Medical Bulletin 17/ April/ 2024

Here are the top medical news for the day:

Are antibiotics effective for lower respiratory tract infections?

According to a study published in the Journal of General Internal Medicine,use of antibiotics provided no measurable impact on the severity or duration of coughs even if a bacterial infection was present.

“Upper respiratory infections like colds, sore throats, and sinus infections have clear antibiotic guidelines. Lower respiratory infections, including pneumonia, affect 3-5% of patients and often prompt antibiotic use due to limited access to X-rays and patient expectations. However, symptom relief and time typically resolve most infections,”said the study’s lead author, Dan Merenstein.

In the study, researchers prescribed antibiotics to people who sought treatment or urgent care settings for lower respiratory tract infections. They used advanced lab tests to identify bacterial or viral infections, categorising them as bacterial-only, viral-only, both viral and bacterial, or no organism detected.

The results showed that of the 29% of people given an antibiotic during their initial medical visit, there was no effect on the duration or overall severity of cough compared to those who didn’t receive an antibiotic.

“In our analysis, 29% of people were prescribed an antibiotic while only 7% were given an antiviral. But most patients do not need antivirals as there exist only two respiratory viruses where we have medications to treat them: influenza and SARS-COV-2. There are none for all of the other viruses.” said Mark H. Ebell, the study’s author.

Overuse of antibiotics can result in dizziness, nausea, diarrhoea, and rash along with about a 4% chance of serious adverse effects including anaphylaxis, which is a severe, life-threatening allergic reaction. Another significant concern of the overuse of antibiotics is resistance. Uncontrolled antimicrobial resistance, due to the overuse of antibiotics, is expected to lower life expectancy and lead to unprecedented health expenditure and economic losses.

Reference:Dan Merenstein, et al.; Antibiotics not associated with shorter duration or reduced severity of acute lower respiratory tract infection; Journal of General Internal Medicine

Is consuming legumes linked to better nutrition intake in toddlers?

A recent study published in the journal Nutrients discussed improvements in diet quality associated with legume consumption in young children.

Early childhood nutrition impacts an individual's development and both acute and long-term disease risk. Legumes are widely known to be excellent sources of protein, carbohydrates, micronutrients, and phytochemicals.Few studies have assessed the benefits of legumes in early childhood diets.Current recommendations advise that toddlers and children consume 1.5 cups of cooked legumes each week

For the study, researchers analysed legume intake and overall dietary intake from birth to 24 months using data from the Women, Infants, and Children Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2). They gathered data from approximately 3,000 mother-child pairs. The study aimed to quantify the consumption of dried beans, lima beans, chilli, and yellow beans in grams and as a percentage of total dietary energy intake. Micronutrient intake was assessed at 11 and 24 months.

The results showed that at all time points, the consumption of yellow and lima beans was very low, with the highest rate of consumption reaching 0.1% at 18 months of age. Likewise, the percentage of infants who consumed dried beans was very low, with 1.2% and 10.5% consuming dried beans by seven and 18 months of age, respectively. The consumption of chili beans was also low at 0.4% by seven months of age and peaking at 5.9% of age at 24 months.

The findings suggested that although bean consumption was low among very young children and limited to chilli and dried beans, it was associated with a better nutritional profile for both macro- and micronutrients at 11 and 24 months of age.

Reference:Choudhary, D., Rideout, T., Millen, A. E., & Wen, X. (2024). Bean consumption during childhood is associated with improved nutritional outcomes in the first two years of life. Nutrients 16(8); 1120. doi:10.3390/nu16081120.

Does GLP-1 drug affect thyroid cancer risk?

A study published in the journal The BMJ found no significant increase in thyroid cancer risk for people with type 2 diabetes on GLP-1 agonists compared with people treated with DPP4 inhibitors.

Glucagon-like peptide-1 receptor (GLP-1) agonists are an effective treatment for controlling blood glucose levels in people with type 2 diabetes, particularly those who do not respond, or stop responding to, first-line treatments, such as metformin. One concern about the medicationsis that some studies suggest they may increase the risk of thyroid cancer.However, these studies point out that the health benefits of the drugs are likely to outweigh this increased risk.

The study used data on more than 145,000 people treated with GLP-1 agonists, and almost 292,000 people treated with DPP4 inhibitors.The researchers followed up participants after a mean of 3.9 years for the GLP-1 group and 5.4 years for the DPP4 group. They identified cases of thyroid cancer from nationwide cancer registers.

The results revealed that in the GLP-1 group, 76 of 145, 410 people developed thyroid cancer, and in the DPP4 group, 184 of 291, 667 developed the disease. The researchers concluded that the relative risk was increased by no more than 31% for those on GLP-1 agonists.

“The meaning of relative risk is the risk compared to someone not taking the medication — 31% is very low and indicates that the risk of developing thyroid cancer due to this medication is relatively low,” said Mir Ali, MD, medical director of MemorialCare Surgical Weight Loss Center.

Reference: Björn Pasternak, Viktor Wintzell, Anders Hviid, Björn Eliasson, et al; Glucagon-like peptide 1 receptor agonist use and risk of thyroid cancer: Scandinavian cohort study; BMJ 2024; 385 doi: https://doi.org/10.1136/bmj-2023-078225