Minerva: November 2002
Beds
are a great habitat for house dust mites, so anti-allergic
mattress covers in carpet free rooms might benefit people who have
asthma. A randomised, double blind placebo controlled study of 30
patients with house dust mite allergy found a significant reduction in
the concentration of Dermatophagoides pteronyssinus in dust from
the covered mattresses after one year. Unfortunately, such allergen
avoidance made no difference to the participants symptoms and
lung function (Thorax
2002;57:784-90).
Smokers
and childless women are known to go through the menopause at a younger
age than other women. Evidence from a British birth cohort suggests
that early life influences also play a role in ovarian ageing. Women of
low weight at age 2 years had an earlier menopause, and those who had
been breast fed had a later menopause (Human Reproduction
2002,17:2474-9).
The
dangers of having a naked flame and, in particular, of smoking, near an
oxygen supply are usually fully explained to respiratory patients who
must be treated with oxygen at home. The need to explain this to
hospital inpatients may not be so obvious. A woman was admitted for
investigation of her haemoptysis and was given oxygen via nasal
cannulas. The attention of the nursing staff was drawn to her
persistent smoking by an explosion—the patient was discovered
with her head leaning out of an open window. She held the remains of a
cigarette and had extensive facial burning. The use of nasal cannulas
may be potentially hazardous for smokers who forget that they are
wearing
them.
Daniel Lawes, specialist registrar
Rupan Banga, senior house officer
Martin Clifton,consultant, department of surgery,
Princess Alexandra Hospital, Harlow CM20 1QX.
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Injury
protection strategies can be divided into active and passive prevention
measures (seatbelts are active, airbags are passive). A study of crash
survivors and the type of restraints used found that belts are clearly
superior to bags in preventing thoracic aorta injuries. Bags alone do
not influence the incidence of thoracic aorta injuries in frontal
collisions, whereas belts prevented them whether or not airbags were
used (Journal of Trauma Injury, Infection, and Critical Care
2002;53:309-13).
When
young people drink water they experience a sympathetic vasoconstriction
without having a rise in blood pressure. Physiologists investigating
this further found that in young people water ingestion is followed by
an increase in cardiac vagal control, which seems to buffer the
sympathetic activation. Minerva thinks this is curious—when she
attended physiology lectures, the sympathetic and parasympathetic limbs
of the autonomic nervous system were always inversely related
(Clinical Science
2002;103:157-62).
Women
with epilepsy worry about taking anti-epileptic drugs in
pregnancy because of fears about harming their unborn children. But
self reporting of drug compliance tends to be unreliable, as
illustrated by a study of hair analysis. Drug detection in proximal
hair growth differed significantly between pregnant and
non-pregnant women. The hair data showed that four of the 26
pregnant women had stopped their medication altogether, yet only one
woman admitted having done so (Epilepsia
2002;63:824-31).
Satisfaction
with out of hours services is strongly linked to whether
patients expectations are met (Family Practice
2002;19:333-8). In a world where patients demands are
beginning to rule over all else, Minerva wonders what would happen if
patients who contacted these services were first asked about their
expectations, before being asked about their medical problems. Perhaps
thats one for the researchers to look at
next.
An 11
year old girl developed a phytophotodermatitis after feeding parsnips
to her horses. The characteristic linear and bullous lesions are caused
by simultaneous exposure of the skin to psoralens found in the parsnips
and ultraviolet light. Patients should be warned that the resulting
postinflammatory pigmentation may last months or even
years.
Daniel Lawes, specialist registrar
Rupan Banga,senior house officer
Martin Clifton, consultant department of surgery,
Princess Alexandra Hospital, Harlow CM20 1QX
Alena Salim, specialist registrar department of
dermatology,Churchill Hospital, Oxford Radcliffe
NHS Trust, Oxford OX3 7LJ
Submissions
for this page should include signed consent to publication from the
patient
Acknowledging
a problem is said to bring us halfway to the solution. Being overweight
but not perceiving this to be the case may explain why obesity is
emerging as a worldwide health problem. In Spain 50% of men and
30% of women who were moderately overweight didnt believe
they were, and the levels of misperception were greatest among older
people, those living in rural areas, and those with little formal
education (European Journal of Clinical Nutrition
2002;56:866-72).
Primo
Levi was an Italian chemist who survived a Nazi concentration camp and
went on to write about the human condition. A review of a book about
him in The Lancet (2002;360:882) says that Levis works
should be commended to all medical students. His prose, says the
reviewer, works “like an enzyme on the indigestible truths of the
atrocities, breaking the detail down in order that those who were not
witnesses would digest what happened and, hopefully, ensure that it is
never
repeated.”
The
words of the editor of Hospitals and Health Networks (August
2002:8) resonate as deeply in Britain as they do in the United States.
One of the great things about being in health care for a long time, she
says, is that you get to see everything at least twice—sometimes
three or four times. Theres the recurrent nursing shortage, too
many or too few specialists, and too many or not enough beds. Some
issues seem to leave the stage only to change costume and reappear in a
later act. Its quite reassuring,
really.
Patients
with functional dyspepsia have no evidence of organic pathology, and
their long term prognosis—regardless of Helicobacter
pylori status—seems good. Of 205 patients followed up over
seven years, only four cases of peptic ulcer were found among the 118
who were H pylori positive, and there were no malignancies. As
repeated investigations had a low diagnostic yield, the authors
question the need for them (Scandinavian Journal of
Gastroenterology 2002;37:905-10).
studentBMJ 2002;10:397-440 November ISSN 0966-6494
