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Revolutionary Chronic Wound Treatment Could Help Millions
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An effective treatment for chronic wounds that does not involve antibiotics but an ionized gas to activate a wound dressing has been developed by a team of international scientists.
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The treatment involves the plasma activation of hydrogel dressings (that are commonly used in wound dressings) with a unique mix of different chemical oxidants that are effective in decontaminating and aid healing in chronic wounds.
Researchers from the University of Sheffield and the University of South Australia, who led the study published this week in the journal Advanced Functional Materials, believe the new method is a significant advance in tackling antibiotic resistance pathogens and has the potential to change the treatment of diabetic foot ulcers and internal wounds.
Professor Rob Short, Professor of Chemistry at the University of Sheffield who co-authored the study, said: "More than 540 million people are living with diabetes worldwide, of which 30 percent will develop a foot ulcer during their lifetime. This is a neglected global pandemic which is set to increase further in the coming years due to a rise in obesity and lack of exercise.
"In England alone, between 60,000 and 75,000 people are being treated for diabetic foot ulcers per week. Infection is one of the major risks. Increasingly, many infections do not respond to normal antibiotic treatment due to resistant bacteria, which results in 7,000 amputations per year.
"There is an urgent need for innovation in wound management and treatment, and it is a real privilege to be part of the international team who have been working on this alternative treatment for over 10 years."
The cost of managing chronic wounds such as diabetic foot ulcers already exceeds $17 billion US dollars annually.
The benefits of cold plasma ionized gas have already been proven in clinical trials, showing it controls not only infection but also stimulates healing. This is due to the potent chemical cocktail of oxidants, namely reactive oxygen and nitrogen species (RONS), produced when it mixes and activates the oxygen and nitrogen molecules in the ambient air.
Dr Endre Szili, from the University of South Australia, who led the study, said: "Antibiotics and silver dressings are commonly used to treat chronic wounds, but both have drawbacks.
"Growing resistance to antibiotics is a global challenge, and there are also major concerns over silver-induced toxicity. In Europe, silver dressings are being phased out for this reason."
The international team of scientists have shown that plasma activating hydrogel dressings with RONS makes the gel far more powerful, killing common bacteria.
Although diabetic foot ulcers were the focus of this study, the technology could be applied to all chronic wounds and internal infections.
"Despite recent encouraging results in the use of plasma activated hydrogel therapy (PAHT), we faced the challenge of loading hydrogels with sufficient concentrations of RONS required for clinical use. We have overcome this hurdle by employing a new electrochemical method that enhances the hydrogel activation," said Dr Szili.
As well as killing common bacteria (E. Coli and P. Aeruginosa) that cause wounds to become infected, the researchers say that the plasma activated hydrogels might also help trigger the body's immune system, which can help fight infections.
"Chronic wound infections are a silent pandemic threatening to become a global healthcare crisis," added Dr Szili.
"It is imperative that we find alternative treatments to antibiotics and silver dressings because when these treatments don't work, amputations often occur."
"A major advantage of our PAHT technology is that it can be used for treating all wounds. It is an environmentally safe treatment that uses the natural components in air and water to make its active ingredients, which degrade to non-toxic and biocompatible components."
"The active ingredients could be delivered over a lengthy period, improving treatment, with a better chance of penetrating a tumor.
"Plasma has massive potential in the medical world, and this is just the tip of the iceberg," Dr Szili says.
The next step will involve clinical trials to optimize the electrochemical technology for treatment in human patients.
- This press release was originally published on the University of Sheffield website
Optimizing Chronic Subdural Hematoma Treatment
Chronic subdural hematoma (CSDH) is a neurological condition where blood clots between the brain's surface and its outer covering, causing symptoms like headaches and weakness. Alarmingly, its global incidence and recurrence rates are rising, especially in older adults with health issues.
Surgery remains the primary treatment for CSDH, but there is increasing interest in multimodal approaches like medication, postoperative drainage, and hematoma irrigation. These methods effectively clear acute hematomas and prevent CSDH recurrence. However, limited data hinders clinical decision-making, and many CSDH studies conducted in China suffer from methodological flaws.
To bridge this gap, a team of researchers led by Mr. Tao Liu, Mr. Zhihao Zhao, and Dr. Jinhao Huang from the Department of Neurosurgery, Tianjin Medical University General Hospital and Ministry of Education, Tianjin Neurological Institute, Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, China conducted a nationwide study, called the multicenter registry study of the CSDH (MRCSDH). The study aimed to assess optimal treatment strategies for CSDH in the Chinese population and was conducted from March 2022 to February 2024.
Mr. Liu says, "Through our MRCSDH trial, we can gather robust data to assess the safety and effectiveness of different treatment methods in reducing CSDH recurrence, identify complications, and craft personalized treatment strategies based on individual patient factors." The study's findings were published in the Chinese Neurosurgical Journal.
MRCSDH, spanning 59 hospitals in mainland China, documented the traits of the patients with CSDH. A standardized treatment protocol, tailored to each patient's needs, was developed based on clinical data. Patients underwent follow-ups after 3-, 6-, 12-, and 24-months post-treatment to assess their clinical outcomes.
As of August 2023, 2,173 patients from 59 hospitals participated, with males comprising 81.1% of the total patients. The average age of the patient group was 70.12 years.
Headache was the dominant symptom in over half of the patients. Burr-hole surgery—a classic surgery for CSDH where small holes are made to remove the hematoma—was the primary treatment method, followed by conservative treatment, which consists of rest, pain control, and management of anticoagulant medication use. Surprisingly, 88.9% of the patients presented a favorable prognosis after three months, with a low recurrence rate of 2.4%.
Mr. Liu emphasizes, "Our study gives us valuable real-world data on CSDH treatment, but we must be cautious of biases and data quality issues in interpretation."
Suffice to say, these findings have the potential to refine the clinical guidelines and, in turn, enhance health care for patients with CSDH.
More information: Tao Liu et al, Multimodality management for chronic subdural hematoma in China: protocol and characteristics of an ambidirectional, nationwide, multicenter registry study, Chinese Neurosurgical Journal (2024). DOI: 10.1186/s41016-024-00356-5
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Your Pain Treatment Agreement
Managing chronic pain with opioids is complicated and challenging. Doctors need to know if patients can follow the treatment plan, if they get desired responses from the meds, and if there are signs of developing addiction. And, patients need to know the potential risks of opioids, as well as the expectations to minimize those risks. Physicians use "medication contracts" to make sure that the patient and provider are on the same page before starting opioid therapy. Such agreements are most commonly used when narcotic pain relievers are prescribed.
The use of a pain management agreement allows for the documentation of understanding between a doctor and patient. Such documentation, when used as a means of facilitating care, can improve communication between doctors and patients.
If your doctor asks you to sign a pain treatment agreement, discuss any concerns you may have with the doctor before signing the agreement. Questions you may want to ask include:
A pain management agreement may include statements such as those listed in the sample document below.
I understand that I have a right to comprehensive pain management. I wish to enter a treatment agreement to prevent possible chemical addiction. I understand that failure to follow any of these agreed statements might result in Dr. __________________________ not providing ongoing care for me.
I, _________________________________________________, agree to undergo pain management by Dr. _____________________________. My diagnosis is __________________________________________________________________. I agree to the following statements:
I will not accept any narcotic prescriptions from another doctor.I will be responsible for making sure that I do not run out of my medications on weekends and holidays, because abrupt discontinuation of these medications can cause severe withdrawal syndrome.I understand that I must keep my medications in a safe place.I understand that Dr. _______________________________ will not supply additional refills for the prescriptions of medications that I may lose.If my medications are stolen, Dr. _______________________________ will refill the prescription one time only if a copy of the police report of the theft is submitted to the physician's office.I will not give my prescriptions to anyone else.I will only use one pharmacy.I will keep my scheduled appointments with Dr. ________________________ unless I give notice of cancellation 24 hours in advance.I agree to refrain from all mind/mood altering/illicit/addicting drugs including alcohol unless authorized by Dr. ______________________.
My treatment plan may change based on outcome of therapy, especially if pain medications are ineffective. Such medications will be discontinued.My treatment plan includes:
Medications ______________________________________________________
Physical therapy/exercise _______________________________________________
Relaxation techniques_______________________________________________
Psychological counseling _______________________
I understand that Dr. ____________________________ believes in the following "Pain Patients Bill of Rights."
You have the right to:
A. The doctor may terminate this agreement at any time if they have cause to believe that I am not complying with the terms of this agreement, or to believe that I have made a misrepresentation or false statement concerning my pain or my compliance with the terms of this agreement.
B. I understand that I may terminate this agreement at any time.
If the agreement is terminated, I will not be a patient of Dr. _____________________ and would strongly consider treatment for chemical dependency if clinically indicated.
______________________________ ______________
Patient Signature Date
______________________________ ______________
Physician Signature Date
______________________________ ______________
Witness Signature Date
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