Journal of Family Medicine and Primary Care最新文献

Background: Police personnel represent a special occupational group who because of the nature of their jobs are at an increased risk of lifestyle disorders such as diabetes and hypertension. Although studies have been conducted to assess the health status of police personnel in India, most of them suffer from small sample sizes, selection bias, and poor generalizability.

Objectives: This large-scale study evaluated the prevalence of diabetes and hypertension along with their risk factors among police personnel in Mumbai, India.

Methods: A population-based cross-sectional study was conducted in 3474 police personnel. The key risk factors of interest were age, gender, and body mass index (BMI). Binary logistic regression was used to quantify the relationship between the independent variables (age, gender, and BMI) and the dichotomous dependent variables (diabetes and hypertension).

Results: 86.3% were males while 13.7% were females. The mean age was 41.6 years. In total, 48.7% of participants were overweight while 19.9% were obese. Totally, 29.2% of participants were pre-diabetic/diabetic and 55.2% were hypertensive. Using adjusted logistic regression, participants with > = 55 years were 7.9 and 3.7 times more likely to have diabetes and hypertension respectively compared to those with < = 34 years. Similarly, obese individuals were 1.6 and 3.1 times more likely to have diabetes and hypertension respectively compared to those with normal BMI.

Conclusions: This study demonstrates a high prevalence of cardiovascular risk factors such as diabetes, hypertension, and obesity among Indian police personnel and provides the scientific basis for planning interventional strategies to improve their health.

Background: Family planning is a critical aspect of reproductive health, influencing individuals and couples; decisions regarding contraception. This study explores the pattern of usage of contraceptives viz. condom, injectables, centchroman tablets, oral contraceptive pills and sterilization, including tubectomy and vasectomy. Understanding these associations is vital for improving the role of counselling in family planning services.

Objective: To assess the magnitude and pattern of contraception usage in an urban health centre in East Delhi.

Methodology: Data were collected and analysed from the family planning counselling register from November 2022 till October 2023 among the couples coming to the family planning clinic of UHTC located in East Delhi. Information about demographic details, live issues, contraceptive being used, contraceptive recommended, client choice and outcome (whether they accepted the recommended contraceptive or not). Responses of beneficiaries were analysed to determine the magnitude and pattern of contraceptive usage.

Results: Among 764 couples, the mean age of females and males was 30.36 years (±5.6) and 34.32 years (±6.2), respectively. Among all participants, 38.32% of couples had two children. The usage of condoms was reported by 40.6% of the participants. Out of the total participants, 58.6% received counselling for permanent methods. The unmet need was identified in 25.2% of the participants.

Conclusion: The study underscores the importance of counselling in shaping family planning decisions. Insights gained in this study can help healthcare providers tailor counselling approaches to better address the diverse needs of individuals and couples.

Streptococcus intermedius, a gram-positive, beta-hemolytic, catalase-negative member of the Streptococcus milleri group, is a commensal organism within the human body that is known for its propensity to cause severe bacterial infections. This case report presents two distinct cases involving culture-positive S. intermedius infections. The first case involves a 53-year-old man diagnosed with new liver, lung, and brain lesions in the setting of suspected renal cell carcinoma. In the second case, an 84-year-old woman was found to have S. intermedius bacteremia with concurrent culture-positive liver abscesses. These cases illustrate the intricate nature of S. intermedius infections, which may manifest with a diverse spectrum of clinically significant systemic symptoms. Presently, there are no standardized protocols for screening, and subsequently managing, S. intermedius infections. Since S. intermedius has the potential to mimic other infections or pathological conditions, it warrants space on a differential until a negative culture or PCR assay is obtained.

Background: Women with a history of previous Cesarean Sections (CS) are faced with two choices during their pregnancy: Vaginal Birth After Cesarean (VBAC) or Elective Repeat Cesarean Delivery (ERCD). VBAC refers to vaginal delivery in women who have previously undergone a CS.

Objectives: Despite limited studies on VBAC in Saudi Arabia, this research aims to assess the knowledge and awareness of Saudi women regarding VBAC.

Methodology: This cross-sectional study was conducted among adult females in Western Saudi Arabia utilizing a convenient snowball sampling technique. The total number of participants was 901 females. The participants completed a self-administered questionnaire, which covered general information, knowledge about VBAC, and factors influencing their decision. Statistical analysis employed Chi-squared, Independent T-Test, and ANOVA.

Results: Our findings revealed that 67.5% of participants had inadequate knowledge about VBAC. Only 45.6% of participants were familiar with the term VBAC. The primary reason for choosing CS over VBAC was medical necessity, as reported by 36.3% of participants. The most common reasons for rejecting VBAC were fear for their child's safety and the fact that a CS was recommended, both reported by 35.1%. The lowest reported reason was external interference from family or spouses, at 10.5%.

Conclusion: Although the majority of our sample consisted of highly educated women, most exhibited poor knowledge regarding VBAC. Therefore, raising awareness about VBAC, especially through healthcare professionals and their clinics, is essential.

Background: Interstitial lung disease (ILD) encompasses a heterogeneous group of disorders characterized by inflammation and fibrosis of lung tissue, leading to impaired gas exchange and respiratory failure. The GAP index, based on gender, age, and pulmonary function, predicts mortality and disease severity in patients with ILD. High-resolution computed tomography (HRCT) is a critical diagnostic tool that provides detailed information on lung morphology and disease extent. This study aims to investigate the relationship between HRCT patterns and the GAP index in patients with ILD, enhancing disease staging and prognostication.

Objectives: 1. To identify various radiological patterns in ILD patients using HRCT of the thorax. 2) To correlate these radiological patterns with the GAP index and verify the relationship mentioned above.

Materials and methods: This retrospective observational study analyzed data from 154 patients with ILD treated at Victoria Hospital, Bangalore Medical College and Research Institute, from January 2021 to September 2023. The inclusion criteria included patients aged ≥ 18 years diagnosed with ILD based on the ATS/ERS criteria. Thoracic HRCT was performed using a Philips Ingenuity 128-slice CT scanner, and pulmonary function tests (PFTs) were conducted using a Power cube Diffusion Plus spirometer. The GAP score was calculated, and the HRCT patterns were compared with the GAP stages. Statistical analyses were performed using IBM SPSS Statistics software.

Results: The study population had a mean age of 55.5 years, consisting of 68 males and 86 females. Shortness of breath (97.4%) and cough (87.7%) were the most common symptoms. Hypertension (31.2%) and diabetes mellitus (28.6%) were the most common comorbidities observed. The prevalence of definitive UIP sharply increased in stage 3 (58.8%) compared to stage 1 (9.5%) and stage 2 (41.5%), with a highly significant P value (<0.0001). In contrast, NSIP was more common in Stage 1 (39.3%) and decreases in later stages, with a significant P value (0.011). Over half of the patients were in GAP Stage 1 (54.5%), with significant correlations found between advancing GAP stages and an increased prevalence of honeycombing (P = 0.0005) and traction bronchiectasis (P = 0.010). The ground-glass opacity decreased with increasing GAP stage (P = 0.035).

Conclusion: This study revealed a significant correlation between particular HRCT patterns and GAP index stages in patients with ILD, highlighting the importance of honeycombing and traction bronchiectasis as indicators of advanced disease. This approach is advantageous in both resource-limited settings, where HRCT availability is limited, and in advanced medical centers, as it can help minimize the need for frequent CT scans.

Introduction: Suicidal ideation is the thought or plan to suicide. It is an important public health issue. A severe cause of mortality worldwide is suicide. Previous studies have analyzed suicidal ideation in patients who have already attempted self-harm. In this study, we aim to find out the prevalence of suicidal ideation and knowledge of danger signs of suicide in a nonclinical population, especially among students of a medical college.

Methodology: An institutional-based analytical cross-sectional study was conducted from February 2021 to October 2021 in a private medical college in Chennai. Data were collected from the medical students of the private medical college using Beck's suicidal ideation scale, (DASS-21), and a semistructured questionnaire. Students aged above 18 years and willing to participate in this study were included. The sample size was calculated as 304 by taking reference value from a previous study by Ahmed et al. in Egypt. The total number of students studying in the college was 700, out of which 310 responses were obtained. Convenient sampling was done. Google forms were circulated to the students and data were collected and analyzed using SPSS version 22.0. Descriptive statistics were calculated. An association between the study variables and suicidal ideation was found by using the Chi-square test. P < 0.05 were found to be statistically significant.

Results: The prevalence of suicidal ideation among the study population was found to be 9%. Factors like the presence of depression, anxiety, stress, dissatisfied lifestyle, history of smoking, drugs, and alcohol consumption were found to be contributing to suicidal ideation. About 37.7% of the study population felt that they knew about the danger signs of suicide.

Conclusion: Promotion of mental health and screening for mental health disorders need to be done regularly. Identified risk factors for suicidal ideation should be addressed and mitigated.

Background: Effective management of hypertension relies on adherence to evidence-based clinical practice guidelines (CPGs) among healthcare providers. However, adherence to hypertension CPGs and the factors influencing it among primary care physicians in Riyadh, Saudi Arabia, remain poorly understood.

Methodology: This descriptive cross-sectional study aimed to assess the knowledge, application, and determinants of adherence to hypertension CPGs among primary care physicians working in Prince Sultan Military Medical City (PSMMC) and its affiliated primary health care centers in Riyadh, Saudi Arabia. A comprehensive sample of 211 primary care physicians was enrolled, and data were collected using a self-administered questionnaire covering demographic characteristics, adherence to hypertension CPGs, and barriers to guideline application. Descriptive statistics and appropriate statistical tests were used for data analysis.

Results: The demographic profile of participants revealed a comprehensive representation of age, marital status, nationality, job title, qualification, and years of practice. The majority of participants demonstrated acceptable levels of knowledge (76.3%) and application (89.1%) of hypertension CPGs. However, barriers related to patient nonadherence to lifestyle modifications and medications were reported, highlighting challenges in implementing guideline recommendations in clinical practice. Significant associations were found between nationality, job title, qualification, and adherence to CPGs, with non-Saudi nationality and junior physicians exhibiting higher rates of unacceptable knowledge and application. Moreover, differences in adherence were observed among physicians following different hypertension CPGs.

Conclusion: While primary care physicians in Riyadh demonstrate a strong foundation in evidence-based hypertension management, addressing barriers and disparities in adherence to CPGs requires targeted interventions and collaborative efforts. Promoting a culture of evidence-based practice, enhancing patient education and engagement strategies, and fostering collaboration among stakeholders are essential steps toward improving hypertension control and prevention in the region.

Dengue fever is a mosquito borne viral infection caused by a Flavivirus with four serotypes named DENV 1 to 4, is becoming a significant public health hazard. The spectrum of dengue presentation varis from asymptomatic to severe dengue. Neurological manifestation in dengue fever is an unusual presentation, however metabolic encephalopathy/vascular strokes, resulting with organ dysfunction occurs in severe dengue infection. We report a case series of 12 dengue patients having encephalopathy from Odisha, Bhubaneswar from a total of 2065 diagnosed dengue positive patients during May 2019 to Jan 2024. Clinically dengue encephalopathy patients diagnosed from altered sensorium with metabolic and radiological parameters. In addition, complications of dengue fever had been compiled. We present these 12 cases having dengue encephalopathy with varied complication and managed with immediate clinical interventions to prevent negative outcomes and to improve the quality of life through early detection. Mortality was one out of 12 cases.

Various types of lymphoma can involve the lumbosacral plexus, mainly diffuse large B-cell lymphoma, in which cancer-related persistent fatigue and fatigability (a new concept that assesses fatigue to specific activities) can occur. We report a rare case of acute right L2-S1 lumbosacral plexopathy secondary to diffuse large B-cell lymphoma, presenting with persistent lower back pain and pronounced fatigability. A 49-year-old male with controlled primary hypothyroidism experienced progressive lower back pain extending to the right lower limb, accompanied by dysesthesias and significant fatigue exacerbated by physical activities. Clinical examination revealed asymmetrical lower limb weakness, an absent right ankle reflex, and a positive straight leg raise test indicative of lumbosacral plexopathy. Comprehensive serological and imaging evaluations, including MRI and 18F-FDG PET-CT, identified lumbosacral spine lesions and widespread lymphomatous involvement. Immunohistochemical analysis confirmed the presence of CD20+, CD10+, bcl2+, bcl6+, and MUM1+ cells, establishing a diagnosis of diffuse large B-cell lymphoma. This case underscores the importance of considering lymphomatous lumbosacral plexopathy in the differential diagnosis of fatigability and lower back pain to prevent misdiagnosis and ensure timely, appropriate treatment. Further studies are suggested to explore the implications of lymphoma on neuropathy and chronic fatigability among survivors.

Background: Multidrug resistant (MDR) Gram negative organisms are becoming increasingly common. Carbapenem resistant Enterobacterales (CRE) pose a major threat and necessitate the development of new antibiotics. MDR and carbapenem resistant infections, which are common in intensive care units and hospitals, lead to increased morbidity, mortality, prolonged hospital stays, and higher healthcare costs. New antimicrobials such as ceftazidime avibactam offer potential alternatives to conventional treatments such as tigecycline and colistin, which have significant side effects and limitations.

Aim: This study focuses on the antibiotic susceptibility of ceftazidime/ avibactam to Gram negative bacilli found in a large number of clinical samples collected from a tertiary care facility in Netaji Subhas Medical University and Hospital, Bihta, India.

Methodology: The study included 81 Gram negative bacteria isolated from patient samples. Based on the Clinical Laboratory Standards Institute guidelines mentioned in the Kirby Bauer disc diffusion method.

Result and conclusion: the results showed that ceftazidime avibactam inhibited 89.9% of the Enterobacteriaceae isolates, which was higher than the 80.3% of amikacin and the 85.1% of meropenem. Ceftazidime avibactam was effective against CRE isolates in 69.9% of cases and against MDR isolates in urine in 94% of cases, which was higher than the 40% of ceftriaxone and 94% of nitrofurantoin. The results show that ceftazidime avibactam can cure MDR and CRE infections, especially urinary tract infections, better than conventional antibiotics, which is a great help in the fight against increasing antibiotic resistance.