eLetters

73 e-Letters

published between 2007 and 2010

  • Intravenous epinephrine?
    Kevin Theintun

    The choice of the route of adminstration of epinephrine as discussed in this case leads to vetricular arrthymia which would be fatal in the setting that defibrillator is not in hand immediately. This would be especially problematic for those practising in the third world countries like us. With no immediate defrillation in hand I think it would be rather reluctant to give adrenaline even intramuscularly in view of appa...

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  • Re: Intravenous epinephrine?
    Rohan V Ameratunga

    As stated in the article, the patient experienced throat tightness, respiratory distress as well as angioedema as part of anaphylaxis. The throat tightness and lower respiratory tract involvement were valid indications for intramuscular adrenaline.

    Failure to treat anaphylaxis promptly may have placed the patient at risk of continued deterioration and death from respiratory failure (bronchospasm or laryngeal...

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  • Response to letter by Dr Jolobe
    Nicolas U Weir

    I am grateful to Dr Jolobe for drawing attention to the dilemma of just how much paroxysmal AF (pAF) is sufficient to produce a clinically important risk of stroke and systemic embolism. So far, research in this field has been limited, focused on primary prevention populations (those with pacemakers for bradycardia), and unclear as to whether several hours or just a few minutes of rapid AF are required.[1][2] Hopefully...

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  • atrial fibrillation burden is crucial to evaluation of suspected cardioembolic stroke
    oscar,m jolobe

    In his allusion to the uncertain significance of "brief and infrequent paroxysms of AF(atrial fibrillation) noted on the event monitor"(1) the author highlighted the thorny issue of the relationship between AF burden and embolic risk(2). The author's misgivings resonated with the comment which has been made that "it is not well known if a "small" AF burden presents any lesser risk of morbidity and mortality compared wit...

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  • Authors' response
    Amanda C Howe

    Jewkes highlights key issues in both diagnosis and management. Questionnaires in common use in UK primary care can help to support the decision to offer pharmacological treatments, but work in press suggests that the relationship between symptoms, scores, and treatment decisions are complex, especially in the elderly and those with co-morbidities(1). Patients find the use of questionnaires can be helpful in verifying the...

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  • Non=pharmacological Treatment of Depression in Primary Care- A Real Issue
    Alex E Jewkes

    Many thanks to Lester and Howe for their overview of current guidelines for the treatment of mild-moderate depression in primary care (1).

    Having recently worked in primary care, I also found difficulty in accessing non-pharmacological treatments for depression in a suitable timescale. Often patients were faced with a wait of many weeks to see the local practice counsellor or for a psychology referral to come t...

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  • Author Reply.
    Miron Prokocimer

    16/2/09

    To the Editor,

    The additional examples detailed above regarding TB-associated DIC and HIV/AIDS-associated splenic hypofunction are indeed noteworthy. The association with AIDS appears to be complex and multi-factorial, attributable not only to the effects of HIV(1) and/or various opportunistic infections on the immunologic function of the spleen (e.g Mycobacterium avium comlex as mentioned,...

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  • Managing Pain in Chronic Kidney Disease
    Rizaldy Pinzon

    Pain is common complain in kidney disease patients. The high prevalence of pain in the chronic kidney disease is particularly concerning because pain has been shown to be associated with poor quality of life. The management of pain in chronic kidney disease patients is challenging. There should be a balance between good pain control and the safety of medication. Adjustment of dosage should be done in many cases. Anal...

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  • Authors reply
    Miron Prokocimer

    16/2/09

    To the Editor

    The additional examples detailed above regarding TB-associated DIC and HIV/AIDS-associated splenic hypofunction are indeed noteworthy. The association with AIDS appears to be complex and multi-factorial, attributable not only to the effects of HIV(1) and/or various opportunistic infections on the immunologic function of the spleen (e.g Mycobacterium avium comlex as mentioned, and...

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  • disseminated intravascular coagulation may be a clue to disseminated tuberculosis
    oscar,m jolobe

    Abnormalities in peripheral blood morphology which are indicative of underlying infection include stigmata of disseminated intravascular coagulation(DIC), exemplified by the presence of schistocytes and fragmented red blood attributable to red blood cell trapping and damage within fibrin thrombi(1). Accordingly, the added value of peripheral blood cell morphology in the diagnosis of infectious diseases(2) includes recogn...

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