Levels and trends of smokeless tobacco use among youth in countries of the World Health Organization South-East Asia Region.

BACKGROUND: At least two rounds of the Global Youth Tobacco Survey (GYTS) have been completed in most of the countries in the World Health Organization South‑East Asia region. Comparing findings from these two rounds provides trend data on smokeless tobacco (SLT) use for the first time. METHODS: This study uses GYTS data from Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor‑Leste during 2006–2013. GYTS is a nationally representative survey of 13–15‑year‑old students using a consistent and standard protocol. Current SLT use is defined as using any kind of SLT products, such as chewing betel quid or nonbetel quid or snuffing any other products orally or through the nasal route, during the 30 days preceding the survey. Prevalence and 95% confidence intervals were computed using SAS/SUDAAN software. RESULTS: According to most recent GYTS data available in each country, the prevalence of current use of SLT among youth varied from 5.7% in Thailand to 23.2% in Bhutan; among boys, from 7.1% in Bangladesh to 27.2% in Bhutan; and among girls, from 3.7% in Bangladesh to 19.8% in Bhutan. Prevalence of SLT was reported significantly higher among boys than girls in Bhutan (boys 27.2%; girls 19.8%), India (boys 11.1%; girls 6.0%), Maldives (boys 9.2%; girls 2.9%), Myanmar (boys 15.2%; girls 4.0%), and Sri Lanka (boys 13.0%; girls 4.1%). Prevalence of current SLT use increased in Bhutan from 9.4% in 2009 to 23.2% in 2013, and in Nepal from 6.1% in 2007 to 16.2% in 2011. CONCLUSION: The findings call for countries to implement corrective measures through strengthened policy and enforcement.

Outcome of pregnancy in women 35 years of age and above.

Pregnancy outcome among women in the age group of 35 years and more are considered to be less favorable than those of younger women. To observe those, this case control study was conducted in the department of Obstetrics & Gynaecology, Mymensingh Medical College Hospital during the period of 1st June 2003 to 31st May 2004. The study includes 100 patients of 35 years of age or above and 100 controls of 20-30 years of age. Observed complications during the pregnancy and delivery were increased incidence of placenta previa, malpresentation, intrauterine death, preterm labour, obstructed labour ruptured uterus etc. Pregnancy related complications were found significantly high (p<0.001) in case group (80%) compared to control group (51%). Rate of caesarian section was also more among the cases. Post delivery maternal complications were more in case group (53%) compared to control (30%) (p<0.001). Perinatal morbidity and mortality was significantly high. Cause of late fetal death in older women include, failure of the uterine vasculature in older women to adapt sufficiently to the increase haemodynamic demands of pregnancy, reduced fetal oxygenation with maternal age and also a rise in the frequency of preexisting hypertension with age. Maternal age is an important and independent risk in pregnancy outcome.

Histopathology based cancer pattern in Mymensingh region of Bangladesh.

To our knowledge, population-based published data regarding the cancer profile in Mymensingh region of Bangladesh is not available. This study was designed to provide information regarding the frequencies of cancers through sample data retrieved from histopathology (surgical pathology) laboratory based cancer registry from two laboratories in Mymensingh. All malignant tumours recorded in 2006 in the register of pathology laboratory of Mymensingh Medical College and one private pathology laboratory in Mymensingh town were taken as sample data for analysis in terms of age groups, gender and types of cancer with relation to site. A total of 470 cases diagnosed as cancer were found in the register, of which males were 249(53%) and females were 221(47%) with male to female ratio 1.2: 1. Highest numbers of cases were found in the age group of 51-60 years. In male group frequency of malignant tumours was found in the age group of 51-60 years and the female group it is 41-50 years. Top five sites of cancer, irrespective of sex, were of stomach, uterine cervix, colo-rectum, lymph nodes and breast. According to decreasing order of frequency, in the males, the top five cancers were of stomach, lymph node, oesophagus, urinary bladder and colo-rectum. In the female groups these were of uterine cervix, breast, ovary, colo-rectum and stomach. Cancer cases in the age group of 51-60 years were significantly higher in males than in females (p<0.001). The commonest cancers in males and females were of stomach and cervix, respectively. As the analysis was based only on surgical specimens, the exact incidence of cancer of lung and liver could not be evaluated. Because, majorities of the malignancies in these organs are diagnosed mainly on cytological examination. Population-based cancer registry should be maintained to explore the exact patterns of cancer in the study region. Cervical cancer screening program and eradication of H. pylori infection program may be helpful for the reduction of incidence of cancer in this region.

Histopathological analysis of hysterectomy specimens.

The objective of this study was to explore the histopathological findings and the rate of removal of ovaries in hysterectomy specimens. This study took into account 328 hysterectomy specimens examined in the Department of Pathology, Mymensingh Medical College and in one private Pathology Laboratory in Mymensingh town from March to August, 2005. Formalin fixed paraffin embedded tissue sections stained with haematoxylin and eosin were examined under light microscope. Patients' age, parts of uterus examined and their histopathological findings were retrieved from laboratory records. The common histopathological findings were: chronic cervicitis (87.80%), leiomyoma (17.07%), uterine prolapse (16.72%), adenomyosis (3.96), non-specific endometritis (3.35%), squamous cell carcinoma of cervix (2.44%), endometrial polyp (2.44%), serous cystadenoma of ovary (2.44%) and endometrial hyperplasia (1.83%). Some of the specimens show more than one lesions in the body of uterus, of which coexistence of adenomyosis and leiomyoma was the most common. Neoplastic lesions in cervix were 4.27%, in body 16.92% and in ovaries 5.06%. Malignant neoplasms were found in cervix 71.43%, in uterine corpus 3.03% and in ovaries 25%. Ovaries of both sides were removed in 48.17% of total cases. Their median age was 45 years, lowest age 23 years and maximum age was 82. The rate of removal of both ovaries was found to be increasing with the increase of age. Only one case was found to be subtotal hysterectomy and others were total hysterectomy. The present study revealed that the most common histopathological cause of hysterectomy is chronic cervicitis. Most common neoplastic cause of hysterectomy is leiomyoma. The rationalities and the possible after effect of hysterectomy in sexual functions and other physiological impairment should be followed up.

Use of parenteral magnesium sulphate in eclampsia and severe pre-eclampsia cases in a rural set up of Bangladesh.

This was a quasi-experimental interventional study to see the role of injection magnesium sulphate in eclampsia and severe pre-eclampsia patients at community level in a rural set up before referral to the hospital. This study was conducted on 265 cases of eclampsia and severe pre-eclampsia over a period of six months from July 2001 to December 2001. Among 265 cases, 133 were in intervention group who had received loading dose of injection magnesium sulphate before referral and the rest 132 were in non-intervention group, had not received injection magnesium sulphate before admision in hospital. The number (mean +/- SD) of convulsion before treatment in intervention and non-intervention groups were 4.7 +/- 2.64 & 6.86 +/- 2.97 respectively. Recurrence of fits observed more in non-intervention group and the difference was statistically significant (p<.001). Mean (+/- SD) time taken to regain full consciousness was 12.0+9.6 and 17.4+7.4 hours in the intervention and non-intervention group respectively (p<.05). Control of convulsion by loading dose of 10 gm of injection magnesium sulphate was achieved in 94.0% of the intervention group and 74.0% in non-intervention group. There was only 3(2.3%) maternal death in study group whereas in non-intervention group maternal death was 14(10.4%) and the difference was highly significant (p<.005). Fourteen (13.7%) babies were still born in intervention group and 21(20%) in non-intervention group. The difference was statistically highly significant (p<.001). Remarkable achievements were obtained through use of magnesium sulphate at the community level at rural setting among the eclampsia and severe pre-eclampsia cases.

Abdominal wall defect: a case report and review.

Ultrasound is well recognized imaging modality for prenatal diagnosis of fetal congenital anomalies. However, precise diagnosis of fetal anomaly with gray scale ultrasound may not be possible at times. Color Doppler ultrasound compliments gray scale ultrasound in accurately diagnosing fetal anomaly. We report a case of an omphalocele with short lower limbs, diagnosed during 3rd trimester on the basis of color Doppler ultrasound. Gray scale ultrasound failed to diagnose the condition initially. Color Doppler sonography helped in accurate diagnosis. Findings were confirmed after termination of pregnancy.