BMJ  2005;331:E382 (17 September), doi:10.1136/bmj.331.7517.E382

BMJ USA: Minerva

Minerva

Minerva

Unlike most people who were nailed to a cross to die, Jesus is said to have died in less than six hours, whereas most crucifixions take up to four days. A letter in the latest electronic issue of Thrombosis and Haemostasis suggests that his Jewish heritage may have endowed him with a hypercoagulable state, making pulmonary embolus from deep vein thrombosis due in part to dehydration and immobilization the most likely cause of his more rapid death. The genetic mutation is common in Israel, especially in people who live in the Galilee area.

There seems to be a link between length of gestation in humans and the risk of the offspring eventually dying from cerebrovascular disease (but not ischemic heart disease). A Swedish study reports that shorter gestation is associated with higher mortality from cerebrovascular disease, and that the risk of death from ischemic stroke goes down in people born after 36 weeks' gestation ( Journal of Epidemiology and Community Health 2005;59: 473-4[Free Full Text]).

The world's first automobile fatality apparently took place in the Irish Midlands in 1869. Mary Ward fell from a steam carriage, which had been designed and built by her cousin, and she died after being crushed by its heavy iron wheels. She had enjoyed a multitude of achievements before her unfortunate premature death at the age of 42, having been a celebrated microscopist, artist, astronomer, and naturalist ( Accident Analysis & Prevention 2005;37: 601-3[Medline]).

Having recently taken to staggering to the gym on a regular basis and working up a great sweat, Minerva has a new appreciation of hydration states. A study of US college football players who train sometimes twice daily in hot and humid environments found that they became clinically dehydrated by day 2 of eight consecutive days of training. Body weight tended to be below baseline both before and after each practice session and urine sodium content dropped by day 2, only recovering by day 8 ( American Journal of Sports Medicine 2005;33: 843-51[Abstract/Free Full Text]).

When it comes to dishing out antibiotics to children for acute otitis media or adopting a "watchful waiting" approach, it's not just the parents who are sometimes uneasy. A US study reports that most physicians have occasionally adopted watchful waiting, but few use it frequently. Acceptability to parents increases with more education and when they feel included in medical decisions. Factors affecting whether doctors used watchful waiting were the number of years in practice, the choice of family medicine as a specialty, and a belief in antibiotic resistance being a problem ( Pediatrics 2005;115: 1466-73[Abstract/Free Full Text]).

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).

Another brainy question is revealed in Neurology ( 2005;64: 2004-5)[Free Full Text]. Do we have brain to spare? Humans hold about 1.5 liters of brain tissue, containing roughly 20 billion neocortical neurons with an average of 7000 synaptic connections each. Magnetic resonance studies help to elucidate how closely cognitive loss parallels the loss of brain tissue. They show that minimal cognitive decline can be detected with minor loss of brain tissue, with the redundancy and plasticity of brain tissue providing a buffer against greater impairment.

"Thermal shrinkage" has been proposed as a curious, but minimally invasive, potential solution to treat lax anterior cruciate ligaments, in order to prevent complete tears or additional meniscal injuries from occurring. Although short term benefit was reported in most of the 19 patients who underwent this treatment in a pilot study, there was a "catastrophic failure" in most of these human guinea pigs at long term follow-up ( American Journal of Sports Medicine 2005;33: 990-5[Abstract/Free Full Text]). Not to be recommended.

Many doctors choosing general practice or family medicine participate in Balint-type groups at some point in their training. These are designed to encourage reflection about the consultation and their relationships with patients. Whether Balint training influences the degree of doctors' empathy or job satisfaction was explored in a study in Family Medicine ( 2005;37: 328-31)[Web of Science][Medline]. The Balint attendees showed the same scores of empathy and were no more satisfied with their jobs than the non-attendees—but they were more likely to say they would choose the same specialty again.

View larger version (136K): [in this window] [in a new window]   Ciprofloxacin was given as primary prophylaxis for spontaneous bacterial peritonitis in a 55 year old woman who had been admitted with alcoholic liver disease. Ten days after admission she went out sunbathing for several hours. Within 48 hours she developed well demarcated erythema over the front of her legs, and large blisters over each knee and the dorsum of her feet. Ciprofloxacin was discontinued, and fluid from the blisters was aspirated under aseptic technique. The erythema gradually dissipated. Phototoxicity has been described for all quinolones, but few cases of ciprofloxacin induced photosensitivity have been reported. Srisha Hebbar senior house officer Srisha_hebbar{at}yahoo.com Neil D Hawkes consultant department of gastroenterology Prince Charles Hospital, Merthyr Tydfil CF47 9DT, UK

A randomized, controlled, double blind study of the effects of candesartan (an angiotensin receptor blocker) on 5436 patients with heart failure, who did not have diabetes at the start of the study, reports that 6% of those in the candesartan group subsequently developed diabetes, compared with 7.4% in the placebo group. It's not exactly news, because other large studies have shown similar effects with ramipril and enalapril, which are both ACE inhibitors. But the authors point out that this is the first study that compares the active drug with a placebo ( Circulation 2005;112: 48-53[Abstract/Free Full Text]).

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