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Introduction: Ingestion of paan masala (a mixture of areca nut with catechu, slaked lime, and added flavoring agents) is one of the means of smokeless tobacco usage which can also have adverse effect on voice such as dryness in vocal folds which in turn may result in depletion of mucosal layer of the vocal folds. Aim: Aim of the study was to investigate the consequence of paan masala usage on voice parameters and to compare the acoustic parameters amid two groups who were paan users and non paan users respectively. Method: A total of 120 samples (3 trials of phonation of sustained vowel /a/) were obtained from male participants between age ranges of 18 – 40 years. 60 recordings were taken from 20 individuals who indulged in intake of paan masala from past 5-10 years. Another 60 recordings were from 20 individuals who were non paan masala users. The recorded samples were subjected to two types of analysis viz. perceptual evaluation was carried out by 10 qualified speech language pathologists based on standardized voice rating scale and acoustic analysis was done using clinically acceptable software. Results: Results of perceptual analysis indicated increased breathiness which was supported by acoustical NNE. Greater values in jitter, shimmer and Normalized Noise Energy (NNE) in paan users indicates of being at risk of having vocal pathologies. These parameters of voice had a significant difference between paan users and individuals who do not consume paan. Conclusion: The results do indicate that consumption of paan poses an impending threat to voice which is evident in abnormal acoustical findings and it is essential for people to be aware of the consequences of devouring paan for mere pleasure of minutes.

Background: Globally, there are over 7 million deaths resulting from tobacco consumption with 1 million deaths in India per year, and among middle-income countries listed as the second major consumer of tobacco products. The prevalence of tobacco consumption according to the recent studies already done is dissimilar among gender, different age categories, religion, urban and rural areas. The study purpose was to assess the prevalence of tobacco consumption among rural men. Methodology: Community-based cross-sectional study conducted from December 2018 to May 2019 in Amarpur village, Uttar Pradesh, India. There were 244 men in the age group of 15–54 years old, selected for the survey. Purposive sampling technique was used for taking sample and SPSS 16 software for statistics analysis. Results: The prevalence of smoked and smokeless tobacco was 36.1% and 42.6%. The most prevalent form of tobacco among smoked form was bidi and hookah, while among smokeless forms were gutka with paan. Among the smokers, 69.3% were willing to quit smoking on smokeless consumers and 78.8% were willing to stop tobacco consumption at some point. Age, marital status, education, and the number of children were associated with tobacco smoker and chewer. Tobacco was highest 38 (48%) among 25–34 years of age for tobacco smoker with P = 0.002, and tobacco chewer highest among 35–44 years which was 34 (61.8%) with P = 0.000. About one-third of the patients do not know that tobacco intake has ill effect on their health; the most common influencing factors for tobacco use were for enjoyment and stress. Conclusion: Prevalence of tobacco consumption was high in this community. Urgent awareness and increased literacy needed to improve knowledge on the effect of smoking in the rural area. Through the development of effective health education and multi-factorial quitting strategies to help those who are willing to quit tobacco.

Background: The role of retinoblastoma (Rb) protein in cell cycle regulation prompted us to take up this study with the aim of assessing its role in the progression of oral cancer and to correlate with various clinicopathological parameters, including habits such as smoking, Paan chewing, and alcoholism. Materials and Methods: This observational study included surgical specimens from 10 apparently normal oral mucosa, 14 oral reactive lesions (ORL), 29 precancerous lesions and 43 oral cancers. The expression of Rb protein in tissue samples were evaluated by immunohistochemistry and correlated with clinicopathological data. The percentage and mean expression of Rb protein were statistically analyzed using Student’s t -test and P < 0.05 was considered as statistically signifi cant difference. Results: The expression of Rb protein was found to increase from normal, ORL, precancerous lesions to cancers. A consistently high expression of Rb protein was seen in oral cancers, with an increase in well-differentiated and moderately differentiated tumors. Patients with combined habits of Paan chewing, smoking, and alcohol consumption had a higher expression compared with those without habits. Conclusion: Within the limitations of this study, it seems that overexpression of Rb protein noted in oral cancer, with an increase in well and moderately differentiated tumors suggest a possible role of Rb in differentiation. The high expression of Rb in patients with combined habits of Paan chewing, smoking and alcohol consumption indicates that Rb pathway may be altered in habitrelated oral malignancies. Key Words: Oral cancer, preneoplastic conditions, retinoblastoma protein, tumor suppressor gene, tumor suppressor proteins

Dear Editor, Betel nut (paan, Areca nut) chewing existed in Myanmar (Burma) since ancient times and it was done by both the kings and princes in the Burmese court and also by the ordinary people. The Burmese kings used golden containers studded with jewels to put the ingredients for betel quid (betel nut, betel leaf, caustic lime, and tobacco), whereas the common people used a lacquerware box. According to historical annals, court ladies offered paan to heroes returning from battles as a sign of respect and affection. It is also a Burmese custom to offer visitors and guests pickled tea leaves, paan, and hot green tea in Myanmar households. These act as stimulants and have effects similar to that of drinking coffee. The Burmese love the betel nut so much that tens of thousands of acres are dedicated to its cultivation.[1] Consequently, the number of betel nut stalls is also growing in towns and cities across Burma.[1] In Myanmar, the practice of chewing paan is increasing among both sexes and it is more popular among rural people than urban dwellers.[1] It tends to stain the lip and the teeth red but this does not signal bad aesthetics in Burmese culture. It is addictive and the Burmese believe that it can aid in digestion, and prevent halitosis and flatulence. After chewing, the end product, i.e., red betel juice has to be spit out. It creates a stain and this has become a concern for sanitation in modern times. Today, in Myanmar, there is a ban on spitting betel juice in public places. This is a big issue in the United States. Burmese immigrants were banned from a laundromat in Fort Wayne, Indiana for spitting betel juice inside the store.[2] Many of the Burmese immigrants are refugees and political asylees and have come from refugee camps along the Thailand-Burma border. They have low levels of education and have difficulty with the acculturation process in America. Various compounds present in the nut, most importantly arecoline, are carcinogenic and contribute to histologic changes in the oral mucosa. People who chew betel nut are 10 times more likely to have oral cancer than those who do not.[1] About 90% of males with oral cancer in Myanmar had histories of habitual betel nut chewing.[3] Chewing paan causes oral submucous fibrosis (OSMF), a precancerous lesion that lies on the causal pathway to oral cancer.[4] Areca nut causes fibroblastic proliferation and an increased collagen formation.[5] In Myanmar, the tongue is commonly affected followed by the palate, and diseases like lichen planus, oral leukoplakia, and erythroplakia can be observed, in addition to submucous fibrosis.[3,6] Even though it has been proved that chewing betel nut causes oral cancer, there are very few education or intervention programs in Myanmar. Monks, men, women, and even kids as young as 10-year-olds chew betel nuts in Myanmar. Myanmar has the highest prevalence of betel nut chewing in the region - about 51.4% of adult males chew paan daily.[7] Compared to this, 32.9% of adult males in India, 31.2% in Nepal, 26.4% in Bangladesh, 24.9% in Sri Lanka, 2.8% in Philippines, 1.3% in Thailand, 0.9% in China, 0.7% in Cambodia, 0.5% in Malaysia, and 0.3% in Vietnam chew betel nut.[8] Of the adult males who chew paan in Myanmar, 31% also smoke tobacco.[7] These two hazardous behaviors are commonly observed together. Betel nut chewing and smoking have a synergistic effect on oral cancer occurrence. In addition, among the 13-15-year-old students in Myanmar, 15.2% of boys and 2.0% of girls chew betel nut.[9] Thus, even in modern times, the trend of chewing betel nut is increasing in Myanmar.[10] In Myanmar, oral cancer is the fourth most common cancer among males and sixth most common among females.[11] Oral cancer ranks second in cancer mortality among males.[12] In addition to oral squamous cell carcinoma, betel quid with or without tobacco causes cancer of the pharynx and cancer of the esophagus in humans.[13,14] Slaked lime is corrosive and causes chronic inflammation, and peptic and duodenal ulcers.[15] There is a need to educate the Burmese in America and also in their native country. Oral cancer is costly to treat in a Third World country like Myanmar where the preventive services are limited. Tobacco is one of the main ingredients in the betel quid. There are no laws in Myanmar that prohibit the sale of smokeless tobacco to minors or prohibit the sale of smokeless tobacco within 100 yards of schools.[1] Thus, Myanmar is still far from banning the practice of chewing betel nut.[16] Currently, in the media, there are awareness campaigns in the form of public service announcements. However, in the major cities, there is a ban on spitting red betel juice in the streets, mainly for sanitary reasons. Betel nut chewing eventually becomes very hazardous to health and is a habit that should be strongly discouraged.

This article provides information on the origin of tobacco and its subsequent spread throughout the world. In the era of the migration of communities, tobacco use gradually gained access and subsequently migrated along with the migrants, establishing in different locations. Probably at that time people were unaware of the health hazards and were using tobacco in treating certain ailments. Much has been known and written about tobacco in the context of oral and general health hazards but little has been explored and is known to many about where from and how this plant, which is now used in various forms, and speading widely. In what form, where, and how it had been served in religious rituals and considered for treatment or remedy of certain ailments in those days could not certainly be known. In the 21(st) century, people are considering hazardous tobacco as beneficial for their teeth, good for concentration of mind, and something which keeps them engaged. Even many professionals, though knowing the deleterious effects, are still using tobacco and gutkha in one or the other form. This article has been designed to revive the awareness for health hazards of tobacco and similar products. A pilot project questionnaire survey comprising this subject involving the educated mass has already been started and will be produced after analysis of data in part II of this paper.