The Directorate of Health (Icelandic: Embætti landlæknis) is an Icelandic government agency which principal role is to promote high-quality and safe health care for the people of Iceland, health promotion, and effective disease prevention measures.
Abstract Background/Introduction Exogenous thyrotoxicosis caused by accidental ingestion of thyroid tissue-contaminated meat, historically known as hamburger thyrotoxicosis, is an exceedingly rare cause of hyperthyroidism and presents a distinct diagnostic challenge. Case presentation Two previously healthy, unrelated men aged 27 and 30 years, living in the same household, presented with a three-week history of progressive fatigue and unintentional weight loss. Neither had a personal or family history of thyroid disease nor exposure to thyroid hormone preparations, dietary supplements, or weight-loss medications. Physical examination demonstrated mild-to-moderate thyrotoxic features, including tachycardia and fine tremor, without ophthalmopathy, thyroid tenderness, or goitre. Biochemical evaluation confirmed thyrotoxicosis with suppressed thyroid-stimulating hormone and elevated free thyroxine and free triiodothyronine concentrations. Thyrotropin receptor and thyroid peroxidase antibodies were negative, while thyroid ultrasonography demonstrated a normal thyroid gland without hypervascularity. Serum thyroglobulin concentrations were within the low-normal range, strongly suggesting an exogenous source of thyroid hormone. Radionuclide thyroid uptake imaging was unavailable because of local resource limitations. Considering the simultaneous presentation, shared dietary exposure, and the combination of thyrotoxicosis, negative thyroid autoantibodies, and low-normal thyroglobulin, dietary thyrotoxicosis factitia was diagnosed. Both patients recovered completely with conservative management. Discussion Dietary thyrotoxicosis should be considered in patients with unexplained thyrotoxicosis, particularly when multiple epidemiologically linked individuals present simultaneously. In resource-limited settings, serum thyroglobulin provides a valuable and cost-effective diagnostic surrogate when radionuclide imaging is unavailable. Conclusion Recognition of hamburger thyrotoxicosis is essential to avoid unnecessary treatment with antithyroid drugs or radioactive iodine. Careful clinical history and appropriate biochemical evaluation are critical for establishing the diagnosis.
Abstract Background HIV/AIDS remains a public health concern globally. Comorbidities add to the disease burden among people living with HIV (PLHIV) and may be associated with poorer health-related quality of life. This study aimed to assess the prevalence of comorbidities, health-related quality of life (HRQoL), and associated factors among people living with HIV in Gandaki Province, Nepal. Methods A cross-sectional study was conducted at the antiretroviral therapy (ART) centre of Western Regional Hospital, Pokhara. PLHIV registered at the ART centre were selected using simple random sampling. A multivariable logistic regression model was used to explore factors associated with HRQoL. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results A total of 337 PLHIV participated in the study. The mean overall HRQoL score was 6.25 ± 1.87, and 52.2% of participants reported poor quality of life. At least one comorbidity was present in 28.2% of participants. The most frequently reported comorbidities were hypertension (36.8%), diabetes (33.7%), tuberculosis (14.9%), hepatitis B (10.6%), and hepatitis C (4.3%). PLHIV with comorbidities had higher odds of poor HRQoL compared with those without comorbidities (AOR = 1.65; 95% CI: 0.98–2.78). Factors associated with comorbidities included marital status, family structure, education, occupation, current alcohol consumption, having a migrant worker spouse, CD4 count, transportation costs, perceived behaviour of healthcare workers, and HRQoL across all except the physical domain. Conclusions Comorbidities were common among people living with HIV. The findings suggest a high prevalence of poor quality of life among PLHIV, with comorbidities potentially associated with poorer HRQoL. These findings underscore the need for integrated interventions that address both health and social factors, including community engagement strategies.
Abstract Background Oral health literacy is the capacity of processing and understanding basic oral health information. Instruments are available for its measurement in English and other languages. But no validated tool is available in Nepali language that could be used to assess oral health literacy level of Nepalese population. The objective of this study was to translate and validate the Nepalese version of Oral Health Literacy Instrument (OHLI-N) from the original English version. Methods The English version of OHLI along with oral health knowledge test was translated into Nepali language. The translated version was reviewed and pretested on conveniently selected 30 participants. A cross-sectional study was conducted among conveniently selected 160 adult patients of 18 years and above visiting dental OPD of a tertiary care center for testing validity and reliability of OHLI-N. Oral examination was done to record DMFT and CPI scores. Concurrent validity, construct validity and predictive validity of OHLI-N was determined. Internal consistency of OHLI-N was evaluated using Cronbach’s alpha (α). OHLI-N was readministered in 25 patients after 2 weeks to assess test-retest reliability using intra-class correlation coefficient (ICC). Results The mean overall OHLI-N score of the participants was 65.9 ± 17.6. OHLI-N scores were significantly associated with educational level of participants ( p < 0.001). A significant positive correlation (r s =0.72) was observed between OHLI-N and oral health knowledge test. Moderate and statistically significant negative correlation was seen between OHLI-N and oral outcomes including DMFT score (r s = -0.49), number of untreated caries (r s = -0.48), number of teeth with bleeding on probing (r s = -0.71) and number of teeth with periodontal pocket (r s = -0.49). OHLI-N showed high internal consistency (α = 0.92) and test-retest reliability (ICC = 0.99). Conclusion The OHLI-N showed good validity and reliability for assessing the oral health literacy level of adult patients visiting a tertiary care center of Nepal.
Although low-intensity pulsed ultrasound (LIPUS) has been widely investigated as a non-invasive regenerative therapy, optimization of stimulation parameters for different tissue conditions and fracture severities remains an active area of research. This study presents the design and translational clinical evaluation of a portable low-cost LIPUS platform incorporating adjustable stimulation intensity and duty-cycle modulation for personalized fracture and tendinopathy management. The developed system operated at 1.5 MHz with configurable acoustic intensities ranging from 40–60 mW/cm2 and adaptable duty cycles (1:1–1:4), delivered for 30 min/session. Clinical evaluation included a retrospective controlled fracture cohort comprising 53 patients (31 treated with adjunctive LIPUS and 22 control group) together with an exploratory cohort of 27 patients with chronic tendinopathic disorders. The fracture cohort included recent fractures, delayed unions, and established non-unions. Additional exploratory applications included chronic lateral epicondylitis (n = 12) and Achilles tendinopathy (n = 15). Adjunctive LIPUS treatment was associated with significantly accelerated fracture healing, particularly in recent fractures (1.43 ± 0.59 vs 3.86 ± 2.82 months, p = 0.001). Delayed-union and non-union cases also demonstrated favorable healing outcomes despite increased biological complexity. Kaplan–Meier analysis revealed significantly faster union probability in the LIPUS cohort. In chronic tendinopathy, 92.6
We studied current vaccination policies for health-care personnel (HCP) in 34 European countries. All (34) countries have vaccination policies for hepatitis B, 33 countries for influenza, and 22 countries for COVID-19. Vaccination policies for measles, mumps, rubella, and varicella exist in 28, 23, 24, and 26 countries, respectively, and for tetanus, diphtheria, pertussis, and poliomyelitis in 21, 23, 23, and 15 countries, respectively. Vaccination policies for hepatitis A exist in 20 countries, and for tuberculosis (BCG vaccine), pneumococcus, herpes zoster, and human papillomavirus in 6, 6, 2, and 1 country, respectively. Lastly, 16 countries have vaccination policies for meningococcus B, 4 for meningococcus C, and 19 for meningococci ACWY (quadrivalent vaccine). Sixteen countries mandate particular vaccinations for HCP (mainly against hepatitis B and measles), including nine as a prerequisite for employment. Comparing the current vaccination policies with those we reported in 2018, we found that on several occasions vaccination programs improved and include an average of four more vaccinations. However, in several countries there are gaps in vaccination policies, particularly against measles, mumps, rubella, varicella, and pertussis. Currently, most countries have vaccination recommendations for healthcare students before entering healthcare facilities. In conclusion, European countries have more comprehensive vaccination policies for HCP compared with 2018, however there are still significant differences between countries, in terms of the number of vaccinations, target personnel, and implementation frame (recommended or mandatory vaccinations). Given the resurgence of multiple vaccine-preventable diseases in recent years, evidence-based and harmonized vaccination policies for HCP in Europe are needed to protect HCP and patients and to enhance safety in healthcare facilities.
