study published in the Journal of the American Heart Association. Rates went up for all women, but Latina/Hispanic women experienced the sharpest rise, with more than 60 cases per 1,000 live births. 

Even more concerning, new data link heart irregularities in older Hispanic women to high blood pressure they had years earlier while pregnant. 

“There are significant changes in cardiac structure and function in Latina women who had high blood pressure during pregnancy, meaning their hearts have abnormalities,” says Odayme Quesada, MD, medical director for The Christ Hospital Women’s Heart Center in Cincinnati and lead author of the study, published in Hypertension.

The findings are important because such differences can predict cardiovascular events later in life, such as heart failure and even death, Quesada explains.     

For the study, researchers analyzed the hearts of 5,168 Hispanic/Latina women with past pregnancies whose average age was about 60. Results revealed that prior HDP was connected with changes in how the heart contracts and relaxes, increased thickness of the heart wall, and higher rates of abnormal geometry in the heart’s left ventricle. 

The study helps answer why women with hypertension during pregnancy often develop future heart problems, Quesada says. Up to 20% of women with HDP will develop high blood pressure 6 months after giving birth, and their lifetime risk of chronic hypertension rises tenfold, studies show. 

“Prior to our study, the question was: Do abnormalities in the structure and function of the heart develop because of the HDP itself or because many of the women who have HDP then go on to develop chronic high blood pressure?” she says. “Our study helps fill in the gaps.”

During her pregnancy, Cantu’s blood pressure was sometimes high at prenatal visits but then would drop. 

The fluctuation was explained away as “white coat syndrome,” she says. The term refers to anxiety or nervousness at doctor visits that can cause blood pressure to rise. Other symptoms she reported to doctors, such as extreme itching and headaches, were waved away as typical pregnancy signs. 

At the time, Cantu says she didn’t know much about preeclampsia. She’d heard the term before but didn’t know how serious it is. None of her family members had experienced the complication.   

Lack of awareness may be one reason HDP is rising faster in Latina women. Studies show Hispanic adults in the U.S. have the lowest rates of hypertension awareness and treatment compared with White, Black, and Asian adults. 

Latinos are also less likely to have their hypertension under control, says Adriana Maldonado, PhD, assistant professor at the Mel and Enid Zuckerman College of Public Health at the University of Arizona. 

Reasons behind poor hypertension control are complex, says Maldonado, lead author of a recent study about hypertension management among Latinos. Some top obstacles include lack of time to engage in lifestyle modifications, health insurance and financial constraints, and language barriers when interacting with health care providers. Limited access to health care services, culturally rich diets, and hesitancy to seek preventative care are also factors. 

Social determinants of health largely explain the disparities, Maldonado says. “That is, the documented low rates of uncontrolled hypertension among Latinos are the result of the intersection of environmental, social, economic, and interpersonal factors.”

Lowering your risk of developing hypertension while pregnant and taking action to control your blood pressure after pregnancy is key, Maldonado and Quesada say. Prevention tips include:

Adopt a heart-healthy diet. An eating style beneficial to your heart can decrease your hypertension risk, Maldonado says. The Dietary Approaches to Stop Hypertension (DASH) eating plan is one option. DASH foods are rich in calcium, magnesium, and potassium. The plan also emphasizes vegetables, fruits, and whole grains. 

Make exercise a priority. Incorporating exercise into your lifestyle is important, Quesada says. The American Heart Association recommends 150 minutes of  physical activity a week. 

Monitor your blood pressure. If you have a history of hypertension during pregnancy, keep a close eye on your blood pressure after delivery, Quesada advises. It’s a good idea to own your own blood pressure cuff and monitor your pressure at home, and use it at least monthly. 

See your doctor regularly. A history of HDP means you should be visiting your doctor at least once a year to assess your cardiovascular risk. HDP is considered a risk enhancer and is factored into your assessment, Quesada says. 

Despite her tragic experience, Cantu knew she wanted more children. But she made sure her next pregnancy was different. 

Cantu learned as much about preeclampsia as possible. She joined the nonprofit EndPreclampsia, a global support organization for patients with HDP. She read, researched, and networked with other women with similar experiences. 

When a second pregnancy was confirmed, Cantu’s sister sent her a blood pressure monitor. Cantu checked her blood pressure at home, twice daily. 

“This time around, I went into doctors’ appointments a lot more knowledgeable,” she said. “I was able to ask more questions. I had more confidence.”

Fortunately, Cantu’s preeclampsia didn’t return during her second pregnancy. In late 2023, she gave birth to a healthy baby girl, now 5 months old. Big sister Amelia, 3, is now a bubbly preschooler. 

Cantu’s strongest advice for other Latinas is to become educated about HDP and to advocate for yourself at medical visits. 

“Inform yourself as much as you can,” she said. “Yes, you should trust your doctor, but it should not be a blind trust. Ask questions. Request tests if necessary. If something doesn’t feel right, advocate for yourself.”



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Achieving SVR Reduces Risk of Cardiovascular Events in Patients with HCV

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This article originally appeared on our sister site, HCPLive.

Hepatitis C virus (HCV) eradication with direct-acting antiviral (DAA) therapy may decrease the risk of carotid atherosclerosis and peripheral artery disease, according to findings from a recent study.

Achieving sustained virological response (SVR) was linked to improvements in intima-media thickness and ankle-brachial index measurements indicative of patients’ risk of cardiovascular events – of note, patients with advanced fibrosis and cirrhosis experienced the greatest benefit from viral eradication.1

Attributed to an estimated 58 million cases worldwide, HCV continues to present a significant global health burden despite the availability of effective treatment in the form of DAAs, which may be able to cure as many as 95% of these infections. Long-term complications such as cirrhosis and hepatocellular carcinoma are known complications of chronic HCV, but speculation regarding an increased risk of non-liver-related mortality in this patient population highlights the need for further research regarding other health risks and the impact of viral eradication with DAA therapy.2,3

“The available evidence indicates HCV eradication lowers the risk for cardiovascular events; however, the different studies methodology makes it impossible to determine if this decrease is caused by the virus eradication, by IFN, or by patient selection and other types of bias,” wrote Anca Trifan, MD, PhD, Director of the Department of Internal Medicine at Grigore T. Popa University of Medicine and Pharmacy in Romania, and colleagues.1

To determine the impact of viral eradication with oral DAA agents on carotid atherosclerosis, peripheral artery disease, steatosis, and liver fibrosis, investigators conducted a prospective study of patients diagnosed with chronic HCV infection or HCV-related cirrhosis from a tertiary center in Romania between January 2017 and March 2022. For inclusion, patients were required to have failed previous antiviral therapy or be treatment-naïve and have a detectable viral load following DAA therapy.1

What You Need to Know

Achieving sustained virological response (SVR) through DAA therapy was associated with improvements in markers of cardiovascular health, such as intima-media thickness and ankle-brachial index.

Patients with advanced fibrosis and cirrhosis experienced the greatest benefit from viral eradication with DAA therapy in terms of cardiovascular parameters.

There was a strong association between liver health indicators, such as liver stiffness measured by vibration-controlled transient elastography (VCTE) with controlled attenuation parameter (CAP), and markers of cardiovascular health. This suggests a potential interplay between liver fibrosis, hepatic steatosis, and cardiovascular disease risk among HCV-infected individuals.

Along with laboratory data, investigators also recorded participants’ liver stiffness as measured by vibration-controlled transient elastography (VCTE) with controlled attenuation parameter (CAP), classifying them as having mild/moderate fibrosis (≤9.5 kPa) advanced fibrosis (>9.6 kPa), or cirrhosis (12.5 kPa). Atherosclerosis modifications were also measured using intima-media thickness and ankle-brachial index.1

All patients were evaluated at baseline, at SVR 12 weeks after the end of the antiviral treatment, and during a follow-up period up to 6 months after SVR.1

Among the cohort, 54.7% of participants were female with a mean age of 58.14 (Standard deviation [SD], 8.8) years. More than half (55.3%) of the study population presented arterial hypertension and 22% were classified as having obesity based on their BMI.1

Investigators noted 25.6% of patients had an intima-media thickness ≥1.5 mm, which is associated with atherosclerotic plaque, and 18.4% had an ankle-brachial index ≤0.90, a common marker for peripheral artery disease. According to VCTE examinations, 51.3% of patients had lower stages of liver fibrosis (F0 and F1), and 34.5% had advanced fibrosis (≥F3) while 63.1% had liver steatosis.1

The average intima-media thickness was 1.22±0.2 mm, with a variance range from 1.14±0.19 mm in the mild and moderate fibrosis (≤F2) group to 1.29±0.25 mm in the severe fibrosis (≥F3) group. Investigators pointed out there were more individuals with carotid thickness in the group with advanced fibrosis and cirrhosis before treatment (55.1%), compared to those with F0–F2 fibrosis (41.8%).1

Following DAA treatment, investigators noticed a substantial decline in liver stiffness (P = .018) and CAP scores (P <.001). In addition, they called attention to significant changes in cardiovascular parameters, including a significant decrease in intima-media thickness values (P <.001) and an increase in ankle-brachial index levels (P <.001).1

Of note, individuals with severe fibrosis (≥F3) had a more critical decrease in intima-media thickness values following DAA treatment, with carotid thickness affecting only 18.2% of individuals in the follow-up period.1

The degree of liver fibrosis had an impact on the quantity of atheroma plaques, with investigators noticing more individuals in the advanced fibrosis and cirrhosis groups (34.4%) presenting atheroma plaques compared to the F1-F2 fibrosis group (20.9%). Moreover, a significant decrease in the number of patients with carotid plaques was observed after the DAA regimen.1

At the baseline, patients with F-F2 fibrosis had a mean ankle-brachial index of 1.02 compared to 0.91 in the severe fibrosis group. However, at SVR evaluation, participants with severe fibrosis presented a significant increase in ankle-brachial index values (P <.001). A similar increase was observed for average intima-media thickness values at SVR evaluation, again demonstrating a significant increase compared to the previous evaluation (1.06; P <.001) that was more pronounced in individuals with severe fibrosis (P = .038).1

Upon analysis, there was a strong association between the CAP score and clinical indicators of atherosclerosis, including intima-media thickness ( r= 0.061; P <.001) and ankle-brachial index (r = 0.057; P <.001). Additionally, investigators called attention to a strong association between liver stiffness at post-SVR evaluation, intima-media thickness values (r = 0.84; P <.001), and ankle-brachial index levels (r = 0.064; P <.001).1

Along with the study’s many strengths that reinforce these findings, investigators were careful to outline several limitations, as well. These included potential misinterpretations of carotid atherosclerosis between observers, the need for longer follow-up to track the progression of hepatic steatosis and fibrosis after DAA therapy, and the absence of histological examinations.1

“Our research highlights the beneficial effect of HCV eradication by the new DAA regimens on both carotid atherosclerosis and PAD. All treated HCV-infected patients experienced significant improvement in IMT and ABI measurements. According to the fibrosis stage as recorded by the liver stiffness evaluation, the maximum benefit was obtained by patients with advanced fibrosis and cirrhosis,” investigators concluded.1

References:

  1. Cuciureanu T, Stanciu C, Năstasă RR, et al. Improvement of carotid atherosclerosis and peripheral artery disease after hepatitis C virus eradication by direct-acting antivirals. Rom J Morphol Embryol. 2023;64(4):483-491. doi:10.47162/RJME.64.4.04
  2. World Health Organization. Hepatitis C. Newsroom. July 18, 2023. Accessed January 23, 2024. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
  3. Lee KK, Stelzle D, Bing R, et al. Global burden of atherosclerotic cardiovascular disease in people with hepatitis C virus infection: a systematic review, meta-analysis, and modelling study. The Lancet Gatroenterology and Hepatology. https://doi.org/10.1016/S2468-1253(19)30227-4



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Reuben Sandwich | The Recipe Critic

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This website may contain affiliate links and advertising so that we can provide recipes to you. Read my disclosure policy.

This incredible Reuben Sandwich is stuffed to the brim on rye bread with layers of thinly sliced corned beef, plenty of Swiss cheese, sauerkraut, and dressing. Broiled until the cheese is melty and everything is warm and flavorful, this is one epic sandwich!

Sandwiches are the best because there are so many varieties, they’re easy to make and they taste amazing. Warm, cold, pressed, or so tall you can barely take a bite, we love them all! Level up your lunch game with these other great sandwich recipes: this irresistible Patty Melt, these Slow Cooker Philly Cheesesteaks, and this classic Monte Cristo Sandwich.

Reuben Sandwich Recipe

There is not much better than a drool-worthy reuben sandwich piled high with all the goods! Sandwiches don’t have to be ordinary or boring! There are so many combinations to customize your own creation and easily enjoy a wide variety of wonderful flavors.

These reuben sandwiches are an explosion of flavor, and they are really quick to make! Briny sliced corned beef is layered with melted Swiss cheese, tangy sauerkraut and topped off with creamy Russian dressing and toasted dark rye bread for the perfect bite every time. Make this a complete meal and serve it with French fries, creamy cucumber salad, or French potato salad.

Ingredients Needed

Super simple, yet so flavorful! This reuben sandwich recipe only requires 6 ingredients. You can definitely switch things up and use whatever you want, but listed here are the classics for the ultimate reuben. Exact measurements are listed below in the recipe card.

  • Dark Rye Bread: This type of bread has a slightly sweet and tangy flavor that is a delicious contrast to the salty meat.
  • Salted Butter: For toasting the slices of bread.
  • Meat: Use layers upon layers of sliced corned beef or pastrami.
  • Swiss Cheese: The classic choice for a reuben, and it melts perfectly in this sandwich.
  • Sauerkraut: Adds a flavorful kick of tang with acidic and salty notes.
  • Russian Dressing: Finish with Russian dressing, or use thousand island dressing.

How to Make a Reuben Sandwich

This is one of my favorite sandwich recipes because it is so easy and tastes SO good. We love to enjoy our sandwiches with a side of potato salad or some potato chips. You are sure to fall in love with this recipe, too! Here’s how it comes together:

  1. Toast Bread: Butter the outsides of the bread and toast lightly in a skillet over medium-high heat, about 3 minutes.
  2. Assemble: Spread a generous amount of Russian dressing on both untoasted sides of the bread. Layer 7 ounces of meat, sauerkraut, and swiss cheese. Keep the top off and broil the stacked half of sandwich until the cheese is melty, about 1-2 minutes. Keep an eye on it so it doesn’t burn!
  3. Serve: Top with the second pieces of bread and slice in half. Enjoy warm!

Tips and Variations

We’re teaching you how to make a classic reuben sandwich. However, there are many ways to change up the traditional recipe and make this your own. Get creative and have fun! Here are some tasty options:

  • Customize: Make this sandwich according to your preferences! You can use more or less of any of the ingredients and leave them out if you don’t want them. The recipe is written for two meat-heavy sandwiches, both stacked with plenty of sauerkraut. Scale it to meet your needs and preferences.
  • Dressing Option: If you don’t have Russian dressing or you don’t want to make it, Thousand Island is a perfect substitute! To add the kick of Russian dressing, add some horseradish or hot sauce to spice things up.
  • Meat Option: Thinly sliced corned beef is traditional on a Reuben, but feel free to use shredded corned beef roast or sliced pastrami if that is easier.
  • Bread: Rye bread is typically used for Reubens, but it’s not for everyone. You could use a marbled rye, Jewish rye, pumpernickel, or you could go for a lighter bread like sourdough or wheat.
  • Use Mayo: Try using a thin layer of mayonnaise on the outside of the bread instead of butter for a delicious diner-style twist.
  • Cooking the Bread: You can toast the bread in a toaster or in a toaster oven. You can even put it in a panini press for a super yummy Reuben panini.
  • Cheese: Use shredded or sliced cheese–it doesn’t have to be Swiss if you don’t like it. Try provolone or gruyere for a tasty alternative.

Storing Leftovers

You can save leftovers in an airtight container for up to 1 day, but it will get soggy the longer it sits. It’s best made and eaten fresh!

More Sandwich Recipes

A delicious sandwich filled with meat, cheese and a tasty sauce always hits the spot! Whether for lunch, dinner or sliders for an appetizer, they are a popular option with pretty much everyone! Here are some more delicious ones that you MUST try!

Pin this now to find it later

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  • Butter the outsides of the bread and toast lightly in a skillet over medium-high heat, about 3 minutes.

  • Spread a generous amount of Russian dressing on both untoasted sides of the bread. Layer 7 ounces of meat, sauerkraut, and swiss cheese. Keep the top off and broil the stacked half of sandwich until the cheese is melty, about 1-2 minutes. Keep an eye on it so it doesn’t burn!

  • Top with the second pieces of bread and slice in half. Enjoy warm!

Serving: 1sandwichCalories: 402kcalCarbohydrates: 2gProtein: 30gFat: 30gSaturated Fat: 9gPolyunsaturated Fat: 1gMonounsaturated Fat: 14gCholesterol: 107mgSodium: 2728mgPotassium: 670mgFiber: 1gSugar: 1gVitamin A: 9IUVitamin C: 61mgCalcium: 28mgIron: 4mg

Nutrition information is automatically calculated, so should only be used as an approximation.





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Improving your health | HealthCare.gov

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Improving your health

Knowing how to use your health coverage is important for better health and well-being. Health coverage isn’t only important when you’re sick, it’s also helpful even when you don’t feel sick.

After your health plan coverage starts, you can use it to help cover medical costs for services like:

Keep up with your health



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A New Guide to Healthy Eating

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Feb. 16, 2024 – When it comes to your diet, your plate is important. Experts say it should include a healthy protein, whole grains, vegetables, and fruit. But rather than ration those ingredients, it might be easier – and healthier – to mix and match colors. 

Not only does this rainbow-driven strategy fuel the body for its best performance, but it might help it prevent diseases or lower disease risk. By shifting the perspective from the plate to the rainbow, we start to understand that variety really IS the key to life.

“Our diet should ideally be a diverse combination of foods that allow certain compounds in foods to interact with one another as well as with systems in the body to produce health benefits,” said Christopher Browne, a doctor of chiropractic and director of human nutrition and functional medicine at the University of Western States in Portland, OR. 

But not every type of food provides these benefits, especially “ultra-processed food, which has been the death knell of health in North Americans,” said Andrea Boggild, MD, medical director of the Tropical Disease Unit at Toronto General Hospital, and an associate professor of medicine at the University of Toronto. 

Knowing which fruits and vegetables may provide the greatest benefits is just as important to ensuring there’s always some room for tasty combinations to match palates. The rainbow way is not about restriction but rather a predominance of whole, plant-based foods along with a few items that maintain what Browne referred to as the “sensory experience of food, along with its social and cultural aspects.” 

All it takes is going back to the basics and making sure that the plate contains all of the major plant colors: red, orange, yellow, green, and blue-purple.

Red

Think beets, strawberries, cherries, and red bell peppers. These foods are rich in antioxidants and contain nutrients that help the body fight inflammation and maintain a healthy immune response. But don’t forget tomatoes, which researchers have recently discovered may be able to fight infectious bacteria responsible for many food-borne illnesses. Jeongmin Song, PhD, a researcher in the Department of Microbiology and Immunology at Cornell University College of Veterinary Medicine in Ithaca, NY, said though the evidence is early, findings showed that fresh tomato juice appears to kill salmonella and E. coli, both of which affect the gut and urinary tract. “The implication was that it’s possible that eating fresh vegetables and fruits will help eliminate bacteria,” she said.

Orange

Like their red cousins, orange plants and vegetables share substances known as carotenoids that are not only responsible for their deep pigmentation, but also appear to play an important role in hormone regulation and reproductive health. These benefits are linked to their strong antioxidant activity, especially in the ovaries. Examples include carrots, yams, persimmons, oranges, apricots, mangoes, and butternut squash. Browne said some research suggests that eating more orange fruits may also potentially delay the start of menopause.

Yellow

Anything but mellow, yellow fruits and vegetables are essential for keeping the gut running smoothly, help to offset extremes in blood sugar when consumed with starchy foods, and also contain powerful antioxidants. Golden delicious apples, Asian pears, lemons, bananas, and pineapples fall into this category. But don’t forget ginger, a flowering plant with a root that packs a punch when it comes to reducing nausea and helping food move through the digestive tract and out of the stomach. Keep in mind that “timing can be crucial,” said Browne. “Some people tolerate things fine with food in their stomach that they wouldn’t tolerate on an empty stomach,” he explained, referring specifically to yellow foods that are particularly acidic, like citrus fruit.

Green

Nothing shouts “plant” more than green. A star of the plate, foods like leafy greens (spinach, chard, collards, kale, and other lettuces), cruciferous vegetables (broccoli, Brussels sprouts), artichokes, snow peas, and fruits like pears and green apples are powerful antioxidants that have been linked directly to heart health. “Vascular health benefits include reducing blood pressure and controlling the expression of genes that promote inflammation,” Browne said. Peppers, especially hot peppers, are especially known for their anti-inflammatory properties. But there is one special standout in the green category: avocados. “Avocados are an amazing source of many of the micronutrients we need every day,” said Kathleen Holton, PhD, MPH, a nutritional neuroscientist and provost associate professor at American University in Washington, DC.

Blue-Purple

It’s ironic that the color blue is often associated with sadness. Not only are blue and purple fruits and vegetables powerful antioxidants, but they have been shown to balance mood, boost learning ability, and positively affect the nervous system. “There’s great research on blueberries and cognitive function,” Holton said. “But we can do even more if those blueberries are part of a healthy diet that removes exposure to certain food additives that cause negative effects.” In addition to blueberries, grapes are a great source of “phytonutrients,” especially naturally occurring substances like polyphenols, which boost their antioxidant properties. “We’re surprised that grapes (red, concord) in particular have many antimicrobial properties to fight infection,” said Song, noting that these power players are the next candidates for laboratory studies. Other important blue-purple foods include blackberries, black raspberries, boysenberries, figs, plums, eggplant, purple cabbage, and purple cauliflower.

Garlic: A Superstar

One way to determine the nutrient value of different fruits and vegetables is the vibrancy of their color. But it turns out that white plays a starring role on the rainbow plate. “If you were going to call something a superfood, garlic would be my number one choice,” Holton said. “Garlic has antibacterial, antiviral, antifungal, and anticancer properties,” she said, “so garlic (and onions) become very flavorful, beautiful additions that are very nutrient-dense when people are cooking.” (Not to mention, garlic and onions are drivers of great flavor).

The gold at the end of the rainbow is wealth, but not in the most common sense of the word. The best advice is to stop counting calories and quantities and ensure that you are putting multicolored foods into your diet every day.

“Diet is all about these different important chemicals that our body needs to have to function optimally,” Holton noted. “The power comes when we put them all together.”



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Top Infectious Disease Stories: Week of February 10

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This week, increased risk of long COVID in individuals who have tested positive for the virus, advancements in the preservation of the microbiome offer new strategies for healthcare-associated infections (HAIs), FDA-approved GSK’s bepirovirsen signaling the company’s goal to cure viral hepatitis, CDC considers changing 5-day COVID isolation guideline, and the first victim of the Alaskapox virus highlights the critical need for increased research into emerging infectious diseases.



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Crockpot Green Beans | The Recipe Critic

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This website may contain affiliate links and advertising so that we can provide recipes to you. Read my disclosure policy.

These Crockpot Green Beans are perfectly tender, packed with flavor and so easy to cook in your slow cooker. All you need is 5 minutes of prep time to have a side dish that pairs well with almost any meal!

Cooking your side dish recipes in the crockpot is so convenient! It’s easy, hands-off and leaves the oven open for other dishes you might be preparing. For other crockpot sides, try these slow cooker cheesy ranch potatoes, amazing slow cooker macaroni and cheese or creamy crockpot mashed potatoes.

Green beans in a slow cooker, topped with cheese and bacon.

Crockpot Green Beans Recipe

A good side dish like Crockpot Green Beans can be the best part of the meal, especially when they’re this tasty! This recipe combines tender green beans with diced onion, garlic, parmesan cheese and plenty of bacon for an incredible complement to dinner! Whether you’re serving them alongside a simple weeknight meal or a holiday spread, they’re going to be a new favorite!

I just love how these turn out perfectly tender and packed with flavor. You simply can’t imagine how amazing these taste! A delicious side for any meal, and clean up is a breeze. These are especially great for cooking around the holidays because they don’t take up any precious oven space. I know your family will love them just as much as mine does!

Ingredients Needed

Not only is this crockpot green beans recipe so simple to make but the list of ingredients is short and sweet! See the recipe card below for a list of exact ingredient measurements.

  • Green Beans: You’ll need 2 pounds fresh green beans for this recipe.
  • Onion and Garlic: For wonderful aromatic savory flavor.
  • Parmesan Cheese: Green beans and grated parmesan cheese are a match made in heaven.
  • Chicken Broth: You’ll need two cups of chicken broth to ensure the green beans don’t dry out while cooking, and also it will add extra flavor.
  • Bacon: Adding in about 6 slices of cooked, crisp and crumbled bacon to cook with the green beans will really take these to the next level.
  • Salt & Pepper: To bring out all of the delicious flavors.

How to Make Crockpot Green Beans

These only take a couple of minutes to prep, and then the slow cooker does all of the work. If you want them to look uniform, cut the ends off of them before cooking. Here’s how everything comes together:

  1. Combine & Cook: Add the onions, garlic, parmesan, bacon, chicken broth, and green beans to a 4-quart slow cooker. Season with salt and pepper as desired. Place the lid on top and cook on high for 2-3 hours, until the green beans are tender.
  2. Serve: You may remove some of the broth before serving and add more crumbled bacon and parmesan, if desired.
Adding green beans to a Crockpot along with Parmesan cheese, bacon, diced onions, and garlic.

Tips and Variations

These green beans are so easy to serve up! These tips will make them turn out perfectly!

  • Add Heat: Spice things up by adding ¼-½ teaspoon of red pepper flakes.
  • Add Lemon: For a bright zing, add a tablespoon of lemon zest and 1-2 tablespoons of fresh lemon juice. 
  • Don’t overcook the beans! A lot of recipes out there recommend cooking the green beans for 4-6 hours on low (or high!!) and that’s just way too much time unless you want mushy green beans. Stick to 2-3 hours of cooking on high or 4 hours on low. If you prefer your beans more al dente, check them after 1-1 ½ hours and see if they’re where you’d like them. 
  • Smaller Beans: If you like to serve your beans in smaller pieces, cut them into 1 ½-2 inch pieces before adding them to the crockpot. They may cook faster in smaller pieces, so check on them after 1 ½ hours.

Crockpot green beans in a serving dish.

Make Ahead and Storing Leftovers

You can have these all prepped and ready to cook! Leftovers are also great! They store well and are easy to reheat.

  • Make Ahead: You may prepare the beans in the crockpot insert up to 24 hours in advance. Cover with plastic wrap or foil and store in the refrigerator until you’re ready to cook them. When ready, simply place the crockpot insert back in the crockpot, place the lid on, and cook as directed. 
  • In the Refrigerator: Store the cooked beans in an airtight container for up to 4 days.
  • To reheat: You can reheat these in your air fryer! Cook them at 350 degrees for about 4-5 minutes or until they are warmed through. Alternatively, you can pop them in the microwave for 1-2 minutes.

Scooping up the green beans with a wooden spoon.

More Delicious Green Bean Recipes

Whether you cook them in an air fryer, Crock Pot or on the stovetop, green beans are such a great side dish! They can be seasoned in a variety ways and pair well with so many mains. Here are some of our family fav recipes that we know you’ll love too!

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  • Add the onions, garlic, parmesan, bacon, chicken broth, and green beans to a 4-quart slow cooker. Season with salt and pepper as desired. Place the lid on top and cook on high for 2-3 hours, until the green beans are tender.

  • You may remove some of the broth before serving and add more crumbled bacon and parmesan, if desired.

Serving: 1servingCalories: 217kcalCarbohydrates: 26gProtein: 9gFat: 10gSaturated Fat: 3gPolyunsaturated Fat: 2gMonounsaturated Fat: 4gTrans Fat: 0.03gCholesterol: 18mgSodium: 499mgPotassium: 564mgFiber: 7gSugar: 7gVitamin A: 1073IUVitamin C: 23mgCalcium: 162mgIron: 2mg

Nutrition information is automatically calculated, so should only be used as an approximation.





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Health insurance and taxes | HealthCare.gov

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Published on February 23, 2023

If you had Marketplace coverage at any point in 2022, or got premium tax credits last year, here’s what you need to know about filing your federal taxes.

  1. Keep your Form 1095-A in a safe place
  2. Check that your Form 1095-A is correct
    • Make sure your household and coverage information, the “” amount, and the monthly premium are correct.
    • If you find a mistake, contact the Marketplace Call Center. We’ll send you an updated form to file.
  3. “Reconcile” with your correct Form 1095-A
    • Use the information from your correct Form 1095-A to complete Part II of Form 8962 (PDF, 110 KB). 
    • Get details on how to “reconcile”
    • If there’s a difference between the amount of premium tax credit you used during the year and the amount you actually qualify for, it will impact your refund or the amount of taxes you owe.



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