589 e-Letters

published between 2017 and 2020

  • A Different Perspective

    To the Editors,

    I have read your article, “So near yet so far: why won’t the UK prescribe medical cannabis?”, and I found it rather informative as well as intriguing. I am from The Bahamas and we, too, have yet to legalize cannabis for medicinal use. I am writing this letter to give my perspective on the legalization of cannabis for medicinal as a nursing student, from a country that still holds the ways in which first world countries do things, very closely.

    Personally, I am in favor of the legalization of cannabis for medicinal as well as recreational use. There have been recent talks in our country by the Prime Minister about the legalization of the hemp industry for economic benefits. In a national address by Prime Minister Minnis (2020), he called the laws about cannabis “outdated” and stated that “there are potentially many opportunities for creative Bahamian businesspeople to get involved in this new industry”. With the Prime Minister speaking publicly about this topic, it gives the country hope that legalization may occur in the future.

    I mentioned being in favor of the legalization of cannabis got recreational use as well because, as a future nurse, it is my duty to be culturally aware. In March, it was reported by Jones (2020) that the Rastafarian Royal Ambassador Priest, Rithmond McKinney, expressed that “the Rastafarian man was being oppressed and being victimized over the years; and stereotyped over the years for the use of cannabis, a...

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  • Letter to the Editor for Understanding lying drivers of obesity in Africa: a scoping review protocol

    The choice of analyzing before submitting was necessary and is considered an acceptable decision when it comes to what was discussed to confirm the validity of the research. The main points of the article are based on obesity causes, specifically, sedentary lifestyle, urbanization, and overconsumption of calorie-dense processed foods. These factors point to the need for more education to the public about the dangers of obesity as well as the possible complications that are associated with obesity. The encouragement of additional programs is also necessary in order to encourage individuals who live more sedentary lifestyles to become more physically active in their day to day lives. Education on proper dietary habits needs to be discussed and pushed in the public as well as taught in schools. Medical professionals need to educate those patients who are at risk, on proper dietary habits. In the study, there was no mention of factors such as the effects of internal diseases and disorders which lead to obesity, such as polycystic ovary syndrome or Cushing's disease. Other factors that were not discussed in the article were those such as stress and lack of sleep. Including data relating to the underrepresented factors that contribute to obesity would have been appreciated because the factors that were discussed are commonly known.

  • RE: Copattern of depression and alcohol use in medical care patients: cross-sectional study in Germany

    Dear Editor:

    This response is in regard to the above article which was recently published on May 6th, 2020. This article offers a profound and thorough explanation of the intent of the authors as it related to their study. I found reading this article very absorbing and informative. Upon reading the article, I recognized and understood the relationship between depression and alcohol use and how they both correlate. Undoubtedly, alcohol can induce or worsen depression and vice versa, therefore, I was highly interested in the results of the study. Depression and alcohol use are increasingly prevalent in today’s society, therefore, seeking to understand the link between consumption of alcohol and depression is of utmost importance. Finding and addressing the link between both variables can help to develop effective interventions.

    I agree with the authors of the study that there is a link between alcohol consumption and depression and the results of their study revealed that the severity of depressive symptoms and the occurrence of severe depression is substantially anticipated by both alcohol use measures after sociodemographic and health behavior control. Researchers like Boden & Ferguson (2011) ascertained similar findings, outlining the possible linkage between the two, relating it to genetic and/or metabolic factors. Sullivan et al. (2005) found that patients with depression normally have an alcohol abuse problem as well and therefore also found a li...

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  • The TOSYMA RCT: Increasing the study sample size to assess the effect of DBT on interval cancer rates in mammography screening

    Walter Heindel 1, Stefanie Weigel 1, Laura Kerschke 2, Karin Spieker 3, Hans-Werner Hense 4, Joachim Gerss 2

    1 Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany.
    2 Institute of Biostatistics and Clinical Research, IBKF, University of Münster, Münster, Germany.
    3 Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany.
    4 Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.

    Correspondence to Prof. Walter Heindel; heindel@uni-muenster.de

    The first primary objective of the TOSYMA trial (ClinicalTrials.gov Identifier NCT03377036; https://clinicaltrials.gov/ct2/show/NCT03377036) is to investigate the hypothesis that digital breast tomosynthesis plus synthesized 2D mammograms (DBT+s2D) leads to a clinically relevant increase in the detection rate of screen-detected invasive cancers compared with standard 2D full-field digital mammography (2D-FFDM) (1).
    The expected increase in cancer detection by the novel technique, however, needs to be balanced against the potential for overdiagnosis. The 24-months cumulative incidence of invasive interval cancers in screen-negative women is therefore defined as a second primary endpoint in the study protocol (1): higher invasive cancer detection r...

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  • Letter to the Editor- Socio ethnic disparities in Severe Maternal Morbidity in Western Australia

    The topic of socioeconomic status and morbidity is a dreary situation. It was discussed that discrimination in addition to socioeconomic status contributed greatly to the high severe maternal morbidity (SMM) of Aboriginal women. This knowledge is unfortunate and points to a greater need for compassion and acceptance of different cultures. Fear of discrimination is notoriously known to negatively impact the chances of persons seeking healthcare for diseases such as HIV. Regarding prenatal care, this can indicate greater needs for ethical reviews of deontology and ethics of care for healthcare workers in Western Australia. Other potential pathways that can reduce SMM in ethnic minorities include educating minority groups about importance of prenatal care and perhaps clinic or clinical days that are dedicated to minority groups such as the Aboriginals and African women could also help in lessening fears of discrimination. This study provides a useful statistical foundation that the Western Australian government and healthcare system can use to proactively target SMM susceptible ethnic groups.
    This is the type of study that should be done throughout the Caribbean to find out what are the rates of severe maternal morbidity between socioeconomic classes and minorities. In Caribbean countries, minorities face similar dilemmas and fear seeking prenatal care and screening because of possible discrimination as well as language barriers.

  • Ambient air pollution and incidence of colorectal cancer

    Ma et al. investigated the effect of exposure to ambient particulate matter with aerodynamic diameters ≤2.5 μm (PM2.5) on the incidence of colorectal cancer (CRC) among a diabetic population (1). The ratio of 1:4 case-control setting was adopted. There was a dose-response relationship between the CRC risks and PM2.5 concentration, and the adjusted odds ratio (OR) (95% confidence interval [CI]) of each 10 µg/m3 increment of PM2.5 for CRC incidence was 1.08 (1.04-1.11). Furthermore, diabetic complication was also significantly related to colorectal cancer, presenting adjusted OR (95% CI) of 1.28 (1.18-1.38). I have a query about their study regarding the causal mechanism.

    Feng et al. reviewed the impact of air pollution on the gastrointestinal (GI) system (2). After exposure to PM, PM moved from the lungs to the GI tract via muco-ciliary clearance. They speculated the potential mechanism underlying air pollution-mediated intestinal pathology via intestinal redox lipidome and microbiome, which might be enhanced by disturbed glucose metabolism (3). Although a direct association between air pollution and colorectal cancer cannot be clearly explained, Ma et al. could find clear positive association between ambient PM2.5 and the incidence of CRC in patients with diabetes mellitus (1). Further studies are required to verify the association between air pollution and CRC.

    1. Ma JW, Lai TJ, Hu SY, et al. Effect of ambient air pollution on the incidence...

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  • The Need of Medical Cannabis

    This response is a written reflection on the article “So near yet so far: why won’t the UK prescribe medical cannabis?" by Nutt D, Bazire S, Phillips LD, et al . Published on the 8th of July 2020. Upon careful discretion of this article, I can say that it is extensively informative in reference to the importance of medical cannabis and, the issues faced in the UK pertaining to the access of said medication. It was a very interesting read and a timely article in itself. Based on the information you provided stating that in a year a minuscule amount of NHS prescriptions where issued and less than 100 to private providers. One can perceive that even though medicinal cannabis is legalized it is not being prioritized, maybe to retain a level of control.
    Further on it is stated that, “statements such as insufficient evidence of efficacy or it is too dangerous are common and used even in the face of personal evidence of patients CBPMs work and, in many cases can be life changing and tolerated.” because of the high level in which cannabis use is stigmatize, many refuse to receive positive information in relation to medicinal cannabis, hence I do agree with the point the article is trying to make. This positive information is refused by many, simply because of the lack of knowledge in relation to medicinal marijuana having little to no THC whereas recreational cannabises has high levels of THC resulting in a lot of negative side effects. In another article by Kev...

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  • Letter to the Editor for , “Accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement: a study protocol for a prospective study,” by Rigobello et al.

    Dear Editors,
    This letter is in relation to your article, “Accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement: a study protocol for a prospective study,” by Rigobello et al. on September 30th, 2020. First, I would like to express my gratitude to the authors for publishing this study because it utilizes two common methods used at the bedside for nasogastric tube insertion in order to determine the accuracy and direct cost of each method. This article immediately piqued my interest because it is important to the patient in that it is concerned with reducing the adverse reactions and risks of incorrect nasogastric tube placement. This is important because it can prevent aspiration. As a nursing student, it is crucial to know the most accurate method to confirm the correct placement of a gastric tube as this is very important to prevent aspiration.
    The article mentions the method of insertion protocol in which it is measured from: “the top of the nose to the earlobe and from the earlobe to the xiphoid appendix (NEX method)” (Rigobello et al., 2020). In the Bahamas, like many other places, we utilize this method and I have practiced this procedure in the laboratory. This a common method for many countries, although it can be argued that it is not the safest. It was also stated that a pH value lower than 6 confirms correct gastric positioning and excludes possible displacement of the tube i...

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  • RE: Alcohol use and alcohol-related harm in rural and remote communities: protocol for a scoping review

    Dear Editor:

    This article which was recently published on August 16th, 2020 offers a profound and thorough explanation of the intent of the authors as it relates to their impending study. What is most significant about this particular research is that it is a first of its kind and resultantly can set the standard for how similar future studies are conducted. Alcohol-related incidents are one of the leading causes of death and injury around the world, therefore seeking to understand the link between frequency of consumption and geographical location is of utmost importance. This stance is supported by Rehm et al (2009) in the article Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. As the authors acknowledged, ascertaining this information can prove crucial to guiding actions that should be taken to mitigate this dreadful impact.

    The authors, Erik Loewen Friesen and Paul Kurdyak opted for a scoping rather than systematic review and this seemed most appropriate for the subject matter. By undertaking a broad and unrestrictive approach in their methodology, they are best able to highlight potential deficits in the literature that can answer the research question. Perhaps through studies of this nature, researchers can make a direct link between where persons live and the likelihood of their being prone to alcohol-related mishaps and heavy usage. In that sense, location can be considered just as grand...

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  • Re: The effect of statins on average survival in randomized trials, an analysis of end point postponement

    Dear Editor:
    This response is in relation to your article. I found this article useful in many different ways for example, the number needed to treat (NNT) systems. I also gained the knowledge of primary and secondary prevention trials. What amazed me though was that the number were so small being that the “highest value was 27 days according to the 4S study.
    While I understand that patients have the right to refuse treatment, I did not expect 70% of individuals to decline. It was good to note that although the survival time was only implemented during the running time of the study, a few follow up trials were done, regardless of the mortality rate discovered. Although, according to Benner et al., (2002), “despite slightly better persistence among patients who began treatment in recent years, long-term use remains low”, the efforts made to research this drug is amazing. The idea of a hybrid model of classical NNT thinking along with a postponement model sounds interesting and effective.
    The focus of your study including all-cause mortality was an unbiased study. What grasped my attention the most was that you realized your mistake, admitted your mistake, made corrections, and apologized for the inconvenienced caused. Thanks for indicating that statins are inexpensive when used in the clinical settings and I agree that if the patient has intolerance or unpleased side effects from statins, it should not be forced upon them. The use of postp...

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