10.18639/RABM.2020.1233416
Cancer and Oncology
Dec 30, 2020
Pancreatic cancer.
Pancreatic ductal adenocarcinoma is a fatal type of cancer with an increasing incidence rate in North America. The only curative procedure of this disease is the Whipple procedure, which is restricted only to those that received an early diagnosis. The remainder of the patients is informed of a dismal prognosis and undergo palliative care through systemic chemotherapy. Multiple modalities are involved in the staging and diagnosis of this disease. However, there seems to be a controversy regarding a gold standard or whether a gold standard exists. Additionally, various emerging techniques warrant heightened sensitivity and specificity in their designated modalities. Transabdominal ultrasound that is most commonly used as the first line of imaging for patients with epigastric pain is found to be virtually insensitive to neoplasms that have a size of 2 cm or less, limiting its application. However, sonographers could resort to contrasts and elastography to increase the conspicuity of the neoplasms. Moreover, endoscopic ultrasound has shown to be a promising imaging modality with an unprecedented degree of sensitivity to tumors with a diameter of less than 1.5 cm. The sensitivity and specificity values of MDCT, MRI, and PET were found to be comparable. The main conclusions consist of the fact that EUS is a highly sensitive test that should be accompanied by MRI, MDCT, PET, or TUS to increase its specificity. Lastly, empathetic communication is vital not only for patient comfort but also to improve the quality of the imaging assessment.
10.18639/RABM.2020.9800005
Microbiology and Immunology
Nov 16, 2020
Post-Operative Wound Infections and Antibiotic Susceptibility Patterns.
Wound infection is considered one of the most common nosocomial infections all over the world. So, the aims and objectives of this study are to identify the pathogenic agents of wound infection infecting hospital admitted patients and commonly used antimicrobial susceptibility profiles. A total of 91 samples were collected for the study. The cultural analysis was done by phenotypic examination as well as Gram staining and biochemical examination to identify the isolates. Finally, antibiotic sensitivity was tested against conventionally used antibiotics. All the samples were aseptically collected from different hospitals in the Tangail area and tests were done in the Lab Zone and Hormone Center, Tangail, Bangladesh between January 2019 and June 2019. 84(92.3%) of the total samples yielded a positive culture and only 7(7.7%) samples were negative growth. Gram-Negative bacteria 64(76.2%) showed more prevalence than Gram-Positive bacteria 20(23.8%). The most predominant isolates were Pseudomonas species 54(64.3%) in this study though Staphylococcus species 20(23.8%), Proteus species 7(8.3%), and Klebsiella species 3(3.6%) were also found. Like most of the previous reports, Pseudomonas species was predominant; this is also corroborated in this study. However, the antimicrobial result of the detected organisms differed compared to studies that were previously done. The isolates were found to be resistant to most common oral antibiotics used, such as Cefuroxime, Colistin, Cephradine, Ciprofloxacin, Ceftazidime, and Ceftriaxone which was alarming. The pathogens showed remarkable sensitivity against Gentamicin and Meropenem. This research needs further work for validating more reliability. This study is designed to provide information on pathogens which are isolated from wound suspected of wound infection hospital admitted patients in Bangladesh and their antibiotic susceptibility profile against locally available antibiotics which are frequently prescribed by the doctors to find a suitable antibiotic for wound infections.
10.18639/RABM.2020.9800004
Original Research Article
Oct 30, 2020
Processes and Practices of Medical Clinics in State Hospitals.
The study aimed to improve the service delivery of medical clinic in Base Hospital Dambadeniya in Sri Lanka by applying lean principles. Focus group discussions with patients and staff, key informant interviews with medical superintendent and consultant physician, survey of patient satisfaction using self-administered questionnaire, and process mapping were carried out to gather data at pre- and post-intervention stages. Long waits, congestion at clinic, and undue queuing at pharmacy had led to poor patient satisfaction and raised concerns in the staff. Application of lean management reduced waits and total requirement of staff and improved patient satisfaction in selected attributes.
10.18639/RABM.2020.1222516
Diabetes
Oct 28, 2020
Diabetes Mellitus
Visfatin is an adipocytokine that has been thought to play a role in the pathogenesis of insulin resistance. Clarifying the role of Visfatin along with its correlation to insulin resistance in Diabetes and Metabolic Syndrome (MS) patients would enhance our knowledge of this novel biomarker. It was a clinic-based cross-sectional study. Serum levels of Visfatin assessed randomly in 118 patients having diabetes, Pre- diabetes, or metabolic syndrome, attending OPD in our institute. Visfatin levels measured along with BMI (Body Mass Index), Blood Pressure (BP), Lipids, Glucose, Insulin, Hs-CRP (High Sensitivity C Reactive Peptide) levels, Homeostatic model assessment is a method for insulin resistance (HOMA-IR) indexes. One-way ANOVA and linear regression analysis were carried out using SPSS 23. Average Serum Visfatin (SV) levels were significantly different in MS (n=34, 9.50±8.22), Diabetic (n=43, 12.04±7.6) and Pre-Diabetic (n=41, 9.07±8.6) groups. SV shows a significant association with fasting blood sugar (p=0.009) and BMI (p=0.038) only in MS patients. Significant correlation not found between Visfatin and insulin resistance (p=0.173) in either of the 3 groups. In the present study, SV levels were not correlated with insulin resistance in metabolic, diabetic, and pre-diabetic patients but SV showed a significant association with fasting blood sugar and BMI in MS patients.
10.18639/RABM.2020.9800003
Microbiology and Immunology
Sep 29, 2020
Citrus Essential Oils’ Antibacterial Effects
Seven citrus essential oils (CEOs) and four terpenes were tested against eleven bacterial pathogenic strains isolated from food to evaluate the antimicrobial effects. All CEOs presented antibacterial activities. In particular, CEOs were very active against Staphylococcus Epidermidis, which was found to be the most sensitive toward all oils, showing high growth inhibition.
10.18639/RABM.2020.1135536
Original Research Article
Aug 24, 2020
Pre-Hospital Ambulance Service.
Ischemic heart disease is the leading cause of mortality that raised demand for pre-hospital emergency care in Sri Lanka. Understanding the performance of Sri Lanka's 1990 Suwa Seriya ambulance service is essential to improve its quality and to reduce morbidity and mortality associated with the disease. This study aims to describe socio-demographic characteristics and evaluate the clinical assessment and management process of patients presenting with acute chest pain of cardiac in origin. A descriptive study was conducted in Gampaha District of the Western Province of Sri Lanka. A total of 154 records of patients with acute chest pain who rang the 1990 call centre over a 3-month period were selected. Composite values for treatment and examinations as a percentage were plotted on run charts to assess the performance and its variations over the study period. About 47.4% of the study group were in 35–65 age group, 53.2% were males, and 81.8% had a typical presentation. The median for composite value for examination as a percentage was 89.5%, indicating substantial control and alignment with the reference package with normal cause variation. The median composite value for treatment as a percentage was 9.96%, a low value with normal cause variation. A good control of the processes of clinical examination and treatment is apparent. A higher median for composite value for examination as a percentage attributed to the formal training process of the ambulance staff. Although a low median was obtained for the composite value for treatment as a percentage, it was stable and pointed room for improvement.
10.18639/RABM.2020.1128039
Original Research Article
Aug 17, 2020
Integration of Patient Care Operations with Emergency Ambulance Service.
Integration in operations between 1990 Suwa Seriya ambulance service and A&E services of hospitals in Sri Lanka was assessed qualitatively using the Mini Focus Group Discussion (Mini-FGD) technique and applying a Likert scale survey. Agreed group-perceived satisfaction of the A&E staff was recorded based on identified thematic areas. The technique of patient handling, reliability of vital sign recording, providing random blood sugar reading, and professional relationship with hospital staff of Suwa Seriya emergency ambulance service were the thematic areas that recorded positive agreed group-perceived satisfaction indicating a potential to broaden integration process with the A&E operations of the country. Quality of providing clinical history, administration of medication, and awareness of A&E operations of emergency ambulance service indicated least agreed group-perceived satisfaction. Moreover, providing clinical notes and investigation records such as electrocardiogram, sharing feedback about the patient, prehospital triaging, and pre-alert system were found to be non-operational. The health-care policymakers of Sri Lanka should exploit the positives and explore the negatives of the A&E staff perception on 1990 Suwa Seriya ambulance service, focusing on widening the integration process.
10.18639/RABM.2020.1121418
Microbiology and Immunology
Jul 30, 2020
Antimicrobial Activity Of Some Plant Leaves’ Extracts Against Some Selected Bacterial Strains.
There is an alternative approach to control the infectious diseases caused by pathogenic bacteria, especially resistant bacteria. This study was designed to determine the antimicrobial activities of Kalanchoe blossfeldiana and Paederia foetida plants’ extracts against some selected bacterial strains. K. blossfeldiana and P. foetida leaves were extracted in methanol. In vitro antibacterial activities were evaluated against 12 bacterial strains including, Staphylococcus gallinarum, Staphylococcus sciuri, Streptococcus constellatus, Streptococcus iniae, Aeromonas diversa, Xanthomonas campestris, Xanthomonas axonopodis, Siccibacter colletis, Edwardsiella anguillarum, Aeromonas cavernicola, Enterobacter xiangfangensis, and Vibrio rotiferianus. Antimicrobial activities were screened by disk diffusion method. In addition, minimum inhibitory concentration (MIC) was determined using broth dilution method. Data were analyzed using SPSS 16 statistical software. In antimicrobial screening, both the plant extracts showed highest inhibition (15 mm zone diameter) against S. gallinarum at the concentration of 20 μg/disk and 15 μg/disk, respectively. In the MIC test, both K. blossfeldiana and P. foetida leaves’ extracts showed the lowest MIC value of 100 μg/ml on V. rotiferianus and S. iniae, respectively. From the above findings, it can be concluded that the extracts may be used as natural antibacterial agent for the treatment of some bacterial diseases. Further investigations on the chemical composition and possible isolation of active ingredients are warranted.
10.18639/RABM.2020.1117679
Microbiology and Immunology
Jun 27, 2020
Fosfomycin is an orally bioavailable bactericidal agent which concentrates significantly in urine and is being increasingly prescribed for patients with Multidrug Resistant Enterobacteriaceae (MDRE) urinary isolates. According to the Clinical and Laboratory Standards Institute (CLSI), disc diffusion (DD) and agar dilution (AD) are the standards for fosfomycin susceptibility testing for urinary Escherichia coli and Enterococcus faecalis isolates, whereas the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines suggest both AD and broth microdilu- tion (BD), but not DD. A prospective study was done in the Department of Microbiology in a tertiary care teaching hospital in Kolkata. MDRE urinary isolates that were resistant to oral and third-generation cephalosporins, either ciprofloxacin or levofloxacin and either of cotrimoxazole or nitrofurantoin were included in the study and tested further for fosfomycin. DD was carried out on Mueller-Hinton agar (MHA) supplemented with 25 µg/ml G6P with 50 and 200 µg discs. E-test was carried out on the same medium with drug concentrations ranging from 0.064 to 1024 µg/ml. Broth dilution was carried out on G6P supplemented Mueller Hinton broth with drug concentrations ranging from 0.25 to 1024 µg/ml. A total of 723 urine samples were obtained in a 2-month period, which yielded 79 Enterobacteriaceae, out of which 30 were MDRE. About 26 (86.67%) of these isolates were susceptible to fosfomycin by CLSI criteria and 25 (83.33%) by EUCAST criteria for minimum inhibitory concen- tration (MIC) by E-test and broth dilution. Only 4 (13.33%) were resistant to fosfomycin by DD. However, heteroresistant colonies were found among 21 (70%) isolates by E-test. None of these were picked up by DD or BD. The MIC of fosfomycin was between 0.25 and 512 µg/ml. These heteroresistant colonies when further subjected to E-test and BD showed resistance with MIC 512 µg/ml, depicting prevalence of heteroresist- ance. E-test can be used as a simple and effective screening method for identifying the fosfomycin heteroresistance and in turn changing the myth of the so high susceptibility rates among MDRE.
10.18639/RABM.2020.1116232
Original Research Article
Jun 12, 2020
Tooth extraction can cause 1.5-2 mm (vertical) and 40-50% (horizontal) alveolar bone resorption to occur for 6 months after extraction and will continue if it is not treated. Alveolar bone resorption will affect the retention, stability, and comfort in the use of dentures because adequate alve- olar bone volume and structure of alveolar ridge are very important to obtain optimal function and prosthetic reconstruction. Currently, there are techniques and materials that can be used to minimize bone resorption. Preservation of alveolar ridges with crab shell-based hydroxyapatite can minimize bone resorption because it has good biocompatibility, osteoconduction, and osteoinduction. The aim of this study is to prove the effectiveness of hydroxyapatite from crab shells in increasing the area of bone trabeculae, transforming growth factor-beta 1(TGF-β1), and alkaline phosphatase (ALP). This laboratory research is an experimental laboratory work with a post-test group design. Crab shell-based hydroxyapatite gel (Portunus pelagicus) was given after the post-tooth socket extraction of the left lower central incisor of Wistar rats, observ- ing the area of trabeculae, TGF-β1, and ALP on the 14th day and 28th day. Hydroxyapatite is made from the calcination process of crab shells using a furnace at 1000°C for 2 h followed by sifting to powder. The powder is added with carrageenan and distilled water so that it becomes a gel preparation. The results of this study were analyzed using the One-way ANOVA test with IBM SPSS version 20. The area of trabeculae, TGF-β1, and ALP between the control group and the treatment group showed p<0.05, which means there were significant differences between the groups. The study showed that hydroxyapatite from the crab shell (P. pelagicus) can increase the area of trabeculae, TGF-β1, and ALP in the post-extraction socket of Wistar rat’s teeth.
10.18639/RABM.2020.1111504
Original Research Article
Jun 12, 2020
There is limited data describing management of older Australians with inflammatory bowel disease (IBD). The prevalence of IBD in the elderly is increasing due to an aging population and increasing overall incidence, which presents challenges in management due to comorbidities and polypharmacy. The aim of the study was to describe demographic and clinical characteristics, and management of IBD in older patients. Around 100 consecutive patients (n = 100) aged above 60 years and attending the IBD outpatient clinic of Fiona Stanley Hospital from January 2019 were selected. Demographic and clinical information were compiled from the digital medical record. Around 59 patients had Crohn’s disease (CD), 39 had ulcerative colitis (UC) and 2 unclassified IBD (IBD-U). Around 75% of patients had a Montreal classification recorded, which is a recommended standard of care. For both CD and UC, no patients had onset of symptoms <17 years old, and the majority had symptom onset after 40 years of age (CD—56%, UC—52%). Around 39% of CD patients had undergone at least one surgery, and 5% a second operation. No UC patients had undergone surgery. 5’Aminosalicylates (59%), antitumor necrosis factor alpha (33%), thiopurines (22%), and vedolizumab (11%) were the most common current treatments. Around 9% of patients were currently taking steroids while 36% had previously taken cor- ticosteroids. Immunosuppressive events were recorded, if they occurred, after treatment with steroids, immunomodulatory or biologic agents. Two patients had melanoma, 12 nonmelanoma skin cancer, 3 solid organ tumors (2 prostate adenocarcinoma and 1 bladder transitional cell carcinoma), 3 latent tuberculosis, 1 myelodysplasia, and 1 septic arthritis. Around 14% of the patients had osteoporosis or osteopenia; 43% of these had prior corticosteroid exposure; however, there was a low rate of bone densitometry. Most patients both with CD and UC were diagnosed over 40. Biologics were the most common treatment category in keeping with the aim of achieving deep remission.
10.18639/RABM.2020.1110414
Case Report
May 28, 2020
The use of artemisinin derivatives has become the mainstay in the treatment of both severe and uncomplicated falciparum malaria. The available report suggests that the derivatives are safe and well tolerated in most patients, with only a few cases of severe adverse drug reactions to some of these derivatives. In the present report, a 30-year-old breastfeeding mother and a resident of Ekpoma, Edo State, Nigeria, who on presenta- tion was diagnosed with severe malaria, developed pruritus 4–6 h after receiving the first dose (150 mg) of intramuscular αβ-arteether. This condition became more intense with widespread pruritic rash and extensive erythematous eruptions and excoriating skin lesions following the second dose of the drug. However, the administration of the drug was discontinued on the third day with the eruptive lesions abating following the administration of antihistamines and steroids (loratadine and prednisolone) for 5 days. In conclusion, the clinical manifestation shows the case of an αβ-arteether-induced dermatitis secondary to an immediate hypersensitivity reaction, which is a rare occurrence with the drug. The adverse drug reaction to this agent also emphasizes the need for postmarketing surveillance and monitoring of most artemisinins, particularly in sub-Saharan Africa where they are being increasingly used for the treatment of malaria.
10.18639/RABM.2020.1109565
Original Research Article
May 18, 2020
Extended average length of stay (ALOS) leads to increased hospital expenditure. Prioritization of emergency endoscopies over routine elective procedures results in delay and adds on to patients’ ALOS at tertiary hospitals. The gastroenterology department of Fiona Stanley Hospital aimed a service improvement project to shorten the ALOS of inpatients by implementing a new quarantined booking and proce- dural system allowing elective access to endoscopic procedures. An additional endoscopy list (quarantine list) was implemented with full participation of the stakeholders once a month for a 3-month trial period for inpatients by moving resources from a nearby satellite service. A comparison of the ALOS of patients before and after realizing the preceding intervention was carried out using the time and date infor- mation obtained from the theater management and the e-referral system of all routine inpatients with a valid e-referral for gastroscopy or colonoscopy. Upper gastrointestinal endoscopies comprised over two-thirds of the inpatient scopes performed. The ALOS and average time spent for referral improved by 1.09 and 1.97 days, respectively. The ALOS reduced by over 1 day, and improvement was noticed in the prereferral segment. Postreferral efficiency did not improve, and undertaking further analysis to determine the root causes for the continual delay is recommended.
10.18639/RABM.2020.1110185
Cancer and Oncology
Apr 30, 2020
The objective of this study was to analyze the molecular characteristics of the podophyllotoxins and its derivatives with the metabolic enzymes and regulate the designing of therapeutic mechanism against malignant cells. One such inhibitor is podophyllotoxin with anticancer activity because of the capability to stop the metabolic enzymes. In this study, we undertook the in silico analysis with respect to molecular docking podophyllotoxin and its derivatives using the Patchdock server. Moreover, drug likeness of podophyllotoxin, etoposide, and teniposide was investigated using Lipinski filter and SwissADME. According to the molecular docking score, podophyllotoxin indicated that both derivatives (especially teniposide) showed a good binding affinity toward selected protein receptors.
10.18639/RABM.2020.1101035
Original Research Article
Apr 30, 2020
The effect of the Albutrisan-NR substrate on the differentiation of the primary brain culture of aging rats and on the culture of the rabbit vibrissa dermal papilla was studied. The substance is a hydrolysate of fish tissue with a molecular weight of up to 5 kDa. It was found that adding 2% of the substance to the culture medium stimulates the growth and differentiation processes in rat brain cells. The possibility of using the substance as a growth factor for 3D cultivation of pluripotent dermal papilla cells and maintaining an uncommitted state was demonstrated. The use of Albutrisan-NR as a trophic factor in neuronal induction of dermal papilla cells was also shown.
