eLetters

273 e-Letters

  • Ketoacidosis and HHS
    Anand CV

    Dear Editor

    We read with interest the educative review by Drs English and Williams,[1] and would like to congratulate the authors for their effort.

    The authors have raised a question- namely why ketoacidosis does not occur in HHS. Accumulation of ketone bodies in the blood in DKA stems from a greatly accelerated hepatic production rate, such that the capacity of non-hepatic tissues to use them, is exceeded....

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  • Pathophysiology of diabetic ketoacidosis
    Viktor Rosival
    Dear Editor

    In their recent review English and Williams state "The primary mechanism for the development of ketoacidosis (DKA) and hyperglycaemic hyperosmolar state (HHS) is ... insulin deficiency per se ... together with a concomitant elevation of the counter-regulatory hormones" but "why ketoacidosis does not occur in HHS is unknown".[1]

    However, the pure existence of HHS is strong evidence against the sta...

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  • Medical profession is already paying the price for its poor public relations skills
    Kieran M Walsh

    Dear Editor

    Persaud is quite right when he says that the medical profession will pay the price for its poor public relations skills.[1]

    Already there have been a number of investigations into the practice of GPs in the UK who had higher than average mortality rates. So far all of the investigations proved to be unfounded - the GPs simply had a lot of patients in nursing homes.

    References...

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  • Author's Reply
    Jonathan M Rhodes

    Dear Editor,

    We think Gordon has been rather selective with his citation of the literature.[1] The issue here is whether serum C reactive protein estimation has acceptable sensitivity in undiagnosed patients presenting for the first time with symptomatic Crohn’s disease. It was first reported for this purpose by Shine et al who found that 19 of 19 newly presenting symptomatic Crohn’s disease patients had...

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  • Serotonin toxicity
    P Ken Gillman

    Dear Editor

    This is a most complex subject. It is difficult to make adequate and constructive comment about this case without going into lengthy details concerning the latest research on serotonin syndrome, which letter space will not allow. [1,2]

    It will be helpful for your readers to appreciate that this report cannot reasonably be upheld to represent serotonin syndrome (better referred to as serot...

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  • Inflammatory Markers in Crohn's Disease
    John N Gordon

    Dear Editor

    I read with interest the review of the management of inflammatory bowel disease by Nayar et al, in which the authors elegantly highlight the major points for the general physician. However I was concerned by the potentially seriously misleading statement that serum C-reactive protein (CRP) concentration is raised in over 95% of patients with symptomatic Crohn's disease, and is useful in distingu...

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  • Is "triple" therapy for heart failure validated ?
    Fahim H. Jafary

    Dear Editor

    We read the comprehensive review on drug treatment of heart failure by McKenzie and Cowley with great interest.[1]

    While they appropriately state the efficacy of the ACE inhibitor/beta-blocker and ACE inhibitor/spironolactone combinations in systolic heart failure, the average reader may get the impression that all three drugs can be used together in a patient. The article fails to clarify f...

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  • Is higher blood pressure always better for patients with post-MI cardiogenic shock ?
    Mohamad Abdelsalam Abdelkader

    Dear Editor

    Cardiogenic shock is an ominous complication of myocardial infarction (MI), occurring in 4 to 7 percent of cases. The majority of patients have an ST elevation (Q wave) MI, but cardiogenic shock can occur, although less frequently after a non-ST elevation (non-Q wave) MI .[1,4]

    The clinical definition of cardiogenic shock is decreased cardiac output and evidence of tissue hypoxia in the presence...

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  • Empyema or lung abscess?
    Martin G Kelly

    Dear Editor

    I have read the self-assessment question published by Karnak et al.[1]

    They present an apparent case of empyema due to Aspergillus fumigatus (was the thoracentesis from pleural space or cavity?). I would question the authors’ interpretation of the computed tomography (CT) in the article. I have looked carefully at the imaging. In my opinion, the CT illustrates a primarily intrapulmonary...

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  • Implementing the British Thoracic Society (BTS) COPD guidelines
    Martin G Kelly

    Dear Editor

    I have read with interest the paper by Dheda et al.[1] It deals with a very important issue – the implementation of guidelines, and whether or not these in fact alter outcomes.

    We have previously demonstrated [2] that these guidelines [3] are poorly adhered to, but equally, may be useful since the scoring systems used (such as scores for appropriateness of admission) correlated with p...

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