280
`
`PostScript
`
`8 Van Ranst M. Chandipura virus: an emerging
`human pathogen? Lancet 2004;364:821–2.
`9 Chadha MS, Arankalle VA, Jadi RS, et al. An
`outbreak of Chandipura virus encephalitis in the
`eastern districts of Gujarat state, India. Am J Trop
`Med Hyg 2005;73:566–70.
`10 Peiris JS, Dittus WP, Ratnayake CB.
`Seroepidemiology of dengue and other
`arboviruses in a natural population of toque
`macaques (Macaca sinica) at Polonnaruwa, Sri
`Lanka. J Med Primatol 1993;22:240–5.
`11 Fontenille D, Traore-Lamizana M, Trouillet V, et al.
`First isolations of arboviruses from Phlebotomine
`sand flies in West Africa. Am J Trop Med Hyg
`1994;50:570–4.
`12 Traore-Lamizana M, Fontenille D, Diallo M, et al.
`Arbovirus surveillance from 1990 to 1995 in the
`Barkedji area (Ferlo) of Senegal, a possible
`natural focus of Rift Valley fever virus. J Med
`Entomol 2001;38:480–92.
`13 Tselis A. Isolation of Chandipura virus from a
`child with febrile encephalopathy. http://
`www.promedmail.org/pls/promed/
`f?p = 2400:1001:7162837423564717958::::
`F2400_P1001_BACK_PAGE,F2400_P1001_
`ARCHIVE_NUMBER,F2400_P1001_USE_
`ARCHIVE:1202,20040806.2160,Y.
`14 Focosi D. Homo sapiens diseases—subcellular life
`forms. http://focosi.altervista.org/pathoviruses.htm
`15 Rose NF, Roberts A, Buonocore L, et al.
`Glycoprotein exchange vectors based on
`vesicular stomatitis virus allow effective boosting
`and generation of neutralizing antibodies to a
`primary isolate of human immunodeficiency virus
`type 1. J Virol 2000;74:10903–10.
`16 John TJ. Chandipura virus, encephalitis, and
`epidemic brain attack in India. Author reply.
`Lancet 2004;364:2175–6.
`17 Bhaskaran CS, Kamala K, Narasimham MVVL,
`et al. Outbreak of viral encephalitis in Andhra
`Pradesh. Report of the Research & Analysis Cell,
`Department of Health, Medical & Family Welfare.
`Government of Andhra Pradesh, India, 2003.
`18 Geevarghese G, Arankalle VA, Jadi R, et al.
`Detection of Chandipura virus from sand flies in
`the genus Sergentomyia (Diptera: Phlebotomidae)
`at Karimnagar District, Andhra Pradesh, India.
`J Med Entomol 2005;42:495–6.
`19 Arankalle VA, Prabhakar SS, Madhukar WA, et
`al. G, N, and P gene-based analysis of
`Chandipura viruses, India. Emerging Infectious
`Diseases 2005;11:123–6.
`20 Wairagkar NS, Shaikh NJ, Ratho RK, et al.
`Isolation of measles virus from cerebrospinal fluid
`of children with acute encephalopathy without
`rash. Indian Pediatr 2002;38:589–95.
`21 John TJ. Encephalopathy without rash, caused by
`measles virus? More evidence is needed. Indian
`Pediatr 2003;40:589–93.
`
`BOOK REVIEWS
`
`Practical approach to pediatric
`intensive care
`
`Edited by Praveen Khilnani. Hodder Arnold,
`2005, £69.00 (approx. J101, $118) (hard-
`back), pp 826. ISBN 0340905824
`
`Khilnani
`Parveen
`and an impressive
`authorship
`from
`across India and the
`USA have set out to
`produce
`a
`text
`emphasising
`the
`practical aspects of
`paediatric
`intensive
`care. It is described
`in the preface as the
`‘‘first comprehensive
`Indian textbook on pediatric intensive care’’.
`Have Khilnani and his colleagues succeeded
`and will the book reach out to a wider
`
`www.archdischild.com
`
`European and North American audience? I
`read on with interest.
`Using a systems approach the book is
`divided into 12 sections. In keeping with
`the title the first section is basic practical
`issues. Unfortunately a tone is set for the
`book immediately. It is plagued by spelling
`mistakes and quite fundamental
`factual
`errors. For example, five different formulae
`and tables are provided for estimating endo-
`tracheal tube size. One formula calculates a
`size 16 tube for a 4 year old rather than the
`correct size 5. Throughout
`the book the
`theme is of poor editing and a lack of focus.
`Allowing the important issue of cardiogenic
`shock to be limited to neonatal disease in a
`paediatric textbook is just one example, but
`one of many I’m afraid.
`These failures are a great pity because
`there is much to admire, particularly in the
`sections on procedures which are comple-
`mented by clear diagrams and schematics. I
`found the information on airway obstruction
`and difficult intubation to be concise and
`informative and the emphasis on basic
`physiology throughout
`is commendable. I
`have a particular interest in the transport
`of critically ill children, and the relevant
`chapter based on the American Academy of
`Pediatrics guidelines is sound, with some
`useful detail relating to aeromedical work.
`The appendix to this chapter details appro-
`priate medications, which is also useful,
`but the lack of international consensus on
`drug names and doses will be limiting for
`some.
`The intensive care of children requires a
`multi-professional approach. The book has a
`short chapter on nursing issues which is
`rather superficial and fails to emphasise the
`impact of extending roles, for example in
`weaning from ventilation. A senior paediatric
`physiotherapy colleague who reviewed the
`chapters on mechanical ventilation felt that
`there was a repetitive discussion of principles,
`modes, and equipment which was both
`potentially confusing and unnecessary. A
`paragraph on the role of chest physiotherapy
`was also felt to be superficial and lacking in
`enough detail to benefit units where phy-
`siotherapy provision was limited.
`Is there anything here for the generalist or
`trainee on attachment? If you have the time
`to hunt for useful information you will find
`it, but I would suggest there are better, more
`focused texts on the market for this audience.
`So for the acid test—will this book become
`a well thumbed copy on the shelves of my
`intensive
`care unit? Unfortunately,
`the
`answer is no. There are just too many errors,
`too many important differences from estab-
`lished practice, and too little emphasis on
`multi-professional team working. In the end
`good intentions are nothing without atten-
`tion to detail.
`
`Press,
`Cambridge: Cambridge University
`2005, £45.00 (approx. J65, $80) (hardback),
`pp 302. ISBN 0521847443
`
`Ethical problems are
`common. Nowadays
`doctors face a dual
`difficulty,
`deciding
`what is best for the
`child while ensuring
`that their actions do
`not
`result
`in com-
`plaint,
`criticism, or
`worse. Will this book
`help paediatricians?
`The simple answer is
`that it might. What it
`does is to spell out
`some clinical scenarios, and then discuss the
`ethical aspects.
`The scenarios are mostly familiar to pae-
`diatricians: severe CNS impairment follow-
`ing hypoxia or
`cardiac arrest; decision
`making in children with complex cardiac or
`intestinal pathology;
`the management of
`malignancy and bone marrow transplanta-
`tion; withholding food and fluids; whether or
`not to ventilate a 23 week gestation infant;
`the management of an infant with septic
`shock whose mother demanded herbal
`therapy.
`The book has 27 contributors, all of whom
`have MD or PhD degrees; one is from the UK,
`but the rest are from the USA. A significant
`part of the book concerns issues that are
`unfamiliar or unheard of in the UK, such a
`healthcare organisation refusing to fund a
`paediatric surgeon (for a child with a Wilms’
`tumour who was then operated on by an
`adult surgeon), or refusing to sanction a
`plastic surgeon for a child whose face had
`been badly bitten by a dog. The gulf
`between medicine in the USA and the UK is
`further illustrated with the comment regard-
`ing a case of intentional poisoning (laxative
`abuse) when it is gloomily noted that the
`management of Munchausen syndrome by
`proxy is ‘‘often not financially rewarding for
`the health care and other practitioners
`involved’’.
`The discussions of each clinical scenario
`vary from being mundane and self-evident to
`thought
`provoking
`and
`helpful.
`Unfortunately an undue proportion of com-
`ments are jargon ridden and unfathomable.
`For example:
`
`‘‘Seeking a ground common to and
`intelligible to holders of utilitarian, are-
`taic or deontological theories, it avoids a
`deductive or top-down approach to
`ethical decision making.’’
`
`Acknowledgements
`I would like to thank ML for her help with
`this review.
`
`S Hancock
`
`‘‘If ‘principilism’ represents an ecumeni-
`cism of theory, casuistry as the term is
`used in bioethics represents a counter-
`vailing inferential intuitionism.’’
`
`or
`
`or
`
`Ethical dilemmas in pediatrics: cases
`and commentaries
`
`Edited by Lorry R Frankel, Amnon Goldworth,
`Mary V Rorty, and William A Silverman.
`
`‘‘I analyze their encounter and its out-
`come as being the product of an
`inapposite model of ethical
`reason-
`ing that cannot be made more compel-
`ling by politicizing adherence to
`principles.’’
`
`Ex. 2032-0001