Betel Nut Chewing Research Articles

Pattern of Occurrence and Severity of Oral Submucous Fibrosis Among Habitual Gutkha, Areca Nut and Pan Chewers

Oral submucous fibrosis (OSF) is a complex, insidious and precancerous disease of the oral cavity. The high use of addictive substances in our local setting merits to be worked on finding out the resultant prevalence of OSF. Objective: To determine the frequency of occurrence and severity of OSF among habitual gutkha, areca nut and pan chewers. Methods: A total of 183 patients with presenting complaints of burning in mouth, difficulty in chewing and cheek biting and who are habitual chewer of areca nut, gutkha or pan for over 6 months with minimum frequency of 1 pack per day were recruited in this study at Oral and Maxillofacial Surgery Department of Liaquat University of Medical and Health Sciences Jamshoro, Pakistan. Severity of OSF was assessed as per clinical staging and findings was reported. Results: The average age of the patients was 34.57±9.98 years. Frequency of occurrence of OSF among habitual gutkha, areca nut and pan chewers was 100%. Regarding severity of OSF among habitual gutkha, areca nut and pan chewers was observed and found 31.15% stage 1, 51.91% stage 2 and 16.94% stage 3. Severity of stages were not statistically significant in all type of addiction. Conclusions: It was concluded that dose-dependent association between the frequency and length of daily use of commercially accessible areca nut and tobacco products and the increased risk of disease.

DPSCs regulate epithelial-T cell interactions in oral submucous fibrosis

BackgroundOral submucous fibrosis (OSF) is a precancerous lesion characterized by fibrous tissue deposition, the incidence of which correlates positively with the frequency of betel nut chewing. Prolonged betel nut chewing can damage the integrity of the oral mucosal epithelium, leading to chronic inflammation and local immunological derangement. However, currently, the underlying cellular events driving fibrogenesis and dysfunction are incompletely understood, such that OSF has few treatment options with limited therapeutic effectiveness. Dental pulp stem cells (DPSCs) have been recognized for their anti-inflammatory and anti-fibrosis capabilities, making them promising candidates to treat a range of immune, inflammatory, and fibrotic diseases. However, the application of DPSCs in OSF is inconclusive. Therefore, this study aimed to explore the pathogenic mechanism of OSF and, based on this, to explore new treatment options.MethodsA human cell atlas of oral mucosal tissues was compiled using single-cell RNA sequencing to delve into the underlying mechanisms. Epithelial cells were reclustered to observe the heterogeneity of OSF epithelial cells and their communication with immune cells. The results were validated in vitro, in clinicopathological sections, and in animal models. In vivo, the therapeutic effect and mechanism of DPSCs were characterized by histological staining, immunohistochemical staining, scanning electron microscopy, and atomic force microscopy.ResultsA unique epithelial cell population, Epi1.2, with proinflammatory and profibrotic functions, was predominantly found in OSF. Epi1.2 cells also induced the fibrotic process in fibroblasts by interacting with T cells through receptor-ligand crosstalk between macrophage migration inhibitory factor (MIF)-CD74 and C-X-C motif chemokine receptor 4 (CXCR4). Furthermore, we developed OSF animal models and simulated the clinical local injection process in the rat buccal mucosa using DPSCs to assess their therapeutic impact and mechanism. In the OSF rat model, DPSCs demonstrated superior therapeutic effects compared with the positive control (glucocorticoids), including reducing collagen deposition and promoting blood vessel regeneration. DPSCs mediated immune homeostasis primarily by regulating the numbers of KRT19 + MIF + epithelial cells and via epithelial-stromal crosstalk.ConclusionsGiven the current ambiguity surrounding the cause of OSF and the limited treatment options available, our study reveals that epithelial cells and their crosstalk with T cells play an important role in the mechanism of OSF and suggests the therapeutic promise of DPSCs.

Prediction methods for oral diseases

With the increasing advancement of science and technology, especially the rapid development of electronic computer technology, machine learning methods have obvious advantages in predicting oral diseases. Especially in the research on oral cancer, this article uses a variety of machine learning methods for prediction and has achieved some remarkable results to provide a basis for subsequent disease treatment. In the prediction analysis of oral cancer, logistic regression, Cox regression, and machine learning algorithms were used to make a preliminary judgment on the triggering factors of oral cancer. The main triggers were dietary habits, betel nut chewing, smoking, and excessive drinking. Secondly, this article explores solutions to oral cancer prediction problems. By comparing various methods, it is concluded that Cox regression is generally used to predict patient survival or recurrence rate, while logistic regression and machine learning algorithms are used to induce Judgment and evaluation of factors, among which machine learning algorithms mainly identify factors with a wide range and high complexity, while logistic regression is used to identify some specific factors. Oral cancer is a malignant tumor. Therefore, early prediction and treatment of oral cancer are not only crucial to the patient's survival rate and oral quality but also play a major role in the progress of medicine and the development of human society.

Abstract 1111: Poor radiation sensitivity and potential radiosensitizers for betel-nuts related head and neck squamous cell carcinoma in Taiwan

Abstract Background: Betel nut chewing might contribute to strong invasion & treatment refractoriness in HNSCC from Taiwan. Betel-nuts exposed HNSCC cell line, TW2.6, had high PDL1, defective p53 mutation, p16 loss, & BCL2 overexpression. In our studies, PI3K/AKT/mTOR inhibitors, anti-angiogenesis therapies, CDK4/6 inhibitors, DDR interventions, epigenetic modifications, and immunotherapy-containing regimens will be future combination options. The genomic signature of TW2.6 has been figured out in our study(AACR2020 & 2023), too, mainly with PIK3CA H1047R mutation, high TMB(8.42 muts/Mb)/MSS, VEGF-A amplification, p53/MYC/HRAS/DDR2/PDGFRbeta/EPHB1/ATM mutations, FAT1 loss, amplification of TERT/FGF10/CCND3/SOX9/IL-7R/SDHA/RICTOR/FLCN, CDK12/PTPRD loss of function, CDK8 mutation, & deletions of STK11/ARID1B/MITF/TNFAIP3 and molecularly-guided novel interventions will be designed. Purpose & Methods: Polo-like kinase 1 inhibitor(volasertib), gluconate(blocking citrate transport & glucose metabolism), IAP inhibitor(Debio1143), glutaminase 1 inhibitor(CB839) were tested on TW2.6 to evaluate synergistic effects with radiation. Results: TW2.6 was resistant to volasertib, gluconate, or radiation alone; but sensitive to Debio1143 and CB839. Volasertib significantly enhanced radiation. The flow cytometry revealed volasertib and radiation resulted in a significant G2/M arrest. Western blotting showed volasertib and radiation increased p-histone3, p-CDK1, & cyclin B levels and induced apoptosis. Gluconate, CB839, or Debio1143 each had significant synergistic effects with radiation. The radiosensitization efficacy would be volasertib>gluconate>CB839>Debio1143. Conclusions: In Taiwan, patients with R/M HNSCC progressing within 3 months after CCRT could be rescued by early ICIs. Recently, sequential CCRT followed by ICI or Debio-1143 with CCRT showed potential survival benefits. In our studies, novel agents such as PLK inhibitor, gluconate, and CB839 had even better radiosensitization compared with Debio1143. Sequential CCRT with novel agents followed by ICI will be the future trend, esp. in biology-aggressive betel-nuts related locally advanced HNSCC in Taiwan. Citation Format: Jo-Pai Chen, Jui-Ying Chang, Ruey-Long Hong. Poor radiation sensitivity and potential radiosensitizers for betel-nuts related head and neck squamous cell carcinoma in Taiwan [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1111.

Clinical Characteristics of Patients with Oral Submucous Fibrosis: A Single Institute Study

Abstract: Background: Oral Submucous Fibrosis (OSMF) is a well-established oral potentially malignant disorder (OPMD) affecting people of Pakistan, India, Bangladesh and Sri Lanka because these nations have a long-standing history of chewing areca nut. Objective: The primary objective of the current study was to assess the clinical features of OSMF in patients presented to the Department of Oral Medicine, Ziauddin University, Karachi, Pakistan. Materials and Methods: This study was done on OSMF patients who came to the Oral Medicine department of Ziauddin University, Karachi, Pakistan from June 2020 to July 2021. Clinicopathological parameters of OSMF like age, gender, habits and its frequency and duration, clinical signs and symptoms and stages were recorded. Result: There were a total of 60 patients of which 35 were males and 25 were females. The mean age of study subjects was calculated to be 36.46±11.96 years. More than 50% of the participants were using a combination of various tobacco products. Most of the patients in our study were of stage III followed by stages II, I and IV. 70% of patients had buccal fibrous bands bilaterally, 36.66% of patients had tongue restriction and 60% of patients complained of burning sensation in the mouth. Conclusion: OSMF becomes a disease of the young generation with a slight male predilection. The majority of individuals suffered from a severe and advanced form of the disease. The development of diagnostic aids is necessary to stop the disease in its early stages.

Exposure assessment to areca alkaloids in the Chinese populations through areca nut chewing.

The online version contains supplementary material available at 10.1007/s13197-024-05966-6.

Arecoline induces neurotoxicity in HT22 cells via the promotion of endoplasmic reticulum stress and downregulation of the Nrf2/HO-1 pathway.

Arecoline, the predominant bioactive substance extracted from areca nut (AN), is the world's fourth most frequently used psychoactive material. Research has revealed that chewing AN can affect the central nervous system (CNS) and may lead to neurocognitive deficits that are possibly linked to the action of arecoline. However, the mechanism behind the neurotoxicity caused by arecoline remains unclear. This study aimed to investigate the neurotoxic effects of arecoline and its underlying mechanism. The results showed that arecoline caused cytotoxicity against HT22 cells in a dose-dependent manner and induced apoptosis by upregulating the expression of pro-apoptotic caspase and Bcl-2 family proteins. Furthermore, arecoline escalated intracellular reactive oxygen species (ROS) levels and Ca2+ concentration with increasing doses, thereby motivating endoplasmic reticulum stress (ERS) and ERS-associated apoptotic protein expression. Additionally, the study found that arecoline attenuates intracellular antioxidant defense by inhibiting the translocation of NF-E2-related factor-2 (Nrf2) into the nucleus and decreasing downstream Heme oxygenase-1 (HO-1) levels. The specific inhibitor Sodium 4-phenylbutyrate (4-PBA) can dramatically attenuate arecoline-mediated cell apoptosis and ERS-associated apoptotic pathway expression by blocking ERS. The antioxidant N-Acetylcysteine (NAC) also effectively reverses the arecoline-mediated increase of ERS-related apoptotic pathway protein levels by scavenging intracellular ROS accumulation. In conclusion, this study suggests that arecoline induces neurotoxicity in HT22 cells via ERS mediated by oxidative stress- and Ca2+ disturbance, as well as by downregulation of the Nrf2/HO-1 pathway.

Evaluation of possible role of fluoride in pathogenesis of oral submucous fibrosis: A pilot study.

Oral submucous fibrosis (OSMF) is a potentially malignant disorder. Although areca nut chewing is an established risk factor, its low prevalence among nut chewers indicates additional factors likely facilitates pathogenesis. We recently demonstrated high fluoride levels in smokeless tobacco products and hypothesized a potential pathological role of fluoride in OSMF. Further exploring this novel role, this study compared fluoride levels in tissue, serum, and saliva samples from OSMF patients and healthy controls. The ethically approved study included 25 clinically confirmed OSMF patients and 25 healthy matched controls. OSMF cases underwent buccal mucosal incisional biopsy, while controls had buccal mucosa tissue sampling during third molar removal. Fasting venous blood and unstimulated saliva were collected. Fluoride levels were analysed using ion chromatography and expressed as median (IQR). OSMF cases showed significantly higher fluoride concentrations compared with controls in tissue biopsies (30.1 vs. 0 mg/kg, p < 0.0001), serum (0.4 vs. 0 mg/L, p = 0.005) and saliva (1.3 vs. 0 mg/L, p < 0.0001). Majority (68%) of controls had undetectable fluoride levels across all samples. Tissue fluoride weakly correlated with OSMF severity (r = -0.158, p = 0.334). The preliminary findings demonstrated increased tissue fluoride levels in OSMF patients compared with healthy controls. Along with a previous study showing high fluoride content in smokeless tobacco products, these findings provided early evidence suggesting fluoride could play a contributory role in OSMF pathogenesis. Further large-scale investigation is warranted to definitively establish whether the association between fluoride exposure and OSMF is indicative of causation.

Clinical outcomes of cetuximab-based treatment for distant metastatic head and neck squamous cell carcinoma: A real-world study using Taiwan Head Neck Society registry database.

For R/M HNSCC, the differences in prognosis and treatment options between distant metastasis (DM) and locoregional recurrence, especially in the DM group, remain unclear. From the Taiwan Head Neck Society registry database, patients who were diagnosed with R/M HNSCC and received cetuximab-based frontline therapy were collected for analysis. Among the enrolled patients, 59.3% (491/827) belonged to the DM group. The DM group had less primary site of oral cavity, less betel nut chewing, higher lactate dehydrogenase (LDH) levels, and higher LDH/albumin ratio compared with the non-DM group. For the patients with primary site of oral cavity and current smokers, DM coexisted with poorer outcomes. In the DM group, EXTREME-like regimen was more suitable for older patients, those with elevated LDH, and those with higher LDH/albumin ratio than TPExtreme-like regimen. DM coexisted with poorer prognosis in certain groups. LDH-associated biomarkers may aid treatment options for DM patients.

Comparative Analysis of Tissue Copper Levels in Oral Submucous Fibrosis (OSMF) Patients

ABSTRACT Background: Oral submucous fibrosis (OSMF) is a recognized potentially malignant oral condition linked to the consumption of areca nut. Chewing areca nut has been shown to elevate soluble copper levels in mouth fluids. Materials and Methods: Participants: The study included a panel of 30 patients with OSMF from Rama Dental College, Kanpur, India, and 30 nonareca chewing individuals serving as controls. Tissue Sample Collection and Analysis: Buccal mucosal biopsies were obtained from both OSMF patients and controls. The tissue copper concentrations were quantified using mass absorption spectrometry (MAS). Additionally, energy-dispersive X-ray microanalysis (EDX) was employed to identify the presence and distribution of copper in the tissue. Statistical Analysis: Statistical comparisons were performed using appropriate methods, with a P-value of less than 0.05 considered statistically significant. Results: MAS analysis revealed that the mean tissue copper level was 6.2 ± 3.1 micrograms per gram (μg/g) in OSMF specimens (n = 30), slightly higher than the 4.5 ± 2.0 μg/g in the nonareca chewing controls (n = 30) (P = 0.1). EDX analysis showed distinct copper peaks in both the epithelium (22/23) and connective tissue (18/23) of OSMF specimens compared to control biopsies. These findings were corroborated by secondary ion mass spectrometry (SIMS) in a subset of samples. Conclusion: The study revealed higher copper concentrations in buccal mucosal tissue of OSMF patients from Rama Dental College, Kanpur, suggesting a potential connection between copper and the initiation of OSMF.

Attitudes of the original people of Papua in consuming areca

The people of Papua have long been consuming areca nut. The embodiment of a person's thoughts and feelings to make a decision to take the act of consuming areca nut is an important attitude for a person. Attitude concerns knowledge, feelings, and the embodiment of actions that will direct someone to behave. This study aims to examine the attitudes of the Papuan people regarding the activity of chewing areca nut, chewing health, and maintaining environmental cleanliness as a result of chewing areca nut. The research was conducted in Manokwari City, West Manokwari District using a survey method with interview techniques of 120 respondents from indigenous Papuans. The measurement indicator uses tiered scores with the lowest score 1 to the highest score 5. Data is analyzed using simple tabulations and partial least squares test. The results of the study conclude that the Papuan people agree that chewing areca nut creates self-confidence, feelings of pleasure, and creates a friendly atmosphere. The Papuan people agree that consuming betel nut causes strong teeth and an odorless mouth. The attitude of the Papuan people in keeping the environment clean as a result of chewing areca nut is manifested in a statement not to throw spit and betel dregs anywhere, but this statement of attitude is not followed by any real behavior. There is a positive relationship between the attitude of chewing and the health of chewing areca nut on the attitude of keeping the environment clean.

Next Generation Sequencing in Detecting Oral Cancer Due to Tobacco Consumption

DNA sequence DNA Sequencing is the first step in establishing phylogenetic trees, protein structure prediction, diagnosis of cancer, discovery of drugs and hence its importance cannot be underestimated. DNA sequencing finds its use in the diagnosis of oral squamous cell carcinoma (OSCC). Oral Cancer is the most common occurring malignancies in the world, especially in India where the prevalence for smoking, Areca nut chewing coupled with a lifestyle that encourages these two activities as fashion are left many people diagnosed with OSCC. Patients with this OSCC are more likely unaware of its side effects and over time might suffer from facial deformity. The importance to understanding the symptoms, prevention and treatment of oral cancer is very much essential today. In this paper, we looked at over 2000 odd papers published and look at the correlation between the next Generation DNA sequencing algorithms (NGS) play an important role in diagnosis of OSCC. This is a further study on some of the papers which have highlighted NGS role in OSCC Diagnosis. We did like to see a comprehensive review on the papers published so far. In the discussion, we will see frequently mutated genes in the OSCC, recent discoveries and OSCC treatment based on the findings.

Spatial Transcriptomic and Metabolomic Landscapes of Oral Submucous Fibrosis-Derived Oral Squamous Cell Carcinoma and its Tumor Microenvironment.

In South and Southeast Asia, the habit of chewing betel nuts is prevalent, which leads to oral submucous fibrosis (OSF). OSF is a well-established precancerous lesion, and a portion of OSF cases eventually progress to oral squamous cell carcinoma (OSCC). However, the specific molecular mechanisms underlying the malignant transformation of OSCC from OSF are poorly understood. In this study, the leading-edge techniques of Spatial Transcriptomics (ST) and Spatial Metabolomics (SM) are integrated to obtain spatial location information of cancer cells, fibroblasts, and immune cells, as well as the transcriptomic and metabolomic landscapes in OSF-derived OSCC tissues. This work reveals for the first time that some OSF-derived OSCC cells undergo partial epithelial-mesenchymal transition (pEMT) within the in situ carcinoma (ISC) region, eventually acquiring fibroblast-like phenotypes and participating in collagen deposition. Complex interactions among epithelial cells, fibroblasts, and immune cells in the tumor microenvironment are demonstrated. Most importantly, significant metabolic reprogramming in OSF-derived OSCC, including abnormal polyamine metabolism, potentially playing a pivotal role in promoting tumorigenesis and immune evasion is discovered. The ST and SM data in this study shed new light on deciphering the mechanisms of OSF-derived OSCC. The work also offers invaluable clues for the prevention and treatment of OSCC.

Efficacy and inflammatory responses of root canal therapy plus periodontal non-surgical treatment for periodontal-endodontic combined dental lesions.

To investigate the efficacy and inflammatory responses of treating periodontal-endodontic combined lesions (PECLs) with root canal therapy (RCT) alone versus RCT combined with periodontal non-surgical treatment (PNST). A total of 103 patients with PECLs admitted between January 2019 and January 2020 to Shenzhen Baoan Women's and Children's Hospital were divided into control (RCT alone, 50 cases) and combined (RCT + PNST, 53 cases) groups. Comparative analyses included efficacy assessment, probing depth (PD), bleeding index (BI), plaque index (PLI), gingival index (GI), serum levels of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and high-sensitivity C-reactive protein (hs-CRP), pain severity during RCT, incidence of adverse reactions, post-treatment tooth conditions, and recurrence rates at 6 and 12 months. Univariate analysis identified factors associated with poor treatment outcome in PECL patients. The combined group demonstrated a higher total effective rate (90.57%) compared to the control group (74.00%) (P < 0.05). Patients receiving combined therapy showed significantly lower PD, BI, PLI, GI, IL-1β, TNF-α, and hs-CRP levels, as well as reduced pain severity and lower recurrence rates at 6 and 12 months (all P < 0.05). The combined group also had a lower incidence of adverse (periodontal distending pain and local foreign body sensation) reactions (7.54%) compared to the control group (26.00%) (P < 0.05). After treatment, the incidence of periodontitis, percussion tenderness, and loosening of teeth in the combined group was lower than that of the control group, and the retention rate of affected teeth was significantly higher (all P < 0.05). Factors such as history of alcoholism, betel nut chewing, and treatment method (RCT) were significantly associated with poorer prognosis in PECL patients (P < 0.05). Combined RCT and PNST improves clinical efficacy, reduces pain severity and inflammation levels, decreases adverse reactions, and enhances tooth retention in PECL patients. This treatment approach should be considered the preferred option for managing PECLs.

Risk Factors of Oral Squamous Cell Carcinoma with Special Emphasis on Areca Nut Usage and Its Association with Clinicopathological Parameters and Recurrence.

Oral squamous cell carcinoma (OSCC) is the most prevalent type of head and neck cancer and is associated with high mortality, particularly in Southeast Asian countries. Areca nut usage, smoking, and alcohol consumption are the most common risk factors for OSCC. Areca nut chewing is highly prevalent in Pakistan and has been attributed to an increase in OSCC cases. This study aimed to determine the association between areca nut usage and various clinicopathological features of OSCC and further evaluate the association of clinicopathological parameters of OSCC with tumor recurrence. The study was conducted using the data of 228 patients with OSCC resected at Liaquat National Hospital, Karachi, Pakistan, over 5 years between 2018 and 2022. Clinicopathological data were collected from hospital archives, and associations between various risk factors and clinicopathological parameters were determined. Males were more commonly affected (77.2%), and the most common age group was <50 years (54.4%). Areca nut usage was reported in 59.6% of cases, and the buccal mucosa was the most common site (62.7%). Areca nut usage was significantly associated with male gender, greater tumor size, greater depth of invasion (DOI), higher tumor stage, nodal stage, presence of perineural invasion (PNI), and recurrence. In addition, multivariate analysis revealed that OSCC recurrence was significantly associated with older age, larger tumor size and DOI, nodal metastasis, and areca nut usage. Areca nut-related OSCCs were associated with poor prognosis and recurrence in our study population. Furthermore, OSCC recurrence was associated with various clinicopathological parameters, such as larger tumor size, a higher DOI, and nodal metastasis.

Evaluation of Efficacy of Tulsi-Turmeric Oil Pulling in Oral Submucous Fibrosis (Vata Pitta Dominant Tridosaja Sarvasara Mukharoga): A Narrative Review

A condition called Oral Submucous Fibrosis (OSMF) primarily affects the Indian subcontinent. It is characterised by abnormal collagen deposition and fibrosis of submucosal tissue that progresses over time. Chewing betel nut is the most prevalent behaviour among Oral Submucous Fibrosis (OSMF) patients, with a 6.3% prevalence rate. Symptoms include ulceration, burning sensation, xerostomia, and limited mouth opening. According to the Brihatrayi (three main classical books), OSMF is associated with sarvasaramukharoga, or disorders of the oral cavity. Tobacco, lime, chilies, betel nuts, and other substances act as irritants and can damage the oral mucosa. Treatment methods include Gandusha (oil pulling), Pittashamaka, yoga, Nasya (nasal drops), Pratisarana (rubbing), etc. The present review was conducted to assess and evaluate the potential efficacy of Tulsi-turmeric oil pulling as a complementary or alternative therapy in managing OSMF

Knowledge, attitude, and practices of areca nut and betel quid chewing among the adult population – A questionnaire-based cross-sectional study

ABSTRACT Background: The use of areca nut also known as supari or chaali is an age-old tradition and very popular in people living in South Asian countries. However, in general, people know very little about its ill effects. Aims: This study aimed to examine knowledge, attitudes, and practices regarding the health risks associated with chewing areca nuts and betel quid among the adult population and to evaluate the knowledge about its possible role as a contributing factor in oral cancer among the adult population. Materials and Methods: The unicentric cross-sectional survey was conducted on 1644 adult subjects belonging to the adult population of Aligarh and nearby places between March 2021 and December 2021. We analyzed the data using the Statistical Package for the Social Sciences (SPSS) software version 22. Results: The overall average age of the participants was 39.32 ± 14.18. The male-to-female ratio was 2:1. Among the study subjects, 54% were betel nut or betel quid chewers. Only 30.8% knew that areca nut may cause oral cancer and with low knowledge related to its systematic effect. Conclusion: Areca nut is a known carcinogenic agent and carries the risk of cancer even if it is used alone. However, information about the systemic ill effect especially its carcinogenic effect is very low among the general population.

Risk Factors for Pneumonia in Toddlers at a Regional General Hospital of Mappi Regency, South Papua Province

Mappi Regency of South Papua has a high prevalence of pneumonia, with 387 cases in 2022 and a death rate of 8. This study aims to prove the risk factors for pneumonia in young children in Mappi Regency. The research used a case-control design, involving 72 samples for a case group and control group, respectively. Variables studied include child factors (male gender, asthma history, history of other diseases or comorbidities, non-exclusive breastfeeding, poor nutritional status); mother factors (low education, lack of knowledge, not employment, and mother’s behavior of smoking and chewing areca nut); environmental factors (habitat density, presence of family members who smoke, family members with a history of pneumonia, use of mosquito coils, and use of wood fuel for cooked); and low family income factors. Data analysis was carried out using chi-square and double logistic regression tests with the help of SPSS 25. The results for the multivariate trial demonstrated that the history of asthma (OR = 20.303; 95% CI = 6.461-63.802), the comorbital history (OR = 4.687; 95% CI = 1.834-11.977), poor nutritional status (OR = 2.905; 95% CI = 1.166-7.240), and the use of cooking wood fuel (OR = 3.831; 95% CI = 1.452-10.108) were risk factors for lung infection in toddlers. A history of asthma was the most risky factor among others. Parents whose children have a history of asthma should recognize asthma triggers in their children such as exposure to cigarette smoke, cold air, and air pollution, and provide medication according to doctor’s recommendations, provide food intake with good nutrition, keep children away from the cooking area where they can inhale smoke from burning firewood used for cooking, and encourage children to get used to a healthy life by washing their hands to avoid cold, diarrhea or other diseases that can worsen their pneumonia.

Head and neck cancers: epidemiology, diagnosis and treatments

Introduction: Head and neck cancers (HNC) affect many subsites in the upper aero-digestive tract. The risk factors include tobacco smoking, chewing betel nut/paan, excessive alcohol consumption, hereditary factors and viruses such as human papillomavirus (HPV) and Epstein–Barr virus (EBV). Early diagnosis, lifestyle changes and HPV vaccination will improve survival. Epidemiology: Globally, recent estimates from GLOBOCAN shows there are 890,000 cases of head and neck cancers annually and 450,000 deaths annually (1). There is an increasing incidence of oral cavity, lip, buccal cancers in the developing world due to higher consumption of tobacco, alcohol and chewing areca nut. There has been an increasing incidence of some HNC due to high-risk strains of human papillomavirus (HPV) (2). Cancers caused by HPV include tonsil cancer, tongue base cancer and unknown primary cancers. The EBV causes nasopharyngeal cancers especially in the Far East. There is a decreasing incidence of some cancers caused by smoking such as laryngeal and hypopharyngeal cancers mainly due to the reduction in smoking rates in some developed countries. Overall, there is a predicted increase in HNC of up to 30% annually by 2030 (2). The HPV-associated cancers affect mainly younger males, who do not necessarily smoke or drink alcohol. The HPV is a strong prognostic factor so patients with HPV positive cancers respond better to treatment as there are less genetic mutations when compared to cancers driven by tobacco smoking. These trends are alarming with socioeconomic impacts. Diagnosis: Symptoms of HNC include difficulty swallowing, persistent sore throat, difficulty breathing, hoarseness, neck lumps, referred pain to the ear, weight loss, and systemic symptoms in advanced disease. A full ENT examination is performed of the oral cavity, oropharynx, neck and ideally flexible nasendoscopy. Ultrasound-guided FNAC or core biopsy of neck lumps are performed. Cross-sectional imaging with CT or MRI scans followed by tumour biopsies either under local or general anaesthetic. Tumour biopsies are assessed using H&amp;E stains, and tests for HPV detection (p. 16 immunohistochemistry, in situ hybridisation or polymerase chain reaction). A PETCT scan is useful for staging cancers, identifying the origin of unknown primary cancers and for surveillance. Treatments: The head and neck cancer multidisciplinary team reviews all investigations and recommends either curative or palliative treatment options that are in every patient’s best interests. Surgery can be open, endoscopic or with the use of a robot. Microvascular reconstruction with flaps is performed as necessary to improve function and quality of life. Oncologic treatments include intensity-modulated radiotherapy (IMRT), which can be combined with chemotherapy. Immunotherapy is a second-line treatment for recurrent HNC currently. Advanced cancers can be treated with palliative intent or best supportive care especially if the patients are frail and have significant comorbidities. There are ongoing clinical trials and research studies exploring better, less-toxic treatments. Multiomics approach and artificial intelligence are exciting developments. Conclusion: There is an increasing incidence of some HNC especially cancers driven by tobacco smoking, alcohol consumption and high-risk human papillomaviruses. Smoking cessation, HPV vaccination, early diagnosis and improvements in treatments are important factors in ensuring good outcomes.

The association between alcohol, betel nut, and cigarette use with hepatitis C virus infection in Taiwan

Hepatitis C virus (HCV) infection may cause chronic liver disease, liver cirrhosis, and liver cancer. It has been reported to associate with habits including alcohol, betel nut and cigarette use. We aimed to investigate the association between alcohol, betel nut, and cigarette use with HCV infection in Taiwan and to explore their effects. A total of 121,421 participants were enrolled from the Taiwan Biobank. They were stratified into two groups according to whether they had (n = 2750; 2.3%) or did not have (n = 118,671; 97.7%) HCV infection. All participants were also classified into four groups according to the number of habits, including a history of alcohol drinking, betel nut chewing, and cigarette smoking. There were 85,406 (no habit), 24,299 (one habit), 8659 (two habits), and 3057 (three habits) participants in the four groups, respectively. Multivariable analysis showed that the participants who had an alcohol drinking history (odds ratio [OR] 1.568; 95% confidence interval [CI] 1.388–1.773; p < 0.001), betel nut chewing history (OR 1.664; 95% CI 1.445–1.917; p < 0.001), cigarette smoking history (OR 1.387; 95% CI 1.254–1.535; p < 0.001), were significantly associated with HCV infection. Furthermore, the participants were classified into four groups according to the number of habits as follows: 85,406 (no habit), 24,299 (one habit), 8659 (two habits), and 3057 (three habits). The HCV infection rates in these four groups were 2.11%, 2.14%, 3.23%, and 4.78%, respectively. Compared to the participants with no or one habit, those with two habits had a higher HCV infection rate (all p < 0.001). In addition, compared to the participants who had no, one or two habits, those who had three habits also had higher HCV infection rates (all p < 0.001). The participants who had three habits had the highest prevalence of HCV infection. In an era when most HCV can be cured, understanding the epidemiology link between habits and HCV may help the case finding.