Highlights

Making injections less painful

A vapocoolant spray reduced pain associated with intravenous cannulation in children and improved the success rate of cannulation. Farion and colleagues report this finding from their double-blind randomized controlled trial involving 80 children aged 6–12 years. See Research, page 31

In another trial, 2 mL of a 24%-sucrose solution given orally to newborns resulted in a modest reduction in pain associated with venipuncture but not with heel-lance or intramuscular injections. Taddio and colleagues included 240 newborns in their study, of whom 120 had diabetic mothers. Sucrose was not associated with serious adverse effects in any group. See Research, page 37

In a related commentary, Anand says that these well-designed trials have several features that support the validity of their conclusions. The trials show that not everything works for every procedure in every patient, disease or age group, he adds. See Commentaries, page 11

Public health emergencies

Wilson and colleagues draw attention to the revised International Health Regulations, which provide guidance on preparing for and responding to global health emergencies. The challenges to complying with these regulations come from problems with capacity in developing countries, the risk of unilateral action in developed countries, and difficulties in implementing the regulations in decentralized countries such as Canada. See Analysis, page 44

Nonrotation of intestines

Embryology-savvy readers will remember that the intestines normally rotate in the fetus. Anomalies of rotation are usually asymptomatic but may sometimes cause abdominal pain, as in this 20-year-old man with an abnormal upper gastrointestinal series who is featured in Clinical vistas. See Practice, page 49

Serpiginous eruption

A 28-year-old woman had an itchy, red, serpiginous eruption on her back after returning from Thailand. What is your call? See Practice, page 51

Kaposi sarcoma

Kaposi sarcoma of the lung is featured in Clinical images. An HIV-positive man presented with multiple lesions on his skin and in his trachea, bronchi and lungs. He responded well to treatment with dexamethasone and a platelet transfusion. See Clinical Images, page 107

Gambling

Provincial governments are in the precarious position of being both the beneficiary and regulator of the gambling industry. Some experts claim that this relationship lacks accountability. See News, page 21

Addiction experts claim that slot machines are psychologically deceptive and are inducing addictive behaviour in people who are not otherwise prone to addictions. See News, page 23