BMJ  2005;330:680 (19 March), doi:10.1136/bmj.330.7492.680

Minerva

Chronic illnesses are prolonged, rarely cured, and don't resolve spontaneously, according to a new medical journal called Chronic Illness. The editors say they chose the word "illness" because it conjures up not only the biomedical manifestations of medical conditions, but also the psychosocial context and the experiences of those who live with these conditions. The journal doesn't yet take a stand on the politics of chronic illness, but it recognises that this is not a politically neutral subject ( Chronic Illness 2005;1: 1-6).

Women who undergo repeated abortions in Canada share a number of characteristics, apart from failure of contraception, or not using it. In a study reported in CMAJ ( 2005;172: 637-41)[Abstract/Free Full Text] a history of physical, sexual, or violence abuse is relatively common, as is a history of sexually transmitted disease, making the times when women present with an unwanted pregnancy a good opportunity to screen for violence and sexual abuse.

Japanese scientists have identified a protein on the surface of sperm that's critical for causing the cell membranes of sperm and eggs to fuse. The team used a monoclonal antibody known to block fusion of mouse sperm and then found the protein that was bound to the antibody. The protein has been called Izumo, named after a shrine dedicated to marriage. Mice genetically engineered to lack Izumo proved to be sterile, making this an interesting target molecule for future forms of contraception or even new treatments for infertility ( Nature 2005;434: 234-8[CrossRef][Medline]).

Teenagers who dislike school are more predisposed to become teenage parents than those who are ambivalent about school. The data came from a longitudinal study of sex education at schools in central and southern England, where teenage girls were surveyed about their sex education and experience and whether they expected to become parents by the age of 20. The causal mechanism isn't obvious, however, and according to the authors is unlikely to involve expectations about parenting or a deficit in sex education ( Journal of Epidemiology and Community Health 2005;59: 223-30[Abstract/Free Full Text]).

The short term benefits and safety of sirolimus-eluting coronary stents are well known. But now data are available, collected over three years in a multi-centre trial of 238 patients randomised to receive either conventional stents or coated stents. Coated stents are associated with a sustained clinical benefit and low levels of major adverse cardiac events. The rate of adverse events at three years was 15.8% compared with 33.1% in patients assigned to conventional stents ( Circulation 2005;111: 1040-4[Abstract/Free Full Text]).

Another—but arguably higher risk—stenting strategy is more prone to problems. A study in the Journal of Thoracic and Cardiovascular Surgery ( 2005:129: 645-51)[Abstract/Free Full Text] analysed four year follow-up data from patients with acute thoracic aortic rupture. Endovascular stent grafting was used in 32 patients and compared with conventional surgical treatment with cardiopulmonary bypass in 28 patients. Despite encouraging early outcomes, the stented group needed more intervention and experienced higher complication rates in the mid-term.

Computer software designed to detect plagiarism found a high prevalence of plagiarism among medical students in Croatia. Just 9% of almost 200 students did not plagiarise at all. A strict warning not to copy text didn't seem to influence the students much: the rates of plagiarism were no different in those who were warned and those who were not. The only difference the warning made was to make the students produce longer essays ( Croatian Medical Journal 2005;46: 126-31[ISI][Medline]).

Minerva's often heard that there are certain personality types which predispose people to developing cancer. Applying complex statistics to long term data from almost 30 000 Swedish twins for six aetiologically different groups of cancers, a study in Cancer ( 2005;103: 1082-91)[CrossRef][ISI][Medline] found no support for the hypothesis that neuroticism, extraversion, or these two personality traits together are associated with cancer risk.

Termination of pregnancy or miscarriages that involve dilatation and curettage sometimes inadvertently remove myometrial tissue as well as removing the products of conception. To determine whether removing myometrium during these procedures predisposes to placenta accreta in any subsequent pregnancies, pathologists examined archival tissues. Myometrial tissue was found in 44% of cases of termination and 35% of cases of miscarriage, but the relation between this and developing placenta accreta remains unclear. Retrospectively, however, women who require a manual placental evacuation are likely to have a history of termination or miscarriage ( Journal of Clinical Pathology 2005;58: 273-5[Abstract/Free Full Text]).

The same growth factor that promotes healthy healing may also be responsible and necessary for sunburn and wrinkles. Animals experimentally enhanced with additional vascular endothelial growth factor (VEGF) and then exposed to ultraviolet B light developed a sunburn-like response and premature ageing of the skin, under conditions where the control animals didn't. Blocking the growth factor prevented the photosensitivity developing, but didn't stop healthy healing after exposure to ultraviolet B light ( Blood 2005;105: 2392-9[Abstract/Free Full Text]).

A 58 year old man presented in the summer with fragility and blistering of the skin on the dorsum of his hands. He had taken naproxen for four years for osteoporosis. Results of a blood, urine, and stool porphyrin screen and serum ferritin and liver function tests were within normal limits. When he stopped taking naproxen, the eruption cleared up. Naproxen may produce pseudoporphyria, which produces blistering on areas exposed to light, mimicking porphyria cutanea tarda. Other non-steroidal anti-inflammatory drugs, COX 2 inhibitors, diuretics, amioderone, and nalidixic acid have also been implicated. Heavy exposure to ultraviolet A light can induce a similar picture—"sunbed pseudoporphyria." Abdul Hafejee (abdulhafejee{at}hotmail.com), specialist registrar, Ian Coulson, consultant, department of dermatology, Burnley General Hospital, Burnley BB10 2PQ

Tempting as it is to blame cigarette smoking for just about everything unhealthy, a short report in the American Journal of Psychiatry ( 2005;162: 619-20)[Abstract/Free Full Text] suggests that smoking among teenagers isn't directly causally associated with an increased risk of later suicidal ideation, once high levels of stress and depression and poor parental attachment in adolescence have been taken into account. Previous studies had reported a link between smoking and suicidal behaviour in psychiatric patients and US army personnel.

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