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Journal of Family Medicine and Primary... May 2024Symptoms for severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) appear 2-3 days after exposure to the virus. Being a virus, detection is primarily by...
BACKGROUND
Symptoms for severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) appear 2-3 days after exposure to the virus. Being a virus, detection is primarily by polymerase chain reaction as this offers superior sensitivity and specificity. There was a misconception that patients with low cycle threshold (Ct) have severe coronavirus disease (COVID), and for individuals with higher Ct, it is the other way around. The prognosis for COVID was derived from various biomarkers and physicians heavily relied on them.
MATERIALS AND METHODS
A cross-sectional study spanning a duration of 2 years was conducted at a tertiary care centre in western India. A total of 201 individuals were included and the correlation between Ct, clinical features and biomarkers was studied.
RESULTS
In the E-gene, 43.28% had lower Ct values and 40.79% had low Ct values in the RdRp gene. 50% of all patients had diabetes, with 60% being between the ages of 61 and 80. 54.1% of hypertension patients belonged to ages between 61 and 80. 90.54% of COVID-positive individuals had lactose dehydrogenase levels ranging from 440 to 760. 79% of patients had a procalcitonin value of more than one but less than six. 79.1% of patients had an erythrocyte sedimentation rate between 36 and 90.
CONCLUSION
Ct value though has a research value; it is a poor prognostic marker when compared to the various biomarkers that have been studied earlier. We cannot conclusively state that all our findings are accurate due to a lack of data but further research into the prognostic value of Ct should be conducted which will help in the ongoing scenario.
PubMed: 38948616
DOI: 10.4103/jfmpc.jfmpc_967_23 -
Journal of Family Medicine and Primary... May 2024Birt-Hogg-Dubé syndrome (BHDS) is a rare hereditary autosomal dominant condition characterized by benign cutaneous lesions, lung cysts, and increased risk of...
Birt-Hogg-Dubé syndrome (BHDS) is a rare hereditary autosomal dominant condition characterized by benign cutaneous lesions, lung cysts, and increased risk of spontaneous pneumothorax and renal cancer. We report a case of a young Indian boy with bilateral pneumothorax as the first symptom of BHDS. Detailed history examination and investigation showed multiple facial lesions; his computerized tomography was suggestive of renal angiomyolipoma, hepatic angiomyolipoma, pulmonary cyst with pneumothorax, and small bilateral subependymal soft tissue density lesion with calcification in the brain, all of which were collectively suggestive of BHDS. Identification of the above commonly presented clinical features as a syndrome is important for even a primary care physician so as to ensure the timely management and if required referral to a higher center.
PubMed: 38948613
DOI: 10.4103/jfmpc.jfmpc_1451_23 -
Journal of Family Medicine and Primary... May 2024Pakistan is in dire need of trained family physicians to enhance the quality of primary health care. To build capacity, there is a need to train the trainers on a large...
AIM
Pakistan is in dire need of trained family physicians to enhance the quality of primary health care. To build capacity, there is a need to train the trainers on a large scale through a feasible and accessible program. Therefore, for the first time, a three-month online course was designed and piloted, in collaboration with national and international family medicine faculty. The aim of this study was to determine the gap between the pre-course expectations and the post-program perceptions of the participants for* a unique family medicine "Train the Trainers" course.
METHODS
A longitudinal-observational study was conducted at a private college of Karachi after approval from the Institutional Review Board. The expectations and perceptions of all (31) participants were recorded through a pre- and post-course questionnaire. Data were analyzed through descriptive and analytical statistics on SPSS-26. The responses to the open-ended questions were analyzed by content analytical approach.
RESULTS
Out of 20 quantitative items on the questionnaire, four were associated with a positive gap between the expectations and perceptions. One item showed a negative gap, while the rest did not show any significant difference. The majority of the participants expressed that they expected to see an improvement in their teaching skills because of the online course.
CONCLUSION
The online course was successful in meeting the participants' expectations. The course delivery can be revisited to further improve its quality according to the participant's feedback, including an opportunity to ask questions and incorporating some face-to-face sessions.
PubMed: 38948611
DOI: 10.4103/jfmpc.jfmpc_1796_23 -
Journal of Family Medicine and Primary... May 2024It has been well reported that medical students do not follow healthy diets overall. Effectively guiding patients to change their health behavior is a crucial skill for...
INTRODUCTION
It has been well reported that medical students do not follow healthy diets overall. Effectively guiding patients to change their health behavior is a crucial skill for primary care providers and family physicians. Our objective was to investigate medical students' dietary decision-making, including the motivations and barriers that influence their dietary choices.
METHODS
A self-administered online questionnaire was conducted among preclinical students at one allopathic medical school in the United States. The survey was comprised of questions about students' dietary goals, habits, and the barriers they face in reaching their nutritional ideals. Trends in the percentage of students who selected each survey answer choice were interpreted.
RESULTS
Of the 363 preclinical students provided with the optional survey, 71 (19.6%) chose to participate. The participants' dietary decisions were predominately driven by convenience. Most students wanted to eat nutritiously to support their well-being but had been eating less healthily since starting medical school due to financial limitations and limited time. Approximately half (46.5%, 33/71) of the participants stated that they would buy the in-house food provided at the medical school campus more often if it better matched their dietary goals, but 36.6% (26/71) would only do so if the new foods were affordable compared to competitor's prices.
CONCLUSION
There is an opportunity to help medical students meet their dietary goals, which are negatively impacted by personal and structural academic barriers. Further research is needed on the obstacles that institutions face in offering healthy, affordable options to medical students.
PubMed: 38948602
DOI: 10.4103/jfmpc.jfmpc_1016_23 -
Journal of Family Medicine and Primary... May 2024Polycystic ovary syndrome (PCOS) is a heterogeneous disorder and various phenotypes have been described. While most women with PCOS are obese, women who are lean also...
BACKGROUND
Polycystic ovary syndrome (PCOS) is a heterogeneous disorder and various phenotypes have been described. While most women with PCOS are obese, women who are lean also suffer from PCOS. Metabolic derangements often accompany this syndrome. Family physicians, being the first point of contact in the healthcare system, play a vital role in the early diagnosis and management of this condition through diet and lifestyle modifications. The present study was conducted at the Diet and Lifestyle Diseases Management Division of a Family Medicine Clinic.
METHODS
We conducted a retrospective analysis of the correlation between body mass index (BMI) and metabolic parameters in women diagnosed with PCOS. The case records of women with PCOS, diagnosed as per modified Rotterdam criteria and who attended the outpatient clinic from January 2020 to December 2022, were chosen. Data on BMI and metabolic parameters were retrieved and statistically analyzed.
RESULTS
Upon analysis of 51 case records, 25.49% of women were in the lean group and 74.51% were overweight or obese. Triglycerides/HDL ratio (1.91 ± 0.47 vs 3.97 ± 5.89) and Vitamin D levels (Median 14.12 vs 16.10 ng/ml) were abnormal in both the obese and the lean women groups. However, there was no significant difference between the groups. Other metabolic parameters were within normal ranges.
CONCLUSION
The present study indicates that metabolic derangements are associated with PCOS, irrespective of BMI. More robust studies in larger population samples are needed to elucidate the role of metabolic derangements and mainly insulin resistance in the pathophysiology of PCOS and its different phenotypes.
PubMed: 38948599
DOI: 10.4103/jfmpc.jfmpc_1425_23 -
Journal of Family Medicine and Primary... May 2024The Saudi Commission for Health Specialties (SCHS) recently proposed the Saudi Meds Family Medicine (FM) 2020 program, which is based on CanMEDS-FM 2017 and includes a...
BACKGROUND
The Saudi Commission for Health Specialties (SCHS) recently proposed the Saudi Meds Family Medicine (FM) 2020 program, which is based on CanMEDS-FM 2017 and includes a number of competencies. The purpose of this study is to evaluate the professionalism of FM residents who follow the modified curriculum of the SCHS.
MATERIALS AND METHODS
A cross-sectional study was conducted between June and August 2023 at King Abdulaziz University Hospital in Jeddah among FM residents from year 1 to year 3 and postgraduates from the FM residency program of both genders. For data collection, a structured self-administered web-based questionnaire adapted from CanMEDS was used.
RESULTS
A total of 45 FM residents responded, with the majority (73.3%) between the ages of 20 and 30 (77.8%), and 62.2% females. In terms of patient professionalism, 93.3% frequently/always demonstrated appropriate professional behavior and relationships in all aspects of practice; 62.2% frequently/always demonstrated a commitment to excellence in all aspects of practice. In terms of professionalism and societal commitment, 80% frequently/always demonstrated accountability to patients, society, and the profession by responding to societal expectations of physicians, and 86.6% frequently/always demonstrated a commitment to patient safety and quality improvement. In terms of professional commitment, 88.9% frequently/always fulfil and adhere to professional and ethical codes, standards of practice, and laws governing practice. In terms of self-commitment, it was discovered that 86.6% frequently/always demonstrated self-awareness and managed influences on personal well-being and professional performance. The majority (80%) managed personal and professional demands for a sustainable practice throughout the physician lifecycle, and 86.7% frequently/always promoted a culture that recognizes, supports, and effectively responds to colleagues in need.
CONCLUSION
FM residents in Jeddah, Saudi Arabia, demonstrated acceptable levels of dedication to patients, society, profession, and self, indicating a high level of professionalism.
PubMed: 38948595
DOI: 10.4103/jfmpc.jfmpc_1564_23 -
Journal of Family Medicine and Primary... May 2024The COVID-19 pandemic resulted in a shift in the way healthcare resources were used. While India faced limited effects in the first COVID wave primarily due to strict...
BACKGROUND
The COVID-19 pandemic resulted in a shift in the way healthcare resources were used. While India faced limited effects in the first COVID wave primarily due to strict lockdown of the county, it was one of the worst affected in the second wave and at one time reported the highest number of daily cases. To address the lack of intensive care units (ICU) beds, the surgical wards of our institute were repurposed to take care of patients requiring supplementary oxygen and other supportive care till either they improved or an ICU bed was available. The medical personnel in charge of the surgical wards were entrusted with the care of patients with support from intensive care support teams (ICST).
AIMS
We aimed to examine the clinical details of patients admitted in the repurposed orthopaedic wards during the second COVID wave and to evaluate the factors that might affect the clinical outcomes in such patients.
METHODS
This was a retrospective review of records of patients admitted in the repurposed orthopaedic wards between 16 April 2021 and 20 May 2021. Details related to demography, COVID-19 presentation, COVID-19-related management and clinical course, including transfers to ICUs, and outcomes in terms of either discharge to home or death were recorded. They were analysed using statistical software.
RESULTS
One hundred and twenty three patients were treated during the said period. Twenty patients died during treatment, resulting in a mortality rate of 16.3%. Age, gender, RT-PCR status, pre-existing comorbidities, SpO2 at admission, method of supplemental oxygen supply, total leukocyte counts, haemoglobin values, serum C-reactive protein, Lactate dehydrogenase (LDH) and creatinine values had no statistically significant association with death of a patient during treatment.
CONCLUSION
Based on the results, one can state that clinicians of surgical specialities having background knowledge of internal medicine from undergraduate education can manage patients of COVID-19 with support from ICST with reasonable outcomes. In case of future pandemics, surgical wards can be repurposed to tide over exigencies. Additionally, primary care physicians, who are often the first point of contact for patients, can allay their apprehensions adequately in future pandemics, thus preventing widespread panic and burdening of healthcare resources.
PubMed: 38948591
DOI: 10.4103/jfmpc.jfmpc_1210_23 -
Journal of Family Medicine and Primary... May 2024Fear and anxiety related to dental and healthcare procedures are common among young adults and can negatively impact dental and healthcare consumership, resulting in...
BACKGROUND AND PURPOSE
Fear and anxiety related to dental and healthcare procedures are common among young adults and can negatively impact dental and healthcare consumership, resulting in poor health outcomes.
PURPOSE
This cross-sectional study aimed to examine young adults' experiences of fear related to dental and healthcare procedures and the potential relationships between the two forms of fear experiences and demographic factors.
METHODS
Young adults (252) were recruited from a large public university and completed a survey about their dental and healthcare fear/anxiety as well as their confidence in healthcare professionals. Descriptive and correlational analyses were completed to describe the experiences of young adults and the relationships between variables.
RESULTS
Ten types of fear/anxiety were identified related to healthcare procedures, with the most common being needles and pain. Nine fears/anxieties were identified for dental visits, of which pain and sensory experiences other than pain were most common. Female participants were significantly more likely to report fear/anxiety related to dental procedures, and there was a statistically significant relationship between fear/anxiety related to healthcare procedures and that related to dental procedures. There was also a significant negative relationship found between confidence in healthcare providers and fear/anxiety related to healthcare procedures.
CONCLUSIONS
Young adults experience fear/anxiety related to healthcare and dentist visits, and this fear/anxiety can impact their confidence in healthcare providers, such as primary physicians. The findings of the current study suggest primary care providers should be aware of potential fears/anxieties and offer patients appropriate supports.
PubMed: 38948590
DOI: 10.4103/jfmpc.jfmpc_961_23 -
Journal of Family Medicine and Primary... May 2024Cancer chemotherapy remains an area of concern, as many of the therapies are uncomfortable involving side effects and unpleasant experiences. These factors could further... (Review)
Review
Cancer chemotherapy remains an area of concern, as many of the therapies are uncomfortable involving side effects and unpleasant experiences. These factors could further reduce patient's quality of life, and even endanger their life. Many therapeutic strategies have been tried to reduce the unpleasant side effects and increase the treatment effectiveness; however, none have shown to have promising effects. One of the main hindrances to cancer therapy is the escape strategies by tumor cells to the immune attack. Promoting inflammation in the tumor microenvironment is the cornerstone and key therapeutic target in cancer chemotherapy. High-salt diet (HSD) intake, though it has deleterious effects on human health by promoting chronic inflammation, is found to be advantageous in the tumor microenvironment. Studies identified HSD favors an increased abundance of species in the tumor environment due to gut barrier alteration, which, in turn, promotes inflammation and favors improved response to cancer chemotherapy. A review of the literature was carried out to find out the effects of an HSD on health and diseases, with special mention of its effect on cancer chemotherapy. Studies emphasized HSD would block the myeloid-derived suppressor cells which will enhance the tumor immunity. Exploration of the precise mechanism of simple HSD regime/ingestion of specific bacterial species as probiotics will be effective and essential to formulate the game-changing cancer chemotherapy. With the modern era of healthcare moving toward precision medicine where the physician can choose the treatment option suitable for the individual, HSD regime/ingestion of specific bacterial species can be considered.
PubMed: 38948582
DOI: 10.4103/jfmpc.jfmpc_1574_23 -
Journal of Family Medicine and Primary... May 2024Undernutrition raises the likelihood of progressing from tuberculosis (TB) infection to active TB illness and causes weight loss. Proper food and nutrition are important...
BACKGROUND
Undernutrition raises the likelihood of progressing from tuberculosis (TB) infection to active TB illness and causes weight loss. Proper food and nutrition are important in the treatment of tuberculosis patients. Active tuberculosis necessitates a substantial energy expenditure. The Tuberculosis treatment guidelines neglect the nutritional supplementation part of Tuberculosis management. The study aims to determine the factors affecting the nutritional status of pulmonary Tuberculosis patients.
MATERIAL AND METHODS
A hospital-based cross-sectional study was conducted from December 2021 to January 2022 among the patients newly diagnosed and above 18 years of age coming to DOTS Centre (DMC) of Pt J.N.M. Medical College, Raipur. Total 120 subjects were selected by consecutive sampling method. Data was analyzed using SPSS version 24, and value <0.05 was considered statistically significant.
RESULT
Among 120 study subjects, malnourished was 54.16% (BMI <18.50 kg/m), normal was 35% (BMI 18.50-24.99 kg/m), overweight was 6.67% (BMI 25-29.99 kg/m), and obese were 4.17% (BMI 30-34.99 kg/m). Among 120 study subjects, the maximum number of them (96.3%) had a dietary gap in their diets which was equal in two groups of 1-50% calorie deficit and 51-100% calorie deficit.
CONCLUSION
A high proportion of tuberculosis patients were undernourished, and even a very distal factor for undernutrition became proximal for tuberculosis patients. To control tuberculosis and to end the tuberculosis disease, an improvement in the nutritional status of the patient should be our priority. By knowing the importance of nutrition in TB patients, the primary care physicians can decrease the morbidity and mortality in TB patients.
PubMed: 38948579
DOI: 10.4103/jfmpc.jfmpc_1948_23