Several hematological alterations are associated with altered hemoglobin A1c (Hb A1c). However, there have been no reports of their influence on the rates of exceeding standard Hb A1c thresholds by patients for whom Hb A1c determination is requested in clinical practice.
iPhones take great pictures. This adapter makes it super easy to take images and make videos with your iPhone through your microscope. You can even use your iPhone to live project/stream your view. The iDu adapter fits iPhone6/6s. It's fitted with a 10x magnifying lens and comes with two adapters to fit a 30 mm or 23 mm eyepiece slot (it should fit all Nikon, Olympus, Zeiss, Leica and other common brand microscopes). Compatible with any compound, dissection, or fluorescent microscope. Simply remove the microscope eyepiece and insert the iDu. Easy as pie.
There are many factors that contribute to accurate test results in the chemistry laboratory. These factors can be broken down into three areas: preanalytical, analytical and post analytical. Preanalytical variables account for 32-75% of laboratory errors, and encompass the time from when the test is ordered by the physician until the sample is ready for analysis.1 The focus of this article will be preanalytical variables that can occur during a venipuncture and specimen processing and how they relate to testing in the clinical chemistry laboratory.
Asthma represents a significant clinical and economic burden to the US healthcare system. Along with other clinical manifestations of the disease, elevated sputum and blood eosinophil levels are observed in patients experiencing asthma exacerbations. The aim of this study was to evaluate the association between blood eosinophil levels and asthma severity defined using Expert Panel Report 3 guidelines.
Among 1,144 patients with an asthma diagnosis, 60 % were classified as having moderate-to-severe asthma. Twenty four percent of patients with moderate-to-severe asthma and 19 % of patients with mild asthma had an elevated peripheral eosinophil count (p = 0.053). Logistic regression showed that moderate-to-severe asthma was associated with 38 % increased odds of elevated eosinophil level (OR 1.38, 95 % CI: 1.02 to 1.86, p = 0.04).
Patients with moderate-severe asthma are significantly more likely to have an elevated peripheral eosinophil count than patients with mild asthma
Multiple Myeloma: Early Death Common and Preventable
Improved survival among patients with multiple myeloma is one of the most impressive cancer treatment success stories in recent years.
A decade ago, patients survived an average 3 to 4 years following a multiple myeloma (MM) diagnosis, but median survival times have doubled and continue to improve, said multiple myeloma researcher Shaji Kumar, MD, of Mayo Clinic, Rochester, Minnesota.
This is due largely to the introduction of novel biologic therapies and greater use of autologous stem cell transplant. While there is still no cure for the neoplastic plasma-cell disorder, these treatments now routinely prolong initial remission and survival.
Early death remains common
Considered a rapidly fatal disease just a decade ago, MM is now considered more of a chronic condition for many, but not all, patients, Kumar said in a telephone interview.
Early death remains a significant and under-recognized problem in multiple myeloma, especially among patients with serious comorbidities or those who are very old. These patients often do not receive today’s gold-standard treatments, and that is a problem, Kumar said.
“About a quarter of patients will die within the first 2 to 3 years of diagnosis, for a number of reasons,” Kumar said, adding that he believes early mortality among multiple myeloma patients could be reduced by a third or even half if strategies to identify and treat those most at-risk were systematically applied.”
“Do’s and Don’ts” in early treatment
These strategies were outlined by Kumar and colleagues from Mayo Clinic and the University of Alabama at Birmingham in a recent analysis, published ahead of print by the American Journal of Hematology.
“Multiple myeloma is not a rare disease, but it is not commonly seen by oncologists in general practice,” analysis co-author Luciano J. Costa, MD, of the University of Alabama at Birmingham said. “Some may see only 1 or 2 of these patients a year, so we felt it was important to highlight some key strategies for reducing early death rates in this population.”
In a separate population analysis of 30,324 multiple myeloma patients published late in 2014, Kumar, Costa and colleagues found that while early mortality–defined as death within a year of MM diagnosis–has decreased over time, it still occurred in 28.6% of patients diagnosed in the U.S. between 1993 and 2010.
The incidence of early death among patients diagnosed before the age of 65 was 17.6% and incidence among older patients was 35.3%.
Majority of MM patients are age 65+
“About two-thirds of patients are 65 or older when diagnosed, so this at-risk group represents the overwhelming majority of patients,” Costa said. “And most of these older patients are not dying from refractory disease.”
Instead, Costa said he believes many die because they are either not getting optimal therapies or because they are very ill from co-morbid diseases at the time of their diagnoses.
These very ill or elderly patients have typically been excluded from multiple myeloma clinical trials, so there is little to guide physicians treating them.
This is why careful risk stratification and identification of co-morbidities immediately following a MM diagnosis is critical, Kumar noted.
“We need to manage the myeloma in the context of the other things going on with the patient,” he said.
The strategy for managing newly diagnosed MM outlined by Costa, Kumar and colleagues included a series of “do’s” and “don’ts” derived from their experience treating patients with the bone marrow cancer. Their aim was not to present comprehensive recommendations for treatment, but, instead, to focus on strategies designed to avoid early complications and death.
Among the recommended “do’s” and “don’ts”:
Do institute prompt systemic therapy
The researchers’ 2014 analysis revealed that the risk of early death was higher when novel MM drugs were not used as part of treatment.
While physicians may be tempted to focus on supportive care for conditions that accompany MM, such as hypercalcemia, bone lesions, renal failure and anemia, the researchers wrote that these treatments should not replace systemic therapy.
“It is crucial to keep in mind that ultimate symptom control or reversal of complication can only be obtained with systemic treatment, and none of the supportive measures above precludes prompt initiation of systemic therapy,” they wrote.
Do treat hypercalcemia aggressively
Approximately 1 in 5 patients develop hypercalcemia, resulting from increased activation of osteoclasts. The researchers noted that the “prompt and effective management of hypercalcemia is imperative to prevent early mortality in newly diagnosed MM.”
They added that in cases of mild hypercalcemia, aggressive rehydration with normal saline along with corticosteroids should suffice, as long as hydration is carefully monitored to avoid congestive heart failure.
In moderate to severe cases (serum calcium >12 mg/dL), an ECG is recommended to rule out arrhythmias. In addition to hydration and corticosteroids, the researchers recommended anti-bone resorption therapies, and they noted that results from two separate trials in patients with malignancy-related hypercalcemia found zoledronic acid to be superior to pamidronate for normalizing calcium levels.
Drugs that cause hypercalcemia should also be avoided, as well as drugs that can worsen neurological status in the setting of concurrent hypercalcemia, “to allow adequate assessment of neurological status.”
Do avoid and manage infections
Infections are the most common cause of early death in MM patients. One study found that 45% of deaths within 2 months of diagnosis were associated with infections. A population-based study from Sweden showed a 7- to 10-fold increase in bacterial and viral infection risk in MM patients, compared to the general population.
The use of prophylactic antibiotics to prevent infections in MM remains controversial, and the researchers noted that routine prophylaxis is not advised. They did, however, recommend the use of TMP-SMX to prevent fungal pneumonias in patients treated with 20 mg/d or more of prednisone. They also recommended prophylactic use of acyclovir or valacyclovir for patients receiving proteasome inhibitors (PIs) that disrupt normal T-cell immunity.
“For all patients receiving bortezomib and for that matter even newer PIs such as carfilzomib, we recommend administering antiviral prophylaxis with acyclovir 400 mg twice daily or valacyclovir 500 mg once a day,” they wrote.
Do avoid thromboembolic events (VTE)
This risk increases with age, and patients with blood cancers such as MM have an especially high risk for clot-related events. The researchers recommend educating all newly diagnosed patients on the warning signs for the development of VTEs. They also recommend the use of VTE prophylaxis in all newly diagnosis MM patients receiving IMiD-immunomodulator therapies.
“In MM patients who develop a thrombosis upon initiating treatment, it is reasonable to hold their treatment and resume after they are therapeutically anticoagulated,” the researchers wrote. “This level of anticoagulation may be continued for the remainder of the duration of MM-directed therapy as long as the risk of serious bleeding complications is deemed acceptable.”
Remaining “do’s” and “don’ts” recommended in the analysis included:
- Do address comorbidities and manage pain.
- Don’t postpone systemic therapy to address localized lesions.
- Don’t administer prolonged courses of high-dose corticosteroids.
- Don’t change well-tolerated therapy due to perceived suboptimal response if clinical benefit is shown.
- Don’t administer radiation when symptoms can be managed with systemic therapy.
- Don’t administer inferior treatment solely based on advanced age of performance status.
“In recent years we have seen an explosion in the number of available therapies for multiple myeloma, but older, sicker patients may not be getting these treatments,” Costa said. “Since about two-thirds of newly diagnosed patients are age 65 or older, it is important to address the issue of suboptimal treatment in this population.”
By Salynn Boyles
Reviewed by Alan S. Weinstein, MD, FACP, Medical Director (retired), Virtua Fox Chase Cancer Program, Marlton, NJ
Recently, the introduction of newer agents such as bortezomib, lenalidomide, thalidomide, liposomal doxorubicin, etc. has led to a flurry of trials aimed at testing various combinations in order to improve survival. Higher response rates observed with these agents have led to their integration into induction therapies. The role of various new therapies vis a vis transplantation has also been examined. Recent advances in the management of plasmacytomas , renal dysfunction, dentistry as well as mobilization of stem cells in the context of myeloma have also found exclusive mention. Since brevity is the soul of wit our attempt has been to present before the reader a comprehensive yet brief text on this important subject.
- File Name Multiple Myeloma – An Overview
- Edition 1st
- Year 2012
- Editor(s) Ajay Gupta
- ISBN-10 9533077689
- ISBN-13 9789533077680
- Size 5.49 MB
- File Format .pdf
- Password bioscience.pk
- Blood collection and testing
- Blood component description
- Preparation and usage
- Red blood cell antigens and antibodies
- Specialized component processing
- Specialized transfusion situations
- Transfusion-transmitted diseases
- Transfusion reactions
- Infectious complications of transfusion
- Therapeutic apheresis and quality
- Acute bleeding and massive transfusion
- Transfusion of the patient with a coagulopathy
- Transfusion of obstetrics, pediatric, immunocompromised, and platelet refractory patients
- Up-to-date references to all aspects of transfusion medicine
- File Name Handbook of Transfusion Medicine
- Edition 1st
- Year 2001
- Editor(s) Christopher Hillyer, Krista L. Hillyer, Frank Strobl, Leigh Jefferies, Leslie Silberstein
- ISBN-10 0123487757
- ISBN-13 978-0123487759
- Size 4.89 MB
- File Format .pdf
- Password bioscience.pk
- File Name Advances in Hematopoietic Stem Cell Research
- Edition 1st
- Year 2012
- Editor(s) Rosana Pelayo
- ISBN 978-953-307-930-1
- Publisher InTech
- Size 19.5 MB
- File Format .pdf
- Password bioscience.pk
- File Name Multiple Myeloma – A New Era of Treatment Strategies
- Edition 1st
- Year 2012
- Author(s) Klaus Podar, Kenneth C. Anderson
- ISBN 978-1-60805-297-4
- Publisher Bentham Science Publishers
- Size 10.9 MB
- File Format .pdf
- Password bioscience.pk
Two years have passed since the CDC finally published guidelines addressing HIV laboratory testing and officially endorsed the “new” HIV laboratory testing algorithm. Although many had become aware of the algorithm in the four years prior, and had adopted it to various degrees, this was the final word on this long-awaited guidance. The algorithm gained visibility prior to the official endorsement mainly because it had been heavily referenced in CDC publications and numerous scientific articles.
Advantages of the new algorithm
Why is the new algorithm superior to the old algorithm? First, the new algorithm emphasizes the use of an antigen/antibody (Ag/Ab) combination assay to screen for HIV infection, as the first step. The use of this more advanced technology (fourth generation) provides improved detection of acute HIV-1 infection because antigen/antibody combination assays not only detect established infection in those who have seroconverted, but can also diagnose HIV infection prior to seroconversion by detecting p24 antigen. Fourth generation assays detect acute HIV infections, on average, five to seven days earlier than the third generation, antibody-only assays.
Second, substituting the HIV-1/HIV-2 differentiation assay for the Western blot in the second step allows for correct identification of HIV-2 infection and earlier detection of HIV-1 infection, compared to the Western blot.
Third, the official addition of nucleic acid testing (NAT) is used to rule out acute HIV-1 infection, which is necessary because although HIV-1/HIV-2 differentiation assays can detect HIV infection on average a few days earlier than the Western blot, none of these can detect HIV infection prior to seroconversion.
There is ample evidence that the new algorithm has increased detection of acute HIV-1 infections, due to the use of Ag/Ab combination assays. This is important both for the patient, who can receive prompt treatment that improves health outcome, and also from a public health perspective, because it reduces disease transmission. Many laboratories now have access to a fourth generation assay, since they are offered by multiple vendors on a variety of automated platforms.
The data are not yet in as to whether the new algorithm has resulted in a significant increase in yield of HIV-2 diagnoses; this would provide critical information regarding prevalence and transmission of HIV-2 infections in the United States.
Challenges of the new algorithm
The new algorithm, however, has presented some real challenges for the laboratory. The biggest adjustment to adopting the new algorithm has been replacing the Western blot with an HIV-1/HIV-2 differentiation assay. The only assay with this capability until recently was the Multispot (Bio-Rad). However, the Multispot is no longer available and will be replaced with Bio-Rad’s Geenius. Although the Geenius is also a single use test (FDA-cleared) for confirming reactive HIV screen results and differentiating between HIV-1 and HIV-2 antibodies, it differs from the Multispot in a number of important aspects. The test uses either recombinant or synthetic peptides corresponding to four HIV-1 antigens, gp160, gp41, p31 and p24, and two corresponding to HIV-2 antigens, gp140 and gp36. There are eight possible interpretations based on the pattern observed. Performance characteristics are comparable to Multispot. Sensitivity is 100 percent for both assays, and specificity values are 99.1 percent and 96.3 percent for the Multispot and Geenius, respectively. The results can be read within 30 minutes and are interpreted using an automated cassette reader, therefore eliminating inter-observer subjectivity. The cassette system also allows for placement of a bar code label on each specimen, improving sample tracking. Additionally, because software is necessary for interpretation, the results are digitally captured, automatically recorded, and stored.
However, because the new HIV-1/HIV-2 differentiation assay requires an additional investment in the reader/software component, beyond the cost of the reagents, there is some concern that some small hospital laboratories will revert to sending out supplemental HIV testing to a reference laboratory. It should also be noted that, although adoption of the new algorithm has grown significantly, there is still substantial demand for Western blot testing. Importantly, when a third or fourth generation assay was used for screening, an indeterminate or negative Western blot should also be followed up with NAAT.
There is also much confusion regarding appropriate use of the fourth generation rapid HIV test. Although at first glance it would appear that this assay can be used in lieu of the laboratory based Ag/Ab combination assay and serve as the entry point into the algorithm, that is not the current CDC recommendation. Citing insufficient evidence for such an approach, the CDC suggests that a preliminary positive result obtained with any rapid test, including an antigen/antibody combination rapid test, must be followed up with a laboratory-based antigen/antibody combination assay.
Fifth generation testing
The horizon appears even more complicated now that the “fifth generation” HIV testing is available. This technology is currently offered only by one vendor, but it has the ability to differentiate between antigen, HIV-1 and HIV-2 antibody-positive specimens. While this simplifies the answer with regard to HIV infection status for the patient, there are no guidelines as to how to proceed with follow-up testing. For example, if the sample is positive for antigen only, then the logical follow-up would be to send out for NAT testing, as there is no reason to test with the supplemental HIV-1/HIV-2 differentiation assay that only detects antibodies. If the sample is positive for HIV-2 only, is it appropriate to follow up with the HIV-1/HIV-2 differentiation assay, because the fifth generation test is FDA-approved as a screen only and a supplemental test is needed? Fifth generation technology presents further complications to the algorithm and more complexity for the laboratory in terms of appropriate follow-up and interpretation for clinicians.
Last, one unintended consequence of the new algorithm is the effect on HIV surveillance programs. Ideally for the purpose of HIV surveillance, public health departments would like to have the final answer as to whether a patient has HIV-1, HIV-2, or acute HIV-1 infection, once the HIV testing algorithm is complete. The problem is that this is almost impossible because testing is almost always fragmented and different steps of the algorithm are performed in different laboratories. Often primary institution laboratories have the ability to perform the screening, even with a fourth generation Ag/Ab combination assay, but cannot complete the remainder of the algorithm. The sample is then sent to the reference laboratory, and that laboratory has to determine how to interpret the results without having the screen results. How to report a partial result and make it clear to the clinician that additional testing is needed and also satisfy public reporting needs is much more difficult in the context of the new algorithm, for both the primary and reference laboratory.
In summary, many technological advances have been made that importantly improve detection of HIV-2 and acute HIV-1 infections. These advances are beneficial for both the patient and society. Although most clinicians and laboratories are now familiar with and support the implementation of the algorithm, laboratories are challenged more than ever to provide appropriate test result interpretation and utilization as well as adequate public health reporting for HIV.
- "Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations". BioScience.pk Digital Library Database. Centers for Disease Control and Prevention (CDC). Published June 27, 2014.
About the author: Patricia Slev, PhD, DABCC, is Associate Professor of Pathology (Clinical), University of Utah and Medical Director of the Serologic Hepatitis and Retrovirus Laboratory, Core Immunology Laboratory and Co-Director Microbial Immunology Laboratory, at ARUP. Board certified by the American Board of Clinical Chemistry, Dr. Slev’s research interests are immunogenetics and pathogen interactions, particularly HIV and viral hepatitis.
Source: Medical Laboratory Observer: The status of laboratory testing for the diagnosis of HIV infection
Description: As of 2010, an estimated 1.1 million persons in the United States were living with human immunodeficiency virus (HIV) infection, of whom an estimated 181,000 were unaware of their infection. Approximately 49,000 new HIV diagnoses are reported to CDC each year, and the estimated number of new infections has remained stable at approximately 50,000 annually from 2008 to 2010. As of 2009, an estimated 83 million adults aged 18 to 64 years reported they had been tested for HIV. Accurate laboratory diagnosis of HIV is essential to identify persons who could benefit from treatment, to reassure persons who are uninfected, and to reduce HIV transmission.
- File Name Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations
- Year 2014
- Editor(s) Bernard M. Branson MD, S. Michele Owen PhD, Laura G. Wesolowski PhD, Berry Bennett MPH, Barbara G. Werner, PhD, Kelly E. Wroblewski MPH, Michael A. Pentella PhD
- Publisher Centers for Disease Control and Prevention (CDC)
- Size 1.31 MB
- File Format .pdf
Bioscience, Biotechnology, and Biochemistry is a monthly, peer-reviewed, scientific journal published by the Japan Society for Bioscience, Biotechnology and Agrochemistry, of which it is the official journal. It was established in 1924 as Bulletin of the Agricultural Chemical Society of Japan, which was renamed to Agriculture and Biological Chemistry in 1961. The journal took its current name in 1991.
The focus of Bioscience, Biotechnology, and Biochemistry is previously unpublished original research results on all topics and fields concerning bioscience, biotechnology, and biochemistry. In addition, articles cover basic and applied sciences regarding microorganisms, including systems supporting their production, and structure. Broad topical coverage includes organic chemistry, bioorganic chemistry, physical chemistry, analytical chemistry, enzymology, biopolymer science, microbiology (including virology), animal science, plant science, food science, and environmental science.
Research applications are directed toward human welfare in general. Hence applications are transferred to industries of fermentation, chemistry and biochemistry, medicines and pharmaceuticals, foods and feeds, and agriculture.
Abstracting and indexing
Bioscience, Biotechnology, and Biochemistry is indexed in the following databases.
- "Agricultural and Biological Chemistry". Literature / Source Database. European Virtual Institute for Speciation Analysis. Retrieved 2010-08-19.
- "Agricultural and Biological Chemistry". Library of Congress Online Catalog. Library of Congress. Retrieved 2010-08-19.
- "Bioscience, Biotechnology, and Biochemistry".Literature/Source database. European Virtual Institute for Speciation Analysis. Retrieved 2010-08-19.
- "An Introduction to the Japan Society for Bioscience, Biotechnology and Agrochemistry". Academy of Science, Fields of Research, Contributions. JSBBA. August 2010. Retrieved 2010-08-19.
Claim- Drinking a cold glass of water after a meal can harm you. The cold water will solidify the oily stuff that you have just consumed, which will line the intestines and lead to cancer.
Verdict- False. Even if you accepted these claims as truth, a statement such as "A cardiologist says if you forward this to 10 people..." should have set off any properly working bullshit meter with a host of bells and flashing red lights. When you drink cold water, it is entering a system that self regulates to keep its core temperature within about half a degree, or around 37 c (98.6 f). ( For those that are wondering, typical oral temperature readings should be slightly cooler at 36.8c (96.2f)). From the time the water first comes into contact with your body, the heat transfer will begin to warm it up, and it will equalize within a few minutes. As an added bonus, drinking a half liter of ice cold water will actually make your body burn around 17 Calories in order to keep its temperature constant. The meal that you just consumed will not be affected in any way, as it will still end up at around the same temperature right up until you... uh "drop it off at the pool", regardless if you decided to wash it down with coffee or ice water afterwards.
Clogged large intestines do not cause cancer, they are a sign of cancer. Cancer is an uncontrolled division of abnormal cells in a part of the body. One way to think of it is when your cells replicate, a small error suddenly occurs in the copy process. That error gets passed down to the next copy and the next copy and the next. Before you know it, that one erroneous cell is now 2, then 4, then 16, then 256... eventually replacing all the good cells with cheap knock offs, and before long you're shopping for replacement parts because the original one(s) can no longer function the way it was meant to. (Sorry for the bad analogy. I think I have been working on cars too much lately.) Don't worry too much if you're feeling a little clogged up though because there are many other reasons for blockage, and most can be solved with a little bit of fiber in your diet.
The heart attack information is reasonably accurate but a little incoherent. Jaw pain may be a symptom of a heart attack, but typically accompanying other symptoms. The American Heart Association's warning signs your ticker may be faulty include;
- Uncomfortable Pressure, a squeezing or pain in the middle of your chest lasting for more than a few minutes
- Mild to intense pain spreading to the shoulders, arms, or neck, or jaw.
- Chest discomfort, feeling light headed, fainting, sweating, nausea, shortness of breath. Anxiety, nervousness, cold or sweaty skin, irregular heart rate,
Not all of these signs will necessarily occur. If you have one or more of these signs it is recommended you seek medical attention immediately, or you're going to end up having a really bad time.
Learning the art of ECG interpretation requires intellect, commitment, effort and perhaps most importantly...an organized approach. I personally have spent thousands of hours (yes thousands) looking at 12-lead ECG tracings, studying ECGs for the cardiology boards, interpreting ECGs for direct patient care and developing the ECG tutorials and quizzes of LearnTheHeart.com.
I assume that most of you reading this blog do not have that much time...so let me share with you what I have discovered in my years teaching ECGs to make the process more simple and perhaps even enjoyable.
Read more: 10 Steps to Learn ECG Interpretation