Scientists diagnose intestinal worms -- using an iPhone microscope

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via edition.cnn.com

An Apple product may help keep the doctor away in Tanzania.

In a discovery that provides doctors in remote areas with an alternative, scientists recently created a microscope using an iPhone, tape, flashlight and camera lens.

They then used it to diagnose intestinal worms in about 200 students in Pemba Island, off Tanzania's eastern coast. .

"To our knowledge, this is the first time the mobile phone microscope had been used in the field to diagnose intestinal parasitic infections," said Isaac Bogoch, an internal medicine specialist at Toronto General Hospital.

Bogoch, who conducted the study with colleagues, used his iPhone 4s.

However, he said, the approach can work with any smartphone that has a good camera and a zoom feature.

African markets are flooded with low-cost smartphones made by Chinese companies, some selling for as low as $80. With mobile phone growth skyrocketing in the continent, price-based competition is becoming vital to tap into the African market share.

From cell phone to microscope

To convert the phone into a microscope, scientists put double-sided tape over the iPhone camera lens. They then pierced a hole in the tape and centered a tiny $9 lens over the phone's camera lens.

Using a flashlight for illumination, they held up stool samples against the lens using the double-sided tape to hold slides in place, and studied them for intestinal parasites through the phone's screen.

Bogoch said they diagnosed 70% of the infections when compared with the results of a conventional laboratory microscope.

Convenience in remote areas

The scientists plan to tap into technology to make the results more accurate.

The mobile phone microscope is convenient because it allows testing for intestinal worms immediately and in close proximity with the patient, Bogoch and his colleagues wrote in their findings.

Innovative approaches that are portable and easy to assemble are vital in far flung areas, where labs are a rarity.

"The idea was to have a cheap solution in remote settings where equipment such as a microscope and electricity are not that easily available," said Benjamin Speich, a corresponding author and scientist at the Swiss Tropical and Public Health Institute.

Mobile phones are popular in Africa, where penetration rates remain high even in remote areas.

'Cheap solution'

Nearly 1.5 billion people -- 24% of the world's population -- suffer from helminth infections, commonly known as intestinal worms, according to the World Health Organization.

Most of those at risk are children, with most infections reported in Africa, the Americas and Asia.

Intestinal parasites are transmitted through contact with infected feces, which can lodge in the soil and spread though poor sanitation.

The study was published this week in the American Journal of Tropical Medicine and Hygiene. It was conducted by scientists from the United States, Switzerland, Tanzania and Canada.

First time in the field

This is not the first time scientists have converted a smartphone into a microscope, but past experiments have been limited to the lab, Bogoch said.

Two years ago, scientists at the University of California, Davis improvised a microscope using an iPhone.

They inserted a small ball lens into a rubber sheet, which they taped over the smartphone's camera.

At the time, researchers said they planned to validate the device for use in the field.

Too Many Colonoscopies in the Elderly

via newoldage.blogs.nytimes.com

Bill Fullington doesn’t remember exactly where he read that all adults over age 50 should be screened for colon cancer. A magazine? Maybe the local paper?

In any case, Mr. Fullington, a retired teacher in Birmingham, Ala., takes excellent care of his health; he never smoked, doesn’t drink, hits the gym daily. “Everybody thinks I’m 30 years younger than I am, because of my zip,” Mr. Fullington said in an interview. So he dutifully arranged to have a colonoscopy in 2008, when he was 80.

The doctor removed two small polyps — “the size of BBs,” Mr. Fullington said — and sent him home to recover. The next day, “I woke up screaming in pain.”

At the emergency room at Brookwood Medical Center, tests showed that the procedure had perforated his colon. Mr. Fullington underwent a colostomy and spent a week in intensive care — and that was just the beginning.

March is Colorectal Cancer Awareness Month, so you may be reading and hearing a lot about the importance of screening. You may even get to walk through the eight-foot-high inflatable simulated colon that makes appearances around the country — and see what polyps look like from the inside. But you may not hear much about when colon cancer screening should stop.

Even the Fight Colorectal Cancer Web site, from the major advocacy group working to make Americans aware of the disease and its prevention, says that all adults over age 50 should be screened. “Don’t wait. Talk to your doctor,” it urges.

But in 2008, just a few months after Mr. Fullington’s colonoscopy, the United States Preventive Services Task Force reviewed years of research and recommended against routine screening for colorectal cancer in adults over age 75 and against any screening in those over 85.

Let’s be clear: Screening those over age 50, the group most at risk, makes complete sense. Removing the polyps that may become cancerous years later (but also may not) can prevent the disease. But while colonoscopy is underused by the poor and uninsured, it’s overused by the elderly.

Dr. James Goodwin, a geriatrician at the University of Texas Medical Branch in Galveston, has led much of the overtesting research. In 2011, using a 5 percent national sample of Medicare beneficiaries, his team showed that older people underwent colonoscopies too often. Medical guidelines call for a repeat test 10 years after the first negative colonoscopy, but their study found that nearly half of patients with negative colonoscopies had another in less than seven years, often within three or five. About a quarter took place without any clear medical indication.

Now, using Medicare data for every patient over age 70 who had a screening colonoscopy in Texas in 2008 or 2009, Dr. Goodwin and company have found that 23 percent were “potentially inappropriate” because the patients were over age 75 or because they had a repeat screening too soon after the last one for no clear medical reason. The study appeared on Monday in the journal JAMA Internal Medicine.

Gastroenterologists more likely to perform inappropriate colonoscopies were older, male, graduates of United States rather than overseas medical schools, and working in high-volume practices. “There are these factories that do colonoscopies on everyone they see,” Dr. Goodwin said.

Why not screen everyone? Because, he explained, at older ages the benefits diminish. “It’s difficult to have this conversation, to say, ‘You don’t need this because you’re not going to live long enough to benefit,’” he acknowledged. But colon cancer develops slowly, and in the many years it takes for small polyps to evolve into cancer, if they do, most old people will have died of other diseases.

Meanwhile, the risks increase. Mr. Fullington, who’d lost 30 pounds, returned to the hospital two months after his perforation to have his colostomy reversed. Discharged, he developed a painful “crimp” in the stomach. Doctors call it ileus, and it’s not uncommon after bowel surgery at older ages.

He returned to the hospital, where the ileus uncrimped without further surgery. But trying to get to the bathroom, “I sat up and went headfirst onto the floor,” Mr. Fullington said. Bloodied and bruised, he needed head X-rays and stitches.

He’s fine today, happily. And complications like his are very rare.

But, Dr. Goodwin noted, for older patients the prep for the colonoscopy itself can cause weeks of cycling between diarrhea and constipation. “It’s not death, it’s not hospitalization, but it’s feeling sick and humiliated and helpless,” he said. “That is a big price.”

Yet public health campaigns have done such a persuasive job that some people, data to the contrary notwithstanding, believe they need routine mammograms and Pap smears and colonoscopies forever. As another study in this week’s JAMA Internal Medicine shows, older adults may feel “a strong moral obligation” to continue testing and are skeptical of government panels and statistics telling them to stop.

Bill Fullington, however, vows he’ll never have another colonoscopy. And at 85, he’s not a candidate for one. “This whole thing would’ve killed 9 out of 10 80-year-olds,” he said. “I’m one tough nut.”