BMJ  2003;327:E136 (4 October), doi:10.1136/bmjusa.02080010 (published 9 October 2002)

BMJ USA: Minerva

Minerva

From BMJ USA 2002;August:462

Why does glyceryl trinitrate alleviate angina in some people, though its benefits quickly wear off in others? The secret apparently lies in an enzyme called mitochondrial aldehyde dehydrogenase. Scientists reporting in the ( Proceedings of the National Academy of Sciences 2002;99:8306-8311[Abstract/Free Full Text]) say the enzyme transforms nitroglycerin within mitochondria (potentially affecting other drugs taken at the same time) and is also destroyed by nitroglycerin, interfering with cells' ability to function.

It's not always easy to convince patients to take medicine as it's prescribed. For some conditions how regularly the drugs are taken makes little difference, but for HIV it can mean the difference between life and death. A population based analysis of almost 1300 HIV positive individuals who started triple combination therapy in 1996 shows that, even after adjustment for other prognostic factors, those who took antiretroviral therapy intermittently were almost three times more likely to have died by 2000 ( AIDS 2002;16:1051-1058[CrossRef][ISI][Medline]).

Another condition where compliance can be critical is diabetes. A retrospective cohort study set in Scotland discovered that adequate adherence to a single prescribed oral hypoglycemic agent was found in just one third of patients. Compliance dropped further as the number of daily tablets rose ( Diabetic Medicine 2002;19:279-284). An editorial in the same issue says these findings cast considerable doubt that the degree of benefit found in formal trials will be observed in clinical practice.

Having a stroke is bad enough, but what about the effect it has on your partner? An individual's "sense of coherence" is crucial in coping with stressful life events, and the same seems true for the spouse of people with stroke. In a Swedish study the spouses' sense of coherence was significantly associated with partnership, sex life, family life, and financial situation before the stroke. Surprisingly, it had nothing to do with the severity of the stroke itself ( Journal of Rehabilitation Medicine 2002;34:128-133[CrossRef][ISI][Medline]).

After an atheromatous plaque ruptures in a coronary artery, platelets play a crucial role in the subsequent thrombus formation, which can lead to infarction. Observing that mean platelet volume is an indicator of larger, more reactive platelets, hematologists hypothesized that it may represent a risk factor for myocardial infarction. This association was confirmed in a population of patients with known heart disease and was independent of smoking, diabetes, and hypertension ( British Journal of Haematology 2002;117:399-404[CrossRef][ISI][Medline]).

Anorexia nervosa is spreading frighteningly in Western countries. It's classified as deliberate weight loss and is a progressive "pursuit of lightness." Looking at contexts where lightness is celebrated—in music, literature and the arts—one writer suggests anorexic behavior is more than a pattern of psychiatric symptoms. Instead, he says, it should be thought of as a meaningful behavior expressing ethical values deeply rooted in Western culture ( Medical Humanities 2002;28:3-8[Abstract/Free Full Text]).

Once a cheat, always a cheat? Psychologists at one university found that when referees were told that a soccer team had a reputation for aggressive and foul play, they were more likely to give red and yellow cards against that team when a player committed a foul ( Psychologist 2002;15:301).

Long life begets long life, and siblings of very old people live longer than the general population. Analyses of data collected from 444 families in which at least one member lived beyond the age of 100 found that the sisters of centenarians had half the risk of dying at any age and so (apart from during the teenage and young adult years) did the brothers. The stability of the survival advantage over one's lifetime suggests that genetic influences are stronger than environmental influences ( Proceedings of the National Academy of Sciences 2002;99:8442-8447[Abstract/Free Full Text]).

Patients with fibromyalgia tell you it isn't just about having aching muscles; they also feel weak. Using a dynamometer to assess grip strength and tests of muscle fatigue resistance, researchers compared 16 women with fibromyalgia syndrome and 85 healthy women. They confirmed a 40% reduction in all muscle function tests in the fibromyalgia group compared with controls (especially during aerobic exercise) and an 80% reduction for static endurance ( Joint Bone Spine 2002;69:293-299[CrossRef][ISI][Medline]).

Some useful advice on how to protect yourself in the "allergy season" comes from Preventive Medicine 2002;34:409-410[CrossRef][ISI][Medline]). If you have to go outdoors, do it early in the morning (pollen counts rise throughout the day). Keep windows closed, and bathe before going to bed (particularly if you've been outside, collecting pollen on your skin). If you have pets, keep them inside or outside, but not both. Minerva can cope with most of these, but thinks the last may prove difficult.

View larger version (105K): [in this window] [in a new window]   A 37 year old man had a renal transplant performed 22 years ago and was taking azathioprine and prednisolone for immunosuppression. He was lost to follow up until he presented with a large squamous cell carcinoma on the dorsum of his right index finger. He subsequently underwent a ray amputation of his finger.. Skin cancer is the most common malignancy in patients with long term immunosuppression. The incidence increases from 10% after 10 years to 40% after 20 years. Patient education in rigorous sun protection and surveillance is critical. Jin J Bong, senior house officer, Mark Lansdown, consultant, Department of surgery, St James's University Hospital, Leeds LS9 7TF, UK

The British cup of tea may one day be compared to the French glass of red wine. A 3.8 year prospective cohort study of 1900 patients admitted to the hospital with a confirmed heart attack has found that self reported tea consumption in the year before acute myocardial infarction is associated with lower mortality after infarction ( Circulation 2002;105:2476-2481[Abstract/Free Full Text]).