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“Monin chooses his target, the governor, and Malraux his, the editor of L’Impartial, Monin offers Cognacq a job at the L’Indochine in the propaganda department…. I shall buy you a nice cap: on it, like on a little boy’s Sunday best sailor’s beret…. The three words that sum up your administration: Disorder, Inequality, Anarchy. Malraux portrays Lachevrotiere as a specialist in “pistol duels with the shortsighted, and sword duels with the one armed.” He builds up a hefty dossier on Lachevrotiere’s military non career. Monin willingly countersigns as a voluntary consort for the duration of the war. (

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The stress of marathon running is well known. Dehydration and electrolyte imbalance are two of the recognised complications of this sport. In a study of collapsed marathon runners, however, investigators noted that hypernatraemia with hyperosmolality was equally common as hypernatraemia with hypo-osmolaity. In some circumstances, therefore, the administration of fluids to collapsed marathon runners may exacerbate hypernatraemia and result in fatal cerebral oedema. (

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Recently C reactive protein (CRP) has emerged as a possible potent risk marker for cardiovascular disease. The B type natriuretic peptides have also received interest as potential risk markers. In a population based prospective study of 764 adults older than 50 years of age in Copenhagen, investigators studied the risk of mortality and first major cardiovascular event in relation to baseline levels of CRP, urinary albumin, and N-terminal pro-brain natriuretic peptide. In this study measurement of N-terminal pro-brain natriuretic peptide provided prognostic information about mortality and risk factor for first major cardiovascular event. It was a stronger risk biomarker for cardiovascular disease and death than CRP. (

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There is more good evidence for chocolate lovers. Dark but not white chocolate seems to have a blood pressure lowering effect. In a study of 15 healthy volunteers dark chocolate was shown to produce a significant drop in systolic blood pressure and also improved insulin resistance as measured by glucose tolerance testing. This was not the case with white chocolate. (

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The controversy surrounding vitamin E continues. In the laboratory this potent anti-oxidant appears to have a protective effect against cancer and cardiovascular disease but clinical trials have failed to show any benefit from its use. Now in a study of 5000 patients with diabetes or cardiovascular disease, nearly 4000 of whom agreed to take vitamin E or placebo, no protective effect on heart disease or cancer was demonstrated in the group that took prophylactic vitamin E. The only positive finding was an increased risk of heart failure among patients who took vitamin E. (

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The lack of refrigeration remains a problem in providing vaccinations for the world’s poor since these drugs often lose their efficacy in the heat. Two hundred years ago a solution for this was to vaccinate orphaned children to propagate the vaccine. The ethical dilemmas involved in such a programme are obvious. However, investigators at Arizona State University now suggest that genetically engineered potatoes may be used to produce a vaccine against hepatitis B virus. This so called edible vaccine proved to be effective in 60% of volunteers who ate raw chunks of the potato. Shifting the strategy from edible vaccines from food to process pills may be the next step in this development. (

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Considerable concern has been raised about reporting bias as the result of selective reporting of results from clinical trials. In a study of all journal articles of randomised trials indexed in PubMed, investigators from Toronto concluded that incomplete reporting of outcomes within published articles of randomised trials is common. Medical literature therefore represents a selective and biased subset of study outcomes and trial protocols should be made publicly available. (

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There is considerable interest in biofilm production in relation to bacterial infections and the development of therapeutic strategies to interfere with it. The importance of this is further emphasised by a study of patients with prosthetic heart valves. In this study Staphylococcus epidermidis, usually a benign bacterium became pathogenic on the heart valve. This appears to be because the bacterium secretes an extracellular polymer poly-gamma-dl-glutamic acid. This in turn forms a biofilm that protects it from the host’s normal innate defences. Targeting this extracellular polymer may be a way to develop new antibacterial therapies. (

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It now appears clear that genetic factors are important in the development of age related macular degeneration (AMD). It is less clear what environmental factors may also have an important role. Results from the Age Related Eye Disease Study Research Group suggest that patients with early intermediate AMD who smoke or have an increase in body mass index are more likely to progress to advanced AMD. The question of whether the use of antacids and anti-inflammatory medications affected progression of AMD could not be ascertained from this study but the authors suggest further study is warranted. (

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Malaria continues to be a worldwide health concern. In certain areas of the world it remains endemic. In a study from Kenya of children who had been infected with falciparum malaria some children developed neurocognitive impairments that were evident as long as 9 years after initial infection. The long term consequences of malaria in children can be profound. Learning disabilities may persist for many years. (

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Among older men there is some interest in testosterone supplements for the effects of so called male menopause. In a randomised controlled trial older men who received supplemental testosterone did not appear to fare better than those who did not when evaluated by a symptom score on androgen deficiency in the ageing male. However, the group that received the supplement appeared to be less sad and grumpy. (

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