A Case of Chronic Granulomatous Disease Masquerading As Tubercular Lymphadenitis in an Infant.

Chronic granulomatous disease (CGD) is a rare inborn error of immunity characterized by recurrent fungal and bacterial infections due to defective nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity. This case report describes an 11-month-old female who was initially diagnosed with tubercular lymphadenitis and presented with fever and bilateral neck swelling. Despite receiving anti-tubercular treatment (ATT) and intravenous antibiotics, the patient experienced recurrent infections and abscesses, prompting further investigation. Laboratory tests revealed normal immunoglobulin levels but abnormal nitroblue tetrazolium (NBT) and dihydrorhodamine (DHR) tests, indicating CGD. Genetic analysis (clinical exome by next-generation sequencing) confirmed a novel NCF2 gene mutation associated with autosomal recessive CGD. This patient was treated with prophylactic antibiotics and antifungals and subsequently underwent successful hematopoietic stem cell transplantation (HSCT). This highlights the diagnostic challenges associated with CGD, particularly in tuberculosis-endemic regions such as India, emphasizing the importance of considering primary immunodeficiency disorders in patients with recurrent infections. Early diagnosis and appropriate treatment, including HSCT, can significantly improve patient outcomes. The patient remained infection-free on prophylactic antimicrobials for 1.5 years post-discharge, demonstrating the potential for a favorable prognosis with timely intervention and comprehensive management.

Utilization of Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) Practitioners' Services Among Older Adults: Results From the Longitudinal Aging Study in India.

BACKGROUND: Ayurveda, yoga, naturopathy, Unani, Siddha, and homeopathy (AYUSH) form an alternative system of medicine in India. Understanding the utilization of AYUSH practitioners' services is crucial to substantiating the current government initiatives to mainstream AYUSH in the Indian health system. The utilization of AYUSH practitioners' services among different sub-populations, including older adults, for various health conditions is underexplored. The present study explores the utilization of AYUSH practitioners' service among older Indian adults and its correlates. METHODS: During 2017-2018, the Longitudinal Aging Study in India (LASI) conducted a nationally representative study among adults aged 45 years or more and their spouses. The study leveraged this data from publicly available LASI. Descriptive analysis and cross-tabulation were performed using a subset of older adults (age ≥ 60 years, n = 31,464). The utilization of AYUSH practitioners' services was taken as the outcome variable. A logistic regression model was employed to understand the independent effect of various explorative variables on the use of AYUSH practitioners' services. RESULTS: One in 14 older adults utilized the services of AYUSH practitioners. The socio-demographic factors that were looked at, including religion, residence, and caste were significant independent factors for AYUSH consultation. Among chronic conditions, hypertension (use-5.6%, AOR: 1.24, CI: 1.09-1.40), diabetes (use-4.2%, AOR: 1.31, CI: 1.09-1.57), and arthritis (use-9.1%, AOR: 0.59, CI: 0.52-0.67) were independent determinants of AYUSH practitioners' service utilization. In the fully adjusted model, the effect of explanatory variables is almost similar to that in the minimally adjusted model. Only the effect of the female gender was accentuated in magnitude, whereas the effect of diabetes was partially attenuated. CONCLUSION: The preference for AYUSH practitioners' service among older adults is determined by the complex interplay between socio-demographic factors and disease conditions. Though utilization of AYUSH practitioners' service was high among certain underprivileged sections, it is assuring that education and income do not affect older populations' preference for AYUSH practitioners' service.

Prevalence and Assessment of Knowledge, Attitudes, and Practices of Tobacco Use Among Medical and Dental Students in Bhubaneswar, Odisha.

Background Tobacco use remains a significant global public health concern, causing millions of preventable and premature deaths annually and imposing substantial economic burdens. India, the second-largest producer and consumer of tobacco products worldwide, bears a significant burden of tobacco-related morbidity and mortality. Medical and dental students represent the future healthcare workforce and role models; hence, their tobacco consumption and attitude would play a vital role in tobacco control. This study aims to estimate the prevalence and assess the knowledge, attitudes, and behaviors regarding tobacco use among medical and dental students in Bhubaneswar, Odisha. Methods A descriptive cross-sectional study was conducted using the Global Health Professional Students Survey (GHPSS) questionnaire. The study included third-year Bachelor of Medicine and Bachelor of Surgery (MBBS) and Bachelor of Dental Surgery (BDS) students from two private medical and two dental colleges in Bhubaneswar, Odisha. Data were collected from February to April 2019 through anonymous self-administered questionnaires, and descriptive and bivariate analyses were performed. Results A total of 400 students were surveyed, with 16% reporting being current smokers (24.3% males, 8.7% females). Furthermore, 36.8% had tried cigarettes and other tobacco products. Nonsmokers demonstrated stronger support for comprehensive tobacco control policies, such as banning advertising and smoking in public places, compared to current smokers. Most students acknowledged the importance of recording tobacco use history and providing educational materials; however, only around 40% had received formal training on smoking cessation. Conclusion The findings highlight the need for targeted intervention among medical and dental students for tobacco cessation. It is vital to foster a positive attitude toward tobacco control among future healthcare professionals. Health professional institutions should take proactive steps to prevent tobacco use among students and develop initiatives to motivate successful cessation training. Investing in tobacco control education for healthcare professionals is crucial to empower them in tobacco cessation efforts and promote healthier societies.

Tobacco Imagery in Movies and Web Series Streaming in India and Their Compliance With the Recent Anti-tobacco Rules for Over-the-Top (OTT) Platforms.

INTRODUCTION: Internet access, smartphones, and televisions have significantly boosted over-the-top (OTT) movies and web series viewing in India, especially among youths. Despite restrictions, OTT platforms continue to promote tobacco products. India has recently enforced the revised OTT Rules 2023 effective September 1, 2023, to counter tobacco promotion in OTT shows. This study explores compliance with the OTT Rules 2023 in popular movies and web series on select OTT platforms in India. METHODS: About 29 movies and 31 web series from seven popular OTT platforms as of September 26, 2023, were analyzed in this study. The incidence of tobacco imagery and compliance with the OTT Rules 2023 were assessed using a standardized format with the help of seven trained coders. Descriptive statistics were used to describe instances of tobacco imagery and violations of the provisions of Indian law. RESULTS: The average incidence of tobacco imagery per included show was 3.95. None of the movies and web series fully complied with the provisions of health spots and audio-visual warnings. Only 35.7% of the shows (movies: 57.1%, web series: 14.3%) fully complied with the anti-tobacco static message provisions. The foreign-origin movies had zero compliance with static messages, though they had fewer tobacco images. Half of the shows for children up to 12 years old had tobacco imagery but fully complied with the static warning message provisions. CONCLUSION: The portrayal of tobacco imagery in OTT shows is prevalent, and their poor compliance with the OTT Rules 2023 is a concern. Therefore, monitoring and stricter enforcement of the OTT Rules should be given priority to protect viewers from tobacco promotion in OTT shows.

Gendered Pattern and Predictors of Tobacco use in India: Evidence from the Second Round of Global adult Tobacco Survey.

Background: India has completed the second round of the Global Adult Tobacco Survey (GATS) to monitor adult tobacco use and progress in tobacco control efforts. This study assesses the gendered pattern of tobacco use and its predictors in the second rounds of GATS. Material and Methods: Publicly available GATS-2 (2016-2017) data was analyzed which contains self-reported tobacco use information of ≥15 years Indians (n = 74,037). The independent predictors of "smoking only," "smokeless only," and "dual use" among current male and female tobacco users were assessed using the multinomial regression model. Results: The burden of "smoking only," "smokeless only," and "dual-use" of tobacco were 8.9% (8.74-9.15), 16.69% (16.42-16.96), and 3.89% (3.75-4.03), respectively, in the second round with wide regional variation as well as male dominance in use. Region, age, education, caste, and religion were significantly and consistently associated with different types of tobacco use in both genders. Other contextual predictors of tobacco use were residence, marital status, occupation, awareness, and wealth index (WI). Conclusions: Tobacco use predictors and their gendered patterns are contextual. Monitoring the predictors for tobacco use, which may change over time, should be given priority in the national tobacco control program.

Health Warnings on Tobacco Packages: A Compliance Assessment Study Around Educational Institutions in Bhubaneswar, India.

Background Graphic health warning labels (HWLs) on tobacco product packaging have been identified by the World Health Organization (WHO) as a cost-effective policy intervention to warn consumers about the health risks of tobacco. Compliance with HWLs shields young individuals from tobacco marketing influences and exposes users to health warnings. Assessing compliance with health warning labels would provide insights into the state of law implementation. The study assessed health warning labels on tobacco packages as per the Cigarettes and Other Tobacco Products (COTPA) (Packaging and Labelling) Amendment Rules of 2020, specifically assessing their availability around educational institutions in Bhubaneswar, Odisha, India. Materials and methods From August 2022 to January 2023, a protocol was employed to collect information on the sale of tobacco products around educational institutions including packages of cigarettes, beedis, and smokeless tobacco (SLT) from Bhubaneswar City. Using multistage random sampling 18 schools were selected in Bhubaneswar City. Areas within 100 yards (91.44 meters) of each school were mapped using a map tool. All prospective tobacco vendors within 100 yards of each school were included in the study. The data on compliance with HWLs were summarized using descriptive statistics. The health warnings compliance assessment of the tobacco products available with the vendors was conducted using three major indicators, including analysis of the font content, size and element of the graphics, and textual health warnings. In addition, the surface area occupied by these warnings was measured using a calibrated ruler. Results Within 100 yards of 18 schools in Bhubaneswar city, 57 vendors were found selling tobacco. About 48 distinct brands and 791 unbranded tobacco products were identified from 2135 packets collected from 57 vendors. Out of the 48 branded product packets examined, 25 brands were for smoking (cigarettes, bidis), while 23 were for SLT products such as khaini, gutkha, and pan masala containing tobacco. Only six brands out of 17 cigarette packs complied with HWL provisions. None of the eight unique bidi packs and 302 unbranded bidi packs were compliant with any HWL compliance indicators. Other compliance-related issues included incomplete health warning labels, out-of-rotation pictorial health warnings, distorted printing (blurry, heavy tint, and faded), and split warnings. Conclusion Tobacco products were sold within 100 yards of educational institutions in clear violation of the COTPA Section 6 provisions. Furthermore, the tobacco products sold were also not in compliance with the health warning label laws under section 7 of COTPA. There is an urgent need for strict enforcement of the provisions relating to the ban on sale within 100 yards of educational institutions and health warning label rules in Bhubaneshwar.

Performance of the Heaviness of Smoking Index in Indian Settings.

Background and objective The heaviness of smoking index (HSI) is a popular tool to assess nicotine dependence in clinical and community settings. Low cigarette consumption and concurrent use of other tobacco products raise concerns about its validity in Indian settings. This study explores the performance of HSI in Indian settings. Methods This study analyzed daily manufactured cigarette smoker data from the cross-sectional Global Adult Tobacco Surveys (GATS) from its first (GAST-1, 2009) and second waves (GATS-2, 2016), both of which were available in the public domain. The HSI scores were calculated based on the number of cigarettes smoked per day (CPD) and time to first smoke (TTFS) after waking up among the current daily cigarette users. This study examined the utility of the HSI scale in Indian settings by estimating the predictability of low dependence on quit attempts and quit intentions using the likelihood ratio parameter. Results About nine in 10 cigarette users in India consumed less than 10 cigarettes per day, yielding a low score on the HSI scale for most of the daily cigarette users. The majority of daily cigarette smokers scored ≤ 1 (low dependence) on the HSI scale both in GATS-1 and GATS-2, irrespective of their exclusive cigarette use status. The absolute value and the 95% confidence limit of positive likelihood ratios (falling below and above one) suggest that the predictability of low dependence on quit attempts and quit intention in the Indian setting is limited. Conclusions The utility of the HSI scale in assessing nicotine dependence among cigarette users in India is limited. This may be attributed to low average cigarette consumption, concurrent use of various tobacco products, and the sociocultural milieu of Indian smokers. This highlights the need for a new rapid nicotine dependence scale tailored to the specific patterns of tobacco use behavior prevalent in the Indian context.

Clinico-radiological Profile of Posterior Reversible Encephalopathy Syndrome and Its Associated Risk Factors in PICU: A Single-center Experience from a Tertiary Care Hospital in Bhubaneswar, Odisha.

OBJECTIVE: Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiographic entity of heterogeneous etiologies having similar clinical and neuroimaging features. Pediatric data are sparse, making early diagnosis challenging, which needs a high index of suspicion. So, we conducted this study to evaluate clinico-radiological features, associated risk factors, etiology, and outcome in children. MATERIALS AND METHODS: This is a retrospective case series of patients, diagnosed as having PRES and followed up at a tertiary care hospital in Eastern India between September 2016 and December 2019. RESULTS: Among 16 patients with a median age of 9.5 years [interquartile range (IQR) 8-13.75] and a male preponderance (75%), common underlying diseases were post-streptococcal glomerulonephritis (56.3%) and renovascular hypertension (12.5%). Acute elevation of blood pressure was found in all patients (n = 16). The neurological symptom was seizure (87.5%), mental changes (68.75%), headache (43.8%), vomiting (31.3%), and visual disturbances (31.3%). The most common triggering factor was hypertension (100%), use of mycophenolate mofetil and prednisolone (12.5%), and hemodialysis (12.5%). Anemia was present in 15 (93.4%) patients at the time of admission. All showed abnormal neuroimaging with 55% having atypical involvement. The most common site was the parietal-occipital cortex (88%), frontal and temporal lobe (44% cases each), and the cerebellum (13%). Clinical recovery was followed by a radiological resolution in all survived except in one, who developed visual impairment. CONCLUSION: Posterior reversible encephalopathy syndrome should be considered in the differential diagnosis of patients who present with acute neurological disturbances and underlying diseases such as renal disorders, vasculitis, malignancy, and use of immunosuppressant accompanied by hypertension. Early diagnosis and treatment of comorbid conditions are of paramount importance for the early reversal of the syndrome. HOW TO CITE THIS ARTICLE: Behera CK, Jain MK, Mishra R, Jena PK, Dash SK, Sahoo RK. Clinico-radiological Profile of Posterior Reversible Encephalopathy Syndrome and Its Associated Risk Factors in PICU: A Single-center Experience from a Tertiary Care Hospital in Bhubaneswar, Odisha. Indian J Crit Care Med 2020;24(12):1223-1229.