eMJA: In Other Journals, 15 September 2008

Many parents have experienced the worry and stress linked with a childhood febrile seizure, but the risks associated with these convulsions have been difficult to determine. A large Danish study of over 55 000 children with a history of febrile seizures has shown that long-term mortality does not appear to be increased in these children. The 28-year study identified a higher mortality rate in the first and second year after a febrile convulsion, with the rate returning to baseline for the normal population after this period. A nested case-control study examining the type and duration of seizure showed that children who experienced simple (15 minutes or less and no recurrence within 24 hours) febrile seizures had a mortality rate similar to the general population. The authors comment that the findings should serve to reassure parents of children who suffer simple febrile convulsions.

Low-down on hypercalcaemia

Some therapeutic practices in medicine become standard care by default, even when evidence may be lacking as to their efficacy and safety. One such exercise is the treatment of hypercalcaemia with furosemide, claim the US authors of a review on the optimal management of hypercalcaemia. Although the use of forced saline diuresis with furosemide for hypercalcaemia continues to appear in textbooks, the results of the review support that best practice is to use hydration with normal saline and immediate biphosphonate therapy. Calcitonin may be required for emergency management of patients with severe symptoms. The authors take into account potential side effects of biphosphonate therapy, but conclude that furosemide no longer has a place in the treatment of hyperclacaemia.

Ann Intern Med 2008; 149: 259-263

The spoils of war

Images of political violence assault our senses through the media on a daily basis. The effect on children exposed to armed conflict, and how the resulting psychological trauma may be minimised, was the subject of a recent Indonesian cluster randomised controlled trial. Researchers set out to determine the effect of a school-based mental health intervention on children affected by political violence in Poso, Indonesia. Almost 500 children (with a mean age of 9.9 years) were enrolled in the study, with one group undergoing regular group sessions including trauma-processing activities and cooperative play. Children on a waiting list were used as a control group. Outcome measures were psychiatric symptoms rated on scales assessing post-traumatic stress, depression, anxiety and hope. Results showed an improvement in post-traumatic stress disorder symptoms and maintenance of hope in the treatment group, but no apparent differences in the other outcomes. Girls benefited more from intervention than boys. The authors comment that they used non-professional community-based facilitators in their intervention, and that this reflects the resources available in such areas. In conclusion they state these results may show that psychosocial interventions alone are unable to reverse the challenges to psychosocial wellbeing presented by chronic poverty and political instability.

JAMA 2008; 300: 655-662

Windows of the soul

The electronic eye may be closer to reality than you think, according to ground-breaking work undertaken by US scientists.1 Previous attempts at creating an imaging device as subtle in design as the human eye have been thwarted by limitations in the fabrication of optoelectronic devices, particularly problems in developing the required technology on a curved surface. Drawing inspiration from the structure of animal eyeballs, the researchers fabricated a network of semiconductor photodetectors on a silicon wafer that can not only tolerate compression but has the ability to elastically transform from a planar to a hemispherical shape. An accompanying commentary observes that these innovations have implications for use not only as bionic implants, but as health-monitoring devices, in industrial applications, and in the development of artificial eyes structured like those of fish or even insects.2

1 Nature 2008; 454: 748-753
2 Nature 2008; 454: 703-704

Wheeze, rattle and purr

Asking if a child has a history of “wheeze” is fraught with problems, as most primary care providers are aware. In a Scottish study, parents of over 1300 children completed a questionnaire about respiratory noises when the children were 2 and 5 years of age. Those reporting wheeze subsequently described the sound as rattling, purring or whistling. The different sounds appeared to be associated with varying outcomes; compared with other respiratory sounds, whistle was more likely to persist and children demonstrating whistling noises were more likely to require asthma medication in the future. The authors comment that subjective reports of respiratory noises in children may be difficult to interpret, and that further characterisations of the sounds may be clinically useful.

Arch Dis Child 2008; 93: 701-704

Dr Tanya Grassi, MJA

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