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Forensic science contributes to national recall of poppy seeds

Forensic science contributes to national recall of poppy seeds

The Forensic Toxicology team at NSW Health Pathology’s Forensic and Analytical Science Service (FASS) played an important role in discovering why commercially available poppy seeds led to 12 hospitalisations across NSW.

After a series of hos­pi­tal­i­sa­tions relat­ed to the use of large amounts of pop­py seeds in Novem­ber 2022, FASS sci­en­tists con­duct­ed foren­sic tox­i­col­o­gy test­ing on blood sam­ples from sev­er­al patients and found unusu­al­ly high lev­els of a chem­i­cal called thebaine.

The­baine, whilst unharm­ful at low­er dos­es, has been known to cause severe ill­ness at high­er lev­els. Symp­toms of the­baine tox­i­c­i­ty include seizures, severe mus­cle pains, severe mus­cle spasms, cramp­ing, stiff­ness, dizzi­ness, abnor­mal move­ments, or car­diac arrest.

While the first cas­es were detect­ed in Queens­land, agen­cies in Vic­to­ria led the inves­ti­ga­tion into the the­baine poi­son­ings. FASS, in con­junc­tion with mul­ti­ple health agen­cies in NSW, used their exper­tise to increase the evi­dence and pro­vid­ed advo­ca­cy which helped lead to major super­mar­ket chains tak­ing pop­py seeds off the shelves and issu­ing a recall.

FASS’s speedy inves­ti­ga­tion was made pos­si­ble with cut­ting-edge analy­sers called Liq­uid Chro­matog­ra­phy Quadru­pole Time-of-Flight Mass Spec­trom­e­try (LC-QTOF-MS). These high­ly sen­si­tive instru­ments detect­ed high lev­els of the­baine and allowed the cross ref­er­enc­ing with inter­na­tion­al library data­bas­es and cer­ti­fied ref­er­ence stan­dards avail­able at FASS.

Foren­sic Tox­i­col­o­gy Senior Sci­en­tist Cather­ine McDon­ald said that a cul­ture of col­lab­o­ra­tion between dif­fer­ent NSW Health agen­cies con­tributed to a suc­cess­ful outcome.
“Pub­lic Health works close­ly with food safe­ty depart­ments in food poi­son­ing cas­es, how­ev­er it’s unusu­al for drug inves­ti­ga­tions to lead to food safe­ty recalls,” she said.

“Col­lab­o­ra­tive inves­ti­ga­tions between inter­state Pub­lic Health depart­ments, food author­i­ties, poi­sons infor­ma­tion cen­tres and foren­sic tox­i­col­o­gy labs was cru­cial in iden­ti­fy­ing the cause of ill­ness in 37 patients around Australia.”

This col­lab­o­ra­tion was fos­tered by the Pre­scrip­tion, Recre­ation­al and Illic­it Sub­stance Eval­u­a­tion (PRISE) pro­gram – a net­work includ­ing NSW Health Pathology’s FASS, NSW Poi­sons Infor­ma­tion Cen­tre (PIC) and the NSW Min­istry of Health – which allowed for the exten­sive blood test­ing vital to the investigation.

Double celebration at Dubbo for David and Diane

It was a double celebration for our Dubbo lab the week before Christmas.

Diane Ben­nett is retir­ing from NSW Health Pathol­o­gy Dub­bo after 28 years.

Diane has been the Senior Sci­en­tist of Micro­bi­ol­o­gy at Dub­bo since 2015 and is retir­ing at the end of 2022.

Known to her col­leagues as a ‘micro guru’, she says she most enjoys know­ing that she has made a dif­fer­ence in the diag­no­sis and treat­ment of patients.
“You’re not just a machine pump­ing out results,” she said.

“Some­times you come up with rare things, and you find hid­den gems; the zebra among the horses.”

Pic­tured with her is David Par­ler, who has been work­ing at Dub­bo as an assis­tant for two days per week for the past 20 years.

Every year the Dub­bo staff put togeth­er a Christ­mas ham­per for David, who con­sid­ers the lab a sig­nif­i­cant part of his life and the staff part of his extend­ed family.

This year was the first year since the COVID pan­dem­ic the staff could come togeth­er and present this ham­per to David per­son­al­ly. He said he was thrilled to receive this gen­er­ous gift.

Diane Ben­nett says she plans to use her retire­ment to trav­el around Aus­tralia, includ­ing see­ing fam­i­ly and friends in West­ern Australia.

Best of luck with the com­ing adven­ture Diane and thank you from all of us at NSW Health Pathology!

 

Meet Emily – pathology courier driver

Meet Emily, one of NSW Health Pathology’s newest courier drivers.

Deliv­er­ing pre­cious sam­ples from our col­lec­tion cen­tres to lab­o­ra­to­ries for test­ing, often over rugged ter­rain and in all con­di­tions, so you get the results you need quickly.

 

Get to know Emily

What is your job title?
NSW Health Pathol­o­gy Courier

How long have you been with NSWHP?
Four months

What attract­ed you to the role?
The diver­si­ty of tasks, places and peo­ple I see every day. No two days are the same, and this job means I trav­el around the city of New­cas­tle, region­al Hunter Val­ley and even fur­ther up the north coast to Port Mac­quar­ie to trans­port pre­cious car­go. Every­where I go there are new peo­ple to meet and inter­est­ing things to learn about the jour­ney of sam­ples from col­lec­tion to analysis.

What do you like best about your job?
Before I start­ed, I did­n’t realise how much work goes into mak­ing sure all the thou­sands of sam­ples col­lect­ed every day get to the right place in crit­i­cal time frames. The amaz­ing peo­ple I work with, as well as the team that analy­ses the sam­ples, work tire­less­ly to keep pathol­o­gy test­ing run­ning for the peo­ple of NSW. I enjoy being part of a large team that qui­et­ly keeps a very impor­tant part of the health sys­tem run­ning on a day-to-day basis.

What are you most look­ing for­ward to over the holidays?
Spend­ing time catch­ing up with fam­i­ly and friends and tak­ing my dog to the beach!

Are you inter­est­ed in join­ing the NSWHP team?
Vis­it our careers page to find out more.

Merry Christmas from NSW Health Pathology

Wishing you a wonderful festive season from NSW Health Pathology staff!

It’s been anoth­er chal­leng­ing year for our teams right across the state.

Our won­der­ful pathol­o­gists, sci­en­tists, tech­ni­cians, couri­ers, col­lec­tors and pathol­o­gy sup­port staff have worked dili­gent­ly through fires, floods and a glob­al pan­dem­ic to deliv­er qual­i­ty pathol­o­gy and foren­sic ser­vices to you – our patients and com­mu­ni­ties right across NSW.

Many NSW Health Pathol­o­gy ser­vices oper­ate over the Christ­mas and New Year peri­od. Find and con­tact your local col­lec­tion cen­tre for more information.

From all of us here at NSW Health Pathol­o­gy, have a very hap­py Christ­mas and a safe and healthy 2023.

Educating via Twitter – a ‘perfect platform’ for pathology

Social media generally, and in particular platforms like Twitter, have been variously described as a bin fire, a sewer and a place for trolls. So why choose it as a platform for education?

Who bet­ter to ask than Dr Tris­tan Rut­land, NSW Health Pathol­o­gy anatom­i­cal pathol­o­gist, and the recent recip­i­ent of a pres­ti­gious US award for his self­less ded­i­ca­tion to pathol­o­gy education.

Dr Rut­land is also very pop­u­lar on Twit­ter. He’s no Elon Musk, but Tris­tan Rut­land (@TristanRutland7) has over 12,000 fol­low­ers and his use of the social net­work­ing plat­form to share and dis­cuss images of pathol­o­gy slides has attract­ed a devot­ed world­wide following.

The win­ner of the 2022 Col­lege of Amer­i­can Pathol­o­gists Res­i­dent Advo­cate Award and the 2020 Kon­rad Muller RCPA Out­stand­ing Teach­ing Award explained how the COVID pan­dem­ic fired his inter­est in what’s known as #PathTwit­ter – an inter­na­tion­al com­mu­ni­ty of pathol­o­gists shar­ing cas­es and edu­cat­ing each oth­er on how to avoid diag­nos­tic pitfalls.

“When the pan­dem­ic kicked off I end­ed up teach­ing our reg­is­trars via dig­i­tal, and that expand­ed to the point where I was teach­ing pret­ty much all the reg­is­trars in Aus­trala­sia in the RCP train­ing pro­gram every Sat­ur­day for four hours for six months,” Dr Rut­land explained.

“Then I had a cou­ple of them say­ing, ‘You should get involved in Twitter’.

“Now, social media has always been a bit of a bin fire, or a dump­ster fire, for me. It was always frus­trat­ing and peo­ple get­ting angry very quick­ly, so I just stayed clear of it. But then some­body intro­duced me to #PathTwit­ter and it’s just com­plete­ly the oppo­site of all that.

“Mar­ket­ing peo­ple would say, ‘it’s where the peo­ple are at’ – and it turns out Twit­ter is actu­al­ly one of the most per­fect plat­forms for pathology.

“You have to be suc­cinct, and you can show images, and that’s what peo­ple want.

“We’re busy peo­ple. Peo­ple can read what I post for two, three min­utes, and in a busy world it just seems to work.”

slide 2

Dr Rut­land has a the­o­ry about why the med­ical com­mu­ni­ty, and pathol­o­gists in par­tic­u­lar, seem to have avoid­ed the nas­ti­ness that has come to be syn­ony­mous with social media.

“We’re all doc­tors who already have a cer­tain lev­el of eth­i­cal behav­iour,” he said.

“Peo­ple who choose to engage on Twit­ter in this edu­ca­tion­al capac­i­ty tend to be sort of more dynam­ic, for­ward-think­ing and will prob­a­bly not want to engage in (nasty behav­iour), that’s not their forum.

“Peo­ple tend to be quite pro­fes­sion­al and very sup­port­ive. I also have patients and oth­er pro­fes­sion­als fol­low­ing me so I’m always very aware of my behaviour.”

Dr Rut­land is also very keen to empha­sise that the shar­ing of infor­ma­tion is done with­out any iden­ti­fi­ca­tion of patients.

tristan slide

He only shares images of cas­es that are years, if not decades old, to avoid any con­nec­tion to patients and it’s all de-identified.

“The whole idea is not to talk about the patient. It’s about dis­cussing the pit­falls and the things that are impor­tant for some­one to learn and make a diagnosis.

“What do you think this pos­si­bly could be? What are the pit­falls and how do you get around it, a bit of a dis­cus­sion about how you could avoid mak­ing this mis­take and poten­tial­ly do a dis­ser­vice for your patients.

“Par­tic­u­lar­ly with unique cas­es, then there’s a big, big, time lag. If some­thing is super rare, you would­n’t put it up the next day, you’d wait a year.”

As much as he enjoys pass­ing on his knowl­edge, Dr Rut­land says he’s also learned from oth­er peo­ple shar­ing their cases.

“I do it because I enjoy teach­ing and I also get some­thing out of review­ing my old­er cas­es, but I have to admit I have been saved and peo­ple in our depart­ment have been saved by stuff that peo­ple have put up on Twitter.

“I’ve actu­al­ly been like, ‘Yes, I’ve seen some­thing like this’, and it’s changed a diagnosis.”

More than that, the plat­form has changed the way he col­lab­o­rates with col­leagues around the world, open­ing up new oppor­tu­ni­ties for learn­ing and research.

“Absolute­ly. I’ve just got an abstract accept­ed for USCAP (Unit­ed States and Cana­di­an Acad­e­my of Pathol­o­gy), which is over in the US next year, and I’m one of about 60 pathol­o­gists that have nev­er met in per­son, haven’t had a zoom call – it was all through Twit­ter,” he said.

“There are peo­ple putting out calls for papers and col­lab­o­ra­tion on Twit­ter, for peo­ple to get involved in research arti­cles, to be involved in new projects and new ini­tia­tives. It’s com­plete­ly changed the way peo­ple collaborate.

“I had no idea this would actu­al­ly be such a pow­er­ful tool.”

He hopes the vis­i­bil­i­ty of the #PathTwit­ter com­mu­ni­ty will attract more peo­ple to pathol­o­gy, a spe­cial­ty strug­gling for num­bers worldwide.

“The irony is we are one of the most active med­ical com­mu­ni­ties on social media, yet it’s still very dif­fi­cult to attract peo­ple. We have trou­ble get­ting peo­ple into our train­ing cours­es and that’s a real shame.

“It’s fig­ur­ing out how to trans­late what we do here into, not nec­es­sar­i­ly engag­ing the gen­er­al pub­lic, but increased recog­ni­tion in the med­ical world.”

He acknowl­edges pathol­o­gy is not often viewed as a “sexy option” for med­ical stu­dents but insists that rep­u­ta­tion is not deserved.

“If I had my time again, I’d do pathol­o­gy again. It’s such a great spe­cial­ty because it’s super inter­est­ing. Peo­ple go, ‘You’re just look­ing at lit­tle glass slides’, but once you know what you’re look­ing at, it’s actu­al­ly real­ly engag­ing, one of the most engag­ing things I’ve done in my life.”

Genomic sequencing unlocks streamlined HIV care

In an Australian first, NSW Health Pathology is pioneering the use of whole genome sequencing to more efficiently match people living with HIV with the antiviral drugs most likely to slow or halt the progress of the potentially life-threatening disease.

The updat­ed assay devel­oped by Pro­fes­sor Sebas­ti­aan van Hal, a micro­bi­ol­o­gist cre­den­tialled in pathogen genomics at NSWHP’s Roy­al Prince Alfred lab, iden­ti­fies which par­tic­u­lar HIV strain the patient has and the strain’s like­ly response to every HIV antivi­ral drug on the market.

Armed with the results of this one pow­er­ful genom­ic test, doc­tors will know which antivi­ral drug will be most effec­tive in fight­ing the patient’s HIV infec­tion, and which med­ica­tions may do lit­tle to slow the virus’ progression.

The updat­ed assay, devel­oped with the assis­tance of NSW Health Pathol­o­gy sci­en­tists Thomas Le and Frances Jenk­ins, is a game chang­er in HIV treat­ment. It has effec­tive­ly future-proofed HIV antivi­ral resis­tance test­ing and giv­en clin­i­cians the infor­ma­tion they need to pro­vide more time­ly, tar­get­ed antivi­ral ther­a­py for Aus­tralians liv­ing with HIV.

Pro­fes­sor van Hal said he embarked on accred­i­ta­tion of the assay after spend­ing six months in Oxford, Eng­land learn­ing sequenc­ing analy­sis of pathogens.

“When I came home I saw an oppor­tu­ni­ty to put my new knowl­edge into prac­tice and stream­line what has tra­di­tion­al­ly been a cum­ber­some process for iden­ti­fy­ing antivi­ral resis­tance,” Prof van Hal said.

“It’s excit­ing to know this is an Aus­tralian first using whole genome sequenc­ing tech­nol­o­gy to test and report drug resis­tance in a virus.”

Pro­fes­sor van Hal explains the tech­nol­o­gy and method­ol­o­gy has come a long way since it came to Aus­tralia in the 1980s.

“In the ear­ly days, Sanger-based sequenc­ing test­ed just two of the virus’ genes for resis­tance against the very lim­it­ed num­ber of antivi­ral drugs on the mar­ket at that time,” Pro­fes­sor van Hal explained.

“As a whole new class of antivi­rals was devel­oped and intro­duced to the mar­ket, clin­i­cians turned to ad hoc, bespoke sequenc­ing to under­stand the virus’ resis­tance to them.”

The advent of new­er tech­nolo­gies, such as Next-Gen­er­a­tion Sequenc­ing (NGS), has rapid­ly advanced genomics. In the field of pathogen genomics, the val­ue of this tech­nol­o­gy was quick­ly realised with its appli­ca­tion for whole genome sequenc­ing of virus­es and bac­te­ria, includ­ing those resis­tant to first-line antibi­otics such as the life-threat­en­ing Staphy­lo­coc­cus and SARS-CoV­‑2.

Now, with Pro­fes­sor van Hal’s lead­er­ship, two years in val­i­da­tion, ver­i­fi­ca­tion against World Health Organ­i­sa­tion guide­lines and NATA accred­i­ta­tion, HIV has been added to the list.

Pro­fes­sor van Hal ran the first of what he pre­dicts will be a small but steady stream of requests in Octo­ber 2022.

Thank­ful­ly, the low inci­dence of HIV trans­mis­sion in Aus­tralia today, achieved through strong proac­tive pub­lic health efforts, means the assay will be a niche, but cru­cial, prod­uct in the pathol­o­gy landscape.

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