30 e-Letters

published between 2013 and 2016

  • 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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  • autism assessment tools- a (partial) misinterpretation
    Alan S Stanton

    Carter and colleagues have done a superb job in summarising the theory and practice of tools used in assessing children for autism. Unfortunately their paper is marred by a mathematical error which, if left unchallenged, could undermine trust in the use of one such tool, the ADOS.

    According to the paper, the positive predictive value (ppv, i.e. the proportion of those who test positive who actually have the cond...

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  • Attention must also be drawn to alternative pathogens for tonsillitis
    oscar,m jolobe

    Although it may be difficult to make a distinction between retropharyngeal abscess, and retropharyngeal cellulitis attributable to organisms such as Group A bete-haemolytic Streptococcus, Staphylococcus Aureus, and Group B Streptococcus(1), retropharyngeal abscess should remain high in the differential diagnosis because Fusobacterium necrophorum(F necrophorum), the gram negative culprit pathogen,although initially givin...

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  • How to use lupus anticoagulants in neonates born to mothers with antiphospholipid syndrome
    Maria Pia De Carolis

    .Dear Sir, We read with great interest the accurate paper by Sen et al. regarding the indications for testing lupus anticoagulants (LA) in pediatric patients1. We believe that two further considerations might provide a complete overview on this issue. First, it has to be underlined the important contribution given by Boffa MC concerning either the laboratory methods for the detection of LA2 or the association between an...

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  • Suboptimal INH dosage in prophylaxis
    Luis I. Gonzalez-Granado

    The authors state that INH does not prevent the development of active tuberculosis. However, it is well known that with lower dosage than 15mg/kg daily of INH, we cannot assure therapeutical INH levels, precluding its efficacy, as it correlates with lower levels than 3g/l in the pharmacokinetic parameter of response Cmax

    Conflict of Interest:

    None declared