Minerva

The benefits of mild hypothermia and other stories . . .

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7310 (Published 11 December 2013) Cite this as: BMJ 2013;347:f7310

Hypothermia has been tried for all sorts of medical conditions, perhaps on the basis that bad things happen less quickly at lower temperatures. In a Japanese trial reported in Stroke (2013, doi:10.1161/STROKEAHA.113.003143), 39 patients with acute ischaemic stroke were randomised to mild hypothermia (34.5°C) for 48 hours with gradual rewarming, while 36 received usual care without hypothermia. The cooled patients showed a significant reduction in cerebral oedema and haemorrhagic transformation, and better functional results at three months.

Small cell lung cancer (SCLC) has an evil reputation, but caught early it can sometimes be cured by surgery, according to an analysis of the National Cancer Data Repository in Thorax (2013, doi:10.1136/thoraxjnl-2013-203884). The study found that the survival of 465 patients with resected SCLC was lower than for patients with resected non-SCLC (five year survival 31% and 45%, respectively) but much higher than for patients of either group who were not resected (3%). The authors concluded that their study supports the emerging clinical practice of offering surgical resection to selected patients with SCLC.

It you had diarrhoea, and Clostridium difficile was detected in your stool, how would you know that the difficult clostridium was actually causing your diarrhoea? After all, many of us carry this germ quite harmlessly. Microbiologists from London, Leeds, and Oxford suggest that the real test is whether your stool contains clostridial toxin, rather than whether it just grows toxin forming clostridia (Lancet Infectious Diseases 2013;13:936-45, doi:10.1016/S1473-3099(13)70200-7). But Minerva has no time for these laboratory fancies: she prefers a well trained sniffer dog like Cliff the Beagle.

In December 1825 the inventor of gastronomy, Jean Anthelme Brillat-Savarin, published his celebrated Physiologie du gout, ou, Méditations de gastronomie transcendante. How delighted he would have been to learn that the human body contains innumerably more taste buds than he ever imagined. A review of intestinal taste receptors in Gut (2013, doi:10.1136/gutjnl-2013-305112) paints an extraordinary picture of internal “gastronomie transcendante.” It says that “the gastrointestinal tract is the key interface between food and the human body and can sense basic tastes in much the same way as the tongue, through the use of similar G protein coupled taste receptors. These receptors ‘taste’ the luminal content and transmit signals that regulate nutrient transporter expression and nutrient uptake, and also the release of gut hormones and neurotransmitters involved in the regulation of energy and glucose homeostasis.”

Of the “non-communicable diseases” associated with obesity, the most characteristic is type 2 diabetes. But a high proportion of obese people with this condition will revert to normoglycaemia after bariatric surgery, especially Roux-en-Y gastric bypass. A study of 690 patients who underwent such surgery at the Geisinger Health System (Lancet Diabetes and Endocrinology 2013, doi:10.1016/S2213-8587(13)70070-6) shows that it is possible to predict the 63% of patients most likely to be partially or completely “cured” of their diabetes. This can be done by using the “DiaRem score,” which is based on just four variables: insulin use, age, glycated haemoglobin concentration, and types of drug prescribed for diabetes.

Minerva likes the idea of “mindfulness,” defined as “purposeful and non-judgmental attentiveness to one’s own experience, thoughts, and feelings.” Back in the days when she was a much younger goddess, she remembers chatting about this sort of thing with Aristotle. It’s an essential attribute for health professionals, but pretty hard to measure. There is something called the mindful attention awareness scale, which was used to assess primary care professionals looking after people with HIV infection in a study reported in Annals of Family Medicine (2013;11:421-8, doi:10.1370/afm.1507). It’s a self reported score, which seemed to correlate reasonably with third party assessment of video recorded clinical encounters. “Interventions should determine whether improving clinician mindfulness can also improve patient health outcomes,” conclude the investigators, but Minerva finds this sentence harder to parse than Aristotle’s Greek.

Minerva loves a good title, especially when it encapsulates the meaning of the article. Her favourites this week are: “Dissonance Between Parent-Selected Bedtimes and Young Children’s Circadian Physiology Influences Nighttime Settling Difficulties” (Mind, Brain, and Education 2013;7:234-42, doi:10.1111/mbe.12032) and “The Peculiar Epidemiology of Dracunculiasis in Chad” (American Journal of Tropical Medicine and Hygiene 2013, doi:10.4269/ajtmh.13-0554). Peculiar because Dracunculus medinensis had disappeared from Chad but has now returned sporadically, having learnt to hitch a ride inside dogs.

Notes

Cite this as: BMJ 2013;347:f7310

Footnotes

  • Let Minerva know what you think of this week’s offerings at minerva{at}bmj.com.

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