BMJ  2003;327:E268 (20 December), doi:10.1136/bmj.327.7429.E268

BMJ USA: Minerva

Minerva

People with genital warts may do better if they treat themselves rather than attending a genitourinary clinic. For 358 immunocompetent adults participating in a randomized controlled trial of self applied podophyllotoxin 0.5% solution or 0.15% cream, compared with clinic treatment with 25% podophyllin, self treatment worked best. The 0.5% solution was most cost effective, but warts reoccurred in more than 40% of participants, equally across the three groups ( Sexually Transmitted Infections 2003;79: 270-275[Abstract/Free Full Text]).

Here's something to think about next time you go to the beach. A study in the Journal of Investigative Dermatology ( 2003;121: 165-171)[CrossRef][ISI][Medline] found that when mice are stressed, and then exposed to ultraviolet B radiation, they tan more heavily and produce significantly more melanocytes. Minerva wonders if this means she'll get a better tan when the beach is crowded.

Sleepiness and just a small amount of alcohol create a deadly cocktail for drivers. A test of 12 healthy men who took part in a simulated driving exercise confirmed that the combination of sleep deprivation and apparently "safe" amounts of alcohol was sufficient to make lane drifting worse. It was also reflected in the electroencephalogram. Subjectively, however, the sleepy drivers were unaware of becoming more sleepy with alcohol ( Occupational and Environmental Medicine 2003;60: 689-692[Abstract/Free Full Text]).

Around eight million new cases of tuberculosis were found worldwide in 2000, and the current rate of increase is 1.7% each year. Nearly half of people with a new diagnosis had positive findings on examination of their sputum and so were highly infectious ( Annals of Medicine 2003;35: 235-243[CrossRef][ISI][Medline]). Part of the recent rise in numbers is due to rapid population growth in Africa and Asia, but two other factors—HIV infection and malnutrition—are remediable to some extent. The review also includes one warning: "doctors who cannot treat TB properly should not treat TB at all."

In cancer research 18 years is a very long follow up, but it was achieved in a study of 237 women with early breast cancer recruited by the National Cancer Institute in the early 1980s. The women were randomized to treatment by modified radical mastectomy or breast conservation ( Cancer 2003;98: 697-702[CrossRef][ISI][Medline]). After 18 years no difference was seen in overall survival or in disease-free survival. Women treated by breast conservation, however, were at continued risk of "in breast" events.

The main risk for patients with non-diabetic kidney disease is progression of the disease, rather than complications affecting other organs. An analysis of data from 11 randomized controlled trials ( Annals of Internal Medicine 2003;139: 244-252[Abstract/Free Full Text]) showed that the lowest rate of progression of the kidney disease was associated with a systolic blood pressure between 110 and 129 mm Hg and an excretion of protein of less than 2 g a day. When antihypertensive treatment was given along with an angiotensin converting enzyme inhibitor, prognosis was improved further.

Between 1996 and 2002 the specialty preferences of US medical students changed, with more emphasis being given to "controllable lifestyle" ( JAMA 2003;290: 1173-1178[Abstract/Free Full Text]). A preference for a controllable lifestyle meant more time for non-medical activities with the family, a lifestyle more likely to be achieved by a dermatologist than a general surgeon or a family physician. Lifestyle now accounts for 55% of the variability in students' choices between specialties.

Is life easier for people if their spouse was in a hospice before dying? A matched retrospective cohort study in Social Science and Medicine ( 2003;57: 465-475) involved almost 200 000 elderly couples. The findings suggest that end of life care in a hospice benefits the spouses of patients who succumb to their disease. Fewer bereaved spouses died within 18 months than would normally be expected, with wives doing significantly better than husbands.

Doctors—and their patients—sometimes feel uneasy about stopping treatment with a proton pump inhibitor after a patient has had a peptic ulcer and been given Helicobacter pylori eradication therapy. But a five year prospective randomized controlled trial concludes that maintenance treatment really isn't necessary ( Archives of Internal Medicine 2003;163: 2020-2024)[Abstract/Free Full Text]. Virtually all 82 patients completed the study, and all remained free of H pylori infection with no peptic ulcer recurrence (see also p 601).

An 84 year old man presented with a six month history of a pruritic rash. It had been treated as eczema with topical steroids, but got worse. His wife had also developed pruritus. Examination showed large areas of confluent white scale on his penis, scrotum, and buttocks. Volar aspects of the wrists contained multiple serpiginous scaling lesions. The rest of his body was covered with erythematous papules. We diagnosed Norwegian scabies and treated him with three cycles of topical 5% permethrin. Three weeks later the scaling had resolved, leaving residual hyperpigmentation. Norwegian scabies occurs predominantly in elderly, infirm, or immunosuppressed people and in those with mental illness. It occurs often in the genital area. E Ladoyanni specialist registrar S Orpin associate specialist A Heagerty consultant, department of dermatology Solihull Hospital, Solihull B90 2JL, UK

Some patients are deeply suspicious of flu vaccines, believing that they're bound to get ill immediately after having one. Older people with chronic obstructive pulmonary disease or asthma are particularly targeted in flu vaccine campaigns, so it's reassuring that a cohort study in Thorax ( 2003;58: 835-839)[Abstract/Free Full Text] found no increased risk of adverse acute outcomes in the first two weeks after vaccination and no increase in the number of prescriptions given for oral steroids.

A bicycle helmet education program aimed at young children had the desired effect of reducing children's risk of being admitted to hospital with head injuries. Interestingly, bicycle related head injuries dropped significantly in both rich and poor communities, even though children from poorer areas generally adopt protective behaviors less ( Journal of Epidemiology and Community Health 2003;57: 668-672)[Abstract/Free Full Text].

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Podophyllin self administration

richard adams
bmj.com, 23 Dec 2003 [Full text]