Minerva
During the month of Ramadan, observant Muslims typically change their eating habits from three meals a day to two. A small study compared 28 men with high lipid concentrations who "fasted" during Ramadan and 10 men with normal lipid concentrations who did not fast, and found that a low fat, low calorie diet made no difference to the non-fasters. It produced a significant reduction in cholesterol concentrations and energy intake, however, for those who fasted (Saudi Medical Journal 2003;24:184-8).
Its good to discover that at least some of the UK governments initiatives for improving care seem to have achieved their aim. A longitudinal observational study in general practice found great improvements in access to services, practices organisation of chronic disease management, and the quality of angina care (British Journal of General Practice 2003;53:298-304). Sadly, quality scores for mental health care and elderly care did not change.
Migration of workers across international borders clearly promotes the exportation of occupational diseases. But published data are scarce. The absence of studies, says a writer in the International Journal of Public Health (2003;48:1-2), reflects neither the dearth of disease nor the sophistication of the science. Its due to the problem of obtaining reliable exposure histories in people who are separated by time and place from their workplaces in foreign countries.
De Tocqueville (1805-59) said, "A great danger is like wine, it makes men affectionate." A study of 75 male soldiers undertaking humanitarian aid relief in Central Africa concludes that good sexual health education is perhaps the best way to ensure that only a few soldiers seek sexual services on deployment. Keeping soldiers busy is another (Journal of the Royal Army Medical Corps 2003;149:38-46).
Minerva has often wondered whether advice to take anti-inflammatories rather than paracetamol for acute swelling and pain holds up. Comparing a conventional daily regimen of paracetamol with ibuprofen after surgical removal of wisdom teeth, a randomised double blind crossover trial found no difference between the two drugs (British Journal of Clinical Pharmacology 2003;55:405-12).
Another drug trial looks at the efficacy of two antidepressants in the treatment of painful polyneuropathy. Venlafaxine (a serotonin and weak noradrenaline reuptake inhibitor) was compared with imipramine (a more conventionally used tricyclic) and placebo. The overall pain scores were the same with the active drugs and higher with placebo. The number needed to treat to get one patient with moderate or better pain relief was 5.2 for venlafaxine and 2.7 for imipramine (Neurology 2003;60:1284-9).
Question: what is the best way to improve training in public health worldwide? Answer: get better lectures. But how do we improve lectures? Let academic faculties worldwide share their lectures. Through this line of thinking, a new concept was born. The Supercourse has 9300 faculty members from more than 7500 universities in 151 countries who created a library of lectures with 1245 lectures available on the internet and on CD. The first in its "just in time" series covers severe acute respiratory syndrome (SARS) and is at www.pitt.edu/~super1/lecture/lec10131/index.htm
A forthcoming sale at Sothebys, the London based auction house, promises something of interest to medical historians. Up for grabs is some mould. But its not just any old mould. This culture has been grown from the spores of Alexander Flemings original mould that led to the discovery of penicillin. Dating from 1951, its thought to be one of a number of samples given by Fleming to his assistants. Estimated price £6000-10000.
A potential new member of the vitamin B family has been announced. Scientists reporting in Nature (2003;422:832) say that pyrroloquinoline quinone (PQQ) qualifies as a new vitamin because it plays a key role in an indispensable biochemical pathway, and must be supplied in our diet because we cant make it ourselves. Like other B vitamins, PQQ is critical to enzyme controlled reduction-oxidation reactions. It is found in meat and vegetables.
Childhood acute lymphoblastic leukaemia can relapse, and its not always clear why. The theories include the growth of cells that contain additional mutations, and the re-emergence of dormant cells from the original clone. Another hypothesis is that the "original" leukaemia was cured, but a "new" one developed. Writing in Blood (2003;101:3635-40), scientists say they now have evidence for the persistence of preleukaemic clone cells to back this up.
Operating on the wrong limb is unforgivable. But when orthopaedic surgeons explicitly asked patients to mark their own limbs by writing "no" on the extremity not to be operated on, only 59% complied correctly; 37% made no mark and 4% made a different mark (Journal of Bone and Joint Surgery 2003;85A:815-9). The authors say this indicates that patients still expect the surgical team to "take care of everything," but patients should be encouraged to take a more active role in their health care.
The internet is increasingly becoming an alternative source of information for patients. A 22 year old man wishing to have a circumcision decided to perform the procedure himself. He acquired a self circumcision kit and instructions from a Korean company via the internet. The constriction device was due to stay on for 10 days. On day 6 it had fallen off, giving the above result.
He presented to casualty with bleeding from the distal prepuce. He was still able to pass urine, and there was no evidence of infection. He subsequently underwent completion of circumcision as an elective case.
Andreas Fox, senior house officer
Sunjay Jain, specialist registrar
Tim R Terry, consultant,
department of urology, Leicester General Hospital, Leicester LE5 4PW
Submissions for this page should include signed consent to publication from the patient
Reflecting on how times have changed, a staff nurse says in Nursing Times (2003;99:33) that just a decade ago it was possible to work on elderly care wards where resuscitation equipment was not available because the patients "did not require it." Later, when equipment did begin to arrive on such wards, it was provided just in case visitors or staff ever needed resuscitation.
A study of two homes for elderly people in the United States makes depressing reading. Not only was the physical environment not conducive to end of life care (noisy, crowded rooms, offering little privacy) but organisational factors also had their role (inadequate staffing levels and lack of supervision). Over half (54%) of the residents developed pressure sores, and 82% of these died with pressure sores (Gerontologist 2003;43(special issue II):76-84).
studentBMJ 2003;11:175-218 June ISSN 0966-6494
