Chronic bronchitis and chronic obstructive pulmonary disease [COPD] among textile workers in Karachi, Pakistan

Objective: To determine the frequency and predictors of chronic bronchitis and COPD among textile workers in Karachi, Pakistan

Study Design: Cross-sectional survey

Place and Duration of Study: Karachi, Pakistan, from October to December 2009

Methodology: Male textile workers from 15 mills of Karachi were inducted. Data was collected using American Thoracic Society respiratory questionnaire [ATS-DLD-78-a] and spirometry

Results: Out of 372 participants, 29 [7.8%] workers had chronic bronchitis [4, 9.1% aged >/= 40 years] and 25 [6.7%] had COPD [12, 27.2% aged >/= 40 years]. Workers with chronic bronchitis had significantly decreased lung function compared to the healthy workers. Those reporting severe self-perceived dust exposure at work, >/= 10 pack years of smoking, uneducated, longer duration of work [>/= 11 years], and ever smokers were more likely to have chronic bronchitis or COPD. In the multivariate analyses, severe self-perceived dust exposure at work [AOR = 7.4; 95% CI: 1.9, 28.0], family history of respiratory illness/symptoms [AOR = 4.8; 95% CI: 1.1, 20.9] and lack of education [AOR = 4.2; 95% CI: 1.1, 16.9] were significant predictors of chronic bronchitis. Duration of work >/= 11 years [AOR = 5.5; 95% CI: 1.5, 19.7] and pack years of smoking >/= 10 years [AOR = 3.5; 95% CI: 1.1, 11.7] were strong predictors for COPD

Conclusion: There is a high frequency of chronic bronchitis and COPD among textile workers. Multiple important predictors for prevention are identified

Available interventions for prevention of cotton dust-associated lung diseases among textile workers

The authors reviewed literature on interventions for cotton dust-associated lung diseases among textile workers. Internet sources [PubMed, Cochrane Library, Google and Google Scholar] were accessed and interventions were categorized into: Engineering or administrative controls, or personal protective equipment [PPE]. Ten relevant articles were shortlisted, five related to engineering controls [pre-processing, bactericidal treatment of cotton, improved workplace design, machinery and dust control measures]. Administrative controls may involve setting standards, environmental surveillance, periodic medical examinations, and workers training. Although specific guidelines are available regarding the use of PPEs, but there was little literature on their effectiveness. It was concluded that there is a dearth of literature regarding field-based assessment of interventions for control of cotton dust associated respiratory diseases and the available studies primarily focus on pre-processing of cotton. This review highlights the uncertainties that remain; and recommends several areas for future research on respiratory health of textile workers

Knowledge, attitude and practices regarding respiratory symptoms among textile workers of Karachi, Pakistan: a cross-sectional survey

To determine the prevalence and predictors of good knowledge, appropriate attitude and appropriate protective practices regarding respiratory symptoms among textile workers, and to determine the association of knowledge, attitude and practices with respiratory symptoms. The cross-sectional study was conducted in 2009 and comprised male workers from 15 textile mills in and around Karachi. A structured and pre-tested questionnaire was used which included questions to explore the knowledge, attitude and practices regarding respiratory symptoms. SPSS 19 was used for statistical analysis. The study had a sample size of 372 and found prevalence of good knowledge to be in 182 [48.9%] workers and appropriate attitude in 302 [81%], while only 80 [21%] were practising these measures appropriately. Being educated and older than 38 years of age, belonging to Sindhi ethnicity, and working in the weaving section were significant [p<0.05] predictors of knowledge, attitude and practices. Generally, there was no significant association of knowledge, attitude and practices with respiratory symptoms [p>0.05]. There was low prevalence of appropriate practices, high prevalence of good knowledge and attitude, indicating an interplay of several other social and environmental factors which need to be explored

Rhabdomyosarcoma in Karachi 1998-2002.

The epidemiological features of rhabdomyosarcoma (RMS), an uncommon malignancy composed of cells with histopathologic features of striated muscle, were studied in Pakistan. Incident RMS cases recorded at the Karachi Cancer Registry during 1998 to 2004 were reviewed and to ensure maximum completeness of data, only those registered between 1998 and 2002 were considered for the present study. Two hundred and seventeen cases were reported to the Karachi Cancer Registry during this five-year period. One hundred and forty eight of the patients (60.4% males; 39.6% females) were residents of Karachi. The crude and standardized annual incidence rates/100,000 were 0.3 for males and 0.2 for females. The incidence was 0.5 in children below 15 years of age. The primary RMS sites in males were head and neck (28.1%), extremities (25.8%), genitourinary (GU) tract (17.9%), trunk (9.0%), orbit (7.9%), and retroperitoneum (3.4%). RMS occurred at other sites in 7.9% of the patients. Corresponding frequencies in females were head and neck (35.6%), extremities (16.9%), GU tract (16.9%), trunk (8.5%), orbit (8.5%) and other sites in 13.6%. Approximately 60% of the cases were childhood RMS and three fourths were below 21 years. The mean age of RMS cases all sites, males, was 18.5 years (95% CI 15.6; 21.4); for childhood RMS, 7.5 years (95% CI 6.0; 9.2); and for adult RMS 34.2 years (95% CI 28.3;40.2). In females, the corresponding figures were 18.2 (95% CI 13.7; 22.7); 6.6 (95% CI 5.0; 8.1) and 33.9 (95% CI 27.5; 40.5), respectively. One hundred cases were retraceable, and the mean survival time, RMS all sites and ages in both genders, was 1.5 years (95% CI 1.1; 1.9). The 5-year survival was 10%, and 3-year survival was 30% whereas 16.7% of the patients died within a year of diagnosis. The indicators of poor prognosis, a late presentation, rapid evolution, advanced disease, tumor burden (tumor size >5.cms) and regional lymph node involvement, are characteristic of RMS in Karachi. Recent advances in RMS multimodality treatment protocols have improved RMS prognosis in patients with limited disease. Pakistan should focus on early diagnosis and prompt treatment of malignancies. This requires health education for the general population to create awareness and training of health professionals at all levels to promote early diagnosis. An RMS group is required, which would monitor the treatment, recurrence, patient education and provide psychosocial support. Cytogenetic studies are advised for a better understanding of biologic differences in RMS cases in this population.

Retinoblastoma in Karachi, Pakistan.

The objective was to assess epidemiologic aspects of retinoblastoma development in Karachi, Pakistan. Incident cases, diagnosed clinically or microscopically and registered at Karachi Cancer Registry (KCR) during 1(st)January 1998 to 31(st) December 2002 were reabstracted, rechecked and reanalyzed for this purpose. One hundred and one cases of retinoblastoma were reported to KCR over the 5 years (1998-2002). Fifty-seven were residents of Karachi, 34 (59.6%) males and 23 (40.4%) females. The gender ratio (M:F) was 1.5. The mean age at diagnosis was 3.96 years (95% CI 2.92; 4.99) and 3.85 years (95% CI 2.72; 4.98) in males and females respectively. The annual crude incidence of retinoblastomas in Karachi was 4.0/100,000 and 2.4/100,000 in children under the age of 5 and 10 years respectively, the corresponding age standardized rates being 5.3/100,000 and 4.8/100,000. The age groups at risk of developing retinoblastoma, associated morbidity and possibility of almost 100% 5-year survival with available treatments, calls for ophthalmologic screening of all infants below 1 year, and high-risk children until the age of 7 years. In order to detect retinoblastoma, as early as possible, health education for parents and health providers, and improved training of ophthalmologists is essential. Genetic testing for siblings and children of retinoblastoma cases and identification of high-risk children would be helpful, but lacks financial feasibility in developing countries at present. Future health care planning should focus on capacity building for neonatal ophthalmologic screening, handling of parents'and children'emotional reactions and opportunities for education, occupational training and cosmetic rehabilitation for surviving retinoblastoma patients.