Is physiological glucocorticoid replacement important in children?

Cortisol has a distinct circadian rhythm with low concentrations at night, rising in the early hours of the morning, peaking on waking and declining over the day to low concentrations in the evening. Loss of this circadian rhythm, as seen in jetlag and shift work, is associated with fatigue in the short term and diabetes and obesity in the medium to long term. Patients with adrenal insufficiency on current glucocorticoid replacement with hydrocortisone have unphysiological cortisol concentrations being low on waking and high after each dose of hydrocortisone. Patients with adrenal insufficiency complain of fatigue, a poor quality of life and there is evidence of poor health outcomes including obesity potentially related to glucocorticoid replacement. New technologies are being developed that deliver more physiological glucocorticoid replacement including hydrocortisone by subcutaneous pump, Plenadren, a once-daily modified-release hydrocortisone and Chronocort, a delayed and sustained absorption hydrocortisone formulation that replicates the overnight profile of cortisol. In this review, we summarise the evidence regarding physiological glucocorticoid replacement with a focus on relevance to paediatrics

An Open Source Biometric Patient Identification System for Low Resource Setting

It is estimated that as many as 1.5 billion people globally do not possess any form of identification [1]. Most of these people currently live in Africa and Asia. The lack of identification prevents them from accessing the basic rights and services afforded to them. In healthcare, proof of identity is required to access basic health services, and accurately monitor one’s diagnosis and treatment. This enables health care facilities to provide quality services. Without any identification, governments and development organisations cannot cater to the basic needs of these individuals. This is a key factor in the increased adoption of digital information systems in healthcare. These systems assist with validating patients’ identities. Additionally, these systems store information about patients’ medical history to allow for more effective treatment practices [2]. Digital information systems have proven to be more reliable than paper-based systems currently used in many health facilities in developing countries. Health service providers are now seeking ways to integrate these systems into their daily operations. Electronic health record systems could potentially solve many problems these facilities face. This includes issues related to data management and patient identification. These systems, when paired with biometric technologies, can remove the need for patients to carry physical identification to gain access to medical services. This would be a great benefit to rural communities. It could also assist with reducing the prevalence of fraud in these communities. Cases where individuals make use of stolen identification cards and multiple identities to access health benefits are known to occur in these areas. Existing biometric identification solutions are not designed specifically for the rural environment. Therefore, an open source biometric patient identification system was developed. The system was developed specifically for a hospital located in a rural setting. The aim was to leverage off existing technologies, and adapt it accordingly to suit the conditions faced by health service providers in these areas.</jats:p