Iodine intake in pregnancy in Ireland — A cause for concern?

Background  

Adequate dietary iodine intake is necessary to maintain maternal thyroid function at a level permitting normal neuropsychological development of the foetus.     

Caffey’s disease: an unusual cause for concern

Background  Caffey’s disease or infantile cortical hyperostosis is a rare cause of irritability, bone pain, soft tissue swelling and fever in the infant. Aims  To review the presentation and diagnosis of an 8-week old infant with focal tenderness of the tibia. Methods  The symptoms, signs, laboratory work-up and radiology are reviewed. Results  The child presented with focal bony tenderness and pyrexia. Laboratory work-up was inconclusive. The diagnosis of Caffey’s disease was made following a skeletal survey to outrule non-accidental injury, which showed similar changes of cortical thickening in the mandible as well as the affected tibia. Conclusions  With our increasing immigrant population, an increasing number of differential diagnoses must be considered when evaluating patients presenting to our emergency rooms. Caffey’s disease is an unusual cause of bone pain in the infant. Symptoms and signs are subtle and the diagnosis is generally made with plain X-rays.     

Nonpalpable intrauterine device threads: Is it a cause for worry?

BackgroundIntrauterine contraceptive device is a popular and effective method of contraception. It can be inserted either as an interval procedure or after abortion or delivery. Threads are attached to the vertical limb so that the user can find out the location of the device. Sometimes the threads are not palpable by the user; this study was conducted to find out the reasons for inability to palpate the threads.Methods and resultsThe retrospective study was conducted over a period of eight years; 110 female patients who complained of inability to feel the threads were included in the study. In most of the cases the device was in the right place. In four cases the device could not be felt on uterine sounding; this could have been due to subendometrial placement of the device. There was no case of perforation by the device.ConclusionInability to feel the threads is a common complaint by the patients who are using intrauterine contraceptive device. In most of the cases the device was in correct position and could be localized by clinical examination. Ultrasonography can help in localization of the device; if used at the time of insertion it can confirm proper insertion and location of the device. This will reassure the client and the health care providers.     

Research, information and consent for the Australian Health Survey: a separate standard for Indigenous people?

In the next Australian Health Survey, Indigenous people under 18 years of age will be excluded from direct clinical measurements and laboratory tests. Indigenous people of all ages were to be excluded from the opportunity, offered to other Australians, to donate blood and urine samples to a national repository. This component has now been abandoned for the whole cohort. This sets perilous precedents of exclusion from opportunities available to all other Australians, and deprives the medical community of information that could inform strategies to improve health profiles and outcomes in this seriously disadvantaged group.     

Can deram be a cause of oral lichen planus?

OBJECTIVE: To study the relationship between oral lichen planus LP and the habit of chewing deram. METHODS: A clinically based controlled observational study including a total of 176 women who used to chew deram and 200 women who never used deram, who consulted the Dermatology Department of Basrah Teaching Hospital, and a private clinic, Barsah, Iraq during the period from February 2005 to July 2007. RESULTS: The study showed that the incidence of oral LP is greater among 176 deram chewers (23.3%) in comparison with 200 women who never use deram (1.5%), particularly among those with frequent (51.2%) and prolonged (65.8%) chewing of deram. Oral lesions, were mostly asymptomatic (80.5%) and predominantly of reticulate pattern (87.9%). Avoidance of deram chewing induced marked or complete improvement of the oral lesions in 56.3% of cases even without treatment within a 3 month follow up period. Pathological examination showed features similar to classical LP. CONCLUSION: Deram chewing should be considered as a possible cause of oral LP, particularly among frequent and prolonged chewers.     

How,and when,can I restrain a patient?

The need to restrain service users will vary according to the area of practice within which practitioners are employed. Many of the principles that relate to the issue of restraining service users are, however, applicable to all, or most, health and social care settings. While the emphasis should be on pre-emptive action, wherever possible, in order to prevent the need to restrain, there are some occasions on which the risks to the service user, or others, of inaction may outweigh those of taking action. Some of the key issues are discussed in this paper.     

What is a doctor, and what does a doctor do?

The Productivity Commission's recent proposal to modify the roles of health professionals raises these important questions.