Highlights of this issue
Extrapulmonary tuberculosis
TB infection can produce disease in any organ system
See also:
- Education: Tuberculosis: 6. Extrapulmonary disease
In recent years unusual presentations of TB have been occurring with increasing frequency. Continuing our Clinical Basics series on TB, Anne Fanning describes the changing epidemiology of extrapulmonary TB and provides a case-based guide to the diagnosis of the disease in a wide range of sites outside the lungs.
Sexual assault cases
Factors associated with charge laying
See also:
In their retrospective cohort study Margaret McGregor and colleagues reviewed the charts and medicolegal reports of 95 sexual assault cases that had been examined by the BC Women's Sexual Assault Service in 1992 and for which a police report had been filed. Factors associated with charge laying included socioeconomic status above the group median (odds ratio [OR] 3.26, 95% confidence interval [CI] 1.099.71) and an assailant who was known to the victim (OR 4.58, 95% CI 1.5213.79). Charges were more likely to be laid in cases with documented moderate to severe injury than in cases with mild or no injury (OR 3.33, 95% CI 1.0610.42), even after adjustment for income level and type of suspect.
Scarce resources
Prevalence projections for end-stage renal disease
See also:
- Evidence: End-stage renal disease in Canada: prevalence projections
- Editorial: The price and challenges of extraordinary success: treating end-stage renal failure in the next millennium
Using 19811996 data from the Canadian Organ Replacement Register, Douglas Schaubel and colleagues have projected that the number of Canadians receiving renal replacement therapy — 17 807 at the end of 1996 — will climb to 32 952 by the end of 2005, for a relative increase of 85%. Among treatment modalities the increased prevalence was projected to be greatest for peritoneal dialysis (6.0% annually), and among provinces it was projected to be greatest in Alberta (7.5% annually). These projections suggest that Canada will face a growing shortage of resources to accommodate patients with end-stage renal disease. In an accompanying editorial Tom Hutchinson explains that the projected increases in prevalence are a testament to lives saved through advances in treatments, and he suggests humane ways to cope with this success.
New virus emerges
Illness in humans linked to contact with infected pigs
See also:
- Public health: New virus emerges in Malaysia
In our Public Health column Editorial Fellow Caralee Caplan describes the emergence of a new virus similar to the recently identified Australian Hendra virus. The novel morbillivirus has affected pig farmers in Malaysia and abbatoir workers in Singapore, causing over 100 deaths.
Finding donor kidneys
Controlled non-heart-beating donors potential source
See also:
- Evidence: Non-heart-beating organ donors as a source of kidneys for transplantation: a chart review
- Editorial: Death provides renewed life for some, but ethical hazards for transplant teams
In their retrospective chart review of 209 patients who died in the emergency department and intensive care unit at the Foothills Hospital in Calgary in 1995, Graham Campbell and Francis Sutherland identified potential controlled non-heart-beating kidney donors — that is, patients with irremediable brain injury who do not meet brain-death criteria and are taken off ventilation support. During the study period there were 33 potential conventional (heart-beating) donors, of which 21 (64%) donated. For the 17 potential controlled non-heart-beating donors, the mean time from withdrawal of ventilation support to cardiac arrest was 2.3 hours, and 13 died within 1 hour. The authors conclude that, assuming a refusal rate of 25% and an organ nonviability rate of 15%, 10 controlled non-heart-beating donors could have increased the supply of cadaveric kidneys for transplantation by 48%. In an accompanying editorial John Dossetor provides ethical guidance in the wake of continued debate surrounding the definition of brain death.
