Minerva

From BMJ USA 2003;September:518

"Do it yourself" screening tools for dementia have found a ready market in the United States. But the early alert Alzheimer's home screening test raises profound legal and ethical issues — not least the effect the test might have on a consumer public that, because of heightened apprehension about what happens to people with dementia, could be described as a group that is already "vulnerable, bordering on desperate" ( Gerontologist 2003;43:292-294[Free Full Text]).

Everyone experiences and describes pain differently. Using functional magnetic resonance imaging and an established scoring system for rating the intensity of a painful heat stimulus, researchers have confirmed that there's a neural basis for these differences. The levels of brain activity in patients who reported similar pain scores were similar — and the higher the subjective scores, the more neural activity detected in the cerebral cortex (Proceedings of the National Academy of Sciences 2003, www.pnas.org/cgi/doi/10.1073/pnas.1430684100).

View larger version (168K): [in this window] [in a new window]   A 41 year old man with multiple tattoos on his arm presented to the dermatology department with an itchy eczematous rash in all the red areas of the tattoos. He had had tattoos for 15 years but had had some of the red areas refilled a year earlier. The rash appeared after the refilling, and it affected red areas that had not been touched up with red dye. This second exposure to red dye triggered an allergic contact dermatitis. Allergy to tattoo pigment is rare, but reaction to cinnabar (mercuric sulfide), the red pigment, is the most common. Sarita Jain, staff grade, Catherine Stephens, consultant, department of dermatology, Poole Hospital NHS Trust, Poole BH15 2JB, UK

An attempt to measure the level of distress in people referred to infertility clinics found that the prevalence of emotional disorder was actually quite low. About a quarter of the women and 10% of the men who responded to the questionnaire had high anxiety scores, and depression was less evident. The results didn't change much over time. Women reported more concerns about life satisfaction, sexuality, and avoidance of friends than did men ( Journal of Psychosomatic Research 2003;54:353-355[CrossRef][ISI][Medline]).

The consumption of junk food arguably places a greater burden on health care systems than healthy food. A spokesman for the Centre for Science in the Public Interest (Canada) says that Canadians should be ready to pay additional taxes on these items, as they already do on tobacco and alcohol, "to pay for the increased financial toll." The association wants such "sin taxes" to apply at both restaurants and grocery shops ( Canadian Medical Association Journal 2003;168:1697[Free Full Text]).

Patients love doing things naturally, so here's a pilot study they might benefit from. On the basis that tea may have an impact on plasma glucose levels, researchers enrolled 20 people with drug controlled type 2 diabetes into a randomized crossover study of drinking oolong tea. Oolong tea lowered glucose and fructosamine concentrations relative to initial concentrations significantly more than did water. The authors hasten to point out that oolong tea may be a useful adjunct to treatment, not a replacement ( Diabetes Care 2003;26:1714-1718[Abstract/Free Full Text]).

Late effects of whiplash injuries include chronic physical and psychiatric symptoms, which seem to be more common in older people and people with a history of musculoskeletal complaints ( Injury 2003;34:434-437[ISI][Medline]). But interestingly, the authors of a small study of 33 people with whiplash injuries didn't find evidence that a psychiatric history before the injury is a determining factor for psychiatric dysfunction after the injury.

Stubbornly recurrent urinary tract infections may occur because bacteria multiply inside the cells that line the bladder wall, forming "pods." Studies in mice show that bacteria like E coli cluster together in a matrix called a biofilm, with pod-like bulges sticking out on the internal bladder surface. The pods are protected from the usual host immune response until they break open, releasing the bacteria and triggering another round of inflammation and symptoms ( Science 2003;301:105-107[Abstract/Free Full Text]).

An irritable bladder is arguably more frustrating than recurrent urine infections. In the United States, 71 study centers took part in the OPERA (overactive bladder: performance of extended release agents) trial, which looked at the efficacy of long acting oxybutynin and tolterodine in women. The drugs were equally good at reducing urge incontinence and were tolerated well, although oxybutynin was significantly better at reducing the number of times women had to pass urine ( Mayo Clinic Proceedings 2003;78:687-695[ISI][Medline]).

"Nocturnal dips" are a sure sign that someone's asthma isn't as well controlled as it could be. A pilot study of people with asthma who hadn't previously used inhaled steroids found that a single dose of inhaled steroid at 4 o'clock in the afternoon prevented a significant drop in lung function 12 hours later ( Thorax 2003;58:632-633[Abstract/Free Full Text]).

A striking article in the Australia and New Zealand Journal of Surgery (2003;73:177-182) warns that the cult and privileged status enjoyed by evidence based medicine has prevented its critics from being heard, and without criticism the movement may wither and die. Among other things, the author discusses the problems of unwitting paternalism, reductionism, the instability of "truth," and the "one size fits all" theory. Patients probably appreciate these concepts even more than doctors.

As most people have a dominant left hemisphere, the findings of a study in Hypertension (2003;42:56-60[Abstract/Free Full Text]) could have major implications. A Dutch team has discovered that there's a predilection for cerebrovascular disease to occur on the left side rather than the right, and that this may be related to greater hemodynamic stress and intimal damage in the left carotid artery. Their stroke registry of almost 2000 patients found a significantly higher incidence of left sided strokes than right.

A prospective randomized trial comparing skin adhesive and subcuticular suturing for closing laparoscopic ports found that the use of adhesive came out on top. Stitching took longer, and the adhesive gave as good a result as stitching and was equally acceptable to patients ( Journal of the American College of Surgeons 2003;196:845-853[CrossRef][ISI][Medline]).

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