A study of portable ultrasound carried out in the USA, Canada and India has revealed the potential of this technology for detecting plaques in peripheral arteries that can lead to heart attacks and stroke before symptoms arise, in both developed and developing country settings, allowing preventive treatment in those affected. The study is by Dr Ram Bedi, Affiliate Assistant Professor, Department of Bioengineering, University of Washington, Seattle, WA, USA, and Professor Jagat Narula, Editor-in-Chief of Global Heart and Icahn School of Medicine at Mount Sinai, New York, USA, and colleagues.

Numerous research studies have shown that it is possible to assess subclinical atherosclerotic cardiovascular disease (ASCVD) using ultrasound imaging. Since more portable and lower cost ultrasound devices are now entering the market, along with increased automation and functionality, it may be possible in future to routinely examine people with ultrasound to establish any ASCVD present before symptoms emerge, so that future disease can be prevented, for example using medication. In this study, ASCVD was determined using ultrasound of both the carotid arteries (those in the neck) and the ileofemoral arteries (entering the top of the leg). The findings were conveniently summarised in an easy to understand index called the Fuster-Narula (FUN) Score.

Data were gathered from 4 cohorts, 2 Indian and 2 North American. In India, a medical camp setting was used, and screening with automated ultrasound imaging was conducted over 8 days in 941 relatively young (mean age 44 years, 34% female) asymptomatic volunteers recruited from the semiurban town of Sirsa (Haryana) and urban city of Jaipur (Rajasthan) in northern India. The cohort from Sirsa was specifically recruited because all participants had already undergone aggressive lifestyle changes (smoking cessation, no alcohol, vegetarian diet, physically active lifestyles, daily meditation), Radiology resident doctors who had no prior training in vascular ultrasound were trained on the spot to perform the ultrasound examinations.

To compare the imaging findings with traditional risk factors, 2 cohorts (481 persons) were recruited from primary care clinics in North America (one in Richmond, Texas, USA, the other in Toronto, Canada). As well as the same ultrasound examinations given in the Indian cohort, comprehensive ASCVD risk factor data was gathered from these participants, all of whom were self-referred asymptomatic individuals (mean age 60 years, 39% female). Data collected included cholesterol levels, blood pressure, glucose level, weight, height, smoking and family history. These people were attending clinics for routine health examinations in most cases. Effectiveness of established ASCVD prevention guidelines was then compared to results from direct imaging. Ultrasound was performed by trained experts at each centre.

In India, ultrasound revealed plaques in at least one artery in almost a quarter (24%) of those examined; 107 (11%) had plaques in only the carotids, 70 (7%) in both the carotids and iliofemoral arteries, and 47 (5%) had plaques in only the iliofemoral arteries. If just the carotids had been examined, 177 (19%) of the asymptomatic subjects would have been identified with plaques; by adding the iliofemoral examination, 47 additional individuals (5% of the total) were identified with plaque. Older age and male sex were associated with the presence of plaque both in urban and semiurban populations (the much higher levels of smoking in men could account for their higher risk).

Data from the American and Canadian clinics showed that 203 subjects (42%) had carotid plaque; 166 of these (82% of those with plaque) would not have qualified for lipid-lowering therapy such as statins under the most widely used guidelines known as ATP III (Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [Adult Treatment Panel]) guidelines. Using the recently published more stringent ATP IV guidelines, 67 people (one third of those with plaque and 14% of the total US/Canadian cohort) individuals with carotid plaque would also have failed to qualify for treatment.

In addition, the study revealed 34 people in the USA/Canada setting who qualified for treatment under ATP III but did not have any plaques, and this number increased to 81 under ATP IV (if receiving treatment such as statins, these people could be said to be overtreated, since no plaques were evident).

The authors say: ‘Our study shows that automation in ultrasound imaging technology allows even non-expert users to rapidly evaluate the presence of subclinical atherosclerosis in a large population. Detection of subclinical atherosclerosis is further enhanced by inclusion of the iliofemoral artery examination.’ EurekAlert

Use of the same syringe or needle to give injections to more than one person is driving the spread of a number of deadly infectious diseases worldwide. Millions of people could be protected from infections acquired through unsafe injections if all healthcare programmes switched to syringes that cannot be used more than once. For these reasons, WHO is launching a new policy on injection safety to help all countries tackle the pervasive issue of unsafe injections.

A 2014 study sponsored by WHO, which focused on the most recent available data, estimated that in 2010, up to 1.7 million people were infected with hepatitis B virus, up to 315 000 with hepatitis C virus and as many as 33 800 with HIV through an unsafe injection. New WHO injection safety guidelines and policy released today provide detailed recommendations highlighting the value of safety features for syringes, including devices that protect health workers against accidental needle injury and consequent exposure to infection.

WHO also stresses the need to reduce the number of unnecessary injections as a critical way of reducing risk. There are 16 billion injections administered every year. Around 5% of these injections are for immunizing children and adults, and 5% are for other procedures like blood transfusions and injectable contraceptives. The remaining 90% of injections are given into muscle (intramuscular route) or skin (subcutaneous or intradermal route) to administer medicines. In many cases these injections are unnecessary or could be replaced by oral medication.

 Patients who received post-operative radiation therapy (PORT), radiation therapy after surgery, lived an average of four months longer when compared to the patients who had the same disease site, tumour histology and treatment criteria and who did not receive PORT, according to research. The Symposium is sponsored by the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO), the International Association for the Study of Lung Cancer (IASLC) and The University of Chicago Medicine.

This study reviewed the records of non-small cell lung cancer patients treated from 2004 to 2006 from the National Cancer Data Base (NCDB), a joint endeavour of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The study authors acquired the data for patients who had surgically resected non-small lung cancer with pathologically involved N2 (pN2) lymph nodes (tumours had spread to the lymph nodes in the centre of the chest (the mediastinum)) and who received chemotherapy. The database was further queried to exclude patients with positive margins, incomplete survival data, those who did not receive adjuvant chemotherapy, histology other than NSCLC, and patients treated with Cobalt-60, non-beam radiotherapy or neoadjuvant radiotherapy. Two thousand one hundred and fifteen patients (2,115) met all of the study criteria. Forty-three percent of patients (918) received PORT; 56.6 percent of the patients (1,197) were not treated with PORT.

Factors associated with overall survival (OS) were assessed through a multivariable Cox proportional hazards model. Inverse probability of treatment weighting (IPTW) using the propensity score was also implemented to reduce biased treatment selection. Using an adjusted Kaplan-Meier estimator and the weighted log-rank test based on the IPTW, patients treated with PORT had an improved overall survival (median survival time) of 42 months compared to 38 months for the patients not treated with PORT (p=0.048).

Multivariable analysis revealed that female gender, adenocarcinoma histology, higher income, urban/rural setting vs. metropolitan setting, lower T state, 1-2 involved lymph nodes vs. ≥3 examined and involved lymph nodes, and younger age correlated to better OS (p<0.05). No direct relation was found between the effects of PORT and the number of involved lymph nodes.

The cost of patients not taking their medications as prescribed can be substantial in terms of their health. Although a large amount of research evidence has tried to address this problem, there are no well-established approaches to help them, according to a new systematic review published in The Cochrane Library. The authors of the review examined data from 182 trials testing different approaches to increasing medication adherence and patient health. Even though the review included a significant number of the best studies to date, in most cases, trials had important problems in design, which made it hard to determine which approaches actually worked.

Only about half of all patients who are prescribed medication that they must administer themselves actually take their medication as prescribed. Many stop taking medication all together and others do not follow the instructions for taking it properly. This has been the case in many different diseases for at least the last half a century. In conditions where effective drug treatments are available, patients who take their medications as per their provider

Novel geometrically encoded magnetic sensors (GEMs), developed by researchers from NIST and NIH, respond to local biochemical conditions