News
Clinical value of daily low-dose aspirin questioned. In a study published in the Journal of the American Medical Association (JAMA) that received wide coverage in the popular press, researchers raised a red flag about the risk of gastrointestinal and cerebral bleeding associated with taking a daily aspirin to reduce the risk of heart attack or stroke. The study, conducted in Italy, involved 370,000 hospitalized patients, half of whom were given a daily dose of aspirin. Study authors reported that those who took the daily aspirin had an increased risk of significant bleeding in the stomach or brain of 55%, which is a higher number than had been indicated by earlier research. One of the study’s authors, Antonio Nicolucci, MD, asserts that the research contraindicated the use of aspirin for that purpose except where significant cardiovascular risk factors were involved: “If the risk of having a cardiovascular event is low, then the risk of bleeding will likely offset any beneficial effect of aspirin.” Not all clinicians agree; in commenting on the study, Jolatna Siller-Matula, MD, says that “The net benefit of aspirin for secondary prevention would substantially exceed the bleeding hazard.” More clinicians are weighing in on an ongoing controversy whose fires will only be fueled by the JAMA study.
HPV and Cancer
New recommendations released in diagnosis of HPV-associated squamous lesions. The College of American Pathologists (CAP) and the American Society for Colposcopy and Cervical Pathology (ASCCP) jointly issued “The Lower Anogenital Squamous Terminology (LAST) Standardization Project for HPV-Associated Lesions: Background and Consensus Recommendations.” The consensus recommendations were released in the online editions of Archives of Pathology & Laboratory Medicine (Archives) and in the Journal of Lower Genital Tract Disease (JLGTD), the official journals of the CAP and the ASCCP, respectively.
The new recommendations provide standardization of diagnostic terminology of lesions associated with the human papillomavirus (HPV) across lower anogenital tract body sites, including the appropriate use of biomarkers to distinguish these lesions. Through implementation of the recommendations, the two organizations aim to enhance communication between pathologists and clinicians, leading to more effective patient management of HPV-associated disease and, ultimately, improved patient outcomes.
“The CAP/ASCCP LAST Project consensus recommendations were developed based on the availability of new science, allowing pathologists to better classify HPV-associated lesions,” says Teresa M. Darragh, MD, FCAP, their lead author. “With this information, patients along with their physicians will be able to better weigh the benefits and risks of management options associated with HPV infections, allowing them to make more informed decisions about their health.”
Infectious Disease
Study indicates that MRSA rates are down. It’s certainly good news, mitigated a bit by the fact that clinicians are not sure why it is happening—but a recent study suggests that the incidence of methicillin-resistant S.aureas seems to have been declining in recent years. The study is based on statistics collected by the U.S. Department of Defense, and covers both hospital- and community-acquired MRSA. The research, which included statistics on more than nine million military personnel, active and nonactive, showed that in 2005, the rate of MRSA infection was 1.7 per 100,000 people. By 2010, that number had dropped to 1.2 infections per 100,000. Study author Clinton Murray, MD, says that the results are encouraging, but stresses, “This isn’t saying we don’t have to worry about MRSA anymore. There is still a heavy burden.” Researchers noted that the reasons for the decline are uncertain, but that improved disease-prevention protocols in hospitals may be paying off. One pleasant surprise was the relative dropoff in infections outside of the hospital setting. In 2005, they constituted 62% of MRSA cases; by 2010, that rate had dropped to 52%. Michael David, MD, an infectious diseases expert at the University of Chicago who was not involved in the study, comments that the drop in community-acquired infections, while encouraging, needs to be put in perspective: the rate and number of infections is still much higher than in earlier decades. Says David: “If a doctor left the United States in 1999, and came back in 2010, he or she would be shocked” at the high number of community-acquired infections. According to the Centers for Disease Control and Infection (CDC), about 19,000 Americans die from MRSA infections annually.
Blood Screening
U.S. Army contracts with Canadian company for rapid testing. The United States Army has announced that it has retained the services of the Canadian company MedMira, Inc., to develop a rapid, multiple-blood screening test to use before emergency blood transfusions. The test is MedMira’s Multiplo Rapid HBV/HIV/HCV Antibody Test screens. The Multiplo assay will be able to screen for all three viruses in three minutes, using one drop of blood. The Army will also provide development costs and fees associated with MedMira obtaining U.S. Food and Drug Administration (FDA) pre-market approval for the product. Says Col. Richard Gonzalez, product manager, U.S. Army Medical Material Development Safety, “A multiplexed test for transfusion-transmitted diseases provides an enabling technology that will be used to mitigate risk in environments where emergency blood collections are necessary to save lives of severely wounded service members.”
