Recurrent hypokalemia in an adult male: A case report on gitelman’s syndrome

Introduction@#Gitelman Syndrome (GS), a rare autosomal recessive inherited disorder, is frequently unrecognized in the clinical setting. GS typically manifests with severe hypokalemia with debilitating and potentially fatal consequences if untreated. As of writing, confirmatory genetic assays are currently unavailable in the country, and the diagnosis of GS is primarily based on several biochemical laboratory tests. This results in the difficulty with prompt diagnosis of GS in the locality.@*Case@#We present a 52-year-old male who came in with chronic, intermittent paraparesis associated with persistent hypokalemia. A diagnosis of GS was made biochemically based on renal wasting of potassium and magnesium, hypocalciuria, and metabolic alkalosis. Electrolyte correction with lifelong supplementation, and administration of Spironolactone resulted in the resolution of bilateral leg weakness. Electrolyte levels were maintained within normal limits in the outpatient setting.@*Conclusion@#GS is an uncommon potentially debilitating disorder that may lead to problematic, potentially fatal consequences to electrolyte abnormalities if left untreated. The lack of awareness and consequent delay in the diagnosis, and the unavailability of confirmatory genetic testing remains a clinical challenge. Timely recognition and initiation of treatment leads to early control of electrolyte levels, and better prognosis.

Factors affecting delays in PhilHealth electronic claims reimbursement among hospitals: An initial study

Background@#In the continuity of care, family and community physicians take into consideration patient insurance coverage, especially for those who require higher levels of care. The Philippine Health Insurance Corporation (PhilHealth) has had its electronic reimbursement claims processing since 2011 but the utilization of this system by hospitals may be affected by delays in claims reimbursement. Factors associated with such delays warrant further investigation.@*Objectives@#This study aimed to determine the perceived factors by concerned hospital staff that affect delays in PhilHealth’s electronic claims processing system.@*Methods@#Three focus group discussions (FGDs) were conducted using a predetermined set of questions. The hospitals were selected from respondents of a survey of a bigger study on the applicability of PhilHealth’s electronic claims processing. Each FGD involved eight-to-ten participants, mostly PhilHealth officers or information technology personnel from different hospitals covering Luzon, Visayas, and Mindanao. The hospitals were of different types/levels and included both government-run and privately-owned.@*Results@#Factors affecting delays in electronic claims reimbursement are intrinsic to the hospitals’ operations, with delays in obtaining the physician’s signature as the most common cause. Accessing PhilHealth’s server was another major factor and was aggravated by problems in clarifying patient eligibility, non-updated data, and variations in the emphasis of regional evaluators. Hospitals within the national capital region and those using their own electronic medical records and health information system had better experiences with the electronic claims reimbursement.@*Conclusions@#The main factors affecting delays in electronic claims reimbursement among hospitals are associated with the hospitals’ institutional processes. The active participation of family physicians and primary care providers can help address these issues and subsequently improve service delivery, PhilHealth utilization, and overall patient satisfaction.

Credibility Judgment Predictors for Child Sexual Abuse Reports in Forensic Psychiatric Evaluations

OBJECTIVE@#We intended to analyze the credibility judgment in written forensic psychiatric reports of child sexual abuse registered in Southern Taiwan.@*METHODS@#Ninety-six cases of child sexual abuse between August 2010 and October 2017 encountered in two hospitals were analyzed. The results in these reports were categorized into credible and non-credible. We identified the factors that distinguished between the two groups in bivariate analyses using chi-square test. A binary logistic regression analysis was performed to determine whether the factors that significantly correlated in the bivariate analyses were independent predictors of credible judgments.@*RESULTS@#Among 96 cases, 70 (73%) were judged as credible. Consistent testimonies of children (odds ratio=40.82) and multiple abuse events (odds ratio=6.05) were positive variables independently related to the sexual abuse allegations judged as credible.@*CONCLUSION@#The number of allegations judged as credible in this study was slightly higher than that reported in other studies. Our findings about predictors for credible cases are not in line with those reported previously. Due to the differences in resources of the cases and backgrounds of the evaluators among multiple studies, direct comparisons with previous studies must be treated with caution.

Disparities in hospital capacities and efficiency of computer-based health insurance claims processing

@#<p style="text-align: justify;"><b>BACKGROUND:</b> The Philippine Health Insurance Corporation (PhilHealth) has adopted several computer-based systems to enhance claims processing for hospitals.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study sought to determine the efficiency gains in the processing of PhilHealth claims following the introduction of computer-based processing systems, taking into account differences in hospital characteristics.</p><p style="text-align: justify;"><strong>METHODS:</strong> Data were obtained from a survey conducted among 200 hospitals, and their corresponding 2014 claims figures as provided by PhilHealth. Summary descriptive statistics of hospital capacities (ownership, service level, and utilization of PhilHealth computer systems) and claims outcomes (claims rejection rates, as well as length of claims processing times for hospitals and with PhilHealth) were generated. Multivariate regression analysis was done using claims outcomes as dependent variables, and hospital capacities as independent variables.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Nearly a quarter of the surveyed hospitals did not utilize any of PhilHealth's computer-based claims systems. Utilization was lowest for primary as well as public facilities. Among those that used the systems, most employed the on-line membership verification program. The mean claims rejection rate was 3.81%. Claims processing by hospitals took an average of 35 days, while PhilHealth required 40 days from receipt of claims to the release of reimbursement. Regression analysis indicated that facilities that utilized computers, as well as private hospitals, had significantly lower claims rejection rates (p<0.05). The claims processing duration was significantly shorter among private facilities.</p><p style="text-align: justify;"><strong>CONCLUSIONS:</strong> Private hospitals are able to process claims and obtain reimbursements faster than public facilities, regardless of the use of PhilHealth's computer-based systems. PhilHealth and public hospitals need to optimize claims processing arrangements.</p>

Advances in the diagnosis, treatment and control of HIV associated tuberculosis

There has been an increase in the number of published tuberculosis/HIV (TB/HIV) research findings in recent times. The potential impact of these findings on routine care has informed this review which aims at discussing current concepts and practices underpinning TB/HIV care and control. Any HIV infected person with a cough of any duration is currently considered a TB suspect. Preliminary results also show that the diagnostic yield of same day sputum samples(front loading) is comparable to two­day samples. Laboratory diagnosis is shifting from Ziehl­Neelsen (ZN) smear microscopy and solid culture to fluorescent microscopy, molecular tests and liquid culture. Concomitant TB/HIV therapy improves survival and WHO has recommended ART for all TB/HIV patients. Unless CD4 cell counts are less than 50 cells/µl, ART can be deferred until end of intensive phase. Evidence of survival benefit at high CD4 cell counts is still lacking. New TB drugs and treatment shortening studies are underway but so far no new TB drugs has been added to the current arsenal and treatment duration still remains six months or more. WHO has recommended the 3Is (intensified TB case finding, isoniazid prophylaxis and infection control) for TB/HIV control in addition to effective therapy, Antiretroviral therapy and TB vaccines. There has been immense progress in TB/HIV research, however optimal management of HIV­Infected TB patients, will require further research and appropriate translation of emerging evidence to policy and practice

Tratamiento cognitivo-conductual para trastornos de ansiedad en niños: manual para el terapeuta

Contenido: Sesiones del tratamiento. Recursos para el terapeuta. Comorbilidad. Depresión/distimia. Hiperactividad. Comportamientos obsesivo-compulsivos. Ataques de pánico. Problemas de cumplimiento. Hipercrítica. Negación de la ansiedad. Rechazo a la escuela. Temores realistas. Dificultades familiares

El Gato Valiente

Cuaderno de actividades del manual para el terapeuta del mismo autor

Terapia cognitivo-comportamental da fobia social / Cognitive-behavioral therapy in social phobia

OBJETIVO: Este artigo revisa aspectos relevantes da fobia social e os estágios de tratamento através da terapia cognitivo-comportamental em crianças, adolescentes e adultos. MÉTODO: A partir do banco de dados Medline, realizou-se revisão da literatura publicada a respeito do tratamento da fobia social por meio da terapia cognitivo-comportamental. RESULTADOS: Revisão da literatura sugere que a fobia social é uma condição prevalente e crônica, caracterizada por inibição social e timidez excessiva. Tanto o diagnóstico como o tratamento desse transtorno são comumente determinados pelo nível de incômodo e pelo prejuízo funcional. Estudos populacionais indicam taxas de prevalência ao longo da vida para a fobia social entre 2,5 e 13,3 por cento. As principais técnicas utilizadas na terapia cognitivo-comportamental para a fobia social são descritas e exemplificadas em um relato de caso. CONCLUSÕES: Há consenso geral na literatura de que a terapia cognitivo-comportamental é eficaz tanto para o tratamento de jovens como de adultos com fobia social. Uma vez que a fobia social com freqüência tem início precoce, a identificação de crianças com risco acentuado para o desenvolvimento de fobia social deve ser priorizada em investigações futuras.

OBJECTIVE: This article reviews relevant aspects of social phobia and the stages of treatment within cognitive-behavioral therapy in children and adolescents, as well as in adults. METHOD: A review of the literature published on the treatment of social phobia using cognitive-behavioral treatments was performed using the Medline database. RESULTS: A review of the literature suggests that social phobia is a chronic and prevalent condition, characterized by social inhibition and excessive shyness. Diagnosis and treatment of the disorder are usually determined by distress level and functional impairment. Population studies indicate that lifetime prevalence rates for social phobia range from 2.5 to 13.3 percent. The main techniques used in cognitive-behavioral therapy for social phobia are described and exemplified in a case report. CONCLUSIONS: There is a general consensus in the literature that cognitive-behavioral therapy is efficacious in the treatment of youth and adults with social phobia. Because of the early onset associated with social phobia, the identification of children at high risk for the development of social phobia should be prioritized in future investigations.

Perforated choledochal cyst in a Jehovah's Witness patient.

Perforation is a rare presentation of a choledochal cyst. The case reported is a 9-month-old female baby with a perforated choledochal cyst. Being a Jehovah's Witness, blood tranfusion was refused. Apart from highlighting this social dilemma, the suitability of a cystojejunostomy as a temporary measure in the above scenario is evaluated and discussed.

Computer graphics interface to a complex simulation

El programa <> es una simulación de un experimento de laboratorio sobre el sistema cardiovascular del gato, diseñado para estudiantes de fisiología y farmacología. Hay dos innovaciones improtantes en esta versión, utilizando el <>: 1) El funcionamiento del programa es altamente interactivo con el estudiante. Cualquier manipulación del estudiante causa una respuesta inmediata en el animal (simulado) experimental. 2) La entrada de los datos por el estudiante, y los resultados que obtiene, son manipulados de manera simple e intuitiva. El <> y el sistema del menú son utilizados para simplificar el control del programa. El teclado no se utiliza. La capacidad gráfica del <> provee una presentación de los resultados que pueden ser interpretados fácilmente y rápidamente por el estudiante. El programa se ha probado con una muestra pequeña de estudiantes de medicina. Utilizando un examen objetivo, los resultados del grupo de <> es superior en cuanto a fortalecer los conocimientos y repaso del tema