Journal of Family Medicine and Primary Care最新文献

Background and objectives: Diabetic nephropathy (DN) is a serious complication of diabetes that requires close monitoring and proper management in order to prevent it. Family physicians play a crucial role in guiding and helping patients to control their blood sugar levels, hence preventing DN. Our objectives are to evaluate the knowledge, attitudes, and practices of family physicians regarding diabetic nephropathy in general and to study the relationship between the attitudes, and practices particularly.

Materials and methods: This is an analytical cross-sectional study that utilized an online prestructured questionnaire. All family residents, specialists, fellows, and consultants working in Riyadh city, KSA Capital, during the year 2024 were eligible for inclusion in our study. The structured questionnaire was adopted form the literature and tested for reliability.

Results: A total of 235 responses were collected from family physicians. Senior residents represented the majority with 59.1%, while consultants accounted for only 15.3%. Over 90% of the participants exhibited high levels of positive attitudes and practices toward educating diabetic patients to manage their condition by themselves, to avoid risk factors of developing any other complications, and to change their lifestyle. We also recorded a positive relationship between family physicians' attitude and their practice. The highest positive significant relationship was 53%. It is recorded between family physicians' attitude and their practice regarding education of the diabetic patients about the importance of patients' self-management. Improving the attitude of family physicians toward the management of diabetics to avoid or delay the emergence of DN will approximately increase their practices by 46%.

Conclusion: Our study revealed a strong direct relationship between family physicians' attitudes and their practices in managing DN. Our findings underscore the importance of enhancing family physicians' attitudes through targeted training and awareness programs to improve DN management and reduce the burden of diabetes-related complications.

Background: Refractive errors are the most common ocular problems affecting all age groups. They are considered a public health challenge. Recent studies indicated that refractive errors are the leading cause of visual impairment and the second cause of visual loss worldwide, as 43% of visual impairments were attributed to refractive errors. The aim of the study was to determine the prevalence of refractive errors among students of the College of Medicine and Applied Medical Sciences College, University of Bisha, Saudi Arabia.

Methods: A descriptive cross-sectional study was used. A total of 212 participants, comprising 106 (50%) males and 106 (50%) females, were involved in the study. The age range of the participants was between 18 and 25 years, with a mean age of 20.6 ± 1.8 years. Data were collected using a predesigned online electronic questionnaire.

Results: The result of the study showed that 127 (59.9%) of the respondents consulted an ophthalmologist with 60 of them within the last 1 year, 20 between 2 and 3 years and the remaining 47 more than 3 years. Short sightedness had the highest prevalence with 38 (17.9%) reported cases of RE, followed by short sightedness with astigmatism 28 (13.2%), and astigmatism without other defects 24 (11.3%) while 12 (5.7%) participants reported long sightedness. Social media was the most reported source of information (55.1%; 27) followed by friends (28.6%; 14), and ophthalmologist (16.3%; 8).

Conclusion: The present study revealed that the prevalence of refractive errors among students in the University of Bisha was high, especially myopia and astigmatism. There was no significant difference regarding gender, age, or course of study in the prevalence of RE among the students of the University of Bisha.

The Chikungunya virus (CHIKV) has emerged as a public health concern around the world as they have large epidemics. These epidemics are associated not just with mild but also with severe clinical manifestations. CHIKV was first discovered in Tanzania in 1952. Because of climate change, urbanization, and international travel, it has expanded. The rising incidence of diseases primarily transmitted by Aedes aegypti and Aedes albopictus mosquitoes highlights the urgent need for better surveillance, vector control, and therapeutics. CHIKV is an RNA virus that mutates frequently leading to genetic diversity and complicating disease management. In this review, we present how genomic variations of CHIKV can affect clinical presentation and transmission dynamics. We discuss the mutations in CHIKV that were analyzed in various outbreaks. We examine the structural and lifecycle characteristics of CHIKV, followed by a detailed exploration of important genomic modifications in structural (E1, E2) and nonstructural (nsP3) proteins, and their consequences for viral propagation, immune evasion, and pathogenicity. Mutations in the E1 protein, for instance, enhance entry into host cells, while mutations in the E2 protein reduce antibody neutralization. Changes in nsP3 are connected to more replication and disease problems. It is difficult to diagnose, treat, and make vaccines for them. The continuous genetic monitoring of viruses is important to check the new variants that are emerging. A comprehensive approach including better diagnostics, selective vector control, vaccine development, and community-based management would help mitigate CHIKV impact. Through illuminating the link between viral evolution and clinical outcomes, the current review aims to stimulate future research and reinforce preparedness against this ever-evolving virus.

Background: Reproductive tract infections (RTIs) are a common health issue among women in developing countries and can have serious long-term consequences. Health-seeking behavior (HSB) is essential in preventing, diagnosing, and managing RTIs. Aim: To determine the prevalence of self-reported symptoms of RTIs, HSB, and treatment utilization among women in the reproductive age group using a validated questionnaire developed for the Indian context.

Methods: A mixed-method approach was utilized. Health-seeking questionnaire items were generated after a brainstorming session with healthcare workers. Multistage sampling was employed to recruit 306 women aged 15-49 years from three villages/wards of rural and urban areas to estimate the prevalence of symptoms of RTIs. Descriptive and inferential statistics were used for data analysis. Binary logistic regression was employed to assess the predictors of care-seeking behavior.

Results: All 24 items of the HSB questionnaire were deemed accepted as the content validity ratio (CVR) was more than 0.99 and retained as the content validity index (CVI) was more than 0.80. Out of 306 women, 26.7% revealed a history of vaginal discharge, primarily white with a sticky mucoid texture. 91.5% exhibited low perceived susceptibility to RTI/STI, 90% elicited high perceived severity, 95% showed high perceived benefit, and 36% scored high on perceived barrier. Perceived barriers included the belief that symptoms were within the realm of normality, shyness in discussing symptoms, and societal fear of judgment over character.

Conclusion: Though 82% heard of RTI/STI, only half of them were aware of the mode of transmission. Prevalence of Vaginal discharge was reported by 27%. Participants exhibited low perceived susceptibility and high to moderate perceived barriers.

Introduction: Infertility is defined by failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Unexplained infertility was often treated with superovulation by using clomiphene, letrozole, or gonadotropins in a stepwise approach, combined with intrauterine insemination (IUI) (e.g. CC/IUI/, letrozole/IUI, and FSH/IUI) followed by ART. Combination of letrozole and clomiphene have been studied in past but there are fewer studies in Indian scenario.

Aims and objectives: The aim of the present study was to compare the combination of Letrozole and Clomiphene citrate (CC) or Letrozole alone for ovarian stimulation in infertile women.

Materials and methods: In an Open label prospective randomized control study, Total 180 women (90 women as cases and 90 as controls) were included in this study. All Patients were evaluated based on history, general physical examination, clinical examination, and relevant investigations. Study participants were divided into two groups; Group 1 received combination of Letrozole and CC, while Group 2 received Letrozole alone. All the women were followed till next menses or pregnancy.

Results: More than three follicles ruptured in 11.1% and 2.2% in Group 1 and 2, respectively. 1-2 Follicle rupture in Group 1 was 46.7% and in Group 2 was 73.3%. Conception in group 1 was 3.3 percent as compared to 2.2 percent in group 2. In group 1, 7.8% women had hot flushes, 6.7% had nausea and 1.1% had ovarian hyperstimulation syndrome (OHSS). In group 2, 4.4% women had hot flushes, 6.7% had nausea and none of them had OHSS.

Conclusion: It was concluded that both the regimes i.e. combination of CC plus Letrozole and Letrozole-alone were equally efficacious and safe to use in the treatment of female infertility with Letrozole-alone regime being slightly more effective in terms of endometrial thickness at trigger.

Objectives: Urinary tract infections (UTIs) are highly prevalent and can lead to severe complications if untreated. While prompt empirical therapy is crucial, initiating treatment without antibiotic susceptibility testing can exacerbate antimicrobial resistance. This study aims to identify the antibiotic sensitivity and resistance pattern of uropathogens causing urinary tract infections in adults at a teaching hospital in South India over five years (2019-2023).

Materials and methods: This retrospective cross-sectional study analyzed all urine culture reports that were positive for a single species of organisms with a significant colony count from both hospitalized and non-hospitalized patients (aged ≥ 18 yrs) who visited our hospital from January 2019 to December 2023. Data were extracted from the culture reports that were maintained electronically in the Department of Microbiology.

Results: Of the total of 46,453 urine culture sensitivity reports available during the study period, 13,124 were culture positive. The majority of the positive urine culture reports belonged to females (62.4%) and the predominant age group affected was >60 years (37.2%). The commonest organisms encountered during these study periods were E. coli (44.6% to 50.5%) followed by Enterococcus (7.8% to 12.4%)/ Klebsiella (9% to 10.5%). Uropathogens exhibited >80% resistance to antibiotics such as ampicillin, cefazolin, ciprofloxacin, penicillin, ceftazidime/clavulanic acid, and cefotaxime in at least one of the study years.

Conclusion: Our study shows a concerning trend of increasing resistance among uropathogens to commonly used antibiotics, warranting an urgent need for urine culture-based antibiotic prescribing practices.

Introduction: Anemia during pregnancy is a significant public health issue globally, especially in developing nations. In India, the prevalence from 33.0% to 89.0%. According to the National Family Health Survey-5, anemia is frequent in all age group and is especially high among pregnant women-at 54.3%. In India, among the causes of maternal deaths anemia is the second leading cause. It contributes significantly to maternal, fetal, and neonatal mortality and morbidity. Therefore, the study evaluates the prevalence and cause of nutritional anemia in pregnancy using biochemical parameter (serum B12, ferritin, folic acid) in North East India and associated socio-demographic factors affecting the prevalence.

Materials and methods: A cross sectional study in a tertiary care hospital was carried out in 315 antenatal patients in the department of obstetrics and gynecology, NEIGRIHMS, Meghalaya, India from November 2022 to April 2024. The subjects were included by randomized sampling. Pregnant women were interviewed followed by clinical examination. The demographic profile of the women taken are-age, booked/unbooked status, residence, religion, family size, dietary history, history of iron-folic acid intake, occupation of the women, educational level and occupation of the mother, socioeconomic status. Socio economic classification was done using modified kuppuswamy scale. World Health Organization classification was used to classify anemia. Further serum biochemical marker (serum vitamin B12, folic, ferritin) was send for all anemic patients. Chi-square test was used.

Results: The prevalence of anemia was found to be 40.9% which has decreased as compared to NHFS (2019-2020) that is 45%. It was observed the prevalence of anemic women with ferritin, vitamin B12, folic acid was 43.41%, 39.7% and 20.9%, respectively. The demographic factors like age, parity, visit, interpregnancy period, residence, iron-folic acid intake, religion, occupation of mother, education of the mother, socioeconomic status, intake of green leafy vegetables were found to have significant association.

Conclusions: Generally, in anemia patients the etiology of anemia is diagnosed by doing peripheral blood smear and accordingly diagnosing if its iron deficiency anemia or vitamin B12/folic acid deficiency anemia. In resource poor areas it may be suitable. We would also like to recommend in tertiary health care facilities biochemical markers of anemia such as ferritin, vitamin B12, folic acid should be provided at a subsidized rate. This will enable the accurate diagnosis of type of nutritional anemia and targeted treatment with iron, vitamin B12, folic acid or combined treatment can be provided to anemic mother with the goal of having a healthy mother and baby.

Introduction: Depression affects women more than men, particularly during pregnancy and the postpartum period. While many women are hesitant to use pharmacotherapy due to concerns about side effects and financial constraints, it becomes imperative to explore alternative therapies like Yoga Nidra, known for reducing stress and anxiety. This study aims to evaluate the impact of Yoga Nidra on mental health during the postpartum period.

Objectives and methods: The objective was to assess the psychological state of postpartum women and the effect of Yoga Nidra on the same. This quasi-experimental study was conducted in a rural-based tertiary care center in central Gujarat. A total of 100 participants, 50 postpartum women in the control group and 50 in the intervention group, were enrolled in the study. The Generalized Anxiety Disorder-7 (GAD-7) and Edinburgh Postnatal Depression Scale (EPDS) questionnaires were administered to the participants at the beginning of the study. The intervention group received eight sessions of Yoga Nidra, each lasting 30 min. At discharge, both groups were administered EPDS again. The data was analyzed using STATA 14 software (STATA 14 Software (StataCorp LLC)).

Results and conclusion: Mean baseline EPDS scores were 12.62 ± 4.6 and 13.76 ± 6.2 in the intervention and control groups, respectively. On average, there was 5.48 units (reduction) improvement in EPDS scores in the intervention group (P < 0.0001) and a 1.5-unit worsening (increase) in the control group (P < 0.0001) at the end of the study. The difference was significant between the groups (+6.98 units, P < 0.0001), thereby concluding that Yoga Nidra is a promising non-pharmacological therapy that can be used to manage immediate postpartum anxiety and depressive symptoms.

Context: Glaucoma is a group of progressive diseases where optic nerve damage leads to vision loss. It is considered the leading cause of irreversible blindness (5.8%), according to the National Programme for Control of Blindness and Visual Impairment (NPCB and VI). Primary open angle glaucoma (POAG) is its commonest form. There is considerable evidence that type 2 diabetes mellitus (T2DM) is a risk factor for POAG. The prevalence of POAG is much higher in the diabetic population than in the general population.

Aims: 1. To estimate the proportion of POAG among the type 2 diabetes mellitus (T2DM) patients attending OPD of a Private Eye Hospital. 2. To determine the associated factors, if any, for POAG among the study population.

Settings and design: A descriptive, observational hospital-based cross-sectional study was conducted for 2 months at a private eye hospital, Kolkata, West Bengal.

Methods and material: 129 previously diagnosed T2DM patients attending the Out Patient Department (OPD) from 01.11.21 to 31.12.21 were interviewed and examined by an ophthalmologist for POAG as per diagnostic criteria comprising both old and new cases.

Statistical analysis used: Student 't' test for comparison of means and Chi-square test determination of association.

Results: Overall proportion of POAG cases was 22.5% (men 19.3% and women 25%). The mean age of POAG for women and men were 59.3 (±8.5) years and 65 (±10.7) years, respectively. Mean blood glucose level and mean intra ocular pressure (IOP) were more among POAG patients (P = 0.037,0.026 and P = 0.004,0.003)). POAG was associated with duration of T2DM (P = 0.004) and hypertension (P = 0.004).

Conclusions: More than one-fifth of T2DM patients had POAG associated with duration of T2DM, mean blood glucose, and hypertension. Tight control of blood glucose and regular ophthalmological examination since early stage are urgently required.

Intrauterine devices (IUCDs), such as the multi-load copper T, are widely used long-acting reversible contraceptive methods due to their effectiveness and convenience. However, complications can arise in rare instances, such as device migration. Case Series Report Case 1: A 26-year-old, G5 P2 A2 L2, presented with 2 months of amenorrhoea and inability to feel CuT thread. USG done revealed intra-uterine pregnancy of approx. 10 weeks gestational age, however intrauterine CuT was not visualized. So, we presumed it a case of expelled CuT. Regular antenatal care continued till term and LSCS was performed at 39 weeks. Intraoperatively a thread was seen embedded in the omentum lying adjacent to the uterus. Further exploration revealed multi-load-copper 375 with pus collection around it. Case 2: A 36-year-old female, Para 2, Live 2, presented with complaints of lower abdominal pain and multiple episodes of haematuria since last 6 months. An initial pelvic ultrasound showed a hyperechogenic intravesical structure of 3.3 cm, suggesting a urinary bladder calculus. A pelvic CT scan revealed a metallic T-shaped structure within the urinary bladder suggestive of a misplaced copper T device. Patient underwent cystoscopic removal of calcified IUCD. Patient had no further urinary symptoms following removal. These cases highlight the importance of monitoring patients with IUCDs for potential complications, especially when threads are missing. They also emphasize considering intravesical migration of CuT as a cause of haematuria in women. Additionally, pelvic cavity exploration during LSCS is vital to locate any migrated IUCDs when such a history exists.