Comparison of cough of 2 and 3 weeks to improve detection of smear-positive tuberculosis cases among out-patients in India.

SETTING: Governmental health facilities in six districts of India. OBJECTIVE: To estimate the prevalence of cough and to compare the detection of smear-positive tuberculosis (TB) among out-patients with cough of > or =2 or > or =3 weeks. DESIGN: Trained health workers questioned each out-patient for presence of cough. Those with cough > or =2 weeks underwent sputum microscopy. RESULTS: Of 55561 out-patients interviewed, 2210 (4%) had cough > or =2 weeks, of whom 267 had sputum-positive TB, compared to 182/1370 with cough > or =3 weeks. The 31% who did not spontaneously complain of cough were less likely to be sputum-positive than those who did (45/680 [7%] vs. 222/1530 [15%], P < 0.001), but they accounted for 45/267 smear-positive cases. Using cough > or =2 weeks as the screening criterion, the estimated number of smears performed per day at each primary and secondary health care facility was respectively 8 and 19, compared to 5 and 12 using cough > or =3 weeks. CONCLUSION: The detection of smear-positive TB cases can be substantially improved by actively eliciting history of cough from all out-patients, and by changing the screening criterion for performing sputum microscopy among out-patients from cough > or =3 weeks to > or =2 weeks. Before implementing this change nationally, its programmatic feasibility should be assessed.

Plasma level of antioxidant nutrients (retinol and alphatocopherol) in cases with different grades of cervical carcinoma.

A study was conducted on 23 patients on various grades of cervical cancer, selected purposely from Dhaka Medical College Hospital. Vitamin A and E level of this histologically proved cases showed mean serum level of vitamin A was 0.41 +/- 0.19 and that vitamin E was 4.21 +/- 2.15, and these low level was constant in all Histopathological grading of cervical cancer. Contraceptive user and smoker had very low level of vitamin A and E. Majority (51%) of the cases, were from lower middle class and 49% were from lower class, seventy seven percent were illiterate, 97% were married before 18 years, 57% had more than 6 children, 71% did not use contraceptive. The availability of vitamin A rich food were within reach of lower income group, than the food source of vitamin E which are usually of animal origin. It is concluded that in cervical cancer had low level of antioxidant vitamins A and E. Further study is indicated for understanding detail antioxidant nutrients role in aetiopathology of cervical cancer in Bangladesh.

Pulmonary and extrapulmonary manifestations in delayed diagnosis of lung cancer in Bangladesh.

Study on the mode of presentation among 3815 lung cancer patients showed that 3608 (75%) presented with respiratory symptoms and 953 (25%) with extrapulmonary symptoms. Of the respiratory symptoms, cough was the complaint in 1940 (51%), features of superior vena cava obstruction (SVO) in 451 (12%), hemoptysis in 332 (9%), and dyspnea in 139 (4%). Analysis of extrapulmonary symptoms showed 348 (9%) patients appeared with complaints of bone pain, 273 (7%) with pyrexia of unknown origin (PUO). 235 (6%) with enlarged cervical glands, 39 (1%) with hoarseness, 29 (0.76%) with arm pain, 14 (0.36%) with jaundice, and the remaining 15 (0.39%) patients, categorized as miscellaneous group, presented with heterogeneous symptoms. In our study, cough, SVO, hemoptysis, dyspnea, bone pain, enlarged cervical glands, and PUO were the commonest mode of presentation and significantly higher than earlier reports (P less than 0.001). Our results may be explained by patient and/or physician delay due poor awareness of high-risk symptoms of lung cancer.

A new combination chemotherapy for recurrent Hodgkin's lymphoma.

Thirty seven Hodgkin's lymphoma patients with recurrence after first remission induced by radiation therapy and/or chemotherapy with mustine, oncovin, procarbazine and prednisolone (MOPP) were randomised to treat with a new combination chemotherapy comprising of doxorubicin, oncovin, procarbazine and prednisolone (DOPP). While the other group received further cycles of MOPP. Twenty two patients received DOPP and out of them 14 (63.6%) showed complete remission (CR). Other group of 15 patients were treated with further cycles of MOPP and among them two (13.3%) showed CR. However, the overall response rate including CR and partial remission (PR) in both the groups were almost same, 90.9% with DOPP and 86.6% with MOPP. It is concluded that DOPP combination is satisfactory and most likely superior to MOPP for producing CR in patients treated with radiotherapy and/or MOPP.

Cancer morbidity.

In the present study, 1736 cases of cancer has been analysed by major sites, sub-sites and mortality trend. The most common cancerous lesion in the male was in the lungs and in the female in the uterine cervix. The second common lesion in male and female were larynx and breast respectively. In children, retinoblastoma was the commonest type of cancer.