303 e-Letters

  • Response to eletter
    Aakash Pandita

    Vishal Gupta 1 , Aakash Pandita 2

    1. Neonatology, Max Hospital, New Delhi, India.

    2. SGPGI, Lucknow, U.P, India

    We thank the reader for appreciating our work. The said patient was worked up for ARC syndrome and mutational analysis was done from outside as the primary care center does not have these facilities. The patient got the genetic analysis done from outside laboratory and came with the f...

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  • Arthrogryposis, renal dysfunction and cholestasis (ARC) syndrome: a rare association with high GGT level and absent kidney.
    Paul Gissen

    Dear Sir/Madam This is a potentially interesting report suggesting unusual features such as high GGT and absent kidney present in a clinically diagnosed case of ARC syndrome. Whilst this finding might be of interest to Paediatricians and Neonatologists, the author do not provide any evidence that their diagnosis is factually correct. They write that the VPS33B sequencing was suggestive of a mutation but no report of the...

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  • Bleach is not sodium hydroxide
    William Hoffman

    The article starts as a report of ingestion of sodium hydroxide tablet and all but one reference within it is to sodium hydroxide.

    The single reference to bleach is the reason for my letter. It is not clear to me that anyone would have large tablets of sodium hydroxide (usu prilled pellets are <<1g), and I confess that solid bleach tablets are not an item I have used. I presume such would be to sanitize a...

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  • Analysis of Synthetic Cannabinoids
    Randolph W Lievertz, MD

    Was the substance that this patient was found with sent to an analytic organic chemist to identify the specific chemical moeties present? Synthesis of cannabinoids can result in a product that has radically different pharmacologic properties than the desired compound. The classic example is Ecstacy. Distillation at the wrong temperature, just a few degrees off, results in a total body paralysis drug. In the presented ca...

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  • Re-Shoulder pain in smokers
    Ali Al Kaissi

    Intersting case with missed clinical data. The available photos of the patient showed abnormal craniofacial contour. The head seems long and narrow with a possibility of a compensatory growth might occured in the antero-posterior direction resulted in a scaphocephalic like skull. The bi - temporal narrowing with narrow frontal area, deep-seated eyes, widow peak with dense eye browes and abnormal length of the nose are fe...

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  • Optic nerve involvement in Acute Lymbhobastic Leukaemia , more than what meets the eye
    Sunil R Moreker

    Acute Lymphoblastic Leukaemia can affect the eye in various ways . It may present with an ischaemic optic nerve involvement (1) or optic nerve swelling due to direct involvement . But sometimes it may also present as an optic nerve involvement as an effect of a drug like Linezolid which has been used for treatment of infections which coexist (2) or it may present as an infiltration of the nerve in combination with...

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  • Re:Association is not causation
    Jennifer Thomas

    BMJ approached the authors for their comments, but did not receive a response. This case was reviewed by two external peer reviewers prior to publication. It uses cautious language throughout and correctly offers no definitive conclusions. BMJ Case Reports is not responsible for claims made in other media.

    Conflict of Interest:

    I am the Publishing Executive for BMJ Case Report...

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  • Association is not causation
    Les B Rose

    Zaidi et al conclude that "Dietary supplements, such as curcumin, may be beneficial for some myeloma patients". This is on the basis of their single case report; in other words it is an anecdote. In contrast, the medicinal chemistry of curcumin has been studied in depth for many years. Nelson et al conclude that, despite over 120 clinical trials, no beneficial effect has been observed (1).

    I am wondering about h...

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  • Re:excellent%20paper%2C%20something%20useful%20to%20add%20towards%20a%20full%20comprehension%20of%20this%20case
    Heather Katz

    Thank you for your suggestion to add other risk factors the patient could have had which may have lead to his diagnosis. According to the records, the patient did have exposures to both radiation and petroleum.

    Conflict of Interest:

    None declared

  • LA clot in Severe Mitral stenosis
    Nitin T Patil

    Varying sizes and quality of clots are seen in severe rheaumatic mitral valve stenosis, especially in Asian subcontinent. LA clots are also found in patients with non-valvular atrial fibrillation, but to a lesser extent as compared to rheumatic valvular disesase and are seen more in the advanced world. The clots can be fresh ones or multilayered organised clots or a mixture of the two. In severe mitral stenosis, because...

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