517 e-Letters

published between 2004 and 2007

  • There is more to the diagnosis of iron deficiency than hypoferritinaemia or microcytosis
    oscar,m jolobe

    A definition of iron deficiency based solely on the serum ferritin cut-off levels stipulated by the authors(1) runs the risk of underestimating the prevalence of this disorder because patients who have iron deficiency in the presence of chronic inflammation may have serum ferritin levels which fall within the normal range(2). In order to identify such patients, the authors could have documented the levels of C reactive...

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  • Is a torn frenum diagnostic of child abuse?
    Sandra S Mascarenhas

    We read with interest the article by Maguire et al 1, reporting the results of a systematic review of torn frenum and other intraoral injuries in diagnosing abuse. We do accept that in the absence of case control studies, the most appropriate study design to answer a diagnostic clinical question, the authors had to settle for case series or case studies. However, when none of the included case series were specifically desi...

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  • Gelofusine and NEC – an inappropriate conclusion
    David A Osborn


    The Archimedes offering by Khashu and Balusubramaniam [1] contains an overstatement of the evidence from our Cochrane Review [2] (Early volume expansion for prevention of morbidity and mortality in very preterm infants) in suggesting in their 'Clinical Bottom Line' that "Weak evidence suggests an increased risk of necrotising enterocolitis with use of Gelofusine in neonates”. We had cautioned against over i...

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  • Recommendations for sudden infant death syndrome prevention: a response from FSID
    George B Haycock

    In the February 2007 issue of the Archives, Mitchell(1) published a discussion document on recommendations for prevention of sudden infant death syndrome (SIDS), focussing particularly on the advice issued by the Department of Health (DoH) in England on 3 occasions, in 2000, 2004 and 2005. A revised version was published in February 2007,(2) too late for inclusion in Mitchell’s paper. In the paper he reviews some of the...

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  • Diagnosis and management of cow's milk protein allergy
    Anders O Thuijl, van

    Dear editor,

    With interest we have read the review by VandenPlas and coworkers (1) in which guidelines for the diagnosis and management of cow’s milk protein allergy (CMPA) in infants are discussed and general recommendations with respect to these issues are given. The authors present two diagnostic algorithms, on which we would like to comment.

    The authors developed separate diagnostic algorithms for ex...

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  • Barriers to education of overseas doctors in paediatrics
    Tanya S Thangavelu

    Mahajan's study was commendable as it was pertinent to a large percentage of training paediatricians within the UK. Being of Indian ethnic origin myself (but from the African continent) I could relate to several issues highlighted by the article.

    Barriers such as communication skills and work culture should also be viewed as goals or strengths whilst training within the NHS. These are major "barriers" when train...

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  • Re: Gelofusine and NEC - a misleading conclusion
    Minesh Khashu

    Dear Dr.Richmond,

    Thankyou for your e letter.

    In the relevant review by Osborn and Evans, (2004) subgroup analysis: Gelatin based plasma substitute versus FFP, the authors clearly state under secondary outcomes:

    The rate of NEC was significantly higher (RR 4.92, 95% CI 1.44, 16.80) in infants who received the gelatin based plasma substitute.

    We agree that analysis 5.11 demonstrate...

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  • Caution over long term immunity
    Dylan M Wilson

    The argument by Roderick et al as to whether varicella vaccine should be introduced has particular relevance to Australia. Here, a single dose only is offered at 18 months, with a further opportunity in the teenage years for those without prior history of disease or vaccination. My concern lies in the provisional evidence of waning vaccine-induced immunity over time, as this will only result in chicken pox shifting from...

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  • Nonsense
    William Broussard

    I have 22 years experience in a pediatric general care unit and can say with certainty that the most important aspect of venipuncture is a skilled technician. EMLA is Ok and distractive techniques can help, but when it comes down to it.. venipuncture is always scary for kids. Rarely do any distractive attempts or local anesthetics do much to diminish the crying and struggling (fear). Whats most important is for the p...

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  • A possible re-emergence of osteomalacia in women and severe hypovitaminosis D in new-born in France
    Anne-Marie SCHOTT

    Dear Editor,

    We found the article of S H Dijkstra et al (1) very interesting. We recently conducted a study in 93 non-pregnant women, aged 20 to 50 years, to determine the prevalence of vitamin D deficiency in women at risk of vitamin D deficiency because of their wearing of concealing clothes (such as a veil). This prospective study was performed between December 2004 and January 2005 in general practitioner se...

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