BMJ  2006;332:1400 (10 June), doi:10.1136/bmj.332.7554.1400

Minerva

Minerva

In the face of an increasing incidence of prostate cancer, researchers have identified a common genetic variant that is associated with this disease in European and African populations. Follow-up of a study from Iceland has localised the variant to the long arm of chromosome 8 (8q24). A specific allele in this region might account for the greater incidence of prostate cancer in men of African-American origin than in Europeans (Nature Genetics 2006; doi: 10.1038/ng1808).

An attempt to use N-acetylcysteine (an antioxidant) to prevent kidney damage during elective abdominal aortic surgery has failed (Anesthesia and Analgesia 2006;102: 1638-45[Abstract/Free Full Text]). A randomised, double blind, placebo controlled trial in 70 patients found that N-acetylcysteine offered no appreciable protection. Some degree of renal injury seems to occur before the crossclamp is applied to the aorta, even in patients with normal preoperative renal function.

Pseudomonas aeruginosa colonises the lungs of young patients who have cystic fibrosis and often causes severe respiratory tract infections. The process is aided by genetic changes that occur within the bacterium during the period of chronic infection. These changes facilitate infection by increasing virulence and conferring a high degree of resistance to antibiotics. Researchers say that some of the commonly found mutations may provide new avenues for treating the infection in these patients (Proceedings of the National Academy of Sciences 2006; doi: 10.1073/pnas.0602138103).

Could birthdays predispose people to vascular events like stroke and heart attacks? Apparently, the answer is yes. This frightening conclusion comes from a Canadian study that found more people were admitted to emergency departments on their birthday as a result of vascular events compared with the control conditions of asthma and appendicitis. The association was stronger if predisposing conditions such as hypertension were present (Neurology 2006; doi: 10.1212/01.wnl.0000217915.06544.aa[Abstract/Free Full Text]).

HIV is thought to have originated from chimpanzees, which harbour the closely related simian immunodeficiency virus (SIV), and recent research in Cameroon chimpanzees seems to confirm this. By analysing the genetic sequence of SIV in chimpanzees, researchers have traced the origins of pandemic and non-pandemic groups of HIV-1 to distinct and geographically isolated chimpanzee communities (Science 2006; doi: 10.1126/science.1126531[Abstract/Free Full Text]).

A qualitative comparison of pain management among 42 hospice and 65 nonhospice residents in two nursing homes found that specialised hospice care provides some benefit to patients, and that good pain management and high quality end of life care depend largely on the context in which they are provided (Gerontologist 2006;46: 325-33[Abstract/Free Full Text]). The "contexts" that adversely affected both groups of residents included limited availability of doctors, lack of knowledge about appropriate drugs, and limitations of the nursing staff.

Conventional total hip arthroplasty and total hip resurfacing were compared in a randomised study of 120 patients (using the other hip as a control). Restoration of the normal proximal femoral anatomy was more precise with resurfacing. In addition, inequality of leg length was restored to within a standard deviation of 4 mm in 86% of the resurfacing group compared with 60% of the conventional replacement group (Journal of Bone and Joint Surgery 2006;88-B: 721-6).

Doctors often show resistance to new technology, especially computer systems. Case study analysis of the implementation of computer information systems in three hospitals showed that the "implementers" themselves played an important part in whether the outcome was successful (CMAJ 2006;174: 1573-8[Abstract/Free Full Text]). Implementation was successful when the implementers dealt with the real reasons underlying this resistance. Implementation failed when they didn't respond to resistance behaviour, offered antagonistic responses, or when support was aimed at the wrong object of resistance.

A study in Hypertension (2006;47: 1168-74[Abstract/Free Full Text]) describes how the prevalence of salt sensitivity (increased salt intake causes acute rises in blood pressure and an increased risk of developing hypertension) doubled as early as four months after surgical menopause— but without an associated rise in blood pressure. The authors suggest that the loss of ovarian hormones unmasks a population of women prone to salt sensitivity who, as they age, will be at greater risk of developing hypertension and cardiovascular disease.

"Choice for all" has been declared the mantra of the new NHS, and the government is going to be rating GPs on their provision of choice by independently surveying patients. The veiled threat is that if patients don't report that they were offered a "choice," their GP surgeries may suffer. Minerva suggests that one way to lessen the risk of this happening is to start every consultation with "What choice can I offer you?" rather than "What can I do for you?"

View larger version (109K): [in this window] [in a new window]   A 42 year old gay man presented with a yellow discharge from his penis, accompanied by dysuria, and he had had two "spots" on his penis for the past six months. On examination, he had a yellow mucopurulent discharge and two large purple nodules, which suggested Kaposi's sarcoma. No other skin lesions were noted elsewhere. He was positive for HIV antibodies. Microscopy of the discharge showed that he was positive for Neisseria gonorrhoea and he was treated for this. The Kaposi's sarcoma lesions reduced in size after he started taking highly active antiretroviral therapy for HIV infection. Kapasi's sarcoma rarely presents only in the genital area in HIV infection, and it should be looked for elsewhere. Dushyant Mital (dmitall7{at}yahoo.co.uk), consultant physician, department of sexual health, Bristol Royal Infirmary, Bristol BS2 8HW

 

Azelaic acid 15% gel used in combination with a polyhydroxy acid skin care regimen is a more effective and better tolerated treatment for rosacea than individual, self selected skin care routines (Journal of Cosmetic Dermatology 2006;5: 23-9[CrossRef][Medline]). Skin dryness was greatly reduced from week four of the study in patients in the treatment group, who also reported less stinging and itching.

The underuse of highly active antiretroviral therapy (HAART) by women with HIV is not linked to dissatisfaction with care, according to a longitudinal analysis in the American Journal of Public Health (2006;96: 1044-51[Abstract/Free Full Text]). Providers should not be put off recommending HAART to dissatisfied patients, say the authors; instead, they should try to improve these women's access to primary care, which could improve uptake of HAART and satisfaction in general.

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Vascular events on birthdays: Canadian study

Alasdair J Macdonald
bmj.com, 11 Jun 2006 [Full text]