Day Family Medicine

Summary: A series of four studies examined the determinants, challenges, and solutions for maternal undernutrition in rural Ethiopia, revealing a complex mix of biomedical, sociocultural, and systemic factors. Undernutrition among pregnant women remains widespread, particularly among those with limited nutritional counselling, gender inequality, and food taboos. Major gaps include weak integration of nutrition counselling into routine maternal care, low provider awareness, and underuse of existing health structures. Sociocultural influences, especially husbands’ decision-making power and limited male involvement; emerged as strong drivers of poor nutrition. Multisectoral nutrition initiatives face implementation challenges such as weak coordination, unclear operational frameworks, and financial constraints, despite opportunities within existing government and community systems. The studies identified the Couples’ Forum as a promising, culturally acceptable intervention that engages both women and husbands in nutrition education. Its feasibility and potential for integration into community health platforms highlight the need for gender-responsive, community-based strategies to address maternal undernutrition.

Abstract Background Fragility fractures caused by osteoporosis are well-known to increase the risk of further fragility fractures; a history of the wrist, vertebral body, or hip fractures increases the risk of further fractures accordingly. Fragility fractures induce lower activities of daily living, and repeated fractures further reduce mobility. Aim of the Work The objective of this study was to identify the proportion of hip fracture among Egyptian females and its associated risk factors, and also to identify the proportion of hidden vertebral fractures among those with fragility hip fractures. Patients and Methods To assess the proportion of fragility hip fractures among males aging 40 years and older we collected the cases of fragility hip fractures presented to orthopedic emergency room during the period from January 1, 2019 to December 31, 2020, excluding those with high impact fractures or pathological fractures. Results Assessment of the anthropometric measures revealed groups differed significantly in the BMI. Assessment of the geriatric depression scale (GDS), mini mental state examination (MMSE), and mini nutritional assessment (MNA) in the two groups demonstrated that the patient's group had significantly higher score in GDS suggestive of depression, and significantly lower score in MMSE and MNA suggestive of associated dementia and malnuitrition respectively. Also evaluation of the prevalence of chronic diseases revealed that patient's group had significantly higher prevalence of diabetes mellitus, higher intake of oral antidiabetics, higher prevalence of dementia, chronic kidney disease. Medical history assessment demonstrated that patient's group were more prevalently using steroid and antiepileptics. GDS, MMSE, and MNA had a diagnostic value for hip fractures predictors of hip fractures highlighted that significant predictors were older age, marital status, low BMI, smoking, depression, poor nutritional status, DM, dementia, CKD, and oral steroids intake. Conclusion Osteoporosis is a complex and costly disease, osteoporotic fractures may be largely preventable, as environmental factors are open to intervention, and effective pharmacological agents are available. From both clinical and economic perspectives, aggressive measures to detect osteoporosis at earlier stages may be warranted.

Storylines of Family Medicine is a 12-part series of thematically linked essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘V: ways of thinking—honing the therapeutic self’, authors present the following sections: ‘Reflective practice in action’, ‘The doctor as drug—Balint groups’, ‘Cultivating compassion’, ‘Towards a humanistic approach to doctoring’, ‘Intimacy in family medicine’, ‘The many faces of suffering’, ‘Transcending suffering’ and ‘The power of listening to stories.’ May readers feel a deeper sense of their own therapeutic agency by reflecting on these essays.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘I: framing family medicine—history, values, and perspectives’, the authors address the following themes: ‘Notes on Storylines of Family Medicine’, ‘Family medicine—the generalist specialty’, ‘Family medicine’s achievements—a glass half full assessment’, ‘Family medicine’s next 50 years—toward filling our glasses’, ‘Four enduring truths of family medicine’, ‘Names matter’, ‘Family medicine at its core’ and ‘The ecology of medical care.’ May readers find much food for thought in these essays.

Trigeminal schwannomas, rare tumors originating from Schwann cells of the trigeminal nerve, present unique diagnostic challenges due to their infrequent occurrence. The clinical manifestation of facial numbness and tingling necessitates a comprehensive approach for accurate diagnosis and optimal management. We present the case of a 45-year-old female who presented with a six-month history of progressive facial numbness localized to the left maxillary and mandibular regions. Intermittent sharp, shooting pain exacerbated by chewing and cold stimuli was reported. Physical examination revealed sensory deficits inleft trigeminal nerve distribution. Magnetic resonance imaging confirmed a well-circumscribed, enhancing lesion along the left trigeminal nerve. Surgical excision of the tumor confirmed the diagnosis of schwannoma. This case underscores the significance of a detailed clinical history, advanced imaging, and collaboration between neurologists and neurosurgeons in achieving an accurate diagnosis and favorable outcome for trigeminal schwannomas. The successful surgical intervention, coupled with histopathological confirmation, contributes to the understanding of these rare tumors.

With aging, there is an increased susceptibility to morbidity, frailty, and disability, which can severely impact an individual's overall health, autonomy, and quality of life. This is particularly pertinent for nursing home residents, who typically suffer from multiple chronic conditions and require multiple medications to manage their health. This scenario often leads to polypharmacy, which is the use of five or more medications concurrently.<br/>Polypharmacy presents a multifaceted challenge: it can be a necessary part of managing complex health conditions but can also become a source of additional health risks if the balance of benefits and harms is not carefully managed. Deprescribing, a strategy to tackle polypharmacy, involves the careful reduction or cessation of potentially harmful or no longer beneficial medications under the supervision of healthcare professionals. The goal of deprescribing is to optimize therapy and ensure that necessary treatments are not denied to older people. Little is known about deprescribing in nursing home residents, therefore this thesis is written.

This thesis explored the experiences of chronic care patients and healthcare professionals with chronic care provision during the COVID-19 pandemic and with the current post-COVID crisis in order to formulate guidance for improving chronic care, considering present and future challenges to healthcare sustainability. Findings suggest person-centered care should be provided in integrated healthcare systems, facilitated by adaptive and responsive healthcare organizations and providers. Special attention should be given to the integral healthcare status of patients. Strategies such as Agile healthcare organization, knowledge management and eHealth support should enable chronic care to be sustainable considering present and future challenges such as the rise of chronic diseases, scarcity of healthcare resources and thread of new pandemics.

The aim of this study was to compare the outcomes of COVID-19 adult patients admitted to the ICU who received deferoxamine to those who received standard of care. Prospective observational cohort study, in the ICU of a tertiary referral hospital in Saudi Arabia to compare all-cause hospital mortality between COVID-19 patients who received deferoxamine and standard of care. A total of 205 patients were enrolled, with an average age of 50.1±14.3, 150 patients received standard of care only, and 55 patients received deferoxamine additionally. Hospital mortality was lower in deferoxamine group (25.5 vs. 40.7%, 95% CI=1.3-29.2%; P=0.045). Clinical status score upon discharge was lower in deferoxamine group (3.6±4.3 vs. 6.2±4, 95% CI: 1.4-3.9; P<0.001), as was the difference between discharge score and admission score (indicating clinical improvement). More patients admitted with mechanical ventilation were successfully extubated in the deferoxamine group (61.5 vs. 14.3%, 95% CI: 15-73%; P=0.001), with a higher median ventilator-free days. There were no differences between groups in adverse events. Deferoxamine group was associated with hospital mortality [odds ratio=0.46 (95% CI: 0.22-0.95); P=0.04]. Deferoxamine may have mortality and clinical improvement benefits in COVID-19 adults admitted to ICU. Further powered and controlled studies are required.