Highlights of this issue

Fatal agricultural injuries in children of preschool age

This retrospective study found that, in Canada, young farm children, particularly boys, are about twice as likely as the total population of young Canadian children to die from an injury. In a related commentary, Day discusses the importance of this research and the role that health professionals can play in advocating for the protection of these children.

See pages 1723 and 1731

Genetics and clopidogrel action

Some patients do not appear to benefit from the antiplatelet action of clopidogrel, a drug that requires metabolism by CYP3A isoenzymes to be active. Suh and colleagues provide evidence that the cause of this resistance — the interaction between clopidogrel and CYP3A inhibitors — depends on a person's CYP3A5 genotype. In a related commentary, Turgeon discusses the need for further study into the genetic contribution to this drug interaction.

See pages 1715 and 1729

β-blockers for hypertension: re-examining published data

In a recently published meta-analysis, investigators asserted that β-blockers should not be used to treat hypertension. However, in that study, all patients were grouped together, regardless of age, and only one end point was used. Because the pathophysiology of hypertension differs in older and younger patients, Khan and McAlister designed another meta-analyis to clarify the efficacy of β-blockers in different age groups. They found that although β-blockers should not be considered first-line therapy for older hypertensive patients without another indication for these agents, in younger patients β-blockers reduced cardiovascular morbidity and mortality.

See page 1737

Analysis • Practice

De Perrot and colleagues review the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Once thought to be rare, CTEPH is being diagnosed more and more frequently (page 1706).

Sendi and Graber describe a patient with recurrent benign aseptic meningitis (Mollaret's meningitis). The most common virus isolated is herpes simplex type 2; the use of acyclovir in these cases is discussed (page 1710).

Determining whether an E.coli report describes a sporadic case or indicates an outbreak is often difficult. Weir reviews this issue, as well as clinical management and prevention of infections (page 1711).