121 e-Letters

published between 2014 and 2017

  • Biotin-Thiamine-Responsive Basal Ganglia Disease Can mimic Acute Disseminated Encephalomyelitis
    Katharine M Forrest

    I read this article with interest as we too made a diagnosis of post-streptococcal acute disseminated encephalomyelitis with basal ganglia swelling in a female aged 11, who had presented with altered conscious level and dystonia, with similar distribution of basal ganglia lesions on MR brain imaging. However, a diagnosis of Biotin-Thiamine-Responsive Basal Ganglia Disease was considered, and homozygous SLC19A3 mutation was conf...

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  • Are EBV- associated acute acalculous cholecystitis and EBV-associated cholestatic hepatitis with reactive gall bladder wall thickening synonymous?
    Varun Kapur

    Dear Editor, We read with interest, the case report written by Dr. Magdalani et al., "Acute Acalculous cholecystitis in a Lebanese girl with primary Epstein- Barr viral infection" in the British Medical Journal Case Reports published on 18 April, 2016.

    The authors describe a case of a previously healthy, 16 year old girl, who presented with history of 10 day fever, sore throat, and upper abdominal pain. She app...

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  • BESS ( benign enlargement of subara chnoid spaces)
    mahesh masand

    The authors rightly mention in their case report that it is not an uncommon finding in normal infants who are referred to the paediatrician because of large head size or a rapid increase in OFC. My concern is that the patient 1 in the case report may send a wrong message to the trainees or other doctors that CT head is the primary mode of imaging in such cases because of high dose of radiation involved with a CT. Most of...

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  • Oscillicoccinum has no benefit for influenza - it's inactive
    Paul Morgan

    The authors make a claim that the patient developed angioedema following ingestion of oscillococcinum, a homeopathic "remedy" used for treating influenza symptoms. The authors claim that evidence of benefit exists to claim that this preparation has proven clinical activity. Unfortunately, they omit to use up-to-date information to base this claim on. The most recent Cochrane review (1), published January 2015 and author...

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  • Not all ST - T & QRS complex changes are myocardial injury.

    I completely agree with the authors in saying that all ST-T changes are not myocardial injury.

    In my experience, not all new widened QRS complex changes (LBBB) indicate myocardial infarction or injury.

    I would like to say this on the basis that quite a few times, a patient with new wide QRS complex and bradycardia is referred to cardiology to rule out myocardial infarction and after investigations pa...

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  • NG tube insertion - to be taken seriously
    Nitin T Patl

    Insertion of the nasogastric tube is taken very casually at the medical graduate level.

    In my opinion , insertion of NG tubes should be done very judiciously and gently in an awake patient.

    Points to note --

    1) Insert the tube very gently in the backwards and downward direction in the nostril, to avoid inadvertent damage of the roof of the nasal cavity, and passage of the tube intracranial....

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  • Preprocedure/pre tracheostomy USG-- is it beneficial /conclusive.
    Nitin T Patil

    I agree with the concept of a pre-tracheostomy USG to visualize the neck veins in case of a percutaneous tracheostomy.

    But I have to 2 points against --

    1) I believe percutaneous tracheostomy is still not a routine method of choice in elective tracheostomy in difficult surgical scenario like - short neck, restricted extension, double chin, big pad of neck fat and especially if patient is sick, as the...

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  • Chloroquine induced bilateral anterior shoulder dislocation: a unique etiology for a rare clinical problem
    Arvind Ganesh Kulkarni

    It is an interesting hypothesis to put forward. The bilateral dislocation of shoulder simultaneously is not very common especially if there has been no episodes of tonic clonic convulsions. However it is very difficult to associate this with the administration of Chloroquine is far fletched and in fact could be incidental. The mechanism of action of Chloroquine in the management of the basic disease does not indicate any...

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  • concurrent cryptococcal meningitis and disseminated tuberculosis occuring in an immunocompetent male
    Arvind Ganesh Kulkarni

    Cryptococcal meningitis used to be quite common in immunocompromised patients, like those with HIV, before the availability of effective HRT for the same. We have seen and managed quite a number of such patients in the last decade of the last century. The prognosis used to be universally poor for these patients. Similarly, we came across disseminated cryptococcosis in immunocompetent patients as well. Some of them had tub...

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  • Uncommon mycosis in a patient with diabetes
    Arvind Ganesh Kulkarni

    Disseminated cryptococcal infection in immunocompromised patients, such as those with HIV, used to be quite common. We have seen and reported a series of patients with cryptococcal meningitis and HIV in the late nineties of the last century, before the availability of effective HRT. The prognosis used to be universally poor. Some of our patients were likely to be immunocompetant since they did not have HIV. These patients...

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