Tobacco Chewing Research Articles

Lateral Medullary Syndrome Presenting as Section Persistent Singultus and Upper Motor Neuron Facial Palsy in a young Adult: A Rare Case

Lateral Medullary Syndrome (LMS) is a collection of different neurologic symptoms after cerebral haemorrhage/infarction. The areas most frequently afflicted are the cerebellum and the posterolateral portion of the brain stem’s medulla oblongata; the Posterior Inferior Cerebellar Artery (PICA) supplies blood. Dizziness, vertigo, nystagmus, nausea, ataxia, dysphagia, vomiting, hiccups, hoarseness, sensation impaired on half of the face, impaired thermal sensation and pain on the contralateral side of the limbs, trunk, ipsilateral face, along with Horner’s syndrome are amongst the typical symptoms of lateral medullary infarction. Hiccups are among the signs that are simple to ignore, although they can also result in oesophagitis, and respiratory depression, as Wallenberg’s syndrome is the most frequently reported. The authors discuss the case of a 30-year-old male who complained of recurrent, uncontrollable hiccups as an LMS-presenting symptom and was brought to our hospital. He arrived at our emergency room complaining of persistent, intractable hiccups and cerebellar symptoms on the left-side. In addition to being hypertensive, he had a long history of tobacco (chewing) and alcohol addictions dating back six years. He had 7, 9 and 10th cranial nerve involvement. The authors are reporting this case because the patient had Upper Motor Neuron (UMN)-type facial palsy, a rare presentation in LMS

Oral Biopsy and Tobacco Cessation

Oral Biopsy and Tobacco Cessation

Applying new approach methodologies to assess next-generation tobacco and nicotine products.

In vitro toxicology research has accelerated with the use of in silico, computational approaches and human in vitro tissue systems, facilitating major improvements evaluating the safety and health risks of novel consumer products. Innovation in molecular and cellular biology has shifted testing paradigms, with less reliance on low-throughput animal data and greater use of medium- and high-throughput in vitro cellular screening approaches. These new approach methodologies (NAMs) are being implemented in other industry sectors for chemical testing, screening candidate drugs and prototype consumer products, driven by the need for reliable, human-relevant approaches. Routine toxicological methods are largely unchanged since development over 50 years ago, using high-doses and often employing in vivo testing. Several disadvantages are encountered conducting or extrapolating data from animal studies due to differences in metabolism or exposure. The last decade saw considerable advancement in the development of in vitro tools and capabilities, and the challenges of the next decade will be integrating these platforms into applied product testing and acceptance by regulatory bodies. Governmental and validation agencies have launched and applied frameworks and "roadmaps" to support agile validation and acceptance of NAMs. Next-generation tobacco and nicotine products (NGPs) have the potential to offer reduced risks to smokers compared to cigarettes. These include heated tobacco products (HTPs) that heat but do not burn tobacco; vapor products also termed electronic nicotine delivery systems (ENDS), that heat an e-liquid to produce an inhalable aerosol; oral smokeless tobacco products (e.g., Swedish-style snus) and tobacco-free oral nicotine pouches. With the increased availability of NGPs and the requirement of scientific studies to support regulatory approval, NAMs approaches can supplement the assessment of NGPs. This review explores how NAMs can be applied to assess NGPs, highlighting key considerations, including the use of appropriate in vitro model systems, deploying screening approaches for hazard identification, and the importance of test article characterization. The importance and opportunity for fit-for-purpose testing and method standardization are discussed, highlighting the value of industry and cross-industry collaborations. Supporting the development of methods that are accepted by regulatory bodies could lead to the implementation of NAMs for tobacco and nicotine NGP testing.

A Rare Case of Verruca Vulgaris Lip and its Surgical Management

Oral verruca vulgaris also known as viral papilloma has been commonly associated with human papillomavirus (HPV) 6 and 11, is a rare lesion. We present a rare case of large sized verruca vulgaris over lower lip mucosa associated with other leukoplakia lesions. A 60-years-old male patient , a tobacco chewer presented with complaint of growth on lower lip for the last 8 months. On Intra oral examination, a single 5 X 3 cms well defined hyperkeratotic grayish-white lesion was found with multiple long papillary projections on the mucosal surface of lower lip . Histopathological examination was suggestive of Verruca Vulgaris. Surgical excision of the lesion with safe margins was carried out. Reconstruction was done using inferiorly based left sided Nasolabial flap. Oral Verruca Vulgaris is a rare lesion which requires a timely diagnosis and treatment to provide asthetically and functionally better outcomes.

Prevalence of Infertility among Young Women with Polycystic Ovarian Syndrome (PCOS)

Background: Polycystic ovarian syndrome (PCOS) is the most common cause of infertility among young women trying to conceive. Most of the times due to lack of awareness, women remain undiagnosed and unable to seek treatment at young age when the success rates of conceiving are higher. Objective: To determine the true prevalence of infertile young women diagnosed with PCOS. Study Design: Prospective study. Settings: Department of Gynecology and obstetrics, Ghulam Muhammad Mahar Medical College, Sukkur Pakistan. Duration: July 2022 to June, 2023. Methods: All young women (18 years – 35 years) diagnosed as PCOS, and failure to conceive for more than 1 year were included for this study. Data were collected regarding baseline and clinical characteristics. Outcome variable was presence or absence of infertility among young women with PCOS. Results: Final analysis was performed on 124 young women diagnosed with polycystic ovarian syndrome. The mean age and standard deviation was 27.84 ± 4.21 years and BMI was 25.14 ± 6.33 kg/m2. More than 80% of women were housewives (n = 101) and had lower socioeconomic background, 60.48% (n = 75). The prevalence of infertility was 62.90% (n = 78) and 37.09% (n = 46) did not have infertility. Infertility was more common among young women with higher mean age (26.34 ± 2.67 years), higher BMI (26.34 ± 2.67 kg/m2), and women addicted to chewable tobacco, p value <0.05. Conclusion: Higher infertility rate is observed among young women diagnosed with polycystic ovarian syndrome. Fertility rate can be increased among such women by providing awareness regarding the disease and treatment plan.

Analyzing the Expression of MicroRNA-375 and its Target Gene p53 in Oral Squamous Cell Carcinoma and its Implication in Oral Carcinogenesis

Objective: Oral mucosal cancers are the 11th most common human malignancies worldwide with a five-year survival rate of ≤50%. The lacunae of reliable diagnostic and prognostic markers pose an enormous challenge to the timely identification and prediction of disease progression in oral cancer. MicroRNAs (miRNAs) are emerging molecular markers associated with cancer initiation, progression, and therapy. The present study evaluated the microRNA -375(miR-375) expression and its target p53 gene in Oral squamous cell carcinoma (OSCC) to validate its utility as a diagnostic marker of the disease. Patients and Methods: This case-control study targeted histopathologically diagnosed cases of OSCC. miR-375 was quantified from 22 cases of OSCC and corresponding control tissues using qRT-PCR. Mutant p53 expression in cases and controls was determined by subjecting the tissues to immunohistochemical Results: Significant downregulation of miR-375 was noted in OSCC tissues (68.1%) compared to the control tissues with a mean fold change of 83.9 (p<0.05). Significant downregulation of miR-375 was noted in Paan and tobacco chewing patients (77.8%). Men exhibited considerable downregulation compared to women (p<0.05). The miR-375 expression levels did not correlate with the patient’s age, location, size, nodal status, and histopathological grade of the tumor. About 63.6 % of OSCC tissues showed mutant p53 positivity. Mutant p53 expression was noted in 73.3% of miR-375 downregulated tumors. Smokers exhibited higher expression of mutant p53 contrary to non-smokers(p<0.00). P53 immunopositivity showed a correlation with tumor size, histopathological grade, and nodal metastasis. Conclusion: The findings of the study indicate that miR-375 downregulation may have a crucial effect on oral carcinogenesis by targeting p53. miR-375 should be further evaluated as a potential marker for oral cancer diagnosis.

Outcome of Adjuvant Radiotherapy and Adjuvant Chemoradiation for Oral Cancers with Close Margins of Resection.

Oral cancers comprise 50% of all head and neck malignancies in India which can be attributed to tobacco chewing. Advanced oral cancers are managed with surgery followed by adjuvant radiotherapy or adjuvant chemoradiation. There is paucity of studies regarding need for adjuvant treatment in oral cancers with close margins i.e. ≤ 0.5cm after formalin fixation. This study aims at documenting the oncological outcome with regards to loco-regional control, disease-free survival, overall survival and complications of adjuvant radiotherapy and adjuvant chemoradiation in operated oral cancer patients having close margins of resection. In this Retrospective cohort study, 163 patients with stage T1-T4 oral cancers operated between 2015 and 2019 who have fulfilled the inclusion and exclusion criteria, received adjuvant treatment and could be followed up for at least one year were included. At the end of 45months, the overall survival was 74.7% and disease specific survival was 82.7%. Among the 7 patients who defaulted radiotherapy, 4 patients succumbed to the disease. Complications were bone marrow depression (2 patients), dysphagia (17) and Trismus (1). Adjuvant radiotherapy should be given in oral cancer patients with close margins of resection since it improves the oncological outcome and disease specific survival and the benefit often outweighs the risk.

In vitro permeation of nicotine and tobacco specific nitrosamines from smokeless tobacco product extracts in a 3D buccal tissue model

Tobacco product use is a risk factor in the development of oral cancer, although epidemiology studies show this risk is far less with smokeless tobacco product use than cigarette smoking. While smokeless tobacco contains harmful and potentially harmful constituents (HPHCs), the oral permeation of HPHCs in oral tobacco products is not completely understood. To improve the understanding, three different extract concentrations of the CORESTA reference products (CRP) for snus (CRP1.1) and moist snuff (CRP2.1) were applied to cellular tissue derived from two donors of EpiOral™ model, a 3D human buccal model, and permeation of nicotine and tobacco-specific nitrosamines (TSNAs) were measured over two hours. Permeation of 0.15% caffeine in complete artificial saliva and cell viability were also measured. Results showed that a consistent and concentration dependent cumulative permeation of nicotine and TSNAs was observed with high percent recovery in all conditions. A high degree of sensitivity was seen for all analytes, with minimal cytotoxicity for both CRPs. The data presented here show the EpiOral™ model is fit-for-purpose to evaluate the permeation of nicotine and TSNAs in nicotine-containing snus and moist snuff oral tobacco.

Consumption of chewing tobacco alters the serum metal contents in pregnant women at Tandojam and adjoining areas.

Chewing tobacco may play a contributing role in complications during pregnancy as it contains various kinds of toxic metals such as lead (Pb), cadmium (Cd), cobalt (Co), manganese (Mn), chromium (Cr), and can cause alteration in serum metal concentration. Hence, the present study aimed to explore the effects of chewing tobacco consumption on serum metal contents in pregnant women. A total number of 200 chewing tobacco consumer pregnant women and 200 age-matched non-consumer pregnant women were selected for the study from the outpatient department of gynaecology at Rural Health Centre Tandojam, Pakistan. After obtaining the sociodemographic characteristics of all participants, 10ml of venous blood was also drawn for serum metal analysis by atomic absorption spectroscopy. Different chewing tobacco samples consumed by consumer pregnant women were collected from local shops of Tandojam, Pakistan. Drinking water samples from the residential areas of consumer and non-consumer pregnant women were prepared and analysed for the same metal contents. In present study, serum Pb, Cd, K and Co were found significantly increased in CPW as compared to NCPW. Serum Pb was found significantly increased in gutkha consumers in comparison to mainpuri consumers. Serum Pb, Cd, and Co were present with significantly increased concentration in serum of CPW who were taking canal and well water for drinking purpose when compared with NCPW. Significant negative strong correlation of serum Pb with K and Cr of drinking water and Na of chewing tobacco samples were observed. Strong positive correlation of serum Cd and Cr with Co of drinking water had been observed. Whereas, serum maternal Co was strongly negatively correlated with Mn of chewing tobacco samples, and serum Cu of CPW had a strong positive correlation with K and Cr of drinking water and Na of chewing tobacco samples.In conclusion, consumption of chewing tobacco alters the serum metal contents in pregnant women at Tandojam and adjoining areas, Pakistan.

CONCEPT OF MUKHA SWASTHYA (ORAL HYGIENE) WITH AYURVEDIC PER-SPECTIVE

Background: Mukha is an Anga who is exposed to several risk factors on a regular basis, hence Mukha Swasthya (oral hygiene) is becoming more and more significant. Tobacco chewing, smoking, and other habits have increased the prevalence of oral cavity diseases. In Ayurveda, Dantdhawana, Kavala, Gandusha, and various other remedies are mentioned to maintain Mukha Swasthya. Ayurvedic classical texts prescribe Dan-tadhwana by Datuna (Chewing Sticks) in the morning and after every meal to prevent mouth ailments. Kavala comprises swishing a certain oil or herbal decoction in the mouth for a particular duration, whereas Gandusha involves retaining a larger quantity of liquid in the oral cavity for a longer period of time. Both treatments pro-mote comprehensive cleansing by eliminating dirt, pollutants, and potentially hazardous germs from the mouth and throat. Material and Method: This review paper has been taken from different Ayurvedic classical textbooks, Text-books of Swasthavritta, and various modern and Ayurvedic research papers from PubMed, Google scholar, SCI etc. Discussion: Ayurveda defines Dantdhawana vidhi as routine oral hygiene maintenance procedure in Dinachar-ya, including Kavala, Gandusha etc. Similar to this, modern practices like tooth brushing and gargling help to maintain oral hygiene to become healthy and free of diseases. These practices enhance dental health, reduce plaque formation, prevent cavities, alleviate halitosis, and promote gum health. Dantadhawana with its antimi-crobial, anti-inflammatory, and tissue-strengthening properties, may contribute to improving oral hygiene and gum health. On the other hand, in Kavala and Gandusha, the swishing action and the prolonged contact of the liquid with the oral tissues enhance the absorption of these beneficial compounds, aiding in the removal of pathogens and the restoration of oral balance. Result: A vital sign of general health, happiness, and quality of life is good oral health. Dental caries, periodon-tal disease, tooth loss, oral cancer, orodental trauma, noma, and congenital impairments including cleft lip and palate are just a few of the illnesses and problems it covers. In Charaka Samhita, Dantadhawana is mentioned as the subset of Dincharya, whereas it was referenced by Acharya Sushruta in the section on cures (Chikista Sthana) and Ashtanga Hridaya primarily mentioned its preventive aspects. In various studies, it is found that Dantadhawana makes natural whitening of teeth, improves oral hygiene, Strengthen teeth and gum. Whereas Kavala and Gandusha help in reduction of harmful bacteria, makes breathe fresh, enhances oral health, nourish oral tissues.

Impact of Treatment Related Side Effects in Quality of Life of Patients with Head and Neck Cancer

Cancer is the leading cause of death in all parts of the world. Head and neck cancer (HNC) comprises a unique group of aero-digestive tract malignancies that include the seventh most common cancer in the world. As patients receiving chemotherapy would usually experience many side effects and these can affect their quality of life captiously. So that this study can be used in amelioration of the Quality of life of patients with head and neck cancer. By understanding the quality of life status, therapy could be optimized accordingly or take precautionary measures to avoid that specific effect. A Cross-sectional study was carried out among 25 samples in the Department of Oncology, ESI PGIMSR, Rajajinagar of Bengaluru. The data was collected by using EORTC QLQ C 30 and HNC 35 questionnaires and responses were recorded. All information was processed and analyzed by using Microsoft Excel. The majority of the subjects included in the study were males (23, 92%) followed by females (8, 8%) The highest number of subjects included in the study belonged to the 50-59 years age group (9, 36%) followed by 60-69 age group (8, 32%). Out of 25 study subjects, 15 patients had social habits of smoking (37%) Alcohol consumption (15,39%), tobacco chewing (5,13%) and No habits (4,11%). The Quality-of-Life score obtained from the 25 study subjects who were undergoing any treatment was found to have a neutral to good quality of life (not excellent). The average raw score and the respective linear score were found to be 4.16,52.66 for global health status, the Functional scale was found to have 1.76,74.8 and the Symptom scale was found to be 1.88,29.29. The correlation was done in SPSS software and found a negative value which interpreted as the increasing Side Effects is leading to the decline in quality of life.

Clinical profile of multi-drug reisitance tuberculosis in adults

on 24 march 1884 etiological agent of tuberculosis was discovered by German doctor Dr. Robert Koch, this discovery led to variety of medical applications in diagnosis and management of pulmonary TB. Among many infectious disease prevalent in India, drug resistant TB is one among the important public health problem. There are many factor which influence occurrences of the drug resistant TB, our study conducted mainly to understand those factors which influences the drug resistant TB i.e clinical profile of drug resistant TB in tertiary hospital VIMS, Ballari. The prospective study was conducted in patients admitted in medical college hospitals affiliated to Vijayanagar Institute of Medical Sciences, Ballari over a period of 2 years from November 2016 to October 2018. All patients with sputum AFB and X-ray suggestive of tuberculosis were sent to CBNAAT (Cartridge-based nucleic acid amplification test) for detection of drug resistance. Clinical and radiological characteristics, and risk factors were recorded and further analysis was made. Out of 150 patients with pulmonary tuberculosis 28 of them were detected with drug resistance tuberculosis. Out of 28 drug resistance tuberculosis patients all 28 patients had resistance to isoniazid and rifampicin (MDR-TB). During the study period, among the drug resistant tuberculosis patients the maximum patients belonged to age group 35 to 48yrs of age and males (n=24, 85.7%) outnumbered females (n=4, 14.3%). Fever (n=26, 92.9%) was common symptom. And next common symptom was cough (n=25, 89.2%), loss of appetite, shortness of breath, hemoptysis, loss of weight, chest pain and wheezing. HIV (39.2%) was the common comorbidities among the study patients, followed by diabetes mellitus (35.7%), HTN (35.7%) and COPD (28.5%). About 71.5% of the cases were smokers and 64.3% had history of alcohol consumption and 14.2% were tobacco chewers in this study. About 57.1 % (n=16) were taken ATT previously and not completed treatment and 4 of them were relapse case. This study had shown that, drug resistance tuberculosis is more common than a rare entity and also shows that drug residence is associated with HIV and drug defaulter. Appropriate adherence with ATT and early diagnosis is main determinant in drug resistance TB.

Artificial Intelligence-based Oral Cancer Screening System using Smartphones

About one-fifth of all oral cancer cases reported globally are from India. The low-income groups in India are affected most due to the wide exposure to risk factors such as tobacco chewing and insufficient access to early diagnostic tools. Visual examination and histological study are the standard for oral cancer detection. This paper proposes the idea of using Autofluorescence-based imaging techniques to detect and classify oral cancer using AI algorithms. Various features of the images along with medical history, age, gender, and tobacco usage are considered as inputs to the proposed Mobilenet classification architecture.

Community-based Screening of Oral Cancer in Selected Districts of Nepal: A Cross-Sectional Study.

Oral cancer screening plays a vital role in the prevention and control of oral cancer. This study aimed to determine the prevalence of oral potentially malignant disorders (OPMDs) in the Nepalese community. A cross-sectional study was conducted in six purposively selected districts in Nepal from May to December 2019. It utilized a camp-based approach, where a standardized questionnaire was administered through face-to-face interviews. Screening of oral cancer was performed by direct visualization and palpation. The study included adults aged 18 years and above, while those already diagnosed with oral cancer were excluded. Logistic regression was used to find out the association between OPMDs and the related variables. A total of 1930 participants with a mean age of 44.3 years (SD=15.1) underwent oral cancer screening. Among them, 32% were current tobacco users, 2% were ex-users, and 11% were alcohol consumers. OPMDs, including suspected cancer, were identified in 139 (7.2%, 95% CI=6.1-8.4) participants. The most common lesion detected was leukoplakia (4.2%), followed by submucous fibrosis (1.5%), erythroplakia (0.9%), and palatal changes due to reverse smoking (0.1%). Additionally, 10 participants were suspected of having oral cancer. Older age group (AOR=7.00; 95% CI=2.76-17.77), male gender (AOR=2.52; 95% CI=1.58-4.02), tobacco chewers (AOR = 14.30; 95% CI=8.82-23.19), and smokers (AOR=4.67; 95% CI=2.88-7.57)) were identified as predictors of OPMDs. This study revealed a high prevalence of OPMDs in Nepal, highlighting the need for oral cancer screening. The findings emphasize the importance of developing strategies to reduce tobacco use and implementing tobacco cessation intervention programs in Nepal to alleviate the burden of oral cancer.

Abstract B124: An assessment of awareness on oral cancer among smokeless tobacco users in the rural skirts of Tamil Nadu, India

Abstract Background In India, the number of newly diagnosed tobacco related cancers has been estimated at approximately 250 000 out of a total of 700 000–900 000 new cancers diagnosed each year. Smokeless tobacco (ST) is tobacco consumed orally, not smoked. It has been in use for as long as other forms of tobacco consumption and its use have increased. The deleterious effects of smokeless tobacco use are perhaps not as well-known as those produced by smoking. Smokeless tobacco use has been recognized as a cause of cancer. In developing countries, tobacco is mostly chewed with other ingredients. The aim of this study is to assess the awareness of health hazards of tobacco among smokeless tobacco users in Kancheepuram District, Tamil Nadu, India. METHODOLOGY The inhabitants of the villages in Kancheepuram district were recruited after ethical clearance from the institutional ethical board, permission from the Village panchayat leader and informed consent from the participants to conduct the study. Inhabitants of the villages aged 18 to 75 years and present on the day data collection and who were willing to participate in the study were included.Random sampling method was used and data was collected from a cross-sectional survey, using a pretested Questionnaire, which included Demographic data, tobacco habits, its frequency and form.Anti-tobacco counselling was given on the spot and followed.The data collected was analysed using SPSS version21. RESULT: The study population consisted of total 800 individuals, male 400 and females 400. From the results it is observed that more than 70% were unaware of the harmful effects of using tobacco products. Majority of the females use smokeless tobacco and smoking tobacco was common among males. Most common cause of tobacco use was pleasure 32.5% and inducing factor were friends 43.7%. High prevalence of potentially malignant lesion were found among this population. Effectiveness of anti-tobacco counselling is greater among the females compared to males. CONCLUSION: The dangers from smoking and chewing tobacco are well documented within the literature but the public’s lack of knowledge of the risks is a concern. Health professionals are encouraged to disseminate information on the subject as widely as possible and improve existing screening programmes to ensure that the public is made aware of these risks, especially those within high-risk groups. Citation Format: Delfin Lovelina Francis, Saravanan SP. An assessment of awareness on oral cancer among smokeless tobacco users in the rural skirts of Tamil Nadu, India [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B124.

Qualitative Analysis of Opinions and Beliefs Associated with the Use of Tobacco Dentifrice among Individuals Attending a Tobacco Counselling Session.

Smokeless tobacco (SLT) use is positively associated with oral, oesophageal, and pancreatic cancers. The tobacco dentifrice is a type of SLT which is applied to the teeth and gums. It is available in different forms which include mishri, gul/gulmanjan, gudhaku, snuff, red tooth powder, and creamy snuff. This qualitative study aims to explore the opinions and beliefs associated with the harmful effects of tobacco dentifrice use. Thirty in-depth interviews were conducted among tobacco dentifrice users visiting a dental hospital. The data were coded and analysed using thematic analysis in ATLAS.ti software 8. A total of 11 codes and six categories were generated which comprised of the reason for the initiation, awareness of health effects, perception of oral tobacco application, perception of quitting, the reason for continued use, and use in society. Family, peers, access to the product, curiosity were important factors to initiate the tobacco dentifrice use. Participants believed in the myth that tobacco dentifrice was beneficial for the teeth, gums, and bowel movements. The participants considered tobacco dentifrice to be less harmful than other forms of tobacco. However, some participants were aware of its adverse effects on health and have tried to quit in the past. None of the participants had taken any professional help for quitting. There were strong beliefs and myths among the participants that tobacco dentifrice was beneficial for oral and general health. There is a need to create awareness and improve the standard of the health warning of such products.

Non-cigarette Tobacco Use and Stroke Among West Africans: Evidence From the SIREN Study.

Non-cigarette tobacco (NCT) represents a form of tobacco use with a misperceived significance in chronic disease events. Whether NCT use is sufficient to promote stroke events, especially among Africans, is yet to be understood. This study assessed the relationship between NCT use and stroke among indigenous Africans. A total of 7617 respondents (NCT users: 41 vs. non-NCT: 7576) from the Stroke Investigative Research and Educational Network (SIREN) study were included in the current analysis. NCT use was defined as self-reported use of smoked (cigars or piper) or smokeless (snuff or chewed) tobacco in the past year preceding stroke events. Stroke was defined based on clinical presentation and confirmed with a cranial computed tomography/magnetic resonance imaging. Multivariable-adjusted logistic regression was applied to estimate the odds ratio (OR) and 95% confidence interval (CI) for the relationship of NCT with stroke at a two-sided p < .05. Out of the 41 (0.54%) who reported NCT use, 27 (65.9%) reported using smokeless NCT. NCT users were older than non-NCT users (62.8 ± 15.7 vs. 57.7 ± 14.8 years). Overall, NCT use was associated with first-ever stroke (OR: 2.08; 95% CI: 1.02, 4.23) in the entire sample. Notably, smokeless NCT use was independently associated with higher odds of stroke (OR: 2.74; 95% CI: 1.15, 6.54), but smoked NCT use (OR: 0.16; 95% CI: 0.02, 1.63) presented a statistically insignificant association after adjusting for hypertension and other covariates. NCT use was associated with higher odds of stroke, and public health interventions targeting NCT use might be promising in reducing the burden of stroke among indigenous Africans. A detailed understanding of the relationship between NCT use and stroke will likely inform well-articulated policy guidance and evidence-based recommendations for public health prevention and management of stroke on the African continent.

Epidemiology, Molecular Pathogenesis, Immuno-Pathogenesis, Immune Escape Mechanisms and Vaccine Evaluation for HPV-Associated Carcinogenesis.

Human papillomavirus (HPV) is implicated in over 90% of cervical cancer cases, with factors like regional variability, HPV genotype, the population studied, HPV vaccination status, and anatomical sample collection location influencing the prevalence and pathology of HPV-induced cancer. HPV-16 and -18 are mainly responsible for the progression of several cancers, including cervix, anus, vagina, penis, vulva, and oropharynx. The oncogenic ability of HPV is not only sufficient for the progression of malignancy, but also for other tumor-generating steps required for the production of invasive cancer, such as coinfection with other viruses, lifestyle factors such as high parity, smoking, tobacco chewing, use of contraceptives for a long time, and immune responses such as stimulation of chronic stromal inflammation and immune deviation in the tumor microenvironment. Viral evasion from immunosurveillance also supports viral persistence, and virus-like particle-based prophylactic vaccines have been licensed, which are effective against high-risk HPV types. In addition, vaccination awareness programs and preventive strategies could help reduce the rate and incidence of HPV infection. In this review, we emphasize HPV infection and its role in cancer progression, molecular and immunopathogenesis, host immune response, immune evasion by HPV, vaccination, and preventive schemes battling HPV infection and HPV-related cancers.

A partial empirical test of the general strain theory on cyberbullying victimization among expatriate students

A partial empirical test of the general strain theory on cyberbullying victimization among expatriate students

Evaluation of fluoride levels in areca nut, tobacco, and commercial smokeless tobacco products: a pilot study

Oral submucous fibrosis (OSMF) is a premalignant condition associated with chewing areca nut and tobacco products. We observed increased fluoride levels in some OSMF-endemic regions,and the observation suggested that fluoride exposure may contribute to its pathogenesis. This study aimed to assess the fluoride content of various smokeless tobacco items as a potential influencing source. Fluoride concentration was analysed in commercial areca nut products, including gutkha, pan masala, and raw areca nut, along with tobacco, slaked lime, and catechu samples from Karnataka, India. Fluoride was measured using alkali fusion and the ion selective electrode method. All products showed high fluoride, with catechu having the highest mean concentration at 51.20 mg/kg, followed by tobacco, gutkha, pan masala, processed areca nut, and raw areca nut. Fluoride was also elevated in soil, but not in water. The findings demonstrate substantial fluoride levels in popular types of smokeless tobacco, and highlight an overlooked source of exposure among consumers of gutkha, pan masala and similar oral tobacco-products. The fluoride content warrants an investigation of potential links with the occurrence and severity of OSMF.