For women with abdominal pain or vaginal bleeding during early pregnancy, patient history and clinical examination alone are insufficient to indicate or eliminate the possibility of ectopic pregnancy, while transvaginal sonography appears to be the single best diagnostic method for evaluating suspected ectopic pregnancy, according to an analysis of previous studies.
The rapid identification and accurate diagnosis of women who may have an ectopic pregnancy is critically important for reducing the maternal illness and death associated with this condition. Ectopic pregnancy is the leading cause of first-trimester pregnancy-related death, responsible for up to 6 percent of maternal mortality during early gestation, according to background information in the article. ‘Fewer than half of the women with an ectopic pregnancy have the classically described symptoms of abdominal pain and vaginal bleeding. In fact, these symptoms are more likely to indicate miscarriage.’
John R. Crochet, M.D., of the Center of Reproductive Medicine, Webster, Texas and colleagues conducted a study to systematically review the accuracy and precision of the patient history, clinical examination, readily available laboratory values, and sonography in the diagnosis of ectopic pregnancy in women with abdominal pain or vaginal bleeding during early pregnancy. The researchers conducted a search of the medical literature and identified 14 studies with 12,101 patients the met the criteria for inclusion in the analysis.
The authors found that presence of an adnexal (structures near the uterus, such as the ovaries and the Fallopian tubes) mass in the absence of an intrauterine pregnancy on transvaginal sonography, and the physical examination findings of cervical motion tenderness, an adnexal mass, and adnexal tenderness all increase the likelihood of ectopic pregnancy. ‘A lack of adnexal abnormalities on transvaginal sonography decreases the likelihood of ectopic pregnancy. Existing studies do not establish a single serum human chorionic gonadotropin [hCG; a hormone] level that is diagnostic of ectopic pregnancy.’
‘Women with abdominal pain or vaginal bleeding during early pregnancy may have an ectopic pregnancy. This systematic review of the literature and meta-analysis confirms that the patient history and clinical examination alone are insufficient to indicate or eliminate the possibility of ectopic pregnancy. In a hemodynamically stable patient, the appropriate evaluation includes transvaginal sonography and quantitative (serial) serum hCG testing. Patients with signs and symptoms of excessive blood loss or hemodynamic collapse should immediately have gynecological evaluation.’ EurekAlert

Replacing the combination of brand-name, antiretroviral drugs currently recommended for control of HIV infection with soon-to-be-available generic medications could save the U.S. health care system almost $1 billion a year but may diminish the effectiveness of HIV treatment.  A study led by Massachusetts General Hospital (MGH) investigators examines the potential impact of such a change.

"The switch from branded to generic antiretrovirals would place us in the uncomfortable position of trading some losses of both quality and quantity of life for a large potential dollar savings," says Rochelle Walensky, MD, MPH, of the MGH Medical Practice Evaluation Center, lead author of the study.  "By estimating the likely magnitude of these offsetting effects now

Researchers at UCLA report that they have refined a method they previously developed for capturing and analysing cancer cells that break away from patients’ tumours and circulate in the blood. With the improvements to their device, which uses a Velcro-like nanoscale technology, they can now detect and isolate single cancer cells from patient blood samples for analysis.
Circulating tumour cells, or CTCs, play a crucial role in cancer metastasis, spreading from tumours to other parts of the body, where they form new tumours. When these cells are isolated from the blood early on, they can provide doctors with critical information about the type of cancer a patient has, the characteristics of the individual cancer and the potential progression of the disease. Doctors can also tell from these cells how to tailor a personalised treatment to a specific patient.
In recent years, a UCLA research team led by Hsian-Rong Tseng, an associate professor of molecular and medical pharmacology at the Crump Institute for Molecular Imaging and a member of both the California NanoSystems Institute at UCLA and UCLA’s Jonsson Comprehensive Cancer Center, has developed a ‘NanoVelcro’ chip. When blood is passed through the chip, extremely small ‘hairs’

Chemists have developed a prototype medical dressing that detects the first signs of the lethal Toxic Shock Syndrome along with other burn wound infections and could potentially save the lives of children with serious burns.

Toxic Shock Syndrome (TSS) is a serious complication of burn infections and particularly dangerous in children under four due to their immature immune systems. Left untreated, a child with a relatively small burn who develops TSS can rapidly deteriorate within a few hours. If left untreated, fifty per cent of children with the full-blown disease can die.

Scientists at the University of Bath have been working with clinicians at the South West Paediatric Burns Centre at Frenchay Hospital in Bristol to create an advanced wound dressing that can detect key microbial pathogens including the bacteria which cause TSS.

They have now developed a prototype dressing that releases dye from nano-capsules triggered by the presence of disease-causing pathogenic bacteria. The dye fluoresces under ultraviolet (UV) light, alerting healthcare professionals that the wound is infected.

The nano-capsules mimic skin cells in that they only break open when toxic bacteria are present, not responding to the harmless bacteria that normally live on healthy skin.

Dr Toby Jenkins, Reader in Biophysical Chemistry at Bath, is leading the project. He explained: ‘Around 5,000 children a year in England and Wales are hospitalised or treated in hospital with serious burns, mostly scalds caused by tea and coffee.

‘The big problem for clinicians is the fast diagnosis of infection. Current methods take between 24 and 48 hours to get an answer as to whether the wound is infected.

‘However our burns dressing gives a simple colour change under UV light if a pathogenic, disease-causing bacteria is present in the burn, meaning clinicians can be alerted quickly to a potential infection.’

Dr Amber Young, Consultant Paediatric Anaesthetist at the South West Paediatric Burns Centre at Frenchay Hospital and Paediatric Clinical Lead South West UK Burn Care Network, is the clinical consultant on the project. She said: ‘At the moment when a child with a small burn develops a high temperature we have no easy way of knowing if the child has a serious bacterial infection, or simply a cough or cold.

‘We currently have to remove the dressing to test for infection, which may result in slower healing and potentially life-long scarring, and is very distressing for the child. This new dressing will mean we will be able to detect the early signs of infection so we can diagnose and treat the child quickly.

‘It could make a real difference to the lives of many thousands of children.’

The prototype has been tested on skin samples in the lab and is currently being optimised for stability and shelf-life. The researchers expect to start safety trials on healthy human volunteers in four years.

Amid increasing fear of overexposure to radiation from CT scans, a panel of experts has recommended more research on the health effects of medical imaging and ways to reduce unnecessary CT tests, as well as industry standardisation of CT machines.
The recommendations were developed at the Radiation Dose Summit, organised by the National Institute of Biomedical Imaging and Bioengineering (NIBIB). The summit included more than 100 medical physicists, radiologists, cardiologists, engineers, industry representatives and patient advocates. The proceedings, held in Bethesda, MD in early 2011, covered currently understood risks of radiation exposure from CT scans, set priorities for future research, and called for changes to industry practices.
‘The number of CT exams in the U.S. has increased by about 10 percent each year over the past decade,’ said John Boone, UC Davis professor of radiology and lead author of the Radiology article. ‘This trend underscores the importance of developing a better understanding of the health risks of radiation exposure versus the benefits of enhanced diagnosis.’
The experts conceded that despite widespread public concern about radiation risks, the biologic effects from medical imaging tests are not entirely understood. Most direct evidence comes from the effects of instantaneous, high-dose, whole-body exposures due to industrial accidents and from survivors of the atomic bombs in Hiroshima and Nagasaki, Japan. Whether these findings can be extrapolated to people exposed to occasional and much smaller dosages applied to only parts of the body is uncertain.
‘The standards regarding ‘safe levels’ of radiation were designed for workplace safety and are very conservative,’ said Boone. ‘We don’t know whether the established thresholds are really meaningful for exposure from medical testing.’
The experts pointed out that because there is a high background incidence of cancer world-wide, the small incremental increase in cancer that may be attributable to low doses of radiation from medical imaging is extremely difficult to ascertain. They stated that national and international registries that track cancers and patient exposures to medical radiation may one day make it possible to conduct large epidemiological studies that could help make such associations.
‘In reaction to media coverage of radiation overexposure cases, some patients refuse to undergo medical imaging procedures,’ said Boone. ‘Yet for almost all patients, the risks of foregoing a needed medical procedure far outweigh any potential radiation-associated risks.’
Even accurately recording patient exposures of radiation from medical imaging is extremely difficult, according to the authors. Although it is easy to ascertain how much radiation a machine administers during an imaging study, the amount actually received by a patient depends on various factors including body size. For example, because of differences in body mass, children and small adults can receive a dose of radiation two to three times that of larger people, even when the dose administered is the same.
Other factors, such as whether the patient lies on a moving or stationary table, also affect the radiation dose received. Federally sponsored research is needed to develop methods to more accurately measure patient exposures from different types of CT scans, the authors suggested. UC Davis Comprehensive Cancer Center