Role of combined oral contraceptive pills as add back therapy in patients receiving GNRH analogue.

This was a randomised control trial involving 25 patients on GnRH analogue in a university hospital over period of six months. The patients were randomised into two groups, twelve patients were treated with GnRH analogue and low dose COCP (treatment group) as add back therapy and thirteen patients were treated with GnRH analogue alone (control group) for three months

Nuchal translucency and pregnancy outcome.

This was a retrospective study done involving 434 patients in a university hospital over period of four years. First trimester ultrasonography were routinely offered for screening of nuchal translucency (NT) at 11 to 13+6 weeks. Morphology scan was performed at 18 to 22 weeks. Pregnancy was followed up till delivery and the information was obtained in all cases by a review of medical records

Hubungan Biaya Promosi Dengan Pendapatan Premi Asuransi Pada PT. Asuransi Jiwasraya (Persero) Cabang Samarinda Tahun 2014-2016

The purpose of this study was to determine the relationship of promotional costs with insurance premium income at PT. Asuransi Jiwasraya (Persero) Samarinda Branch 2014 - 2016. This research is a quantitative research by taking financial data from PT. Asuransi Jiwasraya (Persero) Samarinda Branch in the period 2014 - 2016. Data collection techniques in this study are observation, interviews, documentation, and analysis techniques used are product-moment correlation analysis. Promotion Indicator conducted by PT. Asuransi Jiwasraya (Persero) Samarinda Branch from 2014 to 2016 is Sales Promotion and Public Relations while the Premium Income indicators are insurance products which include Unit Link, JS Achievement, and JS Siharta. Based on the analysis results where the r count is 0.712. In this case when interpreted with a significance level of 5% lies in the interval between 0.60-0.799 with a table interpretation of the value of r, which means there is a relationship between promotional costs with premium income of PT. Asuransi Jiwasraya Samarinda Branch in 2014 - 2016 with the level of "Strong" relationship. The Test Calculation Result is 5,916 while the value with dk = n-2, a level of 5% is obtained at 1,691, meaning that> or 5,916> 1,691 so that the more promotion costs increase the premium income will also increase. Thus the "Relationship Promotion Costs with Insurance Premium Income At PT. Asuransi Jiwasraya (Persero) Samarinda Branch 2014-2016 ", can be said to be" accepte

Payment methods and patient satisfaction among type-2 diabetes patient at a teaching hospital in Malaysia

Diabetes mellitus is a costly chronic disease related to medication, physician consultation and laboratory investigation. The main means of financing healthcare include direct out-of-pocket (OOP) payment and government subsidisation in some countries, or public/private health insurance schemes, or a mix of all. Patient satisfaction is critical in ensuring the use of healthcare services, continuity of care and treatment adherence. In this study, we determined the satisfaction of type 2 diabetes mellitus (T2DM) patients regarding the healthcare services and payment methods at Universiti Kebangsaan Malaysia (UKM) Teaching Hospital, Malaysia. This cross-sectional study involved 313 T2DM patients aged ≥18 years who were included after clinical consultations. We used convenience sampling at the outpatient and inpatient medical centres of Hospital Canselor Tuanku Muhriz and UKM Specialist Centre. A survey consisting of sociodemographic, socioeconomic and payment method types as well as a validated patient satisfaction questionnaire scale were used. The mean age was 59.6 years (SD=13.151), 53.0% of the patients were female, 78.3% were Malay, 76.4% were uninsured, 39.6% were covered by government subsidies, while 36.7% paid OOP. Around 86% were generally satisfied with the overall services. Patients were most satisfied with technical quality (84%), communication skills (83%) and accessibility (80%), but satisfaction was lower in doctors’ service orientation, particularly the interpersonal manner (73%), financial aspect (73%) and time spent with the doctor (70%). Over 86% of patients were satisfied with healthcare services and payment methods; however, patients who paid OOP reported low satisfaction. Full insurance and extending benefits to partially cover both inpatients and outpatients with low co-payment is recommended to increase satisfaction

The translation and validation of the smartphone use questionnaire (SUQ) into the Malay language

Interruptions caused by frequent smartphone use steals attention away from daily activities, bringing serious implications onto an individual’s health, safety and education. Smartphone Use Questionnaire (SUQ) is a 20-item questionnaire developed to assess the pattern of smartphone use and its effect on attention. This study was done to translate and validate the Malay-language version of the SUQ and to measure the psychometric properties of the Malay-version SUQ to justify its use in Malaysia. A forward and back-translation was done by four individuals, who were three physicians and one linguist. Content and face validity was done involving three experts who were a linguist, psychiatrist and epidemiologist. Psychometric testing was conducted on a sample of 195 individuals proficient in the Malay language. A construct validity test was performed using factor analysis and the internal reliability was tested by calculating for the Cronbach’s Alpha. The age range of the sample was 13-59 years, most of which were female and of the Malay race. Using principal component analysis with direct oblimin rotation, the factor analysis extracted two components similar to the original study: General Use and Absent-Minded Use. However, question number 20 was grouped into General Use component, whereas in the original study it was under the Absent-Minded Use component. The Cronbach’s Alpha for the obtained components was 0.884 and 0.927, respectively. This study found that the Malay-version SUQ was a valid and reliable instrument for use in Malaysia in assessing inattention associated with smartphone use

Management of intracranial tuberculous mass lesions: How long should we treat for? [version 2; peer review: 1 approved, 2 approved with reservations]

Tuberculous intracranial mass lesions are common in settings with high tuberculosis (TB) incidence and HIV prevalence. The diagnosis of such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of TB elsewhere and response to TB treatment. However, the treatment response is unpredictable, with lesions frequently enlarging paradoxically or persisting for many years despite appropriate TB treatment and corticosteroid therapy. Most international guidelines recommend a 9-12 month course of TB treatment for central nervous system TB when the infecting Mycobacterium tuberculosis (M.tb) strain is sensitive to first-line drugs. However, there is variation in opinion and practice with respect to the duration of TB treatment in patients with tuberculomas or tuberculous abscesses. A major reason for this is the lack of prospective clinical trial evidence. Some experts suggest continuing treatment until radiological resolution of enhancing lesions has been achieved, but this may unnecessarily expose patients to prolonged periods of potentially toxic drugs. It is currently unknown whether persistent radiological enhancement of intracranial tuberculomas after 9-12 months of treatment represents active disease, inflammatory response in a sterilized lesion or merely revascularization. The consequences of stopping TB treatment prior to resolution of lesional enhancement have rarely been explored. These important issues were discussed at the 3 International Tuberculous Meningitis Consortium meeting. Most clinicians were of the opinion that continued enhancement does not necessarily represent treatment failure and that prolonged TB therapy was not warranted in patients presumably infected with M.tb strains susceptible to first-line drugs. In this manuscript we highlight current medical treatment practices, benefits and disadvantages of different TB treatment durations and the need for evidence-based guidelines regarding the treatment duration of patients with intracranial tuberculous mass lesions

The current global situation for tuberculous meningitis: Epidemiology, diagnostics, treatment and outcomes

Tuberculous meningitis (TBM) results from dissemination of M. tuberculosis to the cerebrospinal fluid (CSF) and meninges. Ischaemia, hydrocephalus and raised intracranial pressure frequently result, leading to extensive brain injury and neurodisability. The global burden of TBM is unclear and it is likely that many cases are undiagnosed, with many treated cases unreported. Untreated, TBM is uniformly fatal, and even if treated, mortality and morbidity are high. Young age and human immunodeficiency virus (HIV) infection are potent risk factors for TBM, while Bacillus Calmette-Guérin (BCG) vaccination is protective, particularly in young children. Diagnosis of TBM usually relies on characteristic clinical symptoms and signs, together with consistent neuroimaging and CSF parameters. The ability to confirm the TBM diagnosis via CSF isolation of M. tuberculosis depends on the type of diagnostic tests available. In most cases, the diagnosis remains unconfirmed. GeneXpert MTB/RIF and the next generation Xpert Ultra offer improved sensitivity and rapid turnaround times, and while roll-out has scaled up, availability remains limited. Many locations rely only on acid fast bacilli smear, which is insensitive. Treatment regimens for TBM are based on evidence for pulmonary tuberculosis treatment, with little consideration to CSF penetration or mode of drug action required. The World Health Organization recommends a 12-month treatment course, although data on which to base this duration is lacking. New treatment regimens and drug dosages are under evaluation, with much higher dosages of rifampicin and the inclusion of fluoroquinolones and linezolid identified as promising innovations. The inclusion of corticosteroids at the start of treatment has been demonstrated to reduce mortality in HIV-negative individuals but whether they are universally beneficial is unclear. Other host-directed therapies show promise but evidence for widespread use is lacking. Finally, the management of TBM within health systems is sub-optimal, with drop-offs at every stage in the care cascade

Mechanism, spectrum, consequences and management of hyponatremia in tuberculous meningitis

Hyponatremia is the commonest electrolyte abnormality in hospitalized patients and is associated with poor outcome. Hyponatremia is categorized on the basis of serum sodium into severe (< 120 mEq/L), moderate (120-129 mEq/L) and mild (130-134mEq/L) groups. Serum sodium has an important role in maintaining serum osmolality, which is maintained by the action of antidiuretic hormone (ADH) secreted from the posterior pituitary, and natriuretic peptides such as atrial natriuretic peptide and brain natriuretic peptide. These peptides act on kidney tubules via the renin angiotensin aldosterone system. Hyponatremia <120mEq/L or a rapid decline in serum sodium can result in neurological manifestations, ranging from confusion to coma and seizure. Cerebral salt wasting (CSW) and syndrome of inappropriate secretion of ADH (SIADH) are important causes of hyponatremia in tuberculosis meningitis (TBM). CSW is more common than SIADH. The differentiation between CSW and SIADH is important because treatment of one may be detrimental for the other; evidence of hypovolemia in CSW and euvolemia or hypervolemia in SIADH is used for differentiation. In addition, evidence of dehydration, polyuria, negative fluid balance as assessed by intake output chart, weight loss, laboratory evidence and sometimes central venous pressure are helpful in the diagnosis of these disorders. Volume contraction in CSW may be more protracted than hyponatremia and may contribute to border zone infarctions in TBM. Hyponatremia should be promptly and carefully treated by saline and oral salt, while 3% saline should be used in severe hyponatremia with coma and seizure. In refractory patients with hyponatremia, fludrocortisone helps in early normalization of serum sodium without affecting polyuria or functional outcome. In SIADH, V2 receptor antagonist conivaptan or tolvaptan may be used if the patient is not responding to fluid restriction. Fluid restriction in SIADH has not been found to be beneficial in TBM and should be avoided