Physicians may soon have a new way to screen patients for Barrett

Magnetic resonance imaging (MRI) measurements of atrophy in an important area of the brain are an accurate predictor of multiple sclerosis (MS). According to the researchers, these atrophy measurements offer an improvement over current methods for evaluating patients at risk for MS.

MS develops as the body’s immune system attacks and damages myelin, the protective layer of fatty tissue that surrounds nerve cells within the brain and spinal cord. Symptoms include visual disturbances, muscle weakness and trouble with co-ordination and balance. People with severe cases can lose the ability to speak or walk.
Approximately 85 percent of people with MS suffer an initial, short-term neurological episode known as clinically isolated syndrome (CIS). A definitive MS diagnosis is based on a combination of factors, including medical history, neurological exams, development of a second clinical attack and detection of new and enlarging lesions with contrast-enhanced or T2-weighted MRI.
‘For some time we’ve been trying to understand MRI biomarkers that predict MS development from the first onset of the disease,’ said Robert Zivadinov, M.D., Ph.D., FAAN, from the Buffalo Neuroimaging Analysis Center of the University at Buffalo in Buffalo, N.Y. ‘In the last couple of years, research has become much more focused on the thalamus.’
The thalamus is a structure of gray matter deep within the brain that acts as a kind of relay centre for nervous impulses. Recent studies found atrophy of the thalamus in all different MS disease types and detected thalamic volume loss in pediatric MS patients.
‘Thalamic atrophy may become a hallmark of how we look at the disease and how we develop drugs to treat it,’ Dr. Zivadinov said.

For this study, Dr. Zivadinov and colleagues investigated the association between the development of thalamic atrophy and conversion to clinically definite MS.
‘One of the most important reasons for the study was to understand which regions of the brain are most predictive of a second clinical attack,’ he said. ‘No one has really looked at this over the long term in a clinical trial.’

The researchers used contrast-enhanced MRI for initial assessment of 216 CIS patients. They performed follow-up scans at six months, one year and two years. Over two years, 92 of 216 patients, or 42.6 percent, converted to clinically definite MS. Decreases in thalamic volume and increase in lateral ventricle volumes were the only MRI measures independently associated with the development of clinically definite MS.
‘First, these results show that atrophy of the thalamus is associated with MS,’ Dr. Zivadinov said. ‘Second, they show that thalamic atrophy is a better predictor of clinically definite MS than accumulation of T2-weighted and contrast-enhanced lesions.’
The findings suggest that measurement of thalamic atrophy and increase in ventricular size may help identify patients at high risk for conversion to clinically definite MS in future clinical trials involving CIS patients.

‘Thalamic atrophy is an ideal MRI biomarker because it’s detectable at very early stage,’ Dr. Zivadinov said. ‘It has very good predictive value, and you will see it used more and more in the future.’
‘The next step is to look at where the lesions develop over two years with respect to the location of the atrophy,’ Dr. Zivadinov said. ‘Thalamic atrophy cannot be explained entirely by accumulation of lesions; there must be an independent component that leads to loss of thalamus.’ Radiological Society of North America

A new computer tool to help reduce the risk of commonly made drug prescribing errors has been launched by a primary care research team and the PRIMIS business unit at The University of Nottingham.

The PINCER Query Library Tool has been developed after a clinical trial showed that an innovative pharmacist-led computer-based prescription checking and GP feedback system led to significantly fewer prescribing errors than traditional computerised feedback alone.

The PRIMIS unit within the Division of Primary Care specialises in health informatics and training and has been working with the PINCER trial research team to develop the tool based on the results of the trial.

The PINCER study involved at-risk patients in 72 general practices taking the drugs that are most commonly and consistently associated with medication errors. The general practices were randomly allocated to receive either computerised feedback on patients at risk, or computerised feedback with support from a pharmacist to correct any errors detected. When followed up six months later the general practices receiving pharmacist support had significantly fewer prescribing errors.

The new PINCER tool is an extension of the PRIMIS CHART Query Library and is now available free to all GP practices in England. CHART helps GPs improve patient care by analysing the data held on their clinical computer systems. GP practices access the library through membership of the PRIMIS Hub scheme.

Professor of Primary Health Care, Tony Avery, in the University

Identifying the "smell" of different types of lung bacteria could lead to a simple breath test to diagnose infections, a study on mice suggests. Breath analysis could reduce lung infection diagnosis times from weeks to minutes, the Vermont researchers said. Scientists have already researched breath tests to diagnose asthma and cancer. An expert said breath analysis was "an important and emerging field".

Diagnosing bacterial infections traditionally means collecting a sample that is used to grow bacteria in the lab. This bacteria is then tested to classify it and see how it responds to antibiotics, which can take time. Doctors see breath analysis, in contrast, as a fast and non-invasive method of diagnosing diseases.
For the study, researchers from the University of Vermont analysed volatile organic compounds (VOCs) given off in exhaled breath by different bacteria as well as different strains of the same bacterium.

They infected mice with two bacteria that are both common in lung infections – Pseudomonas aeruginosa and Staphylococcus aureus – and sampled their breath after 24 hours.  The compounds in their breath were analysed using a technique called secondary electrospray ionisation mass spectrometry (SESI-MS), which is capable of detecting extremely small elements of the chemicals present in their breath.

The researchers said they found a "statistically significant" difference between the breath profiles of the mice infected with the bacteria and the mice that were uninfected.  They also said they were able to differentiate between two species of bacteria and two different strains of the same P. aeruginosa bacterium.

But Jane Hill, co-author of the study, from the University of Vermont College of Medicine, said there were still some challenges to overcome with "breath-prints".

"We are now collaborating with colleagues to sample patients in order to demonstrate the strengths, as well as limitations, of breath analysis more comprehensively," she said.

Richard Hubbard, professor of respiratory epidemiology at Nottingham City Hospital and a spokesman for the British Lung Foundation, said breath analysis was already being used to diagnose children with asthma.

"Breath analysis is an emerging field and is likely to take off across the board. It could be a very useful tool for children with cystic fibrosis, for example, as a guide on how to treat them," he said.
BBC

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