Minerva

From BMJ USA 2002;July:418

A pan-European study of insulin injection technique has some sobering findings: 30% of patients reported a lipohypertrophic lesion (known as a "lipo") at injection sites, and only 38% say they rotate sites each time they inject rapid acting insulin. Less than half of patients had been taught effective lipo prevention, and 22% say they throw used needles into the trash without making the needle safe. But it's not all bad news: 70% say they inject using a skin "pinch-up," which is linked to improved glycohemoglobin levels (Practical Diabetes 2002;19:71-76).

Many doctors use risk calculations for heart disease to help advise their patients. Mortality data taken from a large French study over a 13 year period has helped to identify that the combination of high systolic blood pressure and high serum cholesterol leads to a threefold to fourfold increase in cardiovascular and coronary heart disease in men under the age of 55 (European Heart Journal 2002;23:528-535).

Azithromycin, an expensive antibiotic commonly prescribed in the United States, is rapidly finding favor in Britain. A randomized double blind controlled trial of azithromycin for acute bronchitis in patients without underlying lung disease has found that it's no better than low dose vitamin C (Lancet 2002;359:1648-1654)[CrossRef][ISI][Medline].

Women with polycystic ovarian syndrome can find it difficult to conceive. Some are given clomiphene to induce ovulation, but it doesn't always work. Given that insulin resistance may play a key role in the syndrome, some people think that metformin (a drug that reduces insulin resistance) may help as a pretreatment. But in a randomized placebo controlled double blind crossover study of 26 women, metformin produced no difference in ovulation rates (British Journal of Clinical Pharmacology 2002;53:469-473)[CrossRef][ISI][Medline].

Closing traumatic wounds with Steristrips without extensive cleaning and using local anesthetic first sounds less than ideal. Though such methods don't adhere to the "sacred tenets" of wound closure, there are times when they are the only available option. A prospective analysis of 147 lacerations dealt with in such a way in one large emergency department in Trinidad found this technique to be cheap, quick, and effective, and it resulted in a sepsis rate of just 1.4% (Postgraduate Medical Journal 2002;78:181-182).

People with Alzheimer's disease tend not to show the same degree of conditioned responses to fear as healthy people, putting them at greater risk of injury than others. Fear conditioning relies on a form of memory dependent on the amygdala, and this has now been shown to be impaired in Alzheimer's disease (Neuropsychologia 2002; 40:1187-1195)[CrossRef][ISI][Medline].

View larger version (77K): [in this window] [in a new window]   A 62 year old woman presented to the accident and emergency department with widespread bruising over her left breast. It followed an injury caused by spontaneous deployment of the airbag in the steering wheel. She was driving a 1 liter engine car at a speed of 40 mph and braked suddenly to avoid colliding with a van. She was not taking any anticoagulation or antiplatelet drugs and her clotting profile was normal. Ultrasonography of the left breast showed a hematoma measuring 7×5×3 cm. Injuries caused by spontaneous deployment of airbags are well documented. Severe injuries sustained in relatively minor incidents raise the question of how much protection is actually offered by airbags. Their design needs to be refined Kavitha R Menon, senior house officer, general surgery, Ahmed Al-Mukhtar, specialist registrar, general surgery, M I Aldoori, senior clinical lecturer and consultant vascular surgeon, Huddersfield Royal Infirmary, Huddersfield HD3 3EA, UK

It has been said that a good physician appreciates the difference between postponing death and prolonging the act of dying. An American study that questioned whether specialists differ on do not resuscitate decisions found that specialists in chest and critical care medicine recommended do not resuscitate orders more strongly than cardiologists, general physicians, and housestaff. Among the housestaff, the strength of the order increased with clinical experience (Chest 2002;121:957-963)[Abstract/Free Full Text].

Diltiazem hydrochloride (DTZ) 2% ointment performs as well as glyceryl trinitrate 0.2% ointment for treating chronic anal fissuresand causes far fewer headaches (British Journal of Surgery 2002;89:413-417). But there's a downside to using drugs rather than surgery. As resting anal pressures are likely to revert to pretreatment levels when treatment is stopped, early recurrences of fissures can be expected.

Six obese patients with type 2 diabetes were put on a very low calorie diet and taken off their hypoglycemic agents. After just two days, those whose fasting blood glucose concentrations barely went up after an intravenous glucose challenge could be distinguished from those whose levels deteriorated. The responders continued to do well at 10 and 30 days, and both groups lost weight (abstracts of the 14th "Internistendagen" in Netherlands Journal of Medicine 2002;60:50-51).

A systematic review of 38 trials found that home based and group based interventions to increase physical activity among older adults achieved participation rates of 84-90% (American Journal of Preventive Medicine 2002;22:120-133). Meanwhile, a paper in JAMA (2002;287:742-748)[Abstract/Free Full Text] describes how models of data from 801 subjects show an inverse association between mentally stimulating activities and the development of Alzheimer's disease, lending support to the adage that if you don't use it, you lose it.