BMJ 2006;333:360 (12 August), doi:10.1136/bmj.333.7563.360
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The old ways are often the best. Comparison of a simple home exercise programme with surgical treatment for "jumper's knee" (patellar tendinopathy) found that surgery provided no benefit in terms of continuing symptoms up to one year later. The authors suggest that eccentric strength training should be tried for at least 12 weeks before considering a tenotomy (Journal of Bone and Joint Surgery 2006;88-A; 1689-98).
Why do some people attend accident and emergency departments but disappear before being seen? A large Canadian study reports that impatience during peak periods is the most common reason given, but that more than half of the 4.5% who leave sought medical care within a week (Academic Emergency Medicine 2006;13: 848-52[CrossRef][Medline]). Thirty nine per cent of patients who didn't seek help elsewhere had been triaged on entering the department as "urgent." Complications were rare among those who don't wait, although a small subgroup of "high risk" patients do end up in trouble.
Teenage fans of television wrestling are more likely to engage in "date fighting" (violence between people in a sexual relationship) and general fighting and to carry weapons, although the association is stronger for girls than boys (Pediatrics 2006; 118: 265-72). Students who reported date fighting were more likely to watch wrestling if either of them used alcohol or drugs.
Several complementary and alternative medicines can interfere with the metabolism of other drugs. For anticancer drugs, which often have a narrow therapeutic window, this can have dramatic consequences, including toxicity and reduced activity. In view of the prevailing opinion that "natural" products are harmless, writers in the Oncologist (2006; 11: 732-41
Three antigens that target ghrelin—a hormone that decreases energy expenditure and fat breakdown—could be developed into a vaccine to treat obesity. When given to rats, the antigens bound to ghrelin and induced the formation of anti-ghrelin antibodies. The vaccinated rats showed less weight gain than control rats that were fed the same diet (www.pnas.org/cgi/doi/10.1073/pnas.0605376103).
Scientists emphasise the importance of moderate physical activity for health. Researchers investigating the effect of a regular exercise and active recovery programme on dendritic cells—potent antigen presenting cells that promote antitumour immunity—have found that training over five weeks increases the number of these cells and their activity against tumour cells. While prolonged and extreme physical training adversely affects immunity, regular and moderate exercise might improve immunity (Journal of Sports Medicine and Physical Fitness 2006;46: 307-14).
Researchers have determined how the malaria parasite Plasmodium reaches liver blood vessels and infects the bloodstream (www.sciencexpress.org/3August2006/Page1/10.1126/science.1129720). Merozoites, the stage of the parasite that infects erythrocytes and causes the symptoms of disease, first kill the hepatocytes they inhabit and cause them to detach from the liver tissue. The dead cells then bulge through the lining of the blood vessel and pinch off to form parasite filled vesicles that flow downstream. The merozoites also suppress molecular signals on the dead liver cells that would otherwise induce phagocytosis and their subsequent ingestion.
The trend to pour counsellors on to scenes of devastation to help mop up the tears and distress of people caught up in traumatic events is on the way out. We now have the results of a randomised controlled trial of "emotional ventilation debriefing" and educational debriefing versus no debriefing. The study found that individual debriefing was not useful, and after six weeks people in the emotional debriefing group actually showed more symptoms of post-traumatic stress disorder than controls (British Journal of Psychiatry 2006;189: 150-5
Multiple sclerosis is about twice as common in women as in men. If men have a greater physiological resistance to the disease, then affected men would need a greater number of or more potent susceptibility genes than affected women and they would be predicted to transmit the disease more often to their children. This seems to be the case, because excess paternal versus maternal transmission (the Carter effect) has now been demonstrated in multiple sclerosis (Neurology 2006;67: 305-10
A study in Blood (2006;108: 1100-5
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If you have a hyperactive child, he or she may be heading for a fall in later life. A paper in Psychosomatic Medicine (2006;68: 509-16
As the popularity of thiazides as first line drugs for high blood pressure has increased, so has the incidence of diabetes among patients taking these drugs. An analysis of 59 clinical trials concludes that increases in blood sugar result from thiazide induced hypokalaemia, and that if the low potassium is treated glucose intolerance may be reversed; this might prevent full blown diabetes from developing (Hypertension 2006;48: 219-24
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