BMJ  2004;328:1268 (22 May), doi:10.1136/bmj.328.7450.1268

Minerva

Leonardo da Vinci and Lewis Carroll could both "mirror write," writing from right to left, reversing each letter so that the script looks normal when held up to a mirror. One theory is that mirror writing is a sex linked dominant hereditary trait, particularly among left handed people, with mirror writers benefiting from not one but two language centres, one on each side of the brain, connected via the corpus callosum ( Medical Hypotheses 2004;62: 733-9[CrossRef][ISI][Medline]).

Despite repeated beatings about the head, 82 amateur boxers participating in multiple bouts during a seven day tournament showed no evidence of cognitive dysfunction immediately afterwards. Their serial performance in tests of simple reaction times, choice reaction times, and working memory tests after three bouts was equal to that of boxers who had taken part in one and two bouts, and that of non-boxing control participants. Boxers whose bouts had been stopped by the referee proved the exception ( Neurology 2004;62: 1497-502[Abstract/Free Full Text]).

Smoking can cause chronic obstructive pulmonary disease, but only 15-20% of smokers get it. A study in Chest ( 2004;125: 1706-13)[Abstract/Free Full Text] shows that bronchial cells from smokers who have obstructive disease produce a greater inflammatory response to stimulation with an irritant (tumour necrosis factor alpha) than smokers without airflow limitation. This suggests that some smokers respond much less to irritants in cigarettes.

First time fathers are somewhat neglected when it comes to their needs being met immediately after the birth of the child. A qualitative analysis of interviews with 13 new fathers about critical incidents indicates that if midwives and nurses had a greater awareness of men's experiences during the immediate postpartum period in hospital, first time fathers would feel better about themselves, about their abilities, and about their infant ( Journal of Obstetric, Gynaecologic and Neonatal Nursing 2004;33: 328-39[CrossRef][ISI][Medline]).

Finnish doctors say that examining villous tips in the small intestine for lymphocyte infiltration is a good way to distinguish people who have early signs of coeliac disease from those without. Although villous atrophy is the well known endstage sign of coeliac disease, the villous tip lymphocyte count proved significantly higher in patients with early stage coeliac disease and normal villous architecture. The sensitivity of this method to detect untreated coeliac disease was 0.84, and the specificity was 0.88 ( Scandinavian Journal of Gastroenterology 2004;5; 428-33).

Groundwater contamination by arsenic has doubled the lifetime risk of death from liver, bladder, and lung cancers in Bangladesh. Millions of hand pumped wells installed since the 1970s were supposed to protect 95% of the population from pathogen-borne disease, but over the years almost half the population has been chronically exposed to arsenic ( American Journal of Public Health 2004;94: 741-4[Abstract/Free Full Text]).

Set against an improvement in the number of bath hoists, adapted taps, alarm call systems, shower seats, and wheelchair access to bathrooms in UK hospitals, there's still a disappointing occurrence of broken locks and signs, poor heating, a lack of privacy, wet floors, and inappropriate use of bathrooms as store rooms. It seems that new things can be provided, but maintenance lags far behind, and too many hospital bathrooms are austere, cold, and smelly ( Journal of the Royal Society of Medicine 2004;97: 235-7[Abstract/Free Full Text]).

COX-2 inhibitors come under the cardiovascular spotlight again in Circulation ( 2004;109: 2068-73)[Abstract/Free Full Text]. This time it's an analysis of the relative risk of acute myocardial infarction among COX-2 users. A matched case-control study of over 54 000 patients aged 65 and over found that using rofecoxib, rather than celecoxib or no non-steroidal anti-inflammatory, is associated with a higher relative risk of acute infarction during the first 90 days of use. High doses caused more problems.

A third of girls aged 10-14 in a Canadian study of eating attitudes were currently trying to lose weight, and more than 10% scored above the clinical threshold for disordered eating on the children's version of the eating attitudes test. The prevalence of dieting in adolescent girls has risen from 23% in 2001, arguably turning the problem into a public health disaster ( CMAJ 2004;170: 1559-61[Abstract/Free Full Text]).

Orthopaedic surgeons in Glasgow report the somewhat unorthodox use of femoral nails in managing established non-union of fractures of the humeral shaft. The problem is fortunately rare, and the surgeons put the success of using femoral nails down to their greater width—they can fit wide humeral canals better than humeral nails. Being able to use femoral nails for multiple interlocking also helps achieve good rotational stability ( Injury 2004;35: 523-7[CrossRef][ISI][Medline]).

A 50 year old man with type 2 diabetes mellitus started taking insulin after secondary sulphonylurea failure. When he was reviewed after six weeks his blood sugar was still uncontrolled. The insulin injection site on his abdomen showed bluish-red spots. Poor glycaemic control was attributed to faulty insulin injection technique, leading to the insulin being given intradermally. After he received appropriate training, his glycaemic control improved. Anil Bhansali, associate professor, Shriraam Mahadevan, senior resident, department of endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

This year, the eighth congress of the European Society of Contraception is being held in Edinburgh. It's a fitting place, given that Sir James Young Simpson introduced chloroform for obstetric anaesthesia and analgesia there in 1847. During his professional life the average family size in Scotland was 6.9, and more than 600 women died in childbirth each year. Contraception was considered "too impolite to speak about openly" ( Journal of Family Planning and Reproductive Health Care 2004;30: 79-81[CrossRef][ISI][Medline]).

The placebo response has been artfully demonstrated at the level of single cells in a study in Nature Neuroscience (advance online publication 16 May 2004, doi: 10.1038/nn1250). For several days, patients with Parkinson's disease were injected with drugs that temporarily relieve symptoms of muscle stiffness and tremors; they were then switched to a harmless salt solution, without being told of the change. Surgically implanted metal wires in the brain recorded the electrical activity from single brain cells in the subthalamic nucleus, a region active in Parkinson's. After the sham medication, in patients who showed a clinical response, these neurons became less active.

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