MinervaBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6963.1242 (Published 05 November 1994) Cite this as: BMJ 1994;309:1242
A new class of memory enhancing drugs known as ampakines is being investigated in experiments on rats, and the early results suggest that treatment enhances the animals' performance in learning the way through a maze (Science 1994;266:218-9). The hope is that these drugs may be useful in memory disorders such as Alzheimer's disease, but if they speed learning many healthy people may want them too.
Some messages are worth repeating again and again: one is the value of training members of the public in cardiopulmonary resuscitation. A report in the “British Heart Journal” (1994; 72:408–12) from Gothenburg describes 1660 patients who had a cardiac arrest outside hospital. Survival was 25% in those in whom resuscitation was given by a bystander and only 8% in those in whom no help was given until the ambulance arrived.
The standard triple treatment for eradicating Helicobacter pylori uses metronidazole, but in developing countries the bacterium is often resistant to this drug. In a study in London (Gut 1994;35:1562–6) 27 out of 30 patients of Bengali origin being investigated for dyspepsia were found to have resistant forms of the organism in their stomachs. The report concludes that these findings “constitute a therapeutic problem to which there is as yet no clear solution.”
Ethnic, racial, and geographical variations in disease need to be considered in many settings in multiracial Britain. A report in the “Annals of Rheumatic Diseases” (1994;53:675–80) from Nottingham describes all the patients with systemic lupus erythematosus in the health district. The rate among Afro-Caribbeans was 207/100 000, ten times higher than the 20/100 000 in white people. The rate in Asians was 50/100 000.
Giving reassurance to patients requires reliable data on which to base the opinion, so Minerva was pleased to read a report from Canada (Lancet 1994;344:1134–6) of a follow up of 1296 babies whose mothers had amniocentesis during pregnancy. These infants had no higher rates of abnormalities than controls - with one exception: six children of women who had had amniocentesis had haemolytic disease due to ABO isoimmunisation as against only one born to the 3704 control women.
Studies of the treatment of back pain rarely seem to yield clear cut results, and a paper in “Spine” (1994;19(suppl):2041–6) goes some way to explaining the difficulties. This type of pain may be acute (of recent and sudden onset), transient (lasting no more than 90 days), recurrent (occurring on fewer than half the days in 12 months), or chronic (occurring on at least half the days in 12 months). Each of these types of pain has a highly variable course.
In African countries in which malaria is endemic, such as Ghana, it may account for close to 10% of deaths (World Health Forum 1994;15:265–9). The cost of treating a single patient has risen recently (with more resistance to chloroquine) to around $16; in 1995 for Africa as a whole the economic burden of malaria is expected to be $1.7bn - 1% of the continent's resources.
Calcium citrate is said to provide greater bioavailability of calcium than other salts and so is being recommended as a supplement for prophylaxis against osteoporosis. The drawback, says an article in the “Southern Medical Journal” (1994;87:894–8), is that citrate may enhance the absorption of aluminium from food and tap water, raising the concentration of the metal in the blood - which may be harmful to elderly women with poor renal function.
The decision by two Roman Catholic boys' schools to recommend that their pupils should not receive rubella vaccine because it is derived from cells from an aborted fetus seems to Minerva to be yet another example of male celibate theologians putting the spiritual welfare of men ahead of the physical welfare of women. And what will they advise about other vaccines derived from fetal cells, such as rabies vaccine?
Bacillus cereus, which grows on rice, may cause food poisoning but may also be a cause of meningitis. Investigation of two patients who developed this illness after neurosurgery (Epidemiology and Infection 1994;113:297–306) found that the source of the infection was theatre linen. The spores of B cereus had multiplied on used linen stored in plastic bags, and laundering in a batch continuous washing machine had not got rid of the bacteria, which had presumably spread from the theatre clothing into the air of the operating suite.
An account in “Paraplegia” (1994;32:697–9) of his own experiences by a man with muscular dystrophy asserts that any disabled person who can see and can operate a single joystick can drive a car. Sadly, the government's motability allowance does not cover all the costs, but at least the technical problems have been solved.
Do cardiologists in the United States overtreat their patients? A massive study based on 3000 patients suggests not. It compared patients treated for acute myocardial infarction in the United States and in Canada (New England Journal of Medicine 1994;331:1130–5) and found, as expected, that twice as many of the American patients had had angioplasties or bypass operations - and that at 12 months the Americans scored higher on measures of functional status and quality of life.
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