BMJ  2003;327:E194 (4 October), doi:10.1136/bmjusa.03020009 (published 26 March 2003)

BMJ USA: Minerva

Minerva

From BMJ USA 2003;Feb:116

It's apparently not that easy to diagnose Parkinson's disease in the community. As part of a London based prevalence study, an analysis reveals that at least 15% of people who have been diagnosed as having Parkinson's probably don't fulfill strict criteria for the disease. A further 20% who have sought medical attention probably do have the disease, but haven't been given a diagnosis ( Journal of Neurology, Neurosurgery and Psychiatry 2002;73:529-534[Abstract/Free Full Text]).

When people tackle their smoking habit, they obviously hope that stopping will have an impact on their health. The findings of a Danish population study that looked at the risk of hospital admission for people with chronic obstructive pulmonary disease show that stopping smoking altogether can bring about a 40% reduction in morbidity. Cutting down, even by more than 50%, however, is of questionable benefit ( Thorax 2002;57:967-972[Abstract/Free Full Text]).

Infection with Giardia lamblia predominantly causes diarrhea. An Italian study—prompted by a local outbreak—found that 82% of people who were clinically affected also had pre-existing symptoms of irritable bowel syndrome. In these patients the antibiotic given to eliminate the bug didn't modify the symptoms, but in those without irritable bowel syndrome the treatment was clearly effective ( Journal of Infection 2002;45:169-172[CrossRef][Medline]).

Here's some heartwarming news about our furry friends. Pet ownership has been investigated one step further, this time to show that people with pets had significantly lower resting heart rates and blood pressures, and significantly lower heart rates and blood pressures when performing mental arithmetic, than people without pets. These variables also returned to their baseline measurements more quickly. Interestingly, in pet owners the greatest increases occurred in the presence of their spouse and the lowest in the presence of their pet ( Psychosomatic Medicine 2002;64:727-739[Abstract/Free Full Text]). Presumably pets are perceived as less judgmental than spouses.

Editors of medical journals are put in a difficult position if the associations that own their journal can dictate to them. Both JAMA and the NEJM recently lost their editors through over exuberant owner involvement. In a survey of editors of 33 journals owned by not for profit organizations, 70% reported that they had complete editorial freedom, while the rest said they had a high level of freedom. Despite this, 42% admitted they'd recently been under pressure from the leaders of their owning associations over editorial content. The authors warn editors that if they've not yet tested their freedom, they may actually have less than they perceive ( Science and Engineering Ethics 2002;8:513-528[Web of Science][Medline]).

The active ingredient in cinnamon spice—cinnamaldehyde—may be toxic to human cells, according to a report on BioMedNet (www.bmn.com; Nov 15, 2002). Apparently cinnamaldehyde blocks mitochondrial respiration and causes lysis of cultured liver cells. Previous research shows cinnamaldehyde causes fetal abnormalities in rats. Different countries allow different levels of cinnamaldehyde to be added to food, beverages, and cosmetics. What's not yet known is the level of cinnamaldehyde likely to cause problems in humans.

When teenagers come of age, parents tend to leave them alone for longer periods of time. Not surprisingly, there's an association between lack of supervision and risky sexual behavior, and one survey of highschool children reported in Pediatrics found that most underage sex takes place at home. A significant number of "encounters" took place before 6 pm. Boys who were unsupervised for more than five hours a week after school were twice as likely to have gonorrhea or chlamydial infections (www.pediatrics.org/cgi/content/full/110/6/e66).

A double blind crossover study of gabapentin to treat restless legs syndrome found that it improves both sensory and motor symptoms. In this short study it also seemed to improve sleep and reduce periodic leg movements during sleep and to be well tolerated. Traditional drug treatments for restless legs syndrome come with a plethora of undesirable side effects, so gabapentin may prove to be a great step forward ( Neurology 2002;59:1573-1579[Abstract/Free Full Text]).

Minerva was under the impression that it's poor pay that causes nurses to leave the profession, but an American survey suggests it's doctors behaving badly. More than a third of people interviewed reported that they knew of a nurse leaving an institution because of disruptive behavior by physicians, and 90% said they'd witnessed such behavior. Although two thirds said there were codes of conduct in place, less than half felt these were effective (Physician Executive Nov-Dec 2002:8-11).

View larger version (100K): [in this window] [in a new window]   A 73 year old woman had an isolated symptomless lesion on her right pinna for several years. It had the appearance of a granulomatous plaque. Urged by her son, she finally sought medical advice for it. Histology of the lesion confirmed a granulomatous reaction without an obvious cause. When a further biopsy was sent for microbiological culture the true diagnosis emerged as Mycobacterium tuberculosis infection. She had no evidence of tuberculosis elsewhere, but gave a strong family history—her father, grandfather, and uncle had all died of tuberculosis. Ravi Gowda, specialist registrar, Stephen T Green, consultant, department of infection and tropical medicine, David Gawkrodger, consultant, Kid Wan Shum, specialist registrar, department of dermatology, David Slater, consultant, department of pathology, Sheffield S5 7AU, UK Northern General Hospital, Robert Townsend, specialist registrar, department of microbiology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK

Although statins seem to be gaining credence in all manner of ways, their alleged substantial protection against osteoporotic fractures seems to be false. After analysis of data from their retrospective cohort study, its authors say the "protection" of statins in this arena can probably be explained by previously unmeasured confounding factors ( Injury Prevention 2002;8:276-279[Abstract/Free Full Text]).

A hotly debated premorbid question is about the influence of life events before the clinical manifestation of serious illness. A longitudinal study of people with relapsing-remitting multiple sclerosis in Psychosomatic Medicine (2002;64:916-920[Abstract/Free Full Text]) reports that 85% of exacerbations were associated with stressful life events in the preceding six weeks. On average, stressful life events occurred 14 days before reactivation of multiple sclerosis, compared with 33 days before a randomly selected control date.

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