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Journal of Family Medicine and Primary Care
Number of Followers: 10  Open Access journalISSN (Print) 2249-4863 - ISSN (Online) 2278-7135 Published by Medknow Publishers  [444 journals]
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- The curious case of extinction of family physicians from the Indian Health
System – An open letter to the members of the National Medical
Commission: Draft competency-based medical education curriculum
regulations 2023 – Complete exclusion of family physicians/family
medicine education from the MBBS course curriculum!
Authors: Kumar; Raman
Abstract:
In 2012, India Today, a news agency, reported that ‘Family Physicians are dying silent death’ in India. The number of practicing family physicians is declining rapidly in the most populous country in the world with pressing public health needs. The previous generation of general practitioners/family physicians/family doctors has entered the age group of the seventies and eighties in both urban and rural areas. Unfortunately, no new family physician is opening the practice in these areas. The recent COVID pandemic has clearly demonstrated the ongoing need, demand, and popularity of family physicians among the general public as first-contact dependable and trustworthy doctors. While it may be an enigma why MBBS doctors are no longer opting to become family physicians, to the experts of this domain, it is not a surprise. To outside observers, this phenomenon may appear to be an outcome of changing times, the expansion of medical sciences, new emerging career choices for medical students, or competition within the healthcare market. However, a closer study reveals that the decline of family physician services in India is not a default situation but an outcome of decades of institutional neglect and perhaps a deliberate exclusion. According to the recently released National Medical Commission (NMC) draft curriculum 2023, the undergraduate medical education program is designed with the national goal of creating an “Indian Medical Graduate” possessing the requisite knowledge, skills, attitudes, values, and responsiveness so that she or he may function appropriately and effectively as a PHYSICIAN OF FIRST CONTACT of the community while being globally relevant. However, we are disappointed to note that the Family Medicine subject (discipline of family physicians) component has been entirely excluded from the draft of the MBBS curriculum. The words such as ‘Family medicine’, ‘Family Physician’, ‘General practitioners’, and ‘Family Practice’ have not even been mentioned in the entire 83 pages of the draft MBBS curriculum document. This is not an inadvertent occurrence or a default situation. The erstwhile MCI, the Medical Council of India, played a significant role in diminishing the role of family physicians in the Indian health system. It is to be seen if the NMC is able to reverse this trend by easing the regulatory restrictions on family physicians/family medicine training by including it in the MBBS course.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Barriers to mental health treatment in primary care practice in low- and
middle-income countries in a post-covid era: A systematic review
Authors: Rameez; Sahar; Nasir, Almas
Abstract:
General primary care workers and family physicians are a crucial work force in managing the mental health of people in any given region. However, the barriers they face in low- and middle-income countries (LMICs) may be worsened by the pandemic. This review aims to bring together evidence about mental health treatment challenges experienced by people in LMICs in primary care settings. The review focuses on the shortage of essential mental healthcare services, stigma and lack of competent primary care professionals in establishing these services and their importance in the COVID-19 pandemic context. The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the search strategy included keyword search terms (MeSH) to perform a search across three electronic databases - Critical Appraisal Skills Program assessed PubMed, SpringerLink, and Cochrane and quality of the articles. The articles selected were analyzed through thematic analysis to identify the main themes and conclude our findings. Findings indicate that out of 1792 publications found, 14 studies matched the desired criteria for the studies. Endnotes, database search filters, and Covidence data extraction tools were used to generate the relevant articles in this study. This study shows that primary care institutions have financial and management issues in providing mental health services and a shortage of competent mental health experts in primary care, especially mental health–trained family physicians. The study also identifies community stigma as the most prevalent barrier to seeking mental health therapy, reflecting the lack of community health education in LMICs.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Critical analysis of American heart association and European society of
cardiology guidelines for hypertension
Authors: Sorte; Akshayata G.; Turankar, Tileshkumar B.; Sawale, Shantanu; Acharya, Sourya; Shukla, Samarth
Abstract:
This study places more of an emphasis on the hypertensive guidelines that are recommended for the management of hypertension by the American College of Cardiology (ACC) and the American Heart Association (AHA), as well as the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). This study examines the development of several different guidelines and focuses primarily on contrasting the similarities and differences that are given by American and European guidelines. Both sets of recommendations encourage the use of an optimal method for measuring blood pressure, such as the use of home blood pressure (BP) monitoring, or ambulatory monitoring, which a key recommendation is given by both sets of recommendations for the primary prevention of hypertension, and non-pharmacological treatment, such as modifying one’s lifestyle, as the primary intervention. There are some differences between American and European BP treatment guidelines when it comes to determining what constitutes high BP and determining what BP level should serve as the treatment goal. To start pharmacological therapy, the AHA and ACC suggest maintaining a BP of at least 130/80 mmHg with an ASCVD positive or a cardiovascular risk of more than 10%, but the ESH and ESC propose maintaining a BP of at least 140–159/90–99 mmHg. Following American rules, high BP is divided into two stages; however, according to European recommendations, it is divided into three stages. Both sets of recommendations strongly encourage the use of combination therapies that only require one pill, such as single-pill treatment for multiple conditions, and both sets of recommendations restrict the use of certain drugs, such as beta-blockers, to patients who also have additional medical conditions.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Malaria in newborn: A missed entity for primary care physician
Authors: Mohan; Kriti; Omar, Balram J.; Chacham, Swathi
Abstract: Neonatal malaria and congenital malaria, though thought to be a rare entity in non-endemic areas but incidences from epidemic countries are eye openers. It is still thought by primary care physicians that its existence among neonates is not common even in endemic areas due to a low index of suspicion. In order to attain the objective set out in the global technical strategy against malaria 2016–2030, it is important to have a gravity of this disease in all age groups, especially in children and neonates in which misconception of low burden of infection results in underestimation of its morbidity and mortality in these age groups. This disease is only the tip of the iceberg due to unidentified, underreported and neglected illness and being a pointer towards higher circulation among society and pregnant women. So this review article highlights pathophysiology, epidemiology, clinical features, complications, prognosis, treatment and prevention of malaria in newborns and intends to bring awareness among the caregivers to understand the need for attention towards this neglected disease of neonates so that they should be able to identify and manage the disease in this vulnerable age group.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Assessing universal maternal health service coverage and their
determinants in India: A multicentric cross-sectional study
Authors: Sharma; Shantanu; Bhardwaj, Aditya; Arora, Kanishtha; Akhtar, Faiyaz; Mehra, Sunil
Abstract:
Introduction: Universal maternal health coverage (UHC) envisages access to quality healthcare services by pregnant and lactating women without any financial hardship. Our present study attempts to assess the UHC for maternal health services and their determinants, including access to quality antenatal care (ANC), quality postnatal care (PNC), and child immunization among the marginalized populations of India.Methods: It was a community-based cross-sectional study across five states of India among pregnant or lactating women. Quality ANC score was calculated using four indicators, including ANC registration month, attendance of four or more ANC visits, receiving at least one tetanus toxoid injection, and consumption of 100 iron-folic acid (IFA) tablets. Similarly, quality PNC care score was calculated using four indicators, including PNC within 48 h, breastfeeding initiation time, institutional delivery, and accessing conditional maternity benefit scheme. Logistic or generalized linear regression was used to depict associations depending on the outcome variables.Results: A total of 12,976 pregnant women’s and 18,061 lactating mothers’ data were analyzed. Illiterate women, women from below the poverty line, and rural areas had low-quality ANC and PNC scores compared with their counterparts. Marginalized women had lower odds of immunization of children and lower quality PNC scores than nonmarginalized.Conclusions: Sociodemographic factors, such as caste, education of women, area of residence, and economic status, are major determinants of quality ANC and PNC scores and immunization of children. Hence, interventionists ought to design community-based interventions that address the challenges in the uptake of health services.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Seroprevalence and incidence of primary dengue infection and its
correlation with fetomaternal prognosis in Western Rajasthan
Authors: Prakash; Prabhu; Gupta, Ekta; Nareda, Pooja; Gupta, Eshank; Agarwal, Richa; Ashopa, Vishakha; Beelwal, Anjali
Abstract:
Background: Viral hemorrhagic fevers are becoming increasingly common in the tropics and subtropics. Dengue fever is currently the most important arthropod-borne viral disease because of its widespread distribution in more than 100 countries and its potential for extensive outbreaks of life-threatening disease.Material and Methods: This study was a hospital-based cross-sectional study conducted in the Microbiology Laboratory of Maternal and Child Tertiary Care Hospital in Western Rajasthan, India, between January 2021 and December 2021. Institutional Ethical Committee permission was obtained. All patients with clinical suspicion of dengue-like illness (DLI), attending outpatient department (OPD) or inpatient department (IPD), were included in the study after obtaining their written consent. A blood sample was collected, and the Dengue Duo rapid card test was conducted for the detection of nonstructural protein 1 (NS1) antigen and immunoglobulin (Ig) M or IgG antibody estimation. All positive samples were tested for IgM enzyme-linked immunosorbent assay (ELISA) test using MAC-ELISA.Results: Of 250 positive sample, the distribution of cases as per clinical features was as follows: all cases presented with fever (100%) followed by myalgia (24.5%), headache (16.06%), hemorrhagic manifestation (13.25%), rash (8.84%), and bleeding gums (2.01%). Thrombocytopenia was seen in 30.40% (76/250) of dengue fever cases. NS1 antigen was detected in 157 cases (62.80%) followed by IgG in 84 cases (33.60%), IgM in 77 cases (30.80%), NS1+IgG in 27 cases (10.80%), NS1 + IgM in 16 cases (6.40%), and NS1 + IgM + IgG in five cases (2%). Of 250 samples, 77 cases were IgM positive and 173 were IgM negative by the Dengue Duo card test. Among the 173 Dengue Duo IgM card negative, 131 cases (79.39%) were also detected negative by IgM ELISA and 42 cases (49.41%) were detected positive by IgM ELISA. The sensitivity was 50.59%, the specificity was 79.39%, the positive predictive value (PPV) was 55.84%, the negative predictive value (NPV) was 75.72%, and the diagnostic accuracy was 69.90%. The case fatality of the cases was 2.35%.Conclusion: Early diagnosis and treatment can prevent mortality in pediatric and pregnant females suffering from dengue and dengue-like illness. Facility and availability of ELISA kits should be adequate for early confirmation of suspected dengue patients by ELISA test.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Awareness of sudden infant death syndrome and its associated risk factors
among Saudi mothers attending well-baby clinics at PHC, PSMMC, Riyadh,
Saudi Arabia: A cross-sectional study
Authors: Alanezi; Saleh L.; Almusalam, Yousef A.; Afify, Aymen A.
Abstract:
Introduction: Sudden infant death syndrome (SIDS) is a leading cause of infant mortality all over the world. Mortality due to SIDS can be averted by educating families and caretakers about safe practices for putting infants to sleep. However, the knowledge, attitude, and practices of mothers while putting the infant to sleep is a gray areas in literature.Aims and Objectives: The objectives of the study were to measure the knowledge and awareness about SIDS and its associated risk factors practiced among Saudi mothers attending well-baby clinics in Saudi Arabia to develop appropriate educational program-based interventions for safe practices of infant care.Methods: This cross-sectional study was carried out among 385 mothers attending well-baby clinics of primary health care (PHC) and prince sultan military medical city (PSMMC) in Riyadh Saudi Arabia. Information was captured on sociodemographic characteristics, the health status of mothers and infants, knowledge, attitude, and practice followed by mothers while putting infants to sleep.Results: From a total number of 385 responses, 350 participants were eventually included in the final sample due to the incompletion of the questionnaire of 350 mothers; only 26% (n = 93) mothers had heard of SIDS. However, 259 mothers were willing to attend the awareness session. Only 94 mothers had knowledge as well as practicing the correct behavior of putting the infant to sleep on the back referred to as “good behavior concordant pairs.” Similarly, other good practices include not co-sharing a bed with the infant, removing pillows, blankets, and other wedged objects, using a pacifier, breastfeeding the infant during sleep, not using multiple quilts, not covering the infant’s head with a quilt, not using a head cap. The number of good behavior concordant pairs (in green) were 124, 38, 56, 98, 18, 117, and 68 respectively.Conclusions: The rate of knowledge and practice for good behavior regarding SIDS was low among Saudi mothers in Riyadh Saudi Arabia. SIDS-related deaths can be averted by improving the understanding of SIDS risk reduction practices among mothers by using health promotion strategies.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Undiagnosed hypertension and associated factors among adults in the urban
field practice area of AIIMS Raipur: A community-based screening survey
Authors: Krishna; Ekta; Pal, Anjali; Galhotra, Abhiruchi; Shukla, Arvind Kumar; Parija, Pragyan Paramita; Pathak, Vineet Kumar; Rajath Rao, UR; Naik, Bijaya Nanda
Abstract:
Introduction: Undiagnosed hypertension (HTN) increases the risk of severe consequences such as chronic kidney disease (CKD), hypertensive retinopathy, heart failure, and stroke. Population-based screening can be used to expose the hidden diseased mass with active disease. Thus, a screening survey was conducted to estimate the proportion of people with HTN among apparently healthy adults of age ≥30 years residing at the urban field practice area (UHTC) of AIIMS, Raipur, and also determine the predictors of undiagnosed HTN among the study participants.Methodology: This was a community-based cross-sectional study conducted over 2 months duration in the Ramnagar area, which comes under the urban field practice area of AIIMS Raipur using the STEPS tool is an acronym of study tool provided by WHO i.e. STEPwise approach to NCD risk factor surveillance consisting of three steps viz. questionnaire for behavioural risk factors, physical measurements and biochemical measurements.Results: In this study, 24.2% (95%, confidence interval [CI]: 20.1–28.2) of participants screened positive for HTN. The proportion of males who screened positive for HTN was 28.8% (95% CI: 22.6–35), whereas the proportion of females who screened positive for HTN was 19.6% (95% CI: 14.3–25). In this study, elderly (>60 years), male gender, daily tobacco use, greater waist circumference (male>90 cm and female>80 cm), and daily salt intake of more than 5 g were found to have higher odds of having HTN.Conclusion: The prevalence of undiagnosed HTN in the UHTC of AIIMS Raipur was quite high.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Dietary diversity and nutritional status of adolescents in Lagos, Nigeria
Authors: Olatona; Foluke A.; Ogide, Precious I.; Abikoye, Ebunoluwa T.; Ilesanmi, Oluwafemi T.; Nnoaham, Kelechi E.
Abstract:
Background/Objectives: Adolescents in low- and middle-income countries, such as Nigeria, are at increased risk of malnutrition, especially obesity, but there is limited data describing the risk. We assessed this risk by examining the nutritional status and associated factors such as dietary habits, dietary diversity, nutritional knowledge and sociodemographic characteristics among adolescents in Lagos, Nigeria.Methods: A descriptive cross-sectional study in which 682 adolescents were selected from their communities using a multistage sampling technique. Dietary habits were assessed using a food frequency questionnaire, and dietary diversity was assessed through nonquantifiable 24-h diet recall. Anthropometric measurements were taken to determine nutritional status. Data were analyzed using Epi-Info software version 7.2.3.1. Nutritional status was evaluated using WHO AnthroPlus software. Chi-square was used to test for an association between categorical variables, and P values ≤0.05 were considered statistically significant.Results: The mean age of the adolescents was 13.6 ± 2.3 years, and only 47.4% of them had good nutritional knowledge. Dietary habits were poor and dietary diversity was low. The prevalence of overweight and obesity was 13.4% and 7.0%. Eating dinner, dieting to control weight and daily consumption of foods outside the home were associated with overweight and obesity (P < 0.05).Conclusions: Dietary habits and diversity of the adolescents were poor, while overweight and obesity were high. Eating dinner and daily consumption of foods outside the home were factors associated with being overweight and obesity. Our findings emphasize the critical need for adolescent nutrition programs that address weight control, especially among those who eat outside their homes.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Urinary incontinence prevalence and factors associated with patients
talking with doctors about urine control
Authors: Min; Elissa E.; Thomas, Joseph
Abstract:
Objectives: Patient perceptions of their doctors may influence talking to them about urinary incontinence (UI). We estimated prevalence of UI among Medicare beneficiaries and assessed association between beneficiaries’ demographic and clinical characteristics and whether they spoke to their doctor about UI and association between beneficiaries’ perceptions of their doctor and whether they spoke to their doctor about UI.Methods: This study was approved by the Purdue University Institutional Review Board (IRB) and determined exempt, category 4 (protocol number 1907022503, approval on August 5th, 2019). Medicare Current Beneficiary Survey (MCBS) 2016 data were analyzed. Beneficiaries who indicated that they lost urine control 2–3 times a month or above were classified as experiencing UI. An 11-item patient perception of their physician scale was created based on MCBS items. Perceptions were categorized as favorable or unfavorable. SAS version 9.4 for Unix was used for all analyses. PROC LOGISTIC was used to assess multi-variable association between beneficiaries’ perceptions of their doctors and talking to their doctor about UI.Results: Among 7466 persons meeting inclusion criteria, 1856 (24.9%) had UI. The perception of doctor scale scores ranged from 15 to 44, with mean score = 36.57 (standard deviation = 5.29). The scale Cronbach alpha reliability was 0.93. Using sensitivity and receiver operating characteristic analysis, a cutoff of 30 or higher was identified as a favorable perception. Beneficiaries with favorable perceptions of their doctor were more likely to speak to their doctor about experiencing UI than beneficiaries with unfavorable perceptions (odds ratio = 1.55, 95% confidence interval = 1.03 to 2.35, P-value = 0.038).Conclusion: Overall, the more favorable the perception of their physicians, the more likely beneficiaries were to speak to them about their UI.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Defeating diabetes in the desert: A community-based mHealth diabetes
screening intervention in Jodhpur Rajasthan
Authors: Joshi; Nitin K.; Arora, Vikas; Purohit, Anil; Lohra, Abhishek; Joshi, Vibha; Shih, Ting; Harsh, Jagdish
Abstract:
Background: There is a paucity of demonstrated models for mHealth-based diabetes screening and coordinated care in India, especially in western Rajasthan, which is the part of Thar desert.Materials and Methods: JSPH collaboratively developed and implemented an easy-to-use, noninvasive, mobile phone-based screening interview, to identify adults at high risk for diabetes. The high risk for diabetes was defined using multiple clinical and epidemiologic criteria, all based on the evidence for India and globally. Since participants above 35 years or older were only considered in the screening, the application was designed to categorize the participants as high and low risk.Results: Out of 4000 screened participants, the percentage of males and females were 51% and 50%, respectively. Participants found to be at high risk and low risk were n = 3600 (90%) and 400 (10%). The mean age of high- and low-risk participants was 52.2 (+12.8) and 36.2 (+4.2), respectively. Of the 3600 high-risk individuals who have been given a follow-up interview, 90.50% of high-risk individuals obtained diabetes testing, and of these, 65.67% had a written report showing they test positive for diabetes or prediabetes, requiring ongoing clinical care.Conclusions: JSPH mHealth application provided a novel noninvasive way to better identify those at high diabetes risk in the community and demonstrated how to optimize the use of mobile health methods in diabetes prevention and care services.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Scourge of out-of-pocket expenditure on health: A study on its burden and
predictors in a rural community of West Bengal
Authors: Ghosh; Pritam; Sadhukhan, Sanjoy K.; Dasgupta, Aparajita; Paul, Bobby; Ghose, Sauryadripta; Biswas, Aloke
Abstract:
Introduction: Globally, one-third of current health expenditure had been out-of-pocket expenditure (OOPE). The health system financing of almost all low- and middle-income countries including India rely heavily on out-of-pocket (OOP) payments for health care. OOPE on health payments is particularly hard on any community, especially the poor leading to incomplete or even no treatment during their ill health. This study estimated OOPE among residents of a rural community in West Bengal and explored the associated factors with high OOP expenses.Methods: A community-based cross-sectional study was conducted in a rural community in Singur, West Bengal from June 2019 to February 2020. The study was done among 398 villagers selected from 15 clusters or villages. Households were randomly selected in each village. All members of the selected households were interviewed. SPSS was used for data analysis both for descriptive and inferential statistics.Results: Only 14.6% of morbid persons had catastrophic expenditure. The incidence of catastrophic expenditure was higher among those who opted for private practitioners and or ayurveda, yoga and naturopathy, unani, siddha, and homeopathy (AYUSH) facilities. There was zero catastrophic expenditure for the unqualified sector. There was an increasing trend of OOP payments among the lower socioeconomic groups. Again, low-income individuals had a higher share in cumulative expenditure (Gini coefficient of 0.35). Most of the participants (78.4%) had no health insurance coverage.Conclusion: Promotion for higher utilization of public health facilities may reduce the burden of OOP expenses. Government health insurance schemes must be widened with the inclusion of coverage of outpatient services. Integrating AYUSH services in the public sector is another option to reduce OOP expenses.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Knowledge of schoolteachers on learning disabilities in urban Vellore - A
cross-sectional study
Authors: Jebakumar; Daniel; Marconi, Sam; Kattula, Dheeraj; Priscilla, Ruby A.
Abstract:
Background: Specific learning disability (SLD) is a cognitive neurobiological disorder caused by atypical brain functioning. SLD is recognized when the individual’s achievement in school is below that expected for age, schooling, and level of intelligence. Screening millions of students with SLD by health personnel is a logistical impossibility. Awareness and knowledge about learning disorders among schoolteachers may play a major role in the early identification and management of children with these disorders. Therefore, the assessment of teachers’ knowledge and perceptions about learning disabilities (LDs) is relevant.Method: A school-based cross-sectional study was conducted among teachers in government/government-aided and private schools in Vellore, India. The participants were selected by a simple random sampling method. There was a total of 80 teachers included in the study. Data capture was done using a questionnaire. A Chi-square test was done to test the association and the odds ratio test helped determine the strength of the association. A P-value of
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Clinical, laboratory profile and outcomes in children with snakebite from
Eastern India
Authors: Pattanaik; Biswajit; Mahapatra, Chinmaya; Karthika, IK; Satapathy, Amit K.; John, Joseph; Das, Rashmi R.; Dwibedi, Bhagirathi; Mahapatro, Samarendra; Gulla, Krishna M.
Abstract:
Background: Snakebite remains a significant public health problem worldwide, particularly in rural areas with unexpected morbidity and mortality. This study evaluated the clinical, laboratory profile and outcomes in children with snake bites from Eastern India.Methods: This was a retrospective case record-based study between January 2017 and December 2021. The clinical features, complications, laboratory profiles and outcomes were analysed.Results: Thirty children with snake bites were admitted during this study period. There was a male predominance with a ratio of 2.3:1. The mean age of presentation was 10.4 years. About 60% of bites occurred during the rainy season between July and September. Most bites (96%) were on lower limbs, predominantly showing vasculotoxic features followed by neurotoxic and a combined presentation. In this study, around 53% received anti-snake venom (ASV) before reaching our centre; the median time to reach our centre was 13 h. Complications such as acute kidney injury (AKI), cellulitis, shock and coagulation abnormalities were common in those who arrived early (before 6 h) than in those who reached late (after 6 h). Similarly, the mean duration of hospital stay was less for those seeking medical attention early as compared to those reaching late for treatment (4.7 days vs. 7.2 days). Twenty-six out of 30 (86.7%) were discharged without any sequelae, 3 (10%) children were left against medical advice and one died.Conclusions: Snakebite remains a major health problem in children causing significant morbidity and mortality. Children, in general, especially males, are particularly vulnerable because of their playful and explorative nature and considerable time spent in outdoor activities. Preventive measures, education about avoiding traditional first aid methods and early administration of ASV reduce complications, duration of hospital stay and avoid the use of antibiotics.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Immediate cause and the role of multimorbidity in deaths associated with
COVID 19 among hospitalized patients in a low resource district in Kerala
India: A record-based case-control analysis
Authors: Vaman; Raman Swathy; Valamparampil, Mathew J.; Dalmita, Niya James; Reghukumar, Aravind; Anish, T. S.
Abstract:
Introduction: Multimorbidity is the coexistence of two or more chronic medical conditions in a person. The study aims to investigate the immediate cause of death and risk factors of mortality including multimorbidity among patients hospitalized with SARS CoV2 infection in Kasaragod district in Kerala, India.Methods: A record-based case-control study was done using the hospital records and follow-up surveillance system of SARS-COV 2 patients admitted in the Kasaragod district. SARS-COV 2 patients who had expired during the study period from June to December 2020 and reported as COVID-19 deaths (N = 226) were the cases, and an equal number of hospital controls were the study participants.Results: The mean (SD) age of the cases and controls were found to be 64.6 (14.2) years and 61.5 (13.4) years, respectively. Covid pneumonia alone was reported as the cause of death in more than half (52%) of the study participants. This was followed by cardiovascular events (8.5%) and acute kidney injury (6.5%). Among individual comorbidities among people who expired, diabetes mellitus (53%) was the most common, followed by hypertension (46%) and cardiovascular diseases (23%). More than 50% were found to have multimorbidity. Logistic regression showed chronic kidney disease (CKD) (Adjusted odds ratio (AOR) = 2.18 (1.24–3.83)) and malignancy (AOR = 3.05 (1.27–7.32)) to be significantly associated with mortality as individual determinants. Hypertension–diabetes mellitus [AOR = 1.68 (1.02–2.76), P = 0.043] and hypertension–CKD [AOR = 3.49 (1.01–12.01), P = 0.48] dyads were multimorbidities significantly associated with mortality.Conclusion: Combinations of hypertension with diabetes mellitus and CKD were found to be significant determinants for mortality in hospitalized COVID-19 patients. Uniformity in death certification is required to understand the causes and contributors to death in COVID-19.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- A qualitative study on factors affecting adherence to antidiabetic
medication in patients approaching a health center in an urban area
Authors: Kaur; Paawanjot; Gomra, Rozy; Girdhar, Sangeeta; Sharma, Sarit; Chaudhary, Anurag
Abstract:
Aim: The aim of this study was to evaluate the factors affecting adherence to antidiabetic medication among diabetic patients in India.Setting and Design: A qualitative study was conducted among 40 diabetic patients aged>30 years, on treatment for more than a year without any complications in the Urban Health Centre of Dayanand Medical College and Hospital, Ludhiana, Punjab, India.Materials and Methods: A semistructured questionnaire was harnessed to congregate data by interviewing the patients for 30–40 min in person. The interviews were recorded in the form of audios by acquiring informed consent and transcribed verbatim. The factors were then divided into barriers and enablers which were further subdivided into themes and subthemes as a result of which four major themes were built including individual, social, organizational, and community levels. These major themes were further categorized into several subthemes to assess the nonadherence to antidiabetic medications.Results: The results of the interviews depicted that the lack of knowledge, financial problems, familial issues, misconceptions regarding the disease, and side effects of taking medications daily were the major altruist for nonadherence, whereas on the other hand, positive perception about the disease, family support, and getting medications on affordable prices by some health-care institutes played an important role in enabling medication adherence as about 50% patients were adherent to the medications. Moreover, various interventions were used to escort the patients regarding medication compliance and blood glucose level monitoring such as lifestyle modifications (diet and exercise), use of reminders for medication intake on time, encouraging them to visit health-care centers, or hospitals on time for regular check-ups and by educating them regarding the long-term effects of diabetes and its prevention.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Consumption of energy drinks and their effects on sleep quality among
medical students
Authors: Alshumrani; Ranya; Shalabi, Bashayer; Sultan, Abdulsamad; Wazira, Lamar; Almutiri, Sarah; Sharkar, Azzam
Abstract:
Background and Objectives: Energy drinks contain caffeine, which causes genuine concern among health professionals and authorities about their negative health effects. Their effect on sleep quality specifically was not well studied. In our study, we aim to assess the prevalence of energy drink consumption and its effect on the quality of sleep among Saudi medical students.Materials and Methods: A cross-sectional study was done on 260 medical students who were in their first till the sixth academic year at King Abdulaziz University Jeddah, Saudi Arabia. An online questionnaire was distributed as a Google form including demographics, the beverage questionnaire (BEVQ-15), and the Pittsburgh sleep quality index (PSQI).Results: Coffee was found to be the most favorite (56.5%) caffeinated beverage among medical students, 46.2% reported a sleep duration of 5 h, and 15% reported a sleep latency of more than 30 min. Also, 19.3% were found to have reduced sleep efficiency (less than 74%) and 82.6% used sleep medication once a week. Male students had a significantly higher mean frequency of drinking Energy & Sports drinks (Red Bull, code red, Gatorade, etc.) compared to females. Moreover, 74.6% of the medical students studied had poor sleep quality, with no relationship found between sleep quality and participant demographics, favorite caffeinated beverages, BEVQ-15 scale scores, or the frequency of energy drink consumption. In contrast, the PSQI and BEVQ-15 scores showed a significant positive correlation.Conclusion: Students at the university level should be educated on the causes of poor sleep quality and the effect of energy drinks on sleep quality. More research on a larger sample of Saudi university students is needed to determine the scope of the problem.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Examining the determinants of health and long-term care for older adults
in India through a socio-ecological model – A qualitative assessment
Authors: Jamwal; Sonalika; Golechha, Mahaveer; Bohra, Tasneem
Abstract:
Background: Ageing is associated with multiple long-term health problems and requires medication management, support with activities of daily living, and attention to psychological needs. This study aimed at exploring the enablers and barriers and psychosocial determinants of long-term care.Methods: A qualitative study, using semi-structured interviews and thematic analysis, was carried out from February to June 2018. One-on-one in-depth interviews were carried out with 28 participants, including care recipients (n = 12), caregivers (n = 12), and primary-care physicians (n = 4) at the Community Health Centre in the state of Jammu and Kashmir of India.Results: Attention from family members, leisure activities, faith in the healthcare provider, and a positive attitude towards life were found to be enablers of long-term care. Resource constraints and alienation from the community were barriers. Incorporating the psychosocial needs of care recipients and problems faced by family caregivers is essential in providing good quality care to individuals with chronic illness.Conclusion: The lack of a targeted, nationwide policy has resulted in considerable variability in long-term care services across the country. There is an urgent need to make long-term care an integral part of the Indian health system utilizing a holistic framework to address the health needs of older adults and implementing it through an equitable community-based comprehensive primary health and community-based model.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Resilience and self-compassion among persons with depressive disorders:
Prerequisite for a positive mental health approach
Authors: Dan; V Hubert; Ponnuchamy, Lingam; Anand, Nitin K.; Bhaskarapillai, Binukumar; Sharma, Manoj K.
Abstract:
Background: Treatment gap for common mental health problems, especially of the depressive disorders is consequential in developing countries like India. Positive mental health domains like resilience and self-compassion have been long hailed as protective factors against depression and viable for use in therapeutic aspects. The objectives were to find an association between resilience, self-compassion, and depression.Methods: The study was conducted using a cross-sectional design among 75 respondents who were seeking treatment for major depressive disorders from a tertiary care center during the second wave of COVID-19. Three scales were administered online, namely Beck’s Depression Inventory-II (BDI-II), Connor Davidson Resilience Scale (CD RISC-25), and Self-Compassion Scale-Short Form (SCS-SF). Spearman’s rank correlation test, Chi-square with Fisher’s exact test, and Kruskal Wallis H test were used to study the relationships and differences in average scores with respect to the severity of depression.Results: Most of the respondents had moderate depressive features along with moderately high levels of resilience (CD RISC 25) and self-compassion (SCS-SF) scores. Resilience and self-compassion were found to have no significant relationship with respect to the severity of depression. There was a weakly positive correlation between resilience and self-compassion among those with moderate and severe depression.Conclusion: Since the individuals with depression had higher scores on resilience and self-compassion, the levels of depression remained at moderate levels of severity despite the devastating impact of the second wave of COVID-19 in the Indian sub-continent. Results are to be interpreted with respect to psychosocial contexts arising during the COVID-19 pandemic. Mental health programs can incorporate the variables of resilience and self-compassion in intervention among individuals with depression which have likely been beneficial in their process of recovery.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Haematological screening and its correlation with sociodemographic profile
among the indigenous communities in and around Puducherry
Authors: Kar; Rakhee; Anand, Jeyanthi; Kar, Sitanshu Sekhar; Banu, Narkiss; Kuppusamy, Dheebika; Sivanantham, Parthibane; Bhattacharyya, Maitreyee
Abstract:
Background: Haemoglobin disorders are unique and important health challenges for tribal populations. Hence, this study was undertaken with the aim to screen for haematological disorders, particularly anaemia and haemoglobinopathies, and to assess the sociodemographic profile in indigenous communities residing in and around Puducherry.Methods: This was a community-based cross-sectional study conducted in both urban and rural areas of Puducherry district. We included 556 participants through convenient sampling. Trained research associates visited community to enrol eligible participants and sought information on sociodemographic parameters, health status, and disease profile, using a structured questionnaire; 2–3 ml of blood was collected in ethylene diamine tetra acid anticoagulant for analysis of haematology parameters.Results: Median age of participants was 28 (17–42) years. Majority (58.8%) of the participants were female, married (52.8%). On thalassemia screening, none of the study participants had any haemoglobinopathy. The burden of anaemia among the study population was 38.7% (95% CI: 34.6–42.8%) and was higher among the female participants in both adolescent (54.5%) and adult (57.8%) age groups. The next common haematological abnormality observed was eosinophilia 21.4% (95% CI: 18–25%), more prevalent among males in the age group of 30–60 years.Conclusion: More than half of the women were anaemic. Multidimensional planning and implementation are needed to improve the socio-economic profile and overall health of this vulnerable population.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Access to chronic kidney disease (CKD) care: Its barriers and facilitators
in a community development block in Purba Bardhaman, West Bengal: A
qualitative study
Authors: Mondal; Biman; Samsuzzaman, Md.; Das, Sulagna
Abstract:
Background: Chronic kidney disease (CKD), a leading public health problem, has potential risks and serious implications on the health of individuals and society at large. Few studies explored the factors that influence access to CKD care at the community level in rural areas of West Bengal. A qualitative study was planned among key stakeholders to explore their views and experiences and to identify the barriers and potential facilitators that influence access to CKD care at the primary care level.Methods: Total 23 stakeholders participated in the study. Seventeen in-depth interviews (IDIs) were conducted on a purposive sample of stakeholders (CKD patients, healthcare providers (HCPs) and health planners) and one focus group discussion (FGD) among six community health workers. The audio-recorded interviews were transcribed verbatim. The Lévesque’s framework for access to care as modified by Jodie Bailie et al. was employed to construct interview guides and structure the initial codes. Thematic analysis was undertaken using QSR NVivo version 11 using both inductive and deductive approaches.Results: The major barriers to CKD care at patient level were poor knowledge and awareness of CKD and at the health system level was shortage of skilled staffs, diagnostics and medicines and fragmented referrals. The potential facilitators identified were educational activities to increase the awareness of CKD among HCPs and patients; provision of CKD-related supplies and a system-level approach to care coordination along with m-health-based care.Conclusions: Targeted CKD screening programs and CKD specific trainings may improve awareness of CKD. Additionally, stronger primary care infrastructure, availability of essential drugs and diagnostics and creating an efficient referral process for the quality CKD care are the need of the hour.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Clinical profile of hospitalised moderate category COVID-19 patients:
Short study from a Tertiary Care Centre in Delhi
Authors: Gautam; Sachin; Kumar, Rahul; Bhadoria, Dharam Pal; Mawari, Govind; Kumar, Naresh; Daga, Mradul K.; Pandit, Sanjay; Anuradha, S.; Pradhan, Gaurav Shanker; Garg, Sandeep; Sharma, Gaurav; Raghu, RV; Ritchie, Nupur; Jayamsulekha, Dasari
Abstract:
Background: The clinical profile of hospitalized moderate-category COVID-19 patients has been understudied globally and in India.Aim: The present study was conducted to study the clinical profile and assess the proportions of patients who progressed to severe disease and its predictors among moderate COVID-19 patients.Materials and Methods: In this single-center observational study, 100 moderate-category COVID-19 patients as per Ministry of Health and Family Welfare (MoHFW) criteria of age ≥18 years of either sex, excluding pregnant females from February to November 2021, were studied by analyzing their clinical profiles and assessing Quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score 2 (NEWS-2), and chest computed-tomography severity score (CTSS) to predict progression to severe disease. Severe disease was defined as per MoHFW criteria.Results: Out of 100 moderate-category COVID-19 patients, progression to severe disease was seen in 11 patients (11%), among which eight patients had expired, three patients were discharged, and the rest of the 89 patients (89%) who did not progress to severe disease were discharged. A higher age (62.2± 19.5 vs 54.8 ± 14.6 years), along with multivariate analysis revealing male sex (1.25 times), chronic kidney disease (2.86 times), leukocytosis (6.10 times), thrombocytopenia (1.04 times), anemia (9.3 times), a higher qSOFA score (3.6 times), and a higher NEWS-2 score on admission (1.56 times) had higher odds of progression to severe disease. A significant correlation (P < .05) of qSOFA score with serum LDH, ferritin, and hs-CRP levels; CT severity score with the serum ferritin, IL-6, and LDH levels; and NEWS-2 with serum LDH, hs-CRP, and ferritin levels were found. Moreover, the NEWS-2 score was found slightly better than qSOFA on receiver operating characteristic (ROC) curve analysis, with an area under the curve of 85.8% and 83.2%, respectively, predicting progression to severe disease.Conclusion: Our study revealed male gender, chronic kidney disease, leukocytosis, anemia, thrombocytopenia, a higher qSOFA and NEWS-2 score on admission, and further, NEWS-2 score better than qSOFA on ROC curve analysis, with an area under the curve of 85.8% and 83.2%, respectively, in predicting severe disease among hospitalized moderate COVID-19 patients.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- A cluster onset of acute and accelerated silicosis cases in workers of
ramming mass industries in Jharkhand, Eastern India
Authors: Singh; Dharmendra; Carr, Samit Kumar; Sarkar, Bidisa; Ali, Syed Irfan; Sarkar, Kamalesh
Abstract:
Introduction and Methodology: A cross-sectional study was conducted among workers of ramming mass industries in the East Singhbhum district of Jharkhand, eastern India. Workers had occupational exposure to respirable crystalline silica dust of varied duration between 1 and 6 years. A total of 122 subjects participated in it. Relevant epidemiological information was collected from them. All were x-rayed using 300 mA radiation for the detection of the presence of silicotic opacities if any as described by the International Labour Organisation (ILO) for the detection of silicosis.Results: The study revealed that 61.4% (n = 75) of subjects had silicosis. Of them, 19 had acute silicosis (having a duration of silica dust exposure of 2 years or lesser) and 56 had accelerated silicosis (a duration of occupational exposure of> 2 to 6 years). The offending agent was clouds of respirable crystalline silica dust from the ramming mass industries.Epidemiological Interpretation: To the best of our knowledge, this is the first report of an outbreak of acute and accelerated silicosis cases because of occupational inhalational exposure to ramming mass in India with a sizable portion of female workers with silicosis. Regional as well as national authorities need to take appropriate interventional measures in a programmatic mode as soon as possible.Conclusion: An in-depth investigation on the existence and magnitude of the problem of silico-tuberculosis is needed to be performed in them as silicosis increases the vulnerability of pulmonary tuberculosis among the affected workers.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- A pilot study on the capability of artificial intelligence in preparation
of patients’ educational materials for Indian public health issues
Authors: Mondal; Himel; Panigrahi, Muralidhar; Mishra, Baidyanath; Behera, Joshil K.; Mondal, Shaikat
Abstract:
Background: Patient education is an essential component of improving public health as it empowers individuals with the knowledge and skills necessary for making informed decisions about their health and well-being. Primary care physicians play a crucial role in patients’ education as they are the first contact between the patients and the healthcare system. However, they may not get adequate time to prepare educational material for their patients. An artificial intelligence-based writer like ChatGPT can help write the material for physicians.Aim: This study aimed to ascertain the capability of ChatGPT for generating patients’ educational materials for common public health issues in India.Materials and Methods: This observational study was conducted on the internet using the free research version of ChatGPT, a conversational artificial intelligence that can generate human-like text output. We conversed with the program with the question - ”prepare a patients’ education material for X in India.” In the X, we used the following words or phrases – ”air pollution,” “malnutrition,” “maternal and child health,” “mental health,” “noncommunicable diseases,” “road traffic accidents,” “tuberculosis,” and “water-borne diseases.” The textual response in the conversation was collected and stored for further analysis. The text was analyzed for readability, grammatical errors, and text similarity.Result: We generated a total of eight educational documents with a median of 26 (Q1-Q3: 21.5-34) sentences with a median of 349 (Q1-Q3: 329-450.5) words. The median Flesch Reading Ease Score was 48.2 (Q1-Q3: 39-50.65). It indicates that the text can be understood by a college student. The text was grammatically correct with very few (seven errors in 3415 words) errors. The text was very clear in the majority (8 out of 9) of documents with a median score of 85 (Q1-Q3: 82.5-85) in 100. The overall text similarity index was 18% (Q1-Q3: 7.5-26).Conclusion: The research version of the ChatGPT (January 30, 2023 version) is capable of generating patients’ educational materials for common public health issues in India with a difficulty level ideal for college students with high grammatical accuracy. However, the text similarity should be checked before using it. Primary care physicians can take the help of ChatGPT for generating text for materials used for patients’ education.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Inflammatory markers in geriatric anemia: A study from North India
Authors: Shastri; Malvika; Kotru, Mrinalini; Raizada, Alpana; Mahajan, Bhawna; Jain, Rajat; Sikka, Meera
Abstract:
Background: Inflammation has several effects in the geriatrics with reference to iron deficiency anemia (IDA), anemia of chronic disease (ACD), and unexplained anemia (UA). Whether hyperinflammation is part of their pathogenesis or just incidental is unknown. Data are limited regarding inflammatory patterns in IDA, ACD, and UA in anemic geriatrics and inflammation as a component of UA. There is little known about the overlap of inflammation between ACD and UA.Objective: The study was undertaken to find the proportion of anemic geriatric patients, aged ≥60 years with raised serum levels of inflammatory markers and their study within IDA, ACD, and UA.Materials and Methods: Seventy-five anemic geriatric patients were evaluated for raised serum levels of inflammatory markers: high sensitive C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) along with serum ferritin (SF).Results: Raised markers were seen in 94.7% of anemic geriatric patients.IL-8 was raised most frequently followed by TNF-α, IL-6, hsCRP, and SF. No distinct inflammatory profile could be elicited between ACD and UA. The hyperinflammatory profile irrespective of the underlying etiology of geriatric anemia suggests that aging per se is pro-inflammatory state.Conclusion: Geriatric anemia can be thought to develop on background of subclinical low-grade inflammation along with superimposed nutritional deficiencies or chronic diseases.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Immunological survey of COVID-19 among medicos of tribal preponderant
state of India
Authors: Kumari; Sushma; Jeseena, K; Kiran, Asha K.; Kujur, Manisha; Saroj, Usha; Hembrom, Shailesh S.; Kujur, Anit
Abstract:
Background: Immunological Survey or serosurveys have yielded useful information regarding the spread of the COVID-19 pandemic in the general population, but the impact of the continuing pandemic on the medical students in India is yet to be fully recognised. In this study we assessed the students who had received at least two doses of the COVID-19 vaccine for their antibody response.Methodology: A Hospital based, age-stratified, cross-sectional Analytical study design was adopted for the survey, carried out in tribal state of India among medical students. Consecutive sampling method was used where serum samples were tested for antibodies against the SARS-CoV-2 nucleocapsid (N) protein.Result: The vaccinee group comprised of 187 students mostly aged between 18-23 years 68.4% were females, 56.6 % were vaccinated with covishield. The mean IgG (Immunoglobin G) titre was 7343.74 AU/Ml, less than 1000 AU/Ml was found in 8% of participants, while more than 8000 AU/Ml was found in 32.1%. Participants who got the covaxin vaccine had a higher median IgG titre (median 6491.8 AU/mL, interquartile range 8898 AU/mL).The antibody titre of male was 0.328 times lower than that of female.Conclusion: Despite the fact that covishield’s mean antibody titre was higher, covaxin’s protection lasted longer.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Prevalence of work-related musculoskeletal disorders (WRMSDs) and its
association with modifiable risk factors in metropolitan bus transit
drivers: A cross-sectional comparison
Authors: Sheth; Ankit; Pagdhune, Avinash; Viramgami, Ankit
Abstract:
Background: Bus drivers are one of the top three occupations with the highest prevalence of work-related musculoskeletal disorders (WRMSDs). The present study aimed to determine the pattern and prevalence of WRMSD among metropolitan bus transit drivers, whose job profiles differ from traditional long-distance bus drivers, and to explore the effect of modifiable lifestyle-related risk factors.Materials and Methods: In this cross-sectional study, consenting 254 metropolitan transit bus drivers (with at least five years of job duration) and 73 age-matched indoor desk job workers (administration staff of the same department) as a comparison group enrolled. Sociodemographic and occupational profile were collected on a semi-closed questionnaire. A modified Nordic questionnaire was used to determine musculoskeletal problems. Anthropometric measurement and haematocrit estimation were performed with standard techniques. All statistical analyses including logistic regression were performed with SPSS 26.0.Results: The prevalence of WRMSDs among bus drivers was twice higher than administration staff (49.2% v/s 28.8%). Drivers experienced significantly higher pain for the lower back (36.6% v/s 11%), knee (29.5% v/s 15.1%), and hip (7.5% v/s 1.4%) in comparison with administration staff. Study reported age, tobacco usage, body mass index (BMI) and job profile of drivers (compared to administration staff) as significant predictors of WRMSDs.Conclusion: WRMSDs were significantly higher among metropolitan bus transit drivers in comparison with administrative staff. Furthermore, WRMSDs are strongly associated with tobacco use and BMI. These modifiable risk factors may be the targets for preventive strategies to reduce the burden of WRMSDs among bus drivers.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- A cross-sectional study of anthropometry and immunization coverage of
Anganwadi children in a rural area of Karnataka
Authors: Debata; Ipsita; Ranganath, T. S.; Priya, K Josephine; Tejas, J
Abstract:
Background: Children are a supreme asset to a nation. Beginning six years of life is pivotal for the social, emotional, cognitive, physical, motor, and psychological upbringing of the child. National Family Health Survey (NFHS) 5 data shows 41.9% of children die before the age of five years, with greater mortality in the rural areas (45.7%). The present study was conducted to assess the anthropometric profile and immunization status of children in Anganwadi centers.Materials and Methods: A community-based cross-sectional study was conducted in 21 Anganwadi centers in a rural area in South India. The anthropometry (height, weight, mid-upper arm circumference), morbidity profile, and immunization status of the enrolled and available children were assessed with the help of WHO growth charts, Salter scale, clinical examination, immunization cards, and data from Anganwadi registers.Statistical analysis: Data were compiled and analyzed using SPSS software version 20. Descriptive data were interpreted as mean and percentages and associations were tested with the Chi-square test, and Fisher’s exact test. A P value of
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Evaluation of community-based care delivered by primary healthcare
providers in management of hypertension in a rural area of West Bengal
Authors: Mukhopadhyay; Prianka; De, Maumita; Lahiri, Surajit; Sarkar, Manisha; Haldar, Anima
Abstract:
Background: Lifestyle modifications and medication compliance are key strategies.Objectives: To evaluate the effect of community-based care delivered by trained primary healthcare providers in management of hypertension.Materials and Methods: A longitudinal study was conducted between two groups of newly diagnosed hypertensive patients to evaluate the impact of an educational intervention. Six blocks in a district were chosen with pairwise matching. All primary healthcare providers of one block in each pair were randomized to receive the intervention and the other was controlled. Next screening for risk factors, detection of hypertension, counseling, and follow-up care were provided. The patients within the control group received usual care as per clinician’s discretion. A total of 227 patients in the “study” group and 230 patients in the “control” group were recruited from 12 subcenters selected randomly. Data analysis was done by χ2 test, t test, and GLM analysis using SPSS 16.Results: Patients in the intervention blocks demonstrated a statistically significant mean reduction in SBP of 16.14 ± 0.82 and DBP by 11.65 ± 0.53 compared to 9.83 ± 1.02 and 7.68 ± 0.66, respectively, in the control blocks after adjusting for age, sex, and baseline blood pressure at one-year follow-up. Regarding lifestyle-related cardiovascular risk factors, statistically significant differences were found in favor of the intervention group.Conclusion: The study supports and reinforces the utilization of trained primary healthcare providers under the NPCDCS program in screening and promoting blood pressure control by preventive services to hypertensive patients in the community.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Clinical and radiological efficacy of single-dose intra-articular
high-molecular-weight hyaluronic acid in knee osteoarthritis
Authors: Babu; Anjana; Channaveera, Chethan; Gupta, Ajay; Mittal, Mahesh K.; Johnson, Deepthi S.
Abstract:
Context: While visco-supplementation is being used for the treatment of knee osteoarthritis (OA), the published reports vary widely in benefits afforded by this treatment. It was therefore proposed to assess the objective parameters along with subjective outcomes.Aims: Our study assessed the radiological and clinical efficacy of single-dose high-molecular-weight intra-articular hyaluronic acid (HMW-IAHA) injection in knee OA.Settings and Design: This interventional cohort study was conducted in a calculated sample size of 44 patients with knee OA.Materials and Methods: Visual analog scale (VAS) and knee OA and outcome score (KOOS) were used for clinical assessment, and whole organ magnetic resonance imaging score (WORMS) for radiological assessment. The subjects were given a single dose of HMW-IAHA injection, 90 mg/3 ml, and were assessed on day 0 and day 90.Statistical Analysis: Statistical Package for Social Sciences (SPSS) software was used.Results: At the day 90 follow-up, there was an improvement in mean ± standard deviation values of VAS score (day 0: 8.53 ± 0.81, day 90: 5.97 ± 0.87), KOOS score (day 0: 27.33 ± 15.18, day 90: 57.26 ± 14.26), and the cartilage signal and morphology in the medial femorotibial joint (day 0: 11.02 ± 6.26 and day 90: 10.91 ± 6.22) and patellofemoral joint (day 0: 10.35 ± 4.36 and day 90: 10.28 ± 4.39) compartments. There was a decrease in synovitis score from 2.3 ± 1.61 to 1.3 ± 1.3 in the medial femorotibial joint compartment and total WORMS score (day 0: 66.57 ± 36.06, day 90: 65.14 ± 35.62).Conclusions: A single dose of intra-articular injection with high-molecular-weight hyaluronic acid produces improvement in the clinical symptoms and quality of life as well as is effective in maintaining the articular cartilage integrity and reducing synovial inflammation.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- An educational intervention study to enhance breast cancer awareness among
women and primary healthcare providers of an urban health center area,
Visakhapatnam
Authors: Potluri; Tanmayee S.; Vadlamani, Sarada; Gujjarlapudi, Chaitanya; Nerusu, Nagamani G.; Rongala, Manasa V.
Abstract:
Background: Breast cancer is the most common malignancy in women worldwide posing greater health challenge. The poor survival rate from breast cancer in India may be attributed to lack of awareness, low rate of screening uptake and presentation of cases in advanced stage.Objectives: To assess the baseline knowledge and effectiveness of educational intervention in improving the knowledge regarding breast cancer.Materials and Methods: A quasi-experimental community-based health educational intervention study was performed among 100 women and 18 female primary healthcare providers residing in urban field practice area. Face-to-face interviews were performed using a questionnaire adapted from the Breast Cancer Awareness Measure (Breast-CAM) Version 2. Data were analyzed using SPSS version 25. To assess the difference between pre- and postintervention scores, Mc-Nemar’s test and paired sample t tests were applied. Association between socio-demographic variables and difference in mean scores was assessed by using ANOVA and independent t test. P value less than 0.05 was taken as statistically significant.Results: The mean pre-intervention score of knowledge items (21 including warning signs, risk factors of breast cancer) among 100 women participants was 7.19 ± 3.45 and postintervention mean score was 18.18 ± 2.42. The mean pre-intervention score among 18 primary healthcare providers was 10.89 ± 4.59 and postintervention score was 19.89 ± 1.28. There was significant improvement in mean scores. The increase in percentage of scores in all 21 items postintervention was significant (Mc-Nemar’s test). There was significant association between socio-demographic profile and increase in mean scores. The study identified various barriers for seeking medical care among women.Conclusion: The community-based educational intervention was effective in enhancing the knowledge regarding breast cancer among women.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Serum versican as a potential biomarker in patients with uterine fibroids:
A study from Eastern India
Authors: Jasti; Pratima; Kumari, Suchitra; Singh, Sweta; Anudeep, PP
Abstract:
Objective: Versican is a chondroitin sulphate proteoglycan with raised expression at site of inflammation, and uterine fibroids are associated with local inflammation. Hence, this study aimed to estimate serum Versican levels in pre-menopausal women with uterine fibroids to evaluate its diagnostic efficiency.Materials and Methods: This case–control study included forty uterine fibroid cases and 40 healthy controls. Cases clinically evaluated with USG findings, that is number, location of fibroid and volume calculated by prolate ellipse formula a × b × c × 0.523 (a – height, b – width, c – depth). Biochemical investigations, that is serum Versican levels, were estimated by ELISA with total cholesterol, HDLc and LDLc. Triglycerides by fully automated chemistry analysers. Serum biochemical parameters were compared and correlated with volume of fibroid. Area under receiver operating characteristic curve was calculated along with cut-off value to determine diagnostic potential of Versican, differentiating women with fibroids.Results: In the present study, patients with fibroids had decreased levels of serum Versican (79.43 ± 18.60) as compared to healthy controls (101.81 ± 28.24, P < 0.001). There was a statistically significant negative correlation (r = - 0. 307, P = 0.04) between serum Versican level and volume of fibroid. Area under ROC was 0.726 (95% CI: 0.616-0.836; P = 0.001). The best cut-off value for serum Versican level was 96.90 ng/ml with 90% sensitivity and 48% specificity.Conclusion: Serum Versican levels were found significantly lower in women with fibroid with a negative correlation with volume of fibroid uterus. Furthermore, extensive study would help in substantiating diagnostic potential of serum Versican in fibroid uterus patients.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- A rare case of genital myiasis in a patient with genital prolapse
Authors: Manna; Souvik; Gupta, Varsha; Kumari, Asha
Abstract:
Genital myiasis is an infestation of genital organs by fly larvae, where they feed and develop as parasites. They can cause severe infection, inflammatory reaction and can be linked to psychiatric disturbances. We report a rare case of genital myiasis in an elderly postmenopausal woman aged 82 years from Udaipur, Rajasthan. She presented with complaints of intense pain in the genital region and was diagnosed as a case of genital myiasis of a prolapsed uterus. Pelvic examination revealed ‘Stage-IV’ genitourinary prolapse according to Pelvic Organ Prolapse-Quantification (POP-Q classification), with a big excavatory ulcer indwelled with maggots of Musca domestica. About 100 such maggots were subsequently manually removed with forceps. With proper surgical and nonsurgical interventions, the patient healed completely and the prolapse was reduced completely.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Erythema elevatum diutinum with lower limb neuropathy: A rare presentation
Authors: Kumar; N. Ashok; Dhanaraj, Manoharan; Srinivasan, Shreya; Narendra, Raksha Raja
Abstract:
Nodular lesions can be seen in a wide range of conditions such as infections, granulomatous conditions, neutrophilic disorders, vasculitis, benign tumours and malignant conditions. These numerous aetiologies behind the occurrence of nodular lesions signify the importance of thorough work-up of the patient to diagnose the underlying reason behind the clinical condition. Erythema elevatum diutinum (EED) is a rare vasculitis with variable clinical presentation, the diagnosis of which can be challenging. Extracutaneous signs such as arthralgias, oral and penile ulcers, involvement of the eye and neuropathy have all been linked to it. Various systemic illnesses, infectious diseases, autoimmune diseases, haematological abnormalities and plasma cell dyscrasias are also associated with EED. Such extracutaneous signs in EED patients indicate that the condition may involve several organ systems. Patients with EED should be assessed for systemic manifestations to ensure focused care, since extracutaneous forms of EED may comprise deposition of circulating immune complexes.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Giant anterior abdominal wall desmoid tumor successfully managed with
abdominal wall reconstruction
Authors: Dhivakar; S; Huda, Farhanul; Singh, Sudhir K.; Kumar, Arvind; Das, Asish; Acharya, Preeti
Abstract:
Anterior abdominal wall fibromatosis is a benign soft tissue tumor that is rare, but fast-growing with minimal chances of malignant change. We report a young female with a large abdominal swelling which on evaluation was provisionally diagnosed as anterior abdominal wall fibromatosis on imaging and confirmed by histopathology. She was successfully managed with resection of the tumor with a challenging abdominal wall reconstruction with bilateral inferiorly based external oblique muscle flap followed by a mesh repair. Though rare, these tumors are difficult to miss. The importance of this case report is that it describes the methods of multimodal management of a patient with surgery, reconstruction, and adjuvant therapy leading to better patient outcomes.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Brenner tumors of the ovary: A case series in a teaching institute center
Authors: Sahu; Alaka; Toppo, Anupa; Mohapatra, Kaustav; Panda, Sagarika
Abstract:
Brenner tumors of the ovary are very rare, and mostly benign. Borderline Brenner tumors are rare and malignant Brenner tumors are even much rarer with a worse prognosis. This study was carried out in the Department of Pathology, VSSIMSAR, Burla, Odisha over a period of 3 years. A histopathology study was done in all the cases, while immunostaining was done in selected cases only. A total of seven cases were studied, out of which four (57.14%) cases were diagnosed as benign Brenner tumors, two (28.57%) cases as borderline Brenner tumors, and one (14.28%) case as malignant. Histopathology study is the gold standard for diagnosis of Brenner tumor, with the aid of immunostain whenever necessary.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Quadriparesis with different diagnoses after COVID-19 vaccination: Case
series and literature review
Authors: Wali; Sachin; Gutte, Shreyas; Yadav, Shubham; Gurjar, Mohan; Paliwal, Vimal K.; Singh, Vivek; Azim, Afzal; Poddar, Banani
Abstract:
Following vaccination with adenoviral vector-based ChAdOx1 nCoV-19, serious neurological adverse events have been reported. Here we report two cases who presented with quadriparesis following the adenoviral vector-based ChAdOx1 nCoV-19 vaccine. A 55-year-old male patient presented with quadriparesis after 8 days of the second dose of ChAdOx1 nCoV-19 vaccination. Imaging showed features of stroke with right basilar artery thrombosis; he was started on anticoagulation following which the patient’s neurological status improved and he was discharged during the 7th week of hospital stay. A 19-year-old male patient presented with quadriparesis after 16 days of the first dose of ChAdOx1 nCoV-19 vaccination. Cerebral spinal fluid and nerve conduction study was suggestive of Guillain–Barre syndrome (GBS). Two doses of intravenous immunoglobulin were given, following which the patient’s neurological status improved and he was discharged in the 11th week of his hospital stay. Awareness of neurological adverse effects and emphasis on the underlying mechanism of vaccine-induced thrombotic thrombocytopenia (VITT) and molecular mimicry in patients presenting with quadriparesis following ChAdOx1 nCoV-19 vaccination is important.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Pyomyositis involving the scapular muscles: A case series
Authors: Dharmshaktu; Ganesh S.; Dharmshaktu, Ishwar S.; Pangtey, Tanuja
Abstract:
Pyomyositis or tropical pyomyositis is an uncommon infection of skeletal muscle that may be primary or secondary. Primary type has bacterial aetiology, and Staphylococcus aureus is associated in most cases. The diagnosis requires high index of suspicion and careful assessment of radiological investigations. Diagnosis often requires magnetic resonance imaging (MRI) for better delineation of the disease process, associated site involvement and exclusion of related conditions. Evacuation of pus coupled with appropriate antibiotic therapy is the mainstay and curative in most cases. Caution, however, is required due to increased morbidity, protracted course of recovery and mortality in few cases. The association with comorbidities including immunocompromised status compounds the problem. We describe our experience with this condition in a series of five cases (four male and one female) with diverse involvement of scapular muscle. All cases had primary pyomyositis except one case secondary to shoulder joint tuberculosis. Right side was involved in three and left in two cases. Infraspinatus was commonly involved, and one case had extensive involvement around scapula. All cases were managed by one or multiple aspiration, except one managed with open surgical drainage. The outcome was good in all cases with no recurrence or complication noted in their respective follow-up. Primary care centres may play important role in the early diagnosis of this condition with clinical evaluation and judicious use of imaging. Cases with severe involvement or those requiring advanced procedures may be referred to higher centres as per the requirement. Most of the times, timely diagnosis, antibiotic therapy and drainage of the pus is required and may also be performed in the primary care level through a standard protocol.
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Letter to the editor: Editorial: Opinion of patients seeking primary care
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Authors: Zhang; Guoman
Abstract: Aaa
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
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Abstract: No abstract available
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vaccination
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Abstract:
No abstract available
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
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mucormycosis
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Abstract: No abstract available
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
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Authors: Das; Nikunja K.; Patil, Rajashri A.
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PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
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Authors: Mukhida; Sahjid; Borah, Nirankush
Abstract: No abstract available
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
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Authors: Thangaraju; Pugazhenthan; Velmurugan, Hemasri; Venkatesan, Sajitha
Abstract: No abstract available
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Gestational diabetes: Unfolded area still a concern
Authors: Velmurugan; Hemasri; Neelambaran, Krishnapriya; Thangaraju, Pugazhenthan
Abstract:
No abstract available
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Vaccines for cancer prevention and cure
Authors: Petkar; Prithvi B.; Mendhe, Harshal G.; Choudhari, Sonali G.
Abstract: No abstract available
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Pain as a clinical parameter in severe scorpion envenomation
Authors: Rathod; Santosh G.; Atri, Pallavi
Abstract: No abstract available
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
- Respecting autonomy: Prioritizing patient-centered care and
decision-making capacity for stronger doctor–patient relationships
Authors: Ajluni; Victor
Abstract: No abstract available
PubDate: Tue, 29 Aug 2023 00:00:00 GMT-
