Evaluation of risk factors of oral cancer

This cross sectional study was done for the evaluation of the risk factors of oral cancer. This study was carried out in the department of Otolaryngology-Head & Neck Surgery of Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College Hospital, Dhaka, Bangladesh. A total of 90 consecutive patients with oral squamous cell carcinoma (OSCC) were studied in Otolaryngology department of BSMMU and DMCH from January 2003 to December 2005. A questionnaire was used for data collection from careful history taking, clinical examination and investigations. About 71.1% were habituated with betel quid chewing, 36.7% were habituated with smoking but among 23.3 % also betel quid chewer in addition. None of the patient was found to be habituated with alcohol consumption. Majority of the patients of OSCC were malnourished, of which female were more in number, and it was found that nutritional status was significantly associated with sex. Odds ratio (OD) showed that malnutrition was positively associated with female subjects. Also it was found that 69.01% betel quid chewer was malnourished and nutritional status was significantly associated with chewing and smoking habit. Betel quid chewing, smoking and malnutrition is important risk factor of oral cancer.     

精神分裂症患者嚼食槟榔行为及其相关因素简

目的 分析精神分裂症患者嚼食槟榔行为及其相关因素.方法 采用方便抽样法,于2010年12月～2011年10月对在海南省安宁医院住院的精神分裂症患者嚼食槟榔情况进行分析.结果 精神分裂症患者嚼食槟榔率为48.2％（119/247）.嚼食槟榔的患者中,伴有吸烟习惯者占58.0％（69/119）,有饮酒习惯者占26.1％（31/119）,嚼食槟榔、吸烟、饮酒习惯皆有者占21.8％（26/119）.男性、饮酒、家人从事过与槟榔有关职业的患者更可能嚼食槟榔（OR=4.02,P=0.000;OR=4.32,P=0.001;OR=4.65,P=0.000）.结论 精神分裂症患者嚼食槟榔行为与当地盛产槟榔密切相关,应通过在当地积极开展嚼食槟榔的危害宣传,减少患者嚼食槟榔行为.     

Pattern of cancer occurrence in rural population of West Bengal--a hospital-based study

Incidence of cancer in India is lower than in the West and the commonly affected sites are very different. Cancers of the upper alimentary and respiratory tracts (oral cavity, pharynx, larynx) contribute more than half of the cancers in men and about a quarter in women. Indigenous habits of chewing and smoking seem to be primarily responsible for the high incidence of these cancers. During a 10-year study period, out of a total 20072 cases biopsied, 3226 (16.07%) were malignant. The maximum number of malignancies were from cervix uteri ie, 1499 (44.92%); next oral cavity and pharynx (n = 437; 13.55%) frequently found in males; breast was third in the series. Cancer of the cervix uteri is a major problem in women. Practical measures are to be taken for the prevention of these cancers common in India.     

The effect of betel quid chewing on the Achilles tendon reflex time

This study investigated the effect of betel quid chewing on the somatic motor pathway (Achilles tendon reflex time). The subjects, 48 healthy male volunteers, were divided into 4 groups: a control group; first-time chewers; occasional chewers; and habitual chewers. The Achilles reflex time (ART) of the subjects was taken 5 minutes after ingestion of the quid preparation and their pulse rate and respiratory rate were also recorded. The results show that betel quid chewing reduced the ART and increased the pulse rate and respiratory rate. It can be concluded that betel quid chewing causes a transient peripheral stimulation of the somatic motor pathway with a resultant hyperreflexia.     

Vitamin C and the common cold: a double-blind trial

A large scale double-blind trial was conducted to test the claim that the intake of one gram of vitamin C per day substantially reduces the frequency and duration of “colds”. It was found that in terms of the average number of colds and days of sickness per subject the vitamin group experienced less illness than the placebo group, but the differences were smaller than have been claimed and were statistically not significant. However, there was a statistically significant difference (P <0.05) between the two groups in the number of subjects who remained free of illness throughout the study period. Furthermore the subjects receiving the vitamin experienced approximately 30% fewer total days of disability (confined to the house or off work) than those receiving the placebo, and this difference was statistically highly significant (P <0.001). The reduction in disability appeared to be due to a lower incidence of constitutional symptoms such as chills and severe malaise, and was seen in all types of acute illness, including those which did not involve the upper respiratory tract.     

Identifying Patient Smoking Status from Medical Discharge Records

The authors organized a Natural Language Processing (NLP) challenge on automatically determining the smoking status of patients from information found in their discharge records. This challenge was issued as a part of the i2b2 (Informatics for Integrating Biology to the Bedside) project, to survey, facilitate, and examine studies in medical language understanding for clinical narratives. This article describes the smoking challenge, details the data and the annotation process, explains the evaluation metrics, discusses the characteristics of the systems developed for the challenge, presents an analysis of the results of received system runs, draws conclusions about the state of the art, and identifies directions for future research. A total of 11 teams participated in the smoking challenge. Each team submitted up to three system runs, providing a total of 23 submissions. The submitted system runs were evaluated with microaveraged and macroaveraged precision, recall, and F-measure. The systems submitted to the smoking challenge represented a variety of machine learning and rule-based algorithms. Despite the differences in their approaches to smoking status identification, many of these systems provided good results. There were 12 system runs with microaveraged F-measures above 0.84. Analysis of the results highlighted the fact that discharge summaries express smoking status using a limited number of textual features (e.g., “smok”, “tobac”, “cigar”, Social History, etc.). Many of the effective smoking status identifiers benefit from these features.     

“Different trend” in multiple primary lung cancer and intrapulmonary metastasis

Background

The distinguishing of intrapulmonary metastatic tumors from multiple primary lung cancers is difficult but of great importance for the therapeutic management and prognosis of these patients.

Methods

We used genomic DNA analyzed by six microsatellites (D7S1824, D15S822, D2S1363, D10S1239, D6S1056, and D22S689) with PCR to identify discordant allelic variation from 12 patients. There are five patients with multiple primary lung cancers and seven patients who were diagnosed with intrapulmonary metastases from 850 patients with primary lung cancer in our hospital. The experiments were approved by the West China Hospital Ethics committee (No. 2013 (33)) and all patients agreed to participate in the study and signed an informed consent form.

Results

In the group of metachronous lung tumor, three of five patients have different histological types and one of five patients have the same histological type which showed “contradictory trend”. The other one showed “unique trend”. In the second group (intrapulmonary metastasis lung tumor), one patient showed “contradictory trend” and the others showed “unique trend”.

Conclusions

“Different trends” are useful in discrimination of intrapulmonary metastasis lung cancer and multiple primary lung cancer even diagnosed with the histopathological evaluation.     

A Cervical Cytology Program in General Practice

In a six-year period 723 women were examined using cervical cytology smears. Fifteen cancers of the cervix were discovered, including two invasive growths and 13 carcinoma in situ. A careful follow-up was carried out, and the later appearance of cancer was noted in 12 of 41 patients who initially showed only atypical cells. It is recommended that all patients showing “positive” cells (atypical, suspicious, or cancer morphology cells) undergo cone biopsy for definitive histological diagnosis. Target lesions should have punch biopsy. Four cancers were found in 170 obstetrical patients, and it is recommended that this proved high-risk group be screened both prenatally and postnatally. The importance of annual screening of all women over 20 years of age for cancer of the cervix by cytological methods is emphasized.     

Possible aetiology of oral cancer in Papua New Guinea

Oral cancer is the most common cancer seen in Papua New Guinea. Although there is a broad geographical correlation with betel chewing, there have been no analytical epidemiological studies and the aetiology remains poorly understood. A greater understanding of several putative risk factors and how they may interact is needed prior to any attempt to modify traditional customs. Although current strategies for primary prevention in India are based on the assumption that the risk of betel chewing is related to the tobacco in the quid, this cannot explain oral cancer in Papua New Guinea. In the latter, special epidemiological and laboratory investigations are needed to provide a scientific basis for future prevention.     

The influences of race and environment on ischemic heart disease

Certain “primitive” peoples such as traditional-living nomadic Eskimos have as yet been spared from the current epidemic of ischemic heart disease. A review of risk factors for underdeveloped populations suggests that environment rather than constitution is responsible. Favourable factors include the absence of overeating, a substantial level of of physical activity, only recent acquisition of the cigarette habit and absence of competitiveness. However, risk factors generally operate as in the “white” community, and where a Western lifestyle is embraced through either migration or acculturation the prevalence of ischemic heart disease rapidly increases to the levels encountered in “civilized” groups.     

A Preventive Approach to Impetigo of Treaty Indians Using Staphylococcus Polyvalent Somatic Antigen Vaccine

In a controlled study, Greenberg's staphylococcal polyvalent somatic antigen vaccine was administered to 190 Indian volunteers of a reserve in Saskatchewan in an attempt to reduce the incidence of impetigo. An intradermal skin test dose of 0.1 ml. was given initially. Reactors were forthwith placed in a separate category, otherwise this test injection was followed by intramuscular injection of 0.25 ml. of the vaccine, repeated a second time after six weeks. One hundred and sixty-nine controls received “placebo vaccine”. Four months later the number of cases of impetigo in the vaccinated group had been reduced from 55 to 16. There was no reduction in the control group. The preventive effect waned after five months. The results of this field trial are considered encouraging.     

Peptic ulcer disease: a clinical study in 73 children

Seventy-three children with peptic ulcer have been admitted to The Montreal Children's Hospital and l'Hôpital Sainte-Justine over the past 11 years. The primary ulcer group comprised 39 duodenal and nine gastric ulcers; repeat contrast studies were necessary to demonstrate a crater in 25%. Vomiting was especially prominent in the younger patients (1 month to 6 years). Pain was present in the majority of older patients (6 to 18 years) but was considered “typical” in no more than one third. Bleeding occurred more commonly in the older children but five had occult bleeding only. There was a positive family history in 11 children with primary duodenal ulcers but in none of those with gastric ulcers. Follow-up in 34 cases with primary ulcers showed that close to two thirds of the older children have had recurrent problems. Bleeding and/or perforation was the most common mode of presentation in 25 cases of secondary ulcers. Corticosteroids and increased intracranial pressure were the most frequently associated factors, the younger age group being at greater risk.     

PSYCHIATRIC EVALUATION OF LIMB FRACTURE PATIENTS

The study included 70 consecutive patients with fracture of the lower and upper limbs each and an equal number of age and sex matched normal control subjects. All the subjects were screened using the General Health Questionnaire (GHQ), the Michigan Alcoholism Screening Test (MAST), Carroll Rating Scale for Depression (CRSD), State-Trait Anxiety Inventory (STAI), Impact of Events Scale (IES), Fatigue Scale (FS) and the Perceived Stress Questionnaire (PSQ). Probable “Psychiatric cases” identified by the questionnaires underwent diagnostic psychiatric evaluation. As compared to normal controls, the limb fracture patients obtained significantly higher scores on the GHQ, MAST, CRSD, IES & FS but not on the STAI & PSQ. Psychiatric evaluation revealed significantly higher prevalence of psychiatric disorders in lower limb fracture patients (n=31) as compared to upper limb fracture patients (n=18) and control subjects (n=6). Limb fracture patients had a high prevalence of alcohol dependence/abuse (243%) and depressive disorders (6.4%). The results indicate that psychological intervention would greatly facilitate the management of these patients.KEY WORDS: Alcohol dependence, Depression, Limb fracture patients, Psychological morbidity     

Ectopic Pregnancy: A Review of 113 Selected Cases

One hundred and thirteen selected cases of ectopic pregnancy were analyzed to clarify the diagnostic and therapeutic factors. The incidence of this condition was higher in “ward” patients and in the Negro. Salpingitis was the commonest etiological factor. The common symptoms were pain, a missed period, vaginal bleeding, faintness, nausea and vomiting, and shoulder pain. The common signs were abdominal tenderness, a positive “chandelier sign”, rebound tenderness, a pelvic mass and pallor. Fertility of the women in this series was equal to that of women in the general population of the same age group. The frog (pregnancy) test was the only significant laboratory test. Colpocentesis proved very helpful, whereas dilatation and curettage did not. Conservative operation, consisting of salpingectomy plus a uterine wedge, was recommended for tubal pregnancy and was performed in 107 patients. The ovary was removed only if involved. Interstitial pregnancies were treated by removal of the corneal portion of the uterus and by salpingectomy, rather than hysterectomy; this procedure was successful in four out of four patients. Incidental appendectomy is not recommended.     

Facilitating the acceptance of employment of older registered nurses among Japanese female registered nurses younger than 65 years old

Objective: In Japan, policies to ensure employment for persons aged 65 and older are being implemented. To facilitate the employment of older registered nurses working in hospitals, the understanding of registered nurses younger than 65 is necessary. We investigated the factors associated with the acceptance of employment of older registered nurses among registered nurses younger than 65.Materials and Methods: The subjects were female registered nurses younger than 65 working in 34 hospitals in Mie Prefecture. We distributed anonymous self-administered questionnaires. We conducted factor analyses of both respondents’ opinions on the employment of “Registered nurses aged 65–69” and “Registered nurses aged 70–74”. Multiple regression analysis was conducted to examine the associations between the “Acceptance of employing registered nurses aged 65–69” and “Opinions on the employment of registered nurses aged 65–69” (Statistical model 1). Moreover, multiple regression analysis was also conducted to examine the associations between the “Acceptance of employing registered nurses aged 70–74” and the “Opinions on the employment of registered nurses aged 70–74” (Statistical model 2).Results: Using factor analyses, the same factors were extracted for both, “Registered nurses aged 65–69” and “Registered nurses aged 70–74”. These factors were: “Health and job performance”, “Utilization of the knowledge and experience of older registered nurses”, “Reducing the workload burden of registered nurses”, and “Manners of older registered nurses”. Using multiple regression analyses, “Health and job performance”, “Utilization of the knowledge and experience of older registered nurses”, and “Reducing the workload burden of registered nurses” were significantly associated with “Acceptance of employing registered nurses aged 65–69” (Statistical model 1). The same 3 factors were also significantly associated with “Acceptance of employing registered nurses aged 70–74” (Statistical model 2).Conclusion: Hospital managers must pay careful attention to these 3 factors.     

Prevalence and risk factors of erosive esophagitis in Taiwan

BackgroundErosive esophagitis is a common condition in the western population. However, the prevalence and risk factors of this disorder in Taiwan remain unclear. This study investigated the current prevalence of erosive esophagitis in Taiwan and attempted to identify the risk factors for this disease.MethodsFrom January 2008 to May 2009, 2040 consecutive subjects who underwent upper gastrointestinal endoscopy during their annual health check-up were enrolled. The severity of erosive esophagitis was evaluated according to the Los Angeles classification, and the independent risk factors of erosive esophagitis were analyzed using the logistic regression method.ResultsThe prevalence of erosive esophagitis was 17.3% (352/2040), with 71.6%, 27.8%, 0.5% and 0% cases of grades A, B, C and D, respectively, according to the Los Angeles classification. Univariate analysis revealed that male sex, smoking, alcohol consumption, betel nut chewing habit, body mass index ≥ 27 kg/m², hypertension, use of calcium channel blockers, diabetes, hyperglycemia, hypertriglyceridemia, and hiatus hernia were associated with the development of erosive esophagitis. Multivariate analysis revealed that male sex [odds ratio (OR) = 2.013, 95% confidence interval (CI) = 1.439–2.815; p < 0.001), smoking (OR = 1.301, 95% CI = 1.089–1.555; p = 0.004), body mass index > 27 (OR = 1.348, 95% CI = 1.138–1.598; p = 0.001), and hiatus hernia (OR = 4.331, 95% CI = 3.304–5.784; p < 0.001) were independent risk factors for the development of erosive esophagitis.ConclusionThe current prevalence of erosive esophagitis in Taiwan is 17.3%. Male sex, smoking, obesity, and hiatus hernia are four independent risk factors for the development of erosive esophagitis in the Taiwanese population.     

Opportunities for Electronic Health Record Data to Support Business Functions in the Pharmaceutical Industry—A Case Study from Pfizer,Inc.

The Pfizer Healthcare Informatics team conducted a series of guided interviews with 35 Pfizer senior leaders to elicit their understanding, desires, and expectations of how Electronic Health Records (EHR) might be used in the pharmaceutical industry today and/or in the future. The interviews yielded fourteen use case categories comprising 42 specific use cases. The highest priority use cases were “Drug Safety & Surveillance,” “Clinical Trial Recruitment,” and “Support Regulatory Approval.” Fifteen EHR companies were surveyed to assess their functionality against the specified use cases. Self-reported responses from the EHR companies were highest for “Virtual Phase IV Trials” and “Document Management for Clinical Trials.” This research identifies preliminary opportunities for EHR products to provide aggregate, blinded data to address the interests of the pharmaceutical industry. However, further collaboration between the stakeholders will be necessary to ensure the full realization of the opportunities for data re-use.     

Hospital Infections Caused by a Group of Recently Recognized Strains of Staphylococcus aureus

A survey was made of the phage-types of staphylococci responsible for cross-infection in a large veterans' hospital between 1961 and 1964. An earlier survey had shown that in 1959 most of the infections were caused by staphylocci of the “80/81/82” group. In 1961 a new group of staphylococci were first recognized and provisionally designated as “Atypical Group III” strains; these were non-typable by the usual typing phages but showed inhibition patterns with some of the Group III phages. The “Atypical Group III” staphylococci all showed one or other of four patterns of multiple antibiotic resistance. By 1963 these resistant “Atypical Group III” staphylococci had become more frequent than “80/81/82” strains as causative agents of cross-infection, although both groups have continued to cause infections in the hospital. “Atypical Group III” strains mainly infected surgical wounds and skin ulcers, whereas “80/81/82” strains commonly produced primary skin sepsis, such as boils.