BMJ  2003;327:E159 (4 October), doi:10.1136/bmjusa.02100011 (published 26 January 2003)

BMJ USA: Minerva

Minerva

From BMJ USA 2002;October:586

Playing soothing music in doctors' waiting rooms can alleviate the stress of waiting for a doctor who is running late and provides a sound barrier to prevent reception staff being overheard on the phone. A review commissioned by the Performing Rights Society (which issues licenses for music to be played in public places) found that the benefits of music extend to reducing patients' anxiety and in some cases, even reduces the perception of pain (Health Which? 2002;Aug:5).

People with fungal infections of the toenails are unlikely to get better if given only topical treatment. A review of research reports ( Archives of Dermatology 2002;138:811-816[Abstract/Free Full Text]) found clear evidence that the most effective regimen was three months of oral terbinafine. There was one caveat: most of the published research was funded by the pharmaceutical industry.

Short term weight loss due to reducing fat intake and increasing exercise and vitamins (specifically folic acid) has a favorable effect on body composition and low density lipoprotein cholesterol. The effects are more pronounced in men than women. A paper in the European Journal of Clinical Nutrition (2002;56:585-592[CrossRef][ISI][Medline]) concludes that folic acid supplementation may be an important component of weight loss programs, particularly to prevent increases in homocysteine (an independent risk factor for cardiovascular disease).

In older women the most common presenting complaint at a genitourinary clinic was symptoms of vulval soreness and irritation. Of 124 women seen, 40% had atrophic vulvovaginitis (AVV) and 23% had thrush ( Journal of Family Planning and Reproductive Health Care 2002;28:135-136[CrossRef]). Contrary perhaps to expectation, there was no link between AVV and the use of systemic hormone replacement therapy, but the symptoms respond well to local estrogen therapy.

Patient education is a noble ideal, but much of it depends on patients' being able to read. On an established test of medical literacy, 15% of patients attending one hospital rheumatology clinic were found to be illiterate. These patients experienced higher levels of anxiety (but not depression) and were three times more likely to have attended the clinic than matched controls over the previous 12 months. Much of this excess had to do with poor compliance with drug treatment ( Rheumatology 2002;41:750-754[Abstract/Free Full Text]).

The debate continues about how best to manage ear infections. Specimens taken from 2240 diseased ears identified Pseudomonas aeruginosa as the commonest bacterial isolate in otitis externa, although 201 other species were also identified. With such a surprisingly wide diversity of bugs implicated, the authors suggest choosing the most potent broad spectrum topical treatment available ( Laryngoscope 2002;112:1166-1177[CrossRef][ISI][Medline]).

Children with lower urinary tract infections seem to do just as well in the short and long term with a 2-4 day course of antibiotics as those who take 7-14 day courses. The authors of a systematic review in Archives of Disease in Childhood (2002;87:118-123[Abstract/Free Full Text]) suggest that with the increasing prevalence of organism resistance in urinary tract infections to commonly used antibiotics, short treatments should be investigated further.

View larger version (170K): [in this window] [in a new window]   An 84 year old woman presented with a two week history of deterioration in health and decreased mobility. She described new onset frank hematuria and on admission retained urine because of clots. A vesicular rash on the anterolateral aspect of her right thigh involved the L1 dermatome and was consistent with Varicella zoster in appearance (top). Flexible cystoscopy showed multiple vesicles of the mucosa of the right lateral wall of the bladder (bottom). The L1 distribution concurs with the sympathetic innervation of the bladder. After her catheter was removed she voided successfully. The resolving rash caused discomfort, but she had no suprapubic pain or dysuria. She underwent rehabilitation and was back walking within three weeks. Paul K Hegarty, registrar, Nicholas J Hegarty, senior registrar, Sarah Brennan, senior house officer, T E D McDermott, consultant, Department of urology, Adelaide and Meath Hospital, Dublin Incorporating the National Childrens Hospital at Tallaght, Dublin 24, Republic of Ireland

Hope is fading fast for finding a single agent to treat the common cold. Combination therapy that includes both antiviral and anti-inflammatory components might be more successful, and a randomized, double blind, controlled trial of such a combination found that, over 4.5 days, treatment reduced daily symptom scores by 33-73% compared with placebo. The treatment was well tolerated, and the results suggest early treatment is desirable ( Journal of Infectious Diseases 2002;186:147-154[CrossRef][ISI][Medline]). Minerva hopes that if such treatment reaches the market it's available over the counter.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?