BMJ  2006;332:982 (22 April), doi:10.1136/bmj.332.7547.982

Minerva

Minerva

Scientists are trying to link reactive oxygen species (byproducts of cellular respiration and metabolic activity) with insulin resistance. They've now shown that fat storage cells exposed to chemicals that induce insulin resistance raise the levels of reactive oxygen species and that treating these cells to suppress this production results in reduced insulin resistance. They say that antioxidants might prove useful for treating type 2 diabetes (Nature 2006;440: 944-8[CrossRef][Medline]).

The Medical Defence Union advises doctors to warn their patients that it's not always possible to send data securely through electronic media such as phones, video, internet, email, and faxes. It recommends a thorough review of all communication systems and says that doctors should display warnings in waiting rooms and on practice leaflets, reminding patients about how their data will be used (www.the-mdu.com).

The new national kidney allocation and matching system that is launched this month in the UK promises great improvement in equity of access and for people who have been waiting a long time for a transplant (for more information go to www.uktransplant.org.uk). Children will continue to receive priority, and for people with rare tissue and blood types the system promises a fairer crack at the whip.

Should a patient who has a transient ischaemic attack be admitted to hospital? Proponents say that in the absence of randomised trials, the sensible option is to admit and investigate those who are believed to be at highest risk. The argument against admission is that many patients present late, and keeping them out of a hospital bed will not harm them—provided that investigations are arranged promptly—and is more cost effective (Stroke 2006;37: 1137-40[Free Full Text]).

A prolonged fever and a high white blood cell count are important predictors of serious bacterial infection in children who present with fever of unknown origin. Children who presented to the emergency department of Singapore's main paediatric hospital with a white blood cell count above 16 000/mm were seven times more likely to have a serious infection, and those with a fever lasting more than three days were four times more likely to be seriously ill (Singapore Medical Journal 2006;47: 276-80[Medline]).

Are ENT wards well equipped for managing airway emergencies? No, say researchers from Oxford, who conducted a telephone survey of all English hospitals with inpatient ENT services. Their results show poor provision of emergency airway equipment on the wards and inadequate training for handling airway emergencies. Out of the 103 departments contacted, only 18% had an airway box and just 28% offered training in airway management (Annals of Royal College of Surgeons of England 2006;88: 157-60[CrossRef]).

Calciphylaxis results in well demarcated skin ulcers with purplish wound edges and a thick black eschar covering the wound bed. It is characterised by systemic medial calcification of the arteries, tissue ischaemia, and frank tissue infarction. Obesity, type 2 diabetes, chronic renal failure, and primary hyperparathyroidism are all known risk factors for calciphylaxis. Treatment includes aggressive wound care, pain control, avoiding trauma to local tissue, and correcting calcium abnormalities. Lesions usually lead to non-healing ulcers, sepsis, and cutaneous gangrene and to amputation. Mortality is 60-80% secondary to sepsis. A Swamy, specialist registrar (ashwiniswamy{at}hotmail.com), J D A Clark, consultant, department of diabetes and endocrinology, West Suffolk Hospital, Bury St Edmunds IP33 2QZ

Newborn babies seem to be able to distinguish novel and deviant sounds during quiet sleep. Researchers used magnetoencephalography to examine 12 healthy neonates and found that novel and standard sounds are detected and processed by different mechanisms. This is important, they say, in assessing normal and abnormal cortical responses in newborns (Clinical Neurophysiology 2006;117: 496-503[CrossRef][ISI][Medline]).

Personality disorders and substance misuse are likely to coexist, say Australian researchers. A study of more than 1500 young adult Australians found strong independent associations between cluster B personality disorders (which include antisocial, histrionic, and narcissistic behaviours) and substance use disorders. Researchers found little evidence for any strong confounding or mediating effects of these associations (British Journal of Psychiatry 2006;188: 374-9[Abstract/Free Full Text]).

In children with autism the ability to interpret the communicative intent of others is impaired. That doesn't mean that the regions of the brain involved in such faculties are underactive, argue researchers. When probing the comprehension of irony during communication, they found evidence that the regions of the brain that are used in normal children for such functions are actually hyperactive in children with autism (Brain 2006;129: 932-43[Abstract/Free Full Text]).

Two targeted biological therapies for cancer that are proving exciting are the use of oncolytic viruses and specific antitumour immune cells. A recent report describes a synergistic effect when they are combined and targeted against cancer cells. Experiments on immunocompetent and immuno-deficient mice, using cytokine induced killer cells and modified Vaccinia viruses, resulted in accurate targeting of tumour cells and greater tumour regression (Science 2006;311: 1780-4[Abstract/Free Full Text]).

"Does anybody have the foggiest idea what practice based commissioning is about?" asks a columnist in Doctor magazine (11 April 2006:64). Apart from giving patients short shrift in hospital, turfing them out of A&E departments before they're properly sorted out, and treating day case surgery as if it's now the norm and leaving GPs to patch up the ensuing carnage, it's clearly about "bundling more work on to GPs" and creating rising numbers of redundancies among hospital staff to save money.

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