Minerva

This article originally appeared in BMJ USA

Antinuclear antibodies, commonly associated with autoimmune diseases, may in the future join other tests for coronary atherosclerosis. Unaware of the artery status of 70 people, two observers scored positivity for the antibodies. Of those with known angiographically proven coronary disease, 70% were positive for antinuclear antibodies, compared with 17% of the group with no evidence of coronary disease. Epidemiologically this is poor performance for a diagnostic kit, but the authors say antinuclear antibodies should be considered in the context of existing serum markers for atherosclerosis (Annals of the Rheumatic Diseases 2002;61:110-114)[Abstract/Free Full Text].

Removing indwelling urinary catheters at midnight seems to offer appreciable advantages over the conventional practice of removing them at 6 am. A prospective randomized trial of catheter removal at midnight and 6 am found that patients resumed their normal voiding pattern earlier and were discharged from the hospital when their catheters were removed at midnight. The authors say that a good night's sleep immediately after catheter removal reduces patients' anxiety, and that the bladder is more compliant when filling slowly overnight (British Journal of Nursing 2002; 11:84-90)[Medline].

Drug users can also independently have problems with alcohol misuse. In a survey of 735 people seeking help for drug use who were also current drinkers, three groups of people emerged: those with no alcohol dependence (63%), those with low dependence (19%), and those with high dependence (18%). Those with high alcohol dependence tended to drink extra-strength beer and were more likely to use benzodiazepines, amphetamines, and cocaine powder (Addiction 2002;97:169-178)[Medline].

We doctors like to think we know what it is like to deal with disease, but a writer in QJM (2002;95:51-53)[Free Full Text], who is alive only because she received a liver transplant, eloquently describes the acute loneliness of people who are seriously ill. Doctors, she says, may be able to describe the "why" of a disease, but it's only people who share a common experience who can help find the words to describe how it feels.

Some people think ageism lies behind the undertreatment of elderly patients. A study of people with breast cancer in the Journal of the American College of Surgeons (2002; 194:8-13)[CrossRef][ISI][Medline] largely refutes this, finding that in most cases there are good reasons for omitting standard treatment in the over 65s. These include the presence of other prohibitive medical conditions, favorable tumor pathology, and patients' refusal of treatment.

Analysis of the EUROSTROKE nested case control study confirms that left ventricular failure assessed by electrocardiogram is a powerful risk factor for stroke (odds ratio 2.1). The association is more pronounced in smokers (3.5 v 1.6) and stronger for fatal stroke than for non-fatal stroke (4.0 v 1.5). Left ventricular failure is a marker for longstanding raised blood pressure and it also triggers arrythmias. Both are associated with stroke (Journal of Epidemiology and Community Health 2002; 56[suppl 1]:S8-S13).

Minerva's impression that there are more colds around at the moment than people with flu is confirmed by the Pharmaceutical Journal (2002;268:51). To explain why there are more colds during the winter than the summer the authors suggest that people spend more time indoors during the winter (helping virus spread), levels of virus killing ultraviolet light are lower in winter, and virus replication speeds up in noses cooled by colder air. The stress of Christmas may also suppress the immune system.

Radiofrequency ablation of the soft palate to cure snoring caused by palatal vibration has recently come into vogue. It's associated with less morbidity than either surgery or laser treatment, but it's an expensive technique and little is known about its efficacy. The early trials were promising, but over the longer term, subjective improvement remains low. Eighteen months after having the treatment, 78% said they were still snoring heavily (Journal of Laryngology and Otology 2002;116:116-118.

Women are said to look for their fathers when seeking mates. In this study, 49 women graded male body odorsproduced by men wearing T-shirtson their degree of "pleasantness." The most desirable smells were those produced by men with an intermediate level of genetic similarity, rather than those with a large degree of genetic overlap or none at all. The most desirable donor smells were significantly correlated with genes that the women had inherited from their fathers (Nature Genetics 2002;30:175-179)[CrossRef][ISI][Medline].

View larger version (189K): [in this window] [in a new window]   A woman noticed black patches in her vision. Thinking this was caused by excess skin in her right upper eyelid, her doctor referred her to an eye specialist. At presentation the pupils were equal and reactive, with normal visual acuity (the right pupil seems dilated here because we used tropicamide for the fundoscopy examination). The diagnosis turned out to be a large intraocular tumor. The patient's care was considerably delayed because simple fundoscopy was not performed at the time of the initial consultation. In view of the malignant nature of the condition this delay could have been life threatening. If a primary care doctor is not confident doing fundoscopy, a referral to an optometrist or ophthalmologist is reasonable to obtain a baseline visualization of the fundus. Amar Alwitry, senior house officer, Roger Holden, consultant, department of ophthalmology, Derbyshire Royal Infirmary, Derby DE1 2QY, UK

As one who was recently set upon by an eager young pharmacist, Minerva was delighted by a snippet in Bandolier (2002;9: 7). Imagine you are a chief executive concerned about prescribing habits, and you are armed with the evidence and good economic analysis to show that A not only works as well as B but costs less. Do you: (a) arrange for hordes of young pharmacists to tell your doctors they are wrong, or (b) ask about how savings relate to the cost of making those savings? The no-brainer answer is (b), but sadly (a) is the strategy most often chosen.