BMJ  2006;333:610 (16 September), doi:10.1136/bmj.333.7568.610

Minerva

Minerva

A little change here and there can make a huge difference. The children's ward in Addenbrooke's Hospital in Cambridge has introduced a chef to the team. The ward cook has been cooking to order, allowing children to request food from a range of delicacies at a time that suits them. The scheme was cooked up when it became apparent that meal times clashed with children's treatments and failed to take account of the sensitivity of tastebuds and reduced appetite that can be induced by chemotherapy and radiotherapy (Health Service Journal 2006 Aug 31: 10).

Nerve endings in the skin that respond to cold temperatures and to chemicals that simulate cold, such as menthol, may offer a new avenue for treating chronic pain due to nerve injury. British researchers induced chronic pain in rats and then treated them with menthol or icilin (a similar cooling chemical). Both treatments activated the so called coolness receptor in the skin, producing an analgesic effect (Current Biology 2006; 16: 1591-605[CrossRef][Medline]).

Two million years ago, the primate brain started growing in size at a disproportionate rate, outstripping the mental complexity of its simian cousins. And thanks to the growth in genomic technology, we are beginning to understand what genetically separates humans and animals. Scientists have identified certain highly accelerated regions (HAR) of the primate genome that have evolved rapidly and recently in the evolutionary timescale. Surprisingly, HAR1 codes not for a protein but for an RNA molecule that is expressed in the early fetal life of the human neocortex. A human gene seems to have won the genome race after all (Nature16 Aug 2006; doi: 10.1038/nature05113).

Epidemiologists in the European Journal of Cancer (2006;42: 1835-8) say their retrospective analysis of 79 patients with primary fallopian tube carcinoma shows that past Chlamydia infection does not have a role in the cancer's aetiology. However, they have confused Minerva by pointing out that because chlamydial infection is common at a young age, and primary fallopian tube carcinoma develops decades later, they cannot "definitively exclude the possibility that C trachomatis contributes to the development" of this disease.

McDonald's fast food chain has just been awarded the booby prize for being the least friendly place in Britain to breastfeed, and Ikea was awarded the prize for being the best. The booby prize was launched by the National Childbirth Trust to give to companies for either appalling or outstanding treatment of breastfeeding mums, and nominations were invited from anywhere in the United Kingdom (www.boobyprize.nct.org.uk). Companies in Scotland, which has a law protecting a woman's right to breastfeed in public, received very few nominations.

Imatinib has proved highly effective in the treatment of chronic myeloid leukaemia, but its success is not without side effects. Researchers report on 10 patients taking imatinib who developed severe congestive cardiac failure (Nature Medicine 2006;12: 908-16[CrossRef][ISI][Medline]). Mice treated with imatinib also developed left ventricular contractile dysfunction. The cardiac myocytes taken from both humans and mice showed features suggestive of toxic myopathy, and the researchers found signs of apoptosis, indicating that the cardiac cells were moving towards cell death.

A cancer cluster thought to be caused by a huge telecommunications mast caught the attention of the media in Northern Ireland, resulting in the mast being taken down in 2002. But an extensive investigation showed just three cases of malignant cancer from an original alleged cluster of 11 cases, and a further 17 cancers of mixed types in keeping with the population pattern of cancers. Standardised incidence and mortality rates were within or lower than the expected ranges. These negative findings, however, received scanty media attention (Ulster Medical Journal 2006;75: 195-9[Medline]).

High fibre diets are promoted for good bowel health in adults, but what about children? A randomised controlled double blind trial of a high fibre cocoa husk supplement in children with constipation concludes that it is beneficial for chronic idiopathic constipation, which accounts for over 90% of children who are constipated. The benefits are more obvious in children with a slow transit time (Pediatrics 2006;118: e641-8[Abstract/Free Full Text]).

It is easy to assume that the worse the pain described by patients, the higher their pulse, blood pressure, and respiratory rate might be. However, a retrospective extraction of data from adults presenting with verifiable painful conditions at one emergency department found no association between self reported pain scores at triage and vital signs. These results caution against using vital signs to determine patients' needs for analgesia (Academic Emergency Medicine 2006; 13: 974-9[CrossRef][Medline]).

Depression can have a negative effect on all aspects of a person's job performance, from interpersonal skills to managing time and output tasks. What is more interesting is that, even when the depression has lifted and the symptoms have resolved, performance still differs between the control group and the clinically improved depressed patients (American Journal of Psychiatry 2006;163: 1569-76[Abstract/Free Full Text]).

View larger version (189K): [in this window] [in a new window]   This 32 year old patient with keratoconus had attended our clinic three months earlier with an unexplained coloration of both her soft contact lenses, causing everything she saw to have a pink tinge. Recent clinic review found this was due to the colour pigments of her eye shadow. Colouring of tears (for example, with fluorescein dye) can cause irreversible staining of the hydrophilic soft contact lens, and our patient's symptom resolved after she changed the brand of her eye make-up. Say Aun Quah (sayaun{at}lineone.net), specialist registrar, Rosalind Stewart, senior house officer, Mark Batterbury, consultant, Stephen B Kaye, consultant,St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP

A potential saving of over £300 000 (442 000; $561 500) a year could be made in just one orthopaedic unit by performing intraoperative cell salvage and administering tranexamic acid to reduce the need for blood transfusions in revision hip surgery (Journal of Bone and Joint Surgery (Br) 2006;88: 1141-2). The intervention group required 52 units of blood compared with 139 in the control group, representing a reduction in use of blood of almost 63%.

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