We use cookies to improve our service and to tailor our content and advertising to you.More infoYou can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our cookies policy.
Rankine & collegues have analysed the data in their article in a
very primitive manner.[1] In any research, statistical methods decide the
relevance of various observed data. When these data are presented raw, it
will only lead to confusion.
In their study the relevance of many data, for example WBC count, C-Reactive
Protien, Positve Microbiology and therapeutic impact, could have been...
Rankine & collegues have analysed the data in their article in a
very primitive manner.[1] In any research, statistical methods decide the
relevance of various observed data. When these data are presented raw, it
will only lead to confusion.
In their study the relevance of many data, for example WBC count, C-Reactive
Protien, Positve Microbiology and therapeutic impact, could have been
analysed using simple statistical methods such as: 1) correlation and regression analysis; and 2) t-Test. Applying statistical methods will increase
the validity of the study conclusions.
Reference
1. Rankine J J, Barron D A, Robinson P, Millner P A, Dickson R A. Therapeutic impact of percutaneous spinal biopsy in spinal infection. Postgrad Med J 2004; 80: 607-609.
The study by Jain et al is a much wanted one from India.[1] However, it appears that the
incidence of proximal DVT of 3% is still reasonably high considering the
fact the sample size was very small and that these were a highly selected
low risk group. The two DVTs that were detected were clinically obvious and
involved the proximal veins. Is it possible that there were other
clinically non detec...
The study by Jain et al is a much wanted one from India.[1] However, it appears that the
incidence of proximal DVT of 3% is still reasonably high considering the
fact the sample size was very small and that these were a highly selected
low risk group. The two DVTs that were detected were clinically obvious and
involved the proximal veins. Is it possible that there were other
clinically non detectable calf vein thromboses that could have been missed
on Duplex scanning? One further Duplex scan at 4 weeks might have better
answered this question.
The cost effectiveness would have become less important if one of
these patients had developed a fatal pulmonary embolism, as it is a
preventable complication. The data will carry more weight only if the authors do
a randomised trial of a sufficient sample of patients with and without
prophylactic heparin. Perhaps such a trial would be ethically possible
now, considering the current data!
Reference
1. Jain V, Dhaon B K, Jaiswal A, Nigam V, Singla J. Deep vein thrombosis after total hip and knee arthroplasty in
Indian patients. Postgrad Med J 2004; 80: 729-731.
Whilst providing useful information on the long term natural history of
colorectal cancer, the article by Gomez et al[1] made some basic
anatomical errors. The rectum is a clearly defined separate entity from
the left colon and we feel should be considered as such when comparing
incidence by anatomical site. This is clearly demonstrated by the well
recognised gender difference for rectal cancer....
Whilst providing useful information on the long term natural history of
colorectal cancer, the article by Gomez et al[1] made some basic
anatomical errors. The rectum is a clearly defined separate entity from
the left colon and we feel should be considered as such when comparing
incidence by anatomical site. This is clearly demonstrated by the well
recognised gender difference for rectal cancer. In a prospective study of
more than 2000 patients collected over a three month period in Australia,[2] we found a statistically significant male to female ratio for rectal
cancer of almost 2:1. Similarly, when rectal cancer was considered as a
third site separate from the left colon a statistically significant age
distribution of colorectal cancer was found; the older the patient the
more likely they were to have a more proximal tumour.[3] Such age and
gender factors were not considered in the analysis by Gomez et al. As
average life expectancy is increasing, these factors may well explain the
perceived proximal shift, which will impact on screening programmes for
colorectal cancer.
References
1. Gomez, D, Dalal, Z, Raw, E, Roberts, C, Lyndon, PJ. Anatomical
distribution of colorectal cancer over a 10 year period in a district
general hospital: is there a true "rightward shift"? Postgrad Med J, 2004;
80: 667-9.
2. Spigelman, AD, McGrath, DR (2002) The National Colorectal Cancer
Care Survey. Australian clinical practice in 2000. National Cancer Control
Initiative, Melbourne.
3. McGrath, DR, Spigelman, AD. The impact of age on the treatment of
colorectal cancer in Australia. Ann R Coll Surg Eng, 2004; 86: 228.
I read with great interest the article by Mandal and colleagues,[1] which provides an
excellent introduction to duodenal biopsy in iron deficiency
anemia.
I agree that duodenal biopsy is the gold standard for
diagnosing celiac disease. However, is an invasive test like duodenal
biopsy necessary? There are noninvasive tests such as IgA
transgluta...
I read with great interest the article by Mandal and colleagues,[1] which provides an
excellent introduction to duodenal biopsy in iron deficiency
anemia.
I agree that duodenal biopsy is the gold standard for
diagnosing celiac disease. However, is an invasive test like duodenal
biopsy necessary? There are noninvasive tests such as IgA
transglutaminase antibodies which have sensitivity of 90-98% and
specificity of 95-97%. Furthermore the prevalence of celiac
disease is so low that it is not feasible in terms of risk
associated with the procedures and cost wise to do in all
iron deficiency anemia patients without lesions in EGD and
colonoscopy.
I think we should perform biopsies in people who have
transglutaminase antibodies and are antigliadin antibodies positive.
Reference
1. Mandal AK, Mehdi I, Munshi SK, Lo TCN. Value of routine
duodenal biopsy in diagnosing coeliac disease in patients with iron
deficiency anemia. Postgrad Med J 2004;80:475-477.
With reference to the article by Hurst and Wedzich, [1] the "after discharge" evaluation of a patient with chronic
obstructive pulmonary disease (COPD) would be incomplete without due
consideration of the possibility of treatable coexisting pathologies for
which, as in COPD, cigarette smoking is a risk factor. Coronary heart
disease (CHD) is a prime example, justifying evaluation of left ventricular
fun...
With reference to the article by Hurst and Wedzich, [1] the "after discharge" evaluation of a patient with chronic
obstructive pulmonary disease (COPD) would be incomplete without due
consideration of the possibility of treatable coexisting pathologies for
which, as in COPD, cigarette smoking is a risk factor. Coronary heart
disease (CHD) is a prime example, justifying evaluation of left ventricular
function should further inquiry reveal a history of angina. According to
the Study of Left Ventricular Dysfunction (SOLVD) the subsequent natural
history of asymptomatic left ventricular systolic dysfunction, for which
CHD is a risk factor, can be favourably modified by administration of
angiotensin converting enzyme inhibitors.[2] This is a preventive aspect
of heart failure management which is often unjustifiably overlooked in the
management of COPD.
References
1. Hurst JR and Wedzicha JA. Chronic obstructive pulmonary disease:the clinical management of an acute
exacerbation
Postgraduate Medical Journal 2004;80:497-505
2. The SOLVD Investigatoras
Effect of enelapril on mortality and the development of heart failure in
asymptomatic patients with reduced left ventricular ejection fraction
New England Journal of Medicine 1992:327:685-91
With reference to the article by Hamilton-Miller, aging mechanisms have not yet been fully understood.[1] A great number
of theories have been proposed by scientists, but none of them is
completely satisfactory. The problem could be found in the fact that very
often we look for one deciding, definitive reason for the process of
ageing. It is a sort of search for a big discovery, like a fountain of
youth or s...
With reference to the article by Hamilton-Miller, aging mechanisms have not yet been fully understood.[1] A great number
of theories have been proposed by scientists, but none of them is
completely satisfactory. The problem could be found in the fact that very
often we look for one deciding, definitive reason for the process of
ageing. It is a sort of search for a big discovery, like a fountain of
youth or such. But as always, in life or medicine, the causes of ageing
are made up of many factors, and could only be differentiated by their
priorities.
So, the causes are both genetic and environmental. Recently, there
are a lot of references that support the theory of infective cause of
aging.[2-5] Ageing is "hyperinflamation". The immune system is not
only the most convenient model for studying ageing, but immunity
deficiency is a significant factor in ethiopathogenesis of many diseases
of old age. First and foremost, the practical problem is not just in
increased sensitivity to infections, but it also appears in the attempt to
protect the elderly by immunization.
Deregulation appears to be the main disorder of the immune system in
old age. While certain clones of immune cells do not react to antigens,
others produce auto antibodies and homogeneous immunoglobulines according
to the type of benign monoclonal gamapathies. It is a fact that, although
not diseases in themselves, these disorders are significant in the
development of many other diseases.
Auto antibodies may cause initial lesion of a blood vessel that
continues with the known mechanism of development of arteriosclerosis. In
any case, prognostic significance is essential, because it is generally
known that higher frequency of auto antibodies means shorter survival.
Longevity privilege can be caused by probiotics effects not only regarding
harmonization of the immune system in the elderly, but as result of
“good” bacteria prevalence.
References
1. J M T Hamilton-Miller J M T. Probiotics and prebiotics in the elderly. Postgrad Med J 2004; 80: 447-451.
2. JT Willerson Systemic and local inflammation in patients with
unstable atherosclerotic plaques. Prog Cardiovasc Dis, May 2002; 44: 469-
78.
3. DG Bloemenkamp, WP Mali, BC Tanis, FR Rosendaal, MA van den Bosch,
JM Kemmeren, A Algra, JM Ossewaarde, FL Visseren, AM van Loon, and Y van
der Graaf
Chlamydia pneumoniae, Helicobacter pylori and cytomegalovirus infections
and the risk of peripheral arterial disease in young women.
Atherosclerosis, 2002; 163: 149-56.
4. M Naghavi, P Wyde, S Litovsky, M Madjid, A Akhtar, S Naguib, MS
Siadaty, S Sanati, and W Casscells
Influenza infection exerts prominent inflammatory and thrombotic effects
on the atherosclerotic plaques of apolipoprotein E-deficient mice.
Circulation, 2003; 107: 762-8.
5. R Dittrich, C Dragonas, A Mueller, T Maltaris, J Rupp, MW
Beckmann, and M Maass. Endothelial Chlamydia pneumoniae infection promotes
oxidation of LDL. Biochem Biophys Res Commun, 2004; 319: 501-5.
The authors state that laxatives are to be used in management of body
packers.[1] We urge caution with the use of oil based laxatives.
Oil based laxatives may reduce the tensile strength and "burst"
volume of latex products. This may prove fatal. A massive gastrointestinal
release of cocaine has been reported after the administration of oil-based
laxatives.[2]
The authors state that laxatives are to be used in management of body
packers.[1] We urge caution with the use of oil based laxatives.
Oil based laxatives may reduce the tensile strength and "burst"
volume of latex products. This may prove fatal. A massive gastrointestinal
release of cocaine has been reported after the administration of oil-based
laxatives.[2]
Reference
1. Self Assessment Answers: A man with drowsiness and abdominal pain. Postgrad Med J 2004; 80: 557.
2. Traub SJ, Hoffman RS, Nelson LS. Body packing -the internal
concealment of illicit drugs. N Engl J Med 2003;349:2519-2526.
There is a very sad account of the fatal consequences of
extrapolation of animal findings to humans, "recent experience with fialuridin ... five out of 15 patients
died, two required emergency liver and kidney transplant for liver and kidney
failure-this effect had not been demonstrated in four animal species."[1]
This is a very sobering account of the consequences of extrapolating
animal findings to humans....
There is a very sad account of the fatal consequences of
extrapolation of animal findings to humans, "recent experience with fialuridin ... five out of 15 patients
died, two required emergency liver and kidney transplant for liver and kidney
failure-this effect had not been demonstrated in four animal species."[1]
This is a very sobering account of the consequences of extrapolating
animal findings to humans. Having said that, there are probably innumerable benefits which have
resulted from animal experiments. I think the important point is that these
benefits have been serendipitous. Because it is certain that the similarities which do exist
between animal and human responses to physiological (and other) stimuli have
nothing to do with the fallacious concept of "evolution of species".
Jackson raises a point that is indeed relevant, and I fully agree
that premature extrapolations to human therapeutics are dangerous.[1] If
animals were all horses, wishes would fly! These animal studies only
provide a glimpse into new possibilities and futuristic ideas. I am
concerned about any other interpretation, and my opinion too is that, for
the present, these findings cannot be translated into da...
Jackson raises a point that is indeed relevant, and I fully agree
that premature extrapolations to human therapeutics are dangerous.[1] If
animals were all horses, wishes would fly! These animal studies only
provide a glimpse into new possibilities and futuristic ideas. I am
concerned about any other interpretation, and my opinion too is that, for
the present, these findings cannot be translated into day-to-day practice.
The evolving hypothesis of tissue-specific insulin resistance is
still in the realm of basic sciences, and must cross several boundaries
before it is ready for direct clinical application. Basic scientists
working with animal models have to confront several unique challenges:
genetic polymorphisms, extreme heterogeneity of the illnesses (as in the
case of the metabolic syndrome) and practical aspects, to name a few. I
believe that the “bedside-to-bench” journey is relevant too; what is
needed is a two-way transfer of ideas between the bedside and the bench.
On many occasions, animal models fail us as they are already modeled on an
over-simplified biological basis. It is likely that a clinician’s inputs
on the illness and its complexities are valuable. Connecting the basic
scientist’s knowledge of biological phenomena with the clinician’s
understanding of the realities of human disease effectively could well
fulfill the aim of translational research.[2]
I thank Jackson for raising an important issue, and agree with the
evolutionary aspects as well.
Mallick et al have rightly pointed
that it requires a high degree of clinical suspicion to diagnose these
kind of abscesses.[1] The presentation with lower back pain, hip pain, lower
abdominal pain and a limp is well known. A diligent physical
examination is essential for the prompt diagnosis of this condition.
One of the clinical presentation is femoral neuropathy. Femoral
neuropathy is u...
Mallick et al have rightly pointed
that it requires a high degree of clinical suspicion to diagnose these
kind of abscesses.[1] The presentation with lower back pain, hip pain, lower
abdominal pain and a limp is well known. A diligent physical
examination is essential for the prompt diagnosis of this condition.
One of the clinical presentation is femoral neuropathy. Femoral
neuropathy is uncommon but a known presentation, even in the era when
tuberculosis was common. This phenomenon is explained by the slow
distension of psoas sheath and by the fact that the abscess ruptures
through the psoas fascia before the femoral nerve could be damaged by the
increased intrapsoas compartment pressure. Similarly acute non-tuberculous
psoas infection rarely produces femoral nerve compression in case of psoas
abscess, presumably because the psoas fascia is distensible. Femoral
neuropathy however does occur with iliacus muscle abscess because the
fascia iliaca is relatively indistensible.
Apart from detecting psoas muscle weakness which is the usual
presentation, it is also worthwhile to detect quadriceps weakness if at
all it can be detected, because this muscle group is so strong that the
examiners may not be able to detect the weakness. It may be sometimes
evident from the history of the leg 'giving out' during walking or of the
patient being unable to get out of a chair without using the arms. As the
psoas muscle is innervated by L2, L3,L4, pain can radiate to the hip and
thigh.
Also detecting sensory loss not only over the anterior thigh, but
also on the medial aspect of calf is useful. This loss has a saphenous
nerve distribution (the terminal sensory branch of femoral nerve) the
knee jerk is usually depressed.
Hence it is of value to detect the above neurological signs in any patient
presenting with nonspecific symptoms like lower back pain, flank pain,
lower abdiminal pain,nonspecific pain in the hip and thigh and sometimes a
limp.
References
1. Mallick I H, Thoufeeq M H, Rajendran T P. Iliopsoas abscesses. Postgraduate Medical Journal 2004;80:459-462.
Dear Editor
Rankine & collegues have analysed the data in their article in a very primitive manner.[1] In any research, statistical methods decide the relevance of various observed data. When these data are presented raw, it will only lead to confusion.
In their study the relevance of many data, for example WBC count, C-Reactive Protien, Positve Microbiology and therapeutic impact, could have been...
Dear Editor
The study by Jain et al is a much wanted one from India.[1] However, it appears that the incidence of proximal DVT of 3% is still reasonably high considering the fact the sample size was very small and that these were a highly selected low risk group. The two DVTs that were detected were clinically obvious and involved the proximal veins. Is it possible that there were other clinically non detec...
Dear Editor
Whilst providing useful information on the long term natural history of colorectal cancer, the article by Gomez et al[1] made some basic anatomical errors. The rectum is a clearly defined separate entity from the left colon and we feel should be considered as such when comparing incidence by anatomical site. This is clearly demonstrated by the well recognised gender difference for rectal cancer....
Dear Editor
I read with great interest the article by Mandal and colleagues,[1] which provides an excellent introduction to duodenal biopsy in iron deficiency anemia.
I agree that duodenal biopsy is the gold standard for diagnosing celiac disease. However, is an invasive test like duodenal biopsy necessary? There are noninvasive tests such as IgA transgluta...
Dear Editor
With reference to the article by Hurst and Wedzich, [1] the "after discharge" evaluation of a patient with chronic obstructive pulmonary disease (COPD) would be incomplete without due consideration of the possibility of treatable coexisting pathologies for which, as in COPD, cigarette smoking is a risk factor. Coronary heart disease (CHD) is a prime example, justifying evaluation of left ventricular fun...
With reference to the article by Hamilton-Miller, aging mechanisms have not yet been fully understood.[1] A great number of theories have been proposed by scientists, but none of them is completely satisfactory. The problem could be found in the fact that very often we look for one deciding, definitive reason for the process of ageing. It is a sort of search for a big discovery, like a fountain of youth or s...
Dear Editor
The authors state that laxatives are to be used in management of body packers.[1] We urge caution with the use of oil based laxatives.
Oil based laxatives may reduce the tensile strength and "burst" volume of latex products. This may prove fatal. A massive gastrointestinal release of cocaine has been reported after the administration of oil-based laxatives.[2]
Reference
1....
Editor
There is a very sad account of the fatal consequences of extrapolation of animal findings to humans, "recent experience with fialuridin ... five out of 15 patients died, two required emergency liver and kidney transplant for liver and kidney failure-this effect had not been demonstrated in four animal species."[1] This is a very sobering account of the consequences of extrapolating animal findings to humans....
Dear Editor
Jackson raises a point that is indeed relevant, and I fully agree that premature extrapolations to human therapeutics are dangerous.[1] If animals were all horses, wishes would fly! These animal studies only provide a glimpse into new possibilities and futuristic ideas. I am concerned about any other interpretation, and my opinion too is that, for the present, these findings cannot be translated into da...
Mallick et al have rightly pointed that it requires a high degree of clinical suspicion to diagnose these kind of abscesses.[1] The presentation with lower back pain, hip pain, lower abdominal pain and a limp is well known. A diligent physical examination is essential for the prompt diagnosis of this condition.
One of the clinical presentation is femoral neuropathy. Femoral neuropathy is u...
Pages