Antibiotic resistance
In the introduction to a new series on antibiotic resistance, Nicolle and colleagues discuss strategies to limit resistance. See Commentary, page 371
Patrick and Hutchinson introduce the concept of a “resistance footprint” and urge clinicians to consider the impact of prescribing antibiotics. See Analysis, page 416
Mulvey and Simor review the genetics and mechanisms of antibiotic resistance. As well, they discuss the emergence of resistant organisms and their impact on mortality, morbidity and costs. See Review, page 408
Insulin analogues
Insulin analogues offer little benefit over conventional insulins in terms of glycemic control in patients with diabetes. This is the finding of a meta-analysis by Singh and colleagues that included 69 randomized controlled trials of rapid-acting insulin analogues and 49 trials of long-acting insulin analogues. The authors did observe some weak evidence of benefit with respect to hypoglycemia. See Research, page 385
Routine use of insulin analogues to treat diabetes, particularly type 2 diabetes, is unlikely to represent an efficient use of finite health care resources, say Cameron and Bennett based on their analysis of the cost-effectiveness of this new class of drugs. See Research, page 400
Insulin analogues should be reserved for use in selected patients, such as those with nocturnal hypoglycemia, say Siebenhofer-Kroitzsch and colleagues. See Commentary, page 369
Cancer in children
The 5-year rate of survival for Canadian children with cancer is now about 82% compared to 71% in the late 1980s. As survival rates improve, we need to consider the long-term health and psychosocial effects of childhood cancer on survivors, say Ellison and colleagues. See Practice, page 422
Late postpartum eclampsia
Five days after delivery of a healthy newborn, a 37-year-old woman presented with severe headache and hypertension, and she had a generalized tonic–clonic seizure. Brain imaging showed marked changes to the subcortical white matter, mostly in the occipital lobes. She recovered after receiving treatment for late postpartum eclampsia, and the white matter changes disappeared. See Practice, page 425
Gum hypertrophy
Acute myelomonocytic leukemia is diagnosed based on results of a bone marrow biopsy in this 38-year-old man with gum hypertrophy, fatigue and an extensive petechial rash. See Clinical images, page 471
Research participants
Concerns about the interests and safety of participants in Canadian research studies are exacerbated by the lack of information about the numbers and recruitment practices, as well as by inconsistent guidelines. See News, page 375