Observations of noise induced hearing loss in a heavy engineering industry in Kolkata.

BACKGROUND AND OBJECTIVE: Noise is a major health threat in occupations where its level exceeds the permissible level (90dB). Most serious health effect is Noise Induced Hearing Loss (NIHL). Objective of the present study was to find out any relationship between occupational noise exposure and hearing impairment of the employees in a heavy engineering industry. METHODS: A cross-sectional study was conducted during May 2005 to April 2006 in a selected heavy engineering industry in Kolkata. All the employees working in the factory were included in the study. Data were collected through interview, physical examination, audiometry and environmental noise survey. RESULTS: Among the total of 278 employees of this study, 235 employees were exposed above the permissible occupational noise level (90dB), out of whom 82 (34.90%) employees were deaf which was much more than the deafness among the nonexposed workers 3 (6.98%). Hearing impairment increased as exposure level increased and this was statistically significant (chi2 = 17.97, df = 2, p = 0.0001). Hearing impairment also increased with duration of exposure (chi2 = 7.12, df = 2, p = 0.0284). CONCLUSION: Hearing impairment is associated with occupational noise exposure and thus pre-placement and periodical medical examination is of vital importance.

Analysis of feasibility of myeloablative therapy and autologous peripheral stem cell (PBSC) transplantation in the elderly: an interim report.

An interim report evaluating the feasibility of myeloablative therapy followed by peripheral blood stem cell (PBSC) autotransplant in patients aged >60 years is presented. In the last 2 years 19 patients >60 years old with several oncological conditions, mostly hematological, underwent PBSC autotransplant either as salvage therapy following relapse or resistance to conventional treatment, or as consolidating therapy as a part of a well defined protocol. There were 13 males and six females; the mean age was 66.9 years (range 61-76 years); nine patients had resistant or relapsed lymphoma, six myeloma, two acute leukemia, one Waldenstrom's disease and one lung cancer. Myeloablative schemes included BEAM exclusively for lymphomas, busulfan and melphalan (Bu-MPH) mainly for myeloma, busulfan and cyclophosphamide (Bu-CTX) for lymphomas and leukemia and VP-16 and CTX for lung cancer. Mobilization of CD34+ cells was achieved in all patients with the combination of high-dose CTX and G-CSF with collections between 2.83 to 19.04 x 10(6)/kg (mean 7.1). All patients engrafted with a median time for recovery of PMN (>0.5 x 10(3)/microl) of 10 days (range 8-12 days) and for PLT (>20 x 10(3)/microl) of 12 days (range 10-17 days). Major responses were obtained in 15 of 16 patients evaluable for response and eight patients entered CR; overall eight patients are in CR, five are alive with disease, five are dead from disease progression and one is dead because of congestive heart failure 7 months following PBSC autotransplant. No early deaths following the procedure occurred; major side-effects were grade I-II mucositis (58%), fever with documented sepsis (10%), pneumonia (5%), cardiac, renal and liver toxicity (5%). Cardiac function was evaluated before and after myeloablative therapy by VEF in all patients; no significant modifications were necessary. In conclusion, our experience demonstrates that myeloablative therapies in older selected patients can be feasible; the feasibility of introducing PBSC autotransplantation following myeloablative therapy as a front-line treatment in patients aged >60 years, needs accurate guide lines for selection of appropriate patients.

Sequential high dose-density chemotherapy in advanced ovarian cancer.

Introduction of paclitaxel or anthracyclines can improve the results of chemotherapy in advanced ovarian cancer. Dose intensification (by shortening of intervals between cycles) and sequential administration of active regimens at least theoretically may improve chemotherapy effectiveness. 18 patients entered into a pilot trial of combination chemotherapy. Treatment consisted of cisplatin 50 mg/m2, epidoxorubicin 60 mg/m2 and cyclophosphamide 500 mg/m2 every 14 days for six cycles, followed by paclitaxel 175 mg/m2 (3-hour infusion) every 14 days for four cycles. Granulocyte colony stimulating factor at 300 mcg was employed between cycles on days 5-10. 16 out of 18 patients who entered the study received a full dose chemotherapy with a ratio between actually received and planned dose intensity of 0.8 or more. No life-threatening side effect was observed and toxicity was acceptable. This new approach based on sequential administration of active regimens at high dose intensity proved feasible, active and devoid of unacceptable toxicity. The administration the booth of paclitaxel and epidoxorubicin with cisplatin and cyclophopshamide has been rendered possible. Further studies are warranted.

Sociodemographic and substance use correlates of repeated relapse among patients presenting for relapse treatment at an addiction treatment center in Kolkata, India.

BACKGROUND: In India, substance abuse has infiltrated all socio-cultural and economic strata causing loss of productivity. Prevention of relapse is crucial for its control. OBJECTIVES: To find out the pattern of substance use, relapse rate, its association with various socio-demographic factors and treatment related issues. METHODS: An observational study with cross-sectional design during April 2009-March 2010 at a de addiction centre was conducted among consecutive 284 clients admitted with relapse. They were detoxified earlier in the same centre. Data were collected by interviewing clients with schedule and clinical examination. RESULTS: Brown sugar (an adulterated form of Heroin) was primary drug of abuse in urban area contrary to alcohol in rural area. Commonest age of initiation was between 15-20 years. Polydrug abusers (59.1%) were common. Only 31.3% of the relapse cases took regular follow up. Common psychiatric illnesses were anxiety (44.7%) and depression (30.6%). Peer pressure (77.8%) was commonest cause of relapse. Significantly higher relapse episodes were present with increasing age, Muslim religion, ever marriage, poor literacy, current unemployment, living in nuclear rather than joint family, early age of initiation, longer duration of abuse and no follow up. CONCLUSION: Regular follow up with family, peer and social support are essential along with vocational rehabilitation to prevent relapse.

Assessing cold chain status in a metro city of India: an intervention study.

BACKGROUND: Cold chain maintenance is an essential activity to maintain the potency of vaccines and to prevent adverse events following immunization. One baseline study highlighted the unsatisfactory cold chain status in city of Kolkata in India. OBJECTIVES: To assess the changes which occurred in the cold chain status after the intervention undertaken to improve the status and also to assess the awareness of the cold chain handlers regarding cold chain maintenance. METHODS: Intervention consisted of reorganization of cold chain points and training of health manpower in Kolkata Municipal area regarding immunization and cold chain following the guidelines as laid by Govt of India. Reevaluation of cold chain status was done at 20 institutions selected by stratified systematic random sampling after the intervention. The results were compared with baseline survey. RESULTS: Significant improvement had been observed in correct placing of cold chain equipment, maintenance of stock security, orderly placing of ice packs, diluents and vaccines inside the equipment, temperature recording and maintenance. But awareness and skill of cold chain handlers regarding basics of cold chain maintenance was not satisfactory. CONCLUSIONS: The success of intervention included significant improvement of cold chain status including creation of a designated cold chain handler. The gaps lay in non-availability of non-electrical cold chain equipment and separate cold chain room, policy makers should stress. Cold chain handlers need reorientation training regarding heat & cold sensitive vaccines, preventive maintenance and correct contingency plan.

Expenditure to treat thalassaemia: an experience at a tertiary care hospital in India.

BACKGROUND: The medical and economic problem of thalassaemia are considered to be a vast public health problem in the thalassaemia belt countries, emphasizing more on prenatal diagnosis as the solution of the problem. METHODS: A cross-sectional descriptive study was conducted in the Institute of Haematology & Transfusion Medicine located in Medical College, Kolkata, India to assess the socio-demographic profile, clinical presentation, expenditure for treatment of thalassaemia patients and awareness about cause and prevention of the disease. RESULTS: Thalassaemia patients attended the Govt. setting were mostly from lower socioeconomic status with low level of literacy. Annual expenditure for treatment of thalassaemia ranged from $ 108 to 432; depending on type of treatment with average cost per transfusion was $ 5.2±2.2. Average 18.5%±14.3 of the total annual income was spent on the treatment for thalassaemia. Average man days or school days lost for the patients was 29.87±18.5 and 19.07±12.7 for the accompanying persons. CONCLUSION: Blood transfusion and carrier screening facilities should be decentralized to decrease the expenditure for treatment and alleviate the harassment of the families. Folate and calcium tablets, hepatitis B vaccination can be made available at government setting free of cost.

Functional Disability and Associated Chronic Conditions among Geriatric Populations in a Rural Community of India.

BACKGROUND: Geriatric population and chronic diseases are increasing throughout the world especially in developing countries like India. Because of social change and urbanization, disability is also a problem in India. As the major reasons for geriatric disabilities are chronic diseases, a study was undertaken. OBJECTIVES: To find out the prevalence of different chronic diseases and disability among the geriatric population in a rural community of India and to determine the association between chronic diseases and disability of the geriatric population. METHOD: A cross-sectional, observational community based study was conducted in a rural area of West Bengal, India through house to house visit for Clinical examination, observation and interview with a predesigned pre-tested proforma RESULTS: Out of 495 study population, 80 (16.16%) were found to be functionally disabled as per ADL scale and more than half (56.2%) of them had 3 or more chronic conditions. 92.5% of study populations had one or more chronic conditions CONCLUSION: Association between different risk factors and disability was found with age, sex, anaemia, Chronic Obstructive Pulmonary Diseases(C.O.P.D), scabies, hypertrophy of prostate, ischaemic heart disease, osteoporosis, osteoarthritis and acid peptic disorder were the risk factors of disability. These data suggest the significant chronic conditions and risk factors associated with disability. Measures to reduce such chronic conditions and impairment would be the useful approach for the prevention of disability.

Costs of high-dose salvage therapy and blood stem cell transplantation for resistant-relapsed malignant lymphomas in a southern Italian hospital.

BACKGROUND AND OBJECTIVE: Analysis of costs of high technological procedures such as peripheral blood stem cell (PBSC) autotransplantation in lymphomas are generally finalized at disclosing whether the improvement of survival in a subset of patients is cost effective and whether the cost of the procedure could be reduced. With the aim of revealing a possibility of reducing costs with respect to conditions of safety, we present our experience with PBSC autotransplantation in a particularly poor prognosis subset of patients with lymphoma. DESIGN AND METHODS: The expenses are analyzed for groups of cost and main resources necessary at unitary cost are considered separately. Groups of cost include various phases of the PBSC autotransplantation such as preparative procedures, execution of myeloablative therapy, reinfusion of CD34 cells, supportive therapy after reinfusion until discharge of the patient, general support for the management of patient. All costs are calculated according to 1997 prices and salaries and reported in dollars. The analysis was conducted on 21 patients with lymphoma resistant to other therapies treated by myeloablative therapy and PBSC autotransplantation in an hematologic unit in an open ward; the assistance was provided by staff not exclusively dedicated to bone marrow transplant procedures, with some help from a family member. RESULTS: The PBSC procedure, including all phases, costs from $17,761.9 to $18,259.9 depending on the type of myeloablative therapy employed; the mean cost was $18,092.6. The preparative phase with mobilization of CD34 cells, cryopreservation and reinfusion costed $3,538.7 (19.6% of the total cost); a major cost of this phase was cryopreservation and CD34 manipulation ($857.1). The second phase with myeloablative therapy and reinfusion of CD34 cells had a mean cost of $2,785.9 (15.4% of the total cost); a major cost of this phase was the hospitalization ($1,119.8). The third phase of patient's support after treatment had a total cost of $7,649 (42.3% of the cost of the total procedure) with the major cost being due to hospitalization ($2,571) calculated on a mean of 15 days after the reinfusion of CD-34. The last group of costs, including management support, accounted for $4,119 (22.7%) with a major cost being amortization of the structure ($1,600). The general cost for nurse's assistance to the patient was $1,355.1 (7.5%). INTERPRETATION AND CONCLUSIONS: A procedure of PBSC autotransplantation in resistant lymphoma is affordable without the strict precautions generally given in intensive care units. This provides a substantial reduction of expenses because of the low number of specifically trained staff members and the generally low cost of the necessary supplies. Before, however, proposing PBSC autotransplantation in most patients with resistant lymphoma, an evaluation of whether costs could be further reduced and whether the procedure has a cost benefit impact is needed.