Reversal of fortunes
As we wait in hope for the next generation of anticoagulants, warfarin — despite its narrow therapeutic index, interactions with drugs and foods, and monitoring requirements — remains the mainstay of therapy for many. To minimise its risk of bleeding and safely reverse its effect when necessary, see the consensus statement from the Australasian Society of Thrombosis and Haemostasis (→ Warfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis).
What goes in . . .
With a little help from the food industry, an idea has been circulating that the current obesity epidemic has little to do with eating too much and everything to do with sloth. Not so, say Stubbs and Lee (→ The obesity epidemic: both energy intake and physical activity contribute). There is good evidence that Australians have increased their energy intake in recent years — and it doesn’t take many calories to make a big difference.
The people’s paediatrics
In this issue we unveil our newest Practice Essentials series — Paediatrics. Series editors Couper, Henry and South joined us in canvassing widely for the most-needed topics and, as a result, our authors have produced articles that cover new ground (→ Paediatrics: tackling the common problems).
Starting the series at infancy, Hiscock and Jordan give practical advice on helping a family with a crying baby. What are the medical issues to exclude? How can we support families through the turbulence of conflicting advice to the calm waters of a baby-centred approach? (→ 1. Problem crying in infancy)
An eyeful of myths
Be sceptical of those "miracle cures" for macular degeneration, says Constable, whose editorial) separates fact from fiction (→ Age-related macular degeneration and its possible prevention. We now know more about this rising cause of permanent visual loss, but prevention is still better than cure.
Another age-related myth is the impression that the elderly are gradually consuming more inpatient services as our population ages. Not so, say Gray and colleagues, whose trend analysis paints a different picture (→ Trends in the use of hospital beds by older people in Australia: 1993–2002).
Give death the cold shoulder
A drowning tourist is pulled from the surf by an off-duty lifesaver. In cardiorespiratory arrest, he is resuscitated at the scene, but arrives at your ED with fixed, dilated pupils and an arterial pH of 6.47. What would you do? Some might opt for a palliative course at this point, but staff at a Sydney hospital resorted to a novel approach — controlled hypothermia. Williamson et al describe the remarkable results (→ Near-drowning treated with therapeutic hypothermia).
Australia has played a leading role in showing that therapeutic hypothermia should now be standard care for out-of-hospital cardiac arrest. The editorial by Bernard, an investigator in a seminal trial, primes us on current knowledge about this therapy and its limitations (→ Therapeutic hypothermia after cardiac arrest).
Deaths out of custody
We know that young offenders have high death rates — 9 to 41 times the overall rate for those of the same age in Victoria. What factors might predict early death? Coffey and colleagues follow up nearly 3000 adolescents who had received a custodial sentence by 20 years of age (→ Predicting death in young offenders: a retrospective cohort study).
Ross’s editorial explores ways to reduce this mortality, including how to capitalise on that window of opportunity just before release as people plan for life back in the community (→ The hidden tragedy of offender deaths ).
Syndrome challenge
Many of us would be hard pressed to remember the syndrome usually characterised by asthma, eosinophilia and vasculitis. For even more of a challenge, Sharma et al present a case with digital gangrene, sinusitis, mononeuritis multiplex and glomerulonephritis without asthma and eosinophilia (→A limited form of Churg-Strauss syndrome presenting without asthma and eosinophilia).
Triumph in the tropical north
It’s no wonder public health boffins in north Queensland are trumpeting the value of their hepatitis A vaccination program, as successes of this magnitude are not that common. Hepatitis A was a major problem in this region last decade, with outbreaks affecting a disproportionately large number of Indigenous children. The response was to make hepatitis A vaccines freely available to Indigenous children in the region. Hanna and colleagues report on the program’s success in virtually eradicating hepatitis A from Indigenous and wider communities (→ Impact of hepatitis A vaccination of Indigenous children on notifications of hepatitis A in north Queensland ).
D-ficiency
A group of women found to be deficient in vitamin D during their pregnancy were invited to return for review with their babies several months after giving birth. Things had not necessarily improved, as Thompson and colleagues report, with implications for maternal and infant bone health and for the education of health professionals and mothers (→ Postnatal evaluation of vitamin D and bone health in women who were vitamin D-deficient in pregnancy, and in their infants ).
Another time ... another place
On February 6, 1974. . . a 5-year-old boy walked out on a partially frozen river and plunged into the water . . . [The boy] was carried ashore . . . after being submerged for 40 minutes. He arrived . . . [with] no sign of spontaneous respiration or circulation, his pupils were maximally dilated . . . His rectal temperature was 24°C. . . [After intensive resuscitation and care] the patient was discharged on February 14. . . At the last neurological examination, on March 20, 1975, he was completely normal.
Siebke H, Rød T, et al. Survival after 40 minutes' submersion without cerebral sequelae. Lancet 1975; 1: 1275-1277