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In a rural block in North East India, community health workers (CHW) empowered with a mobile phone-based application screened a total of 2,686 participants for Oral Potentially Malignant Lesions (OPMLs), and an oral medicine specialist recommended treatment remotely. Independent risk factors were determined using independent multiple logistic regression models. Nearly 700 (26%) participants were identified with OPMLs. The sensitivity, specificity, positive predictive values, negative predictive values and accuracy of the CHW was 70.3, 88.4, 66.8, 89.9% and 83.7% respectively. Male gender, married status, smokeless tobacco, paan, areca-nut and alcohol consumption were independent predictors of OPMLs, the burden of which in North East India can be attributed to the high consumption of tobacco and non-tobacco products. Such programmes, with the recommendations from remote specialists, will facilitate early detection in remote settings.

This study deals with the extraction of essential oil from betel leaf using an ultrasound pretreatment method. The sonication time, operating temperature and power have been optimised on the basis ...

Deforestation is a severe threat in the context of climate change and the establishment of protected forest areas is a crucial strategy to conserve and manage forests. This study aims to investigate the impact of betel leaf cultivation on the protected forest area known as the Teknaf Wildlife Sanctuary in the southern coastal area of Bangladesh. The research objectives were to describe the extent of betel leaf cultivation in and around the protected forest area, determine its impact on the forest and describe the socioeconomic factors affecting the cultivation. Data were collected from 2015 to 2017 covering 4622 households in the Teknaf upazila (upazila is an administrative unit). Satellite images were analyzed to determine the impact of cultivation on the forest. Among the factors analyzed the determinants of betel leaf cultivation, family size, occupation and encroachment in the forest were found to have a significant impact. This study identified 4273 paan boroj (betel leaf cultivation plots) covering an area of 250.74 ha, among which 1264 were found inside the forest area occupying 59.76 ha forestland. The average size of a paan boroj was 0.06 ha and in total required 1.32 tons of wooden poles from the forest. Over dependency by local people for their livelihood on forest resources is creating pressure on the protected forest and causing severe deforestation. Sustainable resource use, for example, following a tree-based agroforestry system and adopting more sustainable approaches for betel leaf cultivation, can reduce the deforestation inside the protected forest and conserve biodiversity.

Root rot of Paan methi/Kasuri methi (Foenum-corniculata), induced by the fungus Rhizoctonia solani has become a vital constraint to the growers of paan methi in Rajasthan. Two field surveys were conducted during the Rabi 2018-19 and 2019-20 cropping seasons to determine the distribution and importance of Paan methi root rot incidence in Nagaur district, Rajasthan. The associations of disease incidence with biophysical factors were evaluated. The disease incidence varied among soil types, crop management practices, and cropping seasons. Disease incidence was higher in 2019-20 (28.45%) than in 2018-19 (26.80%). Cropping season, soil type, and previous crop were pathogen-host were significantly associated with root rot incidence.Root rot incidence varied from 20.65 to 33.50 percent in four surveyed tehsils of Nagaur district, Rajasthan. Maximum disease incidence in both years (2018-19 and 2019-20) was recorded in Nagaur Tehsil (33.50%) followed by Jayal (30.07 %), Merta (24.50 %), and Degana (22.00 %). In the Nagaur district of Rajasthan, the overall average disease incidence was 27.65 percent in 48 fields of 24 villages of four tehsils. The survey among areas revealed that none of the locations was found free from the disease.

Spittoons were developed centuries ago as receptacles for spitting, similar to ashtrays for saliva. They were meant for men to dispose their chewing tobacco and the abundant phlegm that accompanied the habit. Convenience turned to concern in the late 19th century when a global tuberculosis (TB) epidemic took hold and scientists realised that spittoons might actually spread diseases. After one exchange at the 1905 International Tuberculosis Congress in Paris, the head doctor of the city’s postal system ordered all spittoons removed from city post offices. In the USA, public health departments launched antispitting campaigns to stop the spread of TB—and in some states made spitting illegal, as it still is. By the mid-20th century, spittoons were gone from most public spaces in the USA.1 Similarly, kidney trays have been used in hospitals for collection of coughed sputum of admitted patients. However, these do not disinfect the collected sputum and naso-oral secretions which may be potential sources of infections during handling by healthcare workers. There are a total of 267 million tobacco users in India.2 Chewing and spitting have been a tradition in India and in South East Asian low-income countries. In India, it is a tradition to offer fennel seeds and sugar crystals to chew after a meal, which act as mouth fresheners and also help digestion. On the other hand, chewing smokeless tobacco products, paan masala and areca nut (supari ), increases the production of saliva followed by a …

Objective: To assess the gingival biotypes in smokeless tobacco (Gutka and Paan) users and compare it with non-tobacco users in Karachi sub-population using trans-gingival probing method (TRAN). Methods: This in-vivo, cross sectional study was conducted in the department of Operative Dentistry from 20th February 2019 to 25th June 2019 Dow University of Health Sciences, Karachi after obtaining ethical approval from the Institutional review board of DUHS (Ref: IRB-1207/DUHS/Approval/2019/21). A total of 70 participants, 35 subjects currently using smokeless tobacco (Gutka and Paan) and 35 non-tobacco users from both genders were included in the study after taking informed consent. Gingival biotype was recorded using probe transparency method. Probing of the gingival sulcus was performed at the mid-buccal aspect of both maxillary incisors. Depending on the visibility of the underlying probe gingiva was categorized as thin or thick. Results: Statistically significant differences in gingival biotype was observed of both groups (p=0.005). Males were recorded with a higher percentage of thick gingiva in both groups (81% in smokeless tobacco and 65% in non-tobacco) while in females thick gingiva was more prevalent in smokeless tobacco group (85.7%) whereas thin gingiva was noted in non-tobacco group (66.7%); although the results between genders was statistically insignificant. The comparison between different age groups, genders and both groups was statistically insignificant. Conclusion: Significant difference was observed between gingival biotype of smokeless tobacco and non-tobacco user groups. No statistically significant results were observed between genders and age groups. Keywords: Gingival biotype, smokeless tobacco, Continuous...

Betel leaf or ‘Paan’ (Piper betle) is an integral component of the addictive chewing stimulant ‘betel quid’ which is traditionally consumed by a large population in the Asian countries. Betel essential oil is also heavily used by the flavour industries. Often, it constitutes of carcinogenic and genotoxic phenylpropanoids. High incidence of the oral carcinogenesis in this part of the world has been linked to the chewing of betel quid as well as Paan. In this study, Piper betleoides C. DC. (wild Paan) was identified as the edible plant source from north‐east India possessing betel‐scented essential oil which was highly rich in sesquiterpenoids majorly germacrene D and β‐caryophyllene. Identity of the plant was confirmed through critical taxonomic studies. Further, the essential oil yield and composition were investigated across different vegetative (young and mature leaves, stem) and reproductive (male and female inflorescence) tissues of P. betleoides through gas chromatography‐mass spectrometry (GC‐MS) and nuclear magnetic resonance (¹H, ¹³C NMR) spectroscopic analyses. The comparative quantitative investigation showed a high dominance by sesquiterpenoids (>90%) in the leaves of P. betleoides with no detection of phenylpropanoids. On the contrary, a high level of phenylpropanoids (>75%) was found in P. betle (Bangla Paan). In effect, P. betleoides can be a potential alternative source of betel‐scented sesquiterpene‐rich essential oil.

In Thailand, the Subdistrict Administrative Organisations (SAOs) have challenges in implementing their responsibilities concerning earthquake disaster prevention and mitigation, due to the infrequency of earthquakes compared to other natural disasters. Yet, since the earthquake of 2014 has had a major effect in Chiang Rai Province, it becomes a significant area of concern for SAOs. Therefore, the SAOs must be able to respond to and manage such disasters efficiently and dynamically in order to support the community. This study aims to examine the roles of local administrative organisation in management and preparedness concerning earthquakes. The case study of this study is focused on Saikao SAO, Paan District, Chiang Rai Province which was the area currently affected by the earthquake on 5 May 2014.

Introduction: The demand for tooth whitening has increased dramatically with the resulting development of new tooth whitening products and procedures. As it is a common scenario that the dentists come across paan stained teeth very regularly in dental practice, the need for this study is to compare if laser bleaching or three day home bleaching is effective for paan stained and give better treatment options for patients. Aim: To compare the effect of laser bleaching on paan stained tooth with home bleaching tooth using digital spectrophotometer Methodology: 20 extracted teeth were preserved in a solution of normal saline with 1% thymol crystals. The teeth were immersed in staining solution containing paan extracts for a period of two week. The specimens were evaluated for pre shades using VitaEasyShade. The stained specimens for paan respectively were divided randomly into 2 groups one for laser bleaching and other for home bleaching. POLA OFFICE + was applied on tooth and activated using the diode laser as per the manufacturer’s instructions for group 1. The bleaching was carried out with Philips Zoom Nitewhite for group 2. The second colour measurement of the specimens was made using VitaEasyShade. Conclusion: The results showed that laser bleaching was effective when compared to three day home bleach in paan stained teeth using digital spectrophotometer.

The present study was undertaken in the production area majorly Nagaur and in some part of Jodhpur district of Rajasthan to access the problems and constraints faced by farmers in the production and marketing of Nagauri (Paan) methi. A total sample of 150 farmers from 30 villages of two districts were selected for the study. The primary data were collected from the farmers by using pre tested structured schedule. The results from investigation shows that most important problem ranked first (Garret’s mean score is 75.60) was faced by farmers are lack of remunerative price of the product, which is 90 % of farmers were facing followed by lack of proper market center (Rank II), monopoly of traders (presence of less competitive firms), higher price spread. Least marketing constraint was payment delay which was faced by 55 per cent farmers ranked XIII. The major production constraints were drying of leaves (Garret’s mean score is 73.41) ranked I followed by irrigation and less use of technology. The appropriate policy suggestions are market establishment, government intervention to provide the remunerative price of Nagauri (Paan) methi and technology use.

Objective: The objective of the current research work was to prepare chewable tablets having Acacia catechu extract useful for mouth ulcers using a 32 factorial design. Methods: Acacia catechu heartwood extract was prepared using a reported method with some modifications. The extract was characterized using TLC against the catechin marker. Then, drug-excipient interaction studies were carried out. The mixture of drug and excipients was evaluated for pre-compression parameters. With the application of 32 factorial design, chewable tablets were prepared using direct compression technique. Prepared tablets were evaluated for post-compression parameters. Results: In vitrodrug release study of the developed formulations was investigated both in intact and crushed form of tablets. Based on in vitroperformance, the best formulations were selected (F6, F7 & F8 from intact and F1, F5 & F9 from the crushed group) and subjected to various kinetic models and evaluated for chewing difficulty index (CDI). Conclusion: The overall results revealed that the formulated chewable tablets complied with the standards and exhibited a satisfactory performance in terms of drug release, chewing difficulty index and other related parameters.

Background: National estimates of tobacco and alcohol use are insufficient to guide policy at sub-national and district level. This study examines sub-national and district-level prevalence and tobacco and alcohol use and its variations in India. Methods: Data on smoking tobacco, smokeless tobacco (SLT) and alcohol use in adults aged 15-49 was analysed from the National Family Health Survey. Sex-stratified prevalence of each types of tobacco and alcohol use at sub-national administrative units was estimated. We fitted multilevel logistic regressions to quantify the variation at the district and community level in tobacco and alcohol use. Findings: Overall, men used any form of tobacco or alcohol (53%, 52.5–53.4) more than women (7.4%, 95% CI 7.3–7.5). 23.4% (95% CI 23.1-23.9) smoked tobacco, with higher use of any SLT (29%, 28.6-29.4) and alcohol (29.2% 28.7-29.6). Women mostly used SLT (5.6%). Cigarette (13.6%, 13.3–14.0) and bidi (13.2%, 12.9–13.5) were most commonly and almost equally used types of smoking tobacco among men. Gutkha/paan masala with tobacco was the most consumed SLT product among both men (15.3%, 15.0–15.6) and women (2.2%, 2.1–2.3), followed by khaini. Beer was the most commonly used alcohol among men, followed by hard liquor. We found that considerable unexplained variation in tobacco and alcohol use attributed to between-population differences at districts (3.5% in smoking, 4% in alcohol and 6% in SLT) and community level (14.9% in smoking, 19.7% in alcohol and 21.5% in SLT) among males. Among females, between-population differences were even larger at districts (16.6% in smoking, 18% in SLT and 29.9% in alcohol) and community level (35.4% in smoking, 32.8% in SLT and 44% in alcohol). Interpretation: Regular assessment of sub-national tobacco and alcohol consumption across different population groups along with development of local cessation interventions must be integrated with health policy to reduce disease burden and preventable deaths. Funding Statement: No specific funding received for this study Declaration of Interests: All the authors declare that they have no conflict of interest. Ethics Approval Statement: The study was reviewed by the National Institute of Cancer Prevention and Research Institutional Ethics Committee and was exempted from full review as the study was based on an anonymous public use dataset with no identifiable information on the study participants.

In Pakistan, extensive use of several precarious chewable tobacco formulations has made oral cancer the second leading malignancy. Selection of literature was done by a survey of studies published from 1990 to 2017 mainly, from PUBMED and few from other search engines, on naswar, gutka, areca nut and betel quid, which included published reviews, original articles and other data sources on chewable tobacco, its epidemiology, pathological implications, and psychological effects. These studies have revealed that the chemicals in these formulations bind and mutate DNA of oral mucosa through down regulating cellular repair pathways and upregulating genetic networks associated with pathogenesis. Areca nut, having aercoline (the major alkaloid) causes carcinogenicity, mutagenicity, and genotoxicity of oral mucosa through increased production of growth factors and corticotrophin-releasing hormone, and genetic alteration in expression of CASP8, APAF-1, BAX, BAD, and upregulation of caspas-3. Gutka addiction leads to precancerous lesions resulting in characteristic facial abnormalities, following trismus. Naswar, in addition to oral cancer, causes adverse cardiovascular events by reducing glutathione per oxidase (GPx) and super-oxide dismutase (SOD), serum levels of HDL, whereas, increasing the ratio of cholesterol, LDL, triglycerides and LDL-C/HDL-C. Betel quid (Paan), causes psychoactivity affecting central and autonomic nervous systems leading to dependence with decreased cognition, euphoria, sweating, salivation, palpitation, heightened alertness and zest to work. Metabolically, cardio-acceleration, cortical desynchronisation of EEG, elevated plasma noradrenaline and adrenaline were found. This review highlights the corrosive effects of various most popular chewable tobacco formulations; and damage done by their cocktail of carcinogenic substances and added ingredients, leading to oropharangeal cancer.

Background Asian Indians (AIs) in the United States exhibit disproportionate burdens of oral cancer and cardiovascular disease, which are potentially linked to smokeless tobacco. However, little is known about the use of cultural smokeless tobacco (CST) products in this population. Methods California Asian Indian Tobacco Use Survey data from 2004 (n = 1618) were used to investigate CST prevalence among California's AIs. CST products included paan, paan masala, and gutka. A multivariable logistic regression was conducted to examine factors (socioeconomic status, acculturation measures, and religious affiliation) associated with current CST use versus never use. Results The current CST prevalence was 13.0% (14.0% for men and 11.8% for women). In contrast, the prevalence of current cigarette use was 5.5% (8.7% for men and 1.9% for women), and the prevalence was lower for cultural smoked tobacco (0.1% for bidis and 0.5% for hookahs). Factors associated with CST use included the following: being male, being 50 years old or older, being an immigrant, speaking an AI language at home, having a higher level of education (adjusted odds ratio [AOR] for high school/some college, 2.6; 95% confidence interval [CI], 1.1-6.5; AOR for college degree or higher, 4.0; 95% CI, 1.7-9.5), having a higher income (AOR for $75,000-$100,000, 2.5; 95% CI, 1.3-4.7; AOR for ≥$100,000, 2.6; 95% CI, 1.4-5.0), identifying as non-Sikh (AOR for Hinduism, 10.0; 95% CI, 6.0-16.5; AOR for other faiths, 10.2; 95% CI, 5.9-17.7), and disagreeing that spiritual beliefs are the foundation of life (AOR, 2.1; 95% CI, 1.2-3.5). Conclusions The current CST prevalence is relatively high among California's AIs in comparison with the prevalence of smoking, with narrower differences between sexes. The association with a higher socioeconomic status is contrary to typical cigarette smoking patterns. Acculturation and religious affiliation are important factors associated with current use. Health care providers and policymakers should consider such determinants for targeted interventions. Cancer 2018;124:1607-13. © 2018 American Cancer Society.

Aims: To assess the prevalence, knowledge, and attitude of gutkha chewing among school children of Arsikere, India. Materials and Methods: Two thousand school children aged between 10 and 15 years were examined with individual interviews along with a questionnaire to evaluate the presence of betel nut and paan chewing habit in various forms. Children of both sexes were included in the study. Responses of all study population and the association between dependent and explanatory variables were assessed using Chi-square test. Results: Twenty-eight percent of children had the habit of gutkha chewing, more among boys than girls at the ratio of 4:1 which was statistically significant (P < 0.05). The habit was more common in government school children than private school children; over 70% of children believed that it is a bad habit, but half the study population was not aware of side effects; 30% of children believed that it is not a bad habit and has no side effects. Conclusion: There is a higher prevalence of gutkha chewing habit in school children who are not aware of the side effects. Children themselves purchase the gutkha and betel nut sachets, hence the Government should ban the sale and purchase by children.

Tobacco use remains a major cause of preventable morbidity and mortality worldwide. The World Health Organization states that 19.1% of the Pakistani population consumes smoked or smokeless tobacco (SLT). Although many population focused studies have focused on the use of SLT in Pakistan, but they have failed to address the use of SLT among laborers, especially the niche population of public and heavy load drivers (that is, transporters). This study aimed to estimate the prevalence of SLT consumption among this population and the relationship of this parameter with knowledge, attitudes, and practices regarding SLT use. From a sample size of 714 participants, 615 responses were obtained, generating an overall response rate of 86%. The prevalence of SLT consumption in the study population was 93.7%; here, gutka was the most frequently consumed preparation (60.2%), followed by naswar (35.8%), paan (32.4%), and Mawa (16.7%). A masticatory habit was the most commonly cited factor leading to dependence (87.8%), followed by the influence of friends and family (83.9%), peer pressure (80.7%), and increased alertness (52.8%). However, 61.3% of participants reported experiencing strong withdrawals upon ceasing SLT use and believed themselves to be addicted and unable to quit usage. These findings suggest that for transporters, a high-risk occupational group dependent on SLT consumption, specific, tailored tobacco-cessation programs and medical assistance are needed to reduce the burden of tobacco-related morbidity and mortality. Key words: Smokeless tobacco (SLT), tobacco use, gutka, heavy load and public drivers, transporters, Karachi.

Background Betel quid (locally–called “paan”) is widely chewed habitually in Pakistan and South and Southeast Asia. It is hand-rolled at paan stalls by smearing a betel leaf (from Piper betel) with slaked lime, catech paste, chopped areca nut, and a variety of condiments and flavoring agents. Paan is considered a group 1 carcinogen for humans by the International Association for Research on Cancer. It is one of the major causes of oral cancer in these regions. The reactive oxygen species released during chewing can initiate carcinogenesis by inducing mutagenesis. Objective The present study was performed to determine the frequency of epithelial dysplasia among habitual paan chewers. It also calculated the association between the quantity and quality of paan chewing and the severity of oral epithelial dysplasia. Methods This was a cross-sectional analytical study. Cytological smears from 300 habitual paan chewers were collected. After fixation with alcohol, smears were then air dried and stained with hematoxylin, eosin, Giemsa, and Pap stains. The material was then examined under an optical microscope. Epithelial dysplasia was identified and graded using the method of Speight. Results Epithelial dysplasia was observed in 57.7% of the habitual paan chewers, which was significantly associated with the number of paans consumed per day as well as duration of paan consumption. These variables were positively correlated with grading of epithelial dysplasia. Conclusions The study concludes that epithelial dysplasia was present in the majority of habitual paan chewers in Lahore city. The correlation between the amount of betel quid chewing and the severity of epithelial dysplasia means the effect is dose-dependent.

California's tobacco control program contracted for tobacco use surveillance of Asian Indian Americans to address the paucity of information about tobacco use in this community, given their growing proportion of California's population. This study examined correlates of conventional (CTU) and Asian Indian traditional tobacco use (TTU) in a population-based sample of predominantly immigrant Asian Indian adults residing in California (N = 3228). The analytic sample (n = 2140) was limited to self-identified immigrants from India. Descriptive statistics, bivariate analyses, and multivariate logistic regressions were conducted to examine correlates of tobacco use among Asian Indian immigrants related to their acculturation and religious affiliation. While 65% of the sample had ever used traditional tobacco products (paan masala, gutka, bidis), only 25% had ever used conventional tobacco (cigarettes, cigar, pipe, chewing tobacco, snuff). Less than 5% reported tobacco use in the past 30 days. Rates of ever TTU and CTU were higher among men than women. Ethnic enclave residence was not associated with tobacco use. Impaired mental health was associated with CTU, and number of years spent in the U.S. was positively associated with both CTU and TTU. Individuals affiliated with Sikhism were less likely to use tobacco than individuals affiliated with Hinduism. Few population-based studies in the U.S. address both CTU and TTU use among Asian Indian immigrants. Tobacco use in Asian Indian immigrants may be seriously underestimated if surveillance is limited to conventional tobacco products. Interventions to reduce tobacco use should address mental health issues and consider religious affiliation.

Introduction Various primary studies and systematic reviews have been conducted to explain the association between smokeless tobacco and oral cancer. This study aims to consolidate and summarize the risk estimates from various systematic reviews with or without meta-analysis to provide the spectrum of estimates on the association between smokeless tobacco use and oral cancer. Methods A comprehensive literature search was done on various databases (PubMed, Google Scholar, IndMED, and TOXLINE) by two of the authors independently. Both qualitative and quantitative data extraction and analysis were performed for the included systematic reviews. Range of risk estimates was obtained and analyzed as quantitative findings due to the limitation of an overview of reviews for the pooled estimates. CASP (Critical Appraisals Skills Programme) and AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) tools were used for the quality assessment of the studies included. Results In total, 12 systematic reviews with or without meta-analysis were included in the review. There was a positive and strong association of Smokeless Tobacco (SLT) use with oral cancer irrespective of gender, region, and type of smokeless tobacco. The risk estimate for the South-East Asia Region (SEAR) ranged 4.44-7.90, for Gutkha it was 8.67, while for Paan it ranged 6.3-7.90 and for overall SLT it ranged 1.36-7.90. Risk estimate for females ranged 5.83-14.56. Conclusions The study confirmed the association between SLT use and oral cancer. These findings are of high importance, especially to the South-East Asia Region.

The Piper betle is a woody, perennial and climbing vine belonging to the family Piperaceae. The fresh leaves of betel vine, generally known as Paan in India, is cultivated at altitudes of 02–1400 m in high land, moist, tropical as well as subtropical region with an annual production worth about Rs. 9000 million. Betel leaves have a great importance on cultural, medicinal and economic aspects. Having a high nutritive and medicinal value, betel leaves prevent indigestion, constipation, bronchitis, congestion, coughs, asthma, etc. Due to perishable nature and quick spoilage, various preservation techniques are adopted to minimize the post-harvest losses of betel leaves. This chapter provides valuable information on biochemistry, processing, preservation and health benefits, and also focuses on various mechanisms that occur through several scientific research activities.

Objectives Tobacco and areca nut are two of the most widely used psychoactive plant substances worldwide, yet the biocultural factors that account for variation in use patterns are not well understood. Here we attempt to understand the high prevalence of, and variation in, tobacco and areca nut use among reproductive-aged women. Methods Research was carried out in Mysore, Karnataka, India. First, we conducted a qualitative investigation where participants engaged in semistructured interviews and focus group discussions to uncover cultural norms of women's tobacco use. Findings informed the second stage of research which quantitatively tested three models of tobacco and areca nut use (N = 74). Results The qualitative study found that women were more likely to chew "natural" forms of tobacco and areca nut products (kaddipudi and paan). Quantitative tests of our hypotheses revealed that kaddipudi and combined tobacco use were best explained by the self-medication model, with somatic and environmental stress as strong indicators of use. The presence of cotinine, our biological indicator of tobacco use, was best modeled by gender inequality. We also found that men and women reported approximately equal tobacco use, even though their preferred types of tobacco and areca nut products differed. Conclusions Findings did not support the protection hypothesis as it relates to plant toxins. Instead, this study suggests that women might exploit neurotoxins such as nicotine and arecoline to offset the cognitive and energetic costs associated with iron deficiency in stressful environments.

Betelvine (Piper betle L.) is commonly consumed as betel quid or paan with areca nut and/or tobacco; and also utilized in Indian medicine systems and in religious ceremonies. The betel production is highly erratic and so is the income of farmers due to natural climatic factors and spoilage during transport. It is therefore important to improve its productivity per vine and per unit area to meet the demand. Correlation, path coefficient and stability analysis was carried out in fifteen genotypes of betelvine including 3 checks under three protected structures, namely, Bareja (E1), Poly tunnel (E2) and Net tunnel (E3). Among the three structures, Net tunnel was found suitable for the cultivation of betelvine in Chhattisgarh. With respect to quality parameters, Meetha paan (2.65 g/100g) followed by Billori (2.23 g/100g) found to have high protein content. Meetha paan (5.89g/100g) followed by Meetha-cum-bangla (5.36g/100g) was also found to possess high starch content. However, low fiber content was recorded in Meetha pan (1.83g/100g), whereas high potassium content was found in Ramtake meetha (933mg/100g) followed by Bidhan pan (991mg/100g). The genotype, Karapaku possessed high potassium content (2.67mg/g). Hedonic five point scale for organolaptic test showed Meetha paan (2.3/5) followed by Bali paan (2.4/5) were less pungent among genotype studied. Highest shelf life was found in genotype Karapaku and Bhaichigudi (18days). The results indicated that number of leaves per vein were positively correlated with leaf width (0.802 and 0.819) followed by leaf area (0.790 and 0.808), leaf area index (0.782 and 0.800), leaf length (0.745 and 0.759), specific leaf weight (0.681 and 0.709), petiole length (0.658 and 0.705), diameter of internodes (0.484 and 0.559) and R-value (0.112 and 0.110) at both phenotypic and genotypic level, respectively. Path analysis identified leaf width (0.8772) and leaf length (0.4712) had direct effects on leaf yield at phenotypic level. Highest positive direct effect on leaf yield was exerted by leaf area (1.3544) followed by leaf width (0.8986) at genotypic level. These characters can be used as selection criterion in a breeding programme to develop varieties of betelvine with high leaf yield. The stability analysis under three different protected structures viz; E1, E2, E3 indicated that the genotypes, Karapaku, Bhaichigudi and Maghai pan are stable across the environment for leaf yield.

Screening for oral cancer by direct visual examination is believed to be ineffective because of the difficulty in differentiating a small number of malignancies from the much more prevalent benign oral mucosal lesions (OML) that are found in high-risk individuals. Standardised clinical diagnoses were recorded for all the OMLs identified during oral visual examination of 1111 individuals with risk factors for oral cancer, including tobacco and areca nut (paan) consumption. Suspicious lesions were referred for biopsy and definitive diagnosis. A total of 1438 OMLs with 32 different clinical diagnoses were identified in 604 participants. Analysis of referrals revealed two distinct groups: visually benign lesions (VBLs) none of which was referred, and visually complex lesions (VCLs) comprising 661 OMLs with nine different clinical diagnoses. After biopsy the VCLs included known potentially malignant disorders (PMDs) as well as benign lesions such as paan mucositis. VCLs (but not VBLs) share risk factors with oral cancer (p

Background: Smoking and use of smokeless tobacco affect oral as well as general health. People are reluctant to achieve good oral health in lieu of the avoidance of deleterious habits. The objective of this study was to analyze two contrasting health behaviors; the oral hygiene practices against tobacco use in a sample from eastern Terai.Methods: This is questionnaire-based cross-sectional survey carried out in Jhapa district located in eastern Nepal. In this report, practice of toothbrushing, use of fluoridated toothpaste, frequency of using tobacco related products (paan, gutkha, chilim, cigarette, bidi, hukkah) was assessed. Association of health behavior to sociodemographic variables were tested with regression analysis at 95% confidence limits.Results: A total of 1178 respondents (response rate = 96.8%) completed the interview, among them 80.8% were males. Mean age was 52.21 years (SD = 15.943). Overall 72.6% used fluoridated toothpaste and toothbrush for cleaning teeth, 58.8% consumed tobacco related products. Interdental aids utilization was very less (1.2% using dental floss). Age was significantly related to both toothbrushing and tobacco-consuming. Educational status was related significantly to toothbrushing (p0.05).Conclusions: Our results showed that consumption of tobacco related products is moderately high in Terai village and oral health practice was found to be influenced by educational status. More such studies to identify status of oral health and impact of tobacco are recommended.Keywords: Oral health; smokeless tobacco; smoking; tobacco

Betelvine (Piper betle L.) cultivation and consumption of betel leaves are traditional and widespread practices in India. The leaves have some medicinal values. For the small and marginal farmers, unable to produce sufficient food on their tiny holdings, and whose labour resources (including family labours) are underemployed, betelvine cultivation may provide a means to put their underutilized labour to productive use enabling them to make ends meet. Betelvine is mainly cultivated in an artificial structure called boroj which is made with locally available cheap materials. Betel leaves are mainly used for mastication as mouth freshener. For successful production of betel leaves, proper manuring, water management and microclimate are important. Betel leaves have some export potentiality also. The agricultural, industrial, medicinal and allied potentialities of the crop are discussed.

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.

Cervical cancer is the second most common cancer in Indian women and 4th most common cancer in women world-wide. Over nearly two decades, we have carried out epidemiological and molecular studies in cervical cancer, with an intent to identify potential early diagnostic biomarkers, predictive and prognostic markers, develop newer therapies against cervical cancer and identify potential new targets for therapy.Our studies had identified 14 high risk and 10 low risk human papilloma virus (HPV) in our cervical cancer patients for the first time; had identified life style related cofactors in the development of cervical cancer (paan chewing, parity, early age at first sexual intercourse and first childbirth, husband with two or more sexual partners). We have developed a p16 ELISA kit for cervical cancer screening for use at point of care like PHC's; identified a 7 gene signature which help identify patients who can be treated with radiotherapy alone; identified potential prognostic markers for use in the clinic; developed the country's first Dendritic cell vaccine therapy for cervical cancer and completed the phase 1 study; have identified newer potential therapeutic targets for treatment of cervical cancer.

South Asians are the third largest Asian group in the US and among the fastest growing racial groups in New Jersey. Tobacco consumption among South Asians is characterized by several smoked and smokeless tobacco products indigenous to the Indian subcontinent. However, there is a paucity of research on tobacco use behaviors among South Asians in the US. The goal of this study was to examine the awareness and use of South Asian tobacco products such as bidis, gutkha, paan, paan masala, and zarda as well as other potentially carcinogenic products such as supari, their context of use, and their cultural significance among South Asians living in the US. Eight focus groups were conducted with South Asian adults living in Central New Jersey. Overall, participants were aware of a wide variety of foreign and American tobacco products with older South Asians identifying a greater variety of indigenous products compared to younger South Asians. Hookah was consistently recognized as popular among the younger generation while products such as paan or paan masala were more commonly identified with elders. Use of tobacco-related products such as paan and supari were described as common at social gatherings or after meals. In addition, light or social users of South Asian tobacco products, including products not consistently defined as tobacco, may not report tobacco use on a survey. Better understanding of the use of these products among South Asians and how some may classify tobacco usage can inform future research and public health interventions in these communities.

Background: People with addictive habits are prone to both infectious and non-infectious diseases. Conflicting results have been reported about propensity of these individuals for development of autoimmune diseases. Therefore, a study was planned to determine the frequency of anti-nuclear antibody (ANA) and anti-dsDNA (dsDNA) antibody in the serum of habitual smokers, paan (areca nut) chewers and other oral addictive habits as compared to subjects without such addictive habits. Methods: Blood samples from 90 subjects (45 with addictive habits and 45 without any addiction) were taken by random sampling after getting written informed consent. Enzyme linked immunosorbent assay (ELISA) was used to test the sera for ANA and anti dsDNA. Results: One subject in the addictive group had ANA and dsDNA antibodies, whereas in the control group, two subjects had anti dsDNA while none of them had ANA. No significant association of these antibodies was observed between the two groups. Conclusions: Addictive habits do not predispose the subjects to develop autoimmune diseases.

Objectives: Oral submucous fibrosis (OSMF) is an insidious precancerous disease mostly seen in the Southeast Asia. This paper aims to study on clinical profile of patients with OSMFMaterial and Methods: This cross sectional study was done in department of ENT and HNS, Nepalgunj Medical College and Teaching Hospital. In outpatient department patients with OSMF were ask to fill up a questionnaire that included identification of patient, occupation, their symptoms and habit of taking betel quid or paan, gutkha, etc. Oral cavity was examined and lesion along with its extent and severity was noted. Intra lesional steroid and antioxidant and physiotherapy were main stay of treatment.Results: There were total 136 patients (98 male and 38 female) from 15th Dec 2013 to 15th Jan 2015. Age of patient ranged from 16 years to 53 years and average being 25.6years. Most common preparation taken was gutkha 131(96.3%) followed by betel nut, betel quid etc. Only 24(17.6%) were taking these preparations for less than 1 year. Common presenting complaints were difficulty in opening mouth followed by burning sensation and dryness of mouth. Clinically, the extent of fibrous band was found to be more commonly involving soft palate, pillars and buccal mucosa. Isolated involvement of different region of oropharynx or oral cavity was less common. Correlation of grade of trismus and average duration of taking these different preparations was highly significant. (p=0.008)Conclusions: Oral submucous fibrosis is commonly associated with intake of gutkha having dose dependent relationship with trismus. Further studies are required why only a small fraction of those using betel quid develop the disease.

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.

Since time immemorial, Piper betle Linn. (betel vine or paan) has been an integral part of various traditional and folk medicines of Southeast Asian countries. The betel leaves are the most valued plant parts routinely used as chewing agent and known to prevent halitosis. Betel vine leaves possess numerous medicinal benefits, such as relieving indigestion, bronchitis, constipation, congestion, and cough. Betel vine leaves are mostly consumed as a part of betel quid, which consists of areca nut (Areca catechu Linn.), tobacco (Nicotiana tabacum Linn.), and slaked lime, a concoction with potent carcinogenic properties. Routine consumption of betel quid is associated with oral cancer, and scientific analyses have attributed that both tobacco and areca nut as carcinogenic, while slaked lime as a promoter of carcinogenesis. Conversely, betel vine leaves are devoid of carcinogenic effects and in turn known to possess cancer preventive effects that can negate carcinogens present in the quid. The aim of the chapter is to provide the information on betel vine’s cancer preventive effects and the mechanisms involved. Moreover, it also highlighted the various phytoconstituents that promote beneficial role of betel vine leaves against different cancers.

Oral cancer is a major public health issue in India with ∼ 77,000 new cases and 52,000 deaths yearly. Paan chewing, tobacco and alcohol use are strong risk factors for this cancer in India. Human papillomaviruses (HPVs) are also related to a subset of head and neck cancers (HNCs). We examined the association between oral HPV and oral cancer in a sample of Indian subjects participating in a hospital-based case-control study. We recruited incident oral cancer cases (N = 350) and controls frequency-matched by age and sex (N = 371) from two main referral hospitals in Kerala, South India. Sociodemographic and behavioral data were collected by interviews. Epithelial cells were sampled using Oral CDx® brushes from the oral cancer site and the normal mucosa. Detection and genotyping of 36 HPV genotypes were done using a polymerase chain reaction protocol. Data collection procedures were performed by qualified dentists via a detailed protocol with strict quality control, including independent HPV testing in India and Canada. HPV DNA was detected in none of the cases or controls. Associations between oral cancer and risk factors usually associated with HPV infection, such as oral sex and number of lifetime sexual partners, were examined by logistic regression and were not associated with oral cancer. Lack of a role for HPV infection in this study may reflect cultural or religious characteristics specific to this region in India that are not conducive to oral HPV transmission. A nationwide representative prevalence study is needed to investigate HPV prevalence variability among Indian regions.