Top Medical Bulletin 30/May/2022

Here are the top medical stories for today:

Nanotechnology Effective in Chronic Wound Healing?     

The incidence of chronic wounds is increasing due to aging population and the augment of people afflicted with diabetes. Knowledge on the biological mechanisms underlying these diseases, there is a lot of medical technologies to conventionally treat the wound however wound healing differs from person to person.

Several nanotechnologies have been developed demonstrating unique characteristics that address specific problems related to wound repair mechanisms. A review in Advance wound care journal, focused on the most recently developed nanotechnology-based therapeutic agents and evaluated the efficacy of each treatment in diabetic models.

The success of topically administered growth factors in chronic wounds is limited. Due to their short in vivo half-life, low absorption rate through the outermost skin later around the wound, as well as rapid elimination by exudation before reaching the wound bed, might limit the efficacy of growth factors topical application.

Conventional medications containing growth factors need to be applied in high doses and/or be repeatedly administrated over a long period, leading to important side effects and increasing the cost of the therapy. Presently, platelet-derived growth factor , fibroblast growth factor, and epidermal growth factor are widely studied for their application in growth factor-mediated wound repair. A major advantage of these nanoplatforms is their adaptability and tunability. For instance, nanotherapeutics can be used in controlled and sustained released of the active ingredient over a period of days or weeks, while conventional delivery systems such as dressing films or gels can sustain the release of the therapeutic agent over 1 to 2 days.

The new chronic wound nanotherapeutics are multifunctional platforms that promote wound healing with minimal scar formation, avoid/treat bacteria contamination, and can even release the active biomolecules encapsulated at specific rates that match wound healing necessities.

Sepsis‐associated hypoglycemia on admission linked with increased mortality in ICU patients  

Hyperglycemia is a common response to acute illness, but it is not often. The frequency and cause of hypoglycemia in septic patients have not been well elucidated  A retrospective review of 265 patients in the journal Acute Medicine and surgery assessed patients with sepsis admitted to a tertiary medical center. Blood glucose levels on admission were evaluated.

The study, focused on sepsis‐associated hypoglycemia in the early phase and evaluated the impact of hypoglycemia on mortality.  Researchers categorized patients with sepsis into five groups according to blood glucose levels. Seven patients were admitted with severe hypoglycemia, 19 with mild hypoglycemia, 103 with euglycemia, 58 with mild hyperglycemia, and 78 with hyperglycemia. There was a significant difference in 28‐day mortality between those with severe hypoglycemia and euglycemia.

Researchers concluded that septic patients with severe hypoglycemia had significantly higher mortality compared with patients with euglycemia.

Midazolam or Propofol – which is better in acute phase for ventilated patients with sepsis  

A recent study reported that Propofol is a better choice of sedative compared to Midazolam based on a light sedation protocol that might be associated with inappropriate sedation during the acute phase, with increased coma and delirium.

The study was an analysis of data from the dexmedetomidine for sepsis in the ICU Randomized Evaluation (DESIRE) trial. Patients were divided into propofol and midazolam groups based on continuously used drug, and sedation control between groups compared on day three. They assessed the incidence of delirium, length of ICU stay, number of ventilator‐free days within the first 28 days, and mortality after 28 days.

The results showed that both groups had similar characteristics, except for age and emergency surgery. The number of well‐controlled sedation patients in the propofol group on day three was significantly higher than that in the midazolam group. The incidence of daily coma and delirium within the initial week was different between groups and increased with midazolam administration. The number of Confusion Assessment Method for ICU‐positive patients was significantly higher in the midazolam group than in the propofol group.

Hence, it was concluded that in patients with sepsis required mechanical ventilation, sedation with midazolam based on a light sedation protocol may be associated with inappropriate sedation during the acute phase, with increased coma and delirium as compared to propofol.

Reducing TV viewing to less than 1H/day helps prevent heart disease  

According to the British Heart Foundation, coronary heart disease is one of the leading causes of death, responsible for around 64,000 deaths each year. People with coronary heart disease are twice as likely to even develop a stroke.

Watching too much TV is associated with increased risk of coronary heart disease regardless of an individual's genetic makeup. In a study published in BMC Medicine, the researchers show that-assuming a causal link-11% of cases of coronary heart disease could be prevented if people watched less than an hour of TV each day.

To examine the link between time spent in screen-based sedentary behaviours such as TV viewing and leisure-time computer use, an individual's DNA, and their risk of coronary heart disease, researchers examined over 500,000 adults who have been followed up prospectively for about 12 years. The team created polygenic risk scores for each individual-that is, their genetic risk of developing coronary heart disease. As expected, individuals with higher polygenic risk scores were at greatest risk of developing the condition.

People who watched more than four hours of TV per day were at greatest risk of the disease, regardless of their polygenic risk score. Compared to these individuals, people who watched two to three hours of TV a day had a relative 6% lower rate of developing the condition, while those who watched less than an hour of TV had a relative 16% lower rate.

Therefore, the researchers concluded that limiting TV viewing might have in preventing coronary heart disease. Individuals who watch TV for less than one hour a day were less likely to develop the condition, independent of their genetic risk.