BMJ  2005;331:58 (2 July), doi:10.1136/bmj.331.7507.58

Minerva

One of the editors of a new online journal Globalisation and Health (www.globalizationandhealth.com, with free access) says: "Modern public health has a love-hate relationship with macro-economics, global trading systems and a whole range of policy clusters that don't, on the surface, have much to do with human health. It's up to a new generation of thinkers and policy-shapers to recognise those connections. We need to figure out what helps and what hinders the way we deliver health services and feed those insights into the wider policy conversation."

Impaired sight or hearing in elderly people causes problems, but the impairment of both these senses is rather more serious. Analysis of data from the US based "longitudinal study on aging" shows that a fifth of adults aged 70 or older reported dual sensory impairment, and that high levels of dual impairment increased the difficulty of preparing meals, shopping, and using the telephone, all of which are critical in helping older people to improve or maintain their functional independence ( Gerontologist 2005;45: 337-46[Abstract/Free Full Text]).

Did you know that randomised controlled trials for the BMJ now need to be registered? If you are conducting a randomised controlled trial that begins enrolling patients after 1 July 2005 you must register it in a public trials registry at or before the start of enrolment for it to be considered for publication in the BMJ. Trials that began patient enrolment on or before 1 July 2005 must be registered before 13 September 2005 to be considered for publication.

When women with anorexia nervosa put on weight they acquire a different shape than do women who have never been anorectic. A study of anorectic women treated for their eating disorder showed that they had significantly greater waist to hip circumference ratio, total trunk fat, visceral adipose tissue, and intramuscular adipose tissue than controls of the same weight ( American Journal of Clinical Nutrition 2005;81: 1286-91[Abstract/Free Full Text]). Subcutaneous adipose tissue and skeletal muscle mass, however, were the same in both groups. The longer term impact on psychological and physical health is not yet known.

After many sad years of not playing her violin, Minerva has finally plucked up the courage to start again. She recently returned from Rumania, where she enjoyed the thrill of playing with the European Doctors Orchestra at its first continental European concert. The orchestra meets for an intensive long weekend twice a year—once in London and once elsewhere in Europe. Any musical medics interested in registering for the next London extravaganza in November are invited to visit the website, www.edo.uk.net.

Many doctors inwardly groan at the thought of being available to their patients by email, but the results of a US pilot study found that both patients and doctors communicating by email reported greater satisfaction and convenience than control groups. Surprisingly, the doctors who offered email communication to patients said their total volume of messages (email and non-email) and the time spent responding to them did not increase ( Journal of the American Board of Family Practice 2005;18: 180-8).

After observing that a high proportion of patients with atrial fibrillation admitted to their cardiology department also had gastric problems, Italian cardiologists introduced an antibody test for Helicobacter pylori as standard practice. They found a highly significant correlation between atrial fibrillation and H pylori infection, particularly in those with persistent atrial fibrillation without demonstrable structural cardiac disease, and confirmed that C reactive protein is a good marker for the inflammatory process ( Heart 2005;91: 960-1[Free Full Text]).

Writer's cramp is the commonest form of focal hand dystonia and is thought to be due to basal ganglia dysfunction. Most symptoms are motor in nature, but there is sensory input too. A study that compared the use of transcutaneous electrical nerve stimulation (TENS) with placebo over two weeks found that TENS gave therapeutic benefit that lasted three weeks. TENS may work by promoting a reshaping of excitatory and inhibitory functions between agonist and antagonist muscles in the central nervous system, which are severely impaired in dystonia ( Neurology 2005;64: 1946-8[Abstract/Free Full Text]).

Brain derived neurotrophic factor (BDNF) is critical for normal neuronal development, and an article in Medical Hypotheses (2005;65: 79-82)[CrossRef][ISI][Medline] proposes that early BDNF hyper-activity may be critical in the development of autism early in life. The theory is supported by findings that serum and brain tissue concentrations of BDNF are higher in autistic patients than in normal controls. Genetic studies of the BDNF signalling pathway may help shed light on the role of BDNF in the pathogenesis of autism and on possible effective interventions.

Laboratory evidence suggests that the autonomic nervous system responds to chronic psychosocial and behavioural stressors with adverse metabolic consequences, which might explain the relation between low social position and high coronary risk. Data from the Whitehall II study, which follows a cohort of almost 2200 healthy male civil servants aged 45-68, seems to support the hypothesis. Chronically impaired autonomic function may link social position to different components of coronary risk in the general population ( Circulation 2005;111: 3071-7[Abstract/Free Full Text]).

View larger version (101K): [in this window] [in a new window]   A middle aged woman with a history of polycythemia vera presented with erythematous extremities and painful burning sensations. Her calves, soles, toes, palms, and fingertips were dark red and mottled. Her symptoms were recurrent and intensified with heat, standing, and exercise and were relieved by rest, limb elevation, and exposure to cold. Acroparesthesias (abnormal touch sensations in the extremities) usually preceded each episode. The clinical findings were consistent with erythromelalgia, which mainly occurs in people with underlying myeloproliferative disorders and high platelet counts. The pathology is characterised by arteriolar wall thickening, fibromuscular intimal proliferation, narrowing of the arteriolar lumen, perivascular mononuclear cell infiltration, and occlusive thrombi, and platelets are the culprits. This patient's platelet count was 550x109/l. Giving aspirin promptly relieves the symptoms and reverses histological lesions and ischaemic defects. Panayiotis D Ziakas, fellow, Stavroula Giannouli, consultant, Michalis Voulgarelis (mvoulgar{at}med.uoa.gr), assistant professor, department of pathophysiology, National University of Athens School of Medicine, Athens, Greece

A new topical anaesthetic cream called liposomal lidocaine is said to be superior to other topical anaesthetics, partly because its onset of action is just 30 minutes. A Canadian double blind randomised trial of liposomal lidocaine in children aged 1 month to 17 years who were undergoing intravenous cannulation found that the use of the active cream, compared with inactive placebo cream, was associated with a higher cannulation success rate, less pain, shorter procedure times, and minor skin changes. The authors recommend that the cream be used routinely for painful cutaneous procedures in all children ( CMAJ 2005;172: 1691-5[Abstract/Free Full Text]).

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Topical anaesthesia for cannulation

Silas W Feaver, et al.
bmj.com, 2 Jul 2005 [Full text]