BMJ  2006;332:558 (4 March), doi:10.1136/bmj.332.7540.558

Minerva

Minerva

Speeding penalty points were introduced in the Republic of Ireland in 2002. Maxillofacial injuries sustained in road crashes were assessed the year before and the year after implementation in two Dublin hospitals (British Journal of Oral and Maxillofacial Surgery 2006;44: 15-9[CrossRef]). The severity and distribution of the injuries remained the same, and the number of patients requiring intensive care and the duration of stay in the units and hospitals were also similar. But the number of operations changed, with a 61% reduction from 57 in the year before implementation to 22 in the following year.

The recent outbreak of severe acute respiratory syndrome (SARS) in Hong Kong doesn't seem to have scared medical students off the idea of performing basic life support, even though some health professionals were infected during resuscitation of affected patients (Resuscitation 2006;68; 93-100[CrossRef][ISI][Medline]). An attitudinal survey found they were definitely concerned about the risk of disease transmission, but they would be more likely to withhold mouth to mouth resuscitation in the presence of vomit or blood than from fear of contracting SARS.

Maternal stress is thought to cause early miscarriage, and 61 women from rural Guatemala now provide the biochemical evidence. Urine samples taken three times a week were tested for pregnancy status and cortisol. Of 22 pregnancies, nine went to term, and 13 miscarried. Women with increased cortisol concentrations during the three weeks from conception were 2.7 times more likely to miscarry. Miscarriages occurred in 90% of pregnancies with increased cortisol during the first three weeks, and in 33% of those with normal cortisol concentration (Proceedings of the National Academy of Sciences of the United States of America 2006 online publication, www.pnas.org/cgi/doi/10.1073/pnas.0511183103).

We revere medicine for its scientific methodology, but don't ignore your instincts. A junior doctor was asked by a senior to insert a second chest drain into a patient with bilateral pneumothoraces. Glancing at the chest x ray, she heard a small voice in her head saying "Something isn't right," but did what she was asked anyway, bowing to the experience of her colleague. Later a radiologist pointed out that the "pneumothoraces" were simply the outline of the patient's scapulas (Casebook 2006;14(1): 7).

There's no consensus about which electrolyte composition of intravenous fluids to use to rehydrate children. The results of a direct comparison of intravenous isotonic saline (0.9% saline plus 2.5% dextrose) with half isotonic saline (0.45% saline plus 2.5% dextrose) for children with gastroenteritis shows that isotonic saline is preferable to hypotonic saline because it offers protection against hyponatraemia without causing hypernatraemia (Archives of Disease in Childhood 2006;91: 226-32[Abstract/Free Full Text]).

An epidemiologist reports a link between the amount of sleep we get and socioeconomic status (defined by years of full time education, access to a vehicle, and occupational social class). Total sleep quantity was greater in more deprived women, measured by years in education, but there was no linear association in men. The researcher says any hypothesis linking sleep with health inequalities should focus on mid-range sleep quantity, not total, since this was more common with more education in both women and, non-significantly, men (Journal of Epidemiology & Community Health 2006;60: 267-9[Abstract/Free Full Text]).

A pilot, randomised study of restricted visiting versus unrestricted visiting in one intensive care unit revealed that, despite significantly higher microbial contamination with unrestricted visiting, the numbers of septic complications were similar in both groups. A more surprising finding was that the risk of cardiac complications was twofold higher with restricted visiting periods. Anxiety scores and stress hormone profiles were higher too, which may have something to do with it (Circulation 2006;113: 946-52[Abstract/Free Full Text]).

The theory behind making a pre-emptive strike against postoperative pain is that treatment is established, preventing central neural sensitisation before the noxious stimulus has begun. A randomised double blind study of sublingual piroxicam in 52 patients scheduled for bilateral hernia repair under general anaesthetic found it significantly more effective when it was administered before surgery, rather than postoperatively. Patient controlled analgesia doses and visual scores of pain 20 hours after surgery were lower in the group given piroxicam preoperatively (Anesthesia & Analgesia 2006;102: 755-8[Abstract/Free Full Text]).

Minerva loves eating garlic but is conscious of its effect on her nearest and dearest. When raw garlic extracts were fed to normal rats even at low doses, the animals' serum cholesterol and triglyceride concentrations dropped significantly compared with a control group. High doses of raw garlic offered the additional benefit of reducing serum glucose concentration. Boiled garlic didn't have the same effect. Patients who like to help themselves may be interested in this dietary intervention (Journal of Nutrition 2006;136: 800-2S).

A 33 year old woman complained of an itchy lower lip for five months. Her symptoms also included oozing, soreness, and scab formation. On examination, she had superficial crusted plaques with erosions on her lower lip. A detailed history revealed that she had taken up playing the clarinet again five months earlier, and the distribution of irritation matched the area of contact with the clarinet reed. We made a diagnosis of "clarinet lip," a condition brought about by sensitivity to Arundo donax, the grass (related to bamboo) used to make traditional clarinet reeds. She was advised to use synthetic polystyrene reeds instead, and the lip healed within 14 days. Anna Duke, medical student (mzyxamd{at}nottingham.ac.uk), Tanya Bleiker, consultant dermatologist, Rabi Nambi, locum consultant dermatologist, department of dermatology, Derbyshire Royal Infirmary, Derby, DE1 2QY

 

A retrospective study of more than 7000 patients who had made at least four visits to their doctor and had at least one elevated blood pressure reading in 2003 revealed that "therapeutic inertia" (failing to increase therapy when treatment goals are unmet) accounted for 19% of the variance in blood pressure control. The researchers calculated that if drug doses had been increased on 30% of the visits (that is, halving the therapeutic inertia), blood pressure control would have increased from the observed 45% to 66% in one year (Hypertension 2006;47: 345-51[Abstract/Free Full Text]).

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BMJ 2007 335: 1052. [Full Text] [PDF]