Funtabulously Frivolous Friday Five 253

King Nebuchadnezzar II – king of Babylon c. 605 BC – c. 562 BC

Although hardly a rigorously designed RCT. The story of the first clinical comparison of outcomes from intervention (PICO anyone?) comes from the Book of Daniel, of the Old Testament of the Christian Bible:

During his rule in Babylon, Nebuchadnezzar ordered his people to eat only meat and drink only wine, a diet he believed would keep them in sound physical condition. But several young men of royal blood, who preferred to eat vegetables, objected. The king allowed these rebels to follow a diet of legumes and water — but only for 10 days. When Nebuchadnezzar’s experiment ended, the vegetarians appeared better nourished than the meat-eaters, so the king permitted the legume lovers to continue their diet.

• Collier R. Legumes, lemons and streptomycin: A short history of the clinical trial. CMAJ. 2009 Jan 6; 180(1): 23–24. [PMC2612069]

Honey!

This is controversial but several centres are now taking up the protocol based on a 2018 study investigating potentially protective oesophageal substances and found honey and Carafate (sucralfate, a common ulcer medicine) both neutralised the tissue pH changes, created more localised and superficial injuries, and noted decrease in in vivo full-thickness injury on cadaveric porcine oesophagus.

Other common household items that were tested and failed were apple juice, orange juice, Gatorade, PowerAde and maple syrup.

So give the girl 10ml (2 teaspoons) of honey, orally, every 10 minutes for up to 6 doses (if you can).

• Anfang RR et al. pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. Laryngoscope. 2018 Jun 11 [PMID 29889306]

Roald Dahl, on his eldest daughter “Olivia”, who died from measles encephalitis in November 1962, aged 7.

In 1986 Roald Dahl penned an open letter encouraging vaccination against measles in an effort to save lives and honour Olivia.

Currently, more than 41,000 children and adults across Europe have been infected with measles in the first six months of 2018 and at least 37 people have died. The number of measles cases seen this year far exceeds the annual totals for every year this decade, which was highest in 2017 when there were 23,927 cases and lowest in 2016 when there were 5273

• Kmietowicz Z. Measles: Europe sees record number of cases and 37 deaths so far this year. BMJ 2018; 362

England

English children consume 50% more energy drinks than their European cousins.  The average sugar content in one energy drink is more than the recommend daily maximum for an adult and the same caffeine content (in mg/ml) as instant coffee.

• Iacobucci G. Sales of energy drinks to children to be banned in England under government plan. BMJ 2018; 362

Nutcracker syndrome.

Nutcracker syndrome (NS) refers to symptomatic compression of the left renal vein (LRV) between the abdominal aorta and superior mesenteric artery with potential symptoms including hematuria, proteinuria, left flank pain, and renal venous hypertension.

The first clinical report of this syndrome was made by El-Sadr and Mina in 1950 while the term “nutcracker syndrome” is thought to have been first used by de Schepper in 1972
It most commonly presents in the second and third decades of life.  It is more common in female than males, has increased frequency during pregnancy, and is more prevalent in people with a lower BMI.

• El-Sadr AR, Mina E. Anatomical and surgical aspects in the operative management of varicocele. Urol Cutaneous Rev. 1950;54:257–262 [PMID 15443180]