BMJ  2003;327:E247 (4 October), doi:10.1136/bmjusa.03080005 (published 3 September 2003)

BMJ USA: Minerva

Minerva

From BMJ USA 2003;August:546

Soaring cesarean section rates in the United States provide food for thought. The rate in 2001 reached an all time high of 24.4%, while that of women having a vaginal delivery after a previous section dropped to an all time low of 16.5%. An editorial in the Journal of Obstetric, Gynecologic, and Neonatal Nursing (2003;32:283-284[CrossRef][ISI][Medline]) asks whether this situation has arisen because the demand for perfection forces unnecessary intervention, and calls for a return to common sense guided by evidence rather than fear of litigation.

Chlamydial infection in men may not be as devastating as it can be in women, but as it's largely asymptomatic, the implications of having it and passing it on unawares are critical. Recent prevalence figures ( Lancet 2003;361:1792[CrossRef][ISI][Medline]) indicate that nearly 10% of men could be infected, and 90% of these were asymptomatic. Although the men studied were young army recruits, they were |P`no more sexually active than the average young male population.|P'

Patients who return home from a tropical country with a fever can cause problems to even the most astute diagnostician. A prospective observational study of febrile children admitted to the hospital who had visited the tropics sometime in the preceding year found that they often have a treatable infection. The most helpful investigations were a full blood count, malarial film, stool and blood culture, and a chest x ray ( Archives of Disease in Childhood 2003 ;88:432-434[Abstract/Free Full Text]) .

People with Crohn's disease often need multiple surgical procedures, so it's important to know how quality of life is affected by surgery. A study looking at the immediate postoperative period found that quality of life measures improved greatly within the first 30 days. Women and patients who had no postoperative complications reported higher scores than other patients. Scores were not affected by the type of surgical procedure or by the nature of the disease ( Journal of the American College of Surgeons 2003 ;196:714-721[CrossRef][ISI][Medline]) .

Supporting the reputed anti-gout efficacy of cherries, a small study in the Journal of Nutrition (2003;133:1826-1829[Abstract/Free Full Text]) found that plasma urate dropped in 10 healthy women who breakfasted on sweet cherries. Their urinary urate concentrations rose after they ate cherries, with peak excretion taking place three hours later.

Despite the availability of a safe, highly effective, and inexpensive vaccine, measles affects more than 30 million children and claims the lives of almost 750 000 each year — more than half of them in Africa. Of all the diseases preventable by vaccines, measles remains the leading killer of children. The WHO says a dose of measles vaccine costs only $0.25, including safe injection equipment. So of all health interventions, measles immunization carries one of the highest health returns for the money spent.

View larger version (84K): [in this window] [in a new window]   During her inpatient stay, this woman developed a painful, unilateral erythematous rash in a butterfly distribution. It predominantly affected the right malar region. Initial differential diagnoses included herpes zoster and systemic lupus erythematosus, but it became clear that this was photosensitivity induced by oral doxycycline. Her bed was situated so that the sun shone on to one side of her face for most of the day. After the antibiotic was stopped and the curtains were drawn, the rash resolved rapidly. Mike Beadsworth, specialist registrar, Saif Al-Abri, specialist registrar, Fred Nye, consultant, N Beeching, senior lecturer, Tropical and infectious disease unit, Royal Liverpool University Hospital Liverpool L7 8XP, UK

Coming from a relatively large family, Minerva understands what it is to be one child among many. In China, where being an only child is the rule, there's concern that such status may be creating generations of fat, egocentric, and maladjusted children. A cross sectional survey from China reports no such thing. The authors found that being an only child conferred no detrimental effects, and may in fact offer some social advantages ( Archives of Disease in Childhood 2003 ;88:467-471[Abstract/Free Full Text]) .

Does type A behavior trigger coronary heart disease? After a nine year follow up of almost 2400 middle aged men, British researchers failed to find that an increased risk of coronary heart disease was associated with type A behavior scores. What became apparent, however, was that the time to first coronary event was strongly inversely related for all Type A scores. The authors say this indicates that type A behavior increases exposure to potential triggers of atherosclerosis, rather than directly affecting the process itself ( Psychosomatic Medicine 2003 ;65:339-346[Abstract/Free Full Text]) .

An artist who developed progressive aphasia associated with frontotemporal dementia produced freer and more original works as her condition wore on. Her language loss was coupled with artistic development, suggesting that language is not required (and may actually inhibit) some types of visual creativity ( Neurology 2003 ;60:1707-1710[Abstract/Free Full Text])

Repairing varicoceles is often done to improve male infertility or unexplained infertility because the dilated veins are thought to result in poor sperm quality and quantity. But when data from seven previously published trials were reanalyzed, varicocele treatment seemed to have little effect on fertility. Surgery increased the pregnancy rate by only 1% ( Lancet 2003;361:1849-1852[CrossRef][ISI][Medline]) .

Primary care doctors faced with an ugly case of suppurating impetigo sometimes resort to oral antibiotics. A systematic review and meta-analysis of 16 appropriate studies of available treatments clearly shows that a topical antibiotic used for seven days should be sufficient to treat a well patient with limited disease ( British Journal of General Practice 2003;53:480-487) .

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