73 e-Letters

published between 2007 and 2010

  • PTB in elderly and diabetic patients
    Stephen M Ellis

    Dr Jolobe eloquently enlarges upon a point that we only touched upon; the paper was aimed at describing the various radiologic appearances associated with PTB and avoided ellaborating on the clinical ramifications.

    Conflict of Interest:

    None declared

  • In the presence of diabetes and old age, lower lobe PTB might be mistaken for pneumonia
    oscar,m jolobe

    In their allusion to atypical patterns of pulmonary tuberculosis(PTB) in diabetes mellitus(DM) and in old age(1), the authors should, perhaps, have elaborated further given the observation that "the impact of DM on the radiological presentation of PTB is important because misinterpretation may lead to delay in appropriate diagnostic tests and treatment thus risking dissemination of PTB to others"(2). These observations h...

    Show More
  • Re:Metformin concerns
    Jan M Keppel Hesselink


    With great interest I read the article on Metformin: safety in cardiac patients, by R Khurana, and I S Malik.

    It might be worthwhile pointing out that long term use of metformine can be the cause of neuropathy due to a chronic difficiency of vitamine B12. Long-term use of metformin is associated with malabsorption of vitamin B(12) (cobalamin). This might in turn have a deleterious effects on the...

    Show More
  • Metformin concerns
    Heikki Savolainen

    Dear Editor,

    The review on metformin safety summarizes cogently the current clinical approach on the use of metformin in special situations (1).

    The picture may be less clear as the drug is also an inhibitor of mitochondrial complex I (2), and oxygen consumption may thus be impaired (3).

    It should be remembered that metformin also increases D-lactate formation, an end metabolite of methylglyo...

    Show More
  • Re: Improving end of life care for nursing home residents: an analysis of hospital mortality and readmission rates
    Lynne Partington

    We were very pleased to see this paper on improving end of life care for nursing home residents. Drawing upon our experience as clinicians and researchers active in nursing home work we would like to identify a number of methodological issues that the paper raises for us. Firstly, in order to better understand the implications of the findings presented here, more information about the population in general and not only the...

    Show More
  • Re: Dr Hawley
    Carol A Hawley

    We have carried out a range of studies on medical aspects of fitness to drive. For further information on this see the UK Department for Transport website where our research has been published: http://www.dft.gov.uk/pgr/roadsafety/research/rsrr/theme6/report91/

    Conflict of Interest:

    None declared

  • Cardiac CT for non-cardiac chest pain
    Mayada H. Issa

    To the editor, The review by Goapalan, et al. on the non- coronary applications of cardiac CT(1) highlights the appeal of making a diagnosis in a time efficient for patients presenting with chest pain. However it is not uncommon to have other incidental pathological findings which may or may not be related to the presenting symptoms. Researchers have reported a prevalence of 56% of incidental non- coronary findings, 15%...

    Show More
  • more on pregnancy specific disorders and on liver disease incidental to pregnancy
    oscar,m jolobe

    Among the pregnancy-specific liver disorders(1), obstetric cholestsis(OC) has been the subject of a recent study which has made important contributions to the diagnosis of this disorder. As a result of simultaneous chromatographic measurement of 15 bile acids from the 16th week of pregnancy onwards, the authors noted that, from the 24th week, OC was associated with predominant increase in cholic acid conjugated with tau...

    Show More
  • commonsense, supervision, and other issues
    oscar,m jolobe

    In addition to its use for "safe pleural intervention such as aspirating small effusions"(1), thoracic ultrasound(TUS), when compared with usual practice, has been shown to mitigate the risk of iatrogenic pneumothorax(odds ratio(OR) 0.3; 95% Confidence Interval(CI), 0.2 to 0.7)when utilised as an adjunct, not only to diagnostic thoracentesis(presumably in the context of small effusions), but also as an adjunct to therap...

    Show More
  • Dr Hawley
    Maria Dineen

    I am undertaking a serious untoward incident investigation relating to a death by dangerous driving involving a mental health service user. Infact two people died. One of the issues I am becoming aware of is the lack of attention to the issue of driving safety in mental health assessments by medical staff and mental health practitioners.

    I am going to purchase your article if I can but have you undertaken any...

    Show More