Parents' and primary healthcare practitioners' perspectives on the safety of honey and other traditional paediatric healthcare approaches.

BACKGROUND: Traditional and complementary healthcare approaches (TCA) are widely used for children, often because of perceived safety. Honey is a traditional remedy for upper respiratory tract symptoms in infants. Health officials currently advise limiting honey use because of the risk of botulism. OBJECTIVE: This paper discusses honey as a traditional healthcare approach for children in a multi-ethnic community, and parents' and primary healthcare practitioners' (PHPs) perceptions of its safety. DESIGN: As part of a larger study exploring beliefs about TCA, this paper focuses on perceived safety and use of honey, using data extracted for detailed analysis. Eleven parent focus groups (n= 92) and 30 interviews with PHPs were conducted. Qualitative data analysis used the Framework approach. SETTING: London Boroughs of Brent and Harrow RESULTS: TCA, particularly home remedies, dietary and religious approaches were popular for children. Honey was a particularly common TCA, reportedly used by 27 (29%) parents for their children. Honey was believed to be traditional, acceptable, accessible, natural and safe. It was most commonly used for respiratory tract symptoms and administered with hot water and lemon juice. PHPs were more concerned about the safety of TCA than parents. Almost half (40%) of PHPs mentioned the use of honey for children, few perceived it as a 'treatment' or were concerned about botulism. Others were aware of the risks and some reported challenges in communicating risk to parents. CONCLUSION: TCA are commonly used for children, honey in particular for respiratory tract symptoms. Parents and some PHPs appear unaware of the risk of botulism from honey use in infants. Healthcare practitioners should ask routinely about the use of honey and other TCA, and consider different parental belief systems in ethnically diverse populations. Further research is required on the use and efficacy of honey for infants, to raise awareness of its benefits and risks.

Detecting causes of pulsatile tinnitus on CT arteriography-venography: A pictorial review.

Pulsatile tinnitus (PT) can be a mild or debilitating symptom. Following clinical examination and otoscopy, when the underlying aetiology is not apparent, radiological imaging can be used to evaluate further. CT arteriography-venography (CT A-V) of the head and neck has recently been introduced as a single 'one catch' modality for identifying the many causes of PT including those which are treatable and potentially serious whilst also providing reassurance through negative studies or studies with benign findings. CT A-V is performed as a single phase study allowing both arterial and venous assessment, hence limiting radiation exposure. Additional multiplanar reformats and bone reconstructions are desirable. Understanding the limitations of CT A-V is also required, with an awareness of the scenarios where other imaging modalities should be considered. The causes of PT can be divided into systemic and non-systemic categories. Non-systemic aetiologies in the head and neck should be carefully reviewed on CT A-V and include a variety of vascular causes (arteriovenous malformations/fistulas, venous or arterial aetiologies) and non-vascular causes (tumours and bony dysplasias). Venous causes (dominant, aberrant, stenosed or thrombosed venous vessels) are more common than arterial aetiologies (aberrant or stenosed internal carotid artery, aneurysms or a persistent stapedial artery). Glomus tumours that are not visible on otoscopy and osseous pathologies such as bony dehiscence and otospongiosis should also be excluded. Careful assessment of all the potential vascular and non-vascular causes should be reviewed in a systematic approach, with correlation made with the clinical history. A structured reporting template for the reporting radiologist is provided in this review to ensure all the potential causes of PT are considered on a CT A-V study. This will help in providing a comprehensive radiological evaluation, hence justifying the radiation dose and for patient assessment and prognostication.

A case of adrenal infarction in a patient with COVID 19 infection.

This case report highlights an unusual presentation of acute adrenal infarction in a Covid-19 patient who presented with abdominal symptoms and hyponatraemia. We discuss the recent literature reviewing how Covid-19 creates a hypercoaguable state, with acute adrenal infarction as a possible prothrombotic complication.

Inflammation of the Temporal Bone.

Temporal bone and ear structure inflammation is commonly due to infection. It can be associated with a variety of complications and postinflammatory sequelae. Where the ear is easily inspected, clinical evaluation suffices. At the deeper aspect of the temporal bone, clinical evaluation is limited. High-resolution computed tomography scanning is suited for temporal bone imaging and is the modality of choice. MR imaging is useful to characterize disease, define the extent and spread of disease, or as a surveillance tool. MR imaging can be used with high-resolution computed tomography scanning to give a comprehensive evaluation of a complex disease process.

Two Cases of Primary Testicular Lymphoma Presenting with Direct Spread along the Spermatic Cord and Gonadal Vessels.

Primary testicular lymphoma is a rare testicular neoplasm that mainly affects elderly patients, with Human Immunodeficiency Virus (HIV) being a known risk factor in the younger population. Approximately 20% of patients will have disseminated disease with extra-nodal involvement at clinical presentation. Rarely, direct spread along the spermatic cord and gonadal vessels can occur and has been described in the literature. We present two cases of this phenomenon where the primary testicular tumour has spread along the gonadal vein to its origin at the inferior vena cava.

The English North-South divide: risk factors for cardiovascular disease accounting for cross-sectional socio-economic position.

AIMS: Given a North-South divide in mortality in England, we aimed to assess the extent of a North-South divide in risk factors for cardiovascular disease (CVD), controlling for markers of socio-economic position (SEP). METHODS: We undertook cross-sectional analyses using respondents from the 2006 Health Survey for England. We assessed mean systolic blood pressure, total cholesterol, body mass index (BMI) and smoking prevalence in the two regions. We built nested regression models adding demographic factors, SEP indicators, behavioural risk factors, vascular disease status and CVD preventive medications stepwise into each model. We examined interactions between region, age and gender. RESULTS: Controlling for demographic variables, we found a northern excess in systolic blood pressure (+1.95mmHg (SE = 0.40)), BMI (0.40kgm(-2) (SE = 0.12)) and smoking prevalence (5.6% (SE = 1.1)). The difference in smoking prevalence was entirely abolished by markers of SEP. Systolic blood pressure and BMI differences were attenuated by SEP, behavioural and disease indicators, but remained (+1.63mmHg (SE = 0.41) and 0.25kgm(-2) (SE = 0.12), respectively). However, they were lost after adjustment for preventive medication. The North-South divide in systolic blood pressure was attributed to differences in men and younger-to-middle-aged groups. Northern respondents were more physically active, especially younger men. CONCLUSIONS: English North-South differences in smoking can be explained through adverse, cross-sectional SEP. Northern excesses in blood pressure and BMI may be associated with differential clinical management. Risk factor differences may, in part, explain a previously found North-South divide in mortality. Further exploration of geographic inequalities, concentrating on the impact of healthcare, may be warranted.