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The polymath: surely a good team mate
While I don’t inherently disagree (in fact, I have an intangible fondness for the Victorian era cultivation of the polymath in society), there is, (as Newton himself noted) only one way forward from any perch-key neechay. I guess we could draw an analogy with the rough and ready nature of the cross-sectional study, a fertile breeding ground for ideas, but a snapshot (or portrait in the 17th century vernacular) accurate only at the time it was sketched. Moot point of course, but, in my corner…
Still wet behind the ears
I might have a distorted view, but my impression for long has been that, for many of us our approach to environmental exposures (beyond the old suspects, cigarette smoke and household pets) has been reactive, a little passive, so often, for example, parents have to raise the issue of household damp themselves. This is neither a small problem in size, social housing recently estimating that 4% of their homes affected. Tom Ruffles and colleagues at the University of Sussex, Brighton, UK, take the ‘moisture anywhere’ association a step further. Using data from the GO-CHILD birth cohort, they show a significant link between damp in the child’s actual bedroom and a range of symptoms and treatment requirements. We have duty to react: not just to routinely include the question but, as advocates – especially given the new legal requirements for landlords to address in the form of Awaab′s law (https://www.gov.uk/government/consultations/awaabs-law-consultation-on-timescales-for-repairs-in-the-social-rented-sector/awaabs-law-consultation-on-timescales-for-repairs-in-the-social-rented-sector%23awaabs-law). See pages 818
Global child health: misspaced water
Clare Smith and Trevor Duke’s group PICU, RCP, Melbourne and Papua New Guinea provide more food for thought in terms of appropriate fluid and electrolyte treatment in febrile illness and undernutrition in low and middle income countries, the complex interplay between cytokine and biochemical physiology inherent to a healthy febrile response – it feels a long time since the ‘bag of fifth normal’ aka 0.18% saline was assigned villain status, but the beauty of this piece is that it goes back the step we so often miss – where is the root cause physiological aberration? See pages 794
Glucose tolerance: more shades
Part 1
The benefits of insulin pump therapy are no secret, the consistent improvements in HbA1C testimony to tighter control. In an intriguing secondary analysis of a previous RCT (enrolment between 2010 and 2014) Michele O’Connell and colleagues delve further into diabetes control and long-term outcomes, comparing, at that point, nascent, pump treatment against multiple daily ejections and socio-cognitive outcomes 2 years after enrolment. The exposure here, arguably is HbA1C and, despite the expected improvement and after an initial (4 month) improvement in self -reported mood, behaviour and cognition beyond which the MDI group were switched to pumps. By 2 years, none of these parameters differed, only parent-reported behaviour problems being lower in the pump-first children. An editorial by Isabel Heyman discusses the labyrinthine interplay between these physical and psychological factors. See pages 806 and 781
Glucose tolerance: more shades
Part 2
It wasn’t long ago, that Archives reported the possibility of infant screening for ‘pre-diabetes’ susceptibility in the form of autoantibodies. This showed substantial promise, but given the age-related potential for false negative results (peak development 9 months to 2 years) the search has extended to more time-sensitive testing. Claire Scudder and colleagues report the feasibility of combining the antibody testing (insulin antibody, GAD, zinc receptor eight and IAA) with the pre-school vaccination, a plausible, attractively opportune window at an age where test yield is likely to be higher. See page 812
Glucose tolerance: more shades
Part 3: the rise and rise of semaglutide
The properties of semaglutide a glucagon-1-like-receptor agonist with both central and intestinal motility effects, first declared themselves in the adult world, but it seemed no time before its potential in children became impossible to ignore. It is licensed for use in children over 12 years fulfilling strict BMI and co-morbidity criteria and Elizabeth-Jane van Boxall and demonstrate in real life practice both effectiveness (in terms of BMI SDS and raw weight) at both 6 months and a year, outperforming its immediate predecessor, ligarglutide. Add to this, fair tolerability with only transient minor side effects and it’s hard not to see it gaining even stronger traction. This (for once a fitting epithet) magic-bullet leap though mustn’t distract from primary prevention at a public health level. See page 822
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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.
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