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Frontiers in Veterinary Science 2024Feline chronic gingivostomatitis (FCGS) is an ulcerative and/or proliferative disease that typically affects the palatoglossal folds. Because of its unknown pathogenesis...
Feline chronic gingivostomatitis (FCGS) is an ulcerative and/or proliferative disease that typically affects the palatoglossal folds. Because of its unknown pathogenesis and long disease course, it is difficult to treat and has a high recurrence rate. Most of the bacteria in the oral microbiota exist in the mouth symbiotically and maintain a dynamic balance, and when the balance is disrupted, they may cause disease. Disturbance of the oral microbiota may play an important role in the development of FCGS. In this study, the medical records of 3109 cats in three general pet hospitals in Xi 'an were collected. Sixty-one cats with FCGS were investigated via questionnaires, routine oral examinations and laboratory examinations. Oral microbiota samples were collected from 16 FCGS-affected cats, and microbial species were identified by 16S rDNA sequencing. The results showed that the incidence of FCGS had no significant correlation with age, sex or breed. However, the incidence of FCGS was associated with immunization, a history of homelessness and multicat rearing environments. The number of neutrophils and the serum amyloid A concentration were increased, and the percentage of cells positive for calicivirus antigen was high in all cases. All the cats had different degrees of dental calculus, and there were problems such as loss of alveolar bone or tooth resorption. Compared with those in healthy cats, the bacterial diversity and the abundance of anaerobic bacteria were significantly increased in cats with FCGS. , and were abundant in the mouths of the affected cats and may be potential pathogens of FCGS. After tooth extraction, a shift could be seen in the composition of the oral microbiota in cats with FCGS. An isolated bacteria obtained from the mouths of the affected cats was homologous to . Both the identified oral microbiota and the isolated strain of the cats with FCGS had high sensitivity to enrofloxacin and low sensitivity to metronidazole. This study provides support to current clinical criteria in diagnosing FCGS and proposes a more suitable antibiotic therapy.
PubMed: 38948672
DOI: 10.3389/fvets.2024.1418101 -
Journal of Family Medicine and Primary... May 2024The severity of laboratory and imaging finding was found to be inconsistent with clinical symptoms in COVID-19 patients, thereby increasing casualties. As compared to...
Machine learning-aided algorithm design for prediction of severity from clinical, demographic, biochemical and immunological parameters: Our COVID-19 experience from the pandemic.
BACKGROUND
The severity of laboratory and imaging finding was found to be inconsistent with clinical symptoms in COVID-19 patients, thereby increasing casualties. As compared to conventional biomarkers, machine learning algorithms can learn nonlinear and complex interactions and thus improve prediction accuracy. This study aimed at evaluating role of biochemical and immunological parameters-based machine learning algorithms for severity indexing in COVID-19.
METHODS
Laboratory biochemical results of 5715 COVID-19 patients were mined from electronic records including 509 admitted in COVID-19 ICU. Random Forest Classifier (RFC), Support Vector Machine (SVM), Naive Bayesian Classifier (NBC) and K-Nearest Neighbours (KNN) classifier models were used. Lasso regression helped in identifying the most influential parameter. A decision tree was made for subdivided data set, based on randomization.
RESULTS
Accuracy of SVM was highest with 94.18% and RFC with 94.04%. SVM had highest PPV (1.00), and NBC had highest NPV (0.95). QUEST modelling ignored age, urea and total protein, and only C-reactive protein and lactate dehydrogenase were considered to be a part of decision-tree algorithm. The overall percentage of correct classification was 78.31% in the overall algorithm with a sensitivity of 87.95% and an AUC of 0.747.
CONCLUSION
C-reactive protein and lactate dehydrogenase being routinely performed tests in clinical laboratories in peripheral setups, this algorithm could be an effective predictive tool. SVM and RFC models showed significant accuracy in predicting COVID-19 severity and could be useful for future pandemics.
PubMed: 38948617
DOI: 10.4103/jfmpc.jfmpc_1752_23 -
Journal of Family Medicine and Primary... May 2024To determine the association between vaccination status and mortality among critically ill patients admitted in a dedicated Covid hospital of Tripura who required...
OBJECTIVE
To determine the association between vaccination status and mortality among critically ill patients admitted in a dedicated Covid hospital of Tripura who required invasive mechanical ventilation.
MATERIAL AND METHODS
This study was conducted at a dedicated Covid hospital of Tripura for a period of six months, i.e., from June 2021 to November 2021. A total of 304 patients were enrolled for this study. Baseline epidemiological, radiological data along with other information like heart rate, pulse rate, oxygen saturation (SpO), etc., were collected through patient record sheet in all cases during hospitalization. Statistical analysis was done by using SPSS 25 version.
RESULTS
Admission and mortality rates in hospital and advanced oxygen support like bi-level positive airway pressure (BiPAP), high-flow nasal cannula (HFNOC), and ventilator use incidences were higher in non-vaccinated patients (17.1%) in comparison to double-dose-vaccinated (0.98%) and single-dose (2.3%)-vaccinated patients.
CONCLUSION
This retrospective data analysis of Covid-19 positive patients admitted in the dedicated Covid Hospital of Tripura suggests that severe infection, need for invasive and non-invasive ventilation, and death were significantly less in the vaccinated patients as compared to the vaccine-naive one.
PubMed: 38948609
DOI: 10.4103/jfmpc.jfmpc_1643_23 -
Journal of Family Medicine and Primary... May 2024The MCP card is used as a tool for pregnant women, young mothers and family members to learn about various types of services which they should assess and utilize. The...
BACKGROUND
The MCP card is used as a tool for pregnant women, young mothers and family members to learn about various types of services which they should assess and utilize. The study was undertaken to see the awareness about MCP card and its components among beneficiaries in urban slum area.
METHODOLOGY
This is a cross-sectional observational study done in urban slum immunization OPD with a sample size of 226. Convenient sampling method was used to select the samples. Mothers consenting and willing to participate in the study were enrolled.
RESULTS
Observed that the MCP card was issued to majority participants at the time of baby immunization (44.15%), followed by at time of delivery (31.4%) and least number received it at the time of pregnancy registration (24.34%). It is also observed that only 53.54%(121) women had read the card while the remaining didn't. Majority thought the primary use of MCP card was vaccination record (91.5%), followed by information tool (52.%). It is observed that knowledge regarding pregnancy care and its related complications leads to better utilization of ANC services.
CONCLUSION
As observed in the present study a sizeable proportion of populations doesn't even read the card, and among those who read it the level of knowledge isn't satisfactory, many use the card as a vaccination record but still the awareness about various vaccines among the beneficiaries remains low.
PubMed: 38948601
DOI: 10.4103/jfmpc.jfmpc_1694_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 2024We assessed the baseline knowledge and the improvement and retention of knowledge after attending diabetes self-management education (DSME) programs with respect to...
Improvement of knowledge following diabetes self-management education with respect to socioeconomic status: A retrospective cohort study among type 2 diabetes in Eastern India.
INTRODUCTION
We assessed the baseline knowledge and the improvement and retention of knowledge after attending diabetes self-management education (DSME) programs with respect to different socioeconomic status (SES). We also looked into the change in body mass index (BMI), blood pressure, and glycemic parameters after attending the DSME sessions.
MATERIALS AND METHODS
This was a retrospective, cohort study carried out via chart review based on data collected from manual or electronic medical records (EMR) and questionnaire responses of 160 adult patients with type 2 diabetes (T2D) who attended two DSME sessions with a gap of at least six months.
RESULTS
Baseline knowledge on diabetes was uniform ( = 0.06), irrespective of differences in SES, and DSME sessions significantly improved the knowledge in all socioeconomic classes ( value < 0.05 in each SES group). However, SES did have a significant influence on the finally acquired knowledge of diabetes as was evident from the final score after attending two DSME sessions. A significant number of patients (48.1%) from our cohort either improved or retained their knowledge of diabetes over a mean follow-up of 15.5 months. The BMI of our cohort was significantly reduced from baseline to final follow-up ( = 0.016).
CONCLUSION
DSME sessions were effective in improving knowledge and awareness among T2D patients, irrespective of socioeconomic classes in Eastern India. The acquired knowledge from DSME sessions was retained over a long time.
PubMed: 38948598
DOI: 10.4103/jfmpc.jfmpc_1597_23 -
Journal of Family Medicine and Primary... May 2024Since beginning of the coronavirus disease (COVID-19) it became clear that severe forms of this infection have primarily affected patients with chronic conditions.
Clinical and epidemiological risk factors associated with hospitalization and mortality rate of COVID-19 patients in Banja Luka County: A retrospective observational cohort study on 40,000 patients.
CONTEXT
Since beginning of the coronavirus disease (COVID-19) it became clear that severe forms of this infection have primarily affected patients with chronic conditions.
AIMS
The aim of the study was to explore clinical and epidemiological characteristics associated with COVID 19 outcomes.
SETTINGS AND DESIGN
The retrospective observational study included 40,692 citizens of Banja Luka County, Bosnia and Herzegovina, who were confirmed as reverse transcriptase polymerase chain reaction (RT-PCR) positive on COVID-19 at a primary healthcare centre from March 2020 to September 2022.
METHODS AND MATERIALS
Epidemiological data were obtained from Web-Medic medical records of patients. The COVID-19 data were obtained from COVID-19 data sheets comprised of patients' RT-PCR testing forms, surveillance forms for severe acute respiratory syndrome coronavirus-2 status, and a map of their positive and isolated contacts.
STATISTICAL ANALYSIS USED
Differences regarding the distributions of patients between groups were analysed using the Pearson chi-square test and Mantel-Haenszel chi-square test for trends, while differences in mean values were compared using an independent sample -test.
RESULTS
The average age of hospitalised patients was significantly higher compared to the age of non-hospitalised patients ( < 0.001). The average age of patients with lethal outcomes was nearly twice as high in comparison to patients with non-lethal outcomes ( < 0.001). Male patients had a higher hospitalization and mortality rate ( < 0.001). The highest hospitalization rate was in patients with chronic renal failure (CRF), diabetes and cardiovascular diseases (CVDs), while the death rate was the highest among patients with CRF and hearth comorbidities. Patients with fatigue and appetite loss had a higher percentage of lethal outcomes. Vaccinated patients had a significantly lower rate of lethal outcome.
CONCLUSIONS
Clinical symptoms, signs and outcomes, are posing as predictive parameters for further management of COVID-19. Vaccination has an important role in the clinical outcomes of COVID-19.
PubMed: 38948596
DOI: 10.4103/jfmpc.jfmpc_1641_23 -
Journal of Family Medicine and Primary... May 2024Recent disease resurgence in China indicates that corona virus infectious disease is still a pertinent public health problem. We stand at a juncture where we are still...
Association of socio-demographic factors with clinical outcome among hospitalized patients in first and second waves of COVID-19 pandemic: Study from the developing world.
BACKGROUND
Recent disease resurgence in China indicates that corona virus infectious disease is still a pertinent public health problem. We stand at a juncture where we are still unsure about the initial dilemmas regarding its birth, therapies, and the emerging novel strains. Medical literature has focused on the clinical, laboratory, radiological, and therapeutic aspects of disease management. There is paucity of literature on the association between socio-demographic variables on disease severity and clinical outcome.
MATERIALS AND METHODS
This retrospective observational study analyzing the socio-demographic variables was performed at a dedicated COVID care center in western Maharashtra, India. Electronic records of all individuals who were admitted to this hospital from July 29 2020, to June 14, 2021, and diagnosed COVID-19 positive by reverse transcriptase polymerase chain reaction (RT-PCR) were identified after due institutional ethical clearance. Patients admitted from July 29, 2020, to February 27, 2021, were categorized as patients presenting during the 'first wave of viral pandemic'. Those admitted from March 01, 2021, to June 14, 2021, have been included as patients admitted during 'second wave of viral pandemic'. The following outcome parameters were collected (presenting symptoms, duration of symptoms before the individual presented for diagnostic RT-PCR, total duration of symptoms, severity of disease at onset, duration of hospital stay, the final outcome (discharge/death) and Charlson's comorbidity index). The linear regression model was used to establish association between socio-demographic factors and disease severity at onset (mild/moderate/severe/critical).
RESULTS
A total of 37033 patients were screened, and the positivity rate with RT-PCR was 16.99% ( = 6275) during the study period. Out of which 45% ( = 2824) of the patients had mild disease requiring home isolation and the remaining 55% of patients required admission. 1590 patients from the first wave and 910 from the second wave of COVID-19 were hospitalized and included in the study after exclusion. The mean age of patients in first wave was 49 years and that in second wave was 54 years with 77.6% and 70.6% males in two waves, respectively. The burden of critical cases was higher in second wave as computed to first wave (10% vs 8%). The second wave had more outreach in the rural population as compared to second one (17.8% vs 12.2%). The mean duration from the onset of symptoms to hospitalization was 03 and 04 days, respectively, in two waves. Mortality associated in two waves was 11.9% and 24%, respectively ( < 0.05). Higher Charlson's comorbidity index was associated with higher mortality, and the cumulative survival from urban area was more as compared to the rural population (log rank - 9.148, = 0.0002).
CONCLUSION
The second COVID-19 wave had significantly higher case mortality. It affected elderly patients and those with rural background. The factors associated with higher mortality during COVID-19 pandemic were rural background, higher Charlson's comorbidity index and late presentation to the hospital. Ongoing vaccine campaigns, thus, should focus on rural areas and individuals with comorbidities especially in developing and least developed countries.
PubMed: 38948593
DOI: 10.4103/jfmpc.jfmpc_57_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 2024In the United States, access to evidence-based behavioral health treatment remains limited, contributing to inadequate treatment for individuals with depression and...
CONTEXT AND AIMS
In the United States, access to evidence-based behavioral health treatment remains limited, contributing to inadequate treatment for individuals with depression and anxiety disorders. The Collaborative care model (CoCM), the integration of behavioral healthcare into primary care, has been shown to be effective in addressing this issue, particularly when delivered virtually through telehealth platforms. While collaborative care has been shown to be effective, little has been studied to understand the impact of patient treatment factors on patient improvement. This study aims to analyze factors associated with patient improvement, measured by PHQ-9 and GAD-7 score changes, in patients with depression and anxiety disorders from Concert Health, a national behavioral medical group offering collaborative care across 18 states.
METHODS AND MATERIAL
Stepwise logistic regression models were utilized to identify factors influencing patient improvement in standardized symptom screener scores (PHQ-9 and GAD-7). Relevant patient-level data, including demographics, clinical engagement, insurance type, clinical touchpoints, and other variables, were analyzed. Results are presented as odds ratios (ORs).
RESULTS AND CONCLUSIONS
We find that increased clinical touchpoints were associated with improved outcomes in both depression (PHQ-9) and anxiety (GAD-7) populations. Commercial insurance was linked to a greater likelihood of improvement relative to Medicaid, and the use of C-SSRS suicide screeners had varied effects on patient outcomes depending on the diagnosis. The duration of time spent in appointments showed a nuanced impact, suggesting an optimal length for touchpoints. Psychiatric consults also impact patient outcomes in both populations. This study sheds light on factors influencing patient outcomes in virtual collaborative care for depression and anxiety disorders, which may be used to inform and motivate further research and allow providers to better optimize and understand the impacts of treatment choices in collaborative care settings.
PubMed: 38948587
DOI: 10.4103/jfmpc.jfmpc_1493_23