Medical Bulletin 04/ September /2024

Here are the top medical news of the day:

Study Unravels Blood Stem Cell Discovery Capable of Producing Human Blood Cells

Research published in the journal Nature Biotechnology claims to have created blood stem cells that closely resemble those in the human body.

The research, conducted by Murdoch Children’s Research Institute (MCRI) and published in Nature Biotechnology, has overcome a significant challenge in generating human blood stem cells. These stem cells are capable of producing red cells, white blood cells, and platelets that closely resemble those found in human embryos.

Human pluripotent stem cells (PS cells) can be turned into blood-forming hematopoietic stem cells (HSCs) that could offer new treatments for various blood-related disorders such as bone marrow failure syndromes. Hematopoietic stem cells from a patient's own pluripotent stem cells can prevent transplant mismatches and graft-versus-host disease.

Genetically edited pluripotent stem cell-derived hematopoietic stem cells can correct genetic defects causing blood diseases. Also, Gene-edited pluripotent stem cell cells can mimic blood diseases accurately, aiding in the development of improved treatments.

In the study, immune-deficient mice were injected with laboratory-engineered human blood stem cells. The research showed that these stem cells developed into functional bone marrow at levels comparable to those observed in umbilical cord blood cell transplants, a well-established standard of success.

The study also revealed that the lab-grown stem cells could be frozen and then successfully transplanted into the mice. This process simulated the preservation of donor blood stem cells before their transplantation into patients.

Reference: Ng, E.S., Sarila, G., Li, J.Y. et al. Long-term engrafting multilineage hematopoietic cells differentiated from human induced pluripotent stem cells. Nat Biotechnol (2024). https://doi.org/10.1038/s41587-024-02360-7

New Rapid Blood Test Can Quickly Detect Heart Attacks in 8 minutes: WESTCOR POC Trial

A new, quick 8-minute blood test can help identify if someone is having a heart attack. This could lead to better treatment for people with chest pain who go to emergency rooms, according to recent research shared at the ESC Congress 2024 in London.

Overcrowding in emergency departments is a major global issue that leads to more deaths and health problems. Chest pain is one of the most common reasons people are admitted to hospitals. Most patients with chest pain end up staying in the hospital longer while doctors check to see if it's a serious heart issue. However, 60-70% of the time, the chest pain turns out to be from less serious causes, like acid reflux.

To quickly assess and safely release low-risk chest pain patients, doctors use fast diagnostic methods. One key test is the high-sensitivity cardiac troponin (hs-cTn) test. This test checks for a protein called troponin in the blood, which signals heart damage if it's present.

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The WESTCOR¬POC randomized clinical trial compared a new point-of-care (POC) hs-cTn test (Atellica VTLi, Siemens Healthineers) with traditional 0-hour and 1-hour central laboratory hs-cTn tests. The POC test had already been shown to be as accurate and precise as the standard central laboratory tests.

In the study, 1,494 adult patients with symptoms of possible heart issues were randomly assigned to either a new point-of-care (POC) test, which takes eight minutes, or the standard central lab test. Both groups had similar characteristics, and decisions about admitting or discharging patients were made by their doctors.

The results showed that the average time spent in the emergency department was slightly shorter for those using the POC test (174 minutes) compared to the standard test (180 minutes). For patients who were seen by a doctor within an hour, the POC test cut the emergency department stay by 15 minutes (147 minutes vs. 162 minutes).

“This simple test only requiring a drop of blood can be performed within 8 minutes without the need for a laboratory,” said author Viola Thulin from Haukeland University Hospital, Bergen, Norway. “Use of point-of-care testing on arrival at hospital has the potential to speed up earlier diagnosis or rule out heart attack and reduce the amount of time some patients spend in the emergency department.”

Reference: WESTCOR-POC - Point of care versus centralised high-sensitivity cardiac troponin in the emergency department’ was discussed during Hot Line 12 on Monday 2 September in room London.

Higher Thiazide Doses May Help Prevent Kidney Stones: JAMA finds

The JAMA Network Open has highlighted that increasing thiazide dosage was associated with greater reductions in calcium, hence it could prevent kidney stones recurrence in patients.

For the study, researchers used the Medicare-Litholink Database to find adults with kidney stones who were prescribed thiazide medications (like hydrochlorothiazide, chlorthalidone, or indapamide) within 6 months of their first 24-hour urine test. They also looked at patients who had follow-up urine tests done between 30 and 180 days after starting their thiazide prescription.

Thiazide dosages were categorized as, low(Chlorthalidone < 12.5 mg/day; Indapamide < 0.6125 mg/day; Hydrochlorothiazide < 25 mg/day), medium(Chlorthalidone 12.5 to < 25 mg/day; Indapamide 0.6125 to < 1.25 mg/day; Hydrochlorothiazide 25 to < 50 mg/day) and high(Chlorthalidone ≥ 25 mg/day; Indapamide ≥ 1.25 mg/day; Hydrochlorothiazide ≥ 50 mg/day).

Researchers assessed how calcium levels changed with low, medium, and high thiazide dosages and linked these changes to the occurrence of symptomatic kidney stone events, such as emergency visits, hospitalizations, or surgeries, within 6 to 48 months after starting the prescription.

Results revealed that higher thiazide doses were associated with greater reductions in urine calcium levels, with a low dose resulting in an 18.9% reduction, a medium dose in a 25.5% reduction, and a high dose in a 28.4% reduction.

Reference: Hsi RS, Yan PL, Maalouf NM, et al. Thiazide Dose, Urine Calcium, and Symptomatic Kidney Stone Events. JAMA Netw Open. 2024;7(8):e2428953. doi:10.1001/jamanetworkopen.2024.28953