BMJ  2003;327:E121 (4 October), doi:10.1136/bmjusa.02060004 (published 23 August 2002)

BMJ USA: Minerva

Minerva

This article originally appeared in BMJ USA

Some older people deny having difficulties walking but have already modified their behavior by using walking canes. The authors of a two year longitudinal survey study found that those who used canes at the start of the study were more likely to have developed new mobility problems at follow up than were those who walked without aids. They suggest that asking patients about task modification rather than difficulty alone may be a more sensitive way to detect early problems ( Journal of the American Geriatrics Society 2002;50:263-268[CrossRef][ISI][Medline]).

About 1 in 40 people have an ischemic stroke within six months of a heart attack. After pooling risk factor data from over 100 000 patients, investigators have invented a new risk stratification score. Using it, they identified 20% of older patients who have a 1 in 25 chance of being rehospitalized for a stroke within six months of a coronary event. The critical factors are less about the characteristics of the infarct, and more about stroke risk factors in general, particularly in elderly people ( Circulation 2002;105:1082-1087[Abstract/Free Full Text]).

Sensory deprivation studies suggest that monotonous environments are stressful. This observation led to a wonderful sounding therapy called "Snoezelen" that purports to create a relaxing, stimulating, and failure-free environment for people to explore at their own pace. A pilot trial of Snoezelen as an intervention for agitated behavior in people with dementia found that it was tolerated well and rated positively by participants and may have reduced their agitation during and immediately after the session ( British Journal of Occupational Therapy 2002;65:61-66).

While the "too posh to push" brigade may be contributing to rising cesarean section rates, obstetricians may make more conventional decisions about their own deliveries. Almost half—45%—of Israeli obstetricians say they support a woman's right to choose a delivery by cesarean section, but only 9% of the respondents said they would prefer cesarean delivery for themselves (if female) or for their partners ( Obstetrics and Gynecology 2002;99:577-580[Abstract/Free Full Text]).

Minerva recalls the days when some housestaff ill advisedly used skateboards to navigate the long corridors of hospitals. Now it's scooters. A randomized crossover experiment to see if dashing with scooters to in-hospital emergencies offers any benefits over conventional running found that riders' pulse rates were significantly lower on arrival. Manual dexterity and response times, however, were not improved ( Resuscitation 2002;52:293-296[Medline]).

What's the first bit of the brain to go in Alzheimer's disease? Not surprisingly, three dimensional magnetic resonance mapping of what areas of brain atrophy over time has shown that the parts of the brain involved with memory have rapid tissue loss early on. The parts of the brain implicated in functions such as speech and perception take longer to atrophy. These observations will provide a useful tool for assessing the efficacy of potential treatments ( Proceedings of the National Academy of Sciences 2002;99:4703-4707[Abstract/Free Full Text]).

Paternal, but not maternal, longevity seems to protect men against coronary disease. A Swedish prospective follow up study of over 6000 men aged 51-59 has found that their death rate from heart disease decreased continuously with increasing age of the father, while the effect of an aging mother was less striking. The relation holds independent of cardiovascular risk factors (including a history of myocardial infarction) among the fathers ( Journal of Internal Medicine 2002;251:258-267[CrossRef][ISI][Medline]).

Inhaled bronchodilators offer little help to babies with bronchiolitis. Nor, it seems, does epinephrine. A small randomized controlled trial of nebulized epinephrine versus saline placebo in babies with acute bronchiolitis already stabilized by supportive treatment produced no benefit in oxygen saturation or in the assessment of respiratory distress ( Archives of Disease in Childhood 2002;86:276-279[Abstract/Free Full Text]). But reducing high fevers, clearing blocked nostrils, feeding a hungry baby, changing a wet diaper, and minimal handling did produce significant reductions in respiratory and heart rate.

View larger version (91K): [in this window] [in a new window]   This 81 year old woman developed a florid, blanching exanthematous maculopapular rash over her trunk, arms, and proximal thighs after two weeks of treatment with ciprofloxacin for a wound infection. Shortly after the rash developed, she became acutely unwell, hypotensive, and drowsy. The topical fentanyl patch used to control her arthritic pain was dry. She promptly recovered with a dose of naloxone. This case illustrates the implications of the transdermal route for the absorption of drugs when the skin circulation is altered. In this case there was hyperemia due to the antibiotic reaction. External heat and fever also increase the absorption rate of fentanyl via transdermal drug delivery systems, and the clearance rate of fentanyl may be greatly reduced in people over the age of 60. S E Farmer, pre-registration house officer, C Wilson, consultant, Department of Orhopaedics and Tauma, University Hospital of Wales, Cardiff CF14 4XW, UK

An estimated 15% of the population in developed countries suffers from allergic rhinitis, mostly due to the house dust mite. Authors of a Cochrane review of the benefits (or otherwise) of measures to avoid mites found just four trials—albeit of poor quality—that satisfied their inclusion criteria. Three interventions resulted in a significant reduction in mite load compared to controls: agents that destroy mites (acaricides), high efficiency particulate air (HEPA) filters, and a bedroom based environmental control program (www.update-software.com/abstracts/ab001563.htm).

Low intensity gamma rays could be the answer for vegetable lovers. Scientists at the Bhabha Atomic Research Center in India have discovered that gamma irradiation of vegetables reduces levels of oligosaccharides, the sugars responsible for the production of flatus. Minerva was astonished to read that every day each person produces between four and five liters of gas (Daily Telegraph March 28:6).

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