News
New HIV screening method leads to apparent spike in testing at Sask. First Nations
A new type of HIV test appears to be dramatically increasing the number of First Nations people getting tested in Saskatchewan. "Dried blood spot testing" is a needle-prick test, which is similar to having a blood sugar test for diabetes. The method is being piloted in First Nations communities as a way to increase the number of number of people getting tested.
Ceal Tournier is the general manager of Saskatoon Tribal Council Health and Family Services, which is leading the project. She said the number of people tested for HIV in STC partner communities in the past six weeks — 114 — is four times higher than the number for the previous six months. The STC is in the process of analyzing the results of the pilot project.
Dr. Ibrahim Khan, the regional medical health officer for First Nations, Inuit Health Branch of Health Canada, said the number of HIV tests performed in Saskatchewan First Nations jurisdictions increased by 11 per cent in 2016. The number of new cases of HIV increased by 10 per cent.
Khan said that in 2016, Saskatchewan had the highest rate of new infections among First Nations people living on-reserve: 45 per 100,000 people. The provincial rate is 16 per 100,000. "The focus in the past couple of years was to improve testing in First Nations because there is a lot of undiagnosed infection in the community," said Khan.
He said the dried blood spot testing was breaking down the barriers to getting tested because people felt more comfortable getting this test than the conventional one. "People felt comfortable doing it, people felt comfortable getting the results, and the timing and the process was easy for them," he said.
"It was non-discriminatory and it was non-judgmental and it was not like the conventional test."
Still unclear if province will stop using Halifax toxicology lab
A week after a highly critical Supreme Court decision questioned the reliability of drug and alcohol testing results from a Halifax toxicology lab in a child custody case, it remains unclear whether the province will halt or continue to use the service.
In her ruling, Justice Theresa Forgeron ruled against a motion by the Department of Community Services to have the director of the Central Health Authority’s toxicology lab, Dr. Bassam Nassar, give expert opinion evidence concerning urine testing samples from a Cape Breton father.
"I find that Dr. Nassar’s opinion, respecting the toxicology lab results, is not reliable where the lab is not designated a forensic lab, where the lab is not subject to external proficiency testing or oversight, and where the lab’s adherence to international standards is uncertain," said Forgeron.
The ruling came in the case of a Cape Breton father who wants unsupervised access with his young daughter. The department disagreed, pointing to three urine testing results — taken between April and July 2017 — that indicated the presence of cocaine. The father disputes the results.
As for the health authority’s response to criticisms of its lab, Shauna Thomson, senior director of pathology and laboratory medicine, offered a brief comment. "We have been investigating options related to specific accreditation for our forensic toxicology laboratory as a means to formally recognize our adherence to national and international standards for some time. Our intent is to move this forward as soon as possible," said Thompson.
While Thompson refers to the lab as a forensic lab, Forgeron, in her decision, said the facility is not designated or certified as a forensic lab but as a clinical lab and no application has been made to have the lab certified.
In her decision, Forgeron said the Halifax facility is not subject to any external testing or oversight that could offer independent assurances that it is free of problems that could result in flawed testing. She said the court drew little comfort from the fact the lab is subject to Accreditation Canada, as Nassar admitted to the court that he could not recall anyone from Accreditation Canada ever inspecting the toxicology lab.
New Blood Test Can’t Really Detect Concussions
The Food and Drug Administration (FDA) recently fast-tracked approval for a blood test that’s said to help detect concussions, but experts say the test’s capabilities are being overstated.
The Brain Trauma Indicator, made by Banyan Biomarkers, received the green light to go on the market in less than six months. That’s a pretty quick timeline for the FDA, which granted its approval under its new Breakthrough Devices Program.
While some experts were impressed by the quick approval duration, others warned that the test isn’t the breakthrough everyone’s been waiting for. In short, it can’t detect concussions. And it’s only meant for adults.
"As with many new medical discoveries, the headlines and the hype can outstrip the reality and I think that has happened here," said Dr. James P. MacDonald, a physician and sports medicine specialist at Nationwide Children’s Hospital in Ohio.
"This new test does not diagnose concussion. It cannot ‘detect’ concussions," MacDonald said. He added that the new device also doesn’t rule out concussions either. "What it does do is help a doctor determine whether a patient may need computed tomography (CT) scans after a head injury to see if an ‘intracranial lesion’ may be visible," he said.
Transfusion Medicine
Decrease seen in red blood cell, plasma transfusions in US
Bottom Line: The frequency of red blood cell and plasma transfusions decreased among hospitalized patients in the United States from 2011 to 2014.
Why The Research Is Interesting: Blood transfusions are one of the most common hospital procedures. Hospitals have implemented blood management programs with restrictive transfusion practices that are aimed at improving patient outcomes, reducing costs and conserving blood.
What and When: An examination of 20 percent of all U.S. hospital inpatient discharges from 1993 to 2014 to examine trends in transfusions of red blood cells, plasma and platelets
How (Study Design): This is a population epidemiology study. A population epidemiology study describes characteristics of one or more large populations, typically without detailed information about underlying causes.
Authors: Aaron A. R. Tobian, M.D., Ph.D., Johns Hopkins University, Baltimore, and coauthors
Results: There was a decrease in red blood cell and plasma transfusions from 2011 to 2014; platelet transfusions remained stable.
Study Limitations: The diagnostic coding used for this study was carried out primarily for billing purposes and it was not possible to verify its accuracy. The study also was limited to inpatient transfusions, so the results may not be generalizable to outpatient transfusions.
Study Conclusions: Observed decreases in red blood cell and plasma transfusions may demonstrate the safety of restricting red blood cell transfusions, blood management programs and blood conservation initiatives.
Microbiology
Toenail Fungus Gives Up Sex to Infect Human Hosts
The fungus that causes athlete’s foot and other skin and toenail infections may have lost its ability to sexually reproduce as it adapted to grow on its human hosts.
Scientists analyzed samples of this tenacious organism, called Trichophyton rubrum, and found that nearly all belonged to a single mating type. What’s more, when they tried to set the fungi up with members of another mating type, they refused to do the deed, even after the scientists enlisted a variety of seduction schemes -- lowering the lights, cloaking the Petri dishes in plastic, flipping them upside down.
If this fungus can’t sexually reproduce, it can’t diversify, and if it can’t diversify, that may mean its days on this planet are numbered, said Joseph Heitman, MD, PhD, senior study author and professor and chair of molecular genetics and microbiology at Duke University School of Medicine.
But don’t expect toenail fungus to appear on the endangered species list anytime soon. "It is commonly thought that if an organism becomes asexual, it is doomed to extinction," Heitman said. "While that may be true, the time frame we are talking about here is probably hundreds of thousands to millions of years."
Though that timeline won’t be much help to the nearly 2 billion people who currently suffer from fungal infections of the skin and nails, the discovery that this species may be asexual -- and therefore nearly identical at the genetic level -- does highlight potential vulnerabilities that researchers could exploit in designing more effective antifungal medications. The findings appear online in the journal Genetics.
Research
New test can detect autism in children, scientists say
Scientists in Britain say they have developed a blood and urine test that can detect autism in children.
Researchers at the University of Warwick said the test, believed to be the first of its kind, could lead to earlier diagnosis of autism spectrum disorders (ASD) in children who could then be given appropriate treatment much earlier in their lives.
As there is a wide range of ASD symptoms, diagnosis can be difficult and uncertain, particularly at the early stages of development. It is estimated that about one in every 100 people in the UK has ASD, with more boys diagnosed with the condition than girls.
Scientists said their research found a link between ASD and damage to proteins in blood plasma. They found the most reliable of the tests they developed was examining protein in blood plasma, which found children with ASD had higher levels of the oxidation marker dityrosine (DT) and certain sugar-modified compounds called advanced glycation end-products (AGEs).
Genetic causes are thought to be responsible for about a third of cases of ASD, while the rest are believed to be caused by a combination of environmental factors, mutations, and rare genetic variants. However, researchers believe their new tests could reveal yet-to-be-identified causes of ASD. They also confirmed the previously held belief that mutations of amino acid transporters are a genetic variant associated with ASD.
The Warwick team worked with collaborators at the University of Bologna in Italy, who recruited 38 children who had been diagnosed with ASD along with a control group of 31 other children between the ages of five and 12. Blood and urine samples were taken from the children for analysis.
The Warwick team discovered there were chemical differences between the two groups. Working with a further collaborator at the University of Birmingham, the changes in multiple compounds were combined using artificial intelligence algorithm techniques to develop a mathematical equation to distinguish between ASD and healthy controls. The outcome was a diagnostic test better than any existing method.
They said the next steps were to repeat the study with further groups of children to confirm the good diagnostic performance and to assess if the test could identify ASD at very early stages, indicate how the ASD is likely to develop further to more severe disease, and assess if treatments were working.
Related articles:
Could blood and urine test be used to diagnose autism?
A New Blood Test May Predict Autism with 92 percent Accuracy
HIV Saliva Test Adapted for Rapid Zika Diagnosis
Researchers at New York University College of Dentistry (NYU Dentistry), in collaboration with Rheonix, Inc., are developing a novel test for Zika virus that uses saliva to identify diagnostic markers of the virus in a fraction of the time of current commercial tests.
The test, which was adapted from an existing model developed by NYU and Rheonix for rapid HIV testing, is described in two new publications appearing in PLOS ONE and the Journal of Visualized Experiments (JoVE).
Blood samples are most often used to test for Zika virus and are typically processed using a common diagnostic technique called real-time polymerase chain reaction (RT-PCR). But blood may not be the best fluid. While the virus disappears in the blood a week or two after a person is infected, it can persist longer in saliva, semen, and urine. In addition, antibodies can remain for months or years in those bodily fluids, which is why it is essential for diagnosis to also detect antibodies after infection.
Backed by funding from the National Institutes of Health, NYU Dentistry researchers are developing a rapid Zika test that combines both nucleic acid and antibody assays using saliva, given that Zika virus and antibodies persist in saliva. A saliva test is also noninvasive, cost effective, and easier to collect than blood or urine.
The new test also has the potential to produce results in a matter of minutes instead of hours or days. Current RT-PCR tests take around three hours and specific antibody tests can take several weeks. NYU researchers are using a different method called isothermal amplification, which can detect a virus’ nucleic acids in as little as 20 minutes, and antibody tests that can take less than an hour using Zika-specific antigens.
Read more about the test by clicking on the article title above.
Just For Fun!
What a Chart of Urine Tells Us About the History of Color Printing
In the early 16th century, books did not include images unless there was a very good reason. “To print images in books at the time required planning, time, and extra money,” says Caroline Duroselle-Melish, a curator at the Folger Shakespeare Library. “They were not simply decorative. An image was a real investment.”
A full-page, color spread in Ulrich Pinder’s medical text, Epiphanie medicorum, printed in 1506 in Nuremberg, Germany, must have seemed crucial to his project. On the left-hand page is a wheel of flasks, each colored a different shade of yellow, pink, black, brown, or greenish blue. Opposite, the same flasks are arranged in rows, with more detail about the colors and what each shade might mean. All the flasks were meant to represent samples of human urine.
At the time, urinalysis had already been practiced for hundreds of years and was on the verge of becoming so popular that people started self-diagnosing their ailments based on the color of their pee. This revolution in home medicine depended in part on printing technology that created access to information once restricted to the medical professionals of the time.
As far back as 100 B.C., Sanskrit medical texts from South Asia described 20 different types of urine and the ailments they might indicate. In ancient Greece, Hippocrates hypothesized that urine represents a filtrate of the four humors, the balance of which determines a person’s health. He believed it came from the blood and was filtered through the kidneys. As an article in Kidney International notes, this was "a fairly accurate description."
Most diagnoses were made by inspecting urine visually. But physicians also tasted samples, and one influential seventh-century scientist developed a test that used heat to precipitate proteins from urine to provide more information. Urinalysis, according to the Journal of the Royal College of Physicians of Edinburgh, can be considered "the first laboratory test documented in the history of medicine."
During the Middle Ages, the popularity of urinalysis increased, and it became a primary tool for health assessment. One 12th-century physician invented a special glass vessel used to collect and examine urine samples. Every respectable physician had one, and they became a symbol of the profession.
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