Journal of Family Medicine and Primary Care最新文献

Introduction: Peripheral neuropathy (PN) occurs in diabetes mellitus. However, the association between PN and rheumatic disease (RD) has not been fully investigated. The aim of this study was to assess the prevalence of PN in patients with RDs with or without Diabetes Mellitus.

Methods: A Cross-sectional cohort study, data extracted from patients medical records started in September 2023 to January 2024 in Abu Dhabi, UAE. A Sudoscan machine report was used to assess The electrochemical skin conductance (ESC), Sudomotor dysfunction is evaluated according to the ESC measured on the feet: >60 μS = no dysfunction; 60-40 μS = moderate dysfunction; and <40 μS = severe dysfunction.

Results: Eighty-one patients with RDs, mean age 58 ± 12. There were 55 females (67.9%), and 26 males (32.1%) attended an ambulatory healthcare clinic in Abu Dhabi, UAE. Thirty-three (40.7%) had diabetes, while 48 (59.3%) did not have diabetes. The mean glycated haemoglobin A1c (HBA1c) was 7.4% in diabetic patients and 5.8% in non-diabetic patients Additionally, all patients had a mean blood pressure of 134/72 and a mean Body Mass Index (BMI) of 31.40 kg/m². Among the study patients, the most common RD was osteoarthritis, which affected 56.8% of the patients. The smallest percentage of patients with PN was found in those with IgG4, at 1.2%. The prevalence of Sudomotor dysfunction (ESC feet: <60 μS) was 72.8% in patients with RDs (all patients diabetic and non-diabetic), while the prevalence of sudomotor dysfunction (ESC feet: <60 μS) in RDs patients with diabetes was 75.8% and 70.8% in RDs patients without diabetes, there was no significant difference between in prevalence of sudomotor dysfunction in RD patients with diabetes compared to RD patients without Diabetes.

Conclusion: Sudomotor dysfunction appears to be common among patients with RD regardless they have diabetes or not. This study recommends screening all RD patients for Sudomotor Dysfunction.

Background: In India, children with neurodevelopmental disabilities are being referred late. One of the possible reasons could be lack of mothers' knowledge regarding developmental milestones. Hence, the objective of this study was to assess the knowledge of mothers regarding infants' developmental milestones in four domains using a self-drafted questionnaire and to enlist the factors influencing mothers' knowledge if any.

Methods: This was an observational study. The study was conducted using a questionnaire which was drafted, face-validated, and pilot-tested. The final drafted questionnaire was used for the data collection. The duration for data collection was June 2019 to November 2019; data were collected from Dhiraj General Hospital. Inclusion criteria of the study were mothers in the age range of 18-40 years and those who were willing to participate in the study. A total of 100 mothers were interviewed on one-to-one interview basis. Collected data were entered in Excel sheets and were analyzed using descriptive analysis.

Results: 73% mothers were aware regarding head holding in the gross motor domain, 61% mothers were aware regarding hand to mouth in the fine motor domain, 41% mothers were aware regarding bisyllables in the language domain, and 64% mothers were aware regarding when an infant starts waving bye-bye in the personal social domain.

Conclusions: Mothers were more aware about the gross motor and personal-social milestones as compared to that of language and fine motor milestones. Our results cannot be generalized.

Cervical cancer, driven by human papillomavirus (HPV) infection, presents a significant health challenge in India, marked by high morbidity and mortality rates among women. This systemic review synthesises the latest research on HPV epidemiology in India, evaluates the effectiveness of existing vaccination programmes and compares India's strategies with those of countries that have successfully mitigated cervical cancer burden. Despite available vaccines targeting high-risk HPV types, vaccine coverage remains suboptimal due to challenges, such as accessibility, vaccine hesitancy and socioeconomic barriers. Comparative analysis suggests that school-based and community engagement strategies could enhance vaccination efforts. Addressing India's cervical cancer burden requires a multifaceted approach that includes expanding HPV vaccination coverage, implementing public awareness campaigns and adopting best practices from global successes. Economic analyses affirm the cost-effectiveness of such strategies, highlighting the potential for significant public health and financial benefits.

Background: Paget's disease of bone (PDB) is associated with considerable morbidity because of bony pains, fractures, and deformities. Remission, as assessed by reduction in alkaline phosphatase levels, does not necessarily correlate with improvement in quality of life (QoL). Health-related quality of life (HR-QoL) in affected individuals is not well-studied in India. This study attempts to describe the QoL in individuals with PDB.

Methods: In this prospective observational study spanning 6 years (Jan 2017-Dec 2022), we included 29 treatment-naïve patients diagnosed with PDB based on clinical, biochemical, and radiographic features. All patients received treatment with antiresorptive agents. SF-36 questionnaire was administered before treatment and at review.

Results: A total of 29 patients with PDB (20 males), with a mean (SD) age of 68.1 (9.8) years, were included. Symptomatic disease was seen in 23/29 (79.3%) and polyostotic disease in 25/29 (86%) subjects. The median duration of symptoms was 6 months (0-24 months). The most frequently involved skeletal sites were the pelvis (69%), vertebrae and sacrum (68%), followed by the skull (48%) and lower limb (48%). The subjects were treated with parenteral zoledronate (65.5%), oral alendronate (24.1%), and denosumab (6.9%). There was a significant improvement in all eight domains of QoL (P = 0.0001) as assessed by the SF-36 questionnaire. The maximum improvement (27.2%) was observed in the physical functioning domain (P = 0.0001).

Conclusion: This study assessed various domains in QoL by using the SF-36 questionnaire at baseline and post-treatment with antiresorptive agents, and it was noted that there was a significant improvement in all domains of QoL.

Background: The bone marrow iron study is the gold standard for differentiation of the two most common causes of anemia i.e. iron deficiency anemia (IDA) and anemia of chronic disease (ACD) in the elderly. However, it is often not feasible to do bone marrow examination (BME) in every elderly anemic patient, due to its invasive nature. Hepcidin, a liver-derived peptide, has been identified as the key systemic regulator of iron homeostasis. Our study highlights the potential diagnostic role of serum hepcidin in the evaluation of anemia in elderly.

Methodology: Hundred elderly patients (≥60 years of age) having iron deficiency anemia (IDA) or anemia of chronic disease/inflammation (ACD) were the study subjects with 15 age-matched healthy controls. All patients were evaluated with history, clinical examination, routine investigations (complete blood count, liver, and kidney function tests), iron profile, and serum hepcidin. The bone marrow iron study was done in every patient to categorize them as IDA and ACD.

Results and discussion: Serum iron, TIBC, MCV, ferritin, and serum transferrin saturation values were differing significantly between IDA and ACD groups. Serum hepcidin levels can be used confidently to differentiate ACD from IDA (P value <0.001). At serum concentration, 198.82 ng/mL sensitivity of hepcidin to differentiate ACD from IDA was 93.9% and specificity was 92.2%. A subset of patients is misdiagnosed when the serum hepcidin level is used as a sole marker, and this also holds true for serum ferritin.

Conclusion: Though serum hepcidin level correlates well with serum iron profile and also serum hepcidin appears to be a useful marker to differentiate ACD from IDA in terms of both sensitivity and specificity, the combined assessment of serum hepcidin and iron profile appears to be a better marker than ferritin and hepcidin alone. This could replace the use of bone marrow iron staining as a diagnostic tool in anemia in elderly.

Background: Early onset of menopause poses a risk for various health issues in women. This study aimed to primarily examine the link between early menopause and indoor air pollution (IAP) and demonstrate this association within the Indian population, considering their place of residence.

Methods: This longitudinal study included 24,862 eligible participants out of 73,000 surveyed. Logistic regression analyses, both crude and adjusted odds ratios (aOR), were used to examine the association between early menopause and various sociodemographic factors, IAP, and place of residence (rural/urban).

Results: The study identified a significant correlation between early menopause and body mass index (BMI), educational status, marital status, occupation, physical activity, self-rated health, and smoking status. Women using unclean fuels did not show increased odds of early menopause (aOR: 1.00, 95% confidence interval [CI]: 0.93-1.08). Poor ventilation was linked to a slightly higher incidence (28.1% vs. 26.9%, aOR: 1.07, 95% CI: 0.99-1.15). Exposure to pollution-generating sources was significantly associated with early menopause (28.8%, aOR: 1.10, 95% CI: 1.02-1.18), especially in urban areas (aOR: 1.17, 95% CI: 1.01-1.36) but not rural (aOR: 1.08, 95% CI: 0.99-1.17). Indoor smoking was linked to higher odds (aOR: 1.09, 95% CI: 1.02-1.17), particularly in rural areas (aOR: 1.09, 95% CI: 1.01-1.18). Overall, IAP was significantly associated with early menopause (aOR: 1.07, 95% CI: 1.01-1.15).

Conclusion: The findings reveal that IAP, from sources such as smoke and pollutants, significantly increases the risk of early menopause among Indian women. Urban women are more affected by pollution, whereas indoor smoking impacts both urban and rural women. Enhancing indoor air quality could reduce early menopause and improve women's health in India.

Patients diagnosed with rheumatoid arthritis have a heightened susceptibility to infections, which may lead to higher rates of illness and death. The heightened susceptibility may arise from the illness itself, which causes changes in the body's innate cellular defense mechanisms, or from the medications used to manage the condition. The precise level of risk for infections associated with traditional disease-modifying anti-rheumatic drugs has not been fully elucidated. This review aimed To investigate the type of infections and the use of antibiotics among patients with rheumatoid arthritis. An electronic literature search was conducted using the MEDLINE database, with the indicated search keywords: infections, antibiotics, use, patients, rheumatoid, and arthritis. To identify relevant information, the search was limited to articles published between 2017 and 2024. The researchers used suitable search terms on Google Scholar to discover and examine relevant scholarly articles. The selection of articles was determined by several inclusion criteria. The research included publications that were published from 2017 to 2024. The study was organized into many sections, each including particular categories within the analysis section.we reportrd that : Within the developing age of focused synthetic treatments for RA, severe infections persist as the primary consequence of long-term treatment. In all patients with rheumatoid arthritis, it is necessary to conduct initial screenings for hepatitis B virus and tuberculosis. Additionally, it is important to administer vaccinations for specific pathogens (such as pneumococcal, herpes zoster, and influenza) before and during treatment. Aggressive therapy should be pursued to effectively manage disease activity in RA patients, while also maintaining constant vigilance for early signs of infections. Extra care should be given to senior rheumatoid arthritis (RA) patients who are over 65 years old and have other medical conditions. These people are often more susceptible to developing infections, regardless of the medication they get. The trials conducted with different antibiotics have confirmed the effectiveness of these medications in treating rheumatoid arthritis. Thus, it is plausible that the culprit responsible for rheumatoid arthritis is a microbe, namely periodontopathic bacteria.

Filariasis is an endemic health issue in India and Southeast Asian countries. The diagnosis is conventionally made by demonstrating microfilaria in a peripheral blood smear. Detection of microfilaria is rarely reported in cytological evaluation, and even more infrequent is the presence of microfilaria in a neoplastic lesion. Here we report a rare case of microfilaria in a routine cytological smear of a liver aspirate, which was diagnosed as hepatocellular carcinoma.

Background: Self-monitoring and self-management are growing phenomena in the care of chronic illnesses, like bipolar disorder. A significant fraction of patients with bipolar disorder are cared for by primary care providers. The use of smart technology may be effective in this setting.

Method: KIOS-Bipolar, a smartphone app that proved superior in a randomized, controlled trial, was beta-tested for two-month periods in 12 patients with bipolar disorder who were under the care of a primary care clinic.

Results: Adherence to the app was 100%. Patients experienced improvements in depressive (-41%) and manic (-46%) symptoms and overall instability (-39%). Patients felt that the system was user-friendly with an average system usability score of 80.8 (range 48-100). Five participants (41.8%) gave a system usability score ≥ 90.

Discussion: This open trial suggests that utilization of a self-management tool may be a useful adjunct in the treatment of patients with bipolar disorder in the primary care setting.