Knowledge, Attitude and Practices towards Menstrual Hygiene among Government and Private School Girls KAP towards menstrual hygiene in school girls

Menstruation is a normal physiological process unique to females. Pre-menarche is characterized by physiological, cognitive, and psychological transitions which may be initiated from the midst of their second decade. The onset of puberty/ menstruation in girls tends to change their role in society. Overall inadequate awareness levels accompanied by socio-cultural taboos and prevailing myths and misconceptions about menarche and menstruation have played havoc on human society. Objective: To diagnose and compare the prevailing level ofknowledge, attitude, and practices of adolescent girls studying in government and private schoolstowards menstrual hygiene and management. Methods: This Analytical and cross-sectional study was conducted at Government Jouhar Girls High School and Shiblee Grammar School System, Gulberg Branch (private) Faisalabad. A self-administered survey-based questionnaire was developed. Prior formal written approval from school authorities was followed by the pre-planned scheduled visits, explaining the purpose of the study, assuring confidentiality of acquired information, and self-administration of survey-based questionnaires. Results: The results indicated that the mean age at menarches of the girls was 13.69±0.95 years. A relatively more percentage of government (59.6%) school respondents followed by private school respondents (57.1%) had satisfactory knowledge about their age of first menarche (p = 0.806). Motivated by the socio-cultural taboos and /or fear or shame a majority of government (59.6%) and private school respondents (57.1%) had satisfactory knowledge about their age of first menarche (p = 0.806). A strong prevalence of Urinary Tract Infection (UTI) was found in private school girls 87(49.2%) and 21(11.9%), followed by respective percentages of 78(43.8%), 16(9.0%) amongst the government school respondents who recorded their responses as agreed and strongly agreed about the development of reproductive tract infection in the post-menstruation period. As far as the adoption of hygienic practices is concerned a relatively high percentage of government school 28(15.7%) followed by private school 14(7.9%) girls strongly disagreed about changing their absorbent material on daily basis. The development of skin abrasions like rashes, itching, and urinary tract infection was found in a relatively high proportion amongst the government school girls 30(16.9%) followed by private school respondents 18(10.2%) in the post-menstruation period. A most common and alarming unhygienic practice prevalent amongst the government and private school girls was the reuse of absorbent cloth,   who responded as agreed and strongly agreed in respective terms as 43(24.2%),   22(12.4%), and 69(39%) and 28(15.8%).  Conclusions: The study concluded that the persistent myths, misconceptions, socio-cultural taboos, and unhygienic practices i.e. Use of old clothes as absorbent, reuse of absorbent material, and delaying tendency of changing absorbent,   amongst the adolescent school girls of government and private institutes which may pose direct adverse health and life quality concerns for the female Pakistani community. The current situation calls for active participatory contributions from education communities to initiate various communication and awareness campaigns regarding pre-menarche knowledge and menstruation management which may aid to strengthen and transform their role as a significant representative of society. 

Contribution of Genetic Changes in Hereditary & Sporadic Forms of Head & Neck Cancer

CYP1A1, GSTM1, GSTT1 and GSTP1 are major detoxifying enzymes related to head and neck cancer (HNC). Polymorphisms in these genes have frequently been reported in literature and are known to follow diverse pattern in relation to different populations. The current study was designed to screen these genes in HNC patients and controls at DNA, mRNA and protein levels. A total of 437 pathologically confirmed HNC patients and 507 normal healthy controls were recruited. The results revealed that the mean age of cancer patients included in the study was 48 +16.59 years. PCR-SSCP was used for genetic screening followed by sequencing. Novel substitution (tyrosine to serine) and frameshift mutation (insertion of T) were found in HNC patients in CYP1A1 gene. GSTM1 and GSTT1 null genotypes were found significantly higher in HNC patients compared to controls (OR 2.3, 95% CI 1.5-5.5 and OR 2.04, 95% CI 1.3-3.1 respectively). GSTM1 deletion mapping revealed an amplified region 98 bp upstream and 293 bp downstream the gene, deleting 6 Kbp segment containing the entire gene. Similarly in GSTT1 gene a region spanning 537 bp upstream and 333 bp downstream was deleted and the total size of this deletion was approximately 9 Kbp. A new technique for mapping of deletion has been introduced that opens new ideas for researchers. Novel mutations in GSTP1 gene in exonic region (substitution A2848T and G2849A) were found in 9.5% HNC patients whereas the controls did not show these mutations. In addition, two intronic deletions of C at nucleotide 1074 and 1466 were also found in patients. Therefore it was found that exonic as well as intronic variations may be involved in HNC risk. Reverse transcriptase PCR was used for mRNA expression variation screening in 4 selected genes. Expression analysis showed that CYP1A1 mRNA expression was markedly reduced in tissues of head and neck carcinoma compared to adjacent normal tissue (OR 4.5, CI 1.5-13.4). Partial loss of expression of GSTM1 and GSTT1 mRNA was also observed at a higher rate in HNC tissues compared to controls (OR 4.5, CI 1.5- 13.4 and OR 3.2, CI 1.1- 9.6 respectively). GSTM1 and GSTT1 expression was also down regulated that was directly correlated with stages of cancer. GSTP1 mRNA expression was significantly higher in cancerous tissue compared to control tissue (OR 4.2, CI 1.2- 15.3). GSTP1 over expression was also observed to be directly correlated with stages of cancer. It was found that 5 patients had variation in GSTP1 mRNA with a large product size than expected. Sequencing revealed insertion of intronic segment between 6th and 7th exon of GSTP1 gene. Germline screening was performed showing mobility shifts which suggested mutation at DNA level resulting in intronic portion retention. ELISA was performed to check the serum GSTs level and significant decrease was observed in head and neck cancer patients compared to controls (P<0.001). Immunohistochemistry was performed to check the protein expression of these genes. CYP1A1 was expressed in cancer tissues as well as controls; however mild expression was observed in patients compared to controls. Regarding the level of GSTT1 mRNA loss and mild expression was common among HNC tissues compared to controls. GSTP1 was overexpressed in most of the tissues compared with controls. From the current study, GSTs and CYP1A1 were found to be one of the factors responsible for systematic progression of HNC. Expression regulation of CYP1A1, GSTM1, GSTT1 and GSTP1 genes is an area which can be further explored. Establishing a marker of prognostic significance as well as its potential role in HNC can help in designing most promising gene therapy for patients