264 e-Letters

published between 2008 and 2011

  • Early intervention may be crucial
    Kok-Weng Lim

    Wyatt et al. (1) are to be commended for producing one of the largest randomised controlled trial on the effectiveness of cranial osteopathy for children with cerebral palsy, which was carried out on behalf of Cerebra. Cranial osteopathy as an adjunctive treatment in cerebral palsy is not new: Dr Beryl Arbuckle, an osteopathic physician, opened the Cerebral Palsy Institute in the 1940s in the USA which offered osteopathic...

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  • Assent is not perfect but its abolition could be worse
    Helen M Sammons

    We read with interest Dr Baines's article on assent for children's participation in research [1] and were pleased that he has highlighted the complexities surrounding assent. We agree that the current situation is confused and legal guidance is inconsistent. This primarily hinges on the poor definition of assent and its place in the consent process.

    We do however challenge Dr Baines's suggestion that assent does...

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  • Mortality of severe anemia increased by fluid resuscitation
    Michael Eisenhut

    The Editorial by Drs.Southall and Samuels pointed out that fluid challenges given in a recent study by Maitland et al. (1) to children in the absence of hypovolemic shock may worsen severe anaemia. It is important to note that 32% of all children enrolled had severe anemia (Hb<5 g/dl) with no significant difference of this proportion between groups. Maitland et al. stated that their data showed that excess mortality w...

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  • Use of WHO New Growth Standards for Developing Countries
    Mrudula A. Phadke

    In response to the interesting article by P B Juliusson et. al. on Growth of Belgian & Norwegian Children compared to the WHO growth standards published in Arch. Dis. of Childhood 2011, 96:916-921 and appreciating the concerns raised by him, we raise few issues pertaining to India. It is stated in the paper that there are significant deviations, we put forth the point that developing countries must first start using WH...

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  • Published
    Shany Eilon

    Dear Sir, Case reports have their importance in the medical literature as you pointed in your editorial [1]. Many journals opt not to publish them as they are not considered "research", but they tend to forget that in many situations, when clinicians are faced with a rare presentation of a common disease or just a rare disease, they recur to case reports in order to form an opinion and counsel patients. Moreover, textbook...

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  • Propranolol for infantile haemangiomas
    Anthony J Nunn

    The excellent review by Sharkey and Shahidullah of oral propranolol treatment for infantile haemangioma did not consider the formulation of propranolol that might be used.[1] In UK a solution of propranolol hydrochloride has a Marketing Authorisation (Syprol(TM); Rosemont Pharmaceuticals Ltd) but is used off-label for this indication. It is available in four different strengths of 1, 2, 8 and 10 mg/ml so there is potent...

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  • Mission Impossible with this formula? Yes.
    Mark D Luscombe

    Marlow and colleagues suggest the use of the formula "Weight = 2(age) +10" for children between 1 and 10 years.

    An individual age group analysis has clearly not been performed here. Had Marlow and colleagues done this they would have found that the formula above suffers with similar problems as the APLS formula. After all, their formula describes a straight line with the same gradient as the APLS formula.


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  • Screening infants for obesity may not be a good idea
    Adriano Cattaneo

    In her article, Mary Rudolph makes an interesting and perhaps even feasible proposal. However, the fact that a reasonably accurate obesity risk tool could be developed and applied does not necessarily mean that screening is a good idea. We would raise the following objections: 1. With the estimated sensitivity (73%) and specificity (53%), the positive predictive value would be only 28%, if the prevalence of obesity was 2...

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  • Drug interaction? - beware potential confounding factors.
    Tim Cheetham

    We all recognise the importance of adverse event reporting but we must also be aware that this can provide a mechanism whereby chance associations can have a profound impact on clinical practice. The recent case report by Shenoy and colleagues highlights this issue (1). As a result of their report, which is meant to show that infacol has an adverse effect on thyroid function tests in a baby with congenital hypothyroidism...

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  • Attachment simplifies the complexity
    Sebastian Kraemer

    What is missing from this welcome paper on systemic approaches in the early months of life is attachment, the most thoroughly researched paradigm in developmental psychology (Music 2011). Attachment is a biological system that we share with all mammals (and many other species) for protecting the infant, but the mother's capacity to do so - to love her child - is powerfully influenced by her own relationships, particularl...

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