Journal of Family Medicine and Primary Care最新文献

Background: Gestational diabetes mellitus (GDM) is the most common medical complication and metabolic disorder of pregnancy. The prevalence of GDM in all pregnancies is approximately 7%. Globally, there are 14% pregnancies with significant variability in prevalence based on diagnostic criteria, sociodemographic characteristics, and geographic region.

Objectives: The aim of this study was to determine the level of depression, breastfeeding self-efficacy, and association of depression among postnatal GDM and non-GDM mothers.

Methods: This cross-sectional descriptive study was conducted in the Obstetric and Gynaecology ward of KIMS hospital using a consecutive sampling technique. Out of 200 postnatal mothers, 100 GDM and 100 non-GDM postnatal mothers were recruited. Data were collected using a the self-structured demographic tool, Edinburgh postnatal Depression Scale, and Breastfeeding Self-efficacy Scale. Written informed consent was taken from the postnatal women before data collection. The inclusion criteria included postnatal women who were willing to participate and understand and respond in Odia or English, and postnatal women who have chronic diseases like tuberculosis, malignancy, renal failure, and cardiac disorder were excluded from the study.

Results: The depression of mothers with GDM was found higher compared to non-GDM mothers, and breastfeeding self-efficacy was lower in GDM and higher in non-GDM mothers.

Conclusion: In the current study, it has been concluded that the depression level of mothers with GDM was found higher compared to non-GDM mothers and breastfeeding self-efficacy was lower in GDM as compared to non-GDM mothers. GDM mothers have a significant impact on depression and breastfeeding self-efficacy during the postpartum period.

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors that arise from interstitial cells of Cajal. Due to vague presentation, location and confusing imaging studies, they tend to mimic gynaecological tumors. They usually diagnosed intra-operative and histopathology followed by tumor specific receptors such as KIT, CD34, CD 117 and DOG 1 are mainstay of diagnosis of GIST. Prognosis of GISTs depends on mitotic rate, tumor size and organ of origin. Resection of mass with tumor free margins is the target of treatment. L ymphadenectomy is not routine. Chemotherapy with tyrosine kinase inhibitors such as Imatinib, Dasatinib, Sorafenib and follow- up depend upon risk category. In this case series, there were four cases with vague symptoms misdiagnosed as gynaecological tumors are reviewed. Preoperatively tumors assumed to be of gynaecological origin were found to be case of GISTs intra-operatively and confirmed by presence of cajal's cells histopathology and mainly by DOG 1, CD117 and tyrosine kinase inhibitor receptors on immunohistochemistry. All belonged to high risk category of GISTs. Any abdomino-pelvic mass detected on ultrasonography and with unusual presentation presenting at primary health centre the possibility of non-gynecological tumors especially GISTs should be kept in mind and should be referred to higher centres for further investigation and proper management.

Primary hyperparathyroidism (PHPT) is relatively uncommon in children, and skeletal deformities due to it are even rarer in this age group. Less than 20 such cases have been reported in the English literature. We describe a case series of three patients who presented with genu valgum deformity and were found to have primary hyperparathyroidism on further evaluation. The cases were primarily managed by removing the adenoma and later taken up for correction of the skeletal deformity. Genu valgum deformity in children can occur secondary to hyperparathyroidism due to a pubertal growth spurt.

Purpose: To determine the clinical pattern and burden of strabismus in a teaching institute of Northeast (NE) India.

Methods: In this hospital-based, cross-sectional study, detailed clinical evaluation of patients with manifest strabismus was carried out for a period of one and half years.

Results: Out of the 7222 new outpatient department attendances, a total of 110 new patients with manifest strabismus were found, with a hospital-based burden of 1.52% [95% confidence interval: 1.3-1.8]. Comitant strabismus was seen in 84.55%, and incomitant in 15.45%. Exotropia comprised 70%, esotropia 26.36%, hypertropia 10%, and hypotropia 2.72%. The angle of deviation was large in most of the participants (69.09%) with a mean of 34.90 ± 17.08 PD for horizontal and 13.29 ± 8.97 PD for vertical deviations. A cause of strabismus could be identified in 30.91%. Paralytic strabismus was seen in 15.45%, sensory in 11.82%, infantile in 1.82%, and accommodative in 1.82%. Amblyopia was found in 5.45%. In our study, 25.45% patients underwent strabismus surgery, while 74.55% patients either needed conservative management or were being worked up for surgery till the end of this study.

Conclusion: This study determined the pattern and burden of strabismus in a teaching institute of NE India. Since the institute caters to patients from different states of NE India, this study gives an indirect picture of the burden of strabismus of the whole of NE India. It is hoped that these data will aid in determining the overall burden of strabismus in the country. They will also help the family medicine and primary care physicians to have an idea about the burden and pattern of strabismus in the community, thus enabling them to create awareness about strabismus, remove the undue apprehensions of patients, and do timely referrals for treatment and prevent irreversible visual loss.

Tuberculosis (TB) can affect any organ, and at times more than one organ in any sequence, in which case it is referred to as disseminated tuberculosis (DTB). We report a patient who presented primarily for psychiatric symptoms of three months' duration, which later turned out to be a case of DTB involving the central nervous system as well as the spine and lungs.

Case presentation: An elderly lady with subacute onset and worsening behavioural changes of three months' duration was referred for exclusion of organic brain disease. The neurological and respiratory examination, chest X-ray, electroencephalogram (EEG), and MRI of the brain were normal. She, however, had elevated C-reactive protein, ESR, and raised CSF opening pressure on lumbar puncture. The CSF cell counts, biochemistry, and cultures were within normal limits. Unable to detect a neurological cause for her illness, she was advised to consult a psychiatrist. Two months later she reported to us again, this time essentially for back pain. Investigations for the back pain (including CT spine) revealed a T12 compression fracture with irregularity of the left T12 pedicle and a para-spinal fluid collection. Pus drained from the collection showed mycobacterium tuberculosis bacteria on staining with ZN stain. The CT scan thorax also showed left lower lobe consolidation and a pleural effusion. Contrast CT scan brain revealed subtle meningeal enhancement at the right parietal region. With standard treatment with a four-drug anti-TB regimen (along with a short course of dexamethasone), she improved well. This case report indicates that the initial clinical presentation of TB in general, as well as DTB, can be misleading, resulting in delay in diagnosis and in initiating treatment.

Background: It is documented that COVID-19 survivors have prolonged morbidity and functional impairment for many years. Data regarding post-COVID-19 lung functions is lacking from the Indian population. We aim to evaluate the lung functions in such patients after 3-6 months of hospital discharge.

Methods: In this prospective observational study, patients were assessed 3 to 6 months post-discharge and underwent standardized pulmonary function tests (PFTs) and CT Thorax if required. The following parameters were measured and correlated with the disease severity: Forced Vital Capacity (FVC), Forced Expiratory Volume in the First Second (FEV1), Forced Expiratory Flows at 25 and 75% of FVC (FEF25%-75%), Peak Expiratory Flow (PEF) and FEV1/FVC.

Results: A total of 52 post-COVID-19 patients were enrolled in the study, with a median age of 43 years (78.8% males). 44.2% of patients had mild disease, 26.9% had moderate disease and 23.1% had severe disease at hospital admission. A restrictive pattern was seen in 20.8% of patients. The mean value of FEV1 and FVC decreased as the disease severity increased. FEV1: mild-3.21 ± 0.71, moderate-2.62 ± 0.61 and severe- 2.51 ± 0.72, P = 0.02; FVC: mild-3.69 ± 0.81, moderate-3.04 ± 0.71 and severe- 2.93 ± 0.87, P = 0.02. After adjusting the confounding factors, the mean pulmonary function values were lower in the patients who required oxygen support, with a significant difference in FEV1, FVC, PEF and FEF 25-75% with P values of 0.025, 0.046, 0.028 and 0.007, respectively. 66.67% had abnormal HRCT findings. Age and high LDH were correlated with HRCT abnormality with P values of 0.015 and 0.024. Age >50 years was found to be an independent predictor of the subsequent development of abnormality on the HRCT thorax.

Conclusions: Patients with COVID-19 pneumonia, which required oxygen, especially severe disease at the time of hospitalization, had a higher rate of abnormal spirometry than patients with mild symptoms. Follow-up CT scans obtained within six months of disease onset showed abnormalities in more than half of patients, particularly elderly patients.

Background: The coronavirus disease (COVID-19) is an infectious disease caused by the newly discovered SARS-CoV-2 virus. Patients diagnosed with COVID-19 experience several complications including hypertension or elevated blood pressure which is a serious medical condition that significantly increases the risks of heart, brain, and kidney diseases.

Objectives: To assess the prevalence and control of hypertension in COVID-19 patients.

Methods: Cross-sectional descriptive hospital-based study conducted in an isolation center at Atbara Teaching Hospital in 2021. The data were collected by interviewing patients through a close-ended questionnaire and analyzed using a statistical computerized program (SPSS version 21).

Results: The main results of the study revealed that the prevalence of blood pressure amongst patients diagnosed with COVID-19 was mild 45%, moderate 17.7%, and severe 10%; of the cases, 25.7% were newly discovered hypertension cases, of the cases 26.7% were diabetic patients; and 70.7% of the study group full recovered form COVID-19 at discharge.

Conclusion: The study concluded that most of the study group had hypertension with COVID-19, some of them were newly discovered cases of hypertension and also had diabetes mellitus which indicates that COVID-19 may cause the onset of hypertension.

We report a case of a 49-year-old female with a history of HIV infection for 12 years. The patient had excellent compliance with antiretroviral medications, raltegravir 400 mg twice daily and truvada once daily for HIV. Over the years, she maintained an undetectable viral load with a CD4+ count >200 cells/μL. She has a history of type II diabetes, hypertension, bipolar manic depression, endometriosis, recurrent herpes simplex attacks, arthritis in both shoulders, irritable bowel syndrome (IBS), and nonalcoholic fatty liver disease (NAFLD). She weighed 148 kg with a body mass index (BMI) of 52.08 kg/m². Her medication included diltiazem 60 mg once a day, glyceryl trinitrate (GTN) spray, metformin 1 g twice daily, and linagliptin 500 mg once daily for her type II diabetes with glycated hemoglobin (HbA1c) of 8.4%. She has full capacity and elected to have bariatric surgery; 4 months postprocedure, she lost 28 kg with a reduced BMI of 38.62 kg/m² with no postoperative complications. Her diabetes control improved, and she no longer required linagliptin and metformin. Following the procedure, she was given supplements including ferrous sulfate, vitamin B12, vitamin D, and calcium. She was also prescribed lansoprazole. The case illustrates that bariatric surgery is an effective and safe operation for people living with HIV. Due to complex needs and the need for regular follow-up; primary care, family, and HIV physicians can all collaborate in the care of individuals living with HIV and who underwent bariatric surgery.

The article presents the LGBTQIA + inclusivity analysis of the Medical Termination of Pregnancy (Amendment) Act 2021, which aims to provide safe abortion services across India. The analysis reports the use of cisgender-heteronormative language, instead of gender-neutral terms and pronouns in the legislation. Sexual assault/rape as an eligibility criterion for permitting abortion under this act does not apply to non-binary, trans- and queer individuals due to non-inclusivity in Rape Laws (Indian Penal Code 375 and 376). The analysis highlights the necessity for critical amendments to expand its scope to ensure LGBTQIA+ inclusive abortion services.