280 e-Letters

  • 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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  • Hazards inherent in the use of either nonsteroidals or paracetamol
    oscar,m jolobe

    Notwithstanding the absence of robust evidence to justify the use of antipyretic analgesics either for reducing patient discomfort or for reducing morbidity and mortality in febrile illnesses(1), it is only in recent times(2)(3) that the issue of drug-related mortality has been adressed in patients receiving either nonsteroidal anti-inflammatory drugs(NSAIDs) or paracetamol for febrile illnesses. Due to insensible losse...

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  • is it showing the exact picture of igA nephropathy?
    gopal chandra ghosh

    I want to highlight few points about the study.First, IgA nephropathy is seen in nearly 40% of renal biopsy specimens of acute glomerulonephritis patients in asia in various study.In this study it is comprising only 8.1% of cases.Second, it is an crossectional study, taking data from the renal biopsy report thus not showing the exact % of acute glomerulonephritis caused by IgA nephropathy.So the finding is quite exaggerat...

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  • Lifestyle modification is still the main strategy to raise HDL-C
    Gauranga C. Dhar

    Management of special type of dyslipidemia; Low HDL-C, high TG, Type- B size LDL-P in patients with T2DM is a big challenge for a physician. For primary LDL-C goal, we the physician usually go for stronger statins like atorvastatin or rosuvastatin. Addition of fenofibrate to the above statins to reduce concomitant high TG really reduces TG level but does such combination offer any strong role in reducing mortality in this p...

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  • Leadership education in medicine and science
    Christian T. K.-H. Stadtl?nder

    Kouzes and Posner (1) once wrote that "The domain of leaders is the future. The leaders unique legacy is the creation of valued institutions that survive over time. The most significant contribution leaders make is not simply to today's bottom line; it is to the long-term development of people and institutions so they can adapt, change, prosper, and grow."

    As Warren and Carnall (2) stated, medical leadership is...

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  • More Errors
    Chris J M Johnstone

    Reply to Reply In reply to De Wets and Bowie's reply to my criticism:

    De Wet and Bowie state 1. Our paper makes it very clear that this is a study of primary care records and not of consultations, GPs or of primary care per se.

    Reply Although this is true, nowhere does the paper explicitly explain that is looking in primary records for errors across the totality of healthcare. This is not mentioned un...

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  • Feedback
    Paul Bowie

    Dear Editor

    Thank you for the opportunity to respond to Dr Chris Johnstone's comments on our 2009 publication.(1)

    1. Our paper makes it very clear that this is a study of primary care records and not of consultations, GPs or of primary care per se.

    2. There is no "common method of measuring rates of harm" in primary care (2) as Johnstone states. We refer to research on medical error and t...

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  • Peripartum cardiomyopathy: current understanding, comprehensive management review and new developments
    Ntobeko B. A. Ntusi

    Dear Sir/Madam,
    We read with interest a review on peripartum cardiomyopathy (PPCM) by Pyatt and Dubey (1) that has recently been published in your journal. Reviewing the epidemiology of PPCM, the authors conclude that, "PPCM appears not to have a hereditary association", and this erroneous assertion is supported by the citation of three references.(2,3,4) However, all three of the papers cited, actually emphasise th...

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  • Neurological and cognite changes in frailty older adults
    Julio C. Romero

    We agree with the authors of this wide and accurate review that persons while they grow old have anatomic and physiological changes in central and peripheral nervous systems, as well as, in cognitive domain expressing in the interview and physical exam of the elderly. But, frequently, the doctors have difficulties to determine where and when the physiological end and the pathological begin in a proper older...

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