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   2014| October-December  | Volume 3 | Issue 4  
    Online since October 15, 2014

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Smoking trends among women in India: Analysis of nationally representative surveys (1993-2009)
Sonu Goel, Jaya Prasad Tripathy, Rana J Singh, Pranay Lal
October-December 2014, 3(4):200-202
Background: There is growing concern among policy makers with respect to alarming growth in smoking prevalence among women in the developing countries. Methods: Using disaggregated data from five nationally representative surveys: Global Adult Tobacco Survey 2010, National Family Health Survey-III (NFHS-III) 2004-2005, NFHS-II 1998-1999, National Sample Survey (NSS) 52 nd Round 1995-1996, NSS 50 th Round 1993-1994 we analysed female smoking trend from 1993-2009. Tobacco use among females was monitored for almost two decades focusing on gender, literacy, and state-specific trends among respondents aged >15 years. Results: Smoking use among women has doubled from 1.4% to 2.9% (P < 0.001) during the period 2005-2010. The prevalence of smoking increased with decrease in per capita State Gross Domestic Product and literacy status for both men and women. Conclusion: As the overall smoking prevalence grows, female smoking is growing at a faster rate than smoking among males, which is an emerging concern for tobacco control in India and requires the attention of policymakers.
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Prevalence of cigarette smoking and its predictors among school going adolescents of North India
Durgesh Thakur, Anmol Gupta, Anita Thakur, Salig Ram Mazta, Deepak Sharma
October-December 2014, 3(4):193-195
Background: Cigarettes smoking is a common mode of consuming tobacco in India. This habit usually starts in adolescence and tracks across the life course. Interventions like building decision making skills and resisting negative influences are effective in reducing the initiation and level of tobacco use. Aims and Objectives: The purpose of this study was to assess the prevalence of adolescent current cigarette smoking behavior and to investigate the individual and social factors, which influence them both to and not to smoke. Methodology: A cross-sectional study was carried out among school going adolescents in Shimla town of North India. After obtaining their written informed consent, a questionnaire was administered. Results: The overall prevalence of current cigarette smoking was 11.8%. The binary logistic regression model revealed that parents' and peers' smoking behavior influence adolescent smoking behavior. Individual self-harm tendency also significantly predicted cigarette smoking behavior. Parental active participation in keeping a track of their children's free time activities predicted to protect adolescents from taking this habit. Conclusion: Our research lends support to the need for intervention on restricting adolescents from taking up this habit and becoming another tobacco industries' addicted customer. Parents who smoke should quit this habit, which will not only restore their own health, but also protect their children. All parents should be counseled to carefully observe their children's free time activities.
  1,376 302 2
Methotrexate, an attractive agent for palliation in head and neck cancers
Mukesh Sharma, Manish Gupta, Vikas Fotedar, Anjna Sharma
October-December 2014, 3(4):229-229
  1,503 164 -
Response to imatinib mesylate in childhood chronic myeloid leukemia in chronic phase
Vijay Gandhi Linga, Ranga Raman Ganta, Krishnamani Iyer Kalpathi, Sadashivudu Gundeti, Senthil J Rajappa, Raghunadharao Digumarti, Tara Roshni Paul, Ashwani Tandon
October-December 2014, 3(4):203-205
Introduction: Childhood chronic myeloid leukemia (CML) accounts for less than 3% of all childhood leukemias, hence, data on imatinib (IM) in adult CML patients has been largely extrapolated to children. We have analyzed our data to add to the existing literature. Aims: Primary objective is to assess the progression-free survival (PFS). Secondary objective are cytogenetic response, overall survival (OS), and toxicities. Settings and Design: This is a retrospective analysis from the case records from a single institution. Materials and Methods: Institutional ethics committee approval was obtained. All the children diagnosed CML in chronic phase (CML-CP) aged less than 18 years registered between 2000 and 2009 were enrolled. All the patients were started on IM at 260 mg/m 2 . Statistical Analysis: Kaplan-Meier curves were used to calculate the PFS and OS. Results: There were 64 children with median age of 13 years (range, 1-18) with male predominance (male:female (M: F) - 1.85:1). Sixty-one patients (95.4%) achieved complete hematological response (CHR) at median of 8 weeks. Thirty-seven (57.8%) patients had evaluation of cytogenetic response and were subjects for outcome analysis. The median time to best cytogenetic response evaluation was 13 months (range, 4-52). Twenty-nine patients (78.3%) achieved complete cytogenetic response (CCyR). At a median follow-up of 36 months (range 5-75), 21 (56.8%) remained progression free and 35 (94.5%) are alive. Adverse events were tolerable. Conclusions: PFS at a median follow-up of 36 months is 56.8% and OS 94.5%.
  1,369 230 2
Tobacco use, Body Mass Index, and Potentially Malignant Disorders Among petrol fillers in Pimpri-Pune (India): A descriptive study
Mamatha G. S. Reddy, Pradnya V Kakodkar, Akanksha Singh
October-December 2014, 3(4):196-199
Background: Since petrol is combustible and smoking is banned at the petrol pumps, it may be predicted that use of smokeless tobacco is more prevalent among the petrol fillers. Also, smokeless tobacco is a major risk factor for developing oral potentially malignant disorders. The present study was conducted to determine the tobacco use, body mass index (BMI), and potentially malignant disorders among a cohort of petrol fillers and also to evaluate the interaction of tobacco use and BMI with the presence of potentially malignant disorders. Settings and Design: The study was conducted at 45 petrol stations located at Pimpri-Pune, India. A descriptive study design was used. Materials and Method: Four hundred and ten petrol fillers aged 17-64 years participated in the study. General information and tobacco history was obtained by interview. Height and weight were recorded to obtain BMI. Oral examination was conducted to identify the potentially malignant disorders. Statistical analysis: Chi-square test, Z test, and logistic regression were used. The level of significance was fixed at 5%. Results and Conclusions: It was found that 242 (59.02%) used tobacco in different forms. 77.68% were tobacco chewers, and 8.26% were smokers. Leukoplakia was prevalent among 68.47%, oral submucous fibrosis among 27.45%, and 5.08% had erythroplakia. Age (χ2 = 11.46, P < 0.05), duration (χ2 = 17.46, P < 0.05), and frequency of tobacco chewing (χ2 = 14.16, P < 0.05) were significantly associated with potentially malignant disorders. Tobacco chewing was more prevalent as compared to smoking. It can be concluded that the petrol fillers are at a high risk for developing oral potentially malignant disorders.
  1,287 244 -
Comparative analysis of cisplatin-induced nephrotoxicity in head and neck cancer and carcinoma cervix during concurrent chemoradiotherapy
Puneet Kumar Bagri, Akhil Kapoor, Ashok Kalwar, Mukesh Kumar Singhal, Daleep Singh, Satya Narayan
October-December 2014, 3(4):217-220
Background: Cisplatin is widely used as radio sensitizer in head and neck cancer (HNC) and carcinoma cervix (CaCx). This study aims to see comparative nephrotoxicity of cisplatin in HNC and in CaCx without obstructive uropathy treated by concurrent chemoradiotherapy (CCRT). Materials and Methods: Fifty patients of HNC and 50 patients of CaCx stage II/III without obstructive uropathy were included in this study. Cisplatin 50 mg intravenous weekly was given before EBRT with adequate hydration and premedication in both groups. Before chemotherapy; blood urea, serum creatinine, and glomerular filtration rate (GFR) were measured. GFR was measured using 99m Tc diethylene triamine pentacaetic acid (DTPA) renogram study. Results: At the end of 4 th week, blood urea level 41-45 mg% was in 40 and 4% in HNC and CaCx, respectively (P = 0.018). At the end of 3 rd and 4 th week, blood urea level >45 mg% was 10 and 6% in HNC cases, respectively. At the end of 4 th week, serum creatinine level 1.1-1.5 mg% was 50 and 8% in HNC and CaCx, respectively (P = 0.047). Serum creatinine level >1.5 mg% was 6, 8, and 22% in HNC at the end of 2 nd , 3 rd , and 4 th week, respectively. GFR <80 ml/min at the end of 4 th week was 14% in HNC and only 2% in CaCx. GFR <100ml/min was significant at the end of 4 th week (P = 0.04). Univariate analysis showed significant relation between reduced oral fluid intake and reduced GFR (P < 0.001). Conclusion: In HNC, during concurrent chemoradiation, as the 3 rd -4 th week is reached, oral mucosal reactions increase and affect oral intake which further add to the cisplatin-induced nephrotoxicity. In CaCx without obstructive uropathy, renal function impairment is less severe as oral intake of water and liquid is not much impaired.
  1,288 220 5
Pediatric oncology services in Nepal
Kailash Prasad Sah, Ramandeep Singh Arora, Sulav Sapkota, Yamuna Poudel, Barry Pizer
October-December 2014, 3(4):227-228
Cancer in children is one of the emerging noncommunicable diseases in Nepal with significant morbidity and mortality. Significant efforts are being made at the government and nongovernment level to provide awareness, early diagnosis, and effective treatment to improve the cure rate of children with cancer. The major challenges include: lack of education, late diagnosis, advanced disease at presentation, financial problems, geographical and transportation difficulties, and inconsistent supply of chemotherapy medicines.
  1,296 152 -
Frequency of 11q23/MLL gene rearrangement in Egyptian childhood acute myeloblastic leukemia: Biologic and clinical significance
Adel Abdelhaleim Hagag, Shebl S Shebl, Nabih H El-Fadaly
October-December 2014, 3(4):206-208
Background: Molecular cytogenetic abnormalities involving 11q23 are among the most common cytogenetic abnormalities in acute myeloid leukemia (AML) patients. Aim of the work: we aimed to evaluate the frequency of MLL/AF9 fusion gene in de novo AML patients, its impact on clinical features, and its prognostic significance. Patients and methods: Twenty-eight children patients with AML and 20 healthy controls were subjected to complete clinical examination and laboratory investigations including, complete hemogram and bone marrow (BM) examination. Diagnosis was based on FAB morphologic and immunophenotypic criteria. Detection of (MLL/AF9) fusion gene was assessed by dual color fluorescent in situ hybridization (FISH). Follow-up were carried out clinically and by blast count in BM, and response to therapy to detect the outcome of the disease. Results: The incidence of MLL-fusion gene MLL/AF9 in AML cases was about (6/28) (21%). Four patients with MLL/AF9 fusion gene were newly diagnosed, two cases were at relapse and no patient at remission showed positivity. As regard the clinical outcome, five out of six MLL positive cases died, three of them during induction and two during relapse. The FAB AML subtypes with MLL/AF9 fusion were one M2, three M4, and two M5. Conclusion: MLL-fusion gene MLL/AF9 was found in about 21% of studied AML patients when assessed by FISH technique and this is of high clinical relevance as most of these abnormalities have been associated with poor prognosis.
  1,250 196 -
Is aspiration as detected on pretreatment video fluorography, a harbinger of poor quality of life and early mortality in cancers of the upper aerodigestive tract treated with radiotherapy?
Punita Lal, Vipul Nautiyal, Tamojit Chaudhuri, Mranalini Verma, Koilpillai Joseph Maria Das, Shaleen Kumar
October-December 2014, 3(4):209-212
Background: Patients with cancers of the upper aerodigestive tract (head and neck cancer (HNC)) tend to aspirate, either due to disease or treatment. The association of aspiration (documented on video fluorography (VFG)) with quality of life (QOL) and unexpected mortality was studied prospectively in patients treated with simultaneous integrated boost technique of intensity-modulated radiotherapy (SIB-IMRT). Materials and Methods: Moderately advanced (stage III/IV) HNC were treated by SIB-IMRT delivering 66 Gy/30 fr, 60 Gy/30 fr, and 54 Gy/30 fr to high, intermediate, and low risk volumes, respectively. They underwent serial VFG and QOL assessments (Quality of Life Questionnaire-Core 30 ( QLQ-C30) and head and neck-35 (HN35) European Organisation for Research and Treatment of Cancer (EORTC) tools) at 0, 3, and 6 months. Pharyngeal musculature (PM) was additionally delineated on planning computed tomography (CT) scans as potential organs at risk (OARs). Results: Between November 2009 and May 2011, 20 HNC were treated as per protocol. All patients were fit (Karnofsky performance status (KPS) ≥ 80). Based on VFG findings, seven patients (4/9 oropharynx and 3/11 laryngopharynx) were grouped as aspirators (A) and remaining 13 as non-aspirators (NA). The QOL study showed that pretreatment coughing and swallowing difficulties were greater in group A versus NA and remained persistently higher. In group A, deaths attributable to aspiration were seen in 3/7 patients, while none occurred in the NA group (Fisher's exact P = 0.03). The mean PM dose was 60 Gy in both the groups and mean V60 was similar at 69 and 67% in A and NA groups, respectively. Conclusions: VFG helps identify patients who aspirate and are at risk of premature death due to its complications, alerting caregivers to direct attention appropriately.
  1,206 188 1
More on the tobacco menace in India
PM Parikh
October-December 2014, 3(4):191-191
  1,189 196 -
Prognostic value of metastatic lymph nodal ratio in squamous cell carcinoma of esophagus: A three-step extrapolative study
Praveen Ravishankaran, Arvind Krishnamurthy
October-December 2014, 3(4):213-216
Background: Transthoracic esophagectomy (TTE) and transhiatal esophagectomy (THE) are the two most common surgical approaches for carcinoma esophagus. Several studies have shown lymph nodal involvement to be one of the most important prognostic factors in carcinoma esophagus. Aims: The primary objective of this study was to explore the effectiveness of the ratio of positive lymph nodes to excised lymph nodes, namely the metastatic lymph nodal ratio (MLNR) as a prognostic factor in the survival of patients with carcinoma esophagus. Settings and Design: Retrospective analysis of a prospective database. Materials and Methods: A review of the operated esophageal cancer patients treated at a tertiary cancer center in South India between January 2002 and December 2006. Statistical analysis was done with the help of SPSS version 17 software (SPSS Inc., Chicago, IL). Proportions were compared using the Chi-square test. Survival data was generated using life table methods. Differences in survival estimates were compared using log-rank test. Results and Conclusions: Our study emphatically showed that the survival outcomes of patients with squamous cell carcinoma of the esophagus can be discriminated based on the MLNR groups, and it can be a reliable prognostic indicator. The overall survival for patients undergoing TTE, or THE for the entire cohort of patients was however not statistically significant. Whether a more aggressive TTE is a better esophageal cancer operation or whether MLNR is the factor that can significantly impact survival regardless of the technique is an issue that would require further investigation.
  1,215 163 1
Urodynamic and continence assessment of orthotropic neobladder reconstruction following radical cystectomy in bladder cancer; a prospective, blinded North Indian tertiary care experience
Vishwajeet Singh, Swarnendu Mandal, Sachin Patil, Rahul Janak Sinha, Dheeraj Kumar Gupta, Satya Narayan Sankhwar
October-December 2014, 3(4):223-226
Aim: The aim of this study is to compare urodynamic and continence parameters among patients undergoing orthotropic neo-bladder substitution with sigmoid or ileal segments. Variations in the Urodynamic parameter between the continent and incontinent patients were also evaluated. Patients and Methods: From January 2008 to March 2012, 44 patients underwent ileal neobladder (IN) reconstruction and 36 patients underwent sigmoid neobladder (SN) reconstruction. Evaluation of Urodynamic and Continence parameters was performed at 12 months after surgery. Results: The average capacity of IN and SN was 510 ml and 532 ml respectively. The voiding pressure, mean peak flow rates and post void residual urine (PVRU) for IN and SN were 27.5 cm H 2 O versus 37 cm H 2 O, 15ml/s versus 17ml/s and 36 ml versus 25 ml respectively. Daytime continence for IN and SN was 93% (41/44) and 89% (32/36), and night-time continence was 91% (40/44) and 78% (28/36) respectively. The compliance, maximum cystometric capacity and PVRU in the daytime continent (versus incontinent) were 61 (versus 41), 471 (versus 651) and 22 (versus 124) and in the night-time continent (versus incontinent) were 57 (versus 43), 437 (versus 654) and 18 (versus 105) respectively. Conclusion : A neobladder constructed from detubularized ileum or sigmoid achieves urodynamically proven adequate capacity and compliance with 89-93% daytime and 78-91% night time continence. Continent men when compared with incontinent (both daytime and night time) were more likely to have comparatively higher compliance, lower maximum cystometric capacity and lower PVRU. Urodynamic study could predict which incontinent men would improve with pelvic floor exercises and clean intermittent catheterization (CIC).
  1,152 189 2
Chronic myeloid leukemia in children, do we have all the answers?
Shweta Bansal
October-December 2014, 3(4):192-192
  1,109 210 -
A rare case of spindle cell lipoma of broad ligament presenting as a pelvic mass
Siddhi Gaurish Sinai Khandeparkar, Bageshri P Gogate, Sanjay D Deshmukh, Smriti S Dwivedi
October-December 2014, 3(4):229-230
  1,103 199 1
Chronic lymphocytic leukemia with massive ascites: An unusual presenting manifestation
Ajay Gogia, Prashant Mehta, Raja Pramanik, Ritu Gupta
October-December 2014, 3(4):235-236
  1,147 131 -
Radiotherapy-enhanced ototoxicity in elderly
Monika S Malgonde, Manoj Kumar
October-December 2014, 3(4):221-222
Introduction: Most head and neck cancers occur in elderly age and there is a natural occurrence of sensorineural hearing loss (SNHL) due to age also. Despite the ages and the physiological changes inherent to ageing, their auditory systems when exposed to aggressive agents caused the hearing loss to be greater as a consequence of the treatment received. Materials and Methods: Histopathologically proved 66 head and neck cancer patients were subjected to radiotherapy (RT) and 34 patients were subjected to concomitant chemoradiation (RT + CT) to study the occurrence of SNHL from 1 st September 2010 to 31 st August 2012. Result: It was found that the percentage of significant SNHL was more in patients >50 years after RT and RT + CT. It was also found that the results were significant. Conclusion: The occurrence of SNHL is more in elderly and the concern for the quality of life of patients undergoing cancer treatment is necessarily growing. Hence, the determination of hearing loss should be a part of investigations to enable better rehabilitation in elderly.
  957 192 -
Cancer notification in India: An update
Himanshi Aggarwal, Pradeep Kumar
October-December 2014, 3(4):236-237
  901 161 -
Imatinib-associated massive upper gastrointestinal hemorrhage and hepatic encephalopathy in a child with Philadelphia positive acute lymphoblastic leukemia: A case report and review of the literature
Silky Jain, Sandeep Jain, Gauri Kapoor
October-December 2014, 3(4):234-235
  904 154 -
Chemotherapy-induced amenorrhea in patients suffering from breast cancer in the Northwest of Iran
Jamal Eivazi-Ziaei, I Asvadi, A Esfahani, J Vaez, A Pourzand, R Shabanloei, MR Sattari
October-December 2014, 3(4):233-234
  859 174 -
Epidemiology of primary small cell carcinoma of the esophagus: A retrospective study
Manigreeva Krishnatreya, Amal C Kataki, Jagannath D Sharma, Bibhuti Bhusan Borthakur, Manoj Kalita
October-December 2014, 3(4):231-232
  847 179 1
A rare case of nonfamilial polyposis coli with immunohistochemical observations with mucin product genes MUC2 and MUC5AC in adenoma-carcinoma progression
Sanjay D Deshmukh, Siddhi Gaurish Sinai Khandeparkar, Bageshri P Gogate, Mrunal Kesari
October-December 2014, 3(4):232-233
  843 138 -
Urine biomarker for benzene exposure and precancerous chromosome damage among gas station attendants in Bangkok, trend after implementation of declaration of standards for control of air quality
Viroj Wiwanitkit
October-December 2014, 3(4):237-237
  803 137 -