Lymph node ratio as a prognostic marker of oral tongue squamous cell carcinoma: a cohort study.

INTRODUCTION: Lymph node metastasis is a poor prognostic indicator and is well established in tongue squamous cell carcinoma. Based on the current staging system, accurate risk stratification is difficult. There is thus a need to evaluate an alternate method for predicting recurrence and survival. The objective of the study was to evaluate lymph node ratio as a prognostic marker as compared with N-staging for tongue squamous cell carcinoma. MATERIALS AND METHODS: We conducted a retrospective cohort study with 56 patients with a lymph node ratio greater than 0.012 (exposed) and 74 patients with a lymph node ratio less than 0.012 (unexposed). Overall five-year survival and disease-free survival were assessed. The Cox proportional hazard model was used to analyse lymph node ratio as a predictor of outcome, together with other covariates. RESULTS: A total of 130 patients were included in the study. Patients with lymph node ratio greater than 0.012 had a poor overall five-year (mean survival time 52.1 months vs 38.1 months) and disease-free survival (mean survival time 53.6 months vs 39.2 months). The hazard of death among patients with a lymph node ratio greater than 0.012 was 3.24 times higher than the hazard of death among patients with a lymph node ratio less than 0.012 (95% confidence interval 1.82-5.77). DISCUSSION: Lymph node ratio is a superior prognostic marker compared with the currently used American Joint Committee on Cancer N-staging. Our findings also suggest that the margin status (involved) of the primary tumour resection adversely affects prognosis.

Cohort analysis of directly observed treatment outcomes for tuberculosis patients in urban Pakistan.

BACKGROUND: This quasi-experimental cohort study aimed to evaluate World Health Organization (WHO) defined tuberculosis (TB) treatment outcomes for patients under directly observed treatment at a health facility (clinic DOT) or at home (family DOT) in urban Pakistan. METHODS: We enrolled 582 sputum smear-positive TB patients being treated by either clinic DOT (n = 295) or family DOT (n = 287) in 11 treatment centres. Patients and/or family members were interviewed for baseline measurements. WHO-defined treatment outcomes were evaluated at the end of treatment. Proportions of 'cured' patients were computed. A log-binomial model was used to evaluate the associations of various factors with 'cured' status. RESULTS: The proportion of 'cured' patients was respectively 66% and 34% in the clinic DOT and family DOT groups (risk difference 0.32; 95%CI 0.24-0.39). Patients on clinic DOT were more likely to achieve cure (adjusted relative risk [RR(adj)] 1.85; 95%CI 1.43-2.39) than those on family DOT, as were patients satisfied with their health care worker's attitude (RR(adj) 5.73; 95%CI 2.54-12.96). CONCLUSION: Clinic DOT nearly doubled the proportion of cured patients compared to family DOT. Efforts to improve care-provider attitudes to enhance patient satisfaction, and effective implementation of the WHO's public-private mix approach, may enhance TB control in this and similar settings.

Prevalence and predictors of smokeless tobacco use among high-school males in Karachi, Pakistan.

A cross-sectional study was conducted in 3 towns in Karachi, Pakistan to investigate the prevalence of and factors associated with the use of smokeless tobacco among 772 high-school adolescent males. A structured questionnaire collected data on sociodemographic factors and history of cigarette and smokeless tobacco use. Prevalence of smokeless tobacco use (gutka, snuff, niswar) was 16.1% (95% CI: 13.5%-18.9%). On multiple logistic regression analysis, the factors significantly related to smokeless tobacco use among the sample were: attending government school [adjusted odds ratio (OR) 6.3], smoking cigarettes (OR 3.2), not seeing anti-tobacco advertisements (OR 1.5), family history of tobacco use (OR 3.9), use of betel quid (OR 2.9) and use of areca nut (OR 3.2).

Prevalence and predictors of smokeless tobacco use among high-school males in Karachi, Pakistan

A cross-sectional study was conducted in 3 towns in Karachi, Pakistan to investigate the prevalence of and factors associated with the use of smokeless tobacco among 772 high-school adolescent males. A structured questionnaire collected data on sociodemographic factors and history of cigarette and smokeless tobacco use. Prevalence of smokeless tobacco use [gutka, snuff, niswar] was 16.1% [95% CI: 13.5%-18.9%]. On multiple logistic regression analysis, the factors significantly related to smokeless tobacco use among the sample were: attending government school [adjusted odds ratio [OR] 6.3], smoking cigarettes [OR 3.2], not seeing anti-tobacco advertisements [OR 1.5], family history of tobacco use [OR 3.9], use of betel quid [OR 2.9] and use of areca nut [OR 3.2]

Prevalence and factors associated with practice of modern contraceptive methods among currently married women in District Naushahro Feroze.

OBJECTIVE: To estimate the prevalence and factors associated with practice of modern contraceptive methods among currently married women of reproductive age group (15-49 years) in District Naushahro Feroze. METHODS: A community based cross-sectional survey was conducted from May to June 2000. We interviewed 420 currently married women of reproductive age group (15-49) years. Information regarding socio-demographic factors, economic condition, their source of information for the message of family planning and reason of using any modern contraceptive method. RESULTS: The prevalence of modern contraceptive method was 27.9%. Final multiple logistic regression analysis showed that with husband agreement (OR, 5.4; 95% CI 2.2-13.2), women could go alone to a health care provider (OR, 1.4; 95% CI 1.1-2.4) and women employment status (OR, 2.5 95% CI 1.2-5.2) were significantly associated with practice of modern contraceptive methods. Similarly, those women who had 3 or more children were more likely to use any modern contraceptive methods compared to those who have 2 or less children. In addition, husband's education was also found significantly associated with family planning practice. CONCLUSION: The practice of modern contraceptive method is low. Socio demographic factors of women were significantly associated with use of modern contraceptive methods. Male and female education and small group discussions of various issues related to family planningand reproductive health may be helpful in creating awareness in the district.