112 e-Letters

  • Let`s not forget CSF lactate
    Mohamed OE Babiker

    The authors have done an impressive task by taking us through the physiological and biochemical basis and the clinical value of serum/blood lactate. However, I was hopeful that they would touch on CSF lactate as an important investigation tool, not only useful for paediatric neurologists but for general paediatricians alike.

    Lumbar puncture (LP) is commonly performed as part of the evaluation process of a chi...

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  • Re:Epilepsy-related Tongue biting as another cause for recurrent oral ulcers
    Esse Menson

    Thank you for identifying another cause of mouth ulcers for consideration in this specific group of patients. You highlight the point that in children with poorly controlled seizures, ulcers will resolve by achieving seizure control if they are related to tongue-biting, thereby avoiding unnecessary investigation for an alternative cause.

    Conflict of Interest:

    None declared

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  • Epilepsy-related Tongue biting as another cause for recurrent oral ulcers
    Sascha Meyer

    Sascha Meyer (MD), Isabel Oster (MD), Sylvia Peterlini (MD), Ludwig Gortner (MD, Professor), Georg Kutschke (MD)

    Dear Sir and Madam,

    We read with interest the 15 minute consultation on recurrent oral ulceration in a child by Le Doare et al. (1). In their report, the authors provide a wide range of differential diagnoses that may lead recurrent oral ulcerations (1).

    In our opinion, it is import...

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  • Re: Question 2 -NeurofibromatosisType1
    Zuher E Lokhandwala

    Dear Editor, We read with interest the article by Peter A Lio et. al. (1). With regards to question no.2, the authors have rightly pointed out that Neurofibromatosis Type 1 (NF1) is the most likely diagnosis.

    Once the diagnosis of NF1 is confirmed, an affected individual should have a thorough initial assessment with particular attention to features of NF1, a physical examination with particular attention to the s...

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  • How to adjust for case-mix when comparing outcomes across healthcare providers
    Bradley N. Manktelow

    We welcome Santhakumaran's article (1) describing some of the problems and misunderstandings that can arise when adjusting for case-mix differences between hospitals. In our recent paper (2) we quantified the bias that is likely to arise when comparing standardised mortality ratios (SMRs) between one neonatal unit and another. In our paper it was shown that, using actual observed differences in case-mix, even if two neo...

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  • Early-onset headache does not predict poor long term headache disability
    Manish Prasad

    I read with interest the "Fifteen minute consultation: headache in children under 5 years of age" recently published online. It would also be worth remembering and will be reassuring to all of us to know that although some characteristics of early-onset headache can be different from that of late-onset headaches for e.g. shorter duration, the overall impact of the headache on the school performance and learning and clini...

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  • 'Benign Enlargement of Subarachnoid Space (BESS)'- an important differential for large head
    Manish Prasad

    I read with interest "The Fifteen-minute consultation on the infant with a large head" published recently by Arnab Seal. Clinicians should also be aware of 'Benign Enlargement of Subarachnoid Space (BESS)'. It is described under various names in literature including benign extra-axial collections of infancy, external hydrocephalus, subdural effusions, etc (1). It presents in infancy with rapid enlarged of head circumferen...

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  • Whether a head is 'abnormally' large depends on the growth chart used
    Charlotte M Wright

    The Fifteen-minute consultation on the infant with a large head just published on line (1) has one major weakness: no mention of which chart the child's head is compared to. Comparison with representative Belgian, Norwegian (2) and British data (3) has shown that European infants' heads appear large compared to the WHO standards. We have undertaken further analyses of the data from the Southampton Women's Survey used fo...

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  • The two fundamental caveats of IGRAs
    oscar,m jolobe

    The reservations exepressed about the interpretation of interferon gamma release assays(IGRAs)(1)are underpinned by the following observations:- IGRAs do not reliably identify subjects with active tuberculosis(even in the context of culture positive disease)(2), as shown by a study where 45 subjects received a diagnosis of active tuberculosis characterised, in 37 of those subjects, by positive cultures for mycobacterium...

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  • Re:autism assessment tools- a (partial) misinterpretation
    Bob Phillips

    As part of the team that undertook review of the paper prior to publication I would like to thank Alan for picking up this misinterpretation and to apologise to our readers for the mistake.

    It's entirely correct that a negative ADOS will be right - the patient will not have autism - about 88% of the time.

    The table 3 is misleadingly titled "prob that the test rules out autism" and should be "post test...

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