BMJ  2004;328:776 (27 March), doi:10.1136/bmj.328.7442.776

Minerva

A randomised, double blind, placebo controlled clinical trial of the efficacy of treatment with zinc or vitamin A in infants and young children in India has found an interesting sex difference. Zinc significantly reduced the duration of fever and very ill status in boys with severe acute lower respiratory infection, but not in girls. Vitamin A offered no benefit, which was surprising because other studies have shown that vitamin A supplementation in children in developing countries substantially reduces all cause mortality ( American Journal of Clinical Nutrition 2004;79: 430-6[Abstract/Free Full Text]).

"Spaghetti syndrome" may become an entity of the past as wireless technology comes in from the cold. Gone will be the days of trailing lines, cables, and sensors around critical care beds. One serious concern is potential interference with medical devices, leading to compromised patient care, but this issue may have been overstated. Bluetooth, the short range radiofrequency link proposed as one of the remedies for spaghetti syndrome, has now been shown not to interfere with medical devices, and vice versa ( Anesthesia and Analgesia 2004;98: 566-7[Free Full Text]).

Most journals publish corrections. A study of published errata linked to randomised controlled trials, in Health Information and Libraries Journal ( 2004;21: 14-20)[Medline], found that, from the information specialist's perspective, 74% were worthwhile obtaining; they related mainly to tables and figures. From the perspective of the experienced reviewer or public health consultant, 5% of these errors were likely to affect a meta-analysis, and 10% would be likely to affect the interpretation of a randomised controlled trial, but not necessarily a meta-analysis.

Clubbed fingers and toes resemble the digits of human embryos, which look a bit like claws. Clubbing may be the return of the embryonic claw digit. One idea, proposed in Medical Hypotheses ( 2004;62: 321-4)[CrossRef][ISI][Medline], is that secondary clubbing (like gynaecomastia) is caused by a pathological condition which alters circulating hormone levels, which in turn activate "dormant" genes, leading to the development of an organ. The authors say that these hormones may be cytokines, which have not yet been identified, behaving as hormones.

The association between active and passive cigarette smoking and subarachnoid haemorrhage is strongly positive, especially in women. A population based case-control study concludes that the link is virtually eliminated within a few years of stopping smoking, even among heavy smokers ( Stroke 2004;35: 633-7[Abstract/Free Full Text]).

Here's another reason for continuing breast feeding as long as possible. Prospective data from a cohort study has found that breast feeding is associated with a lowering of later blood pressure in children born at term. If the association is causal, breast feeding may become part of the overall public health strategy to prevent hypertension ( Circulation 2004;109: 1259-66[CrossRef][ISI][Medline]).

Single case reports warn of the risk of suffering a stroke or heart attack with the use of triptans, which are commonly prescribed for migraine. But a further investigation, using data from a migraine cohort from the general practice research database, found no association between triptan prescription and stroke, myocardial infarction, arrhythmia, or death. However, the risk of stroke and ischaemic heart disease was higher among patients who had not been given a prescription for a triptan ( Neurology 2004;62: 563-8[Abstract/Free Full Text]).

Because it is non-invasive and doesn't involve radiation, ultrasound scanning is being used increasingly to investigate acute non-traumatic abdominal pain. But the yield of "positive" reports—other than in suspected biliary colic and abdominal masses—is low, according to a prospective study in the Postgraduate Medical Journal ( 2004;80: 177-9)[Abstract/Free Full Text]. It improves, however, where there is localised abdominal pain, tenderness, a raised white cell count, or raised results on liver function tests.

Minerva's friends have often observed that she cannot walk and talk at the same time, and she has been known to grind to a halt mid-conversation. A study in Science (www.sciencexpress.org, 18 March 2004, doi:10.1126/science.1095455) investigates what happens when the human brain simultaneously tackles the questions "What does it mean?" and "Is it true?" Both statements are apparently processed in parallel, in the left inferior prefrontal cortex, and the brain keeps a record of what makes a sentence hard to interpret—its meaning, or its validity.

Italian scientists have discovered the presence of an oxytocin receptor gene and protein expression on the human corpus cavernosum, and that oxytocin induced contractility in the corpus cavernosum is regulated by the changing sex steroid milieu. In a rabbit model of hypogonadotropic hypogonadism, oxytocin responsiveness was strongly reduced, and was completely restored by estradiol valerate, but not by testosterone. The team concludes that oxytocin might be involved in a new role for oestrogens in men: post-orgasmic penile detumescence ( Endocrinology 2004;145: 1823-34[Abstract/Free Full Text]).

A 65 year old man with persistent diarrhoea and right iliac fossa pain who underwent capsule endoscopy reported abdominal discomfort and nausea 24 hours after ingesting the capsule. Abdominal radiographs showed that the small bowel was obstructed and that the capsule was impacted in the terminal ileum. The capsule was retrieved in the stools 72 hours after sulphasalazine, prednisolone, and ciprofloxacin were given. When requesting this new investigation, it is worthwhile remembering that the capsule can impact at areas of stenosis in the small bowel, especially in patients with extensive Crohn's disease. George Grammatopoulos, medical student Guy's, King's and St Thomas' School of Medicine, London SE1 9RT, George Katsoras, special registrar Metropolitan Hospital, Neo Faliro, 14561 Athens, Greece

An example of transatlantic cultural differences appears in a privately printed memoir written by an 85 year old American doctor (Milepost 85 by E Grey Dimond; Decorah, Iowa: Anundsen Publishing, 2003). In it he refers to the BMJ's willingness to be quite ribald and to take on issues of sexuality and death. He says if the board of the American Medical Association had to respond, in its own journal, to some of what has appeared in the BMJ it would have fired not only the editor but also the janitor, the doorman, and the postman.