BMJ  2006;333:454 (26 August), doi:10.1136/bmj.333.7565.454

Minerva

Minerva

Chicken or egg? Chronic coughing can cause traumatic inflammation of the airways that, according to a prospective controlled comparative study, mimics the pathological process seen in some diseases that cause cough (Chest 2006;130: 362-70[Abstract/Free Full Text]). The researchers advise caution when attributing pathogenic importance to such inflammatory changes, saying their observations refute the conclusions of others that chronic lymphocytic inflammatory changes by themselves support a specific diagnosis.

Teenagers have their own ways of dealing with chronic pain, and boys and girls seem to use distinct coping strategies. Girls develop emotion focused strategies to cope, including social support, positive statements, and catastrophising, whereas boys engage more in problem focused avoidance, such as behavioural distraction. Of all the strategies identified, internalising and catastrophising accounted for the greatest difference between the sexes (Pain 2006; 123: 275-84[Medline]).

A trial that randomly allocated newborn babies with a family history of asthma to avoidance of house dust mites or control or dietary modifications or control failed to prevent the onset of asthma or atopy during the first five years of life. Avoidance of house dust mites reduced the allergen concentrations in the child's bed by 61% but had no effect on the prevalence of asthma, wheeze, or atopy (Journal of Allergy and Clinical Immunology 2006;118: 53-61[CrossRef][ISI][Medline]).

It's good to talk. People with diabetes have high levels of depression, anxiety, and binge eating behaviour, and a survey of 300 of them found that those who said they wanted to talk to someone about living with diabetes were those who had the highest levels of psychological distress. The results suggest that people with diabetes have good insight into their mental health and that the talking approaches are helpful (Diabetic Medicine 2006;23: 917-9).

Handing out safety net prescriptions for antibiotics (to be used if symptoms persist) is common practice in UK primary care and is gaining popularity in the United States. In one US follow-up study, 62% of patients with otitis media never received any antibiotics after being issued with a safety net prescription, but the rate of recurrence or relapse was greater in children under 2 years old than in older children (34% versus 10%). Many doctors who participated in the original study continued to use safety net prescriptions (Clinical Pediatrics 2006;45: 518-24[Abstract/Free Full Text]).

Minerva's heard mixed reports from women having endometrial polypectomy in outpatient clinics. A study in BJOG (2006;113: 896-901[ISI][Medline]) reports it to be a great success, however, and urges outpatient services to be developed across the UK. Ninety five per cent of women in the outpatient cohort said they would choose outpatient clinics again if they needed further polyps removed, and 82% of the day case cohort said they would prefer to attend the outpatient clinic next time. Most of the women in the study were premenopausal, parous, and in paid employment.

Having drawn attention to the idea of using a lipid infusion to reverse local anaesthetic induced asystole (BMJ 2006;332: 372[Free Full Text]) and received at least one response that pointed out the lack of evidence of efficacy in humans, Minerva feels duty bound to keep readers up to date with recent events. A case report published in Anaesthesia (2006;61: 800-1[CrossRef][Medline]) describes the successful resuscitation of a human with a lipid infusion. There is also a non-commercial website (www.lipidrescue.org) devoted to spreading the word and collecting further case reports.

Resting in a chair for 16 minutes results in a significant drop in both systolic and diastolic blood pressure in untreated hypertensive patients (American Journal of Hypertension 2006;19: 713-7). The drop is due to systemic vasodilation, and 75% of the fall takes place within 10 minutes. Measurement of blood pressure in clinics might be more accurate if all patients could rest for 10 minutes before seeing the nurse or doctor.

A study designed to assess the attitudes of medical students towards racial diversity and sex equality showed that women and students from minority groups had more positive perceptions of race and sex than white men. Communication barriers and lack of sensitivity among healthcare professionals greatly affect clinical care, and future doctors need to be aware of their personal attitudes and develop their ability to empathise with people from different backgrounds (Medical Education 2006;40: 691-6[CrossRef][Medline]).

The severity of depression and anxiety is known to be associated with tinnitus, but now there's evidence that the severity of tinnitus is associated with the prevalence of these psychiatric disorders (Psychosomatics 2006;47: 282-8[Abstract/Free Full Text]). Attempting to treat tinnitus without looking at the associated mental health issues is likely to be unhelpful, and in time psychotherapy and psychotropic drugs may form part of the armamentarium against tinnitus.

Autistic children can exhibit challenging behaviour, but there's more to this than autism. Researchers describe in the American Journal on Mental Retardation (2006;111: 229-49) how the emotional "climate" of the family (known as expressed emotion) also has a role. A study of 149 mothers living with their adolescent or adult child with autism reports that high expressed emotion was related to increased levels of difficult behaviour in the child and more severe autistic symptoms. Characteristics of the child also influenced maternal expressed emotion over time.

A 75 year old man presented with a three week history of diarrhoea. He had had a percutaneous endoscopic gastrostomy tube inserted two years earlier after a hemimandibulectomy for a pathological fracture of his mandible left him unable to swallow solids. The diarrhoea occurred immediately after every feed and had the same smell and consistency as the feed. Computed tomography showed that the tube was in his transverse colon and he had a gastrocolic fistula. Such fistulas are late complications of percutaneous endoscopic gastrostomy tubes, and diarrhoea of this type should alert clinicians to this possibility. Anna Pantling preregistration house officer (annapantling{at}doctors.org.uk), Christopher Tibbs consultant gastroenterologist, Mark Bratby, specialist registrar in radiology Royal Surrey County Hospital, Guildford, GU2 7XX

 

An injectable male contraceptive regimen of norethisterone and testosterone tested on 90 men was well accepted over 12 months (Human Reproduction 2006;21: 2033-40[Abstract/Free Full Text]). The average age of the men was 28, and 75% of them said at the outset that they would try a hormonal contraceptive if available. At the end of the trial, 66% of the participants said they would actually use such a method. No one reported that the method was unacceptable, and there were no significant changes in sexual function or mood states. The biggest disadvantage was the injections themselves.

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BMJ 2006 332: 372. [Full Text] [PDF]