Journal of Family Medicine and Primary Care最新文献

Introduction: Unmanned aerial vehicles (UAVs) or drones have the potential to revolutionize healthcare logistics last-mile delivery. The use of drone technology in healthcare is relatively a new domain with a few sites undertaking pilot trials resulting in a lack of data for analysis, particularly in the healthcare sector. The present study aims to explore the longitudinal analysis and cost-effectiveness assessment of the implementation of drone technology in the public healthcare system.

Methods: Retrospective data from December 2022 to January 2024 were obtained from the World Bank sponsored Meghalaya Drone Delivery Network under the Meghalaya Health Systems Strengthening Project. An economic evaluation of the drones versus vehicle transportation of medical logistics from hub to spoke was conducted. Carbon emissions from vehicles and drones for transportation were also compared.

Results: A total of 214 flights were conducted, transporting 199·05 kg of payload to 11 spoke sites (primary healthcare centers) during 7 months period. The average cost by road transportation for one round trip was INR 2902 (US$ 34·80), whereas by drone, it was INR 3743 (US$ 44·87). The Incremental Cost-Effectiveness Ratio (ICER) for drone transportation is INR 12 (US$ 0·14) per Disability Adjusted Life Years (DALY) averted as compared to vehicle transportation of medical logistics. The healthcare facility with drone services was able to avert 106 DALYs compared to 36 DALYs per month by the healthcare facility with a conventional mode of transportation. The drone services would require an additional INR 56 (US$ 0·67) to save 1 minute to transport medical logistics. The CO₂ emission per payload delivered by drones was up to 99% less than the conventional mode of transportation.

Conclusion: Drone technology in healthcare complements the existing supply chain routes and is a value addition for saving lives in unforeseen medical emergencies. Further trials are required for firming up use cases to understand the challenges associated.

Background: Diabetes mellitus is a prevailing health concern in rural India, with its associated complications, notably diabetic foot ulcers, contributing to significant morbidity and mortality. This journal delves into the potential of continuous glucose monitoring (CGM) technology to revolutionize the management of diabetic foot complications within the context of rural India. The resource constraints and limited access to healthcare facilities prevalent in developing countries accentuate the challenges in diabetic foot care. This article highlights how CGM technology addresses these challenges by providing real-time glucose level insights to patients and healthcare providers alike.

Description: Our 1^st case is a 62-year-old male with a non-healing diabetic foot ulcer, complicated by severe sensorimotor neuropathy owing to suboptimal glycemic control. Our second patient is a 55-year-old male tailor with poorly controlled diabetes who developed a recurrent follicular abscess despite prior antibiotic therapy. Our 3^rd case features a 46-year-old male farmer with uncontrolled diabetes and persistent tinea pedis. Despite multiple antifungal treatments, the infection persisted. By using CGM to monitor blood glucose levels, and adjusting the diet regimen, alongside antidiabetic therapy, all these patients recovered completely without any surgical interventions.

Conclusion: These cases underscore the importance of CGM in achieving tight glycemic control, improving infection resolution, and enhancing patient well-being, particularly in cases where traditional approaches may have been insufficient.

Background: Malnutrition among women in the reproductive age group is a significant risk factor for low birth weight and infant mortality rates. Recent statistics show that undernutrition and overnutrition are double the burden in many developing countries.

Aim: To assess the nutritional status and identify risk factors of malnutrition among rural women in the reproductive age group, Wayanad District, Kerala.

Material and methods: A cross-sectional study was conducted with women aged 18 years to 49 years. A house-to-house survey was done in five villages, covering 56 participants from each village.

Results: About 50.7% of women were 25-40 years old. A significant proportion of 60% was overweight or obese, with a mean body mass index (BMI) of 26.34. Around 43.93% had moderate and 20.36% had high health risk waist - hip ratio (WHR). The mean waist circumference was 81.52. Employment (AOR 2.84, 95% CI 1.10 to 15.19, P = 0.046), fatty food intake (daily or weekly) AOR 4.88, 95% CI 9.43 to 17.29 (P < 0.001), sweet juices or soft drinks intake daily: AOR 2.23, 95% CI 3.44 to 13.96 (P = 0.11), physical activity (mild work) AOR 7.74, 95% CI 8.92 to 87.45 (P < 0.001), and television watching hours (daily) AOR 5.22, 95% CI 4.27 to 48.68 (P < 0.001) were found to be statistically significant with the BMI and WHR.

Conclusion: The number of overweight and obese individuals with moderate to high-risk WHR was substantially higher in this study. An unbalanced, unhealthy diet, along with physical inactivity, contributes to the increase in the number of overweight individuals and central obesity.

Background: COVID-19 pandemic and the resultant social isolation, declined vaccination, and lack of school enrolment have contributed to undernutrition among children.

Objectives: To assess nutritional status and associated factors among children aged 1-5 years enrolled in urban Anganwadis in Austin Town area, Bangalore city, during the COVID-19 pandemic.

Methodology: A random sample of 100 children aged 1-5 years enrolled in two Anganwadis located in Austin Town was chosen. Data were collected using a structured face-validated questionnaire and measuring anthropometry. Nutrition status was classified using WHO Child Growth Standards.

Result: There were 43% females and 57% males. The majority were in the age group of 4-5 years (32%) and belonged to a nuclear family 47%. 76% had a birth weight of more than 2.5 kg, 80% of them were full term, and 92% were immunized for age. Pre-COVID-19, 26% of the families were in lower middle and lower classes, and this proportion increased to 46% during COVID-19. Moderate acute malnutrition was observed among 12% of the children, and severe acute malnutrition was observed among 4% of the children. The factor which was significantly associated with malnutrition was the child's diet history of 3 meals and 2 snacks per day (P value 0.02).

Conclusion: The prevalence of severe acute malnutrition is 4%. Child's diet history of 3 meals and 2 snacks is a significant protective factor against malnutrition. Community-based intervention such as nutrition education should be provided at Anganwadis for prevention of childhood malnutrition.

Background: The delayed cord clamping (DCC) procedure is frequently recommended by medical professionals because of its ability to facilitate the natural transfer of blood from the placenta to the baby, which in turn raises the blood volume that is present in the newborn at the time of birth. However, there is no universally agreed-upon definition for DCC, ECC (early cord clamping) and clamping times vary across studies.

Objective: The objective is to assess and contrast the impacts of ECC and DCC on neonatal haemoglobin, haematocrit and serum bilirubin concentrations in full-term neonates.

Methods: This prospective observational study involved 180 uncomplicated full-term pregnancies, divided equally into ECC <30 seconds and DCC1-3 minutes groups. Cord clamping time was also used to determine neonatal haematological parameters.

Results: Notable disparities were noted between the ECC and DCC groups for mean haemoglobin levels, haematocrit values, birth weight and 5-minute Apgar scores (P < 0.001).

Conclusions: This study established that DCC increases neonatal haemoglobin concentration at birth and improves iron reserve in early infancy. Based on the present evidence, it is evident that delayed cord clamping has a lot of benefits and should be incorporated as a routine procedure in normal, uncomplicated, full-term births.

Background: This study investigates the physical activity levels and workplace stress experienced by health care practitioners at the National Guard Hospital (NGH) in Riyadh. Understanding these factors is crucial for developing targeted interventions to enhance the overall wellbeing of this professional group. The study addresses the dearth of research on the relationship between physical activity, demographic characteristics, and workplace stress among healthcare practitioners.

Methodology: A cross-sectional study was conducted, utilizing a self-administered online questionnaire distributed among 372 health care practitioners at NGH. The questionnaire collected demographic data, assessed physical activity using the International Physical Activity Questionnaire (IPAQ) short form, and measured workplace stress through The Workplace Stress Scale. Statistical analyses, including descriptive statistics, Chi-square tests, and associations using P values, were employed to explore the relationships between physical activity, demographic factors, and workplace stress.

Results: The results revealed a diverse demographic profile, with a mean age of 34.4 years and a predominantly female (69.1%) workforce. Nurses constituted the largest professional group (41.1%), and medical departments housed the majority (72.3%) of participants. While 25.8% engaged in vigorous physical activities, 25.0% in moderate activity, and 76.9% in walking activities, the IPAQ categorization showed that 49.5% had low activity, 18.5% had moderate activity, and 32.0% had high activity. Workplace stress varied, with 7.0% reporting no stress, 21.5% fairly low stress, 34.4% moderate stress, 20.2% severe stress, and 16.9% having a potentially dangerous stress level. Significant associations were found between physical activity levels and departmental affiliation (P = 0.041), while no significant associations were observed between workplace stress and demographic factors.

Conclusion: The findings underscore the importance of tailored interventions that consider the diverse needs of health care practitioners in different departments. Workplace wellness programs should target specific professional groups and address both physical activity and stress management to enhance the overall health and job satisfaction of healthcare professionals.

We report the case of a 34-year-old female who presented with headaches, visual disturbances, and unsteadiness, mostly triggered by head rotation. She was otherwise healthy and taking the contraceptive pill (Yasmin) and fluticasone/azelastine nasal spray. Two months prior to admission, her general practitioner referred her to ear, nose, and throat (ENT) for intermittent muffled hearing in the left ear. ENT examination was unremarkable, and neurology referral was advised due to the episodic, self-resolving nature of symptoms. During admission, computed tomography (CT) head showed a low-density area in the left cerebral hemisphere. Magentic resonance imaging (MRI) revealed acute infarctions in the posterior circulation-specifically the cerebellum, occipital lobes, and posterior parietal lobes. A repeat MRI 48 h later showed a new right occipital infarct. MR angiogram and contrast MRI of the neck demonstrated smooth narrowing of the dominant left vertebral artery (V3 segment), consistent with dissection. Workup for secondary causes was normal. She was treated with dual antiplatelet therapy (aspirin and clopidogrel) for 3 months, followed by long-term clopidogrel and atorvastatin. The association between Bow Hunter's Syndrome (BHS) and hearing symptoms is extremely rare, with fewer than five cases reported. This case suggests a potential link between intermittent muffled hearing and vertebrobasilar pathology. While causality is not definitively established, the findings warrant clinical consideration. Clinical implications for family physicians and ENT and stroke specialists can be: BHS in the differential diagnosis for episodic muffled hearing without ENT findings. Watch for associated symptoms (e.g., dizziness, neck pain, visual changes). Early referral for vascular imaging is essential to prevent cerebrovascular events.

Background: Breast cancer is the most common cancer in women across the world. Immune cells can detect and destroy cancer cells. However, cancer cells acquire certain immune evasion mechanisms such as PD-1+ T-cells, to combat immune response. Limited number of studies have shown PD-1+ T-cells as a prognostic marker in breast cancer, but studies in India are far and few.

Aims: To compare the positivity of PD-1-positive T-cells with known prognostic indicators in breast cancer.

Materials and methods: This descriptive, cross-sectional, prospo-retrospective study was conducted at the Department of Pathology of a Tertiary Care Hospital in Uttarakhand, India. A total of 50 cases were taken. Clinicopathological details were noted. On immunohistochemistry, PD-1 was membranous. The distribution pattern and percentage positivity of PD-1-positive T-cells were noted. Pearson Chi-square/Fisher's exact test was used.

Results: The positivity of PD-1+ T-cells was found to be higher in tumors with luminal B subtype (P = 0.04). Out of the total CD3+ T-cells, 62% were found to be PD-1 positive.

Conclusion: PD-1 positivity was associated with tumor molecular subtypes. No significant association of PD-1+ T-cells with other known prognostic markers of breast cancer was found.

Introduction: Asthma remains poorly controlled worldwide despite clinical guidelines, continuing to cause high morbidity and mortality. This study examines the clinical characteristics, management practices, and factors affecting asthma control in patients attending asthma clinics within primary healthcare centers in the Kingdom of Bahrain, providing insights to enhance chronic disease management in frontline care.

Materials and methods: A cross-sectional study was conducted across 27 primary healthcare centers in Bahrain from June 2022 to June 2023. Participants aged 12 years and older diagnosed with bronchial asthma were included. The Global Initiative for Asthma (GINA) tool was used to evaluate asthma control. Data including sociodemographic information and asthma management characteristics were collected. Descriptive and inferential analyses were performed.

Results: Among 198 participants (mean age 48.4), most were Bahraini (82.3%), female (65.7%), and nonsmokers (94.4%) with an average BMI of 30.58 kg/m². Gastroesophageal reflux (23.2%) and diabetes (20.2%) were the most prevalent comorbidities. Based on the GINA classification, 49.5% had well-controlled asthma. The treatment adherence rate was 75.8%. Uncontrolled asthma was linked to nighttime symptoms (P = 0.001), diabetes mellitus (P = 0.028), higher SABA use per month (P = 0.011) and year (P < 0.001), low asthma control test scores (P < 0.001), and treatment steps 3-5 (P < 0.001). By contrast, better asthma control was associated with medication adherence (P = 0.025) and influenza (P = 0.014) and pneumococcal (P = 0.019) vaccination.

Conclusion: Asthma control in Bahrain's primary healthcare centers is suboptimal, especially among patients with nighttime symptoms, diabetes, frequent SABA use, and low control test scores. Enhancing patient education, optimizing treatment strategies, and addressing comorbidities are critical for improving asthma outcomes.

HIV-TB Co-infection is increasing in the current scenario. TB is the leading cause of mortality in people living with HIV (PLHIV). HIV-infected persons have approximately an 8-times greater risk of TB than persons without HIV infection. HIV infection increases the risk of reactivation of latent TB infection into progressive primary TB disease and later endogenous reinfection TB disease. Once PLHIV get active TB, due to the deficient cell-mediated immunity, the disease is often disseminated and has unusual presentations. Therefore, though pulmonary TB is still the most common form of active TB in PLHIV, frequent involvement of extrapulmonary organs (often in multiple sites) is seen in PLHIV when compared to the HIV-negative population. Here in our case report of a 26-year male with HIV-TB Co-infection, we are discussing one such rare presentation, i.e. acquired broncho-esophageal fistula. This will ensure primary care physicians suspect such rare manifestations while encountering HIV-TB co-infection.