135 e-Letters

  • 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

  • Sexual health and contraception
    Alyson J Elliman

    Straw and Porter write an important article on Sexual health and Contraception (Arch Dis Chld Educ Pract Ed 2012; 97:177-184), but there are some points which I think need clarification or correction. There may also be missed opportunities for highlighting the most effective methods of contraception in real life situations for young people. The statement that 'Levonelle 1500 is an an oral progestogen which can be obtaine...

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  • Unde venis? loosely paraphrased to "where did you spend your last holiday?"
    oscar,m jolobe

    Surprisingly, especially in view of a recent article highlighting the importance of including a history of recent travel when evaluating neurological symptoms and signs(1), such an inquiry was not mentioned as a fundamental requirement in the 15 minute consultation on facial paralysis(2). In the anecdotal report of a patient with multiple cranial nerve involvement(inclusing facial nerve paralysis) in whom the diagnosis of...

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  • The abbreviated patient-held health record should be part of the process of transition
    oscar,m jolobe

    At the heart of good management of the health transition process(figure 1)(1) should be a recognition of the "power of information- putting all of us in control of the healthcare information we need"(2). This can be achieved, in part, through the medium of the so-called "abbreviated patient-held record"(3), so as to bridge the communication gap between a variety of healthcare services when the young person makes the tra...

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