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Pnomh Penh 22.10
After a protracted delivery and some unexpected hesitancy after the cord is deftly cut by the obstetrician, Achariya draws her first breath under the glare of the maternity theatre lamp.
Had her parents delayed leaving the village any longer (the temporary crepuscular defervescence having been falsely reassuring), Mary’s outcome (and ‘the lab had never seen such a high degree of parasitaemia’ said the paediatrician while coupling the artemether), might have been very different.
The surgeon, calm, her operating theatre embalmed in the soothing Guarania melodies, stood back, satisfied that Pilar’s femoral fracture was aligned, the haemorrhage stifled.
It’s almost as if we’re back in the immediate post war years when billboards entreated the public to smoke. Why? Well, obviously tobacco made you a more attractive, sophisticated person.
Even when Doll and Peto’s work vehemently rebutted this myth, the world was already hooked. The demise has been far from universal and, where decline has been seen, has been painfully slow. Hellbent on maintaining profits, the ‘industry’ came up with a new trump card: vaping. And, for a while at least it worked, public health bodies were duped into believing the ‘healthier alternative’ myth.
Let’s fast forward a few years. Jonathan Coutts’ and Ross Langley’s eviscerating Viewpoint, disabuses us of any residual equivocation: the fetal toxicity, acute and chronic effects, the cherry picking of data (is a Delphi panel composed of members with a clear conflict of interests really a Delphi panel?), the veiling of nicotine content and IgE mediated reactions, the now clear association with future use of heavier drugs… Please read this and then please listen to the rightly coruscating podcast – if you’re still not convinced, get back to me on a postcard with reasons why… See page 691
Global child health: labours of love
We believe every paper we publish has potential to influence practice. It is rare, though, to have the privilege of publishing a piece, the principles of which have and will continue to apply to and change the course for the majority of the world’s children: those living in low and middle income countries (LMICs). For more than 20 years, Trevor Duke at the RCH, Melbourne, Australia has compiled annual listings of randomised controlled trials published in the preceding year in LMICs. Though these have been disseminated in other fora, they have never been published in a journal before. This year’s monumental achievement identifies over 500 RCTs, comprising themes including the recently ratified typhoid conjugate vaccine; dolutegravir in HIV; simplified antibiotic courses in fast breathing pneumonia, safety netting after discharge… among many. Ask yourselves whether the grant donors invested well and why are the neglected tropical diseases of 2003 the neglected diseases of 2023? See page 709
A taste of honey
The multiple potential advantages for young children using modifications of pills designed for older children and adults over the traditional suspensions are all superior in the solid form, with the proviso they must be palatable and swallowable. This has led to the development of mini-pills and the literature to date, suggests that uncoated versions are worthy alternatives. There has been a little more hesitancy around coated tablets, some anecdotal reports of associated coughing bouts having led advisory panels to be cautious. Viviane Klingman et al, test this in an elegant crossover study comparing age-appropriate doses of coated minipills with sucrose in children aged 1 to 6 years. The findings should hasten the overdue demise of the bottled, sticky, congealing liquids that, for decades have been a parent child battle of wills. See page 730
Along the watchtower
One of the great achievements of both the British Paediatric Surveillance Unit (BPSU) and Australian equivalent, the APSU has been the lending of perspective. Perspective across the spectrum of rare diseases where the apparent curate’s eggs turn out to be criminally overlooked and those thought to be rampant when put under the strict diagnostic criteria microscope almost vanish. There are three separate surveillance papers which illustrate this breadth beautifully: from the APSU, Yvonne Kurynski et al on the Vitamin D testing epidemic; from the BPSU, Marie Wright et al on the real birth prevalence of Pierre Robin sequence and Tamsin Newlove-Delgado et al on Sydenham’s chorea, topical in the light of the surge in invasive and complicated group A streptococcal disease. See pages 742, 748 and 736
Ethics and law for clinical practice
Inspired by Robert Wheeler’s ‘Clinical Law for Clinical Practice’ series, a new, augmented banner section: Ethics and Law for Clinical Practice. Veronica Neefjes tests whether mediation could potentially have avoided litigation in historic cases. Clare Bell et al assess the preparedness trainees feel in coping with high profile cases and the legal and emotional accoutrements these inevitably entail. Sidarth Vemuri et al using phenomenological interviews, examine approaches to end of life decisions in children with life limiting conditions. See pages 715, 719 and 725
San Diego 08.10
The history hadn’t been unduly alarming, but there must have been a reason they brought her to the ED at 4 AM. The nodes hadn’t really shouted out a diagnosis, but the CBC and film sure did, the blasts centre stage under the lens. Another few hours and… well, who knows?
Patient consent for publication
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.