Honey or Silver for Wound Care???

Hello Summarians!

It is imporatnt to watch for new developments in treating skin infections. With antibiotic resistence on the rise, we need to be thoughtful in how we approach these problems.

What is old becomes new. Such is the case in honey therapy. This article comes from the human side and it provdies some useful information.

Have a Merry Christmas and an enjoyable holiday season!

New Cancer Modality in Dogs

Targeted osmotic lysis (TOL) is a novel therapy combining low-level pulsed electric field stimulation with the generic drug digoxin to selectively kill malignant cancer cells by causing them to swell and rupture. TOL takes advantage of the fact that many advanced carcinomas overexpress voltage-gated sodium channels (VGSCs). By stimulating these channels, the therapy allows sodium ions to flow into cancer cells and then uses digoxin to block the Na+/K+ ATPase pumps, preventing sodium from being expelled. As water follows the excess intracellular sodium, malignant cells rapidly swell and burst, while normal cells remain relatively unaffected. In safety studies with Beagle dogs, three cycles of TOL treatment, involving pulsed electric field stimulation at 18 and 40 V/min combined with digoxin administration, were well tolerated. There were no treatment-related effects on mortality, electrocardiograms, hematology, serum chemistry, or organ weights, and no noteworthy pathological findings. The observed effects were limited to transient inappetence and consequent slight body weight changes. While digoxin has a known and well-characterized safety profile, including potential gastrointestinal and cardiac effects, no serious cardiac complications were seen in the study, though patients should be monitored for arrhythmias. Additionally, TOL therapy may not be suitable for tumors within the canine central nervous system or for dogs with multidrug resistance protein 1 deficiency. Prior computational analyses of the device’s electrical fields indicated that patient and operator exposures are well within established safety limits, more than 75 times below the safe reference levels defined by IEEE standards and significantly weaker than fields from other FDA-approved devices. This confirms that TOL therapy is safe in terms of both drug administration and electromagnetic exposure. 

Hunter, R. P., Randazzo, J. M., Miller, P. R., Paul, D., Gould III, H. J., & Mallozzi, R. (2024). Safety evaluation of targeted osmotic lysis therapy in Beagles. American Journal of Veterinary Research https://doi.org/10.2460/ajvr.24.09.0284 

Bottom line — Looks to be a promising modality.

Monitoring Diabetics Post Op

This study investigated the accuracy of a FreeStyle Libre 2 flash glucose monitoring system (FGMS) in healthy dogs under isoflurane anesthesia compared to a common point-of-care glucose monitor and a laboratory reference method. The researchers induced normotension, hypotension, and hypertension to mimic common intraoperative hemodynamic states. Results showed that the FGMS consistently correlated well with the reference and point-of-care methods, although the system tended to underestimate glucose values during hypertension and overestimate them during hypotension. Notably, the FGMS did not fully meet human ISO 15197:2013 standards for analytical accuracy, but its data were found to be clinically acceptable when evaluated through Parkes consensus error grid analysis, with all readings falling within acceptable clinical zones. The slight lag between blood and interstitial glucose concentration and potential variations in tissue perfusion are likely responsible for the discrepancies, especially when glucose levels change rapidly or during hemodynamic alterations. 

Despite failing ISO requirements, the FGMS offers a less invasive, continuous, and user-friendly way to monitor glucose concentrations in anesthetized dogs, reducing the need for repeated blood sampling. Its ease of use and ability to capture glycemic trends can be especially beneficial for diabetic patients or animals prone to extreme glycemic fluctuations. However, clinicians are advised to confirm extreme hyperglycemic or hypoglycemic FGMS readings with a secondary method, particularly when severe hemodynamic changes or prolonged hypotension occurs. Future studies evaluating the FGMS in dogs with a broader range of glucose concentrations and in diabetic patients under anesthesia will help refine its clinical applications and best use practices. 

Pollack, E. A., Cromwell, L. N., Zhao, Q., & Sage, A. M. (2024). Accuracy of a flash glucose monitoring system in healthy dogs during isoflurane anesthesia. American Journal of Veterinary Research https://doi.org/10.2460/ajvr.24.08.0242 

Bottom line — Libre is good for monitoing post op.

Honey Vs Silver for Wound Treatment.

Severe burn injuries are a global health concern with high mortality and morbidity rates, partly due to complications such as infection and organ failure. Pseudomonas aeruginosa infections pose particular challenges, often associated with substantial mortality and complicated by antibiotic resistance and biofilm formation. Silver-based wound dressings and creams, including silver sulphadiazine, remain a common treatment to control microbial infections in burn wounds, but their prolonged use can impair wound healing and result in cytotoxicity. Medical-grade honey (MGH) has emerged as a promising alternative due to its broad-spectrum antimicrobial activity, lack of resistance development, and fewer adverse effects on healthy tissue. Among MGH products, L-Mesitran Soft, supplemented with vitamins and other components, has demonstrated potent antibacterial effects against P. aeruginosa similar to silver-based therapies and better support for re-epithelialization over extended treatment periods. In contrast, certain Manuka honey-based products, such as Medihoney, have shown less potent antibacterial effects and evidence of cytotoxicity. Studies, including ex vivo human burn wound models and clinical cases, confirm that supplemented MGH effectively eradicates bacterial infections, promotes wound healing, and is safe for use in all patient groups. Therefore, supplemented MGH can be recommended as a first-line therapy to treat P. aeruginosa-infected burn wounds, potentially serving as a superior long-term treatment option compared to silver-based interventions. 

Bouke K.H.L. Boekema, Daniela Chrysostomou, Guido Ciprandi, Anouk Elgersma, Marcel Vlig, Andrea Pokorná, Linsey J.F. Peters, Niels A.J. Cremers, Comparing the antibacterial and healing properties of medical-grade honey and silver-based wound care products in burns, Burns, Volume 50, Issue 3, 2024, Pages 597-610, ISSN 0305-4179, https://doi.org/10.1016/j.burns.2023.10.009. 

Bottom line — Medical Grade Honey may actually be better than silver based therapy.

Just putting things in perspective …

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