Intended for healthcare professionals

Opinion

RSV vaccination roll-outs and electronic nicotine delivery systems

BMJ 2024; 384 doi: https://doi.org/10.1136/bmj.q427 (Published 22 February 2024) Cite this as: BMJ 2024;384:q427
  1. Tom Nolan, clinical editor; sessional GP, Surrey
  1. The BMJ, London

Tom Nolan reviews the latest research

RSV hospital admissions in preterm infants

Each year, respiratory syncytial virus (RSV) quietly sweeps through the world killing over 100 000 children. Somehow, it barely gets a mention in the news cycle, although that may soon change if countries launch RSV vaccination programmes. A meta-analysis sought to estimate the global burden of RSV disease and risk factors for both getting the infection and severe outcomes.

A key finding was that preterm infants born <32 weeks’ gestation have a higher risk of RSV and hospital admission from RSV that persists into their second year of life. Late preterm infants (born between 32 weeks and 37 weeks’ gestation) also had an increased risk of hospital admission, but only until they were 6 months old. Other risk factors for severe outcomes include congenital heart disease, tracheostomy, bronchopulmonary dysplasia, chronic lung disease, and Down’s syndrome.

Lancet doi:10.1016/S0140-6736(24)00138-7

Oral antidiabetic drugs and NAFLD

How much weight should we give to non-alcoholic fatty liver disease (NAFLD) when considering options for oral antidiabetic medications? A nationwide cohort study in Korea tracked 80 178 people with type 2 diabetes taking oral antidiabetic drugs who also had NAFLD. During the four year study period NAFLD regression (as estimated by a drop in fatty liver index from over 60 to under 30) was seen in 4102 people, and 276 developed an adverse liver-related outcome. Use of sodium-glucose cotransporter 2 (SGLT2) inhibitors was associated with greater levels of regression of NAFLD and lower rates of adverse liver-related outcomes compared with thiazolidinediones, dipeptidyl peptidase 4 (DPP-4) inhibitors, and sulfonylureas.

JAMA Intern Med doi:10.1001/jamainternmed.2023.8029

Rising rates of immunosuppression

In 2021, a national survey in the US asked “Do you currently have a health condition that a doctor or other health professional told you weakens the immune system?” One of my memories of that time was speaking to various patients who had been wrongly sent letters to say that they were highly vulnerable, and hearing about the impact on their lives and identity.

The survey has estimated rates of immunosuppression in the US at 6.6% in 2021 compared with only 2.7% in 2013. The rise may also be due to an increase in the number of people taking immunosuppressant medications, and more awareness due to covid-19—but it would be interesting to compare these figures to estimates derived from medical records.

JAMA doi:10.1001/jama.2023.28019

Odd one out competition

Spot the odd one out: Ronald Reagan, Margaret Thatcher, Frank Sinatra, and Mikko Petteri Räisänen. Need a clue? It’s not about the cold war or any special relationships… it’s in their hands. Give up? Ronald Reagan, Margaret Thatcher, and Frank Sinatra all suffered from Dupuytren’s contracture, while Mikko Petteri Räisänen studies it.

A randomised control trial by Räisänen and colleagues recruited 302 people with Dupuytren’s contracture across six hospitals in Finland and randomised them to surgery, needle fasciotomy, or collagenase injection. Success rates were around 70% for all three treatments at three months, but, by two years, surgery came out on top (78% versus 50% and 65% respectively).

Ann Intern Med doi:10.7326/M23-1485

Are we human, or are we vaper?

Some say it’s empathy, others say it’s opposable thumbs, but what really sets humans apart from other animals is our ability to rename objects to make them fit into their surroundings. Take electronic cigarettes: to schoolchildren they’re vapes, for adults they’re often known as mods (those big ones that produce steam engine quantities of smoke): e-cigarettes is the term preferred by people who don’t know anyone who vapes, and, for academics who like to publish in the New England Journal of Medicine, they’re known as electronic nicotine delivery systems.

This new study recruited 1246 smokers (who presumably smoke plant-based nicotine delivery systems) who wanted to quit and compared vapes plus counselling (and optional nicotine replacement therapy) with a control group who received counselling and a voucher to spend on anything. After six months, 28.9% had successfully quit smoking in the vape group, compared with 16.3% of controls.

N Engl J Med doi:10.1056/NEJMoa2308815

Footnotes

  • Competing interests: None declared

  • Provenance and peer review: Not commissioned; not peer reviewed