Treatment Motivation in Lung Tuberculosis Patients at Public Health Centres in Denpasar City during COVID-19 Pandemic

Treatment motivation among patients were heavily influenced by duration of therapy and existing side effects. TB supervisors motivated patients in their therapy. Limited communication from TB supervisors due to COVID-19 pandemic risked lowering treatment motivation in TB patients. Objective: get a general description of treatment motivation in TB patients from PHC in Denpasar. Method: descriptive observational with cross-sectional design in March – August 2021 at five PHC in Denpasar area. This study was done online using questionnaire with Google Forms application. Motivation is grouped into low, moderate, and high based on scores from internal factors, external factors, confidence in treatment, and interpersonal help seeking. Results: 86% of patients (43 people) had high treatment motivation, 12% of patients (6 people) have moderate treatment motivation, and two percent of patients (1 people) had low treatment motivation. Summary: Most of TB patients had high treatment motivation (86%). Communication between TB supervisors and patients are highly advised to motivate patients and increase success rate of therapy. Keywords: [Anti tuberculosis drugs, Lung tuberculosis, Treatment motivation].

Does Adding a Fissurectomy to Botox Sphincterotomy Increase Success Rate or Just Cost?

Background While Botox sphincterotomy with or without fissurectomy has been proven effective in healing anal fissures, they have not been directly compared. We evaluated cost-effectiveness and outcomes between Botox sphincterotomies with and without fissurectomy. Methods A 5-year retrospective review was conducted comparing all patients undergoing Botox sphincterotomy for anal fissure with or without fissurectomy. Outcomes including recurrence/persistence, additional treatments, complications, and total charges were compared between study groups. Results Patients treated without fissurectomy (n = 53) had recurrent/persistent fissure more often (56.6 vs 31.0%, P = .001), and required more Botox treatments. Those treated with fissurectomy (n = 154) had more complications (13.5 vs 0%, P = .003). Patients initially treated without fissurectomy had a median total charge of $2 973, while median total charge for those initially treated with fissurectomy was $17 925 (P < .001). Conclusions Botox sphincterotomy in an office without fissurectomy is a viable option. It may result in longer healing times but is associated with reduced cost, lower complication rates, and no need for anesthesia or operative intervention in most cases. But the choice of treatment route must be individualized.

WILLINGNESS TO BE VACCINATED AGAINST COVID-19 AMONG HIGHER EDUCATION INSTITUTION

Background: The increasing COVID-19 cases worldwide ignite pharmaceutical companies’ effort to discover safe vaccines have been eyed globally. Informed perspectives across medical profession explaining beneficial effects of inoculation, however, various personal views persist which lead to confusion among general public. Objectives: To describe demographic characteristics among education institutions and their willingness to be vaccinated. Methods: Data were collected by google forms, in February 2021. The online form was then pre-tested on 10 respondents to refine questions prior to commencing the survey. Convenience sampling was administered for the selection of voluntary respondents. Data cleaning was done prior to the data analysis. Recoding of string variables and omittion of invalid responses were also done. Descriptive statistics was undertaken in a genuine licensed software of IBM SPSS Statistics version 26. Results: A total of 401 respondents answered the survey. More than half of the respondents are female constituting 62.1% of the sample, whereas males constitute 37.9%, mostly faculty members, single (63.1%), earning 20,000 (54.2%) per month. More than half of the respondents are willing to get vaccinated against COVID-19 (54.6%) and have no preference for a specific type of COVID-19 vaccine (54.9%). Around 30.4% are still unsure if they should get vaccinated or not and 15% have indicated negatively. Comparing both sexes, a larger frequency of males is willing to get vaccinated constituting 69.1% and females (45.8%). Conclusion: Males showed more willingness to be inoculated regardless of COVID-19 vaccine types. Education and continuous campaign on the importance of vaccination program is a must to increase success rate to end the health crisis.

3D transvenous radiofrequency ablation of manifest epicardial posterior-septal accessory pathways in children: Can technology innovations improve the outcome?

Introduction: The aim of the study was to revise our more recent experience about epicardial posterior-septal accessory pathways radiofrequency transcatheter ablation in children and young patients using a transvenous approach through the coronary sinus, to understand if new mapping and ablation technologies can increase success rate and safety. Methods and results: Twenty children (mean age 13 ± 3 years) with epicardial posterior-septal accessory pathways (14 in coronary sinus and 6 in the middle cardiac vein) underwent radiofrequency transcatheter ablation with CARTO-3® system with help of the CARTO-Univu® module. Acute success rate was 73%. No patient was lost to follow-up (mean time 11.4 ± 9 months). The recurrence rate was 19%. Two patients underwent a successful redo-procedure; the overall long-term success rate was 65%. Navistar® catheter presented the highest acute success rate in the coronary sinus. Navistar SmartTouch® was the only catheter that did not present recurrences after the acute success, and it was successfully used in two patients previously unsuccessfully treated with a Navistar ThermoCool®. Acute success rate was 79% without image integration with angio-CT, while it was 63% after the introduction of CARTO-Merge®. Conclusion: Epicardial posterior-septal accessory pathways can be definitively eliminated by transvenous radiofrequency transcatheter ablation in more than half of the cases in children. Acute success rate does not seem to depend on catheters used, but contact-force catheter seems to be useful in cases with recurrences. Image integration with cardiac-CT does not increase success rate, but it is useful to detect coronary sinus alterations to better guide ablation strategy.

Hemophilia

Patients with hemophilia can be safely managed for elective surgery such as adenotonsillectomy as long as adequate planning and consultation with the hematology department occurs. Adequate factor replacement, antifibrinolytics, and careful monitoring are the mainstays of care. The need for frequent venous access can make cannulation of veins difficult, and this can be stressful for the patient and his or her family. Careful planning of any cannulation attempts can alleviate stress, increase success rate, and reduce trauma to veins. If the patient has a long-term central venous line, all precautions to reduce the risk of infection and thrombosis in the line must be adhered to. Development of inhibitory antibodies to factor VIII, or more rarely to factor IX, is currently the most difficult complication to manage in hemophilia patients.