1212 e-Letters

published between 2016 and 2019

  • Re: Treatment of the hyperinsulinaemic hypoglycaemia unresponsive to diazoxide and octreotide: sirolimus should be considered
    Arunabha Ghosh

    We agree that sirolimus may help children with Congenital Hyperinsulinism who do not respond to diazoxide or octreotide. Sirolimus is, however, unlicensed, with little long term experience, and the mechanism by which it reduces hypoglycaemia remains speculative. As sirolimus is an immunosuppressant, its use in young infants has to be carefully monitored in specialist centres under strict protocols. We are, therefore, re...

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  • Point of care lactate testing in resource-poor settings
    Aubrey J Cunnington

    Khan et al. make a strong case for investment in point-of-care lactate testing in low and middle income countries (LMICs) (1). They believe that this would identify children at high risk of death, and would save lives because these children could receive earlier resuscitation. Unfortunately the optimal management of children with hyperlactataemia in LMICs is far from clear. Although Khan et al. extrapolate from findings i...

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  • Holes in the net: safety netting in Emergency Departments needs to improve
    Hannah C Jacob

    Safety netting in the Emergency Department (ED) is key to the practice of safe medicine. Following the article by de Vos-Kerkhof (1), we present further evidence to suggest that there is a lack of standardised safety netting. In addition, we found a disparity between paediatric trainees' perception of their safety netting practice and what they actually documented in the medical notes.

    In a retrospective case...

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  • Re:Invertase is an alternative to Sucraid in the treatment of CSID
    Mark R

    My child also has CSID. She is about to be 8 yrs old and has been on Sucraid for the last 6-7 yrs. I am looking for an alternative to this medication as sometimes we cannot get the medication and have to go a strict diet until we can get some again. I will look into this alternative and post results later.

    Conflict of Interest:

    None declared

  • Re:Is the effect of parental separation underestimated?
    Maria Quigley

    Maria A Quigley1, Claire Carson1, Julia Morinis1,2,3.

    1 National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK

    2 Department of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada

    3 Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada

    We would like to...

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  • Consent from both parents is ethically required
    David J. Llewellyn


    This is a timely and important article. Pretermitting whether parental consent can ever be valid for non-therapeutic surgeries on minors, certainly Mr. Wheeler is correct that at the very least the permission of both parents should be necessary for the circumcision of a male child. Too often here in the U.S. the matter ends up in court. I have been involved in one way or another in seven such cases in t...

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  • aneroid devices should be the preferred "new" sphygmanometers
    oscar,m jolobe

    It would be useful to ascertain whether or not the "new" sphygmanometer being compared with the Omron HEM 711(1) was an aneroid device, given the fact that those of us who lamented what we perceived to be an ill advised rejection of the mercury device welcomed the prospect that aneriod sphygmanometers "may replace the traditional mercury column in the healthcare workplace"(2). In the latter study, there were no signific...

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  • Malnutrition in hospitalized children
    Peter Cartledge

    Dear Sir:

    We read with interest Marko Kerac's excellent article on wasting amongst under 6-month old infants in developing countries (1). There is a considerable amount of excellent research on how to identify malnutrition. We also have comprehensive, effective, evidence on how to manage malnutrition and reduce mortality (2). However, we and others have audited the identification of malnutrition in children...

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  • A Supplemental Nursing System for the Prevention of Neonatal Hypernatremic Dehydration
    Michael L Moritz

    Leven and Mcdonald (1) report on the common occurrence of neonatal hypernatremic dehydration in breastfed infants and how early weighting is an effective means of detecting this condition. Studies of this type are the “tip of the iceberg” of much bigger problem, that of insufficient lactation in primiparous women. It is well recognized that primiparous woman produce less milk than multiparous and that 16% of exclusivel...

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  • Re:Management of Kawasaki disease Eleftheriou et al
    Despina Eleftheriou

    We thank Professor Hall for drawing our attention to this issue. At present there are no relevant published recommendations in the UK but we would agree that both vaccination against VZV and influenza should be offered and recommended to children receiving long term aspirin.

    Conflict of Interest:

    None declared