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  1. Nick Brown, Editor in Cheif1,2,3
  1. 1 Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
  2. 2 Department of Paediatrics, Länssjukhuset Gävle-Sandviken, Gävle, Sweden
  3. 3 Aga Khan University, Karachi, Pakistan
  1. Correspondence to Dr Nick Brown, Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden; nickjwbrown{at}gmail.com

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Antimony for breakfast?

It was often hard to tell the haze of the dust storms (haboubs) from that of the distant shelling of the rebel forces to the South. But there was more. Khartoum in the late 1980s, beyond the emollient Blue and White Nile confluence at least, had an intangible tension. People were dying and dying young, not from stray projectiles from the civil war, but, from an enigmatic illness, all having becoming progressively more unwell on the tarpaulin camps which became their temporary (and usually permanent) homes after leaving the strife and phlebotomine-ridden villages of their former lives in the South. Farah* was one of the many: orphaned by some sort of immune suppressing illness that spirited away both her parents (there was a local name, something to do with dune fever), Ahmed, the paediatrician, was all too familiar with her phenotype. The wasting, the nodes, the pallor, the fever and the spleen: the spleen that (wholly inimicably) had often encroached even the right iliac fossa. Her blood count and differential were typical: white cells on the parsimonious end of the spectrum, the haemogobin and platelets even more dampened. The procedure: as usual, straightforward. A lick of subcutaneous lidocaine from the generator-powered fridge and straight into the splenic parenchyma. ‘Is this even necessary’ (given the bleeding risk and differential diagnosis of nil) was a thought that crossed his mind frequently, but, which he never allowed go any further. As predicted, the slide teemed with amastigotes and the Pentostam (intramuscular – tick, daily-tick, for 6 weeks – tick) rapidly etched on the treatment chart. She knew that some of her relatives made it back to the camp, although as shadows of their former selves. Others never defervesced and, in the parlance, moved on. Her only comfort was that, as she’d been informed by an esteemed elder, doctors like my colleague, Ahmed*, paediatricians they called them, were making a difference, would continue to make a difference and would, before the next rains petered out, bring the tide of bad spirits (the ‘epidemic’ as the papers called it) to an abrupt, longed-for halt.1

Ivocaftor for lunch?

Though much has changed over the last decade in terms of treating cystic fibrosis, the 20th century ‘wasted phenotype’ less etched in the subconsciousness of those whose paediatric careers began after 2010 than those longer in the tooth, the relationship between pancreatic and lung function and intestinal inflammation (direction of causality anyone?) has never really been decodified. In a study couched in the MyCyFAPP project, Maria Roca and followed a group of children on the cusp of the CFTR era with pancreatic insufficiency at the outset and assessed the correlation between subsequent function, calprotectin, quality of life and lung function. Calprotectin successively increased while QoL and lung function fell. Faecal fat however did not change, so the hypothesis-generating question is whether there is some other reason for intestinal inflammation, expectorated-swallowed infected sputum high on the roll call. The editorial by Tim Lee and Claire Lissenbaum suggests several potential mechanisms – the swallowed, infected and pro-intestinal muscosal inflammatory sputum pathway demanding a further look in an era which could so easily in the pulmonary symptom-attenuated era of the membrane regulators, slip off the radar. See pages 552 and 525

Acetylcysteine for tea?

Paracetamol (aminocetofen), even after all these years, is still the first choice analgesic for mild and moderate pain. Though the stage is now shared by multiple other actors, some with their own niches, clonidine, intranasal ketamine for severe pain, COX II inhibitors for the chronic- rheumatological moderate, paracetamol remains top of the cast. Parenteral paracetamol first sneaked behind the curtains in the mid 2000s, at that point more as a pharmacokinetic future player. Interest (as I recall) did not really pick up until well into the 2010s when surgeons were faster to adopt it, finding a niche in post procedural pain. Every advance, though… Florence Vincent and colleagues from the National Poisons Information Service database, estimate the incidence of errors (mainly dose or inadvertent concomitant oral prescribing) between 2008 and 2021. The editorial by Yincent Tse flags the (methods of averting these errors, all preventable despite a narrow therapeutic-toxicity window. See pages 557 and 526

Face to face for supper?

Silja Kosola and colleagues provide another endorsement for this school of thought. Using routinely collected cross-sectional national school health data (from more than 86 000 adolescents) they showed strong associations between excessive internet use (measured by a standardised questionnaire) and unexcused school absences, poorer sleep and lower physical activity. The same group go a step further in their analysis of smart phone use finding an average daily use of close to 6 hours and (sadly, unsurprisingly) associations with low esteem, generalised anxiety, lack of fitness and tiredness. On the tacit assumption of temporality, what is the solution to this (and I do not use the word lightly) pandemic? Ironically, it has been catalysed, to an extent, by the last one when isolation became the norm, the internet the turn-to companion. See page 576

*All names are fictitious.

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  • Collaborators NA.

  • Contributors NA.

  • 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 Not commissioned; internally peer reviewed.

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