News
Finding that breast cancer is an occupational disease for hospital lab workers upheld by Supreme Court of Canada
The Supreme Court of Canada upheld a ruling from the British Columbia Workers’ Compensation Appeal Tribunal (WCAT) that breast cancer among hospital lab workers was an occupational disease. “Katrina Hammer, Patricia Schmidt and Anne MacFarlane were among seven technicians at a single hospital laboratory who were diagnosed with breast cancer,” wrote Mr. Justice Russell Brown. In a 2006 report,the authors were “unable to establish the basis for [an etiological hypothesis based on scientific evidence of causal mechanisms for breast cancer],” and speculated the occurrence may have been caused by known non-occupational risk factors, toxic exposure or a statistical anomaly. In 2007, the B.C. Workers Compensation Board denied the technicians’ claims based on this finding. By 2010, the WCAT reversed the decision, with a majority finding breast cancer as an occupational disease. The Fraser Health Authority sought judicial review. Interveners in the appeal to the Supreme Court of Canada included the Ontario Network of Injured Workers’ Groups and Industrial Accident Victims’ group of Ontario. In 2013, Mr. Justice John Savage, set aside WCAT’s decision and remitted the mater back to WCAT. He ruled that WCAT “was not entitled to ignore the expert evidence in favour of its own expertise or common sense…” That ruling was upheld, in a divided decision, by B.C.’s appeal court. WCAT applied, in February, 2015, for leave to appeal to the Supreme Court of Canada. The workers won!
Whistleblower lawsuit claims misdiagnosis, cover-up at KU Hospital
Dr. Lowell L. Tilzer, a former chair of University of Kansas Hospital’s pathology department, has filed a whistleblower lawsuit against the hospital. The lawsuit charges that the head of the hospital’s pathology department wrongly diagnosed a patient with cancer and then covered up the mistake after an organ of the patient was removed. It is said that the hospital refused to rectify the error and retaliated against the plaintiff after he called the matter to the attention of the Joint Commission. Tilzer, who was chair of the hospital’s pathology department for 6 ½ years until 2015 and has been on staff for 25 years, says that he was summoned to meet with hospital President and CEO on May 31. According to the lawsuit, the CEO asked him if he wanted to resign, berated him for contacting the Joint Commission, accused him of lying to the commission, asked him why he had “done this alone” and described Tilzer’s report to the commission as “pitiful” and “despicable” behavior. Dr. Tilzer said, “I’m not really afraid of being fired but I am afraid if the administration’s attitude for helping cover up the misdiagnosis will affect other patients and hurt other people.” The hospital issued a statement late Friday afternoon saying it first learned of the lawsuit when it was called to respond to it.
Low-cost 3D-printed thermos could help diagnose Zika virus by testing saliva
Engineers at the University of Pennsylvania have developed a rapid, low-cost genetic test (approx. $2 USD) for the Zika virus. The size of a regular soda can, the test uses saliva samples added to a removable slide/cassette inside the thermos. Changes in color reveal whether or not the virus has been detected. The test kit is made up of a thermos bottle, an integrated heating element that uses a chemical reaction and a 3D-printed lid to hold the components together. Preliminary studies have shown the test to be as sensitive as the standard RT-PCR laboratory test. “The Centers for Disease Control and Prevention has approved, on an emergency basis, only laboratory-based molecular tests for the Zika virus,” says Changchun Liu, a research assistant professor from the university. “However, [these tests] require a well-trained technician and expensive instrumentation — conditions that are not optimal for point of care diagnostic applications.” Liu describes the test as “proof of [the] concept,” and says that more experiments must be completed prior to marketing.
Microbiology
FDA clears test for genetic markers of antibiotic resistance
The US Food and Drug Administration (FDA) announced approval for the Xpert Carba-R Assay that will enable hospitals to quickly identify bacteria that are resistant to the strongest class of antibiotics. The test checks patient specimens for the presence of five different genetic markers associated with bacteria that are resistant to carbapenem antibiotics, which are widely used in healthcare facilities to treat severe infections. Carbapenem-resistant Enterobacteriaceae, or CRE, is a family of 70 different kinds of bacteria that have become increasingly prevalent in US hospitals and are considered a major public health threat by the Centers for Disease Control and Prevention (CDC). In a March 2013 Vital Signs report, the CDC estimated that CRE germs kill up to half of the patients who get bloodstream infections from them. That report also indicated that 4% of US hospitals and about 18% of long-term acute care hospitals had at least one patient with a CRE infection. The Xpert Carba-R Assay can detect the genes associated with carbapenemase, the enzyme produced by CRE that disables carbapenem antibiotics, in less than an hour compared to current standard of 4 days.
The yeast infection that kills 60% of those who have it
According to the Centers for Disease Control and Prevention (CDC) report, a new strain of drug-resistant yeast infections has recently been reported spreading throughout the globe and is highly fatal. The new strain of infection-causing yeast is known as Candida auris, and unlike its cousin Candida albicans, this version has developed a complete resistance to the antifungal medications used to combat it. C. auris was first identified in 2009, when it was seen in the ear discharge from a patient in Japan. C. auris infections are typically found in the urinary and respiratory tract. In addition, rather than irritating the skin, these infections can lead to serious blood and wound infections. The Washington Post reported 60% of patients with the infection have died. Additionally, at least two countries have reported outbreaks of C. auris infections involving more than 30 patients.
Related Article: Candida Albicans, Fungus Responsible For Yeast Infections And Thrush, Has Found A Way To Evade Our Immune Systems
Anatomic Pathology
Transforming workflow in the pathology domain
A Health Technology Assessment was conducted in 2012 to evaluate whether scanned digital images were of sufficient quality for diagnostic purposes compared with conventional light microscopy techniques. In the report, good diagnostic agreement was found between intra-observer and inter-observer results when digital image slides were used. On the basis of these findings, the Region Västra Götaland (VGR) in Sweden financed and implemented the Pathology Operating System (PATHOS) project, which is run within three public pathology departments and one private. A total of 480,000 histopathology slides per year can be digitized and shared through the PATHOS network. The objectives of the project was not only to implement new technologies but also to change the workflow of the pathology departments and to support the sharing of information within an agreed model. It was identified that the scale and scope of emerging phenomena (e.g., connectivity, platforms, algorithmic data, and big data) for the transformation of pathology is greater than from other technologies in the past. In their solution of creating a partnership between industry and the pathology domain, it was possible to lower the risk of failure during digitalization. Read the full article to learn about the details of this project.
Molecular Biology
TRNT1 deficiency: clinical, biochemical and molecular genetic features
TRNT1 (CCA-adding transfer RNA nucleotidyl transferase) enzyme deficiency is a new metabolic disease caused by defective post-transcriptional modification of mitochondrial and cytosolic transfer RNAs (tRNAs). In a study published in Orphanet Journal of Rare Diseases, four patients from two families with infantile-onset cyclical, aseptic febrile episodes received whole exome sequencing (clinical presentation details in article). Bioinformatic filtering were utilized to identify recessive compound heterozygous TRNT1 mutations segregating with disease in each family. It was found that normal mitochondrial translation products, using passage matched controls and functional perturbation of 3’ CCA addition to mitochondrial tRNAs (tRNACys, tRNALeuUUR and tRNAHis) in fibroblasts from two patients, demonstrated a pathomechanism affecting the CCA addition to mt-tRNAs. Acute management of these patients included transfusion for anemia, fluid and electrolyte replacement and immunoglobulin therapy. Three-year follow-up findings after treatment by bone marrow transplantation in one patient, with resolution of fever and reversal of the abnormal metabolic profile. The study highlighted that TRNT1 mutations cause a spectrum of disease ranging from a childhood-onset complex disease with manifestations in most organs to an adult-onset isolated retinitis pigmentosa presentation.
Seeing RNA at the nanoscale
Described in a Nature Methods paper, MIT engineers have now developed a way to visualize these molecules in higher resolution than previously possible in intact tissues, allowing researchers to precisely map the location of RNA throughout cells. The original expansion microscopy technique is based on embedding tissue samples in a polymer that swells when water is added. This tissue enlargement allows researchers to obtain images with a resolution of around 70 nanometers, which was previously possible only with very specialized and expensive microscopes. In the most recent study, the researchers used the same kind of anchoring molecule but modified it to target RNA instead. All of the RNAs in the sample are anchored to the gel, so they stay in their original locations throughout the digestion and expansion process. After the tissue is expanded, the researchers label specific RNA molecules using fluorescence in situ hybridization (FISH). This allows researchers to visualize the location of specific RNA molecules at high resolution, in three dimensions, in large tissue samples. The enhanced spatial precision could allow scientists to explore many questions about how RNA contributes to cellular function.
Research
Blood test could use shapes to spot cancer
The first evidence that it is possible to develop blood tests for any infectious disease by screening random libraries of non-biological molecular shapes has been found. As reported in the Journal of Immunological Methods, the new technique, which synthesizes random molecular shapes called “peptoids” hooked onto microscopic plastic beads, can produce millions of molecular shapes. The peptoids are not organic, but if they match to the corresponding shape on an antibody, that antibody will connect to them, allowing the scientist to pull out that bead and examine that peptoid and its corresponding antibody. Using this technique, researchers chemically generated a huge library of random molecular shapes. Then, using blood from HIV-infected patients and from non-infected people, they screened a million of these random molecular shapes to find the ones that bound only to antibodies present in the blood of HIV-infected patients, but not the healthy controls. No HIV proteins or structures were used to construct or select the peptoids, but the approach, nonetheless, successfully led to selection of the best molecular shapes to use in screening for HIV antibodies. The test distinguished between the samples of HIV-positive blood and HIV-negative blood with a high degree of accuracy. “This technology means that we may be able to take a single drop of blood from a patient and detect antibodies to all manner of infections, cancers, or other conditions they may be carrying or been exposed to,” says Donald S. Burke, dean of the Graduate School of Public Health at the University of Pittsburgh.
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