BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7512.360 (Published 04 August 2005) Cite this as: BMJ 2005;331:360

The Dorset based Scientific Exploration Society is looking for a fit doctor and a fit dentist to join an overland support group in November 2005 for an expedition led by explorer John Blashford-Snell, to navigate the Beschillo, one of the major tributaries of the Blue Nile. In addition to collecting geological data and cartographic information, the expedition will also work on several aid projects with local communities, including the refurbishment of a health clinic and construction of a new water well. For more information, telephone 01747 854898.

Liver toxicity is common with paracetamol (acetaminophen) poisoning, but little has been published about acute renal toxicity in such cases, although it is thought that N-acetylcysteine (used to treat hepatotoxicity) may cause renal problems. Data from one US poisons centre over one year report that nine of 11 patients admitted with raised liver function tests after paracetamol poisoning also developed acute renal injury, which was unrelated to the severity of liver injury. Most of them recovered within days, and N-acetylcysteine did not seem to make their condition worse (Renal Failure 2005;27: 381-3).

The way we store memories could be influenced by taking a β blocker, according to US psychiatrists (Nature 2005;436: 448-9). If it's taken at the “right” time it might be possible to prevent the panic experienced by people prone to post-traumatic stress disorder. The idea is to use the drug to break the association between the memory of a traumatic event and the experience of fear, and if the theory is correct the right time to take the drug in order to change the memory is when symptoms of panic start.

Final data from a European review of quality of life related to HIV that was conducted online by the European Men's Health Forum show that nearly half the Europeans living with HIV who took part in the survey are dissatisfied with their lives. Women were more likely to be dissatisfied than men. Men tended to be concerned with the treatment of side effects, emotional and physical wellbeing, ease of taking medication, and discrimination. Women put emotional wellbeing and discrimination at the top of the list (http://www.emhf.org/).

Whether using statistics to explain or baffle, the statistical adviser for the Swiss Medical Weekly offers the following rules of thumb on their use (2005;135: 337-8). Firstly, give all the data if there are few. Secondly, for a preliminary study based on a convenience sample, summarise data with descriptive statistics. Thirdly, for a random survey or randomised controlled trial, calculate confidence intervals. Fourthly, for observational studies, calculate confidence intervals by using multivariate models. Finally, if statistics don't offer added value, he says, simply leave them out.

Minerva's roving eye was caught by a tale with a twist. A paediatrician, writing in the Journal of Clinical Forensic Medicine (2005;12: 164-6) about a toddler who was rushed to hospital with a reduced conscious level, says it was the urine toxicology report that eventually produced the diagnosis of cannabis ingestion. Another clue was the observation that the child had already developed the fine motor skills to feed herself when she was seen stuffing loose pieces of crayon into her mouth after she'd made a full recovery the next day.

You don't have to have brittle bones to sustain rib fractures with a chronic cough, but it helps. A single centre review of cough induced rib fractures over nine years found that 78% were in women; most fractures were found in the sixth rib and at the lateral aspect of the rib cage. Bone densitometry was performed in half the patients, and 65% of these had osteopenia or osteoporosis (Mayo Clinic Proceedings 2005;80: 879-82).

A lively debate about whether or not parenthood is a right lights up the latest issue of the Archives of Disease in Childhood (2005;90: 782-5). One writer wants to see more focus on parental responsibilities than parental rights, less on the right to have a child, and more on the needs and welfare of all children. The other side claims that since the experience of parenthood is central to individual identity in most societies, the United Nations Universal Declaration of Human Rights could be invoked.

How many of us munch our way through our working day? Finnish researchers think they've found a link between work stress and body mass index (BMI), but it's a weak one. They've collected data from more than 45 000 employees and found an association between lower job control, higher job strain, a poor balance between effort and reward, and a higher BMI (Psychosomatic Medicine 2005;67: 577-83). But most of us probably just eat too much and exercise too little.

Although patients who bring in reams of information they've printed off from the internet can be daunting, some doctors actively encourage their patients to read as a form of self-help. One general practice in Somerset that provides a library for patients says “Don't panic about not getting your books back”—the return rate is 98.4% (Journal of Family Planning and Reproductive Health Care 2005;31: 243-4). Minerva is a little sceptical that these findings would be replicated everywhere.

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This 73 year old man was admitted to an emergency unit with a six month history of weight loss and malaise. On examination he had lymphadenopathy and dry skin. He had noticed his skin becoming increasingly dry over the previous three months. The skin showed widespread adherent scales consistent with ichthyosis. Investigations including lymph node biopsy found nodular sclerosing Hodgkin's disease, stage IVB. Acquired ichthyosis may be an important marker of Hodgkin's disease, particularly lymphoma, and can precede the presentation of the underlying neoplasm. Emollients may help, but the definitive treatment of the malignancy is required to control the skin symptoms. Relapse of the ichthyosis can be evidence of a recurrence of the malignancy.

V Madan (vishalmadan{at}doctors.org.uk), specialist registrar, dermatology centre, JB Houghton, consultant, department of haematology, R Ead, consultant, dermatology centre, S Walker, specialist registrar, dermatology centre, Hope Hospital, Manchester M6 8HD

Some of us were brought up to believe that Heberden's and Bouchard's nodes (firm swellings at the distal and proximal inter-phalangeal finger joints, respectively) found in isolation are not particularly indicative of anything pathological. But an x ray study in the Annals of the Rheumatic Diseases (2005;64: 1214-6) refutes this. The authors report a positive relation between both types of nodes and underlying radiographic changes of osteoarthritis, especially the formation of osteophytes.

Guidance at bmj.com/advice

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