News
UBC researchers transform blood types using human gut enzyme
Researchers from the University of British Columbia believe they can make blood transfusions easier for medical professionals and safer for patients thanks to newly discovered enzymes that transform blood type. Lead researcher Stephen Withers said his team discovered enzymes living in the human gut that can change blood into universally usable Type O. That could prevent immune reactions when patients receive the wrong type of blood.
Withers said scientists have been working with enzymes to convert blood for some time but this discovery represents a significant breakthrough. "Researchers have been studying the use of enzymes to modify blood as far back as 1982," Withers said. "However, these new enzymes can do the job 30 times better."
UBC said Withers and his colleagues are applying for a patent for the new technique to test the enzymes on a larger scale and prepare for clinical work. He estimated that, barring any setbacks, O-type blood created with the enzyme technique could be ready for use in medicine in five to 10 years.
STDs in The US Have Surged to a Record-Breaking High, The CDC Warns
Preliminary data released by the Centres for Disease Control and Prevention (CDC) in the US reveal nearly 2.3 million incidences of chlamydia, gonorrhoea, and syphilis were diagnosed in 2017 – an increase of roughly 200,000 from the year before.
It's not entirely clear what's behind the rise, but the literature all points to various factors involving a drop in prevention funding, insufficient access to healthcare and sex education, and stigma about sexually transmitted diseases.
Often considered a historical disease, 'great pox' – better known today as syphilis – is making a terrifying comeback, with 30,644 cases of primary and secondary forms of the condition being diagnosed last year. That's up from 17,375 incidences in 2013.
Gonorrhoea alone jumped from 333,004 cases in 2013 to 555,608. That's a rise of 67 percent. The rate of its diagnosis among men has virtually doubled.
Chlamydia remains the most common of the infections, with 1.7 million cases diagnosed. Just under half of these were among women aged 15 to 24.
Quality
The (True) Value of Laboratory Medicine
As lab medicine professionals, we are fully aware of the unquestionable importance of our profession. In the UK alone, every citizen has an average of 14 tests per year performed by a laboratory medicine specialist. Department heads increasingly rate quality care and value-for-money as key priorities, so a recognition of the value of lab medicine is of crucial importance, especially when it comes to ensuring appropriate allocation of resources. But is laboratory medicine falling at the last hurdle when it comes to providing improved benefits for patients? The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) task force on the impact of laboratory medicine on clinical management and outcomes was set up in 2012 to settle this very problem, to evaluate the evidence supporting the impact of laboratory medicine, and to promote contributions from the field.
No doubt you will have heard the frequently cited claim that laboratory medicine plays a role in 70 percent of clinical decisions. That assertion sounds plausible, but the data on which the claim is based represent unpublished studies and anecdotal observations, and cannot be objectively verified at this stage. So where did it come from?
The earliest reference to the claim can be found in a 1996 paper from the Mayo Clinic in the US, where the author stated, “We know that, although the laboratory represents a small percentage of medical center costs, it leverages 60–70 percent of all critical decisions, e.g. admission, discharge and therapy “. But even that paper failed to provide evidence for its statement. In the 19 years since the paper was published, in true Chinese whispers style, the statement has been taken and extrapolated upon, from 70 percent of critical medical decisions to 70 percent of all medical decisions.
The model proposed by the IFCC task force for measuring the net clinical value of a test involves balancing the benefits that a test delivers against any harm it may cause. For the model to work and to increase the value of a test, it’s important to first accept that testing can sometimes cause harm. In general, that harm stems from one of five possible sources, originally described by Epner et al.:
- An inappropriate test may be ordered
- The appropriate test may not be ordered
- The appropriate test result may not be used properly
- The appropriate test result may be delayed or missed
- The appropriate test result may be wrong or inaccurate.
An incorrect result, the area that receives most of our attention, is also the area with the lowest cause of diagnostic error – primarily because we in the lab have spent so much time focusing on this aspect. Now’s the time we need to get serious about some of the other factors.
Read the full article by clicking on the title above.
Clinical Chemistry
New Diagnostic Test Accurately Differentiates Diabetes Insipidus From Polyuria Polydipsia Syndrome
Investigators from the University of Basel and University Hospital Basel, in Switzerland, have found a better way to test for diabetes insipidus than the previously-used and oft-unpleasant water deprivation test.
In diabetes insipidus, pituitary glands lack the hormone vasopressin, therefore, leading to a salt content disregulation in the body. Without the ability to concentrate their urine, patients lose a lot of fluid and have to drink water constantly to prevent dehydration.
For their study, published in the New England Journal of Medicine, the investigators sought to compare the water-deprivation test with a new diagnostic method which featured direct detection of the biomarker plasma copeptin, a precursor-derived surrogate of vasopressin.
To do this, the investigators recruited 156 patients with hypotonic polyuria at 11 medical centers. A total of 144 patients underwent the water-deprivation and hypertonic saline infusion tests. After the latter test was given, the investigators measured the concentration of copeptin in the patients’ blood. “The most surprising observation is that the new test has a much higher diagnostic accuracy to differentiate 2 diverse diseases: diabetes insipidus and primary polydipsia, as compared to the classical water deprivation test (which has been done for decades as gold standard),” Professor Mirjam Christ-Crain, MD, PhD, told Rare Disease Report®. “The hypertonic saline plus copeptin test should, therefore, replace the ‘old’ test as the new gold standard.”
Although the water deprivation test determined the correct diagnosis with 76.6% accuracy, the copeptin test had a 97% rate of correct diagnoses. The investigators said that this allowed patients to receive faster treatment. Of the 144 patients that underwent both tests, 62 patients had forms of diabetes insipidus and 82 patients had polydipsia.
Transfusion Medicine
World's largest transfusion study in cardiac surgery changes transfusion practices
Lower thresholds for blood transfusions for cardiac surgery patients compared to traditional thresholds provide positive patient outcomes and safety at six months after surgery, according to the world's largest research study on this topic.
The research found that in addition to providing good patient outcomes six months after hospital discharge, the lower threshold - known as 'restrictive transfusion therapy' - reduces the amount of blood transfused and money spent on blood per procedure. The higher, traditional threshold is called 'liberal transfusion therapy.'
Physicians who practice the liberal transfusion approach give blood transfusions early in the surgery to prevent patients' hemoglobin level from falling. Physicians who practice a restrictive approach wait longer to see if the hemoglobin level remains stable or if the patient has further bleeding.
These findings were presented on August 19th at the European Society of Cardiology Annual Congress in Munich, Germany by Dr. David Mazer, principal investigator on the study, anesthesiologist at St. Michael's Hospital, associate scientist in its Keenan Research Centre for Biomedical Science, and Professor of Anesthesia and Physiology at the University of Toronto, with simultaneous publication in the New England Journal of Medicine.
"Our research question was, at what point does the risk of anemia, or the risk of a lower hemoglobin, outweigh the risk of transfusion?" Dr. Mazer said. "We wanted to know whether it is safe to let your hemoglobin go to a lower level before you transfuse. The answer is yes. It'll save blood, make blood more available, reduce costs of transfusion and result in similar or better outcomes."
Microbiology
Dimorphic Fungal Pathogen May Be Causing Fatal Infections in Western US and Canada
A new potentially fatal fungal infection may be on the rise in the western regions of North America, according to new research.
Blastomyces helicus, a dimorphic fungal pathogen, has remained a mystery to researchers and clinicians alike. Although it was initially identified in samples taken from the brain and lungs of a man who died of encephalitis in Alberta, Canada—his initial diagnosis was blastomycosis— the geographic range, epidemiology, and clinical features of disease-causing B. helicus remain unknown. The findings of the study, however, suggest that it may be the cause of fatal infections in the western United States and Canada.
“Fungi are important pathogens of humans, animals, and plants, and yet there is so much we do not yet understand about them,” lead author Ilan Schwartz MD, PhD, FRCPC, assistant professor, division of infectious diseases, University of Alberta, Edmonton, Canada, told Contagion®. “A medically important but poorly understood group of fungi are the dimorphic fungi that cause the endemic mycoses. For many years, mycologists have noted differences in some strains of fungi that caused blastomycosis in different regions, but the availability of genetic analysis has now clarified the relationship of these fungi.”
According to Dr. Schwartz, the newly isolated fungi is related to, but distinct from, Blastomyces dermatitidis, which he describes as “the classic cause of blastomycosis.” Historically, B. dermatitidis has been endemic in areas around the St. Lawrence and northern Mississippi rivers in the United States and Canada. It is found most commonly in animals and, occasionally in humans. The US Centers for Disease Control and Prevention estimates that the annual incidence rate of blastomycosis, in humans, is roughly 1 to 2 per 100,000 individuals.
Anatomic Pathology
HPV-oropharyngeal squamous cell carcinoma now most common HPV-associated cancer
The trends in HPV-related cancers report included data from 1999 to 2015 from cancer registries – CDC’s National Program of Cancer Registries and NCI’s SEER program – covering 97.8% of the U.S. population.
The CDC reported 30,115 new cases of HPV-associated cancers in 1999 compared with 43,371 new cases in 2015.
During the study period, researchers observed a 2.7% increase in rates of oropharyngeal squamous cell carcinoma among men and a 0.8% increase among women. Rates of anal squamous cell carcinoma increased by 2.1% among men and 2.9% among women.
Among women, researchers observed a 1.6% decrease in HPV-related cervical cancer and a 0.6% decrease in rates of HPV-related vaginal squamous cell carcinoma. Rates of vulvar squamous cell carcinoma increased by 1.3%.
Rates of penile squamous cell carcinoma remained stable from 1999 to 2015.
Overall, rates of HPV-related cancers varied by age and race/ethnicity.
Researchers observed a 4% increase in the rate of oropharyngeal squamous cell carcinoma among men aged 60 to 69 years compared with a 0.8% increase among men aged 40 to 49 years.
For anal squamous cell carcinoma, the largest increases occurred among women aged 50 to 69 years (4.6% to 4.8%) and men aged 50 to 59 years (4%).
Research
Blood Test Could Detect Kidney Cancer Up to Five Years Prior to Clinical Diagnosis
Every year, more than 330,000 people are diagnosed with kidney cancer worldwide. More than 80 percent of those new cases are renal cell carcinomas (RCC). When caught early, the five-year survival rate is more than 90 percent. Patients diagnosed with more invasive tumors, however, have dramatically poorer prognoses, with five-year survival rates of 50 percent and 10 percent for patients diagnosed at stages III and IV respectively. Early detection could improve the overall survival rate in patients at high risk for death from RCC.
Now, a team of investigators led by Beth Israel Deaconess Medical Center (BIDMC) medical oncologist Rupal Bhatt, MD, PhD, has demonstrated that a molecule called KIM-1, a protein present in the blood of some patients with renal cell carcinoma is present at elevated levels at the time of diagnosis, can also serve as a tool to predict the disease’s onset up to five years prior to diagnosis. The team’s findings were published in the journal Clinical Cancer Research.
“Our study found a significant association between plasma KIM-1 concentrations and the risk of renal cell carcinomas,” said Bhatt, corresponding author of the study and an Associate Professor of Medicine at Harvard Medical School. “The team also found that KIM-1 concentrations were associated with poorer survival. Further studies are needed, but a sensitive and specific tumor marker that can detect early stage RCC would have strong potential to improve overall survival.”
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