Journal of Family Medicine and Primary Care最新文献

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.

Background: The Gram-negative (GN) bacteria are known to cause a multitude of illnesses.The production of extended-spectrum beta-lactamases (ESBLs) is one of the contributing factors for drug resistance in bacteria. The present study was carried out to estimate the prevalence of ESBL-producing GN bacteria isolated from various clinical specimens in the population of Bihar, East India.

Materials and methods: This prospective cross-sectional study was conducted at Netaji Subhas Medical College and Hospital, a tertiary care hospital in Bihar, East India. The consecutive but non-repetitive clinical samples (urine, pus, sputum, and blood) obtained during the study period (July 2022 to March 2024) were included in the study. Samples from patients across all age groups and genders attending both outpatient and inpatient departments were included in the study. All cultures exhibiting no growth and urine and blood cultures exhibiting mixed growth were excluded from the study. ESBL-producing strains were suspected by phenotypic screening tests. Confirmation of ESBL-producing strains was done by the phenotypic test combined disc method.

Results: Among 1123 organisms isolated in different specimens, 758 were GN, 324 Gram-positive bacteria, and 41 others. Escherichia coli (43%) followed by Klebsiella pneumoniae (16%) were the most common pathogens identified. There were 27% (208/758) ESBLs isolates in this study. Maximum ESBLs were isolated from the urine sample. Escherichia coli was the most common ESBL isolate.

Conclusion: Escherichia coli and Klebsiella pneumoniae were the most common isolates. This study also found a high prevalence of ESBL-producing organisms, among which Escherichia coli was the most common. The prevalence of ESBL is increasing worldwide, and necessary steps to prevent its emergence and spread should be taken.

Background: The internet is being used extensively worldwide, especially among adolescents and young people. Early detection and creating awareness related to psychological dependence among the adolescent population, along with prompt measures towards sound use of technology, is essential.

Materials and methods: A randomized control trial was conducted among 100 participants (50 in each group) in secondary schools of the Bidar district. The study was approved by the Institutional Ethics Committee. Participants were selected using simple random sampling. Data was collected using a self-structured questionnaire and a standardized internet addiction test (IAT). Data was analyzed using SPSS (v. 20, IBM Corporation, New York, United States).

Results: The study revealed that all the adolescents (100%) were using the internet and social media (SM), among which 81 (81.0%) adolescents had psychological dependence. There was a significant difference in the score across different points in the experimental group (mean score within groups = 13.15 at P < 0.001). A significant association was found between the level of knowledge and selected socio-demographic variables like age (P = 0.024) and educational status (P = 0.035).

Conclusion: Health promotion intervention was found effective in enhancing knowledge regarding psychological dependence on the internet and SM. Thereby reducing the level of psychological dependence among adolescents.

Background: This study examined the knowledge and attitudes of parents in Riyadh, Saudi Arabia, regarding human papillomavirus (HPV) and its vaccine. Recognizing the critical role of parental awareness in vaccine acceptance, the research aimed to assess current levels of understanding, identify demographic factors influencing knowledge, and explore attitudes toward HPV vaccination.

Methodology: Using a convenience sampling technique, this quantitative cross-sectional study was conducted between December 2022 and July 2023. The research engaged 330 participants among parents of both genders in Riyadh. Data were collected using a pretested, semi-structured questionnaire adapted from a prior study in Saudi Arabia's western region. Statistical analyses were performed using SAS version 9.4 (SAS Institute Inc., located in Cary, North Carolina, United States), encompassing frequencies, percentages, Chi-square tests, and logistic regression.

Results: The demographic analysis revealed a predominantly female (95.5%), married (90.0%), and educated sample. Positive attitudes toward vaccination were prevalent, with 50.3% expressing willingness to vaccinate. However, over half of the participants (54.2%) lacked awareness about HPV, indicating a need for targeted educational interventions. Higher education levels correlated with better knowledge. Concerns about vaccine side effects were prevalent (29.4%), impacting willingness to vaccinate. Positive attitudes were associated with higher knowledge levels, with 68.5% of those with good knowledge expressing willingness to vaccinate.

Conclusion: This study revealed critical insights into parental knowledge and attitudes regarding HPV and vaccination in Riyadh. The findings emphasize the urgency of educational interventions to enhance awareness and address specific misconceptions. Tailored public health campaigns, considering diverse sources of information and demographic characteristics, are essential for improving vaccination rates and mitigating health risks associated with HPV.

Background: Mental Health Nursing care relies on establishing a trusted relationship between the nurse and the patient. Effective communication and strong clinical reasoning are critical components of this relationship. However, our experiences as educators in psychiatric nursing programs reveal that students often experience anxiety and fear before beginning their clinical practice in psychiatry. To address this challenge and enhance clinical competency, a need was identified for a supportive intervention.

Method: This study aimed to develop and evaluate a Psychiatric Nursing Clinical Virtual Simulation program to enhance knowledge, clinical reasoning, and therapeutic communication skills among third year of nursing students. The pilot study included total 56 third year BSc Nursing students, 29 students randomly assigned in the experimental group and 27 in the comparison group. A virtual simulation program was created using scenario-based videos, interactive modules, and assessments. Participants completed pre- and post-tests, engaged in simulated scenarios, and evaluated their clinical reasoning skills.

Result: Content validity of the tools was ensured through expert review, achieving a Content Validity Index (CVI) score of 0.96. A pilot test was done to confirm the feasibility and reliability of the assessment tools. The findings showed that the virtual simulation program significantly improved knowledge and clinical reasoning skills. Participants reported high satisfaction with the program, highlighting its visual appeal and effectiveness in breaking the limitations of classroom teaching. All students successfully completed the program without difficulty, demonstrating its feasibility and acceptability.

Conclusions: The Psychiatric Nursing Clinical Virtual Simulation program proved to be a valuable educational tool. It effectively addressed students' initial anxiety, enhanced their clinical competence, and fostered a deeper understanding of mental health nursing concepts. Virtual Patients, as part of this program, offer a promising pedagogical approach for developing independent learning and critical skills among nursing students.

Background: Anemia during pregnancy can affect autonomic functions, crucial for maintaining cardiovascular stability. The autonomic nervous system is essential for maintaining homeostasis of the cardiovascular system. This autonomic imbalance can lead to complications such as pregnancy-induced hypertension and insufficient uteroplacental blood flow. Therefore, we planned to evaluate the cardiovascular, autonomic, and cognitive functions of South Indian pregnant women with anemia.

Materials and methods: The present analytical cross-sectional study was conducted in a tertiary care center. A total of 120 pregnant women belonging to early and late trimesters of pregnancy who visited the outpatient department of Obstetrics and Gynaecology were recruited for the study. Basal heart rate (BHR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded. Heart rate variability, a complete battery of cardiac autonomic function tests, which includes lying-to-standing ratio (30:15 ratio), deep breathing ratio (E: I ratio), and diastolic blood pressure response to the isometric handgrip test, was recorded.

Results: BHR and SBP were significantly higher in the study group. DBP was higher in the control group. There was a highly significant difference in hemoglobin levels, with the study group having considerably lower levels. The 30:15 ratio is higher in the study group, with a significant difference indicating that pregnant women with anemia have a higher ratio response when transitioning from a sitting to a standing position than normal pregnant women. The diastolic blood pressure increase in response to the isometric handgrip (IHG) exercise is significantly higher in the study group, indicating a more significant response to isometric handgrip in pregnant women with anemia in the early and late trimesters of pregnancy.

Conclusion: Pregnant women with anemia are more prone to autonomic and cognitive dysfunction than normal pregnant women. The increased heart rate, blood pressure, and altered HRV indices highlight the need for careful monitoring and early identification of anemia during pregnancy.

SARS-CoV-2 vaccination (SC2V) can be complicated by post-acute COVID-19 vaccination syndrome (PACVS). One manifestation of PACVS is small fibre neuropathy (SFN). A positive effect of intravenous immunoglobulins (IVIGs) even 3 years after the onset of PACVS is not known. The patient is a 52-year-old woman who developed PACVS after the second BNT162b2 vaccination in June 2021, which manifested clinically with SFN, myopericarditis, coagulopathy, and ocular, dermatologic, immunologic, and central nervous system (CNS) abnormalities. The SFN itself manifested as sensory disturbances, arterial hypotension and postural tachycardia syndrome (POTS). After the patient received three cycles of IVIGs, starting in June 2024, three years after the onset of PACVS, there was a significant positive effect on her SFN and other symptoms, as evidenced by various specific investigations. This case demonstrates that symptoms and signs of SFN as a manifestation of PACVS may benefit from the administration of IVIGs even years after onset.

Context: Psychiatric disorders are common among people with diabetes but often go undiagnosed and untreated. Various factors increase the risk of mental disorders in diabetic patients.

Aims: 1. To estimate the prevalence of psychiatric disorders among adult patients with type II diabetes mellitus. 2. To identify sociodemographic factors associated with psychiatric comorbidity in the study population.

Settings and design: The present cross-sectional study was conducted under the Department of Community Medicine, JNMC (2023-2024), among the 390 randomly selected type II diabetes mellitus patients.

Methods and materials: Study tools included a predesigned structured questionnaire for collecting data on sociodemographic factors. The General Health Questionnaire (GHQ-12) was used to screen psychiatric disorders, and Diagnostic and Statistical Manual of Mental Disorder 5 Text Revision (DSM-5 Level 1) was used to confirm different psychiatric disorders.

Statistical analysis used: Data were analyzed using IBM SPSS 20.0 software. For assessing the association of psychiatric disorders with sociodemographic factors, binary logistic regression was applied.

Results: Among 390 patients, 177 (45.4%) were males and 213 (54.6%) were females, with a mean age of 56.49 ± 12.49 years. Psychiatric disorders were present in 120 (30.8%) patients, among which depression (27.6%) and anxiety (23.5%) were most common. Psychiatric disorders were more common in patients above 70 years of age, females, living alone, illiterate, presently not working, belonging to the Muslim faith, patients residing in semiurban areas, patients belonging to a 3-generation family, and the upper socioeconomic class. Significant associations were found between the presence of psychiatric disorders and gender, marital status, educational status, and occupational status.

Conclusions: Psychiatric comorbidity is common among patients with type 2 diabetes. Sociodemographic factors such as gender, marital status, level of education, and occupational status are important determinants of psychiatric comorbidity among diabetic patients.

Introduction: Placental pathology is thought to play a significant role in causing stillbirths. Identifying such pathologies can help in preventing stillbirths and improving future pregnancy outcomes. Hence, this study was planned to determine the role of placental pathology in the cases of stillbirth and its association with the risk factors.

Methodology: A descriptive study was conducted on 42 women with stillbirth, in the Department of Obstetrics and Gynaecology, in collaboration with the Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow for 18 months. A detailed questionnaire was used to collect data from study participants and their placental samples were sent for histopathological and microbiological examination. Data were analysed using Statistical Package of Social Sciences version 23.0 for Windows.

Results: Out of 42 women in our study, the majority were primigravida (40.5%) with a mean maternal age of 28.38 ± 4.9 years. Among 42 study participants, 41 (97.6%) had no antenatal checkups, 14 (33.3%) of them had associated comorbidities of which pre-eclampsia was most common (26.2%), 20 (47.6%) showed maternal vascular malperfusion as the commonest histopathological finding and 18 samples (42.9%) had microbial growth. Among the 42 cases, histological findings were seen in 29 placental samples while 13 did not show any histological changes in the placenta. The difference was statistically insignificant (P < 0.05).

Conclusion: In our study, lack of antenatal care, pre-eclampsia/eclampsia, premature rupture of membranes, gestational diabetes and antepartum haemorrhage were found to be the major risk factors for stillbirth. Also, maternal vascular malperfusion and chorioamnionitis along with microbial growth were seen as the major pathological lesions found in placental samples of women with stillbirth.