BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7522.974 (Published 20 October 2005) Cite this as: BMJ 2005;331:974

Minerva suspects that most BMJ readers think that our current epidemic of obesity can best be understood as a sociological phenomenon. Many scientists, on the other hand, prefer to make sense of it in terms of the physiology of appetite control. If you can get past the rebarbative nomenclature, an article in Physiological Reviews (2005;85: 1131-58) will bring you up to speed on neuropeptide Y, ghrelin, oxyntomodulin, glucagon-like peptide 1, and the many other hormones that regulate food intake.

Researchers investigating the “ow” factor have found that more than half of young children give spontaneous verbal expressions of pain when immunised. Children aged 4-6 were videotaped as they had their pre-school immunisations. Fifty three per cent of them used verbalisations to express their pain. “The modal verbalisation was the interjection ‘Ow!,’ which expressed negative affect and was specific to the experience of pain,” say the Canadian authors writing in the Clinical Journal of Pain (2005;21: 499-502). Well there's a surprise.

Have you ever talked to patients about their health problems on the phone? It can be fraught with danger, say American researchers (Journal of General and Internal Medicine 2005;20: 959-63). They use six common situations in medicine to highlight mistakes that can occur when contact is made by phone and describe management strategies to minimise these errors. Only 6% of US residency programmes currently teach telephone medicine, and the authors suggest that it should now be part of the curriculum.

Minerva recently heard about the ultimate cure for athlete's foot. According to a BMJ reader, the only thing that worked for a 60 year old non-diabetic man, after years of trying terbinafine, miconazole, tolnaftates, griseofulvin, natural fibre socks, and local “dry” hygiene, was a powder containing disodium diphosphate, sodium hydrogen carbonate, wheat flour, and raising agents. He applied baking powder between his toes three times daily for two weeks, and the infection finally cleared.

Bonding and building trust in social interactions may be mediated by the hormone oxytocin. Female mice bred to be deficient in oxytocin receptors displayed impaired nurturing towards their pups (forgetting to retrieve them when they wandered off) and receptor deficient male mice tended to be more aggressive towards other males and displayed “social amnesia” when separated from and then reintroduced to female mice (www.pnas.org/cgi/doi/10.1073/pnas.0505312102). The authors say their findings may shed light on social behaviour disorders in humans, such as autism.

Another hormone under the spotlight is progesterone. Its increased production during the luteal phase of the menstrual cycle (from day 18-24) may be responsible for the decreased anaesthetic requirements of women during this phase. Twenty women in the follicular phase (day 1-10) were compared with 20 women in the luteal phase during general anaesthesia (Anaesthesia and Analgesia 2005;101: 1007-11). The amount of sevoflurane needed to sustain anaesthesia in the follicular group was significantly greater than in the luteal group.

Natural vitamin E, known as α tocotrienol or TCT, has neuroprotective properties for mice and rats with induced stroke or spontaneous hypertension. A complex series of experiments described in Stroke (2005;36: e144-52) found that TCT protected neurones from a glutamate challenge and that rats supplemented with oral TCT showed more protection against stroke induced injury than matched controls.

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A 68 year old Hindu priest complained of recurrent painless swelling of the eyelids over two months after repeated exposure to flames from funeral pyres. He had patchy loss of pain and temperature sensation on his face and neck. There were symmetrically distributed skin nodules, plaques, and diffuse, non-pruritic, shiny facial skin patches. He also had eyebrow and periorbital erythematous infiltration; loss of eyelashes and lateral eyebrows; swollen eyelids and lips; prominent forehead folds; and infiltrated, pendulous earlobes. These are the leonine facies of lepromatous leprosy. Nasal blow and skin slit smears showed Mycobacterium leprae bacilli in large clumps (globi).

Ajit Singh Kashyap (kashyapajits{at}yahoo.com), associate professor, Command Hospital (Southern Command), Pune 411 040, India, Kuldip Parkash Anand, professor, Command Hospital (Eastern Command), Calcutta, India, Surekha Kashyap, consultant in hospital administration, Command Hospital

(Southern Command)

Working in the emergency department is like working in a fish bowl, says a writer in Academic Emergency Medicine (2005;12: 956-7). Everyone sees what you're doing and offers advice, and you are often subjected to the “retrospectascope.” This particular clinical tool is often used without specific training, and no preparation is needed. But if the fish bowl contains an excess of internally generated contaminants (dysfunctional operations and services), the water may attract sharks. And swimming with sharks in a fish bowl may decimate the bowl's stable ecosystem, which must be avoided at all costs.

Does total hip replacement improve your balance? In the early post-operative stage it does, but by 12 months the results of balancing tasks in patients with hip replacement approached those of the control group. Trunk pitch (forwards-backwards) and roll (side to side) velocities were less stable after surgery, however, suggesting that patients are still at risk of falls (Journal of Bone and Joint Surgery (Br) 2005;87: 1337-43).

A study of smoking during pregnancy in Turkey found that the percentage of women who smoked at the end of their pregnancy dropped to 9.8% from 26.5% at the start of pregnancy. However, over half of the fathers who smoked continued to smoke at home throughout the pregnancy. Low birth weight and preterm delivery rates were significantly higher in both maternal and paternal smoking groups than in the non-smoking group. Paternal smoking, however, had no effect on intrauterine growth retardation or prenatal death, whereas maternal smoking definitely did (Croatian Medical Journal 2005;46: 832-7).

Humour, when used sensitively, can build connections between the caregiver and patients, but insensitive joking is offensive and distressing. A review of humour in medicine in the Oncologist (2005;10: 651-60) says that acceptance of humour by patients with life threatening illnesses is variable, making it a high risk, although sometimes very successful, strategy. But at worst, it can be a “pejorative maker of an adverse power differential.”

Guidance at bmj.com/advice

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