Top Medical Bulletin 25/May/2022

Here are the top medical stories for today :

Exercise in lung Cancer, the Healthcare providers Opinion (E.C.H.O.)   

Exercise has been reported to reduce the disease as well as treatment impact in patients with lung cancer. Nevertheless, there is limited information available regarding the perception of lung cancer dedicated healthcare professionals' and their advice on exercise. A online survey exploring healthcare professionals' practice patterns, perceptions, barriers, and facilitators of exercise in patients with lung cancer was conducted and the findings are published in Lung Cancer journal.

A total of 141 healthcare providers completed the survey. Overall, 63% of the study participants declared that they frequently assessed exercise level in their patients, and 43% of them reinforced the importance of exercise. However, only 10% referred patients to an exercise program or specialist. Although the majority of the respondents had a positive perception regarding the benefits and safety of exercise, two-thirds of clinicians reported not having adequate training about exercise counselling.

Medical Therapy for Alcohol Use Disorder Likely To Reduce Alcohol Associated Liver Disease 

Alcohol is a deadliest enemy of liver causing several complications. Alcohol-associated liver disease (ALD) is one of the most common and devastating complications of excessive alcohol use. Alcohol- associated liver disease represents a wide spectrum, ranging from the relatively benign hepatic steatosis to cirrhosis and hepatocellular carcinoma.

A recent cohort study investigated patients with alcohol use disorder, those who received medical addiction therapy and found they had a significantly lower risk of developing alcohol-associated liver disease, whereas patients with cirrhosis who received medical addiction therapy had a significantly lower incidence of hepatic decompensation. Findings published in JAMA Open Network suggest an association between use of medical addiction therapy for alcohol use disorder and decreased incidence and progression of alcohol-associated liver disease.

Medical addiction therapy was defined as the documented use of disulfiram, acamprosate, naltrexone, gabapentin, topiramate, or baclofen. Patients were considered to be treated if they initiated medical addiction therapy before the relevant outcome. Incidence of alcohol-associated liver disease was 0.37. This association was evident in naltrexone 0.67,

gabapentin 0.36, topiramate 0.47, and baclofen 0.57. In addition, pharmacotherapy for alcohol use disorder was associated with lower incidence of hepatic decompensation in patients with cirrhosis, including naltrexone and gabapentin. This association persisted even when medical addiction therapy was initiated only after the diagnosis of cirrhosis.

Researchers concluded that results of this study showed that receipt of medical addiction therapy for alcohol use disorder was associated with reduced incidence and progression of alcohol-associated liver disease.

Plant centric healthy diet in youth lowers risk of emphysema in middle age  

Healthy dietary patterns during middle and late adulthood have been associated with a lower risk of Chronic obstructive pulmonary disease . However, the association of diet during young adulthood with respiratory health over the life course is unknown. A new study investigated whether greater adherence to a nutritionally rich plant-centred diet in young adulthood is associated with reduced longitudinal lung function decline and decreased incidence of radiographic emphysema.

A total of 3850 young adults from the Coronary Artery Risk Development in Young Adults (CARDIA) Lung study administered and validated diet history. Lung function was assessed through spirometry performed at different exam years. It was found that greater intake of a plant-centred diet was associated with less decline in forced expiratory volume and forced vital capacity (FVC) throughout the follow-up period; these associations were most pronounced during the first 10 years of follow up.

The researchers concluded that consumption of a high-quality plant-centred diet in young adulthood was associated with less lung function decline over 30 years. Among current or former smokers, adherence to a plant-centred diet was associated with a lower risk of developing radiographic emphysema over 25 years.

Antipsychotic Use During Pregnancy and Risk for Gestational Diabetes    

CNS Drugs journal brought out the study that aimed to assess whether antipsychotic use during pregnancy is associated with gestational diabetes and found that drugs like Olanzapine, clozapine and quetiapine used during pregnancy were associated with increased risks for gestational diabetes and the infant being large for gestational age. 

A Swedish national register‐based cohort study included over 1 lac singleton births. Antipsychotics were divided into 728 first-generation antipsychotics , 1710 in high-risk metabolic second-generation antipsychotics including olanzapine, clozapine and quetiapine, and 541 in other second-generation antipsychotics. The risks for gestational diabetes, foetal growth disturbances, pre-eclampsia, caesarean section and preterm labour were assessed. Women treated during pregnancy were compared to women  not treated during pregnancy and to women who used antipsychotics before/after but not during pregnancy.

The risk ratio for gestational diabetes for women treated with high-risk metabolic second-generation antipsychotics during pregnancy was 2.2 compared to untreated pregnant women and 1.8 compared to women treated before/after pregnancy. Exposed infants had an increased risk of being large for gestational age while other antipsychotics were not associated with metabolic risks.

Hence, the researchers concluded that Olanzapine, clozapine and quetiapine used during pregnancy were associated with increased risks for gestational diabetes and the infant being large for gestational age. Enhanced metabolic monitoring should be considered for pregnant women using these drugs.