Betel Nut Use Research Articles

The role of family history of Cancer in Oral Cavity Cancer

ObjectivesOral and oropharyngeal squamous cell carcinoma (SCC) is the 10th most common cancer in the United States (8th in males, 13th in females), with an estimated 54,010 new cases expected in 2021, and is primarily associated with smoked tobacco, heavy alcohol consumption, areca nut use and persistent high-risk human papillomavirus (HPV). Family history of cancer (FHC) and family history of head and neck cancer (FHHNC) have been reported to play an important role in the development of OSCC. We aimed to investigate the role of FHC, FHHNC and personal history of cancer in first/second degree-relatives as co-risk factors for oral cancer.MethodsThis was a retrospective study of patients diagnosed with OSCC at the Division of Oral Medicine and Dentistry at Brigham and Women’s Hospital and at the Division of Head and Neck Oncology at Dana Farber Cancer Institute. Conditional logistic regressions were performed to examine whether OSCC was associated with FHC and FHHNC of FDRs and SDRs, personal history of cancer and secondary risk factors.ResultsOverall, we did not find an association between FHC, FHHNC and OSCC risk, whereas patients with a cancer history in one of their siblings were 1.6-times more likely to present with an OSCC. When secondary risk factors were considered, patients with a history of oral leukoplakia and dysplasia had a 16-times higher risk of having an OSCC.ConclusionsOur study confirmed that a previous history of oral leukoplakia or dysplasia was an independent risk factor for OSCC. A positive family history of cancer in one or more siblings may be an additional risk factor for OSCC.

Prevalence of Tobacco and Areca-nut Use and Awareness of Its Harmful Effects among Non-academic Staff at Faculty of Dental Sciences, University of Peradeniya

Background: Tobacco and areca nut (AN) are well known risk factors for oral cancer and awareness of these harmful risk habits will reduce the incidence of oral cancer in Sri Lanka. Faculty of Dental Sciences, University of Peradeniya plays a major role in this fight against oral cancer. Hence this study is aimed to evaluate the prevalence of these risk habits among its non-academic staff and their awareness of its harmful effects as they are also responsible stakeholders of the faculty. Method: An institutional based cross sectional study was conducted among 108 non-academic staff members of the faculty using a self-administered questionnaire on risk habit details and their awareness on its harmful effects. Results: Analyzed results revealed that only 4.6% of the sample had tobacco and AN use; betel quid chewing (2.7%) and tobacco smoking (1.8%). However, the awareness on the harmful effects of these products were not very satisfactory as only 48% were overall aware while the unhealthy effects of AN use were known only by 27% of the sample. Contradictorily, 70% of them informed that they have received information regarding the harmful risk habits. Conclusion: It is important to increase awareness among the non-academic staff of the faculty as they become important stakeholders of one of the leading centres in the fight against oral cancer.

Perceptions and Practices of General Practitioners towards Oral Cancer and Emerging Risk Factors among Indian Immigrants in Australia: A Qualitative Study.

Background: In Australia, Indian immigrants are one of the fastest-growing communities. Since oral cancer is widespread in India, the indulgence of Indians in customs of areca (betel) nut use in Australia may be linked to the recent rise in oral cancer cases. Since GPs (general practitioners) are primary healthcare providers, it is pivotal to ensure the oral cancer awareness of GPs. This study aimed to explore oral cancer risk-related knowledge, beliefs, and clinical practices of GPs in Australia. Methods: Fourteen semi-structured interviews were conducted with GPs practicing across New South Wales and Victoria. Purposive and snowball sampling were used for recruitment. Data were analysed through a directed content analysis approach. Results: All GPs were knowledgeable of major oral cancer causative factors including tobacco and alcohol, but some had limited understanding about the risks associated with areca nut preparations. Positive attitudes were evident, with all participants acknowledging the importance of oral cancer risk assessment. Most GPs recalled not performing oral cancer routine check-ups. Conclusion: GPs presented good oral cancer knowledge except for emerging risk factors such as areca nut use. Varied beliefs and inconsistent clinical practices relating to oral cancer screening is concerning. Accessible oral cancer training around emerging risk factors may benefit GPs.

Relationship of Clinical Features with Candidal Carriage in Oral Submucous Fibrosis Patients: A Case-control Study.

Background and Objectives:Oral submucous fibrosis (OSF) is extensively prevalent in India and South-East Asia owing to the habit of arecanut (AN) use. Epithelial atrophy, hyposalivation, and immune alterations in OSF may predispose to increased Candidal carriage. Stomatopyrosis in OSF can result from multiple causes, which may also include Candidal infection. Hence, this study is aimed to assess Candidal carriage, species characterization, salivary flow rate (SFR) and its relationship with the clinical features (stomatopyrosis and mouth opening [MO]) in OSF patients alongwith the response to antifungal treatment in patients with higher Candidal carriage.Methodology:In this case-control study, 60 OSF patients and 30 age- and sex-matched control subjects were enrolled. SFR was assessed using modified Schirmer test. Samples for Candidal assessment were collected with the oral rinse technique and cultured. The isolated yeast species were counted and identified based on Gram staining, germ tube test, and CHROMagar. Data were analyzed with Chi-square test, Pearson's correlation test, and one-way ANOVA test.Results:The distribution of mean visual analog scale (VAS) score, SFR and MO was significantly varied (P < 0.001) in the study and control groups. Candida was found to be present significantly (P = 0.048) in OSF group as compared to control group. Candida albicans was the predominant species. No statistically significant association was obtained regarding Candidal isolation and SFR, burning sensation and MO in OSF patients. Only 1 patient in the study group yielded a high Candidal carriage (>400 CFU/mL) and reported relief in burning sensation (VAS score) with antifungal therapy.Conclusions:OSF patients yielded a significant higher oral Candidal carriage. Although it was not found to be associated directly, its role as a “cause and effect” in SFR and clinical features (stomatopyrosis and MO) of OSF cannot be ignored.

NARRATIVE REVIEW: ARECA NUT AS A HEALTHY AND HALAL PRODUCT FROM SCIENCE PERSPECTIVE IN PREVENTION OF NONCOMMUNICABLE DISEASES

One of efforts to improve public health is to utilize medicinal plants obtained from nature, which are economical and do not have side effects. Type of medicinal plants that is often used by people in Indonesia is Areca Nut. Empirically areca nut are able to overcome various types of diseases. The purpose of this review was to provide confidences in the feasibility of areca nut as raw material for medicinal plants and processed products. The results of the study showed that the potential of areca nut as antibacterial, anti-oxidant and control prevention of noncommunicable diseases. The direct use of areca nut is only as an ingredient with betel leaves and only certain people are able to consume it, while the benefits and efficacies are very diverse, innovation is needed to utilize areca nut in the processing of various healthy and halal food products in the form of flour, candy and coffee. Research is needed to determine the right formulation for physical, chemical and organoleptic efficacies, so that a product that is both healthy and halal can be obtained.

Role of programmed cell death 4 in myofibroblast differentiation in oral submucous fibrosis.

Background:Fibrosis is an uncontrolled healing process, led by persistent differentiation of fibroblast to alpha-smooth muscle actin (αSMA) positive activated fibroblast or myofibroblast. Oral submucous fibrosis (OSMF) is one such condition that is associated with areca nut use. Recently, Programmed Cell Death 4 (PDCD4), a pro-apoptotic marker, has been shown to modulate fibroblast differentiation in various organ fibrosis. The present study aimed to evaluate the role of PDCD4 in the regulation of fibroblast differentiation in OSMF.Materials and Methods:Paraffin-embedded tissue sections from 45 cases of the normal oral mucosa, early OSMF and advanced OSMF were examined for PDCD4 and αSMA expression by immunostaining. Co-expression of PDCD4 and αSMA in fibroblasts was examined using Spearman's correlation test.Results:The stromal fibroblasts showed minimal expression of αSMA in the normal mucosa and early OSMF, while advanced OSMF groups demonstrated a higher frequency of αSMA myofibroblasts. The PDCD4 expression was noted in the normal stromal fibroblasts. However, this expression appeared to progressively reduce with an increasing grade of OSMF. Thus, a negative correlation was noted between stromal PDCD4 and αSMA expression with progressive OSMF.Conclusion:This study demonstrated a putative role for PDCD4 in oral fibrosis consistent with its role in other tissues. The lack of PDCD4 expression with increasing myofibroblast expression in OSMF suggests that targeting its dysregulation may be an attractive translational therapeutic target.

Prevalence of Oral Submucous Fibrosis in Relation to Habits among High School Children of Kanpur City

Background: Oral submucous fibrosis (OSMF) is a chronic insidious disease that affects oral cavity, may also involve pharynx or esophagus, and may be associated with vesicle formation. The present study aimed to determine prevalence of oral submucous fibrosis among school children in Kanpur city through cross-sectional study and its association with various type of quid and areca nut chewing habit. Materials and Methods: In different urban and rural educational areas of the Kanpur district of Uttar Pradesh, a school-based cross-sectional study was carried out. Data on consumption of areca nut were obtained by a self-administered questionnaire based on demographic characteristics, areca nut use, daily frequency of areca nut chewing, other ingredients mixed with nut, tobacco use (smoking and/or chewing), age of initiation of nut chewing, reasons for use, social influence factors, and risk perceptions. All oral examinations were done by specialist examiners who were familiar with oral mucosal lesions in the local population. Results: The results from this study shows that the areca nut chewing habit is significant among school children of rural areas as compare to urban areas in Kanpur district. No female subject was found to be suffering from OSMF in both the urban as well as rural areas however 27 (3.41%) male subjects were found to be suffering from OSMF. Conclusion: In order to spread awareness through educational programs, newspapers, and mass media in neighborhoods and classrooms, steps should be taken at the public health level.

Berberine is as effective as the anti-obesity drug Orlistat in ameliorating betel-nut induced dyslipidemia and oxidative stress in mice

BackgroundBerberine is a phytochemical derived from various plants and is found to be beneficial in the treatment of cardiovascular, hepatic, metabolic, renal and infectious diseases. Betel-Nut (BN) is the fruit of the tropical palm Areca catechu, and its use as a masticatory is strongly associated with dyslipidemia, Metabolic Syndrome and oxidative stress. HypothesisWe tested the hypothesis that berberine is as effective as the standard anti-obesity drug, orlistat, in reducing dyslipidemia, oxidative stress and aberrant lipid synthesis caused by betel-nut, in a murine model treated with an Aqueous Extract of Betel Nut (AEBN). MethodsMale and female Swiss albino mice were administered AEBN at a dose of 2 mg ml−1 in drinking water ad libitum for 16 weeks following berberine (10 mg/kg b.w.) or orlistat (20 mg/kg b.w.) were co-administered orally with AEBN for 8 weeks. At treatment endpoint, control, berberine, orlistat, AEBN, AEBN+berberine and AEBN+orlistat treated mice were sacrificed and evaluated for changes in body weight, relative organ weight, liver histology, oxidative stress, lipid profile, and free fatty acid levels. Expression of total and phosphorylated proteins catalyzing lipid synthesis was evaluated by western blotting. FindingsAEBN treated mice exhibited lower body weight and relative organ weight but fatty degeneration of the liver, dyslipidemia, decreased oleic acid and increased palmitic acid in serum and increased oxidative stress. Western blotting of liver tissue revealed increased expressions of FASN and HMGCR, together with decreased levels of pAMPKα (Thr 172) and pACC (Ser 79) in comparison to age and gender matched controls, suggesting enhanced lipid synthesis. Co-administration of AEBN with berberine or orlistat restored body weight and liver histology to near normal, and reversed all the biochemical and molecular parameters investigated. ConclusionBerberine was found to be as effective as orlistat in reducing dyslipidemia and oxidative stress, and restoring normal lipid synthesis in a murine model of betel-nut use.

Assessment of the oral cancer control activities through care seeking behavior of hospital attendees and their level of awareness

Oral cancer is the most common cancer among males in the Sri Lankan population. The aim of this study was to assess the health seeking behaviors and associated factors for OPMD.A hospital based descriptive cross-sectional study was conducted among Out Patients Department attendees of the Institute of Oral Health, Maharagama, from July 1, 2018 to December 31, 2019 by administering a questionnaire followed by an intra oral examination.The total number of 110 OPMD/oral cancer patients were identified. Awareness on OPMD was that 40 ​%. Majority were unaware of the danger of areca nut and alcohol use. Out of the identified cases during oral examination, 47.3 ​% were incidental findings while only 7.3 ​% were referred by the General Medical Practitioners (GMP). None were referred by the Primary Health Care (PHC) staff.The level of awareness on OPMD and its risk factors were very low. Incidental findings during the dental screening being the main mode of detection of OPMD, highlights the importance of conducting opportunistic screening at dental settings. Implementation of the Risk Factor Model (RFM) approach for the early detection of oral cancer through PHC staff and GMP is validated to encourage more early referrals.

HPV IN ORAL SQUAMOUS CELL CARCINOMA - CHANGING TRENDS IN THE RISK FACTORS AND DEMOGRAPHICS OF ORAL CANCER IN THE INDIAN SUBCONTINENT

<h3>Background</h3> Human papilloma virus (HPV) is a double-stranded DNA virus that infects the epithelial cells of skin and mucosa. It is established now that sexual contacts, both conventional and oral, are means of transferring HPV through direct skin-to-skin contact. A small number of oral cavity cancers are related to HPV infection that may not be due to oral habits. <h3>Objective</h3> To review the existing literature on the association of HPV and oral cancer and to highlight the uniqueness of their clinical presentation and histopathologic appearance. <h3>Methods</h3> A literature search was undertaken, and all relevant data were collected where an association of HPV and oral cancer was established. The focus was on studies involving an Indian population where known risk factors were not present in oropharyngeal cancers. <h3>Results</h3> Several studies reveal the characteristic clinical presentation of oropharyngeal cancer without known etiologic factors such as tobacco smoking or chewing and use of betel nut with or without additives. Women of younger age groups are more likely to fall into this category. HPV of high-risk strains has been isolated from the affected tissues, and a certain uniqueness is observed in the microscopic features of such HPV-associated oral cancers. <h3>Conclusions</h3> The prototypical patient with oral cancer is no longer an elderly man with the habit of smoking or chewing tobacco or betel nut and/or drinking alcohol for many years. HPV is emerging as a powerful risk factor and is increasingly recognized as a subgroup of oral squamous cell carcinoma with a distinct biological and clinical profile.

India as “The Oral Cancer Capital of the World”: The Rising Burden of Oral Malignancies across the Nation

India is a global epicenter of oral cancer patients and the magnitude of the problem is ever increasing day by day. There is excess burden of oral malignancies all over the country and the risk factors associated with the disease are at its peak. Addressing the disease which is quite like an epidemic is a great challenge and major public health issue in India. This review paper discusses the burden of the disease, its top risk factors in India including the use of tobacco, alcohol, areca nut and HPV infections; and methods for prevention and control of oral cancer in India. Keywords: Oral cancer, Burden, Risk factors, Tobacco, Alcohol, Areca nut, HPV, Prevention.

A Qualitative Study of Perceptions and Practices Related to Areca Nut Use Among Adolescents in Mumbai, India.

Areca nut, commonly known as supari, is widely used in India. In addition to tobacco and alcohol, it has been identified as one of the contributory factors for high rates of oral cancer in the country. This qualitative study explored perceptions and practices around the use of areca nut by conducting in-depth interviews and focus group discussions with 61 school-going adolescents in the city of Mumbai, India. Respondents used low-priced sachets of sweetened, flavored areca nut called supari. They perceived supari as harmless because it was sweet, it had a fresh after-taste as compared to bitter-tasting smokeless tobacco products. How can something sweet be harmful was a common argument offered by respondents. Respondents invariably compared and contrasted areca nut to more harmful and addictive tobacco products; perceiving supari to have milder or inconsequential health effects. Supari use was initiated with friends, a sibling, or a cousin. It was almost always used with friends. Respondents also reported difficulty in refusal to use when offered supari by friends. Parental response to finding out about the child's supari use was often muted in comparison to extreme reactions associated with the child's tobacco use. Perceptions of low risk or relative harmlessness of the product, social influence, and the features of the product itself influence adolescents' use of areca nut. Although more research on perceptions of risk, with larger samples, is required, these findings are useful for school-based tobacco prevention and cessation programs and health policy-makers. The study findings have implications for prevention and cessation programs, and policymakers. School-based health education programs should allocate special sessions on areca nut use. Focused mass media communication campaigns describing its harms and association with oral cancer are required for the larger community. As was done for tobacco, Indian policymakers will have to evaluate the marketing, commerce, and distribution of areca nut and create appropriate laws. More research, with larger nationwide samples, is required to examine perceptions of areca nut.

Occurrence of areca alkaloids in wastewater of major Chinese cities

Areca nut is a widely used psychoactive product that can cause multiple health problems, such as oral and pharyngeal cancers. Therefore, it is important to estimate areca nut use and the exposure levels of areca alkaloids that are responsible for its health effects. China is a major producer of areca nut and has a large number of areca nut chewers. In this study, occurrence of areca alkaloids and metabolites in wastewater of major cities across China was examined via wastewater-based epidemiology (WBE). Arecoline, arecaidine, and their metabolite, N-methylnipecotic acid (NMNA) were detected in the overwhelming majority of wastewater samples, with concentrations up to several μg/L. In contrast, guvacoline was only occasionally detected and guvacine was below detection limit in all samples, possibly due to their low contents in areca nut products, low excretion rates, and/or low stability in sewer systems. Strong positive correlations existed between arecoline, arecaidine, and NMNA concentrations. In addition, their loads were much higher in Central and Southern China. This geographic pattern is consistent with previous survey results on prevalence of areca nut chewing. These results indicate that WBE is a potentially useful method to monitor areca nut consumption and to estimate the exposure levels of areca alkaloids.

Evaluation of Successfulness of Capacity Building Programmes on Smokeless Tobacco and Areca Nut Cessation.

Background:Prevalence of smoking in Sri Lanka has shown a gradual reduction whilst the use of smokeless tobacco and areca nut exhibits an increasing trend. At present, only a few well-structured smokeless tobacco (SLT)/areca nut (AN) cessation programs have been conducted in Sri Lanka, which is a gross underachievement as betel chewing-related oral squamous cell carcinoma is the most common cancer in Sri Lankan males. As General Dental Practitioners (GDP) do not contribute significantly to SLT/AN cessation activities at present, capacity building programs on SLT/AN control were carried out. The study evaluated the knowledge, attitude and practices imparted on SLT/AN control among dental surgeons. Methods:Following a single day capacity building program on smokeless tobacco / areca nut control, two self-administered questionnaires were used to assess the improvement of knowledge and change of attitudes among 663 GDPs. Results:Majority had a good knowledge on harmful effects of SLT but not on areca nut. Knowledge of the current legislation on SLT control in Sri Lanka and carcinogenicity of areca nut was not satisfactory. Almost all agreed that proper counseling leads to patient quitting the habit, a formal training is necessary to conduct tobacco control activities and it should be a part of the regular treatment modalities. More than 80% of the participants support strict legislation. Most important factors leading to poor involvement in tobacco cessation activities were lack of expertise and inadequate educational material and not breach of patient privacy and lack of financial incentives. 20.1% dental surgeons had consumed smokeless tobacco / areca nut products in the past and only a few were current users of tobacco and/or areca nut. Conclusions:Well planned workshops are efficient in improving knowledge, practices and attitudes of dental surgeons towards SLT/AN cessation.

Assessment of areca nut use, practice and dependency among people in Guwahati, Assam: a cross-sectional study.

BackgroundAreca nut is the fourth most commonly used psychoactive substance worldwide after tobacco, alcohol and caffeine. In India, it is perceived in various ways, ranging from a ‘fruit of divine origin’ in Hindu religious ceremonies to a mouth freshener. Areca nut use both on its own and with tobacco additives is addictive. The aim of this study was to understand the pattern of areca nut consumption, to determine the Knowledge, Attitude and Practices (KAP) among areca nut users and the dependency associated with areca nut use.MethodsA cross sectional study was conducted in Guwahati, Assam using a self-administered questionnaire eliciting the pattern of areca nut consumption, KAP among users and understanding their dependency using Betel Quid Dependence Scale. The chewers of areca nut alone with or without betel quid, gutkha and tobacco participated in the study. Areca nut users were selected using purposive sampling method from the vendor shops of all the four assembly areas of the city. Their participation was voluntary and free not to answer or quit the survey. The data was analysed using SPSS software.ResultsA total of 500 participants were approached in all four areas, 479 completed the survey (response rate 95%). The people who participated in the study were mostly male with an average age of 40 years, educated to secondary level or higher, married and self-employed. Betel quid with tamul was the most prevalent form of areca nut chewing in both men and women. About 441 (92%) participants experienced pleasure when chewing areca nut and 327 (68%) chewed it to relieve stress. Only 86 (18%) of subjects had ever tried to quit chewing areca nut and 387 (81%) thought that it was highly addictive. The results revealed relatively high levels of endorsement for ‘physical and psychological urgent need’ (mean = 43%) and ‘increasing dose’ (mean = 50%), whereas endorsement level for ‘maladaptive use’ was low (mean = 16%).ConclusionAreca nut use (tamul) is of major concern in India and many Southeast Asian countries and its use has been increasing across the globe. The evidence suggests a dependence similar to tobacco use and policy makers need to refine its strategy for control of its use by engaging with multiple stakeholders and adapting it to local context with surveillance and cessation guidelines in order to address this issue.

Key Drivers to Implement an Evidence-based Tobacco Control Programme in Schools of India: A Mixed-Methods Study.

Background:Adolescence is an influential stage in students’ lives when lifelong behaviours such as tobacco use are formed. During these years, school teachers are important role models for tobacco control among students. A study was conducted among school personnel and administrators to understand the key drivers for implementing an evidence-based school tobacco control program. Methodology:A cross-sectional, mixed-method study was conducted in five districts of Assam, India. The quantitative study was conducted among 565 school personnel across 40 Government-aided schools. Data was collected by means of an anonymous, self-administered questionnaire. Qualitative data was generated from 15 focus group discussions (FGDs) among 146 participants - District Program Officers, Block Education Officers, Cluster Coordinators, Headmasters and Teachers. Results:While the prevalence of smoked tobacco was low (3%), the use of smokeless tobacco was higher (40%), and the prevalence of use of areca nut without tobacco (65%) was still higher among school personnel. They were aware of the school policies prohibiting the use of tobacco among students within or outside school buildings or during school-sponsored activities (81%); they had rather limited knowledge about policy for themselves (58%). There was lack of access to training materials about prevention of tobacco use among youth. The FGDs amongst school personnel resulted in several constructive suggestions on tobacco control in schools mainly in training school teachers, monitoring the program and incentives for execution of the program. However, there was a reluctance to implement a smokeless tobacco control programme since many were current users of smokeless tobacco and areca nut. Conclusion:Tobacco control policies as well as training school personnel in schools need to improve and further measures must be taken to prohibit use of areca nut, which contains carcinogens. The existing system of the education department can be utilised to implement tobacco control programmes effectively.

Risk Factors for Malignant Transformation of Squamous Intraepithelial Lesions

Squamous intraepithelial lesions (SIL) are persistent white and white-red lesions that may represent precursor lesions for invasive squamous cell carcinoma (SCC). SILs encompass epithelial hyperplasia/hyperkeratosis, dysplasia, and carcinoma in situ. Specific indicators within SILs would be helpful for risk determination and treatment decisions. The purpose of this study was to determine the risk of SIL transformation to SCC using clinical appearance, histology, and immunohistochemical staining of biomarkers. A retrospective cohort study was conducted of patients diagnosed with oral cavity SILs between 2002 and 2012. Subjects were identified using billing records and pathology reports. Subjects were included if they had a new diagnosis of SIL via biopsy, histologic blocks/slides available for review, and > 5 years of follow-up after biopsy. Subjects with an existing or previous diagnosis of SCC at time of SIL diagnosis were excluded. Subjects were divided into two groups: 1) Those with SILs who did not transform to SCC and 2) those who transformed. Predictor variables included demographics (gender, age) and medical history (history of tobacco, alcohol, betel nut use, immune status, history of radiation). Macroscopic lesion related variables were site, size, and clinical appearance (described as white, red, heterogenous red-white, ulcerated, or nodular). Microscopic lesion variables were severity of dysplasia, location of atypia within epithelium (lower one-third, lower two-third, or full thickness), mitotic index, and amount of apoptosis, nuclear pleomorphism, rete peg complexity, lichenoid chronic inflammation, and hyperkeratosis. Mitotic index was quantified as the number of mitotically active cells recorded per high-powered field (hpf, 400x). Apoptotic abundance, nuclear pleomorphism, and rete-peg complexity were graded on a semi-quantitative scale 1-5. Lichenoid inflammation and hyperkeratosis were assessed as present or absent. Immunohistochemical lesion variables were p53 and Ki-67 immunoreactivity and measured as amount of positively stained cells per hpf. The primary outcome variable was presence of SCC on a subsequent biopsy (i.e., transformation to SCC). All diagnostic slides were reviewed and rated by a head and neck pathologist (WCF). Statistical results were analyzed using a Chi2 test, Fisher exact test, and 2-tailed t-test. Statistical results were considered significant with a 95% confidence interval if they had a P-value less than .05. A total of 60 subjects (45%, 27 female) were included of which 38 (63%, 17 female) did not transform to SCC whereas 22 (37%, 10 female) transformed. Mean ages of groups 1 and 2 were 58.2 ± 12.0 and 63.1 ± 15.1 years, respectively (P = .202). There were no differences in medical history and lesion location. Mean size of the SIL in groups 1 and 2 was 234 mm2 and 228 mm2, respectively, (P = .957). Transformation was significantly higher for heterogeneous red/white lesions: 5 (13%) in group 1, 9 patients (42%) in group 2 (P = .014). Patients with severe dysplasia were more likely to transform with 10 in group 2 (45.5%) and 2 in group 1 (5.3%) [P = .0003]. Atypia limited to the lower one-third was less likely to transform (P = .0173). Increased apoptosis (P = .043) and rete peg complexity (P = .014) were associated with SCC transformation. There was no difference in immunohistochemical staining of Ki-67 between groups (P = .305). In conclusion, SILs that transformed to SCC were more likely to have a red-white appearance, severe dysplasia, atypia throughout the epithelium, greater apoptosis, and rete peg complexity. Ki-67 immunoreactivity was not associated with transformation. Ongoing evaluation of p53 will be reported. The presence of these factors may influence decision to excise a SIL vs surveillance.

Maxillary Alveolar Carcinoma: Risk of Recurrence and its Relation with Prognostic Indicators

Oral carcinoma is one of the ten most frequently occurring cancers around the world and when grouped together with pharyngeal cancer, it is the sixth most common cancer in the world [1]. In the Asian and South east population the prevalence of oral cancer is on the rise. The unique cultural practices in the Asian population such as snuff dipping, smoking, use of alcohol and areca nut are the main predisposing factors for the development of this cancer

Antifertility effect of betel nut (Areca catechu L) in male rat

Background: Betel nut (Areca catechu L) are traditional beverages in Jambi. Betel nut high dose has a cytotoxic effect on testis and other organs—limited data about the effect of betel nut as male antifertility.Purposes: This study aimed to determine the effect of infertility on betel nut use at a dose of 50 mg/kg body weight (BW) in male rats. Methods: Ten male Sprague Dawney rats that had passed the fertility test, aged 2-3 months and weighing 150-200 grams ware used in this study. The rat was grouped into two groups randomly. Group 1, as the negative control, were received aqua dest, and group 2 was treated by betel nut with dose 50 mg/kg BW for 35 days. When terminated, testis weight weighed using micro scales. Blood collected for measuring testosterone levels. Histopathology assessment of testis used Hematoxylin Eosin Staining and sperm counting from cauda epididymis.Results: The weight of testis in the group received betel nut was lower than the control group. The histopathology of testis showed shrunk, reduced the diameter of seminiferous tubules, and like cytolytic lesions in the germinal layer—the total sperm number and progressive sperms also lower than the control group (p&lt;0.05). There was no abnormality in Leydig cell and interstitium tissue. Male rats after treatment could not impregnate the female rats.Conclusion: Betel nut at dose 50 mg/kg BW have antifertility activity in male rats.

Knowledge and Attitudes of Nursing Students Towards Smokeless Tobacco and Areca Nut Control in Central Province of Sri Lanka

Background: Use of smokeless tobacco (SLT) and areca nut (AN) is widespread in Sri Lanka. Several workshops to train healthcare workers on SLT/ AN cessation programmes (SLT/AN-CP) were carried out. Objective of the study was to evaluate the enhancement of knowledge and attitudes related to SLT/AN-CP among nursing students following a workshop. Methods: A cross sectional study was conducted with the use of two questionnaires. A total of 212 nursing students were assessed and the study group included 184 females (86.8%). Results: Results were analyzed according to the 3 main areas of the assessment, i.e knowledge related to Oral cancer, knowledge related to SLT, its effects and cessation practices and attitudes regarding SLT cessation counselling. Out of the eight questions to assess the knowledge related to oral cancer, five questions demonstrated a statistically significant difference (P&lt;0.05) following the workshop when compared to the pre workshop knowledge. Even though, majority had a good knowledge on harmful effects of SLT and AN, it was interesting to note that 14.15 % of the participants were unaware about the fact that the oral cancer is the commonest cancer among Sri Lankan males. 96.7% agreed that proper counseling would lead patient to quit the habit. Conclusions: This preliminary study showed that the knowledge and attitude towards SLT/AN-CP among nursing students were satisfactory and effective workshops can be used to improve their knowledge and attitudes towards SLT/AN-CP especially in low economical settings