Minerva

Minerva

BMJ 2001; 323 doi: http://dx.doi.org/10.1136/bmj.323.7315.760 (Published 29 September 2001) Cite this as: BMJ 2001;323:760

The Australian measles control campaign was launched in 1998. In the six months after the campaign, coverage of measles, mumps and rubella (MMR) vaccine improved greatly and measles seropositivity rose from 82% to 89% in preschool children and to 94% in 6-11 year olds. Uptake fell again a year later (Bulletin of the World Health Organization 2001;79:882-7). Minerva thinks this indicates the need for annual campaigns, but she wonders if Australia—like the United Kingdom—also fell victim to negative media coverage.

It's official. Sexual activity increases the risk of myocardial infarction (relative risk 2.1 during the hour after sexual activity, with a risk of 4.4% in sedentary patients). But the absolute risk per hour is extremely low, and only 1.3% of 699 patients admitted with a first heart attack had participated in sex up to two hours before the infarct. The authors urge that patient counselling should focus on improved fitness, not abstention from sex (Heart 2001;86:387-90).

Could dietary antioxidants such as vitamin E be useful in the treatment of osteoarthritis? A six month double blind, randomised, placebo controlled study of vitamin E for symptomatic osteoarthritis of the knee has found no benefit at one, three, and six months for any of the primary outcome measures of pain, stiffness, and function (Annals of the Rheumatic Diseases 2001;60:956-9).

Homoeopathic arnica cream has gathered a faithful following and is often bought over the counter for bruises and minor trauma. The act of rubbing it in may well be soothing, but in four placebo controlled trials arnica was found to be no more effective than the placebo. The age old treatment of applying ice and immobilisation may be more beneficial (Prescrire International 2001;10:156).

Yet another negative result—this time the impact of problem drinking on employment. Social cost studies often suggest that alcohol misuse imposes a great economic burden on society, most of which is due to the loss of work productivity and wages. A study of 7620 adults of working age (which used a new database and methodology) indicates that problem drinking and labour are unrelated, and says that earlier estimates of productivity lost through alcohol use have probably been overstated (Health Economics 2001;10:509-21).

A study investigating whether excess morbidity in winter is related to ill health produced by exposure to ambient low temperatures has unexpectedly thrown up an alternative hypothesis. The data indicate that excess winter morbidity may actually be related to health benefits derived in the summer, which are likely to be available to more affluent people. The authors propose that this new theory should be tested in a study designed specifically for the purpose (Journal of Public Health Medicine 2001;23:237-41).

Current Problems in Pharmacovigilance (2001;27:10) says there are continuing safety concerns with off label use of propofol in children. The BMJ previously reported that if propofol had been studied as part of a clinical trial in children, one death would have led to an urgent reappraisal of the trial and treatment. An unpublished clinical trial comparing propofol 2% and 1% against other sedating agents in children now confirms an excess of deaths in the propofol groups (11% and 8% compared with 4% in controls).

Understanding the anatomy of the temporal bone is essential for any otologist. In the wake of the Alder Hey Enquiry a shortage of bones obtained from postmortem examinations is threatening supplies of temporal bones and temporal bone training courses. The Royal College of Pathologists has issued a preferred form for consent to postmortem examination. Use of this, together with closer cooperation with other hospital colleagues and information for relatives (www.cmht.nwest.nhs.uk/morris) should boost supplies again (Journal of Laryngology and Otology 2001;115:689-93).

To document the incidence of Giardia lamblia and the influence on this of breast feeding, 152 infants in rural Egypt were followed from birth to a year. The incidence of asymptomatic infection was 4.5 episodes per child year, and babies who were exclusively breastfed had a lower risk for both asymptomatic and symptomatic infections. Breast feeding reduced the amount of mucus in the stool, loss of appetite, and abdominal tenderness seen in infected babies (American Journal of Tropical Medicine and Hygiene 2001;65:257-60).

The radiograph taken immediately after a primary knee replacement (top) suggests a supracondylar fracture of the femur; a rare but recognised complication after knee replacement. Some surgeons advocate immediate revisional surgery with a long stemmed component. The patient was advised of the fracture and was managed conservatively with a splint. A week later, a follow up film (bottom) showed that the fracture had healed. Similar appearances were seen in another patient's films. The cause was thought to be artefactual crinkling of the film before it was developed. Radiological artefacts are rare but should be considered in the differential diagnosis.

D G Dunlop, specialist registrar, R W Nutton, consultant, Princess Margaret Rose Orthopaedic Hospital, Edinburgh EH10 7ED

The radiograph taken immediately after a primary knee replacement (top) suggests a supracondylar fracture of the femur; a rare but recognised complication after knee replacement. Some surgeons advocate immediate revisional surgery with a long stemmed component. The patient was advised of the fracture and was managed conservatively with a splint. A week later, a follow up film (bottom) showed that the fracture had healed. Similar appearances were seen in another patient's films. The cause was thought to be artefactual crinkling of the film before it was developed. Radiological artefacts are rare but should be considered in the differential diagnosis.

D G Dunlop, specialist registrar, R W Nutton, consultant, Princess Margaret Rose Orthopaedic Hospital, Edinburgh EH10 7ED

Minerva is occasionally asked about “magnetic treatment” for depression, but it's not something she knows very much about. Repetitive transcranial magnetic stimulation (rTMS) sems to be potentially beneficial for numerous psychiatric disorders, including depression and mania. rTMS produces a strong magnetic field that induces electric currents. These modulate the neuronal circuits that are thought to be dysfunctional in such disorders. A detailed review of the topic in the Journal of Psychiatric Research (2001;35:193-215) says that these changes are reminiscent of those produced by antidepressant drugs.

Roll up, roll up! Last chance for budding performers to submit a sketch to this year's BMJ Christmas revue. The theme is “48 minutes to save the NHS,” and this can be interpreted as loosely as you want. Contributions should be no longer than five minutes, and ideas can be submitted as videos, audiotapes, or on paper. The revue will be held in London on Wednesday 28 November. Final deadline for receipt of submissions is lunchtime on Tuesday 2 October. Please send or email to Gaby Shockley (gshockley{at}bmj.com).

Footnotes

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