BMJ  2005;331:E369 (9 July), doi:10.1136/bmj.331.7508.E369

BMJ USA: Minerva

Minerva

Minerva

Patients with chronic breathing disorders tend to be quite anxious and are often depressed. In a cross sectional survey of over 1300 people 80% of them screened positive for depression, anxiety, or both ( Chest 2005;127: 1205-11[Abstract/Free Full Text]). The predictive value of a telephone screen test being positive was estimated to be 80%. What was more worrying in a population with such a high prevalence of anxiety and depression was the extent of untreated morbidity: just 31% were receiving help for their mental state.

Minerva wonders whether it's the technical challenge to surgeons or the advantage to patients that's fueling the minimally invasive trend in surgery. A study of minimal incision techniques for total hip replacement surgery found that a blinded mini-incision approach performed by highly experienced surgeons did not improve early postoperative outcomes, including length of stay in hospital, compared with the standard approach ( Journal of Bone and Joint Surgery [Am] 2005;87: 701-10).

Charles Darwin experienced 40 years of intermittent vomiting, pain, headaches, lethargy, skin problems, and depression after returning from his voyage on the Beagle. Some 20 doctors failed to find the cause of his mystery illness, and most concluded that it was of psychosomatic origin. Today's diagnosis, revealed in the Postgraduate Medical Journal ( 2005;81: 248-51)[Abstract/Free Full Text], suggests he had systemic lactose intolerance all that time. Not only was there a family predisposition to the same problems, but Darwin got better only when by chance he stopped taking milk and cream.

"Clinical inertia" is a condition of doctors that may well compromise the health of their patients. A study of diabetic patients with high HbA_1c concentrations found that fewer than half of them had their drug regimens intensified, regardless of the specialty of the doctor monitoring them ( Diabetes Care 2005;28: 600-6[Abstract/Free Full Text]). Patients looked after by subspecialists were more likely to be started on insulin. Data collection started one year after the publication of evidence indicating that tight glycemic control is critical to prognosis, at a time when the evidence was widely disseminated and being discussed.

Embolization of the uterine artery is a newish approach for the treatment of fibroids. A French study that followed up 85 women who underwent the procedure reports a 17.2% recurrence rate at 30 months ( British Journal of Obstetrics and Gynaecology 2005;112: 461-5). The factors predictive of recurrence were size and number of fibroids, and most of the recurrences became apparent only after two years. The study authors say this is still a small risk, and that for most women, embolization is preferable to open surgery.

Large waist measurements and raised triglycerides may prove to be the best indicator of a risk of cardiovascular mortality in postmenopausal women. A community based sample of 557 women was followed for eight years. After adjustment for age, smoking, diabetes and low density lipoprotein cholesterol, a waist circumference greater than 88 cm and raised triglycerides were associated with a 4.7-fold increased risk for fatal cardiovascular events ( Circulation 2005;111: 1883-90[Abstract/Free Full Text]).

Russian empress Catherine the Great (reign 1762-96) was known to take an active interest in medical advances, and having never had smallpox, put herself and her son forward for smallpox vaccination at a time when the procedure was only just being developed. An "inoculator" was summoned from England to do the deed. French philosopher Voltaire, who enjoyed a regular correspondence with the empress, reported that "she had been inoculated with less fuss than a nun taking an enema" ( Resuscitation 2005;64: 257-60[Medline]).

Married men who take regular exercise enjoy the best self reported mental health, according to a Texas based, single community study in Preventive Medicine ( 2005;40: 438-43)[Medline]. Obese Hispanic (and non-Hispanic white) smokers report the poorest mental health. The Texas Department of Health has declared the importance of the connection between lifestyle and mental health by promoting mental health as a public health issue, but as most public health programs promote healthy lifestyles, any successful strategy should also produce a positive effect on mental state.

Despite a growing trend for menopausal women to take flaxseed supplements, a placebo controlled trial of flaxseed as a dietary supplement reports mixed results. After a year of supplementation, flaxseed produced a favorable—but not clinically significant—reduction in both total and high density lipoprotein cholesterol levels, compared with a wheat germ placebo. But both flaxseed and wheat germ reduced menopausal symptoms, and bone mineral density was similar in both groups ( Journal of Clinical Endocrinology & Metabolism 2005;90: 1390-7[Abstract/Free Full Text]).

A 2 year old child presented with painless swollen wrists and ankles. x Rays showed the cupping and flaring of the epiphyseal-metaphyseal junction of the lower ends of long bones that is typical of rickets. Her 25-hydroxycholecalciferol concentration was 1.5 ng/mL. Nutritional rickets at this age is not uncommon in areas where maternal intake of vitamin D and calcium during pregnancy and lactation is very low. Pavanasam Velayutham consultant endocrinologist Drvelu1974{at}yahoo.co.in Pankaj Mehta consultant radiologist Kovai Medical Center and Hospital Coimbatore, India

Minerva knows she's not alone in having red wine because it's "good for the heart," so she was sad to read that the antioxidant vasodilator polyphenolic compounds of red wine didn't offer the hoped for benefits of mitigating the blood pressure raising effects of alcohol. Compared with abstinence, red wine and beer both pushed up systolic blood pressure in otherwise normotensive men, and neither red wine nor de-alcoholized red wine lowered blood pressure ( Hypertension 2005;45: 874-9[Abstract/Free Full Text]).

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And wine that maketh glad the heart of man.....

harold jitschak bueno de mesquita
bmj.com, 10 Jul 2005 [Full text]