It is well documented that Free radicals (FRs) and their Oxidative Reactions are implicated in more than 70 diseases and disorders [1,2], including inflammatory reactions, such as alergies and rheumatoid arthritis. As FRs and Oxidative stress are also implicated in many cell death processes [3], many scientific activities are being done to discover possible protective effects of the antioxidant therapy [1]. Today, based on Oriental and Mediterranean dietetic studies, we know that many foods,the functionals or nutraceuticals, can improve physiological properties of the human body, improving health and preventing diseases. I should be emphazised that antioxidant activity of foods is one of the most important functional food atributtes.

Persenone A, an avocado compound, was able to inhibit two peroxidative enzymes involved in inflammatory responses, the nitric oxide synthase and cyclooxygenase in mouse macrophages [4]. Murcia et al. [5] demonstrated that avocado possess antioxidant activities as well as many other Mediterranean and Tropical Fruits do. Some years ago, Kikusaki and Nakatani [6] had observed that 12 Ginger compounds have antioxidant activity.

This year, Kim et al. [7] reported that ginger, avocado, carrot, turnip and shimeji mushrooms had higher superoxide radical scavenging activity, suggesting that this phytochemicals can prevent oxidative DNA damage, the first step in cancer carcinogenesis.

It should be noted that in rheumatoid arthritis, there are intensive production of FRs and the antioxidant therapy is very important to control the damaging effects of these substances. As exposed before, Ginger, Avocado and other foods are rich sources of antioxidants with a great potential to be explored in rheumatoid arthritis. However, many more basic and studies are necessary to support a teraphy.

References

(1) Ferrari CKB (1998). Lipid peroxidation in foods and biological systems: General mechanisms and Nutritional and Pathological implications. Rev. Nutr., 11: 3-14 (in portuguese).

(2) Ferrari CKB (2001). Oxidative Stress Pathophysiology: Searching for an Effective Antioxidant Protection. Int. Med. J., 8: 175-84.

(3) Ferrari CKB (2000). Free Radicals, lipid peroxidation and antioxidants: Implications for cancer, cardiovascular, and neurological diseases. Biologia, 55: 581-90.

(4) Kim OK, Murakami A, Takahashi D, Nakamura Y,Torikai K, Kim HW, Ohigashi H (2000). An avocado constituent, persenone A, suppresses expression of inducible forms of nitric oxide synthase and cyclooxygenase in macrophages, and hydrogen peroxide generation in mouse skin. Biosci. Biotechnol. Biochem., 64: 2504-7.

(5) Murcia MA, Jimenez AM, Martinez-Tomé M (2001). Evaluation of the antioxidant properties of Mediterranean and tropical fruits compared with common food additives. J. Food Protect., 64: 2037-46. (6) Kikusaki H, Nakatani N (1993). Antioxidant effect of some Ginger constituents. J. Food Sci., 58: 1407-10. (7) Kim HW, Murakami A, Nakamura Y, Ohigashi H (2002). Screening of edible Japanese plants for suppressive effects on phorbol ester-induced superoxide generation in differentiated HL-60 cells and AS52 cells. Canc. Let., 176:7-16.

Dear Editor

On behalf our Study group, I would like to thank EBN’s Editors for their interest in our work.

In their review, major concerns regarding the design and analysis of our study were raised by Drs Moralejo and Jull, mainly because antiseptic protocols were randomised by services (called "clusters") but outcome was analysed by patients. The authors concluded that while our trial is intriguing, "whether hand rubs and handwashing are truly equivalent remains unclear". In my opinion, the fact that Drs Moralejo and Jull misunderstood the design of our trial does not justify that they unvalidate our conclusion.

The reason why we did not account for cluster randomisation is simple: the design of our study was not a "cluster randomised trial", as they incorrectly suggested. To be the case, each of the 6 services should have been randomly assigned to one of the 2 protocols for the complete 16-month period of the study. In this case only, characteristics of each service, such as teaching versus non-teaching hospitals or surgical team experience, would have differentially affected outcome, because of intracluster dependence between patients within each service.

In fact, each service alternated protocols monthly, so that they equally contributed to include patients in both protocols, as shown in Table 1 of our article. Initial randomisation of the services rather than continuous randomisation of patients was not an error but a choice. Its rational was clearly discussed in our article.

Finally, we must stand on our conclusion that handrubbing and handscrubbing were equivalent in preventing surgical site infection.

Dear Editor,

I was so glad when my daughter, also a nurse, found this piece of research. I note with sadness the date - 2001.

I live in the wilds of Essex, at least 25 miles from the great 'metropolis'. Two years ago I had a vile stroke, so I no longer drive. Recently 'they' noticed that I had AF and must start on anticoagulant treatment instantly. There is a proudly "Nurse led Clinic" at a hospital some half an hour away. It works well BUT the transport picks up patients from all over Essex. Not only is one frequently collected two or three hours before the clinic, but one has to wait for transport for several hours AFTER the efficient 3 minute blood test.

The logistics of this are understandable, but I did begin to wonder why I couldn't do the test myself, or at least go to the much nearer surgery. I kept being told that one had to be 'specially trained'- or that the blood test that was done in the ward was 'different' and needed venous blood - a constant denial of the facts - nurses and doctors kept insisting on their exclusive magical powers.

First we bought the kit - annoyingly expensive! The GP won't play ball, though I keep meeting people who know of practices which are happy to. Nor will the hospital clinic accept my readings - so far. I find the Clinic visits exhausting and 'bad for my health', and I am by no means among the most decrepit of some of the poor folk I travel with, and who sit in wheel chairs waiting for transport.

As a professional who often pioneered small changes in Family Practice which made things easier for our patients I am irritated by this failure to take up simple changes in practice which benefit all of us.

Julia Wyatt
SRN BA Hons (Lond)