Betel Quid Chewing Habit Research Articles

Impact of Matrix Metalloproteinase-8 Polymorphisms on Nasopharyngeal Carcinoma Risk.

Upregulation of matrix metallo-proteinase-8 (MMP-8) serves as a protein-based indicator for predicting nasopharyngeal carcinoma (NPC) metastasis. Nevertheless, the role of MMP-8 genotypes in NPC has never been investigated. This study aimed to explore the involvement of MMP-8 genotypes in NPC development. We employed the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique to analyze MMP-8 genotypes, specifically C-799T (rs11225395), Val436Ala (rs34009635), and Lys460Thr (rs35866072), in a Taiwanese cohort comprising 208 NPC cases and 416 healthy controls. Individuals with either heterozygous or homozygous variant genotypes of MMP-8 rs11225395 showed no significant change in NPC risk compared to those with the wild-type genotype [odds ratio (OR)=0.97 and 0.79, 95% confidence intervals (95%CI)=0.68-1.38 and 0.46-1.36; p=0.9304 and 0.4736, respectively]. Similarly, there was no significant association between the heterozygous genotypes of MMP-8 rs34009635 and NPC risk (OR=0.66, 95%CI=0.24-1.84; p=0.5738). For MMP-8 rs35866072, all individuals in the study were of the TT genotype. Furthermore, the presence of variant alleles at MMP-8 rs11225395 or rs34009635 did not result in altered NPC risk (OR=0.91 and 0.66, 95%CI=0.71-1.16 and 0.24-1.84, p=0.4876 and 0.5769, respectively). Additionally, no significant association was observed between MMP-8 rs11225395 variant genotypes and NPC risk among individuals regardless of smoking, alcohol consumption, or betel quid chewing habits (all p>0.05). There was no association between the MMP-8 genotypes rs11225395, rs34009635, or rs35866072 and NPC risk among Taiwanese individuals. Moreover, no combined effects of MMP-8 genotype with smoking, alcohol consumption, or betel quid chewing habits on NPC risk were observed.

An Assessment of Predisposing Factors of Periodontitis in Individuals

Background: Periodontitis, characterized by clinical attachment loss (CAL), is a prevalent global oral health issue leading to tooth loss. Various predisposing factors such as smoking, dietary habits, stress, and oral trauma are implicated in its development. Understanding these factors is crucial for targeted interventions and improved periodontal health outcomes. Objective: To assess the predisposing factors of periodontitis in individuals. Methods: A descriptive cross-sectional study was conducted on 50 individuals visiting the College of Dentistry, Sharif Medical and Dental College, Lahore. Data were collected by measuring clinical attachment loss. Patients were classified based on CAL into mild, moderate, and severe periodontitis categories. The Chi-square test was used to analyze associations between periodontitis severity and factors like smoking duration, betel quid chewing, stress, oral trauma, and an unbalanced diet. Results: A significant association was found between smoking duration and periodontitis (p=0.04). Individuals with a smoking history of over five years had higher rates of severe (51%) and moderate (18.4%) periodontitis compared to those with a history of less than five years (8.2%). Betel quid chewing (p=0.254), stress (p=0.871), oral trauma (p=0.557), and an unbalanced diet (p=0.883) were not significantly associated with periodontitis. Conclusion: Severe periodontitis was more prevalent in individuals with a smoking history of over five years and those consuming an unhealthy diet. Moderate periodontitis was more common in individuals without a betel quid chewing habit. Mild periodontitis was observed in those reporting stress-related gum or tooth pain and those with a history of oral trauma.

Cytotoxic Effects of Indonesian Betel Quid Components on Oral Keratinocytes and Fibroblasts

A betel quid (BQ) chewing habit has been strongly associated with the development of several oral mucosal diseases. In order to investigate whether individual components of BQ mixtures have distinct physio-pathological effects on oral mucosal cells, we examined the impact of areca nut (AN), Piper betle leaf (Leaf), Piper betle stem inflorescence (SI), areca husk (Husk) and the complete BQ mixture on the growth of oral keratinocytes (OKF-6) and primary oral fibroblasts (MMF-1). Based on their known chemical properties, we selected BQ samples from Banda Aceh (BA) and West Papua (WP) regions for our in vitro study. We used a fluorescein diacetate assay (FDA) to assess the cell viability of BQ components on OKF-6 and MMF-1 cells. The cytotoxic effect of WP-AN on the OKF-6 cell line was observed at a concentration of 100 μg/mL, resulting in a 50% reduction in cell viability (IC50) after a 2-day incubation. Similarly, BA-AN exhibited cytotoxic effect, although at a higher concentration (500 μg/mL). WP-SI also displayed cytotoxic effects at a concentration of 500 μg/mL following 2 days of incubation. In contrast, Leaf, BQ mixture and husk extracts did not show any cytotoxic effects even after 3 days of incubation. No cytotoxic effects were observed at any concentration of BQ components when exposed to MMF-1 cells. Regarding cell proliferation, MMF-1 cells exposed to BA-AN and WP-AN showed increased growth on day 1, followed by decreased growth on day 2, in a dose- and time-dependent manner. Overall, our study indicates that BQ components induce distinctive cytotoxic effects on stromal and epithelial cells from the oral cavity.

Interactive effects of CDKN2B-AS1 gene polymorphism and habitual risk factors on oral cancer.

Oral squamous cell carcinoma (OSCC) is a common malignant disease associated with a high mortality rate and heterogeneous disease aetiology. Cyclin dependent kinase inhibitor 2B antisense RNA 1 (CDKN2B-AS1), is a long noncoding RNA that has been shown to act as a scaffold, sponge, or signal hub to promote carcinogenesis. Here, we attempted to assess the effect of CDKN2B-AS1 single-nucleotide polymorphisms (SNPs) on the susceptibility to OSCC. Five CDKN2B-AS1 SNPs, including rs564398, rs1333048, rs1537373, rs2151280 and rs8181047, were analysed in 1060 OSCC cases and 1183 cancer-free controls. No significant association of these five SNPs with the risk of developing OSCC was detected between the case and control group. However, while examining the clinical characteristics, patients bearing at least one minor allele of rs1333048 (CA and CC) were more inclined to develop late-stage (stage III/IV, adjusted OR, 1.480; 95% CI, 1.129-1.940; p = 0.005) and large-size (greater than 2 cm in the greatest dimension, adjusted OR, 1.347; 95% CI, 1.028-1.765; p = 0.031) tumours, as compared with those homologous for the major allele (AA). Further stratification analyses demonstrated that this genetic correlation with the advanced stage of disease was observed only in habitual betel quid chewers (adjusted OR, 1.480; 95% CI, 1.076-2.035; p = 0.016) or cigarette smokers (adjusted OR, 1.531; 95% CI, 1.136-2.063; p = 0.005) but not in patients who were not exposed to these major habitual risks. These data reveal an interactive effect of CDKN2B-AS1 rs1333048 with habitual exposure to behavioural risks on the progression of oral cancer.

Presence of Candida and its associated factors in participants attending oral cancer screening in the lower northeastern area of Thailand

BackgroundCertain evidence indicated high prevalence of Candida in oral potentially malignant disorders (OPMDs) and oral cancer (OC). This study was aimed to investigate the presence of Candida and its associated factors in participants who attended the oral cancer screening program in the lower northeastern districts of Thailand.MethodsConvenient participants residing in the lower northeastern districts of Thailand who attended the oral cancer screening were enrolled. A questionnaire retrieving demographic characteristics, risk factors of oral cancer, and risk of having Candida was completed. Oral examination was performed by oral medicine specialists or oral surgeons. The participants were categorized into 4 groups according to their clinical diagnosis, namely normal oral mucosa (NOM), OPMDs/OC, non-OPMDs/OC and clinically suspected oral candidiasis (CSOC). Stimulated saliva flow rate was measured. Dip-slide test was performed in each participant to evaluate the presence of Candida. The levels of Candida were categorized into high and low levels according to the score received from the dip-slide test. Factors associated with high levels of Candida were identified using multivariate logistic regression analysis.ResultsA total of 577 participants were recruited. High levels of Candida were found in 31.3%, 24.7%, 25.9% and 18.1% in the OPMDs/OC, the non-OPMDs/OC, the CSOC and the NOM groups, respectively. According to multivariate logistic regression analysis, age above 60 years, female gender, betel quid chewing habit, use of denture, hyposalivation, and being in the CSOC group were found to be significantly associated with high levels of Candida.ConclusionHigher number of participants in the OPMDs/OC group was found to have high levels of Candida. Increasing age, female gender, betel quid chewing habit, use of denture, hyposalivation and having CSOC lesions were associated with high levels of Candida.

Identifying oral microbiome alterations in adult betel quid chewing population of Delhi, India.

The study targets to establish a factorial association of oral microbiome alterations (oral dysbiosis) with betel quid chewing habits through a comparison of the oral microbiome of Betel quid chewers and non-chewing individuals. Oral microbiome analysis of 22 adult individuals in the Delhi region of India through the 16S sequencing approach was carried out to observe the differences in taxonomic abundance and diversity. A significant difference in diversity and richness among Betel Quid Chewers (BQC) and Betel Quid Non-Chewers (BQNC) groups was observed. There were significant differences in alpha diversity among the BQC in comparison to BQNC. However, in the age group of 21-30 years old young BQC and BQNC there was no significant difference in alpha diversity. Similar result was obtained while comparing BQC and Smoker-alcoholic BQC. BQ smoker-chewers expressed significant variance in comparison to BQC, based on cluster pattern analysis. The OTU-based Venn Diagram Analysis revealed an altered microbiota, for BQ chewing group with 0-10 years exposure in comparison to those with 10 years and above. The change in the microbial niche in early chewers may be due to abrupt chemical component exposure affecting the oral cavity, and thereafter establishing a unique microenvironment in the long-term BQC. Linear discriminant analysis revealed, 55 significant features among BQC and Alcoholic-Smoker BQC; and 20 significant features among BQC and Smoker BQC respectively. The study shows the abundance of novel bacterial genera in the BQC oral cavity in addition to the commonly found ones. Since the oral microbiome plays a significant role in maintaining local homeostasis, investigating the link between its imbalance in such conditions that are known to have an association with oral diseases including cancers may lead to the identification of specific microbiome-based signatures for its early diagnosis.

Histopathological and risk factor analyses of oral potentially malignant disorders and oral cancer in a proactive screening in northeastern Thailand

BackgroundLip and oral cavity cancer has been reported as the 10th most common cancer in Thailand. Recently, a screening program for oral potentially malignant disorders (OPMDs) and oral cancer was conducted in the northeastern Thailand which took into consideration a total of 371,911 people who resided in the provinces of Buriram, Chaiyaphum, Nakhon Ratchasima, and Surin.MethodsA total of 330,914 subjects were consecutively screened for risk factors of oral cancer by village health volunteers (VHVs) using a questionnaire (S1). Then, 186,710 subjects with one or more risk factors for oral cancer were referred for oral screening by dental auxiliaries or dentists at sub-district level hospitals (S2) where 86,941 subjects were subsequently screened. Afterwards, 1576 subjects with suspicious oral lesions for OPMDs or oral cancer attended local hospitals for further investigation and treatment. Oral medicine specialists, oral surgeons, and local dentists at the district level hospitals performed biopsies and the samples were sent for histopathological analysis. The objectives of the study were to report the histopathology findings from the biopsies obtained from these subjects and the associated risk factors.ResultsOut of 427 subjects who received biopsies, complete diagnostic results were obtained from 409 patients (462 specimens). The 5 most common histopathological results from these specimens were mild epithelial dysplasia (27.3%), fibroepithelial hyperplasia (14.5%), oral lichen planus/oral lichenoid reactions (11.5%), moderate epithelial dysplasia (8%), and acanthosis with or without hyperkeratosis (5%). Oral squamous cell carcinoma was detected in 14 subjects and 11 other forms of oral cancer were revealed. Among the analyzed risk factors, habitual betel quid chewing was established as a statistically significant risk factor associated with OPMDs and oral cancer.ConclusionThe most frequently observed histopathological results of clinically suspected oral cancer and OPMDs included mild epithelial dysplasia, fibroepithelial hyperplasia, oral lichen planus/oral lichenoid reactions, moderate epithelial dysplasia, and acanthosis with or without hyperkeratosis. Betel quid chewing habit was found to be associated with OPMDs and oral cancer.

Salivary and serum acetaldehyde levels in betel quid chewers, pan masala chewers with or without tobacco and tobacco smokers: A comparative study using head space gas chromatography.

Acetaldehyde, a natural by-product of combustion and photo-oxidation, has been detected at low levels in cigarette smoke. Various literature studies have shown increased salivary acetaldehyde production among smokers and heavy drinkers. The present investigation was performed to estimate the salivary and serum acetaldehyde levels in pan masala chewers (with or without tobacco), betel quid chewers and tobacco smokers. Blood and Saliva samples were collected from 40 participants. The study participants were categorized into 4 groups of 10 individuals each. Subjects with no habits, betel quid chewing habit, pan masala chewing habit with or without tobacco and tobacco smoking habit. All the samples were centrifuged and subjected to gas chromatography (GC) analysis as per standard protocols provided by the manufacturer. No statistically significant difference in either serum or salivary acetaldehyde levels between Pan Masala chewers (with or without tobacco) and smokers was noted. However, higher mean serum and salivary acetaldehyde levels than the normal subjects and betel quid chewers was observed. It may be speculated that natural acetaldehyde, may not be released in estimated quantity of acetaldehyde by head space GC. Nevertheless, it is possible that addition of acetaldehyde as flavoring agents or preservatives for improving acceptability of the product can be a possible cause for these observations. Owing to various socio, economic and political reasons, implementation of the ban remains to be a formidable challenge. With these observations, we believe that absolute ban of all pan masala product is the ideal solution for minimizing the oral cancer burden in India.

Habitual Betel Quid Chewing Patterns and the Risk of Oral Potentially Malignant Disorders: Population-Based Case Control Study

Habitual betel quid chewing is known as risk factor of oral potentially malignant disorders. Comprehensive data on the history of usage patterns and the risk of oral mucosal disorders related to the habitual betel quid chewing had previously been limited in numerous Indonesian populations. The purpose of this study was to investigate the risk of habitual betel quid chewing patterns on the oral potentially malignant disorders in Samosir Island, province of North Sumatra Indonesia. The present study was conducted to the habitual chewers of betel quid in the working area of the local government clinic of Ambarita in Samosir Regency, North Sumatra Province, Indonesia. As study group, subjects with oral potentially malignant disorders i.e. submucous fibrosis and leukoplakia, and as control group, subjects without oral potentially malignant and malignant disorders, were assigned into study. The present study revealed the oral potentially malignant disorders were significantly associated with the duration of chewing betel quid more than 25 years (OR= 4.571; p= 0.022), the number of quids consumed per-day more than 6 quids/day (OR= 4.121; p= 0.024), and lifetime exposure of chewing betel quid more than 1.4x104 hours (OR= 4.571; p= 0.022), meanwhile duration of retention of the quid in the mouth more than 40 min/quid associated with the risk of oral potentially malignant disorders (OR= 2.475; p= 0.225). As the conclusion, the risk of oral potentially malignant disorders might increase with the more the subjects practiced in habitual betel quid chewing patterns.

Factors associated with betel quid chewing among adolescents living in Nattalin township, Bago region, Myanmar

Background: Betel quid (BQ) chewing is a common practice in Myanmar. BQ chewing is a risk factor for oral health problems and is associated with multi-organs cancer. The earlier age and the larger quantity of BQ per day enhance more health risks. The main aim of this study was to find out the prevalence and to identify the factors associated with BQ chewing practice among the adolescent population.Methods: Cross-sectional quantitative (primary) study was conducted on 160 adolescents (10-19 years) in Nattalin township in Myanmar using interviewed structured questionnaire. All data analysis was done by using statistical package for the social sciences (SPSS) statistical software.Results: The prevalence of BQ chewing adolescents was 28.2% of the total sample (n=160). The BQ chewer group contained more males than females. The earliest age of starting BQ chewing was 6 years old. Socio-demographic characteristics included age (equal or more than 15 years) (p<0.001), male (p<0.001), rural residence (p=0.009), working group (p<0.001), pocket money of more than 10000 kyats (p<0.001), having BQ used family members (p=0.017) and BQ used close friends (p<0.001) and the negative attitude (p=0.006) toward BQ chewing were the factors significantly associated with BQ chewing practice in this study.Conclusions: In conclusion, more than one-fourth of the studied adolescents chewed BQ and the majority had a good knowledge level. Many more effective anti-BQ chewing interventions and strong behavioural change health promotion programmes emphasizing the dangers of BQ chewing habits for adolescents need to be developed nationwide.

Simultaneous determination of areca nut- and tobacco-specific alkaloids in saliva by LC-MS/MS: Distribution and transformation of alkaloids in oral cavity

Areca nut and tobacco are frequently used in combination. Cigarette smoking and betel quid (BQ) chewing habits impose greater oral cancer risk than either habit alone. Saliva is a better noninvasive diagnostic material as it is in direct contact with oral mucosa and cancerous lesions. This study describes the application of isotope-dilution LC-MS/MS for simultaneous quantitation of five areca nut-specific alkaloids (ASAs) and three tobacco-specific alkaloids (TSAs) in human saliva. With this method, we demonstrate that the distribution of ASAs vary significantly in smokers who chew BQ habitually, due to the hydrolysis of ASAs and metabolic activity in the oral cavity. The alkaline condition formed due to slaked lime in BQ, plays an important role in the distribution of ASAs and TSAs, by catalyzing the hydrolysis of ester forms of ASAs to their respective carboxylic acid forms besides facilitating the TSA (i.e., nicotine) absorption in the oral cavity. Moreover, our results reveal that oral mucosa rather than saliva contributes to the metabolism of ASAs at oral cavity. Less than 2.1% of ASAs were metabolized by saliva, as determined by in vitro test. Our findings may provide a better insight into the pathobiology of oral carcinogenesis due to BQ chewing.

Combined Impacts of Genetic Variants of Long Non-Coding RNA MALAT1 and the Environmental Carcinogen on the Susceptibility to and Progression of Oral Squamous Cell Carcinoma.

Oral squamous cell carcinoma (OSCC) is the most common malignant tumor of the oral cavity, and long non-coding (lnc)RNA of metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) was recently reported to play a crucial role in OSCC development and progression. However, potential effects of genetic variants of MALAT1 on the development of OSCC are still unclear. Herein, we performed a case-control study in 1350 patients with OSCC and 1199 healthy controls to evaluate the association between functional single-nucleotide polymorphisms (SNPs) of MALAT1 and OSCC susceptibility, as well as its clinicopathologic characteristics. A TaqMan allelic discrimination assay was used to genotype four tagging SNPs, viz., rs3200401 C>T, rs619586 A>G, rs1194338 C>A, and rs7927113 G>A, and results showed that the MALAT1 rs3200401 T allele had a lower risk of OSCC (adjusted odds ratio (AOR): 0.779, 95% confidence interval (CI): 0.632~0.960, p=0.019) and a higher risk of developing moderately (grade II)/poorly (grade III) differentiated OSCC (AOR: 1.508-fold, 95% CI: 1.049~2.169, p=0.027) under a dominant model. According to environmental carcinogen exposure, patients with a betel quid-chewing habit who carried the T allele of rs3200401 more easily developed high-grade (II/III) OSCC (AOR: 1.588, 95% CI: 1.055~2.390, p=0.027), and patients with the same genotype but who did not chew betel quid had a lower risk of developing lymph node metastasis (AOR: 0.437, 95% CI: 0.255~0.749, p=0.003). In addition to rs3200401, the rs619586 AG/GG genotype was associated with increased risks of developing advanced stages (III+IV) and larger tumor sizes (>T2) compared to the AA genotype, especially in the subgroup of betel quid chewers. Furthermore, analyses of clinical datasets revealed that the MALAT1 expression level was upregulated in OSCC compared to normal tissues, especially in the betel quid-chewing population. These results indicated involvement of MALAT1 SNPs rs3200401 and rs619586 in the development of OSCC and support the interaction between MALAT1 gene polymorphisms and the environmental carcinogen as a predisposing factor for OSCC progression.

Effect of MACC1 Genetic Polymorphisms and Environmental Risk Factors in the Occurrence of Oral Squamous Cell Carcinoma.

MACC1 (Metastasis Associated in Colon Cancer 1) is found to regulate the hepatocyte growth factor (HGF)/Met signal pathway, and plays an important role in tumor proliferation, angiogenesis, and metastasis. However, the relationships between MACC1 SNPs (single nucleotide polymorphisms) and oral cancer are still blurred. In this study, five SNPs (rs3095007, rs1990172, rs4721888, rs975263, and rs3735615) were genotyped in 911 oral cancer patients and 1200 healthy individuals by real-time polymerase chain reaction (PCR), and the associations of oral cancer with the SNP genotypes, environmental risk factors, and clinicopathological characteristics were further analyzed. Our results showed that individuals who had GC genotype or C-allele (GC + CC) in rs4721888 would have a higher risk for oral cancer incidence than GG genotype after adjustment for betel quid chewing, cigarette smoking, and alcohol drinking. Moreover, the 715 oral cancer patients with a betel quid chewing habit, who had C-allele (TC + CC) in rs975263, would have a higher risk for lymph node metastasis. Further analyses of the sequences of rs4721888 revealed that the C-allele of rs4721888 would be a putative exonic splicing enhancer. In conclusion, MACC1 SNP rs4721888 would elevate the susceptibility for oral cancer, and SNP rs975263 would increase the metastasis risk for oral cancer patients with a betel quid chewing habit. Our data suggest that SNP rs4721888 could be a putative genetic marker for oral cancer, and SNP rs975362 may have the potential to be a prognostic marker of metastasis in an oral cancer patient.

Association of LINC00673 Genetic Variants with Progression of Oral Cancer.

Oral squamous cell carcinoma (OSCC) is a multifactorial malignancy, and its high incidence and mortality rate remain a global public health burden. Polymorphisms in the long intergenic noncoding RNA 673 (LINC00673) have been currently connected to the predisposition to various cancer types. The present study attempted to explore the impact of LINC00673 gene polymorphisms on the risk and progression of OSCC. Three LINC00673 single-nucleotide polymorphisms (SNPs), including rs11655237, rs9914618, and rs6501551, were evaluated in 1231 OSCCC cases and 1194 cancer-free controls. We did not observe any significant association of three individual SNPs with the risk of OSCC between the case and control group. However, while assessing the clinicopathological parameters, patients carrying at least one minor allele of rs9914618 (GA and AA; OR, 1.286; 95% CI, 1.008–1.642; p = 0.043) were found to develop lymph node metastasis more often compared to those who are homozygous for the major allele. Further stratification analyses revealed that this genetic correlation with increased risk of lymphatic spread was further fortified in habitual betel quid chewers (OR, 1.534; 95% CI, 1.160–2.028; p = 0.003) or smokers (OR, 1.320; 95% CI, 1.013–1.721; p = 0.040). Moreover, through analyzing the dataset from The Cancer Genome Atlas (TCGA), we found that elevated LINC00673 levels were associated with the development of large tumors in patients with head and neck squamous cell carcinoma and the risk of lymphatic spread in smokers. These data demonstrate a joint effect of LINC00673 rs9914618 with betel nut chewing or smoking on the progression of oral cancer.

Risk factors for diabetes mellitus in patients with gastroesophageal reflux disease

Diabetes mellitus (DM) and gastroesophageal reflux disease (GERD) may have a bidirectional association in clinical practice, and both diseases have caused considerable damage to the burden of health care and even hindered the economic development of the society. We sought to discover the risk factors for DM in patients with GERD. The research data was collected from the database of the health management center at a medical center in Southern Taiwan as a retrospective cross-sectional research from January 1, 2016, to December 31, 2018. We used logistic regression to analyze the related factors for DM in patients with GERD. Of the 5578 patients with GERD, 739 had DM. The statistically significant risk factors for DM in GERD were gender, age, body mass index, waistline, betel quid chewing habit, lack of exercise habit, and family history of DM. We conclude that DM in patients with GERD should have regular physical examinations that include a thorough patient history, appropriate laboratory tests, and possible endoscopy. We also suggest that patients with either DM or GERD should be evaluated and treated immediately if they have symptoms, including regular physical examinations and lifestyle interventions, to improve health-related quality of life.

Mean Lipid Profile among Patients Suffering from Oral Sub-mucous Fibrosis reporting in a Tertiary Care Hospital of Karachi, Pakistan: A Descriptive Study

Background: Oral Submucous Fibrosis is a potent pre-malignant condition of Oral cavity, which is prevalent in South Asian countries, due to social habit of pan, gutka, areca nut and betel quid chewing, which is mostly practiced in South-East Asia. A decreased pattern of lipid profile has been observed in literature in many precancerous conditions, this study is based on observation of lipid profile pattern among Oral submucous fibrosis patients in relation with age, gender, body mass index and duration of disease. Objective: A descriptive study to determine mean lipid profile values among oral sub-mucous fibrosis patients. Study Design: Descriptive (cross-sectional) study. Settings: Department of Oral & Maxillofacial Surgery, Abbasi Shaheed Hospital-Karachi Pakistan. Duration: 1st January 2017 till 30th June 2017, for a period of six months. Methodology: Oral Sub-mucous Fibrosis (OSMF) patients, who also met with inclusion criteria of study were selected. Lipid Profile values of TC (total cholesterol), HDL (high density lipids), LDL (low density lipids) and triglycerides were observed among OSMF patients in relation to duration of disease, their different age groups, gender and body mass index (BMI). Results: Out of 104 clinically diagnosed patients of OSMF, 34 females and 70 were males. Mean age was 38.9, most of the patients were in the age group of 20-40 years. Mean and standard deviation of TC, triglycerides, LDL and HDL was 132.19±13.29, 142.25±8.71, 101.87±17.57 and 30.43±2.56 respectively. Conclusion: Results of this study revealed that there is no significant change in pattern of lipid profile among OSMF patients in relation to their different age groups, gender and BMI, but an inverse relation does exist between lipid panel and duration of disease.

Gender difference in betel quid consumption levels and tobacco use among adults in Myanmar

Several small scaled studies in Myanmar investigated determinants of betel quid chewing status but to better understand more complete profiles of betel quid chewing habits, this study investigated the associations of betel quid consumption levels with tobacco and sociodemographic factors using a nationally representative sample in Myanmar. A cross-sectional, secondary data analysis was conducted by using Myanmar demographic and health survey (MDHS) (2015-2016). Chi-square tests and multinomial logistic regression were performed with p-value<0.05 as significance. Men averagely chewed 5.59 (SD=8.229) pieces per day while women chewed 1.25 (SD=3.584) pieces. The prevalence of chewing daily pieces 1-2, 3-5 and 6+ were 7.9%, 17.1% and 34.2% for men and 6.1%, 8% and 7.1 %, respectively, for women. In multivariate analysis, low education, low family wealth, married, and urban were more likely to chew 6+ pieces per day relevant to no consumption in both genders, while a positive association with age was observed only in women. Tobacco use was associated with low consumption level (1-2 pieces), relative to no consumption in both genders. Therefore, this study underlined the need to improve knowledge on the dangers associated with betel quid chewing and tobacco use among socially disadvantaged populations and urban residents.

Aberrant expression of DUSP4 is a specific phenomenon in betel quid-related oral cancer.

Oral cancer due to betel quid chewing habit is very common in South Asian countries. We attempted to detect the presence of a novel gene in epithelial cells stimulated with arecoline, a main component of betel quid. Human gingival epithelial progenitors were cultured and treated with a 3-day alternating regimen with/without 50μg/ml arecoline for 1month. DNA microarray and methylation arrays were analyzed to identify the candidate genes. Immunohistochemical staining was performed in the tissue samples. Genome-wide analyses, quantitative reverse transcription PCR and quantitative methylation-specific PCR revealed DUSP4 as the most significant and promising gene. The methylation levels of DUSP4 were significantly higher in the betel quid-related oral squamous cell carcinoma (OSCC) than those in the non-related OSCC and controls (Mann-Whitney U test, p < 0.05). The number of DUSP4 immunopositive cells in betel quid-related OSCC was significantly higher than those from the non-chewing patients and the controls (p < 0.05). Hypermethylation of DUSP4 may be considered as a specific event in betel quid-related oral cancer.

Oral submucous fibrosis transforming into squamous cell carcinoma: a prospective study over 31years in mainland China.

Oral submucous fibrosis (OSF) is an oral mucous disease caused by betel quid chewing. It is controversial whether OSF can transform into oral squamous cell carcinoma (OSCC). In this prospective study, a group of 567 patients with OSF were enrolled from 1986 to 2017 and followed-up until 2019. The cancerous information was collected and analyzed. OSF transformed into OSCC in 32 cases (32/567, 5.6%). The patient's age ranged from 20 to 69years, and the average age was 52years. The time taken for transformation ranged from 2to 24years, the average being 8.6years. The cancerous transformation occurred in 18 patients (56%) from years 2 to 9, in 13 patients (41%) from years 10-19 and in 1 patient (3%) from 24years. We analyzed the betel quid chewing habits and found all 32 patients with OSCC-chewed betel quid. Betel quid chewing was most prevalent in patients aged 40-69years. Sixteen patients had chewed betel quid for 10-19years (16/32, 50%) and 19 patients (60%) chewed 10-19 slices each day. The OSCC was located in the left or right buccal regions in 23 patients (23/32; 72%) and in the left or right lingual regions in 4 patients (4/32; 12%). Well, moderately and poorly differentiated squamous cell carcinoma was present in 23 patients (23/32; 72%), 4 patients (3/32; 9%), and 5 patients (5/32; 16%), respectively. Our findings supported that OSF is a real oral premalignant disorder. The long duration of the transformation from the OSF to OSCC suggests more frequent examinations and corresponding treatments are necessary for OSF patients.

Do betel quid and areca nut chewing deteriorate prognosis of oral cancer? A systematic review, meta-analysis, and research agenda.

To explore the correlations between the habit of betel quid and areca nut (BQ-AN) chewing and the prognosis of oral cancer (OC). We performed a systematic review and meta-analysis to clarify this issue. Data searches were performed using PubMed, Web of Science, Epistemonikos, and Embase databases through November 2019. The primary outcome was the difference in the prognosis of OC between BQ-AN chewers and non-chewers, measured in terms of 5-year overall survival (OS) and 5-year disease-specific survival (DSS) log (HR) reported in articles. The pooled HR with 95% CI of 5-year OS and 5-year DSS was calculated using a fixed-effects model. Ten articles with eleven OS or DSS survival studies (one of the articles contained two studies), which were published between 2003 and 2017, were eligible for inclusion in the present study. All the 11 studies were observational studies, among which 10 were retrospective and 1 was prospective. One study measured both OS and DSS. Eight studies, with a total of 2,761 patients, used 5-year OS as the primary endpoint and four studies, with a total of 2,551 patients, used 5-year DSS. Overall, the pooled HR evaluating BQ-AN chewers was 1.26 (95% CI: 1.09-1.46) for 5-year OS and 1.40 (95% CI: 1.15-1.70) for 5-year DSS, compared with non-chewers. There was a significant association between BQ-AN chewing and OC survival. Betel quid and areca nut chewing is significantly associated with poor prognosis in patients with OC.