Journal of the Asian Medical Students Association
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Unrooting the Potential of Intranasal Administration of Curcumin as a Novel Asthma Controller by Alleviating Airway Inflammation
Get PDFAsthma is a chronic disease where air passage of the lung is inflamed and swollen. It is among major non-communicable diseases (NCDs) with more than 339 million sufferers and affects patients’ quality of life. Some drugs are currently used to control asthma symptoms, but it has its own economic burden. The aim of this literature review is to assess the potential use of curcumin to control asthma, as curcumin is cheaper and widely available in Indonesia. A total of eight literature was acquired after searching through Pubmed, Clinical Key, Scopus, Science Direct, Proquest, and Wiley Online databases with keywords including “intranasal”, “curcumin”, “asthma”, “inflammation”, and “airway”. Since inflammation is the most featured phenomenon in asthmatics that may lead to airway obstruction, it is important to lessen airway inflammation and thus control asthma. This mechanism can be seen in administration of curcumin, which although having a wide array of interaction with pathways, showcased to have anti-inflammatory effect which is beneficial in asthma. The anti-inflammatory effect of curcumin also negates other pathologic events relevant in asthma and appears to be preventive if administered before exacerbation. Intranasal administration displayed to be the most efficacious in asthma model, bested the efficacy of standard drugs. Lastly, no toxicity was observed by included studies
Effectiveness of the Alarm System Policy on Reducing Ambulance Response Time in prehospital Emergency Patients care
Get PDFIntroduction: Reduction of ambulance response time leads to an increase in positive patient outcomes. In hopes to meet an 8-minute response time guideline for patients with code red, Maharaj Nakorn Chiang Mai Hospital introduced an alarm system policy on 1 November 2017 to decrease turnout time which is a part of response time.
Objective: To determine whether the response time accomplished within 8 minutes would be increased after the introduction of the alarm system policy. Following this, the determination of whether the mortality rate in 24 hours and the mortality rate in the emergency room would be decreased after the introduction of the alarm system policy.
Method: An interrupted time series was conducted in collection of code red patients between 1 November 2015 to 31 October 2019. Data was collected from the medical records of Maharaj Nakorn Chiang Mai Hospital. The time-period for the collected data was separated into the following: pre-protocol period (1 November 2015 to 31 October 2017) and post-protocol period (1 November 2017 to 31 October 2019).
Result: A total of 552 patients was included in the overall analysis. Success rate of response time within 8 minutes of patient with code red in pre-protocol period and post-protocol period was 64.62% and 73.11% respectively, where it was founded that success rate was significantly higher (adjusted odd ratio = 1.627, 95% CI: [1.017, 2.602]; P < 0.05) in post-protocol. A decrease in mortality rate in 24 hours and mortality rate in the emergency room was observed post-protocol from the segmented regression model. However, no significant difference was evident through the process of statistical analysis.
Conclusion: The outcome of this simple alarm system indicates that implementation of the protocol could significantly reduce response time, achieving the 8-minute goal. Therefore, this protocol will promote better emergency service in pre-hospital care
Evaluating Elderly-Specific Triage Tools in a Pre-hospital Setting: A Systematic Review (Resubmission 2)
No full textAbstract
Title:
Evaluating Elderly-Specific Triage Tools in a Pre-hospital Setting: A Systematic Review
Introduction:
An aging global population results in significant changes in the demographic of major trauma patients. Despite this, current triage protocols in the United Kingdom do not include geriatric-specific parameters, leading to under-triage amongst the elderly population.
Objective:The aim of this review is to analyse the quality of elderly-focused triage systems implemented worldwide and interpret findings in the context of the United Kingdom.
Primary outcome: sensitivity and specificity of the triage tool.
Secondary outcome: percent change in-hospital mortality after elderly-specific tool implementation.
Methods:
Literature search from Pubmed and Imperial databases were used to identify primary research into Geriatric Trauma and the triage tools. PRISMA criteria was used to narrow down papers. Studies were appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 and the Quality Assessment Tool for Quantitative Studies accordingly by two independent reviewers. Results from the studies were evaluated using narrative synthesis.
Results:
For the primary outcome, all 7 studies demonstrated an increase in sensitivity when compared to the non-specific protocol (17% to 160% increase). Sensitivity ranged from 13% to 96%. Only one tool met the American College of Surgeons Committee on Trauma (ACS-COT) sensitivity target (95%). All elderly-focused tools demonstrated a decrease in specificity (6.1% to 81% decrease). Specificity ranged from 17% to 93%. Three criteria met the ACS-COT specificity target (75%).
No tools met the ACS-COT targets for sensitivity and specificities simultaneously.
For the secondary outcome, 4 studies showed a percentage decrease in mortality ranging from -10.9% to -32.9%.
Conclusion:
Despite an improvement in sensitivity of geriatric-focused triage tools, their overall diagnostic efficacy in identifying elderly trauma needs remains inadequate. Elderly-focused triage correlated with decreased mortality rates in older adults but the extent in which triage tools affected mortality was unquantified
COVID-19 personal and perceived stigma as predictors of autonomy and relatedness need satisfaction in Hong Kong’s university students
Get PDFIntroduction
Under self-determination theory, need satisfaction leads to psychological well-being, whereas their frustration leads to ill-being. This research explores COVID-19 personal and perceived stigma as predictors of autonomy and relatedness need satisfaction in Hong Kong university students. Personal stigma refers to one’s attitudes and treatment of a stigmatized group. Perceived stigma refers to what one believes are their community’s attitudes and treatment of the same.
Significance
The unprecedented nature of COVID-19 makes it unclear how existing theory translates to COVID-19 stigma. Our research addresses this by showing COVID-19 perceived stigma predicts worsened relatedness satisfaction, which opens implications of its effects on psychological well-being.
Methods
102 university students in Hong Kong recruited in November to answer an online questionnaire. Inclusion criteria include being students in a higher education institution in Hong Kong, at least 18 years of age, residency in Hong Kong, and no prior history of mental illness.
Results
High COVID-19 perceived stigma is associated with worse sense of relatedness adjusted for after adjusting for confounders (β=-1.17, p=0.017). COVID-19 fear is associated with both increased COVID-19 personal stigma (β=1.26, p<0.001) and perceived stigma (β=0.70, p-value=0.009). Personally, knowing someone who was diagnosed with COVID-19 has no association with either decreased COVID-19 personal stigma (β=0.99, p-value=0.355) or perceived stigma (β=0.65, p=0.387).
Conclusion
COVID-19 perceived stigma warrants attention as a predictor of decreased relatedness need satisfaction. Consistent with existing theory on health-related stigma, fear is a factor associated with increased COVID-19 stigma, and should be considered as a target for stigma-reduction interventions
First Trimester Glycated Hemoglobin (HBA1C) Level as a Novel Predictor of Gestational Diabetes Mellitus: a Systematic Review and Meta-Analysis
Get PDFIntroduction: Gestational diabetes mellitus (GDM) is a severe yet neglected threat to maternal and child health, due to its association with multiple adverse pregnancy outcomes. glycated hemoglobin (HbA1c) level is one of the most promising predictor of GDM in early pregnancy based on several cohort studies done recently.
Purpose of study: This systematic review and meta-analysis aims to evaluate the potency of HbA1c level in first trimester as a novel predictor of GDM.
Methods: This review selects cohort studies found by database searching systematically using previously determined inclusion, such as pregnant woman as the subject, assess Hb1Ac level in the first trimester, and assess odds ratio towards (GDM), and exclusion criteria such as assess outcome at postpartum, not assess GDM outcomes, and studies written in languages other than English or Bahasa Indonesia. This review was arranged based on PRISMA guideline.
Results and Discussion: This review included seven cohort studies with the pooled OR of 4.36 [95%CI: 3.66-5.20]. Quantitative analysis shows that HbA1c level in the first trimester is a significant risk factor of GDM development (p<0.00001). However, heterogeneity analyses revealed substantial heterogeneity are detected in the pooled studies. Therefore, to understand the significance of HbA1c level and the development of GDM, further studies are needed.
Conclusion: This study has proven the potency of first trimester HbA1c level as a novel predictor of gestational diabetes mellitus. Thus, it is necessary to integrate the use of HbA1c level screening as part of antenatal care in the first trimester of pregnancy
Doctor Helicopter as a Solution to Reducing the Mortality Rate of Emergency Trauma Patients
Get PDFA. Introduction
Dr. Helicopter is a helicopter with medical personnel on board and used exclusively for emergency patient care and transport. Transferring trauma patient to adequate trauma center is critical for patient’s survival. The death rate of preventable trauma patients in Korea stood at 35.2% as of 2010, which is higher than the figure of 15% in advanced emergency medical countries. We would like to suggest the activation of Dr. Helicopters as a solution to increase patient survival.
B. Objective
Through analysis and interpretation of the paper, we are going to reveal that Dr. Helicopters help increase patient survival.
C. Method
List of papers and journals that we have analyzed.
C-1. Gang Gyeongguk(2015), 「Association between helicopter versus ground emergency medical service in inter-hospital transport of trauma patients」, Journal of trauma and injury, 28(3)
C-2. Kim Taeyeon(2018), 「Effectiveness of the trauma team-staffed helicopter emergency medical service」, Health policy and management, 28(4), 411-422
D. Result
Helicopters are more efficient than ambulances.
Result of ‘method C-1’ shows that mortality rate for patients transported by ambulance and helicopter may not differ significantly. However, since the severity of patients transported by helicopter is worse than that of ambulances, and because helicopters have faster access to more diverse areas than ambulances, one can conclude that helicopters are more efficient than ambulances.
Trauma team-staffed helicopters are more efficient than paramedics.
According to ‘method C-2’, transport team made up of paramedic (119-HEMS) and trauma team involving physician (TTS-HEMS) shows significant difference. Although the severity of patient was higher in TTS-HEMS, it performed more first aid and had lower risk of patient death.
E. Conclusion
Result shows that trauma team-staffed helicopters can effectively increase patient survival. Therefore, Dr. Helicopters equipped with medical equipment should be more activated to transport trauma patients
Exploring the Generational Cognition Differences of Traditional Chinese Medicine and the Impact of Information Communication Media in Taiwan
Get PDFIntroduction
Traditional Chinese Medicine (TCM) has become popular in Taiwan, while there are some differences of recognition existing between generations. Studies showed that different generational groups had unequal thoughts toward TCM. Therefore, such diverse understandings might lead to misinformation. Generally, the media have such a huge impact on health communication in modifying the knowledge towards different medical topics.
Significance
Therefore, studying how communication technology influences the information dissemination of TCM allows us to look into the possible causes of diverse understandings.
Methods
To investigate how differently information sources influence generational recognition, we designed a questionnaire on Google form and collected responses from LINE, Facebook and Instagram. Later, we cross-analyzed the information.
Results
According to our research, generational TCM recognition differences exist, and younger generations have a more decentralized and divergent opinion to the same TCM issue. Communication media do influence the generational recognition of medical information, especially media and relatives, and it is important that the society builds up adequate self-awareness of medical information.
Conclusion
To sum up, we can enhance the dissemination rate of information to improve the TCM-related recognition, while we can also ask professionals and experts to clarify the TCM misunderstandings and make health education about TCM. The behavior will be able to construct a better environment for information recipients, and bridge the recognition gap between different generations
Pathomorphological Changes In The Lungs Of COVID-19 Patients
Get PDFIn December 2019, a novel virus was discovered in China causing severe acute respiratory distress syndrome and the virus was designated as SARS-CoV-2 [1]. On 11th March 2020, the Corona Virus (SARS-CoV-2) was declared a pandemic by World Health Organization (WHO) [2]. Millions of people worldwide have been affected by this virus [3]. Most of the patients shows mild symptoms. Severe cases lead to the death of patients due to severe respiratory failure. Multiple organ failure has been seen in many patients suffering from COVID-1
Region Specific Prophylactic Antibiotic Regimen: Reducing Post Traumatic Septic Mortalit
Get PDFIntroduction: The sequelae of trauma are not only associated with acute organ damage but also chronic secondary complications due to wound and surgical site infection which might lead to sepsis accounting for 19.5-23%. post-traumatic mortality (1,2) Since, timely administration of prophylactic antibiotics can prevent sepsis, it can be used to reduce delayed deaths in trauma patients decreasing the burden on healthcare systems.
Methods: Scientific databases PubMed, Cochrane, ClinicalTrials.Gov and Google Scholar were thoroughly searched to gather necessary information to understand the problem and gather relevant scientific evidence. Clinical Microbiologists and Internal Medicine Physicians were consulted for a comprehensive discussion to formulate solutions to the problem.
Findings: We found that in septic patients ICU (21.8 days) and hospital stay (34.1 days) was significantly prolonged as compared to non-septic (4.7 days; p<.001 and 7.0 days, p<.001) patients increasing the utilization of critical care resources as well as significantly increasing mortality (23.1% vs. 7.6%, p<.001). (1) Regional heterogeneity was observed in the prevalence and resistance patterns of causative organisms. For instance in China, Malaysia and Hong Kong the incidence of Klebsiella sepsis is higher exhibiting 47%, 37% and 32% resistant to Cephalosporins, Gentamicin or both respectively while in India, 38.14% and 7-65% of MRSA and MBL producing organisms are most prevalent. (3,4)
Solutions: We propose a comprehensive strategic plan, involving thorough epidemiological studies with biotyping and antimicrobial susceptibility testing of the prevalent organisms identified from post-trauma sepsis patients. Thereafter, formulation of region specific antibiotic regimens is suggested whose efficiency must be analysed through clinical trials.
Conclusion: Post traumatic sepsis needs strategic management with involvement of all stakeholders. Devising effective region-specific regimens for prophylactic antibiotics based on geographical distribution and resistance patterns of organisms can help to decrease the mortality caused by sepsis in trauma patients. 
Surgical Outcomes of Ureteroneocystostomy and Ureteroureterostomy in Treating Iatrogenic Ureteral Trauma: a Meta-Analysis
Get PDFIntroduction: Ureters are highly susceptible to iatrogenic injury, due to their proximity to vital abdominal and pelvic organs. Ureteral traumas are rare, and only account for 1-2.5% of all urogenital injuries. However, various ureteral injuries can occur during gynecologic, colorectal, and urologic operations, 75% of which are iatrogenic. Ureteral trauma is usually detected later because of its asymptomatic nature in early stages or misclassification as a general clinical condition post-surgery. In the case of delayed detection of iatrogenic ureteral injury, the timing of the operation and correction method should be decided in consideration of the location and extent of the injury along with the type of previous surgery.
Objective: The objective of this study is to compare the outcomes of ureteroureterostomy and ureteroneocystostomy in iatrogenic ureteral trauma management.
Method: We compared studies involving the treatment of iatrogenic ureteral injuries using ureteroureterostomy and ureteroneocystostomy conducted between 2012 and 2021. Retrospective studies were chosen through literature searches on PubMed and Google Scholar. Data were analyzed using packages “meta” and “metasens” in R.
Result: A total of 309 patients participated in 6 studies from 2012 to 2021. 126 underwent ureteroureterostomy, and 183 underwent ureteroneocystostomy. 152 out of 183 (83%) with ureteroneocystostomy and 88 out of 126 (70%) with ureteroureterostomy resolved without any complications. Neither technique seemed to be associated with major complications. Ureteroneocystostomy was associated with fewer complications than ureteroureterostomy (RR=0.90), although the result was not statistically significant (95% CI=0.76-1.07, p-value=0.08).
Conclusion: Iatrogenic ureteral trauma is a major issue in surgical procedures and the surgical method should be chosen according to the factors outlined above. Results showed that ureteroureterostomy and ureteroneocystostomy were both efficient techniques utilized in treatment of iatrogenic ureteral trauma, and there was no statistically significant difference in the outcome of the two techniques