ABSTRACT
Objective: Evidence suggests that the popularity of Reduced Risk Products' (RRPs) is growing globally, and they are being considered as effective aids for tobacco cessation. To explore different policy options for reducing disease burden, this qualitative study investigates the perceptions of the urban adult population regarding the use of e-cigarettes (EC), combustible cigarettes, or both, and the factors influencing their choices. Methods: Twelve focus group discussions (FGDs), involving 132 participants, (68 male, 64 female), aged 18-60, were conducted from August to October 2022 in three metropolitan cities of Pakistan. Thematic analyses were conducted using the NVivo software. The Standards for Reporting Qualitative Research were employed for reporting and conducting purposes. Results: The findings indicate that while all participants discussed the health risks associated with combustible cigarettes and EC and expressed intensions to quit, many continued to smoke or vape. Reasons cited included perceived stress relief, alleviation of medical issues, or addiction hindering cessation efforts. Among the youth, EC use gained popularity due to its social acceptability and the inclusion of appealing flavours and fragrances. Additionally, participants managed the higher costs of ECs by sharing and pooling expenses. Some users of combustible cigarettes transitioned to ECs with the expectation of achieving better health outcomes. Conclusion: This study establishes a foundation for undertaking quantitative research to identify pathways for assisting policymakers in mitigating the growing disease burden. Additionally, it aims to contribute to the achievement of Sustainable Development Goals 3a and 3.4 for Pakistan.
ABSTRACT
Introduction Lymphatic spread is the most common route of spread of endometrial carcinoma, and the most frequently involved lymph nodes are those of the external iliac group. MRI is one of the best imaging tools for the preoperative evaluation of patients with endometrial carcinoma. The objective of the current study is to analyze the relationship between tumor size and lymph node metastasis in patients with type I endometrial carcinoma. Methods This is a prospective observational study performed in the Department of Obstetrics and Gynaecology at Liaquat National Hospital, Karachi, Pakistan. The duration of the study was from January 2020 to January 2021. During this period, 86 patients with biopsy-proven type I endometrial carcinoma were selected. Tumor size was measured by MRI. All participants underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy. Histopathological evaluation was performed according to the College of American Pathologists (CAP) protocols, and staging was performed using the 2009 International Federation of Gynecology and Obstetrics (FIGO) staging system. Lymph nodes were considered positive or negative, irrespective of their number. Result Of the 86 patients, 25 (29.1%) had positive lymph node metastasis. The mean tumor size with positive lymph node metastasis by MRI and histopathology was 7.86 cm and 10.21 cm, respectively. Tumor size determined by MRI and histopathology was significantly associated with lymph node metastasis (p < 0.01 and p < 0.01, respectively). Tumor size was positively correlated with lymph node metastasis (r = 0.715). The cutoff value of >6.5 cm by MRI was established as the statistically significant differentiator of lymph node metastasis. The calculated sensitivity and specificity were 88% and 90.16%, respectively, with an area under the curve (AUC) of 0.920. The cutoff value of >8 cm by histopathology was established as the statistically significant differentiator of lymph node metastasis. The calculated sensitivity and specificity were 80% and 88.52%, respectively, with an AUC of 0.907. Conclusion Our results showed that lymph node metastasis in patients with type I endometrial carcinoma can be predicted by tumor size. This may help incorporate adequate surgical skills and management plans in the treatment course of type I endometrial carcinoma.
