Over-the-counter drugs, dietary supplements and their effect on lab test results

Over-the-counter (OTC) drugs and dietary supplements are widely used and popular, with US households spending an average of almost USD 350 annually on OTC products. In 2006 an average of EUR 67.50 was spent per person on OTC products in Germany.

The use of various OTC drugs and dietary supplements is highly prevalent in Europe and patients are often not willing to disclose this information to laboratory staff and the ordering physician as a survey published in Clinical Chemistry and Laboratory Medicine, published by De Gruyter in association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM), shows.

The study reports on the results of a survey of patients in 18 European countries which shows that those taking OTC products and dietary supplements are not aware of the potential effects on laboratory test results they may have. In addition, patients do not believe that they need to disclose this use to medical and/or laboratory staff.

The study shows that dietary supplements and OTC drugs are more frequently used by middle-aged patients – especially women – with the most common being multivitamins, multiminerals, cranberry and aspirin. All of these compounds, if consumed shortly before blood sampling, may cause changes in lab test results, thus leading to interpretation difficulties and possibly incorrect diagnoses.

Although more data is needed about the frequency of the consumption of various dietary products, vitamins or OTC drugs, the authors believe that a multifaceted approach is necessary to draw attention to the issue using educational interventions which target both healthcare professionals and patients.

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Field test for dog Leishmania exposure evaluated

Dogs infected with Leishmania infantum, a parasite transmitted by the sand fly Phlebotomus perniciosus, are at risk for spreading leishmaniasis infections to humans. A new test, described and evaluated this week in PLOS Neglected Tropical Diseases, provides an easier-than-ever way to test dogs for exposure to P. perniciosus sand flies, and could be used in monitoring the effectiveness of sand fly control efforts.

Canine leishmaniasis (CanL) is a severe multi-systemic disease of dogs that has been reported throughout countries in Latin America, Europe, and Asia. Over 2.5 million dogs are estimated to be infected in southern Europe and the infection is difficult to treat. Control efforts often revolve around targeting sand fly populations. Current ELISA tests, for the presence of a P. perniciosus sand fly saliva protein, are limited to use in a laboratory— rather than field— setting.

In the new work, Laura Willen, of Charles University, Czech Republic, and colleagues prepared an immunochromatographic test (ICT) to rapidly screen dogs for the presence of P. perniciosus. The ICT detects the same antibodies against the fly’s salivary protein—SP03B—as an existing ELISA test. To optimize the test, the team used 53 laboratory-bred Beagles that had either been exposed or unexposed to 200 P. perniciosus sand flies.

When they compared the ICT to two existing ELISA tests, results were in nearly 100% agreement and the ICT was found to have a sensitivity of 100% and a specificity of 86.79%. Raising the detection limit of the test would lead to a specificity of 96.23% without changing the sensitivity.

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PSA: This Online Tool Makes Getting An STI Test Way Less Embarrassing

Let’s be real: Getting screened for an STI can be embarrassing, uncomfortable and pretty bloody awkward. But with sexually transmitted infection rates increasing across Australia year on year, it’s never been more important to get your bits tested.

Enter: Stigma Health, the online tool that provides patients with a personalised pathology request without the hassle of going to the doctors.  And the best part? For the month of September, it’s completely free. 

How it works:

Your risk profile will be determined by your responses to a series of yes/no questions – just like the ones your GP would ask during a face-to-face appointment. Your answers will then be sent to the doctor and you’ll then be issued with the appropriate pathology form for your specific concerns. After taking the test at a collection centre of your choice, you’ll be informed via text when your results are ready. And if your test returns positive, you’ll then be advised on the next steps to take. 

But be warned: not all STI’s can be picked up using this method. If you’re worried about genital warts or herpes, you’ll need in-person medical advice. 

For more details head to Stigma Health.

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$20 blood test could help diagnose hepatitis B patients across Africa

A simple $20 blood test could help diagnose thousands of patients with hepatitis B in need of treatment in some of Africa’s poorest regions.

Researchers have developed an accurate diagnostic score that consists of inexpensive blood tests to identify patients who require immediate treatment against the deadly hepatitis B virus—which can lead to liver damage or cancer.

The score consists of two simple blood tests: one measuring presence of antigens, proteins produced by the virus, and another for enzymes produced by the liver in response, to accurately assess patients for treatment.

The score was found to be as accurate as existing methods for identifying the patients in need of immediate treatment but at a fraction of the cost, $20 compared to $100-500 for current tests.

It is also far more accessible than existing methods—such as liver biopsy or HBV DNA, a much more complicated blood sample analysis—which requires resources and laboratories that are not always accessible in sub-Saharan Africa.

Researchers from Imperial College London and Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, collaborating with the Pasteur Institute in Paris and other African and European institutions, used data from hundreds of hepatitis B patients in The Gambia who were part of the PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa) study.

Clinical data from more than 800 hepatitis B patients, who had been tested through the PROLIFICA programme, were used to develop this new score.

The tests were then validated with data from African patients in Senegal, Burkina Faso, Germany, France and the UK. The results are published in the Journal of Hepatology.

The new diagnostic test, called TREAT-B, was found to accurately identify HBV positive patients who require treatment in 85% of cases (called sensitivity), and could accurately identify those who do not need treatment in 77% of cases (called the specificity).

The scientists say that further research is needed but if the test is successful in larger studies it could be used widely to identify patients in need of hepatitis B treatment and refer thousands of people for life-saving treatment. The test could also be developed further to be implemented as a finger-prick test, similar to those used to detect HIV, to get quicker results.

The researchers also discovered that the diagnosis method worked at all stages of the disease—meaning that people in the early stages of liver disease without symptoms could also be screened and identified.

Imperial’s Dr. Maud Lemoine, co-author of the study, said: “These results show that this simple and inexpensive test could be an accurate way to diagnoses patients in need of hepatitis B treatment in countries with limited resources.

“This could potentially help diagnose and subsequently treat thousands of people across Africa.”

Co-author, Yusuke Shimakawa from the Pasteur Institute said: “Once these results are validated by further studies, they could be potentially integrated into the WHO guidelines and local guidelines—and implemented in daily practice.

“There is great potential to diagnose more people and improve access to treatment.

Viral hepatitis is a major global health problem and in 2013 an estimated 1.45 million people died from the virus. It is the seventh leading cause of death worldwide and about half of deaths are attributable to the hepatitis B virus infection.

The hepatitis B virus infects around 250 million people worldwide, and is transmitted through blood and bodily fluids. In Africa, it is commonly transferred from mother to baby during birth or between children. However the virus causes no immediate symptoms, and can remain undetected in the body for decades until triggering severe complications such as liver damage (cirrhosis) and cancer.

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Study provides promise in search for simple, early test for Alzheimer’s disease

Researchers at Indiana University have found early evidence that tiny snippets of genetic material called microRNA may help with early detection of conditions such as Alzheimer’s disease.

The study, published June 18 in Scientific Reports, found that changes in microRNA are detectable in mice long before they start to show symptoms from neurodegeneration. These microRNA changes may represent an early warning sign, or “biomarker,” for the condition.

“Identifying biomarkers early in a disease is important for diagnosing the condition, and following its progression and response to treatment,” said Hui-Chen Lu, a professor in the Linda and Jack Gill Center for Biomolecular Science and the Department of Psychological and Brain Sciences, a part of the IU Bloomington College of Arts and Sciences, who led the study. “You need something that can predict your future.”

There is currently no treatment to stop or reverse the effects of neurodegenerative diseases such as Alzheimer’s, Parkinson’s, ALS or Huntington’s. It’s also estimated that Alzheimer’s disease alone, which is the most common of these disorders, will affect 14 million Americans and cost taxpayers $1.1 trillion by 2050.

Unlike regular “messenger RNA,” which direct cells to produce specific proteins, microRNA plays a regulatory role, increasing or decreasing the number of proteins that messenger RNAs encode. A single snippet of microRNA can impact the function of tens or hundreds of proteins in the body.

Due to their stability in urine and blood, there is growing interest in using microRNA as biomarkers for disease prediction and diagnosis. Lu’s study is an early step to learn whether microRNA can be used to detect neurodegenerative disorders.

To explore this question, Lu and colleagues analyzed microRNA and messenger RNA in two groups: a healthy group and a group genetically modified to develop symptoms of dementia. The team found the highest level of “dysregulation”—or deviation from normal levels—in the microRNA of the dementia group before their physical symptoms developed.

“Higher levels of pre-symptomatic microRNA dysregulation are significant because it strongly suggests that it may have a role in changes in the brain in later stages,” Lu said.

The team then compared the microRNA changes to the messenger RNA changes to identify biological pathways affected by microRNA dysregulation. Their analysis suggested that changes in microRNA affected pathways related to immunity in the dementia-prone model.

In response, the team then conducted additional tests to study a specific type of microRNA that was elevated in the dementia model. The microRNA—called microRNA 142—is known to play a major role in inflammation, a part of the immune response.

They found that introducing this microRNA into the brain triggered a significant neuroinflammation. The result is important since many other studies have shown that chronic inflammation contributes to many types of disease, including neurodegeneration, Lu said.

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