Journal, Indian Academy of Clinical Medicine最新文献

{"title":"Early Symptoms of Patients With COVID-19 in Family Medicine Centers in South India: A Retrospective Study","authors":"Sajitha M. F. Rahman, R. Pricilla, A. Biswas, Vinodhini Dharmasivam, S. Abraham, V. Sankarapandian","doi":"10.1177/26339447211053431","DOIUrl":"https://doi.org/10.1177/26339447211053431","url":null,"abstract":"Introduction: A recent Cochrane review on the diagnostic accuracy of initial signs and symptoms of COVID-19 reported on the lack of evidence from studies conducted in community-based health-care settings. Since a broad spectrum of patients present to primary health-care services, testing for patients with noninfluenza-like illness and atypical presentations is debatable. Hence, there is an urgent need for documenting the early presenting symptoms of COVID-19 among patients seeking medical care in primary health-care settings. Aim: In this study, we aim to document the early symptoms of patients with COVID-19 and the proportion of asymptomatic infection in family medicine centers in South India. Design: This is a retrospective study of the early symptoms of patients who tested positive between June and December 2020. The data and clinical notes of patients were retrieved from the hospital information system. Setting: This study was undertaken by the Department of Family Medicine (DFM) in a private not-for-profit academic institution in South India. The DFM provides primary and secondary health-care services to nearly 1,50,000 patients from the local urban communities. Results: A total of 330 patients were tested for COVID-19 and the study included 94 patients who tested positive. Around 37% participants were asymptomatic. The commonest symptom was fever (58.6%), followed by tiredness/myalgia (48.3%), loss of taste or smell or appetite (43.1%), and cough or cold (37.9%). Most participants (78.2%) were hospitalized and the rest (21.8%) were home-quarantined. Only 5 (5.7%) of them died due to COVID-19 infection. Conclusion: The results of the study reiterates the role of social distancing, self-isolation, proper masking, and greater vaccination coverage as significant public health interventions.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"1 1","pages":"6 - 10"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85166586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hoagland Sign as an Aid for Antimicrobial Stewardship—A Case Report","authors":"Lakshmi J. Nair, A. Reghukumar, Athul Gurudas, K. Sasidharan, K. Parvathy","doi":"10.1177/26339447211068967","DOIUrl":"https://doi.org/10.1177/26339447211068967","url":null,"abstract":"Hoagland sign is an early and transient bilateral painless upper eyelid edema observed in patients with Epstein-Barr virus (EBV)-related infectious mononucleosis. This sign can predate the appearance of exudative pharyngitis and cervical lymphadenopathy. Usually, this sign disappears by first week of infection. Here, we describe the occurrence of late onset Hoagland sign in a 14-year old boy who presented to us on 10th day of fever. Hoagland sign appeared after 10 days from symptom onset in our patient. Despite persistence of fever, the presence of Hoagland sign which appeared prior to confirmation of EBV infection was a helpful indicator for stopping antibiotics. In view of tonsillar hypertrophy with potential airway compromise and biochemical parameters suggestive of possible secondary hemophagocytic lymphohistiocytosis, he was initiated on steroids with which defervescence and prompt resolution of symptoms occurred. EBV can present as acute undifferentiated febrile syndrome which might result in inappropriate use of antibiotics. This case highlights the importance of using clinical clues like Hoagland sign to optimize antimicrobial stewardship.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"29 1","pages":"43 - 46"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81537371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Test Positivity Rate (TPR) as an Indicator for Strategic Action in COVID-19: A Situational Analysis in Kerala, India","authors":"R. Vaman, M. Valamparampil, Anupriya Augustine","doi":"10.1177/26339447211054234","DOIUrl":"https://doi.org/10.1177/26339447211054234","url":null,"abstract":"Administrators and policymakers have relied on test positivity rate (TPR) for making policy decisions regarding local, regional, and national lockdowns. It has the advantage of easily available data with an easy technique for calculation on day-to-day basis. However, concerns are being raised regarding its use as a sole indicator for determining movement restrictions and lockdowns. The present review provides a perspective of the alterations in TPR in Kasaragod district of Kerala during the first half of 2021. The variations in the number of antigen and reverse transcription polymerase chain reaction (rt-PCR) tests along with the trend of proportion of rt-PCR test are depicted. In places like Kerala where primary care system and contact tracing is comparatively robust than several other regions, testing the appropriate persons in a timely fashion alone is sufficient to cause an upswing in the TPR. Rather than daily change, the overall change in a larger time frame of 1 to 2 weeks could give early warning regarding the emergence of a new wave. TPR alone may not be able to reflect the transmission patterns of COVID-19. Using 7-day median value of TPR along with weekly tests done per 10,000 population, 7-day rolling average of active cases per 10,000 population, or daily number of new positive cases per 10,000 population could bring out a more composite indicator. Such an indicator reflecting the disease dynamics at regional levels will enable people to improve their livelihood without compromising on COVID-19.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"11 1","pages":"31 - 35"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75416711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IL-6 and Breast Cancer Risk: No More Than the Tip of an Iceberg?","authors":"R. Mormile","doi":"10.1177/26339447211061023","DOIUrl":"https://doi.org/10.1177/26339447211061023","url":null,"abstract":"Corresponding author: Raffaella Mormile, Division of Pediatrics and Neonatology, Moscati Hospital, Aversa, Campania 81031, Italy. E-mail: raffaellamormile@alice.it Breast cancer still represents the main cause of cancer-related death in women, although progress has been made in the treatment.1 Interleukin-6 (IL-6) levels have been connected with clinical disease stage and lymph node metastasis in breast cancer patients.2 IL-6 is a potent inflammatory cytokine that has been shown to play a key role in breast cancer growth and metastasis.2 Overexpression of IL-6 has been observed in the tumor microenvironment of several tumors, including breast cancer.1 Chronic inflammation in cancer microenvironment has been demonstrated to promote tumor growth and induce resistance toward chemo and radiotherapy.1 IL-6 and its signaling pathways have been linked to tumor growth, metastasis, and therapeutic resistance in breast cancer.1 Concordantly, inhibition of IL-6 signaling pathways has been suggested to suppress bone metastases in a breast cancer cell line.2 A significant down-regulation of microRNA-126 (miR-126) has been documented in human breast cancer tissues when compared with adjacent normal tissues.3 miRNAs deregulation is commonly detected in human malignancies and implicated in cancer metastasis.3 They have emerged to play crucial regulatory roles in cell growth, proliferation, differentiation, and cell death.3 Notably, miR-126 has been stated to act as a tumor suppressor in breast cancer.3 Increased expression levels of miR-126 have been shown to inhibit metastases in breast cancer.3 Overexpression of miR-126 has been proved to significantly counteract proinflammatory cytokines expression including IL-6.4 Reduced miR-126-3p expression has been reversely associated with increased IL-6.5 It has been indicated that miR-126 regulates inflammatory cytokine secretion via targeting tumor necrosis factor receptor-associated factor 6 (TRAF6).4 miR-126 has been found to significantly decrease TRAF6 expression.4 It represents a member of the TRAF superfamily.4,6 It is an endogenous adaptor of innate and adaptive immune responses that has been revealed to exert oncogenic activity.6 It is also involved in the development of several tissues including lymph nodes and mammary glands.6 It appears to function as a positive regulator of human breast tumorigenesisis.6 It has been proved that TRAF6 plays a critical role in cell proliferation related to human breast tumorigenesis.6 Expression levels of TRAF6 have been found to be upregulated in human breast carcinoma, compared with adjacent healthy tissues.6 However, the potential underlying mechanisms linking TRAF6 to human breast cancer progression still remains unclear.6 All these contentions led us to suppose that downstream signaling pathways related to IL-6 may lead to malignant transformation of breast tissues by perturbation of the expression of tumor suppressor miR126 through upregulation of TRAF6. We suggest th","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"14 1","pages":"51 - 52"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80996173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family Planning Practices in Kerala: A Critical Appraisal Using National Family Health Survey Data","authors":"Reshma Ramesh, K. Prajitha","doi":"10.1177/26339447211064784","DOIUrl":"https://doi.org/10.1177/26339447211064784","url":null,"abstract":"Background Adequate attention to family planning can not only reduce poverty and hunger in countries with high birth rates but also avert maternal and childhood deaths. Kerala, the southernmost state of India, has achieved its replacement level fertility rate far ahead of India. The study aims to analyze the contraceptive prevalence of the state over the years and also at the district level and the choices of different family planning methods in the state. Methodology This study is a secondary data analysis using the available information from the National Family Health Survey (NFHS) available from “The demographic health survey program’s data distribution system.” Results The contraceptive prevalence rate (CPR) of Kerala showed an initial increase followed by a sudden fall by more than 10% in 10 years period during the 2015 survey, thereafter stabilized in 2019. Among the modern contraceptive methods, the most commonly used method consistently over the years was female sterilization (46.6%) and the least common method was male sterilization (0.1%). The unmet needs in family planning in the state varied across the districts from as high as 19.3% to 5.6% though it was reduced by 1.2 percentage units as compared to NFHS-4 data. Conclusion The findings contradict the assumption that the use of modern spacing techniques will increase with female literacy and a higher standard of living. Female-oriented nature of family planning practices in the state should be revisited and strategies should be brought to bring equal participation of males and females. Districts with reduced CPR should be prioritized and region-specific policy recommendations are necessary to address specific needs.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"50 1","pages":"17 - 20"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88633854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tigecycline: Role in the Management of cIAI and cSSTI in the Indian Context","authors":"S. Swaminathan, Prithwijit Kundu","doi":"10.1177/26339447211067579","DOIUrl":"https://doi.org/10.1177/26339447211067579","url":null,"abstract":"The current millennium has witnessed an increased antimicrobial resistance which poses a mammoth challenge for public health management. This has resulted in an increase in morbidity and mortality, resulting in an increase in financial burden to the patients. A recent analysis from 10 hospitals in India reported that mortality rate increases by 1.57 times in patients suffering from multidrug resistance (MDR) bacterial infections as compared to patients infected with similar but susceptible infections. Due to the emergence of MDR and extensively drug-resistant (XDR) bacteria, most of the broad-spectrum antibiotics have been rendered ineffective. The mortality rate with Gram-negative strains is higher than with Gram-positive strains. Tigecycline is the first in class glycylcycline antibiotic with an expanded broad-spectrum activity. Tigecycline enters bacterial cells through energy-dependent pathways or via passive diffusion, to reversibly bind to the 30S ribosomal subunit. It has potent in vitro activity against Gram-negative carbapenemase producers, except Pseudomonas aeruginosa and Proteus spp. It also has good in vitro activity against Carbapenem-resistant Klebsiella pneumoniae strains. Hence, it is considered as a therapeutic option in XDR isolates. Recent meta-analyses have shown tigecycline to be as effective as its comparators with reducing mortality rates. Due to increased resistance reported in carbapenem-resistant isolates in Indian health-care settings, a colistin/polymyxin B-based combination therapy as a treatment option is being sought. A lower mortality rate has been reported with colistin-based combination therapy in Carbapenem-resistant Enterobacteriaceae-associated infections. Combinations with tigecycline, Fosfomycin, and chloramphenicol have shown to improve treatment outcomes. Tigecycline can be a good alternative in MDR and XDR complicated intra-abdominal and complicated skin and soft tissue infections. Appropriately designed clinical trials in Indian health-care setups will reinforce clinician’s confidence in using tigecycline in complex clinical situations.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"10 1","pages":"24 - 30"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77491832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Tobacco Consumption and Control in India","authors":"P. Mohan, H. Lando, Sigamani Panneer","doi":"10.1177/1179916118759289","DOIUrl":"https://doi.org/10.1177/1179916118759289","url":null,"abstract":"Tobacco consumption is a huge public health issue in India and its impact is especially devastating among the poor. Effective tobacco control should be a top priority, both as a health issue and as a method to reduce poverty. Tobacco use is deeply ingrained as a cultural practice and there are a myriad of tobacco types. We reviewed multiple determinants of tobacco consumption including socio-economic status, marriage, population growth, marketing strategies, and price. We also considered the tobacco burden including economic and social costs and adverse health impacts especially those resulting from oral cancer. We then addressed the history of tobacco control legislation in India and challenges in implementation. Tobacco consumption in India is continuing to increase despite tobacco control policy. Needed are more visible and aggressive anti-tobacco campaigns including increased public awareness of tobacco harms and active engagement of worksites and health professionals in promoting tobacco cessation.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73862380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study on Defense Mechanisms to Cope With Stress Due to Stigma Among People Living With HIV/AIDS Reported in Eastern India: A Single Center Experience","authors":"Ayantika Mukherjee, S. Lahiry, A. Mukherjee, Shouvik Choudhury, Rajasree Sinha","doi":"10.1177/1179916117742919","DOIUrl":"https://doi.org/10.1177/1179916117742919","url":null,"abstract":"Aim: To explore the stigmatizing pattern in people living with HIV/AIDS (PLWHA) and assess coping strategies adopted for quality of life (QOL) appraisal. Methods: In the background of a descriptive, cross-sectional research design, PLWHA attending HIV (human immunodeficiency virus) outpatient clinic at Medical College, Kolkata (n = 120) were enrolled through “snowball sampling.” A brief semistructured interview schedule was used to elicit data on socio-demographics. Stigma was assessed using a 4-point scale (40-item). Quality of life was assessed using WHOQOL-BREF (World Health Organization Quality-of-Life) scale (26-item). Results: About 96.7% reported being stressed. Stigma was mostly confronted in socio-familial context. Fear of being stigmatized was much higher compared with those who actually faced stigma (69.2% vs 27.5%; P < .01). Quality of life negatively correlated with internalizing of stigma in the psychological domain (P < .01). Proportion experiencing actual stigma (women vs men: 79% vs 74%) experienced an above moderate QOL. Multiple defense mechanisms were identified. “Altruism,” “Anticipation,” and “Humor” were the most preferred defense strategies. However, such coping strategies appeared to be self-taught and only modestly helpful in managing perceived stigma. Conclusions: People living with HIV/AIDS should avoid internalizing stigmatized feeling and engage in social activities to work toward a better QOL.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84552297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing Antidiabetes Drug Prescriptions With World Health Organization Anatomical Therapeutic Chemical/Defined Daily Dose Index to Assess Drug Utilization Pattern in Elderly Population of Rural Eastern India","authors":"S. Lahiry, Avijit Kundu, Ayan Mukherjee, Shouvik Choudhury, Rajasree Sinha","doi":"10.1177/1177393617703343","DOIUrl":"https://doi.org/10.1177/1177393617703343","url":null,"abstract":"Objective: To analyze drug utilization (DU) pattern of antidiabetes drug (ADD) prescription in elderly type 2 diabetes mellitus (T2DM) in rural West Bengal based on 2016 World Health Organization (WHO) Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) Index. Methods: This was a prospective observational study. Prescription data of 600 elderly patients (age > 60 years) attending outpatient clinic were screened over 12 months (January 2015 to January 2016) from 5 different rural hospitals in West Bengal. Pooled data were sorted and classified in accordance with 2016 ATC/DDD WHO Index. Direct cost associated and consumption of ADD were measured as DDD/1000 patients/day. The adverse drug reactions (ADRs) related to antidiabetic medicines were monitored. Results: During the study period, mean age of patients recorded was 66.4 ± 5.0 years, with 66.6% (n = 396) having history of T2DM > 5 years. Follow-up encounters (n = 2328) revealed metformin (94.67%), sulfonylureas (SUs) (50.54%), pioglitazone (24.22%), voglibose (22.50%), insulin (9.75%), and acarbose (6.82%) to be more prevalent, constituting DU 90% (92.01%). Combination of metformin plus SU was recorded in most of the patients (56%). Insulin, however, was found to be an underutilized class (P < .005). The DDD/1000 patients/day of metformin (2.918), glimepiride (1.577), and gliclazide (0.069) conformed to 2016 WHO ATC/DDD Index. The total ADD consumption during study period was 5.03 DDD/1000 patients/day. The average drug cost per encounter per day was Rs 11.24 ± 2.01. Nineteen ADRs were reported and their descriptions were found to be of hypoglycemia (n = 9), pedal edema (n = 2), and gastrointestinal upsets (n = 8). Target glycemic status was achieved in 40% monthly follow-up encounters. Low-store drug availability and poor compliance to treatment (>60%) were major determinants. Lack of regular aerobic exercises (>85%) and proper knowledge regarding medical nutrition therapy (MNT) (>80%) and low average consultation time (3.5 ± 0.6 minutes) were important contributing factors. Conclusions: The study exhibited increased utilization of 2 drug combinations of oral ADD and lower utilization of insulin during study period. Such inferences merit further exploration.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78133684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"I'm Not Sure What Bothers Me in this Chest X-Ray but an HRCT May Help?","authors":"R. Takhar, Ratan Kumar, Motilal Bunkar, M. Singh, Kuldeep C Gupta, Rakesh Biswas","doi":"10.4137/IJCM.S32479","DOIUrl":"https://doi.org/10.4137/IJCM.S32479","url":null,"abstract":"There are some inevitable risk factors of patient exposure to problems arising from human errors, including missed subtle radiological findings, early identification of which may alter the patient outcomes. Here we are discussing a patient who presented with a prior diagnosis of seasonal allergic rhinitis with symptoms assumed to be bronchial asthma. A second review of chest radiograph after discussion over an online platform (Tabula Rasa group on Facebook) revealed some subtle findings which we missed initially. Further workup of the case revealed some astonishing findings. This case illustrates the importance of discussing unsolved cases on online platforms with peers and also to proceed for higher imaging to detect what has been missed on plain radiography.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90699004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}