[From the Cochrane Library: the use of peer review is still under discussion].

Peer review is generally considered to be an invaluable part of the editorial process of biomedical journals. It is widely assumed that peer review has positive effects on the quality of submitted papers and of biomedical research. This is why improvements in peer reviewing have been studied for some years.

[Clinical reasoning and decision-making in practice. A man with swelling of both corners of the jaw].

A 33-year-old man was referred to an oral surgeon by his general practitioner because ofa bilateral swelling in both jaws. A CT-scan of the head showed enlargement of the parotid glands. After exclusion of mumps and sialolithiasis the patient was treated with oral antibiotics.

[The HIV pandemic in the year 2007, an overview].

--40 million people are infected with HIV worldwide, the majority of whom (63%) are in sub-Saharan Africa. --While the absolute number of HIV infections continues to increase, the rate of growth of the pandemic is stabilising, possibly as a result of changes in sexual behaviour or a maturing ofthe epidemic in countries with high AIDS-related mortality. --80% of people infected with HIV that requires treatment do not have access to antiretroviral drugs.

[Clinical reasoning and decision making in practice. A 9-year-old boy with isolated splenomegaly].

Splenomegaly was discovered by chance in a 9-year-old boy who had no further complaints. Apart from splenomegaly and mild thrombocytopenia, no other pathological condition was found in the first instance. Ultrasound revealed a spleen with a median length of 16.

[Diagnostic image (315). A mentally retarded woman with facial skin lesions].

A 20-year-old African woman had mental retardation and multiple fibromatous facial skin lesions caused by tuberous sclerosis complex.

[Diagnostic image (301). A man with a protruding tibial fragment].

A 55-year-old man presented with a chronic osteomyelitis of the tibia. A sequestrum had already been formed; it protruded through the skin. The sequestrum was easily removed and the wound healed per secundam.

[Leishmaniasis: progress in diagnosis, treatment and prevention].

Visceral leishmaniasis ranks second after malaria in the top 10 fatal parasitic diseases worldwide. Treatment is effective, but most patients live in developing countries where even basic health care is unavailable. Economic factors hamper a targeted approach, which should include the following: preventing transmission by distributing bednets; developing diagnostic tools that can be used in the field without a laboratory; developing new and affordable drugs; and evaluating different drug combinations and treatment schedules that may prevent the development of resistance, as has been done in tuberculosis, HIV and malaria.

[Diagnostic image (298). A woman with a gingival swelling].

A woman aged about 25 years had a local swelling of the gums of her teeth during pregnancy: epulis gravidarum.

[Clinical reasoning and decision-making in practice. A man with inexplicable joint pain and subsequent poor clinical condition].

A 52-year-old man presented with polyarthritis and was negative for rheumatoid factor, anti-CCP and ANA. He was treated with low-dose methotrexate, the drug of first choice in rheumatoid arthritis. The arthritis disappeared, but the patient developed fever, progressive dyspnoea, appetite loss and weight loss.

Quality assessment of reviewers' reports using a simple instrument.

Objective: To validate and test a simple instrument for assessing the quality of a review.

Methods: In this prospective observational study, the quality of 247 reviews of 119 original articles submitted to the Dutch Journal of Medicine was assessed using a 5-point scale that has been used for years by Obstetrics & Gynecology. Each review was assessed by three editors of the journal.

[Diagnostic image (285). A young woman with an incurable head wound].

A 24-year-old woman developed a malignant neoplasm in the scar ofa former burn wound in the occipital area of the head: Marjolin ulcer.

[Clinical reasoning and decision-making in practice. A young boy with fever, pancytopenia and an enlarged spleen].

A 5-year-old boy presented with fever and fatigue after a holiday in northern Italy. On physical examination a marked splenomegaly was found. Laboratory investigations showed a pancytopenia as well as several markers suggesting an autoimmune disease.

[Deficient information in developing countries: Internet alone is no solution].

Health-care personnel in developing countries have poor access to information, partly because the books are out of date and journals and Internet access are lacking, and partly because the information that is available is not appropriate for the local situation. There is too little research aimed at the problems of the Third World. This is due to a lack of interest in Western countries and because local scientists have done too little research.

[Diagnostic image (273). A boy unable to walk].

A 16-year-old boy suffered from progressive paralysis and retching when attempting to drink, due to rabies.

[Diagnostic image (264). A man with malaise and a tucked-up upper abdomen].

An emaciated adult African man had a tucked-up upper abdomen caused by an esophageal obstruction, probably due to a malignancy.

[Diagnosis image (260). A woman with a black crust in the face].

A 25-year-old woman presented to a rural outpatient clinic in Africa with a black crust in the face due to cutaneous anthrax.

[Diagnostic image (256). A boy with bilateral cervical lymphadenopathy].

A teenage boy was seen with a swollen neck due to tuberculous cervical lymphadenitis.

[Clinical reasoning and decision-making in practice. A patient with oliguria following prostatectomy].

A 70-year-old man with clinically localised prostate carcinoma underwent extraperitoneal endoscopic radical prostatectomy. His medical history revealed hypertension, renal colic, hypogonadotropic hypogonadism and recurrent deep venous thrombosis in the legs. The operation was uneventful with 500 ml blood loss and no periods ofhypotension.

[Clinical reasoning and decision-marking in practice. A general practitioner with long-standing anaemia].

In order to calibrate his haemoglobin meter, a general practitioner had his own haemoglobin level checked regularly at a nearby laboratory. At 37 years of age, one of these assays revealed 7,0 mmol/l. Because he had no symptoms, he prescribed himself iron-substitution therapy but the haemoglobin concentration did not normalise.

Visceral leishmaniasis and HIV in Tigray, Ethiopia.

Objectives: To identify characteristics that increased the risk of mortality in Ethiopian visceral leishmaniasis patients in a treatment programme managed by Médecins sans Frontières, in Tigray, Northern Ethiopia.

Methods: Retrospective review of a cohort of 791 patients treated for visceral leishmaniasis.

Results: The cohort displayed all the classical signs and symptoms of the disease.

Comparison of an rK39 dipstick rapid test with direct agglutination test and splenic aspiration for the diagnosis of kala-azar in Sudan.

We compared an rK39 dipstick rapid test (Amrad ICT, Australia) with a direct agglutination test (DAT) and splenic aspirate for the diagnosis of kala-azar in 77 patients. The study was carried out under field conditions in an endemic area of north-east Sudan. The sensitivity of the rK39 test compared with splenic aspiration was 92% (46/50), the specificity 59% (16/27), and the positive predictive value 81% (46/57).

Ethiopian visceral leishmaniasis: generic and proprietary sodium stibogluconate are equivalent; HIV co-infected patients have a poor outcome.

We evaluated generic sodium stibogluconate (SSG) (International Dispensary Association, Amsterdam) versus Pentostam (sodium stibogluconate, GlaxoWellcome, London) under field conditions in Ethiopian patients with visceral leishmaniasis (VL; kala-azar). The 199 patients were randomly assigned to Pentostam (n = 104) or SSG (n = 95) in 1998/99; both drugs were given at 20 mg/kg intra-muscularly for 30 days. A clinical cure after 30-days treatment was achieved in 70.

Development and application of 'simple' diagnostic tools for visceral leishmaniasis.

The diagnosis of visceral leishmaniasis is difficult. Due to the limitations of direct methods to detect parasites, indirect immunological methods are widely employed. The simple affordable and sensitive/specific direct agglutination test (DAT) is perhaps the most important diagnostic tool under field conditions.

Comparison of generic and proprietary sodium stibogluconate for the treatment of visceral leishmaniasis in Kenya.

Objective: To compare the use of generic and proprietary sodium stibogluconate for the treatment of visceral leishmaniasis (kala-azar).

Methods: A total of 102 patients with confirmed kala-azar were treated in a mission hospital in West Pokot region, Kenya, with sodium stibogluconate (20 mg/kg/day for 30 days)--either as Pentostam (PSM) or generic sodium stibogluconate (SSG); 51 patients were allocated alternately to each treatment group.

Findings: There were no significant differences in baseline demographic characteristics or disease severity, or in events during treatment.