527 e-Letters

published between 2015 and 2018

  • Biased Study and Misrepresentation of Actual Rates of Plagiarism in African Medical Journals

    We write to express our concern about the prevalence estimate of plagiarism in African medical journals in the study reported by Rohwer et al.(1) The authors’ finding that 63% of African medical journal articles are plagiarized to some degree is a gross overestimate.

    The study definitions of “some,” “moderate,” and “extensive” plagiarism are unvalidated and, as the authors admit in the fourth paragraph of their Discussion section, lack inter-rater reliability and precision. Articles were classified as having “some” plagiarism if there were as few as 1-2 sentences that included identical words or sentences in another article by different authors even if the sentences were properly referenced. Numerous publishing organizations, including the Council of Science Editors,(2) the World Association of Medical Editors,(3) and the US Office of Research Integrity,(4) reserve the use of plagiarism for instances when another’s words are used without proper credit or attribution. The authors developed their definition based on suggestions from the Committee on Publication Ethics (COPE), yet even COPE’s Flowchart for managing suspected plagiarism in a submitted manuscript defines plagiarism as “unattributed use of large portions of text and/or data.”(5)

    In fairness to the African journals implicated in the study, we request the authors go back to their data, identify all instances in which identical wording with formal source citations were defined as plagiarism, recalcu...

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  • Decline in neonatal mortality in Northern Ghana: Non-specific effects of BCG vaccination or Improvements in health systems?

    Decline in neonatal mortality in Northern Ghana: Non-specific effects of BCG vaccination or Improvements in health systems?

    In an ecological study carried out in Northern Ghana, Welaga et al., assessed changes in neonatal mortality rates (NMR) and BCG vaccination age from 2002 to 2012. The authors found that among home deliveries, median BCG vaccination age declined from 46 days in 1996 to 4 days in 2012. Within the same period , NMR decreased from 46 to 12 per 1000 live births (1). The authors concluded their study by suggesting that the significant decline in mortality observed may be due to the beneficial non-specific effects of early BCG vaccination. The authors should be commended for studying whether BCG vaccination may have non-specific effects. However, several issues need to be raised when interpreting these results.
    1) Adjustment for other vaccine effects
    The authors did not expand on the potential role that improvements on the Expanded Programme on Immunization (EPI) in Ghana may have played in reducing neonatal mortality. Diarrhea and Pneumonia are the main causes of neonatal mortality. Although still sub-optimal, Rotac and PCV3 immunization coverage estimates for Ghana in 2012 were significantly better than in 1996 or 2002 (2). A similar trend was observed for almost all the vaccines in the EPI schedule. For example, UNICEF immunization coverage estimates for Ghana indicate that DTP3 vaccine coverage increased from 71 % in 1996 to 92 %...

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  • In-hospital dementia deaths

    Dear Sirs,

    My research has detected curious patterns of on/off switching in international deaths. Basically, deaths run at a baseline level and then suddenly switch-on to a new and higher level for around 12 to 18 months after which they switch-off and revert back to the baseline. They stay at baseline until the next switch-on event. Deaths in person's with Alzheimer's and other dementias seem highly sensitive to the switch-on events. This curious behaviour is most readily revealed using a rolling (running or moving) 12-month total or average.

    In England, in-hospital deaths show the same on/off-switching.

    Should you have access to monthly data it may be useful if you could apply such a rolling 12-month analysis of the data.

    You can access a list of publications relating to this research at http://www.hcaf.biz/2010/Publications_Full.pdf

    I have proposed that this behaviour may reflect some new type or kind of disease outbreak, however, this is open to further research.

    I hope this response is helpful.

  • Brain damage and chronic kidney disease may be caused by exposure to toxic chemicals

    There is much evidence that exposure to various chemicals, such as lead, chromium, tin, mercury, welding fumes, silicon and in particular organic solvents, may cause both brain damage1-3 and chronic kidney disease,4-7 including diabetic kidney disease.8 Therefore, I suggest that the authors, assisted by occupational hygienists, investigate whether their patients are exposed to such chemicals.

    1. Edling C, Ekberg K, Ahlborg G Jr et al. Long-term follow up of workers exposed to solvents. Br J Ind Med 1990;47:75-82.
    2. Kukull WA, Larson EB, Bowen JD et al. Solvent exposure as a risk factor for Alzheimer's disease: a case-control study. Am J Epidemiol. 1995;141:1059-71.
    3. Yamanouchi N, Okada S, Kodama K, Sato T. Central nervous system impairment caused by chronic solvent abuse-a review of Japanese studies on the clinical and neuroimaging aspects. Addict Biol. 1998;3:15-27. doi: 10.1080/13556219872317.
    4. Zimmerman SW, Groehler K, Beirne GJ. Hydrocarbon exposure and chronic glomerulonephritis. Lancet. 1975;2(7927):199–201.
    5. Ravnskov U, Lundström S, Nordén Å. Hydrocarbon exposure and glomeru-lonephritis: evidence from patients’ oc¬cupation. Lancet. 1983;2(8361): 1214–6.
    6. Nuyts GD, Van Vlem E, Thys J et al. New occupational risk factors for chronic renal failure. Lancet 1995;346(8966):7–11
    7. Ravnskov U. Hydrocarbons may worsen renal function in glomerulonephritis: a meta-analysis of the case-control studies. A...

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  • Results?

    Where can I find the results to this study? email me either the results or the article please

  • From conclusion to action

    Dear Editor,

    This paper highlights the reasons behind high stillbirth in India. The authors have underlined the importance of recording stillbirths to know the reasons why. Now the need is to translate the conclusions of this study into actions. Immediate action is needed to incorporate the reasons highlighted in this study into modules recently published by National Health Mission like, Induction Training Module for ASHAs in Urban Areas and Guidebook for Enhancing Performance of Auxiliary Nurse Midwife (ANM) in Urban Areas, March 2017. Both of these key modules don't focus on stillbirth and its reasons beautifully highlighted in this study. Translating knowledge into action is the first step in controlling the problem in question and this needs to be done at the earliest opportunity to have safe outcome of pregnancy.

  • Improving the specificity of Suspicion of Sepsis

    We know that coding of sepsis is poor.

    This absence of reliable data makes it hard to compare approaches over time and between locations.

    The SoS paper basically lists a lot of codes that the authors associated with infection.

    The authors identified 267 codes indicating possible infection.

    There were 47475 cases with these codes as a primary diagnosis, with 3440 associated deaths.

    We felt that several of these reflected conditions that were not primarily infective in nature

    (or at least in which antibiotics would not be a main component of acute management)

    We removed the most common of these.

    11. N12.X - Tubulo-interstitial nephritis, not specified as acute or chronic

    13. J69.0 - Pneumonitis due to food and vomit

    54. N10.X - Acute tubulo-interstitial nephritis

    62. J84.9 - Interstitial pulmonary disease, unspecified

    73. N71.9 - Inflammatory disease of uterus, unspecified

    86. K57.1 - Diverticular disease of small intestine without perforation or abscess

    90. N48.1 - Balanoposthitis

    99. N48.2 - Other inflammatory disorders of penis

    130. J69.8 - Pneumonitis due to other solids and liquids

    The remaining 258 codes had 45521 cases with 3163 associated deaths.

    95% of cases are captured using the first 76 diagnostic codes.

    We felt that many of the cases reflected infections that...

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  • Professor

    Comments on Patel et al., Maternal anaemia and underweight as determinants of pregnancy outcomes: cohortstudy in eastern rural Maharashtra, India. BMJ Open. 2018 Aug 8;8(8):e021623. doi: 10.1136/bmjopen-2018-021623
    Dear Sir I have read your above article with great interest and I have to congratulate you on this work.
    You investigated an important topic “Anaemia” and its maternal and perinatal outcomes.
    As you have mentioned that anaemia is common health problem and it can lead to adverse pregnancy outcomes. I think unlike the other maternal and perinatal outcomes, there are few publish data on association between anemia and cesarean section.1,2
    You have mentioned that “The risks of CS and pregnancy-related complications during delivery were significantly higher in non-anaemic women versus anaemic women for both data sets (page 4 the first line in Study outcomes: regression.
    These points have also been shown in table 2 in which 20.85%, 23.8% and 29.8% of women with moderate/severe, mild anaemia and non-anaemic women, respectively have cesarean section.
    Lower down in table 3 A it have been mentioned that women with severe /moderate anaemia and women with mild anaemia have lower risk of cesarean section (OR= 0.89, 95% CI=(0.84 to 0.95) and OR= 0.91, 95% CI=(0.86 to 0.97), respectively.
    I think the reverse might result if you combined both types of anemia severe/moderate and mild together (20.85%+ 23.8%= 44.65%). Then your result wo...

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  • Trends in the socioeconomic patterning of overweight/obesity in India: a repeated cross-sectional study using nationally representative data

    1. From this study, the Authors had the aim to examine trends in prevalence of overweight/obesity among adults in India by socioeconomic position (SEP) between 1998 and 2016 but the data that they collected the range was not the same for example they collected the data 1998/1999, 6 years later 2005/2006, then 9 years later 2015/2016. The data from women they collected start from 1998 and for men start from 2005. From this data, maybe many of researchers will ask about this, it is not clear to describe about the prevalence, around 6 or 9 years it had uniqe graphic that we cannot see from this research.

    2. BMI is commonly used by the researcher to classify overweight and obesity in adults. Whereas, BMI is not good enough to describe about nutritional status because BMI does not measure about fat, based on World Health Organization (WHO) Expert Consultation in 2002 to review and assess the issues related to whether population-specific BMI cut-off points are needed in Asian populations. Overweight and obesity are not the same, they have different cut-off. As the Authors mentioned for the overweight the cut-off ≥24,99 kg/m2. Maybe we can distinguish between overweight (≥24,99 kg/m2) and obesity (≥30,00 kg/m2) to see the different of prevalence both of them like the research that Sánchez-Cruz (2018) and Muttarak, Raya (2018) were undertaken from their research. So, Policy makers can know how many adults got overweight and obesity, and this result to be more informative a...

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  • Diagnosing IDNA

    Iron Deficiency is the most common mineral deficiency worldwide and this review highlights important aspects for clinical care. Firstly and foremost is the astonishing lack of research (and recognition) for a condition that affects 10-15% of all people at any one point in time and a top 10 global cause for years living with disability. Second and pertinant to this specific review is how clinicains should diagnose iron deficiency. The 18 clinical trials listed used the definition of Iron Deficiency used was as a low serum ferritin, which varied from less than 50 to less than 15ug/L. The WHO defines Iron Deficiency as a serum Ferritin < 15ug/L. In athletes the repeated stress of exercise creates inflamation that in turn activates the iron regulation protein, Hepcidin that reduces iron bioavailibility causing a functional iron deficiency. In this setting, Transferrin Saturations (%) may be a more accurate indicator of Iron Deficiency. In the the four studies using Ferritin < 16, Transferrin Saturations averaged over 20% in three, i.e. the majority of individuals may have had potential normal iron. Finally, and along the same theme, in the presence of exercise induced / functional iron defiency oral the effect of oral iron is limited so it is not suprising that iron tablets failed to have an effect. Moving forwards, there is a need to better identify and define Iron Deficiency in the 'healthy' female and further studies with appropriate interventions are need...

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