eLetters

263 e-Letters

  • Use of Spironolactone in Heart Failure
    Syed Wamique Yusuf, M.D M.R.C.P

    Dear Editor

    Shah et al [1] have nicely covered the topic of use of diuretics in heart failure.

    In the article,[1] it has been recommended that in patients with substantial edema a combination of high dose loop diuretic and a thiazide diuretic with or without potassium sparing agent is more potent than a high dose of either of these. For diuretic resistance, increasing the frequency of loop diuretic...

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  • Dilemma in traetment of Tuberculosis- Role of Surgery
    omi jindal

    Dear Editor

    As evident from this article [1] and it is also a well recognised fact that Chemotherapy stands as the first choice for treating Extrapulmonary Tuberculosis. The role of surgery is for the treatment of complications arising from the disease itself. But at times, antitubercular therapy cannot be started due to lack of pathological diagnosis even with a strong clinical suspicion and coroborative lab r...

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  • Bullying should not be accepted
    L Radamari

    Dear Editor

    This paper highlights an iceberg tip.[1] Junior doctors straining to climb the slippy hierarchical medical ladder are increasingly taking on higher degrees to better their chances of success. Unfortunately this leads to inappropriate levels of support as this piece of research exposes. Bullish behaviour from powerful academic supervisors, coupled with a lack of support systems, leaves research fellows o...

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  • Colorectal Investigations
    Shyam S. Menon

    Dear Editor

    There are certain inconsistencies in the results. Twenty four procedures were abandoned due to poor bowel preparation but all 316 procedures have been presented in the results. Table 1 seems to be completely erratic as it lists Transverse Colon, Ascending Colon and Caecum as sites of advancement of the Sigmoidoscope. Moreover the number of procedures upto the Splenic flexure in the table do not add upto...

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  • Comment on: paper by Stebbing et al.
    P Smith

    Dear Editor

    This study confirms what everyone knows but it is remarkable that no one has done this before. Objective evidence such as this can now be used to stop what is happening here. Why is there so much power with a few professors just because they win a few grants? Does anyone ever properly assess this sort of thing - we all know it goes on too.

  • Author's reply
    Amit Goyal

    Dear Editor

    We agree with V Ramachandran that the presence of blood in an empty hernial sac should have prompted the surgeon to perform an exploratory laparotomy. The case report reinforces this basic surgical principle and highlights that intra-abdominal malignancy may rarely present as an inguinal mass and lead to blood in the sac.

  • Improper surgical technique
    Vijay Ramachandran

    Dear Editor

    In the case reported by Goyal et al. regarding the presence of a gastrointestinal tumour in a hernial sac, it appears that poor surgery is being passed off as a "lesson" to be learnt by the readers. The presence of a haematoma in an otherwise empty hernial sac should definitely alert the surgeon to the presence of strangulated bowel which has probably reduced into the peritoneal cavity. Having ma...

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  • Compassion and Communication are the key
    Huw C Morgan

    Dear Editor

    Professor Nolan deserves congratulation on his excellent editorial on the need for humanity from doctors towards patients. As someone who has been involved for years in educating Family Doctors in both the UK and developing countries I fully endorse all that he says. Experience of Family Medicine development in many developing countries confirms that where there has been no culture of compassion or comm...

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  • Tissue oxygenation - oriented Approach to patients with ARDS
    Mohamad Abdelsalam Abdelkader

    Dear Editor

    Despite the great advances in critical care medicine, the mortality of ARDS is still high. Protective ventilatory strstegy - utilizing lower tidal volumes and PEEP levels to prevent atelectatic trauma regardless of arterial oxygenation - has been used in an attempt to reduce the mortality of ARDS. Both conventional and protective ventialtory strategies concenterate more on achieving satisfactory arteria...

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  • Authors reply to Huw Morgan
    Andrew P Bond

    Dear Editor

    Dr Morgan is absolutely right about 'imaginary' conditions, there are a number of examples in obstetrics in particular.

    Greta Beresford and I have recently returned from Azerbaijan, and were most encouraged by enthusiastic, knowledgeable seminar participants, many most willing to take on board the principles of evidence-based medicine

    Andrew Bond

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