Minerva

Minerva

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7009.886 (Published 30 September 1995) Cite this as: BMJ 1995;311:886

Another case of bat rabies has been reported from the United States (Morbidity and Mortality Weekly Report 1995;44:625-7). A girl aged 4 died of the disease, and a bat that had been found dead in her bedroom a month before she became ill was exhumed and found to have rabies virus DNA in its brain. Since 1980, 12 of the 25 confirmed deaths due to rabies in the United States have been linked with bats. Postexposure treatment should be given whenever there are grounds for considering a bat bite to be a possibility.

Half way through a marathon a man aged 32 found that pain in his hip and groin, which he had had for a week, had worsened to the point that it prevented him taking his weight on the leg. The case report in “Injury” (1995;26:491-3) describes how he twice attended a major teaching hospital but no radiographs were taken; eventually, after six weeks, an x- ray film confirmed the clinical diagnosis of a displaced stress fracture of the neck of his femur. Six months passed before he could be advised to allow unprotected weight bearing.

Twenty years after the recognition of Lyme disease it is worth recalling that the mother of one of the early patients had great difficulty in finding a doctor prepared to consider the possibility that the epidemic of juvenile arthritis in the Connecticut town might have an infective origin (Chest 1995;108:565-9). She talked to half a dozen doctors before she found one who would listen. Today doctors are even busier: how many nowadays have the time to allow their intellectual curiosity free rein?

Do the Irish drink to excess more than other nations? A review in “Alcohol and Alcoholism” (1995;30:407-17) provides some data. The Republic of Ireland has a higher proportion of total abstainers than Britain, but if they consume alcohol at all Irish men and women are likely to drink slightly more than their British counterparts. Irish women in non-manual occupations drink substantially more than British women of the same class.

Doctors and NHS managers who receive a chain letter asking them to send cards to a boy with cancer, Craig Shergold, should ignore the request. This well meaning scheme got out of hand in 1992 (BMJ 305:1176), when the boy's family was trying to cope with literally millions of cards, and it now seems to have started up again. The family wants to be left in peace. Break the chain.

What happens to people who donate a kidney to a relative? A report in “Kidney International” (1995;48:814-9) based on 48 studies on 3124 patients concludes that the immediate fall in glomerular filtration rate resolves with time and that the only adverse effect is a small, clinically unimportant rise in blood pressure.

What is the best way of identifying people at increased risk of coronary heart disease because of raised lipid concentrations? A comparison of screening guidelines used in Canada and the United States (JAMA 1995;274:801-6) concluded that the ratio of total plasma cholesterol to high density lipoprotein cholesterol is as good a predictor as results of more elaborate investigations. The report also emphasises the importance of the doctor taking other risk factors into account when assessing an individual patient.

Home delivery has many advantages, but the boost that it gives to women's morale seems not to affect their susceptibility to mental illness. A report in the “British Journal of Obstetrics and Gynaecology” (1995;102:701-6) looked at 293 Dutch women having babies, 52% of whom gave birth at home. No difference was found in the frequency either of “birth blues” or of postnatal depression.

Gout now affects 10 of every 1000 people in England--a prevalence more than three times higher than that in the 1970s (Journal of Clinical Epidemiology 1995;48:1153-8). The authors of a study from general practice believe that the probable explanation is that the population has become fatter. Almost half the patients in the survey were taking prophylactic treatment with allopurinol.

Figure1

A woman aged 77 was admitted for investigation of rest pain in her left foot. Her general practitioner had started treatment with inositol, a vasodilator. She was found to have a maculopapular rash, consistent with erythema multiforme, which spared only the left leg. The rash resolved when the drug was stopped. Angiography showed an occlusionof the left external iliac artery, which was successfully treated by angioplasty. The vasodilator seemed to have had little therapeutic effect--but it had proved an accurate diagnostic tool.--N J EVERITT, registrar in surgery, Barnsley District General Hospital S75 2EP

Interviews with 93 patients who had been treated for seasonal affective disorder between 1985 and 1988 showed that the condition had persisted in 35, that 28 had had further episodes of non-seasonal depression, and that 17 had remained completely well. In 13 the symptoms were not clear enough for reliable classification (British Journal of Psychiatry 1995;167:380-4). The authors conclude that diagnostic criteria need to be refined further if they are to be used to predict the future course of seasonal illness.

Among the benefits of taking regular exercise is an increase in self esteem, says a review in the “Canadian Medical Association Journal” (1995;153:317). Men and women of all ages who take regular exercise have a better image of themselves than people who do not take exercise: physical activity “provides opportunities for feeling successful and competent.” That's OK for those who achieve their targets--the unfortunates who drop out of the training run may feel quite the opposite.

Drug combinations given intravenously are highly effective in preventing vomiting in patients taking anticancer drugs, but these regimens are not ideal for use in the home. Research at the Memorial Sloan Kettering Cancer Center in New York has shown that a combination of metoclopramide, dexamethasone, and diphenhydramine taken by mouth (Cancer 1995;76:774-8) was successful in preventing vomiting in three quarters of the patients with small cell lung cancer being treated with cisplatin and the same proportion of those taking cyclophosphamide and doxorubicin.

All the residents of Rochester, Minnesota, receiving treatment with warfarin were included in a study reported in the “Mayo Clinic Proceedings” (1995;70:725-33). A total of 261 patients had received treatment for 221 patient years. The cumulative incidence of major haemorrhage at 1, 3, 12, and 24 months was 1.6%, 3.3%. 5.3%, and 10.6%. Patients known to have malignant disease at the start of anticoagulant treatment had a higher risk of bleeding.

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