BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7437.472 (Published 19 February 2004) Cite this as: BMJ 2004;328:472

A man swimming offshore near Sydney was bitten by a two foot long Wobbegong shark. When the shark refused to let go, he swam to shore, walked to his car, and drove to the local surf club with the shark still attached. On seeing the spectacle, a lifeguard said, “There's nothing in our procedure manual for that type of thing.” The swimmer had only puncture wounds and didn't need stitches, but was given prophylactic antibiotics (http://news.bbc.co.uk/ 11 February 2004).

The National Heart, Lung and Blood Institute family heart study reports in the American Journal of Clinical Nutrition (2004;79: 213-7) its attempt to discover the true link between eating fruit and vegetables, and low density lipoprotein cholesterol. Regression models using data from almost 4500 people show that consumption of fruit and vegetables is inversely related to low density lipoprotein in both men and women, independent of age. The data are self reported, so a reporting bias may have affected the estimates of the effect.

More fruit and veg: the time bomb of obesity is being tackled in the UK partly by government funding amounting to £77m, which is being allocated to establishing a programme of free fruit in schools. Children aged 4-6 years in state schools will be entitled to a free piece of fruit or vegetable each school day, in accordance with the NHS Plan. This will involve distributing 440 million pieces of fruit and vegetables to more than two million children in 18 000 schools across England (CMO's Update 37, January 2004; www.doh.gov.uk/cmo)

Another anti-obesity measure may ultimately prove more harmful than we realise. A paper in Nature Medicine (2004, advance online publication doi:10.1038/nm993) points the finger at some of the drug compounds being developed to treat obesity. Such compounds enhance the effects of PPAR-g (peroxisome proliferator-activated receptor-g), which turns out, when activated, to increase the number and size of precancerous intestinal polyps in mice.

Cardiac patients undergoing surgery often end up low in potassium because of diuretic treatment. A randomised trial in postoperative cardiac surgery patients of potassium supplementation diets versus pills found that eating foods rich in potassium (such as bananas, potatoes, raisins, and avocados) was just as effective at maintaining serum potassium levels as taking pills. This resulted in significantly shorter inpatient stays, and greater patient satisfaction, due to fewer side effects Chest 2004;125: 404-9

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A 19 year old man presented to the emergency department with large, fluid filled blisters on the back of his right hand. Three days earlier he had received cryotherapy for a florid eruption of viral warts over his right hand. The resulting superficial burns healed satisfactorily after debridement of the blisters and subsequent dressings. The patient required one further cryotherapy treatment for a solitary wart on his thumb. Cryotherapy with liquid nitrogen is a widely used local treatment of warts caused by the human papillomavirus. Pain and blistering are recognised complications.

Rahil Shah, senior house officer, H J C R Belcher, consultant hand and plastic surgeon, Queen Victoria Hospital, East Grinstead RH19 3DZ

Despite the popularity of optimism among some healthcare workers, having a positive attitude didn't improve the survival rate of 179 patients with a common form of lung cancer. Reporting a paper published in the latest edition of Cancer, one of the researchers said, “We should question whether it is valuable to encourage optimism if it results in the patient concealing his or her distress in the misguided belief that this will afford survival benefits” (Tallahassee Democrat, 9 February 2004).

Art, however, may be more helpful. “Art that distracts and engages a patient's mind with cheerful and calming colors, forms and images can… reduce the high levels of anxiety that are often present in… waiting rooms,” says an artist and cancer survivor. He continues, “When patients are relaxed and receptive, they place themselves in the best possible state of mind and spirit for medicine to do its work.” The Oncologist (2004;9: 111-4) describes the effects of an exhibition at the Massachusetts General Hospital Cancer Center.

Footballing injuries seem to beget more injuries, according to a prospective cohort study from Iceland reported in the American Journal of Sports Medicine (2004;32(suppl): 5-16S). Previous hamstring strains and previous groin strains predispose to further hamstring and groin injuries, and any previous injury was identified as a risk factor for knee and ankle sprains. Age is another risk factor.

A bill that is being considered by the Maryland Senate Judicial Proceedings Committee would allow some doctors in that state to carry guns and make arrests. The legislation would allow sheriffs to appoint physicians as county medical advisors; they would then receive police training, conduct investigations, and make arrests in cases that involve biological weapons or other “catastrophic health emergencies” (Washington Times, 5 February 2004).

Pain is a symptom that has an impact on the response to antidepressant treatment. An analysis of data from a randomised controlled trial with follow up in 37 primary care clinics found that at the start of the trial, more than two thirds of depressed patients reported pain. After three months of treatment with antidepressants, the odds ratios for poor response to treatment were 1.5 for mild pain, 2.0 for moderate pain, and 4.1 for severe pain, compared with response in patients without pain (Psychosomatic Medicine 2004;66: 17-22).

Guidance at bmj.com/advice

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