121 e-Letters

published between 2012 and 2015

  • ?Zebras
    Alexander M Bobinskas

    Dear Editor,

    I read with interest the description of an orbital floor and nasal bone fractures associated with orbital and subcutaneous emphysema(1).

    The presentation of orbital floor fracture with orbital emphysema in the absence of a history of trauma is indeed unusual as noted by the author. Even more unusual is a nasal bone fracture caused by nose blowing, with the current case apparently being the...

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  • Water and Ketones as Sources of Alternative Cellular Energy
    W. John Martin

    It was a pleasure to see the article by Dr. Goldhammer and colleagues published in a mainstream medical journal. As discussed elsewhere (1) activated water can potentially provide tumor cells with sufficient cellular energy via the alternative cellular energy (ACE) pathway to either undergo apoptosis or complete the maturation process. Moreover, the provision of cellular energy probably explains the effectiveness of homeo...

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  • Ketamine administration by which specialty?
    Tom E Mallinson

    Thank for your this interesting case.

    In the United Kingdom this is a medication used rarely within the hospital environment, although it is gaining popularity in the pre- hospital field. I would be intrigued to know the specialty of the attending physician in this case, and his or her prior experience with ketamine.

    In addition, do the authors feel that ketamine is a superior first choice analgesi...

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  • What if
    Mohammed Hasan Nemat

    What if the patient gave in his history that he went to Nigeria? Would it be mandatory to do all the tests for infectious diseases in Nigeria?. His travel history would give no indication for any further investigation unless we find something relevant clinically. What is always important is to have full history always regardless whether he is undergoing elective surgery or not, he is traveling or not.

    What I wan...

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  • Dengue with bilateral visual loss seen more often since last 10 years mandates eye examination in all cases
    Sunil R Moreker

    The bilateral loss of vision in a case of dengue is very unfortunate and the present case report (1) is very interesting because it has been written quite well and helped in management of a case with bilateral visual loss seen in Mumbai in a case referred to the author for opinion. Dengue causes visual loss due to various reasons ranging from uveitis (2) to optic neuropathy (3)to retinal haemorrhages (4,7), foveolitis (5...

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  • Dengue eye disease more common now?
    Sunil R Moreker

    We read with interest the article by Braithwaite et al. This article has helped us in diagnosis and management of a patient here in Mumbai, India.Dengue Eye Disease has become more common and has been investigated extensively with many diagnostic modalities (1 to 33) and has been suspected to have 10 percent prevalence in some outbreaks of dengue . Dengue could present to an eye surgeon first as subconjunctival haemorrh...

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  • Delay can be costly
    Catherine M. Odelola

    Hopkins et al: Thank you for an interesting article highlighting the importance of exploring and ruling out medical conditions that present with psychotic symptoms. Potentially, there could be near misses and one cannot over emphasize the importance of maintaining high clinical skills in averting this. This article also goes to point that we need to bear in mind that a medical illness can present with symptoms akin to a p...

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    Ramon Puchades

    The article remarks the importance of reviewing the clinical history when the diagnosis or management of the patient is not completely defined, especially in an emergent situation.

    Conflict of Interest:

    None declared

  • Possible reactivation of M. tuberculosis infection?
    David JM Lewis

    The Authors present an interesting case of thoracic spine and lymph node tuberculosis following treatment with BCG for bladder cancer. However, they make the diagnosis of BCG infection (as it should correctly be styled as M. bovis is the parent of BCG) only on the presence of acid fast bacilli in the lymph node biopsy and the temporal association with the previous BCG therapy. However, without either a formal culture and...

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  • spontanious extensive spinal epidural abscess presenting as acute quadriparesis
    arvind ganesh kulkarni

    This patient probably had coagulase negative staphylococcal infection somewhere on his body which probably went unnoticed. We have not been informed about the other investigations carried out for this patient. At least the Blood Cultures should have been sent early in the course of the disease. The extent of the spinal cord compression is rather unusual. Although the immediate decompression is the way of prefered line of...

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