© 2004 Canadian Medical Association or its licensors
Highlights of this issue
SARS
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An uneasy feeling lingers over whether SARS will reappear. In a commentary, Low argues that we have likely seen the last of SARS, since there is no known human reservoir and no compelling evidence that any animal reservoir poses a serious threat. We do seem to know, however, that the infectivity of the virus is relatively low.
During the outbreak last winter, the diagnosis of SARS was based on clinical and epidemiological criteria. Although laboratory testing for the associated coronavirus (SARS-CoV) became available, the protocols for collecting specimens and performing the tests differed between institutions. Tang and colleagues review the experience with reverse-transcriptase polymerase chain reaction (RT-PCR) and serology during the Toronto outbreak. Their findings indicate that stool samples and lower respiratory tract secretions are likely the specimens of choice over nasopharyngeal and throat swabs when performing RT-PCR to detect SARS-CoV in the acute stage. However, the sensitivity of RT-PCR to detect early infection was low (63.3% for stool samples and 58.8% for lower respiratory tract samples), as compared with 96.2% for serologic results of convalescent samples. Although rapid diagnostic tests continue to be optimized, the authors conclude that the diagnosis of SARS must still rely on clinical and epidemiological findings. In a related commentary, Fouchier and Osterhaus tell us that there is a push to develop better tests for SARS-CoV. Most of the current PCR tests were designed to detect the first gene identified from the virus, but the authors point out that other target genes may be more easily detected by PCR, resulting in a more sensitive diagnostic tool.
Global health
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In this issue of CMAJ we renew our commitment to report on global health issues. Commentaries by Jha and colleagues and Maskalyk explain the need for an internationalist perspective on health. We intend to bring this perspective to our research, review and news pages, examining topics as diverse as tropical disease and international trade law.
Boggild and colleagues present a review of the pathogenesis, diagnosis and treatment of leprosy. Although Canada's last leprosarium, on Bentinck Island, closed in 1957, the number of people immigrating from countries where leprosy is endemic has dramatically increased over the past 30 years. The causative organism, Mycobacterium leprae, has an affinity for peripheral nerves, the monocyte–macrophage system and endothelial cells. Peripheral granulomas, weakened cell-mediated immunity and scaly skin lesions (the disease's name originates from the Greek lepos, meaning scale) are some of the resultant clinical features.
Synopsis
We introduce a different look in CMAJ with Synopsis, a new section that combines our News and Practice sections with additional features under the heading of Analysis. A commentary by Choi outlines this section's objective of providing readers with a broad overview of important issues in medicine and health care.
Query
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Readers who make a habit of flipping through magazine pages from last to first will already have discovered Query, a new back-page column that tells it like it is — with some room for embellishment — on the front lines of health care. Our anonymous contributor, Dr. Ursus, will reflect on — and sometimes growl about — moods and occurrences in the daily life of family and emergency practice.
See page 160
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