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.
10.18639/RABM.2020.1110909
Diabetes
Apr 30, 2020
This study was undertaken to assess the thyroid profile of diabetes mellitus (DM) patients and patients with some associated complications in the Edo state, Nigeria. Blood samples from 267 subjects, consisting of 164 diabetic patients (24 type 1 DM and 140 type 2 DM) and 103 nondia- betic apparently healthy individuals (as controls), were analyzed. The thyroid stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) levels were determined using the enzyme linked immunosorbent assay (ELISA). From the result obtained, the T3 level was found signifi- cantly (p < 0.05) higher in diabetic-nephropathy (D-NEPHR) patients than the control subjects, while the TSH and T4 levels of D-NEPHR were insignificantly (p > 0.05) higher than those of the control group. The mean TSH level was significantly (p < 0.05) lower in diabetic hypertensive patients when compared with the control group, while the plasma T3 level was significantly (p < 0.05) higher in diabetic hypertensive patients when compared with the control group. There was no significant difference (p > 0.05) in the mean value of T4 of diabetic hypertensive patients when compared with the control subjects. The mean plasma T3 and T4 were significantly (p < 0.05) higher in diabetic neuropathy (D-NEUR) patients than those of control subjects. There were no significant (p > 0.05) differences in the mean plasma TSH level of D-NEUR patients when compared with those of control subjects. The mean plasma T3and T4 levels of diabetic patients with coronary heart disease (DM-CHD) were significantly (p < 0.05) higher than those of control subjects while the mean plasma TSH level of DM-CHD was significantly (p < 0.05) lower than that of control subjects. No significant (p > 0.05) difference in the mean plasma TSH, T4, and T3 levels of diabetic retinopathy subjects when compared with those of control subjects was obtained.
10.18639/RABM.2020.980000
Toxicology and Pharmacology
Mar 30, 2020
Toxicity studies of methamidophos on the physiological aspects of mammalian organs are limited in the literature. This study aimed to assess hepatic and renal functions in response to a sublethal dose of methamidophos in male domestic rabbits. A daily dose of 1/10 LD50 metha- midophos was given orally to rabbits for 6 weeks. Control animals were given distilled water. Blood samples were collected and analyzed weekly. Serum glucose and bilirubin were increased upon methamidophos intake versus control, with the significant change commenced from the second and fifth weeks, respectively. In general, alanine aminotransferase, aspartate aminotransferase, g-glutamyl transferase, and alkaline phosphatase showed significant elevation throughout the whole experiment. Conversely, cholinesterase was significantly inhibited all over the experimental intervals studied. Serum urea and creatinine showed a significant increase whereas total protein, albumin, and globulin exhibited a significant decrease during the last five weeks of the experiment. Hypocalcemia and hyperphosphatemia were also observed in methamidophos- treated rabbits. Methamidophos exposure at a sublethal dose had a potential toxic effect on liver and kidney functions as indicated by significant alterations in their biomarkers. Such findings can then be extrapolated to human beings to assess the potential hazards in human populations due to methamidophos exposure.
10.18639/RABM.2020.972504
Original Research Article
Mar 30, 2020
Malaysia has high prevalence of obesity in young adults. Obesity leads to health problems such as obstructive sleep apnea (OSA). It is a condition where nocturnal breathing cessation occurs during sleep. Thus, the quantity and quality of sleep is affected. Epworth Sleepiness Score (ESS) is a standardized tool to determine the quality of sleep. The aim of this study was to find the relationship between students’ sleep quality using this questionnaire and their anthropometric measurements. This study adopted a cross-sectional study design, with the convenience sampling technique applied on students of a private university in Malaysia. The participants answered the ESS questionnaire. Their height, weight, neck circumference, and abdominal circumference were obtained and the body mass index (BMI) was calculated. This study was conducted on 200 students with a mean age of 21.55 years. Their average BMI was 23.24 +/- 6.1. The mean duration of sleep in the study population was 6.3 +/- 1.4 SD hours. In the study population, the mean score for ESS was 10.32. A negative correlation between ESS scores and the BMI was noted. Pearson correlation showed —0.026 with a significance of 0.712. ESS scores showed that 17.9% of the study population had high risk of developing OSA. This study shows that as the BMI increases, the quality of sleep decreases, although it is not statistically significant.
10.18639/RABM.2020.958557
Microbiology and Immunology
Feb 20, 2020
Helicobacter pylori has been associated with peptic ulcer and gastric carcinoma. This study aimed to find the seroprevalence of H. pylori infection in some male students of Jazan University, Saudi Arabia. Twenty students were enrolled in the study (n 5 20). Informed consent was obtained from the students. About 2 ml blood was collected intravenously in Improvacuter® evacuated blood collection tubes. The blood was allowed to clot at room temperature. The serum was collected and stored at 2208C for further use. The separated serum was used to detect IgG and IgM antibodies by Enzyme Linked Immunosorbent Assay (ELISA) against H. pylori for the in vitro diagnosis. A total of 11 (55.00%) students tested positive for IgG antibodies against H. pylori indicating previous infection. All the samples tested negative for IgM antibodies against H. pylori indicating no active infection. The seroprevalance of IgG antibodies against H. pylori was found to be very high in some male university students and is a cause of concern regarding their health. Obesity (p < 0.05; Value statistically significant), stress and bad eating habits, eating out, drinking carbonated beverages, and eating spicy food were some of the factors found to be associated with IgG seropositive students. The students were counseled and were instructed to undergo a confirmatory test and get medical intervention. Further large-scale studies need to be performed to plan action against this disease causing organism and to improve the health of students.
10.18639/RABM.2020.960446
Review Article
Feb 15, 2020
Marjolin’s ulcer is a rare malignancy found in nonhealing chronic wounds, with burn injury as the most common predisposing factor. It is an aggressive malignancy that has a long latency period, and it is diagnosed through clinical findings, histopathology, and imaging modalities. Prompt surgical treatment and proper burn wound care strategies are key to prevent further complications and increase in mortality.
10.18639/RABM.2020.964046
HIV and AIDS
Feb 14, 2020
There is growing evidence indicating that drug-resistant bacteria notably Extended spectrum β-lactamases producing Enterobacteria are greatly implicated in immunocompromised groups namely HIV-infected patients. Little is known about the burden of ESPL-E in places where HIV infec- tion is rampant. Therefore, the study was aimed to assess the prevalence, antimicrobial resistance pattern of ESPL-E among HIV/AIDS patients. A cross-sectional study was conducted among HIV/AIDS patients seeking Antiretroviral Treatment (ART) service at the University of Gondar Hospital from February–May, 2017. The pretested and -structured questionnaire was used to collect data on sociodemographic and clinical- related factors. Clean catch midstream urine samples were collected and cultured in line with standard procedures. The drug susceptibility testing was performed by Kirby Bauer disc diffusion method. Extended-spectrum β-lactamase (ESBL) detection was performed using a double- disc synergy test and combined disc methods. Data entry and analysis were performed using SPSS version 20. Among a total of 387 HIV/AIDS patients, 42 (10.9%) Enterobacteria uropathogens were identified. Among these isolates, nine (21.4%) were ESBL producers. The highest preva- lence of ESBL production was Escherichia coli (44.4%) followed by Klebsiella pneumoniae (22.2%) and Enterobacter spp. (22.2%). Higher drug resistance rates were observed among ESBL-producing isolates compared to ESBL-nonproducing isolates. Amox-clavulanic (100%), ampicillin (95%), cotrimoxazole (74%), cefotaxime (88.9%), and ceftazidime (88.9%) had high resistance rates to Extended spectrum β-lactamases pro- ducing Enterobacteria. The overall prevalence of multidrug resistance of all isolates was 92.9%, and all the ESBL isolates were multidrug resistant. Therefore, antimicrobial stewardship programs needed to be promoted for the rational use of drugs especially in the management of HIV/AIDS patients.
