Journal of Family Medicine and Primary Care最新文献

A pregnant woman in her early 30s presented to her family medicine doctor with a nasal septal perforation and a history of past cocaine use. This case required careful evaluation to distinguish between potential causes, including autoimmune vasculitis and drug-induced damage. Management was tailored to her pregnancy, emphasizing conservative nasal care and multidisciplinary support. With cessation of cocaine use and supportive treatment, the patient's nasal condition stabilized. This case highlights the diagnostic complexity of septal perforations and reinforces the importance of identifying cocaine-induced pathology, which in this case avoided unnecessary immunosuppression.

Introduction: The incarcerated population constitute a unique and susceptible group of patients. Cancer is the primary cause of mortality in prisons, being responsible for almost 30% of all fatalities. The objective of this study is to analyze the cancer diagnosis, types, rates, system-wise distribution, and metastasis in the autopsy of the incarcerated population sent for histopathological investigation at a tertiary-care center of Jharkhand.

Methods: A retrospective descriptive study was undertaken in the Department of Pathology, Rajendra Institute of Medical Sciences, Ranchi. The study included all the medicolegal autopsies performed over a period of 4 years, from April 2020 to March 2024.

Results: Among 375 cases, 24 (6.4%) were diagnosed as malignant cancers among the incarcerated population. Adenocarcinomas were the most common type, accounting for 10 cases (41.6%) while metastasis was detected in 14 (58.3%) cases with lymph nodes showing the highest incidence of metastatic deposits. Out of the total number of cases, four (16.6%) were found to have cancers primarily located in the stomach.

Conclusion: The current study demonstrates that the incarcerated population in Jharkhand has elevated rates of metastasis.

Prader-Willi Syndrome (PWS) is a rare genetic disorder characterised by hypotonia, hyperphagia, and developmental delay. We report a case of a 12-year-old girl who presented with excessive hunger, obesity, and cognitive impairment. Molecular analysis revealed a deletion of the paternal chromosomes 15q11-13, confirming the diagnosis of PWS. Our case highlights the importance of early diagnosis and multidisciplinary management in improving the quality of life for individuals with PWS.

Background: Death certificates provide a measure of the relative contributions of different diseases to mortality, which is vital for public health surveillance and for facilitating short-term and long-term plans by the health authorities. Reliable information on deaths and their causes are also vital for decision-makers to monitor the trends of the overall burden of diseases.

Objectives: To evaluate the quality of death certificates reporting over the study period.

Methodology: This study is a retrospective, observational, descriptive type of study. All the variables in the Medical Certification of Cause of Death (MCCD) form IV were taken for data collection in an excel sheet. Data were collected from all the death certificates issued by various inpatient areas of the hospital from January 1, 2021 to December 31, 2021.

Results: A total of 1854 death certificates were issued by the hospital during the study period. Compliance for the patient's name, age, sex, and date of death reached 100%. However, the compliance rates for other variables varied significantly, ranging from 7.5% to 99.19%. The lowest compliance rate of 7.5% was noted for the variable 'onset of symptoms to death' in the cause of death.

Conclusions: Our study's findings emphasize the need for enhanced documentation practices to ensure the accuracy and completeness of death certificates. By identifying the factors that contribute to incomplete documentation and implementing targeted strategies, we can improve the quality of data for medical and public health research, ultimately leading to better patient care and outcomes.

Youth friendly health care with a comprehensive assessment of health and wellbeing needs for adolescent and young adults (AYA) within the health-promoting university concept is lacking in Indonesian context. This research aims to comprehensively develop suitable interventions for improving services for AYA in the context of health-promoting universities. Guided by the theoretical framework of Consolidated Framework for Implementation Research (CFIR) and Practical, Robust, Implementation and Sustainability Model (PRISM), our research consist of three phases in 4 years. Phase 1, aims to explore the health needs of the university students, the current utility of the university health clinics, and the stakeholders' perceptions of the current health service. Phase 2 aims to develop suitable interventions through codesigning process for improving the health services at the university. Phase 3 will implement the interventions at three affiliate university clinics in Indonesia: Universitas Indonesia, Universitas Gadjah Mada and Universitas Airlangga. This research fills a gap in evidence on how to improve health care and wellbeing services for AYA within the health-promoting university context in low- and middle-income countries. The phased research design from mapping current capabilities and needs to codesigning solutions with stakeholders and trialing implementation in three different universities, will enable assessment of feasibility, and scalability to other settings. The potential for impact of this research are to enhance the university services and promoting the attention to the needs of AYA in primary care, being undertaken by a unique collaboration between three leading universities in Indonesia.

Background: Caffeine consumption is widespread among university students and is often used to combat fatigue and enhance cognitive performance. However, excessive intake may be associated with increased stress levels.

Methods: This study aimed to investigate the relationship between caffeine consumption and perceived stress among students at King Khalid University in Saudi Arabia. A cross-sectional online survey was conducted among 1,209 undergraduate students from September to November 2023. Caffeine consumption was assessed using a questionnaire covering 14 common caffeinated beverages. The Arabic version of the 10-item Perceived Stress Scale (PSS-10) was used to measure stress levels. Logistic regression analyses were performed to examine the association between caffeine intake and perceived stress, adjusting for sociodemographic and health-related factors.

Results: Nearly 80% of participants reported consuming >250 mg of caffeine daily. High caffeine consumption was significantly associated with both moderate stress (adjusted OR: 2.40, 95% CI: 1.53-3.77, P < 0.001) and high stress (adjusted OR: 3.66, 95% CI: 1.94-6.92, P < 0.001) compared to low stress, even after adjusting for potential confounders.

Conclusions: Our study reveals a strong association between high caffeine consumption and elevated stress levels among Saudi university students. These findings highlight the need for targeted interventions to address excessive caffeine use and stress management in this population. Future research should explore the long-term effects of high caffeine consumption on academic performance and mental health, as well as evaluate the effectiveness of various intervention strategies.

Introduction: Patient contentment is pertinent for measuring the performance of health- care service delivery, which is a multidimensional construct that depends on many factors. Out-patient department (OPD) is the first point of contact of the hospital with the patient. Patient satisfaction is one of the most essential outcome indicators to be measured to evaluate the quality of services provided to the patient and also provide the opportunity to improve the quality of services.

Methodology: An institution-based mixed methods study (convergent-parallel design) was conducted. Study was conducted in the outpatient departments of a tertiary care hospital. Participants was selected using convenience sampling technique. A self-structured questionnaire was used to collect data.

Results: Out of 2000 patients, 1077 (54%) were highly satisfied, 845 (42%) were moderately satisfied, whereas 78 (4%) were unsatisfied. The overall satisfaction among 2000 patients was found to be 95.8025±2.21. Mean satisfaction improved over the time as the facilities improved.

Conclusion: The overall contentment of patients with the services provided was good. As the institution is newly established, patients' expectations were high and increasing day by day so a few were unsatisfied also.

Background: Staphylococcus aureus (SA) carriage is a risk factor for staphylococcal disease. However, the carriage rates may vary by geography and profession.

Aim: The aim was to determine SA nasal carriage rate and compare the prevalence of methicillin resistance and mupirocin resistance in SA isolated from health care worker and community population.

Settings and design: Cross-sectional study was performed in the Microbiology Department from March 2024 to August 2024.

Material and methods: Nasal swabs from 396 study participants including health care worker and community population, were processed. Methicillin and mupirocin resistance (low level and high level) based on disc diffusion was determined on SA isolates.

Statistical analysis: It was performed using Statistical Package for the Social Sciences (SPSS) software v24.0.

Results: The overall nasal carriage rate for SA was 17.92% (71/396). Among these only nine were methicillin-sensitive SA and 62 harbored a methicillin-resistant S. aureus (MRSA). The SA nasal carriage rate in healthcare workers was 20.20% (40/198) whereas in the community population was 15.65% (31/198). The MRSA nasal carriage rate was 17.17% (34/198) and 14.14% (28/198) in health care workers and community populations, respectively. None of the SA isolates showed mupirocin resistance.

Conclusions: SA carriage rate in anterior nares of healthy healthcare workers is higher as compared to community population. This indicates that health care worker should adhere to infection control practices more stringently. None of the SA isolates showed mupirocin resistance. This might point out that mupirocin is not being used for Staphylococcus decolonization of the nasal carriers.

Introduction: Acne vulgaris is a common dermatological disorder with significant sociopsychological impacts. Isotretinoin is the mainstay of treatment for severe cases. Adverse effects, such as liver enzyme elevations and lipid profile changes, are linked to this medication. Despite these risks, the need of monthly laboratory monitoring has been questioned, particularly in healthy individuals without comorbidities.

Aim: This study investigates the incidence of laboratory abnormalities and evaluates the clinical utility of frequent monitoring in acne patients on isotretinoin therapy in Jeddah, Saudi Arabia.

Methods: This retrospective study included 265 patients treated with isotretinoin at King Abdulaziz University Hospital and King Fahad General Hospital. Data collected included patient demographics, isotretinoin doses, and laboratory results for liver enzymes, triglycerides (TG), and total cholesterol (TC). Laboratory results were assessed at baseline, after 3 months of treatment, and at the last visit. Statistical analyses included the aligned rank transform ANOVA and Wilcoxon Signed-Rank tests to assess changes in laboratory values over time and their relationship with treatment doses.

Results: Our study group had a median age of 24 years, with 70.9% being female participants. Abnormal lab values increased from 11.7% at baseline to 15.8% during treatment and 14.7% at the last visit. The most common abnormality was high TC levels, rising from 6.8% at baseline to 11.7% at the last visit. Alanine aminotransferase (ALT) abnormalities increased from 3.0% at baseline to 4.9% during treatment but decreased to 2.6% at the last visit. Triglyceride abnormalities showed minimal variation, increasing from 1.1% at baseline to 1.9% at the last visit. Changes in ALT and TG levels were dose-dependent, whereas aspartate aminotransferase and TC levels were not significantly influenced by the starting dose.

Conclusion: Our research assessed the importance of monthly monitoring of liver function tests and lipid profiles in patients undergoing isotretinoin therapy. The findings emphasize the significance of a personalized monitoring approach. This approach suggests that monthly laboratory testing may only be necessary for a few patients. However, baseline assessments and patient specific follow-ups remain essential.

Introduction: Alcohol dependence disorder (ADD) significantly impacts public health, society, and the economy. It is characterized by chronic alcohol use, withdrawal symptoms, and cognitive impairments, particularly involving frontal lobe dysfunction. The cognitive impairments, often underexplored, are particularly relevant in primary care settings, where early detection and intervention can greatly influence outcomes. This study investigates the cognitive effects of ADD using neurocognitive tests in inpatients at a government hospital in Central India, highlighting implications for family medicine and primary care management.

Materials and methods: This cross-sectional study assessed cognitive dysfunction and its link to alcohol dependence severity in 90 inpatients at a tertiary care hospital in Central India. Participants, aged 18-65 and meeting ICD-10 criteria for alcohol dependence, underwent cognitive evaluations using the Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), and Severity of Alcohol Dependence Questionnaire (SAD-Q).

Results and discussion: Patients with severe dependence exhibited significantly lower MoCA and FAB scores, with 72.2% scoring below the MoCA cutoff and 33.3% below the FAB cutoff. Negative correlations between SAD-Q and MoCA (-0.509) and FAB (-0.324) scores indicated that higher dependence severity was associated with greater cognitive decline. These findings highlight the importance of integrating cognitive assessments and rehabilitation into primary care practices for effective management of alcohol-related impairments.

Conclusion: The study confirms severe cognitive impairments in ADD, particularly frontal executive functions. Routine cognitive evaluations in primary care settings can enable early detection and comprehensive management, improving patient outcomes and reducing the healthcare burden associated with ADD.