278 e-Letters

  • relevance of time frame and left circumflex as the culprit artery
    oscar,m jolobe

    The occurrence of coronary occlusion in patients without protocol positive ST segment elevation(1) might be attributable either to early catheterisation(2)or to left circumflex artery occlusion(3)(4), the latter also being significantly(p < 0.001) commoner in non ST segment elevation(NSTEMI) patients catheterised within 6 hours of arrival in hospital than in STEMI counterparts also catheterised within that time frame(...

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  • Transthoracic ultrasonography to differentiate bullous emphysema from pneumothorax: a bright future in black and white.
    Subramanian Senthilkumaran

    Respected Editor, The case report by Lai et al. [1] was both interesting and informative. We agree with the usefulness of CT thorax to differentiate pneumothorax from giant bulla with double wall sign. Though CT offers the most accurate diagnostic information, it is difficult to transport unstable patient to a CT suite which is in a remote area from a resuscitative area or to wait for a specialized technician to perform it...

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  • Cost-effective prescribing: Medical schools must take responsibility
    Mohammed A. Rashid

    Nwulu and colleagues present a highly relevant analysis of the financial implications of prescribing by F1 doctors in a UK teaching hospital1.

    It seems that the most important of the recommendations they discuss are for undergraduate medical education. Whilst they mention that most of the 79 doctors they investigated graduated from the same medical school, they do not categorise this further. As their data ind...

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  • Lewy Body Dementia in the Emergency Department
    Bruce D. Adams


    We applaud the timely study by Kennelly et al and agree fully that ED physicians generally lack proficiency for recognizing and managing behavioral complications of dementia. As they succinctly state, "Failure of physicians to identify and highlight cognitive impairment can lead to disastrous consequences".[1] We venture that ED physicians are even less aware of the unique and potentially lethal emergenc...

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  • the current world record for giant left atrium
    oscar,m jolobe

    The 76 year old patient recently reported in this journal with left atrial diameter of 10 cm(1), has been superseded, in the record books, by a 40 year old man with left atrial diameter of 21.5 cm attributable to severe mitral stenosis(2). The latter patient presented with dysphagia, hoarseness, and exertional dyspnoea. References (1)Shah BN., Rubens M Giant left atrium: a forgotten cause of cardiomegaly Postgrad Med J 2...

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  • In response to Dr Levine's letter (13th July 2012)
    Emma M. Salisbury

    We recognise and acknowledge the issues raised by Dr Levine in his letter (13th July 2012). Newly qualified doctors can expect to be as prepared as their undergraduate training allows and their level of clinical supervision facilitates. These are important additional factors when considering preparedness of medical graduates commencing work at foundation year 1 (F1) level. F1 doctors must be able to increase their leve...

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  • Unpreparedness
    David Levine

    Newly qualified doctors can expect to be as prepared as their undergraduate training allows. For the initial management of acutely ill patients, perhaps involving practical procedures, we have to ensure that training and assessment of both students and doctors occur, as far as possible, under similar conditions to those in which doctors will work. 4 days of shadowing help but are not enough. The reality for many newly...

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  • "Xanthelasma palpebrarum -a cutaneous sign of increased cardiovascular risk"-still a misunderstanding
    Gopal Chandra Ghosh

    Xanthelasma palpebrarum ia a sharply demarcated yellowish flat plaque om the upper and lower eyelid, mostly near the inner canthus.In a prospective study done in Copenhagen University revealed that xanthelasme palpebrarum predict risk of myocardial infarction, ischaemic heart disease, severe atherosclerosis, and death in the general population[1].In present study which is a cross-sectional study revealed that xanthelasma...

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  • Natriuretic peptide levels must be interpreted in the light of clinical probability of heart failure
    oscar,m jolobe

    Given the recognition that "choosing appropriate thresholds[for serum natriuretic peptide] is problematic"(1), the best diagnostic strategy for obtaining maximum diagnostic "mileage" from natriuretic peptide levels might be that of interpreting any given result in the light of whether the patient has high, medium, or low clinical probability of heart failure. For that to come about, instead of reinforcing the idea that "In...

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  • Perception
    Russell D Brown

    I can well remember my feelings of unpreparedness in both the areas that current graduates identify as feeling most unready for.

    However, I suspect that having this perception is not a bad thing. I hope that they are able to maintain such a degree of insight and use it to the advantage of their patients and themselves in the long term.

    Should I be asked, I would encourage them to think on it in terms of...

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