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In This Issue
 Newest screen for newborns will indicate heart problems
Taiwan investigates organ transplants from HIV-positive donor
60% of doctors' and nurses' hospital uniforms test positive for dangerous bacteria
The new generation of microbe hunters
Protein in the urine spells kidney failure for African-Americans
Roche sees diagnostics growing as healthcare cost reductions spurs demand
Bird flu back again, U.N. agency warns
Nationwide trends for sepsis in the 21st century
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Newest screen for newborns will indicate heart problems
About 1 in every 120 babies are born with congenital heart disease (CHD), of which about 25 percent is critical, requiring special care early in life. CHD is responsible for more deaths in the first year of life than any other birth defect, but often outcomes can be improved with early detection. Now a group of physicians and scientists has published an important paper that recommends strategies for national screening for critical CHD, using a simple, noninvasive test called pulse oximetry that measures oxygen in blood. Low oxygen levels would trigger further investigation. The screening strategy report was published in the journal Pediatrics on Aug. 22.
"Screening for low-blood oxygen saturation can be an effective way to identify otherwise well-appearing babies who have undetected critical CHD," said one of the report's authors, Alex Kemper, M.D., Associate Professor of Pediatrics at Duke University Medical Center. "One of the biggest challenges in implementing screening will be the follow-up after a positive screen."
The group's recommendations are based on large studies conducted in the United States and Europe. However, there are still many unanswered questions about how to best screen, including timing and the standards for a positive screen. For example, the algorithm's usual cutoff point for oxygen saturation may need to be adjusted for babies in high-altitude nurseries, where blood oxygen levels may be normally slightly lower.
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Taiwan investigates organ transplants from HIV-positive donor
Taiwan's health department is investigating how the organs of an HIV-positive donor were cleared for transplant for five recipients at two hospitals. Four patients at the National Taiwan University Hospital received the man's liver, kidneys and a lung; a fifth patient at National Cheng Kung University Hospital received his heart.
"The major fault lies in the failure to double-check the donor's blood test results before the surgeries," the Taiwan Today report cited National Taiwan University Hospital's spokeswoman as saying. The National Taiwan University Hospital has apologized to the patients who received the transplants and administered them with HIV-prevention medicine.
Under regulations, HIV virus tests should be run before any transplant of organs, tissues, body fluid or cells take place, according to the health department. In the event of HIV-virus transmission as a result of a transplant, penalties for the procedure could result in a three-to-10 year prison sentence.
The hospital could face penalties, including fines between 50,000-500,000 New Taiwan dollars (US$1,700-$17,000) and the suspension of the department that conducted the procedure.
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60% of doctors' and nurses' hospital uniforms test positive for dangerous bacteria
More than 60 percent of hospital nurses’ and doctors’ uniforms tested positive for potentially dangerous bacteria, according to a study published in the September issue of the American Journal of Infection Control, the official publication of APIC - the Association for Professionals in Infection Control and Epidemiology.
A team of researchers led by Yonit Wiener-Well, MD, from the Shaare Zedek Medical Center in Jerusalem, Israel, collected swab samples from three parts of the uniforms of 75 registered nurses (RNs) and 60 medical doctors (MDs) by pressing standard blood agar plates at the abdominal zone, sleeves’ ends and pockets.
The researchers at this 550-bed, university-affiliated hospital found that exactly half of all the cultures taken, representing 65 percent of the RN uniforms and 60 percent of the MD uniforms, harbored pathogens. Of those, 21 cultures from RN uniforms and six cultures from MD uniforms contained multi-drug resistant pathogens, including eight cultures that grew methicillin-resistant Staphylococcus aureus (MRSA).
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The new generation of microbe hunters
It is the start of a new age in microbiology, says James M. Musser, chairman of pathology and genomic medicine at the Methodist Hospital System,and others say. And the sort of molecular epidemiology he and his colleagues wanted to do is only a small part of it. New methods of quickly sequencing entire microbial genomes are revolutionizing the field.
In a recent review, Dr. David A. Relman, a professor of medicine, microbiology and immunology at Stanford, wrote that researchers had published 1,554 complete bacterial genome sequences and were working on 4,800 more. They have sequences of 2,675 virus species, and within those species they have sequences for tens of thousands of strains — 40,000 strains of flu viruses, more than 300,000 strains of H.I.V., for example.
With rapid genome sequencing, “we are able to look at the master blueprint of a microbe,” Dr. Relman said in a telephone interview. It is “like being given the operating manual for your car after you have been trying to trouble-shoot a problem with it for some time.”
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Protein in the urine spells kidney failure for African-Americans
African Americans are four times more likely to develop kidney failure than whites. A new study has found that a condition that occurs when the kidneys are damaged and spill protein into the urine contributes to this increased risk. The study, conducted by William McClellan, MD of Emory University and his colleagues, appears in an upcoming issue of the Journal of the American Society Nephrology (JASN), a publication of the American Society of Nephrology. Kidney failure was most common in individuals who excreted large amounts of protein in their urine. African Americans were more likely to excrete large amounts of protein in their urine than whites.
The article, entitled "Albuminuria and Racial Disparities in the Incidence of End-Stage Renal Disease," will appear online at JASN.
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Roche sees diagnostics growing as healthcare cost reductions spurs demand
Roche Holding AG (ROG) expects government austerity measures to boost its medical-diagnostics unit in the next three to five years thanks to broader use of tests to see which patients should use expensive treatments. The number of tests to help single out the patients who will benefit most from Basel, Switzerland-based Roche’s medicines should double within two to three years, Roche Diagnostics Chief Operating Officer Daniel O’Day said in an Aug. 23 interview.
Products such as a test to detect human papillomavirus, a cause of cervical cancer, and a gene test approved this month alongside Roche’s new melanoma drug Zelboraf will be “solutions for how the countries divide the pies more efficiently,” O’Day said. Roche expects growth at the diagnostics unit to exceed the market this year, outpacing the drugmaker’s larger pharmaceuticals unit as sales decline for its best-selling cancer drug Avastin.
Roche is developing a companion diagnostic test for MetMab, being studied together with the company’s lung tumor medicine Tarceva for patients whose tumors have high concentrations of the Met protein. Roche also made a test to be sold together with Pertuzumab, a breast cancer drug being submitted to regulators for approval this year.
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Bird flu back again, U.N. agency warns
A new vaccine-resistant strain of avian H5N1 influenza has begun circulating in poultry flocks in Vietnam and China, posing "unpredictable risks to human health," the Food and Agriculture Organization (FAO) warned on Monday. "In Vietnam, which suspended its springtime poultry vaccination campaign this year, most of the northern and central parts of the country -- where H5N1 is endemic -- have been invaded by the new virus strain, known as H5N1-2.3.2.1," the FAO said in a statement.
No cases of human infection with the novel strain have yet reported by the FAO or its sister group, the World Health Organization. Vietnam has remained free of human infections with any avian H5N1 strains this year, according to WHO.
The new strain is "apparently able to sidestep the defenses provided by existing [poultry] vaccines," the agency said. But the FAO indicated that poultry infections have been rising again. It said nearly 800 outbreaks had been identified since January 2010, compared with about 300 in 2008. Recent poultry infections have been spotted in Israel, the Palestinian territories, Romania, and Bulgaria. The FAO's chief veterinary officer, Juan Lubroth, said the H5N1 virus was most entrenched in Egypt, Indonesia, China, Bangladesh, India, and Vietnam. Most recent human H5N1 infections have been in Egypt, with another small outbreak under way in Cambodia, according to WHO.
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Nationwide trends for sepsis in the 21st century
Severe sepsis is common and often fatal, although evidence-based therapies have improved patient outcomes. In recent study, researchers from the Medical College of Wisconsin and Orlando Regional Medical Center found that the number of severe sepsis hospitalizations per 100,000 people increased from 143 in 2000 to 343 in 2007. The mean number of organ failures per patient during hospitalization increased from 1.6 to 1.9, although the mean length of hospital stay decreased from 17.3 to 14.9 days, and the mortality rate decreased from 39% to 27%.
However, more patients with severe sepsis were discharged to long-term care facilities in 2007 than in 2000. Despite the increasing number of severe sepsis admissions and declining mortality rates, there are more patients being discharged to skilled nursing facilities and in-home care, which warrants increased attention.
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