eLetters

135 e-Letters

  • 'medically unexplained symptom' means that the doctor has a problem
    S KRAEMER

    Professor Cottrell's guidance for paediatricians confronted with patients whose symptoms cannot be explained minimises the real problem that arises when a mental health opinion may be required. He says "the use if words like 'psychological' is unhelpful and is associated with making things up" which is indeed the case. A very useful study by Furness et al (2009) interviewed hospital paediatricians and child health nurses...

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  • Codeine in paediatrics: CYP2D6 maturation matters, also for other drugs.
    Karel Allegaert

    K Allegaert

    Intensive Care and Department of Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands and Department of Development and Regeneration, KU Leuven, Leuven, Belgium Karel.allegaert@uzleuven.be

    We have read with great interest the review article on the pharmacology, prescribing and controversies of codeine in paediatrics and we agree to a very large extent to the position t...

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  • The YOURR Project: Young People's Opinions Underpinning Rheumatology Research.
    Janet E McDonagh

    Dear Editor, we would like to congratulate Dr Bate et al for so eloquently highlighting the importance of public and patient involvement specifically in paediatric research [1]. We would like to further the discussion by highlighting the involvement of adolescents and young adults who by virtue of age may be in either paediatric and/or adult-focussed research. Mattila et al reported that young people in this age group who...

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  • Re:A different view of studies with deferred consent
    Kerry Woolfall

    The author makes an interesting point about the current legislation and automatic inclusion of data in trials where prior informed consent is not possible.

    EU legislation focuses on when research without prior consent (RWPC) can occur and the need to obtain consent for continued participation, but does not cover the options for use of data collected prior to consent. The exception to this is where consent is not pr...

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  • How to interpret malaria tests
    Aubrey J Cunnington

    Dyer et al. wrote an instructive review on how to interpret malaria tests (1). However there are two important caveats in the interpretation of these tests which they did not mention. First, a positive test does not necessarily confirm a diagnosis of malaria. Second, a positive test does not necessarily mean that malaria is the only diagnosis.

    Strictly speaking, the tests described by Dyer et al. are parasite de...

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  • Extending the spectrum of hypernatraemia
    oscar, m jolobe

    Dear Editor,

    The recognition of endocrine-related hypernatraemia would be enhanced if account were taken, not only of biochemically overt hypernatraemia(1), but also of the possibility that this biochemical derangement might be masked by co-existing inability to excrete salt-free water. The clinical counterpart of this phenomenon is encapsulated in the statement "the symptoms of cranial diabetes insipidus may be ma...

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  • mycobacterium avium also needs to be considered
    oscar,m jolobe

    Dear Editor,

    In addition to the documentation of the radiographic stigmata of paediatric mycobacterium tuberculosis(1), mention also needs to be made that the differential diagnosis of mediatinal and hilar lymphadenopathy should include infection with mycobacterium avium complex(MAC) organisms, especially in patients with HIV/AIDS(2). In the latter context the prevalence of MAC infection in children has been variou...

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  • Decreased conscious level: consider CO poisoning
    Christopher Downing

    Dear Editor,

    Richard Bowker and the Paediatric Accident and Emergency Research Group are to be congratulated on their excellent guideline [1]. It appears comprehensive enough to detect all possible diagnoses while being concise enough to be workable. It does appear vulnerable in the area of poisoning, however.

    Carbon monoxide remains the most common cause of fatal poisoning in the UK [2], and should be...

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  • Resus Room Poster
    Christopher Downing

    Dear Editor,

    I have developed a poster that summarises the evidence-based guideline for the management of decreased conscious level developed by Richard Bowker and the Paediatric Accident and Emergency Research Group (PAERG). It was peer-reviewed and presented at the Inaugural Scientific Conference of the College of Emergency Medicine at Stamford Bridge, London in December 2006, and will probably be published in a...

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  • Glibenclamide for acne?
    Richard G Fiddian-Green

    Dear Editor,

    Drugs that cause acne include those that can impair oxidative phosphorylation such as antidepressants, anti-seizure medications, and cyclosporin which closes the permeability transition pore on mitochondrial membranes. Impairment of oxidative phosphorylation should be accompanied by a fall in cutaneous tissue pH and energy charge. Drugs that aggravate acne include testosterone, corticosteroids, and an...

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