154 e-Letters

published between 2013 and 2016

  • Diagnosis unconfirmed
    Neil Turner

    This could possibly be anti-GBM disease, though bloody diarrhoea isn't a feature of that condition. But there wasn't a renal biopsy to confirm, or specificity tests on the antibody (e.g. Western blotting with it) so evidence is only the ELISA result. Most such assays encounter occasional false positives.

    Conflict of Interest:

    None declared

  • Neurosarcoidosis: Diagnosis towards Clinical Insight
    Wisam AK Yassin

    Dear Sir, We have read your impressive article "Neurosarcoidosis presenting as a large dural mass lesion" published in BMJ Case report on 8 November 2016. I have read about neurosarcoidosis thoroughly because of my previous exposure with few patients who were recovered as per diagnosis and prognosis.

    First, your esteem has mentioned that the biopsy confirmed the diagnosis while the diagnosis of sarcoidosis depe...

    Show More
  • A daily dose of 3,000 IU vitamin D should be safe in a 4-year-old child
    Adrian R Martineau

    The case report from Dr. Boyd and Dr. Moodambail highlights the potential for over-zealous administration of vitamin D to result in toxicity (1). However, we contend that it is very unlikely that the reported daily dose of 3,000 IU (75 micrograms) vitamin D would elevate serum 25-hydroxyvitamin D (25[OH]D) concentrations to over 2000 nmol/L in a 4-year-old child. The US Institute of Medicine specifies a safe Upper Level...

    Show More
  • Optimum management of Femoral Neck Stress Fractures.
    Alexander M. Wood

    We would like to thank Petrin et al for an informative case report[1] on an important injury sustained in athletes and service personnel. We agree that a high degree of suspicion for stress fractures should be maintained as we have previously reported the problems with a missed femoral neck stress fracture[2], and the more literature that is available highlighting these training injuries is useful for medical staff lookin...

    Show More
  • Non-Disclosure of CAM usage: a case of "for every complex problem, there is a solution that is plain, simple and wrong"?
    Sandra L Lucas

    We thank Dr. Boyd and Dr. Moodambail for their recent article in BMJ Case Reports, which describes the case of a four-year old boy with hypercalcaemia and hypervitaminosis D that was possibly attributed to the inappropriate prescribing of nutrient supplements. The case was complicated by the fact that the parent failed to disclose the use of these supplements until several days into the child's admission.


    Show More
  • Re: Trandermal Hyoscine Induced Unilateral Mydriasis
    Sarah C Alexander

    A 4 year old patient with a known diagnosis of a brainstem glioma, ventriculo-peritoneal shunt and ventricular access device was referred to our paediatric district general ward for review following a head injury. She had been knocked over at nursery by her brother on a bicycle and sustained an occipital head injury. Following this, the nursery staff noticed that her pupils were asymmetrical. Mum had collected her from...

    Show More
  • Aspirin unmasking acquired haemophilia A in a patient with prostatic cancer
    Arvind Ganesh Kulkarni

    Malignancy of the prostate is very well known to liberate lots of tissue factors controlling the coagulation process. This patient must have developed some sort of Disseminated intra vascular coagulation which was enhanced by the simultaneous administration of Aspirin. Most of the tests used to diagnose a particular coagulation deficiency have a considerable overlap in clinical setting. To say that this patient has develo...

    Show More
  • Vitamin D
    Anne Thomas

    I think it is irresponsible of this author not to mention that there has indeed been research linking vitamin D to Autism and it is quite reasonable for parents to consider that supplements might improve their child's symptoms. https://www.vitamindcouncil.org/health-conditions/autism/ I have certainly seen in clinical practice a reduction in autistic symptoms in patients over the summer months.

    There is also evi...

    Show More
  • Anisakidosis as an emerging problem
    Roberto Calisti

    A relevant warning, particularly in front of an Anisakis' wide diffusion outside its traditional environment as a consequence of global warming.

    Nowadays, Anisakis is frequently present in anchovies, sardines and mackerels in Northern Mediterranean too, causing infestations after consuming uncooked or half-cooked fish.

    It is very difficult to recognize Anisakidosis if the suspect doesn't arise and th...

    Show More
  • Mouthpiece intermittent positive pressure ventilation: An old yet underutilized technique for long-term management of respiratory muscle failure.
    Royce X. Shou

    Dear Authors,

    We applaud your recognition that daytime mouthpiece intermittent positive pressure ventilation (IPPV) can serve as a practical alternative in cases of end stage respiratory muscle failure in which tracheostomy is usually the eventual conventional intervention of choice among the majority of today's clinicians. Lack of familiarity indeed seems to be the reason open-circuit mouthpiece ventilation, am...

    Show More