BMJ  2005;331:E374 (13 August), doi:10.1136/bmj.331.7513.E374

BMJ USA: Minerva

Minerva

The leprosy bacterium grows in humans, armadillos, and the footpads of mice—but not in test tubes. A genetics study of strains of Mycobacterium leprae from patients around the world now shows that a single bacterial clone that has spread but barely mutated over time is responsible for the world's entire leprosy infection. It now looks as if leprosy originated in East Africa, and Europeans and North Africans took it to West Africa. The slave trade took it from there to the Caribbean and South America ( Science 2005;308: 1040-2[Abstract/Free Full Text]).

Inhibiting gastric acid is critical when managing active peptic ulcer bleeding that doesn't stop spontaneously. A randomized placebo controlled trial comparing treatment with infusing somatostatin and a proton pump inhibitor found that both achieved high intragastric pH values compared with placebo, but that somatostatin was more effective during the first 12 hours of treatment. In this case, somatostatin is thought to work by inhibiting gastrin, in addition to its vasoactive effect of reducing bleeding ( Scandinavian Journal of Gastroenterology 2005;40: 515-22).

If someone gave you $10 to complete an automated telephone survey about your sexual behavior, would you? And what if they paid you $40 to send a urine specimen by mail for testing for sexually transmitted diseases? A pilot study in the United States found that 86% of randomly selected citizens were more than happy to comply. The new approach may be the most feasible method of estimating infection prevalences in a population ( Sexually Transmitted Diseases 2005;81: 236-8). It's also good to know that no specimens were lost in transit.

Is it more cost effective to introduce free nicotine replacement therapy or implement smoke-free workplaces? Working through the figures for a single US state shows that after one year a nicotine replacement therapy program would result in 18 500 people quitting at a cost of $7020 per person, while a smoke-free workplace policy would result in 10 400 people quitting at a cost of $799 each. With a ninefold difference in cost, smoke-free workplace policies are clearly the way to go ( American Journal of Public Health 2005;95: 969-75[Abstract/Free Full Text]).

Given plenty of information, fewer than 20% of women eligible to take tamoxifen to reduce the risk of breast cancer and who perceived themselves to be at very high risk of the disease decided to take the drug. Researchers interviewed 250 women about their attitudes towards taking tamoxifen and found a mean self perceived five year risk of breast cancer of 32.7%. Women with very high perceived risk were no more likely to choose tamoxifen than those with the lowest perceived risk, and adverse side effects were the main reason for declining it ( Cancer 2005;103: 1996-2005[CrossRef][ISI][Medline]).

View larger version (59K): [in this window] [in a new window]   This is the mouth of a 58 year old woman who has secondary Sjögren's syndrome associated with limited scleroderma (CREST). Over the past three years her previously normal dentition has deteriorated dramatically. There is no evidence of any coexisting self neglect. Dental caries are a common complication of Sjögren's syndrome due to the decreased production of saliva. Regular dental inspection is essential, and scrupulous dental hygiene is required, with fluoride toothpaste and mouthwash; this should be reinforced in the medical clinic. Saliva substitutes or systemic cholinergic drugs may be useful. Sugar-free mints may also stimulate the flow of saliva. Holly Piper specialist registrar hollypiper{at}hotmail.com Tom Sheeran consultant rheumatologist department of rheumatology Cannock Chase Hospital, Cannock, Staffordshire WS1 1 2XY, UK

One of the fears of women considering a hysterectomy is whether their sexual function will be affected. A study of 27 women recorded their vaginal and clitoral sensitivity to warm, cold, and vibratory sensation before and after hysterectomy. The women reported that sensation at the vaginal walls had deteriorated after surgery, but clitoral sensation was mostly preserved. A minority of patients reported a decline in general sexual function, emphasizing the relative importance of clitoral compared with vaginal contributions to sexual function ( European Journal of Obstetrics and Gynecology and Reproductive Biology 2005;119: 242-5).

Some people believe that childhood immunizations influence children's subsequent development of allergies. Pertussis vaccine, for example, is thought to be positively associated with allergies and BCG to provide protection. But a case-control study of more than 7000 children found that neither the triple vaccine (diphtheria, tetanus, and pertussis) nor MMR (measles, mumps, and rubella) increases the risk of hay fever; nor did BCG reduce the risk. Late immunization seems to reduce the risk, but this could be related to another factor, such as a febrile illness, causing both postponement and reduced risk ( Archives of Disease in Childhood 2005;90: 567-73[Abstract/Free Full Text]).

When the dust from the dramatic fallout over COX-2 inhibitors has settled, we should "continue to prescribe these effective drugs with a careful and calm appraisal of the risk-benefit ratio," says an editorial in Hospital Medicine ( 2005;66: 264-7). The authors remind us that it's possible that non-selective non-steroidal anti-inflammatory drugs also increase the risk of heart attack, and that the blood pressure should be checked and treated in all patients taking these drugs.

Homeless adults in North America don't have higher rates of diabetes, hypertension, and high cholesterol than the rest of the population; it's just that the control of their conditions is worse and their smoking rates are higher, resulting in cardiovascular disease being the leading cause of death in this group. When 202 randomly selected homeless people from shelters in Toronto agreed to be interviewed (89% were men; the mean age was 42), 15% reported cardiovascular disease. Only a third said they were taking aspirin or cholesterol lowering drugs ( Circulation 2005;111: 2629-35[Abstract/Free Full Text]).