BMJ  2005;331:1280 (26 November), doi:10.1136/bmj.331.7527.1280

Minerva

A paper entitled Cooking up Fine Remedies in Medical History ( 2005;49: 395-422) includes the following recipe for treating white tiger wind sickness. Use three skewers of pork. Combine with hempseed and half a cup of wine, and hold in the mouth so as to apply by spraying from the lips. Apply the meat to the affected part, chanting. So much more poetic and magical than simply writing, "Apply to affected area."

Slimy frog skins could move centre stage in the campaign against HIV infection. Antimicrobial peptides from frog skin secretions inhibit HIV infectivity in vitro. They are too toxic at high concentrations to be of much use as a treatment but apparently have great preventive potential in mucosal creams. Frogs secrete chemicals on to their skin to make them distasteful to potential predators, but these substances also provide a first line defence against bacteria, fungi, and viruses ( Drug Discovery Today 2005;10: 1489-90).

A study from five European countries followed a cohort of 22 000 people who had survived a first myocardial infarction to assess readmissions for cardiac disease over eight years. The results show that ambient air pollution (nitrogen dioxide, carbon monoxide, ozone, and particles less than 10 µm) is associated with an increased risk of cardiac readmissions for these patients ( Circulation 2005;112: 3073-9[Abstract/Free Full Text]).

Women who have stopped smoking in pregnancy are most likely to relapse in the first two weeks after giving birth. Half the women in this small study of 62 pregnant women had relapsed by the second week, with the overwhelming need for rest and relaxation, depression, and anxiety being cited as the main reasons. Although most women were smoking far fewer cigarettes postpartum than before they got pregnant, the authors of a study in the Journal of Obstetric Gynecological and Neonatal Nursing 2005;34: 703-12[CrossRef][Web of Science][Medline]) say that interventions to prevent relapse need to be given before mothers leave hospital.

The present trend for using pulsed (and therefore cheaper) antifungal treatment for infected nails is challenged by a study in the Journal of the American Academy of Dermatology ( 2005;53: 578-84)[CrossRef][Web of Science][Medline]. The authors warn that their study population of older men with severe onychomycosis may limit the universality of their results, which showed that continuous treatment with oral terbinafine was better than pulsed treatment. They were also surprised to find that oral terbinafine was generally less effective at achieving a complete cure than they had previously believed.

Automated external defibrillators are not recommended for use in children under 1 year old. But the first case report of a 4 month old baby who was successfully resuscitated using an automated external defibrillator may change that. In this case, the shock was sufficient to cause a period of asystole and bradycardia immediately afterwards (suggesting myocardial stunning) but no neurological injury seemed to be sustained. This case may indicate a role for automated defibrillators in the homes of babies at risk of sudden cardiac death ( Resuscitation 2005;67: 135-7[CrossRef][Web of Science][Medline]).

A 30 year old man presented to the emergency department with left loin pain and frank haematuria after falling heavily playing football. He was tender in the left loin, and renal trauma was suspected. Abdominal computed tomography showed a stable fracture of the transverse process of L3. It also showed a 5 mm calculus in the left ureter causing hydronephrosis. Ultrasonography showed multiple stones in the left kidney. Mechanical percussion techniques have been used therapeutically after shock wave lithotripsy to dislodge such calculi from the lower pole of the kidney. However, in this case the trauma sustained to the lumbar region probably dislodged a calculus from the renal parenchyma into the left ureter. The patient presumably presented with both ureteric colic and pain from the fracture. Michael J Lamyman senior house officer, (mikelamyman{at}doctors.org.uk), James Orbell, senior house officer, Douglas J Noble, senior house officer, Horace D'Costa, consultant radiologist Horton Hospital, Banbury, Oxfordshire OX19 9AL

A new fast track assessment clinic run by a London based community mental health team has resulted in a large reduction in the time between receipt of non-urgent referrals from general practitioners and the first appointment being given. The interval fell from 55 days to 18 days, and the time to assessment fell from 71 days to 26. The other advantage was fewer wasted appointments ( Psychiatric Bulletin 2005;29: 413-5[Abstract/Free Full Text]).

Cutting dairy products from your diet helps reduce cholesterol concentrations, and a prospective Spanish study now shows that consuming low fat dairy products also reduces the risk of developing high blood pressure. The study participants were well educated graduates, and the findings were strong even after the authors controlled for age, sex, physical activity, body mass index, and other dietary factors related to hypertension ( American Journal of Clinical Nutrition 2005;82: 972-9[Abstract/Free Full Text]).

Minerva's brain functions at variable rates depending on the time of day, her emotional state, and physical health. Reaction time is defined as the time that elapses between the brain detecting a stimulus and the moment a response starts. In humans, studies have shown that no one—regardless of the state they are in—can react in less than 0.11 seconds ( British Journal of Sports Medicine 2005;39: 786[Free Full Text]).

Children adopted from foreign orphanages by US families have been shown to have significantly different concentrations of the hormones oxytocin and arginine vasopressin from children raised by their biological parents in the United States. Both hormones relate to social bonding, and both increase after playful social contact. Children raised by their biological parents had higher concentrations to start with and showed higher rises after social play than the adopted children. Failure to receive optimal care as a young child may therefore permanently disrupt normal development of these hormonal systems (Proceedings of the National Academy of Sciences 22 Nov 2005, www.PNAS.org/cgi/doi/10.1073/pnas.0504767102).

Is breast cancer a zoonosis? In mice, breast cancer is most commonly caused by mouse mammary tumour virus, which is transmitted both in the germline and through infectious virions. The existence of a human homologue of the virus has not yet been confirmed, but some research laboratories have detected sequences closely related to mouse mammary tumour virus in DNA isolated from human breast cancer tissue. Based on the evidence from the past six decades, the authors speculate that the breast cancer virus may be transmitted from mice to humans through cats, as some cats seem to be infected with a slightly modified version of the virus ( Microscopy Research and Technique 2005;68: 197-208[CrossRef]).

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Ureteric stone diagnosis

Ranjan Thilagarajah
bmj.com, 28 Nov 2005 [Full text]