A team of researchers have discovered a new way for early detection of a potentially deadly fungal infection in patients with suppressed immune systems such as those being treated for leukemia or who have had an organ transplant.
A multidisciplinary research group led by Allan Brasier of The University of Texas Medical Branch at Galveston.
Patients receiving leukemia chemotherapy treatments, bone marrow stem cell transplants or lung transplants are some of those at risk for serious infection by the disease-causing Aspergillus fungus, a common mould in the environment that easily becomes airborne. When inhaled, the mould colonizes the respiratory tract. In patients with immune suppression from their chemotherapy treatment, the mould invades into the bloodstream where it spreads and infects several organs including the liver, lungs and brain. People with normal immune systems are able to destroy the inhaled mould without becoming infected.
Despite close monitoring for infection and aggressive anti-fungal therapy in vulnerable people, the fatality rates are as high as 50 to 90 percent depending on a patient’s underlying disease and site of infection. While early diagnosis can improve the patient’s outcome, timely detection of the infection is difficult.
Currently, the infection is diagnosed with X-rays and tests that measure levels of fungal molecules that produce an immune reaction in a patient’s blood. These tests are not very accurate and often can lead to a wrong diagnosis.
The study describes how the team studied patients undergoing chemotherapy for leukemia, bone marrow transplants and lung transplants from several of the collaborating institutions and identified, confirmed and evaluated a new method of detecting the infectious mould in patients with leukemia. Similar people with no health conditions participated in the study as a comparison group.
The test results for the mould were different for each group of patients, so future commercial diagnostic tests using this technology should be tailored for different medical conditions commonly linked with this infection.
Brasier, director of UTMB’s Institute for Translational Sciences, said the breakthrough was ‘an example of successful collaboration that brought together experts in several different scientific fields to approach a difficult problem.’ The team’s discovery could translate to refined diagnostics, earlier treatment and improved survival for patients affected by this infection. More studies will be needed to confirm and validate this panel as a diagnostic test in independent patients.

The University of Texas Medical Branch at Galveston http://tinyurl.com/hezj57l

For children with autism and a class of genetic disorders, exposure to diagnostic ultrasound in the first trimester of pregnancy is linked to increased autism severity, according to a study conducted by researchers at UW Medicine, University of Washington Bothell and Seattle Children’s Research Institute.
The study looked at the variability of symptoms among kids with autism, not what causes autism. The researchers found that exposure to diagnostic ultrasound in the first trimester is linked to increased autism symptom severity. The greatest link is among kids with certain genetic variations associated with autism; 7 percent of the children in the study had those variations.
Food and Drug Administration (FDA) guidelines recommend that diagnostic ultrasound be used only for medical necessity.
‘I believe the implications of our results are to bolster the FDA guidelines,’ said corresponding author Pierre D. Mourad, a UW professor of neurological surgery in Seattle. He is also a professor of engineering and mathematics at UW Bothell. As a UW Medicine scientist, he specializes in translational research on ultrasound and the brain.
Mourad said their results are related to the first trimester of pregnancy. Data from looking at the effect of ultrasound on the second and third trimester showed no link, he said.
Mourad said he and his colleagues now intend to look more closely into links between ultrasound and autism severity, as well as the possibility – thus far not shown – that ultrasound exposure could contribute to autism incidence.

UW Medicine http://tinyurl.com/hupd4oq

SpiroCall enables patients to measure lung function over a phone call. It is designed to work with any type of phone around the world, not just smartphones.
Most people in the developing world who have asthma, cystic fibrosis or other chronic lung diseases have no way to measure how well their lungs are functioning outside of a clinic or doctor visit. But many do have access to a phone, though it may be a 10-year-old flip phone or a communal village landline instead of the latest app-driven smartphone.
That’s why University of Washington computer science and engineering and electrical engineering researchers have developed SpiroCall, a new health sensing tool that can accurately measure lung function over a simple phone call.
A paper to be presented shows that SpiroCall’s results came within 6.2 percent of results from clinical spirometers used in hospitals and doctor’s offices, meaning it meets the medical community’s standards for accuracy.
‘We wanted to be able to measure lung function on any type of phone you might encounter around the world – smartphones, dumb phones, landlines, pay phones,’ said Shwetak Patel, Washington Research Foundation endowed professor of computer science & engineering and electrical engineering at the UW. ‘With SpiroCall, you can call a 1-800 number, blow into the phone and use the telephone network to test your lung function.’
In 2012, researchers from the UW’s UbiComp Lab introduced SpiroSmart – which lets people monitor their lung function by blowing into their smartphones.
The patients take a deep breath in and exhale as hard and fast as they can until they can’t exhale any more. The phone’s microphone senses sound and pressure from that exhalation and sends the data to a central server, which uses machine learning algorithms to convert the data into standard measurements of lung function.

University of Washington http://tinyurl.com/hgpmr2u

About a quarter of healthcare providers said their virtual care programmes – telemedicine and telehealth – are financially sustainable and are improving efficiency, patient volumes and loyalty by filling gaps in medical specialties or helping chronically ill patients, according to a poll conducted by KPMG LLP, the U.S. audit, tax and advisory firm.
Telehealth, which uses technology to connect clinicians with patients, is gaining credence in urgent care settings from mobile devices, ‘primary care plus’ from retail clinics or for psychiatric assessments in an emergency department. Telemedicine – clinician-to-clinician consults – has a long history in radiology and for remote, underserved patient populations where specialists are needed for their clinical expertise, but it is gaining greater use. For example, telemedicine is used for neurology consults for stroke patients and also for referring nursing home patients to hospitals if they need more acute care.
‘Healthcare providers need to think of virtual care as a means to improve patient access and provider efficiency, especially as value-based contracts and other reimbursement incentives gain a greater share of revenue, while meeting patient care needs by filling gaps for key medical specialties,’ said Dr. Richard Bakalar, managing director at KPMG and a member of the firm’s Global Healthcare Center of Excellence. ‘Telehealth is rapidly evolving beyond urgent care and is increasingly used for follow up visits and helping chronically ill patients connect with their doctor online. Health plans and government payers are seeing the value from the technology and enhancing reimbursement for virtual care.’
Yet, approximately 35 percent of respondents in the poll said they have not yet started a programme incorporating virtual care, and the remaining 40 percent are in early stages.

• KPMG’s poll found that the biggest drivers for expediting adoption of virtual care were:
• Increase patient volumes and loyalty (29 percent)
• Care coordination of high risk patients (17 percent)
• Reduce costs for access to medical specialists (17 percent)
• Meaningful use and payer incentives for adoption (13 percent)
• Patient requests/consumer demand (13 percent).

Implementing a virtual care programme is not without challenges, however. Healthcare providers cited several, including:

• Too many other technological priorities (19 percent)
• Maintaining a sustainable business model (18 percent)
• Organizational readiness to implement new services/technology (18 percent)
• Regulatory compliance and risk concerns (15 percent).

KPMG LLPhttp://tinyurl.com/hlgwoyk

Patients who have had a stroke in the back of the brain are at greater risk of having another within two years if blood flow to the region is diminished, according to results of a multi-centre study led by researchers at the University of Illinois at Chicago. These stroke patients are the most likely to benefit from risky intervention to unblock arteries, and they can be identified using a new MRI-based technology developed at UIC.
The vertebrobasilar region in the back of the brain is responsible for locomotion and balance. Vertebrobasilar strokes can be devastating, causing partial or total paralysis. They account for 30 percent to 40 percent of all strokes, or about 200,000 cases per year in the U.S.
Stroke patients found to have narrowing of the blood vessels in the back of the brain caused by atherosclerosis can have angioplasty, a procedure to open blocked arteries, but the procedure carries its own risks. And because blockages don’t always correlate to locally reduced blood flow – thought to be the real culprit in raising stroke risk – researchers wanted to better understand the relationship between arterial blockages, blood flow, and recurrent strokes.
‘Having a blockage present in a blood vessel doesn’t always correlate to low blood flow,’ says Dr. Sepideh Amin-Hanjani, professor of neurological surgery at the UIC College of Medicine and principal investigator on the study. ‘There can be a blockage and flow can be normal, if other nearby blood vessels are able to compensate.’
She and her colleagues wanted to try to identify which stroke patients are at highest risk for further strokes and so might benefit from angioplasty despite the risks of the procedure.
They followed 72 adult patients who had a stroke or temporary symptoms of a stroke, known as a transient ischemic attack, in the back of the brain and who also had at least 50 percent blockage of the arteries in that part of the brain. The patients were followed for an average of 22 months at five academic medical centres as they continued receiving standard care for their condition from their neurologists.
Participants were evaluated for reduced blood flow in the back of the brain using NOVA, or Noninvasive Optimal Vessel Analysis, a software program that can quantify the volume, velocity, and direction of blood flowing through any major vessel in the brain using standard MRI equipment. The NOVA software was developed at UIC by Dr. Fady Charbel, professor and head of neurological surgery, who is a co-author of the new study.
One-fourth of the study participants were found to have diminished blood flow in the back of the brain, which turned out to be a significant predictor of subsequent stroke. These patients had 12- and 24-month stroke-free survival rates of 78 percent and 70 percent, respectively, compared to 96 percent and 87 percent for patients with normal blood flow.
‘At one year, the risk for patients with low blood flow was about five times as high as risk for patients without low flow in the back of the brain,’ Hanjani said. For these patients, the benefits of angioplasty probably outweigh the risks.
‘About three-quarters of patients didn’t have low blood flow in the vertebrobasilar region – other arteries are doing the job of ensuring that proper blood flow is reaching that area – and these patients would not benefit from treatments aimed at opening the vessels, such as angioplasty – in fact, the procedure would put these patients at unnecessary risk,’ Hanjani said.

University of Illinois at Chicago http://tinyurl.com/jxl37yo