Intrauterine devices (IUDs) are a safe and common form of contraception. Uterine rupture and migration of the IUD is a rare complication of insertion but can be serious and cause damage to adjacent organs. We present a case report of a 43 year old woman with chronic abdominal pain who was diagnosed with an IUD in the wall of the sigmoid colon. That IUD had been inserted in the uterine cavity 22 years earlier.
Introduction: Prescriptions of unlicensed drugs along with public discussion have increased in recent years. The cause of this increase is unclear.
Material and methods: This is a retrospective descriptive study of applications of unlicensed drugs in Iceland in the years 2020 and 2021, as well as applications in Sweden for the year 2020. Information was collected on unlicensed prescription applications, registered drugs and stock-out time. Information was analyzed and categorized to describe the scope of unlicensed prescriptions in the two countries during the study time.
Results: In Iceland, 49.161 applications were approved in 2020 and 46.581 in 2021. The most common reason for using unlicensed products was that no registered drug was on the market with the same ATC-number (Anatomical Therapeutic Chemical code) and formulation. Shortage of drug was the reason for unlicensed prescription in 8.8% of cases in 2020 and 7.6% in 2021. The list of the 50 most prescribed drugs included the same drugs in 70% of the cases in both years. The five most prescribed drugs were the same in both years. In Sweden, 38.458 applications were approved in 2020. Of the most prescribed unlicensed drug, 46% were as no registered drug with same ATC-number and dosage form was marketed.
Conclusion: Many unlicensed drugs, prescribed in Iceland, are the same year after year. Only a small part of the applications approved were due to shortage of drug. The use of drugs without marketing license in Iceland in 2020 was higher than in Sweden when adjusted for the size of the market and population. Getting the five most prescribed unlicensed drugs licensed in Iceland could reduce largely, the total of prescription of unlicensed drugs in Iceland.
In recent months the incedence of invasive group A streptococcal infections (Streptococcus pyogenes) has increased worldwide. In the Children's Hospital Iceland 20 such cases were admitted during a four month period, until which time the avarage was one or two children admitted with an invasive GAS infection per year. To demonstrate the variability in the presentation of these invasive infections four cases were chosen for discussion in this case-series. Empyema with toxic shock syndrome, meningitis, orbital abscess and fascitis of the leg are reviewed.
In view of the ongoing rise of ADHD prescriptions among adults in Iceland, it is important that doctors are aware that psychosis is a rare but at times a serious adverse reaction to such treatment. In 2022 5% of adults were prescribed medication to treat ADHD in Iceland. In this case report we present a case of methylphenidate-induced psychosis in a young man with no previous history of psychotic episodes who required admission to the psychiatric intensive care unit.
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