News/ Trends/ Analysis

Observatory

News/ Trends/ Analysis

MRSA and C diff deaths down in U.K. The number of deaths in England and Wales for which methicillin-resistant
Staphylococcus aureus (MRSA) and Clostridium difficile
were recorded as a contributory factor fell sharply between 2007 and
2008, but the infections were still responsible for 30,000 deaths in
five years. Data from the Office for National Statistics showed the
number of death certificates mentioning C diff fell by 29%
between 2007 and 2008, to 5,931. This is the first year that mentions of
C diff on a death certificate have fallen since records began in
1999. The number of death certificates mentioning MRSA fell by 23% over
the same period, to 1,230 — the second year in a row that mentions of
MRSA have fallen. Overall, between 2004 and 2008, C diff was
involved in 1:1,000 deaths in England and Wales. MRSA was involved in
3:1,000 deaths.

Cookie dough E coli outbreak remains a
mystery. According to the U.S. Centers for Disease Control and Prevention (CDC),
the multistate outbreak of Escherichia coli O157:H7 linked to
Nestle cookie dough appears to be over, but the issue has not been
adequately resolved, so the agency continues to work with public-health
officials in several states, the U.S. Food and Drug Administration
(FDA), and the U.S. Department of Agriculture Food Safety and Inspection
Service. As of July 31, 2009, 80 people from 31 states were reportedly
infected with a strain of E coli O157:H7 with a particular DNA
fingerprint. Of those cases, 35 people have been hospitalized and 10
have developed hemolytic uremic syndrome. Most patients reported eating
prepackaged raw Nestle Toll House cookie-dough products. In late June,
the FDA found a strain of E coli O157:H7 in a sample of the
recalled cookie dough, but the culture did not match the outbreak
strain. E coli O157:H7 has not been previously associated with
raw cookie dough.

New blood tests spot heart attacks quicker.
Two European
studies have found that new blood tests are capable of detecting if a
person is having a heart attack soon after chest pains start — a time
when current tests are not definitive. Traditional tests can take hours
to register levels of the chemical cardiac troponin in the blood, but
the new tests work more quickly and more accurately, according to the
studies published in the Aug. 27 issue of the New England Journal of
Medicine. In both studies, the accuracy of the newer tests was 94% to
96% compared with 85% to 90% for the older tests.

Blood test for TB often inexact in kids. A new type of blood test for tuberculosis (TB) has limitations for use
in children — especially very young children and those with abnormal
immune function — reports a study in the August issue of The
Pediatric Infectious Disease Journal. London researchers analyzed
the results of interferon-gamma release assays (IGRA) in 237 children
with suspected or possible TB. IGRA tests are increasingly being used in
place of conventional skin tests for diagnosing latent (present but
inactive) TB infection or active TB disease. The study found that 35% of
the children had “indeterminate” results from IGRA tests, meaning the
results were unclear as to whether or not they had TB infection or
disease. Many of the children had abnormal immune function; for this
group, the rate of indeterminate results reached 66%. Indeterminate
results were also more likely for younger children. The IGRA test missed
one-fourth of children who later developed confirmed tuberculosis.

MGUS not linked to as many diseases. A symptomless blood
disorder, monoclonal gammopathy of undetermined significance (MGUS), is
not linked to as many serious diseases as previously thought, according
to a study published in the August 2009 issue of Mayo Clinic
Proceedings. MGUS affects roughly 3% of the U.S. population and has
long been thought to be a precursor of serious diseases, such as
multiple myeloma, primary amyloidosis, and Waldenstrom macroglobulinemia.
Among 17,398 samples tested, the presence or absence of MGUS, 605 cases
of MGUS were identified. Researchers then looked at the incidence of
more than 16,000 different diagnosis codes in the samples with MGUS and
those without. They identified 14 real disease associations, while 61
disease associations with MGUS were determined to be likely
coincidental.

Test for all GI cancers shows promise. Screening for all
cancers of the gastrointestinal (GI) tract may be feasible with a stool
DNA test, says a researcher at the Mayo Clinic, Rochester, MN. Stool DNA
tests detected mutations from the tumors of 68% of patients who had
known GI cancers, located from the oropharynx to the colon, reports
Digestive Disease Week. To assess the feasibility of a stool DNA
test for all GI cancers, the Mayo Clinic team collected samples from 70
patients with proven GI cancers and 70 healthy controls matched by age
and sex (median age 65; 65% male). Researchers identified mutations in
tissue biopsies to serve as markers for each patient's tumor and
searched for the mutations in the stool of the patients and a matched
control. The mutations showed up in 68% of the stool samples from the
patients with cancer and none of the control samples. The test
identified 40% of oropharyngeal, 65% of esophageal, 62% of pancreatic,
75% of biliary/gallbladder, and 100% of stomach and colorectal cancers.
The test also identified 61% of the patients with precancers — 100% of
pancreatic intraductular papillary mucinous neoplasia and 56% of
colorectal advanced adenoma.

Urinary marker predicts diabetes complications. Increased urinary excretion of the protein IgM in patients with type 1
diabetes was associated with an elevated risk for cardiovascular
mortality and end-stage renal disease, which may represent a prognostic
marker for these complications, a new study suggests. Increases in
urinary excretion of albumin caused by dysfunction in the glomerular
barrier are characteristic of early diabetic neuropathy, according to
Sweden's Lund University researchers, but as the kidney damage
progresses and structural changes develop, large molecules such as IgM
also can cross the barrier and appear in the urine. To clarify the
potential prognostic impact of IgM excretion, particularly in light of
varying degrees of albuminuria, researchers recruited 139 patients from
an outpatient clinic beginning in 1984, and followed them until 2007 or
death. During the study period 38 patients died — 32 from cardiovascular
events — and 20 developed end-stage renal disease. Researchers
determined that IgM excretion predicted cardiovascular mortality and
renal failure independently of the level of albuminuria. Regardless of
the degree of albuminuria, patients with high IgM excretion had at least
a threefold higher risk of cardiovascular death, the researchers
concluded.

Spit could aid oral-cancer detection. Researchers
have successfully identified markers of oral cancer in saliva, according
to a report in Clinical Cancer Research. Scientists measured microRNA
levels in the saliva of 50 patients with oral squamous-cell carcinoma
and 50 healthy control patients. They identified at least 50 microRNAs
that may be associated with oral cancer. Two specific microRNAs,
miR-125a and miR-200a, were present at significantly lower levels in
patients with oral cancer than in the healthier controls. Scientists say
the findings published in the journal Clinical Cancer Research need to
be confirmed.

Conferences

Oct. 24-27.
AABB's Annual Meeting and TXPO 2009 for transfusion and cellular-therapy
professionals will take place at New Orleans' Ernest N. Morial
Convention Center. The event will feature 130 educational
sessions and nearly 200 exhibitors. Go to
www.aabb.org .

Oct. 27-28. AACC's 10th Anniversary Laboratory Automation Conference in Kansas City, MO, features top automation experts to teach you how to optimize your laboratory systems through innovative software solutions; use automation and data management to maximize your workforce resources and increase lab efficiency; amplify lab ROI through strategic implementation of quality techniques; and apply middleware solutions to strengthen process control. Learn more at

http://www.aacc.org/events/meetings/Pages/5707.aspx .

Oct. 29-30. Join top experts at “Lab Automation: Finding the Right Fit for Your Lab” at
the Little America Hotel in Salt Lake City for tips and strategies for lab
automation projects, and tours of ARUP automated laboratories. Visit
www.aacc.org .

Nov. 5-6. “Translating Novel Biomarkers to Clinical Practice: Role and Opportunities
for the Clinical Laboratory” in Bethesda, MD, will feature discussions of
clinical proteomics, co-development of therapeutic compounds and proteomic
assays, regulation of technologies, and developments in standardization.
Go to www.aacc.org.  

Nov. 19-22. The Association for Molecular Pathology 2009 Annual Meeting at the Gaylord
Palms Resort and Convention Center, Kissimmee, FL, will cover the major
areas of clinical molecular diagnostics: hematopathology, infectious
diseases, inherited genetic diseases, and technical topics. Visit
www.amp.org/2009 .

Dec. 5-8. The American Society of Hematology's 51st annual meeting at the Ernest N. Morial Convention Center in New Orleans, offers dozens of sessions covering the breadth of hematology, including nanotechnology, complementary medicine, emergency preparedness, and the impact of healthcare disparities on patient outcomes based on factors such as race, socioeconomic status, geography, and age. See more at
www.hematology.org/Meetings/Annual-Meeting .

Jan. 29-30, 2010. The 17th Annual First Coast Infectious Disease/Clinical Microbiology Symposium will be held at the Renaissance Resort at World Golf Village, St. Augustine, FL. To access program and register online go to
www.firstcoastidcm.com .

Webinars

Oct.13. 2:00 p.m.-3:30 p.m. ET. “Health Care Reform and the Clinical Laboratory.” Congress is working on legislation that would overhaul the entire health-delivery system, including laboratory operations. If enacted, this bill may significantly impact testing volume, utilization patterns, coverage policy, laboratory reimbursement, and more. Learn what these changes may mean for the laboratory community. Register at www.aacc.org/events/meetings/Pages/5696.aspx .

Nov. 4, 11:00 a.m. – 12:00 p.m. “Slaying Sepsis: Saving Lives with Faster and Better Treatment,” part of
Instrumentation Laboratory's ILluminations Webinar Series, offers
information on the early diagnosis of sepsis and septic shock with. Jeffrey
C. Fried, MD, an expert in critical care medicine, who will discuss the
relationship between rapid treatment and mortality, including the use of
lactate measurements in early diagnosis. Register for this free webinar at
www.ilus.com/illuminations .

Ongoing: “Demystifying Clinical Use of Cardiac Markers: Troponin and Natriuretic Peptides” addresses the variety of factors that affect the clinical utility of troponin and natriuretic peptides. Learn how these variables affect tests and know how best to use them clinically. Two sessions include “Demystifying Troponin” and “Demystifying Natriuretic Peptides.” Links to free programs are at
www.aacc.org/events/online_progs/cardiac-markers/Pages/default.aspx .

Ongoing: “Weathering the Storm: Surviving and Succeeding in
Today's Economy,” part of an AACC Executive Thought Leadership Series
supported exclusively by Siemens Healthcare Diagnostics, contains the
audio and PowerPoint presentation in a synchronized format. This program
is available on demand at no charge at www.aacc.org .

AUDIOCONFERENCES

Ongoing: Order the recording of “Automated Histology in the Clinical Laboratory: Best Practices and New Technologies” at
www.g2reports.com/audioconferences/1103.html . This session offers an in-depth view of emerging technologies that are transforming the clinical histology market. Learn about new histological assays and improved technology, and gain an understanding of what pitfalls to avoid when integrating new technologies.

Ongoing: Order the CD of “How to Achieve Cost Savings for Your Lab by Analyzing Test Utilization Patterns” at
www.g2reports.com/audioconferences/1089.html . This presentation describes how laboratories can save shave hundreds of thousands of dollars every year by identifying and eliminating expensive tests that are of little to no clinical value.