Journal of Family Medicine and Primary Care最新文献

Background: Despite various measures, the neonatal mortality rate in outborn neonates is significantly high and makes impossible to achieve sustainable developmental goals.

Objectives: To recognize the risk factors of mortality in outborn neonates.

Methods: A prospective observation cohort was studied at Government Medical College, Nagpur, for a duration of two and a half years on all outborn neonates. Neonates who died within an hour, whose parents left the hospital against medical advice, and not willing to participate were excluded. Demographic, maternal, and neonatal clinical parameters and transport data were collected. Clinical diagnosis was done by using standard definitions. All the neonates were followed up till discharge or death. Mortality rate and risk factors of mortality were identified. Chi-square test, Mann-Whitney test, and unpaired "t" test were used for comparison between survival and nonsurvival neonates. Univariate and multiple logistic regression models were used to identify independent risk factors of mortality by adjusted odds ratio and 95% confidence interval. P < 0.05 was considered as significant.

Results: Inadequate antenatal care (adjusted odds ratio [aOR] 1.93, 95% confidence interval [CI] 1.00-3.78, P = 0.04), increased travelling distance (aOR 1.00, 95% CI 1.00-1.00, P < 0.0001), preterm birth (aOR 0.89, 95% CI 0.85-0.93, P < 0.0001), abnormal respiratory rate (aOR 0.97,95% CI 0.96-0.98, P = 0.001), abnormal heart rate (aOR 0.96, 95% CI 0.95-0.98, P < 0.0001), hypothermia (aOR 0.72, 95% CI 0.54-0.96, P = 0.02), low oxygen saturation (aOR 0.90, 95% CI 0.87-0.93, P < 0.0001), and poor perfusion (aOR 1.93, 95% CI 1.68-2.21, P < 0.0001) were the independent risk factors of mortality.

Conclusion: Inadequate antenatal care, increased travelling distance, preterm birth, abnormal respiratory rate, abnormal heart rate, hypothermia, low oxygen saturation, and poor perfusion are independent predictors of mortality. Improvement of utilization and delivery of maternal/neonatal care, transport system, and early recognition of risk factors of mortality are keys to attain of SDG.

Introduction: Cognitive enhancers (CEs) are increasingly prevalent among university students, particularly in healthcare fields, with significant implications for academic performance and student wellbeing.

Methods: This cross-sectional study aimed to investigate the prevalence, associated factors, and effects of CE usage among undergraduate healthcare students at King Saud University, Saudi Arabia.

Results: A sample from six different health care colleges with a total of 611 participants was taken, and all of them completed a self-administered questionnaire covering demographics, CE usage patterns, reasons for use, and perceived effects. 432 (70.7%) utilized cognitive enhancers, and 179 (29.3%) did not. The respondents were 322 (52.7%) from male and 289 (47.3%) from female. Female students were found to consume CI 2.6 times more compared to their male students (P = 0.0003). Also, students in the clinical year used CE more frequently (third year 80.8%, fourth year 73.7%, and fifth year 82.2%) than students in the preclinical year (P = 0.0001). Moreover, students in the 22-25 age group use significantly more CE (OR = 3.6; p=<0.0001) than students in other age groups. Students at the college of medicine use more CE (OR = 2.73; p=<0.0001) as followed with nursing (OR = 2.1; P = 0.004), dentistry (OR = 1.92; P = 0.003), and applied medical sciences (OR = 1.7; P = 0.007). Furthermore, there is a significant association between coffee and cognitive functioning among students (OR = 2.6; P = 0.005). High-achieving students are more likely to use CI (p=<0.001).

Conclusions: In conclusion, CIs were used by the majority of university students. The females, high achievers, and senior students significantly use CI.

The present systematic review and meta analysis was to synthesize the available data, mostly concerning safety and side effects of the available literature on minoxidil therapy for facial hair loss, to provide family physicians with evidence to guide their initial assessment and decisions concerning treatment and referral for this conditions. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines were followed concerning study selection, synthesis, and reporting. A thorough search was conducted utilizing PubMed, Scopus, Web of Science, and Cochrane databases. A focus was placed on papers published between January 2001 and May 2024. Based on a quality assessment of the study using the standards outlined in the Cochrane Handbook for Systematic Reviews of Interventions, the risk of bias (RoB 2.0) was graded as low, unclear, or high. A total of 302 studies were obtained by our search approach from 294 studies from electronic databases and eight studies from manual search. After duplicates were eliminated, 196 records were left, and 93 studies were eliminated based on their titles and abstracts. An additional 84 studies were eliminated for not meeting inclusion criteria after reading over the complete text of the remaining 103 records. Consequently, the current systematic review contained 19 RCTs. Upon utilizing the RoB 2.0 tool, it became apparent that most of the examined studies raised some concerns about RoB. Five studies reported high RoB, while six studies revealed low RoB. This systematic review establishes low dose minoxidil treatment as an effective intervention for those seeking to enhance facial hair development with relatively minimal side effects, which can be relevant in primary care settings.

Introduction: Neurocysticercosis (NCC), caused by the larval stage of Taenia solium, is the leading parasitic disease affecting the central nervous system (CNS), particularly in endemic regions like India. NCC often presents with diverse clinical manifestations, complicating diagnosis. Despite its significant burden, limited data exist on the disease's epidemiology in Jharkhand, an endemic area. This study aimed to evaluate the demographic, clinical, and radiological profiles of NCC and correlate them with serological findings.

Materials and methods: This cross-sectional study was conducted at the Department of Microbiology, Rajendra Institute of Medical Sciences (RIMS), Ranchi, from September 2018 to August 2019. A total of 69 patients with radiological findings suggestive of NCC were included. Neuroimaging (CT/MRI) findings were categorized as definitive or probable NCC based on revised diagnostic criteria. Serum samples were analyzed using ELISA to detect Taenia solium IgG antibodies. Data were statistically analyzed using SPSS version 20.0.

Results: Out of 69 patients, 44 (63.8%) were ELISA positive. Males predominated (77.3%), with most cases in the 11-20 years age group (25.0%). Single lesions were more common (59.1%), with the parietal lobe being the most frequently affected site (50.0%). Seizures were reported in 97.7% of cases, with partial seizures with secondary generalization being the most common type (53.5%). Dietary habits revealed high raw vegetable consumption (95.5%) and non-vegetarian diets (79.5%). Definitive NCC was identified in 6.8% of cases, while 93.2% were classified as probable NCC.

Conclusion: This study highlights NCC as a significant health concern in Jharkhand, predominantly affecting males and presenting with seizures. The integration of serological testing, radiographic findings, and clinical data is essential for accurate diagnosis. This first-of-its-kind study emphasizes the need for larger community-based research to understand NCC's true impact in this region.

Background: Acute pancreatitis (AP) is among the most frequent gastrointestinal disorders that often require hospitalization with varied prognosis depending on the severity. Early assessment of severity is critical for improved outcomes. Traditional scoring systems are complex and resource intensive. The neutrophil to lymphocyte ratio (NLR) is a biomarker that is simple to estimate, valid, and accurate for predicting severity.

Methods: This predictive accuracy study was conducted on 110 patients. NLR values were measured over four days (days 0 3), and patients were grouped into mild acute pancreatitis (MAP) or severe acute pancreatitis (SAP) groups. Operating characteristic (ROC) curves were plotted following logistic regression analysis, for appropriate optimal cutoff values each day. Complications such as acute lung injury, shock, and acute renal failure were also assessed.

Results: Of the total 110 patients analysed, 58% were mild, while 42% were severe. Alcohol (57%) was the most common cause followed by gallstones (38%). NLR values were consistently higher in patients with SAP compared to those with MAP on all days. The optimal NLR cutoff values for predicting SAP were 5.66 (area under curve [AUC] 0.998), 4.70 (AUC 0.968), 3.73 (AUC 0.952), and 2.96 (AUC 0.913) on days 0, 1, 2, 3, respectively. Acute lung injury (24.5%) was the most common complication, followed by shock (22%) and acute renal failure (11.5%).

Conclusion: NLR has emerged as a reliable and simple biomarker for the early prediction of SAP. Its simplicity and predictive accuracy make it a valuable instrument for stratifying AP patients, especially in resource limited settings. Further studies are needed to integrate NLR into clinical protocols for managing acute pancreatitis.

Background: Multi-morbidity poses complex challenges associated with more complex clinical management, poor treatment outcomes, longer hospital stays, and increased healthcare costs. In this context, nurses serve as crucial agents in delivering holistic patient-centered care among multimorbidity patients but there exists a noticeable gap in their curriculum which needs to be modified. Nursing faculty plays a vital role in advancing the nursing profession and nursing curriculum modification and development is one of the most important roles of nursing faculty. This study explores the perspectives of nurses and nursing faculties regarding the integration of multimorbidity into nursing curricula.

Methods: Using a phenomenological approach, the study conducted 25 in-depth interviews have been conducted among nursing teachers, nursing officers, and community health officers across various nursing colleges and health centers in Odisha, India. Open-ended questions and probes were employed to elicit rich insights. The digitally recorded interviews were transcribed, translated into English, and then thematically analyzed.

Findings: Thematic analysis of the in-depth interview transcripts revealed two overarching themes: "Patient with multimorbidity requires evidence-based, patient-centered care" "mitigating challenges faced by patient, Nurse and health sector." Participants enunciated the importance of integration of multimorbidity management in nursing curricula. They highlighted the challenges faced by nurses/nurse educators due to knowledge gaps of nursing personnel on multimorbidity and have suggested to inculcate the management of multimorbidity in the nursing curriculum.

Conclusion: The nurses occupy a unique position as frontline healthcare providers, both within hospital settings as nursing officers and in community setups as community health officers. This study explores the perspectives of nurses and nursing faculties to integrate the management of multimorbidity in the nursing curriculum. This study revealed the significance of integration of multimorbidity in the nursing curriculum and advocate to add this.

Background: Chronic Hepatitis B is a global public health concern with significant morbidity and mortality. Identification of serological markers is essential for diagnosis, monitoring, and treatment planning.

Objectives: To determine the distribution of HBV seromarkers (HBsAb, HBcAb, HBeAg, anti-HBe, HBcIgM) among HBsAg-positive individuals, and assess co-infection with HIV, HCV, and HDV.

Methods: A total of 19,607 patients were screened for HBsAg at RIMS, Ranchi. Of these, 481 were HBsAg-positive, and 351 had further seromarker profiling using Chemiluminescence Immunoassay. Co-infection with HIV, HCV, and HDV was also evaluated.

Results: Among 351 HBsAg-positive patients, 80.05% were asymptomatic and 98.29% had chronic infection. HBeAg was positive in 23.36%, anti-HBe in 66.66%. HIV co-infection was seen in 6.26% of cases, predominantly in the 31-40 age group.

Conclusion: The majority of HBV cases were chronic and asymptomatic, with a notable percentage co-infected with HIV. Routine screening for HBV seromarkers is recommended to guide treatment and control transmission.

Abdominal pain is a frequent complaint in primary care, but rarely due to pheochromocytoma. A 23-year-old male farmer presented with right lumbar pain for 3 months, unintentional weight loss of 10 kg, and a nonproductive cough for 1 month. Initial evaluation revealed anemia and right-sided pleural effusion. Abdominal ultrasonography and contrast-enhanced CT demonstrated a large heterogeneous right suprarenal mass with retroperitoneal lymphadenopathy and pleural deposits, suggestive of malignant pheochromocytoma. The patient was referred to endocrinology for further management. This case highlights the importance of family physicians in recognizing red flags such as chronic abdominal pain, weight loss, and respiratory symptoms, and ensuring early referral. Strengthening family medicine services can facilitate timely diagnosis of serious illnesses, reduce complications, and improve patient outcomes.

Introduction: Recent research highlights that the gut microbiota of pregnant women undergoes significant changes throughout pregnancy, influenced by factors such as diet, environment, and sociocultural practices. A diverse gut microbiome during pregnancy is linked to improved metabolic health and the lower risk of complications like gestational diabetes and pre-eclampsia.

Objective: This study aimed to investigate the relationship between dietary practices of different communities of Assam and Manipur with the composition of gut microbes during pregnancy.

Methods: A total of 18 pregnant women completed a survey assessing macronutrient consumption during the first and third trimesters. Dietary data, obtained through questionnaires, were subjected to PCoA (Principal Co-ordinate Analysis) to find similarities and dissimilarities in dietary patterns. Metagenomics analysis of stool samples was done to study the consortium of gut bacteria for the participants.

Results: This study has demonstrated that higher intake of carbohydrates and fats during pregnancy results in a decrease in phylum such as Firmicutes and Actinobacteria. Phylum such as Gemmatimonadetes, Crenarchaeote, Fibrobacteres, and Fusobacteria dominated the gut of most participants.

Conclusion: The relationship between gut microbiota composition and dietary habits among pregnant women in Northeast India is essential for designing effective nutritional interventions aimed at improving both maternal and infant health. Future studies should prioritize longitudinal research to better understand these connections and their impact on public health in the region, with a particular focus on identifying the specific foods and dietary patterns responsible for the observed similarities.

Background: Pulmonary artery hypertension (PAH) is a severe complication of obstructive airway diseases (OADs), leading to right heart dysfunction and increased morbidity and mortality. Elevated pulmonary pressures above 20 mmHg predict poor outcomes, emphasizing the need for early diagnosis and treatment. This study examines the correlation between PAH severity and OAD, aiming to inform targeted therapies.

Materials and methods: This cross-sectional observational study included OAD patients attending the Respiratory Medicine Department at PIMSR, Vadodara, from March 2023 to March 2024. Pulmonary function was assessed via spirometry per ATS/ERS guidelines, and PAH was graded using transthoracic echocardiography. Statistical analysis included the Z test for continuous data and Chi-square or Fisher's exact test for nominal data, with significance set at P < 0.05.

Results: Spirometry revealed average FEV1 (%) of 74.3 ± 13.6 with values of (2.9L ± 0.13L), FVC (%) of 95.5 ± 6.0 with values of (3.72L ± 0.89L), and FEV1/FVC of 77.6 ± 12.4. Post-TB OAD patients had the lowest values (FEV1), while asthma patients had the highest (FEV1). Mild PAH was observed in 42 (52.5%) OAD patients, 23 (28.8%) have moderate PAH, and 15 (18.8%) have severe PAH.

Conclusion: A significant association (P < 0.001) was observed between airflow obstruction severity and PAH severity. Severe airflow obstruction correlated with severe PAH, while mild obstruction aligned with mild PAH. Post-TB OAD had the highest proportion of severe PAH, with PAH severity increasing as airflow obstruction worsened.