Local responses to the Maharashtra gutka and pan masala ban: A report from Mumbai.

Background: The Maharashtra government has banned the production, sale, distribution and storage of gutka, and pan masala in the Maharashtra State due to the increasing burden of cancer and reproductive health problems attributable to the use of these products. In view of this, it is important to understand the way producers', sellers' and users' are adapting to the ban. Objective: During the two months following the ban (July 19 th through Sept 30, 2012), a research team studying smokeless tobacco use and promotion in a low income community of Mumbai conducted rapid surveillance to assess the impact of the ban in the study community. Materials and Methods: Assessment involved documenting new points of sale, informal observations of tobacco use, and interviews with thirteen shop owners and eight gutka users'. Overall changes in accessibility, availability, patterns of use of tobacco products, perception of ban, social norms and surveillance activities were assessed. Results: Tobacco companies were marketing new products that resembled gutka, under similar brand logos. Surveillance, financial and social cost of selling gutka or using it in public have had an immediate effect on reducing local supply, demand and use and increasing stigma associated with its use. There was an increased recognition of ill-effects of gutka on cancer among sellers' but not overall. Conclusions : To reduce the overall consumption of tobacco in the community, it is critical to include programs that create awareness about effects of smokeless tobacco on health and sustain surveillance levels. This would maintain requirements of the ban, and sustain limits on accessibility, availability and use of these products in the community and other similar communities.

A Correlation with Retinal Thickness Using Retinal Thickness Analyzer and the Responses of Multifocal Electroretinogram in Patients with Diabetic Macular Edema

PURPOSE: To assess the correlation between retinal thickness determined with a retinal thickness analyzer (RTA) and the responses of multifocal electroretinogram (mfERG) in patients with diabetic macular edema. METHODS: RTA and mfERG were performed in patients with diabetic macular edema (20eyes, 10 patients) and normal subjects (10eyes, 10 patients). The measured retina of RTA and mfERG overlapped based on the anatomical landmarks of the fundus. The center of macula was defined as "Area 1", and the central 5 degree retina including the center of macula was defined as "Area 2". The correlations between retinal thickness and the local responses in each area were assessed. RESULTS: The mean retinal thickness of patients with diabetic macular edema was significantly greater than that of normal subject, and the results of mfERG typically represented decreased amplitudes and delayed latencies. In the matching of retinal thickness and local responses in Area 2, amplitudes of N1 & P1 decreased and latency of P1 delayed as the retinal thickness increased. The correlation was prominent in patients with diabetic macular edema. CONCLUSIONS: In the matching of RTA and mfERG of patients with diabetic macular edema, retinal thickness and local responses were significantly correlated.