EKF Diagnostics, the global in vitro diagnostics company, has published a guide to ‘Diabetes and HbA1c testing’ which can be found at EKF’s new Diabetes Portal (www.ekfdiagnostics.com/diabetes-portal.html). This new educational guide draws on EKF’s expertise in the diagnosis and monitoring of diabetes and associated conditions. It provides an overview of the global diabetes ‘epidemic’, symptoms and complications, through to discussion on methods for diagnosis and monitoring using both glucose and HbA1c testing, with consideration given to factors influencing their measurement.
Diabetes is a growing issue, particularly in developing countries, with five million people dying from diabetes related complications in 2015 alone. Although not an ‘epidemic’ in the conventional sense, there are currently 415 million people living with diabetes and this is predicted to grow to 642 million by 2040. Approximately 46% of people living with diabetes are doing so without a full and proper diagnosis with subsequent complications, and associated healthcare costs.
There are multiple options for the diagnosis of diabetes, most of which involve measuring the level of glycemic control a person exhibits. In addition to methods such as fasting plasma glucose and two-hour plasma glucose, another option is to use glycated hemoglobin (HbA1c) which reflects average plasma glucose over an 8-12 week period. As well as lab-based testing, WHO has approved HbA1c for diabetes diagnosis with a Point of-Care-Testing (POCT) device, providing the test is undertaken by a trained professional adhering to an appropriate External Quality Assurance scheme and using a methodology traceable to the IFCC reference method. POCT HbA1c testing gives a strong indication of both diabetes and pre-diabetes within a timeframe that enables immediate intervention.
Since it is not impacted by the same issues as blood glucose monitoring, HbA1c testing is fast becoming the preferred technique for diabetes and pre-diabetes diagnosis and monitoring. There are situations where use of HbA1c is not appropriate though. EKF’s new Guide includes discussion on both glucose and HbA1c testing and where factors may influence measurement of both diagnostic markers.
“The often ‘low to no’ maintenance approach to disease management of diabetes is not only dangerous but can also significantly contribute to ongoing healthcare costs. At present, approximately 12% of global health expenditure is spent on diabetes, and without significant changes to the way patients and health systems monitor glycemic control this will surely rise,” said Gavin Jones, Global Product Manager for Diabetes Care at EKF Diagnostics. “To enhance patient outcomes and reduce the cost for long-term healthcare of the diabetic and pre-diabetic population, we aim to improve patient access to diabetes care techniques, whatever their location. This can be achieved by providing affordable, easy-to-use POCT analysers and chemistry assays for both diabetes diagnosis and monitoring.”
EKF’s expertise and product range cover all aspects of diabetes care, from research and hospital laboratories to diabetes clinics, emergency rooms and GP surgeries. Products include the Biosen C-Line glucose analyser, which uses chip sensor technology to provide low cost, fast and lab accurate glucose results. Quo-Test and Quo-Lab point-of-care HbA1c analysers that deliver results meeting NGSP and IFCC POC requirements in four minutes. And lastly, to aid the diagnosis and monitoring of diabetes related conditions such as ketoacidosis, EKF offers Beta-Hydroxybutyrate LiquiColor Reagent and the handheld STAT-Site M β-HB strip-based analyser.
www.ekfdiagnostics.com

Simpler, easier method for performing biopsy can improve patient care
A simpler biopsy procedure than the one traditionally used can give equally good results while reducing stress for patients and workers, and allowing for faster diagnosis, according to a study.
During various procedures performed by gastrointestinal endoscopists, small tissue samples are taken from the patient for examination, which is known as biopsy. The traditional endoscopic forceps biopsy method can be labour intensive as well as stressful for the workplace environment.
With this method, each specimen is removed and placed in fixative vial for identification. This is labour intensive, adding to the length of the procedure and the time under sedation. Biopsy samples from each site are filtered to remove fixative, inspected to record specimen number and size, and transferred to a container to undergo several more processing steps before being mounted on slides to be examined for abnormalities or disease.
According to the study authors, diagnosis is delayed by this complex and costly protocol. In addition, staff may be affected by ergonomic stress and workplace risk from exposure to sharps, toxic fixative, infectious material, and soil.
The researchers aimed to test a faster way of collecting, handling and processing the samples to slides through a method called endoscopic multiple biopsy (MB).
MB uses a single endoscope pass within the patient to obtain up to 25 biopsy specimens during withdrawal of the endoscope. These are collected and stored in a plastic chamber inside the removable metal tip of the endoscope. After completing the biopsy series, the metal tip is cut off, immersed in fixative, and sent to pathology. There, the plastic storage chamber’s design supports rapid logging of specimens, diagnosis by frozen section and microwave (one hour) or routine paraffin processing (four to six hours) of the specimen tissue.
For the study, biopsies were performed during colonoscopy, upper GI endoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). The blinded retrospective study compared 125 colon surveillance biopsies in 15 patients who underwent MB with 15 patients who underwent forceps biopsies performed on the same day.
The researchers found that the processed MB specimens were not significantly different from batched processed forceps biopsy specimens for depth, orientation (done manually), fixation, artifacts, and diagnostic information. Multiple biopsy colonic specimens were significantly (26%) smaller but had better epithelial (cellular covering) preservation than forceps specimens. Each biopsy saves 61 seconds during withdrawal.
The authors concluded that single-pass MB reduces biopsy time with less specimen damage, work, workplace risk, and soiling. Diagnostic quality is equal to forceps biopsy with better cellular preservation, although 26% smaller. In pathology, the plastic chamber reduces work and workplace risk. MB speeds diagnosis and improves productivity in endoscopic biopsy and histopathologic processing (microscopic examination of biopsy samples for signs of or disease). They encourage larger studies at multiple centers to determine the value of MB for diagnosing a larger set of GI diseases.

American Society for Gastrointestinal Endoscopy
www.asge.org/home/about-asge/newsroom/news-list/2017/08/04/august-gie-studies-show-promising-results-for-patients-with-endoscopic-treatments

MEDICAL FAIR THAILAND 2017 concluded its most successful edition to date. It saw 830 companies from 66 countries, 18 national pavilions and country groups, and welcomed more than 9,000 quality trade visitors from over 70 countries.

There were many opportunities for networking and business matching, with 13,000 meetings requested through the free business matching service. MEDICAL FAIR THAILAND also hosted many industry-leading concurrent conferences and seminars that were well-attended throughout the three days with 650 attendees.

Mr. Gernot Ringling, Managing Director of Messe Düsseldorf Asia, organizer of MEDICAL FAIR THAILAND said: “The exhibition is a record-breaking edition, with a strong showcase of innovations from leading exhibitors as well as highly satisfied visitors. MEDICAL FAIR THAILAND certainly serves the booming medical market of Southeast Asia. We also welcomed 25% more visitors than for the 2015 edition, of which 33% were from overseas, indicative of the increasing interest from regional healthcare professionals. ”

The increased representation from Thai companies was testament to the relevance of the event for local businesses to springboard their commercial offerings on an international platform.
Commenting on their second participation at the exhibition Ms. Theeraporn Thiramonth, Project Coordinator, Innovation Strategy Department, National Innovation Agency (NIA), said, “All the innovative products we showcased throughout MEDICAL FAIR THAILAND 2017, whether medical device, diagnostic device, or telemedicine, have been internationally certified, in compliance with international standards, so can be distributed throughout Asia, as well as Europe and the US.” The NIA is a public organization under the Ministry of Science and Technology, with the mandate to assist private companies to develop their innovations and products, and supporting them to successful commercial launch.

For French company Clariance specializing in the manufacture of spinal implants, according to Sales Director Mr. Marc-Antoine Lemaire, the exhibition was the event of choice to explore ways of expanding their business in the Asian market, and “a region where there is huge potential for growth. We found MEDICAL FAIR THAILAND 2017 incredibly useful in networking with Southeast Asian decision-makers and meeting potential partners and distributors, especially in Thailand.”

MEDICAL FAIR THAILAND 2017 also saw first-time group participation from Canada, the European Union, India, the Netherlands and Russia.  Expressing his tremendous satisfaction with the exhibition, Mr. Rajiv Nath, Forum Coordinator for the Association of Indian Medical Device Industry (AiMED) said: “We are very happy to bring an Indian delegatation to the exhibition and be part of the growth story of Thailand.  We came to bring affordable and safe healthcare to Thailand and I am very sure we will be back again in 2019 with a pavilion of at least 300 sqm.  We look forward to working with the people of Thailand and the medical community of Thailand.”

Dr. Tan Kok Yang, Head & Senior Consultant from Singapore’s Khoo Teck Puat Hospital, who also spoke at the Advanced Rehab Technology Conference (ARTeC), said, “The co-location of a conference such as ARTeC with an exhibition like MEDICAL FAIR THAILAND is definitely good synergy and a relevant platform for physicians and those involved in allied healthcare. Overall, there is a good attendance at the conference and the exhibition offers a good range of products and solutions, particularly those related to rehab care.”
www.medicalfair-thailand.com

Robot-assisted laparoscopic surgery to remove a patient’s entire kidney requires slightly longer operating times and results in increased costs compared with the use of traditional laparoscopic surgery, according to a large, multiyear analysis conducted by researchers at the Stanford University School of Medicine.
However, the two approaches have comparable patient outcomes and lengths of hospital stay, the study showed. Laparoscopic surgery is a minimally invasive procedure in which surgical operations are done through small incisions. The removal of the entire kidney is called a radical nephrectomy.
“Although the laparoscopic procedure has been standard of care for a radical nephrectomy for many years, we saw an increase in the use of robotic-assisted approaches, and by 2015 these had surpassed the number of conventional laparoscopic procedures,” said Benjamin Chung, MD, associate professor of urology. “We found that, although there was no statistical difference in outcome or length of hospital stay, the robotic-assisted surgeries cost more and had a higher probability of prolonged operative time.”
The discrepancy may be due to the time needed for robotic operating room setup or due to a surgeon being in the earlier part of his or her learning curve, resulting in a subsequent increase in operating room and instrumentation costs, the researchers speculated.
Surgical robots are helpful because they offer more dexterity than traditional laparoscopic instrumentation and use a three-dimensional, high-resolution camera to visualize and magnify the operating field. Some procedures, such as the removal of the prostate or the removal of just a portion of the kidney, require a high degree of delicate manoeuvring and extensive internal suturing that render the robot’s assistance invaluable. But Chung and his colleagues wondered whether less technically challenging surgeries, such as the removal of a whole kidney, may not benefit as significantly from a robot’s help.
The researchers analysed data from 416 hospitals across the country from 2003 to 2015. They found that in 2003 about 65 percent of patients with kidney tumours that necessitated the removal of the entire organ underwent an open surgical procedure. About 34 percent had their kidney removed using a laparoscopic procedure, and only the remaining 1.5 percent of cases were conducted with robot-assisted surgery. By 2015, the proportion of patients who underwent the open procedure had decreased to about 50 percent, but the use of robot-assisted laparoscopic surgery for the remaining cases had surpassed that of traditional laparoscopic surgery, 27 percent to 23 percent.
When they pooled the data across the years, the researchers found that among nearly 24,000 patients, almost 19,000 underwent a traditional laparoscopic procedure and about 5,000 underwent a robotic-assisted procedure. They found that 46.3 percent of those patients whose surgeon used the robot had a total procedure time of more than four hours. In contrast, about 28.5 percent of the patients whose surgeon used the conventional laparoscopic procedure were in the operating room for more than four hours.
On average, the total hospital cost (including the cost of supplies, room and board, pharmaceuticals and operating room time) for the robot-assisted procedure exceeded that of the traditional laparoscopic procedures by about $2,700 per patient. The researchers speculated that the increased cost may be due to longer times spent in the operating room and the disposable instruments upon which surgical robots rely.
The increase in robot-assisted surgery for many procedures may be due to a variety of factors, the researchers said. The technology clearly benefits patients for certain types of surgeries. In other situations, there may be an expectation on the part of the hospital or the surgeons themselves to justify the large initial investment in purchasing the robot by using it for many types of procedures. And, regardless of the procedure, use of the robotic platform can assist the surgeon in many ways to make the operation more comfortable for the surgeon. Finally, patients themselves may view robot-assisted surgery as more technologically advanced.
Chung noted that the study covers a time period when many physicians were just learning to use the robots for this type of procedure; as time passes, it’s possible the operating time will decrease and that the cost differences between the two procedures will narrow. But for now, the study suggests that robot-assisted surgery isn’t always the right choice.
Stanford Medicine med.stanford.edu/news/all-news/2017/10/robot-assisted-surgery-for-kidney-removal-linked-to-longer-times.html

Cedars-Sinai neuroscience investigators have found that Alzheimer’s disease affects the retina – the back of the eye – similarly to the way it affects the brain. The study also revealed that an investigational, non-invasive eye scan could detect the key signs of Alzheimer’s disease years before patients experience symptoms.
Using a high-definition eye scan developed especially for the study, researchers detected the crucial warning signs of Alzheimer’s disease: amyloid-beta deposits, a buildup of toxic proteins. The findings represent a major advancement toward identifying people at high risk for the debilitating condition years sooner.
The study comes amid a sharp rise in the number of people affected by the disease. Today, more than 5 million Americans have Alzheimer’s disease. That number is expected to triple by 2050, according to the Alzheimer’s Association.
“The findings suggest that the retina may serve as a reliable source for Alzheimer’s disease diagnosis,” said the study’s senior lead author, Maya Koronyo-Hamaoui, PhD, a principal investigator and associate professor in the departments of Neurosurgery and Biomedical Sciences at Cedars-Sinai.
“One of the major advantages of analysing the retina is the repeatability, which allows us to monitor patients and potentially the progression of their disease.”
Yosef Koronyo, MSc, a research associate in the Department of Neurosurgery and first author on the study, said another key finding from the new study was the discovery of amyloid plaques in previously overlooked peripheral regions of the retina. He noted that the plaque amount in the retina correlated with plaque amount in specific areas of the brain.
“Now we know exactly where to look to find the signs of Alzheimer’s disease as early as possible,” said Koronyo.
Keith L. Black, MD, chair of Cedars-Sinai’s Department of Neurosurgery and director of the Maxine Dunitz Neurosurgical Institute, who co-led the study, said the findings offer hope for early detection when intervention could be most effective.
“Our hope is that eventually the investigational eye scan will be used as a screening device to detect the disease early enough to intervene and change the course of the disorder with medications and lifestyle changes,” said Black.

newswise
www.newswise.com/articles/noninvasive-eye-scan-could-detect-key-signs-of-alzheimer-s-disease-years-before-patients-show-symptoms