121 e-Letters

published between 2014 and 2017

  • Opsoclunus-Myoclonus in dengue may be confused with Febrile Convulsion
    Sunil Moreker
    The present report (1) of dengue shock syndrome raises many important questions.It is estimated that at least 10% of dengue fever cases evolve to severe and eventually lethal forms of the disease and a negative serology does not rule out dengue (2). In such cases one has to rely on early clinical features to prevent complications. One such presentation that emerges is Opsoclonus Myoclonus Syndrome (3)(4) A one year old patient pr...
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  • From Anecdote to Extravagant Extrapolation
    Steven F Bierman

    Masters and colleagues present an instructive case study in the May 16, 2014 issue of BMJ.(1) Unfortunately, it does not teach what they assert: namely, that "midlines should not be used for the administration of drugs which are vesicants and...potentially vesicant in nature...."

    A cancer patient with a history of right-sided DVT secondary to a PICC, undergoes a failed effort to insert a left-sided PICC--due to...

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  • Response to pleuropericardial effusion an unusual presentation of polymyalgia rheumatica
    Enrique E. Valverde

    We have read with attention the case report of Chhabra et al. describing the presentation of pleuropericardial effusion in a case of polymyalgia rheumatica (PMR)1. The authors described a case of an 86-year- old woman with a one-month history of progressive dyspnea, a two-month history of shoulder girdle pain, and significant weight loss. The report ruled out diagnoses of elderly-onset rheumatoid arthritis (EORA), because...

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  • Childhood Polyarteritis Nodosa
    Madhav D. Manikal

    This is a very interesting and unusual case. In the absence of a biopsy-proven diagnosis, and in the absence of Autoantibodies, would Fabry's Disease enter the differential diagnosis ? The skin lesions in Fabry's may not be present initially and usually present later in the disease evolution.

    Conflict of Interest:

    None declared

  • Clinical utility of reverse 'hot cross bun', 'Mercedes-Benz', 'face of the giant panda and her cub' signs with pontine infarcts: a radiological pandora
    Nishant S. Ranawat

    I would like to congratulate the authors on the elaborate description of the MRI findings in their patient. Whereas, these findings are interesting, the more important question is what do they represent and what did the patient have? Neurological injury from myriad disorders, acute and chronic, can leave various intricate traces on the brain parenchyma. All of these can be given elaborate and idiosyncratic names. However...

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  • Low protein C activity does not necessarily indicate protein C deficiency: Timing of the test is important.
    Nay Min Tun
    The patient in the case report had two levels of protein C with values of 60.8% and 64.5%. The first value was apparently unreliable because it was tested during the acute thrombotic episode. The accuracy of the second value is also questionable even though it was tested during heparin bridging. How long heparin bridging was done before the repeat testing was not mentioned in the case report. Ideally, patients should be off warfar...
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  • Regional anesthesia and traumatic extremity fracture - can they safely coexist?
    Matthew A. Warner

    Marappa Ganeshan and colleagues provide an intriguing case of acute compartment syndrome occurring after operative management of distal radius fracture under regional anesthesia with brachial plexus blockade (i.e. axillary block) as an outpatient surgical procedure.1 The patient, though comfortable in the immediate postoperative period, presented to the emergency department approximately 24 hours after discharge with an...

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  • Dengue Eye disease is 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 haemorrhage and ec...
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  • Dysphagia aortica
    arvind ganesh kulkarni

    It is not at all an uncommon presentation of the aortic lesions which most commonly is .due to anurysmal dilatation of the arch or the descending aorta in the elderly patients especially with hypertension. We have seen this type of presenting symptomatology in patients going first to gastroenterologist some times even after upper GI scopy without doing a simple chest Xray. Some times it may even lead to avoidable complica...

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  • Visual Impairment in Ultramarathon Runners
    Tracy B Hoeg

    Drs. Cope and Kropelnicki have presented an interesting case of visual impairment developing during a multiple day ultramarathon which they conclude had resulted from corneal abrasion(1).The runner reportedly described cloudy vision and that the eye was sore and with a sensation as if a foreign body was in his eye. But, it was also noted that the runner "felt no pain or damage to the eye" while running, and examination o...

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