Minerva

Wernicke's encephalopathy is difficult to diagnose because the classic triad of confusion, ataxia, and ophthalmoplegia occurs in only 10% of patients, and inebriated people are often confused and ataxic. A report on managing Wernicke's encephalopathy in emergency departments says that homeless alcoholic patients are most at risk; it's these patients whose charts end up at the back of the queue. When they wake up, they often leave the hospital without a full assessment and without being given B vitamins. The report says that intravenous multivitamins should be considered early, even if patients are still drunk (Alcohol and Alcoholism 2002;37:513-521). [Abstract/Free Full Text]

Aloe vera is known for its effects on wound healing, particularly for thermal burns. A review in the European Journal of Herbal Medicine (2002;6:28-32) indicates that aloe vera applied topically is beneficial in treating skin damage induced by radiation, particularly if applied immediately after irradiation. But there's no evidence for its use when taken orally.

Condom use seems to be improving in many countries. But even if people are persuaded to use condoms, it's still a problem to get them used correctly (AIDS Care 2002;14:779-788) [CrossRef][Medline]. Of almost 800 young women at risk of sexually transmitted diseases surveyed in one American study, 44% reported delayed use (defined as condom use initiated after penetration had occured) in the previous three months, and 19% said they had experienced a slipped or broken condom.

The small print may be accurate, but headlines are sometimes completely off the wall. A fine example of this is highlighted in the Oncologist (2002;7:475-476) [Free Full Text]. A paper in the New England Journal of Medicine comparing "watchful waiting" for prostate cancer with radical prostatectomy grabbed the news last September. The New York Times proclaimed "Prostate cancer surgery found to cut death risk"; the Boston Globe trumpeted "Two studies find no advantage to prostate surgery." Neither report was correct.

Overweight people often diet by counting calories. But a study in the American Journal of Clinical Nutrition (2002;76:1207-1213) [Abstract/Free Full Text] shows that simply eating smaller portions of food results in less energy intake. The size of portions of macaroni and cheese at lunch significantly influenced energy intake regardless of sex and body mass index, with a 30% difference in energy consumption between those who ate the largest portion and those who ate the smallest.

Lung function declines over time in people with asthma. In a five year study, forced expiratory volume was measured every three months; lung function declined in a linear fashion over time. The rate of decline depended on the baseline FEV1, and in younger patients the rate of decline increased only when the baseline function was poor to start with (Chest 2002;122:1944-1948) [Abstract/Free Full Text].

Average American adolescents aged between 12 and 15 consume over 60 mg of caffeine a day, mostly in sodas, according to a study in Pediatrics (2003; 111:42-46) [Abstract/Free Full Text]. A fifth of them consume more than 100 mg a day. Not surprisingly, the caffeine interferes with their sleep patterns, making them sleepier during the day. Adolescents' caffeine consumption waxes and wanes during the week, peaking on Saturdays, when bedtimes are delayed until nearly midnight.

Young and groovy readers—or, at least, the young and groovy patients of older and crustier readers—should be aware of a new health hazard associated with hip-hugging jeans. Hip-huggers can trap the lateral femoral cutaneous nerve as it goes under the inguinal ligament, causing tingling or burning on the lateral aspect of the thigh. One Canadian doctor reports three cases in "mildly obese" young women (Canadian Medical Association Journal 2003;168:16) [Free Full Text]. The treatment? Wear dresses that are one size too big, not "low rise" trousers that are one size too small.

View larger version (120K): [in this window] [in a new window]   A 54 year old man noticed spontaneous lower limb bruising and had lost two teeth. For four years his diet had consisted of beans, bread, and egg whites, with the occasional apple in the summer. He developed perifollicular petechiae and his hair follicles had a "corkscrew" appearance. Hemoglobin was 5.84 g/dL (normochromic, normocytic). His vitamin C concentration was <2 µmmol/L (normal range > 32 µmmol/L), consistent with a clinical diagnosis of scurvy. He also had folate, B12, and protein deficiency. Scurvy is traditionally a disease of mariners, but food faddists are also at risk. Nicholas D Magee, registrar in general medicine, R P Convery, consultant in general medicine, Craigavon Area Hospital, Portadown, Craigavon BT63 5QQ, UK; Sharon Lovell, consultant in general medicine, Royal Victoria Hospital, Belfast BT12 6BA, UK

Just in case you haven't enough to do in the morning, researchers from Texas suggest weighing your children's backpacks and removing unnecessary items before sending them off to school (Archives of Disease in Childhood 2003;88:18-19). [Abstract/Free Full Text] Ninety six per cent of parents don't, putting their children at risk of musculoskeletal injury. You'll need to weigh the children too—they should be carrying less than 20% of their body weight.