The Observatory & Fast Facts

Aug. 22, 2018
Vitamin D

Vitamin D could alleviate RA symptoms. Scientists have discovered that in rheumatoid arthritis (RA) patients, lower levels of vitamin D are associated with increased disease severity. Their findings, announced at the recent 70th AACC Annual Scientific Meeting & Clinical Lab Expo, indicate that vitamin D supplementation could significantly improve quality of life for RA patients.

While there is no cure for RA—an autoimmune disease that affects more than 1.3 million Americans—treatment with powerful therapies such as biologic or disease-modifying antirheumatic drugs can lead to remission of symptoms. However, research shows that within a year of achieving remission, half of RA patients relapse.

This can be due to patients tapering or stopping medication to reduce negative side effects, as well as the fact that some individuals develop antibodies that inhibit biologic drugs in particular. A more effective and sustainable treatment is therefore needed so that more RA patients can benefit from long-lasting remission.

Vitamin D could potentially fill this role, as it is a critical modulator of immune activity and earlier findings have suggested that RA could be tied to vitamin D deficiency. No previous studies, however, have assessed how vitamin D levels impact the clinical course of this condition.

This led a research group helmed by Tomas De Haro Muñoz, MD, of Hospital Universitario Campus de la Salud in Spain, to investigate the relationship between vitamin D levels and the severity of RA symptoms. They measured levels of 25-hydroxyvitamin D (25(OH)D)—a marker of vitamin D status—in blood samples from 78 patients with RA and 41 healthy controls. The researchers also recorded whether the RA patients had active disease or were in remission.

Statistical analysis of 25(OH)D measurements showed that, overall, the RA patients had low 25(OH)D concentrations compared to healthy individuals, with only 33 percent of RA patients displaying adequate vitamin D levels. Notably, 25(OH)D levels were even lower in patients who had active disease and displayed more severe symptoms, such as a higher number of painful and inflamed joints, compared to patients in remission. These findings suggest that targeting vitamin D deficiency could potentially be key to helping patients achieve and maintain RA remission.

Pregnancy

Not all home ovulation tests are equally reliable. Research reveals that two out of three of the digital home ovulation tests sold by U.S. retailers do not accurately predict when a woman is ovulating. This information is critical for women trying to get pregnant and could improve their chances by helping them to better select at-home tests to guide intercourse timing.

Women in the U.S. are waiting longer and longer to have their first babies. As women continue to postpone motherhood, at-home ovulation tests are becoming an increasingly popular way for women to detect when they are ovulating so that they can time intercourse precisely and increase the likelihood of conception in the face of waning fertility. It is therefore imperative that these tests perform with high accuracy, as false results can delay or even prevent conception, which in turn can result in significant emotional stress as well as unnecessary medical investigations.

A team of researchers led by Sarah Johnson, PhD, however, has found that of the three digital home ovulation tests available in the U.S. in 2017, two of them only detected ovulation to within one day in about half of women tested. Only one test gave reliable results, detecting ovulation to within one day in about 95 percent of women tested.

Johnson’s team determined this by testing 33 women with three batches of each digital home ovulation test as well as with transvaginal ultrasonography. The researchers then compared the at-home test and ultrasonography results.

Notably, all three home tests accurately measure lutenizing hormone (LH) levels, which indicate when a woman is ovulating, but the researchers found that other elements of test design are equally important. Tests should provide enough LH measurement sticks so that women do not run out of test sticks before their day of ovulation—an occurrence that would put an unnecessary burden on women to figure out whether they failed to ovulate or simply need to buy more test sticks. Equally essential is having a reliable digital test reader that not only detects the LH surge that precedes ovulation but also accurately displays that result.

Infectious Diseases

The National Institute of Health (NIH) says tickborne diseases are likely to increase. The incidence of tickborne infections in the U.S. has risen significantly within the past decade. It is imperative, therefore, that public health officials and scientists build a robust understanding of pathogenesis, design improved diagnostics, and develop preventive vaccines, according to a new commentary in the New England Journal of Medicine from leading scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH).

Bacteria cause most tickborne diseases in the U.S., with Lyme disease representing the majority (82 percent) of reported cases. The spirochete Borrelia burgdorferi is the primary cause of Lyme disease in North America; it is carried by hard-bodied ticks that then feed on smaller mammals such as white-footed mice and larger animals such as white-tailed deer.

Although there are likely many factors contributing to increased Lyme disease incidence in the U.S., greater tick densities and their expanding geographical range have played a key role, the authors write. For example, the Ixodes scapularis tick, which is the primary source of Lyme disease in the northeastern U.S., had been detected in nearly 50 percent more counties by 2015 than was previously reported in 1996.

The public health burden of tickborne disease is considerably underreported, according to the authors. For example, the U.S. Centers for Disease Control and Prevention (CDC) reports approximately 30,000 cases of Lyme disease annually in the U.S. but estimates that the true incidence is 10 times that number. According to the authors, this is due in part to the limitations of current tickborne disease surveillance, as well as current diagnostics, which may be imprecise in some cases and are unable to recognize new tickborne pathogens as they emerge. These limitations have led researchers to explore new, innovative diagnostics with different platforms that may provide clinical benefit in the future.

Phlebotomy

Guide to good capillary blood sampling. EKF Diagnostics has published an Educational Guide which provides a quick overview of capillary blood sampling best practice. It aims to help healthcare professionals understand common causes of pre-analytical errors and reduce their impact on hemoglobin results. Entitled “Capillary sampling and its relevance for correct hemoglobin results,” it is available to download from the company’s website.

Capillary blood (finger-stick) sampling is increasingly being used worldwide due to the growing availability of point-of-care (POC) testing. With anemia affecting about 25 percent of the global population and a much higher prevalence in developing countries, hemoglobin is the most frequently performed test in POC hematology. It is also used routinely by blood collection services to ensure safe donations.

Notably, hemoglobin (Hb) values are among the parameters most prone to being affected by pre-analytical errors. Incorrect capillary blood sampling is the most common reason for inaccurate POC hemoglobin results. So, in order to avoid generating variant and misleading Hb results, healthcare personnel drawing blood must adhere to strict and standardized blood sampling techniques which ensure accurate and consistent POCT results that are comparable to laboratory techniques.

In addition to discussing the reasons behind the vital importance of good capillary blood sampling, the new guide provides easy step-by-step instructions on best practice capillary sampling. These present a simple visual explanation based on published detailed guidelines from the Clinical and Laboratory Standards Institute and the World Health Organization (WHO), with specific considerations added for hemoglobin testing.

Mental Health

Depression linked to low blood levels of acetyl-L-carnitine. People with depression have low blood levels of acetyl-L-carnitine, according to a Stanford University School of Medicine scientist and her collaborators in a multicenter study. The findings, published online in the Proceedings of the National Academy of Sciences, build on extensive animal research. They mark the first rigorous indication that the link between acetyl-
L-carnitine levels and depression may apply to people, too.

Naturally produced in the body, acetyl-L-carnitine is also widely available in drugstores, supermarkets and health food catalogs as a nutritional supplement. People who live with severe or treatment-resistant depression, or whose bouts of depression began earlier in life, have particularly low blood levels of the substance.

In animal studies, rodents responded to acetyl-L-carnitine supplementation within a few days. Current antidepressants, in contrast, typically take two to four weeks to kick in—in animal experiments as well as among patients.

The new study recruited 20- to 70-year-old men and women who had been diagnosed with depression and, amid episodes of acute depression, had been admitted to either Weill Cornell Medicine or Mount Sinai School of Medicine, both in New York City, for treatment. These participants were screened via a detailed questionnaire and assessed clinically, and their blood samples and medical histories were taken. Twenty-eight of them were judged to have moderate depression, and 43 had severe depression.

When their blood samples were compared with those of 45 demographically matched healthy people, the depressed patients’ acetyl-L-carnitine blood levels were found to be substantially lower. These findings held true for both men and women, regardless of age.

Further analysis showed that the lowest levels occurred among participants whose symptoms were most severe, whose medical histories indicated they were resistant to previous treatments, or whose onset of the disorder occurred early in life. Acetyl-L-carnitine levels were also lower among patients who reported a childhood history of abuse, neglect, poverty, or exposure to violence.

Even as they reported these interesting results, the researchers stressed that significantly more research is needed before any recommendation can be made that supplementation with the substance be used as a treatment for people with depression.

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