BMJ  2005;330:854 (9 April), doi:10.1136/bmj.330.7495.854

Minerva

In 1991, the World Health Assembly set a target of eliminating leprosy as a public health problem by 2000. A review in the Bulletin of the World Health Organization ( 2005;83: 230-5)[ISI][Medline] assesses progress. Although the elimination programme has been successful in delivering highly effective antibiotic therapy worldwide, rates of detection of new cases in countries with the highest prevalence of endemic leprosy—Nepal, India, and Madagascar, for instance—have stayed much the same. Understanding how leprosy is transmitted remains a challenge.

Uterine leiomyomata, more usually known as fibroids, account for a large proportion of hysterectomies, but not much is known about what causes the tumours. The nurses' health study, a large prospective study of women's health in the United States that has been running since 1989, finds that risk rises with increasing diastolic blood pressure ( American Journal of Epidemiology 2005;161: 628-38[Abstract/Free Full Text]). There may be an analogy between the formation of atherosclerotic plaques and the pathogenesis of uterine leiomyomata since both involve abnormal behaviour of smooth muscle cells.

With spring in the air, people will be exploring the countryside, getting bitten by ticks and consulting their doctors with worries about Lyme disease. It may be hard to know what to tell them. A review in the Annals of the Rheumatic Diseases ( 2005;64: 519-523)[Abstract/Free Full Text] draws attention to our ignorance of the natural course of European borreliosis, the absence of placebo controlled trials of antibiotic treatment, and the disappointing response rate of late stage manifestations to antibiotic treatment.

Binge drinking is becoming a problem on American college campuses. In a nationwide survey, college students exceeded their non-college attending peers on almost all indicators of alcohol use, including weekly binge drinking ( Archives of General Psychiatry 2005;62: 321-7[Abstract/Free Full Text]). Although those in college were drinking more, they were not at greater risk of symptoms characteristic of alcohol dependence, such as increasing tolerance, withdrawal symptoms, or inability to cut down their drinking. Whether students continue to drink too much after they leave college is unknown.

Polymyalgia rheumatica is common in late middle aged and elderly people, so it is surprising to discover that the syndrome wasn't defined or named until 1957. The diagnosis remains a matter of clinical judgment, and, beyond the raised erythrocyte sedimentation rate and rapid response to steroid treatment, there is no confirmatory test. All the criteria based diagnostic definitions that have been proposed have a high sensitivity, according to a recent comparison ( Annals of the Rheumatic Diseases 2005;64: 626-9[Abstract/Free Full Text]). Unfortunately, lack of information on how specific they are means that we still can't usefully judge which set of criteria performs best in practice.

Pharmacologically, caffeine is a kissing cousin of theophylline, and in high doses it can produce sympathomimetic effects. However, according to a study from Denmark, where the consumption of coffee is high, drinking beverages containing caffeine carries no excess risk of atrial fibrillation or flutter. The Danish diet, cancer and health study recruited 50 000 middle-aged people and followed them for about six years ( American Journal of Clinical Nutrition 2005;81: 578-82[Abstract/Free Full Text]). During this time 555 people developed atrial fibrillation or flutter, but analysis of risk by fifths of the distribution of caffeine intake showed no hint of a trend.

Antibiotics affect immune function and inflammation and interfere with the metabolism of phytochemicals by intestinal microflora. These mechanisms might act in a way that influences cancer risk. Last year, concern increased when a case-control study from the US reported that use of antibiotics was associated with a higher risk of breast cancer. But a recent attempt to replicate the findings using the UK general practice research database failed to find an association between breast cancer and antibiotic use, either overall or in analyses by duration of treatment or indication for prescription. A small, statistically non-significant increase in risk occurred among users of antibiotics prescribed to treat skin disorders ( American Journal of Epidemiology 2005;161: 616-9[Abstract/Free Full Text]).

Plasma testosterone levels gradually decline over a man's lifetime, and whether this gives rise to symptoms or adverse health effects is disputed. A group of investigators adopted a pragmatic approach by carrying out a randomised controlled trial of testosterone supplementation in elderly men ( Age and Ageing 2005;34: 125-30[Abstract/Free Full Text]). Although bioavailable testosterone increased in the treatment group, the researchers found no statistically significant differences in total symptom scores on the ADAM (androgen deficiency in the ageing male) questionnaire when compared with placebo. Subgroup analysis, however, showed that those receiving the active supplement tended to be less sad and grumpy.

A 17 year old boy presented with a two week history of flu-like symptoms, swelling of the eyelids, and rash over his torso, legs, and arms. He had been on a school trip to Malawi six weeks earlier and had enjoyed swimming in an area of Lake Malawi thought to be free of schistosomiasis. His eosinophil count was 0.98 x 109/l, but schistosomal serology and stool and urine examinations for ova were negative. A clinical diagnosis of Katayama fever (acute schistosomiasis) was made. He was treated with praziquantel and prednisolone and made a complete recovery. Elinor Moore, specialist registrar, Stephen Wright, consultant, Tom Doherty (tom.doherty{at}uclh.org), consultant, Hospital for Tropical Diseases, London WC1E 6AU

Measurement of BNP—brain natriuretic peptide, which despite its name is synthesised in the heart—is proving useful in the diagnosis of heart failure in adults. It may also be useful at the other end of the life span. In 63 preterm infants, circulating BNP concentrations correlated closely with clinical and echocardiographic measurements of patent ductus arteriosus ( Pediatrics 2005;115: e255-61[Abstract/Free Full Text]). The authors say that measurement of BNP may aid decisions about when a patent ductus requires treatment.

Academics concerned with how members of the public think about science are bothered by the apparently irreconcilable conflict between two perceptions. On one hand, science is a demystifying influence since it seeks to explain how the universe works in terms of knowable forces—but on the other, science is magically transcendent in its ability to produce technological miracles. An article in Public Understanding of Science ( 2005;14: 25-46)[Abstract] argues that the way science is represented in superhero comics epitomises this conflict. The author says that, unlikely as it may seem, these comics are one of the cultural arenas where the public meaning of science is worked out.

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