Minerva: September 2001
The synthesis of a new class of ring peptides that selectively increase the permeability of bacterial cell membranes is reported in Nature (2001;412:4525). The accompanying in vitro and pilot studies in mice demonstrating the efficacy of these peptides against methicillin resistant Staphylococcus aureus are encouraging. New antimicrobial agents are urgently needed to counter growing drug resistance.
The difficulty of accurately charting the spread of an emerging infectious disease is illustrated by a seroepidemiological survey undertaken six weeks after New York's first epidemic of West Nile encephalitis (Lancet 2001;358:2614). The 1999 outbreak was thought to have affected 2.6% of the popula tion, but the survey data show that 90% of mildly symptomatic and asymptomatic infections were missed.
The side effects of treatment may take time to become apparent. In this instance a man with schizophrenia developed restless toes, a movement disorder associated with flupentixol decanoate, a depot antipsychotic drug. The condition was detected only when holes appeared in his shoes.
Happily, this resolved after his treatment was changed to olanzapine, an atypical antipsychotic drug (and he got a new pair of shoes).
John Milton, lecturer in forensic mental health,
East Midlands Centre for Forensic Mental Health, Leicester LE5 0LE
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A clear account of the global distribution of West Nile virus appears in Emerging Infectious Diseases (2001;7(suppl 3)). One of a group of papers in a special supplement, it emphasises “the ease with which exotic pathogens can move between continents,” and the need to improve the surveillance, prevention, and control of vectorborne diseases.
Cartilage injuries rarely heal, and most result in degenerative change of the affected joint. Much research is being directed towards exploring the therapeutic potential of chondrocyte transplantation. The successful in vitro culture and resultant proliferation of chondrocytes in an alginate matrix bodes well (Annals of the Rheumatic Diseases 2001;60:78190). It's still a long way from proving clinical value, though.
Defining the role of molecular diagnostic and prognostic tests in routine clinical management is not easy. As the cost of testing falls, tests may be carried out just because they are cheap and readily available (Molecular Pathology 2001;54:2035). The case for establishing an independent national body to make recommendations on optimal use is surely persuasive.
“Premobile” infants aged 6 months or less have an alarming tendency to roll. Of a cohort of 14 009 infants aged 6 months, 22% were reported as having sustained a fall, mostly from beds and sofas. In 97% of cases the injury involved the head (Archives of Disease in Childhood 2001;85:1047).
Fortunately, concussion or fracture was rare, occurring in only 21 cases, but the need for vigilance is clear.
A comparative study of the accuracy of magnetic resonance angiography (MRA) and intraarterial angiography in patients with symptomatic coronary artery stenosis found that MRA overestimated the degree of stenosis in 7% of patients (Journal of Neurology, Neurosurgery, and Psychiatry 2001;71:155 60). Repeated ultrasound assessments may be as or more accurate and would certainly be cheaper.
A 25 year old woman presented with left sided weakness and a patchy right sided sensory loss, which developed while diving in Egypt.
Recompression therapy was started, leading to an unsustained improvement in symptoms and signs.
Magnetic resonance imaging of her cervical spine subsequently showed a lesion at the level of C4, and transverse myelitis was diagnosed. The patient made a nearly full recovery after steroids were given. This case illustrates the importance of a thorough neurological examination in all suspected cases of decompression illness. It is also a poignant reminder that neurological symptoms and signs in divers may be due to neurological disease other than decompression sickness.
R M Bateman, senior house officer,R N Sawyer Jr, medical director,
Centre for Defence Hyperbaric Medicine, Royal Hospital Haslar, Gosport, Hampshire PO12 2AA
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Publication of hospital league tables based on crude death rates has spurred the development of outcome measures that take account of case mix. A good example is provided in Heart (2001;86:1504). Data on 2153 patients with confirmed acute myocardial infarction were used to establish and validate a simple predictive model for 30 day mortality from all causes based on age, heart rate, and systolic blood pressure on admission.
Up to 2% of women suffer from recurrent miscarriage. The misery underlying this bald statistic can only be guessed at. Women with a polymorphism of the gene encoding endothelial nitric oxide synthase are 1.6 times more likely to have the condition (Human Reproduction 2001;16:16447). Let's hope this insight into pathogenesis holds promise for improved patient management.
Trachoma is estimated to cause 15% of global blindness, and mass treatment with antibiotics is now advocated in endemic areas. In a randomised trial comparing oral azithromycin and topical tetracycline in eight villages in the Gambia, oral treatment proved more effective (Bulletin of the World Health Organization 2001;79:63240). Disease prevalence in villages allocated to azithromycin fell from 16 % to 7.7 % after 12 months, while it remained close to 16% in villages allocated to tetracycline.
studentBMJ 2001;09:305-356 September ISSN 0966-6494
