2 e-Letters

published between 2017 and 2020

  • Yes, an important place for depot triamcinolone in hay fever!

    We commend the author’s endeavours to present an unbiased review concerning depot triamcinolone. However, this review cannot be judged a total success; there are numerous flaws that cry out to be corrected. The most important issue is the excessive focus on potential side effects, that are generally regarded as of minor significance.
    We understand that this is a somewhat lengthy comment, but since the journal states that ‘critique and disagreement are important features of science’, we hope that we are allowed to express our opinion in order to be able to promote further debate.

    The title, negatively framed, states ‘Still no place for depot triamcinolone in hay fever?’ and we get the feeling that the author already skipped the question mark and directly continued with the key learning point that ‘in 1999, Drug and Therapeutics Bulletin (DTB) noted that despite the likelihood that a single injection of triamcinolone will relieve hay fever symptoms, there was uncertainty about the efficacy and safety of repeated administration’.1
    This notion is too easily repeated in the current conclusion. The first part of the first sentence of the conclusion section informs us again that a single injection of triamcinolone has likelihood that it will relieve hay fever symptoms. The fact that it probably causes symptom reduction should be enough reason to explore the possible indications for this therapy.
    Therefore, the only logical conclusion should have been that...

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  • Mucopleurastasis: A description of the phenomena of patients reporting the symptom of being ‘caught in the chest’.

    Medicine has a long history of having its own technical and discriptive language.

    This has often developed from observations of medical phenomena being explored and cataloged scientifically, presented in a way that is descriptive and useful for clinicians.

    Ireland is a country defined by it literature. It is famous for its coloquial language and linguistic idiosyncrasities. From Joycian ‘chamber music’ to Wildes’ wit and Irish idioms like ‘being away with the fairies’, it is clear that we more than most have our own way with words.

    This is not disimilar to many parts of the world where dialects have evolved to better represent the cultural nuiances of the given area. In many ways language evolves out of a need to communicate amongst each other.

    In Ireland, specifically the geographically isolated West coast, many patients present to their family doctor reporting that they are ‘caught in the chest’. For some, particularly as you move away from the West and certainly out of Ireland, this may seem an unusual symptom or at least an unusual turn of phrase, but for a GP from the West of Ireland, this presentation occurs at least several times a day and more frequently during the winter months.

    So what exactly is the message that these patients are trying to convey and why indeed is it such a common presentation?

    This description of the sensation they are experiencing generally refers to patients with respiratory tract type infections. M...

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