Iodine is crucial for thyroid hormone synthesis and fetal neurodevelopment. Major dietary sources of iodine in the United States are dairy products and iodized salt. Potential consequences of iodine deficiency are goiter, hypothyroidism, cretinism, and impaired cognitive development. Although iodine status in the United States is considered sufficient at the population level, intake varies widely across the population, and the percentage of women of childbearing age with iodine deficiency is increasing. Physicians should be aware of the risks of iodine deficiency and the indications for iodine supplementation, especially in women who are pregnant or lactating.
Inaccuracy of glucose monitoring may derive from test strip, patient, pharmacological, environmental, and other factors. Incorrect results may cause serious harm and change clinical decisions. 2,3 To ensure reliable results, POC devices and test strips should be stored and operated according to manufacturer specifications. In tropical settings, temperature and relative humidity may exceed specified ranges.Our goal was to assess the effects of storage temperature, operating temperature, and operating relative humidity (RH) when ambient conditions in patient ward areas naturally exceeded manufacturer limits because of the tropical setting of Siriraj Hospital. During ISO 22870 4,5 certification inspection, we discovered out-of-limit temperature and RH discrepancies that had to be investigated and corrected. Methods Glucose Meters and Test StripsWe evaluated the photometric SureStep®Flexx meter, SureStep™ Hospital glucose test strips, and control solutions Background: Hospitals in tropical countries experience conditions that exceed manufacturer temperature and humidity limits for point-of-care (POC) glucose reagents. Our goal was to assess the effects of out-of-limits storage temperature, operating temperature, and operating humidity on POC glucose measurement reliability.Methods: Quality control measurements were performed monthly using glucose test strips stored under controlled conditions and in inpatient wards under ambient conditions. Glucose test strips were evaluated in groups organized by operating temperatures of 24-25 (group 1), 28-29 (group 2), and 33-34°C (group 3), and relative humidity (RH) of ≤70 (group A), ~80 (group B), and ~90% (group C). Results:Glucose results for different storage conditions were inconsistent. Measurements at higher operating temperatures had lower values with mean differences of -2.4 (P < .001) and -36.5 (P < .001) mg/dL (28-29 vs 24-25°C), and -3.6 (P < .001) and -37.4 (P < .001) mg/dL (33-34 vs 24-25°C) for low and high control levels, respectively. Measurements at higher RH had lower values with mean differences of -4.0 (P < .001) and -13.2 (P < .001) mg/dL (~80 vs ≤70% RH), and -5.8 (P < .001) and -16.6 (P < .001) mg/dL (~90 vs ≤70% RH) for low and high levels, respectively. Conclusions:High temperature and high RH decreased glucose concentrations for the POC oxidase-based system we evaluated. We recommend that individual hospitals perform stress testing, then determine if maximum absolute differences, which represent highest risk for patients, are clinically significant for decision making by using error grid analysis.
Idiopathic retroperitoneal fibrosis is a rare fibro-inflammatory disease that can be associated with other IgG4-related diseases (IgG4-RDs). It is exceedingly uncommon to encounter this condition in a patient with Riedel's thyroiditis (RT), another disease in the IgG4-RD family. We present the case of a 53-year-old man with a history of RT who presented for severe localized lower abdominal and suprapubic pain due to obstructive uropathy from extensive retroperitoneal fibrosis. The biopsy of the mass demonstrated fibroinflammatory tissue, and its immunohistochemistry was notable for IgG4-positive plasma cells. This case highlights the challenge associated with the diagnosis and management of this rare manifestation of IgG4-RD. In a patient with a history of any form of IgG4-RDs, providers should be vigilant for any signs or symptoms that suggest the development of fibrosis in other organs.
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