“Sweating sickness” in Tudor England and other storiesBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f686 (Published 06 February 2013) Cite this as: BMJ 2013;346:f686
Thomas Cromwell, Henry VIII’s henchman, woke one day to find his bed sheets damp and his wife warm and flushed. She was dead when he returned from work. Speculation about the cause of this “sweating sickness” included people’s sins, the stars and planets, mysterious vapours, magic spells, and the French. But the sickness was not found in France, and it was unusually more common among rich people than poor people, which made an arthropod borne infection by lice or ticks (prevalent among the wealthy) likely (Hektoen International winter 2013, www.hekint.org/sweating-sickness-liebson.html).
In the wake of epidemiological findings suggesting that multivitamin use increases the risk of death, a meta-analysis of randomised controlled trials of supplements—used for the primary or secondary prevention of a range of diseases—reports more positive news. Among independently living adults (average age 62 years; average duration of supplementation 43 months), taking multivitamins with multiminerals had no effect on all cause mortality (American Journal of Clinical Nutrition 2013;97:437-44, doi:10.3945/ajcn.112.049304). Minerva, however, continues to wonder why people take them.
In a large study of tamoxifen and exemestane in postmenopausal women with hormone sensitive breast cancer, those older than 75 years are at increased risk of distant recurrence (Oncologist 2013;18:8-13, doi:10.1634/theoncologist.2012-0315). All participants had taken adjuvant systemic endocrine therapy, but the older women were less likely to have had chemotherapy, suggesting that this undertreatment might be important. The authors suggest that chemotherapy should be considered in relatively fit elderly women who might conventionally have been steered away from it.
Patients who eventually recover responsiveness after a prolonged, anoxic vegetative state (VS) demonstrate two features that suggest better prognosis. A study of 43 inpatients with VS reports that apart from being younger, those who recovered responsiveness also showed spared pupillary reflexes, active pain responses, and intermittent sympathetic hyperactivity. The presence of median nerve evoked potentials and a coma recovery scale score greater than six (based on clinical criteria) were both significant predictors of recovery of responsiveness (Neurology 2013;80:464-70, doi:10.1212/wnl.0b013e31827f0f31).
Successful micturition and voiding require both anatomical and neurological interactions. In vitro testing of 10 men undergoing radical prostatectomy found that anterior prostate tissue has sufficient contractile strength to induce the shortening of the organ required, and that the ventral prostate (the front of the organ) has higher contractile strength than the dorsal prostate or proximal urethra. These tests confirm what has been seen in vivo on real time magnetic resonance imaging—that the ventral prostate initiates micturition (British Journal of Urology International 2013, doi:10.1111/j.1464-410X.2012.11698.x).
Regardless of age or sex, being unmarried or living alone increases the risk of fatal and non-fatal heart attacks. Researchers found that mortality rates at 28 days were up to 168% and 175% higher in unmarried men and women, respectively, compared with their married counterparts. However, most of the excess mortality seemed to occur before hospital admission. Explanations include people with poorer health being more prone to being unmarried or divorced; and married people being better off financially, having more social support, and having earlier intervention of cardiac events before admission (European Journal of Preventive Cardiology 2013, doi:10.1177/2047487313475893).
First pregnancies complicated by postpartum haemorrhage (PPH) have no detrimental effect on future fertility, but women who have caesarean sections at the time of the first PPH are less likely to conceive again, according to a 20 year Scottish study (BJOG 2013, doi:10.1111/1471-0528.12120). Researchers used the Aberdeen database to look at 34 334 first pregnancies, 10% of which were complicated by PPH. Women with PPH in their first pregnancy were 2.9 times more likely to have PPH again during their second pregnancy than those without PPH in their first pregnancies (18% v 6.9%).
Squeaky hips are reported by people who have undergone ceramic-on-ceramic total hip replacement. Noise production was examined against range of movement, ligament laxity, patient self reports, activity, and orientation of the acetabular component. Of 208 consecutive Delta Motion hips, 69% were silent, 11% created noise other than squeaking, 8% were unreproducibly squeaky, and 13% demonstrated reproducible squeaking. Greater ranges of movement, greater ligament laxity, smaller head size, and less acetabular incline were all significantly associated with reproducible squeaking. Despite the noise, all patients remained happy with their hips (Bone and Joint Journal 2013;95-B:160-5, doi:10.1302/0301-620X.95B2.30450).
Cite this as: BMJ 2013;346:f686