The article discusses several medical topics and includes responses from various authors: 1. **Neutrophil Leukocytosis in Infectious Mononucleosis**: James McSherry argues that the presence of neutrophil leucocytosis is not a reliable indicator of acute bacterial infection in patients with infectious mononucleosis, especially when the prevalence of the condition is high. This has implications for healthcare providers treating young populations. 2. **Rational Therapy and Poststreptococcal Diseases**: McSherry questions the role of irrational therapy in the reduction of poststreptococcal glomerulonephritis and rheumatic fever, suggesting that the widespread use of antibiotics may have contributed to the virtual disappearance of these diseases. 3. **Chronic Inflammatory Bowel Disease in Childhood**: D H Shmerling suggests that a more comprehensive approach to diagnostic investigations is needed for chronic inflammatory bowel disease in children. He recommends including detailed radiographic follow-up of the small bowel and colonoscopy with biopsies as integral parts of the diagnostic process. 4. **Community Care vs. Hospital Outpatient Care for Hypertensive Patients**: Rupert Jones questions the conclusions of a study comparing community versus hospital outpatient management of mild-to-moderate hypertension. He argues that the small difference in blood pressure between the two groups may not be significant in terms of reducing cardiovascular complications and that hospital management was associated with a higher incidence of cardiovascular events. 5. **Paracetamol-Induced Acute Renal Failure**: A L Harris shares a case of a 21-year-old woman who experienced paracetamol-induced acute renal failure but received early treatment with cysteamine, resulting in a milder clinical course. He suggests that early treatment may be beneficial. 6. **Sexually Transmitted Disease Surveillance**: C B S Schofield raises concerns about the accuracy of a statement in a note on sexually transmitted disease surveillance. He notes that the 5% treatment failure rate quoted is inconsistent with recent findings and requests clarification on the evidence supporting this figure. The authors of the original note acknowledge the error and provide updated information. Overall, the article highlights the importance of careful and evidence-based medical practices and encourages further research and discussion in various medical fields.The article discusses several medical topics and includes responses from various authors: 1. **Neutrophil Leukocytosis in Infectious Mononucleosis**: James McSherry argues that the presence of neutrophil leucocytosis is not a reliable indicator of acute bacterial infection in patients with infectious mononucleosis, especially when the prevalence of the condition is high. This has implications for healthcare providers treating young populations. 2. **Rational Therapy and Poststreptococcal Diseases**: McSherry questions the role of irrational therapy in the reduction of poststreptococcal glomerulonephritis and rheumatic fever, suggesting that the widespread use of antibiotics may have contributed to the virtual disappearance of these diseases. 3. **Chronic Inflammatory Bowel Disease in Childhood**: D H Shmerling suggests that a more comprehensive approach to diagnostic investigations is needed for chronic inflammatory bowel disease in children. He recommends including detailed radiographic follow-up of the small bowel and colonoscopy with biopsies as integral parts of the diagnostic process. 4. **Community Care vs. Hospital Outpatient Care for Hypertensive Patients**: Rupert Jones questions the conclusions of a study comparing community versus hospital outpatient management of mild-to-moderate hypertension. He argues that the small difference in blood pressure between the two groups may not be significant in terms of reducing cardiovascular complications and that hospital management was associated with a higher incidence of cardiovascular events. 5. **Paracetamol-Induced Acute Renal Failure**: A L Harris shares a case of a 21-year-old woman who experienced paracetamol-induced acute renal failure but received early treatment with cysteamine, resulting in a milder clinical course. He suggests that early treatment may be beneficial. 6. **Sexually Transmitted Disease Surveillance**: C B S Schofield raises concerns about the accuracy of a statement in a note on sexually transmitted disease surveillance. He notes that the 5% treatment failure rate quoted is inconsistent with recent findings and requests clarification on the evidence supporting this figure. The authors of the original note acknowledge the error and provide updated information. Overall, the article highlights the importance of careful and evidence-based medical practices and encourages further research and discussion in various medical fields.