BMJ  2005;330:E348 (16 April), doi:10.1136/bmj.330.7496.E348

BMJ USA: Minerva

Minerva

Catching and treating congenital hypothyroidism early is thought to produce a favorable outcome, but a study in Pediatrics ( 2005;115: e52-7[Abstract/Free Full Text]) shows that even when there are similarities in genes and environment, children treated for congenital hypothyroidism don't do as well as their siblings. In long term follow up, affected and non-affected children were tested at the same time and given the same tests. In the past, critics have pointed to disparities in testing as being the cause of any differences found.

Survival in patients with Parkinson's disease is less than in the general population. A 13 year follow up of 800 patients with Parkinson's disease enrolled in a drug trial found that neither sex nor age influenced overall survival. A poorer response to levodopa was a significant predictor of shorter survival regardless of the severity of the disease at the time of starting treatment, and regardless of the dose used ( Neurology 2005;64: 87-93[Abstract/Free Full Text]).

For just 60 US cents a month for every person living in a developed country, world hunger could be cut in half by 2015. The United Nations' Hunger Task Force calculates this to be the cost to achieve the millennium development goal for hunger agreed by all member nations in 2002, and has identified 313 "hunger hotspots" around the world. Naturally enough, political commitment, hand in hand with policy reform, is required, alongside the money ( Science 2005;307: 357-9[Abstract/Free Full Text]).

A study of Turkish girls aged 13 to 17 reports that those who wear concealing clothes for religious reasons had significantly lower levels of vitamin D than other girls, and that half of this group were actually deficient in vitamin D. The bone density measurements, however, were not significantly different, despite this age being critical for the laying down of bone mass. It remains to be seen whether health problems emerge later on. The authors say that vitamin D supplements may be useful for any religious groups that wear concealing clothes ( Journal of Nutrition 2005;135: 218-22[Abstract/Free Full Text]).

From the restoration of sexual function to the possibility of mending a broken heart: a potential new use for Viagra (sildenafil) is described in Nature Medicine (online publication January 23; doi:10/nm1175). Mouse models have been used to demonstrate that the heart failure caused by hypertrophy of cardiac muscle induced by sustained pressure overload can be reversed by sildenafil, returning the function of the heart's chambers to normal.

A 53 year old man presented with an ulcer on the sole of his left foot, attributed to a possible penetrating injury three months previously. Macular irregular pigmentation 4 cm in diameter surrounded the area. Biopsy of the ulcer showed acral lentiginous melanoma, with melanoma in situ in the adjacent area. This tumor is diagnosed most frequently in the seventh decade and is an unusual variety of melanoma in white people, but the most common form of melanoma in other races. B P Amirtha Vani specialist registrar Amirtha_vani{at}yahoo.co.uk Frances Humphreys consultant department of dermatology Warwick Hospital, Warwick CV34 5BW, UK

Years of intense training involving the performance of repetitive complex movements make musicians prone to dystonia, a condition of sustained involuntary muscle contractions causing abnormal movements. Robert Schumann, the 19th century pianist, suffered from it. Leon Fleisher, a modern day performer, was restricted to playing pieces for left hand only for 30 years. He says he owes his eventual return to two handed playing in 1995 to botulinum toxin injections, but in line with others who've had the treatment, he still has weakness in the treated fingers ( Neurology 2005;64: 186-7[Free Full Text]).

An apple a day keeps the doctor away, and more specifically the gastroenterologist. Apple polyphenol extracts prevented both oxidative damage and indomethacin induced damage to human gastric epithelial cells in the laboratory and also in live rats. In addition to preventing oxidative injury, the extracts also brought about a fourfold increase in intracellular antioxidant activity ( Gut 2005;54: 193-200[Abstract/Free Full Text]).

Six months after coronary artery bypass grafting, the single most useful predictor of health status is not age, history of a previous heart attack or heart failure, diabetes, or left ventricular function. It's a depression score: higher levels of depressive symptoms at the time of the operation are a strong risk factor for poor functioning six months later ( Circulation 2005;111: 271-7[Abstract/Free Full Text]).

Given the caution exercised when prescribing methotrexate to patients, with frequent blood monitoring and in some cases supervision in hospital, Minerva was interested to read that a longitudinal study of 248 patients with rheumatoid arthritis treated with methotrexate over seven years found that the drug was rarely discontinued, and not often because of blood test abnormalities ( Annals of the Rheumatic Diseases 2005;64: 207-11[Abstract/Free Full Text]). In this study the probability of continuing to take methotrexate over five years was 79%; 10% of all patients stopped it permanently because of adverse effects, and a third of those who stopped did so because the drug didn't offer any benefit.

A randomized controlled trial in a US emergency department comparing oral rehydration therapy with intravenous fluids in children with mild to moderate dehydration caused by gastroenteritis shows that oral rehydration therapy is no worse than fluids by the intravenous route at correcting the problem. Hospital admission was more likely to be avoided in children who were given oral rehydration, and it was started more quickly than intravenous fluids ( Pediatrics 2005;115: 295-301[Abstract/Free Full Text]).