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Though he’d gained a little weight since the height of his legal sparring prowess, he still had an aura, a charisma which few of his high street rivals could even start to muster, let alone match. He pulled some of the old tricks: the harlequin waistcoat, the ostentatious handkerchief, the textured paper, but no one held these against him. On the contrary, he emanated confidence and his immaculate office (even the paperweight was consistently angled to catch the evening sun) only served to heighten this. His secret? ‘Filing, my friend – it’s all to do with classification’. His cabinet testified to this: cross tabulated by year and family. One visit was enough, for all but the most sceptical, to be drawn into his argument.
Labelling – permanent
Names are an inherent part of our identity. Most of us are content with the one chosen by our parents: those are more equivocal might have substituted with original ‘choice’ with a middle name or negotiated a change unrelated to either. Where, though does the law stand on names (despite parental protestation to the contrary) that could potentially harm a child, dissolve self-esteem, leave them vulnerable to bullying or, even exploitation. We’ve all had this experience: usually dismissing it with flutter of (perhaps sometimes a little over-self-righteously) exasperation. Robert Wheeler’s ever-provocative series in Clinical Law for Clinical Practice, describes a case where one of a set of twins born to a mother herself with multiple skeletons in the cupboard was given the name of a poison on the basis of it being natural and derived from (beautiful) plants. See page 869
Sweat conductivity and cystic fibrosis diagnostics: the sequel
Some months ago, Archives published a manuscript from a Brazilian group (Bedran et al) demonstrating the exceptionally high-test validity of sweat conductivity in cystic fibrosis diagnosis compared with the gold standard chloridometry. This test has a long history going back to Dr Harry Schwachman’s work in the US in the late 1950s, but despite credible credentials, never quite caught on as more than a screening tool in high income country settings and has now arguably been further superseded by genetic testing. Why is this method of such importance in low- and middle-income settings? Because it’s quick, because it’s cheap and because it doesn’t depend on lab expertise or mutation analyses. Extending their hypothesis, the same group, Linjie Zhang and colleagues in Belo Horizonte present a meta-analysis, the results of the component studies of which are highly consistent and in the A/A+performance league. See page 904
Global child health: tuberculous meningitis
Anyone who has witnessed the slow, deterioration in function in a child with tuberculous meningitis (but without a confirmed diagnosis) will appreciate the findings from Setyo Handrastuti and colleagues in Depok, Indonesia. The opening gambit was the frequent inaccessibility of CSF culture, gene Xpert and axial imaging and tested whether a combination of clinical signs was predictive against the standards of basal meningeal enhancement on CT and/or CSF stain and culture available in their own centre, their validation suggesting excellent rule out value. See page 884
Medicins avec frontieres?
Genetic advances have become so commonplace to the point (or at least risk of) nonchalance that it’s easy to forget the years of work underpinning each one. One of the newer kids on the block is gene/gene-related therapy in spinal muscular atrophy, headline treatments, onasemnogene, nusinersen and others improving quality of individual and family lives dramatically. The rider, as with many orphan drugs, is that one has to ‘qualify’ in terms of disease severity and age. Lena Xiao and colleagues in Toronto, Canada present findings from a qualitative study based on interviews with parents of children with SMA before regionalised funding became available: frustration at inequity of distribution; pressure to pay and disappointment at non-availability were over-riding themes and, like any new treatment, the issues related to implementation are achingly relevant. See page 929
In contention for most misleading names, ‘haemoptysis’ is at, at least podium level. What it means is blood from the lungs, in other words an infra-laryngeal source, appearing in the mouth. What it does not mean (and this is where the misuse appears) is blood appearing in the mouth. This differentiation is important as it determines pretty much everything that is subsequently done. Many ‘cases’ are of nasopharyngeal, oral or even gastric origin (scope for the wrong scope?) and Ian Balfour-Lynn’s review reminds us to be selective with the CT and bronchoscopy, but rather work on excluding the common – with an open mind of course when volumes are beyond the norm. See page 879
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Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.