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Context: Tobacco addiction is an important public health problem. Among several theories of addiction proposed, PRIME theory of motivation is found to be a comprehensive one to synthesise prevention strategies., Aims: This case study was conducted on the basis of PRIME theory to explain smokeless tobacco (SLT) addiction patterns among slum dwelling female residents of Cuttack district, Odisha., Settings and Design: Cuttack district of Odisha state and Qualitative synthesis., Methods and Material: Qualitative semistructured face-to-face interviews and framework analysis techniques were employed. The study was conducted over a period of 2 months between February 2020 and March 2020. Face-to-face interviews of 26 participants of Dasha Sahi slum using a semistructured questionnaire assessing responses based on five main themes including P, Plans; R, Responses; I, Impulses And Inhibitory Forces; M, Motives; and E, Evaluations of the said theory., Statistical Analysis Used: Verbatim transcripts were analysed using thematic framework analysis., Results: A majority of the participants were multiple SLT product users, and they did not have an immediate plan to quit. Most of the participants showed strong emotional attachment with these products and considered them the only source of pleasure (want) in a life full of miseries. The words "Tobacco" and "Nicotine" were medical jargons for them. Though they were aware of the harmful effects, they had a positive evaluative belief about its use because of cognitive dissonance. Most of them were habitual users living in an environment full of physical and social cues., Conclusions: This case study is well in line with the PRIME theory in explaining the addictive behaviour; a comprehensive multi-strategic approach was formulated for inculcating quitting behaviour among this disadvantaged section of the population as suggested by the proposer of this theory., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Hypophosphatemic osteomalacia in an adult often gives clinical diagnostic challenges. Usually, they are caused by either tumor-induced osteomalacia or due to genetically mediated hypophosphatemia, particularly X-linked hypophosphatemia. However, heavy metal toxicity, leading to global proximal renal tubular dysfunction, is a rare cause, and in particular, cadmium toxicity is rarely encountered in clinical practice. The presence of bony pain and neurological deficit, along with a classical exposure history, provides the diagnostic clue. In this background, here we present a middle-aged man who had severe bony pains all over his body and lower back stiffness for five years. He underwent an initial workup as a suspected spondyloarthropathy but was later on, found to have hypophosphatemic osteomalacia and severe proximal renal tubular dysfunction. Further, the workup revealed elevated FGF-23. His occupational history revealed prolonged exposure to cadmium fumes in the silverware industry. He improved moderately with treatment; however, significant renal damage is still present. This case highlights the importance of considering cadmium toxicity in proper clinical and occupational contexts in the evaluation of hypophosphatemic osteomalacia in an adult., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Introduction: The year 2020 brings in a paradigm shift in medical education with the emergence of the COVID-19 pandemic. Since the government of India initiated the first countrywide lockdown, educational institutions, including medical colleges, have adopted online mode for undergraduate teaching. Medical education is virtually incomplete without appropriate practical exposure. This study was conducted to understand the opinion of the medical students towards online classes as an impact of this pandemic on medical education., Materials and Methods: A descriptive online survey was conducted using a google form among medical undergraduate students from across India. Snowball sampling was used to recruit study participants. The responses were analyzed using numbers and percentages. Continuous variables were expressed as the mean and standard deviation of the mean., Results: The mean age of the 1426 respondents was 20.46 years. The majority of the responses were from Karnataka (412), followed by Odisha (167). While fairly a good number of respondents agreed that online classes provided a conducive environment and independence in learning, a large proportion disagreed or remained neutral in terms of its usefulness. This could be attributed to several reasons, which may be categorized into three important groups: the technical competence of the students, the provision of an enabling environment and the ability of the teachers., Conclusion: Students had varying opinions on online classes, but most emphasized the need for redoing the lessons taught online., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Introduction: The incidence of hanging has increased over the last ten years and is the most common method of suicide. Because of its multifactorial causation, the reason behind hanging remains unfolded unless the victims leave a suicidal note. In the present study, the psychodynamic factors of hanging were assessed among the survivors of suicidal hanging., Materials and Methods: The cross-sectional study was conducted at S.C.B Medical College and Hospital, Cuttack, India, over a period of three years. Eighty-two individuals admitted in medicine ward of this tertiary care hospital to receive treatment for the complications as a sequel of hanging and willing to participate in study were included after obtaining informed consent. The information was recorded in a pre-designed pro forma., Results: Subjects from rural areas (87.8%) and low socio-economic backgrounds (67.1%) attempted suicide more often. Most of the victims were in the age group of 21-30 years, followed by less than 20 years. The most common cause of attempted suicide by hanging was family-related issues, and mainly by immediately available materials like dupattas, saree, lungi, and other fabrics. Females in rural areas and males from urban areas attempted suicide by hanging in significantly higher proportions ( P = 0.041)., Conclusion: Most people commit suicide at a younger age due to failure to cope with the different stressful situations. The most common reason for attempted suicide by hanging was family-related issues. Early intervention in family disputes in developing countries, especially in younger individuals, may help to curb suicide., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Competing Interests: None

Background and Aims: Patients with type 2 diabetes mellitus are more prone to thyroid disorders. Hypothyroidism in them leads to an aggravation of microvascular complications. Diabetic patients with hypothyroidism also are at an increased risk of cardiovascular disease. Screening for thyroid dysfunction in diabetic patients will allow early treatment of hypothyroidism. The aim of this study was to assess the level of thyroid dysfunction in patients with type 2 diabetes mellitus and to identify the association of thyroid dysfunction with diabetic complications., Methods: This is a cross-sectional study that was conducted at departments of Medicine & Endocrinology in JIPMER, Pondicherry, between June 2016 and May 2019. 331 patients with type 2 diabetes mellitus attending the out-patient department without any prior history of thyroid disease, chronic liver disease or acute illness were recruited for the study. All subjects were screened for diabetic complications (nephropathy, neuropathy, retinopathy & cardiovascular disease). Thyroid function test was done in all subjects using chemiluminescent immunoassay method., Results: Hypothyroidism was seen in 13.9%, while hyperthyroidism was observed in 3.6% of the study subjects. Thyroid dysfunction was more common among females than males. No correlation was seen between thyroid dysfunction and diabetic complications in the study subjects., Conclusion: The prevalence of thyroid dysfunction is 17.5% in patients with type 2 diabetes mellitus. Thyroid dysfunction did not have any correlation with diabetic complications., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Family Medicine and Primary Care.)

Objectives: To determine the prevalence of obesity and its relationship with subclinical hypothyroidism in women with polycystic ovarian syndrome (PCOS). To compare the clinico-biochemical parameters of obese and lean PCOS patients., Materials and Methods: A total of 287 women with PCOS were included in this study after consent. The demographic, anthropometry, clinical, and hormonal (thyroid-stimulating hormone [TSH] and total testosterone) parameters were recorded along with pelvic ultrasonography (USG) for all PCOS subjects. They were divided into lean (body mass index [BMI] between 18.5 and 22.9) and overweight (BMI ≥23), and the number of subclinical hypothyroid patients were calculated in each group. The clinico-biochemical parameters of both groups were compared., Results: The majority (61%) of our patients were overweight. There was no significant difference in the prevalence of subclinical hypothyroidism between overweight and lean PCOS patients. The obese PCOS patients were older than lean PCOS patients, and they had higher serum testosterone with elevated systolic and diastolic blood pressure (BP)., Conclusion: The majority of our patients were found to be overweight and there was no association between obesity and subclinical hypothyroidism among PCOS patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Family Medicine and Primary Care.)

Background: Hemophagocytic lymphohistiocytosis (HLH) is an uncommon, potentially fatal, hyperinflammatory syndrome that may rarely complicate the clinical course of disseminated Mycobacterium tuberculosis (MTB). The clinical course of tuberculosis-associated HLH (TB-HLH) has been reported to be unpredictable., Materials and Methods: Here we describe the clinicopathological features, laboratory parameters, management, and outcome data of a patient who satisfied the 2004 diagnostic criteria for HLH secondary to disseminated MTB; we also do a systematic review of the international literature on TB-HLH. The literature review (January 1975-March 2014) found that HLH complicated the clinical course of 63 tuberculosis patients (41 males, 22 females, mean age = 45 ± 23.5 years) with a high mortality rate of 49% (31/63 died). The mean serum ferritin level (n = 44/63) was 5963 ng/mL (range 500-38,539 ng/mL); and a higher proportion (54.2%) of patients had pancytopenia at presentation. On univariate analysis (n = 53/63), age >30 years [hazard ratio (HR): 2.79, 95% confidence interval (CI):1.03-7.56, P = 0.03], presence of comorbidities (HR 4.59, CI: 1.08-19.52, P = 0.04), marked hemophagocytosis in bone marrow (HR: 2.65, CI: 1.16-6.05, P = 0.02), and nonusage/delayed usage of antitubercular therapy (ATT) (HR: 3.44, CI: 1.51-7.87, P = 0.003) were associated with decreased survival, though none of these parameters attained statistical significance (P > 0.05) in multivariate analysis. Usage of corticosteroids and/or immunomodulator drugs (HR 1.00, CI: 0.66-3.22, P = 0.35) did not alter the outcome in these patients., Conclusion: HLH should be considered as a differential diagnosis in patients with tuberculosis who present with cytopenias, organomegaly, and coagulopathy. Strong clinical suspicion and early usage of ATT might be useful in reducing the morbidity and mortality. The utility of immunosuppressive/immunomodulator therapy lacks general concensus among treating physicians, and warrants further studies.

Background: Chronic pain of musculoskeletal origin is a very common symptom and has major effect on the physical, mental, and economic aspects of the patients. There is always a crave among physicians and patients for effective analgesic, curable preparation that can be locally applied., Aim: The aim of this study is to assess the efficacy and safety of "Ayush Tulsi Jiwan Plus" oil in chronic pain management of musculoskeletal origin., Materials and Methods: Fifty patients of chronic musculoskeletal pain of unknown origin of mild to moderate condition were advised to apply "Ayush Tulsi Jiwan Plus" oil locally twice daily for 6 weeks and examined weekly. After completion of the treatment, the efficacy of the therapy was assessed on the basis of the subjective criteria such as perception of pain, tenderness, swelling, and joint mobility., Results: In this study, mean baseline score versus last visit score of pain (2.84 ± 0.68 vs. 1.33 ± 0.76), tenderness (1.64 ± 0.74 vs. 0.36 ± 0.56), and swelling (0.64 ± 0.85 vs. 0.38 ± 0.66) was significantly decreased, and also clinical improvement was seen in the study participants along with no evidence of adverse drug reactions., Conclusion: The analysis of the overall effect of this "Ayush Tulsi Jiwan Plus" oil preparation was found efficacious and topically safe in chronic pain conditions. However, further study will be required with larger sample size and in heterogeneous population to elicit long-term effect of this polyherbal preparation.

Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. The Expanded Program on Immunization (EPI) was flagged off in India in 1978. According to the recommendation of National technical advisory group of India (NATGI), Government of India is going to include four new vaccines in the UIP for whole India. The four new vaccines are Inactivated Poliomyelitis Vaccine (IPV) for polio, rota viral vaccine, vaccine against rubella, and Japanese encephalitis vaccine (179 districts in India). Here, authors have tried to show a comparative descriptive analysis of the hemophilus influenza and pneumococcal pneumonia with rota virus, so that in near future Government of India can also consider their inclusion in the national UIP. In India, 39.2% of all diarrheal death are due to rota virus, whereas 0.72 million deaths are due to hemophilus influenza B and 1.3 million are due to pneumococcal pneumonia in <5 years age-group. India's indigenous developed rota viral vaccine's (Rotavac) efficacy is 56% in 1(st) year compared to H influenza B (Hib) efficacy 95% and PCV13 vaccine "3 + 1" dose efficacy 100% (South Africa). Rotarix incremental cost-effectiveness ratio is US $21.4 to US $34 per disability-adjusted life years (DALYs) compared to Hib US $ 819 per DALYs in India. In case of pneumococcal vaccine, India needs more trails on the serotype specificity, efficacy, and cost-effectiveness but there is enough evidence that hemophilus influenza burden is high in India and the present Hib vaccine is safe and highly effective. In future with the help of donor agencies, India should include the hemophilus influenza B and pneumococcal pneumonia vaccine in national UIP which will save millions of poor children's life.