Inside Diagnostics - Spring 2015 (EN) by nal von minden GmbH

new art laboratories

Inside Diagnostics Spring 2015

PRENATAL DIAGNOSTICS The most important tools in diagnosis

HERPES Measures for prevention and diagnosis

SLEEP ON PRESCRIPTION 3Z-Drugs: Zolpidem, Zopiclone, Zaleplon Rapid Tests

In this issue

P R I Z E D RpAagW e 10 More on

Laboratory Diagnostics Laboratory Service Consulting & Service

Inside Diagnostics

Foreword

Dear reader, For this first issue of 2015, we decided to highlight the topic of pregnancy, including its methods of detection (invasive and non-invasive) as well as prenatal diagnosis. As usual, we also examine a chosen drug topic and for this first issue of the year, we decided to focus on our tests for new parameters: Mescaline and Zopiclone, related to Zolpidem and Zaleplone. We present you with a short insight relating to these drugs including their usage, addiction and treatment. The panel of STDs that we already browsed is very large but the topic of herpes has never been explored before. Thus for this issue, our specialists have written a very interesting article on the topic that will help you to understand the key facts. We also dedicated a space for our customer satisfaction survey and its

Click here and subscribe in one easy step! Executive editor: Inside Diagnostics Nicolas Kennof Tel.: 0941 29010-36 inside-diagnostics@nal-vonminden.com

Page 2

results. Please have a look at what our customers think of us! In our short news, you can read about blood borne viruses in intravenous drug users, Medica 2014, World Aids Day 2014 and much more â&#x20AC;Ś Finally, from this issue on, we will only produce three magazines a year. Our motivation remains high but unfortunately due to internal organisation, it is necessary to decrease the number of issues in order to maintain the same quality. Enjoy reading this issue and donâ&#x20AC;&#x2122;t forget to participate in our prize draw on page 10. Yours faithfully,

Nicolas Kennof

Inside Diagnostics

Content Themes 3Z-Drugs �� 4 Influenza/BBVs �� 6 Antibiotic resistance /Strep A �� 8 Herpes �� 9 Prenatal Diagnosis �� 12

nvm Inside Prize draw ��10 Customer Satisfaction Survey ��14 Medica 2014/Short News ��15 Contact/Medical Man ��16

PRENATAL DIAGNOSIS | Page 12

Every pregnancy is complemented by a wide range of prenatal diagnostic methods, all of which are geared towards supporting the mother and child in the best possible way. Such diagnostics include the detection of problems as early as possible, to enable fast treatment, as well as keeping a close eye on the possibility of infections. Read more on page 12.

Impressum Inside Diagnostics nal von minden GmbH Customer Magazine Contact: nal von minden GmbH Nicolas Kennof Friedenstraße 32 93053 Regensburg Chief Editor: Nicolas Kennof Editors: Torsten Winkler, Kristina Sambs, Raffaela Seiband, Sabrina Rabenhofer, Christopher Beiderbeck, Anne Kaiser, Andrea Kreuzer, Theresa Koller, Jacob James, Martina Kastenmaier, Alexandre Lages, Miguel Estevez, Lukas Eder, Katharina Anna Haney, Helen Murr inside-diagnostics@nal-vonminden.com Layout: Martina Kastenmaier, Kasia Orlowska

Page 3

Drugs Z-Drugs

Prescription sleeping pills

An aid to addiction? Z-Drugs: zolpidem, zopiclone, zaleplon

3. Zopiclone

The term “Z-drugs“ is used to describe a new generation of sleep-inducing drugs, which include the drugs zolpidem, zopiclone, and zaleplon. These new generation drugs primarily induce sleep, but can also be used as a sedative, to treat or prevent epileptic seizures and as muscle relaxants. Once ingested, these drugs aid the induction of sleep with few unwanted side effects the following day. Structurally, Z-drugs differ from benzodiazepines (a group of pharmaceuticals that are administered as a sedative and for relaxation), but clinically they have similar effects. Although less addictive than benzodiazepines, “Z-drugs” are still controversial because of their potentially serious side effects. Zolpidem, for instance, may cause cognitive disorders and psychosis. The World Health Organization (WHO) has put “z-drugs” on the same level as benzodiazepines.

In small doses, zopiclone has a sleep-inducing effect; at higher doses, however, it is sleep-enforcing. In addition, it has an anxiolytic (anxiety reducing) effect, is muscle relaxant and helps against cramps. In Germany this drug was approved in March 1994.

What is behind the 3 Z? 1. Zolpidem Zolpidem is a drug which is used in modern hypnotics. It is currently the most prescribed sleeping pill in Europe and the United States. Zolpidem is absorbed quickly and easily by the body and its effects include sedation, muscle relaxation and relief against cramps. It soothes insomnia and, at low doses, the stages of sleep do not seem to be affected significantly. At higher doses, however, changes in sleep are comparable to those caused by benzodiazepines. Zolpidem is approved for the short-term treatment of insomnia. 2. Zaleplon Zaleplon is used for the treatment sleep disorders. The active ingredient zaleplon is used to treat patients whose difficulties falling asleep are severe and present a considerable burden. The maximum duration of treatment should not exceed two weeks.

http://www.deutsche-apotheker-zeitung.de/pharmazie/news/2012/04/12/dhs-apotheken-in-der-pflicht/6990.html (12.11.2014) http://www.erowid.org/pharms/zolpidem/ (12.11.2014)

Page 4

http://www.gl-pharma.at/fachinfo/1263406717.pdf (12.11.2014) http://www.erowid.org/pharms/zopiclone/ (12.11.2014)

Side effects and drug dependence Almost everyone has problems falling asleep from time to time, and in serious cases it is certainly advisable to consider medication. The danger with 3Z drugs, however, is that they can become addictive after only a few weeks. Benzodiazepine was all the rage in the sixties, but it carries a high potential for addiction. The danger was recognized and seems to have been averted, as sales have since fallen sharply. However, the pharmaceutical manufacturers have compensated their downturn in sales with modern generics and the prescriptions for zolpidem, zopiclone and zaleplon , now declared sleep aid medications ,have increased in recent years. Between 1993 and 2007, sales of zolpidem packages increased from 1.4 to 3.7 million, and zopiclone from 0.8 to 3.9 million. In the majority of cases, the patient is prescribed the largest possible package with the maximum dosage. More and more often, Z-drug addicts can be found in rehab centers. Dr. Rüdiger Holzbach, physician and addiction psychiatrist, has reported that the number of patients who lose control over these drugs is increasing steadily and that, in many cases, addicts are taking more than 20 pills daily. The tablets are often consumed in the morning, in order for effects to be felt throughout the day. However ,they are not meant for long-term use, as this may have adverse side effects such as lack of emotion, impaired concentration, fatigue, seizures, and physical damage to internal organs.

http://www.spiegel.de/spiegel/print/d-65089118.html (12.11.2014) http://www.ndr.de/ratgeber/gesundheit/tablettensucht103.html (12.11.2014) http://www.aok-gesundheitspartner.de/rh/vigo_pflege/gesund_und_aktiv/suchtpraevention/medikamente/index.html (12.11.2014) http://www.spiegel.de/spiegel/spiegelwissen/d-67700446.html (12.11.2014)

Drugs Z-Drugs

The initial effect of sleeping pills and tranquilizers may decrease after only a few weeks. Patients then often take more pills to help them fall asleep or to relax and thus often lose control. Those who continue to take the pills soon start complaining of fatigue, headaches, and feeling dejected and dazed. Their concentration becomes more and more impaired, their reactions are slower and addicts can barely cope with everyday life anymore. As a result, they isolate themselves and the addiction often causes family and work-related problems. The prolonged use of benzodiazepines and Z-drugs can lead to memory loss and delusions may occur. In many cases it takes months for the patients to even become aware of their addiction. When they stop taking the pills, insomnia, dizziness, fatigue, and restlessness return. Unfortunately, addicts rarely recognize these symptoms as withdrawals,

and rather interpret them as a recurrence of their initial symptoms. Therefore, they once again resort to the pills for relief. Patients who want to break this vicious cycle permanently ought to seek professional help urgently. Falk Hoffmann, drug expert at the University of Bremen, Germany, notes the importance of doctors and pharmacists in raising awareness that these pills are not as harmless as declared in review articles sponsored by the manufacturers. Due to the psychoactive effects and the relatively high legal availability of zolpidem, zopiclone, and zaleplon, they are also increasingly used as intoxicants. nal von minden has a rapid test available. Contact us for more information. KH

istockphoto.com ÂŠ Li Kim Goh

Page 5

Infectiology Influenza

Influenza

The Role of Rapid Influenza Diagnostic Tests Influenza, both seasonal and pandemic, is one of the biggest challenges for global health. Throughout history, flu pandemics have caused insurmountable healthcare crises with the most deadly, the 1918 Spanish Flu, having an estimated death toll of between 20 and 50million people worldwide.

(ILSs) whereby clinical diagnosis would be difficult. Due to the fact that RIDTs cannot offer definitive negative results, the test outcome should be used along with clinical observations and potential exposure history in order to make effective patient management decisions.

Influenza is categorized into type A and B based on differences in their surface haemagglutinin (H) and neuraminidase (N) glycoproteins. Both type A and type B influenza cause an acute respiratory disease, in which its severity is highly dependent on the combination of H and N glycoproteins. Two of the most common strains of flu are the A (H1N1) and A (H3N2) which often cause the majority of seasonal flu infections.

Closed Community Outbreak Management

Each year, seasonal flu is implicated as a factor in the death of thousands of people across the globe. It is extremely hard to accurately quantify the number of fatalities directly associated with influenza infection as many people, especially the elderly, may die from complications such as pneumonia rather than as a direct result of the viral infection. The fact that many symptoms are not exclusive to influenza infections can make accurate clinical diagnosis difficult. Many influenza symptoms are clinically indistinguishable from symptoms common in respiratory synctial virus (RSV), adenovirus and rhinovirus infections. Definitive diagnosis of influenza infections will almost always require laboratory analysis of respiratory samples. Role of Rapid Influenza Diagnostic Tests It is imperative to understand the burden that influenza can have on both healthcare resources as well as financially in epidemic countries. Rapid influenza diagnostic tests (RIDTs) offer diagnosis of influenza infections in a much shorter timeframe than traditional laboratory diagnostics, thus alleviating the pressure on laboratories, especially during outbreaks. The most common types of RIDTs work by detecting the core nucleoprotein (NP) as opposed to the variable H and N glycoproteins. This means that they are able to detect both influenza A and B strains but are unable to differentiate between them. Individual Diagnostics RIDTs can be used to aid the diagnosis of influenza infections in those patients presenting with influenza-like symptoms

In closed and semi-closed communities such as educational institutes, the use of RIDTs can be used to aid in the implementation of control measures in the event of an outbreak of ILSs. The limitations of RIDT test sensitivity can be overcome with the detection of influenza antigens in a number of patients presenting with ISLs. In the ideal scenario, a small number of positive results should be confirmed using traditional laboratory based methods such as RT-PCR. Outbreak Surveillance As with closed and semi-closed communities, RIDTs can be used alongside confirmatory methods to aid clinical diagnosis in identifying influenza outbreaks. RIDTs can be useful in wider outbreaks to identify the infection foci and to prioritize specimens for confirmatory testing. Important Factors When utilising RIDTs in a clinical setting it is important to fully understand the test limitations and factors which may affect test accuracy. It is essential that RIDTs are only used by trained collectors and interpreters to ensure biosafety precautions and correct pre-analytical procedures are in place so that the correct result can be identified from the test. Carrying out the test procedure as per the package insert is imperative to ensure the accuracy of the test is maximized. Failure to follow specified test reading times can also lead to erroneous results. Finally it is also important to have a patient management plan in place in order to effectively deal with test results. With RIDT limitations, such as non-definitive negative results, understanding the significance of the test results is important in order to effectively control the outbreak. By combining RIDT results with other clinical information it is possible to interpret the RIDT results with confidence.

Page 6

Infectiology BBVs

Virus infections

Control of BBVs in IV Drug Users Preventing the spread of blood borne viruses (BBVs) in intravenous drug users (IDUs) is an important public health problem. Reducing the spread of BBVs is essential in the fight to tackle drug abuse and key to aiding the recovery of IV drug users for who a positive result may lead to a further feeling of being disenfranchised from mainstream society. The benefits of preventing the spread of BBVs are not just important for those at risk of infection but also for the wider community as well through the reduction of long term treatment costs. Although the sharing of drug paraphernalia has been on the decrease over the last couple of decades due to effective harm reduction approaches, the number of intravenous drug users infected with HIV, HBV and HCV is still far higher than that of the general population. It is estimated that over 90 per cent of people infected with HCV in the UK have at some stage in their life been an IDU. Harm reduction services such as the implementation of needle and syringe exchange programs targeting IV drug users in the community have been seen as successful in reducing the number of new infections of BBVs, especially for HIV. Countries that have implemented needle exchange programs have seen a steady decline in HIV infections rates in IDUs when compared with those that havenâ&#x20AC;&#x2122;t offered such services. There have also been unexpected benefits of introducing exchange programs such as increased engagement with other services such as intervention programs.

into safer injecting practices, promoting the switching to nonIV administration methods and spreading awareness of HBV and HCV vaccinations are all integral parts of these effective programs. It is important for awareness and education programs to fully understand social and cultural barriers that currently prevent many users accessing conventional healthcare. By overcoming these barriers it should allow services to improve access and engagement between at risk users and testing and treatment programs. Outreach programs have shown success when used in combination with an effective mobile testing protocol to offer point of care testing to those users who may be at the highest risk from infection. Careful planning and implementation is important when initiating BBV testing programs. Despite advances in the public awareness of HIV, Hepatitis B and Hepatitis C there is still a social stigma attached to these diseases. Understanding the emotional and psychological consequences of a positive result is especially important when working with IV drug users who are often already experiencing ostracism in society to prevent a relapse of their recovery. nal von minden offers rapid tests for HIV, HBV, HCV as well as many other clinically significant diseases for IDUs such as TB â&#x20AC;&#x201C; feel free to contact us for more information.

Community outreach programs targeting IV drug use hotspots such as hostels and gyms have also shown to be effective in raising awareness of the risks of BBV infections. Education

*Quellen: http://www.nta.nhs.uk/bbv.aspx http://ukpolicymatters.thelancet.com/policy-summary-needle-exchange-schemes-for-injecting-drug-users/ https://www.gov.uk/government/collections/hiv-surveillance-data-and-management Health Protection Agency. Shooting up. Infections among injecting drug users in the UK October 2008 (updated October 2009).

Coffey E, Young D. Guidance for hepatitis A and B vaccination of drug users in primary care and criteria for audit. London: RCGP, 2005. Vandelli C, Renzo F, Romano L et al. Lack of evidence of sexual transmission of hepatitis C among monogamous couples: results of a 10-year prospective follow-up study. Am J Gastroenterol 2004; 99(6): 855-9 NICE. Technology Appraisal 106. Hepatitis C - peginterferon alfa and ribavirin. London: NICE, August 2006.

Page 7

Rapid Tests Antibiotic resistance/Strep A

Antibiotic resistance The alarming increase in antibiotic resistance calls for heightened awareness surrounding the prescription of antibiotics The dangers of excessive antibiotic use and its consequences have been under discussion in Germany for many years. Amongst physicians, there is now a heightened sense of caution and, as a result, the number of antibiotics being prescribed is in decline. However, a closer look at the situation in Europe also shows that, for example, antibiotics are used less in Scandinavia, the Netherlands and Austria than in Germany, where the prescribing of antibiotics is yet to be reduced considerably. The increasing development of bacterial resistance is being observed with great concern. The spread of multi-resistant pathogens continues to be a growing problem not only in hospitals and nursing homes, but also in doctors’ offices. For affected patients, this means that there are only limited treatment options. If the last-resort antibiotics are no longer effective, this may quickly result in the development of life-threatening infections. Where does antibiotic resistance come from? There are various causes for the development of resistance to antibiotics. A very large influence is agriculture. Only about 30-50% of antibiotics produced annually are used for the treatment of infectious diseases in humans, the remainder being used in agriculture. Veterinary antibiotics used in agriculture are very similar or the same as those prescribed to humans. Through our food intake we constantly consume a number of antibiotics or already resistant bacteria. This is the perfect environment for bacteria to continue increasing its defense shield and thus the path towards resistance continues its course. It has been proven that the growth rate of resistance to antibiotics in medicine depends strongly on the number of prescriptions – especially when superfluous - and compliance with the prescribed treatment period. It is therefore critical to not prescribe antibiotics when they are not strictly necessary or suitable for their intended purpose. But how does that work? Laboratory diagnostic possibilities for differentiation at the point of care The fundamental basis for deciding whether antibiotics can fight an infection is to know whether the infection is bacterial or viral in nature. In most cases, antibiotics are only prescribed for infections that are bacterial in nature. For the diagnostic differentiation of infection, the following markers provide a suitable support

C-reactive protein (CRP) The Capsule-reactive protein is an acute phase protein that is formed rapidly in response to inflammation, infection, and tissue damage in the body. It is especially suitable for distinguishing between bacterial and viral infections, since the concentration is only slightly elevated in viral infections, but greatly increases in bacterial infections. Increases of 10-50 mg/l show mild to moderate bacterial infections, but more so severe viral infections. An increase of> 50 mg/l, however, indicates severe bacterial infections. Another important threshold for the use of antibiotics is 80mg/l. White blood cell count Leukocytes take on the role of guards who patrol, constantly looking for pathogens in the body. If they find any, they multiply to fight the pathogen. Compared to C-reactive protein , leukocytes are a lot more inert. Where the white blood cell count has increased, it indicates that the CRP value has already been rising for some time. Conversely, a decrease in infection will be followed by a delayed decrease in leukocytes. The white blood cell count is by no means a bad diagnostic tool. The presence of urogenital infections, for example, can be detected directly by leukocytes. Procalcitonin Procalcitonin is normally produced in the C cells of the thyroid gland as a precursor of the hormone calcitonin. Like CRP, PCT can be used as a marker for the presence of a bacterial infection, where its concentration in blood increases drastically. Compared to CRP, PCT increases rapidly in the blood, making for a quicker distinction between viral and bacterial infections. Group A Streptococcus Group A streptococci are often the main reason for infections of the upper respiratory tract, such as scarlet fever. Group A Streptococci are bacteria, which can usually be successully treated with antibiotics. As a variety of viral infections may also occur in the upper respiratory tract, a distinction between bacterial and viral infection is crucial for the right treatment. Which marker is optimal in determining the use of antibiotics generally depends on the overall clinical picture. For example, as a ‘strawberry tongue’ is a typical indicator of scarlet fever, it is therefore advisable to test for group A streptococci. RS

Page 8

Gynecology Herpes

Herpes

Once herpes, always herpes! Is that correct?

You can get infected with herpes through kissing; you will always have it and it will return again and again! These are the most common statements about herpes, yet are they really true? Does herpes stay in the body and return again and again? To put it simply, yes! Once you are infected with the virus, you cannot get rid of it. What is herpes? A herpes infection is caused by the herpes simplex virus. There are 2 types of virus, whereby cold sores are usually caused by virus type 1, and genital herpes usually caused by virus type 2. A herpes infection is most commonly visible via blisters on the lip or other affected areas. Genital herpes is one of the most common sexually transmitted diseases, and is recognisable through bead-like nodes in the genital area. The first symptoms are itching in the genital area, discharge, and a tingling sensation on the skin. Blisters will develop when in the more advanced stage of the infection. How is herpes transmitted? Can I become infected with herpes through drinking from a dirty glass? No, thankfully, it is not so easy. The virus cannot survive for long outside the body, and there is thus no risk of contaminated from a used glass or lipstick. Oral Herpes is transmitted through skin to skin contact, such as kissing or oral sex and genital herpes is transmitted through bodily fluids such as semen or vaginal secretions. Condoms are thus very good protection against herpes and, as with other sexually transmitted diseases, are an absolute must. Furthermore, an infection with herpes can promotes in-

fection with other sexually transmitted diseases because the bodyâ&#x20AC;&#x2DC;s immune system is weakened by the virus and the defense mechanisms no longer function optimally. Therapy In most cases, infection with virus type 1 remains unnoticed, but if an itch or burn is detected on the lips, ointments and creams from the pharmacy can usually help to alleviate the symptoms. Initial infection with virus type 2, is usually more severe (acute disease) and therefore requires a visit to your doctor. The doctor usually uses a blood sample and a swab from the blister fluid for diagnosis. Both samples are then sent to a laboratory for examination and if herpes is diagnosed, therapy begins. However, it is not possible to cure the virus, only to reduce the progression of the infection. Ointments will help against itching from a minor infection, but burning and painful rashes can only be alleviated with antiviral drugs (such as drugs with the active substance acyclovir). These virus-inhibiting agents, taken orally or in creams for topical application, inhibit the metabolism of the cell and thus prevent further growth. After around 2 weeks, symptoms will be much improved and the blisters on the lips will disappear. Unfortunately, as no cure is possible, the virus remains in the body and may resurface from time to time. Herpes is most likely to reappear when other infections or viruses, such as the flu , weaken the body. Stress can also contribute to returning herpes infections. As there is no cure, one can only strengthen the bodyâ&#x20AC;&#x2DC;s defenses, to lessen the chances of it returning. RS

1 https://www.gib-aids-keine-chance.de/wissen/sti/herpes.php 2 http://www.frauenaerzte-im-netz.de/de_herpes-infektionen-was-ist-herpes-_629.html

istockphoto.com ÂŠ lolostock

Page 9

nvm inside Prize Draw

Join in & Dear reader,

win!

Thank you to all those that look part in our competition in the last issue. We congratulate Mr A. Rottler. This issue, we offer you again the opportunity to win a great prize.

The term ´prenata

l diagnosis´ refers

to the examinatio a) prehistoric eels n of: b) mother and child throughout pregnan cy c) the mysterious sp ecies known as ‘pre natal’

Good luck! Your Inside Diagnostics team

Participate under the following link: http://www.nal-v onminden.com/en/ prizedraw.html Or send an E-Mail to: gewinnspiel@na l-vonminden.com

The prize is a Philips Living Colors Iris… •

16 million colors

•

Remote control included (not compatible with the Hue ecosystem)

•

Adjustable speed of automatic color changing mode

•

210 lumens, 120V

Just click the Link above or send an E-Mail to gewinnspiel@nalvonminden.com Closing date is the 15th of May 2015

Page 10

nvm inside Prize Draw

Please mark the right answer,

simply fill the form & win!

Name

Firma

Adresse

Stadt

E-Mail

Unterschrift Conditions of Participation 1. The Promoter is nal von minden GmbH. 2. To enter simply fill in your details on the form here above and fax it to +49 941 290 10-50 or send it by post to: nal von minden GmbH, Christopher Beiderbeck, Friedenstrasse 32, 93053 Regensburg, Germany. Participation is also possible by email; please send an email with your answer and your complete address with the subject line as “Prize Draw” to gewinnspiel@nal-vonminden.com. You also can participate online: http://www.nal-vonminden.com/en/prizedraw.html The winner will be chosen at random and be drawn from those who have entered the correct answer. 3. This prize draw is open to European residents aged 18 years or over, with the exception of employees of the Promoter, their families, agents and anyone else connected with this promotion. Only one entry per person. No entrant may win more than one prize. 4. No purchase necessary to enter the prize draw and the participation is free. By entering the prize draw each entrant agrees to be bound by these terms and conditions. Entries must be received by the 15th of May 2015. 5. The winner will be notified via email or post and will receive the prize by post. 6. Prizes are subject to availability. In the event of unforeseen circumstances, the Promoter reserves the right (a) to substitute alternative prizes of equivalent or greater value and (b) in exceptional circumstances to amend or foreclose the promotion without notice. No correspondence will be entered into. 7. The prize is a Philips LivingColors Iris. No cash or prize alternatives will be offered. The winner‘s entitlement to the prize is not transferable. 8. The Promoter shall not be responsible for damages, losses or liabilities of any kind, including without limitation, direct, indirect or consequential loss or damages arising out of or in relation to the prize draw. 9. Any liability for damages of nal von minden GmbH and their officers, employees and agents in connection with the competition, irrespective of the legal reason, is, as far as legally permissible, limited to cases of intent or gross negligence. 10. The promoter’s decision in respect of all matters to do with the competition will be final and no correspondence will be entered into. Legal recourse is excluded. Data protection 1. Being a responsible entity as defined by the German Federal Data Protection Act, nal von minden GmbH collects, processes, and uses personal data (first name and last name, date of birth, street address, postal code, place, country, and email address) disclosed to nal von minden GmbH in connection with the Prize Draw only in compliance with the applicable laws and regulations referring to data protection. nal von minden GmbH will not disclose your personal data to any third party. Your personal data will be collected, processed and used exclusively for the purpose of carrying out the Prize Draw. The promoter is allowed to send future issues of the “Inside Diagnostics” by e-mail. Unsubscribe at any time by sending an informal e-mail to gewinnspiel@nal-vonminden.com 2. You are entitled by law to request free information about the personal data nal von minden has stored in relation to your person, and to request that nal von minden GmbH corrects, blocks or deletes these personal data. Please contact nal von minden GmbH if you want to claim any of these rights referred to above. 3. If you request that your personal data be deleted before the Prize Draw is completed, your entry into the Prize Draw is deemed to be terminated as well. In that case, you are no longer eligible for a prize.

Page 11

Gynecology Prenatal Diagnosis

Pregnancy

Prenatal Diagnosis Pregnancy is a landmark experience in any woman’s life and, of course, the child’s best interests are her main concern. This means that pregnancy, a time of great anticipation and upheaval, is also somewhat tainted by uncertainty and fear. For this reason, each pregnancy is complemented by a wide range of prenatal diagnostic methods, all of which are geared towards supporting the mother and child in the best possible way. This can include detecting various issues as early as possible in order so that they can be treated, as well as keeping a close eye on the possibility of infections. Biologically speaking, every pregnancy begins with the fertilization of an egg by a sperm. However, emotionally speaking, pregnancy begins at home with a positive pregnancy test result,and without even realizing it, the mother is now one step closer to one of the most important parts of pregnancy – the prenatal diagnosis. Following a positive pregnancy result, a gynaecologist is sought for confirmatory testing and further examination. Two types of diagnostic methods are used for this: invasive (the uterus is probed internally) and non-invasive (only external examination). Depending on the individual situation, it may also be important to screen the mother for specific infectious diseases. Non-invasive methods Aside from blood collection, non-invasive methods comprise of purely external examination, which according to current knowledge, poses no risk to the unborn child. Some non-invasive examinations can include: •

Ultrasound examination

Ultrasound is the most common form of antenatal examination. Only a few years ago, all an ultrasound screen was able to show was a jumble of non-descript pixels that could only be interpreted by the trained eye. However, modern technology has progressed so far that even you or I can see the child sucking its thumb in the womb or doing somersaults. The two- or even three-dimensional image is generated by means of (fine) ultrasound, which is painless and harmless for both mother and child.

Page 12

•

Nuchal Translucency

An ultrasound of sufficient resolution can be carried out by specially-trained physicians between the 11th (11+0) and 14th (13+6) week of pregnancy to measure nuchal translucency. During this time, lymphatic fluids accumulate in the child’s neck and, in some circumstances, too much of fluid can heighten the risk of abnormalities. These mainly include trisomy 21 (Down’s Syndrome) or monosomy X (Turner Syndrome) – a condition in that, instead of an XY chromosome pairing (male) or an XX chromosome pairing (female), only a single x chromosome is found in each cell throughout the body. •

First-trimester screening (FTS)

The nuchal translucency scan is usually combined with a blood test to measure two levels of pregnancy-specific substances – free beta-hCG and PAPP-A. Together they are known as the first-trimester screening since, as described above, they take place between the 11th and 14th week of pregnancy known as the first trimester. First-trimester screenings are not diagnostic test methods in the strictest sense, but rather a means of calculating the probability of a child developing Down’s Syndrome. The results of the blood test are combined with those of the nuchal translucency scan along with other factors such as the mother’s age, weight and whether she is a smoker or non-smoker. All factors are then analysed by a computer algorithm which compares the possible combinations against a database of healthy and Down’s Syndrome children, thus calculating the probability of the baby being born with Trisomy 21. The findings are then use as a guide in later examinations looking to make an actual diagnosis (see below invasive methods such as amniocentesis or chorionic.) Invasive Methods In the case of invasive methods, the mother’s body is examined internally as part of a minor surgical procedure. For this reason, invasive methods carry a much higher risk of miscarriage (0.5-8.8%, depending on the study and the source). This means that any potentially invasive examination and its risks must be fully discussed with the mother prior to consent.

Gynecology Prenatal Diagnosis

Both chorionic villus sampling and amniocentesis are suitable for successfully detecting chromosomal abnormalities (such as Trisomy 21), as well as some methabolic diseases. •

Chorionic villus sampling

During chorionic villus sampling, a needle is used to puncture the abdominal wall and inserted into the abdominal cavity, where a sample of chorionic villi is taken from the placenta. As the placenta is formed from the fertilized egg, it is usually genetically identical to the child. In contrast to amniocentesis, the child’s amniotic sac is not punctured as part of this examination. Whereas in the past chorionic villus sampling was carried out at the beginning of the 9th week of pregnancy (prior to the advent of first-trimester screenings), nowadays it usually takes place at the beginning of the 13th week of pregnancy. •

Amniocentesis

Amniocentesis, like chorionic villus sampling, aids the detection of chromosomal abnormalities and metabolic diseases. However, amniocentesis differs in that the child’s amniotic sac is punctured with a need through the mother’s abdomen so that a sample of amniotic fluid can be taken. The embryro’s cells contained within the amniotic fluid can then be analysed in a laboratory using a karyogram. In addition to chromosomal and phenotypic changes, various infectious diseases are often an additional focus of prenatal diagnosis testing. Whilst some diseases may go unnoticed in a non-pregnant person, the same condition could have devastating consequences during pregnancy, leading to birth defects or even miscarriage. Such conditions are referred to collectively as the STORCH panel (in English ‘TORCH’), which is an acronym for the major infectious diseases in pregnancy: S: Syphilis T: Toxoplasmosis O: Others, such as parvovirus B19, hepatitis C, Varicella zoster virus, literiosis or Coxsackie virus R: Rubella

Two examples, toxoplasmosis and cytomegalovirus, have been discussed in more detail below. •

Toxoplasmosis

Toxoplasmosis is an infectious disease transmitted by cats that are infected with the parasite toxoplasma gondii. If a pregnant woman is infected with this parasite during the first two trimesters of pregnancy, it can often lead to a miscarriage, mental disability in the child and/or organ damage, depending on the week in which the child was infected. For this reason, women should be checked for infection early in their pregnancy. A positive IgG result indicates that there is already a past, healed toxoplasmosis infection. This poses very little risk to the child. However, in the case of a negative IgG result, exposure to cats and their faeces should be avoided with vigilance. A positive IgM result would indicate that the patient has an acute toxoplasmosis infection. •

Cytomegalovirus

As with toxoplasmosis, cytomegalovirus is harmless to nonpregnant women and usually heals itself without incident. However, if infection occurs within the first or second trimester of pregnancy, it has the potential to be transmitted to the child and may cause deformities. Nine out of ten children born with cytomegalovirus will suffer with the long-term consequences of the infection. The risk of becoming infected with CMV during pregnancy is particularly high amongst women who come into regular contact with young children (such as kindergarten teachers), amongst who CMV is more prevalent. For this reason, a woman’s IgG serostatus should be checked in early pregnancy and seronegative woman should not be around children. In the case of a negative IgG result, there is no risk of infection for the unborn baby and such women may come into contact with children without consequence. To conclude, it is clear that prenatal diagnosis, with its noninvasive and invasive methods, is a vital element of antenatal care. It aids in the detection of potential issues early in the pregnancy, and also serves to alleviate the worries of expectant mothers.

C: Cytomegalovirus, Chlamydia H: Herpes simplex virus

istockphoto.com © 4X-image

Page 13

nvm inside Customers

Customer Satisfaction Survey

Thank you for participating In June, we sent out a survey to our customers in order to get feedback from them and determine their level of satisfaction. First of all, we’d like to say a big ‘thank you’ to all of you who took the time to complete the survey and tell us what you think. It really helped us to find out what we do best, but also showed us where there is still room for improvement. Last but not least, it provided us with great ideas for future product development. You helped us know how to better care for you.

Kundenmeinungen

proactive

84%

80%

74%

innovative

experienced

84%

convenient to work with

80%

price performance ratio nal von minden quality

Our product quality is 1.5 times better than the quality of our competitors.

for nal von minden products is in average higher than the one of our competitors.

of our customers are happy with how we solved their problems.

97.5% … would recommend nal von minden.

98% … of our customers.

85%

of our customers are

satisfied by the employees

»Very good support. Very competent contact persons. Very fast delivery time.«

at nal von minden.

»Smooth process regarding orders and questions; reliable when it comes to problem solving; always nice and friendly.«

nal von minden is always available for its customers. So said …

83%

of our customers qualify the information they receive as very complete.

convenient to understanding appealing order with customers‘ needs with our design

Our customers estimate that the

competitors quality

77%

76%

needs Our website ed. ov pr to be im 53% of our

79%

Only

customers are

of our customers are satisfied with our delivery time and our courier service.

satisfied.

2.5%

… only do not want to recommend nal von minden.

73%

s of the customer

NK, LE

Page 14

ny.

like our compa

nvm inside Short News

Medica 2014a great – success Like every year, we have spared neither expense nor effort, dear customers, in showcasing our newest products and to be there for you at our regular stand at the fair in Düsseldorf. Amongst other things, a particular highlight at this year’s Medica was the “Colibri”, which currently holds the title for the smallest rapid test analyser in the world. The rest of our program was also received with enthusiasm. We would like to extend our sincerest thanks to all our visitors, but also to our dedicated exhibition team and our colleagues at Moers for their enduring support. Should you not have had the opportunity to visit the fair this year, we have something special for you – for the first time ever you can catch a glimpse of this year’s event by viewing our Medica video. Simply click on the link at the end of this article. Check it out, it’s worth it! http://youtu.be/djGL7ckgJZ0

Watch now! Our video MK WORLD AIDS DAY Every year since since 1988, the World AIDS Day takes place on 01 December. It is organized by UNAIDS, the United Nations AIDS organization, and dedicated to raising awareness of AIDS and remembering those who have died of the disease. Different organizations worldwide also want to raise awareness of the fight against HIV and encourage people to show support to people living with HIV. It is estimated that more than 35 million people across the world have HIV. In addition, World AIDS Day serves to remind politicians, the economy, the media, and society that the HIV virus is far from being defeated. More and more often, World AIDS Day is also used by the media to increase reporting on HIV and AIDS. There are annual campaigns in several countries – for example, the 2014 theme for World AIDS Day in the USA was “Focus, Partner, Achieve: An AIDS-free Generation.” nal von minden has several rapid tests for the detection of HIV 1/2/0 antibodies in its portfolio. Please contact us for more information. http://www.fpa.org.uk/campaigns-we-support/world-aids-day (07 December 2014) http://aids.gov/news-and-events/awareness-days/world-aids-day/ (07 December 2014)

Page 15

Contact Details nal von minden GmbH Carl-Zeiss-Straße 12 47445 Moers Germany Friedenstraße 32 93053 Regensburg Germany CEOs: Sandra von Minden Roland Meißner Thomas Zander Tel.: +49 941 29010-0 Fax: +49 941 29010-50 info@nal-vonminden.com www.nal-vonminden.com Commerical Reg: HRB 5679 Steuer-Nr. 244/133/00130 UST-ID-Nr. DE 189 016 086

Discover our comprehensive product range! For all products and innovations please visit: www.nal-vonminden.com

JUST AS MEDICAL MAN IS WALKING THROUGH THE TOWN, HE SEES THE MONSTER. A GIGANTIC CACTUS THREATENS THE TOWN.

BUT MEDICAL MAN ALWAYS HAS A PLAN! WITH HIS SPECIAL AMMUNITION HE GOES TO GET THE CACTUS! gOOD THAT I ALWAYS HAVE A FEW Z-DRUGS AT THE READY...

HM???? WHAT IS GOING ON??????????? …

Stamp, stamp

HE LOADS THE CANNON QUICKLY, AIMS…

Stamp, stamp

...AND THE MONSTER CACTUS FALLS INTO A DEEP SLUMBER.

GEEKTOWN IS SAVED!!!

Rev 01 / IMAGE-DE / 01-13

The other day in geektown…

You‘Re in trouble now!!!

SNORING SLEEPING

AND THEY SAY THAT CACTI ARE EASY TO CARE FOR!!!!!!!! HMPF!!

Rapid Tests Laboratory Diagnostics Laboratory Service Consulting & Service

www.nal-vonminden.com/inside-diagnostics

The ADVENTURES OF Medical Man The JOLLY grEEN cactus