BMJ  2005;330:154 (15 January), doi:10.1136/bmj.330.7483.154

Minerva

To most people's astonishment, the belief (derived from observational studies) that hormone replacement therapy (HRT) offered cardiovascular protection was neatly overturned by the results of randomised clinical trials. Discussing this divergence in Hypertension ( 2004;44: 789-5)[Abstract/Free Full Text], the authors say we shouldn't be walking away from HRT research, as there's still much to be learnt about its effect on the cardiovascular system. For example, are the effects of oestrogen a class effect shared by all oestrogen receptor agonists? What are the effects of oestradiol metabolites on the cardiovascular system? And do progestins affect the metabolism of oestradiol?

Helicobacter pylori is apparently the commonest chronic bacterial infection in humans. In Glasgow, a trawl through the notes of all children who underwent breath testing for H pylori in the children's hospital from 1995 to 2002 identified a highly significant positive association between H pylori colonisation and poverty. Colonisation was most prevalent in the most deprived areas ( Scottish Medical Journal 2004;49: 136-8[Medline]).

Half a million organ donor registration leaflets were recently mailed out to more than 10 000 general practices. Research carried out by UK Transplant found that although 90% of the public say they support organ donation, only 19% have actually registered their wish to help others after their death. For leaflets call the donor line, 0845 606 0400 ( GP Bulletin Jan 2005: 4).

Over 23% of America's physicians received their medical training outside the United States, with most (64%) coming from low or lower middle income countries. This group includes more than 5000 doctors from sub-Saharan Africa, which represents 6% of all doctors practising in sub-Saharan Africa now. Almost 86% of these Africans practising medicine in the United States come from Nigeria, South Africa, and Ghana, and the vast majority were trained at 10 medical schools (www.human-resources-health.com/content/2/1/17).

A controlled laboratory study has shown that an antifibrotic agent called suramin may improve muscle recovery after a strain injury. The drug decreased the stimulating effect of transforming growth factor-1 on the growth of muscle derived fibroblasts, leading to significantly less fibrous scar tissue formation in vitro. It also enhanced muscle strength in skeletal muscle injured by strain ( American Journal of Sports Medicine 2005;33: 43-51[Abstract/Free Full Text]).

A large Finnish study of work stress and smoking suggests a positive link between the two. A survey of more than 46 000 workers found that those with lower rewards and those who worked very hard for insufficient reward were more likely to be smokers. Those who smoked most intensely had higher job strain and a bigger imbalance between stress and reward. The authors say that the work environment should be taken into account when creating smoking cessation programmes ( Journal of Epidemiology and Community Health 2005;59: 63-9[Abstract/Free Full Text]).

A BMJ reader was recently involved in trying to find the cure for a patient with intractable hiccups. His hospital's ear, nose, and throat (ENT) department was sadly lacking in knowledge, but a quick Medline and internet search revealed numerous treatments, including conventional drugs such as chlorpromazine, phenytoin, and atropine, but also granulated sugar, phrenic nerve crush, hypnosis, and folk remedies such as sneezing induced by black pepper and the induction of sudden fright. In the end what worked was vinegar, supplied by the hospital canteen. The mechanism remains unclear.

Acute poisoning by non-steroidal antiinflammatory drugs (NSAIDs) is the third commonest cause of deliberate overdose in some parts of the United Kingdom. The gastrointestinal side effects tend to be mild and self limiting, although in a 17 year old who had taken 14 g of ibuprofen the result was acute duodenal perforation. The risk, of course, is that the overdose of a NSAID could mask the early signs of peritonitis, making it important that anyone presenting with overdose and abdominal pain should be closely observed until the pain has resolved ( Clinical Toxicology 2004;42: 983-5).

A 50 year old man had sudden blurring of vision in his left eye. Examination showed left optic disc swelling, peripapillary retinal oedema, splinter haemorrhage, and diffuse cotton wool spots. Mild atherosclerotic changes of the retinal arterioles were seen in the right fundus, which was otherwise unremarkable. His blood pressure was 200/105 mm Hg. It is rare for malignant hypertension to cause asymmetric hypertensive retinopathy. Several putative protective mechanisms in the less involved eye of this patient may account for this unusual presentation. Right retinal artery atherosclerosis may be involved in the pathogenesis of these asymmetric manifestations, making the atherosclerotic blood vessel walls rigid and less compliant to a sudden surge in blood pressure. Wai-Man Chan (Cwm6373{at}netvigator.com), consultant physician, Vesta C K Chan, registrar, David T L Liu, specialist registrar, Dennis S C Lam, consultant surgeon, department of ophthalmology and visual sciences, Kin-Hung Liu, ultrasonographer, Yue-Leung Chan, radiologist, department of diagnostic radiology, Prince of Wales Hospital, Hong Kong, China

Minerva was bemused when she read that pregnancy increases the body mass index (BMI) in adolescents ( Journal of Nutrition 2005;135: 74-80[Abstract/Free Full Text]). Isn't that obvious? But a birth cohort study from Brazil indicates a clear link between pregnancy and permanent increase in BMI after pregnancy. The BMI of women who had had a single pregnancy in the teenage years was 0.81 more than those who did not become pregnant as teenagers, and it was 1.58 more in those who had had two or more teenage pregnancies.

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Rapid Responses:

Read all Rapid Responses

Hiccups and ENT?

Timothy J Hoare
bmj.com, 17 Jan 2005 [Full text]

Re: Hiccups

Oliie Parker
bmj.com, 19 Jan 2005 [Full text]

Unilateral hypertensive retinopathy

Abhijit Chaudhuri, et al.
bmj.com, 24 Jan 2005 [Full text]