Inhibitory effects of various ayurvedic and Panamanian medicinal plants on the infection of herpes simplex virus-1 in vitro and in vivo

Extracts of 40 Ayurvedic medicines and 39 Panamanian medicinal plants were screened for their inhibitory activity on the plaque formation of herpes simplex virus type 1 (HSV-1) in cultured cells. The extracts of 11 plant species showed potent inhibitory activity at a concentration of 100 μg/mL, while those of ten species showed moderate activities. Repeated oral administration of each extract of Rhus acuminata (galls), Saraca indica (bark), Strychnos potatrum (seeds) appreciably suppressed the development of typical skin lesions induced by infection of HSV-1 in BALB/c mice. The extract of S. potatrum prolonged both development of skin lesion and mean survival time. This indicates that S. potatrum is a possible candidate for therapeutic application for HSV-1 infection.     

Solitary duodenal hamartomatous polyp with malignant transformation: Report of a case

A solitary duodenal hamartomatous polyp is rare and it is considered to be either a variant of Peutz-Jeghers syndrome (PJS) or a separate entity. Patients do not have cutaneous manifestations and have only one hamartomatous polyp. The presentation is nonspecific and it resembles common conditions, such as a peptic ulcer disease. Most are incidentally diagnosed during endoscopy for other indications. Malignant transformation has been reported. This report describes the case of a 46-year-old man who presented with chronic intermittent abdominal pain. The initial endoscopy showed an abnormal twisting of the duodenum with a dilated duodenum. He was later diagnosed to have a solitary duodenal hamartomatous polyp with malignant transformation, which was treated by surgery. A review of the literature on the pertinent cases of this type of lesion is also presented.     

Cardiovascular risk levels in general practice patients with type 2 diabetes in rural and urban areas

OBJECTIVE: To investigate the change of cardiovascular risk factor from 2000 to 2002 in general practice patients with type 2 diabetes in urban and rural areas, and the association between cardiovascular risk (both single risk factors and coronary heart disease absolute risk (CHDAR)) and rurality in three years. METHODS: In total, 6305 patients were extracted from 16 Divisions (250 practices). Multivariate regression at Division, practice and patient levels was conducted with adjustment for age and gender. RESULTS: In each of the three years, most single individual risk factors and CHDAR were high. Comparing 2002 with 2000: for urban patients in 2002 total cholesterol (OR 0.85) and low-density lipoprotein (OR 0.81) significantly decreased, and high-density lipoprotein (HDL) (OR 1.16) significantly increased; for rural patients in 2002 HbA1c (OR 0.85) significantly decreased and HDL (OR 1.22) significantly increased; and CHDAR significantly improved only in urban patients (OR 0.93) in 2002. In 2002 rural patients were still more likely to be overweight/obese (OR 1.16), be current smokers (OR 1.36), and have worse HDL (OR 0.84) and triglycerides (OR 1.23) than their urban counterparts. CONCLUSION: Some key individual risk factors and CHDAR did not improve in rural patients with type 2 diabetes despite a number of programs designed to provide comprehensive care to rural patients with diabetes. More emphasis is needed on supporting access to lifestyle changes (such as smoking, diet and physical activity) in rural primary health care.     

Diverticular Disease and Colorectal Neoplasms: Association between Left Sided Diverticular Disease with Colorectal Cancers and Right Sided with Colonic Polyps

Background: Both colorectal cancer (CRC) and diverticular disease (DD) are common in the affluent West, and their prevalence is also increasing in the rest of the world with economic development. Both diseases have common epidemiologic characteristics; increasing incidence, more common with advancing age and related to specific dietary changes. However, studies of associations between the two have generated mixed results with some showing positive correlations, whilst others have shown no or negative links. Most of these studies have been from the West with study populations that were predominantly Caucasians. Here the focus was on DD and colorectal neoplasms, including CRC, in Brunei. Materials and Methods: All patients who had undergone complete colonoscopy between 2011 and 2014 were identified and retrospectively reviewed. Patients under the age of 18 years old or had previous colonic surgeries (including previous CRC resection) were excluded. Results: The total number of colonoscopies included in the study was 2,766 (mean age 53.214.8 years old, male 51.8%), of which DD, CRC and colonic polyps were detected in 17.3%, 4.7% and 28.2% respectively. The proportions of DD, polyps and CRC increased proportionally with age ( < 30 years, 30-49, 50-69 and 70). Overall, there was no association between the presence of DD and CRC (3.6% vs. 5.0%, p=0.179) but there was a significant association between CRC and left sided DD (p=0.034 by trend). There were also a significant association between presence of DD and polyps (36.1% vs. 28.2%, p=0.001), in particular with right-sided and pan-DD (p=0.001 for trend). Conclusions: Our study showed that the prevalence of DD, CRC and polyps increases with age. There were significant associations between presence of left-sided DD with CRC and right-sided or pan-DD with colonic polyps. This suggests shared risk factors. Further studies are required to assess links in other countries of the Asian Pacific region.     

Chronically ill Australians' satisfaction with accessibility and patient-centredness

Objective. To evaluate the association of characteristics of patients andgeneral practices with patient assessment of quality of care. Design. Cross-sectional multi-practice study using the general practiceassessment survey. Settings. General practices in Australia. Participants. Ninety-six general practices and 7505 chronic illness patientsaged 18 years. Main outcome measures. Access of care and patient-centredness. Results. Two factors were identified in factor analysis: ‘Accessof care’ and ‘Patient-centredness’. Multilevelregression analysis showed significant associations betweenpatients' assessments and patient and practice characteristics.Patients from smaller practices (one to three general practitioners)reported better access to care compared with larger practices.Patients from urban areas were more satisfied with patient-centrednessthan those from rural areas. Self-reported health status andage had a positive and home ownership, employment and education,and patients from non-English-speaking countries a negativerelationship with both scores. Females were more satisfied withpatient-centredness. Conclusions. Patient assessments of quality of care and patient-centrednesswere strongly associated with practice and patient characteristics.This has important implications for interpreting assessmentsof the quality of primary care, and for policy and practicemeasures designed to improve this.     

Predictors of primary care referrals to a vascular disease prevention lifestyle program among participants in a cluster randomised trial

Background

Cardiovascular disease accounts for a large burden of disease, but is amenable to prevention through lifestyle modification. This paper examines patient and practice predictors of referral to a lifestyle modification program (LMP) offered as part of a cluster randomised controlled trial (RCT) of prevention of vascular disease in primary care.

Methods

Data from the intervention arm of a cluster RCT which recruited 36 practices through two rural and three urban primary care organisations were used. In each practice, 160 eligible high risk patients were invited to participate. Practices were randomly allocated to intervention or control groups. Intervention practice staff were trained in screening, motivational interviewing and counselling and encouraged to refer high risk patients to a LMP involving individual and group sessions. Data include patient surveys; clinical audit; practice survey on capacity for preventive care; referral records from the LMP. Predictors of referral were examined using multi-level logistic regression modelling after adjustment for confounding factors.

Results

Of 301 eligible patients, 190 (63.1%) were referred to the LMP. Independent predictors of referral were baseline BMI ≥ 25 (OR 2.87 95%CI:1.10, 7.47), physical inactivity (OR 2.90 95%CI:1.36,6.14), contemplation/preparation/action stage of change for physical activity (OR 2.75 95%CI:1.07, 7.03), rural location (OR 12.50 95%CI:1.43, 109.7) and smaller practice size (1–3 GPs) (OR 16.05 95%CI:2.74, 94.24).

Conclusions

Providing a well-structured evidence-based lifestyle intervention, free of charge to patients, with coordination and support for referral processes resulted in over 60% of participating high risk patients being referred for disease prevention. Contrary to expectations, referrals were more frequent from rural and smaller practices suggesting that these practices may be more ready to engage with these programs.

Trial registration

ACTRN12607000423415

     

Papillary cystic carcinoma of the pancreas and present status of pancreatic malignancies in Brunei

During the 10-year period from January 1986 to December 1995, a total of six cases of pancreatic carcinoma were documented in Brunei. Among them was a case of papillary cystic carcinoma of the pancreas, in which the patient, a 22-year-old woman, presented with a painless upper abdominal mass that had been increasing in size over a 6-year period. Ultrasonography showed a well circumscribed solid and cystic pancreatic mass. The tumor was excised locally and the patient remained disease-free at 8 months' follow-up. This papillary cystic carcinoma of the pancreas deserves special mention as it has a low-grade malignant potential, is amenable to local resection, and has a good long-term survival rate after excision.     

Granulomatous mastitis: Presentation,treatment and outcome in 43 patients

BackgroundGranulomatous mastitis is a rare benign breast condition commonly affecting women of child-bearing age. It is characterised histopathologically by the presence granuloma and microabscess formation. It is frequently mistaken for inflammatory breast carcinoma both clinically and mammographically. The aim of this study was to retrospectively review the clinical presentation, radiological investigation, histopathological features, treatment and outcome of granulomatous mastitis of women presenting to Ripas Hospital between October 1997 and June 2009.ResultsForty-three patients with a mean age of 34 years presented with a diagnosis of granulomatous mastitis. All patients presented with a palpable breast lump; 24 (56%) patients also experienced pain in the lump and 3 (7%) patients also had associated nipple discharge on presentation. The role of radiological imaging is found to be limited in differentiating GM from other inflammatory and malignant conditions of the breast. Forty (93%) patients underwent a surgical procedure as the main treatment; in the form of excision or incision and drainage of the breast lesions. Mean follow-up was 15 (range 1–80) months with recurrence in 10 (23%) patients.ConclusionGranulomatous mastitis presents clinically with a palpable breast lump. The diagnosis is often only made histopathologically after surgical excision or core biopsy. Complete surgical excision or incision and drainage of the lesion are the main treatment modalities. Treatment with corticosteroids and immunosuppression remains controversial and there is tendency for this condition to recur after treatment.     

Quality of life of Australian chronically-ill adults: patient and practice characteristics matter

Background  

To study health-related quality of life (HRQOL) in a large sample of Australian chronically-ill patients and investigate the impact of characteristics of patients and their general practices on their HRQOL and to assess the construct validity of SF-12 in Australia.