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Patient Survey in General Medicine Outpatients Clinic - Experience of A New Hospital

Background and purpose: Patient's perception is crucial for hospital running, especially for a new hospital. This survey was to investigate issues such as the source of patients, time section of visiting, the transport mode of patients, and the merit/demerit of a new hospital. Materials and Methods: An innominate self-filled questionnaires survey was conducted at out-patient department (OPD) of general medicine (GM) clinics during 3/2018 to 4/2018. There were 253 out-patients return questionnaires. The descriptive analysis, Chi-square test and logistic regression were used to analyze the source of patients, demographic characteristics of participants among different time section of visiting, transportation way to hospital, and return visit at GM for clinical care. Results: The 71.3% participants were older than 40 years old. The proportion of ＜40 years old participants at night clinic (44.9%) was higher than in the morning (19.8%) and afternoon (26.3%) clinics. The percentage of participants with first visit to hospital and GM was higher at night (34.7%) than in the morning (25.9%) and afternoon (17.9%) clinic. Motor cycle (44.3%) and private car (28.9%) were the main transport modes, only 15.61% participants used shuttle bus. The main reasons of patients to visit hospital were attributed to hospital close to home (60.5%), follow original physician to hospital (30.8%) or recommendation of friends and relatives (29.2%). Superior medical skills and good service attitude were the two significant factors to attract and maintain participants to first visit and revisit GM clinic for care. (P＜0.05) The kindness and patience of medical staffs and new & clean environment were the perceived quality of hospital. However, the pathway and signs (5.1%), speed of register/pay out/check out system (5.1%), and length of waiting time (4.7%) need to be strenghthened. Conclusions: Night clinic was important and necessary for young patients. The motorcycle and private car as the primary transport mode indicated that more public transportation and shuttle buses were needed for patients. The superior medical skills and good service attitude were the main reasons for patients to visit OPD. The persist improvement of service pathway and environment was the cornerstone of progressive increase in service volume.

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The Effect of Appropriately Reducing The Dose of Nuclear Medicine on The Quality of Image Uptake

Objective: Diagnosis and treatment which make use of nuclear medicine and radiopharmaceutical to be used as disease have already for several decades. The nuclear medical science is in the technique and the equipment of aggressive with radiopharmaceutical develop continuously, make the focus that can accept prevention, diagnosis and treatment more and more. According to previous reference and clinical research, checking the nuclear medicine dose takes the cause and effect relation that the quality learns at the nuclear medicine image, played a role of opposite balance. This research is proposed a hypothesis: If in the acceptable scope, well timed and appropriate of reduce nuclear medicine dose administration to patients as low as possible, which can increase image quality. On the other hand, reduce with the hurt of patients by radiation. Methods: The experiment is through the big rat vein to inject a same density, and different dose of ^(99m)Tc. The mainly purpose is under same time condition to observe: 1. The relationship between the time and the static state image with nuclear medicine which measures with low, standard and high dose. Injecting three different kinds of dose which measure the free ^(99m)Tc to rats, takes ＂time calculation＂ as foundation. 2. The way which makes use of a nuclear medical science picks its dynamic image, observing rat of injecting the low doses ^(99m)Tc; The image picks quality whether with inject a standard the isotope homology for measuring of quantity and high or better. 3. End, after injecting the low, standard and high dose of free ^(99m)Tc, its medicine detention the radiation effect produced by organ takes the influence of quality to the image. Results: Test a result manifestation, rat at the low dose of nuclear medicine is administered after six hours (a half-life), which static image at standard and high dose with free ^(99m)Tc, for taking image mutually in comparison, the influence in the peripheral organ is smaller to the main organ, and the image quality is better. But, consume of uptake time opposite increment. And the result of dynamic state image are homology with the static image, but, total uptake rate is poor to static state. Conclusions: Through the image result, reducing of the adequacy that we put forward when thinking give to be subjected to check patient to check a medicine thing quantity to take in the static state image up, really can get better result. And in the dynamic state image, if we could take instrument to be like to change to a total count number from time number, the income result image will be equal with static state image in vivo.

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Kabuki Syndrome with Growth Hormone Deficiency and Precocious Puberty: A Case Report

Kabuki syndrome (KS) is a rare disease with unknown etiology, variable signs, and symptoms. Genetic defects related to KS such as mutations in the Histone-lysine N-methyltransferase 2D (KMT2D/MLL2) gene have been discussed over the years. Treatment with growth hormone, luteinizing hormone-releasing hormone (LHRH) analog, and zinc supplementation have shown positive effects on the patient's height and in the management of the precocious puberty. Here, we present a case of an 11-year-old female diagnosed with KS. She had a KMT2D/MLL2 mutation, which manifested as growth hormone deficiency and precocious puberty. Her clinical symptoms improved following treatment with growth hormone, LHRH analog, and zinc supplementation. This case report underscores the importance of early intervention and proper management of the disease.

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Cystic Fibrosis: Two Case Reports of Adults in Taiwan

Almost any adult bronchiectasis is considered a non-cystic fibrosis in Taiwan. Herein, we present two cystic fibrosis cases with bronchiectasis and recurrent pulmonary infection. DNA extracted from the peripheral blood was sent for molecular diagnosis of cystic fibrosis transmembrane conductance regulator gene mutation analysis under clinical suspicion. Mutation variant analysis improves the epidemiological and genetic database to develop additional precision medicines for cystic fibrosis patients of different ethnicities.

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Pyrimethamine Treatment for Toxoplasmosis Uveitis in An AIDS Patient

Objective: To report the effect of pyrimethamine treatment in ocular toxoplasmosis which failed to treat with baktar and clindamycin in a 43-year-old male with acquired immune deficiency syndrome (AIDS). Methods: Retrospective interventional case report. Results: This case presented with left blurred vision, and left fundoscopy revealed necrotizing retinitis, frosted angitis and kyrielesis plaques. These findings were characterized with toxoplasmosis uveitis with elevated aqueous toxoplasmosis IgG level. He was undergoing HARRT, anti-tuberculosis therapy combined with trimethoprim-sulfamethoxazole (baktar) and clindamycin for systemic opportunistic infection, but toxoplasmosis uveitis still occurred. We started full pyrimethamine therapy for 28 days and the retinitis resolved gradually without recurrence at 14 months follow-up. Conclusions: Pyrimethamine treatment rather than baktar and clindamycin therapy is effective for AIDS-related toxoplasmosis uveitis.

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Multiple Intracranial and Spinal Meningiomas: Management of This Rare Condition

Multiple intracranial and spinal meningiomas presenting concurrently is rare. In this paper, we presented a case of meningiomatosis (right frontal meningioma and T4-5 spinal meningioma) and we also describe the clinical characteristics, imaging findings, and management plan. Approximately 1-10% of cases present multiple intracranial meningiomas that are usually associated with neurofibromatosis. Only some case reports of multiple intracranial and spinal meningiomas have been provided in the literature. Concurrent meningiomas are usually asymptomatic, and conservative treatment is considered. Determining which tumor is causing a patient's symptoms and signs is crucial. In our experience, the asymptomatic lesion can be managed with conservative treatment and can be monitored until any focal sign presents or the tumor size increases.