BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e7223 (Published 31 October 2012) Cite this as: BMJ 2012;345:e7223

Does the intake of dairy products affect blood pressure? In a meta-analysis of nine cohort studies that followed up a total of 57 000 subjects for between two and 15 years, there were over 15 000 cases of incident hypertension. Total consumption of dairy products and consumption of low fat dairy products and milk were inversely associated with blood pressure. But there was no relationship between blood pressure and the consumption of high fat dairy products, fermented dairy products, yoghurt, and cheese (Hypertension 2012;60:1131-7, doi:10.1161/hypertensionaha.112.195206).

Uncircumcised boys have more urinary tract infections (UTIs) than those who are circumcised, and researchers wondered whether a visible urethral meatus might be the critical factor. So 393 circumcised and uncircumcised boys, not yet potty trained, and from whom doctors had requested a catheter urine culture, were assessed. At insertion of the catheter, a nurse characterised the meatus as completely visible, partially visible, or non-visible. Of the circumcised boys, 4.8% had confirmed UTIs, significantly lower than the rate among uncircumcised boys with a fully visible meatus. Urethral visibility was therefore considered immaterial (CMAJ 2012;184:E796-803, doi:10.1503/cmaj.111372).

Age alone is no longer an absolute contradiction to lung transplantation. A retrospective review of the utility of lung allocation scores among nearly 16 000 adult lung recipients identified 1.4% of them who were 70 years or older and 29.5% who were aged 60-69 years. Age 70 or more is currently associated with outcomes similar to those of patients aged 60-69 years (Journal of Thoracic and Cardiovascular Surgery 2012;144:1133-8, doi:10.1016/j.jtcvs.2012.07.080).

A three month study involving 94 women had 15 anaesthetists recording the height of the thoracic block to touch, pinprick, or cold when spinal anaesthesia was deemed satisfactory for caesarean section surgery to start. The median block height for touch, pinprick, first cold, and icy was T10, T5, T5, and T3 respectively. All the women had satisfactory anaesthesia despite 81% of them having a block to touch below T6. The researchers say that single modality assessment of block height, especially using just touch, may erroneously indicate inadequate anaesthesia for caesarean section (Anaesthesia 2012, doi:10.1111/anae.12034).

In a moving article, a doctor describes how her healthy first pregnancy ended in stillbirth at 35 weeks. She recalled her change of fortune overnight from health to death, and the shift from hope to futility as she first sees and then hears about the death of her son in utero. Her delivery is induced, and she has a “silent birth.” And even at delivery she still hopes that everyone has been wrong and that by some miracle her baby son will be born alive (Hektoen International 2012;4, www.hekint.org).

In Japan, doctors prescribe oral desmopressin for nocturia. A randomised controlled trial of 116 adults reports that, compared with men, women need a lower dose and the drug’s antidiuretic action lasts longer. The researchers interpret these results as indicating a sex-specific therapeutic window with a decreased risk of hyponatraemia while retaining adequate reduction of night time bladder voids. Extrapolation of the results suggests that men required 58 µg of desmopressin to achieve similar duration of action to women receiving 25 µg (BJUI 2012, doi:10.1111/j.1464-410X.2012.11547).

How do you view the current complaints processes and what effect do they have on your wellbeing and approach to practising medicine? The British Medical Association is investigating the psychological and physical impact of complaints processes on doctors and intends to use the results to inform health policy and improve care for patients. If you’re a BMA member with views on complaints processes at local, General Medical Council, or health service ombudsman level, look out for the email you’ll receive to participate in the anonymous Impact study.

Telomeres are protein structures located at the end of chromosomes. The shorter telomeres are, the more apoptosis (programmed cell death) is induced. Scientists hypothesised that age-adjusted pre-transplantation telomere length might predict treatment related mortality after haematopoietic stem cell transplantation. In a multivariate analysis, recipients’ age and age-adjusted telomere length were both independently associated with death due to transplantation, and the authors say that age-adjusted recipient telomere length is inversely correlated with treatment related death after transplantation as an independent biological marker (Blood 2012;120:3353-9, doi:10.1182/blood-2012-01-403337).

Trace elements may be critical to pancreatic carcinogenesis. A Spanish study that compared 118 cases of pancreatic cancer with 399 hospital controls found that significantly increased risks of pancreatic cancer were observed among subjects whose toenails contained highest quartile concentrations of cadmium, arsenic, and lead. But high concentrations of selenium and nickel were inversely associated with the risk of pancreatic cancer. The researchers suggest that selenium intake should be tested as a chemoprotective intervention in high risk individuals (Gut 2012;61:1583-8, doi:10.1136/gutjnl-2011-301086).

Psychosexual counselling is gaining public awareness, but the consumer correspondent of the Journal of Family Planning and Reproductive Health Care (2012;38:264-7, doi:10.1136/jfprhc-2012-100448) says she’s often asked the same key questions by clients. Yes, it is preferable for both partners to attend counselling because sex is a reflection of the relationship as a whole. And, no, the couple won’t have to participate in intimate exercises in the therapy room. However, as in so much else, homework may help..

The European Doctors Orchestra is made up of doctors from across Europe. On 25 November, at Cadogan Hall, London, the orchestra will be joined by Thomas Carroll, who will perform Elgar’s Cello Concerto. The orchestra will also be playing Brahms’ Tragic Overture and Tchaikovsky’s Fourth Symphony, with themes described by the composer as the alternation of hard reality with “swiftly passing dreams and visions of happiness.” Proceeds will go to Barnardo’s to support its work with children. For tickets, go to www.cadoganhall.com/event/european-doctors-orchestra-121125/


Cite this as: BMJ 2012;345:e7223

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