Medical Bulletin 17/January/2024

Here are the top medical news stories of the day:

Bladder tumors reduced by 90% using nanorobots

Bladder cancer has one of the highest incidence rates in the world and ranks as the fourth most common tumour in men. Despite its relatively low mortality rate, nearly half of bladder tumours resurface within 5 years, requiring ongoing patient monitoring. Frequent hospital visits and the need for repeat treatments contribute to making this type of cancer one of the most expensive to cure.

While current treatments involving direct drug administration into the bladder show good survival rates, their therapeutic efficacy remains low. A promising alternative involves the use of nanoparticles capable of delivering therapeutic agents directly to the tumour. In particular, nanorobots—nanoparticles endowed with the ability to self-propel within the body—are noteworthy.

Now, a study published in the prestigious journal Nature Nanotechnology reveals how a research team successfully reduced the size of bladder tumours in mice by 90% through a single dose of urea-powered nanorobots.

Reference: Bladder tumors reduced by 90% using nanorobots; Nature Nanotechnology, DOI: 10.1038/s41565-023-01577-y

Erectile dysfunction medications may increase risk of death when combined with common chest pain medication

Phosphodiesterase type 5 inhibitors (PDE5i)—an erectile dysfunction drug sold under the names Viagra, Levitra, Cialis, and others—are a common medical treatment for erectile dysfunction (ED) in men with cardiovascular disease (CVD). However, a new Swedish study published today in the Journal of the American College of Cardiology suggests that patients are at higher risk for morbidity and mortality over time when PDE5is and nitrate medication are both prescribed.

Erectile dysfunction is a common condition in middle-aged and older men and is a strong predictor of coronary artery disease. Nitrates are medications commonly used to treat angina, or chest pain. Both can cause drops in blood pressure, so they are contraindicated for use together. However, there is little real-world data on the implications of using both and the number of people who are prescribed both is growing.

Reference: Erectile dysfunction medications may increase risk of death when combined with common chest pain medication; Journal of the American College of Cardiology

Trazadone and CBT no more effective than placebo for improving insomnia among long-term dialysis patients

A clinical trial of more than 120 persons undergoing hemodialysis found that cognitive behavioral therapy for insomnia (CBT-I) or trazodone were no more effective than placebo for improving mild to moderate chronic insomnia. These findings are important given the prevalence of insomnia among long-term dialysis patients. The study is published in Annals of Internal Medicine.

Insomnia affects up to 50 percent of persons undergoing long-term dialysis. Because insomnia is associated with exacerbated fatigue, depression, pain perception, and poor quality of life, patients place a high priority on finding effective treatments for this condition. CBT-I and trazodone are commonly used interventions to treat insomnia in the general population, but evidence for efficacy and safety of insomnia treatments cannot be extrapolated to persons undergoing long-term dialysis.

 Reference: Trazadone and CBT no more effective than placebo for improving insomnia among long-term dialysis patients; Annals of Internal Medicine, DOI: 10.7326/M23-1794