News
Managing stress in the laboratory
It’s 15 minutes to the end of your shift but it feels like it will take 15 hours to finish. Exhaustion has kicked in after a busy day and being pulled in multiple directions. The stress to complete your workload is palpable. Patients depend on you.
You are not alone. There are many other medical laboratory professionals who feel the same way across Canada as identified in a recent CSMLS study.
In the article published on the Lab Testing Matters website, Margaret Blaetz describes her diagnosis and management of acute panic attacks which were brought on by workplace stress. Although she recognizes that her situation may be considered extreme compared to some, Blaetz also acknowledges that it can be a reality for many who face stress on a regular basis. She provides simple and effective tools to manage stress and reminds us to develop habits for relaxation. As she states, “The tools I use, daily and in times of need, have made a significant change in my life. And it can for you too. You have nothing to lose...Except maybe some stress.”
Related Project: CSMLS will be providing LABCON attendees with a peek of the Mental Health Toolkit to support medical laboratory professionals in their search for information to understand and manage mental health issues. Full launch in October 2016.
Direct-to-consumer lab tests, no doctor visit required
The market for direct-to-consumer laboratory tests was valued at $131 million last year, up from $15 million in 2010 according to Kalorama Information. Home testing services like InsideTracker say they are empowering consumers, allowing them to spot metabolic red flags before they progress to disease. It has been argued that there is a lack of evidence that such monitoring makes a meaningful improvement in health.
Critics of such home testing say the services often lack proper medical oversight and convince healthy people that they’re sick, leading to unnecessary testing and treatment. For example, a New York State attorney general accused two companies, DirectLabs and LabCorp, of violating a state law that requires laboratory tests to be carried out at the request of licensed medical practitioners. DirectLabs has been accused of selling tests that were reviewed by a chiropractor who had never spoken with any of the patient consumers. DirectLabs did not respond to a request for comment but paid a fine and stopped business in New York. Read this article to hear more about the debate.
Clinical Chemistry
Calgary student invents $7 artery-disease screening test
Zeel Patel, a grade 11 student in Calgary, created the CADSense test for clogged arteries that is many times faster and cheaper than what is currently available. The paper-based test is placed into a blood sample and can detect an early biomarker of atherosclerosis called oxidized LDL. If the biomarker is present, the paper turns yellow or brown, indicating the patient likely has plaque in their arteries and should seek medical attention.
Patel says his invention is able to detect the signs of atherosclerosis instantly, unlike current tests that have to be sent to a lab. "What my chemical reaction is actually based off of is that it uses potassium phosphate and adds in potassium iodide, which targets the lipid peroxide, so molecules on the surface of the biomarker… and it produces a triiodide ion" he explains.
The test costs approximately $7 and can be administered at home.
Hematology
Stem cell transplant cures children with sickle cell anemia, says Alberta hospital
Sickle cell anemia is a chronic illness where blood vessels can become blocked when blood cells change into a sickle shape, potentially affecting every organ and causing strokes, lung disease, heart strain and spleen and bone damage. With advanced drug therapy treatment, life expectancy is 55-60 years.
The success of a procedure performed in Calgary to treat sickle cell anemia was first performed in 2009 and has since cured seven girls and two boys to date. "To our knowledge, no one else is offering this protocol in children with sickle cell anemia," said Dr. Greg Guilcher, who is also an assistant professor in the departments of oncology and pediatrics at the University of Calgary.
What sets the Calgary procedure apart from other sickle cell anemia treatments in young children is the lead up to the transplant. "This protocol uses the 'lightest' doses of medication — no chemotherapy but immune suppressing drugs only, with a low dose of radiation," said Dr. Guilcher. More exciting is the fact that there have been no incidents of stem cell rejection.
This device can detect malaria in 5 seconds
There are two main ways to detect malaria: a diagnostic test on a blood drop sample or test a drop of blood under a microscope to find the parasite.
John Lewandowski, a 26-year-old PhD student in mechanical engineering at MIT, said rapid malaria detection is very important as it affects 200 million people every year and some parish within 24 hours.
He has made a mechanical device called RAM (Rapid Assessment of Malaria) that can diagnose malaria from a drop of blood in five seconds. Costing about $100 to $120, the RAM is battery-operated and is made from low-cost materials. The plastic box (4×4 inches) has a small circuit board, a laser and a few magnets on the inside. It has an LCD screen, an SD card slot and a plastic disposable cuvette on the outside.
The clinical trials of the RAM device have been tested by the Disease Diagnostic Group in India since 2013. “In India, the field study of 250 patients showed 93% to 97% accuracy,” Lewandowski also said that a new field study will be introduced this summer in Nigeria with up to 5,000 patients.
Transfusion Medicine
Tainted blood infects thousands of Indians with HIV
A new study report found that at least 2,234 people contracted the human immunodeficiency virus (HIV) from blood transfusions administered in India in the past 17 months. The alarming figure shows the gap in India’s blood screening practices and highlights financial deficits that may have led to this contamination.
India has more than two million people living with HIV/AIDS. Legally, all hospitals are supposed to have screened donated blood for contamination of HIV, hepatitis B, hepatitis C, syphilis and malaria. However, as the figures suggest, some hospitals and clinics are non-compliant with the mandated screening practices. "But each such test costs 1,200 rupees ($18) and most hospitals in India do not have the testing facilities. Even in a big city like Mumbai, only three private hospitals have HIV testing facilities. Even the largest government hospitals do not have the technology to screen blood for HIV," said Chetan Kothari who requested the study data from the National AIDS Control Organization.
Microbiology
A call for universal HCV screening
Based on their findings among nearly 5,000 patients seen at the Johns Hopkins Hospital emergency department (ED), researchers are recommending universal hepatitis C virus (HCV) screening for all adults (18+).
The 8-week study involved HCV testing (Genedia HCV enzyme immunoassay) among all adult ED patients with excess blood specimens. Of 4,713 unique patients with excess blood specimens taken as part of routine care, 13.8% were HCV antibody-positive. Nearly 1/3 of these individuals had undocumented HCV infection. Of those with undocumented HCV infection, 75% would have been diagnosed based on birth cohort testing and risk-based testing protocols. However, just testing in accordance with CDC guidelines would have missed 25% of cases.
The researchers acknowledged that their proposal to broadly expand HCV testing would demand significant resources, but emphasized the importance of identifying patients early in the course of HCV infection. A cost analysis is provided in the article. “This is an infection that can now be cured if detected early, rendering people noninfectious and thereby preventing the dire consequences that are associated with the virus,” said senior author Dr. Thomas Quinn, a professor of medicine at Johns Hopkins.
Anatomic Pathology
Liquid biopsy may help doctors track changes in tumors
Doctors used blood drawn from a patient's arm to analyze DNA that tumors typically shed into the bloodstream, explained lead researcher Philip Mack, director of molecular pharmacology at the University of California, Davis, Comprehensive Cancer Center.
A study of more than 15,000 patients with 50 different tumor types determined that liquid biopsy can accurately detect mutations in cancer DNA. In the study, the researchers used a new genetic scan called Guardant360 that analyzes cancer DNA in patients' blood, looking for mutations in 70 different cancer-related genes. The study compared liquid biopsy results to genetic tests performed on biopsied cancer tissue for 398 of the patients, and found that blood samples contained the same mutations as tissue 94 -100% of the time. They also found that the test could detect genetic changes in a cancer that occur as tumors gain resistance to targeted cancer drugs.
Overall, the liquid biopsy revealed possible treatment options for more than 63% of patients tested, including FDA-approved drugs as well as eligibility for clinical trials. Mack believes the real value of liquid biopsy will show itself as a patient's cancer treatment proceeds. Liquid biopsy provides an easier way to keep track of treatment.
Molecular Biology
New test helps identify rare genetic diseases in newborns
New gene screening methods may greatly improve doctors' ability to quickly diagnose rare genetic diseases in newborns, researchers say.
The findings were published in the CMAJ (Canadian Medical Association Journal). The new test includes all 4,800+ genes currently known to be linked with rare diseases. Canadian researchers used the test to try to diagnose 20 newborns who had a variety of medical problems. Half of the infants had neurological symptoms, such as seizures. The gene sequencing panel provided a genetic diagnosis for eight of the infants (40%). For two babies, their diagnoses directly affected their medical care.
"This technique can be performed in a hospital-based laboratory," Dr. David Dyment, of Children's Hospital of Eastern Ontario stated. "This will allow for diagnoses to be made quickly, providing answers to anxious families and potentially life-saving interventions in some cases."
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