Intended for healthcare professionals



BMJ 2000; 321 doi: (Published 12 August 2000) Cite this as: BMJ 2000;321:460

Women with chronic diseases such as migraine or asthma often report that symptoms fluctuate in time with their menstrual cycle. Severity of ischaemic heart disease can also vary with the time of the month, researchers report in Heart (2000;84:189-92). They found that exercise tests in premenopausal women with ischaemic heart disease were best mid-cycle, when serum concentrations of oestrogen were high, and worst in the early follicular phase, when serum concentrations were low.

Unlucky travellers who catch malaria near European airports from imported mosquitoes are in double jeopardy—firstly from the disease, and secondly from delays in diagnosis (Eurosurveillance 2000;5:76-80). One 25 year old woman had severe falciparum malaria for nearly a month before someone spotted the parasites in a blood film taken for another purpose. She worked on a chicken farm 2 km away from a French airport—the presumed source of a cluster of four cases last summer. In at least one, the offending mosquito had hitched a ride out on an airport bus.

Travel medicine is becoming more of an issue for British pets now they can holiday abroad with their owners. Several vets have already reported “exotic” parasitic diseases in animals returning from mainland Europe. Someone should be monitoring these cases, write three vets from London, and advising travellers on risks, prophylaxis, and treatment of common diseases, particularly in dogs (Veterinary Record 2000;147:143). A thorough brushing will dislodge ticks picked up during walkies, they add.

Evidence from Britain and the United States suggests that meningococcal meningitis in children is linked to parents' smoking habits. Further data from schoolchildren in the Czech Republic confirm this finding (Archives of Diseases in Childhood 2000;38:117-21). A case-control study shows that children's risk of the disease is increased nearly threefold for every 20 cigarettes smoked per day in their household. The effects of smoking are independent of other social class indicators, such as the mother's education.

For 30 years, researchers have been trying to find out why so many people fail to comply with medical treatment. A meta-analysis in Archives of Internal Medicine makes one thing clear: people who are chronically ill and depressed are three times less likely to take their drugs and follow medical advice than people who are physically ill but psychiatrically well (2000;160:2101-7). Although it's plausible that poor compliance is associated with depression, other studies will have to determine which comes first.

The Brady Act, introduced by US legislators in 1994, requires licensed gun dealers to run background checks on purchasers and delay the completion of the purchase for a five day “cooling off” period. The act's impact has been hard to measure, but the latest attempt fails to show any effect on rates of suicide or homicide—except for a fall in the number of suicides in men over 55 (JAMA 2000;284:585-91). Gun running across state borders and a vigorous but unregulated secondary gun market make it almost impossible to interpret data from this “natural experiment,” says one commentator.


This 47 year old woman with breast cancer developed a widespread blue rash 15 minutes after injection of blue patent V dye (Guerbet Laboratories, Milton Keynes) during a sentinel lymph node biopsy. She was treated with hydrocortisone and chlorpheniramine and the surgery was abandoned. The rash lasted 72 hours. Her operation—a mastectomy with latissimus dorsi flap—was successfully completed a week later. Anaphylaxis after patent V dye is rare, but anaesthetists and surgeons should be prepared and treat it swiftly when it does occur.

M H Mullan, research fellow, M W Kissin, consultant, department of surgery, S J Deacock, consultant immunologist, N F Quiney, consultant anaesthetist, Royal Surrey County Hospital, Guildford GU2 5XX

The incidence of variant Creutzfeldt-Jakob disease is increasing in the United Kingdom, says a research letter in the Lancet (2000;356:481-2). The number of deaths per year has gone up by a third since 1995, and the number of new cases per year has gone up by a quarter over the same period. The authors say their figures are likely to represent a real increase, not simply an improvement in ascertainment.

Inhaled corticosteroids reduce symptoms, improve lung function, and help to keep people with moderate or severe asthma out of hospital—but do these drugs save lives? A case-control study from Canada suggests they do (New England Journal of Medicine 2000;343:332-6). People with severe asthma who had died of their disease used significantly fewer canisters of inhaled steroids in the year before death than surviving controls. The benefits were seen with low doses, taken regularly.

Parents of infants in neonatal intensive care units would be horrified by the list of bacteria grown from toys placed in infants' cots ( Almost all the toys in one study were colonised to a greater or lesser extent, some (44%) with potentially pathogenic bacteria. Toys are probably the only moveable items in a unit that are not disinfected regularly, and although there's no evidence that colonised toys do any harm, few investigators, if any, have looked.

It's now clear that certain adult diseases including hypertension and type 2 diabetes are somehow preprogrammed in utero. People with type 2 diabetes, for example, are more likely to have had a low birth weight than healthy controls. A cohort study from Helsinki goes further and finds that type 2 diabetes is also linked to catch-up growth in early childhood followed by accelerated growth between the ages of 7 and 15 (Annals of Internal Medicine 2000;133:176-82).


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