Journal of Family Medicine and Primary Care最新文献

Vitamin D3 is crucial for various physiological functions in the body, playing a vital role in the maintenance and regulation of the skeletal, immune, muscular, and nervous systems. Excessive supplementation of Vitamin D3, despite its well-documented health benefits, can lead to toxicity. In severe cases, toxicity manifests as hypercalcemia, hypercalciuria, and multi-organ dysfunction. This report presents a case involving a 58-year-old woman with postmenopausal osteoporosis, who developed markedly elevated serum 25(OH)D3 levels of 556 ng/mL due to uncontrolled cholecalciferol supplementation. Notably, the patient remained asymptomatic, with no abnormalities detected in calcium-phosphate metabolism tests. Vitamin D3 levels normalized spontaneously five months after cessation of supplementation. This case underscores the importance of regular medical oversight when using cholecalciferol, particularly over-the-counter preparations, to monitor calcium-phosphate balance parameters and prevent potential complications.

Introduction: India reports more than 9 million animal bite cases and 5000 deaths due to rabies every year, which postexposure prophylactic vaccines can prevent. Delayed vaccination can be fatal. We assessed the causes of the delay in initiating postexposure prophylaxis (PEP) in the Shivpuri district of Madhya Pradesh, India.

Methodolgy: We defined delay as >24 h between the bite and initiation of PEP. We interviewed all animal bite cases reported in the outpatient or emergency departments at the District Hospital of Shivpuri in Madhya Pradesh for PEP from January to September 2023 using a structured questionnaire on the sociodemographic profile, nature, site, animal of the bite, and treatment time of the cases. In-depth interview of the cases who delayed the treatment about the factors responsible was done. Chi-square was applied as a significance test for factors associated with delay in treatment, and P < 0.05 was taken as significance.

Results: A total of 422 animal-bite cases were interviewed; males were 289 (68%), rural residents were 293 (69%), and those aged 10-19 years were 100 (24%). Dogs caused 394 (93%) of bites, affecting lower limbs 220 (52%). Treatment delay occurred in 157 (37%) of cases. Factors were closed facilities due to holidays or delay in reaching, 56 (36%); work-related, 51 (32%); treatment unawareness, 38 (24%); lack of accompaniment, 22 (14%); and financial, 21 (13%). Delays were significantly higher among rural residents, those living >10 km from facilities, and cases with income <₹10,000/month.

Conclusions: We recommend awareness campaigns in rural areas regarding rabies and extending timings of healthcare facilities.

Context: Malnutrition is a major cause of morbidity and mortality among children. Different feeding practices have an influence on the nutritional health of the child.

Aims: To ascertain the feeding practices of caregivers of children 1 to 3 years of age in North India, Chandigarh and to assess the nutritional status among children with different feeding practices by caregivers.

Settings and design: A community-based cross-sectional study was conducted among 200 caregivers and their children residing in urban (60%), slum (30%) and rural (10%) using multistage cluster random sampling.

Methods and material: Feeding practices were assessed using child feeding questionnaire.

Statistical analysis: Mean scores and difference in means were calculated for feeding domains. Proportions and differences in proportions were calculated for malnutrition. Indices and Z scores were calculated. Spearman correlation coefficient was calculated to check the correlation between feeding styles and malnutrition.

Results: Among the seven feeding domains, 'perceived responsibility' of child feeding (4.8 ± 0.03), P = 0.639 and 'concern about child weight' (4.4 ± 0.04), P = 0.003 were predominant among the caregivers. Mean scores for 'concern about child weight' (P = 0.003), 'pressure to eat' (P < 0.05) and 'monitoring' (P < 0.05) feeding domains were significantly higher in urban (4.6, 3.7, 3.7) as compared with slum (4.3, 3.6, 3.4) and rural areas (4.4, 3.6, 3.5), respectively. About 42.5% children were underweight, 57% stunted and 24% wasted. Feeding domain 'monitoring' had a weak correlation (≤0.39) with z scores for malnutrition (P = 0.277) and stunting (P = 0.229). Other feeding domains had very weak (≤0.19) or no correlation (ρ = 0) with malnutrition.

Conclusions: Feeding practices of caregivers are related with malnutrition, stunting and wasting among children.

Introduction: Several research studies have indicated a possible association between markers of systemic inflammation and osteoporosis. Nevertheless, the precise relationship is still unclear due to the insufficient number of studies, necessitating additional research. The objective of this study was to examine the connection between systemic inflammation markers (SIMs) and the incidence of osteoporosis and osteopenia.

Materials and methods: Data were gathered from the National Health and Nutrition Examination Survey (NHANES) conducted in the United States from 2009 to 2018. To evaluate the relationships between four systematic immune-inflammation markers-systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR)-and the occurrence of osteoporosis and osteopenia, a multivariate logistic regression analysis was utilized. Odds ratios (OR) along with 95% confidence intervals (CI) were calculated.

Results: Multivariate regression analysis revealed that female gender, lower BMI, and older age were identified as risk factors for osteoporosis, while having a higher family income-to-poverty ratio was found to be a protective factor. Among SIMs, only PLR was significantly associated with the prevalence of osteoporosis. Individuals in the highest tertiles of PLR had a 1.221-fold increase in osteoporosis prevalence compared to those in the lowest tertiles (OR = 1.221, CI = 1.001-1.488, P = 0.048). Subgroup analysis indicated stronger associations between NLR and osteoporosis in older individuals or males. Regarding osteopenia, NLR emerged as a significant protective factor for its prevalence. Interestingly, subgroup analysis revealed stronger associations between SIMs and osteopenia in younger individuals or females.

Conclusion: Not all SIMs demonstrated significant associations with osteoporosis and osteopenia. An increased PLR has been recognized as a possible risk factor for osteoporosis, whereas a high NLR might act as a protective factor against osteopenia. Additionally, it is crucial to highlight that the predictive value of SIMs can vary among individuals depending on their age and gender.

Background: Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed sleep disorder characterized by repeated upper airway obstruction during sleep, contributing to significant health risks. While global data highlight its high prevalence, evidence from rural Indian populations remains limited.

Objectives: To estimate the prevalence of people at risk of OSA among adults (≥18 years) residing in Budge-Budge II block of West Bengal and to identify associated socio-clinical risk factors, if any.

Methods: This community-based study was conducted from November 2024 to January 2025 in Budge-Budge II Block, West Bengal. A sample of 205 adults was selected using multistage random sampling. Data were collected through household visits using a pre-tested structured schedule that included the modified Berlin questionnaire for OSA risk assessment. Medical records were reviewed; anthropometric measurements and blood pressure recordings were obtained. Statistical analysis included descriptive statistics and logistic regression to identify risk factors.

Results: The mean age of the participants was 43.35 ± 16.30 years, and 54% were female. The overall prevalence of high risk for OSA was 29%, with a higher proportion among males (57.6%). Hypertension was present in 31.7% of the participants, while 40% had a body mass index above the normal range. Multivariate analysis identified significant associations (P < 0.05) between high risk for OSA and factors such as advanced age, male gender, hypertension, obesity, and regular alcohol consumption.

Conclusion: The study observed a substantial burden of undiagnosed OSA risk in rural West Bengal. Given the association with modifiable risk factors, community-level interventions, including the training of health workers for early screening using tools like the modified Berlin questionnaire and prompt referral, can aid in reducing the public health impact of OSA in underserved areas.

Introduction: The main hurdles to achieving early diagnosis and management of leprosy and its complications are lack of community awareness and the challenging social stigma. Healthcare workers play a key role in increasing community awareness and eliminating stigma about leprosy, and it is one of the important responsibilities. The objective of the study is to assess the knowledge of Allied Health Sciences (AHS) students about leprosy before and after the training program and to explore the stigma prevailing in the society about leprosy.

Materials and methods: It was a pre- and post-test mixed-method study involving both quantitative and qualitative components. Group discussion was conducted for 74 AHS students (lab technicians and nursing students). A paired t-test was used for pre and post-test analysis. Manual content analysis was done for the statements that emerged during the group discussion.

Results: The mean change in overall score was 0.228, which was significant (t = 7.54, P < 0.01). There was an improvement in the knowledge score after training. The Pearson correlation coefficient between pre-test knowledge score and post-test scores was significant (r = 0.318, P = 0.04). The majority of them stated that leprosy patients will be isolated by the community as stigma remains a main challenge.

Conclusion: Implementation of need-based health education and sensitization programs should be improved, and more emphasis needs to be placed on early case identification of leprosy.

A double aortic arch is a rare congenital heart anomaly not typically diagnosed in adults. It can present with nonspecific symptoms including dysphagia, a cough, and hoarseness which can lead to a delay in diagnosis or misdiagnosis. This case reviews a 44-year-old woman who presented with dysphagia and was diagnosed with a double aortic arch. The purpose of this case is to highlight how this rare congenital anomaly can present in adulthood in the primary care setting and to identify the possible work-up and management for these individuals.

Background: Exercise during pregnancy provides well-documented benefits for maternal and fetal health, including reduced risk of gestational diabetes, hypertension, and postpartum depression. However, healthcare providers lack the knowledge or confidence to promote physical activity during routine antenatal care. This study assesses the knowledge, attitudes, and practices (KAP) of primary care physicians in Jeddah, Saudi Arabia, regarding antenatal physical activity.

Methods: A cross-sectional study utilizing a structured questionnaire evaluated physicians' knowledge of exercise benefits, adherence to guidelines, attitudes toward prenatal physical activity, and implementation of clinical counseling practices. Descriptive statistics and Chi-square tests were used to examine associations between KAP scores and physician characteristics.

Results: Of 85 physicians, 95% agreed on exercise benefits, and only 24.7% demonstrated awareness of American College of Obstetricians and Gynecologists (ACOG) guidelines. Positive attitudes (median score: 3/4) contrasted with limited practices: only 17.4% routinely counseled patients, and 18.6% provided educational materials. Key barriers included lack of competency (87.2%), time constraints (81.4%), and cultural beliefs (73.3%). No significant associations were found between KAP scores and gender, age, or years in practice.

Conclusion: Although Saudi physicians show growing recognition of prenatal exercise benefits, implementation of structured counseling remains limited. To improve compliance, targeted educational interventions, standardized clinical prompts, and enhanced patient education materials are necessary to bridge the gap between knowledge and practice.

Introduction: Fetal blood sampling is considered the best option in overcoming the increased false positivity of cardiotocography (CTG) but is not used in many developing countries due to logistics difficulties. Hence, obstetricians highly rely on CTG for diagnosing fetal hypoxia. Studies of suspicious and pathological CTG correlating with umbilical blood parameters are limited. Lactate can be a reliable marker to assess intrapartum hypoxia. However, the correlation of suspicious and pathological CTG with lactate is least studied.

Material and methods: A prospective observational cohort study was conducted to correlate suspicious and pathological CTG with umbilical cord arterial blood gas parameters in laboring pregnant women and to compare the maternal and neonatal outcomes.

Results: Out of 2350 women subjected to continuous CTG, 104 and 101 participants had suspicious and pathological CTG, respectively. A statistically significant association of CTG was seen in women with preterm delivery and with the use of tramadol. The association of primary outcomes like pH, base excess, and lactate with CTG findings was significant.

Discussion: Other modalities to confirm acidosis should be used before an intervention in women with suspicious CTG. Drugs like tramadol and agents used for induction may play a role in abnormal CTG tracing in suspicious CTG. Cord blood lactate has a stronger association with CTG when compared with other umbilical cord parameters.

Conclusion: Pathological CTG should be taken cautiously as it carries a greater risk of perinatal distress, but suspicious CTG tracing needs to be supplemented with additional tests before any interventions.

Introduction: Oral potentially malignant disorders (OPMDs), including leukoplakia, oral submucous fibrosis, and erythroplakia, are precursors to oral cancer, a major public health issue in India. The primary etiological factors for OPMDs are the use of tobacco (smoking and smokeless) and alcohol consumption, which are deeply embedded in cultural practices and contribute significantly to the rising incidence of oral cancer. The Cigarettes and Other Tobacco Products Act (COTPA) of 2003 aims to regulate tobacco usage, but implementation remains inconsistent, particularly in rural areas. This study explores the correlation between these adverse habits and OPMDs in an Indian population, aiming to develop a classification system for high-risk patients.

Materials and methods: A cross-sectional study included 262 patients diagnosed with OPMDs and 100 control subjects with a history of adverse habits but no clinically visible lesions. Patient data was collected through questionnaires and medical records from the Department of Head and Neck Oncology in Kolkata, with statistical analysis performed using SYSTAT software to compare age, sex, habit history, and the prevalence of OPMDs across groups.

Results: The mean age of OPMD patients was 38 years, with 100% male patients. Tobacco use (both smoking and smokeless) and alcohol consumption were significantly more prevalent in the OPMD group compared to controls. The most common clinical diagnosis was homogeneous leukoplakia, with mild dysplasia being the most frequent histopathological finding. Statistical analysis revealed a strong association between adverse habits and OPMD diagnosis.

Conclusion: This study underscores the significant role of tobacco and alcohol in the development of OPMDs and OSCC. A classification system based on demographics, habit history, and socio-economic status is proposed for effective triaging of high-risk individuals. This could enhance early detection and intervention, particularly in high-risk populations, thereby contributing to oral cancer prevention.