BMJ  2005;330:52 (1 January), doi:10.1136/bmj.330.7481.52

Minerva

"Women, Girls and HIV/AIDS," the fourth issue of Health Alert—Asia Pacific, published by the Health Action Information Network (www.hain.org/Ha/hanewsletter.htm), examines the factors that make women vulnerable to HIV. This issue looks particularly at the gender and human rights dimensions of HIV and AIDS, and it discusses programmes that create environments that would empower women and uphold their health and dignity.

Shakespeare, the Bible, and Gray's Anatomy are the only three written works needed on a doctor's shelf, according to American novelist and Nobel Prize winner Sinclair Lewis. Gray's Anatomy, first published in 1858, has undergone major surgery in its recently launched 39th edition, and has been fully restructured by body region rather than by organ system. The number of illustrations has risen to nearly 2000. But thanks to the removal of unnecessary "Victorian purple prose," the number of pages has shrunk from 2100 to 1600 (www.graysanatomyonline.com).

Imagine being able to move a cursor across a computer screen, just by thinking about it. It's now possible. Scientists have invented a non-invasive brain-computer interface, a system that translates electrical signals in the brain into physical outputs. They have demonstrated that humans can control two dimensional movement with an interface that analyses electroencephalographic activity (brain waves) recorded from the scalp (www.pnas.org/cgi/doi/10.1073/pnas.0403504101). Potential uses include helping people paralysed by stroke or spinal cord injuries.

Non-steroidal anti-inflammatory drugs are often used to treat muscle injuries, but a study in the American Journal of Sports Medicine ( 2004;32: 1856-9)[Abstract/Free Full Text] indicates that they have similar effects to simple analgesics which don't offer anti-inflammatory properties. Lower cost, lower risk analgesics such as paracetamol (acetaminophen) may be just as effective.

"The experiential side of medicine... is nowhere more ironically suppressed than in the patient record," say the authors of an editorial in Medical Humanities ( 2004;30: 57-8)[Free Full Text]. We're good at recording the data, and the measurable variables, but not the firsthand expression of the "inner" course of the illness. Capturing this might depend on the patient or their representative making their own contribution to the notes. A practical nightmare perhaps, but a suggestion, the authors say, that should be confronted, not dismissed out of hand.

A paper with a corny title, "Fifty ways to leave your rubber," explores the many excuses men who have sex with sex workers in Kenya offer to rationalise unsafe sex. Observations made in bars, discos, and guesthouses in Mombasa fell into six categories: condoms are not pleasurable, they're defective, they're harmful, they're unnecessary, they're too hard to use, and external forces prohibit their use. Some of these barriers could be overcome with improved knowledge and the introduction of devices controlled by women. But focusing just on disease control is unlikely to have a positive impact in a world where the first aim is pleasure ( Sexually Transmitted Infections 2004;80: 430-4[Abstract/Free Full Text]).

Brucellosis is a true zoonosis—in nearly all cases the infection is transmitted directly from animals to humans. An unmatched case-control study of brucellosis in the West Bank identified that most of the risk factors for brucellosis transmission are modifiable. Consumption of unpasteurised milk and other dairy products, contaminated raw meat, and direct contact with infected animals including lambing, milking, herding, and slaughtering are all potentially avoidable ( Saudi Medical Journal 2004;25: 1640-3[Medline]).

In children with cerebral palsy, drooling a lot has more to with their swallowing difficulties, than producing too much saliva. An analysis of 14 children with cerebral palsy found that the severity of drooling is positively correlated with the severity of dysarthria and is associated with poor oral coordination, incompetent lips, poor oral sensation, and dysphagia. Treatments that aim to increase the frequency and efficiency of swallowing, in addition to efforts to improve head and neck control, are likely to help the problem, however severe the condition ( Developmental Medicine and Child Neurology 2004;46: 801-6[CrossRef][ISI][Medline]).

Intravenous lidocaine is effective at suppressing the cough reflex of tracheal intubation, intubation, extubation, bronchography, bronchoscopy, and laryngoscopy. A double blind randomised placebo controlled trial has found that when lidocaine is given one minute before fentanyl, it also suppresses the cough induced by fentanyl, which is often given just before induction of general anaesthesia. However, it doesn't affect the severity of cough ( Anesthesia and Analgesia 2004;99: 1696-8[Abstract/Free Full Text]).

A 78 year old woman who had a right total knee arthroplasty in 1995 was referred with a three month history of a sharp sudden lateral right knee pain. She had a palpable lump over the fibular head. An x ray showed an aggressive expanding lesion of the proximal fibula. An ultrasound guided biopsy was performed and the histology showed no neoplastic features, but a granulomatous pseudo-tumour occurring in response to extensive wear particles generated by the total knee arthroplasty. The pathological process involves osteolysis secondary to wear debris, and usually takes place within the effective joint space. There is evidence of lysis in this case at both femoral epicondyles. The joint should be explored, the debris removed, and the polyethylene exchanged. This condition may be confused with primary bone malignancy. Sherif Mouneir Isaac (sherifisaac{at}aol.com), registrar in orthopaedics, A L Ruiz, consultant orthopaedic surgeon, Stoke Mandeville Hospital, Aylesbury HP21 8AL; N Athanasou, consultant in pathology, M Gibbons, consultant orthopaedic surgeon, P W Cooper, medical photographer Nuffield Orthopaedic Centre, Oxford OX3 7LD

The season of excess and goodwill has been and gone. The pre-holiday mania is followed by post-holiday depression, financial and emotional. But there may be a way to mitigate the latter, says the Canadian Medical Association's journal ( CMAJ 2004;12: 171[Free Full Text]). Buying your relative a goat for a half starved family in a poor country, rather than yet another silk tie, may have helped to restore the balance. If we don't, the holiday season will soon become a classifiable disease and we'll be taking tranquillisers to help us through.

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