Minerva

The four most common causes of chronic cough are identified by a review in Chest (2006;129: 59-62). They are upper airway cough syndrome (formally known as postnasal drip syndrome), asthma, non-asthmatic eosinophilic bronchitis, and gastroesophageal reflux disease. They may be clinically silent, apart from the cough. The authors conclude that the most efficient approach is to focus on detecting these four causes rather than routinely searching for the many other obscure causes.

Olle Hansson was a Swedish paediatric neurologist famed for campaigning against the unethical promotion and marketing of drugs. To honour his work, an annual award is made to someone from a developing country who shows the same qualities. Nominations for the 2006 award should recognise individuals who promote the concepts and rational use of essential drugs and who actively increase awareness among consumers about “the dangers of irrational and hazardous drugs” (for more information go to www.haiap.org).

Young women who terminate their pregnancies are at increased risk of subsequent mental health problems, according to a 25 year cohort study from New Zealand. The most vulnerable women are those aged between 15 and 25 years. Forty one per cent of the cohort had become pregnant at least once before the age of 25. Of these, 14% who had had an abortion reported higher rates of depression, anxiety, suicidal behaviour, and substance abuse, which remained high after adjustment for confounding factors (Journal of Child Psychology and Psychiatry 2006;47: 16-24).

Whether your ear wax is dry or wet seems to depend on your genes. The dry variety is found more commonly in East Asian populations, and the wet stuff is commoner in African and European populations. The gene responsible for determining earwax type is known as ABCC11 and was identified by examining a Japanese population with both types of wax (Nature Genetics 29 Jan 2006, doi: 10.1038/ng1733).

The anxiety of fathers watching their child being delivered by caesarean section influences how the mother feels and can increase her perception of pain. A study of psychosocial influences on women's experiences of elective sections reports that the mother's fear fluctuates (it's greater when the nerve block is introduced than at the time of the initial incision), and that the emotional state of the birth partner affects it (Psychosomatic Medicine 2006;68: 167-74).

Three quarters of US citizens say they favour quarantining people who have potentially been exposed to serious contagious diseases, yet 42% don't support compulsory quarantine measures, which would include arresting people who don't comply (Health Affairs 24 Jan 2006, doi: 10.1377/hlthaff.25.w15). When the survey was conducted in Hong Kong, Singapore, and Taiwan it showed significantly more support for compulsory quarantine, probably because people in these countries have experienced the reality of diseases such as SARS (severe acute respiratory syndrome).

Figure 1.

A 35 year old man presented after returning from holiday in Mexico. On the advice of a local barman, he had squeezed and rubbed limes on his legs to soothe several insect bites. He developed a painful, blistering rash in a bizarre distribution over the parts of his legs that had been exposed to the sun. Phytophotodermatitis is caused by photosensitisation from furocoumarins (which include psoralens) in plants and subsequent exposure to ultraviolet A wavelengths. It is not immune mediated, so it doesn't imply allergy to the offending plant. Common culprits include citrus fruits, celery, and rue. Typically, lesions are linear and leave pronounced hyperpigmentation.

Stuart N Cohen (cohensn@yahoo.com), specialist registrar, Sheelagh M Littlewood, consultant, department of dermatology, Queen's Medical Centre, Nottingham NG7 2UH

A fully automated internet smoking cessation programme shows that, in the short term at least, such interventions can be pretty successful. The cessation rate at 90 days was 24.1% for the treatment group and 8.2% for the control group. Participants were randomly assigned to a group and the internet programme presented strategies and motivational materials tailored to the user's race, sex, and age (Tobacco Control 2006;15: 7-12).

Childhood obesity is predictive of bullying in both sexes, according to a prospective cohort study in the Archives of Disease in Childhood (2006;91: 121-5). Before adolescence, obese boys and girls are likely to be the victims of bullying because they look different from the norm. Older obese boys are likely to be bullies, perhaps because of their physical dominance.

After reports that dogs can sniff out cancer, Portuguese researchers propose a theory that the volatile organic compounds produced by tumours are products of major histocompatibility complex genes. They say that two lines of evidence support their idea. Firstly, human body smells are genetically determined by human leucocyte antigens (the equivalent of major histocompatibility complex in humans), which are present in blood, urine, and sweat. Secondly, there is a strong association between changes in expression of human leucocyte antigens and cancer (Medical Hypotheses 2006;66: 270-2).

Do children who chew gum before surgery present a higher anaesthetic risk than those who don't? The answer is—possibly. A comparison of children not given chewing gum before arriving in the operating theatre with children who were told to chew gum found that those who chewed gum had a significantly greater gastric fluid volume than the non-chewers. Whether this translates into clinical significance remains to be investigated (Anesthesia and Analgesia 2006;102: 415-7).

Curious about medieval forms of contraception, a historian cut the top off a lime and inserted it into her vagina, just like a modern diaphragm. She says it didn't sting, fitted neatly over her cervix, and stayed there—and she could move around without feeling it even when she pressed it with her finger (Journal of Family Planning and Reproductive Health Care 2006;32: 59-60). According to oral tradition, lime juice kills sperm and Candida and creates a hostile environment for “most forms of venereal disease.”