A sage discovery: Plant-derived compounds have potent anti-inflammatory effects

New research reveals that two specific plant-derived compounds may be effective for fighting inflammation and pain. The findings are published in the British Journal of Pharmacology.

Diterpenoids are found in certain plants, fungi, and marine organisms, and two in particular - carnosol (CS) and carnosic acid (CA) - are known to interfere with multiple pathways in the human body associated with inflammation and pain.

A team led by Giuseppe Bifulco, PhD of the University of Salerno in Italy, and Andreas Koeberle, PhD of the Friedrich Schiller University Jena in Germany, have investigated the effects of these natural products in their pure form in inflammatory pain through research involving human cells and mice. The researchers found that the diterpenoids inhibited two enzymes involved in inflammation, fever, and pain. Overexpression of one of these enzymes has been observed in several inflammatory disorders as well as in many human tumors; the second enzyme is also a major player in inflammation and other immune-related processes in the body.

"We have demonstrated that 5-LO and mPGES-1, two key enzymes of inflammation, are primary targets of CS and CA, which are major bioactive ingredients of herbs that are used as spices - namely sage and rosemary - and in traditional medicine," said Dr Bifulco. "Our study provides comprehensive insights into their anti-inflammatory mechanism. Understanding both the molecular basis and pharmacological relevance of natural products is essential to fully exploit the power of nature for human health."

The investigators noted that dual inhibitors of 5-LO and mPGES-1 are considered potential alternatives to classical anti-inflammatory and analgesic drugs that have well-documented side effects. Recently, the mPGES-1 inhibitor GRC 27864 (Glenmark Pharmaceuticals Ltd.) entered the first phase of clinical development.

"The discovery of new dual 5-LO/mPGES-1 inhibitors, like CS and CA, represents a valid strategy for the treatment of inflammatory and cancer diseases and further justifies the use of sage and rosemary in traditional medicine," said Dr Koeberle. "It is important that these natural products are tested in different experimental inflammation and cancer animal models as well as in imaging studies to obtain a complete comprehension of the molecular basis behind their observed biological activity."

Pharmacy / Pharmacist Primary Care / General Practice Importance of including purpose of medications on prescriptions

In a Perspective article in the July 28, 2016 issue of the New England Journal of Medicine, Gordon D. Schiff, MD, lead author and general internist at Brigham and Women's Hospital, and his co-authors Enrique Seoane-Vazquez, PhD of the Massachusetts College of Pharmacy and Health Sciences and Adam Wright, PhD, informatics expert at BWH call for including the purpose of medications on prescriptions to inform and enhance safety by narrowing medication choices to those indicated for a specific problem.

"Currently, even though there is a widespread commitment to sharing drug information with patients, the reason for a medication prescription is generally not recorded or shared when it is being written and is therefore missing a key piece of information," Schiff says.

The authors outline how incorporating indication into the prescription can make prescribing better and safer, stating the following reasons:

• Reduce errors including mismatches, prescribing or dispensing errors, and errors related to drugs of similar names.
• Enable patients to better understand and adhere to their medication regimens and question the necessity of a medication.
• Provides clinicians with a system to identify therapeutic alternatives to choose the best drugs for their patients' problems.
• Informs prescribers, pharmacists, caregivers and patients regarding what is being treated and what outcomes are desired.
• Reconciles list of medications by indication, rather than randomly, alphabetically, or chronologically and make duplicates and discontinued medications much easier to spot.
• Permits clearer assessments and comparisons to track and evaluate prescriptions and measure a drug's long term effectiveness.

The Perspective article points out that historically, patients were intentionally kept in the dark about the ingredients and indications for their drugs, which dates back to an 1833 article in the Boston Medical and Surgical Journal which explained why prescriptions should be written in Latin to protect patients from knowledge of the names of, and indications for, the prescribed drugs and allow the patient to rely on the skill of the physician.

With funding from the U.S. Agency for Healthcare Research and Quality (AHRQ), BWH researchers are bringing together information technology design specialists and policy leaders for a three-year project to build a prototype that will allow prescribers to start from the patient's problem and guide users toward best choices.

Due largely to logistics in the way drug prescriptions are written - previously on paper, now on computer - this deficit is one the Brigham researchers say should be fixed and are working to correct and overcome. "We will be testing our hypothesis that electronic prescribing needs to incorporate this missing link and that this system will result in a safer, more efficient way of ordering medications to benefit patients, families, prescribers, pharmacists, and other members of the health care team," Schiff said.

Article: Incorporating Indications into Medication Ordering - Time to Enter the Age of Reason, Gordon D. Schiff, M.D., Enrique Seoane-Vazquez, Ph.D., and Adam Wright, Ph.D., New England Journal of Medicine, doi: 10.1056/NEJMp1603964, published 28 July 2016.

Asbestos / Mesothelioma Litigation / Medical Malpractice Landmark asbestosis ruling is good news for sufferers, UK

Court of Appeal rules entitlement to proportional compensation from as low as 2.3%.

In a landmark asbestosis case, The Court of Appeal ruled today that asbestosis sufferers could be entitled to proportional compensation from as low as 2.3% from negligent employers, based upon the number of years worked. The historic ruling confirms that proportional compensation is applicable even if the employer's overall contribution to the condition was minimal and the entitlement was as low as 2.3%.

The ruling relates to retired electrician, Mr Albert Carder, who was exposed to asbestos whilst working at Exeter University. Although most of his asbestos exposure occurred earlier in his career, Mr Carder's lawyers, Moore Blatch, calculated that his employment at the university contributed 2.3% toward his asbestosis.

The Court of Appeal today upheld the calculation and judgement made by The High Court in July 2015 that Mr Carder was entitled to compensation. But at the time Exeter University's insurers appealed, arguing the proportion of the exposure was minimal and had made "no discernible difference to his condition".

Moore Blatch asbestos disease lawyer John Hedley, representing Mr Carder comments: "This decision is very important and will influence other asbestos cases. Whilst there is a long established principle around minimal contributions to asbestos exposure by employers, this case helps define what minimal actually means. We can confidently say this contribution can be as low as 2.3% or even less. Whilst the compensation is not substantial, it will help Mr Carder and the ruling will help many other people who are in a similar position."

Mr Carder said: "It's a huge relief for this case to have finally settled and to also know that I can return to court, should my condition deteriorate, which is of great comfort to me and my family. When I started my career asbestos was thought to be such a wonderful thing; unfortunately we were not made aware of the dangers."

Mr Carder's overall damages from his total exposure to asbestos were assessed at approximately £67,500, with the university's contribution confirmed to be £1,713.

New research confirms correlation of common bacteria (including MRSA) and eczema

A new study published in the British Journal of Dermatology has shown that, on average, 70% of eczema patients are colonised with Staphylococcus aureus bacteria (S. aureus, including MRSA) on their skin lesions. Patients with more severe disease had a greater risk of being colonised. These results provide an indication of the importance of colonisation as a possible trigger in eczema.

The systematic review from Erasmus MC University looked at 95 observational studies comprising over 9000 patients. Interestingly, 39% of eczema patients carried S. aureus on healthy skin, compared with 70% that carried it on lesional skin where the dermatitis is present. This is an almost twenty-fold increase compared to healthy controls.

In addition, up to 80% of eczema patients were found to have a strain of S. aureus that produced a toxin. These toxins have been known to stimulate the inflammatory response, contributing to the skin barrier defects in eczema, and may therefore be a primary trigger of the condition.

Currently, eczema is mainly treated with corticosteroids and in the case of infection, with antibiotics. However, these drugs can result in side effects, drug-resistance and damage to the skin's normal beneficial bacteria, making them unsuitable for long-term use.

Professor of Paediatric Dermatology at the Erasmus MC University Suzanne Pasmans, and senior author of the paper said: "This review demonstrates the importance of colonisation with S. aureus, as a factor in the pathogenesis of atopic dermatitis. To decipher the exact role of S. aureus, studies using targeted antistaphylococcal therapy for the skin need to be done."

Micreos, a Dutch biotech company who helped fund the review, is leading the way with the development of Staphefekt™, a bacteria-killing enzyme, or endolysin, specific to S. aureus, which is as effective in killing MRSA as other strains of S. aureus.

The mechanism of action of endolysins is unrelated to that of antibiotics, so even resistant bacteria, such as MRSA, are susceptible. Staphefekt™ is the first endolysin registered for use on the skin's microbiome, and is currently used as the active compound in Gladskin (a range of topical creams and gels for inflammatory skin conditions, such as eczema).

Unlike antibiotics, bacterial resistance to Staphefekt has not been observed or expected, and its specificity means beneficial bacteria are preserved, making it suitable for long-term daily use.

Prof Pasmans added: "We have just enrolled the first patients in a prospective, randomised, placebo controlled trial using Gladskin. This study will provide insight in the effects of targeted S. aureus elimination on the overall skin-microbiome and clinical symptoms of eczema".

Article: Prevalence and odds of Staphylococcus aureus carriage in atopic dermatitis: a systematic review and meta-analysis, Totté, J.E.E., van der Feltz, W.T., Hennekam, M, et al., British Journal of Dermatology, doi: 10.1111/bjd.14566, published online 5 July 2016.

Diabetes Regulatory Affairs / Drug Approvals FDA approves Adlyxin to treat type 2 diabetes

The U.S. Food and Drug Administration approved Adlyxin (lixisenatide), a once-daily injection to improve glycemic control (blood sugar levels), along with diet and exercise, in adults with type 2 diabetes.

"The FDA continues to support the development of new drug therapies for diabetes management," said Mary Thanh Hai Parks, M.D., deputy director, Office of Drug Evaluation II in the FDA's Center for Drug Evaluation and Research. "Adlyxin will add to the available treatment options to control blood sugar levels for those with type 2."

Type 2 diabetes affects more than 29 million people and accounts for more than 90 percent of diabetes cases diagnosed in the United States. Over time, high blood sugar levels can increase the risk for serious complications, including heart disease, blindness and nerve and kidney damage.

Adlyxin is a glucagon-like peptide-1 (GLP-1) receptor agonist, a hormone that helps normalize blood sugar levels. The drug's safety and effectiveness were evaluated in 10 clinical trials that enrolled 5,400 patients with type 2 diabetes. In these trials, Adlyxin was evaluated both as a standalone therapy and in combination with other FDA-approved diabetic medications, including metformin, sulfonylureas, pioglitazone and basal insulin. Use of Adlyxin improved hemoglobin A1c levels (a measure of blood sugar levels) in these trials.

In addition, more than 6,000 patients with type 2 diabetes at risk for atherosclerotic cardiovascular disease were treated with either Adlyxin or a placebo in a cardiovascular outcomes trial. Use of Adlyxin did not increase the risk of cardiovascular adverse events in these patients.

Adlyxin should not be used to treat people with type 1 diabetes or patients with increased ketones in their blood or urine (diabetic ketoacidosis).

The most common side effects associated with Adlyxin are nausea, vomiting, headache, diarrhea and dizziness.Hypoglycemia in patients treated with both Adlyxin and other antidiabetic drugs such as sulfonylurea and/or basal insulin is another common side effect. In addition, severe hypersensitivity reactions, including anaphylaxis, were reported in clinical trials of Adlyxin.

The FDA is requiring the following post-marketing studies for Adlyxin:

• Clinical studies to evaluate dosing, efficacy and safety in pediatric patients.
• A study evaluating the immunogenicity of lixisenatide.

The new app, called Dermofit, has been designed to help train non-specialist doctors, nurses, and medical students to more accurately identify different skin lesions and growths along with their related diagnoses, using interactive, cognitive training techniques and an extensive image reference library. Launched earlier this month, Dermofit is already in use in a range of medical training settings around the world, helping healthcare professionals develop a greater knowledge of the variety of visual characteristics that different skin lesions have, and the way that these can be used to determine benign cases from more serious examples of skin cancer. Dermofit was first devised by Prof. Jonathan Rees, grant chair of dermatology at the University of Edinburgh, who came up with the idea to develop a digital tool to help medical professionals accurately identify malignant and benign skin lesion and skin growths at an early stage. The result of 4 years of research and development by the University of Edinburgh, Dermofit provides trainee doctors, nurses, and other non-specialist healthcare professionals with digital resources that allow them to hone their ability to correctly identify specific skin lesion types and, as a result, improve the accuracy with which they can determine skin cancer diagnoses. Algorithms group skin lesion photos based on color and texture In the case of suspected skin cancers - including malignant melanoma, squamous cell carcinoma, or basal cell carcinoma - the need for prompt referral to a specialist for assessment and treatment is essential. However, in many cases, these referrals are often unnecessary. "Thirty percent of doctors will automatically send a patient to a hospital if they have signs of a skin growth," says Prof. Rees. "But the evidence is that the vast majority of people who are seen and referred do not have skin cancer or anything serious at all." Resources that can equip non-specialist care practitioners with the skills necessary to more accurately identify these different types of skin growth and lesion can therefore be extremely valuable, in terms of improving the quality of care provided to patients and also reducing costs for care providers. Dermofit uses algorithms that automatically groups library photos of skin lesions based on their color and texture properties. Selecting from a library of more than 1,300 images, the Dermofit app will take the user to further sets of similar lesion types to illustrate the difference in lesions that may look similar but are from different skin lesion classes. Other modules allow users to further build and test their skills of identification and diagnosis. Bob Fisher, who specializes in computer vision and helped design the computer algorithms for the app, adds: "Dermofit contains a photo library of skin lesions to help inform practitioners to diagnosis more effectively." Practitioners can click on the image of a lesion of interest which then leads to further similar lesions. As lesions are selected, further sets of similar lesions are displayed. This gives familiarity with the different skin lesion types and allows users to differentiate between lesions that look similar, but that are from different skin lesion classes," he says. A rapidly growing area of medical training The use of cognitive teaching tools is a rapidly growing area of medical training, as it allows healthcare professionals to develop the necessary skills that are required to more accurately diagnose and treat patients within risk-free digital environments. Providing healthcare practitioners with training tools like Dermofit helps them acquire skills that would otherwise require years of practical experience. Simedics, a U.K.-based company specializing in digital products and publishing for the healthcare industry, is the commercial partner responsible for bringing Dermofit to market. They hope that the product will become instrumental in providing an effective way to train medical students and primary care practitioners in this area and, as a result, help improve skin cancer detection rates and patient care. The company is already working with teaching hospitals, universities, and organizations around the world to incorporate Dermofit into teaching regimens. More information on the Dermofit project is available at dermofit.org. Dermofit is available on iOS and can be downloaded from the App Store. Written by Matthew Driver, managing editor of The Journal of mHealth

The study forms the first part of a four-paper series published by The Lancet that provides an overview and update of worldwide trends of physical activity and the global impact of physical inactivity.

The first series observing physical activity was released in 2012 ahead of the Summer Olympic Games. The study authors caution that there has been little progress in tackling the global pandemic of physical activity since the 2012 Olympics, with a quarter of adults worldwide failing to meet physical activity recommendations.

In the analysis, the researchers posed the question: Does exercise reduce or eradicate the harmful effects - including increased risk of early death - that are associated with prolonged sitting?

Health risks that are linked to physical inactivity include an increased risk of heart disease, stroke, type 2 diabetes, and some cancers, with recent estimates suggesting that more than 5 million people die each year globally due to failing to meet daily activity levels.

Total worldwide cost of physical inactivity at least $67.5 billion

Findings from the second part of the series - a world-first study to estimate the economic burden of physical inactivity worldwide - shows that globally in healthcare expenditure and lost productivity, physical inactivity cost the world $67 billion in 2013.

"Physical inactivity is recognized as a global pandemic that not only leads to diseases and early deaths, but imposes a major burden to the economy," says Dr. Melody Ding, senior research fellow at The University of Sydney's School of Public Health, Australia.

Dr. Ding notes that if no action is taken to improve population levels of physical inactivity, the economic burden of physical inactivity is projected to increase globally, predominantly in low- and middle-income countries.

The World Health Organization (WHO) recommend that adults aged 18-64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week.

In the first paper of the series, the researchers analyzed 16 studies, which included data from over 1 million people.

The team formed four groups of individuals based on their level of moderate-intensity exercise, ranging from 5-75 minutes per day. Moderate-intensity exercise was defined as walking 3.5 miles per hour or cycling at 10 miles per hour.

1 hour of exercise daily can mitigate risks of early death

Results from the study show that people that spend 8 hours a day sitting but are physically active have a significantly lower risk of death than people who spend fewer hours sitting, but who are not physically active.

Moreover, the increased risk of death associated with spending 8 hours sitting was eliminated by 1 hour of physical activity per day.

People who had the greatest risk of death were those individuals who sat for prolonged periods and were mostly inactive. They were between 28-59 percent more likely to die early, compared with those in the most active group, which is a similar risk to that associated with smoking and obesity.

The study finds that only around 25 percent of participants did an hour or more exercise per day.

"There has been a lot of concern about the health risks associated with today's more sedentary lifestyles," says Prof. Ulf Ekelund, of the Norwegian School of Sports Sciences, Norway, and the Medical Research Council Epidemiology Unit at the University of Cambridge, United Kingdom.

"Our message is a positive one: it is possible to reduce - or even eliminate - these risks if we are active enough, even without having to take up sports or go to the gym."

Prof. Ulf Ekelund

"For many people who commute to work and have office-based jobs, there is no way to escape sitting for prolonged periods of time. For these people in particular, we cannot stress enough the importance of getting exercise, whether it's getting out for a walk at lunchtime, going for a run in the morning or cycling to work. An hour of physical activity per day is the ideal, but if this is unmanageable, then at least doing some exercise each day can help reduce the risk," he adds.

Watching TV for long durations raised death risk in most activity groups

Also observed in the study was time spent watching TV per day - a particular type of sedentary behavior - in a subgroup of approximately half a million people.

Watching TV for 3 hours per day was associated with an increased risk of death in all activity groups, except among the most active. The authors say that this association could be because long hours watching TV may be a marker of a more unhealthy lifestyle in general, including being less likely to take exercise.

In a third paper in the series looking at the progress and challenges in physical activity since the 2012 Olympics, Prof. Jim Sallis, of the University of California-San Diego, says: "The global pandemic of physical inactivity remains, and the global response has been far too slow."

App trains healthcare professionals to detect early stage skin cancer

The new app, called Dermofit, has been designed to help train non-specialist doctors, nurses, and medical students to more accurately identify different skin lesions and growths along with their related diagnoses, using interactive, cognitive training techniques and an extensive image reference library.

Launched earlier this month, Dermofit is already in use in a range of medical training settings around the world, helping healthcare professionals develop a greater knowledge of the variety of visual characteristics that different skin lesions have, and the way that these can be used to determine benign cases from more serious examples of skin cancer.

Dermofit was first devised by Prof. Jonathan Rees, grant chair of dermatology at the University of Edinburgh, who came up with the idea to develop a digital tool to help medical professionals accurately identify malignant and benign skin lesion and skin growths at an early stage.

The result of 4 years of research and development by the University of Edinburgh, Dermofit provides trainee doctors, nurses, and other non-specialist healthcare professionals with digital resources that allow them to hone their ability to correctly identify specific skin lesion types and, as a result, improve the accuracy with which they can determine skin cancer diagnoses.

Algorithms group skin lesion photos based on color and texture

In the case of suspected skin cancers - including malignant melanoma, squamous cell carcinoma, or basal cell carcinoma - the need for prompt referral to a specialist for assessment and treatment is essential. However, in many cases, these referrals are often unnecessary.

"Thirty percent of doctors will automatically send a patient to a hospital if they have signs of a skin growth," says Prof. Rees. "But the evidence is that the vast majority of people who are seen and referred do not have skin cancer or anything serious at all."

Resources that can equip non-specialist care practitioners with the skills necessary to more accurately identify these different types of skin growth and lesion can therefore be extremely valuable, in terms of improving the quality of care provided to patients and also reducing costs for care providers.

Dermofit uses algorithms that automatically groups library photos of skin lesions based on their color and texture properties.

Selecting from a library of more than 1,300 images, the Dermofit app will take the user to further sets of similar lesion types to illustrate the difference in lesions that may look similar but are from different skin lesion classes. Other modules allow users to further build and test their skills of identification and diagnosis.

Bob Fisher, who specializes in computer vision and helped design the computer algorithms for the app, adds: "Dermofit contains a photo library of skin lesions to help inform practitioners to diagnosis more effectively."

Practitioners can click on the image of a lesion of interest which then leads to further similar lesions. As lesions are selected, further sets of similar lesions are displayed. This gives familiarity with the different skin lesion types and allows users to differentiate between lesions that look similar, but that are from different skin lesion classes," he says.

A rapidly growing area of medical training

The use of cognitive teaching tools is a rapidly growing area of medical training, as it allows healthcare professionals to develop the necessary skills that are required to more accurately diagnose and treat patients within risk-free digital environments.

Providing healthcare practitioners with training tools like Dermofit helps them acquire skills that would otherwise require years of practical experience.

Simedics, a U.K.-based company specializing in digital products and publishing for the healthcare industry, is the commercial partner responsible for bringing Dermofit to market. They hope that the product will become instrumental in providing an effective way to train medical students and primary care practitioners in this area and, as a result, help improve skin cancer detection rates and patient care.

The company is already working with teaching hospitals, universities, and organizations around the world to incorporate Dermofit into teaching regimens.

More information on the Dermofit project is available at dermofit.org.

Dermofit is available on iOS and can be downloaded from the App Store.

What is a Hiatal Hernia?

A hernia is where internal tissue or part of an organ pushes through a weakness in the body part's "wall" that normally keeps it in.

The insides of the belly are held in the abdominal cavity by the abdominal wall, for example. That is the wall affected by inguinal hernias.

The organs of the abdomen are also kept in place by the diaphragm. The diaphragm separates the abdominal cavity's organs from the heart and lungs in the chest cavity. It is a dome-shaped muscular layer between the two cavities.

The diaphragm is the part of the body that is affected by a hiatal or hiatus hernia. This muscle moves up and down for breathing. There are no open holes in the diaphragm, but key structures and vessels run through it.

The biggest one of these is the food pipe, named the esophagus. It runs down from the back of the mouth to the stomach, connecting the two, and is critical for pushing food down.

Just above the stomach, the diaphragm normally:

• Tightly surrounds the esophagus to keep abdominal organs and tissues in their place
• Stays attached to the esophagus when the food pipe narrows down after food passes through into the stomach

This narrowing down of the esophagus helps to keep the contents of the stomach from coming back up the chest part of the food pipe.

A hiatal hernia is where part of the upper stomach pushes through the diaphragm at this usually snug point. Part of the stomach can "herniate" at this "hiatus" if the opening is weakened.

Contents of this article:

1. Causes and risk factors
2. Symptoms of a hiatal hernia
3. Prevention and treatment

Causes and risk factors for a hiatal hernia

Experts do not fully understand all of the causes of the weaknesses that result in hiatal hernias.

A hiatal hernia is thought to be caused by pressure pushing up on the diaphragm. There may be inherited genetic factors that make some people more at risk from pressure.

Experts believe that hiatal hernias are caused by pressure pushing up on the diaphragm.

The weakening has been linked to a number of risk factors that make it more likely. Hiatal hernias are more common among people:

• Over 50 years of age
• With obesity

Other risk factors include upward strain because of weightlifting. Even straining to push out a stool when emptying the bowel can be a factor. So too can persistent coughing or vomiting. These temporarily increase the pressure inside the abdominal cavity.

A hiatal hernia is seen more often in pregnant women. The abdominal organs are simply pushed upward during pregnancy. This sometimes causes the bulging through the diaphragm at the esophagus.

A defect in the diaphragm present at birth is another cause, but these hiatal hernias are rare.

Injury affecting the diaphragm can also lead to a hiatal hernia, such as trauma from falls or traffic accidents. Some food pipe surgeries carry the risk of one developing. This risk ought to be far outweighed by the benefits whenever a surgery is needed, however.

Symptoms of a hiatal hernia

The stomach bulging up as a hiatal hernia often gives no symptoms. It is often detected only by chance in people who have a scan for another reason.

These hernias are split into two broad forms:

The symptoms of a hiatal hernia are caused by acid coming up from the stomach.

• Sliding hiatal hernias are the most common and usually small. These hernias move up and down, rather than having a stomach portion that remains fixed and bulged out of place
• Fixed or rolling hiatal hernias are less common. About 1 in 10 hiatal hernias remain out of place, pushed up through the diaphragm

Both types are often without symptoms. The symptoms that are caused by hiatal hernias are the result of acid going up from the stomach.

Acid going up from the stomach can cause heartburn - a burning sensation around the lower chest area. Heartburn tends to worsen in relation to different foods and drinks or happens when lying down and bending over, especially when done soon after eating. It can produce a bad taste in the back of the throat, as well as bloating and belching.

If the heartburn symptom in particular becomes a regular problem, people have acid reflux. Acid reflux is a condition when heartburn keeps on happening at least twice a week.

If acid reflux happens too regularly for too long, this can progress to gastroesophageal reflux disease (GERD).

The heartburn, acid reflux, and GERD's relationship to a hernia, though, is that:

• Most hiatal hernias do not produce heartburn symptoms and problems
• Problems with acid going back up the food pipe are often because of something different to a hiatal hernia

Prevention and treatment of a hiatal hernia

The risk of a hiatal hernia related to obesity means that tackling obesity could prevent it, or at least help with controlling symptoms. Other known causes and risk factors are not preventable. In all cases when there are symptoms, these can be managed.

For any hiatal hernia, changes to eating and drinking can help. Dietary tips to help against hiatal hernias producing heartburn symptoms include:

• Reducing total meal sizes
• Reducing portions
• Not having so many of the foods that trigger more acid to be pushed up

Eating less chocolate could help against heartburn symptoms.

Items that may need reducing include:

• Alcohol
• Caffeine
• Chocolate
• Tomatoes
• Acidic foods and drinks
• Fatty or spicy foods

The timing of eating and drinking can be a factor because mealtimes affect when acid can flow back into the esophagus.

People should have meals 3 hours of more before lying down to bed. They should also sit up while eating.

The British National Health Service add another tip. Real problems with acid might be helped by raising the head end of the mattress so that the bed slopes slightly toward the feet. If this is worth trying, they state, raise the whole body length of the bed into a slope. Using only pillows to raise just the head could put pressure on the abdomen and make acid problems worse.

Pharmacy options

If a hiatal hernia is causing enough of a problem with acid reflux, doctors may prescribe a drug to reduce stomach acid and heartburn symptoms.

Treatments to relieve symptoms are also available over the counter without prescription:

• Antacids are liquids or chewy tablets that reduce the acidity of the stomach contents
• Alginate products make a foamy gel at the top of the stomach contents, providing a barrier to acidic contents

Doctors can prescribe stronger medications for persistent problems.

Alzheimer's drug shows promise for patients in phase III trial

Tau is considered a hallmark of Alzheimer's disease; the protein can form twisted fibers in the brain called "tangles," which are believed to cause nerve cell death.

In a study recently presented at the Alzheimer's Association International Conference 2016 (AAIC 2016), held in Toronto, Canada, researchers reveal how a drug called LMTX shows promise for halting the formation of tau tangles.

Alzheimer's disease is estimated to affect 5.4 million people in the United States, and by 2050, it is expected to affect around 13.8 million Americans, unless new treatments are identified that tackle the disease at its roots.

For years, scientists have worked to find ways to combat the two prime suspects for Alzheimer's development: tau tangles and amyloid plaques - clumps of beta-amyloid protein, which are believed to disrupt nerve cell communication.

Medical News Today have reported on some interesting developments in this field; a study earlier this month, for example, revealed the creation of a vaccine that researchers say could halt the formation of tangles and plaques.

While an undoubtedly exciting development, it will still be another 3-5 years before this vaccine can be tested in humans, and this long road to human trials been the case for the vast majority of Alzheimer's studies - until now.

Dr. Serge Gauthier - of the Departments of Neurology & Neurosurgery, Psychiatry, and Medicine at McGill University in Canada - and colleagues have completed the first ever phase III trial of a drug that targets the tau protein, and the drug in question - LMTX - proved beneficial for a small subgroup of patients.

LMTX found beneficial for patients not using other Alzheimer's treatments

According to the researchers, LMTX - developed by TauRx Pharmaceuticals - is a tau aggregation inhibitor (TAI), meaning it targets the tau protein in the brain and prevents it from forming tangles that contribute to Alzheimer's disease.

For their phase III trial, Dr. Gauthier and colleagues enrolled 891 patients of an average age of 70.6 years who had mild or moderate Alzheimer's disease. Subjects were recruited from 115 sites over 16 countries across Asia, Europe, North America, and Russia.

Participants were randomized to receive one of three treatments for 15 months: oral LMTX at a dose of 150 milligrams daily, oral LMTX at a dose of 250 milligrams daily, or a control dose of 8 milligrams of LMTX daily - the placebo - in order to maintain blinding to treatment.

Around 85 percent of subjects were also using other forms of approved treatment for Alzheimer's, the team reports.

At study baseline and every 13 weeks thereafter, subjects underwent brain imaging and standard tests of cognitive functioning and day-to-day functioning, including the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-Cog) and Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL).

Results of LMTX efficacy and safety were assessed as a whole and by disease severity, region, and the use of other Alzheimer's treatments.

Across the full study population, LMTX at both doses was found to have no benefit for cognitive functioning, daily functioning, or brain atrophy - the loss of nerve cells - compared with the placebo.

However, the team found that patients who were not using any other approved Alzheimer's treatment - that is, they only used LMTX - showed improvements in cognitive and daily function, as well as reduced brain atrophy. These effects were found for both doses of LMTX.

At least one adverse event was reported by more than 80 percent of participants. Gastrointestinal problems, nervous system disorders, infections and infestations, and renal and urinary disorders were the most commonly reported conditions.

Team 'excited' by the findings

While the study only demonstrated the benefits of LMTX for a small number of Alzheimer's patients, the researchers are encouraged by the findings.

"In a study of this size across a combined mild to moderate patient population, it is both encouraging to see improvements of this magnitude in the standard cognitive and functional tests and reassuring to see the supporting brain scan evidence of a slowing in disease progression during 15 months of treatment," says Dr. Gauthier.

"As a practicing clinician I see Alzheimer's patients, their families and caregivers every day, and continually share their desperate need for a truly therapeutic product as today we only have symptomatic treatments available to us.

In a field that has been plagued by consistent failures of novel drug candidates in late-stage clinical trials and where there has been no practical therapeutic advance for over a decade, I am excited about the promise of LMTX as a potential new treatment option for these patients."

Dr. Serge Gauthier