Women and tobacco: A cross sectional study from North India.

BACKGROUND: Tobacco is a leading risk factor for different types of diseases globally. Tobacco smoking by women is culturally unacceptable in India, but still women smoke tobacco at various times of their life. AIMS: The aim was to estimate the prevalence and pattern of tobacco use among women and to study the associated sociodemographic factors. SETTINGS AND DESIGN: This cross‑sectional study was conducted among women aged 30 years or over in an urban resettlement colony for the migrant population at Chandigarh, India. METHODOLOGY: The study included women used tobacco products on one or more days within the past 30 days. Through systematic random sampling, 262 women were studied. As a part of the study 144 bidi smoking women were interviewed using detailed semi‑structured questionnaire. STATISTICAL ANALYSIS: Descriptive statistics and hypothesis testing with Chi‑squared test and logistic regression were done using SPSS 16.0 version. RESULTS: Overall, the prevalence of tobacco use was 29.4% and that of bidi, zarda and hookah were 19.8%, 8.8%, and 2.7%, respectively. Around 6.2% women used tobacco during pregnancy. Teenage was the most common age of initiation of bidi smoking. Logistic regression analysis showed that the prevalence of tobacco use was high among Hindu unemployed women with no formal education belonged to scheduled caste, and those having grandchildren. CONCLUSIONS: This study highlighted high rates of tobacco use and explored both individual and family factors related to tobacco use among women. Affordable, culturally acceptable, sustainable and gender‑sensitive individual and community‑specific interventions will reduce the prevalence and effects of tobacco use.

Comparison of the Effects of Sevoflurane and Halothane on Arterial Oxygenation during One Lung Ventilation.

We investigated the effect of halothane and sevoflurane on oxygenation during one lung ventilation (OLV) in 24 patients undergoing elective thoracic procedures. After induction with thiopentone, 4-5 mg/kg and morphine 0.1 mg/kg, suxamethonium 2mg/kg was administered to facilitate tracheal intubation with a double lumen tube. Anaesthesia was maintained with 1.5-3% sevolurane (group 1, n = 12) or 1.1.5% halothane (group 2, n = 12) in 02 with N20 (1:1) and pancuronium bromide. Arterial blood gases were recorded before surgery in the lateral position with two lung ventilation (2LV), 10, 20 and 30 minutes after beginning of one lung ventilation. Morphine and endtidal inhalational anaesthetic concentration were titrated to desired anaesthetic depth and haemodynamic variables. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and central venous pressure (CVP) were measured during the study period. In both the groups there was a significant decrease of PaO2 apparent at 10 minutes after initiation of OLV. Thereafter PaO2 remained stable throughout the study period in both the groups. It is concluded that oxygenation did not differ significantly with either sevoflurane or halothane during OLV. It is also concluded that decrease in oxygenation with OLV is complete by 10 minutes of its initiation.

Sevoflurane for trans-sternal thymectomy in myasthenia gravis.

Myasthenic gravis (MG) is an autoimmune disease associated with acetylcholine receptor deficiency. Patients with MG exhibit increased sensitivity to non-depolarising muscle relaxants. In an attempt to avoid neuromuscular blockers, we used sevoflurane in two myasthenic patients undergoing trans-sternal thymectomy. Inhalation of 8% sevoflurane in oxygen using vital capacity technique produced rapid, pleasant and smooth induction and provided good tracheal intubating conditions. In both patients anaesthesia was maintained with 1.5-2% end-tidal concentration of sevoflurane and nitrous oxide in oxygen without adjunctive neuromuscular blocking agents. There were minimal changes in cardiovascular variables and recovery was faster. It is suggested that sevoflurane may be the main anaesthetic for both induction and maintenance in myasthenic patients undergoing trans-sternal thymectomy.

Comparison of perioperative morbidity in patients with ovarian malignancy undergoing radical cancer surgery with or without prior chemotherapy.

Evaluation was undertaken of the effect of chemotherapeutic drugs on the perioperative morbidity of patients with ovarian malignancy undergoing radical surgery. Twenty patients who had received cytotoxic drugs pre-operatively (group I) were compared with 11 patients in whom radical surgery was the first line of treatment (group II). Pre and post-operative cardiac, pulmonary, renal, hepatic and coagulation functions were compared in both groups, as well as the critical intra- and post-operative events like cardiac pump failure, respiratory dysfunction, rhythm disturbances, blood loss, etc. Demographic data, ASA status, biochemical and haematological parameters and cardiac ejection fractions were comparable in the two groups but patients in group I had significantly higher left ventricular end diastolic dimensions (P < 0.01). A higher number of patients in group I had pre-operative respiratory and coagulation factor abnormalities but critical intra- and post-operative events in both groups were comparable. The surgical time was significantly (P < 0.01) longer in group I (5.5 +/- 2.5 h) as compared to group II (4.5 +/- 1.5 h). One patient with extensive tumour spread and pre-operatively deranged coagulation profile (group I) died of disseminated intravascular coagulation in the post-operative period. It is concluded that patients with advanced ovarian malignancy, treated with cytotoxic drugs are more likely to have pre-operative cardiac, respiratory and coagulation abnormalities, which should be managed by thorough pre-operative evaluation and intensive intra- and post-operative monitoring.