BMJ  2006;332:128 (14 January), doi:10.1136/bmj.332.7533.128

Minerva

Minerva

It is important that women conceive while they are a healthy weight and also gain the recommended amount of weight during pregnancy, a study in the Journal of Nutrition (2006;136: 140-6)[Abstract/Free Full Text] says. In white women, excessive weight gain during pregnancy is associated with stopping breast feeding early, whatever their body mass index before pregnancy.

Alerting the emergency department that a patient with a suspected heart attack was being brought in by ambulance produced a significant reduction in door to needle times in Glasgow, where thrombolysis is carried out in the Royal Infirmary's emergency department (Emergency Medicine Journal 2006;23: 79-81[Abstract/Free Full Text]). Half of the patients in the pre-change (no alert) group had a door to needle time of under 30 minutes, compared with 91% of the post-change (alert) group (P = 0.005).

A Swiss retrospective analysis of colonoscopies, done over nine years on people aged > 50 years with symptoms indicative of colorectal cancer, reports that a cancer was found in 12.3% of the group and that most of the cancers were advanced (Swiss Medical Weekly 2005;135: 679-83). The authors say that to detect cancer at an early stage, screening programmes should focus on appropriate asymptomatic populations (aged > 50 with, for example, a positive family history), rather than on symptomatic patients.

Falciparum malaria turns out to be one of the most common causes of language disorders in the tropics. Three groups of children (aged 6-9 years) admitted to a Kenyan hospital had their speech and language performance assessed (Developmental Medicine and Child Neurology 2006;48: 51-7[CrossRef][ISI][Medline]). Language impairment was seen in 12% of the group previously admitted with cerebral malaria and 9% of the group with a history of malaria and seizures, compared with 2% of the children who had not been exposed to severe malaria. The pathogenesis isn't clear, but the increased prevalence of epilepsy in those who have had severe malaria may be a causal factor.

Why are pet cats and dogs prone to diabetes, but pigs aren't? Apparently because pigs have been bred for their ability to accumulate and store energy efficiently for later consumption by humans, and are therefore protected against the toxic effects of a "diabetogenic" environment (one that favours inactivity and energy abundance). The current diabetes epidemic in developing countries may be happening for similar reasons. The indigenous human populations living there have not yet had time to genetically adapt to their new diabetogenic environments, and even the "adapted" populations of European descent are struggling (CMAJ 2006;174: 25-6[Free Full Text]).

Native, immigrant, and returned refugee populations have different sorts of health problems. In Croatia, after the 1991-5 war, and despite the fact that all three groups had been exposed to war stress, native adults showed the highest prevalence of chronic diseases, such as hypertension and cardiovascular disease, whereas immigrant adults had the lowest. Returning refugees stood somewhere between the two. Health services in countries ravaged by war should reflect these differences (Croatian Medical Journal 2006;46: 990-5).

If you've ever worried that your heart may not stand the stress of space flight, fear not. Knowing that gravity reduces venous return, which decreases cardiac output and induces vasoconstriction to prevent blood pressure falling, scientists hypothesised that weightlessness would increase cardiac output and induce vasodilation. Testing out their theory in astronauts aboard the space shuttle Columbia, they report that the vasodilation lasts for at least a week into space flight, confirming it's OK for the cardiovascular system to fly in space (Hypertension 2006;47: 69-73[Abstract/Free Full Text]).

A woman presented to the hospital after having fallen over her dog while walking on the cliffs. She had briefly lost consciousness. On arrival she had what seemed to be a linear burn on her neck where she had been wearing a gold chain. Closer inspection showed fern-like erythema emanating from the burn. There had been a thunderstorm at the time, and closer questioning elicited that she only thought she had stumbled over the frightened dog. A diagnosis of lightning injury was made, and she was admitted. Six hours later characteristic arborescent patterns (Lichtenberg figures) had appeared on her trunk and legs. Margaret Hocking (margaret.hocking{at}rcht.cornwall.nhs.uk), accident and emergency consultant Royal Cornwall Hospital, Truro

"Time is brain." A neurologist has worked out that, after an acute stroke, each minute that ticks away without intravenous tissue plasminogen activator treatment equates to an additional two million neurones being lost. So, compared with the average neurone loss in an ageing brain, the ischaemic brain ages 3.6 years each hour without treatment (Stroke 2006;37: 263-6[Abstract/Free Full Text]).

Professional sporting organisations and some military agencies have started to invest in shock absorbing insoles in footwear to prevent overuse injuries. But a study in the Journal of the Royal Society of Medicine (2006;99: 32-7)[Abstract/Free Full Text] indicates that such blanket changes of policy aren't supported by evidence. Air Force recruits randomised to receive either standard issue footwear without shock absorbing insoles or those with shock absorbing insoles showed similar rates of lower limb injuries during their basic training.

Temporal artery biopsy is the gold standard diagnostic test for temporal arteritis, but how often does the result influence clinical practice? A retrospective audit of 44 patients who had undergone a temporal artery biopsy over two years found that in 31 of them the biopsy didn't influence their ongoing management, despite a negative biopsy result. Eighteen patients had been advised to continue corticosteroid treatment on the basis of a clinical diagnosis of temporal arteritis, and 13 had their treatment plan or diagnosis changed before the biopsy result became available (Quarterly Journal of Medicine 2006;99: 33-6[Abstract/Free Full Text]).

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