Journal of Family Medicine and Primary Care最新文献

Background: Coronavirus disease 2019 (COVID-19) a global problem, has affected all aspects of health, that is, physical, social, and mental. Our study aimed to describe various social-demographic factors and existing comorbidities that affected mortality in COVID-19 admitted patients.

Materials and methods: This was a hospital-based retrospective study. The study included medical records of COVID-19 patients admitted from April 2021 to August 2021. Data was entered in Microsoft Excel 2013 and analyzed in STATA version 18.0. The Chi-square test, unpaired t-test, and Cox proportional hazard model were employed for analysis.

Results: Of the total 1156 admitted patients, 103 hospitalized patients progressed to death (8.91%). Factors found to be significant with non-survivorship were age, residence, admission status, and coexisting comorbidities. In hazard analysis, geriatric patients had 4.358 times more hazard of death. Patients with diabetes and hypertension had two times higher hazard of death than patients without these comorbidities.

Conclusion: Mortality of patients was substantially higher in patients' ages above 60 years and patients with comorbidities. Therefore, close monitoring and priority treatment should be provided to elderly patients and patients with comorbidities.

Background and aim: Non-alcohol fatty liver disease (NAFLD) is a metabolic disorder that represents the hepatic manifestation of systemic process, and is a strong risk factor for diabetes Meletus, whereas the presence of DM increases the severity of NAFLD/NASH and its progression. Data on the impact of diabetes on NASH phenotype is sparse from northern India. We studied and compared the clinical profile of NALFD in the presence and absence of DM and the effect of diabetes on NASH.

Methods: We did a cross-sectional analysis of data from NAFLD patients (n = 90) who were divided into diabetic and non-diabetic cohorts and their respective demographic, biochemical, imaging and histological features were recorded and compared.

Results: Out of 90 patients, 53.3% were females with a mean age of 44 ± 12 years. The mean BMI and WHR of the study cohort were 28.9 ± 3.4 and 1.01 ± 0.15, respectively. The current study showed that 35.8% were diabetics. The mean age and WHR were 52 ± 11 years vs 40 ± 10 years and 1.1 ± 0.17 vs 0.99 ± 0.09, respectively, in diabetic and non-diabetic NAFLD patients. Non-invasive fibrosis scores, including BARD (2.8 vs 1.73), FIB-4 (3.4 vs 2.2) and NFS (0.97 vs -1.13), were significantly higher in diabetic NAFLD compared to non-diabetic NAFLD (P < 0.03). The histological grade of steatosis and fibrosis as depicted by the mean NAS score (5.7 ± 1.2 vs 4.63 ± 0.8) was higher in diabetic NAFLD vs non-diabetic NAFLD; however, only the fibrosis stage was statistically significant between the groups (P < 0.001).

Conclusion: Despite the small no of cases, we should conclude that there is a bidirectional relationship between NAFLD and DM where the progression of one increases the rate of progression of other. Diabetic patients have higher risk of NASH and hence increased risk of liver related mortality and should be screened early for NAFLD/NASH.

Introduction: Chronic respiratory symptoms (dyspnoea, coughing, sputum production) associated with abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that result in persistent, frequently progressive airflow obstruction are the hallmarks of COPD, a diverse lung illness. The current investigation aimed to establish a clinical profile of patients with recently diagnosed COPD who present to a healthcare facility in Vadodara.

Materials and methods: The Department of Respiratory Medicine conducted an observational cross-section study on individuals with recently discovered COPD. The study comprised records of 50 participants, from September 2022 to January 2024. Along with the spirometry results, pertinent clinical data were gathered.

Results: The study's patient population presented with an average age of 61.52 years. The fact that every patient in the research was over 40 years old suggests that COPD is becoming more common in people over 40. There was a male majority among the 50 patients, with 40 (80%) male and 10 (20%) female. Most common age group was smokers accounted for 80% of the total cases, suggesting that their incidence of COPD is greater. Average FEV1 at presentation was 41 L/min for 50 patients. Among 50 patients, 6% falls under mild, 28% under moderate, 42% under severe, and 24% under very severe according to GOLD grading and severity of airflow obstruction.

Conclusion: Despite the fact that tobacco smoke is thought to be the main cause of COPD. Indoor and outdoor air pollution are major issues in many nations, including India. One of the main risk factors for COPD is smoke from activities such as burning wood or biomass fuels in addition to work exposure. The ageing of the global population and ongoing exposure to COPD risk factors are expected to contribute to a rise in the prevalence and burden of COPD in the ensuing decades. The fact that most newly diagnosed patients in this research were older and more symptomatic and that most identified individuals had moderate to severe COPD, indicates the importance of spirometry programs in primary care for the early detection of COPD. Our findings suggest that a new campaign requiring patients to undergo spirometry and routine follow-up may be able to identify a sizable proportion of patients with undiagnosed COPD and perhaps improve their quality of life.

Background: Cervical cancer is the second leading cause of cancer-related deaths in Indian women, constituting a significant public health problem. Improving knowledge regarding cervical cancer, human papillomavirus (HPV), and HPV vaccines will help in increased vaccine acceptance and prevention of cervical cancer.

Material and methods: This cross-sectional study was conducted among 801 college-going students of Patna, Bihar, using a predesigned, semistructured, self-administered questionnaire. Data analysis was performed using the SPSS version 20 (Statistical Package for Social Sciences) software.

Results: A total of 801 students participated in the study, and the mean (SD) age was 20.6 ± 2.2 years. The knowledge of students in the medical group was found to be higher than that in the nonmedical group. In the medical group, 93% of the students were aware of cervical cancer versus 71.3% students in the nonmedical group. Awareness regarding the etiological role of HPV in cervical cancer was 84.3% in the medical group compared to 16% in the nonmedical group. Most (82.5%) medical students knew of the existence of a vaccine against HPV in contrast to just 12.5% of the nonmedical group. Willingness to take the vaccine in the medical group was 84.3% versus 46.5% in the nonmedical group. Willingness to pay for the vaccine was reported by 55.6% and 7.5% in the medical and nonmedical groups, respectively.

Conclusion: The comparative results of the two groups identified specific areas where awareness campaigns should be intensified for both medical and nonmedical groups. This study further highlighted nonmedical students, which also represents the general population has very less knowledge about HPV and the HPV vaccine. The findings emphasize the importance of awareness campaigns and educational interventions to improve understanding and vaccine uptake among potential beneficiaries.

Introduction: Breast cancer (BC) is considered one of the most commonly diagnosed cancers. Early detection is critical for effective management. This study aims to assess the utility of ultrasonography (US) and mammography (MG) in detecting BC features.

Methods: This retrospective cross-sectional study involved the electronic records of 263 female patients diagnosed with BC. The mean age was 45.71 ± 12.25 years (17-90 years). A cross-tabulation test was performed to correlate the presence of each malignant feature (Yes/No) on both US and MG and the final ultrasonography diagnosis (benign/malignant). The compatibility between the presence of each feature on both imaging techniques was measured by the percentage of agreement in reporting the feature that was reported as Kappa. The sensitivity and specificity for each feature were calculated, and the receiver operating characteristic curve was used to measure the area under the curve for each feature on both modalities.

Results: The strong compatibility between the two techniques was 87.1%, 94.29%, 66.92%, 79.85%, 77.56%, 77.18, and 79.84% for irregular shape, uncircumscribed, spiculated margins, tissue distortion, nipple retraction, skin thickening, and the presence of lymphadenopathy, respectively (P < 0.001). Boxplots show that the sensitivity of the US ranged from 37% to 95%, and the specificity ranged from 27% to 91%. However, MG's sensitivity ranged from 44% to 93%, and the specificity ranged from 36% to 73%.

Conclusion: US and MG images show similar morphological changes, enhancing diagnostic accuracy in breast lesions. US characterizes echogenicity, provides real-time imaging, and uses color and pulsed Doppler techniques for vascularity and lymphadenopathy detection, while MG is better for identifying different calcification types.

Dapsone hypersensitivity syndrome, although rare, may manifest with fever, rash, and multi-organ failure, mimicking other common diseases. This case study involves a 9-year-old female patient presenting with fever and acute liver injury, in which the intake of dapsone was not revealed until much later. We discuss how the diagnosis was made and the successful outcome following prompt treatment. A high index of suspicion and vigilant history-taking, along with a detailed past treatment history, can provide early clues in reaching a diagnosis. Early intervention with systemic corticosteroids improves the outcome of dapsone hypersensitivity syndrome and can prevent mortality.

[This corrects the article on p. 4128 in vol. 13, PMID: 39629448.].

Exogenous lipoid pneumonia (ELP) is a rarely reported entity caused by aspirating or inhaling fat or oil-containing substances. Clinically, patients present with subacute to chronic-onset non-specific symptoms such as cough, fever, breathlessness, and general malaise. In addition, lobar or multifocal interstitial and parenchymal infiltrates on chest imaging can mimic any other infectious etiology. Diagnosis of lipoid pneumonia is often missed or delayed in many cases and requires a high index of clinical suspicion. We report a case of a 36-year-old nursing officer who presented with a cough and right-sided pneumonia on chest imaging. She was being treated empirically with antitubercular therapy without any clinical response to the treatment. ELP was diagnosed after carefully evaluating the radiological findings, reviewing the clinical history, and finding supportive evidence of lipid-laden alveolar macrophages in her broncho-alveolar lavage fluid. It is vital to uphold a heightened clinical suspicion for non-infectious etiologies in non-resolving pneumonia and investigate the patient thoroughly before resorting to empirical treatments.

Background: Acanthosis nigricans (AN) is a common finding often associated with hyperinsulinemia and childhood obesity. There has been a lack of studies evaluating the association of AN with underlying cardio-metabolic risk factors in children and adolescents. Our objective was to study the association between AN and cardio-metabolic risk factors in children with overweight/obesity.

Methods: This cross-sectional study included school-going children (6-16 years of age) with overweight/obesity. Physical examination, anthropometry, and blood pressure (BP) data were collected. Fasting blood samples were collected to measure insulin, glucose, homeostasis model assessment index (HOMAIR), and lipid profile.

Results: Of 1930 children screened, 545 had overweight/obesity, and were included. Boys to girls ratio was 1.27. AN was present in 46.4% of children. Children with AN had higher body mass index [BMI] (P < 0.01), waist circumference [WC] (P < 0.01), systolic (P = 0.03), and diastolic BP (P = 0.02), hyperglycemia (P = 0.02), hyperinsulinemia (P < 0.01), and a higher HOMA-IR (P < 0.01) compared to those without AN. HDL level was lower in children with AN.

Conclusions: Children with overweight/obesity who have AN have significant elevations of BP, insulin level, and HOMA-IR. AN is a clinical marker that seems to be associated with cardio-metabolic risk factors in children with overweight/obesity in the given study population.

Introduction: Policymakers can better grasp regional health challenges by investigating the disease profile in a specific area. It is challenging to understand the burden and pattern of diseases in the aspirational district of Sirohi, Rajasthan, which is also a partially tribal district, due to the lack of studies on disease profiling among the tribals in the state.

Aim: To determine the prevalent diseases among the people of district Sirohi through secondary data analysis of data collected from government healthcare facilities.

Materials and methods: We conducted a retrospective analysis of health data from the records of the government health system in the district Sirohi, Rajasthan, for the last three years, from 2020 to 2022. Our analysis specifically examined illnesses that affected pregnant women, children, and patients attending outpatient and inpatient departments.

Results: Over three consecutive years, tribal blocks had a higher load of diseases compared to the non-tribal blocks of the Sirohi district. Diarrhoea contributed 67.9% of childhood illnesses, followed by pneumonia (14.4%). The occurrence of maternal anaemia among pregnant women was 81%, with a noticeable upward trajectory. The most common reasons for admission to the in-patient department were respiratory illnesses (n = 6,145), diarrhea with dehydration (n = 4,339), snake bites (n = 687), and typhoid (n = 539). Pindwara had the highest number of respiratory illness (n = 2897, 47.1%) compared to all other blocks.

Conclusion: This study emphasizes the necessity of addressing the health challenges encountered by tribes in district Sirohi. To tackle these issues, it is imperative to execute a targeted and precise strategy. There is a lack of data within tribal communities, which necessitates additional research to formulate a targeted strategy for tribal health.