BMJ  2003;327:1296 (29 November), doi:10.1136/bmj.327.7426.1296

Minerva

Breast feeding mothers with postnatal depression are often advised not to take antidepressants. A study in Pediatrics ( 2003;112: e425)[Abstract/Free Full Text], however, indicates that taking a selective serotonin reuptake inhibitor such as fluoxetine may be safe. All but one exclusively breast fed infant in this study showed no meaningful changes in platelet serotonin transport while their mothers were taking daily fluoxetine. It's premature to suggest treatment guidelines, say the authors, but the picture may be more grey than we thought.

Fifteen years ago it was said that reversible dementia was significantly less prevalent than previously estimated. This prediction has been borne out by an updated meta-analysis in the Archives of Internal Medicine ( 2003;163: 2219-29)[Abstract/Free Full Text]. Potentially reversible causes were found in just 9% of cases of cognitive decline studied, and only 0.6% of these actually did reverse. Given such dismal figures, the diagnosis of dementia carries clinical and economic implications.

Another prediction that seems to have fallen short of actuality is the negative effect on outcome of age at the time of a head injury. People under the age of 60 had been predicted to do better than those over 60. Now the evidence shows that for patients with head injuries the risk of dying increases as early as 30 years of age ( Journal of the American College of Surgeons 2003;197: 711-6[CrossRef][ISI][Medline]).

Lemons, garlic, virgin olive oil, and the African potato have all at some time been implicated as being able to alter the course of disease. In South Africa, the Medicines Control Council prematurely terminated a study on the safety and efficacy of the Hypoxis plant extract (the potato that has been claimed to hold anticarcinogenic properties) in HIV positive patients because of bone marrow suppression. Hypoxis induced immune suppression has been confirmed experimentally in the feline immunodeficiency virus model ( South African Medical Journal 2003;93: 798).

Lactose tolerance among northern Europeans is thought to reflect the evolutionary advantages of being able to digest milk within a society that is highly dependent on milk products. But what about the cows? In the latest issue of Nature Genetics ( 2003; www.nature.com/ng/10.1038/ng1263) researchers looked at the six most important milk proteins in 20 000 cows from 70 breeds in seven European countries. The area where they found the greatest genetic diversity among cows neatly overlaps the region with both the most lactose tolerant people and the centre of the Neolithic cattle herding culture. Cows and people have thus had a strong influence on the genetic structure of one another's populations.

A new type of channel that influences blood pressure has been identified. Like the L-type calcium channels, these T-type channels may prove to be useful targets for blood pressure lowering drugs. Animal studies show that the flow of calcium ions through T channels are essential for carrying out the vessel relaxing effects of nitric oxide ( Science 2003;302: 1416-8[Abstract/Free Full Text]).

Minerva was almost overcome by the fumes of hair products when she recently visited her hairdresser. A longitudinal follow up of 191 hairdressing apprentices and 189 office workers in Occupational and Environmental Medicine ( 2003;60: 831-40)[Abstract/Free Full Text] threw up some interesting observations. In the initial phase, the prevalence of respiratory symptoms was significantly lower and lung function tests were significantly better among the hair-dressers. In the final phase, the results for respiratory symptoms were similar, and results of lung function tests had worsened significantly among the hairdressers. The authors say that a "healthy worker" effect cannot be ruled out.

The BMA, the Department of Health, and the Royal College of General Practitioners have compiled a comprehensive report called Good Practice Guidelines for General Practice Electronic Patient Records. It's been written partly in response to the growing number of organisations that are considering moving to a paperless practice. A word of warning for anyone wishing to print out the report (www.rcgp.org.uk) for ease of reading: it's 73 pages long.

A patient with haematuria who ended up with invasive bladder cancer is reported in Casebook, the magazine of the Medical Protection Society (November 2003:23). The patient was about to move to another part of the country, and his original GP suggested the patient ask his new GP to investigate things further. As the haematuria didn't recur, the patient didn't bother to mention it again. If something urgent requires action, says the defence union, doctors have a responsibility to ensure that action is taken, regardless of whether the patient is leaving the practice.

A 29 year old man was found to be HIV positive in January 2001. He has not required antiretroviral therapy and his current CD4 lymphocyte count is 552x106/l and HIV viral load 41 700 copies/ml. Recently he presented with white lesions that were developing on his tongue (top). The clinical diagnosis was oral hairy leukoplakia, a manifestation of Ebstein-Barr virus in people positive for HIV. (This is rarely seen in HIV negative people but may occur with immunosuppression after solid organ transplantation.) He responded well to two weeks of oral aciclovir, 400 mg three times daily (bottom). Margaret Kingston, specialist registrar, Emile Morgan, consultant, department of genitourinary and HIV medicine, Royal Bolton Hospital, Bolton BL4 0JR

Despite strong evidence that giving people with severe heart failure blockers is a good thing, their use in heart failure is still not widespread. Perhaps it's the anti-intuitive nature of the practice. An article in Heart ( 2003;89: 1442-4)[Free Full Text] describes a study that confirms that patients with severe cardiac failure who are not taking a blocker are at a significantly greater risk of death; it finds that not taking a blocker is an independent predictor of mortality.

www.thebookseller.com is holding a competition. Digital voting offers readers the opportunity to win the Diagram Prize for the oddest book title of the year. The titles nominated include The Big Book of Lesbian Horse Stories, 277 Secrets Your Snake Wants You To Know, The Voodoo Revenge Book, and Hot Topics in Urology. At time of writing, this last had achieved 15% of the vote.

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