Category: Lab Tests and Imaging

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Continuous Glucose Monitors can Overestimate Blood Sugar Levels

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Continuous Glucose Monitors (CGMs) are growing in popularity but new peer-reviewed research, published in The American Journal of Clinical Nutrition, from the University of Bath, suggests they may not be as accurate as many believe. Originally designed to help people living with diabetes manage their blood sugar, these devices are now being used by the health-conscious to track how different foods affect their glucose levels.

The study, from the University’s Centre for Nutrition, Exercise and Metabolism and funded by innocent drinks, warns that CGMs could be overestimating blood sugar levels in healthy adults, leading to unnecessary dietary changes.

The research measured blood sugar responses in healthy volunteers (non-diabetic, within a healthy BMI range) using two methods: a CGM (the Abbot Freestyle Libre 2,  a commercially available device, also provided on the NHS) and the gold standard finger-prick test.

The research aimed to assess the accuracy of CGMs in measuring responses to various fruit-based products, ranging from whole fruit to smoothies.

The findings were striking. The CGM consistently reported higher blood sugar levels compared to finger-prick tests.

Key Findings

When participants consumed a smoothie, the Abbott Freestyle Libre 2 CGM overestimated the GI by 30%, reporting a GI of 69 (medium) compared to the traditional test result of 53 (low).

Whole fruit was misclassified as medium or high-GI foods by CGMs, while the finger-prick test showed they were low-GI. This could lead users to mistakenly believe that fruit could cause harmful spikes in blood sugar.

CGMs overestimated the time spent above the blood sugar level threshold recommended by Diabetes UK, by nearly 400%, potentially causing unnecessary worry for people whose blood sugar is actually well-controlled.

The research also debunked the common myth that blending fruits into a smoothie raises their GI. Whether eaten whole or blended, fruits like apples, bananas, mangoes, and oranges remained low on the glycaemic index.

The research concludes that CGMs are unlikely to be a valid method to determine whether a food is high or low-GI.

Professor Javier Gonzalez from the Department for Health said: “CGMs are fantastic tools for people with diabetes because even if a measurement isn’t perfectly accurate, it’s still better than not having a measurement at all. However, for someone with good glucose control they can be misleading based on their current performance. For healthy individuals, relying on CGMs could lead to unnecessary food restrictions or poor dietary choices. If you want to assess your blood sugar accurately, traditional methods are still the way to go. We want to better identify the sources of the error in CGMs so that we can improve their performance in the future and have active research on this topic.”

According to Professor Javier Gonzalez from the University of Bath, the inaccuracy of CGMs can be attributed to several factors:

“CGMs may be inaccurate because they measure glucose in the fluid surrounding your cells, not directly in your blood. This can lead to discrepancies due to factors like time delays, blood flow, and how glucose moves between different parts of the body.”

Source: EurekAlert!

Categories : Lab Tests and Imaging Mental HealthTags : Leave a comment

Postpartum Depression Discovery Opens Door to Blood Test, Earlier Treatment

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Photo by Alina Matveycheva

New postpartum depression research from the School of Medicine and Weill Cornell Medicine could lead to a blood test to identify women at risk and possibly even to a preventive treatment.

The research, published in Neuroposychopharmacology, suggests that pregnant women may have characteristic levels of certain molecules in their blood that can warn that they are at risk of developing postpartum depression (PPD). These molecules, called neuroactive steroids, are derived from progesterone.

Measuring those molecules via a simple blood test could let doctors get women treatment for PPD sooner – possibly even before symptoms appear, the researchers say. “Studying postpartum depression gives us a way to identify biological changes that occur before someone becomes depressed because the timing of postpartum depression is predictable,” said researcher Jennifer Payne, MD, an expert in reproductive psychiatry at UVA Health and the University of Virginia School of Medicine.

Understanding Postpartum Depression 

Postpartum depression affects 10% to 15% of new moms.

“Postpartum is the only time in people’s lifespans when we know there is a biological trigger which guarantees that a certain percentage of people will become ill,” said Weill Cornell’s Lauren Osborne, MD, who co-led the study with Payne. “If we can untangle this biology and find predictors for it, not only will we be helping women, but it may give us a step up in trying to find predictors for other psychiatric illnesses also.”

It’s unclear why some women develop postpartum depression, but the new findings suggest that an imbalance in the body’s metabolism of progesterone may be a factor. 

About the Study

To better understand the role of progesterone, the researchers focused on the hormone and on its “metabolic pathway” in the body. The scientists measured levels of neuroactive steroids derived from progesterone in the blood of 136 women during their second and third trimesters. Of these, 33 went on to develop postpartum depression after giving birth.

Two neuroactive steroids seem to affect the risk of developing PPD – pregnanolone and isoallopregnanolone. Pregnanolone acts on a particular cellular receptor to reduce stress. Isoallopregnanolone, on the other hand, acts on the same receptor to increase stress.

In the third trimester, women who went on to develop PPD had a lower pregnanolone/progesterone ratio and a higher isoallopregnanolone/pregnanolone ratio compared with those who did not, the researchers found. Elevated progesterone levels in late pregnancy were also associated with a higher risk of PPD.

Next Steps

The researchers plan to attempt to replicate their results in a larger, more diverse group of women in hopes of developing a clinical test to predict the risk of PPD. Further, they say their work could lead to a preventive treatment – possibly one of two prescription drugs, brexanolone and zuranolone, already available to treat PPD.

“We don’t know if these drugs would work as a preventive measure for people who are at risk of developing postpartum depression, but based on our findings, they have the potential to prevent [its] development,” Osborne said.

Source: University of Virginia Health System

Categories : Lab Tests and Imaging NeurologyTags :

New Tech could Cut Epilepsy Misdiagnoses by up to 70% Using Routine EEGs

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Doctors could soon reduce epilepsy misdiagnoses by up to 70% using a new tool that turns routine electroencephalogram, or EEG, tests that appear normal into highly accurate epilepsy predictors, a Johns Hopkins University study has found.

By uncovering hidden epilepsy signatures in seemingly normal EEGs, the tool could significantly reduce false positives, seen in around 30% of cases globally, and spare patients from medication side effects, driving restrictions, and other quality-of-life challenges linked to misdiagnoses.

“Even when EEGs appear completely normal, our tool provides insights that make them actionable,” said Sridevi V. Sarma, a Johns Hopkins biomedical engineering professor who led the work. “We can get to the right diagnosis three times faster because patients often need multiple EEGs before abnormalities are detected, even if they have epilepsy. Accurate early diagnosis means a quicker path to effective treatment.”

A report of the study is newly published in Annals of Neurology.

Epilepsy causes recurrent, unprovoked seizures triggered by bursts of abnormal electrical activity in the brain. Standard care involves scalp EEG recordings during initial evaluations. These tests track brainwave patterns using small electrodes placed on the scalp.

Clinicians partly rely on EEGs to diagnose epilepsy and decide whether patients need anti-seizure medications. However, EEGs can be challenging to interpret because they capture noisy signals and because seizures rarely occur during the typical 20 to 40 minutes of an EEG recording. These characteristics makes diagnosing epilepsy subjective and prone to error, even for specialists, Sarma explained.

To improve reliability, Sarma’s team studied what happens in the brains of patients when they are not experiencing seizures. Their tool, called EpiScalp, uses algorithms trained on dynamic network models to map brainwave patterns and identify hidden signs of epilepsy from a single routine EEG.

“If you have epilepsy, why don’t you have seizures all the time? We hypothesized that some brain regions act as natural inhibitors, suppressing seizures. It’s like the brain’s immune response to the disease,” Sarma said.

The new study analyzed 198 epilepsy patients from five major medical centers: Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, University of Pittsburgh Medical Center, University of Maryland Medical Center, and Thomas Jefferson University Hospital. Out of these 198 patients in the study, 91 patients had epilepsy while the rest had non-epileptic conditions mimicking epilepsy.

When Sarma’s team reanalysed the initial EEGs using EpiScalp, the tool ruled out 96% of those false positives, cutting potential misdiagnoses among these cases from 54% to 17%.

“This is where our tool makes a difference because it can help us uncover markers of epilepsy in EEGs that appear uninformative, reducing the risk of patients being misdiagnosed and treated for a condition they don’t have,” said Khalil Husari, co-senior author and assistant professor of neurology at Johns Hopkins. “These patients experienced side effects of the anti-seizure medication without any benefit because they didn’t have epilepsy. Without the correct diagnosis, we can’t find out what’s actually causing their symptoms.”

In certain cases, misdiagnosis happens due to misinterpretation of EEGs, Husari explained, as doctors may overdiagnose epilepsy to prevent the dangers of a second seizure. But in some cases, patients experience nonepileptic seizures, which mimic epilepsy. These conditions can often be treated with therapies that do not involve epilepsy medication.

In earlier work, the team studied epileptic brain networks using intracranial EEGs to demonstrate that the seizure onset zone is being inhibited by neighboring regions in the brain when patients are not seizing. EpiScalp builds on this research, identifying these patterns from routine scalp EEGs.

Traditional approaches to improve EEG interpretation often focus on individual signals or electrodes. Instead, EpiScalp analyses how different regions of the brain interact and influence one another through a complex network of neural pathways, said Patrick Myers, first author and doctoral student in biomedical engineering at Johns Hopkins.

“If you just look at how nodes are interacting with each other within the brain network, you can find this pattern of independent nodes trying to cause a lot of activity and the suppression from nodes in a second region, and they’re not interacting with the rest of the brain,” Myers said. “We check whether we can see this pattern anywhere. Do we see a region in your EEG that has been decoupled from the rest of the brain’s network? A healthy person shouldn’t have that.”

Source: Johns Hopkins University

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Taking Blood Pressure in Public or Noisy Settings does not Affect Reading

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A randomised crossover trial found minimal difference between blood pressure (BP) readings obtained in public spaces versus those taken in private offices. These findings suggest that public spaces can be an acceptable setting for BP screenings, despite prior clinical guideline recommendations advising quiet settings for BP measurement. The results are published in Annals of Internal Medicine.   

Researchers from Johns Hopkins University randomly assigned 108 adults in Baltimore, MD to  the order in which they had triplicate BP measurements in each of 3 settings: 1) private quiet office (private quiet [reference]); 2) noisy public space (public loud); and 3) noisy public space plus earplugs  (public quiet) to evaluate the effect of noise and public environment on BP readings. The primary outcomes were differences between the mean BPs obtained in each public setting with those obtained in the private setting. The average noise level in the private quiet setting was 37 decibels (dB) and the average noise level in the public setting was 74dB.

In the private quiet setting, the average systolic BP (SBP) and diastolic BP (DBP) were 128.9 and 74.2mmHg, respectively. In the public loud setting, the mean SBP and DBP were 128.3 and 75.9mmHg and in the public quiet setting, the mean SBP and DPB were 129.0 and 75.7mmHg. The results indicate that the differences in BP readings in public, loud spaces versus the clinically recommended setting of a private office are small and not clinically significant. The researchers say these results support the implementation of mass hypertension-screening programs in settings including supermarkets, places of worship and schools.   

Source: EurekAlert!

Categories : Lab Tests and Imaging Obstetrics & GynaecologyTags :

Point-of-care Ultrasound Enhances Early Pregnancy Care, Cuts Emergency Visits by 81%

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Published in Annals of Family Medicine, a University of Minnesota Medical School research team found that implementing point-of-care ultrasounds (POCUS) to assess the viability and gestational age of pregnancies in the first trimester enhanced care for pregnant patients and cut emergency visits by 81% for non-miscarrying patients.

Previously, early pregnancy care was provided through separate appointments for ultrasound, risk assessment and patient education. This new integrated approach allows patients who are under 14 weeks pregnant to receive comprehensive care during a single visit. This includes ultrasound-based pregnancy dating, immediate assessment of pregnancy viability, risk evaluation and on-site counselling – all based on real-time ultrasound results.

“Our study demonstrates that the use of point-of-care ultrasound provides meaningful benefit to the patients we serve by addressing early pregnancy problems at the time they are identified,” said Allison Newman, MD, an assistant professor at the U of M Medical School and family medicine physician at M Health Fairview Clinic. “POCUS in early pregnancy helps clinicians more efficiently and accurately diagnose problems without compromising the quality of needed first trimester assessments – saving time, money and stress for patients.”

The research team introduced this integrated approach at M Health Fairview Clinic – Bethesda in autumn 2022, allowing the clinic to quickly identify high-risk cases and offer timely intervention for issues such as miscarriage or abnormal pregnancies. They found:

  • The clinic saw an 81% reduction in emergency visits, urgent clinic appointments and first-trimester phone inquiries for non-miscarrying patients. 
  • Clinic implementation led to more timely diagnosis of abnormal pregnancies and improved education and support for all patients, including those who experience miscarriage. 
  • For miscarriage cases, the time from initial concern to diagnosis decreased from an average of 5.8 days to 1.7 days.

Suggested next steps include rolling out the process more widely within other family medicine practices and performing a wider study across multiple sites.

Source: University of Michigan

Categories : Cancer Lab Tests and ImagingTags :

New Blood Test for Pancreatic Cancer Exceeds Gold Standard

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Pancreatic cancer. Credit: Scientific Animations CC BY-SA 4.0

A recent double-blinded, peer-reviewed analysis published in Cancer Letters revealed that an experimental test for pancreatic cancer correctly identified 71% of lab samples compared to only 44% correctly identified by the current gold-standard test.

An experimental blood test for pancreatic cancer that was developed by teams led by VAI Professor Brian Haab, PhD, and Randall E. Brand, MD, a physician-scientist and professor of medicine at the University of Pittsburgh, created the test. This evaluation by a commercial laboratory is an important milestone toward making the test available for patients.

Before the new test can be used by doctors to diagnose cancer, it must undergo clinical validation. During this process, a CLIA-accredited diagnostics laboratory adapts the experimental test into a version that reliably works under the strict conditions in a clinical lab. CLIA is a rigorous federal standard that ensures lab quality.

“Validation studies are essential for transforming a test developed in an academic lab into one that is used to diagnose real people,” Haab said. “For a person being evaluated for pancreatic cancer, the stakes are high. Validation studies ensure that new tests work as intended.”

The new test works by detecting two sugars — CA199.STRA and CA19-9 — that are produced by pancreatic cancer cells and escape into the bloodstream. CA19-9 is the current gold-standard biomarker for pancreatic cancer. Haab’s lab identified CA199.STRA as a cancer biomarker and developed the technology to detect it.

The new test also greatly reduced the number of false negatives while maintaining a low false positive rate, according to the recent analysis. Low rates of false positives and false negatives are important because they reflect the test’s ability to correctly identify the presence or absence of cancer.

Clinical validation of the test will be conducted by ReligenDx, a CLIA-accredited diagnostics lab based in Pennsylvania. The process is expected to take two years.  

If successful in clinical validation, Haab envisions the test being used in two main ways: 1. Catching pancreatic cancer more quickly in people at high risk of the disease, which would enable earlier treatment and 2. Monitoring progression and treatment response in people diagnosed with pancreatic cancer.

Source: Van Andel Research Institute

Categories : Antibiotics Lab Tests and ImagingTags :

PCT Test Fails to Shorten IV Antibiotics for Hospitalised Children

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A groundbreaking UK study led by the University of Liverpool has examined whether an additional procalcitonin (PCT) blood test could safely shorten the time children spend on intravenous (IV) antibiotics in hospitals. Despite promising previous analysis, the findings showed that using the PCT biomarker to guide treatment decisions did not reduce antibiotic duration when compared to usual care.

The study, published in the Lancet Child & Adolescent Health, is part of the ‘Biomarker-guided duration of Antibiotic Treatment in Children Hospitalised with confirmed or suspected bacterial infection’ (BATCH) trial. BATCH is a UK national research trial to tackle antibiotic overuse in hospitalised children and reduce the spread of antimicrobial resistance (AMR).

Antibiotic overuse is a key driver of AMR, one of the world’s greatest public health challenges. Infections caused by resistant bacteria lead to longer hospital stays, higher healthcare costs, and increased mortality. Children are especially vulnerable, and smarter use of antibiotics is essential to protect their future health.

This study, conducted across 15 hospitals, enrolled nearly 2000 children aged between 72 hours and 18 years with suspected bacterial infections.

The researchers found that adding the PCT test to routine care did not reduce the duration of IV antibiotic use. The test was safe but costlier than standard methods, and healthcare teams faced challenges integrating it into their decision-making processes.

The study comes after a systematic review and cost-effectiveness analysis conducted by NICE in 2015 evaluated PCT testing to guide antibiotic therapy for the treatment of sepsis, and recommended further studies to adequately assess the effectiveness of adding PCT algorithms to guide antibiotic treatment in hospitalised adults and children with suspected or confirmed serious bacterial infection.

The results highlight that introducing new tools like PCT tests alone isn’t enough. Effective use requires:

  • Robust Antimicrobial Stewardship (AMS) programmes: Many hospitals already use AMS programmes to ensure antibiotics are prescribed responsibly, reducing unnecessary use.
  • Training and education for Clinicians: Familiarity with new tests and confidence in interpreting results are crucial for success.
  • Implementation research: Future studies should identify barriers and facilitators to implementation to optimise fidelity of the intervention.
  • Behaviour change: Better understanding of the complex interactions influencing whether/how/why clinicians act on information from diagnostic tests to make antibiotic prescribing decisions will improve trial intervention fidelity and facilitate implementation and adoption of tests shown to be effective.

The findings emphasise the importance of continuing to invest in AMS programmes and public health campaigns to reduce antibiotic misuse. The researchers note that although PCT-guided treatment didn’t provide clear benefits in this trial, it could still play a role in specific situations with further refinement.

Chief investigator Professor Enitan Carrol, from the University of Liverpool, said: “The BATCH study was a pragmatic trial evaluating if the intervention works under real-world conditions where clinicians do not have to adhere to diagnostic algorithms about antibiotic discontinuation. Adherence to the algorithm was low in our study, and there were challenges in integrating the test into routine clinical workflows. The study highlights the importance of including behaviour change and implementation frameworks into pragmatic trial designs.”

Source: University of Liverpool

Categories : Allergies Lab Tests and ImagingTags :

Gluten Free Diet Reduces Coeliac Symptoms – and ‘Good’ Gut Bacteria

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A research team led by the University of Nottingham has used magnetic resonance imaging (MRI) to better understand the impact a gluten free diet has on people with coeliac disease, which could be the first step towards finding new ways of treating the condition.

The MARCO study – MAgnetic Resonance Imaging in COliac disease is published in Clinical Gastroenterology and Hepatology (CGH) (link connects to BioRxiv copy).

Coeliac disease is a chronic condition affecting around one person in every 100 in the general population. When people with coeliac disease eat gluten, which is found in pasta and bread, their immune system produces an abnormal reaction that inflames and damages the gut tissue and causes symptoms such as abdominal pain and bloating.

The only treatment is a life- long commitment to a gluten free diet, which helps recovery of the gut tissue but still leaves many patients with gastrointestinal symptoms.

Luca Marciani, Professor of Gastrointestinal Imaging at the University, led the study. He said: “Despite being a common chronic condition, we still don’t precisely know how coeliac disease affects the basic physiological functioning of the gut and how the gluten free diet treatment may further change this.

“We launched the MARCO study to try and address this issue, by using MRI along with gut microbiome analysis to give us new insights into how a gluten-free diet affects people with coeliac disease.”

The team recruited 36 people who had just been diagnosed with coeliac disease and 36 healthy volunteers to participate in the study. Images were taken of their guts with MRI, along with blood and stool samples. The patients then followed a gluten free diet for one year and came back to repeat the study. The healthy participants came back one year later too and repeated the study, but they did not follow any diet treatment.

The study found that the newly diagnosed patients with coeliac disease had more gut symptoms, more fluid in the small bowel and that the transit of food in the bowel was slower than in the healthy controls.

The microbiota (the ‘bugs’ living in the colon) of the patients showed higher levels of ‘bad bugs’ such as E.coli. After one year of a gluten free diet, gut symptoms, bowel water and gut transit improved in the patients, but without returning to normal values. But the gluten free diet also reduced some of the ‘good bugs’ in the microbiota, such as Bifidobacteria associated with reduced intake of starch and wheat nutrients, due to the different diet.

The patient study was conducted by Radiographer Dr Carolyn Costigan, from Nottingham University Hospitals, as part of her PhD studies at the University of Nottingham.

It was particularly interesting to see how the imaging results on gut function correlated with changes in the ‘bugs’ in the colon microbiota. The findings increase our understanding of gut function and physiology in coeliac disease and open the possibility of developing prebiotic treatments to reverse the negative impact of the gluten free diet on the microbiome.”

Luca Marciani, Professor of Gastrointestinal Imaging

Dr Frederick Warren from the Quadram Institute, which contributed to the research, said: “This study is the result of an exciting and innovative research collaboration bringing together medical imaging technology and gut microbiome analysis. We provide important insights which pave the way for future studies which may identify novel approaches to alleviate long-term symptoms in coeliac patients.”

Source: University of Nottingham

Categories : Lab Tests and ImagingTags :

Is Preventive Health Tech a Benefit or a Worrisome Distraction?

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Preventive health technologies, such as wrist-worn activity trackers or health and fitness apps, are popular tools for promoting wellbeing, but new research published in the Journal of Consumer Affairs reveals that consumer engagement with these technologies can be considered a double-edged sword.

The study, which involved 30 in-depth interviews with users, found that consumers engage with preventive health technologies based on a variety of health goals—for example, to lose weight, improve performance, monitor data of an enjoyable activity, or acquire a healthy routine.

These diverse goals led users to experience different “engagement trajectories.” For example, some people had increased engagement initially and then reached a stabilization point of engagement, while others had reduced engagement after their initial interest. Still others became obsessive and over-engaged with the technology over time, while others had fluctuating cycles of engagement.

Investigators found that consumer engagement with preventive health technologies can have beneficial or detrimental effects on wellbeing depending on these types of trajectories. Particularly, while these technologies can support healthy routines, they can also lead to compulsive usage, ultimately leading to users’ ill-being.

“As preventive health technologies become more integrated into our daily lives, it’s crucial to understand the factors that lead to over-engagement and ill-being, so that designers of health apps can mitigate these risks,” said corresponding author Lisa Baiwir, a PhD candidate at the University of Liège, in Belgium.

Source: Wiley

Categories : Cancer Lab Tests and ImagingTags :

Telltale Chemical in the Breath can Warn of Lung Cancer

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Credit: Scientific Animations CC4.0

Exhaled breath contains chemical clues to what’s going on inside the body, including diseases like lung cancer. And devising ways to sense these compounds could help doctors provide early diagnoses — and improve patients’ prospects. In a study in ACS Sensors, researchers report the development of ultrasensitive, nanoscale sensors that in small-scale tests distinguished a key change in the chemistry of the breath of people with lung cancer.

Besides carbon dioxide, people also exhale other airborne compounds. Researchers have determined that declines in one exhaled chemical — isoprene — can indicate the presence of lung cancer. However, to detect such small shifts, a sensor would need to be highly sensitive, capable of detecting isoprene levels in the parts-per-billion (ppb) range. It would also need to differentiate isoprene from other volatile chemicals and withstand breath’s natural humidity. Previous attempts to engineer gas sensors with characteristics like these have focused on metal oxides, including one particularly promising compound made with indium oxide. A team led by Pingwei Liu and Qingyue Wangset out to refine indium oxide-based sensors to detect isoprene at the level at which it naturally occurs in breath.

The researchers developed a series of indium(III) oxide (In2O3)-based nanoflake sensors. In experiments, they found one type, which they called Pt@InNiOx for the platinum (Pt), indium (In) and nickel (Ni) it contains, performed best. These Pt@InNiOx sensors:

  • Detected isoprene levels as low as 2ppb, a sensitivity that far surpassed earlier sensors.
  • Responded to isoprene more than other volatile compounds commonly found in breath.
  • Performed consistently during nine simulated uses.

More importantly, the authors’ real-time analysis of the nanoflakes’ structure and electrochemical properties revealed that Pt nanoclusters uniformly anchored on the nanoflakes catalyzed the activation of isoprene sensing, leading to the ultrasensitive performance.

Finally, to showcase the potential medical use of these sensors, the researchers incorporated the Pt@InNiOx nanoflakes into a portable sensing device. Into this device they introduced breath collected earlier from 13 people, five of whom had lung cancer. The device detected isoprene levels lower than 40 ppb in samples from participants with cancer and more than 60 ppb from cancer-free participants. This sensing technology could provide a breakthrough in non-invasive lung cancer screening and has the potential to improve outcomes and even save lives, the researchers say.

Source: American Chemical Society