Journal of Family Medicine and Primary Care最新文献

Introduction: The need to understand the global burden of heart failure following the pandemic has arisen as a result of an increase in papers that support cardiac involvement in coronavirus disease 2019 (COVID-19). Therefore, the current study aims to provide a more thorough explanation of the function and use of cardiac biomarkers in dead and alive COVID-19 patients.

Methods: All patients who were referred and admitted to Razi Hospital, Ahvaz, Iran, from March 2020 to March 2021 with a diagnosis of COVID-19 were included in this study.

Results: During the study period, 753 patients were hospitalized with a diagnosis of COVID-19. In total, 157 cases died from the disease (case fatality rate: 20.84%). Pre-existing cerebrovascular accidents (CVAs) were more frequent in dead cases (14% vs. 6.4%). It was observed that atrial fibrillation was normal in most of the alive cases in comparison to dead patients (P value = 0.014). Moreover, it was seen that CRP, IL-6, and procalcitonin were increased in dead patients. Also, an association was found between ejection fraction (EF) value and death rate (P value = 0.035). The higher frequency of positive troponin occurring in the dead group suggested a possible adverse effect on the mortality rate (22.3% vs. 16.4%).

Conclusion: Adults with COVID-19 commonly have cardiac manifestations, including symptoms of myocardial damage. In light of the recognized utility of troponin, ejection fraction, procalcitonin, IL-6, and CRP in COVID-19 patients with suspected myocardial damage, we should develop a safe and precise diagnostic algorithm that may contain patients' clinical histories and additional variables that may facilitate the prediction of myopericarditis.

Background: Early initiation of breastfeeding reduces infant mortality and morbidity and prolongs the duration of breastfeeding.

Objective: The present study was conducted to assess the prevalence of early initiation of breastfeeding and factors associated with early initiation of breastfeeding in the urban area of Jabalpur district of Madhya Pradesh.

Methodology: The present community-based cross-sectional study was conducted in an urban area of Jabalpur district of Madhya Pradesh from March 2017 to July 2018 on 370 recently delivered mothers. Data were collected by interview, using the pretested structured questionnaire and analyzed using SPSS, version 20. Significance was set at the value of P < 0.05.

Results: The prevalence of early initiation of breastfeeding was found to be 45.4%. The percentage of mothers initiating breastfeeding earlier increased when they belonged to the higher age group, nuclear family, were educated, employed, counseled during antenatal visits, non-primigravida and delivered in health institutions. It was also observed that type of delivery, socioeconomic status of mothers, birth weight of baby and occupation of husband are not significantly associated with the early initiation of breastfeeding.

Conclusion: Increasing literacy amongst the population, promoting marriages at an appropriate age, counseling pregnant women regarding early initiation of breastfeeding during antenatal care visits and institutional deliveries can significantly increase the prevalence of early initiation of breastfeeding in the mothers of urban areas of Jabalpur district, Madhya Pradesh.

Purpose: To estimate the proportion and pattern distribution of glaucoma disease in a teaching hospital of North-East India.

Materials and methods: Retrospective hospital-based study of glaucoma cases from January 2014 to December 2022.

Results: Out of a total of 89725 new patients, 449 patients had glaucoma with a prevalence of 0.50% (95% CI: 0.46%-0.55%) of which 361 (80.4%) were ≥40 years and 88 (19.6%) were <40 years. The commonest type was POAG (32.1%) followed by PACG (17.6%) while JOAG was 7.8%. Males (67.2%) were predominant with a male: female ratio of 2.0:1. The mean age of patients was 53.4 (17.1) years. PACG was found to be significantly higher among females (p=0.001) whereas POAG was higher among males (p=0.003). There was no association of either age or systemic conditions with the prevalence of POAG and PACG. Hypertension and diabetes were present among 139 (31.0%) and 103 (23.0%) respectively while 13 (2.9%) had chronic obstructive pulmonary disease (COPD), 5 had coronary artery disease (CAD) and 5 hypothyroidism.

Conclusion: The prevalence of glaucoma though lower compared to other parts of the country, the number was significant, warranting screening activities owing to its silent nature. PACG was significantly higher among females while POAG was higher among males. Systemic factors like COPD, CAD and hypothyroidism require further studies for better understanding of the temporal association with glaucoma.

Introduction: Legislative assemblies often provide a platform for legislators to question the government during question hours, which are crucial for governance However, question hours remain understudied, especially when addressing health policy and systems related issues in lower- and middle-income countries. This study assesses the 14^th Kerala Legislative Assembly questions, focusing on health-related areas to provide insights for health policy formulation and decision-making processes.

Materials and methods: We sourced and transcribed all starred questions (346) related to health that were answered by the health minister in the 14^th Legislative Assembly between 2016 and 2021 from the archives of the assembly website. We conducted a thematic analysis of these questions and mapped them into various themes, guided by the World Health Organization building blocks framework.

Results: About 7.8% of all questions (N = 4404) were related to health (N = 346). Of these questions, the majority were directly related to service delivery (43.4%), followed by health information (16.5%). Health financing, food safety, and human resources were the least discussed topics throughout the assessed period within the state. The legislators primarily focussed on health services and health information, with less attention given to health financing, food safety, and human resources regardless of constituency or political affiliation.

Discussion: This study underscores the need for a balanced approach to public health issues, highlighting the importance of legislators to priortizing health services and information, while also addressing health financing, food safety, and human resources. This would enable a robust and resilient public health system to effectively address diverse health concerns.

Existing data suggest that clozapine has lesser propensity of developing akathisia as compared to first general antipsychotics. Clozapine is mostly used in patients with treatment-resistant schizophrenia, which is a second-generation antipsychotic. Akathisia is one of the rare side effects of clozapine. A 34-year-old woman with a 7-year history of schizophrenia exhibited positive and negative symptoms, initially treated with haloperidol and clonazepam. Despite relief in positive symptoms, she experienced recurring cycles of symptom exacerbation upon discontinuing medication. Because of poor compliance, she was admitted and started on clozapine, reaching 150 mg/day. Although showing symptom improvement, she developed clozapine-induced akathisia, characterized by restlessness and limb movements. Propranolol and a gradual reduction in clozapine alleviated akathisia, supplemented by lorazepam. The Barnes Akathisia Rating Scale dropped to 0 after three weeks. This case highlights the challenges of managing schizophrenia and the importance of tailored medication strategies. The use of clozapine should be customized based on each patient's needs to prevent clozapine-induced akathisia.

Background: Urbanization, sedentary lifestyles, and dietary changes have all contributed to an increase in the prevalence of metabolic syndrome (MetS) in Indian populations during the past 10 years. Numerous markers have been investigated to determine if a person is at risk for developing MetS, with the bulk of them having to do with adipose tissue. Recently, adiponectin and leptin, two biomarkers with a high correlation to cardiometabolic health or disease, are of particular interest.

Methods: In the general population of India, 100 persons were included. Body mass index (BMI), waist circumference, systolic and diastolic blood pressure, fasting blood glucose, plasma lipids, adiponectin, leptin, insulin, and the homeostasis model were measured to assess insulin resistance. We used binary logistic regression analysis to determine the connection between the researched factors and MetS and Spearman's analyses to evaluate correlations.

Results: In all, 200 participants (100 men and 100 women) were enrolled in the study. Men's and women's median ages were 53 and 48, respectively (P < 0.05). Men had significantly greater WHR, SBP, and DBP (P < 0.05, respectively). Women had significantly higher levels of triglycerides, LDL, insulin, adiponectin, leptin, and HOMA-IR (P < 0.05, respectively). Leptin-to-adiponectin ratio was significantly and positively correlated with BMI (r = 0.597, P < 0.001), waist circumference (r = 0.576, P < 0.001), triglycerides (r = 0.190, P = 0.001), insulin levels (r = 0.329, P < 0.000), and HOMA-IR (r = 0.301, P < 0.000).

Conclusion: In this study, higher levels of LAR, together with higher levels of leptin and lower levels of adiponectin, were found to be significantly linked with MetS. To properly determine whether LAR can be a predictor of MetS, independent of confounding factors, research with adequate design must be conducted.

Purpose: To identify the awareness, behaviour and psychological impact of cyberbullying among adolescent.

Method: A Cross-sectional questionnaire-based study conducted on secondary school students from grades 9-12^th. The study got approval from the Institutional Research Board. The Inclusion criterion was school students of all nationalities who were willing to participate. Signed informed consent signed was taken. We used a P value of < 0.05 and a 95% confidence interval (CI).

Result: Out of 513 enrolled, 450 completed the survey (response rate 87.7%). Age ranged between 13 to 20 years of them 303 (67.3%) were female. Awareness of cyberbullying was 96.2%. The prevalence of cyberbullying among adolescence was 22.2% (95% CI: 18.89-26.93). 42% of Victims reported cyberbully event leading to stoppage in 78.6% of cases. Most of the victims reported to their parents followed by friends then cyber helpline or Police. Characteristics of perpetrators were males, below-average academic performance and social relations, from same batch, and had emotionally unstable personalities. Association of being a victim does not relate to their Age, gender, grade, or parent's education but relate to their nationality (P < 0.001) and being younger siblings (P < 0.027). Association between event reporting and gender was not significant (P < 0.859). Association between worsening social relationships (teachers and parents) (P < 0.001), feeling neglected (P < 0.001), personality type (agreeableness and emotional instability) (P < 0.016) and being a Cyberbully victim was statistically significant. Association of depression and anxiety with being a cyberbully victim was statistically significant (P < 0.001) and directly proportional to the severity.

Conclusion: High rate of awareness and Low prevalence of cyberbullying was found among adolescence. High risk of psychological problems was reported and a good social relationship (teachers and parents) was an important protective factor from it.

Background: Vaccine hesitancy has been inching up and its root cause lies in the factors that influence the vaccination. The present study was conducted to find out the proportion and factors contributing to vaccine hesitancy for routine childhood vaccinations in the slum population.

Methods: A community-based cross-sectional study was carried out among 210 children between the age group of 0 and 59 months residing in the urban slums of Ranchi in 2021. Data were collected during the household visit by interviewing the parents using a predesigned pretested interview schedule which was developed based on the validated version of the vaccine hesitancy survey questionnaire originally developed by the World Health Organization Strategic Advisory Group of Experts' working group on vaccine hesitancy. Associations between variables were analyzed using logistic regression.

Results: A total of 210 children whose parents had given consent were included in our study. The majority of the families, 188 (89.5%), were not hesitant while only 22 (10.5%) were vaccine hesitant. Tribal children and unreserved category children had adjusted odds ratio of 4.41 (95% CI, 1.61-45.46) and 7.75 (95% CI, 1.07-56.08) for the delay as against their reference category.

Conclusions: Most of the children were vaccinated in our study area and the families have shown confidence in vaccines. Although there were delays in vaccination and the reasons for the delays must be addressed to prevent these vaccine-hesitant populations from turning into vaccine-refusal population. Uniformity in vaccination days in different health facilities in slum areas, appropriate antenatal information, and counseling regarding childhood vaccinations, widespread awareness, and improving mother's education can help address the issue of vaccine hesitancy.