1.Gonadotropin-releasing hormone stimulation test and diagnostic cutoff in precocious puberty: a mini review
Siti Nadirah AB RAHIM ; Julia OMAR ; Tuan Salwani TUAN ISMAIL
Annals of Pediatric Endocrinology & Metabolism 2020;25(3):152-155
The gonadotropin-releasing hormone (GnRH) stimulation test is a valuable tool in diagnosing and differentiating causes of early pubertal occurrences. Utility of the test can be limited in some instances, however, including the early phases of pubertal hypothalamic-pituitary-gonadal axis activation, in girls showing commonly overlapping pictures, and in obese children due to excess circulating estrogen that suppresses luteinizing hormone (LH). A lack of consistent baseline and stimulated gonadotropin cutoffs observed in different studies also contributes to limitations in testing. Nevertheless, early detection of true pathological causes for pubertal disorders is needed to allow prompt treatment and better prognosis. While basal LH can be beneficial as a good screening tool for detecting pubertal disorder, it does not preclude the need for GnRH testing. The aim of this review was to highlight the role of GnRH stimulation tests and varying testing cutoffs in diagnosis of precocious puberty and its classification.
2.The Frequency and Cost of Redundant Biochemistry Test in Tertiary Teaching Hospital
Siti Nadirah Ab Rahim ; Julia Omar ; Aniza Mohammed Jelani ; Najib Majdi Yaacob ; Wan Norlina Wan Azman
Malaysian Journal of Medicine and Health Sciences 2022;18(No.1):114-120
Introduction: Laboratory tests account for 66% of clinical decision making and reducing inappropriate test utilisation
is a step towards optimising patients’ care and hospital cost savings. This study aims to identify the rate and cost of
redundant test requests in our centre. Methods: A cross-sectional study comprising laboratory results of 14 analytes
in renal function test (RFT) and liver function test (LFT) were made. Data involved blood results from adult patients
admitted to Hospital Universiti Sains Malaysia from January to December 2018. The redundant test is defined as test
results consecutively normal twice and requested within 26 hours for analytes in RFT and 50 hours for analytes in
LFT. Cost contributions were estimated by multiplying cost-per-test with total redundant requests. The test redundancy in different wards and disease groups were also evaluated. Results: Equal distribution of RFT and LFT requests
were observed in both genders (50% respectively), with the most requests seen in the 60 – 79 years age group. More
than 20% redundancy rate was observed for seven analytes (ALT, total bilirubin, sodium, urea, potassium, AST,
Chloride), and overall redundancy was 19.7%, equals to Malaysian Ringgit (MYR) 669,105.00. Oncology wards
and genitourinary diseases contribute to the highest redundancy rate. Conclusion: This study estimated MYR 600
thousands of saving if test redundancy were to be eliminated. The finding is hoped to serve as a platform for future
intervention and policymaking. Future planning to optimise the current laboratory request system and collaboration
among physicians and laboratory professionals can minimise test inappropriateness.