Medical Bulletin 22/ October/ 2024

A modified insulin that can prevent sudden drops in blood sugar has been demonstrated in laboratory experiments and animal models, reports a paper in Nature. This could provide a more flexible way to supplement insulin for individuals with diabetes and reduce sudden drops in blood glucose.

Researcher Rita Slaaby and colleagues present a modified form of insulin with activity that varies according to the levels of glucose in the blood. The molecule, named NNC2215, is equipped with a switch that can open and close in response to glucose. Under high glucose concentrations, the switch opens, and the insulin becomes more active, removing glucose from the blood. When glucose levels decrease, the switch moves to a closed state, which prevents glucose uptake.

Laboratory experiments showed that upon an increase in glucose concentration from 3 to 20 mM, the NNC2215 insulin receptor affinity increased by 3.2-fold, validating its potential to respond to changes in blood glucose levels. In rat and pig models of diabetes, NNC2215 proved to be as effective as human insulin in lowering blood glucose. Its increased glucose sensitivity was shown to provide protection against hypoglycemia in these animal subjects.

This modified insulin may aid in preventing the sharp drops in glucose that can severely affect individuals with diabetes, especially during sleep. This could improve both long- and short-term complications associated with diabetes, the authors note.

Reference: Hoeg-Jensen, T., Kruse, T., Brand, C.L. et al. Glucose-sensitive insulin with attenuation of hypoglycaemia. Nature (2024). https://doi.org/10.1038/s41586-024-08042-3

Indian Council of Medical Research (ICMR) Director General Dr Rajiv Bahl spoke about new projects and achievements in public health and highlighted a significant advancement in tuberculosis (TB) diagnosis: a new handheld X-ray device developed for screening TB, enhancing early detection and treatment efforts, ultimately improving public health outcomes.

Speaking at the 19th International Conference of Drug Regulatory Authorities (ICDRA) INDIA-2024, ICMR DG Dr Bahl said, "The handheld X-rays are available at a very high cost and now the IIT Kanpur in partnership with ICMR has developed a handheld X-ray indigenously which will be less than half the cost of what the cost of imported handheld X-rays are. This will make sure we can have screening for TB near the homes of patients and even the vulnerable population."

A simple blood test could help doctors identify women in labor who are at risk for preeclampsia -; a leading cause of maternal death -; and take precautions to prevent it, according to research presented at the ANESTHESIOLOGY® 2024 annual meeting.

Researchers have determined doctors can predict a woman's risk of developing preeclampsia by calculating the ratio of two blood proteins -; fibrinogen and albumin -; measured in routine blood tests done when women in labor enter the hospital. Fibrinogen is involved in blood clotting and inflammation, while albumin helps maintain fluid balance and carries hormones, vitamins and enzymes throughout the body. Both can be disrupted with preeclampsia -; fibrinogen may be elevated, albumin may be reduced, or both can occur.

There is no universally established normal value for this fibrinogen-to-albumin ratio (FAR), which can range from 0.05 to 1 or higher. Higher fibrinogen-to-albumin ratio values are often associated with increased inflammation, infection or serious health conditions, and the higher the fibrinogen-to-albumin ratio, the greater the concern. This trend has been consistently seen when fibrinogen-to-albumin ratio is used to evaluate other inflammatory conditions, such as rheumatoid arthritis, cardiovascular diseases and inflammatory bowel disease.

In the study, researchers analyzed the records of 2,629 women who gave birth between 2018 and 2024, 1,819 who did not have preeclampsia, 584 who had preeclampsia with mild features or symptoms, and 226 who had preeclampsia with severe features or symptoms (including blood pressure of 160/110 mm Hg or higher and signs of organ damage, including severe headaches, high liver enzymes, visual disturbances, low platelet count or kidney impairment). The researchers determined those who had a higher fibrinogen-to-albumin ratio were more likely to develop preeclampsia than those with a lower fibrinogen-to-albumin ratio. They found that the predicted likelihood of developing any degree of preeclampsia was 24% for patients with a fibrinogen-to-albumin ratio of at least 0.1 on admission to the hospital, and it rose to more than 41% when that value was above 0.3.

She noted that while this ratio should be assessed for all pregnant women, calculating the fibrinogen-to-albumin ratio is especially important for women who are at higher risk for preeclampsia, such as Black women and those with high blood pressure and obesity. "Additional research is needed to determine the exact range of the fibrinogen-to-albumin ratio that would be considered concerning and would be helpful to incorporate into routine prenatal care as a predictive tool for early identification of preeclampsia," she said.

Listening to music may help patients recover from surgery through a lower heart rate, reduced anxiety levels, less opioid use and lower pain, according to researchers.

A reduction in cortisol levels when listening to music may play a role in easing patients’ recovery, according to a meta-analysis presented at the American College of Surgeons Clinical Congress 2024 in San Fransisco.

“When patients wake up after surgery, sometimes they feel really scared and don’t know where they are,” said Eldo Frezza, professor of surgery at California Northstate University College of Medicine. “Music can help ease the transition from the waking up stage to a return to normalcy and may help reduce stress around that transition.”

Frezza and study co-authors noted that unlike some more active therapies such as meditation or pilates which require considerable concentration or movement, listening to music is a more passive experience and can be incorporated by patients without much cost or effort almost immediately after surgery.

To reach this conclusion, the team analysed existing studies on music and its role in helping people recover from surgery, narrowing a list of 3,736 studies to 35 research papers.

In their analysis, the researchers found that the simple act of listening to music after surgery, whether with headphones or through a speaker, had noticeable effects on patients during their recovery period:

Patients who listened to music had a statistically significant reduction in pain the day after surgery. Across all studies, patient self-reported anxiety levels were reduced by about 2.5 points, or 3 per cent.

Patients who listened to music used less than half of the amount of morphine compared to those who did not listen to music on the first day after surgery, the research noted. They also experienced a reduced heart rate (around 4.5 fewer beats per minute) compared with patients who did not listen to music. Although we can’t specifically say they’re in less pain, the studies revealed that patients perceive they are in less pain, and we think that is just as important,” said Shehzaib Raees, first author of the study.

Reference: ARTICLE TITLE

Effects of Postoperative Music Therapy on Patient Outcomes: A Systematic Review and Meta-Analysis