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BMJ. 2007 October 6; 335(7622): 728.
PMCID: PMC2001036

Minerva

House cats may serve as sensitive sentinels in assessing human exposure and adverse health outcomes related to low level but chronic PBDEs (polybrominated diphenyl ethers) found in flame retardants, which end up as household dust. The risks in young animals, through even brief exposure in cat food, include mild learning impairments and reduced concentrations of circulating thyroxine. The risks are unknown in humans, but parents may be advised to vacuum frequently (Science NewsOnline 15September 2007 www.sciencenews.org/articles/20070915/food.asp).

People with fatty livers tend to develop insulin resistance and raised glucose concentrations, but Japanese researchers now think that whether diabetes develops depends on the type of fatty acids in the liver. They created a strain of mice lacking an enzyme that increases the length of the carbon chain of fatty acids, and these mutant mice developed fatty livers which were predominantly made up of shorter fatty acids. When fed on high fat diets, these mice developed fatty livers but not insulin resistance or high glucose levels (Nature Medicine 30 September 2007 doi: 10.1038/nm1662).

Bed rails are often put in place to prevent people falling out of bed, and they're used for other reasons too. They can help patients manoeuvre themselves in bed or can be used as an aid to transferring in and out of bed. But because of a belief among the public that bed rails should and ought to stop falls, in a substantial number of negligence claims the failure to apply them is specifically mentioned (Clinical Risk 2007;13:173-8 doi: 10.1258/135626207781572693).

In line with some doctors Minerva knows, an addiction psychiatrist paraphrases the saying misattributed to Göring: “Whenever I hear the words ‘evidence based' I reach for my gun” (SCANbites 2007;4(Autumn):2 www.scan.uk.net). He says the existing literature fails to adequately reflect his daily practice, because his core intervention of “boundary setting” is completely ignored by researchers. Every team treats every individual patient differently to find boundaries that work.

What can be done about MRSA (methicillin resistant Staphylococcus aureus), apart from the obvious hand washing? The Annals of the Royal College of Surgeons of England (2007;89:661-4 doi: 10.1308/003588407X209419;665-7 doi: 10.1308/003588407X205341;668-71 doi: 10.1308/003588407X209400) carries three papers with suggestions. One says that surgical marker pens should be disposable; another, that case notes might be carriers of infection between healthcare workers. The third paper points the finger at hospital bed control handsets as a possible culprit.

To see if an electronic anaesthetic information management system could be linked with a drug dispensing system in a large US hospital, more than 11 000 cases were reviewed. The investigation compared records of drugs recorded as given to patients, with the records of drugs recorded as removed from the dispensing system. Discrepancies occurred in 15% of cases; three quarters of these resulted from an error either in the amount of drug waste documented or in documenting the drug given (Anesthesia and Analgesia 2007;105:1061-5 doi: 10.1213/01.ane.0000282021.74832.5e).

Do people who cope well with stress have something special going on? A paper in Psychosomatic Medicine (2007;69:614-20 doi: 10.1097/PSY.0b013e31814cec64) suggests the answer may lie in our serotonin transporter (5-HTT) genotypes. A longitudinal study in 1993 assessed coping strategies, and 10 years later researchers determined genotypes for 5-HTT promoter polymorphism from genomic DNA obtained from 127 participants. The long and the short of it is that the short variant of the 5-HTT promoter gene was associated with the use of fewer problem solving strategies.

The relation between a high total cholesterol level and the risk of a stroke is not as obvious as you might think. In a Danish study of 652 unselected patients with ischaemic stroke who arrived at hospital within 24 hours of the onset of the stroke, the severity of the strokes was measured with the Scandinavian stroke scale and mortality within 10 years of the stroke was established. A survival analysis showed an inverse linear relation between serum cholesterol and mortality, favouring the hypothesis that high cholesterol levels favour the development of minor, rather than major, strokes (Stroke 2007;38:2646 doi: 10.1161/STROKEAHA.107.490292).

A curious observation in Blood (2007;110:2231-4 doi: 10.1182/blood-2007-02-071423)

describes how cells from allogeneic blood and marrow transplants can contribute to the formation of non-haematopoietic tissues. Using a technique known as short random repeat analysis, researchers found that, two or more years after transplantation, fingernail clippings from nine out of 21 stem cell recipients contained up to 73% of donor DNA.

Evidence from several types of studies of varying quality shows that garlic protects against colorectal cancer (Journal of Nutrition 2007;137:2264-9http://jn.nutrition.org/cgi/content/abstract/137/10/2264). Though measures of garlic intake vary in human epidemiological studies, even stronger evidence come from animal studies, which consistently find a protective effect.


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