eLetters

135 e-Letters

  • Toe walking in infancy
    Siddika S. Yalcin
    I read with interest Sivaramakrishnan et al's structured approach to a child with toe walking [1]. Various levels of contexts such as parenting, maternal education, poverty and social networks interact with each other and with genetic expression to create long-lasting consequences for development [2,3]. Sometimes, single or isolated negative environmental factors may make a major contribution to developmental problems with most n...
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  • Not all petechial rashes require admission.
    Robin D Marlow

    This was succinct and helpful article. However as a paediatric emergency doctor I would query the phrase "There is still a risk of meningococcal disease even when blood tests are normal; therefore, admit all children for 4-6 hours with hourly observations". It may seem pedantic, but this is not what NICE says. The pathway states "Assess clinical progress (vital signs) and carry out observations at least hourly over t...

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  • Re: Toe walking in infancy
    Arnab Seal

    We agree that baby walkers and door suspenders can be associated with transient toe walking and delayed walking, which usually would correct spontaneously relatively quickly once the children stop using the device. The use of such devices should be strongly discouraged as part of normal parenting practice. Enquiry regarding inappropriate use of either of these devices in a toddler who has tip toe gait on independent or sup...

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  • A different view of studies with deferred consent
    Anthony M Kaiser

    Thank you for outlining so clearly the current basis for "deferred consent" studies and suggesting good practice in dealing with the issues it raises. Unfortunately I believe that the current practice is the worst of possible worlds: not only do we submit vulnerable subjects to interventions without the expression of their/their parents' autonomy (ie consent), but also we risk losing any data obtained because we retrospect...

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  • Doubts about diagnosis
    Ulrich Heininger

    Dear Editor

    I enjoyed reading the first edition of the "Education and Practice Edition" a lot. However, after having read the article "Use your eyes" I was not convinced that Oliver's clinical presentation truely was caused by Borrelia burgdorferi infection, and I would like to challenge the authors for the following reasons:

    1. Erythema migrans usually is a mild disease that hardly ever leads to...

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  • Use your Ears
    Debajit Sen

    Dear Editor,

    We read with great interest the article by O’Hare et al [1]. We commend the general educational messages of the authors but feel compelled to highlight some important errors and omissions.

    In the table of differential diagnosis of monoarticular arthritis, it is also important to consider the diagnoses of trauma/non-accidental injury, the exclusion of which would be the prime indication for...

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  • Re: Use Your Ears
    Robert W Marshall

    Dear Editor,

    We read with interest the article by O’Hare et al [1] and would like to congratulate the authors on their interesting case, but would like to make the following points:

    • Assessment of the musculoskeletal system is poorly performed not only by adult medical trainees [2,3] , but also by paediatric trainees: a recent survey showed that only 1.6% of general paediatric admissions...
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  • The 'more missed' status epilepticus
    Santosh Venketraman Kondekar

    Dear Editor,

    In India, we come across many cases of status epilepticus in toddler age group. These children usually do not have a fever associated and have an history of improper breast feeding and weaning.

    The children may have clinical evidence of rickets, which had been neglected. The common cause of these children getting rickets is dietary, namely lack of vit D and inadequate sun exposure. The chil...

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  • More evidence is needed in the antibiotic treatment of Pseudomonas aeruginosa colonisation
    Federico Marchetti

    Dear Editor,

    In presenting various therapeutic approaches for the management of Cystic Fibrosis (CF), Smyth RL primarily considers evidence obtained from The Cochrane Library as either systematic reviews of randomised controlled trials (RCTs) or RCTs .[1] The antibiotic treatment of Pseudomonas aeruginosa (PA) when first isolated, is still an open question. When discussing this aspect, Smyth RL considers only the...

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  • Pasteurisation
    David Colgate

    Dear Editor,

    I am a corporate member of UKAMB and consider issue three of the Guidelines to be an excellent reference.

    However, to minimise the risks after feed preparation the thermal treatment (Pasteurisation)requirements should not only mirror issue two published by RCPCH but also include the following amplification of treatment, based on work by the late Prof J David Baum.

    The Pasteurisati...

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