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BMJ. 2007 July 21; 335(7611): 164.
PMCID: PMC1925194

Minerva

A 43 year old man who was returning after a week in Nigeria was seen behaving oddly at Heathrow airport. He was agitated, sweating profusely, and disoriented. Routine screening in customs found his urine tested positive for cocaine. A chest x ray showed multiple well defined objects in the stomach, and on admission to hospital he became tachycardic and hypertensive. He deteriorated, and cocaine poisoning was suspected. At emergency laparotomy 89 packets of cocaine were removed from his stomach and bowel (QJM 2007;100:461 doi: 10.1093/qjmed/hcm046).

Obtaining travel insurance with a history of significant illness can be difficult and expensive. Macmillan Cancer Support is working with a banking group to find out more about customers' experiences. People who have had cancer are invited to participate in the research by calling Direct Line Insurance for a quote—call 0845 246 1643 and quote marketing code 6000—before 25 July. Rest assured you don't have to buy a policy to take part in the survey. Alternatively go to www.macmillan.org.uk/travelinsurance

The concept of a “missed dose” is used in many studies of adherence to medication, but the term means different things to different people. Semi structured interviews with 45 HIV positive patients and 17 of their clinicians found a wide variation in what they thought “missed dose” meant: 55% of the patients thought that delaying taking a pill for more than six hours constituted a missed dose, but only one of the doctors agreed. Most patients thought the best thing would be not to take that dose at all after such a delay, but most doctors disagreed with this (AIDS Care 2007;19:775-80 doi: 10.1080/09540120600708501).

Are patients who don't show up for their first appointment at specialist clinics putting themselves at risk? A retrospective analysis of 151 patients who failed to attend a “two week wait” or “urgent” appointment at a colorectal clinic between 1996 and 2004 found that 59 had also failed to attend other clinics. Of the 58 patients referred with suspicious colorectal symptoms (23 of whom were persistent non-attenders), five had colorectal cancers, 16 had benign disease, and 12 had entirely normal outcomes (Annals of the Royal College of Surgeons of England 2007;89:484-6 doi: 10.1308/003588407X183319).

The National Medical Journal of India (2007;20:56-8) offers advice to authors that is universally applicable. Don't, an editorial says, let institutional politics make a liar of the scientific record. If you know authorship abuse is happening, take it seriously and create in-house policies on who can and should be listed as an author. The editorial goes on: if you're already a senior author, show some humility—wouldn't an acknowledgement suffice? And if you're a junior author, be brave: clarify authorship rights at the start of a project to avoid disappointment at the end.

Minerva surmises that people with schizophrenia may have difficulties holding down jobs, but an interesting finding about employment patterns in the UK, France, and Germany is that local social contexts seem to be as important as factors related to the individual or the illness. Data from the European schizophrenia cohort study show that participants are working in all sections of the job market, and that those who are graduates, are living with their families, or have experienced just a single psychotic episode are more likely to be working. Germany enjoys the highest employment rate (British Journal of Psychiatry 2007;191:30-7 doi: 10.1192/bjp.bp.105.020982).

Fire fighters have a higher than average prevalence of sarcoidosis. An investigation of exposure to “dust” from the World Trade Center after its collapse on 11 September 2001 reports that since then, new-onset sarcoidosis has been found in 26 members of New York's fire department, significantly more than expected. Half presented during the first year after exposure, and 69% had findings consistent with asthma. Of those who agreed to challenge testing, eight had airway hyper-reactivity, findings not seen in fire fighters with sarcoidosis before the disaster (Chest 2007;131:1414-23 doi: 10.1378/chest.06-2114).

Here's a lesser known use for vitamin C. Following a report that vitamin C protects against complex regional pain syndrome, researchers designed a dose-response study of vitamin C in patients with wrist fractures. The double blind trial in 416 patients found that a daily dose of 500 mg of vitamin C for 50 days significantly reduced the prevalence of complex regional pain syndrome after wrist fractures. Complaints related to the use of plaster casts predicted the development of the syndrome (Journal of Bone and Joint Surgery 2007;89A:1424-31 doi: 10.2106/JBJS.F.01147).

A company that offers cremation services in Israel has a lot to contend with. For example, there is no law allowing cremation in Israel, and yet there is no law forbidding it. There is no Hebrew word for “cremation”—the only term available is “burning bodies,” and that's a hard concept to market in a country with strong memories ofthe holocaust. The company often refers to the Bible to prove cremation is a Jewish custom, and despite fierce objections raised by religious officialdom, the trend is growing (Pharos International summer 2007;(summer):4-9).


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