News
Canadian lab employee isolated after possible Ebola exposure
An employee at a Canadian government-run infectious disease lab may have been exposed to Ebola, health officials said Tuesday. The incident occurred Monday at a level 4 containment lab at the National Centre for Foreign Animal Disease, which is part of the Canadian Science Center for Human and Animal Health in Winnipeg, Manitoba.
The individual was working with pigs that had been infected with the deadly virus for research purposes. In accordance with safety protocols for protection against the highly contagious virus, the employee was donning a protective suit. However, a split in the seam of the protective suit was discovered during the standard decontamination process for leaving the lab, an indication that exposure to the virus may have occurred.
"Our employees are well aware of the risks and how to control them. All proper emergency procedures were followed," said Dr. John Copps, Director of the Canadian Food Inspection Agency, the worker's employer.
The employee has begun 21 days of "self-isolation" and monitoring by local health officials. "At this point, there is no risk to Canadians, to the community or to other employees of the lab, because the individual is not infectious," said Dr. Theresa Tam, deputy chief public health officer of the Public Health Agency. This is the first incident involving Ebola in Canada. The agency said the information was shared in the interest of transparency.
Video: See how a suit designed to protect you from Ebola isn’t perfect.
Testing of investigational inactivated Zika vaccine in humans begins
The first of five early stage clinical trials to test the safety and ability of an investigational Zika Purified Inactivated Virus (ZPIV) vaccine has begun at the Walter Reed Army Institute of Research (WRAIR) in Maryland (part of the U.S. Department of Defense).
The ZPIV vaccine is based on the same technology WRAIR used in 2009 to successfully develop a vaccine for another flavivirus called Japanese encephalitis. The ZPIV vaccine contains whole Zika virus particles that have been inactivated. However, the protein shell of the inactivated virus remains intact so it can be recognized by the immune system and evoke an immune response.
The new study aims to enroll 75 people (aged 18 to 49) with no prior flavivirus infection (includes Zika virus, yellow fever virus, dengue virus, Japanese encephalitis virus and West Nile virus). Participants will be randomly divided into three groups: 1) 25 participants will receive two intramuscular injections of the ZPIV test vaccine or a placebo (saline) 28 days apart; 2) The other two groups (50 participants each) will receive a two-dose regimen of a Japanese encephalitis virus vaccine or one dose of a yellow fever vaccine before beginning the two-dose ZPIV vaccine regimen. Additionally, a subgroup of 30 of the participants who receive the two-dose ZPIV regimen will receive a third dose one year later. All participants in the trial will receive the same ZPIV dose at each injection (5 micrograms). The WRAIR study is expected to be completed by fall 2018. Four additional Phase 1 studies to evaluate the ZPIV investigational vaccine are expected to launch in the coming months and described in this article.
Clinical Chemistry
Urine samples may yield clues to fetal health
Abnormal fetal growth and birth weight are risk factors for chronic diseases later in life, such as type 2 diabetes and obesity. Published in BMC Medicine, researchers found that metabolic substances in a mother's urine appear to indicate how large a baby will be at birth.
"We used a technique called NMR spectroscopy to identify, for the first time, a panel of 10 urinary metabolites in the third trimester of pregnancy that were associated with greater fetal growth and increased birth weight," said study co-lead author Mireille Toledano, of Imperial College London.
For the study, urine samples and lifestyle information were collected from more than 800 pregnant women in Spain (aged 28 to 33). Changes in these amino acids and other metabolites detected in a mother's urine explained 12% of the variation in birth weight. This finding was independent of other known factors such as a mother's weight and smoking or drinking. "We found that a 50% increase in the mother's level of individual BCAAs equated to a 1 to 2.4% increase in birth weight," said study co-lead author Muireann Coen.
The study only found an association between levels of branched-chain amino acids and abnormal growth patterns, not a direct cause-and-effect relationship. Still, "this proof-of principle study highlights the value metabolic profiling of pregnant women could have on personalizing pregnancy plans to improve fetal growth outcomes," the researchers said.
Hematology
ASH partners with other organizations to address knowledge gaps in AML care
While there have been recent advances in the diagnosis and management of acute myeloid leukemia (AML), specialists caring for these patients are not always aware of these advances and how to implement them for clinical benefit. The American Society of Hematology (ASH) has partnered with several organizations on independent educational programming designed to help address knowledge gaps in the diagnosis and treatment of AML. The American Society for Clinical Pathology (ASCP), the Oncology Nursing Society (ONS), the National Marrow Donor Program®/Be The Match®, and The France Foundation have joined ASH to create and implement a specialized curriculum, titled "Acute Myeloid Leukemia MATTERS: A Multidisciplinary Approach To Testing and Diagnosis, Evaluation of Risk, and Personalized Treatment Selection."
AML MATTERS aims to address knowledge gaps in the entire multidisciplinary team, first by surveying AML care specialists to identify specific knowledge gaps and then by creating educational programs to address areas that are lacking. The program is intended to address issues pertaining to accurate diagnosis of AML, risk stratification of patients, appropriate treatment options based on clinical guidelines, monitoring and managing adverse events, and engaging and providing patients with information about the disease and their treatment options. The curriculum, which will begin in 2017, includes four educational summits, presentations at both the ASH and ASCP annual meetings, and the creation of updated materials for physicians and nurses.
Microbiology
13 cases of 'superbug' fungal infection in U.S.
Candida auris fungal infection is emerging as a health threat worldwide, and it appears to spread in hospitals and other health care facilities, according to the U.S. Centers for Disease Control and Prevention (CDC). In June, they issued a clinical alert about the global emergence of C. auris and requested that laboratories report cases and supply patient samples.
Federal health officials say 13 cases of the potentially deadly, drug-resistant fungal infection have been reported in the United States. Four of those cases ended in death, but health officials said it's not clear if the deaths were due to the infection or the patients' underlying health conditions. Of the 13 cases reported between May 2013 and August 2016, seven are described in the latest report and occurred in four states: Illinois, Maryland, New Jersey and New York. The other six cases remain under investigation. All of the patients had serious underlying medical conditions and had been hospitalized an average of 18 days when diagnosed with C. auris infection. Four patients died, the CDC said, but whether the fungal infection was the direct cause of the deaths remains unclear. Two patients had been treated in the same hospital or long-term care facility and had nearly identical fungal strains. This suggests that C. auris can be spread within health care facilities, investigators said.
First study to link antibiotic resistance with exposure to the disinfectant chlorhexidine
Chlorhexidine is a common ingredient in a number of disinfectants used widely in the home and in healthcare settings, where it is a critical part of many infection control practices. Published in Antimicrobial Agents and Chemotherapy, a journal of the American Society for Microbiology, the first study to link chlorhexidine exposure with resistance to colistin (a last resort antibiotic often used against multidrug resistant pathogens) has been reported.
In the study, the investigators tested the hypothesis that K. pneumoniae could survive exposure to increased concentrations of chlorhexidine, and that these exposures might cause resistance to commonly used antibiotics. They selected specific strains of K. pneumoniae that were representative of isolates routinely found in the clinic. While some strains died on exposure, others were able to survive at much higher concentrations of chlorhexidine than their parental strains. Some also gained resistance to colistin.
The investigators also found gene mutations in the exposed K. pneumoniae that conferred resistance to both compounds. "If the same response is seen in hospitals, this might mean that we need to rethink how and where some types of critical disinfectants or antiseptics are used in the clinic." said coauthor Dr J. Mark Sutton, Public Health England.
Molecular Genetics
Targeted precision medicine can eliminate cancer risk in patients with Type 2 diabetes
The links between Type 2 diabetes and cancer are complex: people suffering from diabetes mellitus essentially have a higher risk of developing cancer but, on top of that, some diabetes drugs are also suspected of increasing the risk in some cases. However, scientists at the Department of Medicine III and the Section for Science of Complex Systems at MedUni Vienna have demonstrated that these risks can now be practically eliminated by using optimised, personalised therapy.
A statistical survey was compiled of 1.85 million Austrians who had been in hospital at least once. Around 300,000 of these had Type 2 diabetes and were treated with approximately 300 different combinations of diabetes drugs (incretin-based therapies and SGLT-2 inhibitors were not yet involved at this time). The study found that primary insulin-stimulating drugs (sulphonylurea and insulin) displayed a significantly higher cancer risk than insulin inhibitors, especially in the case of pancreatic cancer in men and women, liver cancer in men and lymphoma in women. However, if statins are taken at the same time this risk was significantly reduced as compared with non-diabetic patients.
Safety
1 in 18 Canadian hospital patients experience harm from preventable errors
How safe are Canada's hospitals? As it turns out, 138,000 — or one in every 18 — patients admitted to a Canadian hospital in 2014-15 suffered some kind of harmful event that could potentially have been prevented, from getting the wrong drug to developing an infection. Of those 138,000 patients, about 30,000 had more than one adverse event that compromised their care. "We know that most patients experience safe care, but when harm happens there's a big impact on patients, families and the health team," said Kathleen Morris, vice-president of research and analysis at the Canadian Institute for Health Information (CIHI), which compiled the report.
Those most at risk for hospital-related harms are patients with multiple medical conditions, such as cancer and diabetes, who have several specialists involved in their care, said Morris, adding that the more complex a patient's health status, the higher the rate of harmful incidents.
Hospital-related harms, which were measured using a new tracking tool developed by CIHI and the Canadian Patient Safety Institute, found that patients who experienced an adverse event spent an extra four days on average in a hospital bed. Of the 138,000 patients identified in the report, 17,300 — or one in eight — died while in hospital.
Research
Challenges in transgender healthcare: The pathology perspective
Despite increasing awareness and decreasing stigmatization of the transgender population, many barriers must be overcome before we can fulfill our long-term goal of achieving the highest standards of care for members of this diverse societal subgroup. To our disadvantage, the literature is scarce regarding the pathology and laboratory medicine challenges associated with caring for transgender patients.
In this review article, the researchers focused on identifying the common terminology regarding the epidemiology of and challenges faced by transgender people in receiving essential healthcare, from the pathology/laboratory medicine perspective. The authors also argue that electronic medical records and laboratory information systems should allow for designation of assigned sex at birth, gender identity, and preferred name and pronouns. This change will especially aid pathology staff members, such as those in phlebotomy and transfusion medicine, who interface directly with patients.
Healthcare facilities should incorporate formal training in transgender health issues and provide inclusive structural facilities, such as unisex restrooms. In laboratory medicine, studies are needed to establish reference ranges for laboratory tests for transwomen and transmen. The results of such studies will likely reveal heterogeneity within the transgender population. In anatomic pathology, personnel should be aware of the complexities in handling and interpreting specimens and biopsies from transgender patients. Ultimately, fulfillment of these goals will allow transgender patients to maximize their overall health, psychological well-being, and self-actualization.
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