Minerva

The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus has recommended changes in the diagnostic criteria for the various forms of the disease (Diabetes Care 1997;20:1183-97). A casual plasma glucose concentration of 11.1 mmol/l in a patient with symptoms will now be enough. The terms “insulin dependent” and “non-insulin dependent” are no longer acceptable, says the report, which prefers type I and type II diabetes for the conditions in which there are respectively insulin deficiency and insulin resistance.

Symptoms of rectal pain, blood or mucoid discharge, tenesmus, and constipation suggest a rectal fissure, but another possibility that should be borne in mind is genital herpes (Journal of the Royal College of Surgeons of Edinburgh 1997;42:272-82). Rectal infection with herpes simplex virus may occur in sexually active women but need not be related to rectal sex. Unless tests are done for sexually transmitted diseases the diagnosis may be missed.

A study in Sweden of 300 women aged 30–65 found a strong social gradient in serum lipid concentrations, with an unhealthy lipid profile more common in blue collar workers (Journal of Epidemiology and Community Health 1997;51:400-7). Part of the variation in lipids was associated with lifestyle factors, but other strong determinants included the “decision latitude” at work (factors such as taking part in decisions, skills, …