Journal of Family Medicine and Primary Care最新文献

Background: Oral diseases make significant contributions to the global burden of disease, which is particularly high in the underprivileged groups of both developed and developing countries. The underlying cultural beliefs and practices influence the conditions of the teeth and mouth, through diet, care-seeking behaviors, or use of home remedies. The aim of the study was to assess the oral hygiene practices and beliefs of the tribal gypsies among the Chennai population.

Methods: The cross-sectional study consisted of questionnaire with 10 closed ended questions. The first part of the questionnaire included information on age, sex, education, and occupation. Second part the questionnaire included information on oral hygiene practices, attitudes toward oral health and oral health beliefs. The collected data was tabulated in Microsoft Office excel. Statistical analysis was conducted by using SPSS version 23.0.

Results: From the above results, it can be concluded that the people had enough knowledge about the oral hygiene practices. About 82% believed that if dental problems were neglected there would be serious implications for their oral health.

Conclusion: Based on the findings, it can be concluded that the gypsies might have favorable compliance for oral health promotional programs.

Introduction: The global incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) is in the rise in the setting of obesity. Currently, hepatic steatosis is being diagnosed with imaging techniques, blood biomarkers, or liver biopsy. This study explores the newer laboratory indices like albumin/GGT ratio, ALT/HDL ratio, and atherogenic index of plasma (AIP) in overweight and obese individuals predicted with hepatic steatosis.

Methods: Patients attending master health screening were recruited and were divided into healthy control, overweight, and obese groups based on their body mass index (BMI). Fasting venous samples were collected from all the participants. Lipid profile and parameters related to liver function were processed, and the new indices albumin/GGT ratio, ALT/HDL ratio, and AIP were calculated and evaluated.

Results: The mean concentration of all three indices showed statistically significant differences, especially between the control and obesity groups. Albumin GGT ratio correlated negatively, whereas ALT HDL ratio and AIP correlated positively with fatty liver index (FLI) and hepatic steatosis index (HSI). The cut-off value obtained for predicting MASLD in the study was <0.20, >0.49, >0.58 for Albumin GGT ratio, AIP, and ALT HDL ratio respectively.

Conclusion: These novel indices can serve as a cost-effective tool to predict MASLD in a population, especially in resource-limited settings. Hence, these indices can be included in the laboratory reports during routine health screening, and lifestyle intervention can be initiated at the early stage.

A 42-year-old man with class III obesity (body mass index [BMI] ≈40 kg/m²), prediabetes (glycated hemoglobin (HbA1c) 6.2%), and stage-2 hypertension (≈150/95 mmHg) underwent a supervised lifestyle intervention. His diet was modified to a one-meal-a-day (OMAD) regimen emphasizing Dietary Approaches to Stop Hypertension (DASH)-style nutrition, coupled with regular exercise (swimming and walking). After three months, he lost ~10% of his body weight, with notable improvements in BMI, HbA1c, alanine aminotransferase (ALT), and blood pressure. Despite these gains, low-density lipoprotein (LDL) cholesterol paradoxically rose. We review recent literature on OMAD/intermittent fasting (IF), the effects of exercise on metabolism, and lifestyle management of obesity and prediabetes. The case outcomes largely align with evidence that IF plus exercise aids weight loss and glycemic control, but we discuss potential lipid risks and underscore the need for medical oversight. This case highlights a novel, patient-adapted regimen of OMAD/DASH and exercise, illustrating how intensive behavioral interventions can improve metabolic health while requiring careful monitoring of lipid changes.

Aim: This study evaluates the association between first-trimester hemoglobin A1c (HbA1c) levels and glucose tolerance test (GTT) results to assess the utility of HbA1c as a predictive biomarker for gestational diabetes mellitus (GDM).

Methods: A retrospective, descriptive study was conducted on 634 pregnant women between January and December 2022 at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. After excluding cases with HbA1c ≥6.5% (48 mmol/mol), 552 participants were included in the final analysis. Data on demographic characteristics, HbA1c levels, biochemical parameters, and GTT results were collected and analyzed.

Results: Out of 552 participants, 183 (33%) were diagnosed with GDM. Among those with elevated HbA1c levels (≥5.6), 59 (54%) had GDM. Additionally, 99 (17.9%) women had a single positive oral glucose tolerance test (OGTT), while 50 (9.1%) had two positives, and 34 (6.2%) had three positives. A significant difference in fasting glucose levels was observed between pregnant women with GDM and normal HbA1c (<5.6%) (4.78 ± 0.76) and those with elevated HbA1c (≥5.6%) (5.39 ± 1.47) (P = 0.001). Pregnant women with GDM exhibited significantly higher fasting glucose (4.98 ± 1.08 mmol/L) and HbA1c levels (5.54 ± 0.43%) compared to non-GDM counterparts (4.32 ± 0.76 mmol/L; 5.31 ± 0.33%, P = 0.001).

Conclusion: Measurement of HbA1c during the first trimester may be a useful approach for identifying pregnant women at an increased risk of GDM. Incorporating HbA1c testing into standard prenatal care could enable earlier risk assessment and prompt interventions, helping to reduce unfavorable outcomes for both mother and fetus. Additional research is needed to confirm these results and determine the most appropriate HbA1c cutoff values for clinical practice.

Giardiasis, a common cause of parasitic diarrhea, is caused by the protozoan parasite Giardia lamblia (Giardia intestinalis or Giardia duodenalis). This intestinal flagellate protozoan is prevalent among children worldwide and is a significant source of traveller's diarrhea. It is estimated that there are about 2.5 million cases of giardiasis-related diarrhea and nutritional deficits in children every year, with the majority occurring in developing countries. Since 2004, the World Health Organization has classified it as one of the neglected tropical diseases. Those most at risk for complications from giardiasis are children aged 1-5 years and undernourished individuals in developing countries who may experience malabsorption, weight loss, and growth retardation. The prevalence rates are expected to be around 2%-5% in developed countries and significantly higher at 20%-30% in developing countries. Here, we report the case series of seven pediatric children with various clinical presentations with failure to gain weight and abdominal pain being the most common among all the cases ultimately presenting with long-term sequelae like malnutrition and growth retardation. This case series underscores the importance of considering giardiasis in the differential diagnosis of pediatric patients presenting with growth retardation and gastrointestinal symptoms, particularly in endemic areas. Early diagnosis and appropriate treatment are crucial in mitigating the long-term health impacts of this neglected tropical disease.

Background: The COVID-19 pandemic led governments worldwide to priorities vaccine development and distribution. However, vaccine hesitancy among healthcare workers (HCWs) posed a significant challenge. This study aimed to explore the HCWs' knowledge, beliefs, and attitudes towards COVID-19 vaccination in Madhya Pradesh, India, using a mixed-method approach.

Materials and methods: A mixed-methods design was used to collect data from 519 HCWs. Quantitative data were obtained through stratified random sampling via face-to-face or online surveys, while qualitative insights were gathered through purposive sampling for in-depth interviews.

Results: The sample primarily consisted of nurses (95%), with roles as vaccinators (86.3%) and coordinators (11%). A large proportion (75.5%) were directly involved in patient care during the pandemic, and 31.6% had previously been diagnosed with COVID-19. Most participants expressed confidence in the vaccine's effectiveness (65.5%) and immunity (71.8%), though 21.6% were skeptical of its necessity and 16% had concerns about its safety. Views on vaccine prioritization and post-vaccination risks varied. Despite these differences, participants generally expressed satisfaction with the vaccination programmed, highlighting the need for transparent communication and addressing safety concerns. Qualitative data revealed the importance of trust in scientific research, professional responsibility, peer influence, and logistical challenges in shaping vaccine attitudes.

Conclusion: The findings emphasize the need for targeted communication strategies to address vaccine hesitancy among HCWs. By considering these complexities, policymakers can develop interventions to increase vaccine uptake and strengthen frontline defenses against future pandemics.

In childhood epilepsy, infantile epilepsy constitutes a very high number and is usually associated with significant co-morbidities. So, this warrants the diagnosing and initiating treatment at the earliest. Infantile epilepsy is described from day one of life of a child till completion of 2 years of life. Recently, there has been improvement in diagnosing infantile epilepsy by rapid advancements in genetic testing by novel tests like use of Cytogenetic microarray (CMA) and next generation sequencing (NGS). These techniques help in better management of infantile epilepsy. In last few years, approach has changed to precisely diagnosing the epilepsy understand whether there is an underlying genetic basis and if proven so, its role in treatment protocols. However, as of now, there is no consensus on stepwise approach or development of standard guidelines to incorporate detailed genetic evaluation in the management of infantile epilepsy.

Introduction: Elevated blood pressure is one of the commonly modifiable risk factors of cardiovascular diseases (CVDs). Inadequate prevention, diagnosis, and treatment of hypertension lead to increased cardiovascular complications in low- and middle-income countries such as India. We aimed to estimate the prevalence of undiagnosed hypertension and assess the associated cardiovascular risk among older adults in India.

Methods: Data from Longitudinal Ageing Study in India (LASI), 2017-18 were utilized. We included 45991 participants aged ≥40 years who were not aware about their hypertension status. A multivariable regression model assessed the correlates of undiagnosed hypertension presented as adjusted odds ratio (AOR) with 95% CI. Cardiovascular risk assessment was done using World Health Organization/International Society of Hypertension (WHO/ISH) chart for South-East Asian Region D (SEAR-D).

Results: The prevalence of undiagnosed hypertension was 12%. Undiagnosed hypertension was significantly associated with alcohol consumption [AOR: 1.58 (95% CI: 1.32-1.88)] and obesity [AOR: 1.77 (95% CI: 1.41-2.24)]. 36% of the undiagnosed individuals with hypertension had visited healthcare facility at least once in the past 12 months. We observed 43% of the undiagnosed Individuals with hypertension had the CVD risk of <10% as per WHO/ISH risk chart.

Conclusion: A significant proportion of undiagnosed individuals with hypertension are at a risk of having CVD which cannot be overlooked. Primary care should be strengthened to increase the early diagnosis and treatment where the recent initiatives of upgraded Ayushman Arogya Mandir may play a major role. Additionally, primary care providers should not miss the opportunistic screening of patients visiting healthcare facilities.

Introduction: Beta-thalassemia trait (BTT) and iron deficiency anemia (IDA) are the two most common causes of microcytic hypochromic anemia. Differentiating these conditions is crucial, particularly in school-aged children, to reduce the societal burden of anemia. Red cell indices and formulas derived from red blood cell (RBC) parameters provide simple, rapid, and cost-effective diagnostic tools. While these indices are primarily used in pediatric populations, they can also aid in diagnosing microcytic anemia in adults.

Methodology: This cross-sectional observational study was conducted in the Department of Pathology, Rajendra Institute of Medical Sciences (RIMS), Ranchi, from May 1, 2016, to April 30, 2017. A total of 406 patients (190 males and 216 females), aged 3-50 years, with microcytic hypochromic anemia, were randomly selected. The diagnostic performance of the Mentzer index (mean corpuscular volume (MCV)/RBC count) and the Patra index (MCV/red cell distribution width (RDW)) was evaluated based on sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), efficiency, and Youden's index.

Results: The Patra index demonstrated superior diagnostic accuracy, with a sensitivity of 88.23%, specificity of 99.7%, and Youden's index of 87.93%. This index proved to be a more reliable tool for differentiating BTT from IDA than the Mentzer index.

Conclusion: Given its high sensitivity, specificity, and affordability, the Patra index is an effective screening tool for primary care physicians, particularly in resource-limited settings. Its low cost and ease of sample transport make it a valuable method for initial screening, with positive cases confirmed by high-performance liquid chromatography (HPLC) using the same EDTA-anticoagulated blood sample.

Uterine leiomyomas stand as the predominant benign pelvic tumours among women. The diagnosis and management of a giant leiomyoma can be challenging. Herein, we are reporting the case of a 44-year-old multiparous woman who presented with huge abdominal distention. On imaging, a huge solid cystic mass of 42 × 25.7 × 35.8 cm was occupying the whole abdominopelvic cavity. After evaluation and multidisciplinary discussion, the patient was taken up for surgery. A giant grey-white solid cystic mass attached to the fundus and body of the uterus was found. Intraoperatively, around 23 litres of clear seromucinous fluid was gradually drained from the mass. After decompression of the mass and careful dissection, a hysterectomy was performed. Bilateral ovaries and fallopian tubes were grossly normal. The histopathology established the diagnosis of Giant cystic leiomyoma with massive cystic degeneration. Such massive cystic degeneration in uterine leiomyoma is an exceedingly rare finding.