Archive for month: October, 2024

Good wound healing is critical to infection prophylaxis and satisfactory rehabilitation in Total Knee Arthroplasty (TKA). Currently, two techniques, i.e., barbed continuous subcuticular suture without skin adhesive or combined use skin adhesive (n-butyl-2) are being used for superficial wound closure of TKA. While a new skin adhesive (2-octyl) with self-adhesive mesh has been employed as an alternative to conventional surgical skin closure in TKA, its superiority, especially in reducing wound complications and improving wound cosmetic outcomes has not been investigated.

Liu et al conducted a study to compare 2-octyl, n-butyl-2, and no skin adhesive in terms of safety and efficacy in TKA superficial wound closure. It has been published in ‘Arthroplasty’ journal.

The authors conducted a multicenter, prospective, randomized controlled study in 105 patients undergoing primary TKA. Each patient’s knee was randomized to receive 2-octyl, n-butyl-2, or no skin adhesive skin closure with all using barbed continuous sutures in deep tissue. Wounds were followed 1, 3, 5 days, 2, 6 weeks, and 3 months after surgery. Wound discharge, complications, cosmetic outcomes, patient satisfaction, and wound-related costs were compared among these three methods.

Key findings of the study were:

• Wound discharge was less in 2-octyl group and n-butyl-2 group than in non-adhesive group at 1 day, with the discharge only being less in 2-octyl group than in the non-adhesive group at day 3 and day 5 days (P<0.05).

• There was no statistical difference in the incidence of other wound complications among the groups (P>0.05).

• The 2-octyl group achieved better cosmetic efects than the other two groups in 6 weeks and 3 months (P<0.05).

• Compared to the non-adhesive group, 2-octyl group scored higher in overall patient satisfaction score in 2 weeks and incurred lower costs (P<0.05).

The authors concluded that – “Skin closure in TKA using 2-octyl adhesive material showed superiority to no skin adhesive or n-butyl-2. It reduced wound discharge and improved cosmetic outcomes, without increasing wound complications. In addition, the use of 2-octyl could achieve excellent patient satisfaction and lowered costs compared to no skin adhesive. Our study demonstrated that the use of 2-octyl was a safe and effective as a wound closure technique in patients undergoing TKA.”

2-octyl: 2 -Octyl cyanoacrylate skin adhesive with flexible self-adhesive polyether mesh (DERMABOND PRINEO Ethicon, Inc)

n-butyl-2: N-butyl-2-cyanoacrylate skin adhesive (HISTOACRYL® B.Braun, Melsungen, German)

Further reading:

Comparison of the safety and efficacy of three superficial skin closure methods for multi-layer wound closure in total knee arthroplasty: a multicenter, prospective, randomized controlled trial. Liu et al Arthroplasty (2024) 6:51 https://doi.org/10.1186/s42836-024-00271-1

Patients with congestive heart failure (CHF) having a compromised blood supply, are at greater risk of sudden cardiac death (SCD). With an estimated incidence as high as 22% among these patients, current clinical guidelines recommend using implantable cardioverter defibrillators (ICDs) to help mitigate the risk of SCD.

Although the application of ICDs in patients with CHF is backed by substantial evidence, these studies did not include people with chronic kidney disease (CKD), who are an important clinical population. In other words, it is unclear whether the use of ICDs is justified in patients with CKD, especially with mild and moderate presentations, given the inherent risk involved in installing these devices.

To address this knowledge gap, researchers led by Associate Professor Yoshihiro Sobue from Fujita Health University, Japan, investigated to what extent kidney function can be a good predictor for the risk of SCD. This study was published in ESC Heart Failure on June 10 2024, and was co-authored by Hideo Izawa, also from Fujita Health University, and Eiichi Watanabe from Fujita Health University Bantane Hospital.

Elaborating on the rationale behind this examination, Dr. Sobue says, “The objective of our study was to prospectively investigate the risk factors for SCD in a cohort of over 1,500 patients hospitalized with CHF classified based on the left ventricular ejection fraction (LVEF) and the New York Heart Association (NYHA) functional class, as well as the potential role of kidney function as a determinant of SCD.” Adding further on the importance of using renal dysfunction for SCD, he says, “The determination of renal dysfunction as an independent risk factor of SCD is important because patients with moderate-to-severe renal dysfunction were excluded in the studies on which current ICD implantation guidelines are based.”

The study ultimately included 1,676 patients who had visited Fujita Health University Hospital for decompensated heart failure. During the follow-up period, 198 of these patients suffered from SCD. Among these events, 23% occurred within 3 months of discharge.

On conducting statistical analyses of the gathered data, the research team identified two key independent predictors for the risk of SCD following discharge. The first was LVEF, which is already considered in the current guidelines. The second was the estimated glomerular filtration rate (eGFR), which is a measure of how well the kidneys can filter blood.

By adding eGFR as a predictor alongside LVEF, regression models could predict SCD more accurately. However, as the researchers noted, the predictive power of kidney function in this way diminished over time, being more effective in the first few months after discharge. Coincidentally, roughly a quarter of all cases of SCD occurred within three months of discharge.

In summary, the findings of this study underline the importance of considering additional factors, such as kidney condition, when weighing the benefits of using ICD in a patient. “Refining the criteria for ICD implantation holds the potential for significantly improving the prevention of SCD and reducing the incidence of complications arising from unnecessary ICD implantations. Hopefully, applying an enhanced stratification methodology involving eGFR may yield better clinical outcomes,” remarks Dr. Sobue.

In the long term, these findings may steer the way for the revision of guidelines for the use of ICDs and improve the outcomes for patients with CHF, both with and without CKD.

Reference:

Yoshihiro Sobue, Eiichi Watanabe, Yusuke Funato, Masanobu Yanase, Hideo Izawa, Renal dysfunction is a time-varying risk predictor of sudden cardiac death in heart failure, ESC Heart Failure, https://doi.org/10.1002/ehf2.14892.

China: As insomnia continues to affect millions globally, the choice of treatment options remains crucial for patient health. Recent studies highlight a significant distinction in cardiovascular (CV) risk between two common classes of sleep medications: Z-drugs and benzodiazepines. This differentiation underscores the importance of informed prescribing practices for those with sleep disorders.

Toddlers in the UK obtain nearly half (47%) of their calories from ultra-processed foods (UPFs), and this rises to 59% by the age of seven, according to a new study led by UCL researchers.

The study, published in the European Journal of Nutrition, looked at data from 2,591 children born in the UK in 2007 and 2008 whose parents recorded what their children ate and drank over three days.

The most common UPFs consumed by the toddlers-who were 21 months when their parents recorded their diets – were flavoured yoghurts and wholegrain breakfast cereals, products typically seen as healthy. By the age of seven, the most common UPFs were sweet cereals, white bread and puddings.

Lead author Dr Rana Conway, of the UCL Institute of Epidemiology & Health Care, said: “Ultra-processed foods are not all bad for our health and the foods typically eaten by the toddlers in our study are ones that are seen as quite healthy.

“However, some wholegrain cereals and flavoured yoghurts have high levels of added sugar and salt and our study found that toddlers who consumed more ultra-processed foods also had a higher intake of these ingredients.

“This is concerning, especially as toddlers in general consume more added sugar and salt than is recommended.

“Aside from sugar and salt, a diet that includes a lot of ultra-processed food is less likely to get children used to the natural flavours of whole foods and therefore less likely to encourage healthy eating later in life.”

Senior author Professor Clare Llewellyn, of the UCL Institute of Epidemiology & Health Care, said: “Eating patterns in the early years are important, as they help set habits that can persist through childhood and into adulthood. This was reflected in our findings, with 21-month-olds who ate more ultra-processed foods also likely to be higher consumers of ultra-processed foods at the age of seven.”

The researchers analysed data from the Gemini twin cohort study, using the Nova classification to divide the food and drink consumed into four groups: unprocessed or minimally processed foods (eggs, milk, vegetables, fish and fruit); processed culinary ingredients (salt, butter and oil); processed foods (tinned fish, peanut butter and cheese); and UPFs (cereals, yoghurts, industrially made sliced bread, biscuits, sausages, crisps).

UPFs are typically industrially produced and contain ingredients not used or very rarely used in home cooking, such as emulsifiers, colourings and sweeteners.

Toddlers were divided into five groups according to their ultra-processed food intake. The research team found that toddlers in the lowest UPF group consumed 28% of their calories from UPFs, while for toddlers in the highest of the five groups this was 69%.

They also found that ultra-processed foods consumed at 21 months predicted UPF consumption at seven years old. Toddlers who consumed the most UPFs were 9.4 times more likely to be in the highest UPF-consuming group at age seven compared to toddlers who consumed the lowest proportion of UPFs. The research team said this may be partly attributable to the “hyperpalatable” nature of these UPFs, as they tend to be foods higher in fat, sugar and/or salt.

In all five UPF groups, the toddlers’ consumption of free sugars exceeded the UK government recommended maximum of 5% of daily calorie intake. In the two highest UPF groups, added sugar intake exceeded 10% on average.

The researchers called for policies to redress the balance of children’s diets towards a lower proportion of UPFs, such as restricting the promotion of unhealthy foods marketed towards children, adding warning labels to products (e.g. those that are high in sugar), and subsidising fresh and minimally processed food.

Dr Conway said: “It’s not easy to feed children healthily in our current food environment. Highly processed foods are often cheaper than the foods parents would like to give their children, such as fresh fruit and vegetables.

“Also, despite labels suggesting they’re a healthy choice, ultra-processed foods marketed for children often contain too much sugar and salt. This makes it harder for parents to make healthy choices.”

In the paper, the research team also said there was a range of commercial products intended for young children that would not be classified as a UPF as they did not contain UPF-style ingredients but mimicked UPFs in terms of textures. These might include vegetable sticks or puffs or snacks resembling cookies.

Early exposure to these foods, the researchers wrote, was unlikely to encourage consumption of vegetables, even if the foods’ nutritional content was healthy (i.e., they did not include added sugar or salt).

In their study limitations, the researchers noted that people of white ethnicity and a higher socioeconomic status were over-represented in their population sample compared to the UK population as a whole.

Reference:

Conway, R.E., Heuchan, G.N., Heggie, L. et al. Ultra-processed food intake in toddlerhood and mid-childhood in the UK: cross sectional and longitudinal perspectives. Eur J Nutr (2024). https://doi.org/10.1007/s00394-024-03496-7