eLetters

113 e-Letters

published between 2004 and 2007

  • confounding factors when defining the cut-off level for NT-pro BNP
    oscar,m jolobe

    Dear editor

    The cut off level for NT-pro BNP proposed by the authors(1) should take into account the fact that blood levels of this parameter may be lower in subjects with body mass index equal to or exceeding 30 kg/metre squared despite left ventricular end diastolic pressures which exceed those of counterparts with lower body mass indices(2). Lower cut-off levels might then have to be devised in obese subjects....

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  • atypical presentations of acute coronary syndrome include left bundle barnch block and absence of ch
    oscar,m jolobe

    Dear editor

    In the above study acute coronary syndrome(ACS) was defined as the presence of ischaemic cardiac symptoms (presumably, chest pain)(1), and it was not made clear whether or not this was to the exclusion of a pain-free presentation(2) characterised, instead, by, for example, sudden onset left ventricular failure or "collapse"(3). In the "worst case scenario" exclusion of ST segment elevation (STEMI) patient...

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  • Health’s sector in Cuba: looking better performance.
    Frank C. Alvarez-Li

    Dear Editor

    Cuba represents an important alternative example where modest infrastructure investments combined with a well-developed public health strategy have generated health status measures comparable with those of industrialized countries (1). However the economic crisis which began in 1991 after the withdrawal of the Soviet Union wreaked havoc on many aspects of Cuban society. Although the impact on health in...

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  • Isolated systolic hypertension, ageing and control in Cuba
    Pedro O. Orduñez

    Dear Editor,

    Isolated systolic hypertension and ageing is common in Cuba too and we wish to share our more recent results.

    Cienfuegos is the demonstration area for the Action Plan for the Multifactorial Reduction of Noncommunicable Diseases in Cuba. As a part of this project, a baseline was taken to obtain up-to-date information on the prevalence and control levels of hypertension (HBP). There are 76,803 inhab...

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  • the possible role of acidosis-related capillary permeability in adult respiratory distress syndrome
    oscar,m jolobe

    Dear Editor,

    Although adult respiratory distress syndrome (ARDS) is a complication common to both ketotic and non-ketotic diabetic decompensation (1), being arguably attributable to the development of adverse osmotic gradients which generate pulmonary oedema (2), the fact that ARDS is much commoner in diabetic ketoacidosis (DKA) than in hyperosmolar non-ketotic (HONK) diabetic decompensation (3)(4)(5) suggests that th...

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  • a role for cranberry juice in the management of benign prostatic hyperplasia
    oscar jolobe

    Dear Editor,

    In the discussion on the medical management of benign prostatic hyperplasia [1], it was an omission not to make mention of the role of the ingestion of cranberry juice in reducing the recurrence rate of urinary tract infection and/or bacteriuria. The reported antibacterial properties of cranberry juice are attributable to its ability to inhibit bacterial adherence [2], and this has translated into a 12%-2...

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  • Modernising Medical Carriers-Some concerns
    Surya P Rajeev

    Dear Editor,

    I am an SHO in the 'old' system. I believe the MMC has certain advantages but I have some serious concerns as well.

    The maintenance of a personal portfolio and more time and attention from the educational supervisors sounds quite good. The concerns are:

    1. The training period for acquiring the generic skills varies from person to person. The move from time- based to competency-bas...

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  • Complications of coeliac disease-Do not forget neurological manifestations
    Rajesh N Bankar

    Dear Editor,

    Coeliac disease gluten-sensitive enteropathy remains under-diagnosed and can have serious complications. [1] Gluten sensitivity has various manifestations such as enteropathy, dermatopathy and neuropathy. Furthermore, due to the disease overlap about 8% of patients with coeliac disease develop neurological manifestations. [2] The most common manifestations are ataxia and peripheral neuropathy; and rapidly...

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  • Practical issues on altitude illness
    Kaushal R Pandey

    Dear Editor,

    The author rightly mentions that many people on expedition try to avoid prophylactic diamox.[1] It is not just because people want to experience the natural or the side effects of the medicine but in my experience in the Everest region, many western trekkers did not want to take diamox because they believed it masks the symptoms of Acute Mountain Sickness. Diamox accelerates the natural process of acclimat...

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  • Reply letter to: Acute mountain sickness: medical problems associated with acute and subacute exposu
    Laxmi v Ghimire

    Dear Editor

    It was interesting to go through the informative article on mountain sickness by C Clarke. [1] There are some points we wish to make.

    The author mentions that the preventive dose of acetazolamide for Acute Mountain Sickness(AMS) is 125mg but does not mention its role in the treatment of AMS. Acetazolamide is used widely in the Himalayas at a dose of 250 mg twice daily until the symptoms resolv...

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