Two unrelated male infants presented in San Francisco (

, one at 3 months with irritability, and the other at 2.5 months with convulsions. Both had hyponatraemia, serum hypo-osmolality, and urine hyperosmolality, consistent with the syndrome of inappropriate antidiuretic hormone secretion but neither had detectable arginine vasopressin (antidiuretic hormone) in serum. Both infants had a missense mutation, causing gain-of-function, of the X-linked V2 vasopressin receptor gene. The condition has been called the nephrogenic syndrome of inappropriate antidiuresis.

In developing countries almost half of all births are supervised by traditional birth attendants. In rural Pakistan (

; see also perspective article, ibid: 2047–8) traditional birth attendants received 3 days of training in antenatal and delivery care, use of a disposable delivery kit, and care of the newborn. Obstetric teams set up outreach clinics for antenatal care. Perinatal mortality fell significantly by 30% compared with control districts. A 26% fall in maternal mortality was not statistically significant.

More evidence that high environmental noise levels are bad for children has come from a study in Holland, Spain, and the UK (

, see also comment, ibid: 1908–9). A total of 2844 children aged 9–10 years living near Schiphol, Barajas, and Heathrow airports were included in the study. Exposure to chronic aircraft noise was associated with impairment of reading comprehension and of …