Highlights of this issue

Fetal alcohol spectrum disorder

Figure. Photo by: Anson Liaw

Fetal alcohol syndrome is defined by the classic triad of intrauterine and postnatal growth retardation, specific facial anomalies and adverse brain effects (mainly mental retardation). However, the triad occurs infrequently, and it is now appreciated that a spectrum of clinical problems, both physical and neurobehavioural, stems from alcohol exposure in utero. Koren and colleagues review the range of clinical problems in fetal alcohol spectrum disorder. They also provide information regarding screening questionnaires for diagnosing problem drinking, counselling of women during pregnancy and a novel laboratory test that uses neonatal meconium to detect evidence of maternal drinking.

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Cholesterol-lowering drugs after coronary revascularization

Figure.

Hypercholesterolemia is a well-established risk factor for coronary atherosclerosis. Although cholesterol-lowering drugs are strongly recommended to modify this risk factor, and may even offer additional benefits such as improving endothelial function and enhancing plaque stability, it is unknown whether physicians and patients follow this recommendation. Brophy and colleagues report on the rate at which almost 12 000 patients filled at least one prescription for cholesterol-lowering drugs after coronary revascularization. After a mean follow-up of 3 years, they found that 37.2% of the patients had not had a single prescription filled. They also found that patients whose initial revascularization procedure was coronary artery bypass grafting were less likely than those who initially underwent angioplasty to have the prescription filled (odds ratio 0.77, 95% confidence interval 0.73–0.81). The authors suggest that continuity of care plays a crucial role in assuring long-term adherence to treatment in this group of patients.

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Rehabilitation medicine: spasticity

Figure. Photo by: Christine Kenney

In the final article of CMAJ's series on rehabilitation medicine, Satkunam reviews the problem of spasticity in adults who have sustained an insult to the central nervous system. The pathophysiology of spasticity centres on the stretch reflex arc, comprised of muscle fibres and sensory and motor neurons. However, we are reminded that any noxious stimuli can increase the severity of the problem. The author outlines the practical approach to the management of patients with spasticity, including the clinical evaluation and various treatment options.

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Antiviral therapy for SARS

Although physicians are accustomed to having a vast armamentarium of pharmacologic choices in normal practice, those who treated cases of severe acute respiratory syndrome (SARS) this past year were confronted with a disease for which there was no clear treatment. Some reports showed that ribavirin and steroids were of some help, whereas others showed that such treatment had no effect on clinical outcomes. From a unique perspective as the editor-in-chief of the China Medical Tribune, Zhaori discusses our experience to date with antiviral therapy in the treatment of SARS.

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