Journal of Family Medicine and Primary Care最新文献

Background: For those who often use needles, such as nurses and laboratory professionals, needle stick injuries are a fact of life. Even if it's not medical waste, it can still happen if you touch garbage. Approximately 385,000 healthcare professionals stab themselves unintentionally each year. The likelihood of virus transmission after a skin puncture injury depends on the person who used the object in the first place, the quantity of blood involved, the type of needle or syringe in question, the length of time since it was last used, and the type of injury. Post-exposure prophylaxis should be taken into account.

Objective: The objective of the study is to assess the impact of a structured educational campaign on nursing students' understanding of needle stick injuries and related post-exposure prophylaxis for HIV/AIDS.

Methodology: Quasi experimental research design was used. Sixty nursing students B.Sc (N) and GNM (N) 1^st year students were selected by using purposive sampling technique. The study was conducted at selected private nursing colleges at District Kangra, Himachal Pradesh.

Results: In the pre-test knowledge score, (25%) nursing students had poor level of knowledge, (66.66%) nursing students had average level of knowledge, and (8.34%) nursing students had good level of knowledge. The post-test knowledge score (43.34%) nursing students had good level of knowledge, (56.66%) nursing students had average level of knowledge, and (0%) nursing students had poor level of knowledge The t value in the group was 9.50 which were highly significant at P < 0.05 level.

Conclusion: Compared to video-assisted instruction, the lecture and demonstration technique is more successful. The fact that both teaching techniques contribute to improving understanding of HIV/AIDS and needle stick injuries.

Context: Anganwadi workers (AWWs) require technical skills for growth monitoring of under-five children. Anthropometric skills help Anganwadi workers assess any changes or deterioration in the normal growth of children.

Aims: To determine the effect of a structured training program on the anthropometric skills of Anganwadi workers in rural areas of Raebareli district in Uttar Pradesh.

Settings and design: A community-based interventional study, was conducted among 162 AWWs, 73 from Salon and 89 from Rahi development blocks of Raebareli district.

Methods and material: The skills of AWWs in anthropometric measurement domains (weight, height/length, and mid-upper arm circumference) were assessed using a pre-tested observatory checklist both before and after the training sessions. The skills for each domain were assessed on four points i.e. standard procedure applied to the child, assurance of safety precautions, observer protocol during anthropometry, and precision and accuracy in recording measurement.

Statistical analysis used: The McNemar Chi-square test was used for paired categorical data analysis. P < 0.05 was considered to be statistically significant.

Results: The mean age of the study population was 43.30 ± 9.68 years. The mean years of their job was 16.68 + 7.38 years. About one-fourth (26.5%) of AWWs had received training within the last three years. Inadequate/non-functional equipment (9.8%), low honorarium (29.4%), interruption in timely supply of supplementary food (6.3%), non-cooperation of the community (84.6%), insufficient space (58.0%), and availability of periodic job aids (16.8%) were the major challenges that were faced by ICDS workers. The anthropometric skills of the AWWs were found to improve significantly in almost all the domains. The proportion of AWWs following standard procedure, assurance of safety precautions, observer protocol during anthropometry, precision, and accuracy on recording measurement were found to increase significantly after a structured training program. (P < 0.05).

Conclusions: A structured training programme focusing anthropometric skills on play an important role in increasing the skills of AWWs in growth monitoring. AWWs' capacity to monitor child growth must be refreshed regularly through separate focussed training programs rather than during comprehensive sessions.

Introduction: Primary care physicians are crucial in fighting COVID-19, especially with the emergence of the new JN.1 sub-variant.

Measures to reduce risk: Given your direct exposure to infected patients, it is imperative to establish a protocol for triaging patients with respiratory symptoms and to uphold a minimum distance of 2 meters between patients and primary care physicians. Patients suspected or diagnosed with the JN.1 sub-variant should be advised to wear surgical masks for their protection and others protection. Primary care physicians must also use personal protective equipment (PPE) and maintain strict hand hygiene practices when dealing with these patients. Patient samples should be treated as high risk for contamination, and laboratory procedures should be meticulously evaluated for potential hazards. PPE should be tailored to the procedure.

Conclusion: To protect the health and well-being of primary care physicians, who play a critical role in addressing the challenges, it is essential to strictly adhere to infection control measures.

Introduction: Hearing amplification devices provide ample auditory input that can help to decrease the cognitive strain caused by hearing loss. Depending on the kind and severity of hearing loss, using hearing aids has variable effects on auditory working memory. This study looked into the auditory working memory capacity after using hearing aids for more than 6 months.

Method: Sixty individuals of a mean age of 53.4 ± 6.07 years with severe to profound hearing loss in the age range of 40-60 years participated. Out of them, 30 individuals with a mean age of 53.5 ± 6.7 were using digital hearing aids and another 30 individuals with a mean age of 53.3 ± 5.4 years were not using a hearing aid. Forward and backward digit span task (DST) and Mini-Mental Status Examination (MMSE) were investigated to estimate the auditory working memory capacity.

Results: Mean MMSE scores of those individuals with severe to profound hearing loss (53.3 ± 5.43) using (HAU) a hearing aid (25.7 ± 2.97) and individuals not using (NHAU) a hearing aid (22.1 ± 5.11) were compared across each other. The result revealed that the mean MMSE score of HAU was significantly higher than the mean score of NHAU. The mean DST (forward, backward, and total) score of HAU (6.40 ± 1.47) was cosiderably higher than the mean score of NHAU (5.33 ± 1.12).

Conclusion: Results showed that mean MMSE and DST scores were higher in the HAU category, but when compared across the gender, no statistical differences were observed. The change in auditory working memory and other cognitive abilities were attributed to the usage duration of the hearing aids.

Aims and objectives: Group B streptococcus (GBS) colonization during pregnancy can lead to invasive infections in neonates including meningitis or sepsis. The major risk factor for neonatal disease is the rectovaginal colonization of GBS during pregnancy and delivery. The objectives of this study were as follows: 1) to screen antenatal patients at 35-37 weeks of gestation for GBS colonization, 2) to determine the prevalence of GBS among pregnant women, 3) to formulate an antibiotic policy with respect to antepartum antibiotic prophylaxis and empiric choice of antibiotics for early onset neonatal sepsis, and 4) to ascertain the maternal and neonatal outcomes in pregnant women with positive GBS colonization.

Material and methods: A prospective observational study was conducted among 50 obstetric patients at 35-37 weeks of gestation attending the outpatient and inpatient departments of a tertiary care hospital. High vaginal and rectal swabs were collected and immediately transported to the microbiology lab and were sent for culture and sensitivity testing using the standard culture methods. The incidence of positive cultures was noted and was taken up as a reference for statistical calculations.

Results: Out of the 50 vaginal samples, one sample showed GBS positivity having a prevalence of 2%. Rectal swabs did not grow GBS for all samples. Neither the pregnant woman nor the newborn showed any symptoms or signs due to GBS. GBS grown in vaginal culture was highly sensitive to benzyl penicillin and other penicillins, cephalosporins, clindamycin, daptomycin, vancomycin, meropenem, and linezolid.

Conclusion: Based on our findings, screening the patients with routine rectovaginal swabs may not be necessary in our population. Also, empiric treatment with antibiotics for GBS in symptomatic mothers cannot be justified, and hence, GBS should be considered as an insignificant pathogen.

Diabetic autonomic neuropathy is one of the most common complications of diabetes which is asymptomatic in early stage. Hence HRV and AFT are performed to detect and prevent its progression to advanced stages. To discuss the HRV and AFT findings in diabetic patients. An observational study was conducted in Physiology department of AIIMS, Bhopal in collaboration with the Medicine department of the institute. Seventy-two diagnosed Type-2 Diabetes mellitus patients were examined using POWER LAB AND LAB CHART 8 BY AD INSTRUMENT: For recording heart rate variability (HRV) and Ewing's battery of tests: For Autonomic function testing. Microsoft Excel was utilized for data compilation and for result analysis. In the present study, based on HRV parameters sympathetic involvement was seen in 39% while parasympathetic involvement was seen in 15% of patients. Balanced state was observed in 46% of the patients. Based on AFT battery, normal early involvement was observed in 62% of the patients while definite and severe involvement was observed in 14 and 24%, respectively. Diabetic autonomic neuropathy was observed in 72% of the patients based on HRV and AFT testing. In severe involvement, orthostatic hypotension was seen. Severe involvement was observed in 24% of the patients in present study. Involvement of the vagal parasympathetic component of ANS was obvious evidenced by increase in resting heart rate, decrease in Valsalva ratio, E/I index, and standing ratio. Diabetic autonomic neuropathy was observed in majority of patients with normal early involvement seen predominantly and though majority of them were in balanced state, sympathetic involvement was also seen at large. HRV studies depicted a decrease of total power, decreased low frequency (LF) and high frequency (HF) with LF/HF and SD1/SD2 ratios depicting sympathetic involvement.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation and damage in the joints. It often requires treatment with disease-modifying antirheumatic drugs (DMARDs) to manage symptoms and prevent progression. The study investigates the long-term antibody responses to COVAXIN and COVISHIELD vaccines in RA patients.

Methodology: This cross-sectional study (IEC approval no: AlIMS/BBN/IEC/AUG/2021/60-R dated Sept 05, 2022, and Ref No: 799/U/IEC/ESICMC/F490/09/2022 dated Oct 31, 2022) enrolled 103 diagnosed RA patients receiving DMARDs and 183 healthy controls. The participants who completed 1 year after the second dose of vaccination were included, and detailed information on demographic, medical, and vaccination were collected. Laboratory investigations included complete blood count, inflammatory markers, and antispike antibody levels. Statistical analyses assessed differences between COVAXIN and COVISHIELD subgroups, considering DMARDs usage and disease duration.

Results: Among RA patients, both COVAXIN and COVISHIELD groups exhibited low disease activity. No significant (P > 0.05) differences were found in IL-6, CRP, or antispike antibody levels between COVAXIN and COVISHIELD subgroups in RA patients and healthy controls. Notably, 89% of female RA patients received COVISHIELD. Co-morbidities, including hypothyroidism (44%), were prevalent in COVISHIELD-received RA patients. Antibody concentration varied significantly among DMARDs usage groups in COVAXIN-vaccinated RA patients, with a notable difference between three-drug and HCQ-alone regimens. However, no such difference was observed in the COVISHIELD group. Disease duration did not significantly impact antispike antibody concentration in either of the vaccination group.

Conclusion: RA patients had a decreased antibody response, 1 year after receiving the second dose of the COVID-19 vaccine. Nonetheless, there was no discernible difference in the antispike antibody concentration between the COVISHIELD and COVAXIN vaccination groups. Additionally, immunosuppressive medications significantly impact serological responses to these vaccines.

Familial hypercholesterolemia is a multi-gene disorder affecting 1 in 200-500 individual which is characterized by increased level of total cholesterol and low density lipoprotein (LDL) which deposit cholesterol reach protein leading to xanthomas, corneal arcus and prone to develop risk for atherosclerosis and coronary heart disease. 11 year female, born of consanguineous marriage attended with yellowish patches (Xanthelasma) bilaterally present over upper eyelid, buttock since 5-6 years. In family history younger girl along with both parents has Xanthelasma. In investigations, routine blood, urine and ECG& ECHO was normal except lipid profile of patient and sibling was abnormal. Child was treated with atorvastatin and dietary advice. In follow up after 3 month, child had complained of neck pain and swelling to left side. Then USG neck and Color Doppler showed reduced diastolic flow of left ICA and type two plaques and type 111 plaque in Rt common carotid artery. Anti-platelets was added and referred to cardiologist for coronary angiography which showed LAD - proximal mid distal diffuse plaque, LCX- proximal eccentric plaque. This case highlights the significance of conscious and proactive genetic screening for familial hypercholesterolemia especially in consanguineous marriage, to diagnose, treat and prevent mortality with premature coronary artery disease.

Intestinal obstruction represents a critical surgical emergency with a myriad of potential causes, ranging from mechanical blockages to functional impairments. In contrast to developed nations, where the usual causes of obstruction are adhesions, strictures, and metabolic derangements, infective etiologies, like tuberculosis and parasitic infestations, are more common in developing countries. We present a case report of a 22-year-old man presenting with acute intestinal obstruction due to a massive ascariasis infestation. The patient exhibited classical symptoms of intestinal obstruction, including abdominal pain, distension, and vomiting. Imaging studies revealed multiple air-fluid levels, suggesting a small bowel obstruction. Emergency surgical intervention was performed, and a substantial number of live worms were extracted from the small intestine, relieving the obstruction. Postoperative recovery was uneventful, and the patient was discharged with anthelmintic therapy and instructions for improved sanitation practices. This case underscores the importance of considering worm bezoars as a differential diagnosis in patients presenting with acute intestinal obstruction, particularly in endemic regions, and highlights the significance of prompt surgical intervention for resolution. Additionally, it emphasizes the critical role of public health measures in preventing and managing parasitic infestations.

Aim: It was thought that resistance acquired during treatment of systemic diseases can lead to resistant bacteria in eye infections. However, evidences are showing emergence of bacterial resistance owing to prior topical antibiotic usage. In the current study, we intended to promote evidence-based usage of antibiotics during outbreak of epidemic keratoconjunctivitis.

Methods: A descriptive study was designed. First 50 patients who visited the outpatient department of ophthalmology with signs and symptoms of EKC during the outbreak in the months of July-August, 2023 in a tertiary hospital in northern India were included in the study. Prior usage of topical antibiotics during this epidemic outbreak was the exclusion criteria. Conjunctival swabs were taken and subjected to Gram staining and Culture and sensitivity, for any bacterial infection.

Results: Only two slides of gram stain showed gram-positive cocci. These two samples were positive for Methicillin resistant Staphylococcs Aureus (MRSA). Rest of the 48 samples were negative for any bacterial growth. P value for no growth in bacterial cultures was <0.05, which is significant.

Conclusions: Our study suggests restrain from overusage of topical antibiotics in outbreaks of EKC until microbiological outcomes suggest otherwise. In view of presence of MRSA in neo-natal sample, and its known serious complications, we suggest prophylactic use of topical antibiotic and its modifications once reports of culture and sensitivity are available.