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Tuberculosis (TB) is a disease that has been present in the human race for thousands of years. Evidence of spinal tuberculosis has been found in human remains from the Neolithic period and in mummies from Egypt and Peru.

Hippocrates described “phthisis” (consumption — a historic term for TB) as the most widespread disease of his time, and observed that it was usually fatal. In the 17th and 18th centuries, the disease was responsible for a quarter of all adult deaths in Europe.

In the mid-19th century, TB was believed to be a hereditary illness due to malfunctioning host cells. Then, in 1882, German physician Robert Koch demonstrated the presence of a bacillus in tubercular tissue after developing a new staining technique. He cultivated the bacteria and succeeded in infecting animals with TB using isolated cultures. He thereby definitively established the infectious nature of tuberculosis.

For several decades, medical devices have been growing smaller, cheaper, and more portable. Point-of-care tests, performed outside the traditional laboratory, are now widely used for pregnancy testing, monitoring blood glucose in diabetes, and for many other applications.

Researchers at John Hopkins University have developed a new blood test that shows promise for identifying colorectal, breast, lung, and ovarian cancers at their earliest stages. It will need validation in much larger studies but could someday be useful for screening people who have an increased risk of developing cancer.

Pancreatic cancer is one of the deadliest types of malignancies because most individuals are diagnosed too late to substantially benefit from surgery. A new blood test, recently published about in Science Translational Medicine, could change that by detecting pancreatic cancer in its earliest stages.

The U.S. Food and Drug Administration (FDA) recently granted approval for a new testing system that can more quickly identify the microbe causing a bloodstream infection once a blood culture is positive. It is the first testing system that can rapidly determine which antibiotics are most effective for the given bacteria or yeast, according to the FDA.

Diabetics who are treated with insulin are instructed to check their glucose levels routinely so that they can adjust their insulin doses if levels are too high or too low. Many type 2 diabetics who are not treated with insulin use self-monitoring to help check whether their glucose levels are under control. Now a new study on regular glucose monitoring for people with non-insulin-dependent type 2 diabetes has found that for these patients, daily monitoring of glucose levels did not improve either the patients' glucose control or their quality of life. As a result of the study, the authors suggest these patients should not routinely monitor their glucose levels. The study was published in the Journal of the American Medical Association Internal Medicine and presented at the recent Scientific Sessions of the American Diabetes Association.

New culture-independent tests are much more sensitive than traditional diagnostic methods in detecting the cause of infectious diarrhea, a significant problem that leads to nearly 500,000 hospitalizations and more than 5,000 deaths in the USA every year.

Diarrhea is defined as three or more loose or liquid stools in 24 hours, or more frequently than is normal for the person. Diarrhea is often, but not always, infectious, meaning that it is thought to be caused by a microbe such as a virus, bacterium or parasite that can spread from person to person.These new tests are so sensitive and may detect multiple organisms, infectious disease expertise may be necessary to interpret the clinical significance and facilitate appropriate public health surveillance.

A panel of experts, led by those at Emory University School of Medicine (Atlanta, GA, USA) have written guidelines that include seven tables that busy clinicians can quickly reference for information about the various ways people acquire the microbes, exposure conditions, post-infectious symptoms and clinical presentation, as well as recommended antimicrobial, fluid and nutritional management. The new infectious diarrhea guidelines provide an update of the 2001 guidelines. While the guidelines mention travel-associated diarrhea and Clostridium difficile diarrhea, other more-specific guidelines on those topics provide detailed guidance and are referenced.

Some of the recommendations for diagnostics include stool testing should be performed for Salmonella, Shigella, Campylobacter, Yersinia, C. difficile, and Shiga toxin-producing Escherichia coli (STEC) in people with diarrhea accompanied by fever, bloody or mucoid stools, severe abdominal cramping or tenderness, or signs of sepsis. Bloody stools are not an expected manifestation of infection with C. difficile. A broader set of bacterial, viral, and parasitic agents should be considered regardless of the presence of fever, bloody or mucoid stools, or other markers of more severe illness in the context of a possible outbreak of diarrheal illness (e.g., multiple people with diarrhea who shared a common meal or a sudden rise in observed diarrheal cases).

All specimens that test positive for bacterial pathogens by culture-independent diagnostic testing such as antigen-based molecular assays (gastrointestinal tract panels), and for which isolate submission is requested or required under public health reporting rules, should be cultured in the clinical laboratory or at a public health laboratory to ensure that outbreaks of similar organisms are detected and investigated. The optimal specimen for laboratory diagnosis of infectious diarrhea is a diarrheal stool sample (i.e. a sample that takes the shape of the container). For detection of bacterial infections, if a timely diarrheal stool sample cannot be collected, a rectal swab may be used. Molecular techniques generally are more sensitive and less dependent than culture on the quality of specimen.

Frequent monitoring of hemoglobin and platelet counts, electrolytes, and blood urea nitrogen and creatinine is recommended to detect hematologic and renal function abnormalities that are early manifestations of hemolytic-uremic syndrome (HUS) and precede renal injury for people with diagnosed E. coli O157 or another STEC infection (especially STEC that produce Shiga toxin 2 or are associated with bloody diarrhea).

Andi L. Shane, MD, MPH, MSc, an associate professor and lead author of the guidelines, said, “Diagnostic testing combined with clinical expertise is helpful in identifying a cluster of infections that may signal an outbreak. However, even if they don't need to be tested, most people will benefit from rehydration therapy while waiting for the infection to run its course.” The study was published on October 19, 2017, in the journal Clinical Infectious Diseases.

References

https://www.labmedica.com/microbiology/articles/294771303/infectious-diarrhea-guidelines-recommend-when-to-test.html

The American College of Obstetricians and Gynecologists (ACOG) recently published new breast cancer screening guidelines for women with an average risk of breast cancer. The guidelines were published in the July issue of the journal Obstetrics & Gynecology and stress the importance of women making the decision about the timing of breast cancer screening together with their healthcare practitioner.

"Our new guidance considers each individual patient and her values," said Christopher M. Zahn, MD, ACOG vice president of practice activities, in a press release. "Given the range of current recommendations," says Dr. Zahn, "we have moved toward encouraging obstetrician–gynecologists to help their patients make personal screening choices from a range of reasonable options."

The new guidelines recommend that for women of average risk, meaning no personal or family history of breast cancer and no other risk factors for breast cancer, the decision as to when to start and end screening for breast cancer as well as how often should be based on conversations about a woman’s health history and her preferences.

While new technologies to screen for breast cancer are currently in development, the most common tests are a physical exam by a trained health professional and a mammogram, a low-dose x-ray that allows specialists to look for changes in breast tissue.

The new ACOG guidelines recommend that women at average risk for breast cancer be offered screening mammograms starting at 40 years of age. If women choose to wait, they should start getting screened no later than age 50. When women of average risk decide to begin regular screening mammograms, they should have them every 1 to 2 years until age 75. After that, women should decide with their healthcare practitioner whether, and how often, to have a mammogram.

To make informed decisions about screening, women should receive information from their healthcare practitioner on the benefits as well as the harms of screening. While regular screening mammograms in average-risk women have reduced deaths from breast cancer, they can also lead to potential harms. These may include false-positive results (results that indicate breast cancer when none is present), increased anxiety, unnecessary follow-up testing (e.g., biopsies), detection of breast cancer that would not progress to cause symptoms (overdiagnosis) and overtreatment. Overdiagnosis and overtreatment can expose women to harms such as unnecessary surgery, chemotherapy and radiation therapy. After talking with their healthcare practitioners about their options, women are empowered to "fully consider their breast cancer screening options and take an active and informed role in their health care," according to ACOG.

While other organizations have guidelines that vary somewhat from ACOG's, they recognize the importance of personalized decisions:

• The US Preventive Services Task Force, a voluntary panel convened by the federal government whose recommendations are not binding, recommends mammograms every other year starting at age 50. Between ages 40 and 49, the decision should be made individually.
• The American Cancer Society says screening should be offered to women when they are 40 years old but recommends starting by age 45 years and continuing annually until age 55. At 55 years old, women can decide to continue having annual mammograms or decrease screening to every other year.

The new ACOG guidelines do not recommend breast self-exams for average risk women because the ACOG panel found that there is no evidence that self-exams are beneficial for patients. ACOG instead recommends that doctors speak with average-risk women about the normal look and feel of their breasts and advise each patient to contact their physician if she perceives changes, such as a mass, nipple discharge, redness or pain. Clinical breast exams, those performed by healthcare practitioners, can be offered to women ages 25 to 39 every one to three years and annually to women over 40 years old, according to ACOG.

The new ACOG guidelines do not offer recommendations for women at high risk of breast cancer or women with dense breasts who have a slightly higher risk than average-risk women of developing breast cancer.

References:

https://labtestsonline.org/news/acog-most-women-should-collaborate-with-their-doctors-on-plan-for-breast-cancer-screening/