Local government in the move to a district health system

This article gives a short overview of the background and legislation regarding health services delivered by local authorities. It reviews the latest legislative and policy changes regarding the development of a district health system and the role of the municipalities in this system. The article also reviews the progress made and challenges to be overcome in moving toward a district health system

A newer avenue for evaluation of thyroid dysfunction.

Attempt has been made to rationalise the biochemical assessment of patients suspected to have thyroid dysfunction by introduction of a new rapid and supersensitive immunoradiometric assay (IRMA) for TSH. 294 patients were subjected to thyroid investigation viz; tT3, tT4 and TSH (IRMA). Of these, 51 (17.34%) were hypothyroid, 22 (7.48%) were hyperthyroid and 221 (75.1%) were euthyroid. The ratio of thyroid disorder in male to female was 1:3.38. In all patients with hyperthyroidism TSH (IRMA) was 0.05 to undetectable and it was more than 4.5 ulu/ml in hypothyroid patients. TSH (IRMA) was low in one euthyroid patient a 0.34% incidence of false negativity. In 2 patients with subclinical hyperthyroidism TSH (IRMA) was low while tT3 and tT4 were normal. TSH (IRMA) therefore may obviate the need for more time consuming and expensive TRH test and simplify the approach to thyroid function tests in patients suspected to have masked or overt hyperthyroidism.