Journal of Family Medicine and Primary Care最新文献

Context: Cervical cancer is a global public health problem. It is the fourth most common cancer in women globally. Human papillomavirus (HPV) vaccine has reduced the incidence of HPV-related illness in the past decade. However, for the vaccination programs to be successful, recommendation by the primary care physicians is essential.

Aims: The aim of this study was to evaluate the knowledge, attitude, practices, and barriers toward HPV vaccination among physicians practicing at a teaching hospital in Karachi, Pakistan.

Settings and design: This is a cross-sectional study carried out with a sample size of 165 among doctors practicing in Family medicine, Internal medicine, Pediatrics, and Gynecology outpatient clinics at a teaching hospital.

Methods and material: Physicians were approached in outpatient clinics, and a pilot-tested coded questionnaire was filled by them. Statistical Analysis Used: Data were analyzed using SPSS version 19.

Results: Results show 22.4% males and 77.6% females participated in the study. 20% were internists, 35.2% were family physicians, 18.8% were pediatricians, and 26.1% were gynecologists. In terms of knowledge, 67.2% physicians showed good knowledge. In terms of attitude, it was found that 90.9% of physicians showed positive attitude toward prescribing HPV vaccine. However, only 37.5% physicians prescribed HPV vaccine to patients. Cost of vaccine, time constraints, and lack of knowledge among female patients were recognized as the most common barriers against prescribing the vaccine.

Conclusions: From these results, we can infer that overall practices of our physicians are lacking, with respect to prescribing the HPV vaccine. Positive attitude should be taken as an advantage, and overcoming the barriers should be considered as the next step for improvement of our practice.

Thyroid hormones are among the most prescribed medications to patients worldwide and are commonly used to treat hypothyroidism. Thyroxine is also indicated after total thyroidectomy for Graves' disease or a multinodular goitre. In this commentary, we discuss and provide guidance for family medicine and primary care clinicians on how to navigate thyroid hormone replacement in patients after total thyroidectomy for cancer.

Background: India contributes to the highest number of neonatal deaths in the world, a fourth of the world's total. Targeted interventions can be planned after a specific analysis of region-specific causes if India is to achieve the sustainable development goal (SDG 3.2) of neonatal mortality of 12 per 1000 live births.

Material and methods: A retrospective study of medical records of all neonates admitted in the special care neonatal unit (SCNU) over the 6-year period of 2018-23 at a teaching medical college.

Results: A total of 9462 neonates were admitted over the 6-year period. The trends in mortality were encouraging, declining from 19.40% in 2018 to 12.34% in 2023. The reduction was more in outborn (24.32% to 11.68%) than inborn (14.86% to 12.89%) neonates. The low birth rate also declined from 40.77% in 2018 to 25% in 2023. The rate of discharges went up. The trends in etiology of death were uniform over the years with respiratory distress syndrome (RDS) (37.24%), hypoxic-ischemic encephalopathy (HIE) (29.5%), sepsis (16.12%), prematurity (11.45%), and congenital malformations (2.47%) being the chief contributors to death among newborns admitted in SNCU.

Conclusion: The trends are encouraging but may be insufficient to meet the target of SDG 3.2. Further targeted intervention to tackle preventable cause, such as perinatal asphyxia, sepsis, better antenatal care, and better management of preterm neonates on mission mode, is need of the hour as they continue to contribute significantly to neonatal mortality.

Background and objectives: There is more possibility of COVID-19 among obese people; hence, research into how well vaccinations work in this population should be focused. More scientific studies are required to document the effect of body mass index (BMI) on the usefulness of the adenovirus vector vaccine as reviews are lacking. This study was done to see the association between obesity with COVID-19 infections due to poor vaccine response among them.

Methods: A cohort of fully vaccinated individuals of a city in western India were contacted, and a retrospective cohort study was conducted. An average of 400-425 participants among the obese group (exposed) and an average of 400-425 participants among the nonobese group were taken. Data on sociodemographic details, vaccination status, height and weight for BMI calculation, COVID-19 infection status, and its clinical features were collected using predesign, pretested, semistructured questionnaires. Societies were randomly selected from eight different zones of the city, and all the eligible individuals of the society available at the time of survey were interviewed. Data entry and analysis were done using Microsoft excel, Open Epi, Quantpsy, and SPSS-16 software. Relative risk and odds ratios were calculated in open epi software.

Results: The ratio of obese to nonobese individuals was 1:1. Accordingly, 409 obese and 409 nonobese participants were recruited. The mean age of participants was 41.3 ± 14.9 years. As high as 144 (17.6%) of respondents were having history of previous infection before vaccination, and around 42 (5.1%) respondents of the overall study population were infected after the first dose of vaccination. The total count of people for infections before receiving a single dose of vaccination irrespective of body status was reported to be 144 (17.6%) out of a total of 818 candidates.

Interpretation and conclusions: We can conclude that not only obesity is a risk factor but also it increases the severity of COVID-19 infection.

Context: Cardiovascular disease (CVD) is an important cause of mortality in rheumatoid arthritis (RA).

Aims: Evaluation of lipid profile and atherogenic index of plasma (AIP) in newly diagnosed DMARD naïve patients of RA younger than 50 years of age, and its comparison with age- and sex-matched healthy controls.

Settings and design: Cross-sectional comparative study.

Methods and material: 48 patients aged 18 to 50 years fulfilling the ACR/EULAR criteria for RA, not yet on DMARD or steroids and 51 healthy controls were included. Disease activity was assessed, and lipid profile was estimated: total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG) and very low-density lipoprotein (VLDL). Atherogenic index of plasma (AIP) was calculated using a standard formula.

Statistical analysis used: Independent sample t-tests were used to determine the statistical significance of mean values between the case and control groups. Pearson's correlation test was used to correlate various components of the lipid profile and the atherogenic index with DAS28-ESR.

Results: Significantly reduced levels of HDL (39.31 ± 6.52 mg/dl) were found in patients with RA as compared to the healthy controls. Serum TG was significantly higher in the cases (138.35 ± 39.23 mg/dl). TC level was significantly elevated in the cases. Mean atherogenic index in cases was significantly higher (0.17 + 0.14) in some cases. Only a weak correlation was found between lipid profile components and DAS28-ESR.

Conclusions: Serum HDL level was significantly lower, and TC, TG levels and AIP were significantly higher in younger patients of early DMARD naïve RA pointing to a higher CV risk.

Introduction: The classical definition of patient safety given by the IOM is, "the prevention of harm to patients." To expect error less performance from human beings working in a complex, highly challenging, and stressful health care environment is unrealistic. The emphasis must be on fostering a culture of safety that involves multiple stakeholders including healthcare workers, healthcare organizations, and patients.

Aim: To assess the culture of patient safety among healthcare professionals.

Settings and design: A descriptive cross-sectional study was conducted using a pre-validated survey instrument in a tertiary care pediatric hospital.

Methods and material: The data were collected over a period of 1 month (from 4^th January 2022 to 5^th February 2022) using pre-validated questionnaire based on "Surveys on Patient Safety Culture™ (SOPS™) Hospital Survey Version 2.0 (SOPS Hospital Survey 2.0)". Both web-based and paper-based questionnaire forms were distributed among the health care workers.

Results: Totally, 61% of the respondents had average positive response to patient safety, 75% positive response about communication of patient safety error and 74% about teamwork in crisis. A total of 74% responded that supervisors or clinical leaders support them in pursuit of patient safety, 73% about proper handovers. About 69% mentioned about a culture of organizational learning and continuous improvement, 59% reported any patient safety event, 49% believed in support from Hospital management and 42% believed that if a patient safety error is reported it is responded to positively by the seniors by taking corrective measures.

Conclusions: The study presented with a plethora of outcomes that can be used for promoting safe healthcare. A policy for continuous improvement should be implemented to ensure the culture of safe and sustainable patient care.

Background: Sleep and mental health are deeply interlinked, with poor sleep quality, a common issue among medical students, having a profound impact on their mental well-being.

Methods: A cross-sectional study was conducted among medical students in a tertiary care hospital in Imphal, Manipur. Data were collected using a self-administered questionnaire consisting of the Pittsburgh Sleep Quality Index (PSQI) and Depression Anxiety Stress Scale (DASS-21). Descriptive statistics, Chi-square test, and Pearson correlation test were applied, and P < 0.05 was considered statistically significant.

Results: A total of 425 respondents took part in the study, including 268 undergraduate and 157 postgraduate students. Most participants, 236 (55.5%) had poor sleep quality. Among the participants, 168 (39.5%) had depression, 167 (39.3%) had anxiety, and 95 (22.4%) had stress. Poor sleep quality was significantly associated with academic year among undergraduate students (P = 0.005), increased total screentime per day (P = 0.024), and increased screentime before sleep (P = 0.007). Depression, anxiety, and stress were significantly associated with younger age (P = 0.001), the undergraduate course being pursued (P = 0.001, 0.003, and 0.001), and increased screen time before sleep (P = 0.021, 0.046, and 0.039). Depression, anxiety and stress scores had a significant positive correlation with the global PSQI score.

Conclusion: More than half of the participants experienced poor sleep quality, with four out of ten experiencing depression or anxiety, and two out of ten experiencing stress. Hence, medical institutes must implement sleep hygiene education and screen time reduction initiatives to enhance students' sleep quality and overall well-being.

Anesthetists pose different challenges in burn cases associated with polytrauma. Here, we present a case of a 35-year-old male electrician with an electric burn and a fall from height who sustained major chest trauma (hemothorax, pneumothorax, emphysema, and multiple rib fracture, and bilateral femur fracture). The collocated burn over the spinal region posed the challenge to administering a subarachnoid block, which was overcome with a paramedian approach anesthesia. The surgical outcome was good, and the patient was stable post-surgery. The paramedian approach provides an excellent alternative to the midline approach for spinal anesthesia. It should be considered in burn patients where it is impossible for the patient to flex, where the intervertebral space is very low, or when there is a burn present over the spinal region. Ultimately, early therapy and mobility goals, two essential components of burn care and rehabilitation, can be achieved with the use of paramedian regional anesthesia.

Background: The COVID-19 pandemic has underscored the impact of secondary fungal infections on patient outcomes. This single-center study explores asymptomatic fungal infections in COVID-19-positive and COVID-19-negative pneumonia cases, elucidating the intricate relationship between viral respiratory illnesses and fungal co-infections.

Methods: Conducted at a single center, this cross-sectional study examines the prevalence, risk factors, and clinical implications of asymptomatic fungal infections in patients with COVID-19-positive and COVID-19-negative pneumonia. Various demographic, clinical, and laboratory parameters were analyzed.

Results: Fungal infections were significantly more prevalent in COVID-19 positive pneumonia cases (60%) compared to COVID-19 negative pneumonia cases (36%), with a notable P value of 0.016309. Furthermore, COVID-19-positive patients exhibited distinct clinical characteristics, including increased use of remdesivir (94%), higher rates of invasive mechanical ventilation (36%), and a prolonged hospital stay (14.29 days).

Conclusion: This study sheds light on the heightened vulnerability to asymptomatic fungal infections in COVID-19-positive pneumonia cases. Understanding these infections prevalence and their associated factors is crucial for comprehensive patient care and may influence treatment strategies, emphasizing the need for targeted interventions in viral respiratory illnesses.

Background: Diabetes mellitus (DM) is a chronic metabolic disorder characterized by high blood sugar levels. It significantly increases the risk of cardiovascular diseases and autonomic neuropathy. Yoga has been shown to improve autonomic function and glycemic control in diabetic patients.

Objective: To compare the autonomic nervous system (ANS) function between diabetic patients and regular yoga practitioners using Ewing's battery tests.

Methods: This cross-sectional study included 270 participants, divided into two groups: 135 diabetics (Group I) and 135 yoga practitioners (Group II). Participants' height, weight, and BMI were measured. ANS function was assessed using Ewing's battery tests, which included heart rate (HR) and blood pressure (BP) responses to various stimuli. Statistical analysis was performed using SPSS, with significance set at P ≤ 0.05.

Results: Diabetic participants showed lower HR responses to standing from a supine posture, the Valsalva maneuver, and slow deep breathing, indicating impaired parasympathetic function. They also exhibited higher BP responses to the cold pressor test, sustained handgrip, and standing, reflecting sympathetic overactivity. In contrast, yoga practitioners demonstrated better autonomic function with higher HR responses and lower BP responses in these tests. The findings suggest that yoga promotes parasympathetic dominance and reduces sympathetic overactivity.

Conclusion: Regular yoga practice significantly improves autonomic function in individuals, including those with diabetes. These results support the incorporation of yoga as a complementary therapy in diabetes management to enhance cardiovascular health and reduce autonomic dysfunction.