Journal of Family Medicine and Primary Care最新文献

Hand, foot, and mouth disease (HFMD) is a clinical syndrome characterized by a febrile illness, followed by an oral exanthema and a macular, maculopapular, or vesicular rash of the hands, also involving palms, feet, and buttocks caused by enteroviruses of the picornaviridae family. It is a benign self-limiting disease which spreads by fecal-oral, oral-oral, and respiratory droplet contact. This case series describes cases of HFMD, presenting with typical clinical features in the North Indian region where early diagnosis and management of the condition can be carried out to halt the disease progression and prevention for the betterment of children. We came across four cases of HFMD in the month of early September to October. Their parents were health care workers, and the patients had typical symptoms and signs, except in one case, which showed extensive vesicular eruptions and crusting. All children improved at domiciliary care. Active communication and close monitoring are what is required to manage HFMD without complications. These cases infer that counseling and monitoring are an integral part in the management of HFMD.

Context: The prevalence of gestational diabetes mellitus (GDM) in the Indian subcontinent has increased exponentially, especially after new diagnostic criteria. Identifying women who need close monitoring is a challenge. Ultrasound has been used to guide therapy but its use in the management of GDM has been used indiscriminately due to paucity of information. The use of ultrasound to guide the number of antenatal visits for adequate glycemic control has not been researched adequately. There is also a need to contrive antenatal care strategies that can obtain optimal neonatal outcomes without burdening the health system in low-middle income countries (LMIC).

Aims: Our study was to compare pragmatic standard management of GDM with an ultrasound-guided regime (USGR) to prevent neonatal complications to ensure optimal care.

Settings and designs: A randomized controlled trial was done in a tertiary hospital between May 2019 and September 2021 in South India.

Methods and materials: Five hundred and eighty-eight women were randomized to a standard regime or USGR.

Statistical analysis: χ² and t-test were used to compare outcomes.

Results: Maternal and neonatal outcomes between standard and ultrasound USGR showed no significant difference in outcomes. Fetuses in USGR with AC ≥ 70^th centile had macrosomia (3.59% vs 26.67%, P < 0.001), increased severity of diabetes (2.97% vs 16.67%, P < 0.001), 3^rd- and 4^th-degree perineal tear (2.95% vs 27.27%, P < 0.001). The increased number of visits did not decrease adverse outcomes.

Conclusion: This small well-designed study did not show any advantage with USGR as compared to the pragmatic simple standard regime, in the treatment of women with GDM.

Context: Medical educators face different challenges in this digital era with the pressure for clinical practice as well as teaching. In blended learning Internet technologies are used along with face-to-face teaching to deliver learning methodologies.

Objective: To assess the efficacy of the blended learning dermatology course on Family Medicine residents at a teaching hospital. Methodology: It was interventional (pre and post) study with purposive sampling. All the Family Medicine residents enrolled at The Aga Khan University Hospital participated in the study after giving consents. The course covered most common skin conditions. Multiple slide sessions, online lectures, clinical presentations, case-based scenarios, and quizzes were included in the course. Knowledge was assessed through pre- test by multiple choice questions. Post tests were taken after completion of the modules to assess the improvement in the knowledge of residents about basic dermatological conditions by multiple choice questions. After completion of sessions a survey questionnaire was administered to evaluate the perception of participants about blended learning strategy.

Results: The tests scores were significantly higher in the post test. The majority of the residents were satisfied with the course delivery. A statistically significant difference was found between pre and post test results with a P value 0.000.

Conclusions and recommendation: Blended learning is an effective and innovative teaching strategy that helped family medicine residents to enhance their learning more effectively. We recommend that this method of teaching strategy should be used in other clinical disciplines in different contexts.didifferent contexts.

Background: Atypical presentations of ACS delay its recognition and treatment in the older adults. During hospitalization, depression and functional decline, which is unique to older adults, leads to poor clinical outcome. Steps taken for its prevention is unlikely to become a priority for the Cardiologist. This study was conducted to identify depression among older adults who developed ACS during hospitalization for noncardiac illness and their outcome.

Methods: 310 older adults with ACS were included from 26 June 2020 to 13 October 2020. Subjects were divided into those admitted primarily due to an ACS (Group I, n = 94) and those developing ACS after admission for noncardiac illness (Group II, n = 216). Co morbidities, medications, investigations, management, clinical outcome, Geriatric Depression Scale was compared between the two groups at the time of admission, after 30 days and after 6 months.

Results: Majority of them were admitted due to acute kidney injury (27.1%) in group II and had a non ST elevation ACS (90.2%). Optimum management was given to a lesser extent because of the clinical condition of these patients. Depression during hospitalization, during follow up and poor clinical, functional and cognitive outcome was more in group II.

Conclusion: Optimum medical management was not given to considerable number of patients because of atypical presentations, clinical condition, along with functional and cognitive decline which resulted from depression. Clinicians must be vigilant for the development of depression when an older adult is admitted to the hospital, as early detection and optimum management provides better clinical outcome.

Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes; so, a nerve conduction study (NCS) is conducted to detect the type of neuropathy that is present. To discuss the NCS findings in diabetic patients. An observational study was conducted in the Physiology Department of AIIMS, Bhopal, in collaboration with the Medicine Department of the Institute. Seventy-two diagnosed type 2 diabetes mellitus (T2DM) patients were examined using NCS (Nihon Kohden Neuropack XI Machine). Microsoft Excel was utilized for data compilation and result analysis. Based on NCS, 94% of patients were abnormal, and 6% were normal. Of abnormal patients, 89% had asymmetrical involvement, and 5% had symmetrical involvement. About 74% had mixed neuropathy, 11% had motor neuropathy, and 10% had sensory neuropathy. Mixed involvement was seen in 60% of patients and axonal involvement in 35% of patients, and 5% were normal. Lower limb involvement was seen predominately. The most common bilaterally involved motor nerve was the peroneal nerve, seen in 49% of cases, whereas the most common bilaterally involved sensory nerve was the sural nerve involved in 59% of cases. The left tibial nerve was the most common unilaterally involved motor nerve seen in 32% of cases, and the left sural nerve was the most common sensory nerve involved in 54% of cases. Asymmetric sensorimotor involvement with mixed involvement (axonal + demyelinating) was seen in diabetic patients. Peroneal and sural nerves were the most common bilaterally involved motor and sensory nerves, respectively. Similarly, the left tibial and left sural nerves were the most common unilaterally affected motor and sensory nerves, respectively.

Background: The accessory breast tissue is found in 6%. It is seen commonly in the axilla. It is asymptomatic or causes pain, restricts arm movement, causes cosmetic problems, or causes anxiety. We evaluated symptoms, signs, investigations, treatment, and postoperative complications of women with accessory breast tissue.

Methods: Our cross-sectional study was conducted in the Surgery OPD, Nagpur, on 52 women who presented with accessory breast tissue in the period from January 2019 to October 2023.

Results: In this study, of 52 patients, the majority, that is, 38 (73.07%) patients, presented with uneasiness due to the position of mass followed by 25 (48.07%) with swelling in the axilla. Twelve (23.07%) patients presented with pain in mass in premenstrual and menstrual periods, and seven (13.46%) patients with accessory nipples. Fifty (96.15%) patients had axillary swelling. One (1.92%) patient each had swelling in groin and thigh. Thirty-six (69.2%) patients had sonography findings consistent with breast-like tissue. In nine (17.30%) patients, findings suggested lipoma. Surgical excision was conducted in 52 (100%) patients. In 43 (82.69%) patients, histopathology was consistent with simple breast tissue. In six (11.53%) patients, it was fibroadenoma, and in three (6.76%) patients, histopathology was suggestive of carcinoma. Twenty-eight (53.84%) patients had no complications. Thirteen (25%) patients had an allergy to sticking, six (11.53%) patients had uneven scar, and four (7.69%) patients had hypertrophy of scar.

Conclusion: In our study, in the majority of patients, the site of accessory breast tissue was axilla. It caused uneasiness. Surgical excision was conducted in all patients. Postoperative complications were the least.

Introduction: The Siddha system of medicine (SSM) is one of the Indian Systems of Medicine (ISM). In recent times, it has received adequate support from the Indian Ministry of Ayush. Like many such indigenous systems of medicine globally, the SSM is based on its own theoretical principles, philosophy, and methods of practice. Nevertheless, SSM conducts and needs basic and applied research using scientific methods. Such research is evidenced by research publications. In the absence of a review, we did a bibliometric analysis of research publications from SSM for the period of 1972-2019.

Materials and methods: We used the term "Siddha" to retrieve the data from the PubMed database. We retrieved data from the National AYUSH research portal and homepages of institutions mandated to do research in SSM. We abstracted bibliometric information and used Epi info (Version 7.2) for analysis. We described the trends and key characteristics.

Results: Of a total of 2009 retrieved articles, we included 1457 (73%) for analysis. Between 1972 and 2001, the median number of publications per year was three (range: 0-13). Beyond 2012, the publications increased exponentially with an annual growth of 23%. The maximum number of publications (n = 224) was in 2019. Among 43 countries that produced the papers, India topped it (88%). Of 1457, 1.7% (n = 25) of publications from Siddha institutions were indexed in PubMed.

Conclusion: A bibliometric review of research output from SSM suggests that the publications have increased in the last two decades. The review recommends improving research output from SSM in terms of quantity and quality.

Aim: Urolithiasis is the most prevalent urinary tract disease, posing a global public health concern. The escalating prevalence and recurrence rates of urolithiasis are attributed to lifestyle modifications, such as reduced physical activity and dietary habits. This retrospective study aims to explore the risk factors associated with urolithiasis among individuals diagnosed with this condition.

Method: A retrospective hospital-based study involving 60 participants meeting the inclusion criteria was conducted. The participants were selected through convenience sampling from the urology, nephrology, and medical wards at Saveetha Medical College and Hospital. Demographic variables were collected, and the risk factors were assessed using a checklist on one-to-one interviews.

Results: The study unveiled that most participants (68%) were male. Eighty percent of participants had the risk factor of decreased water intake, 74% consumed excess tomatoes, 56% had a history of recurrent urinary tract infections, 64% consumed an excessive amount of salt daily, 72% experienced a decreased urine output, 53% had a habit of alcohol consumption, and 45% included milk and milk products in their daily diet. A small percentage (5%) had a family history of urolithiasis. Additionally, 6% were undergoing Siddha treatment.

Conclusion: The findings from this study underscore the significant factors contributing to urolithiasis. They can inform public health campaigns to raise awareness about lifestyle modifications, dietary changes, and hydration protocols contributing to kidney stone formation.

Hearing loss and deafness have been globally recognized as one of the major public health concerns that need immediate attention. Noise mapping refers to the systematic process of measuring and visualizing the noise level distribution in a well-defined location, preferably in urban settings or industrial areas. This exercise of noise mapping is generally done with the intention of identifying the noise hotspots and measuring the extent of exposure to noise levels in different areas. The process of noise mapping at the community level is expected to have some challenges and these must be identified to effectively deal with them. In conclusion, we cannot undermine the fact that there is an immense need to implement effective noise management strategies to reduce the development of health-related implications. In dealing with this global concern, noise mapping is a crucial tool to provide comprehensive insights about noise levels in different areas, which in turn can be utilized to take specific actions for building a healthier and sustainable environment.

Background: Understanding sexual maturity and bone fusion is crucial in forensic investigations and legal contexts. This study investigates the contemporary trend of sexual maturity and bone fusion in females, comparing the observed age-related characteristics with documented ages. Such analyses contribute to the accuracy of age estimation methods used in medico-legal scenarios.

Methods: A comprehensive study was conducted involving a diverse sample of females, and their sexual maturity and bone fusion were assessed relative to documented ages. The research utilized a cross-sectional design, collecting data through interviews, medical examinations, and radiographic imaging. Ethical approval was obtained, and participants provided informed consent. Variables included documented age, age of menarche, stages of sexual maturity, dentition, and bone fusion. Validation of model performance was conducted.

Results: Among 70 cases studied, the mean age of menarche was 10.48 years (range: 7-12 years). Maternal reports indicated menarche onset between 12-17 years. Tanner's Staging 5 for pubic hair and fully developed breasts occurred at 14 years. Permanent teeth increased with age, with 28 or more teeth present at age 14 or above. Fusion of the distal end of the Radius and Ulna with the parent bone was positive from 15 years onwards. The regression model predicted age accurately (97.99% fit).

Conclusion: The results highlight the early onset of sexual maturation, consistent teeth eruption, and bone fusion patterns in females. The observed correlations offer valuable insights for medicolegal practitioners and forensic experts.