Intended for healthcare professionals

Minerva Minerva

Minerva

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7336.554 (Published 02 March 2002) Cite this as: BMJ 2002;324:554

Compliance with eradication treatment for Helicobacter pylori might improve with shorter courses. A new short term regimen of amoxicillin, clarithromycin, and lansoprazole or ranitidine for five days (or the same antibiotic-lansoprazole combination for three days, with a two day pretreatment with lansoprazole) achieved overall eradication of 86.4% in 243 patients, all of whom finished the course. Eradication failure was associated with younger age (under 55) and having a history of peptic ulcer disease (Archives of Internal Medicine 2002;162:153-60).

Evidence from a Danish prospective cohort suggests that pregnant women who drink a moderate level of alcohol are at a higher risk of a stillbirth (American Journal of Epidemiology 2002;155:305-12). Women consuming five or more drinks a week had three times the risk of stillbirth compared with women who had less than one drink a week. Stillbirths due to fetoplacental dysfunction increased from 1.37 per 1000 births for women who had less than one drink a week, to 8.83 per 1000 births for women consuming more than five drinks a week.

A nurse led chronic pain clinic set up to help general practitioners in Belfast revealed that 54% of patients taking regular non-steroidal anti-inflammatory drugs were at risk of gastropathy from their medication. These patients were over 60 or had a history of gastro-oesophageal reflux or gastric or duodenal ulceration (International Journal of Clinical Practice 2002;56:21-5). Some patients may have entered the high risk group simply through ageing—a factor that practice based repeat prescription reviews may miss.

Uterine fibroids may be caused by a genetically acquired metabolic glitch. The gene in question is fumarate hydratase, a housekeeping gene that is responsible for providing fuel to all cells in the body. Scientists have discovered that people with leiomyomata of the skin and uterus are born with a mutation of this gene and that very low fumarate hydratase activity in certain cells causes tumours to develop (Nature Genetics 2002; advance online publication http://www.nature.com/cgi-taf/DynaPage.taf?file=/ng/journal/vaop/ncurrent/abs/ng849.html).

A body of evidence about the dangers of rapid anaesthetic-antagonist opiate detoxification programmes has accumulated since a BMJ editorial sounded a note of caution in 1997 (315:1249-50). The latest comes from a US centre that performs ultrarapid opioid detoxification with subcutaneous naltrexone pellets. The six case reports include pulmonary oedema, prolonged withdrawal, drug toxicity, variceal rupture, aspiration pneumonia, and death (Academic Emergency Medicine 2002;9:63-8). These programmes continue to flourish, say the authors, without good clinical effectiveness or safety data.

Minerva recently learnt that the radiation used for a plain abdominal radiograph is equal to that of 50 chest films. Abdominal radiographs are often requested for patients with acute non-specific abdominal symptoms and signs, but they make little impact on further management. Of 131 abdominal films requested on the day of admission and prospectively analysed in one district general hospital, only 12% conformed to the Royal College of Radiologists' guidelines. Just 7% had an influence on clinical management (Postgraduate Medical Journal 2002;78:94-6). Safety aside, there's also the question of wasted resources.

Keeping cardiopulmonary resuscitation as simple as possible may encourage more bystanders to jump in and help. Computer simulations of blood flow and gas exchange during the procedure indicate that continuous chest compressions (without any attempt at ventilation) produce much greater blood flow than either of the usual 5:1 or 15:2 compression to ventilation ratios. Though the ratio of five compressions to one ventilation produced the highest arterial oxygen levels, continuous compressions alone produced the lowest oxygen levels (Resuscitation 2002;52:55-62).

Does penis size at birth vary with ethnicity? Doctors who measured the length and width of the penis of 105 full term newborn boys from the three main ethnic groups in Vancouver—Chinese, white, and East Indian—found small but significant differences. It may only be a matter of millimetres, but for babies who are defined by published normative data as borderline micropenis, the differences could be critical (Hormone Research 2001;55:278-81).

Some postmenopausal women swear that dietary soy protein combats their hot flushes. But a six month double blind study looking specifically at the long term effects of soy on endogenous steroid hormones found no change in concentrations of oestrogen, cortisol, insulin, glucagon, or follicle stimulating hormone over time. The data suggest a non-clinically significant effect on thyroid hormone concentration (American Journal of Clinical Nutrition 2002;75:145-53).

Despite reports of resistance in many parts of the world, chloroquine is still useful as a prophylactic drug against Plasmodium falciparum in some circumstances. In Cameroon, researchers gave pregnant women weekly chloroquine to try to reduce the incidence of malaria induced anaemia at delivery. They found a 35% reduction in risk for anaemia in the treatment group compared with the control group (relative risk 0.65, 0.4-1.06) with primiparous women benefiting even more than multiparous women (Tropical Medicine and International Health 2002;7:29-34).

Figure1

A 55 year old man with known chronic obstructive pulmonary disease was treated with standard doses of levofloxacin and prednisolone for two weeks for an infective exacerbation of his illness. At the end of the two weeks he sustained a full rupture of both Achilles tendons when he crouched down to put a video in his machine. The injuries were treated conservatively with below-knee plasters. Tendon injuries are a known important complication of treatment with quinolone antibiotics, especially in elderly people and when used in conjunction with corticosteroids. Under these circumstances quinolone antibiotics should be used with caution.

S Weller, general practitioner, Petersgate Medical Centre, Scawthorpe, Doncaster DN5 9PQ

Minerva has often wondered why her UK medical degree is a BM; if she had trained in the United States she would have received an MD. The story goes that in the first American medical schools a BM degree was awarded after four years' work, and further course work and a thesis entitled students to an MD. But so few students returned to take a doctorate that the authorities dropped the bachelor degree altogether, and from 1809 everyone was awarded an MD (Mermann AC.The Renaissance of American Medicine: a Century of New Learning and Caring. Lanham, MD: University Press of America, 2001).

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