A reference card that includes first aid instructions.
A few basics, such as an ace bandage, gauze, tweezers, scissors, antiseptic and cotton-tipped swabs.
Moleskin to put on blisters.
Aloe vera gel for sunburn.
A digital thermometer.
Packets of oral rehydration solution.
A copy of your health insurance card.

This class of medicines, called oral bisphosphonates, are the most commonly used drugs to treat osteoporosis and other bone diseases. While anecdotal reports have suggested that they may increase the risk of esophageal cancer, the scientific evidence has been limited, the researchers noted.

“What we lack at present is a full picture of the benefits versus risks for long-term use of bisphosphonates, which are increasingly commonly prescribed,” said lead researcher Dr. Jane Green, a clinical epidemiologist, in the Oxford University’s Cancer Epidemiology Unit. “Our results are a small part of this picture.”

There are no immediate implications for clinical practice, Green stressed.

“Esophageal cancer is uncommon, and even if risk is doubled it is still low” for any one person, she said.

Also, “like any observational study, we cannot be sure that the results reflect a true effect of the drugs — it could be that people more likely to get cancer are prescribed bisphosphonates [more often] — although we accounted for the major known possibilities. As usual, more research is needed,” Green said.

The report is published in the Sept. 2 online edition of the BMJ.

In the study, Green’s team used the UK General Practice Research Database to collect data on almost 3,000 men and women with esophageal cancer, more than 2,000 with stomach cancer and over 10,000 with colorectal cancer diagnosed between 1995 and 2005.

They compared these patients with age- and sex-matched people without these conditions.

The team found people who had had 10 or more prescriptions for bisphosphonates written for them, or had received prescriptions for these drugs over about five years, had almost double the risk of esophageal cancer, compared with people who didn’t take these drugs.

Green’s group also found an increased risk for stomach or bowel cancer, according to the report.

Usually, esophageal cancer is seen in one of 1,000 people at ages 60-79 over five years. Based on these findings, the researchers estimate that taking oral bisphosphonates over five years increases this to two cases per 1,000 people.

Another recent study that looked at the same link using the same database didn’t find an increase in esophageal cancer from bisphosphonates, but this new study followed patients for twice as long as the earlier study and therefore had more “statistical power,” the researchers said.

Diane Wysowski, an epidemiologist with the U.S. Food and Drug Administration and author of an accompanying journal editorial, commented that “several adverse esophageal events have been reported with the use of oral bisphosphonates, including erosion and inflammation of the lining of the esophagus, esophageal stricture and perforation, and esophageal cancer.”

If the results from this study are confirmed and oral bisphosphonates double the rate of esophageal cancer, esophageal cancer rates would still remain relatively low from a population standpoint, she said.

“However, because oral bisphosphonates are widely used on a chronic basis, the results, if confirmed, could have implications for a large number of patients,” Wysowski said.

The possibility of adverse effects on the esophagus should prompt doctors who prescribe these drugs to consider risks vs. benefits, ask patients about digestive disorders before prescribing, and to reinforce directions for use on the basis of each individual product, she said.

Wysowski advises patients to: “Be sure to follow the directions for use and report to your doctor any difficulty swallowing or throat, chest, or digestive discomfort so that your doctor can evaluate the need for oral bisphosphonate discontinuation.”

SOURCES: Jane Green, M.D., Ph.D., clinical epidemiologist, Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, England; Diane Wysowski, Ph.D., epidemiologist, U.S. Food and Drug Administration; Sept. 2, 2010, BMJ, online

In a study published in the journal Science on Thursday, an international team of scientists said the drug, called NITD609, is effective against the two most common parasites responsible for malaria — Plasmodium falciparum and P. vivax — and also against a range of drug-resistant strains.

In experiments on mice with malaria, the scientists found that NITD609 works in a different way from other antimalarial drugs and that one oral dose was enough to clear the disease.

More safety tests are needed before the drug can be given to humans, but the researchers said that if those are positive, clinical trials in humans could begin at the end of this year.

“A single-dose cure would go a long way to addressing the unmet medical need in malaria, and we look forward to seeing how this compound performs in clinical trials,” said Rick Davis, of Britain’s Wellcome Trust, which supported the research.

The World Health Organization (WHO) says there are about 243 million cases of malaria each year, causing an estimated 863,000 deaths, mostly among young children in Africa.

Although malaria is preventable and curable, it is estimated that in Africa a child dies from the disease every 45 seconds.

The best treatments for malaria are artemisinin combination therapy (ACT) drugs made by firms like France’s Sanofi-Aventis, but they can be expensive. Resistance to chloroquine and sulfadoxine-pyrimethamine, the cheapest malaria drugs, is becoming more common.

The experimental drug NITD609 belongs to a new class of drugs called spiroindolenes. It was identified by the Novartis Institute for Tropical Diseases (NITD) working in an international collaboration supported by the Wellcome Trust, the international Medicines for Malaria Venture (MMV), the U.S. National Institutes of Health (NIH) and several other bodies.

Scientists screened 12,000 chemicals using an ultra-high throughput robotic screening technique before they singled out NITD609 as a potential drug candidate.

Anthony Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases, said the experimental compound had several “desirable features,” including that it targets a parasite protein not attacked by any existing malaria drugs.

NITD609 also has properties which could enable it to be manufactured in pill form and in large quantities.

“From the beginning, NITD609 stood out because it looked different, in terms of its structure and chemistry, from all other currently used antimalarials,” said Elizabeth Winzeler, also with the NIH, who worked on the team.

If NITD609 behaves similarly in people to the way it works in mice, she said in a report on the work, it may be possible to develop it into a drug that could be taken just once — far easier than current standard treatments in which malaria drugs are taken between one and four times a day for up to seven days.

British drugmaker GlaxoSmithKline is carrying out late-stage testing in people of an experimental vaccine against malaria and expects to see results by 2011. The firm says that if it proves effective, it will seek regulatory approval for the vaccine, called Mosquirix, by 2012.

(Editing by Tim Pearce)

In an analysis of 21 studies published in the past 13 years, researchers found that postmenopausal women who reported the highest intakes of dietary lignans were 14 percent less likely to develop breast cancer than those with low intakes.

The same relationship was not seen, however, among premenopausal women.

The findings, published in the American Journal of Clinical Nutrition, add to a conflicting body of research into the relationship between dietary phytoestrogens and breast cancer risk.

Phytoestrogens are plant-based compounds that are structurally similar to estrogen and may have weak estrogen-like, as well as anti-estrogen, activity in the body. Some studies have linked high phytoestrogen intake to a lower risk of breast cancer, but others have suggested that the compounds may help fuel breast cancer growth — or have no significant effect on a woman’s risk of the cancer.

Lignans are one of the three main types of phytoestrogen. The new study focused on lignans, in part because they are the main phytoestrogen in the typical Western diet.

Flaxseed and sesame are particularly high in lignans, and the compounds are also found in whole grains, berries and some other fruits, a number of vegetables such as broccoli and kale, and green tea.

For this study, Dr. Jenny Chang-Claude and colleagues at the German Cancer Research Center in Heidelberg combined the results of 21 previous studies on lignan intake and breast cancer risk. In some of the studies, researchers also took blood or urine samples to measure participants’ levels of enterolignans — compounds created when intestinal bacteria interact with dietary lignans.

Overall, the researchers found no correlation between women’s lignan intake and their risk of breast cancer. However, when they separated the women by menopause stage, they found that “high” lignan intake – which they did not define in the study – was related to a somewhat lower risk of breast cancer.

In one study of nearly 60,000 postmenopausal women in France, for example, the one-quarter of women with the highest lignan intake were 17 percent less likely to develop breast cancer during the study period compared with the one-quarter with the lowest intake — estimated based on dietary questionnaires the women completed at the outset.

Breast cancer is the most common cancer in women worldwide, accounting for around 16 percent of all female cancers. It kills around 519,000 people globally each year.

The researchers on the French study accounted for a number of other factors in breast cancer risk — including the women’s age, family history of breast cancer, weight and history of estrogen exposure from birth control pills or hormone replacement therapy. The relationship between lignan intake and breast cancer risk remained.

Still, the overall findings of the review show only an association between higher lignan intake and lower breast cancer risk — and do not prove that the compounds themselves confer the protection.

The studies the researchers evaluated had various limitations, such as relying on dietary questionnaires to estimate lignan intake instead of measuring it or watching what subjects ate.

And many were case-control studies, where researchers compared the reported diet histories of women with breast cancer to those of women without the disease; these types of studies are not as strong as prospective studies — where, for example, researchers would collect diet information at the outset, then follow women over time to see which ones developed breast cancer.

If lignans do have an effect on breast cancer development, these findings suggest it is likely to be “moderate,” Chang-Claude told Reuters Health in an email.

Still, foods high in lignans are also generally healthy ones, the researcher noted. “Therefore, it might be advisable for postmenopausal women to include some lignan-rich foods in their diets,” she said.

In theory, lignans and other phytoestrogens might protect against breast cancer by inhibiting the body’s own estrogen activity, or through other pathways, such as the compounds’ antioxidant effects.

It’s not clear why lignan intake would have different effects in pre- and postmenopausal women, according to Chang-Claude and her colleagues. One possibility, they note, is that any protective lignan activity is only effective when women’s natural estrogen levels are relatively lower, as they would be after menopause.

The hope is to find a few simple measures that will tell whether a drug is likely to cause serious side-effects, and then share them among drug developers and regulators, members of the team reported in the journal Nature Biotechnology on Monday.

The group, called the Predictive Safety Testing Consortium, chose a panel of biomarkers — proteins that indicate disease or injury — to predict kidney injury from experimental drugs.

The unprecedented collaboration includes the U.S. Food and Drug Administration and the European Medicines Agency, and the hope is to streamline the approval process as well.

“Better biomarkers will allow drug developers to make more informed decisions about which products to move forward in testing, the doses at which they should be used, and ways to design clinical trials that will provide clear information about product benefit and safety,” Dr. Joseph Bonventre of Brigham and Women’s Hospital and Harvard Medical School in Boston and colleagues wrote in a commentary.

The group chose seven potential biomarkers in urine to detect specific kidney injuries in rats.

Up to a third of new drugs in development are abandoned because they damage some organ in lab animals, but Bonventre said this is often unjustified, giving the Bristol Myers Squibb AIDS drug Sustiva, known generically as efavirenz, as an example.

Sustiva kills kidney cells in rats, but not in monkeys or humans, Bonventre wrote. The drug, an important part of the arsenal used against AIDS, could have been abandoned.

Frank Dieterle of the Novartis Institutes for BioMedical Research in Basel, Switzerland and colleagues noted that two biomarkers called serum creatinine, or SCr, and blood urea nitrogen, or BUN, are currently used to measure kidney damage, but they are not very accurate.

“This is the first report to use a broad panel of urinary biomarker values to demonstrate that renal injury can be monitored at both the point where toxicity begins and when it reverses after the withdrawal of treatment,” they wrote in one of the series of reports in the journal.

Frank Sistare of Merck Research Laboratories in West Point, Pennsylvania and colleagues said the collaboration saved everyone time and trouble.

“Agreement to the use of pre-existing study samples accelerated experimental progress and saved over $4 million in estimated animal, human and other associated study expenses,” they wrote.

David Warnock of the University of Alabama at Birmingham and colleagues said the collaboration should also simplify new drug approvals.

“Until now, both the FDA and EMEA required pharmaceutical companies to submit the results of renal toxicity biomarker qualification tests separately,” they wrote.

“The successful collaboration of fiercely competitive pharmaceutical companies (overcoming substantial intellectual property barriers) with scientists from academia and regulatory bodies is particularly notable,” they added.

It provides “the best evidence yet that eating nuts reduces LDL cholesterol and improves the blood lipids profile,” said Dr. Joan Sabate, who chairs the nutrition department at the Loma Linda University School of Public Health in California and was a co-author of the report, published May 10 in Archives of Internal Medicine.

Sabate and fellow researchers at the university pooled data on 583 men and women who had participated in 25 nut consumption trials. The results showed that eating about 2.3 ounces of nuts a day — a third of a cupful — reduced total cholesterol levels by 5.1 percent and “bad” LDL cholesterol by 7.4 percent.

That amount of nut eating also improved the ratio of LDL cholesterol to “good” HDL cholesterol by 8.3 percent and caused a decrease of 10.2 percent in triglyceride levels among people with high levels of those blood fats.

Sabate is a leading figure in the somewhat limited field of nut nutrition. His first report on the beneficial effects, published in 1993, led to other studies that eventually prompted the U.S. Food and Drug Administration to issue a qualified health claim for nuts a decade later.

The 2003 FDA statement said that “scientific evidence suggests but does not prove that eating 1.5 ounces of most nuts per day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.”

On food labels, that claim is followed by a caution: “See nutrition information for fat content.”

The FDA statement was issued in response to a petition filed by the International Tree Nut Council Research and Education Foundation, which supports the work done by Sabate and other nut nutrition researchers. The foundation helped fund the latest report.

The new study found that the benefits from eating nuts was greatest among thin people, those with high LDL cholesterol and those consuming a fat-rich diet.

But enthusiasm for nuts should be restrained, Sabate said. They are highly caloric, and thus can contribute to obesity. A 3-ounce-a-day limit was recommended.

Jeannie Gazzaniga-Moloo, a spokeswoman for the American Dietetic Association who is in private practice in Sacramento, Calif., said that “nuts can be a very healthy addition to any diet,” but she recommends eating somewhat less of them.

She said she suggests that her clients consume about an ounce a day of nuts — about 22 walnuts, for example, providing about 150 calories — as part of their daily diet. “They are rich in protein and dietary fiber as well as numerous proteins and in various vitamins,” Gazzaniga-Moloo said.

“They should eat the nuts they enjoy,” she said. “They can try a variety.”

Sabata said that the type of nuts eaten doesn’t seem to matter. The study found essentially the same results for walnuts, almonds, peanuts, pecans, hazelnuts, macadamias and pistachios.

“Nuts are a matrix of healthy nutrients, and the most obvious reason for the cholesterol-lowering effect is their unsaturated fat content,” Sabate said. “Nuts also contain fiber, vegetable protein, phytoesterols and other antioxidants.”

The best evidence for the beneficial effect of nuts, though, has come from studies of walnuts and almonds, he added.

SOURCES: Joan Sabate, chairman, nutrition department, Loma Linda University School of Public Health, Loma Linda, Calif.; Jeannie Gazzaniga-Moloo, Ph.D., R.D., dietitian, Sacramento, Calif.;

Cerebrovascular disease, which includes stroke and other disorders that affect the brain’s blood vessels, is associated with disability and a decline in memory and reasoning powers in older adults.

The new study included 686 dementia-free older adults who had their blood pressure measured during three study visits at 24-month intervals. The participants, who also underwent MRI to check for cerebrovascular disease, were divided into four groups depending on whether they had high or low blood pressure, and whether they had high or low blood pressure fluctuations between visits.

People with the lowest fluctuations had changes of about 5.5 percent (among those with low blood pressure) and 5.2 percent (among those with high blood pressure), while those with the highest fluctuations had changes of 14.2 percent, the study authors noted.

High blood pressure and fluctuations in blood pressure were both independently associated with increased risk of cerebrovascular disease. But people with both factors were at even greater risk, according to study author Adam M. Brickman, of the Taub Institute at Columbia University in New York City, and colleagues.

The researchers also found that participants with the highest blood pressure and fluctuation levels were most likely to be prescribed blood pressure-lowering drugs. This suggests that failure to adhere to treatment may be a source of blood pressure fluctuation.

“Cerebrovascular disease is associated with a constellation of conditions that lead to disability, including cognitive impairment, mood and movement disorders,” the researchers concluded. The new findings, they stated, suggest that managing blood pressure fluctuations, even in older adults with normal blood pressure, “may be beneficial in reducing the risk of cerebrovascular disease and in maximizing healthy cognitive aging.”

The study is published in the May issue of the journal Archives of Neurology.

SOURCE: JAMA/Archives journals, news release.

Researchers followed women who were diagnosed with early-stage breast cancer and underwent breast-conserving therapy, which consists of a lumpectomy followed by radiation therapy.

Fifteen years after treatment, the overall risk of developing a new, second cancer was 25 percent in the 796 smokers and 19 percent in nonsmokers. The risk of developing cancer in the breast that hadn’t been treated for cancer was 13 percent for smokers and 8 percent in nonsmokers.

“These new data are significant in that they show women can exercise some control over a known risk factor for developing a new second cancer,” senior investigator Dr. Bruce G. Haffty, associate director of the Cancer Institute of New Jersey, said in a news release.

The study was to be presented at the annual meeting of the American Radium Society, May 1 to 5 in Cancun, Mexico.

Nearly half of U.S. teens younger than college age report having had sexual intercourse, according to the Kaiser Family Foundation, with the median age of intercourse being 16.9 years for males and 17.4 years for females.

“Parents and physicians are often seeking clues for when it’s time to have ‘the talk’ about sex with a teenager,” Dr. Megan A. Moreno of the University of Wisconsin-Madison and co-author of a study on kids’ posting on social networking sites, said in a news release from the American Academy of Pediatrics. “Our study suggests that if sexual content is noted on a teen’s social networking site profile, it’s definitely time for that talk.”

The researchers examined Facebook pages of 85 first-year college students and studied their responses to a survey about their sexual experiences and their future intentions regarding sex.

Those who displayed sexual references on their Facebook pages were more likely than the others to be planning to have sexual intercourse.

The study authors wrote that social networking sites such as Facebook could give parents, clinicians and educators insight into whether to target teens with details regarding safer sex.

The study was to be presented at the Pediatric Academic Societies’ annual meeting in Vancouver.

They tested four so-called targeted therapies in patients with specific biomarkers — mutations that the drugs were designed to counteract.

After eight weeks, 46 percent of the patients on the trial had their tumors grow more slowly or shrink, compared with about 30 percent of usual lung cancer patients.

The best results were seen with Nexavar, known generically as sorafenib, sold by Onyx Pharmaceuticals Inc and Bayer AG, the researchers told a meeting of the American Association for Cancer Research on Sunday.

“Sorafenib performed very well regardless of marker status,” Dr. Edwin Kim of M.D. Anderson told a news conference. Nexavar is designed to target a mutation in a gene called KRAS that is seen in lung and other cancers.

More than half — 56 percent — of the patients with no mutations in KRAS were helped by Nexavar and 61 percent of those with the mutation were helped, Kim told the meeting, compared with 32 percent for the other three drugs.

“It overall had very impressive activity,” Kim said.

Nexavar is approved for liver and kidney cancer. It has the “potential to blaze a trail in lung cancer as well,” Kim said.

The trial, called BATTLE for Biomarker-integrated Approaches of Targeted Therapy for Lung Cancer Elimination, was designed to be different from other cancer trials. The researchers looked for some kind of effects after two months of treatment — either limited growth of the tumor or a sign it had shrunk.

As they learned from the trial, they adapted. The first 97 patients were randomly treated and as the study progressed, information on individual mutations and on the early results were used to fine-tune who got what treatment.

EARLY PROGRESS

“If a patient was able to achieve disease control at eight weeks their survival was 11.3 months,” Kim said. Patients who did not see any effects of the drugs by two months only lived on average for seven months.

This means doctors will be able to assess treatments much sooner, saving time, money and anguish for patients and their families.

Another difference — they got nice, big samples of patients’ tumors up front, so they could continue to test the tissue as new drugs are designed or as new discoveries are made about them. The researchers want to encourage doctors and patients to do this as a matter of course with lung cancer.

Erlotinib, sold by Roche Holding AG and OSI Pharmaceuticals Inc under the brand name Tarceva, is designed to block EGFR, a gene that is overactive in many types of cancer cells.

Tarceva, a pill, helped 71 percent of the lung cancer patients with EGFR mutations and 34 percent of those without them.

Erwin Lobo, a 37-year-old patient with stage 3 lung cancer, is one. “I still do not have my hair and … I used to have really nice skin but this is one of the side-effects,” Lobo told the news conference. “But hey, I am here, I am sharing my story with you all and I am very happy I am alive.”

Lobo’s cancer had spread to his brain and he should have only lived 30 days after that happened, but he was at the news conference more than four months later.

Other drugs in the study were AstraZeneca PLC’s Zactima, or vandetanib, designed to act against VEGF, a gene used by tumors to grow vessels to supply blood; and bexarotene, sold under the brand name Targretin by Eisai Pharmaceuticals to treat a type of lymphoma, which targets a gene called cyclin D1.

The study, funded by the U.S. Army, included 255 patients with advanced lung cancer who had previously been treated with chemotherapy.

The drugs had few side-effects, with 11.5 percent having a collapsed lung, or pneumothorax, and 6.5 percent suffering high-grade toxicities — both much lower-than-usual rates.

The researchers are already designing BATTLE 2 and BATTLE 3 trials to test more patients, new biomarkers and new drugs.