Contribution of germ line BRCA2 sequence alterations to risk of familial esophageal cancer in a high-risk area of India.

The incidence of esophageal squamous cell carcinoma (ESCC) is very high in the northeast region of India. An earlier study from China and Iran suggested that mutations in BRCA2 gene may play a role in the etiology of familial ESCC. However, the frequency of BRCA2 gene germ line mutations and its contribution to risk of familial aggregation of ESCC in high-risk region of India are not known. In the current study of 317 cases of esophageal cancer, 92 (29%) cases had a family history of esophageal and/or other cancers. Of these 92 patients, 45 (49%) patients had a family history of esophageal cancer. The risk of developing esophageal cancer was higher in cases where family history showed occurrence of cancers in first-degree relatives (odds ratio [OR]: 3.1; confidence interval [CI]: 1.9-5.3) than in second-degree relatives (OR: 1.3; CI: 0.25-3.2). Moreover, the risk of developing esophageal cancer was higher in subjects whose predegree suffered from esophageal cancer (OR: 2.4; CI: 1.1-4.1) than from any other cancers (OR: 1.1; CI: 0.32-3.3). The subjects with family history of cancer were more likely to develop ESCC if they were tobacco chewers (OR: 4.2; CI: 2.1-5.8) and betel quid users (OR: 3.6; CI: 1.8-4.6). Screening for mutations of the BRCA2 gene in the germ line DNA was carried out for 20 familial and 80 nonfamilial ESCC patients. One hundred unrelated healthy controls from the same population were included in this study. Nonsynonymous variants in exon 18 (K2729N) and exon 27 (I3412V) of BRCA2 gene were found in 3 of 20 patients with familial ESCC. No sequence alterations were found in 80 nonfamilial ESCC cases (P=0.01) and 100 healthy controls (P=0.0037), suggesting that germ line BRCA2 gene mutation may play a role in familial aggregation of ESCC in high-risk region of India.

The association of selected sociodemographic factors and differences in patterns of substance use: a pilot study in selected areas of Northeast India.

Emergence of new addictive substances and progressive increase of 'drug abuse" has become a serious problem in many countries. Despite legal restriction and administrative control, the use of illicit drugs (like opium, heroin, proxyvan, etc.) has increased considerably in many parts of Northeast India. A sample of 1831 people (age 10 years and above) were interviewed during 1997-1998 about their drug use habits, if any, and types of substance used, in Meghalaya and upper Assam. Prevalence of substance use was 29.4% tobacco (20.5% chewers and 12.7% smokers), 12.5% alcohol, and 4.9% opium. In Meghalaya, prevalence of tobacco use was high (41.7%), which was mainly due to the large number of female chewers and male smokers. Opium and cannabis users were mainly confined in Assam close to the Arunachal Pradesh border, indicating a regional influence. Wide differences were observed in the prevalence pattern of tobacco and alcohol use across location, sex, age, education, and occupation. An association of sociodemographic factors with substance use was documented. Religion and ethnic group have significant association with tobacco use patterns but are insignificant with regard to alcohol use. Use of multiple substances and use of cannabis as a substitute for opium are the major problems indicating drug dependence. Mean ages for substance use initiation were: 18.5 years for tobacco, 21.8 years for alcohol, and 25.8 years for opium. Not with-standing the study's limitations, these findings are useful for planned prevention efforts and formulation of a specific program considering the importance of regional and sociodemographic factors.

Betel nut and tobacco chewing; potential risk factors of cancer of oesophagus in Assam, India.

Cancer of the oesophagus is the most commonly diagnosed cancer in males in Assam, in north-eastern India, and ranks second for females. The chewing of betel nut, with or without tobacco and prepared in various ways, is a common practice in the region and a case-control study has been designed to study the pattern of risk associated with different ways of preparing and chewing the nuts. 358 newly diagnosed male patients and 144 female have been interviewed together with 2 control subjects for each case chosen at random from among the attendants who accompanied patients to hospital. There were significant trends in risk ratios associated with the frequency of chewing each day, with the duration of chewing in years and with the age at which the habit was started that were apparent for both males and females and which remained significant after allowance was made for other known risk factors, notably tobacco smoking and alcohol consumption. The adjusted ratios, in comparison with non-chewers, were 13.3 M and 5.7 F for chewing more than 20 times a day, 10.6 M and 7.2 F for persons who had chewed for more than 20 years and 10.3 M and 5.3 F for those who had started before the age of 20. Among the different combinations of ingredients that were chewed the adjusted odds ratios were highest for those who had been using fermented betel nut with any form of tobacco (7.1 M and 3.6 F). The risk associated with tobacco smoking and alcohol consumption, which are high in some parts of the world, were less in Assam than those associated with the chewing of betel nut.

Role of dietary habits in the development of esophageal cancer in Assam, the north-eastern region of India.

The etiology of esophageal cancer remains largely unknown. In recent years, the role of dietary habits in the development of esophageal cancer has received much attention. Prevalence of esophageal cancer in Assam is highest among all the states of India. To identify the possible risk factors, a hospital-based case-control study was conducted with 502 cases and 1,004 controls. "Kalakhar," a unique and locally made food item, has emerged as a significant risk factor (odds ratio = 8.0, 95% confidence interval = 5.1-11.5, p < 0.001). Consumption of very spicy foods, hot foods and beverages, a diet containing high amounts of chili, and leftover food was positively associated with the risk of esophageal cancer. Green leafy vegetables and fruits were protective for esophageal cancer. The risk factors associated with consumption of locally prepared food items, e.g., kalakhar, and some dietary practices did not decrease, even after adjustments with different confounding factors. However, further studies are required to conclusively implicate these factors in causation of esophageal cancer.

Differences in blood pressure level and hypertension in three ethnic groups of northeastern India.

A cross sectional study on hypertension was done on 294 subjects aged 30 years and above. 150 households were selected randomly representing 50 households from each locality inhabited exclusively by the rural Mizos, indigenous rural Assamese and the tea-garden workers respectively, in the northeastern region of India. Blood pressure was measured by sphygmo-manometer in sitting posture. Anthro-pometric measurements were taken using standard procedure for measuring height, weight, waist and hip girth. Information on age, sex, ethnicity, literacy, alcohol intake, smoking pattern, physical activity, occupation, amount of salt consumption was collected using a standard and pre-tested questionnaire. Significant differences were observed in both the systolic and diastolic blood pressure levels among the three different ethnic groups selected for this study (p < 0.0001). Multiple regression analyses indicated that in Mizos, age, waist circumference and alcohol intake were independently associated with increase in systolic blood pressure whereas smoking was found to be negatively associated with systolic blood pressure (R2 = 0.391, p < 0.001). Factors, which were the best predictors of diastolic blood pressure, were age and body mass index [(kg/m2) (R2 = 0.227, p < 0.001)]. In the rural Assamese population, the best predictors of systolic blood pressure were age and waist circumference (R2 = 0.263, p = 0.018). For the diastolic blood pressure, age, alcohol intake and body mass index were important correlates (R2 = 0.131, p < 0.001). In the tea garden community, important predictors of systolic blood pressure were age, gender and marital status (R2 = 0.187, p < 0.001). On the other hand, age and alcohol intake were best predictors for diastolic blood pressure (R2 = 0.09, p < 0.001).

Prevalence and pattern of substance abuse at bandardewa, a border area of assam and arunachal pradesh.

A total of 312 persons aged 10 years and above were interviewed to collect information about their habits of taking tobacco, alcohol and other substances. The study reveals that 40.4% of the respondents used tobacco irrespective of their using pattern, with significant difference between sexes (p< 0.001). Among tobacco users 58.2% were only tobacco chewers. 26.3% were smokers and 15% of them were practicing both the modes. 61.4% among housewives were tobacco users. Prevalence of alcohol use was 36.5% among the respondents. Alcohol use among males (39.5%) was slightly higher than females (32.6%). A significant association of alcohol users (p< 0.01) was observed with level of educational status. 3.4% of the study population were found to be habituated with substance abuse other than tobacco and alcohol. Percentage of injecting drug users was found to be 1.28%. A very small number (0.64%) was also found to be addicted to petrol inhalation.

Tobacco use in Mizoram, India: sociodemographic differences in pattern.

A study on tobacco use was carried out in Aizawl district of Mizoram, India, to assess the prevalence and pattern of tobacco use. An area served by two Sub-health Centers representing town and village population were selected for a household survey. 375 people (age 10 years and above) were interviewed about their habits of taking tobacco. Use of tobacco was high among males (56.6%) and females (45.7%), but the high prevalence of smoking among males (42.3%) and chewing among females (27.9%) indicates the existence of sex differences in tobacco use pattern. Age and occupation had significant association with tobacco use but influence of education was very low and its association was not significant. Mean age for start of tobacco chewing and smoking for males and females varied significantly. However, the mean age of start for adolescent and young age (10-29 years) tobacco users was 17.2 years (SD +/- 2.3). Though there are some limitations to this study, these findings revealed differential patterns of tobacco use which is valuable information for prevention effort.

A study of neonatal deaths in the tea gardens of Dibrugarh district of upper Assam.

A total of 2432 live births and 46 stillbirths were studied in some of the tea gardens of Dibrugarh district of upper Assam. The neonatal mortality rate was 46.5 per 1000 live births per year. Immaturity (21.2%), fever/sepsis (13.3%), breathing disorder (12.4%), neonatal tetanus (11.5%) and neonatal diarrhoea (8.8%) accounted for most of the neonatal deaths. There were 42.9% low birth weight infants and this was associated with 92.8% of total neonatal deaths and 34.3% of preterm babies were associated with 90.7% of neonatal deaths. The case fatality rate among low birth weight and preterm babies was 9% and 11% respectively. High risk of neonatal deaths had been found among the neonates in case of no maternal immunisation, delivery attended by untrained person and newborn care at home.

Opium addiction in assam : a trend analysis.

A survey on opium use was earned out in Tinsukia district of upper Assam to assess the present prevalence and pattern of opium abuse and compared with earlier findings of the year 1981 (Baruah et al., 1995). A total of 75 addicts could be detected during the survey and 61 were interviewed using structured questionnaire. The results indicate significant decline in prevalence in opium use over the years in all the villages under high prevalence area. Out of 61 addicts, 51 addicts had started taking opium before 1980 and only 10 new addicts were added by 1990. The trend analysis of opium user's from 1979 to 1995 indicates a linear trend with high rate of decline in opium addicts statistical analyses, supports the hypothesis that linear declining trend is the best fit. By 1995, only four addicts were found having continued taking of opium.

Profile of heroin addicts in Nagaland, India.

A total of 395 drug addicts from Nagaland, India during 1992-1993 were studied. Of these, 331 (83.8%) were primary abusers of heroin. Mean age of the group was 21.8 years +/- SD 3.84. Of these 5.2% were females. The majority were unmarried (92.1%) and 52% had completed 10 years of schooling. Drug-related school dropout rate was 72.8%. Unemployment was predominant (90.3%) in the group, of which most were never employed. Christianity was the main religion (90.9%) of the group. The mean age at first use of heroin was 17.6 years +/- SD 3.68. The mean duration of dependence on heroin was 4.4 years +/- SD 2.8. Heroin was injected by 80.9% subjects. Friends were the main source of introduction. Concurrent use of tranquilizers and codeine containing cough syrups was prevalent in the event of a short supply of heroin. The involvement of young, unemployed, unmarried persons in heroin addiction; widespread prevalence of the injection route and needle sharing; chronicity of heroin dependence; paucity of specialized treatment avenues and proximity to the Golden Triangle facilitating illicit traffic, have contributed to emergence of heroin addiction as a major public health problem in Nagaland.

Codeine containing cough syrup addiction in assam and nagaland.

The drug abuse monitoring study of Regional Medical Research Center, Dibrugarh, reported 181 and 395 addicts from the states of Assam and Nagaland respectively in one year. Of these, 48 (26.5%) and 49(12.4%) cases were contributed by the primary abuse of codeine containing cough syrups. A11 addicts were males in their early twenties. Most of the addicts were unmarried and educated up to matriculation. The majority of addicts in Assam were Hindus (85.4%) and in Nagaland Christians (81.63%). Unemployment was predominant in both the groups. The mean age for the first use of codeine cough syrup was 17.44 years (Assam) and 15.77 years (Nagaland). Nagaland had more chronic abusers. Addicts were used the oral route several times a day and friends were the main source of introduction. Mild forms of physical and psychiatric disorders were reported Easy over-the-counter availability, lesser expenditure, milder withdrawals and ease of consumption without secrecy were some of the reasons for the emergence of this new form of addiction in Assam and Nagaland.