MinervaBMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7018.1514 (Published 02 December 1995) Cite this as: BMJ 1995;311:1514
- C B KOAY, registrar,
- C A MILFORD, consultant ear, nose, and throat department
The higher the plasma homocysteine concentration the higher the prevalence of vascular disease in the coronary, cerebral, and peripheral arteries. A study of 16000 men and women in Norway (JAMA 1995;274:1526-33) has shown that concentrations of homocysteine were higher in men than women, rose with age, and rose with the number of cigarettes smoked—but were lower in those who took regular exercise. What is not yet known is whether plasma homocysteine is directly concerned in the pathogenesis of vascular disease or is just a marker for increased risk. There is some evidence that lowering the plasma homocysteine concentration reduces the incidence of thrombotic events.
Clinicians who are anxious about the recent upsurge in multiple drug resistance in bacteria should take some comfort from a report in “Science” (1995;270:724-7) headed “Antibiotics that resist resistance.” Large pharmaceutical companies have put a lot of money into at least 25 new drugs with chemical structures and actions unfamiliar to bacteria. The hope, says the report, is that because bacteria haven't yet come across these new types of antibiotics they will not be able to use their established methods of developing resistance.
Trials in Sweden of an acellular pertussis toxoid vaccine have given encouraging results (New England Journal of Medicine 1995;333: 1045-50).Side effects were only minor, and the protection given against whooping cough was substantial, though not complete. The research group is planning a mass vaccination campaign: it argues that the toxoid vaccine against diphtheria, which also gives incomplete protection, has made that disease virtually extinct.
The belief that women have more mental illness than men may be mistaken, according to an editorial in the “Medical Journal of Australia” (1995;163:434-5) based on a report from the National Health and Medical Research Council. The prevalences of schizophrenia and bipolar disorder are the same in the two sexes, and while women are more commonly diagnosed as having anxiety, depression, and eating disorder, men more commonly misuse alcohol and drugs and have antisocial personality disorders. Men commit suicide more commonly and are more often victims of post-traumatic stress disorder.
A rise in the concentration of carbon monoxide in the atmosphere led to an increase in rates of admission to hospital with congestive cardiac failure among elderly citizens of seven cities in the United States (American Journal of Public Health 1995;85:1361-5). Carbon monoxide is thought to raise the blood pressure and may have a direct toxic effect on the myocardium.
Seborrhoeic dermatitis affects a high proportion of patients infected with HIV—as many as 80% in some series—and is recognised as an indicator in stage II of HIV disease. A report in the “British Journal of Dermatology” (1995;133:694-8) found that recovery of Malassezia yeasts from patients with seborrhoeic dermatitis was no more common in those with HIV infection than in those with no evidence of the virus. The failure of that hypothesis means that no explanation can yet be offered for the high frequency of seborrhoeic dermatitis associated with HIV infection.
A study of the prevalence of Alzheimer's disease in African Americans and Nigerian Africans found that the age adjusted rates were 3.7% in Indianapolis and 1.4% in Ibad an (American Journal of Psychiatry1995;152:1485-92). The authors admit that their findings could have many explanations, but one interesting possibility is that Alzheimer's may be another disease associated with technically advanced societies.
The population of the United States accounts for 5% of the world's total but it consumes almost 50% of the world's illegal drugs, says a review by Joseph Califano of substance abuse published in “Tobacco Control” (1995;Suppl 2:19-22). “If a disease like cancer or diabetes afflicted as many Americans as tobacco, alcohol, and drug abuse and addiction do, this nation would mount a research effort on the scale of the Manhattan project to deal with it.”
Men with high serum cholesterol concentrations but no history of myocardial infarction benefit from cholesterol lowering drugs. A trial in Scotland in 6595 men aged 45-64 with cholesterol concentrations above 7 mmol/l compared pravastatin with placebo for five years (New England Journal of Medicine 1995;333:1301-7). There were 248 coronary events in the placebo group and 174 in the men taking the active drug. Overall mortality was 22% lower in the men given pravastatin than in those given placebo.
A man aged 60 presented with right sided deafness and a facial nerve palsy. A magnetic resonance imaging scan showed a mass lesion arising from the junction of the right clivus with the petrous bone. He was known to have multiple enchondromatosis (Ollier's disease), in which the chondromas may become sarcomatous. It is rare for the cranial bones to be affected. The lesion was resected, with a suboccipital and temporal craniotomy approach. Histological examination confirmed the clinical suspicion of a chondrosarcoma. After the operation the patient remained well.
Africanised or killer bees have become established in Mexico and the southern United States in the past 10 years and are continuing to proliferate (Archives of Internal Medicine 1995;155:2038-43). Mortality from attacks by the bees has been put as high as 15%, with more than 190 reported deaths in Mexico. The authorities have mounted a public education campaign intended to reduce the numbers of potential sites for new colonies.
Should ethics journals be discussing dilemmas that may never occur in the real world? Minerva found some problems in deciding her response to an article in the “Journal of Medical Ethics” (1995;21:292-7) which postulated that homosexual orientation might become diagnosable early in pregnancy and that the orientation could be changed to heterosexual by means of a single injection of an androgen. Should parents be given the information and allowed to choose to do nothing, to have the androgen given, or to have the pregnancy terminated?