No abstract

We report the first reported cases of epidemiologically linked invasive group A streptococcal septicaemia, with one fatality, following primary chickenpox infection in previously fit and well children who attended the same preschool. Invasive group A streptococcal sepsis is a well documented complication of chickenpox, which requires prompt and aggressive treatment. Following the cluster, public health measures were put in place to prevent further disease. Varicella vaccination has been shown to significantly reduce hospital admissions as well as deaths related to chickenpox infection. This is the first reported cluster of two epidemiologically linked patients in the UK.

SUMMARYHyperglycaemic hyperosmolar state (HHS) is a life-threatening condition rarely seen in paediatrics. It is becoming increasingly recognised with the growing incidence of childhood type 2 diabetes mellitus (T2DM). We present a 16-year-old boy with Bardet-Biedl syndrome, with comorbidities including chronic renal impairment requiring renal transplant, isolated growth hormone (GH) deficiency and obesity, who presented on routine follow-up with new onset T2DM and in HHS. Investigations revealed hyperglycaemia (45.7 mmol/L), ketones of 0.1 mmol/L, pH 7.38 and osmolarity 311 mOsmol/kg. After acute management with fluid resuscitation and intravenous insulin, he is now stable on metformin. He has lost weight, renal function is stable and he has stopped GH therapy. We discuss the dilemmas encountered in his long-term management due to his renal transplant and comorbidities, and whether or not, given his significant T2DM risk, this case was preventable or predictable. BACKGROUND

Jean Yong and colleagues discuss the development of part time working for women doctors and the results of a survey of the working patterns of those who have trained part time in paediatrics