eLetters

265 e-Letters

  • Should inexperienced trainees be delivering acute medical services?
    Ieuan H Davies

    Dear Editor

    Earlier this year your journal published an article by Smith and Poplett [1] which discussed the findings of a questionnaire that had been answered by newly qualified pre-registration house officers and senior house officers. The questions concerned various aspects of basic acute medical care. The results suggested significant gaps in knowledge and understanding of both the signs and immediate managem...

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  • Causes of osteolysis
    Shirish G Dubey

    Dear Editor

    I complement the authors on an excellent case. Could I however, point out that in the table on causes of osteolysis, there is no mention of crystal arthropathy. Calcium pyrophospahte dihydrate(CPPD) and basic calcium phosphate (BCP) associated crystal arthritis are known to cause osteolysis in a small no of patients. These would form part of the differentail diagnosis for any patient with this presentat...

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  • Reversibility of autonomic neuropathy
    Cecil M Thomas

    Dear Editor

    The author has demonstrated reversibility of autonomic neuropathy those cases very well. Metabolic and vascular factors contribute to the pathogenesis of autonomic and peripheral neuropathy. It is related to the duration and severity of hyperglycemias

    Clinically overt diabetic neuropathy is characterized by neuroanatomical changes of the node of Ranvier and myelinated axons, and by decreas...

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  • Knowledge of acute care is subacute
    Cecil M Thomas

    Dear Editor

    This article has correctly pointed out the deficit in todays training system. There is no lack of knowledge but the lack of skills and inability to use them in acute situations. There are various reasons like shortage of doctors,long working hours, doctors providing phlebotomy services.

    A more formalised and structured approach to training in acute situations and procedures should be provided. T...

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  • Can montelukast exacerbate allready present mild CSS.
    Mohamad Abdelsalam

    Dear Editor

    In the case report presented, a 12-month follow up (after montelukast was discontinued) has not shown any exacerbations of CSS simillar to that occured after initiation of montelukast. However,the patient was mantained on 10 mg prednisolone (low-dose) to prevent couph, fever and peripheral blood oesinophilia,suggesting underlying but mild CSS that has been exacerbated by montelukast.

  • Knowledge but not useful knowledge
    Andy Levy

    Dear Editor

    It is not clear in this article how the conceptual leap from some of the knowledge tested to inability to care for critically ill patients has been made. Does not knowing the survival rate of patients suffering a cardiac arrest, for example, or the role of the bag attached to a non-rebreathing oxygen mask really compromise patient care?

    From the limited results presented, there is no data whats...

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  • Coagulation is the defense against tuberculosis
    Friedrich Flachsbart

    Dear Editor

    Fulminant hemoptoe was the killer of Europe. Tuberculosis killed people in their best years. And so, thrombosis was the defense against hemoptoe. A prethrombotic state is a survival-benefit in Europe. Factor V (Leiden) is such a prethrombotic state in 5 % of the Europeans. No man in Africa has this thrombotic shield against tuberculosis, but they do have the sickle-cell-anemia as survival-benefit against...

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  • Drug Treatment for Depression in Patients Inside Rehabilitation Wards
    Salvador Vale

    Sir- Shah and colleagues report (1) about the prevalence of psychiatric disorders affecting elderly people institutionalised in a rehabilitation unit, concludes about depression that it is common among older adults, it is a treatable condition and that in cases which there are cognitive impairments associated to concomitant depression, the cognitive impairments are worsened by the depressive disease. Although the relev...

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  • Leaders must take a stand on life issues
    Robert A Best

    Dear Sirs: A good friend of mine in Europe, Dr. Gonzalo Herranz MD/Phd emailed me your article, which I found exceedingly well researched as well as well written.

    There is no doubt that Western Civilization is in a culture war, a war "within", a "spreading spiritual malaise" in the words of Irving Kristol. Writing in 1840, Tocqueville imagined a society consumed with such a malaise, in which government, com...

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  • Cerebral venous sinus thrombosis: heparin or nothing.
    M B Lewis

    A recent review article in your journal gives the impression that the case for heparinisation of patients with cerebral venous thrombosis (CVT) is proven [1]. The largest and most robust study did not come to this conclusion and its results did not achieve statistical significance [2]. Given that CVT has a spectrum of presentations from headache to coma, a blanket approach to treatment in the absence of good evidence and...

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