A home garden project in rural South Africa has proved fruitful. In an experimental village, 126 home gardens were established to produce yellow and dark green vegetables. Serum retinol (vitamin A) levels rose significantly among people living there and vitamin A levels remained high in the village's young children at follow up. Maternal knowledge about vitamin A also improved considerably. Interestingly, retinol concentrations in the nearby control village fell significantly during the period of the study (American Journal of Clinical Nutrition 2002,76:1048-54).

A community based project designed to keep older women on their toes also reports significant success. Relative to controls, women aged 65-75 with known osteoporosis who took part in a specific twice-weekly exercise programme improved in both dynamic balance and strength. Both factors are critical determinants of risk for falls, particularly in elderly women .

Osteoporotic men, on the other hand, seem to fare less well. A postal survey of older people who had sustained hip fractures found that on discharge from hospital 4.5% of men had been given treatment for osteoporosis compared with 27% of women. At one to five year follow up, 27% of men were taking treatment, compared with 71% of women .

A class of drugs called potassium channel openers may prevent myocardial muscle being damaged after a heart attack. A particular type of potassium “gate” in mitochondrial cells seems to have an important role in protecting against cell damage caused by low oxygen levels. And in animal studies, drugs that opened the potassium gate protected isolated hearts against the type of tissue damage sustained after infarction .

Blood conservation programmes reduce the need for allogeneic blood transfusions. Immediate preoperative isovolaemic haemodilution is well established, and involves holding erythrocytes outside patients' bodies while they bleed diluted blood. Little is known about hypervolaemic haemodilution, which involves in vivo dilution of erythrocytes by creating hypervolaemia with asanguinous fluids, in an attempt to reduce erythrocyte loss. A small prospective randomised study found the two techniques were comparable in terms of blood requirements, time needed, and the costs incurred .

The first clinical trial using combined radiotherapy and gene therapy to treat previously untreated prostate cancer reports that the approach is safe and feasible, and patients encountered no more toxicity than those who received either treatment alone. It's too early to judge the efficacy of this joint approach, but the authors note that since prostate cancer can be a multifocal disease, optimal treatment is likely to require a uniform distribution of the gene carrying vector throughout the gland .

Men who inherit a mutant BRCA2 gene (which causes breast and ovarian cancer in female carriers) have at least a fivefold risk of developing prostate cancer. A Europe-wide trial proposes to compare known genetic variations in prostate cancer patients with those in healthy volunteers, to try to identify which ones confer higher than average risks for developing aggressive disease. Cancer Research UK's IMPACT study is looking to enrol 500 men with a mutant gene and will run for five years.

Minerva's memory is an erratic animal. Babies', on the other hand, seem to come on in leaps and bounds as each month passes. Scientists report in the latest issue of that 6 month olds can only recall a vivid event for 24 hours, whereas 9 month olds can recall an event up to a month after it happens. By the age of 21 months, toddlers can recall things that happened four months earlier. Frontal lobe function therefore seems to start maturing towards the end of the first year but isn't fully developed until the end of the second.

Midwives are said to offer a model of care in which the providers themselves are the “instrument” of care, and midwifery has been shown to produce excellent outcomes. They work to create an environment of calm, trusting in the normal birth process and being present in such a way as to seem to be doing very little. A writer in the says this runs counter to the industrialised view of obstetrics, where technology and intervention have become the norm.

Women with a history of breast cancer are usually advised to steer clear of hormone replacement therapy, although the jury is still out on the validity of this approach. A cautious five year prospective clinical trial that followed 77 menopausal women with stage I and II breast cancer who were oestrogen receptor negative and free of disease for at least two years concludes that oestrogen hormone replacement does not compromise disease-free survival. The authors say it's really time for a large randomised trial on the subject .

Infants are traditionally wrapped up well when they are transferred from the delivery suite to the neonatal intensive care unit. But paediatricians in Cardiff now challenge this practice. Their small study of 10 wrapped and 10 unwrapped infants suggests that unwrapping didn't adversely affect core temperature, but it did allow better essential clinical observation during transfer (Archives of Disease in Childhood Fetal and Neonatal Edition 2002;87:F232).

Figure.

A 26 year old man presented with an ulcer on his elbow two months after trekking in the Bolivian rainforest. It was associated with lymphangitis, and his general practitioner initially treated him with a course of flucloxacillin. When there was no response, he referred to him to our department. He was diagnosed as having cutaneous leishmaniasis of the new world and treated with a 10 day course of intramuscular stibogluconate, an arsenic based compound. A recurrence followed his initial recovery, and he needed a repeat course of treatment.

Cutaneous leishmaniasis is caused by various species of Leishmania (protozoa) and is spread by sandfly bites. It occurs in large parts of Africa, South America, and Asia and also in southern Europe. Systemic leishmaniasis is called kala azar.

Nirmalan Arulanantham, specialist registrar, An Vanthuyne, research nurse, Christopher J Ellis, consultant physician, department of Infectious Diseases and Tropical Medicine, Birmingham Heartlands Hospital