Intended for healthcare professionals



BMJ 2010; 340 doi: (Published 09 February 2010) Cite this as: BMJ 2010;340:c744

The perils of twins and in vitro fertilisation are illustrated in Human Reproduction (2010; published online 29 January, doi:10.1093/humrep/dep447). A woman experienced massive bleeding mid-pregnancy that required nearly 30 units of blood and products. She was delivered three months prematurely for severe growth restriction of one twin. The other, normal sized baby had cerebral palsy. The mother’s terrified description of events leads Minerva to conclude that however desperate infertile couples might be, single embryo transfer should be offered more often by doctors charged with “first of all, do no harm.”

Older people with heart failure often have low levels of vitamin D. Thinking that this insufficiency might contribute to weak muscles and poor exercise tolerance, researchers tested the effects of vitamin D supplementation in a randomised, double blind, placebo controlled trial in adults older than 70 with systolic heart failure. The distance walked in six minutes and quality of life scores did not significantly improve in the active treatment group after 20 weeks, indeed their quality of life actually worsened slightly (Circulation Heart Failure 2010; published online 26 January, doi:10.1161/circheartfailure.109.907899).

American surgeons delicately suggest that men would benefit from being more like women (Surgery 2010;147:134-7, doi:10.1016/j.surg.2009.04.033). Their hypothesis is based on evidence that female animals tolerate trauma and haemorrhage better than male animals, that oestrogen protects organs from damage and attenuates inflammation induced by trauma. Moreover, the deficit in survival after trauma and haemorrhage seen in female animals that have undergone ovariectomy is repaired with administration of exogenous oestrogen. The authors also point out that women survive injury and sepsis better than men and wonder whether administering oestrogen to injured men could improve their chances.

Kissing as an evolutionary adaptation is another curious proposition (Medical Hypotheses 2010;74:222-4, doi:10.1016/j.mehy.2009.09.033). The hypothesis suggests that through mouth to mouth sexual kissing, women control when they are exposed to their partner’s diseases—thus, if the woman becomes pregnant, her fetus could avoid primary infection with teratogenic diseases such as human cytomegalovirus during vulnerable periods of development. As this protection would only be conferred if women also avoid contact with other men, the authors argue, viral teratogens could also be a pressure towards the development of monogamy.

Paracetamol may protect kidneys after crush injuries. Scientists report that it prevents the formation of free radicals generated by haemoproteins such as myoglobin, which is released after muscle tissue injury and then accumulates in the kidneys. The dosing levels that protected rats from kidney damage were within the clinically therapeutic range for humans. The researchers say their observations could apply in other situations in which heme containing proteins are released from cells—for example, in heart attacks, malaria, and sickle cell disease (Proceedings of the National Academy of Sciences 2010; published online 1 February, doi:10.1073/pnas.0910174107).

A “planting and eating soybean” project for people living with HIV/AIDs in rural China has brought considerable benefit to those who took part. Participants were encouraged to eat soy food every day after the soy was harvested, four months after planting. Eating regular soy resulted in 93% of participants feeling better; 86% of them reported less sickness, 61.3% had a higher total blood protein, 58.1% had a higher haemoglobin, and 54.8% had a higher CD4 count. The project was popular and easy to sustain (AIDS Care 2010;22:126-32, doi:10.1080/09540120903012536).

Another soy study wasn’t so successful. A double blind randomised controlled trial of isoflavone tablets taken by healthy postmenopausal women showed no effect of treatment on bone mineral density of the spine, femur, neck, or whole body. From the baseline to 36 months later, bone mineral density fell regardless of treatment. The idea was that extracted soy isoflavones would offer a bone-sparing effect with biological and lifestyle factors modulating loss of density, but it was not to be (American Journal of Clinical Nutrition 2010;91:218-30, doi:10.3945/ajcn.2009.28306).


Cite this as: BMJ 2010;340:c744

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