492 e-Letters

published between 2005 and 2008

  • Interaction between high-sensitivity C reactive protein levels and magnesium levels in the children
    Ahmet Sert

    We read with interest the article by Rodríguez-Morán et al who undertook a community-based cross-sectional study of 488 apparently healthy children aged 10–13 years to assess the hypothesis that magnesium deficiency is associated with elevated high-sensitivity C reactive protein (hsCRP) levels (1). The headline of the article is ‘’Serum magnesium and C-reactive protein levels’’ whereas in their study the authors wrote th...

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  • Use of appropriate inhaler devices for optimal delivery of inhaled corticosteroids
    Samatha Sonnappa

    The BTS guidelines on the management of asthma clearly state that in children aged 0-5 years, pressurised metered dose inhaler (pMDI) with spacer is the preferred method of delivery of inhaled corticosteroids (ICS); and in children aged 5-12 years and adults, dry powder inhalers (DPI) are as effective as pMDI with spacer (Grade A evidence).(1) The cover illustration of the August issue of the Archives shows a young boy...

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  • Re: The PACU model is complimentary to Paediatric emergency but is not an Alternative.
    Mitch E Blair


    The above letter by Haythornthwaite et al. raises a number of important points. It also highlights how misinterpretation of the findings, no matter how subtle and easily made, can have an impact on the way in which the findings could be viewed and possibly used. Each point raised by the above authors are dealt with below:

    1) This paper concludes that PACU model is an effective alternative to...

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  • System Failure
    Felix Oberender

    Thank you for sharing this interesting study. Do such staggering results in this core area of physician activity, however, not also beg the question of system failure? A number of reasons come to mind, eg. time pressures, the frequent need to re-chart, wide variations in chart design etc.

    It may seem enticing to include navigating this system in the ST interviews but would it then not just add yet another bell-c...

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  • Pulling together for Children's TB services
    Beate Kampmann

    We read with interest the review of TB services for children in the UK by Adalat et al. Although the survey was conducted several years ago and prior to the publication of the recent NICE guidelines, several key issues mentioned in the article continue to impair the care for children with TB in the UK: - Tuberculosis in children remains an under-appreciated condition and is not sufficiently prioritized in public healt...

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  • KK Ong

    Dear Editor,

    We acknowledge Dr Nichols's point that the 2006 WHO charts still (and indeed fortunately) show that a small proportion of infants will demonstrate weight faltering and these infants may well need assessment for underlying pathology and/or nutritional support. Indeed the application of these WHO charts to UK practise is the subject of an ongoing DoH-funded RCPCH expert working group and implementatio...

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  • Gelofusine - not even a suggestion of a link with NEC
    Sam Richmond

    Whilst I am pleased to see that Drs Khashu and Balasubramaniam have agreed to retract their previous statement that "Weak evidence suggests an increased risk of necrotising enterocolitis with the use of Gelofusine in neonates" it is clear from the second paragraph of Dr Khashu’s letter [1] that they still have not grasped the point of logic that Dr Evans and I have separately tried to get across. As a very similar error t...

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  • Isotonic maintenance fluids do not produce hypernatremia
    Michael L Moritz

    Coulthard proposes that 0.18% saline should be the maintenance fluid of choice in children and that an intravenous fluid with a sodium composition of 0.45% saline or higher will lead to an increased number of cases of hypernatremia. His arguments are based primarily on two false premises: 1) that SIADH is extremely rare and 2) that renal concentrating defects are common. In 2003, we proposed the use of 0.9% saline as a...

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  • Fluid prescription should be logical, safe and simple.
    John J Fitzsimons

    We were interested to read Dr Coulthard’s opinions on maintenance intravenous fluids(1) in the context of NPSA patient safety alert 22.(2) As highlighted by Stewart et al in their response to Dr. Coulthard’s article(3) there is no default fluid designated by the NPSA however when we examined all of the NPSA recommendations, with regard to our patient population, we decided to opt for the isotonic fluid 0.9% Saline with...

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  • Apnoea and SIDS in sitting devices
    Alistair J. Gunn

    Dear Editor, Cote et al recently reported that a small proportion of infants deaths that were unexplained after careful examination occur when babies are left in sitting devices (1). Vaucher suggests that the relative risk of death may actually be lower in sitting devices since some babies spend prolonged periods in sitting devices (2). This would be correct if risk was similar for all devices. In practice though, the majo...

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