294 e-Letters

  • Emphasis on Lifestyle Management Not Evidence Based
    Philip C Robinson

    I read with interest the manuscipt by Jeyaruban and colleagues. However I am disappointed that a major issue identified was a "Failure of adherence to lifestyle changes".

    There is scant evidence that lifestyle changes have any clinically relevant impact on gout management.

    Surgical weight loss is one of the few non medication related interventions that has a substantial impact on serum urate.

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  • Planning better care at the Casualty Department
    Alfredo D. Espinosa-Brito

    Dear Editor:

    We are living a new epoch all over the world. Also in clinical medicine. As it is known, for example, the model of a single doctor participating heavily at each step of treatment is giving way to expanded- care teams.

    Moreno-Rodriguez identified an universal crisis of the clinical method, with dangerous consequences in the practice of medicine. Among its main causes there are: a deteriora...

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  • Re: Healthy eating: an NHS priority
    Joanne A Hastings

    Promoting healthy eating certainly needs to be a greater priority within the NHS but I suspect changing culture will be easier said than done. I the hospital I worked at last year, the central point of the hospital was a Greggs. There was no canteen and whilst there was a cafe selling healthier food above the Greggs I found many patients did not know it existed and for the staff it did not have the same opening hours as...

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  • Old Age: Strong and incessant exercise in the open air
    Martin Hofmeister

    Dear Editor,

    I read with interest the article "Physical activity is medicine for older adults" by Taylor in the Postgraduate Medical Journal (1). I agree that physical activity is and remains an organismic necessity and the best buy for public health (2-3)!

    The German physician Christopher William Hufeland (1762 - 1836) wrote in his famous work 'Art of Prolonging Life' in 1797: "Harmony in the movements...

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  • Re: Old Age: Medicine is activity (Do not forget Susruta of India)
    Martin Hofmeister

    Dear Professor Jorwal,

    In history of exercise physiology is often forgotten that Susruta of ancient India was the first physician to prescribe physical activity for health reasons. He promoted dietary changes and daily exercise of moderate intensity such as brisk walking to minimize the consequences of diabetes and obesity (1). Today, elderly people are very likely to benefit even from simple, full-body exercise...

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  • Adrenaline in the management of anaphylaxis. What about medical students?
    Daniela Zauli

    The paper by Plum et al. (1) prompted us to verify how fourth year medical students performed in choosing the initial dose and route of administration of adrenaline in the treatment of adult anaphylaxis. The question was one of the 20 they had to answer by blackening the correct box (C for this specific question) to pass the Clinical Immunology (CI) exam. Many (approximately two-thirds) of the 192 students who resp...

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  • Old Age: Medicine is activity
    Pankaj Jorwal


    This article points out the well documented fact that increased physical activity has clear-cut protective effect from all cause mortality(1). Developing countries like India are also acknowledging such facts and are issuing guidelines for the same so as to promote health care of elderly even at primary health care level(2).

    With development and prosperity the average individual age is increasin...

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  • Holistic care needs to be met with holistic education
    James M Read

    The increasing numbers of frail elderly patients certainly poses a challenge for all parts of the healthcare landscape within the UK and beyond. Whilst organisational change and modifications to where, when and how we deliver care is important this must be underpinned by appropriate education for doctors and allied healthcare professionals.

    Much of this needs to be aimed at more junior staff, especially medical...

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  • Less health care might be fair in the older patient.
    M. Justin Zaman

    Predicting prognosis in this older group of patients is complex due to their highly variable health status, driven by their fundamentally different prognosis to younger patients. We have published two recent pieces on this theme, showing that firstly though there was an incremental reduction in the use of evidence-based therapies for ACS (acute coronary syndrome) with older age and that better survival was associated with...

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  • Evaluating the 5Fs mnemonic for cholelithiasis in a peruvian population
    Daniel E. Mendoza-Quispe
    Dear editor: We read with great interest the paper by Bass et al[1] on the mnemonics of cholelithiatis in the november 2013 issue of PMJ. The authors conclude that Family History should be considered as a predictive factor. We would like to share our own experience on this matter. We collected 173 consecutive patients diagnosed of cholelithiasis, inpatients and ambulatory care patients, during January and February, 2014. In all c...
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