293 e-Letters

  • 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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  • Unsheathed needles: a good idea?
    George Tsavellas

    Dear Editor,

    Whilst Huang and Dutta correctly state that re-sheathing of needles is almost universally condemned, one must also remember that needle-stick injuries can also occur as a result of needles not being re-sheathed. This happened to me as a young house- officer, when a nurse dropped an unsheathed needle from a tray, and it promptly embedded itself int...

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  • Sympathetic effects via renin release
    Steve Jordan Kane

    Dear Sir,

    This case is extremely useful as an illustration of the varying presentations of phaeochromocytomas. The inclusion of the CT and the details of the differential effects given depending upon the catecholamine released were helpful.

    I might venture a further, perhaps more important, mediator of the dramatic drop in K+ noted in this patient and other phaeos. There are a large number of beta ad...

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