Gutkha Users Research Articles

Cellular diameter in desquamated cells of smokeless tobacco users

Background: Tobacco-induced mucosal changes have been identified in exfoliated cells. The morphology of the exfoliated cells depends on the nature of the changes taking place in the epithelial layer; conversely, alteration in cytological pattern may be attributed to the changes occurring in the epithelial layer. Applying this possibility, exfoliative cytological techniques have been applied to examine the effect of tobacco on the oral mucosa. Aims and Objectives: The study was conducted to study the alterations in the cellular diameter of buccal mucosal cells. Materials and Methods: In a case controlled study, 240 participants were divided into four groups according to their habit of consumption of tobacco leaves, tobacco with areca nut, participants with oral lesions, and participants without any such habit. The groups were, further, subdivided according to their age. Desquamated cells from the buccal mucosa of were collected and smeared on a slide. The cells were stained with Papanicolou (rapid kit). Fifty cells per slide were studied and photomicrographs were obtained at ×40 magnification. The cellular diameter was obtained using the Leica 1000 software. Results: The mean cell diameter was found to be highest in the group of normal subjects (49.51±7.31 micron), followed by the group of tobacco users (43.52±1.92 micron) and Gutkha users (39.05±3.57 micron). The mean cell diameter was minimum (24.97±3.13 micron) in the group of oral lesion patients. According to the ANOVA test, the difference in cell diameter among various groups is found to be highly significant (P<0.0001). Conclusion: Tobacco used in any form can induce changes in the buccal mucosa. In our study, mean cellular diameter decreased from normal-cells to cells affected by oral lesions.

Comparative Cytomorphometric Study of Exfoliated Oral Epithelial Cells from a Population of Smokers, Tobacco Users and Gutkha Chewers

Introduction: Tobacco remains one of the most important preventable cause of addiction, sickness and mortality in the world as it affects the oral epithelium. Normal epithelium undergoes continuous exfoliation or shedding of its superficial cells, and it is replenished by new crop of cells from the basal layer. The rationale of exfoliative cytology lies in the epithelial physiology. The purpose of this study is to conduct quantitative cytomorphometric studies on squames obtained from a population of Tobacco and Gutkha users, to assess the cytomorphometric changes in Nuclear Area (NA) and Cytoplasmic Area (CA) of squames from tobacco smokers, tobacco chewers, gutkha chewers, to compare the results with control group normal healthy individuals and among themselves. Methods: Oral smears were taken from buccal mucosa of total 200 individuals. The smears were histochemically stained and cytomorphological assessment was done. Groups were compared by one way analysis of variance (ANOVA) and the significance of mean difference between the groups was done by Tukey’s post hoc test after ascertaining normality by Shapiro-Wilk test andhomogeneity of variances by Levene’s test. Results: The mean Nuclear area of tobacco chewer (C) was the highest and the normal individual (N) was the least. The mean Cytoplasmic area of normal individual (N) was the highest and the tobacco chewer(C) was the least. Conclusions: This study supports and extends the view that cytomorphometric evaluation of keratinocytes can serve as a useful diagnostic adjunct for early detection of oral cancer. Keywords: exfoliative cytology; cytomorphometric; tobacco users; gutkha users.

Patterns of Periodontal Destruction among Smokeless Tobacco Users in a Central Indian Population.

Background: Findings of studies testing the association between smokeless tobacco (SLT) use and periodontal health have shown varying results in different populations. Considering the high prevalence of SLT use in India, the present study was conducted to understand the pattern of periodontal destruction within different areas of the dentition among SLT users. Methods: Age, gender, oral hygiene habits, the frequency and duration of SLT consumption, the type of SLT product used, and the site of retention of the SLT product in the oral cavity were recorded among 90 SLT users. Probing depth (PD), recession (REC), and clinical attachment loss (CAL) at SLT-associated and non SLT-associated teeth of the mandibular arch were compared based on the site of retention of the SLT product, the type of product used, and the duration of the habit. Results: REC and CAL were significantly higher at the SLT-associated zones compared to non SLT-associated zones and at both interproximal and mid-buccal sites of SLT-associated teeth. Among individuals who had the habit for more than 5 years and also among those who had the habit for 5–10 years, PD, REC, and CAL were significantly higher at SLT-associated teeth than at non SLT-associated teeth. Significantly greater periodontal destruction was observed at SLT-associated teeth among khaini users and gutkha users. Conclusions: Smokeless tobacco consumption resulted in greater destruction of periodontal tissues. The severity of periodontal destruction at SLT-associated sites differed depending on the type of smokeless tobacco used, the site of retention of the SLT, and the duration of the habit.

Serum Immunoglobulins as Diagnostic Markers in Smokeless Tobacco Users for Prevention of Oral Potentially Malignant Disorders

Background:Smokeless tobacco (SLT) remains a threat amongst a large population across the globe and particularly in India. Among the 28 known carcinogens in SLT, tobacco-specific nitrosamines are considered to be the most potent and it has been shown to cause immunomodulatory effects making the individual susceptible to various diseases. Immunoglobulins (Ig) form the defense against pathogens at the mucosal surfaces and SLT might interfere with its production and function. Therefore, the present study was undertaken to estimate the level of IgG and IgA in SLT patients and establish a correlation between them. Materials and Methods:A total of 60 subjects (34 khaini users and 26 gutkha users) were selected for the study. Complete demographic data and history was taken and clinical examination done to evaluate any oral mucosal changes. Venous blood samples were taken to analyze the serum immunoglobulin parameters. Results:Significant changes were observed in the serum IgA and IgG level in SLT users. Serum IgG level had a positive correlation whereas serum IgA had a negative correlation with the form of SLT and were statistically insignificant. Conclusion:The present study might serve as an early diagnostic tool and helpful in creating awareness on the hazards of using SLT among the Indian population as a despicable substitute to smoking tobacco. It also confers an imperative role into SLT mediated effects on immunoglobulins levels.

Perceived Benefits, Knowledge about Cancer and Attitude towards Promotion of Gutkha Amongst Gutkha users from Nepal

Introduction: Gutkha, a mixture of areca nut pieces, tobacco and slaked lime, is a potential carcinogen. It causes oral submucous fibrosis. Many people do not possess this knowledge and thus consume gutkha daily. The consumption is highly prevalent in Nepal because of easy availability of this material. Although ban of advertisement is implemented in Nepal in electronic media, the impact has not been significant.
 Objective: To find the prevalence of different beneficial effects cited, to determine awareness about cancer and attitude towards ban of advertisement, production and sale in current gutkha users from rural Terai dwellers of Nepal.
 Methodology: We interviewed 1217 households in a community survey in which 151 were current gutkha consumers, their responses about perceived benefits, cancer knowledge and views on ban of its sale and promotion was analyzed. The relationship with demographic variables were tested with Chi-square test with level of significance set at 0.05.
 Results: Among the current users, the reason of consuming gutkha was mostly 'feeling of well-being' (38.4%), about 40% thought it can cause cancer. The knowledge was not associated with gender, age group and literacy but statistically related with marital status (p<0.05). Majority were in favor of ban on advertisement (74.2%) and on production, sale and consumption (70.2%).
 Conclusion: The level of knowledge of cancer causation is very low and education level had not been significantly associated to knowledge. More gutkha users were in favor of its ban which is a positive finding.

Value of Micronuclei Count as a Predictor of Cytotoxic Damage in Smoked and Smokeless Tobacco Users

Background: Tobacco usage in the smoked and smokeless forms has reached epidemic proportions in the Asian sub-continent often leading to oral cancer which is the sixth most common cause of cancer related deaths globally. Micronuclei (MN) count is a promising indicator for the cytotoxic effects of tobacco usage. Our study was aimed at establishing a correlation between the MN counts among various tobacco habits. Methods: Exfoliated cells were collected over a period of three years from 2015 to 2017, from a total of 400 individuals consisting of 100 individuals each of smokers, gutkha chewers, khaini chewers and controls. PAP staining was done and the number of cells with micronuclei was counted under 40 X, by two independent examiners. The mean MN count was compared using the ANOVA test for statistical analysis. Results: Significant increase in micronuclei count was observed in individuals with tobacco habit. Mean value of epithelial cells with micronuclei ± SD was 1.58 ± 0.24 for controls, 7.51 ± 0.59 for smokers, 13.95 ± 0.97 for khaini chewers and 15.45 ± 1.17 for gutkha users. Conclusion: The MN count can be used as an early indicator for susceptibility to Oral squamous cell carcinoma (OSCC), as a non-invasive early detection tool for mass screening, for patient education as well as to check for efficacy of treatment.

Is There Any Impact Of The Gutkha Ban on Users and Vendors in Rangareddy District? A Cross Sectional Study

Introduction:Gutkha contains harmful and carcinogenic chemicals and oral cancer caused by tobacco usage has been reported as a major preventable cause of death worldwide by the World Health Organization. The Telangana state government implemented a ban on gutkha usage starting in 2013 but how effective this ban has been remains unclear.Objectives:The objective of this study was to determine the actual impact of the gutkha ban on users and vendors.Methodology:A cross-sectional study was conducted among gutkha users and tobacco vendors in Ranga Reddy district, Telangana. Based on a pilot study the sample size was determined as 368 and 384 for users and vendors respectively. Two separate questionnaires were administered to these groups. The parameters studied mainly included knowledge regarding the ban, and its impact.Results:About 49.1% of the users were aware of the ban on gutkha. Newspapers were the main source of information regarding the ban as reported by 45.3% of users. After the ban, 29.8% of gutkha users switched to other tobacco products. Awareness of health hazards and non-availability of gutkha was the most important reason stated for quitting or reducing consumption.Conclusion:The perspective of ban when visualized from the users point of view depicted a negative impact while the vendors portrayed a positive impact. Considering the addictive potential of the ingredients of gutkha, recording the effects of the ban on regular consumers and determining whether they can still obtain the products by illicit trade, would be noteworthy for implementation of strict rules.

Dynamic ventilatory functions in assessment of pulmonary system in gutkha users

Background There are diverse opinions about the degree of adaptability of the respiratory system in delivering the physiological needs in case of tobacco users. Role of the normal respiratory system in delivering oxygen to meet the demands of various degrees of exercise has been a topic of considerable debate. One view holds that the respiratory system is not normally the most limiting factor in the delivery of oxygen; others hold the absence of structural adaptability to physical training as the cause of limitation of the pulmonary system. The role of ventilatory functions in evaluating the respiratory functions in gutkha users has not been studied adequately in previous studies. Hence, there was a need for this study. Materials and methods Pulmonary function tests were performed before and after maximal exercise testing to assess dynamic lung functions in two groups: gutkha chewers and nongutkha chewers. Results On studying the differences in dynamic lung functions in two groups of nongutkha chewers and gutkha chewers, there was no difference in forced vital capacity and forced expiratory volume in 1 s, before or after exercise testing. The other flow rates maximum mid-expiratory flow, peak expiratory flow rate, and mid-expiratory flow 25-75% were on the higher side in nonchewer individuals, which were consistently maintained after exercise testing. A higher adaptability of the respiratory system to the training stimulus in the form of a higher elastic recoil pressure of the lungs and a lower resistance of medium to small airways is suggested as the mechanism of adaptability in this study.

Dynamic ventilatory functions in assessment of pulmonary system in gutkha users

BackgroundThere are diverse opinions about the degree of adaptability of the respiratory system in delivering the physiological needs in case of tobacco users. Role of the normal respiratory system in delivering oxygen to meet the demands of various degrees of exercise has been a topic of considerable debate. One view holds that the respiratory system is not normally the most limiting factor in the delivery of oxygen; others hold the absence of structural adaptability to physical training as the cause of limitation of the pulmonary system. The role of ventilatory functions in evaluating the respiratory functions in gutkha users has not been studied adequately in previous studies. Hence, there was a need for this study.Materials and methodsPulmonary function tests were performed before and after maximal exercise testing to assess dynamic lung functions in two groups: gutkha chewers and nongutkha chewers.ResultsOn studying the differences in dynamic lung functions in two groups of nongutkha chewers and gutkha chewers, there was no difference in forced vital capacity and forced expiratory volume in 1 s, before or after exercise testing. The other flow rates maximum mid-expiratory flow, peak expiratory flow rate, and mid-expiratory flow 25-75% were on the higher side in nonchewer individuals, which were consistently maintained after exercise testing. A higher adaptability of the respiratory system to the training stimulus in the form of a higher elastic recoil pressure of the lungs and a lower resistance of medium to small airways is suggested as the mechanism of adaptability in this study.

Detection of aneugenicity and clastogenicity in buccal epithelial cells of pan masala and gutkha users by pan-centromeric FISH analysis.

Chewing of betel quid, smoking and alcohol consumption are all associated with higher incidences of oral cancer. Genetic damage can be detected by fluorescent in situ hybridization (FISH) using human centromeric probes. In the present study FISH was performed on buccal epithelial cells of pan masala and gutkha chewers alone with and without additional tobacco smoking and/or alcohol consumption. The study comprised of 1500 male individuals. The present study found the highest frequency of micronuclei without a centromeric region (MN(-)) among gutkha users who also smoked and drank (P < 0.05). A significant increase in cells having micronuclei with a centromeric region (MN(+)) was observed among pan masala users who also smoked (P < 0.05). The study reveals that the clastogenic effects of pan masala/gutkha increase with smoking and alcohol consumption, but aneugenic effects were also observed among the pan masala chewers who smoked.

Impact of 'gutkha and pan masala ban' in the state of Maharashtra on users and vendors.

Gutkha and pan masala contain harmful and carcinogenic chemicals. Hence, Maharashtra Government banned their manufacture, storage, distribution and sale on 19 th July 2012 for a year. The objective of this study is to determine the impact of the ban on gutkha and pan masala on its users and vendors. A cross- sectional study was conducted among gutkha and/or pan masala users and tobacco vendors in the selected area of Mumbai city, 4-6 months after the implementation of the ban. The parameters studied included knowledge regarding the ban, usage or discontinuation of use of the banned products, product availability, withdrawal symptoms among quitters, etc., A total of 68 users and five tobacco vendors were enrolled in this study. Although all users were aware about the ban on gutkha, very few knew about the ban on pan masala. Only 5.9% of users knew that currently the ban had been declared for only 1 year. Electronic media was the main source of information regarding the ban as reported by 45.6% users. All users and vendors were in favor of the ban. After the ban, 23.53% gutkha users quit their habit while 55.88% reduced their gutkha consumption. Non-availability of gutkha was the most important reason stated by the gutkha users for quitting or reducing the consumption. In spite of the ban, gutkha is still available in the market, but at an increased cost or in a different form. Nearly 23.53% of gutkha users have quit their habit post-ban despite its availability through illegal sources.

Cytomorphometric analysis of the keratinocytes obtained from clinically normal buccal mucosa in chronic gutkha chewers

Objective: The objective of this study was to examine the cellular changes induced by chronic gutkha chewing in buccal mucosa as revealed by cytomorphometry. Study design: Nuclear area (NA), cellular area (CA), nuclear diameter (ND), cellular diameter (CD), ratio of NA to CA (NA:CA), ratio of ND to CD (ND:CD) of exfoliated buccal squames obtained from clinically normal appearing buccal mucosa of chronic gutkha chewers ( n = 30), were stained by Papanicolou method and observed under light microscope. 100 cells in each case were measured using image analyser. Non-gutkha users (healthy) served as negative controls ( n = 20) and oral squamous cell carcinomas (OSCCs) in gutkha users served as positive controls ( n = 20). All the variables except for ND:CD (using Shapero-Wilk test) were normally distributed and hence their mean difference was tested using ANOVA followed by Tukey test. In case of ND:CD non-parametric Kruskal-Wallis test followed by Mann-Whitney test was applied. Results: A highly significant decrease in CD, CA, increase in ND, NA, ND:CD and NA:CA were observed in smears obtained from chronic gutkha chewers when compared with the healthy controls ( P < 0.05). The mean value of ND and NA in gutkha chewers was greater than those of healthy controls, but lesser than that of OSCC cases. Conversely, the CD and CA gradually decreased from healthy controls to gutkha chewers to OSCC cases. Conclusions: The findings indicate that gutkha chewing influences the cellular alterations. The study confirms cytomorphometric changes in the buccal keratinocytes of chronic gutkha chewers.

English

AIM: To study the prevalence and etiopathogenesis of Oral submucosal fibrosis (OSMF). MATERIAL & METHODS : The present study was conducted on 206 cases of OSMF attending ENT OPD, G.R. Medical College & J.A. Group of hospitals, Gwalior, M.P. from January 2010 to January 2012. It was a randomized prospective tertiary hospital based study. RESULT : In the present study Males were predominating with overall M: F ratio 2.67:1. Most of the cases belong to 31-40 year of age group. About 49.52 % patient used heavy spices & chillies. Maximum cases 62.13% were gutkha users & 32.35 % were using gutkha or other products for 10-20 years. About 91.48 % cases chewed & spitted out the gutkha. It was also observed that 77.65% cases kept gutkha in mouth bilaterally. About 27.18% OSMF cases showed association with ulcero-proliferative growth in oral cavity & oropharynx. CONCLUSION: This article gives an insight into OSMF & associated lesions in this region of north India and adds to its biological

Micronucleus investigation in human buccal epithelial cells of gutkha users.

Background:Gutkha is a cheap and convenient betel quid substitute, which is popular among all age groups. Various studies reveal its carcinogenic nature that leads to oral submucosus fibrosis and increases the chances of oral cancer. The micronucleus (MN) assay in exfoliated mucosal cells is a useful method for observing genetic damage in humans.Aim:To observe the genotoxic effect of gutkha on human buccal epithelial cells.Materials and Methods:The MN assay was performed to assess the frequency of MN in human buccal epithelial cells. The study comprises 60 individuals of which 30 individuals were gutkha chewers and another 30 were nonusers (control). The MN frequency was scored to estimate the genotoxic damage.Results:In gutkha users, the frequency of MN was highly significant (17.4 ± 0.944) as compared with nonusers (control) groups (4.53 ± 0.331) (P < 0.001).Conclusions:The MN assay in human buccal epithelial cells is a useful and minimally invasive method for monitoring genetic damage in humans. Asignificantly higher frequency of micronucleated cells are found among gutkha users.