Intended for healthcare professionals



BMJ 2006; 332 doi: (Published 26 January 2006) Cite this as: BMJ 2006;332:246

A UK-Iraqi network hopes to help reverse the scientific isolation that Iraq is in and, by doing so, return the favour that Iraq did for the world in the areas of science and arts. Books to Iraq ( has been set up to help Iraqi pharmacists get current textbooks into the eight pharmacy schools there. Iraq is important in the history of pharmacy. Baghdad was a prominent centre for science and culture. Enlightened caliphs created an atmosphere where scholars of many nations could contribute to intellectual life, and scientists translated and preserved ancient Greek, Persian, and Indian manuscripts.

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A 49 year old woman presented with a severe flare up of ulcerative colitis. Intravenous hydrocortisone, aminosalicylates, and ciclosporin treatment was started, and after seven days oral prednisolone was introduced. This letter was one of a series of 12 written by the woman over the subsequent six days, and received by a member of the medical team. An examination of the patient's mental state showed a florid psychosis. Steroid psychosis is an important, but often overlooked, dose related adverse drug reaction. The onset is most common with oral steroid treatment and higher doses of steroids. This patient recovered fully after steroid withdrawal, although up to 10% of affected patients have ongoing psychiatric problems.

Samer Taslaq, (samer.taslaq{at} preregistration house officer, Frances Baawuah, senior house officer, Gautam Mehta, specialist registrar, Department of gastroenterology, Charing Cross Hospital, London W6 8RF

At times of stress it's the weaker, male fetuses that miscarry more often than the naturally stronger females, perhaps explaining why live male births decline at times of societal crises, which include natural disasters and economic recessions. Rather than putting this phenomenon down to a stress response that ends up damaging unborn babies, Swedish researchers say their data analyses support an alternative hypothesis that stressed mothers actively “cull” weaker fetuses (

The thought of being wheeled into a magnetic resonance scanner is stressful enough for most of us, but add to that the stress of being asked to do a task on a computer while inside and you have a perfect scenario for looking at what happens to the brain under mental stress. Observations of 20 healthy men and women in this situation indicate that exaggerated activity in the cingulate cortex of the brain can generate excessive rises in blood pressure. This may be part of the explanation for the link between stress and heart disease. (Psychophysiology 2005;42: 627-35).

The Men's Health Forum (MHF 9 January 2006: 12) gives some advice to men, who notoriously avoid visiting GP surgeries. Attending emergency departments for anything and everything is like calling roadside rescue when you've run out of petrol. It'll take ages, might not help, and could be avoided with a check up in advance. It also denies resources for real emergency cases.

A study designed to find out how much agreement exists between patients receiving palliative care in the community and the healthcare professionals looking after them reports that assessments of pain in both groups were broadly similar. But GPs over-identified nausea, vomiting, and constipation, and healthcare professionals in general assessed emotional symptoms as more severe than did patients. They were also more likely to report depression and anxiety than the patients. Fatigue, on the other hand, was a common symptom less likely to be picked up by the professionals (British Journal of General Practice 2006;56: 27-34).

An infusion of glucose, insulin, and potassium given to non-diabetic patients under-going coronary artery bypass surgery improved early postoperative cardiovascular performance, reduced the need for inotropes, and may have reduced the incidence of myocardial injury sustained during surgery. The concoction was tested blind against placebo in 280 patients, and these significant improvements were not gained at the expense of more non-cardiac problems developing (Journal of Thoracic and Cardiovascular Surgery 2006;131: 34-42).

Performing unnecessary surgery is considered ethically inappropriate, so what are the implications for a company that wishes to take samples of bone tissue to grow them into wedding rings? It's a real life situation, and so far only couples who have a prior need for surgery are being considered. But examining the issues in the Journal of Medical Ethics (2006;32: 13-16), a writer argues there may be no reason why non-medical projects, such as creating jewellery, might not warrant surgical intervention. Why should medically motivated interventions hold a privileged status over other motivations?

The internet is a common and increasingly used resource for medical and health information. But according to a survey patients are most interested in using the internet to communicate directly with their healthcare providers (Annals of the Rheumatic Diseases 2006;65: 121-3).

An Israeli team have tested a highly concentrated fibrin glue to treat complex perianal fistulae. The glue, mixed with antibiotics, is instilled along the fistula tract without the need for muscle division. Of the 60 patients who underwent the procedure in one trial, 53% achieved complete healing, and 29% achieved significant improvement despite incomplete healing. None of the 60 had any new problems with continence, and all resumed normal activity the day after being “glued.” The authors estimate that glue helped about half of their volunteers avoid extensive surgery (Diseases of the Colon and Rectum 2005;48: 2167-72).

Anecdotal data indicate a possible link between baby immunisations and transient bulging fontanelles. But a trawl through a US database (vaccine adverse event reporting system) showed just 18 possible cases. The average time between vaccination and symptom onset was 18 hours, 15 of the children had also been febrile, and the time to resolution was three days. The authors say cause and effect is far from established, and even if further work confirms transient bulging fontanelles as a rare side effect, the benefits of vaccination vastly outweigh this risk (Journal of Pediatrics 2005;147: 640-4).

Blasting a localised prostate cancer with high-intensity focused ultrasound using a rectal probe can induce complete necrosis of the tumour through intact skin. A three year follow-up of 63 patients who underwent such treatment (without any adjuvant treatment) reports that the disease-free survival rates—as measured by serum levels of prostate specific antigen (PSA)—were 100% for men with a PSA nadir after treatment of < 0.2 ng/ml, 74% for men with a PSA nadir 0.21-1.0 ng/ml, and 21% for those with a nadir > 1 ng/ml, making the PSA nadir a useful predictor of outcome (BJU International 2006;97: 56-61).

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