BMJ 2003;326:1154 (24 May), doi:10.1136/bmj.326.7399.1154
Minerva
Culinary and medicinal herbs provide important sources of dietary
antioxidants. But according to a study in the
Journal of Nutrition
(2003;133:
1286)
|
|
The facial and dental consequences of prolonged finger sucking are well
known, but deformity of the sucked finger is much less common. A 15 year old
girl had sucked her right index finger every night since birth. This had
resulted in a 90° anticlockwise rotational deformity. As an infant she had
been nursed on her front and this may have been why her finger, rather than
her thumb, had been sucked. The deformity was corrected with an osteotomy and
K wiring. Mark Howard Wilson, clinical fellow, Helena Van Dam, clinical fellow, Charles Nduka, specialist registrar, Mohammed Shibu, consultant, department of plastic surgery, Royal London Hospital, London E1 1BB
|
Obesity and diabetes may all be in the head. Homing in on the part of the brain that affects food intake, Italian scientists discovered that hypothalamic neurons respond to increased concentrations of long chain fatty acids by decreasing glucose production in the liver. When the researchers blocked a critical enzyme in hypothalamic cells, food intake and glucose production decreased dramatically. They say that drugs that target such brain circuits could be useful in combating both obesity and type 2 diabetes ( Nature Medicine 2003;advance online publication DOI:10.1038/nm873).
Unexplained crying distresses parents of infants. One hypothesis is that these babies display high "responsivity." Researchers observed the responses of 93 babies aged 8 days to two mildly challenging procedures: the Guthrie heel prick test and a neurobehavioural test involving undressing, putting down, and handling the baby. Those who cried most, rather than fussed, during the neurobehavioural test were likely to be the babies who cried a lot at home and were "colicky," confirming that responsivity characteristics are at least partly responsible ( Developmental Medicine and Child Neurology2003;45: 400-7[CrossRef][ISI][Medline]).
Minerva found at least one solution for what to do with crying newborns in the latest issue of New Generation, the magazine of the National Childbirth Trust (May 2003: 16-7). It's swaddling. Apparently the act of binding the baby tightly to itself in strips of fabric is reassuring for babies, although the evidence for this seems to lie more in presumption than science. The author says that more gentle baby wrapping may achieve the same end without delaying the infant's development.
Investigations into a large outbreak of cholera in Nigeria revealed that the 102 cases examined were more likely than the controls to have drunk water bought on the street. They were also less likely to have drunk tap water in their homes or to have washed their hands with soap before eating food ( Journal of Water and Health 2003;1: 45-52[Medline]).
A randomised trial of aggressive versus expectant management protocols for women in active labour shows that the more aggressive approach succeeded in reducing the caesarean section rate in nulliparous women (16% v 23%). The aggressive protocol used more oxytocin and required more intensive nursing, but there was no difference in the use of analgesia, episiotomy, or neonatal Apgar scores in the two groups ( British Journal of Obstetrics and Gynaecology 2003;110: 457-61).
The important economic consequences of irritable bowel syndrome for employers in the United States are spelt out in Archives of Internal Medicine (2003;163: 929-35)
Episodes of psychosis recurring each autumn sounds like an extreme version of seasonal affective disorder. A case report in the Postgraduate Medical Journal (2003;79: 239-40)
Cigarette smoke is a short term respiratory irritant that should be avoided altogether by people with asthma. A prospective cohort study of 64 emergency departments in North America identified that 35% of adults with asthma seen were current smokers. Half of these admitted that smoking makes their asthma worse, but only 4% stated that smoking was responsible for their current exacerbation. As emergency departments see their fair share of people with uncontrolled asthma, this is probably a good place to target smoking cessation efforts ( Chest 2003;123: 1472-9
Cognitive decline with age is not inevitable, nor does it necessarily lead to dementia. A prospective analysis of 95 people over the age of 72 found that 49% remained cognitively intact and the rest developed a cognitive decline. The average time to reaching the study's criterion for cognitive decline was almost four years. Those who declined were more likely to have the APOE 4 genotype ( Neurology 2003;60: 1489-94
Minerva knows it's far easier to pop a pill than to change a behaviour, so she was interested to read in Dispensing Doctor (2003;19: 26-8) that antiobesity pills are causing great consternation. Obesity is without doubt a area of huge health concern, and treating it with pills is of particular interest to those who hold the prescribing purse strings. In the absence of a treatable cause of obesity, the author urges that expensive pills should never detract from a concerted effort at behavioural change.
Telling children that they have a chronic and life threatening disease isn't easy. A diagnosis of HIV carries particular difficulties. When a south London family clinic examined parents' concerns about disclosing the diagnosis, the main reasons for delaying disclosure to children who have been vertically infected was the fear that the child would accidentally reveal their diagnosis to others. This would also reveal their mother's diagnosis and expose the family to potential stigma, discrimination, and prejudice ( AIDS Care 2003;15: 169-76[Medline]).
Guidance at bmj.com/advice
Tools
Services
Rapid responses for this article
There are no rapid responses for this article.Most read last month
Student BMJ
Risk of surgery for inflammatory bowel disease: record linkage studies
What can you learn from this BMJ paper? Read Leanne Tite's Paper+
