BMJ  2006;332:676 (18 March), doi:10.1136/bmj.332.7542.676

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Yet another trial that set out to find a drug to prevent recurrent vasovagal faints reports a sad failure. Metoprolol, a blocker, proved no better than placebo and joins the ranks of salt, fluids, fludrocortisone, and paroxetine in making no difference to the study population of adults who faint on a regular basis (Circulation 2006;113: 1164-70[Abstract/Free Full Text]).

Having a history of autoimmune disease is associated with a 45% increase in risk for schizophrenia. In a large Danish epidemiological study, nine autoimmune disorders had higher prevalence among patients with schizophrenia, and 12 autoimmune diseases had higher prevalence among the parents of those with schizophrenia. Thyrotoxicosis, coeliac disease, acquired haemolytic anaemia, interstitial cystitis, and Sjogren's syndrome had higher prevalence among both patients and relatives (American Journal of Psychiatry 2006;163: 521-8[Abstract/Free Full Text]).

It's not just exclusive breast feeding that matters in improving neonatal mortality, but early initiation. According to a study in Pediatrics (www.pediatrics.org/cgi/doi/10.1542/peds.2005-1496), 16% of neonatal deaths worldwide could be prevented if breast feeding began on day 1 of life, and 22% if it were started within the first hour. The analysis is based on nearly 11 000 breastfed babies in Ghana born in 2003-4 who survived to day 2.

Two years is the standard interval set for retraining lay people in cardiopulmonary resuscitation and use of automated external defibrillators, although skill deterioration has been observed before the two years are up. Volunteers who were trained and then subsequently tested by means of a simulated resuscitation showed small declines in skills over time, but most retained sufficient resuscitation skills up to 17 months after initial training. Most needed less than 10 minutes to retrain (Academic Emergency Medicine 2006;13: 254-63[CrossRef][ISI][Medline]).

The suggestion that vitamin C may protect against cardiovascular disease has received some support from a study showing it has anti-inflammatory properties and seems to protect against endothelial dysfunction in men with no history of heart disease or diabetes (American Journal of Clinical Nutrition 2006;83: 567-74[Abstract/Free Full Text]). Both plasma and dietary intake of vitamin C were significantly and inversely related to C reactive protein and tissue plasminogen activator, markers of inflammation and endothelial dysfunction respectively. Also, plasma (but not dietary) vitamin C was inversely linked to fibrinogen concentrations and blood viscosity.

Being involved in a traumatic motor vehicle crash is less likely to cause new widespread pain than you might think. A study comparing people who had been in such a crash with a control group who hadn't found just 8% of the crash victims reported new onset widespread pain six months later, and their increased relative risk went down when precrash somatic and psychological distress states were taken into account. The authors suggest that psychological distress related to the trauma is likely to explain the experience of new pain (Annals of the Rheumatic Diseases 2006;65: 391-3[Abstract/Free Full Text]).

Heart tissue produced by tissue engineering has been used to treat some cases of myocardial infarction and to repair congenital cardiac defects, and researchers have now found that they can greatly improve its contractility with new techniques that allow blood vessels to develop within the tissue. Transplanted into rat models, the vascularised tissue showed improved cardiac function and maintained its superior performance three weeks later (Artificial Organs 2005;29: 866-75[CrossRef][ISI][Medline]).

This 4 week old boy had developed a widespread, erythematous circinate eruption, most marked on the face and scalp, at 2 weeks of age. He was not distressed by it and was feeding normally and thriving. His mother has systemic lupus erythematosus (SLE) and was seropositive for anti-Ro antibodies (present in 30% of patients with SLE). Neonatal cutaneous lupus develops in 5% of babies of mothers with anti-Ro antibodies. It is a benign condition due to passive autoimmunity and requires no treatment. The eruption fades by 6 months of age, as the infant clears the maternal antibodies, and leaves no scarring. William Dennes, sub-specialist in maternal fetal medicine (w.dennes{at}imperial.ac.uk), Catherine Nelson-Piercy, consultant obstetric physician, Queen Charlotte's and Chelsea Hospital, London W12 0HS

 

Scotland may be cold and wet for more months of the year than the southern climes of the UK, but it's the place to move to if you are beginning to dement. Not only will you get free help with washing, eating, and dressing, but you will also get your dementia drugs free on the NHS. The National Institute for Health and Clinical Excellence, which makes recommendations about the funding of drugs in England and Wales, admits the drugs that help in dementia are effective but claims they are just too expensive. Scotland's counterpart, the Scottish Intercollegiate Guidelines Network, concludes otherwise.

It's common knowledge that women with diabetes tend to produce big babies, but there's a highly significant correlation between yolk sac size and maternal type 1 diabetes right from the word go, according to an ultrasound study reported in Gynecologic and Obstetric Investigation (2006;61: 80-6[ISI][Medline]). The authors say that gross changes in yolk sac size probably reflect problems of the maternal-fetal transport system in early pregnancy complicated by type 1 diabetes.

Bone grafts taken from iliac crests are usually favoured to treat non-united scaphoid fractures because they're believed to have greater osteogenic potential and superior biomechanical properties. However, a retrospective study of 68 consecutive cases of non-united scaphoid fractures treated with bone grafts from the iliac crest or distal radius found that the type of bone graft made no difference to the location of the fracture, duration of the non-union, or the fixation implants used—nor to the success rate, which was 66% with both types of graft (Journal of Hand Surgery 2006;31B: 47-51).

The water used for the final rinse in endoscope disinfectors should be "bacteria-free," but a survey from 20 different units reports that 60% of rinse water samples didn't fulfil this criterion. Infection control teams became very anxious and didn't know whether their equipment should be taken out of service, and each unit responded differently. Writing from the Health Protection Agency in Southampton, a microbiologist suggests that common guidance be adopted, which specifies a series of action levels of increasing severity, depending on the bacterial count in the water.

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Guidance at bmj.com/advice

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