BMJ  2005;331:1152 (12 November), doi:10.1136/bmj.331.7525.1152

Minerva

Under-reporting of sexual abuse, alongside a failure to adhere to post-exposure prophylaxis against HIV infection, is undermining the implementation of the antiretroviral roll-out programme in South Africa. The first case of seroconversion after abuse, in a 13 year old girl who was sexually abused by two men, is described in the Journal of Clinical Forensic Medicine ( 2005;12: 268-70)[CrossRef][Medline]. In one government hospital in 2003, 598 victims of rape were offered prophylaxis, but a staggering 85% failed to take the full course. This patient was one of them.

Molecular mimicry may link the development of Crohn's disease with certain foods. Crohn's has a histological similarity with intestinal tuberculosis, leading to the assumption that mycobacterial antigens could have a role in its aetiology. Several food additives (emulsifiers, thickeners, surface finishing agents, and plasticisers) share structural characteristics with mycobacterial lipids, so these compounds may stimulate the same pro-inflammatory cytokine cascade triggered in the gut by mycobacteria. Confirmation of this mechanism could lead to a strong emphasis on dietary treatment ( Medical Hypotheses 2005;65: 859-64[CrossRef][ISI][Medline]).

Maternal fatigue by day 14 after the birth of a baby is apparently the most predictive variable for symptoms of postpartum depression ( Journal of Obstetric Gynecologic and Neonatal Nursing 2005;34: 577-86[CrossRef][ISI][Medline]). Minerva has yet to meet a new mum who is not tired two weeks after giving birth.

If you want to read a riveting rant about the virtues of vitamin D, and why flu epidemics occur in winter, go to www.knowledgeofhealth.com/report.asp?story= Why%20Flu%20Epidemics%20Occur%20in%20Winter. The author is a self declared member of the vitamin D Council, which he describes as a non-profit organisation trying to end the epidemic of vitamin D deficiency. It might be just another person jumping on the flu pandemic bandwagon, but could he be on to something?

Would you be willing to pay for inpatient treatment if it was offered at a health spa? Researchers conducting a randomised trial comparing spa treatment with weekly physiotherapy in patients with ankylosing spondylitis asked participants what they would be willing to pay for inpatient treatment if it was delivered at either a rehabilitation hospital or a spa resort and for two levels of benefit. Respondents were prepared to pay more for the spa environment and greater benefit, irrespective of their sex or level of pain or income ( Annals of Rheumatic Diseases 2005;64: 1650-2[CrossRef]).

Activated eosinophils are responsible for the sneezing and wheezing of allergic responses and also for releasing a cascade of other inflammatory mediators. Pin1 is an enzyme that has recently been shown to increase the stability of one of these mediators, and drugs targeting Pin1 activity might therefore reduce or alleviate many allergic reactions. For example, culturing lung eosinophils with Pin1 inhibitors reduced their survival ( Nature Immunology Nov 2005; doi: 10.1038/ni1266).

Stroke patients are not always elderly; sometimes they are young and are carers themselves. A study of the effect on children of having a parent who has had a stroke highlights that the health and behaviour of these children improves over the course of the first year after a stroke. Children at risk of problems at one year are best predicted by how well they are doing when stroke rehabilitation starts, whether the other parent is depressed, and how the healthy parent perceives his or her marriage ( Stroke 2005;36: 2436-40[Abstract/Free Full Text]).

A 50 year old diving instructor who wore soft contact lenses presented with an acutely painful red eye one week after diving in a disused quarry. She had obvious inflammation with a corneal ring infiltrate. Corneal biopsy confirmed the presence of acanthamoeba, and treatment with topical chlorhexidine and propamidine improved her keratitis. Acanthamoeba is a cystic protozoan that is ubiquitous in fresh water and highly resilient. The most common ocular problem it causes is corneal infection (keratitis). Although diving in salt water does not pose an increased risk of acanthamoeba keratitis for people who wear contact lenses, freshwater diving should be discouraged. Alastair Lockwood, senior house officer, (Alastairlockwood2000{at}yahoo.co.uk), Kong Then, specialist registrar, Peter McDonnell, consultant, Birmingham and Midland Eye Centre, City Hospital, Birmingham B18 7QU

Minerva's just learnt a new word. It's floccin-aucinihilipilification, and according to an editorial in the Journal of Clinical Epidemiology ( 2005;58: 1079-80)[CrossRef][ISI][Medline] it's a 19th century word meaning the action or habit of estimating something as worthless. Systematic reviews, for example, are often good at assessing the evidence and concluding that there isn't enough of it or that it isn't very good.

An adult hell bent on self harm is often ambivalent about receiving medical treatment. The question is, how valid is their capacity for such decision making? A study conducted in the emergency room of one UK hospital concludes from semistructured interviews that capacity is not static and that it can be improved by giving patients simple written information about the proposed treatment ( Emergency Medicine Journal 2005;22: 799-802[Abstract/Free Full Text]). Continuing incapacity was significantly associated with cognitive impairment and severe psychiatric disturbance, and, not surprisingly, these patients were more likely to refuse treatment.

A paper investigating whether paediatricians and other doctors immunise their own children reports some interesting differences, not least that both groups gave their children additional vaccines to those recommended ( Pediatrics 2005;116: e623-33[Abstract/Free Full Text]). Of greater concern is that around 10% of non-paediatricians delayed giving their babies some of the childhood immunisations. This indicates that clarification of misconceptions about overloading the immune system are still not getting through even to doctors, who are themselves charged with giving advice to non-medical parents.

Hip resurfacing is growing in popularity, but it seems that the procedure compromises blood flow to the femoral head and in some cases the oxygen concentration drops to zero. The posterior surgical approach itself causes a mean 60% drop, and in this small study of 10 patients, the oxygen concentration didn't improve on wound closure ( Journal of Bone and Joint Surgery (Br) 2005;87: 1468-74).

A dispirited anaesthetist writes in the Journal of the Royal Society of Medicine ( 2005;98: 526)[Free Full Text] that his experience of life in the NHS is of discussing things on behalf of patients, but ultimately he as a clinician has no control over decision making. Policy changes are imposed without any regard for the hours busy people have given for consultation, and opinions are apparently unwanted. Is it any wonder, he says, that so few medical staff attend meetings any more?

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Rapid Responses:

Read all Rapid Responses

"Floccinoccinihilipilification"

Usha K. Sharma
bmj.com, 14 Nov 2005 [Full text]

Wool gathering and the longest word

Jeff Aronson
bmj.com, 15 Nov 2005 [Full text]

More Floccinaucinihilipilification

H. Larry Penning
bmj.com, 17 Nov 2005 [Full text]