Nasopharyngeal carcinoma in the Northeastern states of India / 癌症

Nasopharyngeal cancer (NPC) is a rare disease in most parts of the world, except for Southeast Asia, some parts of North Africa and the Arctic. It is mostly seen in people of Chinese origin. In India, NPC is also rare, except for the Hill States of Northeast India, particularly Nagaland, Manipur, and Mizoram. The striking feature of NPC in Northeast India is that the incidence ranges over the complete spectrum from the lowest (as 0.5/100 000 to 2.0/100 000 among Caucasoid) to the highest (as about 20/100 000 among Cantonese/Zhongshan dialect Chinese). The age-adjusted rate of NPC in Kohima district of Nagaland State is 19.4/100 000, which is among the highest recorded rates. By contrast, in Assam, one of the so-called Hill States but not itself a hilly state, NPC is much less common. The Northeastern region is distinguished by a preponderance of the Tibeto-Burman languages and by variable mongoloid features among peoples of the region. The nature of the migratory populations who are presumed to be bearers of the mongoloid risk is unknown, but these NPC occurrence features provide an outstanding opportunity for NPC risk investigation, such as that of the hypothesis of Wee et al. for westward displacement of Chinese aborigines following the last glacial maximum.

Chlorinated drinking water, cancers and adverse health outcomes in Gangtok, Sikkim, India.

Long-term impacts of drinking chlorinated water on the incidence of cancers and other adverse health outcomes were assessed in a population-based cross-sectional study. The study was conducted by comparing a group exposed to chlorinated drinking water for more than thirty years with control groups with less or no exposure to chlorine. A house-to-house survey was completed to gather information on residential history, age, education, income, source and extent of treatment of water and health characteristics. All residents below thirty years of age were excluded from the database used for analyses to ensure that the groups were comparable. Fourteen cancer cases were found in the long-term exposed groups of 1085 persons and 9 cancer cases in the two control populations of 725 persons. The odds ratio for cancers (OR) was 1.05 (95% CI = 0.43-2.65) and is not statistically significant. Odds ratios for gastrointestinal disorders, kidney problems and skin infections were statistically significant ranging from 2.06 (95% CI = 1.01-4.17) to 2.2 (95% CI = 1.45-3.33). These OR values indicate that there is no significant association between the incidence of cancer and exposure to chlorinated water while chlorinating drinking water significantly reduced the incidence of non-carcinogenic adverse health effects like gastrointestinal diseases, skin infections, and kidney diseases.

Predictors of treatment delays for tuberculosis in Sikkim.

BACKGROUND: This study examined the factors associated with delays (i) between the onset of symptoms and the patient's first visit to a medical facility (patient delay), and (ii) between a patient's visit to a medical facility and the diagnosis of tuberculosis (health system delay). METHODS: A cross-sectional survey was conducted of 323 patients (median age 30 years, men: 190) reporting to 2 tuberculosis units and 4 microscopy centres in East Sikkim using a pre-tested structured interview schedule. Patient records were verified for dates of investigations, diagnosis and treatment. Bivariate and multivariate analyses were done to find out the associations between dependent and independent variables. RESULTS: The median patient and health system delays were 21 and 7 days, respectively. Patient delay >30 days was reported by 17% and health system delay > 7 days by 49% of the participants. Patient delay was associated with self-medication (OR 2.28, 95% CI: 1.0-5.18), choice of government doctors as first contact (OR 2.76, 95% CI: 1.15-6.62), use of traditional healers (OR 2.18, 95% CI: 1.03-4.61) and cost of treatment 3Rs 400 compared with <Rs 100 (OR 2.52, 95% CI: 1.17-5.38). Important predictors of health system delays were first contact with private doctors (OR 33.1, 95% CI: 13.44-81.49) and cost of treatment (OR 2.5; 95% CI: 1.22-5.128). CONCLUSION: Efforts need to be made to eliminate the factors causing a delay in the initiation of treatment of patients with tuberculosis. These should include increasing awareness to avoid self-medication, the availability of free treatment, and training traditional healers and private doctors in the treatment of tuberculosis.

Gallstone disease in the Himalayas (Sikkim and north Bengal): causation and stone analysis.

OBJECTIVES: To know the extent of gallstone disease in Sikkim and North Bengal. METHODS: 487 (14.4%) patients with gallstones were diagnosed among 3375 patients with dyspepsia in 3 years. All patients with gallstone were evaluated based on a predefined questionnaire. Abdominal sonography was performed and obesity index was calculated. Gallstones retrieved at surgery from 29 patients were subjected to infra-red spectroscopic analysis. RESULTS: The patients with gallstones included 375 women with average age of 40 years and 112 men with average age of 48.7 years. 15.7% of the women were nulliparous, 12% had one child and 23% had two children each. 73% of patients were of normal weight and 97% were non-vegetarians. Only cholesterol gallstones were found in these patients. CONCLUSIONS: Gallstones are common in Sikkim and North Bengal among dyspeptics. A majority of patients are of normal weight. The disease occurs a decade earlier in women, most of whom have only up to two children.

Thyroid function in a goitre endemia.

A study was conducted to determine the thyroid function in a goitre endemia. Sadam is small village in the south district of Sikkim. Severe iodine deficiency exist in this village (prevalence of goitre 73.5%, cretinism prevalence 4%; mean urinary iodine exeretion 4.13 ng/dl - SD 3.1). Total of 72 out pf 142 households were randomly selected. All the inmates of the households above 14 years of age were examined for goitre and blood samples were collected from them for estimation of concentration of thyroid stimulating hormones (triiodothyroine T-3, thyroixe T-4) and thyroid stimulating hormone (TSH). Total of 244 subjects were examined, (137 males and 107 females). Goitre was detected in 149 (61.1%) individuals. The mean T-3, T-4 and TSH concentrations in the non-goitrous groups were (SD in parenthesis) 110.13 ng/dl (26.19), 10.12 ug/dl (2.38) and 1.01 uu/ml (0.52). The corresponding values for the goitrous group were, 132.22 ng/dl (46.25), 9.06 ug/dl (2.04) and 1.33 uu/ml (1.19). The differences in the mean concentrations between the goitrous and non-goitrous groups were statistically significant. An inverse correlation between the goitre size and T-4 on the one hand, and TSH and T-4 on the other hand was noticed. The result of the study show that functional decompensation of the thyroid occur in the majority of goitrous subjects.

An epidemiological study of coronary heart disease in different ethnic groups in Delhi urban population.

A community based epidemiologival survey of coronary heart disease (CHD) was carried out on a random urban sample of 13,560 adults of different ethnic groups in Delhi. CHD was diagnosed either on the basis of clinical history, supported by documentary evidence of treatment in hospital/home or on the ECG evidence in accordance with Minnesota Code. The prevalence rate of CHD on clinical basis per 1000 adults was the highest in Sikhs (47.3), lowest in Muslims (22.8) and identical in Hindus (31.8) and Christians (31.2). The prevalence rate/1000 of silent CHD on the basis of ECG was high in Muslims (89.5) and Sikhs (87.3), low in Christians (25.0) and intermediate in Hindus (60.0). The Sikhs showed the highest prevalence rate of myocardial infarct (MI) (15.5) and angina (AP) (31.8) compared to other communities. The prevalence rate of CHD on clinical basis was higher in males than females in all communities. The prevalence of silent CHD was higher in females in Hindus and Sikhs but in Muslims it was higher in men (94.8) than in women (85.2). The wide variations in prevalence rates of CHD in different ethnic groups cannot be explained satisfactorily on the basis of conventional risk factors and support the multifactorial etiological character of CHD.

Iodine deficiency disorders in school children of Sikkim.

Sikkim is a small state in the eastern Himalayas. A survey was conducted to determine the prevalence of iodine deficiency disorders in the state. A two stage sampling procedure was adopted. In stage one, all villages in the state were listed and 249 were randomly selected for the survey. In stage two, households, were randomly selected from the selected villages using the electoral lists. The basic sampling unit was a household and all members of the households were studied. A total of 17,837 subjects were studied from 3,197 households of 249 villages. Overall prevalence of goitre and cretinism in the community as a whole, were 54.03% and 3.46% respectively. Of the population studied, 5939 were children in the age group of 5 to 16 years. There were 3,005 boys and 2,934 girls. Goitre was detected in 3,381 (56.9%). Goitre prevalence in the boys was 55.4% and in girls it was 58.5% (p = < 0.05). Grade I goitre was seen in 2,472 (73.1%), grade II in 888 (26.3%) and grade III in 21 (0.6%). Endemic cretinism was diagnosed in 175 subjects (2.9%). Cretinism prevalence in the boys was 3.1%, and in girls in was 2.8% and this difference was not significant. Neurological; cretinism was the predominant form (98.3%). Estimation of urinary iodine concentration in 167 subjects revealed the mean concentration to be 3.64 u/dl (SD 2.47). The median value was ug/dl indicating the skewed distribution of the urinary iodine concentration. The study shows the existence of severe iodine deficiency in the school-aged children of Sikkim.(ABSTRACT TRUNCATED AT 250 WORDS)