Wednesday, 27 April 2011

Pulmonary aspergillosis: an alternative diagnosis to lung cancer after a positive PET scan.

Positron emission tomography (PET) scans are used in the clinic to assist with diagnosis and staging in lung cancer. False positive scans can arise due to inflammation and infections. The clinical features of pulmonary aspergillosis may include single or multiple nodules and possible cavities which resembles those of lung cancer.

A recent publication (Baxter et al 2011) investigating 10 cases of pulmonary aspergillosis including both allergic, chronic and aspergilloma type cases - has demonstrated that increased radioisotope uptake on PET scans can be attributed to their aspergillosis. All types of aspergillosis studied could lead to a possible positive PET scan.

Thus aspergillosis is a possible cause of false positivity by PET scanning. Since it is vital not to miss a diagnosis of lung cancer other histological diagnostic techniques must be used . Open surgical routes of biopsy entail risk factors for the patient - but the advent of CT guided biopsy as a non surgical method of tissue diagnosis is preferable when appropriate - and may be combined with serology and PCR techniques to confirm or eliminate a diagnosis of aspergillosis or malignancy.

Tuesday, 19 April 2011

Science, Engineering & Technology Student of the Year Awards 2011

The SET awards are a series of awards for those already carrying out research, teaching or who are a student in any university across Europe or the USA. Running since 1998 they have recently been re-launched. They are sponsored by a series of major companies and judged by a collection of high quality panels taken from most of the major professional institutions in each field including the Royal Society of Chemistry, British Computing Society, British Pharmacological Society and many more.

Quoting the SET website:
Supported by Industry, and leading scientific and technical institutions, the SET awards are multidisciplinary to reflect the wide range of degrees our universities have to offer.

The SET awards provide a showcase for educational excellence by publicly recognising the exceptional achievements of both students and universities. They are presented at a spectacular ceremony bringing together hundreds of technology students and academics, as well as senior figures from industry, government, science and the media.

This is a great way to get your research efforts better recognised - well worth consideration.

Monday, 18 April 2011

BEI extend their services to include Aspergillus

One of the main ways in which the result of a piece of research can be checked is for a second group to repeat the experiment and test if it gets the same result as the first group. If the same result is observed then we can be more confident that the result is true, but what if the result is different? Is it a bad result? What do we do now? - repeat the whole experiment again, potentially taking several more months or even years.

There are many examples of this but perhaps one of the most relevant to medical mycology involving Aspergillus is the slow progress of the development of the PCR assay for detection & diagnosis of Aspergillosis. We have discussed this in an earlier blog.

One cause of the lack of repeatability of an experiment is that something important changed when the first experiment was repeated - in our example the second group may have used a slightly different strain of Aspergillus or might have used slightly different chemical reagents or methods. For this reason it is important to have standard reference strains of the fungus that everyone has access to, standard reagents that everyone can use and standard methodology with which everyone can perform the experiment.

Although this sounds simple and even obvious it can get very difficult to achieve and can get very demanding on limited resources in each laboratory causing dispute and disappointment.

The National Institute of Allergy and Infectious Diseases (NIAID - part of the US government funded National Institute for Health NIH) is attempting to provide resources to reduce these problems. The BEI  (Microbiology and Infectious Diseases Biological Resources Repository) has for some years provided a repository for free access to specific microbes and reagents so that scientists and doctors can deposit those that were used for a particular experiment without fear of loss of legal protection of the results of their experiments
BEI Resources was established by the National Institute of Allergy and Infectious Diseases (NIAIDto provide reagents, tools and information for studying Category A, B, and C priority pathogens, emerging infectious disease agents and other biological materials of relevance to the research community.  BEI Resources acquires authenticates, and produces reagents that scientists need to carry out basic research and develop improved diagnostic tests, vaccines, and therapies. By centralizing these functions within BEI Resources, access to and use of these materials in the scientific community is monitored and quality control of the reagents is assured.
In addition to supplying the infectious disease community with materials, BEI Resources also encourages and supports the deposit of materials from researchers and institutions. Depositing materials with BEI Resources has many advantages to the researcher and the research community including secure storage, community access.

These facilities are now being extended to include any infectious organisms, including Aspergillus. The entire medical mycology community can benefit. Not only that there are also resources being allocated to provide services to exend the scope of BEI to include the development of new reagents such as antibodies & recombinant protein expression & purification so as to provide new tools to the whole research community. These services will be available to all research teams all over the world.

These important new services & facilities may well help speed up research and in in relation to Aspergillus in particular could lead to a significant reduction in the time it takes to develop new more rapid diagnostic techniques for aspergillosis which would lead to more effective treatment for everyone.

Wednesday, 13 April 2011

5th Advances Against Aspergillosis Conference - January 2012

Aspergillosis presents us with many problems in our efforts to improve diagnosis and treatment, not the least being to raise awareness amongst doctors, nurses and scientists around the world of the many illnesses caused by the fungus Aspergillus.

Many cases are still diagnosed late as the symptoms of some forms of aspergillosis so closely resemble those of other, much more common infections and illnesses. It is possible that many cases lie undiagnosed (ABPA, CPA, SAFS) and could be better treated when treatment with antifungals could possibly be of great benefit to the patient's quality of life and prognosis.
The 5th Advances Against Aspergillosis is the latest in a biennial series that began in 2004 and remains the only specialist international conference to focus exclusively on aspergillosis. Evidence of its effect on increasing awareness lies in the ever increasing numbers attending: in 2004 364 scientists & doctors from 28 countries attended but by 2010  533 attended from 49 countries.
Doctors are encouraged to attend as part of their required 'Continuing Medical Education' (CME) program, thus ensuring awareness is as widespread as possible. Hopefully this will improve the number of cases that are diagnosed.

Outwith its success at raising awareness, the conference itself has grown in its influence by providing an opportunity for medical specialists and scientists from a wide range of fields of expertise to meet and listen to what others are doing around the world, discuss the latest developments and to make plans & coordinate what should be done next.
In 2010 there was even an additional meeting dedicated to patients with talks given from several doctors & scientists who are leaders in their fields (see these recorded talks here). These recordings have since been viewed tens of thousands of times by patients all over the world, and informed patients are playing their part in raising awareness amongst the medical staff treating them.

The 5th Advances Against Aspergillosis conference has a lot to live up to and is taking bookings and abstracts already in an effort to ensure its success continues.

Complete programme is currently under development.
08:00 - 08:45 Daily breakfast sessions: Meet the Professor
Session 1 Cutting issues in pathogenesis of aspergillosis
Session 2 Emerging clinical associations with aspergillosis
Session 3 Top six papers in aspergillosis in 2011
Session 4 Novel immunological insights into aspergillosis
Session 5 Portraits of non-fumigatus Aspergilli
Session 6 Genomics and proteomics
Session 7 Management of aspergillosis
Session 8 Diagnostics and imaging
Session 9 Controversies in Aspergillus biology
Session 10 Antifungal resistance
Session 11 Controversies in aspergillosis

The conference is located in the ancient city of Istanbul, the second largest city in the world and the city at the centre of four successive empires starting in the year 330 (Roman Empire). There is sure to be something of interest to do in the evenings!

As this is the only conference dedicated exclusively to aspergillosis it is one of our main priorities to promote as we play our part in teh ongoing campaign to improve treatment & diagnosis of aspergillosis. We will be revisiting this conference regularly on this blog and on the Aspergillus Website.

Friday, 8 April 2011

"You've never had it so good" - Public Satisfaction With The NHS is at All Time High

The health service in Britain has long been run with the principle in mind 'Free at the point of delivery, providing according to need rather than ability to pay'. The National Health Service is paid for by all taxpayers in the UK for the benefit of all UK citizens.
Over the years since its launch the NHS has been criticised frequently for poor facilities, poor management, lack of investment, inefficiency amongst many others and it is easy to lose sight of the overriding benefits it provides - but some of this is apparently starting to change.

The British Social Attitudes (BSA) survey has been running since 1984, each year asking the same questions of a carefully selected group of UK citizens. Some of those questions have been about the public satisfaction with the NHS. For most of the last 27 years the answer to the question “All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service is run nowadays?” has been answered positively by around 40%. Since 2001 that number has risen every year to give a figure today of 64% - the highest ever recorded.

Answers to the question “From your own experience, or from what you have heard, please say how satisfied or dissatisfied you are with the way in which each of these parts of the National Health Service runs nowadays: … local doctors or GPs?… being in hospital as an inpatient?… attending hospital as an outpatient?… Accident and Emergency departments?” have also given far more positive responses compared with 10 years ago, in particular approval of Outpatients visits have risen over 22%.

Are these result politically driven? For example might supporters of the left (Labour) want to support the huge amount of investment made by their government over the last decade, and supporters of the right (Conservative) want to minimise their support? For this reason people who completed the survey were asked what their political affiliation was. The politics of  answerers to the question “All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service is run nowadays?” can thus be tracked. The results from supporters of all political parties show marked improvement in satisfaction.

Is this an isolated result from one questionnaire? Ipsos-Mori polls for this same period asked the question “What would you say is the most important issue facing Britain today?” + “What do you see as other important issues facing Britain today?”. In the year 2000 50% answered 'The NHS' and 10% answered 'The economy'. By 2009 concern with the NHS had dropped to 12% while concern for the economy had climbed to 70%. Once again the general view seems to be that the NHS is better in 2009 than it was in 2000.

The improvement in satisfaction of UK citizens for the NHS seems to be real and quite broadly felt by people from across society. The British Medical Journal (BMJ) makes several comments about these observations, not the least of which is that this rise in approval coincides with a period when the government of the last 10 years or so invested heavily in the NHS - indeed improving the NHS was one of the prime policies of that time. That investment has borne fruit. We can only hope that the current downturn in funding does not completely reverse this clear trend.

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