Bibliography : Smokeless Tobacco -no less harmful

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Das S, Upadhaya P, Giri S Arsenic and smokeless tobacco induce genotoxicity, sperm abnormality as well as oxidative stress in mice in vivo. 2016 Genes Environ.
Vol. 38, pp. 4 
article DOI  
Abstract: BACKGROUND:
Arsenic, a naturally occurring metalloid is a well-known water contaminant which causes a wide range of serious adverse health effects including cancer upon long-term exposure. Recent studies have shown high arsenic contamination in the ground water of North Eastern states of India including Southern Assam. Smokeless tobacco consumption locally known as "sadagura" is one of the most prevalent life style habit in southern Assam. The present study was undertaken in mice test system in vivo. Mice were exposed to smokeless tobacco (5 mg/kg body weight /day) and sodium arsenite (0.2 mg/kg body weight /day, 2 mg/kg body weight/day) independently and in combination for 90 days.
RESULTS:
The results were compared with groups with only sodium arsenite exposure and groups which were exposed to only smokeless tobacco extract. Genotoxicity was evaluated by studying the incidence of micronucleated polychromatic erythrocytes from bone marrow. Both the tested doses of sodium arsenite induced statistically significant micronucleated polychromatic erythrocytes as compared to control group, however, sodium arsenite and smokeless tobacco extract could not increase the incidence of micronucleated polychromatic erythrocytes as compared to their individual counterparts when treated in combination in mice test system. Germ cell toxicity was evaluated by recording the sperm head abnormalities and total sperm count. Combined treatment of sodium arsenite and smokeless tobacco extract in lower dose induced a significant increase in sperm head abnormality as compared to only sodium arsenite and smokeless tobacco extract. Liver, kidney and intestine tissues were analyzed for various oxidative stress evaluations such as lipid peroxidation (MDA), Glutathione (GSH) and superoxide dismutase (SOD) assay. Sodium arsenite in combination with smokeless tobacco extract show higher genotoxic and germ cell toxic effects as compared to control but not when compared to their individual counterparts.
CONCLUSION:
Impairment of the sperm head morphology by sodium arsenite and smokeless tobacco extract alone and in combination with lower dose of sodium arsenite could be oxidative stress mediated effects. Besides, combination treatment of both the agents may not produce additive effects related to micronucleated polychromatic erythrocytes induction and decline of total sperm count.
BibTeX:
@article{DasS2016,
  author = {Das S, Upadhaya P, Giri S},
  title = {Arsenic and smokeless tobacco induce genotoxicity, sperm abnormality as well as oxidative stress in mice in vivo.},
  journal = {Genes Environ.},
  year = {2016},
  volume = {38},
  pages = {4},
  doi = {http://dx.doi.org/10.1186/s41021-016-0031-2}
}
Ganguli A, Das A, Nag D, Bhattacharya S, Chakrabarti G Potential role of autophagy in smokeless tobacco extract-induced cytotoxicity and in morin-induced protection in oral epithelial cells. 2016 Food Chem Toxicol.
Vol. 90, pp. 160-70 
article DOI  
Abstract: Toxic components of STE induced serious, adverse human oral health outcomes. In the present study, we observed that STE was involved in oral toxicity by reducing the viability of human squamous epithelial cells, SCC-25, along with the simultaneous induction of both apoptosis and autophagic signaling. STE was also found to induce significant amount ROS generation in SCC-25 cells. The dietary flavonoid morin, found abundantly in a variety of herbs, fruits and wine, has been reported to attenuate ROS-induced pathogenesis including autophagy. In this study we designed three different treatment regimes of morin treatment, such as pre, co, and post - treatment of STE challenged SCC-25 cells. In all cases morin provided cytoprotection to STE challenged SCC-25 cells by augmenting STE induced ROS-dependent cytotoxic autophagy. Hence, morin is a potential option for antioxidant therapy in treatment of STE induced toxicity.
BibTeX:
@article{GanguliA2016,
  author = {Ganguli A, Das A, Nag D, Bhattacharya S, Chakrabarti G},
  title = {Potential role of autophagy in smokeless tobacco extract-induced cytotoxicity and in morin-induced protection in oral epithelial cells.},
  journal = {Food Chem Toxicol.},
  year = {2016},
  volume = {90},
  pages = {160-70},
  doi = {http://dx.doi.org/10.1016/j.fct.2016.02.011}
}
Gupta R, Verma V, Mathur P Quitline Activity in Rajasthan, India. 2016 Asian Pac J Cancer Prev.
Vol. 17(Suppl 2), pp. 19-24. 
article  
Abstract: Quitline activity in Rajasthan, India is a voluntary activity of Rajasthan Cancer Foundation (RCF) since April 2013. To kick-off, it took the benefit of the State Government- PIRAMAL SWASTHYA (PS)1 collaborative 104 Health Information Helpline that existed already in public-private partnership. It is a reactive quitline that helps callers through the counselors and nursing staff trained specifically through the weekly sessions held by the first author, the RCF resource on quitline. Besides structuring of the scripts for primary intervention and follow-ups after 1 week, 1 month, 6 months and a year, he also monitors calls, advices and coordinates with the supervisors to manage and analyze the data base, and reports to the PS lead at the Jaipur Center on overall performance and to plan strategic communication with the State Government on its outcomes. The quitline has limitations of its informal existence through a voluntary effort of RCF, no specific resource allocation, suboptimal data management, minimal awareness in the masses due to poor IEC (Information, Education and Communication; except its efforts made by RCF in last 1 year through the government-run State TV and City Radio) and staff shortage and its attrition due to lack of plan for career advancement. Despite these challenges in the year 2013, the quit line has registered a quit rate (for complete abstinence) of 19.93% amongst 1525 callers. The quit rate were 58.01% (304/ 524) among the responders at the 3rd follow-up at 18 months (in September 2014)2. In view of an increase in quit rate by 5- 9 times over the prevailing quit rate in the former ever daily users [both smokers and the users of smokeless tobacco (SLT)], efforts are being made by RCF in concurrence with PS to have this cost-effective model established formally with optimal resource allocation in collaboration with willing agencies (the State and Central Governments and the International Quitline Agencies) and its replication in 4 more states where PS is collaborating with the respective state governments similarly (Assam, Chhattisgarh, Jharkhand and Karnataka).
BibTeX:
@article{GuptaR2016,
  author = {Gupta R, Verma V, Mathur P.},
  title = {Quitline Activity in Rajasthan, India.},
  journal = {Asian Pac J Cancer Prev.},
  year = {2016},
  volume = {17},
  number = {Suppl 2},
  pages = {19-24.}
}
Iswarya SK, Premarajan KC, Kar SS, Kumar SS, Kate V Risk factors for the development of colorectal carcinoma: A case control study from South India. 2016 World J Gastrointest Oncol.
Vol. 8(2), pp. 207-14 
article DOI  
Abstract: AIM:
To study the association of colorectal carcinoma (CRC) with diet, smoking, alcohol, physical activity, body mass index, family history and diabetes.
METHODS:
All consecutive patients with CRC confirmed by histopathology diagnosis were included. Age (± 5 years) and gender matched controls were selected among the patients admitted in surgery ward for various conditions without any co-existing malignancy. Food frequency questionnaire (FFQ) was developed and validated after pretesting by investigator trained in data collection techniques. Cases and controls were interviewed ensuring privacy, in similar interview setting, with same duration of time for both cases and controls without any leading question. Biological variables like family history of CRC in first degree relatives, history of diabetes mellitus; behavioral factors like tobacco use both smoking and smokeless form, alcohol consumption and physical activity were recorded. Dietary details were recorded using a FFQ consisting 29 food items with seven categories. Analysis was done using appropriate statistical methods.
RESULTS:
Ninety-four histopathologically confirmed cases of CRC and equal number of age and gender matched controls treated over a period of two years were studied. Age distribution, mean age, male to female ratio, education level and socioeconomic status were similar in cases and controls. Intake of food items was categorized into tertile due to skewed distribution of subjects as per recommended cut off for consumption of food item. On univariate analysis red meat [OR = 7.4 (2.935-18.732)], egg [OR = 5.1 (2.26-11.36)], fish, fried food and oil consumption were found to be risk factors for CRC. On multivariate analysis red meat consumption of more than 2-3 times a month (OR = 5.4; 95%CI: 1.55-19.05) and egg consumption of more than 2-3 times a week (OR = 3.67; 95%CI: 1.23-9.35) were found to be independent risk factors for the development of CRC.
CONCLUSION:
Egg and red meat consumption found to be independent risk factors for CRC. Smoking, alcohol, physical activity and family history were not associated with increased risk.
BibTeX:
@article{IswaryaSK2016,
  author = {Iswarya SK, Premarajan KC, Kar SS, Kumar SS, Kate V},
  title = {Risk factors for the development of colorectal carcinoma: A case control study from South India.},
  journal = {World J Gastrointest Oncol.},
  year = {2016},
  volume = {8(2)},
  pages = {207-14},
  doi = {http://dx.doi.org/10.4251/wjgo.v8.i2.207}
}
Itagi AB, Arora D, Patil NA, Bailwad SA, Yunus GY, Goel A Short-term acute effects of gutkha chewing on heart rate variability among young adults: A cross-sectional study. 2016 Int J Appl Basic Med Res.
Vol. 6(1), pp. 45-9 
article DOI  
Abstract: BACKGROUND AND OBJECTIVES:
An increase in the consumption of smokeless tobacco has been noticed among high school, college students, and adults. Despite the antiquity and popularity of chewing tobacco in India, its effects have not been investigated systematically in humans. The aim of this study was to investigate acute effects of gutkha chewing on heart rate variability (HRV) among healthy young adults.
MATERIALS AND METHODS:
A total of 60 young adult males were included in the study. Each individual was asked to chew tobacco and subjected to HRV analysis. HRV analysis using short-term electrocardiogram recording was used to measure HRV parameters before gutkha chewing and at 5, 15, and 30 min after chewing tobacco. One-way analysis of variance and paired t-test was used to assess changes over time.
RESULTS:
There was a significant increase in heart rate (HR) during tobacco chewing. Mean HR at baseline measured 73.0 ± 6.2 bpm. There was a rise in mean HR to 83.7 ± 9.1 bpm at 5 min during tobacco chewing and gradual reduction to baseline observed after 15 min followed by no significant change till 30 min. The normalized low-frequency power and LF/high-frequency (HF) power ratio were elevated after 5 min; however, normalized HF power was reduced after 5 min tobacco chewing.
CONCLUSION:
Gutkha is closely associated with traditional cardiovascular risk factors as detected by a transient enhancing sympathetic activity during tobacco chewing in the form of increased HRV parameters or an imbalance between sympathetic and parasympathetic neural activity among healthy young adults.
BibTeX:
@article{ItagiAB2016,
  author = {Itagi AB, Arora D, Patil NA, Bailwad SA, Yunus GY, Goel A.},
  title = {Short-term acute effects of gutkha chewing on heart rate variability among young adults: A cross-sectional study.},
  journal = {Int J Appl Basic Med Res.},
  year = {2016},
  volume = {6(1)},
  pages = {45-9},
  doi = {http://dx.doi.org/10.4103/2229-516X.174008}
}
Mini GK, Thankappan KR Switching to smokeless tobacco, the most common smoking cessation method: results from the Global Adult Tobacco Survey, India. 2016 Public Health.
Vol. 136, pp. 172-4 
article DOI  
BibTeX:
@article{MiniGK2016,
  author = {Mini GK, Thankappan KR},
  title = {Switching to smokeless tobacco, the most common smoking cessation method: results from the Global Adult Tobacco Survey, India.},
  journal = {Public Health.},
  year = {2016},
  volume = {136},
  pages = {172-4},
  doi = {http://dx.doi.org/10.1016/j.puhe.2016.03.035}
}
Naveen-Kumar B, Tatapudi R, Sudhakara-Reddy R, Alapati S, Pavani K, Sai-Praveen KN Various forms of tobacco usage and its associated oral mucosal lesions. 2016 J Clin Exp Dent.
Vol. 8(2), pp. 172-7 
article DOI  
Abstract: BACKGROUND:
To study the various forms of tobacco usage and its associated oral mucosal lesions among the patients attending Vishnu Dental College Bhimavaram.
MATERIAL AND METHODS:
An observational cross-sectional study was conducted in a total of 450 patients who were divided into three groups based upon type of tobacco use, as Group-1 Reverse smoking, Group-2 Conventional smoking, Group-3 Smokeless tobacco group and each group consists of 150 subjects.
RESULTS:
Reverse smoking was observed to be more prevalent among old females with smoker's palate and carcinomatous lesions being the most common. Conventional smoking was observed more in male patients with maximum occurrence of leukoplakia and tobacco associated melanosis. Smokeless tobacco habit was predominantly seen in younger males. Habit specific lesions like tobacco pouch keratosis, Oral Submucous Fibrosis (OSMF), Quid induced lichenoid reaction were noticed in smokeless tobacco habit group except for erythroplakia which was noticed only in conventional smoking group and it was not significant statistically.
CONCLUSIONS:
In the present study it was found that the usage of reverse smoking habit was most commonly seen in females and this habit is practiced in and surrounding areas of Bhimavaram with more occurrence of carcinoma compared to conventional smoking and smokeless tobacco.
BibTeX:
@article{Naveen-KumarB2016,
  author = {Naveen-Kumar B, Tatapudi R, Sudhakara-Reddy R, Alapati S, Pavani K, Sai-Praveen KN},
  title = {Various forms of tobacco usage and its associated oral mucosal lesions.},
  journal = {J Clin Exp Dent.},
  year = {2016},
  volume = {8(2)},
  pages = {172-7},
  doi = {http://dx.doi.org/10.4317/jced.52654}
}
Priyanka R, Rao A, Rajesh G, Shenoy R, Pai BM Work-Associated Stress and Nicotine Dependence among Law Enforcement Personnel in Mangalore, India. 2016 Asian Pac J Cancer Prev.
Vol. 17(2), pp. 829-33 
article  
Abstract: PURPOSE:
To investigate the work associated stress and nicotine dependence among law enforcement personnel in Mangalore, India.
MATERIALS AND METHODS:
A cross-sectional questionnaire survey was conducted among law enforcement personnel in Mangalore, India. Demographic details, stress factors experienced at work and nicotine dependency were the variables studied. The extent of stress factors experienced at work was assessed using the Effort-Reward Imbalance scale (ERI). Nicotine dependence was measured using the Fagerstrom Test for Nicotine Dependence (FTND) and the Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST). Logistic regression was used for the statistical analysis.
RESULTS:
Three hundred and four law enforcement personnel participated in the study, among whom 68 had the presence of one or more habits like tobacco smoking, tobacco chewing and alcohol use. The mean effort score was 15.8±4.10 and the mean reward and mean overcommitment scores were 36.4±7.09 and 17.8±5.32 respectively. Effort/Reward ratio for the total participants was 1.0073 and for those with nicotine habit was 1.0850. Results of our study demonstrated no significant association between domains of ERI scale and presence of habits but work associated stress was associated with the presence of one or more habits. Compared to constables, head constables had 1.12 times higher risk of having a nicotine habit.
CONCLUSIONS:
Our study implies job designation is associated with nicotine habits. However, there was no association between work associated stress and nicotine dependence among law enforcement personnel in Mangalore.
BibTeX:
@article{PriyankaR2016,
  author = {Priyanka R, Rao A, Rajesh G, Shenoy R, Pai BM.},
  title = {Work-Associated Stress and Nicotine Dependence among Law Enforcement Personnel in Mangalore, India.},
  journal = {Asian Pac J Cancer Prev.},
  year = {2016},
  volume = {17(2)},
  pages = {829-33}
}
Raja M, Saha S, Krishna-Reddy V, Mohd S, Narang R, Sood P Effectiveness of oral health education versus nicotine replacement therapy for tobacco cessation- a parallel randomized clinical trial. 2016 J Clin Exp Dent.
Vol. 8(1), pp. 64-70 
article DOI  
Abstract: BACKGROUND:
India has millions of tobacco users. It is the leading cause of deaths due to oral cancer and hence needs effective strategies to curb it. Hence the aim of present study was to evaluate and compare the effectiveness of Oral Health Education (OHE) and Nicotine Replacement Therapy (NRT) in tobacco cessation.
MATERIAL AND METHODS:
The clinical trial consisted of Manohar Lal Kapoor (MLK) factory workers (n= 40) giving history of tobacco consumption (smoking/smokeless) within past 30 days. They were randomized into OHE (n=20) and NRT (n=20) groups. Baseline evaluation (demographic, smoking/ smokeless behaviour) was done. Fagerstrom test was used for Nicotine Dependence (FTND) and to assess nicotine addiction level. Follow up was done at an interval of 1week, 2 weeks, 1 month, 2 months and 3 months to assess the reduction in the mean FTND score. "Nano-CheckTM Rapid Nicotine test" was used for the qualitative detection of cotinine in human urine. Appropriate statistical analysis was performed (Paired and Unpaired t test).
RESULTS:
In both OHE and NRT group there was a significant reduction (p< 0.00001) in mean Fagerstrom score at every follow up but when both the groups were compared mean Fagerstrom score reduction was more in NRT than OHE at all time interval though it was not statistically significant (p>0.05).
CONCLUSIONS:
NRT is better than OHE when both the groups were compared. However, it was found that any intervention given to tobacco users either NRT or OHE is helpful for the patients in the process of quitting tobacco
BibTeX:
@article{RajaM2016,
  author = {Raja M, Saha S, Krishna-Reddy V, Mohd S, Narang R, Sood P},
  title = {Effectiveness of oral health education versus nicotine replacement therapy for tobacco cessation- a parallel randomized clinical trial.},
  journal = {J Clin Exp Dent.},
  year = {2016},
  volume = {8(1)},
  pages = {64-70},
  doi = {http://dx.doi.org/10.4317/jced.52738}
}
Raman R, Pal SS, Ganesan S, Gella L, Vaitheeswaran K, Sharma T The prevalence and risk factors for age-related macular degeneration in rural-urban India, Sankara Nethralaya Rural-Urban Age-related Macular degeneration study, Report No. 1. 2016 Eye (Lond).
Vol. 30(5), pp. 688-97 
article DOI  
Abstract: PurposeTo report the age- and gender-adjusted prevalence rates of early and late age-related maculopathy (ARM) and associated risk factors in rural and urban Indian population.MethodsA population-based cross-sectional study was carried out in South India between 2009 and 2011. Of the 6617 subjects ?60 years enumerated ones, 5495 (83.04%) participated in the eye examination. A detailed history including data on demographic, socioeconomic, and ocular history was obtained. Participants underwent detailed ophthalmic evaluation including 30° 3-field photograph as per Age-Related Eye Disease Study protocol. The ARM was graded according to the International ARM Epidemiological Study Group.ResultsAge- and gender-adjusted prevalence of early ARM was 20.91% (20.86-20.94) in the rural population and 16.37% (16.32-16.42) in the urban population. Similarly, the prevalence of late ARM was 2.26% (2.24-2.29) and 2.32% (2.29-2.34) in the rural and urban population, respectively. In both rural and urban populations, risk factors that were related to both early and late ARM were age, per year increase (OR, range 1.00-1.08); middle socioeconomic status (OR, range 1.05-1.83); and smokeless tobacco (OR, range 1.11-2.21). Protective factor in both was the presence of diabetes mellitus in all ARM (OR, range 0.34-0.83). Risk factors, only in the rural arm, were female gender (OR, range 1.06-1.64), past smoker (OR, 1.14), and serum low-density lipoprotein cholesterol level (OR, 1.03).ConclusionsThe study reports smokessless tobacco as a risk factor for both early and late ARM and identified a higher prevalence of early ARM in the rural population compared with urban population.
BibTeX:
@article{RamanR12016,
  author = {Raman R1, Pal SS1, Ganesan S1, Gella L1,2, Vaitheeswaran K3, Sharma T1.},
  title = {The prevalence and risk factors for age-related macular degeneration in rural-urban India, Sankara Nethralaya Rural-Urban Age-related Macular degeneration study, Report No. 1.},
  journal = {Eye (Lond).},
  year = {2016},
  volume = {30(5)},
  pages = {688-97},
  doi = {http://dx.doi.org/10.1038/eye.2016.14}
}
Sinha DN, Abdulkader RS, Gupta PC Smokeless tobacco-associated cancers: A systematic review and meta-analysis of Indian studies. 2016 Int J Cancer.
Vol. 138(6), pp. 1368-79 
article DOI  
Abstract: The International Agency for Research on Cancer (IARC) has concluded that there is sufficient evidence in humans for the carcinogenicity of smokeless tobacco (SLT) for mouth, oesophagus and pancreas, based largely on Western studies. We wanted to confirm this by conducting a systematic review using Indian studies because India faces the biggest brunt of SLT-attributable health effects. A systematic search was conducted for published and unpublished studies. Two authors independently reviewed the studies and extracted data. Summary odds ratio (OR) for each cancer type was calculated using fixed and random effects model. The population attributable fraction (PAF) method was used to calculate the attributable burden of incident cases. A significant association was found for oral-5.55 (5.07, 6.07), pharyngeal-2.69 (2.28, 3.17), laryngeal-2.84 (2.18, 3.70), oesophageal-3.17 (2.76, 3.63) and stomach-1.26 (1.00, 1.60) cancers. But in random effects model, laryngeal-1.79 (0.70, 4.54) and stomach-1.31 (0.92, 1.87) cancers became non-significantly associated. Gender-wise analysis revealed that women had a higher risk (OR = 12.0 vs. 5.16) of oral but a lower risk (1.9 vs. 4.5) of oesophageal cancer compared with men. For oral cancer, studies that adjusted for smoking, alcohol and other factors reported a significantly lower OR compared with studies that adjusted for smoking only or smoking and alcohol only (3.9 vs. 8.4). The annual number of attributable cases was calculated as 49,192 (PAF = 60%) for mouth, 14,747 (51%) for pharynx, 11,825 (40%) for larynx, 14,780 (35%) for oesophagus and 3,101 (8%) for stomach.
BibTeX:
@article{SinhaDN2016,
  author = {Sinha DN, Abdulkader RS, Gupta PC},
  title = {Smokeless tobacco-associated cancers: A systematic review and meta-analysis of Indian studies.},
  journal = {Int J Cancer.},
  year = {2016},
  volume = {138(6)},
  pages = {1368-79},
  doi = {http://dx.doi.org/10.1002/ijc.29884}
}
Turk T, Chaturvedi P, Murukutla N, Mallik V, Sinha P, Mullin S Raw and real: an innovative communication approach to smokeless tobacco control messaging in low and middle-income countries. 2016 Tob Control.  article DOI  
Abstract: The evidence on the efficacy of tobacco control messages in low and middle-income country (LMIC) settings is limited but growing. Low message salience and disengagement, in the face of tobacco control messages, are possible barriers to self-efficacy and cessation-related behaviours of tobacco users. Although adaptations of existing pretested graphic and emotional appeals have been found to impact on behaviours, more personalised, culturally relevant and compelling appeals may more fully engage message receivers to elicit optimal behavioural responses. The objective of these case studies is to use lessons learnt from high-income country tobacco control communication programmes, and adapt practical approaches to provide cost-effective, culturally nuanced, graphic and personalised messages from tobacco victims to achieve the optimal behavioural impact for population-level communication campaigns in the resource-constrained settings of LMICs. The 'raw and real' messaging approach, which emanated from message pretesting in India, outlines creative and production processes for the production of tobacco victim testimonials, given the need to source patients, facing life-threatening conditions. This cost-efficient approach uses real tobacco victims, doctors and family members in a cinéma vérité style approach to achieve more personalised and culturally resonant messages. The methodological approach, used for the development of a number of patient testimonial messages initially in India, and later adapted for tobacco cessation, smoke-free and graphic health warning communication campaigns in other countries, is outlined. Findings from campaigns evaluated to date are encouraging as a result of the simple fact that true stories of local people's suffering are simply too difficult to ignore.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BibTeX:
@article{TurkT2016,
  author = {Turk T, Chaturvedi P, Murukutla N, Mallik V, Sinha P, Mullin S},
  title = {Raw and real: an innovative communication approach to smokeless tobacco control messaging in low and middle-income countries.},
  journal = {Tob Control.},
  year = {2016},
  doi = {http://dx.doi.org/10.1136/tobaccocontrol-2016-052968}
}
Vidyasagaran AL, Siddiqi K, Kanaan M Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis. 2016 Eur J Prev Cardiol.  article  
Abstract: OBJECTIVE:
The purpose of this study was to assess the risk of ischaemic heart disease (IHD) and stroke (non-fatal and fatal) among adult ever-users of smokeless tobacco (ST).
DESIGN:
The study design involved a systematic review and meta-analysis of observational studies.
METHODS:
Data sources for the review included key electronic databases and reference lists. Studies were included based on design (cohort or case-control), exposure (exclusive use of ST or adjusted for smoking), and outcome (non-fatal and fatal IHD and stroke). Data extraction included reported measures of association (risk ratios (RRs) or odds ratios (ORs)) between ever-use of ST (current or past) and cardiovascular disease (CVD) outcomes among non-smokers, and other study characteristics. The Newcastle-Ottawa scale was used to assess study quality. Summary measures were estimated using random effects models.
RESULTS:
Twenty studies were included in the meta-analyses. Overall, significantly increased risk of IHD deaths (1.15, 95% confidence interval (CI: 1.01-1.30) and stroke deaths (1.39, 95% CI: 1.29-1.49) was found among ever-users of ST. We did not find an overall significant increased risk for IHD (1.14, 95% CI: 0.92-1.42) or stroke (1.01, 95% CI: 0.90-1.13). But geographical variations were marked for IHD, with significant positive association in Asian studies (1.40, 95% CI: 1.01-1.95), and the INTERHEART study, where ST data was mainly reported from Asia (2.23, 95% CI: 1.41-3.53). European studies did not show an increased risk for non-fatal CVD.
CONCLUSION:
An association was found between ever use of ST and risk of fatal IHD and stroke, consistent with previous reviews. ST consumption also appears to significantly increase risk of non-fatal IHD among users in Asia, but not in Europe.
BibTeX:
@article{VidyasagaranAL2016,
  author = {Vidyasagaran AL, Siddiqi K, Kanaan M},
  title = {Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis.},
  journal = {Eur J Prev Cardiol.},
  year = {2016}
}
Asha V, Dhanya M Immunochromatographic Assessment of Salivary Cotinine and Its Correlation With Nicotine Dependence in Tobacco Chewers. 2015 J Cancer Prev.
Vol. 20(2), pp. 159-63 
article DOI  
Abstract: BACKGROUND:
This study assessed the correlation between nicotine dependence and salivary cotinine levels in tobacco chewers and checked the reliability of Fagerstorm test in tobacco cessation programmes.
METHODS:
The study sample included 75 tobacco chewers aged between 20 to 50 years. Self-reported nicotine dependence was evaluated using Fagerstorm Test for Nicotine dependence-smokeless tobacco questionnaire. Patients were categorized into low, moderate and high dependent chewers based on their answers to the questionnaire. The unstimulated salivary cotinine levels were measured by immunochromatographic assay using the NicAlert saliva test. Data was analysed using the chi-square test for testing intra-group variation, analysis of variance for testing between-groups variation, and the Spearman coefficient for assessing the association between variables.
RESULTS:
No statistically significant association was seen between salivary cotinine levels and nicotine dependence. A weak positive correlation was noted between the above variables (r = 0.230). In the group studied, it was evident that the patients were under-reporting the nicotine dependence.
CONCLUSIONS:
The measurement of salivary cotinine by immunochromatographic assay using NicAlert saliva test is a useful and convenient method for studying the nicotine dependence in tobacco chewers. Immunochromatography-based cotinine test strips are an easy method of detecting salivary cotinine in a dental setup. From this study we are of the opinion that a simple questionnaire like Fagerstorm test can give a less adequate analysis of patient's dependence especially in countries like India, where patients tend to under-report their dependency. Immediate feedback from a chairside test can help both the dentists and patients during a tobacco cessation programme.
BibTeX:
@article{AshaV2015,
  author = {Asha V, Dhanya M},
  title = {Immunochromatographic Assessment of Salivary Cotinine and Its Correlation With Nicotine Dependence in Tobacco Chewers.},
  journal = {J Cancer Prev.},
  year = {2015},
  volume = {20(2)},
  pages = {159-63},
  doi = {http://dx.doi.org/10.15430/JCP.2015.20.2.159}
}
Balakrishnan C, Aswath N Estimation of serum, salivary immunoglobulin G, immunoglobulin A levels and total protein, hemoglobin in smokeless tobacco chewers and oral submucous fibrosis patients. 2015 Contemp Clin Dent.
Vol. 6((Suppl 1)), pp. 157-62 
article DOI  
Abstract: BACKGROUND:
Oral submucous fibrosis (OSMF) is a debilitating, potentially cancerous oral condition. Although areca nut is the most important causative agent, it is also considered that the disease is immunologically mediated.
AIM OF THE STUDY:
To establish that autoimmunity and nutritional deficiency play a role in the etiopathogenesis of OSMF.
OBJECTIVES OF THE STUDY:
To show that serum immunoglobulin markers (immunoglobulin-G [IgG], immunoglobulin-A [IgA]) and nutritional parameters such as total serum protein (TSP), Hemoglobin (Hb) play a role in causing OSMF and also to correlate serum, salivary IgG, IgA levels in OSMF patients.
SETTINGS AND DESIGN:
A case-control study was done with 50 patients (25 patients who were provisionally diagnosed as OSMF - Group I, and 25 patients who were chronic smokeless tobacco chewers and who did not have any intraoral lesion - Group II).
MATERIALS AND METHODS:
Five milliliters of blood and saliva were collected from both the groups. Quantitative analysis of serum, and salivary IgG, IgA was done by turbidometric immunoassay. TSP and Hemoglobin (Hb) were estimated by spectrophotometry.
STATISTICAL ANALYSIS:
Results were analyzed by independent samples t-test and one-way analysis of variance (ANOVA).
RESULTS:
All patients of OSMF showed significant (P < 0.01) increase in serum IgG, IgA, and salivary IgG levels as compared to smokeless tobacco chewers. The salivary IgA levels showed a significant decrease in OSMF patients (P < 0.05). TSP and Hb levels showed significant (P < 0.01) decrease in OSMF patients as compared to smokeless tobacco chewers.
CONCLUSION:
The elevation of immunoglobulin levels supports the concept of autoimmunity. The decrease in TSP and Hb suggests that nutritional deficiency plays a defined role in the occurrence as well as a further progression of OSMF.
BibTeX:
@article{BalakrishnanC2015,
  author = {Balakrishnan C, Aswath N},
  title = {Estimation of serum, salivary immunoglobulin G, immunoglobulin A levels and total protein, hemoglobin in smokeless tobacco chewers and oral submucous fibrosis patients.},
  journal = {Contemp Clin Dent.},
  year = {2015},
  volume = {6},
  number = {(Suppl 1)},
  pages = {157-62},
  doi = {http://dx.doi.org/10.4103/0976-237X.166820}
}
Biswas S, Manna K, Das U, Khan A, Pradhan A, Sengupta A, Bose S, Ghosh S, Dey S Smokeless tobacco consumption impedes metabolic, cellular, apoptotic and systemic stress pattern: A study on Government employees in Kolkata, India. 2015 Sci Rep.
Vol. 5, pp. 18284 
article DOI  
Abstract: Smokeless tobacco (SLT) remains a threat amongst a large population across the globe and particularly in India. The oral use of tobacco has been implicated to cause physiological stress leading to extreme toxicological challenge. The study included 47 SLT-users and 44 non-users providing a spectrum of pathophysiological, clinico-biochemical, antioxidant parameters, cell cycle progression study of PBMC and morphological changes of red blood cells (RBC). The expressions of p53, p21, Bax, Bcl-2, IL-6, TNF- ?, Cox-2, iNOS were analyzed from thirteen representative SLT-users and twelve non-users. Difference in CRP, random glucose, serum cholesterol, TG, HLDL-C, LDL-C, VLDL-C, neutrophil count, monocyte count, ESR, SOD (PBMC) and TBARS (RBC membrane) were found to be statistically significant (p?
BibTeX:
@article{BiswasS2015,
  author = {Biswas S, Manna K, Das U, Khan A, Pradhan A, Sengupta A, Bose S, Ghosh S, Dey S},
  title = {Smokeless tobacco consumption impedes metabolic, cellular, apoptotic and systemic stress pattern: A study on Government employees in Kolkata, India.},
  journal = {Sci Rep.},
  year = {2015},
  volume = {5},
  pages = {18284},
  doi = {http://dx.doi.org/10.1038/srep18284}
}
Dwivedi S, Goel A, Khattri S, Sharma P, Pant KK Aggravation of inflammation by smokeless tobacco in comparison of smoked tobacco. 2015 Indian J Clin Biochem.
Vol. 30(1), pp. 117-9 
article DOI  
BibTeX:
@article{DwivediS2015,
  author = {Dwivedi S, Goel A, Khattri S, Sharma P, Pant KK},
  title = {Aggravation of inflammation by smokeless tobacco in comparison of smoked tobacco.},
  journal = {Indian J Clin Biochem.},
  year = {2015},
  volume = {30(1)},
  pages = {117-9},
  doi = {http://dx.doi.org/10.1007/s12291-014-0467-8}
}
Panda R, Srivastava S, Persai D, Mendenhall E, Arora M, Mathur MR System level approaches for mainstreaming tobacco control into existing health programs in India: Perspectives from the field. 2015 J Family Med Prim Care.
Vol. 4(4), pp. 559-65 
article DOI  
Abstract: INTRODUCTION:
India is the second largest consumer of tobacco in the world, and varieties of both smoked and smokeless tobacco products are widely available. The national program for tobacco control is run like a vertical stand-alone program. There is a lack of understanding of existing opportunities and barriers within the health programs that influence the integration of tobacco control messages into them. The present formative research identifies such opportunities and barriers.
METHODS:
We conducted a multi-step, mixed methodological study of primary care personnel and policy-makers in two Indian states of Andhra Pradesh and Gujarat. The primary purpose of our study was to investigate health worker and policy-maker perceptions on the integration of tobacco control intervention. We systematically collected data in three steps: In Step I, we conducted in-depth interviews (IDIs) and focus group discussions with primary care health personnel, Step II consists of a quantitative survey among health care providers (n = 1457) to test knowledge, attitudes and practices in tobacco control and Step III we conducted 75 IDIs with program heads and policy-makers to evaluate the relative congruence of their views on integration of the tobacco control program.
RESULTS:
Majority of the health care providers recognized tobacco use as a major health problem. There was a general consensus for the need of training for effective dissemination of information from health care providers to patients. Almost 92% of the respondents opined that integration of tobacco control with other health programs will be highly effective to downscale the tobacco epidemic.
CONCLUSIONS:
Our findings suggest the need for integration of tobacco control program into existing health programs. Integration of tobacco control strategies into the health care system within primary and secondary care will be more effective and counseling for tobacco cessation should be available for population at large.
BibTeX:
@article{PandaR2015,
  author = {Panda R, Srivastava S, Persai D, Mendenhall E, Arora M, Mathur MR},
  title = {System level approaches for mainstreaming tobacco control into existing health programs in India: Perspectives from the field.},
  journal = {J Family Med Prim Care.},
  year = {2015},
  volume = {4(4)},
  pages = {559-65},
  doi = {http://dx.doi.org/10.4103/2249-4863.174288}
}
Sinha DN, Rizwan SA, Aryal KK, Karki KB, Zaman MM, Gupta PC Trends of Smokeless Tobacco use among Adults (Aged 15-49 Years) in Bangladesh, India and Nepal. 2015 Asian Pac J Cancer Prev.
Vol. 16(15), pp. 6561-8 
article  
Abstract: BACKGROUND:
Smokeless tobacco (SLT) has long been realized as an important component of the fight for global tobacco control. It still remains a major problem in countries like India, Bangladesh and Nepal. The objective of this study was to estimate the trends of SLT use in three countries of the SEARO WHO office.
MATERIALS AND METHODS:
We used data from national surveys in three countries (Bangladesh, India and Nepal) to estimate trends in prevalence of current SLT use. All available nationally representative data sources were used. Estimates were weighted, age standardized and given along with 95% confidence intervals. Significance of linear trend in prevalence over time was tested using the Cochrane-Armitage test for trend. A p value of less than 0.05 was considered statistically significant.
RESULTS:
We identified three surveys for Bangladesh, three for India and four for Nepal that met the selection criteria (such as Demographic and Health Surveys, WHO-STEPwise approach to Surveillance and Global Adult Tobacco Surveys). A significantly increasing trend was noticed in the prevalence of current SLT use among Bangladeshi men (20.2% to 23%, p=0.03). In India, a similar significantly increasing trend was seen among men (27.1% to 33.4%, p<0.001) and women (10.1% to 15.7%, p<0.001). In Nepal, there was a no significant trend among both men (39.1% to 31.6%, p=0.11) and women (5.6% to 4.7%, p=0.49).
CONCLUSIONS:
In the study countries SLT use has remained at alarmingly high levels. Usage trends do not show any signs of decline in spite of control efforts. Tobacco control measures should focus more on controlling SLT use.
BibTeX:
@article{SinhaDN12015,
  author = {Sinha DN, Rizwan SA, Aryal KK, Karki KB, Zaman MM, Gupta PC},
  title = {Trends of Smokeless Tobacco use among Adults (Aged 15-49 Years) in Bangladesh, India and Nepal.},
  journal = {Asian Pac J Cancer Prev.},
  year = {2015},
  volume = {16(15)},
  pages = {6561-8}
}
Thakur JS, Prinja S, Bhatnagar N, Rana SK, Sinha DN, Singh PK Widespread inequalities in smoking & smokeless tobacco consumption across wealth quintiles in States of India: Need for targeted interventions. 2015 Indian J Med Res.
Vol. 141(6), pp. 789-98 
article DOI  
Abstract: BACKGROUND & OBJECTIVES:
India is a large country with each State having distinct social, cultural and economic characteristics. Tobacco epidemic is not uniform across the country. There are wide variations in tobacco consumption across age, sex, regions and socio-economic classes. This study was conducted to understand the wide inequalities in patterns of smoking and smokeless tobacco consumption across various States of India.
METHODS:
Analysis was conducted on Global Adult Tobacco Survey, India (2009-2010) data. Prevalence of both forms of tobacco use and its association with socio-economic determinants was assessed across States and Union Territories of India. Wealth indices were calculated using socio-economic data of the survey. Concentration index of inequality and one way ANOVA assessed economic inequality in tobacco consumption and variation of tobacco consumption across quintiles. Multiple logistic regression was done for tobacco consumption and wealth index adjusting for age, sex, area, education and occupation.
RESULTS:
Overall prevalence of smoking and smokeless tobacco consumption was 13.9 per cent (14.6, 13.3) and 25.8 per cent (26.6, 25.0), respectively. Prevalence of current smoking varied from 1.6 per cent (richest quintile in Odisha) to 42.2 per cent (poorest quintile in Meghalaya). Prevalence of current smokeless tobacco consumption varied from 1.7 per cent (richest quintile in Jammu and Kashmir) to 59.4 per cent (poorest quintile in Mizoram). Decreasing odds of tobacco consumption with increasing wealth was observed in most of the States. Reverse trend of tobacco consumption was observed in Nagaland. Significant difference in odds of smoking and smokeless tobacco consumption with wealth quintiles was observed. Concentration index of inequality was significant for smoking tobacco -0.7 (-0.62 to-0.78) and not significant for smokeless tobacco consumption -0.15 (0.01 to-0.33) INTERPRETATION & CONCLUSIONS: The findings of our analysis indicate that tobacco control policy and public health interventions need to consider widespread socio-economic inequities in tobacco consumption across the States in India.
BibTeX:
@article{ThakurJS2015,
  author = {Thakur JS, Prinja S, Bhatnagar N, Rana SK, Sinha DN, Singh PK},
  title = {Widespread inequalities in smoking & smokeless tobacco consumption across wealth quintiles in States of India: Need for targeted interventions.},
  journal = {Indian J Med Res.},
  year = {2015},
  volume = {141(6)},
  pages = {789-98},
  doi = {http://dx.doi.org/10.4103/0971-5916.160704}
}
Shukla A Potentially malignant disorders of the oral cavity: a clinical study. 2014 Indian J Otolaryngol Head Neck Surg.
Vol. 66(1), pp. 79-85 
article DOI  
Abstract: Oral cancers in India, unlike in the West are the most common cancers encountered, be it a primary or a tertiary referral practice. This makes the study and management of these cancers an important issue especially for the otolaryngologist. It is well known that the most common variant of oral cancers is the squamous cell carcinoma. Also the etiology is well established; with tobacco use in both smoking and smokeless forms, alcohol, betel nut and recently the Human Papilloma virus infection being implicated. Certain conditions which definitely increase the probability of getting oral cancers are known and this study aims in revisiting these aspects of pre-malignancy. The progression from a pre-cancerous lesion/condition to frank cancer is well established across many studies and many specialties. Also timely recognizing these pre-cancerous conditions and administration of proper treatment will greatly help in reducing the morbidity and mortality from subsequent much advanced and dangerous oral cancer. Keeping these facts in mind this study was planned to study the established pre-cancerous lesions which are known to progress to oral cancers.
BibTeX:
@article{A2014,
  author = {Shukla A},
  title = {Potentially malignant disorders of the oral cavity: a clinical study.},
  journal = {Indian J Otolaryngol Head Neck Surg.},
  year = {2014},
  volume = {66(1)},
  pages = {79-85},
  doi = {http://dx.doi.org/10.1007/s12070-013-0680-4}
}
Addala L, Pentapati CK, Reddy Thavanati PK, Anjaneyulu V, Sadhnani MD Risk factor profiles of head and neck cancer patients of Andhra Pradesh, India. 2012 Indian J Cancer
Vol. 49(2), pp. 215-9 
article DOI  
Abstract: OBJECTIVE:
To define the demographic risk profile and stage at diagnosis among the head and neck cancer (HNC) patients reported in two hospital-based cancer registries in Andhra Pradesh.
MATERIALS AND METHODS:
A cross-sectional study was conducted in patients with histologically confirmed diagnosis of squamous cell carcinoma of the head and neck during 2002-2006. Data on the demographic profile and clinical information were obtained from hospital and clinical records. Staging was based on the American Joint Committee on Cancer and included primary tumor size (T), regional neck status (N), and group stage. The site of cancer was classified based on the International Classification of Disease for oncology (ICD-02).
RESULTS:
A total of 5458 cases of HNC were included in this study. Majority of the subjects were in the age range of 40-69 years with a significant male preponderance in all the age groups (P<0.001). The most common habit was the combination of smoking, alcohol, and chewing in both males and females (20.1 and 35.1%, respectively) (P<0.001). Tongue and buccal mucosa were the most common sites of cancer in both males (26.8 and 12.8%, respectively) and females (22.9 and 19.8%, respectively) (P<0.001). Tongue was the commonest site of cancer occurrence with respect to all the habits (both singly and in combination) except for chewing tobacco where buccal mucosa was the most common site. Males were more likely to be diagnosed in stage 3 (37.6%) and 4 (20.6%), while females were diagnosed in stage 1 (36.3%) and 2 (32.7%) (P<0.001).
CONCLUSION:
A male preponderance of cancer occurrence and combination of all the three habits (smoking, alcohol, and chewing) were found to be the significant risk factors. Males were more likely to be diagnosed later than females
BibTeX:
@article{AddalaL2012,
  author = {Addala L, Pentapati CK, Reddy Thavanati PK, Anjaneyulu V, Sadhnani MD},
  title = {Risk factor profiles of head and neck cancer patients of Andhra Pradesh, India.},
  journal = {Indian J Cancer},
  year = {2012},
  volume = {49(2)},
  pages = {215-9},
  doi = {http://dx.doi.org/10.4103/0019-509X.102865}
}
Aggarwal A, Jain M, Jiloha RC Varenicline for smokeless tobacco dependence. 2010 J Postgrad Med
Vol. 56(1) 
article DOI  
BibTeX:
@article{AggarwalA2010,
  author = {Aggarwal A, Jain M, Jiloha RC.},
  title = {Varenicline for smokeless tobacco dependence.},
  journal = {J Postgrad Med},
  year = {2010},
  volume = {56(1)},
  doi = {http://dx.doi.org/10.4103/0022-3859.62414}
}
Agrawal S, Karan A, Selvaraj S, Bhan N, Subramanian SV, Millett C Socio-economic patterning of tobacco use in Indian states. 2013 Int J Tuberc Lung Dis.
Vol. 17(8), pp. 1110-7 
article DOI  
Abstract: BACKGROUND:
Studies in India have identified marked variations in overall tobacco use between socio-economic groups. We examined whether associations between socio-economic status (SES) and tobacco use varied across individual Indian states by tobacco type.
METHODS:
Cross-sectional survey of 100,855 households in 24 Indian states and Union Territories conducted in 2009-2010. Outcome measures were household tobacco consumption by type. Logistic and linear regression models were used to examine associations at the household level between education, income and use and volume of tobacco consumed.
RESULTS:
Overall, 52% of households used any form of tobacco product; the predominant form was smokeless tobacco(22%), followed by bidi (17%) and cigarettes (4%). Increasing household income and higher education level were associated with a higher likelihood of cigarette use but a lower likelihood of bidi and smokeless tobacco use in some Indian states. Increasing household income was associated with higher volumes of cigarette and bidi use among consuming households; however, association between educational level and volume of tobacco consumption was inconsistent.
CONCLUSION:
SES has a varying impact on different types of tobacco use in Indian states. Policy makers should consider socio-economic patterning of tobacco use when designing, implementing and evaluating tobacco control interventions in different states of India.
BibTeX:
@article{AgrawalS2013,
  author = {Agrawal S, Karan A, Selvaraj S, Bhan N, Subramanian SV, Millett C},
  title = {Socio-economic patterning of tobacco use in Indian states.},
  journal = {Int J Tuberc Lung Dis.},
  year = {2013},
  volume = {17(8)},
  pages = {1110-7},
  doi = {http://dx.doi.org/10.5588/ijtld.12.0916}
}
Anand PS, Kamath KP, Shekar BR, Anil S Relationship of smoking and smokeless tobacco use to tooth loss in a central Indian population. 2012 Oral Health Prev Dent
Vol. 10(3), pp. 243-52 
article  
Abstract: PURPOSE:
The present study was conducted to determine the patterns of tooth loss among subjects with different tobacco- related habits and compare it with non-users of tobacco.
MATERIALS AND METHODS:
A total of 1075 patients over the age of 14 years attending the Department of Periodontics, People's College of Dental Sciences and Research Centre, Bhopal, India from May to September 2009 were included in the study. Besides name, age and gender, information regarding tobacco habits was recorded through interviews. Based on thetobacco habits, the patients were grouped into 4 categories: group 1 (non-users of tobacco), group 2 (smokers only), group 3 (smokeless tobacco users only) and group 4 (users of both smoking and smokeless tobacco). Tooth loss was determined by clinical examination of all permanent teeth excluding the third molars. Tooth loss included missing or extracted teeth as well as teeth indicated for extraction due to periodontal disease, dental caries or wasting diseases. Prevalence and mean tooth loss for whole dentition, maxillary and mandibular arches were compared between the 4 groups. The chi-square test and one-way ANOVA were used for comparing the prevalence and mean tooth loss, respectively, between different groups.
RESULTS:
The overall prevalence and mean tooth loss, respectively, for different groups were as follows: group 1: 28.3% and 0.85; group 2: 56.1% and 1.97; group 3: 58.7% and 2.38; group 4: 56.7% and 2.48 (P < 0.001 for both prevalence and mean tooth loss). The prevalence and mean tooth loss, respectively, for the maxillary arch for the different groups were: group 1: 15.3% and 0.32; group 2: 43% and 1.24; group 3: 34.3% and 0.91; group 4: 45.4% and 1.26 (P < 0.001 for both prevalence and mean tooth loss). The prevalence and mean tooth loss, respectively, for the mandibular arch for the different groups were: group 1: 22.3% and 0.52; group 2: 33.6% and 0.73; group 3: 50.9% and 1.48; group 4: 48.5% and 1.23 (P < 0.001 for both prevalence and mean tooth loss).
CONCLUSION:
When compared to non-users of tobacco, tooth loss was greater among subjects who consumed tobacco. In India, where consumption of tobacco in different forms is very common, public health programmes need to be implemented to increase public awareness regarding the adverse effects of tobacco on oral health.
BibTeX:
@article{An2012,
  author = {Anand PS, Kamath KP, Shekar BR, Anil S.},
  title = {Relationship of smoking and smokeless tobacco use to tooth loss in a central Indian population.},
  journal = {Oral Health Prev Dent},
  year = {2012},
  volume = {10(3)},
  pages = {243-52}
}
Anantharaman D, Chabrier A, Gaborieau V, Franceschi S, Herrero R, Rajkumar T, Samant T, Mahimkar MB, Brennan P, McKay JD Genetic variants in nicotine addiction and alcohol metabolism genes, oral cancer risk and the propensity to smoke and drink alcohol: a replication study in India. 2014 PLoS One.
Vol. 9(2) 
article DOI  
Abstract: BACKGROUND:
Genetic variants in nicotinic acetylcholine receptor and alcohol metabolism genes have been associated with propensity to smoke tobacco and drink alcohol, respectively, and also implicated in genetic susceptibility to head and neck cancer. In addition to smoking and alcohol, tobacco chewing is an important oral cancer risk factor in India. It is not known if these genetic variants influence propensity or oral cancer susceptibility in the context of this distinct etiology.
METHODS:
We examined 639 oral and pharyngeal cancer cases and 791 controls from two case-control studies conducted in India. We investigated six variants known to influence nicotine addiction or alcohol metabolism, including rs16969968 (CHRNA5), rs578776 (CHRNA3), rs1229984 (ADH1B), rs698 (ADH1C), rs1573496 (ADH7), and rs4767364 (ALDH2).
RESULTS:
The CHRN variants were associated with the number of chewing events per day, including in those who chewedtobacco but never smoked (P?=? 0.003, P?=? 0.01 for rs16969968 and rs578776 respectively). Presence of the variant allele contributed to approximately 13% difference in chewing frequency compared to non-carriers. While no association was observed between rs16969968 and oral cancer risk (OR?=? 1.01, 95% CI?=? 0.83- 1.22), rs578776 was modestly associated with a 16% decreased risk of oral cancer (OR?=? 0.84, 95% CI?=? 0.72- 0.98). There was little evidence for association between polymorphisms in genes encoding alcohol metabolism and oral cancer in this population.
CONCLUSION:
The association between rs16969968 and number of chewing events implies that the effect on smoking propensity conferred by this gene variant extends to the use of smokeless tobacco.
BibTeX:
@article{AnantharamanD2014,
  author = {Anantharaman D, Chabrier A, Gaborieau V, Franceschi S, Herrero R, Rajkumar T, Samant T, Mahimkar MB, Brennan P, McKay JD},
  title = {Genetic variants in nicotine addiction and alcohol metabolism genes, oral cancer risk and the propensity to smoke and drink alcohol: a replication study in India.},
  journal = {PLoS One.},
  year = {2014},
  volume = {9(2)},
  doi = {http://dx.doi.org/10.1371/journal.pone.0088240}
}
Angadi PV, Rekha KP Oral submucous fibrosis: a clinicopathologic review of 205 cases in Indians. 2011 Oral Maxillofac Surg
Vol. 15(1) 
article DOI  
Abstract: INTRODUCTION:
Oral submucous fibrosis is a disease due to a chronic, insidious change in fibro-elasticity, characterized by burning sensation in the oral cavity, blanching, and stiffening of the oral mucosa and oro-pharynx leading to trismus and inability to open the mouth. The symptoms and signs depend on the progression of the lesions and number of affected sites. It is predominantly seen in Indians and other Asians. Once the disease has developed, there is neither regression nor any effective treatment. There are only few studies on the frequency and clinicopathological feature of oral submucous fibrosis in the Indian population in recent years.
MATERIAL AND METHODS:
The present study evaluated 205 cases of oral submucous fibrosis for the age, sex, site of involvement, duration of disease at the time of diagnosis, associated habits and common presenting symptoms, presence of other mucosal lesions, malignant potential, and the histopathology.
RESULTS AND DISCUSSION:
Oral submucous fibrosis was seen in younger age (20-30 years) than that reported in literature and showed a characteristic male preponderance. A strong association with smokeless tobacco use especially arecanut in the form of gutkha was established and was related to earlier development of oral submucous fibrosis (OSMF), i.e., within a year of the habit. A total of 11.6% of cases were associated with malignancy and occurred predominantly in males.
CONCLUSION:
This article gives an insight into OSMF in this part of southern India and adds to its biologic profile.
BibTeX:
@article{AngadiPV2011,
  author = {Angadi PV, Rekha KP.},
  title = {Oral submucous fibrosis: a clinicopathologic review of 205 cases in Indians.},
  journal = {Oral Maxillofac Surg},
  year = {2011},
  volume = {15(1)},
  doi = {http://dx.doi.org/10.1007/s10006-010-0225-x}
}
Arimilli S, Damratoski BE, Prasad GL Combustible and non-combustible tobacco product preparations differentially regulate human peripheral blood mononuclear cell functions. 2013 Toxicol In Vitro.
Vol. 27(6), pp. 1992-2004 
article DOI  
Abstract: Natural killer (NK) cells and T cells play essential roles in innate and adaptive immune responses in protecting against microbial infections and in tumor surveillance. Although evidence suggests that smoking causes immunosuppression, there is limited information whether the use of smokeless tobacco (ST) products affects immune responses. In this study, we assessed the effects of two preparations of cigarette smoke, ST extract and nicotine on T cell and NK cell responses using Toll-like receptor-ligand stimulated human peripheral blood mononuclear cells (PBMCs). The tobacco product preparations (TPPs) tested included whole smoke conditioned media (WS-CM), total particulate matter (TPM) and a ST product preparation in complete artificial saliva (ST/CAS). The PBMCs were stimulated with polyinosinic:polycytidylic acid (poly I:C) and lipopolysaccharide (LPS). A marked reduction of the expression of intracellular IFN-? and TNF-? was evident in NK cells and T cells treated with WS-CM and TPM. Consistently, attenuation of ligand-induced secretion of cytokines (IL-1?, IL-10, IL-12 and TNF-?) from PBMCs treated with WS-CM and TPM were observed. While the treatment with TPPs did not alter the expression of the maturation marker CD69, WS-CM and TPM inhibited the cytolytic activity of human PBMCs. Suppression of perforin by WS-CM was also detected. Although interference from the vehicle confounded the interpretation of effects of ST/CAS, some effects were evident only at high concentrations. Nicotine treatment minimally impacted expression of cytokines and cytolytic activity. Data presented herein suggests that the function of NK cells and T cells is influenced by exposure to TPPs (based on equi-nicotine units) in the following order: WS-CM>TPM>ST/CAS. These findings are consistent with the hypothesis put forward by others that chronic smoking leads to immunosuppression, an effect that may contribute to increased microbial infections and cancer incidence among smokers.
BibTeX:
@article{ArimilliS2013,
  author = {Arimilli S, Damratoski BE, Prasad GL},
  title = {Combustible and non-combustible tobacco product preparations differentially regulate human peripheral blood mononuclear cell functions.},
  journal = {Toxicol In Vitro.},
  year = {2013},
  volume = {27(6)},
  pages = {1992-2004},
  doi = {http://dx.doi.org/10.1016/j.tiv.2013.06.015}
}
Arora M, Madhu R Banning smokeless tobacco in India: policy analysis. 2012 Indian J Cancer
Vol. 49(4), pp. 336-41 
article DOI  
Abstract: India is the second largest producer and third largest consumer of tobacco. According to GATS India Report (2009-10), the users of only smokeless tobacco (SLT) are more than double than that of smokers. SLT use is an imminent public health problem, which is contributing to high disease burden in India. It is a "unique" tobacco product due to its availability in myriad varieties, easy access, and affordability especially for adolescents. It has been studied to be a gateway product and facilitates initiation. Currently, the Food Safety and Standards Authority of India (FSSAI) have prohibited the use of tobacco and nicotine in any food products; yet, the implementation of a permanent ban on SLT across India is still pending. This paper examines how multiple legislations have failed to effectively control or regulate SLT in India and regionally; thus, there is need to strengthen SLT control efforts as "no ordinary product."
BibTeX:
@article{AroraM2012,
  author = {Arora M, Madhu R},
  title = {Banning smokeless tobacco in India: policy analysis.},
  journal = {Indian J Cancer},
  year = {2012},
  volume = {49(4)},
  pages = {336-41},
  doi = {http://dx.doi.org/10.4103/0019-509X.107724}
}
Aruna DS, Prasad KV, Shavi GR, Ariga J, Rajesh G, Krishna M Retrospective study on risk habits among oral cancer patients in Karnataka Cancer Therapy and Research Institute, Hubli, India. 2011 Asian Pac J Cancer Prev
Vol. 12(6), pp. 1561-6 
article  
Abstract: BACKGROUND:
Retrospective studies on oral cancer patient profiles related to risk habits could provide etiologic clues for prevention in specific geographic areas.
OBJECTIVE:
To study risk habit characteristics of oral cancer patients.
METHODS:
A cross sectional retrospective case record study of oral cancer patients who reported during 1991-2000 to Karnataka Cancer Therapy and Research Institute, Hubli, India was conducted. Data on socio-demography, histopathology, site of cancer and risk habit profiles of the patients were recorded in a predesigned Performa by one calibrated examiner with internal validity checks.
RESULTS:
The 1,472 oral cancer patients constituted 11% of total cancer patients. Mean age of the patients was 55 years, ranging from 12-88, with a male: female ratio of 2:1. 1,110 (75%) oral cancer patients had risk habits, 55% were habituated for >10 years and 25% were habit free. 751(51%) patients had individual and 359(24%) had combined risk habits. Majority 59% were chewers of betel quid alone (17%)/betel quid with tobacco (42%); smokers were (31%) and alcohol users were (14%) of patients. Chewers of gutkha, khaini were more in <40 years and betel quid in >40 years. Risk habituates were highest (87%) in patients with cancer of buccal mucosa, commonly affected site attributed to chewing habit in (51%) of patients.
CONCLUSIONS:
The prevalence of oral cancer was higher among elderly males predominantly with risk habits of betel quid/tobacco chewing and smoking for more than 10 years.
BibTeX:
@article{ArunaDS2011,
  author = {Aruna DS, Prasad KV, Shavi GR, Ariga J, Rajesh G, Krishna M},
  title = {Retrospective study on risk habits among oral cancer patients in Karnataka Cancer Therapy and Research Institute, Hubli, India.},
  journal = {Asian Pac J Cancer Prev},
  year = {2011},
  volume = {12(6)},
  pages = {1561-6}
}
Avti PK, Vaiphei K, Pathak CM, Khanduja KL Involvement of various molecular events in cellular injury induced by smokeless tobacco. 2010 Chem Res Toxicol
Vol. 2397), pp. 1163-74 
article DOI  
Abstract: Smokeless tobacco (ST) consumption is implicated in the pathogenesis of oral diseases, including cancer. However, its pathological effect in other organs is not well understood. In the present study, the effect of aqueous extract of smokeless tobacco (AEST) prepared from "gutkha" (a form of ST) on the xenobiotic drug-metabolizing enzymes, histopathological changes, and damage to the genetic material in lung, liver, and kidney of rats was evaluated. Animals were orally administered AEST at a low dose (L-AEST, 96 mg/kg body wt/day) for 2 (L-AEST(2)) and 28 weeks (L-AEST(28)) and at a high dose (H-AEST, 960 mg/kg body wt/day) for 2 weeks (H-AEST(2)). Real-time PCR and immunohistological studies showed that administration of L-AEST(2) did not induce the expression of phase I cytochrome P450s (CYP1A1, 1A2, and 2E1) and phase II mu-glutathione-s-transferase (GST-mu) drug-metabolizing enzymes in lung, liver, and kidney. Although H-AEST(2) administration significantly induced both gene and protein expression of CYP1A1, 1A2, and 2E1 in all of the above organs, it mildly expressed the phase II detoxifying enzyme, GST-mu, in type I and type II epithelial cells of lung and in proximal tubular cells of kidney. L-AEST(28) enhanced the gene and protein expression of CYP1A1, 1A2, and 2E1 in lung, liver, and kidney in a differential manner and induced the expression of GST-mu in lung and kidney. L-AEST(28) induced the micronuclei formation in the peripheral blood mononuclear cells, TNF-alpha in plasma, and myeloperoxidase activity in the organs. L-AEST(28) significantly enhanced Bax, p53, and NF-kappaB and decreased Bcl-2 gene expressions differentially in an organ-specific manner. The differential changes in these organs due to AEST might be due to their different physiological functions and variable sensitivities toward the metabolites of AEST, which create a microenvironment favorable for AEST-induced pathogenesis. This study broadens the insight into the different molecular mechanisms in various organs, which appear to be deregulated due to AEST.Understanding these processes may help in clinical treatment planning strategies for tobacco-related diseases.
BibTeX:
@article{AvtiPK2010,
  author = {Avti PK, Vaiphei K, Pathak CM, Khanduja KL.},
  title = {Involvement of various molecular events in cellular injury induced by smokeless tobacco.},
  journal = {Chem Res Toxicol},
  year = {2010},
  volume = {2397)},
  pages = {1163-74},
  doi = {http://dx.doi.org/10.1021/tx900458x}
}
Balasubramaniam G, Sushama S, Rasika B, Mahantshetty U Hospital-based study of endometrial cancer survival in Mumbai, India. 2013 Asian Pac J Cancer Prev.
Vol. 14(2), pp. 977-80 
article  
Abstract: BACKGROUND:
Endometrial cancer is common in western women, and the rates are very high; however in India, the rates are as low as 4.3 per 100,000 (Delhi).
OBJECTIVE:
To estimate the survival of endometrial cancer patients based on age, education, family history, tobacco habit, number of pregnancies, clinical extent of disease and treatment received.
MATERIALS AND METHODS:
The present retrospective study was carried out at the Tata Memorial Hospital (TMH), Mumbai, India, between 1999-2002. 310 cases treated in TMH were considered as eligible entrants for the study. Five-year survival rates were estimated using actuarial and loss-adjusted (LAR) methods.
RESULTS:
The proportions of patients dying above 50 years of age, non-residents and illiterates was higher than their counterparts. 54.8% of patients had some form of treatment before attending TMH. There were only 4.2% tobacco-chewers and only 6.1% had a family history of cancer. There were 25.8% who had 3-5 pregnancies (not living children) and 38.1% did not remember the pregnancy history. The 5-year overall survival rate was 92%. The five-year rates indicated better prognosis for those aged less than 50 years (97%), non-tobacco-chewers (94%), with no family history of cancer (93%), with localized disease (93%) and those treated with surgery either alone or as a combination treatment (95%).
CONCLUSIONS:
The present study showed that endometrial cancer patients with localized disease at diagnosis have a good outcome in India. A detailed study will help in understanding the prognostic indicators for survival especially with the newer treatment technologies now available.
BibTeX:
@article{BalasubramaniamG2013,
  author = {Balasubramaniam G, Sushama S, Rasika B, Mahantshetty U.},
  title = {Hospital-based study of endometrial cancer survival in Mumbai, India.},
  journal = {Asian Pac J Cancer Prev.},
  year = {2013},
  volume = {14(2)},
  pages = {977-80}
}
Balhara YP, Jain R A receiver operated curve-based evaluation of change in sensitivity and specificity of cotinine urinalysis for detecting active tobacco use. 2013 J Cancer Res Ther
Vol. 9(1), pp. 84-9 
article DOI  
Abstract: BACKGROUND:
Tobacco use has been associated with various carcinomas including lung, esophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach, and cervix. Biomarkers such as concentration of cotinine in the blood, urine, or saliva have been used as objective measures to distinguish nonusers and users of tobacco products. A change in the cut-off value of urinary cotinine to detect active tobacco use is associated with a change in sensitivity and sensitivity of detection.
AIM:
The current study aimed at assessing the impact of using different cut-off thresholds of urinary cotinine on sensitivity and specificity of detection of smoking and smokeless tobacco product use among psychiatric patients.
SETTINGS AND DESIGN:
All the male subjects attending the psychiatry out-patient department of the tertiary care multispecialty teaching hospital constituted the sample frame for the current study in a cross-sectionally.
MATERIALS AND METHODS:
Quantitative urinary cotinine assay was done by using ELISA kits of Calbiotech. Inc., USA. We used the receiver operating characteristic (ROC) curve to assess the sensitivity and specificity of various cut-off values of urinary cotinine to identify active smokers and users of smokeless tobacco products.
RESULTS:
ROC analysis of urinary cotinine levels in detection of self-reported smoking provided the area under curve (AUC) of 0.434. Similarly, the ROC analysis of urinary cotinine levels in detection of self-reported smoking revealed AUC of 0.44. The highest sensitivity and specificity of 100% for smoking were detected at the urinary cut-off value greater than or equal to 2.47 ng/ml.
CONCLUSIONS:
The choice of cut-off value of urinary cotinine used to distinguish nonusers form active users of tobaccoproducts impacts the sensitivity as well as specificity of detection.
BibTeX:
@article{BalharaYP2013,
  author = {Balhara YP, Jain R.},
  title = {A receiver operated curve-based evaluation of change in sensitivity and specificity of cotinine urinalysis for detecting active tobacco use.},
  journal = {J Cancer Res Ther},
  year = {2013},
  volume = {9(1)},
  pages = {84-9},
  doi = {http://dx.doi.org/10.4103/0973-1482.110384}
}
Balhara YP, Jain R, Sundar SA, Sagar R A comparative study of reliability of self report of tobacco use among patients with bipolar and somatoform disorders. 2011 J Pharmacol Pharmacother
Vol. 2(3), pp. 174-8 
article DOI  
Abstract: OBJECTIVE:
To compare the use and reliability of self-reported tobacco use (both smoked and smokeless) among patients with bipolar disorder and somatoform disorders.
MATERIALS AND METHODS:
The study was conducted at psychiatry out-patient department of a tertiary care hospital. A total of 50 consecutive patients were recruited. The subjects were asked about the use of tobacco products (smoked as well as smokeless) over the past one week. Those reporting affirmatively in response to the question were assessed using Fagerstrom Test for Nicotine Dependence (FTND) scales. Quantitative urinary cotinine levels were assessed using Enzyme-linked immunosorbent assay (ELISA).
RESULTS:
Calculation of Cohen's kappa using cross tabulation revealed discordance between the self-reported use of smoked as well as smokeless tobacco products in both the groups. Analysis using the lower cut off of 50 ng/ ml also revealed discordance between the self-reported tobacco use (smoked as well as smokeless) for both the groups.
CONCLUSIONS:
The reliability of self-report is questionable among both these groups for smoking as well as smokeless tobacco products
BibTeX:
@article{BalharaYP2011,
  author = {Balhara YP, Jain R, Sundar SA, Sagar R.},
  title = {A comparative study of reliability of self report of tobacco use among patients with bipolar and somatoform disorders.},
  journal = {J Pharmacol Pharmacother},
  year = {2011},
  volume = {2(3)},
  pages = {174-8},
  doi = {http://dx.doi.org/10.4103/0976-500X.83282}
}
Banerjee SC, Ostroff JS, Bari S, D'Agostino TA, Khera M, Acharya S, Gany F Gutka and Tambaku Paan use among South Asian immigrants: a focus group study. 2014 J Immigr Minor Health.
Vol. 16(3), pp. 531-9 
article DOI  
Abstract: Smokeless tobacco use is prevalent among South Asian immigrants, particularly in the forms of gutka and tambaku paan. In this paper, we examined (a) gutka and tambaku paan initiation and use patterns among South Asian immigrants, and (b) perceptions related to quitting and tobacco control. Six focus groups were conducted with 39 South Asian adult gutka/tambaku paan users, in three different South Asian languages (Gujarati, Bengali, and Urdu). Participants reported easy availability of gutka and tambaku paan in neighborhood stores, and noted several factors that promoted initiation (including social networks, perceived benefits, and curiosity). Due to awareness of low social acceptance of gutka and tambaku paan in the US, some participants discussed changing patterns of use following immigration. Finally, participants proposed roles of various agencies (e.g., doctors'/dentists' role, government-led initiatives) for tobacco control in South Asian immigrant communities. This research provides implications for improving tobacco control efforts in the United States, particularly for South Asian immigrants
BibTeX:
@article{BanerjeeSC2014,
  author = {Banerjee SC, Ostroff JS, Bari S, D'Agostino TA, Khera M, Acharya S, Gany F},
  title = {Gutka and Tambaku Paan use among South Asian immigrants: a focus group study.},
  journal = {J Immigr Minor Health.},
  year = {2014},
  volume = {16(3)},
  pages = {531-9},
  doi = {http://dx.doi.org/10.1007/s10903-013-9826-4}
}
Bathi RJ, Parveen S, Burde K The role of gutka chewing in oral submucous fibrosis: a case-control study. 2009 Quintessence Int, pp. 19-25  article  
Abstract: OBJECTIVE:
To learn about the use of various chewing substrates, such as areca nut and gutka, among subjects with oral submucosal fibrosis (OSMF) and controls with no oral mucosal lesions.
MATERIALS AND METHODS:
In this hospital-based case-control study, 220 patients with OSMF were selected and compared with matched controls with regard to dietary habits, including spice use, smoking history, and preference for chewing substrates. Relative risk of various chewing habits was calculated using an odds ratio and logistic regression analysis to understand the influence of chewing habits, spices, and smoking on the development of OSMF. Discriminate analysis was employed to determine which risk factors were valid and reliable discriminators between individuals with or without OSMF.
RESULTS:
The relative risk of developing oral submucosal fibrosis was highest with gutka-chewing habit (relative risk, 1,142.4), which was significant (P < .01) at 95% confidence interval. The next highest relative risk for development of oral submucosal fibrosis was observed for the combination of gutka with other chewing habits. The relative risk of developing submucosal fibrosis increased with the frequency of chewing habit up to 15 times daily with a duration of habit up to 4 years. The relative risk decreased with chewing frequency beyond 15 times daily and 4 years in duration. Logistic regression and discriminative analysis show that chewing areca nut and gutka, especially daily, greatly influence the development of submucosal fibrosis.
CONCLUSION:
This study suggests that chewing commercially available areca-nut preparations such as gutka is strongly associated with the development of oral submucosal fibrosis.
BibTeX:
@article{BathiRJ2009,
  author = {Bathi RJ, Parveen S, Burde K.},
  title = {The role of gutka chewing in oral submucous fibrosis: a case-control study.},
  journal = {Quintessence Int},
  year = {2009},
  pages = {19-25}
}
Bhagyalaxmi A, Atul T, Shikha J Prevalence of risk factors of non-communicable diseases in a District of Gujarat, India. 2013 J Health Popul Nutr
Vol. 31(1), pp. 78-85 
article  
Abstract: The study attempted to identify the prevalence and distribution of risk factors of non-communicable diseases among urban and rural population in Gujarat, India. Using the WHO stepwise approach, a cross-sectional study was carried out among 1,805 urban and 1,684 rural people of 15-64 years age-group. Information on behavioural and physiological risk factors of non-communicable diseases was obtained through standardized protocol. High prevalence of smoking (22.8%) and the use ofsmokeless tobacco (43.4%) were observed among rural men compared to urban men (smoking-12.8% and smokeless tobacco consumption-23.1%). There was a significant difference in the average consumption of fruits and vegetables between urban (2.18 +/- 1.59 servings) and rural (1.78 +/- 1.48 servings) area. Prevalence of overweight and obesity was observed to be high among urban men and women in all age-groups compared to rural men and women. Prevalence of behavioural risk factors, overweight, and obesity increased with age in both the areas. Twenty-nine percent of the urban residents and 15.4% of the rural residents were found to have raised blood pressure, and the difference was found to be statistically significant (p < 0.01). For both men and women, the prevalence of overweight and obesity, hypertension, and lack of physical activities were significantly higher in the urban population while smoking, smokeless tobacco consumption, poor consumption of fruits and vegetables were more prevalent in the rural population. The results highlight the need for interventions and approaches for the prevention of risk factors of non-communicable diseases in rural and urban areas.
BibTeX:
@article{BhagyalaxmiA2013,
  author = {Bhagyalaxmi A, Atul T, Shikha J},
  title = {Prevalence of risk factors of non-communicable diseases in a District of Gujarat, India.},
  journal = {J Health Popul Nutr},
  year = {2013},
  volume = {31(1)},
  pages = {78-85}
}
Bhutia Y, Ghosh A, Sherpa ML, Pal R, Mohanta PK Serum malondialdehyde level: Surrogate stress marker in the Sikkimese diabetics. 2011 J Nat Sci Biol Med
Vol. 2(1), pp. 107-12 
article DOI  
Abstract: BACKGROUND:
The pbreakdown of phospholipids lead to accumulation of malondialdehyde (MDA) that is preferred as a surrogate marker of oxidative stress in diabetics.
OBJECTIVE:
To compare serum MDA levels along with other biochemical parameters between type 2 diabetic patients with and without complications.
MATERIALS AND METHODS:
This cross-sectional study was carried out in the Department of Biochemistry of a tertiary care teaching hospital in Sikkim on 60 type 2 diabetics and compared with 100 non-diabetic participants. The un-hemolyzed blood samples were used for estimation of biochemical parameters; MDA was estimated in serum by using trichloroacetic acid (TCA) and 1% thiobarbituric acid (TBA). Whole blood was used for estimation of glycated hemoglobin. The comparison of different parameters between cases and control was calculated by using Student's t test.
RESULTS:
In the study and control groups, no significant difference was noted with regard to independent variables. The fasting and postprandial serum glucose along with glycated hemoglobin from whole blood and the lipid profile differed significantly between the study and control groups. Overall, tmean serum MDA level in the study group was significantly higher thanin the controls. Male sex, addiction to tobacco (smoking and smokeless inclusive), longer duration of diabetes (?5 years), and presence of complications (both microvascular and macrovascular) significantly increased the MDA level.
CONCLUSION:
To sum up, the serum MDA level was observed to be significantly high in diabetics with and without complication along with other parameters.
BibTeX:
@article{BhutiaY2011,
  author = {Bhutia Y, Ghosh A, Sherpa ML, Pal R, Mohanta PK.},
  title = {Serum malondialdehyde level: Surrogate stress marker in the Sikkimese diabetics.},
  journal = {J Nat Sci Biol Med},
  year = {2011},
  volume = {2(1)},
  pages = {107-12},
  doi = {http://dx.doi.org/10.4103/0976-9668.82309}
}
Biswas AK, Sarkar J Tobacco use among urban school boys of Paschim Midnapore, India. 2010 J Pak Med Assoc
Vol. 60(9), pp. 789-9 
article  
Abstract: OBJECTIVES:
To assess the prevalence, perception and pattern of tobacco use among 13-15-year-old urban school boys along with associated factors of tobacco use.
METHODS:
A cross sectional, observational, study was carried out among 454 urban school boys aged 13-15 years studying in VIII, IX, X using self administered modified Global Youth Tobacco Survey Questionnaire. Data were analyzed by frequency distribution tables, proportion, line diagram, chi square test as required.
RESULTS:
Out of 454 students, 201(44.3%) were ever users of tobacco whereas 135(29.7%) were current users. Majority of the current users utilized both form of tobacco. Initiation of tobacco before 10 years were more in smokeless (11.4%) form than smoking (4.5%), but smokers showed steep rise (49.3%) at 14-15 years. Proportion of current users significantly (p < 0.001) increased along with increase in pocket money. Compared to non-users current users had more exposure to tobacco in the family and friends. Both current users and nonusers showed positive attitude towards tobacco use. Though knowledge of harmful effects of tobacco was well perceived but significantly more (p < 0.005) non-users had shown interest to prohibit smoking in public places. More non-users (75%) than ever users (26.4%) had shown favourable opinion regarding futuretobacco use.
CONCLUSION:
Due increased exposure to the world through several ways and increased modern amenities to influence teenagers, there is high prevalence, average perception and variable patterns of tobacco at Midnapore town where tobacco is trapping teenagers which needs proper intervention.
BibTeX:
@article{BiswasAK2010,
  author = {Biswas AK, Sarkar J.},
  title = {Tobacco use among urban school boys of Paschim Midnapore, India.},
  journal = {J Pak Med Assoc},
  year = {2010},
  volume = {60(9)},
  pages = {789-9}
}
Chandirasekar R, Kumar BL, Sasikala K, Jayakumar R, Suresh K, Venkatesan R, Jacob R, Krishnapriya EK, Kavitha H, Ganesh GK Assessment of genotoxic and molecular mechanisms of cancer risk in smoking andsmokeless tobacco users. 2014 Mutat Res Genet Toxicol Environ Mutagen.
Vol. 767C, pp. 21-27 
article DOI  
Abstract: Inexpensive forms of tobacco are widely used in developing countries such as India. We have evaluated genotoxicity endpoints (chromosome aberrations, micronucleus frequency, comet assay) and polymorphisms of the XRCC1 and p53 genes among smokers and smokeless tobacco (SLT) users in rural Tamilnadu, South India. Cytogenetic, DNA damage and SNP analyses were performed on peripheral blood samples; micronucleus frequency was measured in peripheral blood and buccal mucosa exfoliated cells. Both categories of tobacco users had elevated levels of genotoxic damage. SNP analysis of tobacco users revealed that 17% carry the XRCC1 gln399gln genotype and 19% carry the p53 pro72pro genotype. Both genotypes are associated with increased risk of cancer.
BibTeX:
@article{ChandirasekarR2014,
  author = {Chandirasekar R, Kumar BL, Sasikala K, Jayakumar R, Suresh K, Venkatesan R, Jacob R, Krishnapriya EK, Kavitha H, Ganesh GK},
  title = {Assessment of genotoxic and molecular mechanisms of cancer risk in smoking andsmokeless tobacco users.},
  journal = {Mutat Res Genet Toxicol Environ Mutagen.},
  year = {2014},
  volume = {767C},
  pages = {21-27},
  doi = {http://dx.doi.org/10.1016/j.mrgentox.2014.04.007}
}
Chandirasekar R, Suresh K, Sasikala K, Kumar BL, Venkatesan R, Ganesh GK, Jacob R Genotoxicity assessment in smokeless tobacco users: a case-control study. 2013 Toxicol Ind Health
Vol. 29(2), pp. 216-23 
article DOI  
Abstract: India has a long history of tobacco, which includes chewing tobacco and smoking tobacco in various forms. Initially, thesmokeless tobacco chewing habit was seen among the majority of the farmers who cultivated tobacco; but in recent years,smokeless tobacco is available in many forms and is cheaper as well and hence it is widely being used among literate and illiterate people. The subjects of our study are living in hilly regions of Yerkaud in Salem district, South India. Most of the inhabitants of our study area are illiterate and more particularly they are unaware of the health effects due to tobacco use. Recent epidemiological reports have strongly indicated the association of cancer risk with usage of smokeless tobacco. The prime aim of our study is to evaluate the genotoxic effects of tobacco use by analysing the cytogenetic end points such as chromosome aberrations in peripheral blood and micronucleus in peripheral blood and buccal cells. About 85 smokeless tobacco users were enrolled for the study and same numbers of age- and sex-matched nontobacco users were also enrolled to serve as controls. The result of our study revealed that tobacco users displayed varied levels of elevated chromosomal damage and micronucleated cells than nontobacco users. The variation in the extent of genetic damage was dependent on the duration of the tobacco use. In conclusion, this study might be helpful in creating awareness on the hazards of the smokeless tobacco products among the global population as a whole for those who chose such products as a cheap alternative totobacco smoke.
BibTeX:
@article{ChandirasekarR2013,
  author = {Chandirasekar R, Suresh K, Sasikala K, Kumar BL, Venkatesan R, Ganesh GK, Jacob R.},
  title = {Genotoxicity assessment in smokeless tobacco users: a case-control study.},
  journal = {Toxicol Ind Health},
  year = {2013},
  volume = {29(2)},
  pages = {216-23},
  doi = {http://dx.doi.org/10.1177/0748233711432571}
}
Chandra P, Govindraju P Prevalence of oral mucosal lesions among tobacco users. 2012 Oral Health Prev Dent
Vol. 10(2), pp. 149-53 
article  
Abstract: PURPOSE:
To determine the prevalence of oral mucosal lesions associated with tobacco among patients visiting the dental hospital.
MATERIALS AND METHODS:
A selection of 1525 patients visiting the Department of Oral Medicine and Radiology were interviewed regarding tobacco habits. Examination of the oral cavity was performed by trained examiners under good illumination using diagnostic instruments. Oral mucosal lesions were diagnosed based on the clinical features.
RESULTS:
The patients were divided into groups based on their tobacco habits. Out of 1525 patients, 359 patients (23.5%) had the habit and 265 (73.8%) of them had oral mucosal lesions. Leukoedema was the most prevalent lesion. Leukoplakia was found in 3.5% of the patients. Malignancy was found only among chewers.
CONCLUSION:
Nearly three-quarters of the patients with the tobacco habit had oral mucosal lesions. This emphasises that routine examination of oral mucosa is important and that the patients must be motivated to quit this harmful habit.
BibTeX:
@article{ChandraP2012,
  author = {Chandra P, Govindraju P.},
  title = {Prevalence of oral mucosal lesions among tobacco users.},
  journal = {Oral Health Prev Dent},
  year = {2012},
  volume = {10(2)},
  pages = {149-53}
}
Chatterjee T, Haldar D, Mallik S, Sarkar GN, Das S, Lahiri SK A study on habits of tobacco use among medical and non-medical students of Kolkata. 2011 Lung India
Vol. 28(1)5, pp. 5-10 
article DOI  
Abstract: BACKGROUND:
Age-old practice "using tobacco" is a well known major global concern as it victimizes all its lovers by a host of chronic noncommunicable diseases including cancer; all develop very slowly and silently, and can cause premature death.
OBJECTIVES:
To assess the pattern of tobacco use among the medical and nonmedical college students.
MATERIALS AND METHODS:
A cross-sectional descriptive study was carried out in Kolkata collecting anonymous data from 515 medical and 349 nonmedical college students of two medical and two general colleges, selected randomly.
RESULT:
Overall prevalence of tobacco use (18.3% vs 43.6%) and smoking (14.9% vs 40.7%) were significantly less in medical subjects, both across the sex and years of study. Lower rate of tobacco adoption at college level, higher quitting rate, correct knowledge regarding uselessness of filter attached with cigarette, and ill-effects of tobacco consumption were observed among medical participants. More nonmedical subjects were increasingly smoking compared to medical students. Filter-tipped cigarette was the top choice, and smoking was more prevalent mode of use among the nonmedical participants, most (62.3%) of whom were mild users. Curiosity was the top influencing factor for the initiation of tobacco use and two-third users wanted to quit.
CONCLUSION:
Although the mortal habits was comparatively less among medical students, the medical environment seemed to fail to curb the dreadful practice totally. Thereby it can be recommended that active behavior-changing communication is required for all sections of the society to tear out the social root of the problem instead of unimpressive vague health warnings in vogue
BibTeX:
@article{ChatterjeeT2011,
  author = {Chatterjee T, Haldar D, Mallik S, Sarkar GN, Das S, Lahiri SK.},
  title = {A study on habits of tobacco use among medical and non-medical students of Kolkata.},
  journal = {Lung India},
  year = {2011},
  volume = {28(1)5},
  pages = {5-10},
  doi = {http://dx.doi.org/10.4103/0970-2113.76293}
}
Chattopadhyay S, Saha A, Mondal SK, Kundu SK, Azam M, Sur PK Patterns of tobacco usage and cessation practice among the doctors of a tertiary hospital in Kolkata. 2012 J Indian Med Assoc.
Vol. 110(7), pp. 434-6 
article  
Abstract: The study was aimed to know the prevalence of smoking among medical population in Bengal. For this purpose, pretested and predesigned questionnaires were distributed among doctors of one tertiary medical college hospital in Kolkata. The survey showed that 89.39% of male doctors used tobacco in any form at any point of their life. But, only 27.69% of female doctors used tobacco including present, past and occasional user; 30.3% of male doctors and 6.15% of female doctors have given up the habit. Smoking was the most prevalent form of tobacco usage among male doctors (42.42% are regular user and 12.12% are occasional user). Chewing is the most prevalent among female doctors (15.38% are regular user and 1.53% are occasional user). Some use tobacco in the form of smoking and chewing. Most of the doctors started the habit of tobacco use during their college days. There is a trend of giving up the habit particularly after the age of 40 years. So, the use of tobacco is quite prevalent among male doctors in Bengal. But, it is very much appreciable that there is a trend of giving up the habit. As most of doctors adopted the habit during their college days,more emphasis should be given on study course regarding hazards of tobacco, so that future doctors do not adopt the habit and become role model in the society.
BibTeX:
@article{ChattopadhyayS2012,
  author = {Chattopadhyay S, Saha A, Mondal SK, Kundu SK, Azam M, Sur PK},
  title = {Patterns of tobacco usage and cessation practice among the doctors of a tertiary hospital in Kolkata.},
  journal = {J Indian Med Assoc.},
  year = {2012},
  volume = {110(7)},
  pages = {434-6}
}
Chockalingam K, Vedhachalam C, Rangasamy S, Sekar G, Adinarayanan S, Swaminathan S, Menon PA Prevalence of tobacco use in urban, semi urban and rural areas in and around Chennai City, India. 2013 PLoS One.
Vol. 8(10)(e76005) 
article DOI  
Abstract: BACKGROUND:
Tobacco use leads to many health complications and is a risk factor for the occurrence of cardio vascular diseases, lung and oral cancers, chronic bronchitis etc. Almost 6 million people die from tobacco-related causes every year. This study was conducted to measure the prevalence of tobacco use in three different areas around Chennai city, south India.
METHODS:
A survey of 7510 individuals aged >?=?15 years was undertaken covering Chennai city (urban), Ambattur (semi-urban) and Sriperumbudur (rural) taluk. Details on tobacco use were collected using a questionnaire adapted from both Global Youth Tobacco Survey and Global Adults Tobacco Survey.
RESULTS:
The overall prevalence of tobacco use was significantly higher in the rural (23.7%) compared to semi-urban (20.9%) and urban (19.4%) areas (P value <0.001) Tobacco smoking prevalence was 14.3%, 13.9% and 12.4% in rural, semi-urban and urban areas respectively. The corresponding values for smokeless tobacco use were 9.5%, 7.0% and 7.0% respectively. Logistic regression analysis showed that the odds of using tobacco (with smoke or smokeless forms) was significantly higher among males, older individuals, alcoholics, in rural areas and slum localities. Behavioural pattern analysis of current tobaccousers led to three groups (1) those who were not reached by family or friends to advice on harmful effects (2) those who were well aware of harmful effects of tobacco and even want to quit and (3) those are exposed to second hand/passive smoking at home and outside.
CONCLUSIONS:
Tobacco use prevalence was significantly higher in rural areas, slum dwellers, males and older age groups in this region of south India. Women used mainly smokeless tobacco. Tobacco control programmes need to develop strategies to address the different subgroups among tobacco users. Public health facilities need to expand smoking cessation counseling services as well as provide pharmacotherapy where necessary.
BibTeX:
@article{ChockalingamK2013,
  author = {Chockalingam K, Vedhachalam C, Rangasamy S, Sekar G, Adinarayanan S, Swaminathan S, Menon PA},
  title = {Prevalence of tobacco use in urban, semi urban and rural areas in and around Chennai City, India.},
  journal = {PLoS One.},
  year = {2013},
  volume = {8(10)},
  number = {e76005},
  doi = {http://dx.doi.org/10.1371/journal.pone.0076005}
}
D'Souza G, Rekha DP, Sreedaran P, Srinivasan K, Mony PK Clinico-epidemiological profile of tobacco users attending a tobacco cessation clinic in a teaching hospital in Bangalore city. 2012 Lung India
Vol. 29(2), pp. 137-42 
article DOI  
Abstract: BACKGROUND:
Tobacco-attributable mortality in India is estimated to be at least 10%. Tobacco cessation is more likely to avert millions of deaths before 2050 than prevention of tobacco use initiation.
OBJECTIVE:
To describe the clinico-epidemiological profile of attendees of a tobacco cessation clinic in a teaching hospital in Bangalore city.
MATERIALS AND METHODS:
A descriptive study of 189 attendees seen over 2 years in the Tobacco Cessation Clinic of a tertiary-care teaching hospital in Bangalore, with information on socio demographic characteristics, tobacco-use details, nicotine dependence, family/medical history, past quit attempts, baseline stage-of-change, and treatment initiated.
RESULTS:
Only 5% were 'walk-in' patients; 98% of attendees were smokers; 97% were males. The mean (±SD) age of attendees was 48.0 (±14.0) years. Most participants were married (88%), and predominantly urban (69%). About 62% had completed at least 8 years of schooling. Two-thirds of smokers reported high levels of nicotine dependence (Fagerström score >5/10). About 43% of patients had attempted quitting earlier. Four-fifths (79%) of tobacco-users reported a family member using tobacco. Commonly documented comorbidities included: Chronic respiratory disease (44%), hypertension (23%), diabetes (12%), tuberculosis (9%), myocardial infarction (2%), stroke (1%), sexual dysfunction (1%) and cancer (0.5%). About 52% reported concomitant alcohol use. At baseline, patients' motivational stage was: Precontemplation (14%), contemplation (48%), preparation/action (37%) and maintenance (1%). Treatment modalities started were: Counseling alone (41%), nicotine replacement therapy alone (NRT) (34%), medication alone (13%), and NRT+medication (12%).
CONCLUSIONS:
This is the first study of the baseline profile of patients attending a tobacco cessation clinic located within a chest medicine department in India. Important determinants of outcome have been captured for follow-up and prospective documentation of outcomes.
BibTeX:
@article{DSouzaG2012,
  author = {D'Souza G, Rekha DP, Sreedaran P, Srinivasan K, Mony PK.},
  title = {Clinico-epidemiological profile of tobacco users attending a tobacco cessation clinic in a teaching hospital in Bangalore city.},
  journal = {Lung India},
  year = {2012},
  volume = {29(2)},
  pages = {137-42},
  doi = {http://dx.doi.org/10.4103/0970-2113.95314}
}
Das A, Bhattacharya A, Chakrabarty S, Ganguli A, Chakrabarti G Smokeless tobacco extract (STE)-induced toxicity in mammalian cells is mediated by the disruption of cellular microtubule network: a key mechanism of cytotoxicity. 2013 PLoS One.
Vol. 8(7)(e68224) 
article DOI  
Abstract: Smokeless tobacco usage is a growing public health problem worldwide. The molecular mechanism(s) underlying smokeless tobacco associated tissue damage remain largely unidentified. In the present study we have tried to explore the effects of aqueous extract of smokeless tobacco (STE) on tubulin-microtubule, the major cytoskeleton protein that maintains cells morphology and participates in cell division. Exposure to STE resulted in dose-dependent cytotoxicity in a variety of mammalian transformed cell lines such as human lung epithelial cells A549, human liver epithelial cells HepG2, and mouse squamous epithelial cells HCC7, as well as non-tumorogenic human peripheral blood mononuclear cells PBMC. Cellular morphology of STE-treated cells was altered and the associated disruption of microtubule network indicates that STE targets tubulin-microtubule system in both cell lines. Furthermore it was also observed that STE-treatment resulted in the selective degradation of cellular tubulin, whereas actin remains unaltered. In vitro, polymerization of purified tubulin was inhibited by STE with the IC50 value?150 µg/ml and this is associated with the loss of reactive cysteine residues of tubulin. Application of thiol-based antioxidant N-acetyl cysteine (NAC) significantly abrogates STE-mediated microtubule damage and associated cytotoxicity in both A549 and HepG2 cells. These results suggest that microtubule damage is one of the key mechanisms of STE-induced cytotoxity in mammalian cells.
BibTeX:
@article{DasA2013,
  author = {Das A, Bhattacharya A, Chakrabarty S, Ganguli A, Chakrabarti G},
  title = {Smokeless tobacco extract (STE)-induced toxicity in mammalian cells is mediated by the disruption of cellular microtubule network: a key mechanism of cytotoxicity.},
  journal = {PLoS One.},
  year = {2013},
  volume = {8(7)},
  number = {e68224},
  doi = {http://dx.doi.org/10.1371/journal.pone.0068224}
}
Das SN, Khare P, Singh MK, Sharma SC Fas receptor (CD95) &amp; Fas ligand (CD178) expression in patients withtobacco-related intraoral squamous cell carcinoma. 2011 Indian J Med Res, pp. 54-60  article  
Abstract: BACKGROUND & OBJECTIVES:
Fas receptor and Fas Ligand (FasL) system has been implicated in the resistance to apoptosis, insensitivity to chemotherapy and in providing immune privileged status to most of the tumours. However, no reports are available on Fas and FasL expression in patients with tobacco-related oral carcinoma. Therefore, the present study was undertaken to observe Fas and FasL expression and their correlation with clinicopathological features as well as cell cycle parameters.
METHODS:
Immunohistochemistry for Fas, FasL and DNA flow cytometry for cell cycle parameters was successfully done on 41 paraffin embedded tumour and 10 normal samples. The results were evaluated for possible association of Fas and FasL with clinicopathological features and cell cycle parameters.
RESULTS:
Weak Fas expression was observed on the cell membrane only in 2 of 41 (5%) oral tumours while FasL immunoreactivity was seen in 26 of 41 (63.4%) tumours. In contrast, all ten normal oral tissues exhibited strong cytoplasmic and membrane Fas receptor immunoreactivity but absence of FasL staining. Older patients, greater tumour size and lymph node positivity were found to be associated with high expression of FasL. Significantly higher (P<0.01) expression of FasL was observed in oral tumours with aggressive DNA pattern like aneuploidy and high S-phase fraction.
INTERPRETATION & CONCLUSIONS:
Downregulation of Fas receptor and up-regulation of Fas ligand appear to be an important feature of tobacco-related intraoral carcinoma. Association of FasL expression with advanced clinical stage and aggressive DNA pattern suggests that the Fas and FasL system may be used as an important prognostic variable in patients with tobacco-related intraoral squamous cell carcinoma.
BibTeX:
@article{DasSN2011,
  author = {Das SN, Khare P, Singh MK, Sharma SC},
  title = {Fas receptor (CD95) &amp; Fas ligand (CD178) expression in patients withtobacco-related intraoral squamous cell carcinoma.},
  journal = {Indian J Med Res},
  year = {2011},
  pages = {54-60}
}
Das SN, Khare P, Singh MK, Sharma SC Correlation of cyclin D1 expression with aggressive DNA pattern in patients withtobacco-related intraoral squamous cell carcinoma. 2011 Indian J Med Res, pp. 381-6  article  
Abstract: BACKGROUND & OBJECTIVES:
Cyclin D1 has been strongly implicated in cell proliferation particularly in the G1/S checkpoint of the cell cycle, and prognoses in human malignancies. We investigated the correlation between cyclin D1 overexpression and clinicopathological features as well as cell cycle parameters to understand its clinical significance in patients with tobacco-related oral squamous cell carcinoma (OSCC).
METHODS:
Immunohistochemistry for cyclin D1 and DNA flowcytometry for cell cycle parameters was done on paraffin embedded tumour samples from 45 patients with OSCC RESULTS: Higher expression of cyclin D1 was observed only in 30 (66.6%) of 45 cases that correlated with advanced age (P <0.02), higher tumour stage (P<0.01), histological differentiation and lymph node metastasis (P <0.01). Analysis of nuclear DNA pattern revealed cyclin D1 immunoreactivity in tumours with aggressive DNA pattern such as aneuploidy (P<0.05) and higher S phase fraction (P<0.04).
INTERPRETATION & CONCLUSIONS:
Higher expression of cyclin D1 in oral cancer appears to be closely linked to cell proliferation, differentiation and lymph node invasion. Pre-operative evaluation of cyclin D1 in biopsy specimen may be useful in planning the most appropriate treatment strategies in patients with tobacco-related OSCC.
BibTeX:
@article{DasSN2011a,
  author = {Das SN, Khare P, Singh MK, Sharma SC},
  title = {Correlation of cyclin D1 expression with aggressive DNA pattern in patients withtobacco-related intraoral squamous cell carcinoma.},
  journal = {Indian J Med Res},
  year = {2011},
  pages = {381-6}
}
Dave D, Saffer H Demand for smokeless tobacco: role of advertising. 2013 J Health Econ
Vol. 32(4), pp. 682-97 
article DOI  
Abstract: While the prevalence of smokeless tobacco (ST) is low relative to smoking, the distribution of ST use is highly skewed with consumption concentrated among certain segments of the population (rural residents, males, whites, low-educated individuals). Furthermore, there is suggestive evidence that use has trended upwards recently for groups that have traditionally been at low risk of using ST, and thus started to diffuse across demographics. This study provides the first estimates, at the national level, of the effects of magazine advertising on ST use. The focus on magazine advertising is significant given that ST manufacturers have been banned from using other conventional media since the 1986 Comprehensive ST Act and the 1998 ST Master Settlement Agreement. This study is based on the 2003-2009 waves of the National Consumer Survey (NCS), a unique data source that contains extensive information on the reading habits of individuals, matched with magazine-specific advertising information over the sample period. This allows detailed and salient measures of advertising exposure at the individual level and addresses potential bias due to endogeneity and selective targeting. We find consistent and robust evidence that exposure to ST ads in magazines raises ST use, especially among males, with an estimated elasticity of 0.06. There is suggestive evidence that both ST taxes and cigarette taxes reduce ST use, indicating contemporaneous complementarity between these tobacco products. Sub-analyses point to some differences in the advertising and tax response across segments of the population. The effects from this study inform the debate on the cost and benefits of ST use and its potential to be a tool in overall tobacco harm reduction.
BibTeX:
@article{DaveD2013,
  author = {Dave D, Saffer H.},
  title = {Demand for smokeless tobacco: role of advertising.},
  journal = {J Health Econ},
  year = {2013},
  volume = {32(4)},
  pages = {682-97},
  doi = {http://dx.doi.org/10.1016/j.jhealeco.2013.03.007}
}
Sharma DC Tobacco use among India's street children raises concern. 2009 Lancet Oncol
Vol. 10(9), pp. 844 
article  
BibTeX:
@article{DC.2009,
  author = {Sharma DC.},
  title = {Tobacco use among India's street children raises concern.},
  journal = {Lancet Oncol},
  year = {2009},
  volume = {10(9)},
  pages = {844}
}
Deshpande A, Kiran S, Dhillon S, Mallikarjuna R Oral submucous fibrosis: a premalignant condition in a 14-year-old Indian girl. 2013 BMJ Case Rep  article DOI  
Abstract: A 14-year-old Indian girl presented with difficulty in mouth opening and burning sensation while eating. On examination, blanching of the oral mucosa with diffuse white pigmented lesion of size 3.5 to 2 cm along with melanotic pigmentation was seen on the left buccal mucosa posteriorly. The patient was diagnosed with oral submucous fibrosis. A comprehensive treatment plan was made based on conservative management that included motivation and intense counselling of the patient and her parents so that she quits the habit of chewing areca nut and tobacco, along with systemic treatment of vitamin B complex supplements, antioxidants, multivitamins and oral physiotherapy. We present this case to highlight the difficulties faced by the clinical practitioners in providing treatment because of the taboos and myths associated with surgical treatment modality in rural population as well as to emphasise the menace of increasing consumption and availability of tobacco and areca nut to children.
BibTeX:
@article{DeshpandeA2013,
  author = {Deshpande A, Kiran S, Dhillon S, Mallikarjuna R},
  title = {Oral submucous fibrosis: a premalignant condition in a 14-year-old Indian girl.},
  journal = {BMJ Case Rep},
  year = {2013},
  doi = {http://dx.doi.org/10.1136/bcr-2013-200786}
}
Dodani K, Anumala N, Avula H, Reddy K, Varre S, Kalakonda BB, Arora N, Suri C, Avula JK Periodontal findings in patients with oral submucous fibrosis and comet assay of affected gingival epithelial cells. 2012 J Periodontol
Vol. 83(8), pp. 1038-47 
article  
Abstract: BACKGROUND:
Oral submucous fibrosis (OSF) involves large sections of population and is related to certain chewing practices that involve direct exposure of the gingiva to noxious chemicals and additives. The impact of such practices, although studied extensively in relation to the cheek mucosa, is not elucidated as far as gingival tissues are concerned. The possible DNA damage on affected gingiva is also one of the objectives of the present study.
METHODS:
One hundred cases of individuals with OSF and 89 without OSF were examined for periodontal parameters and compared. Biopsies of gingival tissue from both categories were examined with conventional hematoxylin and eosin staining for epithelial, connective tissue, and inflammatory changes. Comet assay of epithelial cells obtained from scraping the gingival surface of both patients with OSF and control individuals was performed.
RESULTS:
Patients with OSF had poorer oral hygiene and greater loss of attachment, probing depth, and recession compared with controls. Significant histopathologic changes in the form of loss of rete ridges with gingival epithelium reduced to a flattened surface was observed. All the patients with OSF showed comet cells in larger numbers. The controls also showed comet cells but in fewer numbers, and the number of individuals showing comet cells was significantly less.
CONCLUSION:
OSF showed significant changes in affected gingiva, and the presence of comet cells in all the patients with OSF is a significant indicator of possible pathognomonic developments.
BibTeX:
@article{DodaniK2012,
  author = {Dodani K, Anumala N, Avula H, Reddy K, Varre S, Kalakonda BB, Arora N, Suri C, Avula JK.},
  title = {Periodontal findings in patients with oral submucous fibrosis and comet assay of affected gingival epithelial cells.},
  journal = {J Periodontol},
  year = {2012},
  volume = {83(8)},
  pages = {1038-47}
}
Doni BR, Patil S, Peerapur BV, Kadaganchi H, Bhat KG Estimation and comparison of salivary immunoglobulin A levels in tobacco chewers,tobacco smokers and normal subjects. 2013 Oral Health Dent Manag.
Vol. 12(2), pp. 105-11 
article  
Abstract: AIMS:
To estimate the salivary immunoglobulin A (IgA) levels in tobacco chewers, tobacco smokers and normal subjects and to compare the salivary IgA levels among tobacco chewers and tobacco smokers.
METHODS:
The study group consisted of 80 subjects (tobacco users), 40 tobacco chewers and 40 tobacco smokers. Unstimulated whole saliva was collected from all tobacco users and 40 healthy age- and gender-matched non-tobacco users as control group. The study and control groups were divided into four subgroups based on age range. Salivary IgA levels were estimated by single radial immunodiffusion assay (SRID). All data were analysed using statistical software and to compare the results in three groups, single-factor analysis of variance was applied.
RESULTS:
The mean salivary IgA level in control group was 16.76 ± 1.37 mg/dl (SD); in tobacco chewers it was 7.89 ± 0.61 mg/dl (SD) and in tobacco smokers it was 6.55 ± 0.99 mg/dl (SD). The salivary IgA levels were decreased in tobacco chewers and tobacco smokers compared with the controls. Among the tobacco users, tobacco smokers had much reduced salivary IgA levels compared to tobacco chewers. All of these results were highly significant (P<0.001).
CONCLUSIONS:
The present study showed that tobacco chewers and tobacco smokers had decreased salivary IgA levels and among tobacco users, tobacco smokers had much reduced salivary IgA levels compared to tobacco chewers in unstimulated whole saliva.
BibTeX:
@article{DoniBR2013,
  author = {Doni BR, Patil S, Peerapur BV, Kadaganchi H, Bhat KG},
  title = {Estimation and comparison of salivary immunoglobulin A levels in tobacco chewers,tobacco smokers and normal subjects.},
  journal = {Oral Health Dent Manag.},
  year = {2013},
  volume = {12(2)},
  pages = {105-11}
}
Dwivedi S, Aggarwal A, Dev M All in the name of flavour, fragrance &amp; freshness: commonly used smokeless tobacco preparations in &amp; around a tertiary hospital in India. 2012 Indian J Med Res  article  
Abstract: BACKGROUND & OBJECTIVES:
There is a general misconception that smokeless tobacco particularly sweetened and flavoured paan masala and gutkas are safe to use. The present study was undertaken with the objective of highlighting the deceptive and aggressive marketing techniques adopted by the manufacturers of smokeless tobacco preparations exploiting cultural, social and religious values. Another object was to highlight the lack of transparency in terms of content, weight, quality control and warning.
METHODS:
All empty pouches of the used paan masalas, gutka, khaini or surti in and around a tertiary care hospital at east Delhi were collected. Their constituents were studied as per written declaration by the manufacturers on each packet. Information on net weight, cost, presence and type of warning, and quality assurance on each brand provided on side of the packets was noted.
RESULTS:
A total of 1136 pouches of 33 brands/varieties were collected. Most of the gutka preparations contained tobacco, betel nut, unknown flavouring agents, undeclared spices and heavy metals. Warning regarding the harmful effect of tobaccowas written in 90.9 per cent of brands with 81.8 per cent in English language only in minute font. Contents of the products were mentioned in 84.8 per cent of brands and only 27.3 per cent of those mentioned the net weight of the ingredients.
INTERPRETATION & CONCLUSIONS:
Seemingly 'innocuous' tobacco preparations in the form of paan masalas, gutka, khaini, surti or mouth fresheners contain various harmful substance like tobacco, betel nut, sugar coated fennel, saccharine, heavy metals like silver, unknown flavouring agents and undeclared spices in unknown quantities. Lack of transparency in terms of content, weight, quality control and warning is duping unsuspecting consumers.
BibTeX:
@article{DwivediS2012,
  author = {Dwivedi S, Aggarwal A, Dev M.},
  title = {All in the name of flavour, fragrance &amp; freshness: commonly used smokeless tobacco preparations in &amp; around a tertiary hospital in India.},
  journal = {Indian J Med Res},
  year = {2012}
}
Fotedar S, Sogi GM, Fotedar V, Bhushan B, Singh B, Dahiya P, Thakur AS Knowledge of, attitude towards, and prevalence of tobacco use among dental students in Himachal Pradesh State, India. 2013 Oral Health Dent Manag.
Vol. 12(2), pp. 73-9 
article  
Abstract: AIM:
The aim of the study was to assess the prevalence of tobacco use and knowledge of and attitude towards cessation counselling among dental students in Himachal Pradesh State, India.
METHOD:
The present study was conducted with the 219 third-year Bachelor of Dental Surgery (BDS) students in the five dental colleges of Himachal Pradesh during the month of March 2012. The Global Health Professional Students Survey (GHPSS) questionnaire, developed by the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC) and the Canadian Public Health Association, was used in this study. The data were evaluated using statistical software and statistically tested with the chi-square test.
RESULTS:
The response was 210 (96%). Lifetime prevalence was 15% for smoking and 2% for tobacco use other than for smoking. Eighteen (9%) students were current smokers and four (2%) were tobacco users other than for smoking. Male students were significantly (P<0.001) more likely than female students to be current cigarette smokers. Approximately 14 (47%) of sometime smokers had smoked on school property and two (50%) of the sometime users of other tobacco products had used those products on school property. As for attitudes, 169 (85%) felt that health professionals serve as role models for their patients and the public. Only 17 (8.5%) of surveyed students had received formal instruction in smoking-cessation approaches during their training and 167 (84.3%) thought that health professionals should receive specific training on cessation techniques.
CONCLUSION:
Although the current prevalence of tobacco use among third-year dental students in Himachal Pradesh is low, it still needs to be addressed by providing them with the necessary skills and support to quit smoking successfully and to provide counselling.
BibTeX:
@article{FotedarS2013,
  author = {Fotedar S, Sogi GM, Fotedar V, Bhushan B, Singh B, Dahiya P, Thakur AS},
  title = {Knowledge of, attitude towards, and prevalence of tobacco use among dental students in Himachal Pradesh State, India.},
  journal = {Oral Health Dent Manag.},
  year = {2013},
  volume = {12(2)},
  pages = {73-9}
}
Sridharan G Epidemiology, control and prevention of tobacco induced oral mucosal lesions in India. 2014 Indian J Cancer.
Vol. 51(1), pp. 80-5 
article DOI  
Abstract: Oral cancer is one of the leading causes of human morbidity and mortality especially in developing countries like India.Tobacco consumption in smokeless and smoking form along with alcohol is considered as the primary risk factors. Tobacco is a major health challenge with various tobacco products available for use which are known to have deleterious effects on the oral mucosa. The oral lesions caused by tobacco are inclusive of those that are less likely to progress to cancer; lesions with increased tendency to develop into cancer and cancerous lesions. Prevention and control of tobacco induced oral mucosal lesions is the prime requisite currently and mainly involves measures undertaken at primary, secondary and tertiary levels. Primary prevention plays a pivotal role in tobacco induced lesions and steps can be taken at policy level, community as well as individual level. This review paper focuses on the epidemiological data of tobacco induced oral mucosal lesions in India available in the literature with an overview on various strategies for their prevention and control.
BibTeX:
@article{G2014,
  author = {Sridharan G},
  title = {Epidemiology, control and prevention of tobacco induced oral mucosal lesions in India.},
  journal = {Indian J Cancer.},
  year = {2014},
  volume = {51(1)},
  pages = {80-5},
  doi = {http://dx.doi.org/10.4103/0019-509X.134651}
}
Gao H, Prasad GL, Zacharias W Combusted but not smokeless tobacco products cause DNA damage in oral cavity cells. 2014 Environ Toxicol Pharmacol.
Vol. 37(3), pp. 1079-89 
article DOI  
Abstract: The aim of this work was to investigate genomic DNA damage in human oral cavity cells after exposure to different tobaccoproduct preparations (TPPs). The oral carcinoma cell line 101A, gingival epithelial cells HGEC, and gingival fibroblasts HGF were exposed to TPM (total particulate matter from 3R4F cigarettes), ST/CAS (2S3 smokeless tobacco extract in complete artificial saliva), and NIC (nicotine). Treatments were for 24 h using TPM at its EC-50 doses, ST/CAS and NIC at doses with equi-nicotine units, and high doses for ST/CAS and NIC. Comet assays showed that TPM, but not ST/CAS or NIC, caused substantial DNA breaks in cells; only the high ST/CAS dose caused weak DNA damage. These results were confirmed by immunofluorescence for ?-H2AX protein. These data revealed that the combusted TPP caused substantial DNA damage in all cell types, whereas the two non-combusted TPPs exerted no or only minimal DNA damage. They support epidemiologic evidence on the relative risk associated with consumption of non-combusted versus combusted tobacco products, and help to understand potential genotoxic effects of such products on oral cavity cells.
BibTeX:
@article{GaoH2014,
  author = {Gao H, Prasad GL, Zacharias W},
  title = {Combusted but not smokeless tobacco products cause DNA damage in oral cavity cells.},
  journal = {Environ Toxicol Pharmacol.},
  year = {2014},
  volume = {37(3)},
  pages = {1079-89},
  doi = {http://dx.doi.org/10.1016/j.etap.2014.03.022}
}
Ghosh S, Hong CS, Feingold E, Ghosh P, Ghosh P, Bhaumik P, Dey SK Epidemiology of Down syndrome: new insight into the multidimensional interactions among genetic and environmental risk factors in the oocyte. 2011 Am J Epidemiol
Vol. 174(9), pp. 1009-16 
article DOI  
Abstract: Down syndrome birth is attributable to multiple maternal risk factors that include both genetic and environmental challenges, but there is limited understanding of the complicated interactions among these factors. In the present study, a case-control analysis of approximately 400 infants with or without suspected Down syndrome reported between 2003 and 2009 and their parents in and around Kolkata, India, was conducted. Maternal exposure to 2 environmental risk factors (smokeless chewingtobacco and oral contraceptive pills) was recorded, and families were genotyped with microsatellite markers to establish the origin of nondisjunction errors as well as recombination patterns of nondisjoined chromosome 21. With logistic regression models, the possible interactions among all of these risk factors, as well as with maternal age, were explored. Smokelesschewing tobacco was associated with significant risk for meiosis II nondisjunction and achiasmate (nonexchange) meiosis I error among young mothers. By contrast, the risk due to oral contraceptive pills was associated with older mothers. Study results suggest that the chewing tobacco risk factor operates independently of the maternal age effect, whereas contraceptive pill-related risk may interact with or exacerbate age-related risk. Moreover, both risk factors, when present together, exhibited a strong age-dependent effect.
BibTeX:
@article{GhoshS2011,
  author = {Ghosh S, Hong CS, Feingold E, Ghosh P, Ghosh P, Bhaumik P, Dey SK.},
  title = {Epidemiology of Down syndrome: new insight into the multidimensional interactions among genetic and environmental risk factors in the oocyte.},
  journal = {Am J Epidemiol},
  year = {2011},
  volume = {174(9)},
  pages = {1009-16},
  doi = {http://dx.doi.org/10.1093/aje/kwr240}
}
Gupta B, Johnson NW Emerging and established global life-style risk factors for cancer of the upper aero-digestive tract. 2014 Asian Pac J Cancer Prev.
Vol. 15(15), pp. 5983-91. 
article  
Abstract: BACKGROUND:
A risk factor is any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury. The term 'risk factors' comes with a cluster of related terms like risk indicator, modifiable risk factor, risk marker, determinant, and demographic risk factor, which are often used more-or-less interchangeably.
MATERIALS AND METHODS:
The development of cancer is of multifactorial origin. At the cellular level, the development of cancer is viewed as a multistep process involving mutation and selection for cells with progressively increasing capacity for proliferation, survival, invasion, and metastasis. Established and emerging risk factors in addition to incidence and prevalence of cancer of upper aero-digestive tract were here identified.
RESULTS:
Established risk factors for cancer of upper aero- digestive tract identified were age, gender, lifestyle habits like smoked and smokeless tobacco, alcohol consumption, diet inadequate in fruits and vegetables and unsafe sexual practices. The emerging significant risk factors are oral trauma and dental risk factors like inflammation and infection.
CONCLUSIONS:
Understanding and quantifying impact of risk factors that cause cancer is vital for health decision-making, planning and prevention to improve global health. Various established and national policies and programmes should be implemented to raise awareness and reduce exposure to cancer risk factors, and to ensure that people are provided with the information and support they need to adopt healthy lifestyles.
BibTeX:
@article{GuptaB2014,
  author = {Gupta B, Johnson NW},
  title = {Emerging and established global life-style risk factors for cancer of the upper aero-digestive tract.},
  journal = {Asian Pac J Cancer Prev.},
  year = {2014},
  volume = {15(15)},
  pages = {5983-91.}
}
Gupta B, Kumar N A cross-country comparison of knowledge, attitudes and practices about tobaccouse: findings from the global adult tobacco survey. 2014 Asian Pac J Cancer Prev.
Vol. 15(12), pp. 5035-42 
article  
Abstract: BACKGROUND:
Knowledge and individual perceptions about adverse effects of all forms of tobacco exert direct influence on the level of tobacco consumption in various socio-demographic groups. The objective of this study was to determine the nature, extent and demographic correlates of knowledge, attitudes and perceptions of use of tobacco among adults in low and middle income countries.
MATERIALS AND METHODS:
The Global Adult Tobacco Survey, conducted in fourteen different countries from 2008-2010, was sourced for the data analyzed in this study. Descriptive statistical analyses were conducted to determine the prevalent knowledge and individual perceptions amongst adults about all forms of tobacco consumption.
RESULTS:
There was relatively high awareness about the harmful effects of smoking tobacco with main awareness being about its relationship with lung cancer (>90% in most countries). In contrast, there was relatively low awareness about harmful effects of smokeless tobacco (< 90% in all countries except India and Bangladesh), and observed correlations of smokingtobacco with heart attacks (40.6% in China, 65.1% in India) and stroke (28.2% in China, 50.5% in India).
CONCLUSIONS:
A large proportion of adults living in low and middle income countries possess adequate knowledge about smoking tobacco but have inadequate awareness as well as false perceptions about smokeless forms of tobacco. Popular beliefs of inverse relationships of tobacco consumption with knowledge, attitudes and perception of populations towardstobacco are challenged by the findings of this study.
BibTeX:
@article{GuptaB2014a,
  author = {Gupta B, Kumar N},
  title = {A cross-country comparison of knowledge, attitudes and practices about tobaccouse: findings from the global adult tobacco survey.},
  journal = {Asian Pac J Cancer Prev.},
  year = {2014},
  volume = {15(12)},
  pages = {5035-42}
}
Gupta PC, Ray CS, Narake SS, Palipudi KM, Sinha DN, Asma S, Blutcher-Nelson G Profile of dual tobacco users in India: an analysis from Global Adult TobaccoSurvey, 2009-10. 2012 Indian J Cancer
Vol. 49(4), pp. 393-400 
article DOI  
Abstract: INTRODUCTION:
Individuals who use both smoked and smokeless tobacco products (dual tobacco users) form a special group about which little is known. This group is especially relevant to India, where smokeless tobacco use is very common. The aim of this study was to characterise the profile of dual users, study their pattern of initiation to the second product, their attitudes toward quittingas well as their cessation profile.
METHODS AND MATERIALS:
The GATS dataset for India was analyzed using SPSS? .
RESULTS:
In India, dual tobacco users (42.3 million; 5.3% of all adults; 15.4% of all tobacco users) have a profile similar to that of smokers. Some 52.6% of dual users started both practices within 2 years. The most prevalent product combination was bidi-khaini (1.79%) followed by bidi-gutka (1.50%), cigarette-khaini (1.28%), and cigarette-gutka (1.22%). Among daily users, the correlation between the daily frequencies of the use of each product was very high for most product combinations. While 36.7% of dual users were interested in quitting, only 5.0% of dual users could do so. The prevalence of ex-dual users was 0.4%.
CONCLUSION:
Dual users constitute a large, high-risk group that requires special attention.
BibTeX:
@article{GuptaPC2012,
  author = {Gupta PC, Ray CS, Narake SS, Palipudi KM, Sinha DN, Asma S, Blutcher-Nelson G.},
  title = {Profile of dual tobacco users in India: an analysis from Global Adult TobaccoSurvey, 2009-10.},
  journal = {Indian J Cancer},
  year = {2012},
  volume = {49(4)},
  pages = {393-400},
  doi = {http://dx.doi.org/10.4103/0019-509X.107746}
}
Gupta R, Gupta N, Khedar RS Smokeless tobacco and cardiovascular disease in low and middle income countries. 2013 Indian Heart J.
Vol. 65(4), pp. 369-77 
article DOI  
Abstract: Smoking is an important cardiovascular risk factor, however, use of smokeless tobacco has not been well studied. Smokeless tobacco use is high in countries of South and Southeast Asia, Africa and Northern Europe. Meta-analyses of prospective studies of smokeless tobacco users in Europe reported a relative risk for fatal coronary heart disease of 1.13 (confidence intervals 1.06-1.21) and fatal stroke of 1.40 (1.28-1.54) while in Asian countries it was 1.26 (1.12-1.40). Case-control studies reported significantly greater risk for acute coronary events in smokeless tobacco users (odds ratio 2.23, 1.41-3.52), which was lower than smokers (2.89, 2.11-3.96), and subjects who both chewed and smoked, had the greatest risk (4.09, 2.98-5.61). There is a greater prevalence of hypertension and metabolic syndrome in users of smokeless tobacco. Smokeless tobacco use leads to accelerated atherothrombosis similar to smoking. There is an urgent need for public health and clinical interventions to reduce smokeless tobacco addiction.
BibTeX:
@article{GuptaR2013,
  author = {Gupta R, Gupta N, Khedar RS},
  title = {Smokeless tobacco and cardiovascular disease in low and middle income countries.},
  journal = {Indian Heart J.},
  year = {2013},
  volume = {65(4)},
  pages = {369-77},
  doi = {http://dx.doi.org/1016/j.ihj.2013.06.005.}
}
Gupta S, Gupta OP, Srivastava S Role of CYP2E1genetic polymorphism in the development of oral leukoplakia amongtobacco users in North Indian population. 2014 Indian J Cancer.
Vol. 51(2), pp. 154-8 
article DOI  
Abstract: AIM:
The aim of the study to find out role of CYP2E1 genetic polymorphism in development of oral leukoplakia among tobaccousers in North Indian population, this study was carried out at Department of Oral and Maxillofacial Pathology, King George's Medical University, Lucknow, UP.
STUDY DESIGN:
Study include a total of 105 leukoplakia patients were genotyped for CYP2E1 polymorphism (93 males and 12 females; mean age ± SD: 47.5 ± 10.6) and 96 unrelated healthy controls (85 males and 11 females; mean age ± SD: 49 ± 11.1). All the patients had either reported for treatment of leukoplakia or were diagnosed with leukoplakia during routine oral examination.
RESULTS:
A total of 105 leukoplakia patients and 96 controls were included in the study. The mean age of leukoplakia patients and control were 47 ± 10 and 51 ± 10 years respectively. The exclusive smokers comprised 62 (59%) leukoplakia patients and 53 (53%) controls. The exclusive smokeless tobacco users were 16 (15%) in leukoplakia patients and 27 (28%) in controls groups, while 27 (26%) leukoplakia patients and 16 (17%) controls have both types (smoking as well as smoke less) of tobacco habits simultaneously. Range of life time smoking exposure in leukoplakia and controls were (5-80 PY in both groups) but the mean smoking exposure in both groups were (leukoplakia: 28 ± 21.8 PY, control: 27: ±17 PY). But the meansmokeless tobacco dose in two groups were (leukoplakia: 150 ± 175 CY, controls: 137 ± 110 CY).
CONCLUSION:
All the results demonstrate an association between CYP2E1 genetic polymorphism and leukoplakia risk, premalignant lesion. It indicates that the CYP2E1 polymorphism, singly showed a protection towards the oral leukoplakia. Independent confirmation of this finding is required, and additional examination of the joint effect of CYP2E1genotype and other non-tobacco-related exposures is needed before more conclusive interpretation of our results can be made. This study demonstrates the importance of genetic variations in CYP2E1genes in susceptibility towards oral leukoplakia and it is conceivable that these variants will interact with environmental carcinogens and possibly some combinations of these genotypes will be at a high risk to oral leukoplakia.
BibTeX:
@article{GuptaS2014,
  author = {Gupta S, Gupta OP, Srivastava S},
  title = {Role of CYP2E1genetic polymorphism in the development of oral leukoplakia amongtobacco users in North Indian population.},
  journal = {Indian J Cancer.},
  year = {2014},
  volume = {51(2)},
  pages = {154-8},
  doi = {http://dx.doi.org/10.4103/0019-509X.138266}
}
Hashemipour MA, Gholampour F, Fatah F, Bazregari S Snus (nass) and oral cancer: A case series report. 2013 Dent Res J (Isfahan).
Vol. 10(1), pp. 116-21 
article DOI  
Abstract: Snus (nass) is a form of snuff used in a similar manner to American dipping tobacco, but it does not typically result in a need for spitting. Possible hazards associated with this material include malignant and premalignant lesions in the oral cavity and gastrointestinal tract. The use of smokeless tobacco has increased in the Middle East in recent decades, particularly among teenagers and young adults. Therefore, practitioners must be able to recognize malignant and premalignant lesions. Although, an estimated 10-25% of the world's population uses smokeless tobacco, this practice is virtually unknown in Iran. The aim of this study is to report a series of cases of squamous cell carcinoma and verrucous carcinoma occurring in the users of snus, who referred to the Department of Oral Medicine in Kerman Dental School.
BibTeX:
@article{HashemipourMA2013,
  author = {Hashemipour MA, Gholampour F, Fatah F, Bazregari S},
  title = {Snus (nass) and oral cancer: A case series report.},
  journal = {Dent Res J (Isfahan).},
  year = {2013},
  volume = {10(1)},
  pages = {116-21},
  doi = {http://dx.doi.org/10.4103/1735-3327.111813}
}
Hassan KM, Verma A, Prakash S, Chandran V, Kumar S, Banerji A Prevalence and association of lifestyle factors with extracranial carotid atherosclerosis in non-cardioembolic anterior circulation strokes in adult males less than 50 years: One year cross-sectional study. 2013 Ann Indian Acad Neurol.
Vol. 16(4), pp. 516-20 
article DOI  
Abstract: BACKGROUND:
Data is scarce on prevalence of extracranial carotid atherosclerosis (ECA) in strokes <50 years and its association with lifestyle factors.
OBJECTIVE:
Study role of (a) ECA in non-cardio-embolic anterior circulation young strokes, and (b) smoking and alcohol in ECA.
MATERIALS AND METHODS:
Cardiovascular risk factors and evidence of ECA on carotid doppler ultrasound (CDUS) was evaluated in an one-year preliminary cross-sectional study of consecutive strokes between 20 years and 49 years. Females were excluded.
RESULTS:
There were 46 male strokes (mean age 38.26 yrs), 17.39% had hypertension, 2.23% had coronary artery disease; none was diabetic. Tobacco users and alcohol consumers were 24/46 (52.17%) cases each. ECA was found in 14/46 (30.44%) cases. Seven of these 14 (50%) i.e., 7/46 cases (15.21%) had carotid occlusion, four had <50%, three had >70% stenosis. 'Smoking and smokeless tobacco use' was found in 71.42% (10/14) symptomatic carotid lesions compared to 43.75% (14/32) strokes without carotid lesions. Prevalence odds ratio for tobacco use and ECA was 3.21 (95% CI: 0.83-12.44) while that of alcohol and ECA was 1.33 (95% CI: 0.38-4.72).
CONCLUSION:
Prevalence of ECA in strokes <50 years was high due to lifestyle factors which predispose to atherosclerosis at younger age.
BibTeX:
@article{HassanKM2013,
  author = {Hassan KM, Verma A, Prakash S, Chandran V, Kumar S, Banerji A},
  title = {Prevalence and association of lifestyle factors with extracranial carotid atherosclerosis in non-cardioembolic anterior circulation strokes in adult males less than 50 years: One year cross-sectional study.},
  journal = {Ann Indian Acad Neurol.},
  year = {2013},
  volume = {16(4)},
  pages = {516-20},
  doi = {http://dx.doi.org/10.4103/0972-2327.120448}
}
Hatsukami DK, Tomar S Commentary on Post et al. (2010): Snus, a cautionary reminder. 2010 Addiction  article DOI  
BibTeX:
@article{HatsukamiDK2010,
  author = {Hatsukami DK, Tomar S.},
  title = {Commentary on Post et al. (2010): Snus, a cautionary reminder.},
  journal = {Addiction},
  year = {2010},
  doi = {http://dx.doi.org/10.1111/j.1360-0443.2010.02922.x}
}
Ihsan R, Devi TR, Yadav DS, Mishra AK, Sharma J, Zomawia E, Verma Y, Phukan R, Mahanta J, Kataki AC, Kapur S, Saxena S Investigation on the role of p53 codon 72 polymorphism and interactions withtobacco, betel quid, and alcohol in susceptibility to cancers in a high-risk population from North East India. 2011 DNA Cell Biol
Vol. 30(3), pp. 163-71 
article DOI  
Abstract: The association of TP53 codon 72 polymorphism with cancer susceptibility remains uncertain and varies with ethnicity. Northeast India represents a geographically, culturally, and ethnically isolated population. The area reports high rate oftobacco usage in a variety of ways of consumption, compared with the rest of Indian population. A total of 411 cancer patients (161 lung, 134 gastric, and 116 oral) and 282 normal controls from the ethnic population were analyzed for p53 codon 72 polymorphism by polymerase chain reaction-restriction fragment length polymorphism. No significant difference in genotypic distribution of p53 between cases and controls was observed. Results suggested betel quid chewing as a major risk factor for all the three cancers (odds ratio [OR]=3.54, confidence interval [CI]=2.01-6.25, p < 0.001; OR=1.74, CI=1.04-2.92, p=0.03; and OR=1.85, CI=1.02-3.33, p=0.04 for lung, gastric, and oral cancers, respectively). Tobacco smoking was associated with risk of lung and oral cancers (OR=1.88, CI=1.11-3.19, p=0.01 and OR=1.68, CI=1.00-2.81, p=0.04). Interactions between p53 genotypes and risk factors were analyzed to look for gene-environment interactions. Interaction of smoking and p53 genotype was significant only for oral cancer. Interactions of betel quid with p53 genotypes in lung cancer showed significant increase for all the three genotypes, indicating a major role of betel quid (OR=5.90, CI=1.67-20.81, p=0.006; OR=5.44, CI=1.67-17.75, p=0.005; and OR=5.84, CI=1.70-19.97, p=0.005 for Arg/Arg, Arg/Pro, and Pro/Pro, respectively). In conclusion, high incidence of these cancers in northeast India might be an outcome of risk habits; further, tissue- and carcinogen-specific risk modification by p53 gene is probable.
BibTeX:
@article{IhsanR2011,
  author = {Ihsan R, Devi TR, Yadav DS, Mishra AK, Sharma J, Zomawia E, Verma Y, Phukan R, Mahanta J, Kataki AC, Kapur S, Saxena S},
  title = {Investigation on the role of p53 codon 72 polymorphism and interactions withtobacco, betel quid, and alcohol in susceptibility to cancers in a high-risk population from North East India.},
  journal = {DNA Cell Biol},
  year = {2011},
  volume = {30(3)},
  pages = {163-71},
  doi = {http://dx.doi.org/10.1089/dna.2010.1119}
}
Jacob PS, Nath S, Patel RP Evaluation of interleukin-1? and 8 in gutka chewers with periodontitis among a rural Indian population. 2014 J Periodontal Implant Sci.
Vol. 44(3), pp. 126-33 
article DOI  
Abstract: PURPOSE:
Smokeless tobacco-based oral-use products like gutka are popular in India. Gutka usage leads to increased periodontal destruction and inflammation; however, the relevant mechanism remains unknown. This study aimed to elucidate the role of gutka in periodontitis by examining its effect on the levels of interleukin (IL) 1? and IL-8 from the gingival crevicular fluid (GCF).
METHODS:
A total of 45 patients were enrolled in this study. Thirty patients with periodontitis (15 gutka chewers [GCP] and 15 nongutka chewers [NGC]) and 15 periodontally healthy controls (HC) were selected. The full-mouth plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and recession (RC) were recorded. The IL-1? and IL-8 levels in the GCF of all subjects were assessed through an enzyme-linked immunosorbent assay (Quantikine).
RESULTS:
The IL-1? and IL-8 levels were not significantly higher in the GCP group (IL-1?, 369.01±273.44 µL; IL-8, 205.97±196.78 µL) as compared to those in the NGC group (IL-1?, 195.57±96.85 µL; IL-8, 178.61±149.35 µL). More gingival RC and loss of attachment was seen among the GCP group (RC: 2.02±0.31, P=0.013; CAL: 4.60±0.56, P < 0.001) than among the NGC group (RC, 1.21±1.15; CAL, 3.70±0.32); however, PD was deeper among the NGC subjects (P=0.002). PI and GI were significantly higher for the periodontitis group (P < 0.001) when compared to the HC, but there was no difference among gutka chewers and non-chewers (P=0.22 and P=0.89). A positive correlation was found between the IL-8 levels and the duration of gutka chewing (r=-0.64, P<0.01).
CONCLUSIONS:
Gutka chewing leads to increased gingival RC and clinical loss of attachment. There was no effect seen in the proinflammatory cytokine levels in the GCF of gutka users.
BibTeX:
@article{JacobPS2014,
  author = {Jacob PS, Nath S, Patel RP},
  title = {Evaluation of interleukin-1? and 8 in gutka chewers with periodontitis among a rural Indian population.},
  journal = {J Periodontal Implant Sci.},
  year = {2014},
  volume = {44(3)},
  pages = {126-33},
  doi = {http://dx.doi.org/10.5051/jpis.2014.44.3.126}
}
Jadhav K, Singh D Assessment of psychological dependence among tobacco users: A survey held among the rural population of India to call for attention of tobacco cessation centers. 2013 Dent Res J (Isfahan).
Vol. 10(4), pp. 467-73 
article  
Abstract: BACKGROUND:
In India most of the tobacco cessation centers are concentrating only on urban population, whereas, literature reveals that it is rural population, which shows high frequency of consumption of tobacco. It is well known that high frequency of tobacco consumption is associated with psychological dependence. This study aimed at identifying, which form of tobacco consumption (smoking or smokeless) is associated with psychological dependence and is associated with which particular age group in rural population.
MATERIALS AND METHODS:
It was a questionnaire based survey where 200 subjects were enrolled. Revised version of standard Fagerstrom Test for Nicotine dependence (FTND) was given to each subject to answer. The collected data was statistically analyzed by using Karl Pearson Correlation (r) test and Student's t-test.
RESULTS:
Study showed that subjects above 40 years of age are psychologically highly dependent on tobacco smoking as compared to tobacco chewing. Tobacco chewing is more prevalent among the younger population (20-30 years of age) and type of habit does not have any influence over psychological dependence below 40 years of age. A positive correlation was observed between duration of habit and psychological dependence in all age groups irrespective of type of the habit of tobaccoconsumption.
CONCLUSION:
This study attempts at creating a new avenue for the tobacco cessation centers where they can target their efforts towards rural population particularly people above 40 years of age with a tobacco smoking habit so that they can actually reduce the burden of a number of people at risk for developing tobacco associated oral cancer.
BibTeX:
@article{JadhavK2013,
  author = {Jadhav K, Singh D},
  title = {Assessment of psychological dependence among tobacco users: A survey held among the rural population of India to call for attention of tobacco cessation centers.},
  journal = {Dent Res J (Isfahan).},
  year = {2013},
  volume = {10(4)},
  pages = {467-73}
}
Jain R, Jhanjee S, Jain V, Gupta T, Mittal S, Goelz P, Wileyto EP, Schnoll RA A double-blind placebo-controlled randomized trial of varenicline for smokeless tobacco dependence in India. 2014 Nicotine Tob Res.
Vol. 16(1), pp. 50-7 
article DOI  
Abstract: INTRODUCTION:
The rate of smokeless tobacco use in India is 20%; its use causes serious health problems, and no trial has assessed behavioral or pharmacological treatments for this public health concern. This trial evaluated varenicline for treating smokeless tobacco dependence in India.
METHODS:
This was a double-blind placebo-controlled randomized trial of varenicline (12 weeks, 1mg, twice per day) with 237smokeless tobacco users in India. All participants received behavioral counseling. Outcomes included self-reported and biochemically verified abstinence at the end of treatment (EOT), lapse and recovery events, safety, and medication adherence.
RESULTS:
Self-reported EOT abstinence was significantly greater for varenicline (43%) versus placebo (31%; adjusted odds ratio [AOR] = 2.6, 95% CI = 1.2-4.2, p = .009). Biochemically confirmed EOT abstinence was greater for varenicline versus placebo (25.2% vs. 19.5%), but this was not statistically different (AOR = 1.6, 95% CI = 0.84-3.1, p = .15). Compared with placebo, varenicline did not reduce the risk for a lapse (hazard ratio [HR] = 0.86, 95% CI = 0.69-1.1, p = .14), but it did increase the likelihood of recovery to abstinence (HR = 1.2, 95% CI = 1.02-1.4, p = .02). Greater adherence increased EOT cessation rates for varenicline (39% vs. 18%, p = .003) but not for placebo (28% vs. 14%, p = .06). There were no significant differences between varenicline and placebo in rate of side effects, serious adverse events, hypertension, or stopping or reducing medication.
CONCLUSIONS:
Varenicline is safe for treating smokeless tobacco dependence in India, and further examination of this medication for this important public health problem is warranted.
BibTeX:
@article{JainR2014,
  author = {Jain R, Jhanjee S, Jain V, Gupta T, Mittal S, Goelz P, Wileyto EP, Schnoll RA},
  title = {A double-blind placebo-controlled randomized trial of varenicline for smokeless tobacco dependence in India.},
  journal = {Nicotine Tob Res.},
  year = {2014},
  volume = {16(1)},
  pages = {50-7},
  doi = {http://dx.doi.org/10.1093/ntr/ntt115}
}
Jain S, Mathur S, Mathur A, Mathur S, Agarwal H, Dubey T, Kulshresth M, Butoli J Effect of tobacco use on arterial stiffness in community dwelling females. 2012 J Assoc Physicians India, pp. 20-3  article  
Abstract: AIMS:
The goal of this study was to investigate the changes in arterial stiffness by evaluation of arterial stiffness index and pulse wave velocity in community dwelling tobacco user females and to correlate those changes with duration of tobacco use, amount consumed and severity of addiction.
METHODS:
This observational cohort study was conducted in Department of Medicine at Dr. S N Medical College, Jodhpur, comprised of 100 females, out of which 55 were community dwelling females using tobacco (cases) and 45 are age-sex matched healthy control group. Out of 55 tobacco user females 21 (38%) were smoker and 34 [62%] were smokeless tobaccouser. Pulse wave velocity and arterial stiffness index were evaluated by means of an 8-channel real-time PC-based simultaneous acquisition and analysis system (Periscope).
RESULTS:
Average C-F PWV in tobacco user female was 1327 +/- 515.2 as compared to 796 +/- 157.3 in control and average ASI was 71 +/- 20.9 in tobacco user female as compared to 62 +/- 13.9 in control that is statistically significant (p < or = .05). Both C-F PWV and ASI were significantly higher in tobacco user than control. Average C-F PWV in smoker group is 1683 +/- 566.7 as compared to 1108 +/-387.9 in smokeless group. Average ASI is 76 +/- 22.9 in smoker group as compared to 66 +/- 18.9 in smokeless tobacco user group. Both C-F PWV and ASI were higher in smoker group than smokeless group that is statistically significant (P Value 0.0018).
CONCLUSIONS:
This study has demonstrated that PWV and ASI are increased in tobacco user females and they are independent predictor of cardiovascular morbidity. Tobacco use either smoking or smokeless causes Atherovascular diseases. Smoking is more prone to increase atherosclerosis and cardiovascular morbidity in comparison to smokeless tobacco use.
BibTeX:
@article{JainS2012,
  author = {Jain S, Mathur S, Mathur A, Mathur S, Agarwal H, Dubey T, Kulshresth M, Butoli J},
  title = {Effect of tobacco use on arterial stiffness in community dwelling females.},
  journal = {J Assoc Physicians India},
  year = {2012},
  pages = {20-3}
}
Jayalekshmi PA, Gangadharan P, Akiba S, Koriyama C, Nair RR Oral cavity cancer risk in relation to tobacco chewing and bidi smoking among men in Karunagappally, Kerala, India: Karunagappally cohort study. 2011 Cancer Sci
Vol. 102(2), pp. 460-7 
article DOI  
Abstract: The Karunagapally cohort in Kerala, India was established in the 1990s. The present study examined oral cancer risk among 66,277 men aged 30-84 years in the cohort, using Poisson regression analysis of grouped data, stratified on attained age, calendar time, education, and family income. By the end of 2005, 160 oral cancer cases were identified by the Karunagapally Cancer Registry. Tobacco chewing increased oral cancer risk (P < 0.001). Particularly increased was the risk of cancers of the gum and mouth (relative risk [RR] = 4.7; 95% confidence interval [CI] = 2.8-7.9), which increased with higher daily frequencies (P < 0.001) and longer duration (P < 0.001) of tobacco chewing. Alcohol drinking was not significantly related to oral cancer risk regardless of tobacco chewing. Bidi smoking significantly increased oral cancer risk (RR = 2.6; 95%CI = 1.4-4.9) only among men without tobacco chewing habits. The risk increased with higher daily consumption (P < 0.001), longer duration (P = 0.001), and younger age at start of bidi smoking (P = 0.007). In location-specific analysis, bidi smoking was significantly associated with cancer of the gum and mouth (RR = 3.6; 95%CI = 1.1-12.1), and its risk significantly increased with larger daily consumption of bidis (P = 0.013) and younger age at the start of smoking (P = 0.044). Tongue cancer risk was significantly increased among men who smoked bidis for 30 years or longer, and men started bidi smoking at 18 years old or younger. The present study is the first cohort study showing that tobacco chewing increases cancers of the gum and mouth among men keeping chewing tobacco in the cheek, and that bidi smoking strongly increased oral cancer risk among men without a tobacco chewing habit.
BibTeX:
@article{JayalekshmiPA2011,
  author = {Jayalekshmi PA, Gangadharan P, Akiba S, Koriyama C, Nair RR.},
  title = {Oral cavity cancer risk in relation to tobacco chewing and bidi smoking among men in Karunagappally, Kerala, India: Karunagappally cohort study.},
  journal = {Cancer Sci},
  year = {2011},
  volume = {102(2)},
  pages = {460-7},
  doi = {http://dx.doi.org/10.1111/j.1349-7006.2010.01785.x}
}
Jena PK, Bandyopadhyay C, Mathur MR, Das S Extending application of the 'hardcore' definition to smokeless tobacco use: estimates from a nationally representative population in India and its implications. 2012 Asian Pac J Cancer Prev
Vol. 13(12), pp. 5959-63 
article  
Abstract: BACKGROUND:
The term 'hardcore' has been applied to use of smoking tobacco and generally referred to as the inability or unwillingness of regular smokers to quit. The component constructs of hardcore except nicotine dependence are product neutral. With the use of 'time to first chew' as a measure of nicotine dependence, hardcore definition can be extended to characterize smokeless tobacco users. Hardcore users respond less to tobacco cessation interventions, and are prone totobacco induced diseases including cancer. Thus identifying hardcore users would help in estimate the burden of high risk population for tobacco induced diseases. Smokeless tobacco use is predominant and accounts for more than 50% of oral cancer in India. Hence, hardcore chewing information could be used for planning of tobacco and cancer control interventions. The objective of this study was to assess the prevalence and associated factors of hardcore smokeless tobacco use in India.
MATERIALS AND METHODS:
Global Adult Tobacco Survey (GATS)-India 2010 data were analyzed to quantify hardcoresmokeless tobacco use in India with following five criteria: (1) current daily smokeless tobacco use; (2) no quit attempt in the past 12 months of survey or last quit attempt of less than 24 hours duration; (3) no intention to quit in next 12 months or not interested in quitting; (4) time to first use of smokeless tobacco product within 30 minutes of waking up; and (5) knowledge ofsmokeless tobacco hazards.
RESULTS:
The number of hardcore smokeless tobacco users among adult Indians is estimated to be 5% (39.5 million). This group comprises 23.2% of daily smokeless tobacco users. The population prevalence varied from 1.4-9.1% across different national regions of India. Logistic regression modeling indicated age, education and employment status to be the major predictors of hardcore smokeless tobacco use in India.
CONCLUSIONS:
The presence of a huge number (39.5 million) of hardcore smokeless tobacco users is a challenge totobacco control and cancer prevention in India. There is an unmet need for a universal tobacco cessation programme and intensification of anti-tobacco education in communities.
BibTeX:
@article{JenaPK2012,
  author = {Jena PK, Bandyopadhyay C, Mathur MR, Das S.},
  title = {Extending application of the 'hardcore' definition to smokeless tobacco use: estimates from a nationally representative population in India and its implications.},
  journal = {Asian Pac J Cancer Prev},
  year = {2012},
  volume = {13(12)},
  pages = {5959-63}
}
Jena PK, Kishore J, Pati S, Sarkar BK, Das S Tobacco use and quit behaviour assessment in the Global Adult Tobacco Survey (GATS): invalid responses and implications. 2013 Asian Pac J Cancer Prev.
Vol. 14(11), pp. 6563-8 
article  
Abstract: BACKGROUND:
Tobacco use and quit attempts are two key indicators of the Global Adult Tobacco Survey (GATS) that assess quit attempts among current as well as former tobacco users. The relevant data have inherent policy implications fortobacco cessation programme evaluation. This study aimed to review the concepts of quit attempt assessment and quantifying invalid responses considering GATS-India data.
MATERIALS AND METHODS:
GATS assessment of tobacco use and quit attempts were examined in the current literature. Two categories of invalid responses were identified by stratified analysis of the duration of last quit attempt among current users and duration of abstinence among former users. Category A included absolute invalid responses when time- frame of assessment of current tobacco use and less than former tobacco use were violated. Category B included responses that violated the unit of measurement of time.
RESULTS:
Current daily use, current less than daily use and former use in GATS were imprecisely defined with overlapping of time-frame of assessment. Overall responses of 3,102 current smokers, 4,036 current smokeless users, 1,904 former smokers and 1,343 former smokeless users were analyzed to quantify invalid responses. Analysis indicated overall 21.2% (category A: 7.32%; category B: 17.7%) and 22.7% (category A: 8.05%; category B: 18.1%) invalid responses among current smokers and smokeless users respectively regarding their duration of last quit attempt. Similarly overall 6.62% (category A: 4.7%; category B: 2.3%) and 10.6% (category A: 8.6%; category B: 3.5%) invalid responses were identified among former smokers and smokeless users respectively regarding their duration of abstinence.
CONCLUSIONS:
High invalid responses for a single assessment are due to the imprecise definition of current use, former use and quit attempt; and failure to utilize opportunity of direct data entry interface use during the survey to validate responses instantly. Redefining tobacco use and quit attempts considering an appropriate timeframe would reduce invalid responses.
BibTeX:
@article{JenaPK2013,
  author = {Jena PK, Kishore J, Pati S, Sarkar BK, Das S},
  title = {Tobacco use and quit behaviour assessment in the Global Adult Tobacco Survey (GATS): invalid responses and implications.},
  journal = {Asian Pac J Cancer Prev.},
  year = {2013},
  volume = {14(11)},
  pages = {6563-8}
}
Joshi MS, Verma Y, Gautam AK, Parmar G, Lakkad BC, Kumar S Cytogenetic alterations in buccal mucosa cells of chewers of areca nut and tobacco. 2011 Arch Oral Biol
Vol. 56(1), pp. 63-7 
article DOI  
Abstract: OBJECTIVE:
the rationale of the study was to evaluate the cytological alterations especially micronucleus (MN) and other nuclear anomalies in buccal mucosa cells of chewers to understand the genotoxic and clastogenic potential of chewing mixture (containing areca nut and tobacco as main ingredients).
METHODS:
the buccal cytome assay involves the examination of epithelial smear to determine micronucleated cell and other nuclear anomalies after the Feulgen plus light green staining. The assay was applied to exfoliated buccal mucosa cells of 262 subjects [non-chewers - 161 and chewers - 101 (includes 20 subjects with OSMF)] and 1000 cells per individual were examined microscopically. Nuclear anomalies were compared among chewers, non-chewers and OSMF subjects and correlated with consumption of quids per day and duration of chewing in years.
RESULTS:
MN cells were found significantly (p<0.0001) higher among chewers and OSMF subjects as compared to non-chewers. Further analysis indicated that MN was significantly higher in OSMF subjects with respect to even chewers. Nuclear buds were significantly higher (p<0.0001) in OSMF subjects as compared to chewers as well as non-chewers. Nuclear anomalies viz. binucleated, karyorrhexis and karyolysis were also considerably higher in OSMF subjects as compared to non-chewers.
CONCLUSION:
the MN and other nuclear anomalies reflected genetic damage and cytotoxicity, associated with tobacco and areca nut consumption. Further, these data reveal a risk for development of OSMF among chewers of mixture containing areca nut and/or tobacco, as all the OSMF subjects were chewers.
BibTeX:
@article{JoshiMS2011,
  author = {Joshi MS, Verma Y, Gautam AK, Parmar G, Lakkad BC, Kumar S.},
  title = {Cytogenetic alterations in buccal mucosa cells of chewers of areca nut and tobacco.},
  journal = {Arch Oral Biol},
  year = {2011},
  volume = {56(1)},
  pages = {63-7},
  doi = {http://dx.doi.org/10.1016/j.archoralbio.2010.08.012}
}
Joshi R, Taksande B, Kalantri SP, Jajoo UN, Gupta R Prevalence of cardiovascular risk factors among rural population of elderly in Wardha district. 2013 J Cardiovasc Dis Res.
Vol. 4(2), pp. 140-6 
article DOI  
Abstract: BACKGROUND:
Cardiovascular diseases (CVD) are a leading cause of mortality among adults in India, and their risk factors (tobacco, hypertension, diabetes, overweight, and obesity) are common. Most risk-factor surveys have focused on young and middle aged adults. We measured the prevalence of risk factors for CVD among elderly (age 60 years or more) in rural India.
METHODS AND RESULTS:
In a door-to-door cross-sectional survey we did a non-laboratory based assessment of risk factors (smoking or tobacco use in any form, diabetes mellitus, either known or newly detected hypertension, abnormal waist-hip-ratio, or a high body mass index) among elderly living in 23 villages in rural central India. Laboratory based assessment of risk factors was done in those who had two or more of the five measured conventional risk factors. We compared the distribution of risk factors between men and women. Among 2424 elderly included in the study (51% women, mean age 67), the prevalence of smokeless tobacco use was 50.8% (95% CI 48.1-52.8; smoking 10.5% (95% CI 9.3-11.8); and hypertension46.3% (95% CI 44.3-48.4). Only 10.2% participants were previously known to have had hypertension, and remaining 36.1% were detected to be hypertensive during the survey. A total of 8.2%(95% CI 7.0-9.5) participants were overweight and 4.1% (95% CI 3.3-4.9) had central obesity. The prevalence of dyslipidemia in those who underwent blood based tests was 40.6% (95% CI 36.5-44.9); and hyperglycemia 4.9% (95% CI 3.2-7.1).
CONCLUSIONS:
Strategies to reduce the risk of cardiovascular disorders among elderly should be focused on reducingtobacco use and early detection and optimal control of hypertension.
BibTeX:
@article{JoshiR2013,
  author = {Joshi R, Taksande B, Kalantri SP, Jajoo UN, Gupta R},
  title = {Prevalence of cardiovascular risk factors among rural population of elderly in Wardha district.},
  journal = {J Cardiovasc Dis Res.},
  year = {2013},
  volume = {4(2)},
  pages = {140-6},
  doi = {http://dx.doi.org/10.1016/j.jcdr.2013.03.002}
}
Joshi SC, Saxena SR, Satyawali VN, Joshi A, Nigam P, Singh VK, Rai SP Oesophageal carcinoma--a study of risk factors (emphasis on nutrition) in a teaching hospital of Kumaon region of Uttarakhand. 2009 J Assoc Physicians India  article  
Abstract: BACKGROUND:
Cancer oesophagus is common in India and is the third leading cause of cancer death in males and fourth in females. Various factors are responsible for it and present study was undertaken to study the various risk factors with stress on nutritional factors associated with it.
METHODS:
Ninety-four cases of oesophagus cancer and matched equal number of healthy individuals (control) constituted the study. They were assessed for their dietary pattern during the preceding 10-15 years with the help of standard food frequency questionnaire method. Information regarding consumption of alcohol, smoking and tobacco chewing with or without betel leaf was taken in detail.
RESULTS:
Seven hundred and eighty upper GI endoscopy revealed 94 (12.05%) cases of oesophageal carcinoma. Histopathology revealed squamous cell carcinoma in 87 cases (92.50%), adenocarcinoma in 6 cases (6.30%) and one with mixed picture of adenocarcinoma and squamous cell carcinoma. Sixth (36.17%) and 7th (23.40%) decade of persons were mainly affected with male to female ratio of 2.1:1. They were mostly of lower socio-economic (82.90%) status. Various risk factors came across were less consumption of green and leafy vegetables and fruits and consuming more spicy fried and hot food and beverages. Increased risk was seen more often with consumption of alcohol (neat and without or less salad and snacks), smoking beedi and cigarette, and tobacco chewing with or without betel leaf. It is directly related to amount, frequency, mode and duration of use.
CONCLUSIONS:
Malignancies in general are result of multiple factors and interaction of several environmental factors. One factor cannot be blamed but combination of factors increases the risk of oesophageal carcinoma. Nutritional factor is also one of the major contributing factor increasing the risk of oesophagus cancer.
BibTeX:
@article{JoshiSC2009,
  author = {Joshi SC, Saxena SR, Satyawali VN, Joshi A, Nigam P, Singh VK, Rai SP},
  title = {Oesophageal carcinoma--a study of risk factors (emphasis on nutrition) in a teaching hospital of Kumaon region of Uttarakhand.},
  journal = {J Assoc Physicians India},
  year = {2009}
}
Kamal A, Majeed F, Pasha O, Rehman H, Islam M, Azam I, Ilyas M, Hussain M, Masood K, Ahmed B, Nazir S, Sajjad Z, Kasner SE Clinical, lifestyle, socioeconomic determinants and rate of asymptomatic intracranial atherosclerosis in stroke free Pakistanis. 2014 BMC Neurol.
Vol. 14(1)(155) 
article  
Abstract: BackgroundIntracranial Atherosclerotic Disease (ICAD) is the most frequent etiology of stroke with high prevalence among Asians. Despite this, early determinants of ICAD have not been described from this region.MethodsThe study is an analytical prospective cross-sectional study of 200 adults from Radiology Departments of two diagnostic centers in Karachi. Eligible participants confirmed the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS) and underwent an interview covering medical, socio demographic, lifestyle and anthropometric evaluation using locally validated and standardized definitions. Magnetic Resonance Images (MRI) were centrally reviewed to detect ICAD using the criterion used in the Warfarin¿Aspirin Symptomatic Intracranial Disease study. The risk factors associated with asymptomatic ICAD are reported along with prevalence ratios.ResultsOf the 200 participants, ICAD was found in 34.5% (n¿=¿69) of the participants. Mean age was 37.1 (S.D 15.1) years with 62% younger than 45 years. Self-reported hypertension was found in 26.5% subjects, diabetes in 9%, dyslipidemia in 5% and depression in 60%. Smokeless tobacco (Adjusted PR 3.27 (1.07-6.05)), Western diet, high socioeconomic status (Adjusted PR 2.26 (1.99-5.62)) and dyslipidemia (Adjusted PR 1.88 (1.25-2.21)) had significant associations with ICAD after multivariable analysis. Age, gender, diabetes, hypertension, depression and physical activity did not have a significant association.ConclusionICAD was found on MRI in one in three asymptomatic Pakistanis and was associated with modifiable risks. Initiatives targeting primary prevention may be able to decrease the burden of disease caused by stroke due to ICAD.Study Registration Number NCT02072876 2/25/2014.
BibTeX:
@article{KamalA2014,
  author = {Kamal A, Majeed F, Pasha O, Rehman H, Islam M, Azam I, Ilyas M, Hussain M, Masood K, Ahmed B, Nazir S, Sajjad Z, Kasner SE},
  title = {Clinical, lifestyle, socioeconomic determinants and rate of asymptomatic intracranial atherosclerosis in stroke free Pakistanis.},
  journal = {BMC Neurol.},
  year = {2014},
  volume = {14(1)},
  number = {155}
}
Kasat V, Joshi M, Somasundaram KV, Viragi P, Dhore P, Sahuji S Tobacco use, its influences, triggers, and associated oral lesions among the patients attending a dental institution in rural Maharashtra, India. 2012 J Int Soc Prev Community Dent
Vol. 2(1), pp. 25-30 
article DOI  
Abstract: BACKGROUND:
World Health Organization (WHO) predicts that tobacco deaths in India may exceed 1.5 million annually by 2020.
OBJECTIVES:
The aim of this study was to estimate the prevalence of tobacco use, its influences, triggers, and associated oral lesions among the patients of Rural Dental College and Hospital of Loni, Maharashtra.
MATERIALS AND METHODS:
A hospital based cross-sectional study was conducted from June - December 2010. All the patients from the outpatient department and with tobacco habits were included in the study. Patients were interviewed through a pre-tested structured questionnaire in relation to their tobacco habits, its influences and triggers. Also clinical examination was carried out to check for any tobacco related oral lesions. For the data analysis, Microsoft Excel and chi-square test was used.
RESULTS:
The overall prevalence of tobacco use was 16.38%. Smokeless form of tobacco was more prevalent in both males (81.84%) and females (100%). Majority of the patients (males - 68.22%, females- 90.62%) were light tobacco users. About 76.09% males and 31.25% females admitted that they developed the habit due to initial influence of friends. The most common oral mucosal lesion in both the males (42.20%) and females (11.07%) was tobacco hyperkeratosis. Most common trigger for tobacco use was "work related" (69.14%) in males and "after meals" (53.13%) in females.
CONCLUSION:
Since the number of tobacco users visiting the dental hospital is reasonably high; dentists can contribute to restrain the hazard through community educational activities such as de-addiction counseling of tobacco users to quit the habit.
BibTeX:
@article{KasatV2012,
  author = {Kasat V, Joshi M, Somasundaram KV, Viragi P, Dhore P, Sahuji S.},
  title = {Tobacco use, its influences, triggers, and associated oral lesions among the patients attending a dental institution in rural Maharashtra, India.},
  journal = {J Int Soc Prev Community Dent},
  year = {2012},
  volume = {2(1)},
  pages = {25-30},
  doi = {http://dx.doi.org/10.4103/2231-0762.103454}
}
Kaur J, Sawhney M, Dattagupta S, Shukla NK, Srivastava A, Ralhan R Clinical significance of phosphatidyl inositol synthase overexpression in oral cancer. 2010 BMC Cancer.  article DOI  
Abstract: BACKGROUND:
We reported increased levels of phosphatidyl inositol synthase (PI synthase), (enzyme that catalyses phosphatidyl inositol (PI) synthesis-implicated in intracellular signaling and regulation of cell growth) in smokeless tobacco(ST) exposed oral cell cultures by differential display. This study determined the clinical significance of PI synthase overexpression in oral squamous cell carcinoma (OSCC) and premalignant lesions (leukoplakia), and identified the downstream signaling proteins in PI synthase pathway that are perturbed by smokeless tobacco (ST) exposure.
METHODS:
Tissue microarray (TMA) Immunohistochemistry, Western blotting, Confocal laser scan microscopy, RT-PCR were performed to define the expression of PI synthase in clinical samples and in oral cell culture systems.
RESULTS:
Significant increase in PI synthase immunoreactivity was observed in premalignant lesions and OSCCs as compared to oral normal tissues (p = 0.000). Further, PI synthase expression was significantly associated with de-differentiation of OSCCs, (p = 0.005) and tobacco consumption (p = 0.03, OR = 9.0). Exposure of oral cell systems tosmokeless tobacco (ST) in vitro confirmed increase in PI synthase, Phosphatidylinositol 3-kinase (PI3K) and cyclin D1 levels.
CONCLUSION:
Collectively, increased PI synthase expression was found to be an early event in oral cancer and a target forsmokeless tobacco
BibTeX:
@article{KaurJ2010,
  author = {Kaur J, Sawhney M, Dattagupta S, Shukla NK, Srivastava A, Ralhan R.},
  title = {Clinical significance of phosphatidyl inositol synthase overexpression in oral cancer.},
  journal = {BMC Cancer.},
  year = {2010},
  doi = {http://dx.doi.org/10.1186/1471-2407-10-168}
}
Kaur J, Sinha SK, Srivastava RK Integration of tobacco cessation in general medical practice: need of the hour. 2011 J Indian Med Assoc
Vol. 109(12), pp. 925-8 
article  
Abstract: Tobacco use is the single most preventable cause of death and disability. Tobacco use causes almost one million deaths annually in India, which is much more than the combined mortality due to malaria/TB and HIV/AIDS. It is estimated to cause one billion deaths in the 21st century, eighty per cent of which will occur in the developing countries like India. Tobacco use is increasing in the country. Global Adult Tobacco Survey, 2010, estimated that more than one-third of adults (35%) in the country use tobacco, out of which 21% use smokeless tobacco, 9% smoke and 5% use both. The prevalence of overalltobacco use among men was 47.9% and among women was 20.2%. Global Youth Tobacco Survey, India, 2009, estimate 14.6% of 13-15 years school going children use tobacco. There is urgent need for addressing the tobacco epidemic in India. Though effective interventions for tobacco cessation such as brief counselling, nicotine replacement therapy, non-nicotine pharmacotherapy are available, their use by general practitioners is restricted due to lack of adequate dissemination of information in their use. Use of these simple assessment tools and practice of these effective interventions by general medical and healthcare practitioners will go a long way in addressing the rising tobacco epidemic in India and making general healthcare more comprehensive.
BibTeX:
@article{KaurJ2011,
  author = {Kaur J, Sinha SK, Srivastava RK},
  title = {Integration of tobacco cessation in general medical practice: need of the hour.},
  journal = {J Indian Med Assoc},
  year = {2011},
  volume = {109(12)},
  pages = {925-8}
}
Kaur P, Rao SR, Radhakrishnan E, Ramachandran R, Venkatachalam R, Gupte MD High prevalence of tobacco use, alcohol use and overweight in a rural population in Tamil Nadu, India. 2011 J Postgrad Med
Vol. 57(1), pp. 9-15 
article DOI  
Abstract: BACKGROUND:
Cardiovascular diseases are one of the leading causes of death in India. There is high prevalence of cardiovascular risk factors in urban Tamil Nadu. There are limited data on the prevalence of behavioral risk factors and overweight in rural Tamil Nadu.
AIM:
We estimated prevalence of behavioral risk factors, overweight and central obesity in a rural population in Tamil Nadu, India.
SETTING AND DESIGN:
We conducted a cross-sectional survey in 11 villages in Kancheepuram/Thiruvallur districts, Tamil Nadu.
MATERIALS AND METHODS:
Study population included 10,500 subjects aged 25-64 years. We collected data on behavioral risk factors and anthropometric measurements. Body mass index (BMI) was categorized using the classification recommended for Asians. Central obesity was defined as waist circumference ?90 cm for men and ?80 cm for women. We computed proportions for all risk factors and used trend chi-square to examine trend.
RESULTS:
Among the 10,500 subjects, 4927 (47%) were males. Among males, 1852 (37.6%) were current smokers and 3073 (62.4%) were current alcohol users. Among females, 840 (15.1%) were smokeless tobacco users. BMI was ?23.0 kg/m 2 for 1618 (32.8%) males and 2126 (38.2%) females. 867 (17.6%) males and 1323 (23.7%) females were centrally obese. Most commonly used edible oil was palm oil followed by sunflower oil and groundnut oil.
CONCLUSION:
We observed high prevalence of tobacco use, alcohol use and central obesity in the rural population in Tamil Nadu. There is need for health promotion programs to encourage adoption of healthy lifestyle and policy interventions to create enabling environment.
BibTeX:
@article{KaurP2011,
  author = {Kaur P, Rao SR, Radhakrishnan E, Ramachandran R, Venkatachalam R, Gupte MD.},
  title = {High prevalence of tobacco use, alcohol use and overweight in a rural population in Tamil Nadu, India.},
  journal = {J Postgrad Med},
  year = {2011},
  volume = {57(1)},
  pages = {9-15},
  doi = {http://dx.doi.org/10.4103/0022-3859.74284}
}
Kausar A, Giri S, Mazumdar M, Giri A, Roy P, Dhar P Micronucleus and other nuclear abnormalities among betel quid chewers with or without sadagura, a unique smokeless tobacco preparation, in a population from North-East India. 2009 Mutat Res
Vol. 677(1-2), pp. 72-5 
article DOI  
Abstract: Genotoxicity is one of the important endpoints for risk assessment of various lifestyle factors. The study is the first report on the genotoxic effect associated with sadagura, a unique smokeless tobacco prepared in southern Assam province of North-East India. Sadagura is consumed with or without betel quid and/or smoking. In the present cytogenetic monitoring study, analysis of micronuceus (MN), nuclear bud, binucleated, karyorrhectic, karyolytic and pyknotic cells tests were performed in the exfoliated buccal cells of 75 habituates and compared to controls matched for gender, age, and habit. Significant increase in the frequency of MN was found in sadagura chewers (0.48%, P < 0.001), smokers (0.46%, P < 0.01), betel quid with sadagura chewers (0.91%, P < 0.001) and smokers chewing betel quid with sadagura (0.53%, P < 0.001) as compared to the unexposed control group (0.07%). Betel quid chewers showed significant increase (1.65%, P < 0.05) in the frequency of binucleated cells as compared to the control group (0.16%). Results of this study demonstrated that sadagura consumed as a single agent or in combination with betel quid, leads to a significant induction of cytogenetic damage in the buccal epithelial cells of habituates. We suggest that analysis of other degenerative nuclear changes in addition to MN can provide valuable information while evaluating potential genotoxic agents.
BibTeX:
@article{KausarA2009,
  author = {Kausar A, Giri S, Mazumdar M, Giri A, Roy P, Dhar P},
  title = {Micronucleus and other nuclear abnormalities among betel quid chewers with or without sadagura, a unique smokeless tobacco preparation, in a population from North-East India.},
  journal = {Mutat Res},
  year = {2009},
  volume = {677(1-2)},
  pages = {72-5},
  doi = {http://dx.doi.org/10.1016/j.mrgentox.2009.05.007}
}
Kaushal M, Chattopadhyay I, Phukan R, Purkayastha J, Mahanta J, Kapur S, Saxena S Contribution of germ line BRCA2 sequence alterations to risk of familial esophageal cancer in a high-risk area of India. 2010 Dis Esophagus
Vol. 23(10, pp. 71-5 
article DOI  
Abstract: The incidence of esophageal squamous cell carcinoma (ESCC) is very high in the northeast region of India. An earlier study from China and Iran suggested that mutations in BRCA2 gene may play a role in the etiology of familial ESCC. However, the frequency of BRCA2 gene germ line mutations and its contribution to risk of familial aggregation of ESCC in high-risk region of India are not known. In the current study of 317 cases of esophageal cancer, 92 (29%) cases had a family history of esophageal and/or other cancers. Of these 92 patients, 45 (49%) patients had a family history of esophageal cancer. The risk of developing esophageal cancer was higher in cases where family history showed occurrence of cancers in first-degree relatives (odds ratio [OR]: 3.1; confidence interval [CI]: 1.9-5.3) than in second-degree relatives (OR: 1.3; CI: 0.25-3.2). Moreover, the risk of developing esophageal cancer was higher in subjects whose predegree suffered from esophageal cancer (OR: 2.4; CI: 1.1-4.1) than from any other cancers (OR: 1.1; CI: 0.32-3.3). The subjects with family history of cancer were more likely to develop ESCC if they were tobacco chewers (OR: 4.2; CI: 2.1-5.8) and betel quid users (OR: 3.6; CI: 1.8-4.6). Screening for mutations of the BRCA2 gene in the germ line DNA was carried out for 20 familial and 80 nonfamilial ESCC patients. One hundred unrelated healthy controls from the same population were included in this study. Nonsynonymous variants in exon 18 (K2729N) and exon 27 (I3412V) of BRCA2 gene were found in 3 of 20 patients with familial ESCC. No sequence alterations were found in 80 nonfamilial ESCC cases (P=0.01) and 100 healthy controls (P=0.0037), suggesting that germ line BRCA2 gene mutation may play a role in familial aggregation of ESCC in high-risk region of India.
BibTeX:
@article{KaushalM2010,
  author = {Kaushal M, Chattopadhyay I, Phukan R, Purkayastha J, Mahanta J, Kapur S, Saxena S.},
  title = {Contribution of germ line BRCA2 sequence alterations to risk of familial esophageal cancer in a high-risk area of India.},
  journal = {Dis Esophagus},
  year = {2010},
  volume = {23(10},
  pages = {71-5},
  doi = {http://dx.doi.org/10.1111/j.1442-2050.2009.00975.x}
}
Kaushal M, Mishra AK, Raju BS, Ihsan R, Chakraborty A, Sharma J, Zomawia E, Verma Y, Kataki A, Kapur S, Saxena S Betel quid chewing as an environmental risk factor for breast cancer. 2010 Mutat Res, pp. 143-8  article DOI  
Abstract: Northeast region of India shows high incidence of tobacco-related cancer with widespread consumption of betel quid andtobacco in different forms. There is an increasing incidence of breast cancer and eminent use of tobacco in females in this region. Thus, we analysed the role of tobacco exposure and polymorphisms in detoxification enzymes in breast cancer risk. Polymorphisms in five gene variants (GSTT1, GSTM1, GSTP1, TP53 and CYP17) and four environmental exposure variables (tobacco smoking, tobacco chewing, betel quid chewing, alcohol) were analysed in 117 breast cancer cases and 174 cancer free controls. Multifactor dimensionality reduction identified betel quid chewing as the single main risk factor and women with betel quid chewing history had five times the risk of developing breast cancer [4.78 (2.87-8.00) 0.001]. In logistic regression analysis, GSTT1 null and GSTM1 null genotypes conferred 41% less [0.59 (0.34-1.03) 0.06] and 55% less [0.58 (0.30-1.02) 0.05] reduced risk to breast cancer, respectively. However, the risk increased in women with GSTP1 variant G allele which conferred 1.43 times [(0.96-2.11) 0.07] more risk to breast cancer. In conclusion this study suggests betel quid chewing as a significant risk factor for developing breast cancer. Moreover, the lack of detoxification enzymes GSTT1 and GSTM1 are associated with reduced breast cancer risk.
BibTeX:
@article{KaushalM2010a,
  author = {Kaushal M, Mishra AK, Raju BS, Ihsan R, Chakraborty A, Sharma J, Zomawia E, Verma Y, Kataki A, Kapur S, Saxena S.},
  title = {Betel quid chewing as an environmental risk factor for breast cancer.},
  journal = {Mutat Res},
  year = {2010},
  pages = {143-8},
  doi = {http://dx.doi.org/10.1016/j.mrgentox.2010.08.011}
}
Kishore J, Kohli C, Sharma PK, Sharma E Noncommunicable disease risk profile of factory workers in Delhi. 2012 Indian J Occup Environ Med.
Vol. 16(3), pp. 137-41 
article DOI  
Abstract: BACKGROUND:
Noncommunicable diseases (NCDs) are becoming more prevalent in India. The data for presence of NCDs and its risk factors among factory workers is deficient in India.
MATERIALS AND METHODS:
A cross-sectional comparative study was carried out among 37 factory workers and equal number of comparable subjects from general population. Screening for presence of diabetes along with its risk factors was made in both the groups using pretested predesigned World Health Organization STEPwise approach to surveillance (WHO STEPS) questionnaire in rural area of Delhi. Data was analyzed using SPSS version 16 software. The estimation of risk in two groups was done with calculation of odds ratio (OR). P values less than 0.05 were considered significant.
RESULTS:
A total of 74 participants were included in the present study. Hypertension and diabetes was present in 13.5 and 5.4% of factory workers and four (10.8%) and three (8.8%) subjects in comparative group, respectively. Seven (18.9%) factory and eight (21.6%) non-factory subjects fell in the category of current smoker or smokeless tobacco users. High density lipoprotein levels were found abnormal among one (2.7%) factory worker and nine (24.3%) subjects in comparative group (P-value = 0.01). Behavioral risk factors, alcohol consumption, and fruits and vegetable intake were significantly different among two groups.
CONCLUSION:
Factory workers were having better profile than non-factory subjects except for risk factors such as alcohol intake and inadequate fruits and vegetable intake. However, healthy worker effect phenomenon cannot be ruled out.
BibTeX:
@article{KishoreJ2012,
  author = {Kishore J, Kohli C, Sharma PK, Sharma E},
  title = {Noncommunicable disease risk profile of factory workers in Delhi.},
  journal = {Indian J Occup Environ Med.},
  year = {2012},
  volume = {16(3)},
  pages = {137-41},
  doi = {http://dx.doi.org/10.4103/0019-5278.111761}
}
Kumar J, Deshmukh PR, Garg BS Prevalence and correlates of sustained hypertension in adolescents of rural Wardha, central India. 2012 Indian J Pediatr
Vol. 79(9), pp. 1206-12 
article DOI  
Abstract: OBJECTIVE:
To study the prevalence of hypertension and its determinants among adolescents in rural areas of Wardha.
METHODS:
The cross-sectional study was carried out in villages under PHC Talegaon (Talatule) of Wardha district of central India. Out of total population of 37,946 in the PHC, 7435 were adolescents. For the study purpose 1055 adolescents' were selected by simple random sampling method. Among sampled adolescents, 990 were interviewed and examined. The study was conducted during January 2008-December 2008. Hypertension was defined as raised BP (average SBP and/or DBP >95th percentile) for age, sex and height on two additional occasions. Data thus generated was entered and analyzed using epi_info 6.
RESULTS:
The prevalence of hypertension and pre-hypertension was found to be 3.4% and 10.6% respectively. Bivariate analysis showed significant association (p?CONCLUSIONS:
The prevalence of hypertension and pre-hypertension was 3.4% and 10.6% respectively. The significant correlates of hypertension and pre-hypertension were age, type of family, BMI of subject and blood pressure of mother and father.
BibTeX:
@article{KumarJ2012,
  author = {Kumar J, Deshmukh PR, Garg BS},
  title = {Prevalence and correlates of sustained hypertension in adolescents of rural Wardha, central India.},
  journal = {Indian J Pediatr},
  year = {2012},
  volume = {79(9)},
  pages = {1206-12},
  doi = {http://dx.doi.org/10.1007/s12098-011-0663-y}
}
Kumar V, Yadav CS, Datta SK, Singh S, Ahmed RS, Goel S, Gupta S, Mustafa M, Grover RK, Banerjee BD Association of GSTM1 and GSTT1 polymorphism with lipid peroxidation in benign prostate hyperplasia and prostate cancer: a pilot study. 2011 Dis Markers
Vol. 30(4), pp. 163-9 
article DOI  
Abstract: Association of glutathione S-transferase (GST) M1 and T1 deletions with benign prostate hyperplasia (BPH) and prostate cancer is well reported. These enzymes metabolize numerous toxins thus protecting from oxidative injury. Oxidative stress has been associated with development of BPH and prostate cancer. The present study was designed to analyze role of GST deletions in development of oxidative stress in these subjects. GSTs are responsible for metabolism of toxins present intobacco therefore effect of tobacco usage in study groups was also studied. Three groups of subjects: BPH (53 patients), prostate cancer (57 patients) and controls (46 subjects) were recruited [corrected]. Genotyping was done using a multiplex polymerase chain reaction (PCR) method. Malondialdehyde (MDA) levels as marker of oxidative stress were estimated by measuring thiobarbituric acid reactive substance (TBARS) in plasma. Based on genotyping, subjects were categorized into: GSTM1+/GSTT1+, GSTM1-/GSTT1+, GSTM1+/GSTT1- and GSTM1-/GSTT1-. Significantly higher plasma MDA levels were noticed in GSTM1-/GSTT1- as compared to GSTM1+/GSTT1+ in all study groups. Double deletion (GSTM1-/GSTT1-) is associated with higher oxidative stress which might play a role in the pathogenesis of BPH and prostate cancer. However, other markers of oxidative stress should be analyzed before any firm conclusion.
BibTeX:
@article{KumarV2011,
  author = {Kumar V, Yadav CS, Datta SK, Singh S, Ahmed RS, Goel S, Gupta S, Mustafa M, Grover RK, Banerjee BD.},
  title = {Association of GSTM1 and GSTT1 polymorphism with lipid peroxidation in benign prostate hyperplasia and prostate cancer: a pilot study.},
  journal = {Dis Markers},
  year = {2011},
  volume = {30(4)},
  pages = {163-9},
  doi = {http://dx.doi.org/10.3233/DMA-2011-0774}
}
Kumari S, Dutta A Protective effect of Eleteria cardamomum (L.) Maton against Pan masala induced damage in lung of male Swiss mice. 2013 Asian Pac J Trop Med.
Vol. 6(7), pp. 525-31 
article DOI  
Abstract: OBJECTIVE:
To study the potential ameliorating properties of cardamom Elettaria cardamomum (E. cardamomum) L. Maton against pan masala induced damage in lung of male Swiss mice.
METHODS:
The experimental animals were divided into 3 groups (control, pan masala treated group and pan masala with cardamom treated group) to evaluate pan masala toxicity. The observations were substantiated with profound changes in the lung tissue as revealed in the histologic and transmission electron microscopic examinations.
RESULTS:
Lung of pan masala treated group showed adenocarcinoma, edema, and inflammation with increased activity of acid phosphatase, alkaline phosphatase, and lactate dehydrogenase. The deleterious effects were seen to be less in cardamom treated group and the enzymatic activity also decreased significantly (P<0.05) in the ameliorating group.
CONCLUSIONS:
Thus, the present experiment exciting results are observed when cardamom is supplemented with pan masala, or when given alone.
BibTeX:
@article{KumariS2013,
  author = {Kumari S, Dutta A},
  title = {Protective effect of Eleteria cardamomum (L.) Maton against Pan masala induced damage in lung of male Swiss mice.},
  journal = {Asian Pac J Trop Med.},
  year = {2013},
  volume = {6(7)},
  pages = {525-31},
  doi = {http://dx.doi.org/10.1016/S1995-7645(13)60090-5}
}
Lahan V, Ahmad S, Gupta R RLS relieved by tobacco chewing: paradoxical role of nicotine. 2012 Neurol Sci
Vol. 33(5), pp. 1209-10 
article DOI  
BibTeX:
@article{LahanV2012,
  author = {Lahan V, Ahmad S, Gupta R.},
  title = {RLS relieved by tobacco chewing: paradoxical role of nicotine.},
  journal = {Neurol Sci},
  year = {2012},
  volume = {33(5)},
  pages = {1209-10},
  doi = {http://dx.doi.org/011-088210.1007/s10072-z}
}
Lakhanpal M, Yadav DS, Devi TR, Singh LC, Singh KJ, Latha SP, Chauhan PS, Verma Y, Zomavia E, Sharma J, Chandra Kataki A, Saxena S, Kapur S Association of interleukin-1? -511 C/T polymorphism with tobacco-associated cancer in northeast India: a study on oral and gastric cancer. 2014 Cancer Genet.
Vol. 207(1-2), pp. 1-11 
article DOI  
Abstract: The IL-1? -511 C/T polymorphism is associated with increased IL-1 production and with increased risk of developing cancers. In this study, 251 patients (125 with gastric cancer [GC] and 126 with oral cancer [OC]) and 207 normal controls from northeast (NE) India were genotyped for the IL-1? -511 C/T polymorphism by PCR-restriction fragment length polymorphism (RFLP) and sequencing. Analysis of results showed betel-quid chewing to be a major risk factor (OR = 2.01, 95% CI = 1.05-3.87; P = 0.035) for OC. Inheritance of the IL-1? -511 CT or TT resulted in a 2.6- to 3.05-fold increase in the risk of developing OC relative to that of participants who possessed the reference genotype (OR = 2.57, 95% CI = 1.06-6.22; P = 0.036 and OR = 3.05, 95% CI = 1.22-7.63; P = 0.017), after adjusting for potential confounders. The dominant genetic model also confirmed the presence of the T allele as a significant risk factor for OC (OR = 2.72, 95% CI = 1.15-6.42; P = 0.02). In GC, interaction of the CT genotype with tobacco and betel-quid chewing habits conferred a significant 78% and 89% reduced risk of cancer, respectively. In conclusion, for the NE Indian population, the IL-1? -511 CC and CT genotypes were significantly associated with increased risk of OC. However, the interaction of the CT genotype with risk habits may play a preventive role for GC but not for OC.
BibTeX:
@article{LakhanpalM2014,
  author = {Lakhanpal M, Yadav DS, Devi TR, Singh LC, Singh KJ, Latha SP, Chauhan PS, Verma Y, Zomavia E, Sharma J, Chandra Kataki A, Saxena S, Kapur S},
  title = {Association of interleukin-1? -511 C/T polymorphism with tobacco-associated cancer in northeast India: a study on oral and gastric cancer.},
  journal = {Cancer Genet.},
  year = {2014},
  volume = {207(1-2)},
  pages = {1-11},
  doi = {http://dx.doi.org/10.1016/j.cancergen.2014.01.002}
}
Leelavathi M, Das S Electronic cigarettes: new kit on the rack. 2012 Int J Clin Pract
Vol. 66(4), pp. 417 
article DOI  
Abstract: CONTEXT:
Single cell gel electrophoresis (SCGE) or "comet assay" is a rapid and very sensitive fluorescent microscopic method for detecting various forms of DNA damage at individual cell level.
AIMS:
The aim of the present study was to detect the extent of DNA damage in oral cancer, oral submucous fibrosis (OSMF) and leukoplakia in comparison to normal individual.
SETTINGS AND DESIGN:
A total of 44 consecutive patients with oral cancer (n=26), leukoplakia (n=12) and OSMF (n=6) and 10 healthy normal volunteers with normal oral epithelia (controls) were recruited from Dr. R. Ahmed Dental College and Hospital and were assessed for the extent of DNA damage using SCGE following clinical diagnosis.
MATERIALS AND METHODS:
Peripheral blood was collected by venepuncture and comet assay was performed using SCGE. Mean tail length was compared between diagnostic groups and between different oral habit groups using t-tests and analysis of variance (ANOVA). Pearson's product moment correlation was used to examine the linear association between the extent of DNA damage and oral habit pack-years. Scheffe's pair-wise test was employed to adjust for multiple comparisons.
RESULTS:
None of the controls were associated with any oral habits. Mean (±SD) tail lengths (in mm) for cancer (24.95 ± 5.09) and leukoplakia (12.96 ± 2.68) were significantly greater than in controls (8.54 ± 2.55, P<0.05). After adjustment, well-, moderately, and poorly differentiated carcinomas had significantly greater tail length than controls. Whereas the extent of DNA damage in cancer cases was significantly greater in leukoplakia than in compared to OSMF (11.03 ± 5.92), the DNA damage in latter was not different from controls. DNA damage for people with any oral habit (19.78 ± 7.77) was significantly greater than those with no habits (8.54 ± 2.55; P<0.0001).
CONCLUSIONS:
DNA damage measured by SCGE is greater in leukoplakia and squamous cell carcinoma, but not in OSMF. Deleterious oral habits are also associated with greater DNA damage.
BibTeX:
@article{LeelavathiM2012,
  author = {Leelavathi M, Das S.},
  title = {Electronic cigarettes: new kit on the rack.},
  journal = {Int J Clin Pract},
  year = {2012},
  volume = {66(4)},
  pages = {417},
  doi = {http://dx.doi.org/10.1111/j.1742-1241.2011.02866.x}
}
Maiti GP, Ghosh A, Chatterjee R, Roy A, Sharp TV, Roychoudhury S, Panda CK Reduced expression of LIMD1 in ulcerative oral epithelium associated with tobaccoand areca nut. 2012 Asian Pac J Cancer Prev
Vol. 13(9), pp. 4341-6 
article  
Abstract: PURPOSE:
The aim of this study was to cast light on initiating molecular events associated with the development of premalignant oral lesions induced by tobacco and/or areca nut.
METHOD:
Immunohistochemical analyses of cell cycle regulatory proteins (LIMD1, RBSP3, p16, RB, phosphorylated RB, p53), EGFR and SH3GL2 (EGFR associated protein) were performed with inflammatory/ ulcerative epithelium and adjacent hyperplastic/mild dysplastic lesions.
RESULTS:
No change in expression of the proteins was seen in inflammatory epithelium. Reduced nuclear expression of LIMD1 was evident in ulcerative epithelium. In hyperplastic lesions, reduced expression of RBSP3, p16, SH3GL2 and overexpression of p-RB and EGFR were apparent. Reduced nuclear expression of p53 was observed in mild dysplastic lesions.
CONCLUSION:
Our data suggest that inactivation of LIMD1 in ulcerative epithelium might predispose the tissues to alterations of other cell cycle regulatory and EGFR signaling proteins needed for the development of premalignant oral lesions.
BibTeX:
@article{MaitiGP2012,
  author = {Maiti GP, Ghosh A, Chatterjee R, Roy A, Sharp TV, Roychoudhury S, Panda CK.},
  title = {Reduced expression of LIMD1 in ulcerative oral epithelium associated with tobaccoand areca nut.},
  journal = {Asian Pac J Cancer Prev},
  year = {2012},
  volume = {13(9)},
  pages = {4341-6}
}
Maity N, Chand P, Murthy P Role of nicotine receptor partial agonists in tobacco cessation. 2014 Indian J Psychiatry.
Vol. 56(1), pp. 17-23 
article DOI  
BibTeX:
@article{MaityN2014,
  author = {Maity N, Chand P, Murthy P},
  title = {Role of nicotine receptor partial agonists in tobacco cessation.},
  journal = {Indian J Psychiatry.},
  year = {2014},
  volume = {56(1)},
  pages = {17-23},
  doi = {http://dx.doi.org/10.4103/0019-5545.124709}
}
Majumdar AS, Joshi PA, Giri PR Resveratrol attenuated smokeless tobacco-induced vascular and metabolic complications in ovariectomized rats. 2013 Menopause.
Vol. 20(8), pp. 869-76 
article DOI  
Abstract: OBJECTIVE:
The aim of this study was to evaluate the effect of smokeless tobacco extract on ovariectomized female rats and to investigate the role of resveratrol in alleviating associated vascular and diabetic complications.
METHODS:
Thirty-six female Wistar rats (8 wk old) were subjected to bilateral ovariectomy (OVX) or sham operation and randomly assigned to six groups: sham operation; OVX; OVX + aqueous extract of smokeless tobacco (AEST); OVX + AEST + 17?-estradiol; OVX + AEST + resveratrol 25 mg/kg/day PO; and OVX + AEST + resveratrol 50 mg/kg/day PO. All treatments were given for 60 days. Various vascular and metabolic markers (such as serum glucose, triglycerides, cholesterol, insulin, estradiol, glycosylated hemoglobin, glucose tolerance), ex vivo vascular reactivity of aortic ring, and aortic collagen levels were estimated after the treatments.
RESULTS:
Oral exposure to smokeless tobacco extract in ovariectomized female rats triggered a significant increase in metabolic markers (viz, serum triglycerides, cholesterol, glucose, insulin, glycosylated hemoglobin), and aortic collagen levels. It also led to decreased serum nitrate-nitrite levels and vascular reactivity. Resveratrol 50 mg/kg/day PO attenuated detrimental changes in aortic reactivity and aortic collagen levels, improved glucose tolerance, and reversed the deleterious effects on other serum parameters comparable to 17?-estradiol.
CONCLUSIONS:
Resveratrol treatment for 60 days abrogates the deleterious effects of smokeless tobacco on ovariectomized female rats. Resveratrol in adequate doses can be effectively used as an alternative to estrogen therapy for smokeless tobacco-induced vascular and diabetic complications.
BibTeX:
@article{MajumdarAS2013,
  author = {Mallikarjuna R, Gangwal RR, Shanthraj SL, Dave B},
  title = {Resveratrol attenuated smokeless tobacco-induced vascular and metabolic complications in ovariectomized rats.},
  journal = {Menopause.},
  year = {2013},
  volume = {20(8)},
  pages = {869-76},
  doi = {http://dx.doi.org/10.1097/GME.0b013e31827fdda4}
}
Mallikarjuna R Gangwal RR, S.S.D.B. Report of gutkha (smokeless tobacco) use in children aged 10-12 years. 2013 BMJ Case Rep  article DOI  
BibTeX:
@article{MallikarjunaR2013,
  author = {Mallikarjuna R, Gangwal RR, Shanthraj SL, Dave B.},
  title = {Report of gutkha (smokeless tobacco) use in children aged 10-12 years.},
  journal = {BMJ Case Rep},
  year = {2013},
  doi = {http://dx.doi.org/10.1136/bcr-2012-008319}
}
Mathur P, Shah B Evidence building for policy: tobacco surveillance/surveys and research in India. 2011 Indian J Public Health
Vol. 55(3), pp. 177-83 
article DOI  
Abstract: India is at a crucial juncture relating to tobacco control and implementing the recommendations of the WHO FCTC. Tobaccoconsumption in the country remains alarmingly high in urban as well as rural areas. Smokeless tobacco consumption is very popular among larger masses, including the youth. Cigarette smoking has declined, but bidi use has increased concomitantly. Youth continue to be lured to initiate tobacco consumption through efficient marketing strategies of tobacco companies. The epidemiology of tobacco consumption is markedly varied across the country, with high rates in 15 States. Progress has been made towards tobacco control by the enactment of laws and regulations and the National Tobacco Control Program. Strengthening their implementation and enforcement is the biggest challenge and requires resource inputs. Evidence generation and its translation and utilisation for policy interventions would be useful.
BibTeX:
@article{MathurP2011,
  author = {Mathur P, Shah B.},
  title = {Evidence building for policy: tobacco surveillance/surveys and research in India.},
  journal = {Indian J Public Health},
  year = {2011},
  volume = {55(3)},
  pages = {177-83},
  doi = {http://dx.doi.org/10.4103/0019-557X.89947}
}
Mehra D, Kaushik RM, Kaushik R, Rawat J, Kakkar R Initial default among sputum-positive pulmonary TB patients at a referral hospital in Uttarakhand, India. 2013 Trans R Soc Trop Med Hyg.
Vol. 107(9), pp. 558-65 
article DOI  
Abstract: BACKGROUND:
Initial default is a serious issue which can enhance the transmission of TB. We determined the magnitude of and the causative factors for initial default among sputum-positive pulmonary TB (PTB) patients.
METHODS:
In this prospective study, 2310 patients attending a referral hospital in Uttarakhand state, north India, with presumptive TB were investigated and 555 patients with sputum-positive PTB were followed-up for initiation of anti-TB treatment (ATT) during 2010-2012. The patients not confirmed as having started ATT were considered initial defaulters.
RESULTS:
Initial default was seen in 120 (21.6%) patients comprising 22 (18.3%) defaulters during diagnosis and 98 (81.6%) defaulters after referral for directly observed treatment, short-course (DOTS). The initial default rate was significantly higher among patients from rural areas than urban areas, illiterate patients than literate patients and smokeless tobacco-users than non-users (p<0.05 for all). The main reasons for initial default among patients referred for DOTS were limited trust in DOTS (n = 44, 44.8%), adverse effects of previous ATT (n = 41, 41.8%), dissatisfaction with health services (n = 38, 38.7%), local deaths while taking DOTS (n = 28, 28.5%), advice by others against DOTS (n = 25, 25.5%), disbelief in the diagnosis (n = 18, 18.3%) and patient death before starting treatment (n = 4, 4.0%).
CONCLUSION:
A high initial default rate was seen among patients with PTB. There is an urgent need to promote public awareness to lower the initial default rate.
BibTeX:
@article{MehraD2013,
  author = {Mehra D, Kaushik RM, Kaushik R, Rawat J, Kakkar R},
  title = {Initial default among sputum-positive pulmonary TB patients at a referral hospital in Uttarakhand, India.},
  journal = {Trans R Soc Trop Med Hyg.},
  year = {2013},
  volume = {107(9)},
  pages = {558-65},
  doi = {http://dx.doi.org/10.1093/trstmh/trt065}
}
Mini G, Sarma P, Thankappan K Pattern of Tobacco Use and its Correlates among Older Adults in India. 2014 Asian Pac J Cancer Prev.
Vol. 15(15), pp. 6195-8 
article  
Abstract: PURPOSE:
We examined tobacco use pattern and its correlates among older adults.
MATERIALS AND METHODS:
We used data of 9,852 older adults (>=60 years) (men 47% mean age 68 years) collected by the United Nations Population Fund on Ageing from seven Indian states. Logistic regression analysis was used to assess the correlates of tobacco use.
RESULTS:
Current use of any form of tobacco was reported by 27.8% (men 37.9%, women 18.8%); 9.2% reported only smoking tobacco, 16.9% smokeless tobacco only and 1.7% used both forms. Alcohol users (OR:5.20, 95% CI:4.06-6.66), men (OR:2.92, CI :2.71-3.47), those reporting lower income (OR:2.74, CI:2.16- 3.46), rural residents (OR 1.34, CI 1.17-1.54) and lower castes (OR:1.29, CI:1.13-1.47) were more likely to use any form of tobacco compared to their counterparts.
CONCLUSIONS:
Tobacco cessation interventions are warranted in this population focusing on alcohol users, men, those from lower income, rural residents and those belonging to a lower caste.
BibTeX:
@article{MiniG2014,
  author = {Mini G, Sarma P, Thankappan K},
  title = {Pattern of Tobacco Use and its Correlates among Older Adults in India.},
  journal = {Asian Pac J Cancer Prev.},
  year = {2014},
  volume = {15(15)},
  pages = {6195-8}
}
Mishra GA, Pimple SA, Shastri SS An overview of the tobacco problem in India. 2012 Indian J Med Paediatr Oncol.
Vol. 33(3), pp. 139-45 
article DOI  
Abstract: This is a review paper comprehensively encompassing the different aspects of tobacco control with particular reference to the Indian scenario. The information on prevalent tobacco habits in India, health hazards and environmental hazards due totobacco use, passive smoking and its impact, economics of tobacco, legislation to control tobacco in India, the tobaccocessation services and the way ahead for effective tobacco control are discussed. Tobacco is a leading preventable cause of death, killing nearly six million people worldwide each year. Reversing this entirely preventable manmade epidemic should be our top priority. This global tobacco epidemic kills more people than tuberculosis, HIV/AIDS and malaria combined. This epidemic can be resolved by becoming aware of the devastating effects of tobacco, learning about the proven effective tobaccocontrol measures, national programmes and legislation prevailing in the home country and then engaging completely to halt the epidemic to move toward a tobacco-free world. India is the second largest consumer of tobacco globally, and accounts for approximately one-sixth of the world's tobacco-related deaths. The tobacco problem in India is peculiar, with consumption of variety of smokeless and smoking forms. Understanding the tobacco problem in India, focusing more efforts on what works and investigating the impact of sociocultural diversity and cost-effectiveness of various modalities of tobacco control should be our priority.
BibTeX:
@article{MishraGA2012,
  author = {Mishra GA, Pimple SA, Shastri SS.},
  title = {An overview of the tobacco problem in India.},
  journal = {Indian J Med Paediatr Oncol.},
  year = {2012},
  volume = {33(3)},
  pages = {139-45},
  doi = {http://dx.doi.org/10.4103/0971-5851.103139}
}
Mishra GA, Shastri SS, Uplap PA, Majmudar PV, Rane PS, Gupta SD Establishing a model workplace tobacco cessation program in India. 2009 Indian J Occup Environ Med
Vol. 13(2), pp. 97-103 
article DOI  
Abstract: BACKGROUND:
Tobacco use is highly prevalent and culturally accepted in rural Maharashtra, India.
AIMS:
To study the knowledge, attitude, and practices (KAP) regarding tobacco consumption, identify reasons for initiation and continuation of tobacco use, identify prevalence of tobacco consumption and its relation with different precancerous lesions, provide professional help for quitting tobacco, and develop local manpower for tobacco cessation activities. SETTINGS, DESIGN, METHODS AND MATERIAL: The present study was conducted for one year in a chemical industrial unit in Ratnagiri district. All employees (104) were interviewed and screened for oral neoplasia. Their socio-demographic features, habits, awareness levels etc. were recorded. Active intervention in the form of awareness lectures, focus group discussions, one-to-one counseling and, if needed, pharmacotherapy was offered to the tobacco users.
RESULTS:
All employees actively participated in the program. Overall, 48.08% of the employees were found to use tobacco, among which the smokeless forms were predominant. Peer pressure and pleasure were the main reasons for initiation oftobacco consumption, and the belief that, though injurious, it would not harm them, avoiding physical discomfort on quitting and relieving stress were important factors for continuation of the habit. Employees had poor knowledge regarding the ill-effects of tobacco. 40% of tobacco users had oral precancerous lesions, which were predominant in employees consumingsmokeless forms of tobacco.
CONCLUSIONS:
Identifying reasons for initiation and continuation of tobacco consumption along with baseline assessment of knowledge, attitudes, and practices regarding tobacco use, are important in formulating strategies for a comprehensive workplace tobacco cessation program.
BibTeX:
@article{MishraGA2009,
  author = {Mishra GA, Shastri SS, Uplap PA, Majmudar PV, Rane PS, Gupta SD.},
  title = {Establishing a model workplace tobacco cessation program in India.},
  journal = {Indian J Occup Environ Med},
  year = {2009},
  volume = {13(2)},
  pages = {97-103},
  doi = {http://dx.doi.org/10.4103/0019-5278.55129}
}
Mishra R, Das BR Cyclin D1 expression and its possible regulation in chewing tobacco mediated oral squamous cell carcinoma progression. 2009 Arch Oral Biol.
Vol. 54(10), pp. 917-23 
article DOI  
Abstract: OBJECTIVE:
Proto-oncogene cyclin D1 is a G1 phase specific cell cycle regulator and known for its role in various cancers. The aim of the study was to understand oral cancer progression by observing the mRNA and protein expression of cyclin D1.
METHODS:
Different oral tissue samples were selected as a model to study oral cancer progression. Those include healthy oral mucosa, premalignant lesions (Leukoplakia, Erythroplakia, Oral SubMucous Fibrosis) and oral cancer (OSCC) samples. Cyclin D1 mRNA and protein expression were detected by slot-blot and by immunohistochemical methods, respectively.
RESULTS:
Premalignant lesions (PML) showed average 3-fold increase in the mRNA expression than normal oral mucosa (p = 0.001) whereas only 1.3-fold increase in mRNA has been observed in OSCC samples over the PML. On the other hand OSCC showed average 4-fold increase in mRNA expression than normal oral mucosa (p < 0.001). Cyclin D1 protein accumulation has been observed in 31.3% (16/51) of the OSCC samples whereas the normal oral mucosa and the PML showed no immunoreactivity. Oral cancer samples showing positive cyclin D1 immunoreactivity has increased from 15.0% (3/20) well differentiated SCC to 31.2% (5/16) moderately differentiated SCC to 53.3% (8/15) poorly differentiated SCC, found statistically significant (p = 0.05).
CONCLUSION:
By observing the expression of cyclin D1 in different stages, we have noticed two major transitions that occur in normal oral mucosa that leads to oral cancer. The first transitional event transforms the normal oral mucosa to PML whereas the second transition drives the PML to OSCC. These findings give evidence that the first transition induces cyclin D1 mRNA with no detectable cyclin D1 protein. The induction of mRNA is maintained with increased cyclin D1 protein accumulation in the second transition.
BibTeX:
@article{MishraR2009,
  author = {Mishra R, Das BR},
  title = {Cyclin D1 expression and its possible regulation in chewing tobacco mediated oral squamous cell carcinoma progression.},
  journal = {Arch Oral Biol.},
  year = {2009},
  volume = {54(10)},
  pages = {917-23},
  doi = {http://dx.doi.org/10.1016/j.archoralbio.2009.07.003}
}
Mistry R, Pednekar M, Pimple S, Gupta PC, McCarthy WJ, Raute LJ, Patel M, Shastri SS Banning tobacco sales and advertisements near educational institutions may reduce students' tobacco use risk: evidence from Mumbai, India. 2013 Tob Control.  article DOI  
Abstract: BACKGROUND:
India's Cigarettes and Other Tobacco Products Act bans tobacco sales and advertisements within 100 yards of educational institutions. In school-adjacent neighbourhoods in Mumbai, we assessed adherence to these policies and whether tobacco vendor and advertisement densities were associated with students' tobacco use.
METHODS:
High school students' tobacco use was measured using a multistage cluster sampling survey (n=1533). Field geographic information systems data were obtained for all tobacco vendors and advertisements within 500 m of schools (n=26). Random-effects multilevel logistic regression was used to estimate associations of tobacco vendor and advertisement densities with ever tobacco use, current smokeless tobacco use and current tobacco use.
RESULTS:
There were 1741 tobacco vendors and 424 advertisements within 500 m of schools, with 221 vendors (13%) and 42 advertisements (10%) located within 100 m. School-adjacent tobacco vendor density within 100 m was not associated with thetobacco use outcomes, but tobacco advertisement density within 100 m was associated with all outcomes when comparing highest to lowest density tertiles: ever use (OR: 2.01; 95% CI 1.00 to 4.07), current use (2.23; 1.16, 4.28) and currentsmokeless tobacco use (2.01; 1.02, 3.98). Tobacco vendor density within 200, 300, 400 and 500 m of schools was associated with current tobacco use and current smokeless tobacco use, but not ever use.
CONCLUSIONS:
The tobacco sales ban near educational institutions could be expanded beyond 100 m. Greater enforcement is needed regarding the current bans, particularly because advertisement density within 100 m of schools was associated with all students' tobacco use outcomes.
BibTeX:
@article{MistryR2013,
  author = {Mistry R, Pednekar M, Pimple S, Gupta PC, McCarthy WJ, Raute LJ, Patel M, Shastri SS},
  title = {Banning tobacco sales and advertisements near educational institutions may reduce students' tobacco use risk: evidence from Mumbai, India.},
  journal = {Tob Control.},
  year = {2013},
  doi = {http://dx.doi.org/10.1136/tobaccocontrol-2012-050819}
}
Mohamed S, Janakiram C Periodontal status among tobacco users in Karnataka, India. 2013 Indian J Public Health.
Vol. 57(2), pp. 105-8 
article DOI  
Abstract: A cross-sectional study was designed to assess the prevalence of periodontal diseases among tobacco and non-tobaccousers. A total of 2,156 dentate subjects were selected in the age group of 35-44 years through multi-stage sampling method. A total of 350 and 175 subjects were selected from household survey from each district in rural and urban areas. Subjects were interviewed for the tobacco usage status, followed by clinical assessment of periodontal status. Prevalence of calculus, periodontal pockets of 4-5 mm depth and loss of attachment of 0-3 mm and 4-5 mm was significantly more frequent among current tobacco users. The subject with smoking and chewing tobacco has an odds ratio (OR) 1.6 (95% confidence intervals [CI] 1.14-2.31) and OR 1.7 (95% CI 1.38-2.28) respectively. The findings contribute to the evidence of smoking as a risk factor for periodontal disease.
BibTeX:
@article{MohamedS2013,
  author = {Mohamed S, Janakiram C},
  title = {Periodontal status among tobacco users in Karnataka, India.},
  journal = {Indian J Public Health.},
  year = {2013},
  volume = {57(2)},
  pages = {105-8},
  doi = {http://dx.doi.org/10.4103/0019-557X.115006}
}
Mohanty VR, Rajesh GR, Aruna DS Role of dental institutions in tobacco cessation in India: current status and future prospects. 2013 Asian Pac J Cancer Prev.
Vol. 14(4), pp. 2673-80 
article  
Abstract: Tobacco abuse is a major preventable cause of premature death and disease, including various cancers. The Global AdultTobacco Survey India (GATS) 2009-10 revealed that more than one-third of adults use tobacco in one form or the other. Nearly two in five smokers and smokeless tobacco users made attempts to quit the habit in the past 12 months. Tobaccodependence is a chronic condition characterized by susceptibility of relapse over years. It can be well handled by sustained professional support from health care providers mainly through behavioral counseling and pharmacotherapy. Dental professionals can play a pivotal role in diagnosing and effectively managing tobacco dependence. Dental Institutions have rapidly grown in last two decades across the country and so has the curriculum been adapted to improve student competencies to accommodate changing disease patterns and technological advances, but not in regard to tobaccocessation. Untapped dental manpower like undergraduates, dental hygienists and other paramedical staff need effective training to be more penetrative. The present review paper explores the potential role of dental training institutions and recommends various approaches to counter public health jeopardy of tobacco related diseases.
BibTeX:
@article{MohantyVR2013,
  author = {Mohanty VR, Rajesh GR, Aruna DS.},
  title = {Role of dental institutions in tobacco cessation in India: current status and future prospects.},
  journal = {Asian Pac J Cancer Prev.},
  year = {2013},
  volume = {14(4)},
  pages = {2673-80}
}
Mojidra BN, Archana K, Gautam AK, Verma Y, Lakkad BC, Kumar S Evaluation of genotoxicity of pan masala employing chromosomal aberration and micronucleus assay in bone marrow cells of the mice. 2009 Toxicol Ind Health
Vol. 25(7), pp. 467-71 
article DOI  
Abstract: Pan masala is commonly consumed in south-east Asian and other oriental countries as an alternate of tobacco chewing and smoking. Genotoxic potential of pan masala (pan masala plain and pan masala with tobacco known as gutkha) was evaluated employing chromosome aberration (CA) and micronucleus (MN) assay in vivo. Animals were exposed to three different doses (0.5%, 1.5% and 3%) of pan masala plain (PMP) and gutkha (PMT) through feed for a period of 6 months and micronucleus and chromosomal aberrations were studied in the bone marrow cells. Induction of mean micronuclei in polychromatic erythrocytes (MNPCE) and normochromatic erythrocyte (MNNCE) was higher in both types of pan masala treated groups with respect to control group. Both pan masala plain and gutkha treatment significantly induced the frequency of MNPCE and MNNCE in the bone marrow cells, indicating the genotoxic potential. Furthermore, slight decline in the ratio of polychromatic erythrocytes to normochromatic erythrocytes was also noticed, suggesting the cytotoxic potential even though the ratio was statistically non significant. A dose-dependent, significant increase in chromosome aberration was observed in both types of pan masala treated mice with respect to control. However, no significant difference in micronucleus and chromosomal aberration induction was noticed between two types of pan masala exposed (PMP and PMT) groups. Results suggest that both types of pan masala, i.e. plain and gutkha, have genotoxic potential.
BibTeX:
@article{MojidraBN2009,
  author = {Mojidra BN, Archana K, Gautam AK, Verma Y, Lakkad BC, Kumar S.},
  title = {Evaluation of genotoxicity of pan masala employing chromosomal aberration and micronucleus assay in bone marrow cells of the mice.},
  journal = {Toxicol Ind Health},
  year = {2009},
  volume = {25(7)},
  pages = {467-71},
  doi = {http://dx.doi.org/10.1177/0748233709345939}
}
Mondal R, Ghosh SK, Choudhury JH, Seram A, Sinha K, Hussain M, Laskar RS, Rabha B, Dey P, Ganguli S, Nathchoudhury M, Talukdar FR, Chaudhuri B, Dhar B Mitochondrial DNA copy number and risk of oral cancer: a report from Northeast India. 2013 PLoS One.
Vol. 8(3) 
article  
Abstract: BACKGROUND:
Oral squamous cell carcinoma (OSCC) is the sixth most common cancer globally. Tobacco consumption and HPV infection, both are the major risk factor for the development of oral cancer and causes mitochondrial dysfunction. Genetic polymorphisms in xenobiotic-metabolizing enzymes modify the effect of environmental exposures, thereby playing a significant role in gene-environment interactions and hence contributing to the individual susceptibility to cancer. Here, we have investigated the association of tobacco - betel quid chewing, HPV infection, GSTM1-GSTT1 null genotypes, and tumour stages with mitochondrial DNA (mtDNA) content variation in oral cancer patients.
METHODOLOGY/PRINCIPAL FINDINGS:
The study comprised of 124 cases of OSCC and 140 control subjects to PCR based detection was done for high-risk HPV using a consensus primer and multiplex PCR was done for detection of GSTM1-GSTT1 polymorphism. A comparative ?Ct method was used for determination of mtDNA content. The risk of OSCC increased with the ceased mtDNA copy number (Ptrend ?=?0.003). The association between mtDNA copy number and OSCC risk was evident among tobacco - betel quid chewers rather than tobacco - betel quid non chewers; the interaction between mtDNA copy number and tobacco - betel quid was significant (P?=?0.0005). Significant difference was observed between GSTM1 - GSTT1 null genotypes (P?=?0.04, P?=?0.001 respectively) and HPV infection (P<0.001) with mtDNA content variation in cases and controls. Positive correlation was found with decrease in mtDNA content with the increase in tumour stages (P<0.001). We are reporting for the first time the association of HPV infection and GSTM1-GSTT1 null genotypes with mtDNA content in OSCC.
CONCLUSION:
Our results indicate that the mtDNA content in tumour tissues changes with tumour stage and tobacco-betel quid chewing habits while low levels of mtDNA content suggests invasive thereby serving as a biomarker in detection of OSCC.
BibTeX:
@article{MondalR2013,
  author = {Mondal R, Ghosh SK, Choudhury JH, Seram A, Sinha K, Hussain M, Laskar RS, Rabha B, Dey P, Ganguli S, Nathchoudhury M, Talukdar FR, Chaudhuri B, Dhar B.},
  title = {Mitochondrial DNA copy number and risk of oral cancer: a report from Northeast India.},
  journal = {PLoS One.},
  year = {2013},
  volume = {8(3)}
}
More Y, Sharma S, Chaturvedi P, D'Cruz AK Gingivobuccal mucosal cancers: resection to reconstruction. 2014 Curr Opin Otolaryngol Head Neck Surg.
Vol. 22(2), pp. 95-100 
article DOI  
Abstract: PURPOSE OF REVIEW:
Oral cancer is rapidly emerging as a major health problem across the globe. The Southeast Asian subcontinent has a high incidence of oral cancer and gingivobuccal complex forms the commonest subsite. The habit of chewing smokeless tobacco and areca nut are mainly responsible for this site predilection. The majority of literature and guidelines stem from the western world and there is ambiguity about tumor behavior among various continents. Thus, it is imperative to do this review for improving our understanding about this specific subsite, its behavior, treatment and outcomes.
RECENT FINDINGS:
Gingivobuccal mucosal cancers (GBCs) usually present as large lesions with early mandibular involvement and cervical node metastasis. Level I nodes are often the first echelon. Surgical resection of the mandible is often en bloc with primary GBCs. A marginal or segmental mandibular resection is based on paramandibular soft tissue involvement. Microvascular free tissue reconstruction is ideal. Prognostic factors include tumor depth greater than 4? mm, skin involvement, nodal metastases and extra capsular spread.
SUMMARY:
Early mandibular involvement and neck node metastases need to be considered in treatment planning. Appropriate reconstruction is key to early recovery and good quality of life.
BibTeX:
@article{MoreY2014,
  author = {More Y, Sharma S, Chaturvedi P, D'Cruz AK},
  title = {Gingivobuccal mucosal cancers: resection to reconstruction.},
  journal = {Curr Opin Otolaryngol Head Neck Surg.},
  year = {2014},
  volume = {22(2)},
  pages = {95-100},
  doi = {http://dx.doi.org/10.1097/MOO.0000000000000027}
}
Motgi AA, Chavan MS, Diwan NN, Chowdhery A, Channe PP, Shete MV Assessment of cytogenic damage in the form of micronuclei in oral epithelial cells in patients using smokeless and smoked form of tobacco and non-tobacco users and its relevance for oral cancer. 2014 J Cancer Res Ther.
Vol. 10(1), pp. 165-70 
article DOI  
Abstract: CONTEXT:
Early detection of cytological damages may help in reduction of morbidity and mortality in patients with oral cancer.
AIMS:
(1) The primary aim of this study is to assess the cytogenic damage in the form of micronuclei (MN) in patients withsmokeless and smoked tobacco using habit. (2) The secondary aim of this study is to compare the MN score in patients using tobacco and patients with no tobacco habit. (3) To find out incidence of MN according to duration and frequency oftobacco usage.
SETTINGS AND DESIGN:
This is a clinical study.
MATERIALS AND METHODS:
A total of 100 patients each with the habit of smokeless tobacco (SLT) chewing, smokedtobacco usage and with no habit were included in the study. Epithelial cell smears were prepared and slides were stained with Papanicolaou stain. Scoring of at least 1000 cells was done and a MN frequency score was assigned for exfoliated oral mucosal cells.
STATISTICAL ANALYSIS:
Analysis of variance and post hoc tests were used. Results: The difference between the total number of cells with MN was not appreciable between the smokeless and smoked tobacco groups, though the total number of MN was higher in subjects using SLT. Total number of cells with MN and the total number of MN were significantly lower in non-tobacco users when compared with tobacco users. There was very weak positive correlation between the total number of MN as per the duration and frequency of the tobacco habit.
CONCLUSION:
The use of smokeless and smoked tobacco are associated with cytotoxic and genotoxic effects. SLT seems to cause more damaging effects than the smoked form.
BibTeX:
@article{MotgiAA2014,
  author = {Motgi AA, Chavan MS, Diwan NN, Chowdhery A, Channe PP, Shete MV},
  title = {Assessment of cytogenic damage in the form of micronuclei in oral epithelial cells in patients using smokeless and smoked form of tobacco and non-tobacco users and its relevance for oral cancer.},
  journal = {J Cancer Res Ther.},
  year = {2014},
  volume = {10(1)},
  pages = {165-70},
  doi = {http://dx.doi.org/10.4103/0973-1482.131454}
}
Mr P, Guruprasad Y, Jose M, Saxena K, K D, Prabhu V Comparative Study of Genotoxicity in Different Tobacco Related Habits using Micronucleus Assay in Exfoliated Buccal Epithelial Cells. 2014 J Clin Diagn Res.
Vol. 8(5), pp. 21-4 
article DOI  
Abstract: BACKGROUND:
Oral cancer is one of the most debilitating diseases afflicting mankind. Consumption of tobacco in various forms constitutes one of the most important etiological factors in initiation of oral cancer. When the focus of today's research is to determine early genotoxic changes in human cells, micronucleus (MN) assay provides a simple, yet reliable indicator of genotoxic damage.
AIMS AND OBJECTIVES:
To identify and quantify micronuclei in the exfoliated cells of oral mucosa in individuals with differenttobacco related habits and control group, to compare the genotoxicity of different tobacco related habits between each group and also with that of control group.
PATIENTS AND METHODS:
In the present study buccal smears of 135 individuals with different tobacco related habits & buccal smears of 45 age and sex matched controls were obtained, stained using Giemsa stain and then observed under 100X magnification in order to identify and quantify micronuclei in the exfoliated cells of oral mucosa.
RESULTS:
The mean Micronucleus (MN) count in individuals having smoking habit were 3.11 while the count was 0.50, 2.13, and 1.67 in normal control, smoking with beetle quid and smokeless tobacco habit respectively. MN count in smokers group was 2.6 times more compared to normal controls. MN count was more even in other groups when compared to normal control but to a lesser extent.
CONCLUSION:
From our study we concluded that tobacco in any form is genotoxic especially smokers are of higher risk and micronucleus assay can be used as a simple yet reliable marker for genotoxic evaluation.
BibTeX:
@article{MrP2014,
  author = {Mr P, Guruprasad Y, Jose M, Saxena K, K D, Prabhu V},
  title = {Comparative Study of Genotoxicity in Different Tobacco Related Habits using Micronucleus Assay in Exfoliated Buccal Epithelial Cells.},
  journal = {J Clin Diagn Res.},
  year = {2014},
  volume = {8(5)},
  pages = {21-4},
  doi = {http://dx.doi.org/10.7860/JCDR/2014/8733.4357}
}
Mukherjee A, Sinha A, Taraphdar P, Basu G, Chakrabarty D Tobacco abuse among school going adolescents in a rural area of West Bengal, India. 2012 Indian J Public Health
Vol. 56(4), pp. 286-9 
article DOI  
Abstract: Adolescents are vulnerable targets of tobacco industry with all consequences of usage. Studies reveal that tobacco abuse is rising in this age group in India. A cross sectional survey was carried out in two coeducational high schools of Anandanagar village of Singur block, Hooghly district, West Bengal among 276 students of VIII-IX standard to study the knowledge and abuse of tobacco and to find out influencing socio-demographic factors. Knowledge score was higher in females, students from nuclear families, and those with literate parents. Low prevalence of tobacco intake was obtained among the students, with 9.8% reported having ever used smokeless tobacco and 4.3% ever smoked. Tobacco intake was higher among those with a history of parental tobacco intake. Continued information education and communication (IEC) activities should be conducted by the school authorities, with involvement of nongovernment organizations (NGOs) and parents for primary prevention.
BibTeX:
@article{MukherjeeA2012,
  author = {Mukherjee A, Sinha A, Taraphdar P, Basu G, Chakrabarty D.},
  title = {Tobacco abuse among school going adolescents in a rural area of West Bengal, India.},
  journal = {Indian J Public Health},
  year = {2012},
  volume = {56(4)},
  pages = {286-9},
  doi = {http://dx.doi.org/10.4103/0019-557X.106416}
}
Mukherjee S, Bhowmik AD, Roychoudhury P, Mukhopadhyay K, Ray JG, Chaudhuri K Association of XRCC1, XRCC3, and NAT2 polymorphisms with the risk of oral submucous fibrosis among eastern Indian population. 2012 J Oral Pathol Med
Vol. 41(4), pp. 292-302 
article DOI  
Abstract: BACKGROUND:
Arecanut and smokeless tobacco usage is a major cause for oral submucous fibrosis (OSF) and its subsequent development to oral squamous cell carcinoma in South-east Asian population. Polymorphisms at N-acetyltransferase 2 locus, coding for an enzyme catalyzing acetylation of aromatic amines, might cause DNA adduct formation because of improper acetylation of these polyaromatic hydrocarbons. DNA repair enzymes remove these adduct to prevent malignancy.
METHODS:
In this hospital-based study, 100 controls and 88 OSF patients were genotyped at four polymorphic sites on NAT2 481 (C > T; silent), 590 (G > A; Arg197 > Gln), 803 (A > G; Lys268 > Arg), 857 (G > A; Gly286 > Glu) and two on XRCC1 18067 (C > T Arg 194 > Trp), 28152 (G > A Arg 399 > Gln), and one of XRCC3 26304 (C > T Thr 241 > Met) loci by PCR-RFLP to determine the risk of the disease.
RESULTS:
Heterozygous XRCC3 codon 241 [OR 2.07 (1.05-4.06)], homozygous variant of NAT C481T [OR 2.81 (1.09-7.21)], and both heterozygous and homozygous variants of NAT codon 268 and 286 [OR 2.31 (1.20-4.45) and 4.98 (1.87-13.14), and 6.12 (2.75-13.62) and 2.65 (1.04-6.72)] individually influenced susceptibility to OSF in the population.
CONCLUSION:
Gene-gene interaction analysis by multifactor dimensionality reduction (MDR) revealed that XRCC3 Thr 241 Met had the largest univariate effect followed by XRCC3 Thr 241 Met - NAT2 A857G in men that presents a highly synergistic interaction as one of the potential combinations of single nucleotide polymorphisms (SNPs) to increase the risk of OSF in men if exposed to arecanut or smokeless tobacco usage. These observations can speculate the impact of the studied SNPs on the etiology of OSF.
BibTeX:
@article{MukherjeeS2012,
  author = {Mukherjee S, Bhowmik AD, Roychoudhury P, Mukhopadhyay K, Ray JG, Chaudhuri K.},
  title = {Association of XRCC1, XRCC3, and NAT2 polymorphisms with the risk of oral submucous fibrosis among eastern Indian population.},
  journal = {J Oral Pathol Med},
  year = {2012},
  volume = {41(4)},
  pages = {292-302},
  doi = {http://dx.doi.org/10.1111/j.1600-0714.2011.01097}
}
Nagarajappa R, Ramesh G Tooth wear among tobacco chewers in the rural population of Davangere, India. 2012 Oral Health Prev Dent.
Vol. 10(2), pp. 107-12 
article  
Abstract: PURPOSE:
In India, people chew tobacco either alone or in combination with pan or pan masala, which may cause tooth wear. The purpose of this study was to assess and compare tooth wear among chewers of various forms/combinations oftobacco products in the rural population of Davangere Taluk.
MATERIALS AND METHODS:
A cross-sectional study was conducted on 208 subjects selected from four villages of Davangere Taluk. Tooth wear was recorded using the Tooth Wear Index by a calibrated examiner with a kappa score of 0.89. The chi-square test was used for statistical analysis.
RESULTS:
The subjects chewing tobacco had significantly greater tooth wear as compared to the controls (P < 0.001). It was also observed that the frequency and duration of chewing tobacco was directly proportional to the number of pathologically worn sites.
CONCLUSION:
The abrasives present in the tobacco might be responsible for the increased tooth wear among tobaccochewers.
BibTeX:
@article{NagarajappaR2012,
  author = {Nagarajappa R, Ramesh G},
  title = {Tooth wear among tobacco chewers in the rural population of Davangere, India.},
  journal = {Oral Health Prev Dent.},
  year = {2012},
  volume = {10(2)},
  pages = {107-12}
}
Nagarajappa S, Prasad KV Oral microbiota, dental caries and periodontal status in smokeless tobaccochewers in Karnataka, India: a case-control study. 2010 Oral Health Prev Dent.
Vol. 8(3), pp. 211-9 
article  
Abstract: PURPOSE:
The aim of the present study was to compare dental caries and periodontal disease status associated with oral microflora among smokeless tobacco chewers and non-chewers.
MATERIALS AND METHODS:
Forty-two smokeless tobacco chewers and 42 non-chewers (age 20 to 60 years) were assessed for dental caries and periodontal disease status using the Decayed Missing Filled Surface (DMFS) Index, Community Periodontal Index (CPI) and Loss of Attachment (LA) Index. Stimulated saliva and subgingival plaque samples were collected from each subject for performing a culture-based analysis of 20 types of oral microorganisms. Qualitative and semi-quantitative culture-based analysis using MacConkey agar, and aerobic and anaerobic blood agar was carried out to determine the total cultivable microflora. Mutans-Sanguis agar, Pfizer selective Enterococcus agar and Rogosa SL agar were used for the culture of microorganisms associated with dental caries. Mann–Whitney U test and Student t test were employed to compare colony-forming units (CFUs) and caries experience between smokeless tobacco chewers and nonchewers. Z proportionality test was used to compare the periodontal disease status.
RESULTS:
Caries experience among chewers (26 of 42), that is those subjects who were affected by caries, was significantly less at 61.9% (mean DMFS = 3.5) compared to non-chewers (38 of 42, 90.5%) (mean DMFS = 5.5) (P < 0.05). Deep pockets measuring > 5.5 mm on a CPI probe were found among 26.2% of chewers and 19.1% of nonchewers, with no statistically significant differences (P > 0.05). Counts of Lactobacillus species were significantly lower among chewers (median CFU = 0.788 x 10?) than among non-chewers (median CFU = 1.52 x 10?) (P < 0.05). Prevotella and Porphyromonas species had a median CFU of 0.04 x 105 in chewers and 0.15 x 10? in non-chewers, whereas Fusobacterium species had a median CFU of 0.02 x 10? in chewers and 0.1 x 10? in non-chewers (P < 0.05).
CONCLUSIONS:
A higher percentage of caries among non-chewers can be explained by greater numbers of Lactobacillus species in this population. Chewers experienced a slightly higher incidence of periodontal disease than non-chewers, but the difference was not significant. These clinical observations suggest a lower ability of Gram-negative bacteria to mediate more periodontal disease in this population.
BibTeX:
@article{NagarajappaS2010,
  author = {Nagarajappa S, Prasad KV.},
  title = {Oral microbiota, dental caries and periodontal status in smokeless tobaccochewers in Karnataka, India: a case-control study.},
  journal = {Oral Health Prev Dent.},
  year = {2010},
  volume = {8(3)},
  pages = {211-9}
}
Chaturvedi P Uvular abnormalities in patients with submucous fibrosis. 2009 Oral Dis
Vol. 15(7), pp. 516 
article DOI  
BibTeX:
@article{P.2009,
  author = {Chaturvedi P.},
  title = {Uvular abnormalities in patients with submucous fibrosis.},
  journal = {Oral Dis},
  year = {2009},
  volume = {15(7)},
  pages = {516},
  doi = {http://dx.doi.org/10.1111/j.1601-0825.2009.01578.x}
}
Panda B, Rout A, Pati S, Chauhan AS, Tripathy A, Shrivastava R, Bassi A Tobacco control law enforcement and compliance in Odisha, India--implications fortobacco control policy and practice. 2012 Asian Pac J Cancer Prev
Vol. 13(9), pp. 4631-7 
article  
Abstract: INTRODUCTION:
Tobacco use is a leading cause of deaths and disabilities in India, killing about 1.2 lakh people in 2010. About 29% of adults use tobacco on a daily basis and an additional 5% use it occasionally. In Odisha, non-smoking forms are more prevalent than smoking forms. The habit has very high opportunity cost as it reduces the capacity to seek better nutrition, medical care and education. In line with the WHO Framework Convention on Tobacco Control (FCTC), the Cigarettes and Other Tobacco Products Act (COTPA) is a powerful Indian national law on tobacco control. The Government of Odisha has shown its commitment towards enforcement and compliance of COTPA provisions. In order to gauge the perceptions and practices related to tobacco control efforts and level of enforcement of COTPA in the State, this cross-sectional study was carried out in seven selected districts.
MATERIALS AND METHODS:
A semi-structured interview schedule was developed, translated into Odiya and field-tested for data collection. It mainly contained questions related to knowledge on provisions of section 4-7 of COTPA 2003, perception about smoking, chewing tobacco and practices with respect to compliance of selected provisions of the Act. 1414 samples were interviewed.
RESULTS:
The highest percentage of respondents was from the government departments. 70% of the illiterates consumedtobacco as compared to 34% post graduates. 52.1% of the respondents were aware of Indian tobacco control laws, while 80.8% had knowledge about the provision of the law prohibiting smoking in public places. However, 36.6% of the respondents reported that they had 'very often' ' seen tobacco products being sold 'to a minor', while 31.2% had seen tobacco products being sold 'by a minor'. In addition, 24.8% had 'very often' seen tobacco products being sold within a radius of 100 yards of educational institutions.
BibTeX:
@article{PandaB2012,
  author = {Panda B, Rout A, Pati S, Chauhan AS, Tripathy A, Shrivastava R, Bassi A.},
  title = {Tobacco control law enforcement and compliance in Odisha, India--implications fortobacco control policy and practice.},
  journal = {Asian Pac J Cancer Prev},
  year = {2012},
  volume = {13(9)},
  pages = {4631-7}
}
Panda R, Venkatesan S, Persai D, Trivedi M, Mathur MR Factors determining intention to quit tobacco: exploring patient responses visiting public health facilities in India. 2014 Tob Induc Dis
Vol. 12(1)(1) 
article DOI  
Abstract: INTRODUCTION:
Intention to quit and setting a quit date are key steps in the process towards improving quit rates and are thus an integral part of tobacco cessation efforts. The present study examined various motivating factors of "intention to quit" and "setting a quit date" in patients visiting public health facilities in two states of India.
METHODS:
A total of 1569 tobacco-users visiting public health facilities in 12 districts of the states of Andhra Pradesh and Gujarat were assessed through an interviewer-administered questionnaire. Bivariate and multivariable logistic regression was performed to assess the effect of socio-demographic characteristics, nicotine dependence, previous quit attempts and motivational factors on "intention to quit within 30 days" and "setting a quit date".
RESULTS:
Only 12% of patients intended to quit tobacco within 30 days and about 11% of them were ready to set a quit date. Respondents aged above 25 years were 53% less likely to quit tobacco within 30 days when compared to those below 25 years (95% Confidence Intervals [CI]: 0.22 to 0.99). Smokeless tobacco users were associated with an odds ratio (OR) of 2.05 (95% CI: 1.15 to 3.65) for "setting a quit date" when compared to smokers. Those with 1 to 5 previous quit attempts (in the past twelve months) were associated with an OR of 2.2 (95% CI: 1.38 to 3.51) for "intention to quit" and 2.46 (95% CI: 1.52 to 3.96) for "setting a quit date". "Concern for personal health" and "setting an example for children" were associated with ORs of 3.42 (95% CI: 1.35 to 8.65) and 2.5 (95% CI: 1.03 to 6.03) respectively for "setting a quit date".
CONCLUSIONS:
This study is amongst the first in India to explore factors associated with the "intention to quit" and "setting a quit date" among patients visiting public health facilities. Our findings suggest that socio-economic and individual-level factors are important factors depicting intention to quit and setting a quit date. We recommend the need for well-defined studies to understand the long term effects of factors influencing tobacco cessation for patients visiting public health facilities in India.
BibTeX:
@article{PandaR2014,
  author = {Panda R, Venkatesan S, Persai D, Trivedi M, Mathur MR},
  title = {Factors determining intention to quit tobacco: exploring patient responses visiting public health facilities in India.},
  journal = {Tob Induc Dis},
  year = {2014},
  volume = {12(1)},
  number = {1},
  doi = {http://dx.doi.org/10.1186/1617-9625-12-1}
}
Pandey A, Patni N, Sarangi S, Singh M, Sharma K, Vellimana AK, Patra S Association of exclusive smokeless tobacco consumption with hypertension in an adult male rural population of India. 2009 Tob Induc Dis  article DOI  
Abstract: INTRODUCTION:
Tobacco consumption is a major source of mortality and morbidity in India . Prevalence of smokeless tobacco (ST) consumption in India is around 20%. Studies have shown increased prevalence of cardiovascular disease risk factors and an increased incidence of adverse cardiovascular events among the ST consumers. This is a cross-sectional study done to look into the association of exclusive smokeless tobacco consumption with hypertension, in an adult male rural population of north India.
METHODS:
All male residents of a village in north India above 15 years of age, who did not have any acute or chronic morbidity were included after taking an informed consent. Subjects were interviewed regarding their demographic profile, socioeconomic status and tobacco consuming habits. Current smokeless tobacco user was defined as one who has ever consumed tobacco orally in past 1 month. Blood pressure of the subjects was also recorded. Cut offs used for systolic and diastolic hypertension were 140 mm hg and 90 mm Hg respectively.
RESULTS:
443 subjects were included in the study. Prevalence of exclusive ST users was 21% while 19.4% consumed both forms and 26.6% did not take any form of tobacco. Mean systolic and diastolic BP were significantly higher in exclusive ST users(systolic BP=139.2+17.4,diastolic BP = 86.8+11.5)as compared to the non users(systolic BP= 135.7+18.8 , diastolic BP= 82.6 +11.5; p value < 0.05). The prevalence of diastolic hypertension was significantly higher in exclusive ST users as compared to non users ( 40.9%, 22.9% ;p value = 0.01) . The OR for diastolic hypertension in male ST users was 2.3( 95% C.I. = 1.3-4.3). Prevalence of systolic hypertension was higher in exclusive ST users too though this was not statistically significant (43%,36.4%;p value = 0.39.).
CONCLUSION:
ST consumption is associated with increased prevalence of high BP in the adult male rural population.This is an indicator of increased predisposition to major adverse cardiac events later in their life time. Prevention of ST consumption could be an important intervention in preventing the ongoing upswing in prevalence of chronic heart disease.
BibTeX:
@article{PandeyA2009,
  author = {Pandey A, Patni N, Sarangi S, Singh M, Sharma K, Vellimana AK, Patra S.},
  title = {Association of exclusive smokeless tobacco consumption with hypertension in an adult male rural population of India.},
  journal = {Tob Induc Dis},
  year = {2009},
  doi = {http://dx.doi.org/10.1186/1617-9625-5-15}
}
Pandey R, Mehrotra D, Mahdi AA, Sarin R, Kowtal P, Maurya SS, Parmar D Association between mitochondrial C-tract alteration and tobacco exposure in oral precancer cases. 2013 Natl J Maxillofac Surg
Vol. 4(2), pp. 219-24 
article DOI  
Abstract: INTRODUCTION:
Tobacco exposure is a known risk factor for oral cancer. India is home to oral cancer epidemic chiefly due to the prevalent use of both smoke and smokeless tobacco. To reduce the related morbidity early detection is required. The key to this is detailing molecular events during early precancer stage. Mitochondrion is an important cellular organelle involved in cell metabolism and apoptosis. Mitochondrial dysfunction is thought to be the key event in oncogenesis. Last decade has seen a spurt of reports implicating mitochondrial mutations in oral carcinogenesis. However, there are few reports that study mitochondrial deoxyribonucleic acid (mtDNA) changes in oral precancer. This study aims to understand and link effect oftobacco exposure on mtDNA in oral precancer cases.
SUBJECTS AND METHODS:
A total of 100 oral precancer cases of which 50 oral leukoplakia and 50 oral submucous fibrosis were recruited in the study and a detailed questionnaire were filled about the tobacco habits. Their tissue and blood samples were collected. Total genomic DNA was isolated from both sources. Mitochondrial C-tract was amplified and bidirectional sequencing was carried out. Mutations were scored over matched blood DNA.
RESULTS:
There was a significant association between the presence of mitochondrial C-tract alteration and duration oftobacco exposure. The probability increased with increasing duration of tobacco consumption. The risk of having this alteration was more in chewers than in smokers.
CONCLUSIONS:
Tobacco in both form, chewable and smoke, is oncogenic and causes early changes in mitochondrial genome and chances increases with increasing duration of tobacco consumption.
BibTeX:
@article{PandeyR2013,
  author = {Pandey R, Mehrotra D, Mahdi AA, Sarin R, Kowtal P, Maurya SS, Parmar D},
  title = {Association between mitochondrial C-tract alteration and tobacco exposure in oral precancer cases.},
  journal = {Natl J Maxillofac Surg},
  year = {2013},
  volume = {4(2)},
  pages = {219-24},
  doi = {http://dx.doi.org/10.4103/0975-5950.127655}
}
Patel BP, Trivedi PJ, Brahmbhatt MM, Shukla SN, Shah PM, Bakshi SR Mutagen sensitivity in oral cancer patients, healthy tobacco chewers and controls. 2010 Acta Cytol
Vol. 54(2), pp. 169-74 
article  
Abstract: OBJECTIVE:
To analyze chromosomal aberrations (CA) as an index of DNA damage, to measure DNA repair capability using mutagen sensitivity assay and to correlate tobacco exposure with CA.
STUDY DESIGN:
Oral cancer patients, healthy tobacco chewers and healthy tobacco nonusers were studied for spontaneous and mutagen-induced CA. An arbitrary unit obtained for lifetime tobacco exposure (LTE) was compared with CA.
RESULTS:
Mean levels of spontaneous and mitomycin-C-induced CA were higher in patients as compared to chewers and controls. DNA repair capability of patients was significantly deficient (p < or = 0.016) as compared to that of chewers. LTE was significantly higher (p = 0.004) in patients than chewers. Chewers having high LTE and spontaneous CA above cutoff levels might be at a greater risk of oral carcinogenesis.
CONCLUSION:
There is a probable risk of oral carcinogenesis in healthy tobacco consumers having higher CA and LTE. Whether the deficient DNA repair capacity of oral cancer patients is due to the disease process or the tobacco exposure needs to be confirmed with a larger population study.
BibTeX:
@article{PatelBP2010,
  author = {Patel BP, Trivedi PJ, Brahmbhatt MM, Shukla SN, Shah PM, Bakshi SR},
  title = {Mutagen sensitivity in oral cancer patients, healthy tobacco chewers and controls.},
  journal = {Acta Cytol},
  year = {2010},
  volume = {54(2)},
  pages = {169-74}
}
Patel D, Kassim S, Croucher R Tobacco promotion and availability in school neighborhoods in India: a cross-sectional study of their impact on adolescent tobacco use. 2012 Asian Pac J Cancer Prev
Vol. 13(8), pp. 4173-6 
article  
Abstract: BACKGROUND:
Adolescent tobacco use is a major public health problem. However, there is little information about the impact of tobacco advertising and availability near schools on adolescent tobacco use in India.
METHODS:
The various tobacco products and brands available in outlets within 100 meters of two high schools in an Indian town were identified. A stratified random sample of 172 participants from these two schools completed a questionnaire ontobacco use and socioeconomic status.
RESULTS:
Eighteen outlets selling tobacco products were identified. In the two schools the current use of smoked andsmokeless tobacco was 9.1% and 17.4% respectively. School location and low socio-economic status of adolescents were associated with tobacco awareness of advertisements (p=0.001) and the receipt of a free sample (p= 0.032). Advertisements on billboards, posters and the receipt of a free tobacco sample were significant factors (p=0.031, p=0.016, p=0.017 respectively) in current tobacco use.
CONCLUSION:
In this study a significant proportion of adolescents used tobacco. Tobacco- promotion activities (advertising, the receipt of a free sample), school location and economic status were found to be associated with adolescent tobaccoinitiation. The local environment should be included in the prevention of adolescent tobacco initiation.
BibTeX:
@article{PatelD2012,
  author = {Patel D, Kassim S, Croucher R.},
  title = {Tobacco promotion and availability in school neighborhoods in India: a cross-sectional study of their impact on adolescent tobacco use.},
  journal = {Asian Pac J Cancer Prev},
  year = {2012},
  volume = {13(8)},
  pages = {4173-6}
}
Patel V, Chatterji S, Chisholm D, Ebrahim S, Gopalakrishna G, Mathers C, Mohan V, Prabhakaran D, Ravindran RD, Reddy KS Chronic diseases and injuries in India. 2011 Lancet., pp. 413-28  article DOI  
Abstract: Chronic diseases (eg, cardiovascular diseases, mental health disorders, diabetes, and cancer) and injuries are the leading causes of death and disability in India, and we project pronounced increases in their contribution to the burden of disease during the next 25 years. Most chronic diseases are equally prevalent in poor and rural populations and often occur together. Although a wide range of cost-effective primary and secondary prevention strategies are available, their coverage is generally low, especially in poor and rural populations. Much of the care for chronic diseases and injuries is provided in the private sector and can be very expensive. Sufficient evidence exists to warrant immediate action to scale up interventions for chronic diseases and injuries through private and public sectors; improved public health and primary health-care systems are essential for the implementation of cost-effective interventions. We strongly advocate the need to strengthen social and policy frameworks to enable the implementation of interventions such as taxation on bidis (small hand-rolled cigarettes), smokeless tobacco, and locally brewed alcohols. We also advocate the integration of national programmes for various chronic diseases and injuries with one another and with national health agendas. India has already passed the early stages of a chronic disease and injury epidemic; in view of the implications for future disease burden and the demographic transition that is in progress in India, the rate at which effective prevention and control is implemented should be substantially increased. The emerging agenda of chronic diseases and injuries should be a political priority and central to national consciousness, if universal health care is to be achieved.
BibTeX:
@article{PatelV2011,
  author = {Patel V, Chatterji S, Chisholm D, Ebrahim S, Gopalakrishna G, Mathers C, Mohan V, Prabhakaran D, Ravindran RD, Reddy KS.},
  title = {Chronic diseases and injuries in India.},
  journal = {Lancet.},
  year = {2011},
  pages = {413-28},
  doi = {http://dx.doi.org/10.1016/S0140-6736(10)61188-9}
}
Pednekar MS, Gupta PC, Yeole BB, Hébert JR Association of tobacco habits, including bidi smoking, with overall and site-specific cancer incidence: results from the Mumbai cohort study. 2011 Cancer Causes Control
Vol. 22(6), pp. 859-68 
article DOI  
Abstract: Bidis are hand-rolled cigarettes commonly smoked in South Asia and are marketed to Western populations as a safer alternative to conventional cigarettes. This study examined the association between bidis and other forms of tobacco use and cancer incidence in an urban developing country population.
METHODS:
Using data from the large, well-characterized Mumbai cohort study, adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were computed from Cox proportional hazards regression models in order to compare the relative effect of various forms of tobacco use on cancer incidence.
RESULTS:
During 649,228 person-years of follow-up 1,267 incident cancers occurred in 87,222 male cohort members. Incident oral cancer in bidi smokers (HR = 3.55; 95% CI = 2.40,5.24) was 42% higher than in cigarette smokers (HR = 2.50;95% CI = 1.65,3.78). For all respiratory and intrathoracic organs combined, the increase was 69% (HR = 5.54; 95% CI = 3.46,8.87 vs. HR = 3.28; 95% CI = 1.99,5.39); for lung and larynx, the increases were 35 and 112%, respectively. Smokeless tobacco use was associated with cancers of the lip, oral cavity, pharynx, digestive, respiratory, and intrathoracic organs.
CONCLUSIONS:
Despite marketing claims to the contrary, we found that smokeless tobacco use and bidi smoking are at least as harmful as cigarette smoking for all incident cancers and are associated with increased risk of oral and respiratory/intrathoracic cancers.
BibTeX:
@article{PednekarMS2011,
  author = {Pednekar MS, Gupta PC, Yeole BB, Hébert JR.},
  title = {Association of tobacco habits, including bidi smoking, with overall and site-specific cancer incidence: results from the Mumbai cohort study.},
  journal = {Cancer Causes Control},
  year = {2011},
  volume = {22(6)},
  pages = {859-68},
  doi = {http://dx.doi.org/10.1007/s10552-011-9756-1}
}
Philip PM, Parambil NA, Bhaskarapillai B, Balasubramanian S Evaluation of a specially designed tobacco control program to reduce tobacco use among school children in Kerala. 2013 Asian Pac J Cancer Prev.
Vol. 14(6), pp. 3455-9 
article  
Abstract: BACKGROUND:
Smoking and smokeless tobacco use are almost always initiated and established during adolescence. More than 80% of adult smokers begin smoking before 18 years of age. The main objective of the present study is to assess the feasibility of preventing adolescent tobacco use with the help of a specially designed tobacco control program.
MATERIALS AND METHODS:
A cross sectional survey on tobacco use and related health effects was conducted using a structured questionnaire in 13 randomly selected schools in Kannur district of Kerala. These students were followed for a period of one academic year with multiple spaced interventions such as anti-tobacco awareness classes, formation of anti-tobacco task forces, inter-school competitions, supplying IEC (information, education and communication) materials and providing a handbook on tobacco control for school personnel. Final evaluation was at the end of one year.
RESULTS:
There were 4,144 school children who participated in the first phase of the study. The prevalence of tobaccosmoking and chewing habits were 9.85% and 2.24% respectively. Ninety-one percent had parental advice against tobacco use and only 3.79% expressed desire for future tobacco use. The final evaluation witnessed a sharp decline in the current tobaccouse as 4.68%. We observed a statistically significant difference towards the future use of tobacco (p<0.001) and awareness about the ill effects of passive smoking (p<0.001) among boys and girls. Further a significantly increased knowledge was observed among boys compared to girls about tobacco and oral cancer (p=0.046).
CONCLUSIONS:
The comprehensive school based tobacco control project significantly reduced the tobacco use pattern in the target population. School tobacco projects incorporating frequent follow ups and multiple interventions appear more effective than projects with single intervention.
BibTeX:
@article{PhilipPM2013,
  author = {Philip PM, Parambil NA, Bhaskarapillai B, Balasubramanian S},
  title = {Evaluation of a specially designed tobacco control program to reduce tobacco use among school children in Kerala.},
  journal = {Asian Pac J Cancer Prev.},
  year = {2013},
  volume = {14(6)},
  pages = {3455-9}
}
Prabhakar V, Jayakrishnan G, Nair SV, Ranganathan B Determination of Trace Metals, Moisture, pH and Assessment of Potential Toxicity of Selected Smokeless Tobacco Products. 2013 Indian J Pharm Sci.
Vol. 75(3), pp. 262-9 
article DOI  
Abstract: The characterization and classification of smokeless tobacco products has been a continuously evolving process. This is based on a number of different parameters like nicotine content, moisture content, amount of heavy metals, pH, and in vitro cytotoxicity assays. Their contexts often vary between countries, research institutions, and legal requirements. The categorisation of these products is quite challenging due to the diffused sample sizes, diverse array of branded products on offer, and the absence of a centralized manufacturing facility. This study aims at a systematic classification of 10 smokeless tobacco product samples from the retail market based on their potential toxicity upon long-term use. The estimation of potential toxicity follows a well-established method that employs the concentration of toxic metals in the different samples. The potential toxicity as well as heavy metal concentrations of the smokeless tobacco products analysed was found to be much higher than acceptable limits. For instance, the levels of lead, cadmium, copper and zinc of 2.5, 1, 4 and 23 ppm, respectively, are well above their recommended limits. The results from the study indicate that chronic use of smokeless tobacco products is a significant health risk, especially in the vulnerable population. Further studies of this nature will help establish a toxicological fingerprint on the diverse class of products that floods the market now.
BibTeX:
@article{PrabhakarV2013,
  author = {Prabhakar V, Jayakrishnan G, Nair SV, Ranganathan B},
  title = {Determination of Trace Metals, Moisture, pH and Assessment of Potential Toxicity of Selected Smokeless Tobacco Products.},
  journal = {Indian J Pharm Sci.},
  year = {2013},
  volume = {75(3)},
  pages = {262-9},
  doi = {http://dx.doi.org/10.4103/0250-474X.117398}
}
Pramanik P, Ghosh M, Choudhary A, Ghosh B, Ganguli IN Effect of 'Khaini'--a form of smokeless chewing tobacco on pulmonary functions. 2013 Indian J Physiol Pharmacol.
Vol. 57(1), pp. 84-6 
article  
BibTeX:
@article{PramanikP2013,
  author = {Pramanik P, Ghosh M, Choudhary A, Ghosh B, Ganguli IN},
  title = {Effect of 'Khaini'--a form of smokeless chewing tobacco on pulmonary functions.},
  journal = {Indian J Physiol Pharmacol.},
  year = {2013},
  volume = {57(1)},
  pages = {84-6}
}
Pratinidhi A, Gandham S, Shrotri A, Patil A, Pardeshi S Use of 'Mishri' A Smokeless form of Tobacco During Pregnancy and its Perinatal Outcome. 2010 Indian J Community Med
Vol. 35(1), pp. 14-8 
article DOI  
Abstract: BACKGROUND:
Use of 'Mishri' (Tobacco containing teeth cleaning powder) is common in the central and southern part of India.
OBJECTIVES:
To study the effects of Mishri use on the fetus during pregnancy and the perinatal outcome, and stopping its use.
MATERIALS AND METHODS:
All apparently healthy pregnant women were enrolled at 20 weeks of gestation from rural Maharashtra, India. Information related to use and giving up of Mishri, previous obstetrical history, current pregnancy, delivery and outcome during the perinatal period were recorded. Appropriate tests of significance were applied.
RESULTS:
Out of 705 enrolled pregnant women, 218 (30.9%) were using Mishri. The proportion of women with complications during the previous perinatal period, complaints and complications during the current pregnancy/delivery and the number of stillbirths were significantly more among Mishri users. A relative risk of abnormal delivery was 2.7 for the users. In spite of counseling, 153 women never stopped the use of Mishri and gave birth to babies weighing on an average 169.9 gm less (statistically significant) than babies born from the group that never used it. Babies of 28.8% who stopped/reduced consumption of Mishri were significantly benefited.
CONCLUSIONS:
The improvement seen in babies born to 28.8% mothers who stopped/reduced consumption of Mishri by 32 weeks during the current pregnancy is of paramount importance in the developing world for primary prevention of low birth weight.
BibTeX:
@article{PratinidhiA2010,
  author = {Pratinidhi A, Gandham S, Shrotri A, Patil A, Pardeshi S.},
  title = {Use of 'Mishri' A Smokeless form of Tobacco During Pregnancy and its Perinatal Outcome.},
  journal = {Indian J Community Med},
  year = {2010},
  volume = {35(1)},
  pages = {14-8},
  doi = {http://dx.doi.org/10.4103/0970-0218.62547}
}
Priya M, Lando HA Tobacco control: an issue twinned with oral cancer control. 2014 Int Dent J.  article DOI  
Abstract: Oral cancer is a silent crisis in India. Thirty per cent of all cancers are oral cancer, and approximately 17% of all cancers in men and 10.5% of all cancers in women are oral cancer. Approximately 70,000 new cases are reported annually and 46,000 oral cancer-related deaths occur each year in India; furthermore, the number of cases is rapidly increasing. With this crescendo there may be an estimated 100,000 new cases by 2020, which is insurmountable, especially in emerging economies like India. This astronomical increase is a direct result of tobacco usage. The Global Adult Tobacco Survey performed in 2010 (GATS-2010) reported that approximately 274.5 million people in India use tobacco in various forms. Increasing use of smokeless tobacco, especially by women and children, is of major concern. The World Health Organisation has identified tobacco control and oral cancer control measures as a health priority. However, prevention of tobacco use in India is a great challenge owing to low overall literacy rates and to greater prevalence among people in lower socio-economic strata. Addressing this problem requires a multidisciplinary approach. This paper presents a situational analysis of oral cancer in India and the role of tobacco in making it the epicentre of the disease, and focuses on the role of dental care-givers in influencing and promoting tobacco-control programmes and early detection of oral cancer.
BibTeX:
@article{PriyaM2014,
  author = {Priya M, Lando HA},
  title = {Tobacco control: an issue twinned with oral cancer control.},
  journal = {Int Dent J.},
  year = {2014},
  doi = {http://dx.doi.org/10.1111/idj.12124}
}
Quraishi R, Jain R, Balhara YP Profile of nicotine use among alcohol dependent patients visiting a tertiary care center in north India. 2014 Indian J Psychol Med.
Vol. 36(2), pp. 174-8 
article DOI  
Abstract: BACKGROUND:
Use of tobacco among alcohol dependent population is quite frequent. This co-morbidity increases the risk for various diseases. Understanding the pattern of tobacco use with co-morbid alcohol use may help in planning appropriate prevention/treatment strategies. The study aimed at examining the profile and pattern of nicotine use among alcohol dependent patients visiting a tertiary care treatment center in North India.
MATERIALS AND METHODS:
Male patients fulfilling diagnostics and statistical manual of mental disorder fourth edition, criteria for nicotine and alcohol diagnostics and statistical dependence, attending the out-patient department of the tertiary care treatment center were recruited after obtaining informed consent. The socio-demographic profile, drug use history, nicotine associated health problems and general health problem were recorded. Motivation to stop tobacco use was assessed qualitatively using the direct questions about their interest and intentions to quit.
RESULTS:
A total of 150 subjects were included in the study. The mean age of the study sample was 37.6 ± 10.44 years.Tobacco was reported as the gateway drug in 90% of the cases. Exclusive bidi use reported in 42% of the subjects. Mean duration of bidi and co-morbid alcohol use was higher than cigarette or smokeless tobacco use. Self-reported health problems associated with nicotine use and general health was reported by 41% and 39% of the subjects. Unsuccessful past quit attempts was present in 85% cases. More than 90% of subjects remained interested in quitting the tobacco use. An increased liver enzyme (aspartate transaminase, alanine transaminase and gamma-glutamyl transferase) were observed in 43, 32 and 47% of the cases.
CONCLUSION:
The results suggest the nicotine and alcohol dependent patients represent a separate population requiring higher attention from the treating physician.
BibTeX:
@article{QuraishiR2014,
  author = {Quraishi R, Jain R, Balhara YP},
  title = {Profile of nicotine use among alcohol dependent patients visiting a tertiary care center in north India.},
  journal = {Indian J Psychol Med.},
  year = {2014},
  volume = {36(2)},
  pages = {174-8},
  doi = {http://dx.doi.org/10.4103/0253-7176.130987}
}
Raja M, Saha S, Mohd S, Narang R, Reddy LV, Kumari M Cognitive Behavioural Therapy versus Basic Health Education for TobaccoCessation among Tobacco Users: A Randomized Clinical Trail. 2014 J Clin Diagn Res.
Vol. 8(4), pp. 47-9 
article DOI  
Abstract: INTRODUCTION:
Tobacco is the greatest disease-producing product which is known to man and it is a primary cause of many oral diseases and adverse oral conditions. This study was conducted to bring the behavioural changes and to educate individuals about the harmful effects of tobacco.
METHOD:
Subjects reporting to the tobacco cessation centre of the Department of Public Health Dentistry and giving a history of tobacco consumption (smoking/smokeless) within past 30 day period were randomized into 2 groups: cognitive behavioural therapy (CBT) group (study group) and Basic health education (BHE) group (control group). Baseline evaluation (of demographic parameters, smoking/ smokeless behaviour) was done and Fagerstrom's test for Nicotine Dependence (FTND) was used to assess subjects' nicotine addiction levels. Follow up was done at intervals of 2 weeks and 4 weeks to assess the reduction in the mean FTND score. Appropriate statistical analysis was performed (Paired and Unpaired t-test).
RESULTS:
Of all the subjects who reported to the department, 40 subjects were recruited in the study. A majority of the subjects were males who belonged to rural areas, who had completed high school and most of them had consumed more than 10 sachets of pan masala daily, for an average of 10 years. In both CBT and BHE groups, significant reductions in mean Fagerstrom scores at 1st and 2nd follow ups from baseline and between 1st and 2nd follow ups were seen. But when both groups were compared, reductions in mean Fagerstrom scores were found to be more in CBT group than in BHE group at all time intervals, though it was not statistically significant.
CONCLUSION:
Any intervention given to tobacco users from either CBT or BHE groups, helped the patients in quitting habit oftobacco.
BibTeX:
@article{RajaM2014,
  author = {Raja M, Saha S, Mohd S, Narang R, Reddy LV, Kumari M},
  title = {Cognitive Behavioural Therapy versus Basic Health Education for TobaccoCessation among Tobacco Users: A Randomized Clinical Trail.},
  journal = {J Clin Diagn Res.},
  year = {2014},
  volume = {8(4)},
  pages = {47-9},
  doi = {http://dx.doi.org/10.7860/JCDR/2014/8015.4279}
}
Ramakrishnan S, Thangjam R, Roy A, Singh S, Ramakrishnan L, Seth S, Narang R, Bhargava B Acute effects of tobacco chewing on the systemic, pulmonary and coronary circulation. 2011 Am J Cardiovasc Drugs
Vol. 11(2), pp. 109-14 
article DOI  
Abstract: Tobacco use is highly prevalent in India, with almost half of adult men consuming tobacco in either smoke orsmokeless forms (particularly chewing). Although cigarette smoking is known to produce acute hemodynamic effects, there is a lack of data concerning such effects of chewing tobacco.
OBJECTIVE:
The aim of this study was to determine the acute hemodynamic and coronary vasomotor effects of chewingtobacco.
METHODS:
Twelve habitual tobacco chewers (mean?±?SD age 51.3?±?6.9 years) undergoing elective coronary angiography were included in the study. Following coronary angiography, a 7F thermodilution Swan Ganz continuous cardiac output pulmonary artery catheter was used to continuously measure the right heart pressures and cardiac output. Having obtained baseline hemodynamic data, 1g of tobacco was given to be chewed. Subsequently, hemodynamic data were obtained periodically over a period of 60 minutes. A repeat left coronary injection was performed, 10 minutes after giving the tobacco, in the right anterior oblique view to estimate the diameter of the left anterior descending (LAD) artery by quantitative coronary angiography.
RESULTS:
Chewing tobacco led to a significant acute increase in heart rate (from 68.3?±?12.4?beats/min to 80.6?±?14.6?beats/min, peaking at 10 minutes) and cardiac output (from 3.8?±?0.45?L/min to 4.7?±?0.64?L/min, peaking at 15 minutes). There were no significant changes in the right atrial, pulmonary artery, or wedge pressures and hence no change in the pulmonary vascular resistance. More importantly, chewing tobacco was associated with coronary vasoconstriction (proximal LAD diameter change from 3.17?±?0.43?mm to 2.79?±?0.37?mm; p-value 0.02; mid LAD diameter change from 2.75?±?0.36?mm to 2.40?±?0.22?mm; p-value 0.03).
CONCLUSION:
Chewing smokeless tobacco leads to coronary vasoconstriction and also produces significant hemodynamic alterations. These changes may have a bearing on excess vascular disease.
BibTeX:
@article{RamakrishnanS2011,
  author = {Ramakrishnan S, Thangjam R, Roy A, Singh S, Ramakrishnan L, Seth S, Narang R, Bhargava B},
  title = {Acute effects of tobacco chewing on the systemic, pulmonary and coronary circulation.},
  journal = {Am J Cardiovasc Drugs},
  year = {2011},
  volume = {11(2)},
  pages = {109-14},
  doi = {http://dx.doi.org/10.2165/11586750-000000000-00000}
}
Raute LJ, Sansone G, Pednekar MS, Fong GT, Gupta PC, Quah AC, Bansal-Travers M, Sinha DN Knowledge of health effects and intentions to quit among smokeless tobaccousers in India: findings from the International Tobacco Control Policy Evaluation (ITC) India Pilot Survey. 2011 Asian Pac J Cancer Prev
Vol. 12(5), pp. 1233-8 
article  
Abstract: INTRODUCTION AND BACKGROUND:
The prevalence of smokeless tobacco use in India is the highest in the world, with 26% of adults reporting being users of smokeless tobacco only. But to date, there are few studies of beliefs, knowledge, and other psychosocial measures relating to smokeless tobacco use in India. The aim of the present study was to use data from the ITC India Pilot Study conducted in 2006 to examine beliefs about the harms of smokeless tobacco use, knowledge of health effects, and intentions to quit among current smokeless tobacco users in two states, Maharashtra and Bihar.
METHODS:
Data from the ITC India Pilot Study, a face-to-face crosssectional survey of 248 adults reporting exclusive current use of smokeless tobacco in Maharashtra and Bihar, were analyzed with respect to the knowledge of health effects, beliefs about harmfulness, and intentions to quit smokeless tobacco use.
RESULTS:
Around three quarters (36%) of smokeless tobacco users from Maharashtra and two thirds (62%) from Bihar had a 'bad' opinion about smokeless tobacco use. About 77% believed that smokeless tobacco use causes mouth cancer, followed by gum disease (66%) and difficulty in opening the mouth (56%). Significant differences were found in health knowledge between urban and rural smokeless tobacco users in both states. Only 38% of smokeless tobacco users reported having intentions to quit, and only 11% had intentions to quit within the next 6 months. Smokeless tobacco users who reported higher knowledge of the specific health effects from smokeless tobacco use were more likely to have intentions to quit.
CONCLUSION:
Despite the fairly high levels of awareness of health effects from smokeless tobacco use in Maharashtra and Bihar, the majority of smokeless users had no intentions to quit. Increased educational efforts about the detrimental health effects from smokeless tobacco use may result in higher levels of knowledge about the harms of smokeless tobacco and this in turn could increase quit intentions and subsequent quitting among users.
BibTeX:
@article{RauteLJ2011,
  author = {Raute LJ, Sansone G, Pednekar MS, Fong GT, Gupta PC, Quah AC, Bansal-Travers M, Sinha DN.},
  title = {Knowledge of health effects and intentions to quit among smokeless tobaccousers in India: findings from the International Tobacco Control Policy Evaluation (ITC) India Pilot Survey.},
  journal = {Asian Pac J Cancer Prev},
  year = {2011},
  volume = {12(5)},
  pages = {1233-8}
}
Ravindran G, Devaraj H Aberrant expression of ?-catenin and its association with ?Np63, Notch-1, and clinicopathological factors in oral squamous cell carcinoma. 2012 Clin Oral Investig
Vol. 16(4), pp. 1275-88 
article DOI  
Abstract: The present study focuses on the correlation between the expression pattern of ?-catenin (component of Wnt signaling), ?Np63 (proliferation marker), and Notch 1 (transmembrane receptor) in oral squamous cell carcinoma. The study also aims to investigate the interaction between ?-catenin and ?Np63 in oral cancer. Furthermore, we also analyzed the prognostic significance of ?-catenin, ?Np63, and Notch 1 in oral squamous cell carcinoma. Immunohistochemical analysis of ?-catenin, ?Np63, and Notch 1 were done in 62 cases of oral squamous cell carcinoma. Co-immunoprecipitation analysis was done to study the possible interaction between ?-catenin and ?Np63 in oral cancer. Kaplan-Meier method was used to estimate overall and disease-free survival, and the Log-rank test was used to compare the resulting curves. Statistically significant positive correlation was found between the localization of ?-catenin and the expression of ?Np63 (p = 0.001**, r (s) = 0.427), whereas, no significant association was found between the expression pattern of ?-catenin and Notch 1. Interestingly, interaction between ?-catenin and ?Np63 was observed in oral carcinoma. Moreover, ?-catenin and ?Np63 may be related to worst survival in oral carcinoma. Statistically significant positive association between localization of ?-catenin and expression of ?Np63 suggests that they might have dependent roles in maintaining the proliferation of oral carcinoma cells. In addition, the downregulated expression of Notch 1 was related to invasion and differentiation status of oral carcinoma cells. Furthermore, ?-catenin and ?Np63 may be used as independent prognostic markers of oral carcinoma. On the other hand, interaction of ?-catenin with ?Np63 may be a key event in maintaining the proliferation of oral carcinoma cells. The present study indicates that ?-catenin and ?Np63 may be used as independent prognostic markers of oral carcinoma and the interaction of ?-catenin with ?Np63 may be a crucial event in regulating proliferation and differentiation of oral carcinoma cells, which may be used as a target for therapeutic implications.
BibTeX:
@article{RavindranG2012,
  author = {Ravindran G, Devaraj H.},
  title = {Aberrant expression of ?-catenin and its association with ?Np63, Notch-1, and clinicopathological factors in oral squamous cell carcinoma.},
  journal = {Clin Oral Investig},
  year = {2012},
  volume = {16(4)},
  pages = {1275-88},
  doi = {http://dx.doi.org/10.1007/s00784-011-0605-0}
}
Ray JG, Ganguly M, Rao BS, Mukherjee S, Mahato B, Chaudhuri K Clinico-epidemiological profile of oral potentially malignant and malignant conditions among areca nut, tobacco and alcohol users in Eastern India: A hospital based study. 2013 J Oral Maxillofac Pathol.
Vol. 17(1), pp. 45-50 
article DOI  
Abstract: CONTEXT:
With an increase in the abuse of various oral habitual products in India over the past few decades; the incidence of oral potentially malignant conditions as leukoplakia, oral submucous fibrosis and squamous cell carcinoma (SCC) rates have also increased. No recent study has been conducted reporting the scenario of oral cancer and potentially malignant conditions in Eastern India (specifically Kolkata).
AIMS:
The present study was conducted at Dr. R. Ahmed Dental College, Kolkata during 2010-2011 to find a possible correlation between the effects of the different oral habits, age, sex and the different types of oral mucosal lesions among patients reported to the hospital. This study also enabled us to see the predilection of the various histopathological stages of the lesions for different sites of the oral cavity.
SUBJECTS AND METHODS:
The study group consisted of 698 patients having either oral potentially malignant or malignant lesion. The control group consisted of 948 patients who had reported to the hospital for different oral/dental problems and had the habit of tobacco, areca nut and/or alcohol usage for at least 1 year.
STATISTICAL ANALYSIS:
The unadjusted odds ratio, the 95% confidence interval, and the P value were calculated to correlate patients with/without different kinds of habit and having/not having various kinds of oral lesions.
RESULTS:
Our study shows that for males having the habit of taking smokeless tobacco or mixed habit poses the highest risk for developing SCC. For females, significant risk of developing SCC was found in patients habituated to processed areca nut chewing.
CONCLUSION:
This study presents probably for the first time in recent years the occurrence of oral potentially malignant and malignant conditions amongst patients having deleterious habits in a hospital based population of Kolkata.
BibTeX:
@article{RayJG2013,
  author = {Ray JG, Ganguly M, Rao BS, Mukherjee S, Mahato B, Chaudhuri K},
  title = {Clinico-epidemiological profile of oral potentially malignant and malignant conditions among areca nut, tobacco and alcohol users in Eastern India: A hospital based study.},
  journal = {J Oral Maxillofac Pathol.},
  year = {2013},
  volume = {17(1)},
  pages = {45-50},
  doi = {http://dx.doi.org/10.4103/0973-029X.110720}
}
Ray JG, Mukherjee S, Mahato B, Sripathi Rao BH, Chaudhuri K Comparative distribution of Lysyl Oxidase (G473A) and NQO1 (C609T) polymorphism among tea-garden workers (habitual chewers of betel quid) of Darjeeling district and Kolkata city of West Bengal. 2013 Contemp Clin Dent.
Vol. 4(4), pp. 476-81 
article DOI  
Abstract: CONTEXT:
Chewing of processed arecanut products with tobacco and betel quid has been attributed to many oral pathological conditions. These products are very popular among the youngsters of lower economic groups. Genetic predisposition has been now identified as a major risk factor for increasing the susceptibility toward the disease among these chewers.
AIMS:
Our study mainly aims to find out the predisposition of LOX (G473A) and NQO1 (C609T) polymorphisms and present a comparison between the population (habitually exposed to processed arecanut and smokeless tobacco products) of a metro-city Kolkata and the tea-garden workers of Darjeeling district of West Bengal.
SETTINGS AND DESIGN:
Subjects for the study was recruited from various oral health check-up camps organized in the tea-gardens of Darjeeling district and Kolkata city.
MATERIALS AND METHODS:
Genotyping analysis was done through a Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP)-based approach.
STATISTICAL ANALYSIS USED:
A two-way contingency table analysis software (JAVASTAT: http://statpages.org/ctab2 × 2.html) using 95% confidence interval was used to study the distribution of genotypes among the populations. A P < 0.05 was considered to be significant.
RESULTS:
The results indicates both the heterozygous and homozygous carriers of NQO1 C > T (609) was found to be significantly higher among the north Bengal tea-garden workers [OR 0.480 (0.280-0.82) P = 0.01; 0.218 (0.091-0.524) P = 0.0001], respectively. Interestingly CT (21% in both) and TT (8% and 7%, respectively) were found to be equally distributed in the two populations. For LOX G > A (473) a significantly higher number of Kolkata individuals were found to carry the heterozygous GA allele in individuals aged <30 years [OR 3.779 (1.684-6.547) P = 0.001]. However, none were carrier of heterozygous GA allele of Kolkata population as compared with 29% north Bengal tea-garden workers aged above 31 years.
CONCLUSIONS:
A close observation of occurrence of oral diseases over time among such a population will be helpful to identify risk genotypes responsible for betel quid-induced oral diseases.
BibTeX:
@article{RayJG2013a,
  author = {Ray JG, Mukherjee S, Mahato B, Sripathi Rao BH, Chaudhuri K},
  title = {Comparative distribution of Lysyl Oxidase (G473A) and NQO1 (C609T) polymorphism among tea-garden workers (habitual chewers of betel quid) of Darjeeling district and Kolkata city of West Bengal.},
  journal = {Contemp Clin Dent.},
  year = {2013},
  volume = {4(4)},
  pages = {476-81},
  doi = {http://dx.doi.org/10.4103/0976-237X.123047}
}
Rekha KP, Angadi PV Verrucous carcinoma of the oral cavity: a clinico-pathologic appraisal of 133 cases in Indians. 2010 Oral Maxillofac Surg
Vol. 14(4), pp. 211-8 
article DOI  
Abstract: INTRODUCTION:
Verrucous carcinoma (VC), a rare variant of squamous cell carcinoma is an established entity with distinctive morphology and specific clinical behavior. To date, only a small series of head and neck verrucous carcinomas have been reported in the literature.
MATERIALS AND METHODS:
The present study evaluated 133 cases of verrucous carcinoma for the age, sex, site of involvement, duration of disease at the time of diagnosis, associated habits and common presenting symptoms, presence of other mucosal lesions, recurrence, and the histopathology.
RESULTS AND DISCUSSION:
Verrucous carcinoma accounted for 16.08% among oral squamous cell carcinoma compared to 2-12% reported in the literature. VC was more common in males with greater predilection to buccal mucosa due to widespread use of tobacco chewing in Indian scenario. Age distribution was lower as compared to other studies with prominence in the fifth decade. Mandibular involvement was more frequent as compared to those in literature.
CONCLUSION:
Development of recurrence following radiotherapy in few cases supports anaplastic changes by radiotherapy.
BibTeX:
@article{RekhaKP2010,
  author = {Rekha KP, Angadi PV.},
  title = {Verrucous carcinoma of the oral cavity: a clinico-pathologic appraisal of 133 cases in Indians.},
  journal = {Oral Maxillofac Surg},
  year = {2010},
  volume = {14(4)},
  pages = {211-8},
  doi = {http://dx.doi.org/10.1007/s10006-010-0222-0}
}
Khanna S The interaction between tobacco use and oral health among tribes in central India. 2012 Tob Induc Dis
Vol. 10(1) 
article DOI  
Abstract: BACKGROUND:
A study was undertaken to evaluate the effect of tobacco related practices on oral health of tribes in Central India. The use of smokeless tobacco, gutkha & associated products is on the rise amongst the younger generation making oral precancer & cancer a public health concern.
METHODOLOGY:
A pioneering study was conducted to evaluate the tobacco related practices amongst tribes and its impact on oral health. The study included 411 tribals of the Baiga group. Guided dialogue techniques and proforma based evaluation formed a part of the study.
RESULT:
53.04% of individuals between 21 to 40yrs are addicted to deleterious habits. There is a marked consumption (72%) of tobacco & associated products among the geriatric population (60 yrs & above).Insecure livelihoods, malnutrition & increased stress levels contribute to the stark increase of addiction of tobacco related practices.
CONCLUSION:
The healthcare infrastructure needs to be upgraded to meet the demands of changing disease profile amongst the vulnerable population. Assessment of impact of disease on existing public health would enable formulation of adaptive measures and suggestions for amelioration.
BibTeX:
@article{S.2012,
  author = {Khanna S.},
  title = {The interaction between tobacco use and oral health among tribes in central India.},
  journal = {Tob Induc Dis},
  year = {2012},
  volume = {10(1)},
  doi = {http://dx.doi.org/10.1186/1617-9625-10-16}
}
Sabanayagam C, Shankar A The association between active smoking, smokeless tobacco, second-hand smoke exposure and insufficient sleep. 2011 Sleep Med
Vol. 12(1), pp. 7-11 
article  
Abstract: BACKGROUND:
Studies have shown that cigarette smoking is associated with sleep disorders in the general population. But studies examining the association between smokeless tobacco use, second-hand smoke exposure and insufficient rest/sleep are limited.
METHODS:
We examined the association between smoking, smokeless tobacco use (n=83,072), second-hand smoke exposure (n=28,557) and insufficient rest/sleep among adults aged ?20 years in the state-based 2008 Behavioral Risk Factor Surveillance System. Exposure to second-hand smoke was defined as >1 day of exposure to cigarette smoking either at home or in the workplace in the preceding 7 days. Insufficient rest/sleep was defined as not getting enough rest/sleep everyday in the preceding 30 days.
RESULTS:
Compared to never smokeless tobacco users, the odds ratio (OR; 95% confidence interval [CI]) of insufficient rest/sleep was 1.16 (1.00-1.36) and 1.74 (1.37-2.22) among former and current users. Compared to non-smokers/non-smokeless tobacco users, the OR (95% CI) of insufficient rest/sleep for those who were both current smokers and currentsmokeless tobacco users was 2.21 (1.66-2.94). Regarding second-hand smoke exposure among non-smokers, those with second-hand smoke exposure had higher odds for insufficient rest/sleep than those without. In contrast, the odds of insufficient rest/sleep were similar among current smokers with or without second-hand smoke exposure.
CONCLUSIONS:
In a multiethnic sample of US adults, compared to non-smokers/non-smokeless tobacco users, those who were both current smokers and current smokeless tobacco users had twice the odds of insufficient sleep. Second-hand smoke exposure was associated with insufficient rest/sleep among non-smokers.
BibTeX:
@article{SabanayagamC2011,
  author = {Sabanayagam C, Shankar A.},
  title = {The association between active smoking, smokeless tobacco, second-hand smoke exposure and insufficient sleep.},
  journal = {Sleep Med},
  year = {2011},
  volume = {12(1)},
  pages = {7-11}
}
Saddichha S, Rekha DP, Patil BK, Murthy P, Benegal V, Isaac MK Knowledge, attitude and practices of Indian dental surgeons towards tobaccocontrol: advances towards prevention. 2010 Asian Pac J Cancer Prev
Vol. 11(4), pp. 939-42 
article  
Abstract: AIMS AND METHODS:
We assessed the knowledge, attitude and practices of dental surgeons in the city of Bangalore, Karnataka, concerning use of tobacco in their patients. A self-administered questionnaire was administered to all dental surgeons prior to a sensitization program on nicotine dependence.
RESULTS:
The dental surgeons who responded (n=100) reported a need for increasing sensitization on the issue of tobaccoespecially among health professionals. Only 33% knew that nicotine is the most addictive drug and knowledge was poor about pharmacological as well as non pharmacological methods of treatment of nicotine dependence. Only 52% asked all their patients about tobacco use. However, almost all dental surgeons agreed that there should be a ban on public use of tobacco.
IMPLICATIONS:
The results of this study call for sensitizing health professionals on a larger scale on the issue of tobaccouse and its treatment.
BibTeX:
@article{SaddichhaS2010,
  author = {Saddichha S, Rekha DP, Patil BK, Murthy P, Benegal V, Isaac MK.},
  title = {Knowledge, attitude and practices of Indian dental surgeons towards tobaccocontrol: advances towards prevention.},
  journal = {Asian Pac J Cancer Prev},
  year = {2010},
  volume = {11(4)},
  pages = {939-42}
}
Sarkar BK, Arora M, Gupta VK, Reddy KS Determinants of tobacco cessation behaviour among smokers and smokeless tobacco users in the states of Gujarat and Andhra Pradesh, India. 2013 Asian Pac J Cancer Prev(14(3)), pp. 1931-5  article  
Abstract: BACKGROUND:
This study was undertaken to identify the socio-demographic determinants of quit attempts among smokers and smokeless tobacco users to identify correlates of tobacco cessation behaviour in India.
MATERIALS AND METHODS:
This was a cross-sectional study for the outcome of quit attempts made by current tobaccousers in last 12 months in twelve districts in two states. Simple and multivariable logistic regression analysis was used to obtain the odds ratios (ORs) of socio-demographic variables (age, gender, education, occupation, socio- economic status, community, area, type of family) and tobacco user status (smoker/smokeless).
RESULTS:
In the combined analysis, a smoker had higher predicted probability of attempting quitting (OR- 1.41,CI 1.14 -1.90), in comparison to a smokeless tobacco user and a tobacco user in the state of Gujarat was less likely to attempt quitting than a user in Andhra Pradesh (OR-0.60, CI 0.47-0.78). The probability of making a quit attempt was higher among tobacco users who were more educated (OR-1.40, CI 1.04-1.94), having a higher socio-economic status (SES) (OR-2.39, CI 1.54-3.69), and belonging to non-agricultural labourer occupational group (OR-1.90, CI 1.29-2.78). The effects were maintained even after adjusting for all other variables. In disaggregated analysis, findings were similar except in smokeless as a separate group, education level was not significantly associated with quit attempts and with lower odds (OR-0.91, CI 0.58-1.42).
CONCLUSIONS:
This is one of the first studies to provide useful insight into potential determinants for quit attempts oftobacco users in India including smokeless tobacco users, exploring the socio-demographic patterning of correlates of quit attempts.
BibTeX:
@article{SarkarBK2013,
  author = {Sarkar BK, Arora M, Gupta VK, Reddy KS.},
  title = {Determinants of tobacco cessation behaviour among smokers and smokeless tobacco users in the states of Gujarat and Andhra Pradesh, India.},
  journal = {Asian Pac J Cancer Prev},
  year = {2013},
  number = {14(3)},
  pages = {1931-5}
}
Sarkar S, Sharma A, Basu D Comparison of craving between smoked and smokeless tobacco across a variety of cue exposures. 2013 Subst Use Misuse.
Vol. 48(3) 
article DOI  
Abstract: Smokeless tobacco use is a major health issue but has received less attention in craving research. The present non-funded study aimed to assess craving associated with smokeless tobacco compared to smoked forms. Forty-eight nicotine dependent male subjects attending a deaddiction center in India were recruited. The subjects were exposed to six nicotine related and two control cues in random order for variable time durations. The urge to consume the tobacco product was rated.Tobacco-related cues produced different patterns and degrees of craving among users of smoked and smokeless tobacco. This has implications for management and drug development.
BibTeX:
@article{SarkarS2013,
  author = {Sarkar S, Sharma A, Basu D.},
  title = {Comparison of craving between smoked and smokeless tobacco across a variety of cue exposures.},
  journal = {Subst Use Misuse.},
  year = {2013},
  volume = {48(3)},
  doi = {http://dx.doi.org/10.3109/10826084.2012.752851}
}
Satheeshkumar PS, Mohan MP Malignant potential of oral submucous fibrosis due to intraoral extraction wounds and poor oral hygiene. 2014 Oral Oncol.
Vol. 50(1), pp. 5-6 
article DOI  
BibTeX:
@article{SatheeshkumarPS2014,
  author = {Satheeshkumar PS, Mohan MP},
  title = {Malignant potential of oral submucous fibrosis due to intraoral extraction wounds and poor oral hygiene.},
  journal = {Oral Oncol.},
  year = {2014},
  volume = {50(1)},
  pages = {5-6},
  doi = {http://dx.doi.org/10.1016/j.oraloncology.2013.10.011}
}
Sathish T, Kannan S, Sarma PS, Thankappan KR Incidence of Tobacco Use Among Adults (15-64 Years) in Rural Kerala. 2013 Asia Pac J Public Health  article  
Abstract: We analyzed data from a cohort study in rural Kerala, India, to study the incidence of current smoking and current smokeless tobacco use. At baseline, of 452 individuals aged 15 to 64 years, 385 were current nonsmokers and 402 were current nonusers of smokeless tobacco. Over a mean follow-up of 7.1 ± 0.2 years, 5.5% became current smokers and 9.0% became current smokeless tobacco users. Among men, 21.1% (95% confidence interval [CI] = 11.1-36.4) of younger individuals (15-24 years) became current smokers and 22.2% (CI = 10.6-40.8) of older individuals (55-64 years) became current smokeless tobacco users. No women smoked both at baseline and at follow-up, but 9.7% (CI = 3.4-24.9) of older women (55-64 years) became current smokeless tobacco users. These findings call for effective implementation of India's Cigarettes and OtherTobacco Products Act, 2003.
BibTeX:
@article{SathishT2013,
  author = {Sathish T, Kannan S, Sarma PS, Thankappan KR},
  title = {Incidence of Tobacco Use Among Adults (15-64 Years) in Rural Kerala.},
  journal = {Asia Pac J Public Health},
  year = {2013}
}
Savant SC, Hegde-Shetiya S, Agarwal D, Shirhatti R, Shetty D Effectiveness of individual and group counseling for cessation of tobacco habit amongst industrial workers in pimpri, pune--an interventional study. 2013 Asian Pac J Cancer Prev
Vol. 14(2), pp. 1133-9 
article  
Abstract: BACKGROUND:
In India, tobacco consumption is responsible for one of the highest rates of oral cancer in the world, the annual oral cancer incidence is steadily increasing among young tobacco users. Studies have documented efforts taken by physicians, doctors and even dentists, in the form of individual or group counseling to curb tobacco use in smoke orsmokeless form. However, which one is more effective, still remains an unanswered question. The aim of the study was to compare the effectiveness of individual and group counseling for cessation of the tobacco habit amongst industrial workers in Pune and to compare quit rates.
MATERIALS AND METHODS:
An interventional study design was selected for 150 industrial workers which were stratified randomly into three groups (control, individual and group counseling groups) and interventions were provided to individual and group counseling groups over a period of six months, which were then compared with the control group that received brief intervention at the start of the study.
RESULTS:
There was significant difference in the quit rates of the participants in the individual counseling group (ICG) and group counseling group (GCG) when compared at 6 months with the control counseling group (CCG). In the individual counseling group was 6% while in group counseling group it was 7.5% after six months of counseling.
CONCLUSIONS:
No conclusion could be drawn whether individual or group counseling were better interms of quit rates. Individual and group counseling groups were definitely better than the control group when compared at 3 and 6 months, respectively.
BibTeX:
@article{SavantSC2013,
  author = {Savant SC, Hegde-Shetiya S, Agarwal D, Shirhatti R, Shetty D.},
  title = {Effectiveness of individual and group counseling for cessation of tobacco habit amongst industrial workers in pimpri, pune--an interventional study.},
  journal = {Asian Pac J Cancer Prev},
  year = {2013},
  volume = {14(2)},
  pages = {1133-9}
}
Sehgal S, Kaul S, Gupta BB, Dhar MK Risk factors and survival analysis of the esophageal cancer in the population of Jammu, India. 2012 Indian J Cancer.
Vol. 49(2), pp. 245-50 
article DOI  
Abstract: OBJECTIVE:
To identify the risk factors of esophageal cancer and study their effect on the survival rates patients of Jammu region, India.
MATERIALS AND METHODS:
Detailed information was collected on socio-demographic, dietary and clinico-pathological parameters for 200 case control pairs. Discrete (categorical) data of 2 independent groups (control and cases) were summarized in frequency (%) and compared by using Chi-square (?2 ) test. The mean age of two independent groups was compared by independent Student's t-test. To find out potential risk factor (s), the variable (s) found significant in univariate analysis were further subjected to multivariate logistic regression analysis. The association of potential risk factors with patients survival (3-year overall survival) was done by Kaplan-Meier survival curve analysis using Log-rank test. A 2-tailed (a = 2) P < 0.05 was considered statistically significant.
RESULTS:
Out of the 63 response parameters, seven were found highly significant on multivariate analysis. The mean (± SD) age was 56.74 ± 10.76 years, the proportions of males were higher than females, mostly illiterate and lower income group. Among dietary characteristics, snuff was highest (OR = 3.86, 95% CI = 2.46-6.08) followed by salt tea (OR = 2.53, 95% CI = 1.49-4.29), smoking (OR = 1.97, 95% CI = 1.18-3.30), sundried food (OR = 1.77, 95% CI = 1.10-2.85) and red chilly (OR = 1.76, 95% CI = 1.07-2.89). Probability of survival lowered significantly (P < 0.05 or P < 0.01 or P < 0.001) in those consumingtobacco in the form of snuff (Log-rank c 2 = 24.62, P = 0.000) and smoking (Log-rank c 2 = 5.20, P = 0.023) as compared to those who did not take these.
CONCLUSIONS:
The analysis finally established snuff (smokeless tobacco) as the most powerful risk factor of esophageal cancer in Jammu region, followed by the salt tea, smoking and the sundried food.
BibTeX:
@article{SehgalS2012,
  author = {Sehgal S, Kaul S, Gupta BB, Dhar MK.},
  title = {Risk factors and survival analysis of the esophageal cancer in the population of Jammu, India.},
  journal = {Indian J Cancer.},
  year = {2012},
  volume = {49(2)},
  pages = {245-50},
  doi = {http://dx.doi.org/10.4103/0019-509X.102921}
}
Sehgal VN, Sehgal S, Oberai R, Verma P, Sharma S, Pahwa P, Dogra S Oral squamous cell carcinoma of the mandibular region presenting as multiple discharging sinuses: imperative of magnetic resonance imaging and computerized tomography. 2013 Skinmed.
Vol. 11(3), pp. 181-4 
article  
Abstract: A 40-year-old woman presented with red swelling of the right mandibular region of the face. She had several painful, progressive, ulcerative, raised serosanguinous discharging sinuses. The presence of granules and bony contents were not reported. She was an habitual tobacco and betel chewer for the past 20 years. There was no history of injury/trauma over the site in the past. Progressive loss of appetite and body weight was prominent. She was nonambulatory and denied treatment.
BibTeX:
@article{SehgalVN2013,
  author = {Sehgal VN, Sehgal S, Oberai R, Verma P, Sharma S, Pahwa P, Dogra S},
  title = {Oral squamous cell carcinoma of the mandibular region presenting as multiple discharging sinuses: imperative of magnetic resonance imaging and computerized tomography.},
  journal = {Skinmed.},
  year = {2013},
  volume = {11(3)},
  pages = {181-4}
}
Sellappa S, Balakrishnan M, Raman S, Palanisamy S Induction of micronuclei in buccal mucosa on chewing a mixture of betel leaf, areca nut and tobacco. 2009 J Oral Sci, pp. 289-92  article  
Abstract: Betel quid containing areca nut and chewing tobacco is used in many parts of India. In this study we evaluated the micronuclei (MN) in buccal mucosa of healthy individuals from southern India, who were regularly chewing a mixture of betel leaf, areca nut and tobacco. A total of 44 subjects were examined. The study population included 15 chewers, 14 chewers with smoking habit and 15 controls with the mean age of 38.57 +/- 0.54, 34.50 +/- 0.95, and 33.28 +/- 0.89 years, respectively. The mean percentage of MN was 1.90 +/- 1.03 in chewers, 2.00 +/-1.12 in chewers with smoking habits and 0.81 +/- 0.66 in controls. There was no significant difference between the mean percentages of the two experimental groups. It can be concluded that a mixture of betel leaf, areca nut, and tobacco is unsafe for oral health.
BibTeX:
@article{SellappaS2009,
  author = {Sellappa S, Balakrishnan M, Raman S, Palanisamy S.},
  title = {Induction of micronuclei in buccal mucosa on chewing a mixture of betel leaf, areca nut and tobacco.},
  journal = {J Oral Sci},
  year = {2009},
  pages = {289-92}
}
Shah KA, Karnes HT A review of the analysis of tobacco-specific nitrosamines in biological matrices. 2010 Crit Rev Toxicol.
Vol. 40(4), pp. 305-27 
article DOI  
Abstract: Tobacco use constitutes a leading cause of mortality and morbidity worldwide. Tobacco-specific nitrosamines (TSNAs) are an important class of biomarkers for tobacco carcinogen uptake. The current review focuses on the issues and developments in analysis of these compounds in human biological matrices. The two most widely used techniques for TSNA bioanalysis are gas chromatography coupled with thermal energy analysis and liquid chromatography coupled with mass spectrometry, employing various sample preparation techniques. The review provides an overview of the tools and techniques currently available for TSNA bioanalysis that will help towards the ultimate goal of understanding the mechanisms of cancer caused by the use of tobacco products. A contrast and comparison of the important aspects of bioanalysis such as sample preparation, compound detection, and throughput is discussed for the thermal energy analysis- and mass spectrometry-based techniques. Complex sample extraction procedures, throughput, and the ability to validate are important issues of concern for the gas chromatography-thermal energy analysis-based methods. On the other hand, addressing ion suppression matrix effects remains an important challenge for hyphenated mass spectrometry-based methods. The review also provides an extensive summary of analytical procedures for various studies measuring tobacco-specific nitrosamines in different biological matrices.
BibTeX:
@article{ShahKA2010,
  author = {Shah KA, Karnes HT.},
  title = {A review of the analysis of tobacco-specific nitrosamines in biological matrices.},
  journal = {Crit Rev Toxicol.},
  year = {2010},
  volume = {40(4)},
  pages = {305-27},
  doi = {http://dx.doi.org/10.3109/10408440903394435}
}
Sharma A, Das BC, Sehgal A, Mehrotra R, Kar P, Sardana S, Phukan R, Mahanta J, Purkayastha J, Saxena S, Kapur S, Chatterjee I, Sharma JK GSTM1 and GSTT1 polymorphism and susceptibility to esophageal cancer in high- and low-risk regions of India. 2013 Tumour Biol.
Vol. 34(5), pp. 3249-57 
article DOI  
Abstract: Glutathione transferases, a super family of dimeric phase II metabolic enzymes play a vital role in biotransformation of many substances. This study evaluates the influence of genetic polymorphism of GSTM1 and GSTT1 gene loci on esophageal cancer risk in Assam and Delhi from India. DNA from blood samples of esophageal cancer cases (203,112) and controls (286,150) from Assam and Delhi, respectively, were extracted. GSTM1 and GSTT1 polymorphisms were analyzed by multiplex PCR procedure. Differences in proportions were tested using Pearson's chi-square test with odds ratio (OR) and 95 % confidence interval (CI). Risk of esophageal cancer was approximately twice in individuals having homozygous GSTM1 (OR-2.1, 95 % CI, 1.44-3.13) and GSTT1 null genotypes (OR-1.7,95 % CI, 0.99-2.77) in Assam, and around three times in GSTT1 null genotype (OR-2.9, 95 % CI, 1.56-5.27) in Delhi population. GSTM1 null genotype seems to play a protective role (OR-0.7, 95 % CI, 0.39-1.27) in Delhi. A significant association of GSTM1 null genotype with esophageal cancer was observed in a younger age group in Assam (OR-2.7, 95 % CI, 1.48-5.01), and in Delhi population association was observed in smokers with GSTT1 null genotype (OR-2.5, 95 % CI, 1.04-6.07), and alcoholics having GSTM1 null genotype (OR-2.6, 95 % CI, 0.99-6.77). Significant association of GSTM1 null genotype in Assam was observed between cancer cases and controls in fermented betel nut chewers only (OR-2.8, 95 % CI, 1.19-6.72), whereas, smoking and alcohol failed to show any correlation with GSTM1/GSTT1 genotypes. Cancer development is not only due to exogenous or endogenous carcinogens but depends on their interaction with genes that are involved in the detoxification of these carcinogens.
BibTeX:
@article{SharmaA2013,
  author = {Sharma A, Das BC, Sehgal A, Mehrotra R, Kar P, Sardana S, Phukan R, Mahanta J, Purkayastha J, Saxena S, Kapur S, Chatterjee I, Sharma JK},
  title = {GSTM1 and GSTT1 polymorphism and susceptibility to esophageal cancer in high- and low-risk regions of India.},
  journal = {Tumour Biol.},
  year = {2013},
  volume = {34(5)},
  pages = {3249-57},
  doi = {http://dx.doi.org/10.1007/s13277-013-0897-6}
}
Sharma M, Bairy I, Pai K, Satyamoorthy K, Prasad S, Berkovitz B, Radhakrishnan R Salivary IL-6 levels in oral leukoplakia with dysplasia and its clinical relevance totobacco habits and periodontitis. 2011 Clin Oral Investig
Vol. 15(5), pp. 705-14 
article DOI  
Abstract: The development of oral cancer proceeds through discrete molecular changes that are acquired from loss of genomic integrity after continued exposure to environmental risk factors. It is preceded in the majority of cases by clinically evident oral potentially malignant disorders, the most common of which is leukoplakia. Early detection of these oral lesions by screening methods using suitable markers is critical as it mirrors molecular alterations, long before cancer phenotypes are manifested. Assessment of salivary interleukin-6 (IL-6) as a marker of malignant progression was undertaken in patients with leukoplakia having coexisting periodontitis (n = 20), periodontitis patients without leukoplakia (n = 20), and healthy controls (n = 20) by competitive enzyme-linked immunosorbent assay. Results showed elevation of IL-6 levels in leukoplakia with coexisting periodontitis and in periodontitis patients when compared to healthy control (P < 0.001). Within the leukoplakia group, IL-6 level was found to be increased with increase in the severity of dysplasia. The use of tobacco was seen to play a significant role in the elevation of salivary IL-6.The importance of IL-6 as a specific marker for leukoplakia with dysplasia and the role oftobacco as an independent risk factor has been highlighted.
BibTeX:
@article{SharmaM2011,
  author = {Sharma M, Bairy I, Pai K, Satyamoorthy K, Prasad S, Berkovitz B, Radhakrishnan R.},
  title = {Salivary IL-6 levels in oral leukoplakia with dysplasia and its clinical relevance totobacco habits and periodontitis.},
  journal = {Clin Oral Investig},
  year = {2011},
  volume = {15(5)},
  pages = {705-14},
  doi = {http://dx.doi.org/10.1007/s00784-010-0435-5}
}
Sharma P, Saxena S, Aggarwal P Trends in the epidemiology of oral squamous cell carcinoma in Western UP: an institutional study. 2010 Indian J Dent Res
Vol. 21(3), pp. 316-9 
article DOI  
Abstract: OBJECTIVE:
The purpose of the study was to identify trends in incidence rates of oral squamous cell carcinoma (OSCC) at specific anatomic sites or within specific age or sex groups in the Western Uttar Pradesh population.
MATERIALS AND METHODS:
The study covers the period from January 2004 through April 2009. OSCC cases were retrospectively analysed for site, age, gender and habits and the findings were formulated to chart the trends in Western U.P.
RESULTS:
The study revealed a male to female ratio of 2.2:1 with the largest number of OSCCs developing in the fourth and fifth decades of life. Overall, the most common site was the buccal mucosa (63.75%), followed by retromolar area (15%), floor of the mouth (11.25%), lateral border of the tongue (3.75%), labial mucosa (3.75%), and palate (2.5%). Smokeless tobaccohabit was more prevalent than smoking tobacco in both men as well as women. Karl - Pearson's correlation coefficient was calculated to find the degree of association between the two variables i.e. between gender to buccal mucosa and gender tosmokeless and smoking tobacco habits, which were found to be positively correlated with respect to the age.
CONCLUSION:
Oral cancer is an important cause of morbidity and mortality worldwide with an incidence rate that varies widely by geographic location. Even within one geographic location, the incidence varies among groups categorized by age, sex, site or habit.
BibTeX:
@article{SharmaP2010,
  author = {Sharma P, Saxena S, Aggarwal P.},
  title = {Trends in the epidemiology of oral squamous cell carcinoma in Western UP: an institutional study.},
  journal = {Indian J Dent Res},
  year = {2010},
  volume = {21(3)},
  pages = {316-9},
  doi = {http://dx.doi.org/10.4103/0970-9290.70782}
}
Sharma R, Grover VL, Chaturvedi S Tobacco use among adolescent students and the influence of role models. 2010 Indian J Community Med.
Vol. 35(2), pp. 272-5 
article DOI  
Abstract: BACKGROUND:
Seventy per cent of premature deaths among adults are due to behavioral patterns that emerge in adolescence, including smoking.
OBJECTIVE:
The objective was to study the prevalence of tobacco use among adolescent students in South Delhi and its epidemiological correlates.
MATERIALS AND METHODS:
This was a cross-sectional study.
SETTING:
Three schools and two colleges of South Delhi were chosen. There were 550 adolescent students aged 14-19.
STATISTICAL ANALYSIS:
Statistical analysis was done using proportions, the chi-square test, and multivariate logistic regression.
RESULTS:
A total of 88 (16.0%) students reported having ever tried cigarette or bidi smoking. The prevalence of current smoking was 7.1%. Exactly 10% (55) of the students reported having ever used smokeless forms of tobacco. The prevalence of tobacco use overall was found to be 20.9%, and was significantly higher (P=0.016) among the males than the females.Tobacco use was found to be significantly associated with having seen a brother/sister smoke (OR 5.15), best friend smoke (OR 2.92), and belonging to a nuclear family (OR 1.96).
CONCLUSIONS:
Tobacco use is still an important risk behavior among adolescent students. This study found a strong association of tobacco use by the adolescents with their having seen various role models ever smoking
BibTeX:
@article{SharmaR2010,
  author = {Sharma R, Grover VL, Chaturvedi S},
  title = {Tobacco use among adolescent students and the influence of role models.},
  journal = {Indian J Community Med.},
  year = {2010},
  volume = {35(2)},
  pages = {272-5},
  doi = {http://dx.doi.org/10.4103/0970-0218.66891}
}
Siddiqi K, Gupta PC, Prasad VM, Croucher R, Sheikh A Smokeless tobacco use by south Asians. 2013 Lancet Glob Health.  article DOI  
BibTeX:
@article{SiddiqiK2013,
  author = {Siddiqi K, Gupta PC, Prasad VM, Croucher R, Sheikh A},
  title = {Smokeless tobacco use by south Asians.},
  journal = {Lancet Glob Health.},
  year = {2013},
  doi = {http://dx.doi.org/10.1016/S2214-109X(13)70021-4}
}
Singh AP, Shah PP, Ruwali M, Mathur N, Pant MC, Parmar D Polymorphism in cytochrome P4501A1 is significantly associated with head and neck cancer risk. 2009 Cancer Invest  article DOI  
Abstract: A case control study was undertaken to investigate the association of polymorphisms in cytochrome P4501A1 (CYP1A1) with squamous cell carcinoma of head and neck (HNSCC) in North Indian population. The variant genotypes of CYP1A1*2A and CYP1A1*2C were found to be overrepresented in cases when compared to controls. The HNSCC risk also increased several folds in cases with combination of variant genotypes of CYP1A1*2A or CYP1A1*2C with null genotype of glutathione-S-transferase M1 (GSTM1), a phase II enzyme, particularly in cases who were tobacco users (smokers and tobacco chewers), demonstrating the role of gene-gene and gene-environment interactions in the development of HNSCC.
BibTeX:
@article{SinghAP2009,
  author = {Singh AP, Shah PP, Ruwali M, Mathur N, Pant MC, Parmar D.},
  title = {Polymorphism in cytochrome P4501A1 is significantly associated with head and neck cancer risk.},
  journal = {Cancer Invest},
  year = {2009},
  doi = {http://dx.doi.org/10.1080/07357900902849657}
}
Singh GP, Rizvi I, Gupta V, Bains VK Influence of smokeless tobacco on periodontal health status in local population of north India: A cross-sectional study. 2011 Dent Res J (Isfahan).
Vol. 8(4), pp. 211-20 
article DOI  
Abstract: BACKGROUND:
Limited studies have been published so far, which revealed the association of different types of smokeless tobacco on various periodontal health indicators, including mobility and furcation, on North Indian population. The present study has been undertaken to evaluate the effects of commonly used smokeless tobacco forms on periodontal health in Lucknow, North India.
METHODS:
This cross-sectional study investigated the effect of commonly used smokeless tobacco on periodontal health in local population of Lucknow, for which 2045 individuals were evaluated. Amongst them, 1069 individuals were found to be using some kind of tobacco; amongst the tobacco users, n=122 were smokers, n=657 were only using only smokeless tobacco and n=290 were using both smokeless tobacco as well as tobacco in smoking form. After completing the questionnaire, all the participants underwent clinical examination for the various clinical parameters.
RESULTS:
The impact of smokeless form of tobacco use was significantly higher on all the periodontal health indicators, viz., plaque index, gingival index, calculus, clinical attachment loss, gingival recession, mobility, furcation, lesion, and probing pocket depth. Both duration and frequency of smokeless tobacco use significantly affected the periodontal health.
CONCLUSION:
The periodontal health of the general population in the region required immediate attention as majority of subjects irrespective of their habit status had onset of clinical attachment loss and gingival recession, more so amongst thesmokeless tobacco users than smoking form of tobacco as well as than from non-tobacco users.
BibTeX:
@article{SinghGP2011,
  author = {Singh GP, Rizvi I, Gupta V, Bains VK.},
  title = {Influence of smokeless tobacco on periodontal health status in local population of north India: A cross-sectional study.},
  journal = {Dent Res J (Isfahan).},
  year = {2011},
  volume = {8(4)},
  pages = {211-20},
  doi = {http://dx.doi.org/Gul; Paan (betel quid); oral hygiene status; smokeless tobacco}
}
Singh RK, Singh S Help to quit. 2009 Br Dent J., pp. 518-9  article DOI  
BibTeX:
@article{SinghRK2009,
  author = {Singh RK, Singh S.},
  title = {Help to quit.},
  journal = {Br Dent J.},
  year = {2009},
  pages = {518-9},
  doi = {http://dx.doi.org/10.1038/sj.bdj.2009.1089}
}
Singh S, Loke YK, Spangler JG, Furberg CD Risk of serious adverse cardiovascular events associated with varenicline: a systematic review and meta-analysis. 2011 CMAJ.
Vol. 183(12), pp. 1359-66 
article DOI  
Abstract: BACKGROUND:
There have been postmarketing reports of adverse cardiovascular events associated with the use of varenicline, a widely used smoking cessation drug. We conducted a systematic review and meta-analysis of randomized controlled trials to ascertain the serious adverse cardiovascular effects of varenicline compared with placebo among tobaccousers.
METHODS:
We searched MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, websites of regulatory authorities and registries of clinical trials, with no date or language restrictions, through September 2010 (updated March 2011) for published and unpublished studies. We selected double-blind randomized controlled trials of at least one week's duration involving smokers or people who used smokeless tobacco that reported on cardiovascular events (ischemia, arrhythmia, congestive heart failure, sudden death or cardiovascular-related death) as serious adverse events asociated with the use of varenicline.
RESULTS:
We analyzed data from 14 double-blind randomized controlled trials involving 8216 participants. The trials ranged in duration from 7 to 52 weeks. Varenicline was associated with a significantly increased risk of serious adverse cardiovascular events compared with placebo (1.06% [52/4908] in varenicline group v. 0.82% [27/3308] in placebo group; Peto odds ratio [OR] 1.72, 95% confidence interval [CI] 1.09-2.71; I(2) = 0%). The results of various sensitivity analyses were consistent with those of the main analysis, and a funnel plot showed no publication bias. There were too few deaths to allow meaningful comparisons of mortality.
INTERPRETATION:
Our meta-analysis raises safety concerns about the potential for an increased risk of serious adverse cardiovascular events associated with the use of varenicline among tobacco users.
BibTeX:
@article{SinghS2011,
  author = {Singh S, Loke YK, Spangler JG, Furberg CD.},
  title = {Risk of serious adverse cardiovascular events associated with varenicline: a systematic review and meta-analysis.},
  journal = {CMAJ.},
  year = {2011},
  volume = {183(12)},
  pages = {1359-66},
  doi = {http://dx.doi.org/10.1503/cmaj.110218}
}
Singh SP, Deshmukh A, Chaturvedi P, Murali Krishna C In vivo Raman spectroscopic identification of premalignant lesions in oral buccal mucosa. 2012 J Biomed Opt
Vol. 17(10) 
article DOI  
Abstract: Cancers of oral cavities are one of the most common malignancies in India and other south-Asian countries. Tobacco habits are the main etiological factors for oral cancer. Identification of premalignant lesions is required for improving survival rates related to oral cancer. Optical spectroscopy methods are projected as alternative/adjunct for cancer diagnosis. Earlier studies have demonstrated the feasibility of classifying normal, premalignant, and malignant oral ex-vivo tissues. We intend to evaluate potentials of Raman spectroscopy in detecting premalignant conditions. Spectra were recorded from premalignant patches, contralateral normal (opposite to tumor site), and cancerous sites of subjects with oral cancers and also from age-matched healthy subjects with and without tobacco habits. A total of 861 spectra from 104 subjects were recorded using a fiber-optic probe-coupled HE-785 Raman spectrometer. Spectral differences in the 1200- to 1800-cm-1 region were subjected to unsupervised principal component analysis and supervised linear discriminant analysis followed by validation with leave-one-out and an independent test data set. Results suggest that premalignant conditions can be objectively discriminated with both normal and cancerous sites as well as from healthy controls with and without tobacco habits. Findings of the study further support efficacy of Raman spectroscopic approaches in oral-cancer applications.
BibTeX:
@article{SinghSP2012,
  author = {Singh SP, Deshmukh A, Chaturvedi P, Murali Krishna C},
  title = {In vivo Raman spectroscopic identification of premalignant lesions in oral buccal mucosa.},
  journal = {J Biomed Opt},
  year = {2012},
  volume = {17(10)},
  doi = {http://dx.doi.org/10.1117/1.JBO.17.10.105002}
}
Sinha DN, Gupta PC, Ray C, Singh PK Prevalence of smokeless tobacco use among adults in WHO South-East Asia. 2012 Indian J Cancer  article DOI  
Abstract: Smokeless tobacco (SLT) use is an understudied problem in South-East Asia. Information on SLT use among the adult population was collected from various available sources. SLT use prevalence varies among countries in the region. The prevalence of SLT use is known for all countries at national level in the region with the exception of Bhutan and DPR Korea. For Bhutan, data pertains to Thimphu only. There is no available data on SLT use for DPR Korea. Using all available data from Bhutan, India, Myanmar, Nepal, and Sri Lanka, SLT use was found to be higher among males as compared to females; however, in Bangladesh, Indonesia, and Thailand, SLT use was higher among females as compared to males. Among males, prevalence of SLT use varied from 51.4% in Myanmar to 1.1% in Thailand. Among females, the prevalence of SLT use varied from 27.9% in Bangladesh to 1.9% in Timor-Leste. The prevalence also varies in different parts of countries. For instance, the prevalence of current use of SLT in India ranges from 48.7% in Bihar to 4.5% in Himachal Pradesh. In Thailand, prevalence of current use of tobacco use varies from 0.8% in Bangkok to over 4% in the northern (4.1%) and northeastern (4.7%) region. Among all SLT products, betel quid was the most commonly used product in most countries including Bangladesh (24.3%) and Thailand (1.8%). However, Khaini (11.6%) chewing was practiced most commonly in India. Nearly 5% of the adult population used tobacco as dentifrice in Bangladesh and India. SLT is more commonly used in rural areas and among disadvantaged groups. Questions from standard "Tobacco Questions for Surveys (TQS)" need to be integrated in routine health system surveys in respective countries to obtain standardized tobacco use data at regular intervals that will help in providing trends of SLT use in countries.
BibTeX:
@article{SinhaDN2012,
  author = {Sinha DN, Gupta PC, Ray C, Singh PK.},
  title = {Prevalence of smokeless tobacco use among adults in WHO South-East Asia.},
  journal = {Indian J Cancer},
  year = {2012},
  doi = {http://dx.doi.org/10.4103/0019-509X.107726}
}
Sinha DN, Palipudi KM, Rolle I, Asma S, Rinchen S Tobacco use among youth and adults in member countries of South-East Asia region: review of findings from surveys under the Global Tobacco Surveillance System. 2011 Indian J Public Health
Vol. 55(3), pp. 169-76 
article DOI  
Abstract: BACKGROUND:
This paper examines the prevalence of current tobacco use among youth and adults in selected member countries of the South-East Asia Region using the data from school and household-based surveys included in the GlobalTobacco Surveillance System.
MATERIALS AND METHODS:
Global Youth Tobacco Survey (GYTS) data (years 2007-2009) were used to examine currenttobacco use prevalence among youth, whereas Global Adult Tobacco Survey (GATS) data (years 2009-2010) were used to examine the prevalence among adults. GYTS is a school-based survey of students aged 13-15, using a two-stage cluster sample design, and GATS is a household survey of adults age 15 and above using a multi-stage stratified cluster design. Both surveys used a standard protocol for the questionnaire, data collection and analysis.
RESULTS:
Prevalence of current tobacco use among students aged 13-15 varied from 5.9% in Bangladesh to 56.5% in Timor-Leste, and the prevalence among adults aged 15 and above was highest in Bangladesh (43.3%), followed by India (34.6%) and Thailand (27.2%). Reported prevalence was significantly higher among males than females for adults and youth in all countries except Bangladesh, Sri Lanka and Timor-Leste. Current use of tobacco other than manufactured cigarettes was notably higher than current cigarette smoking among youth aged 13-15 years in most countries of the Region, while the same was observed among adults in Bangladesh, India and Thailand, with most women in those countries, and 49% of men in India, usingsmokeless tobacco.
CONCLUSION:
Tobacco use among youth and adults in member countries of the region is high and the pattern of tobaccoconsumption is complex. Tobacco products other than cigarettes are commonly used by youth and adults, as those products are relatively cheaper than cigarettes and affordable for almost all segments of the population. As a result, use of locally produced smoked and smokeless tobacco products is high in the region. Generating reliable data on tobacco use and keytobacco control measures at regular intervals is essential to better understand and respond with effective tobacco control intervention.
BibTeX:
@article{SinhaDN2011,
  author = {Sinha DN, Palipudi KM, Rolle I, Asma S, Rinchen S},
  title = {Tobacco use among youth and adults in member countries of South-East Asia region: review of findings from surveys under the Global Tobacco Surveillance System.},
  journal = {Indian J Public Health},
  year = {2011},
  volume = {55(3)},
  pages = {169-76},
  doi = {http://dx.doi.org/10.4103/0019-557X.89946}
}
Sinha RJ, Singh V, Sankhwar SN, Dalela D Donor site morbidity in oral mucosa graft urethroplasty: implications of tobaccoconsumption. 2009 BMC Urol  article DOI  
Abstract: BACKGROUND:
The purpose of this prospective study was to evaluate the donor site morbidity in patients who have undergone oral mucosa graft urethroplasty for stricture of the urethra. The impact of smoking and oral consumption of tobaccoand/or paan masala on the donor site was also assessed. This study is probably the first of its kind where the affect of smoking, paan masala and tobacco chewing on the donor site morbidity has been documented.
METHODS:
Forty-eight patients suffering from stricture of the urethra underwent oral mucosa graft urethroplasty between July 2005 and December 2007. The patients were divided into two groups (users or non-users) based on tobacco consumption and oral hygiene. The donor site was evaluated at frequent intervals for pain, swelling, numbness, bleeding, salivation and tightness of mouth.
RESULTS:
Donor site morbidity was more in users with poor oral hygiene. Pain scores were higher amongst the users and the morbidity persisted longer in the users compared to non-users with good oral hygiene.
CONCLUSION:
Patients who consume tobacco and have poor oral hygiene should be warned regarding poorer outcomes after oral mucosa graft urethroplasty.
BibTeX:
@article{SinhaRJ2009,
  author = {Sinha RJ, Singh V, Sankhwar SN, Dalela D.},
  title = {Donor site morbidity in oral mucosa graft urethroplasty: implications of tobaccoconsumption.},
  journal = {BMC Urol},
  year = {2009},
  doi = {http://dx.doi.org/10.1186/1471-2490-9-15}
}
Sreedhar G, Narayanappa Sumalatha M, Shukla D An overview of the risk factors associated with multiple oral premalignant lesions with a case report of extensive field cancerization in a female patient. 2014 Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub.  article DOI  
Abstract: BACKGROUND:
Field cancerization is a well-known and well-documented process of malignant transformation first coined by Slaughter et al. in 1953. Tobacco chewing was associated with the greatest increase in the risk of multiple oral premalignant lesions and may be the major source of field cancerization of the oral cavity in the Indian population. The field cancerization will probably help clinicians in complementing evaluation of pathologic biopsy specimens.
MATERIAL AND METHODS:
We present a case report of field cancerization in a 63-year-old Indian female. She presented with an intra-oral generalized hyperkeratotic verruciform type white lesions involving right and left buccal mucosa, lower labial mucosa, upper and lower vestibule, dorsal, ventral and right lateral border of the tongue, hard and soft palate. Microscopic examination revealed features of verrucous carcinoma in one area, squamous cell carcinoma in another and carcinoma in situ in other areas. Based on the overall features in various areas of the oral cavity, the lesion was diagnosed as field cancerization.
CONCLUSION:
Reviewing the literature revealed the presence of a field with genetically altered cells appear to be induced bytobacco (smoking/smokeless form). The large number of premalignant cells in the fields may increase cancer risk considerably. Thus screening and monitoring of the field may have serious implications for oral cancer prevention.
BibTeX:
@article{SreedharG2014,
  author = {Sreedhar G, Narayanappa Sumalatha M, Shukla D},
  title = {An overview of the risk factors associated with multiple oral premalignant lesions with a case report of extensive field cancerization in a female patient.},
  journal = {Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub.},
  year = {2014},
  doi = {http://dx.doi.org/10.5507/bp.2013.092}
}
Srivastava M, Parakh P Predictors and prevalence of nicotine use in females: A village-based community study. 2010 Ind Psychiatry J
Vol. 19(2), pp. 125-9 
article DOI  
Abstract: BACKGROUND:
Nicotine use and abuse is gaining increasing attention due to its negative and serious medical consequences. Multiple morbidities occur due to the intake of nicotine in various forms.
AIMS:
To find the prevalence and type of nicotine use/abuse in females.
SETTINGS AND DESIGN:
House to house survey in a village in Purvanchal, i.e. eastern part of Uttar Pradesh and bordering Bihar.
MATERIALS AND METHODS:
Semi-structured performa was used to collect data; a house to house visit was made to collect data.
STATISTICAL ANALYSIS:
Simple percentages were calculated.
RESULTS:
Tooth powder form of nicotine use is common and the need to address this problem is urgent.
CONCLUSIONS:
Widespread dissemination of knowledge and legislative measures have to be undertaken to stop the problem.
BibTeX:
@article{SrivastavaM2010,
  author = {Srivastava M, Parakh P},
  title = {Predictors and prevalence of nicotine use in females: A village-based community study.},
  journal = {Ind Psychiatry J},
  year = {2010},
  volume = {19(2)},
  pages = {125-9},
  doi = {http://dx.doi.org/10.4103/0972-6748.90344}
}
Srivastava S, Malhotra S, Harries AD, Lal P, Arora M Correlates of tobacco quit attempts and cessation in the adult population of India: secondary analysis of the Global Adult Tobacco Survey, 2009-10. 2013 BMC Public Health., pp. 263  article DOI  
Abstract: BACKGROUND:
Nearly 275 million adults (15 years and above) use tobacco in India, which contributes substantially to potentially preventable morbidity and mortality. There is good evidence from developed country settings that use of tobaccocessation services influences intention to quit, with a higher proportion of attempts being successful in fully quitting. There is little evidence about cessation and quitting behaviour in the Indian context. This study assesses the socio-demographic characteristics and cessation services used by adults i) who attempted to quit smoked and smokeless tobacco and ii) who were successful in quitting.
METHODS:
The study was a cross-sectional secondary data analysis of the Global Adult Tobacco Survey, India, 2009-10. There were 25,175 ever tobacco users aged 21 years and above included in the study. Bivariate and multivariate logistic regression analysis was done to determine associations between socio-demographic variables and cessation services utilized with attempts to quit tobacco and successful quitting.
RESULTS:
Of the ever tobacco users, 10,513 (42%) made an attempt to quit tobacco, and of these 4,395 (42%) were successful. Significant associations were demonstrated between male gender, increasing educational attainment and higher asset quintiles for both those who attempted to quit and those who were successful. Younger age groups had higher odds of quit attempts than all except the oldest age group, but also had the lowest odds of successful quitting. Heath care provider advice was positively associated with attempts to quit, but both advice and use of cessation aids were not associated with successful quitting.
CONCLUSIONS:
This study provides the first national evidence on the relationships between quitting attempts and successful quitting with socio-demographic characteristics, health care provider advice and use of cessation services. The findings of the study have important implications for scaling up tobacco cessation services in India, and indicate a need to re-examine in greater detail the effects of socio-demographic factors, type of tobacco product used and levels of dependency on quitting. Health system factors such as coverage and accessibility of cessation services, type of service, and its duration and follow up also have to be examined in detail to ascertain effects on quitting behavior.
BibTeX:
@article{SrivastavaS2013,
  author = {Srivastava S, Malhotra S, Harries AD, Lal P, Arora M.},
  title = {Correlates of tobacco quit attempts and cessation in the adult population of India: secondary analysis of the Global Adult Tobacco Survey, 2009-10.},
  journal = {BMC Public Health.},
  year = {2013},
  pages = {263},
  doi = {http://dx.doi.org/10.1186/1471-2458-13-263}
}
Tandon A, Singh NN, Sreedhar G Revealing anti-cariogenic efficacy of smokeless tobacco: A pilot study. 2013 J Oral Maxillofac Pathol.
Vol. 17(1), pp. 57-60 
article DOI  
Abstract: BACKGROUND:
The tobacco plant, Nicotiana tabacum, has been responsible for more deaths than any other herb. However, the literature has also been endowed with its use as "holy herb" since the pre-Columbian era. Used for treating pain, poisonous bites, ulcers, nasal polyps, and basal cell carcinoma; it also acts as an important ingredient of commercially available toothpastes; and even used as tobacco vaccines against Streptococcus species as highlighted in the literature.
AIMS AND OBJECTIVES:
(1) To elicit the anti-microbial property of tobacco against Streptococcus mutans, if any, in rawsmokeless tobacco. (2) To study the relationship of duration and growth inhibition efficacy of smokeless tobacco.
MATERIALS AND METHODS:
Extracts were prepared by centrifugation of mixed raw smokeless tobacco with Ringer's lactate solution and with saliva. The extracts were placed in wells prepared on Mitis salivarius culture plate and incubated at 37°C for 24 h after 0 h, 1 h, and 2 h of extract preparation. The inhibition zones were measured on the underside of plate using the vernier calipers.
RESULTS:
Smokeless tobacco has a statistically significant zone of inhibition, which proves its anti-microbial activity against S. mutans. However, the mean zones of inhibition were greater for Ringer's lactate and tobacco group as compared to test samples (saliva and tobacco) with subsequent reduction of inhibition zones with an increase in duration.
CONCLUSION:
The anti-microbial property of extensive tobacco resources can be utilized from their extracts in order to balance the deterioration it had caused to mankind.
BibTeX:
@article{TandonA2013,
  author = {Tandon A, Singh NN, Sreedhar G},
  title = {Revealing anti-cariogenic efficacy of smokeless tobacco: A pilot study.},
  journal = {J Oral Maxillofac Pathol.},
  year = {2013},
  volume = {17(1)},
  pages = {57-60},
  doi = {http://dx.doi.org/10.4103/0973-029X.110727}
}
Thakur JS, Prinja S, Bhatnagar N, Rana S, Sinha DN Socioeconomic inequality in the prevalence of smoking and smokeless tobaccouse in India. 2013 Asian Pac J Cancer Prev.
Vol. 14(11), pp. 6965-9 
article  
Abstract: BACKGROUND:
Tobacco consumption has been identified as the single biggest cause of inequality in morbidity and mortality. Understanding pattern of socioeconomic equalities in tobacco consumption in India will help in designing targeted public health control measures.
MATERIALS AND METHODS:
Nationally representative data from the India Global Adult Tobacco Survey (GATS) conducted in 2009-2010 was analyzed. The survey provided information on 69,030 respondents aged 15 years and above. Data were analyzed according to regions for estimating prevalence of current tobacco consumption (both smoking and smokeless) across wealth quintiles. Multiple logistic regression analysis predicted the impact of socioeconomic determinants on both forms of current tobacco consumption adjusting for other socio-demographic variables.
RESULTS:
Trends of smoking and smokeless tobacco consumption across wealth quintiles were significant in different regions of India. Higher prevalence of smoking and smokeless tobacco consumption was observed in the medium wealth quintiles. Risk of tobacco consumption among the poorest compared to the richest quintile was 1.6 times higher for smoking and 3.1 times higher for smokeless forms. Declining odds ratios of both forms of tobacco consumption with rising education were visible across regions. Poverty was a strong predictor in north and south Indian region for smoking and in all regions forsmokeless tobacco use.
CONCLUSIONS:
Poverty and poor education are strong risk factors for both forms of tobacco consumption in India. Public health policies, therefore, need to be targeted towards the poor and uneducated.
BibTeX:
@article{ThakurJS2013,
  author = {Thakur JS, Prinja S, Bhatnagar N, Rana S, Sinha DN},
  title = {Socioeconomic inequality in the prevalence of smoking and smokeless tobaccouse in India.},
  journal = {Asian Pac J Cancer Prev.},
  year = {2013},
  volume = {14(11)},
  pages = {6965-9}
}
Torwane NA, Hongal S, Sahu RN, Saxena V, Chandrashekhar BR Assessment of prevalence of tobacco consumption among psychiatric inmates residing in Central Jail, Bhopal, Madhya Pradesh, India: A cross-sectional survey. 2013 Ind Psychiatry J.
Vol. 22(2), pp. 161-4 
article DOI  
Abstract: AIM:
The aim of the current cross-sectional study was to assess the prevalence of tobacco consumption among psychiatric jail patients residing in Central Jail, Bhopal, Madhya Pradesh, India.
MATERIALS AND METHODS:
The study subjects consisted of prediagnosed psychiatric patients residing in Central Jail, Bhopal, Madhya Pradesh, India. A matched control consisting of cross-section of the population, that is, jail inmates residing in the same Central Jail locality was also assessed to compare the psychiatric subjects. An 18 item questionnaire was used to assess the prevalence of tobacco consumption among study subjects.
RESULTS:
The total number of subjects examined was 244, which comprised of 122 psychiatric inmates and 122 nonpsychiatric inmates. Among all psychiatric inmates, about 57.4% of inmates had a diagnosis of depression, 14.8% had psychotic disorders (such as schizophrenia), and 12.3% had anxiety disorder. A total of 77% study inmates, which comprised of 87.7% psychiatrics and 66.4% nonpsychiatrics had a habit of tobacco consumption (smokeless or smoking).
CONCLUSION:
The information presented in this study adds to our understanding of the common tobacco related practices among psychiatric inmate population. Efforts to increase patient awareness of the hazards of tobacco consumption and to eliminate the habit are needed to improve oral and general health of the prison population.
BibTeX:
@article{TorwaneNA2013,
  author = {Torwane NA, Hongal S, Sahu RN, Saxena V, Chandrashekhar BR},
  title = {Assessment of prevalence of tobacco consumption among psychiatric inmates residing in Central Jail, Bhopal, Madhya Pradesh, India: A cross-sectional survey.},
  journal = {Ind Psychiatry J.},
  year = {2013},
  volume = {22(2)},
  pages = {161-4},
  doi = {http://dx.doi.org/10.4103/0972-6748.132937}
}
Verma S, Yadav S, Singh I Trace metal concentration in different Indian tobacco products and related health implications. 2010 Food Chem Toxicol
Vol. 48(8-9) 
article DOI  
Abstract: Concentrations of seven heavy metals, viz. Cd, Ni, Pb, Cr, Cu, Fe and Zn were determined in 30 samples of various brands of five different tobacco product types easily available in Indian markets. Three product types cigarettes, cigars and biri (tobaccorolled in dry leaf and smoked without filter) are consumed by smoking while chewing tobacco and snuff are consumed by chewing and sniffing, respectively. The metal content showed smoking and non-smoking type, brand and element specific variations. In the non-smoking type, chewing tobacco samples contained more heavy metals compared to snuff samples. Biri showed minimum metal content compared to cigarettes and cigars among the smoking types. This could be due to the metal enrichment during both chemical and physical processing in finished product; biri being the most raw and cheap product. The intra brand variations also indicate the same as the processing technologies are exclusive and different for each brand. The results are nearly comparable to the existing data with limited exceptions. We suggest that the smoke and ash produced could be significant contributor to metal load in the soil, air and water systems in addition to the adverse human health effects via direct tobacco consumption.
BibTeX:
@article{VermaS2010,
  author = {Verma S, Yadav S, Singh I.},
  title = {Trace metal concentration in different Indian tobacco products and related health implications.},
  journal = {Food Chem Toxicol},
  year = {2010},
  volume = {48(8-9)},
  doi = {http://dx.doi.org/10.1016/j.fct.2010.05.062}
}
Vijaya L, Asokan R, Panday M, Choudhari NS, Ramesh SV, Velumuri L, Boddupalli SD, Sunil GT, George R Baseline Risk Factors for Incidence of Blindness in a South Indian Population- The Chennai Eye Disease Incidence Study. 2014 Invest Ophthalmol Vis Sci.  article DOI  
Abstract: Purpose: To report the baseline risk factors and causes for the incident blindness. Methods: Six-years after the baseline study, 4419 subjects from the cohort underwent a detailed examination at the base hospital. Incident blindness was defined by World Health Organization criteria as visual acuity of less than 6/120 (3/60) and/or a visual field of less than 10 degrees in the better seeing eye at the six-year follow up provided that eye had , a visual acuity of better than or equal to 6/120 (3/60) and visual field greater than 10 degrees at baseline. For incident monocular blindness, both eyes should have visual acuity of more than 6/120 (3/60) at baseline and developed visual acuity of less than 6/120 (3/60) in one eye at six-year follow up. Results Incident Blindness - 21 participants (0.48%, 95% confidence intervel (CI) 0.3 to 0.7) became blind, significant baseline risk factors were increasing age (p=0.001), smokeless tobacco use (p<0.001) and no history of cataract surgery (p=0.02). Incident monocular blindness was found in 132 participants (3.8%, 95%CI 3.7 to 3.8), it was significantly more (p<0.001) in the rural population (5.4%, 95% CI 5.4 to 5.5) than in the urban population (1.9%, 95% C I1.8 to 1.9), baseline risk factors (p<0.001) were increasing age, rural residence and no history of cataract surgery was a protective factor (p=0.03). Conclusions: Increasing age was a significant risk factor for blindness and monocular blindness. No history of cataract surgery was a risk factor for blindness and a protective factor for monocular blindness.
BibTeX:
@article{VijayaL2014,
  author = {Vijaya L, Asokan R, Panday M, Choudhari NS, Ramesh SV, Velumuri L, Boddupalli SD, Sunil GT, George R},
  title = {Baseline Risk Factors for Incidence of Blindness in a South Indian Population- The Chennai Eye Disease Incidence Study.},
  journal = {Invest Ophthalmol Vis Sci.},
  year = {2014},
  doi = {http://dx.doi.org/10.1167/iovs.14-14614}
}
Vijayaraghavan M, Pierce JP, White M, Messer K Differential use of other tobacco products among current and former cigarette smokers by income level. 2014 Addict Behav.
Vol. 39(10), pp. 1452-8 
article DOI  
Abstract: With the declining sales of cigarettes, the tobacco industry has been promoting other forms of combustible and smokeless tobacco to current and former cigarette smokers. Exposure to the promotion of tobacco products has been shown to vary by income level. We combined the 2006 through 2011 National Surveys on Drug Use and Health to compare the prevalence and patterns of other tobacco use (cigar, snuff, and chewing tobacco) between current and former cigarette smokers by income level. Other tobacco use was minimal among females and among male non-smokers. Approximately a third of both current and former male cigarette smokers reported past-year other tobacco use. Overall, current smokers were more likely than former smokers to have used cigars (adjusted odds ratio (AOR) 1.69, 95% CI 1.50-1.92) or snuff (AOR 1.14, 95% CI 1.01-1.28) in the past year. The association of smoking status with other tobacco use differed by income level (interaction term p-value<0.001). Among lower income groups, current smokers were more likely to use cigars and snuff compared to former smokers. Among the highest income group, former smokers were just as likely to use smokeless tobacco as current smokers. The differing patterns of use of other tobacco between current and former smokers by income level highlight a need for studies to understand the motivations for the use of these products and their role in smoking cessation
BibTeX:
@article{VijayaraghavanM2014,
  author = {Vijayaraghavan M, Pierce JP, White M, Messer K},
  title = {Differential use of other tobacco products among current and former cigarette smokers by income level.},
  journal = {Addict Behav.},
  year = {2014},
  volume = {39(10)},
  pages = {1452-8},
  doi = {http://dx.doi.org/10.1016/j.addbeh.2014.05.029}
}
Vora HH, Mehta SV, Shukla SN, Shah PM No mutation detected in five hot spot codons of the TP53 gene by restriction site mutation analysis in patients with carcinoma of the tongue. 2010 Int J Biol Markers
Vol. 25(1), pp. 46-51 
article  
Abstract: The present study evaluated 5 of the 8 main TP53 mutation hot spots in cancer by restriction site mutation analysis and compared the results with p53 protein expression in patients with cancer of the tongue. Tumor samples from 49 patients with tongue cancer were screened for TP53 mutations in exons 5 through 8 by PCR restriction site mutation analysis and for p53 protein expression by immunohistochemistry using the DO-7 antibody. Nuclear accumulation of p53 protein was seen in 22% (11/49) of the tumors, whereas none of the patients exhibited TP53 mutations in exons 5 through 8. The observed data suggest that TP53 mutations alone are not responsible for abnormal accumulation of p53 protein in tobaccochewing-mediated tongue carcinogenesis.
BibTeX:
@article{VoraHH2010,
  author = {Vora HH, Mehta SV, Shukla SN, Shah PM},
  title = {No mutation detected in five hot spot codons of the TP53 gene by restriction site mutation analysis in patients with carcinoma of the tongue.},
  journal = {Int J Biol Markers},
  year = {2010},
  volume = {25(1)},
  pages = {46-51}
}
Zolty BC, Sinha PK, Sinha DN Best practices in tobacco control in the South-East Asia Region. 2012 Indian J Cancer
Vol. 49(4), pp. 321-6 
article DOI  
Abstract: The tobacco epidemic is an increasing threat to public health with the tobacco burden particularly high in WHO's South-East Asia Region (SEAR). The Region has many obstacles to tobacco control, but despite these challenges, significant progress has been made in many countries. Although much work still needs to be done, SEAR countries have nevertheless implemented strong and often innovative tobacco control measures that can be classified as "best practices," with some setting global precedents. The best practice measures implemented in SEAR include bans on gutka, reducing tobaccoimagery in movies, and warning about the dangers of tobacco. In a time of scarce resources, countries in SEAR and elsewhere must ensure that the most effective and cost-efficient measures are implemented. It is hoped that countries can learn from these examples and as appropriate, adapt these measures to their own specific cultural, social and political realities.
BibTeX:
@article{ZoltyBC2012,
  author = {Zolty BC, Sinha PK, Sinha DN.},
  title = {Best practices in tobacco control in the South-East Asia Region.},
  journal = {Indian J Cancer},
  year = {2012},
  volume = {49(4)},
  pages = {321-6},
  doi = {http://dx.doi.org/10.4103/0019-509X.107718}
}
Smokeless Tobacco: Harm reduction debatable. 2007 CA Cancer J Clin.  article  
BibTeX:
@article{2007,
  author = {[No authors listed]},
  title = {Smokeless Tobacco: Harm reduction debatable.},
  journal = {CA Cancer J Clin.},
  year = {2007}
}
Verma A Cytogenetic investigations on patients with oral submucous fibrosis 1998 J Indian Med Assoc
Vol. 96(2), pp. 51-2 
article  
Abstract: Lymphocyte cultures were set up from venous blood samples collected from 23 patients of submucous fibrosis (SMF) and 10 normal controls. Slides, thus prepared, were processed and screened for G-, C-banding and sister chromatid exchange (SCE) frequency analysis. No gross chromosomal anomalies except that a few breaks and gaps were observed to be randomly distributed throughout the genome. However, a proportionate increase in SCE frequency in SMF patients as compared to the normal control individuals was observed. An attempt has been made to correlate the period of betel leaves, nuts, quid and tobacco chewing with the incidence of chromosomal anomalies and increase in SCE frequency and its sexwise distribution in these patients.
BibTeX:
@article{A.1998,
  author = {Verma A.},
  title = {Cytogenetic investigations on patients with oral submucous fibrosis},
  journal = {J Indian Med Assoc},
  year = {1998},
  volume = {96(2)},
  pages = {51-2}
}
Adhvaryu SG, Dave BJ, Trivedi AH An in vitro assessment of the genotoxic potential of pan masalas. 1989 Indian J Med Res.
Vol. 90, pp. 131-4 
article  
Abstract: An aqueous extract of pan masala was tested for its in vitro effects on Chinese hamster ovary (CHO) cells by utilizing parameters like sister chromatid exchange (SCE), cellular kinetics and chromosome aberration (CA) assay. The cytogenetic damage brought about by the extract was dose dependent. The increase in SCE values was highly significant (P less than 0.001) for all the three concentrations tested. The treatment delayed the cell cycle progression. Frequencies of chromosome aberrations were elevated for all the concentrations utilized, however, a significant rise was obtained only at the highest concentration of 50 microliters/ml.
BibTeX:
@article{AdhvaryuSG1989,
  author = {Adhvaryu SG, Dave BJ, Trivedi AH},
  title = {An in vitro assessment of the genotoxic potential of pan masalas.},
  journal = {Indian J Med Res.},
  year = {1989},
  volume = {90},
  pages = {131-4}
}
Anuradha CD, Devi CS Serum protein, ascorbic acid & iron & tissue collagen in oral submucous fibrosis--a preliminary study. 1993 Indian J Med Res.
Vol. 98, pp. 147-51 
article  
Abstract: A study of 36 patients with oral submucous fibrosis, revealed that all patients had the habit of chewing betel nut, pan masala or the traditional mixture (betel nut, betel leaf and lime) suggesting a link between fibrosis and arecanut. There was an increase in the globulin fraction of protein and hence a decreased A/G ratio in these patients. There was a significant increase in total protein levels possibly due to the increase in globulin fractions and other serum proteins. Ascorbate and iron levels decreased perhaps because of their utilisation in collagen synthesis. The total tissue collagen content increased significantly in patients with advanced disease and, it increased with the progression of the disease leading to hypomobility of the tongue, lips, cheeks, soft palate and faucial pillars.
BibTeX:
@article{AnuradhaCD1993,
  author = {Anuradha CD, Devi CS.},
  title = {Serum protein, ascorbic acid & iron & tissue collagen in oral submucous fibrosis--a preliminary study.},
  journal = {Indian J Med Res.},
  year = {1993},
  volume = {98},
  pages = {147-51}
}
Avasn Maruthit Y, Rao RS, Palivela H, Thakre S Impact of gutkha chewing & smoking on microbial environment of oral cavity: a case study on slum dwellers of selected areas in Visakhapatnam. 2004 J Environ Sci Eng
Vol. 46(4), pp. 268-73 
article  
Abstract: Oral diseases are still a neglected epidemic. During the recent years, in India, both in urban and rual, consumption of tobacco in the form of direct chewing of gutkha is alarmingly increasing especially in the young adults as which is major reason for subsistence of oral cancer. In the present investigation an attempt was made to find out the relationship between gutkha chewing including smoking and oral micro flora in some slum dwellers of Visakhapatnam. The subjects were randomly selected and their health data was collected by distributing questionnaire to control and effected subjects. The oral saliva samples were collected from both gutkha chewers, smokers and from control groups by using saline swabs and inoculated on suitable nutrient media. The results revealed that decrease in salivation and mucous formation in gutkha chewers, which further resulted in reduction in number of oral micro flora. Aspergillus species appeared only in gutkha chewers and smokers. Gutkha chewing and smoking thus, may lead to an increase in the oral pathogens by reducing the normal symbiotic microbial flora.
BibTeX:
@article{AvasnMaruthitY2004,
  author = {Avasn Maruthit Y, Rao RS, Palivela H, Thakre S},
  title = {Impact of gutkha chewing & smoking on microbial environment of oral cavity: a case study on slum dwellers of selected areas in Visakhapatnam.},
  journal = {J Environ Sci Eng},
  year = {2004},
  volume = {46(4)},
  pages = {268-73}
}
Avti PK, Kumar S, Pathak CM, Vaiphei K, Khanduja KL Smokeless tobacco impairs the antioxidant defense in liver, lung, and kidney of rats. 2006 Toxicol Sci.
Vol. 89(2), pp. 547-53 
article  
Abstract: The present study was designed to evaluate the effects of long-term use of aqueous extract of gutkha (a form of smokeless tobacco) on the antioxidant defense status and histopathological changes in liver, lung, and kidney of male Wistar rats. Animals were orally administered aqueous extract of smokeless tobacco (AEST) at a low dose (96mg/kg body weight per day) for 2 and 32 weeks, and at a high dose (960 mg/kg body weight per day) for 2 weeks. High-dose AEST for 2 weeks decreased the hepatic glutathione (GSH) and glutathione peroxidase (GPx), and increased lipid peroxidation (Lpx) by 17%, 19%, and 20%, respectively. Low-dose AEST for 32 weeks significantly decreased (p < 0.05) the antioxidant status in these organs. In liver, AEST decreased GSH levels and the activities of superoxide dismutase (SOD), catalase (CAT), and GPx by 34.6%, 29%, 17.1%, and 17.4%, respectively, but it increased Lpx by 64%. In kidney, GSH, SOD, CAT, and GPx were decreased by 26.6%, 23%, 33%, and 18%, respectively, with an increase of Lpx by 65%. AEST decreased the lung GSH, SOD, CAT, and GPx, and increased lung Lpx by 43%, 28.5%, 37%, 40%, and 24%, respectively. However, no change in the plasma levels of vitamins A, C, and E were observed with AEST treatment. Histopathological findings suggest that administration of AEST at the high dose for 2 weeks or at the low dose for 32 weeks could cause mild to moderate inflammation in liver and lungs. In conclusion, a decrease in the antioxidant defense system and long-term inflammation caused by smokeless tobacco may be risk factors for gutkha-induced pathogenesis.
BibTeX:
@article{AvtiPK2006,
  author = {Avti PK, Kumar S, Pathak CM, Vaiphei K, Khanduja KL},
  title = {Smokeless tobacco impairs the antioxidant defense in liver, lung, and kidney of rats.},
  journal = {Toxicol Sci.},
  year = {2006},
  volume = {89(2)},
  pages = {547-53}
}
Babu S, Bhat RV, Kumar PU, Sesikaran B, Rao KV, Aruna P, Reddy PR A comparative clinico-pathological study of oral submucous fibrosis in habitual chewers of pan masala and betelquid. 1996 J Toxicol Clin Toxicol
Vol. 34(3), pp. 317-22 
article  
Abstract: Background: Oral submucous fibrosis associated with chewing of betel nut products has an estimated prevalence of 0.2-1.2% in India. The increasing use of pan masala/gutkha, a mix of tobacco and a less moist form of betelquid lacking the betel leaf, seems associated with an earlier age of onset of oral submucous fibrosis.
Method: A prospective study examined the in vivo effects of pan masala/gutkha and betelquid chewing on buccal mucosal cytology in 50 patients with oral submucousmfibrosis and 40 controls.
Results: The percentage of nucleolated intermediate cells or proliferative fraction of buccal mucosa cells was significantly higher in all habitual chewers than controls. Pan masala/gutkha chewers presented with oral submucous fibrosis after 2.7?0.6 y of use whereas the betelquid users presented with oral submucous fibrosis reported 8.6?2.3 y of use (p<0.05).
Conclusions: Habitual chewing of pan masala/gutkha is associated with earlier presentation of oral submucous fibrosis than betelquid use. Factors which may be responsible for these differences are the tobacco content, the absence of the betel leaf and its carotenes and the much higher dry weight of pan masala/gutkha.
BibTeX:
@article{BabuS1996,
  author = {Babu S, Bhat RV, Kumar PU, Sesikaran B, Rao KV, Aruna P, Reddy PR},
  title = {A comparative clinico-pathological study of oral submucous fibrosis in habitual chewers of pan masala and betelquid.},
  journal = {J Toxicol Clin Toxicol},
  year = {1996},
  volume = {34(3)},
  pages = {317-22}
}
Babu S, Sesikeran B, Bhat RV Oral fibrosis among teenagers chewing tobacco, areca nut, and Pan masala. 1996 Lancet.
Vol. 348(9028)(692) 
article  
BibTeX:
@article{BabuS1996a,
  author = {Babu S, Sesikeran B, Bhat RV},
  title = {Oral fibrosis among teenagers chewing tobacco, areca nut, and Pan masala.},
  journal = {Lancet.},
  year = {1996},
  volume = {348(9028)},
  number = {692}
}
Bagwe AN, Ganu UK, Gokhale SV, Bhisey RA Evaluation of the mutagenicity of 'pan masala', a chewing substitute widely used in India. 1990 Mutat Res.
Vol. 241(4), pp. 349-54 
article  
Abstract: Mutagenicity of polar and non-polar extracts of a popular brand of 'pan masala' was examined using the Salmonella/mammalian microsome test (Ames assay) and 2 tester strains of Salmonella typhimurium, TA98 and TA100. These extracts were also subjected to pretreatment with sodium nitrite at acidic pH, to simulate conditions for endogenous nitrosation. The aqueous, aqueous:ethanolic and chloroform extracts as well as their nitrosated mixtures were non-mutagenic in the Ames assay, in the presence and absence of metabolic activation. Only the ethanolic extract elicited a weak mutagenic response in strain TA98 without metabolic activation demonstrating the presence of direct-acting frameshift mutagens in 'pan masala'.
BibTeX:
@article{BagweAN1990,
  author = {Bagwe AN, Ganu UK, Gokhale SV, Bhisey RA},
  title = {Evaluation of the mutagenicity of 'pan masala', a chewing substitute widely used in India.},
  journal = {Mutat Res.},
  year = {1990},
  volume = {241(4)},
  pages = {349-54}
}
Bathi RJ, Prabhat p53 aberrations in oral sub mucous fibrosis and oral cancer detected by immunohistochemistry. 2003 Indian J Dent Res
Vol. 14(4), pp. 214-9 
article  
Abstract: Study of expression of p53 oncoprotein in several precancerous and cancer have been done, but only one literature is available regarding p53 expression in Oral Sub Mucous Fibrosis (OMSF), hence this study was taken up (i) to determine the expression of aberrant p53 in Oral Sub Mucous Fibrosis (OSMF) and Oral Squamous cell carcinoma (SCC) patients. (ii)To study correlation if any between p53 expression and degree of dysplasia in OSMF and SCC patients and (iii)To study correlation if any between p53 expression and habits in OSMF and SCC patients. Study Design consists of biopsy specimens of 38 cases of OSMF and 37 cases of Squamous cell carcinoma were subjected for staining by immunohistochemistry for p53 protein using LSAB visualization
system kit. Clinical details along with habits were recorded and the data analyzed with ttest and chi- square test. Results of the study reveals 18 cases of OSMF and 26 cases of SCC were positive for p53 protein. Only 4 cases of SCC showed (++)grade and the rest all had (+)grade. Out of 75 patients, 65 had the habit of smoking and chewing, 4 patients history of habit was not known. Among patients with habits (65), 40 specimens were +ve for p53 stain and 2 out of 6 without history of habit, 2 out of 4 unknown history of habit took up p53 stain. To conclude study showed higher percentage of p53 positive cells in oral cancer cases when compared to oral sub mucous fibrosis cases. It suggests p53 expression may correlate with increase in dysplasia or malignant transformation. Both smoking and chewing habits had a significant role in p53 positive expression.
BibTeX:
@article{BathiRJ2003,
  author = {Bathi RJ, Prabhat},
  title = {p53 aberrations in oral sub mucous fibrosis and oral cancer detected by immunohistochemistry.},
  journal = {Indian J Dent Res},
  year = {2003},
  volume = {14(4)},
  pages = {214-9}
}
Bhisey RA, Ramchandani AG, D'Souza AV, Borges AM, Notani PN Long-term carcinogenicity of pan masala in Swiss mice. 1999 Int J Cancer
Vol. 83(5), pp. 679-84 
article  
Abstract: Carcinogenicity of pan masala, a dry powdered chewing mixture of areca nut, catechu, lime, spices and flavoring agents was evaluated by means of the long-term animal bioassay 6- to 7-week old male and female S/RVCri mice were divided randomly into intermediate and lifetime exposure groups and fed normal diet without pan masala (zero dose) or diet containing 2.5% and 5% pan masala. Animals in the intermediate-exposure group (n=10/gender/dose group) were killed after 6, 12 or 18 months of treatment, while those in the lifetime-exposure group (n=54/gender/dose group) were killed when moribund or at the termination of the experiment at 24 months. Several tissues were processed for histopathological examination. The body weight and survival rate of mice fed pan masala were lower than that of the controls. Histopathological observations of tissues from control animals did not reveal any neoplastic alterations. However, lifetimemfeeding of pan masala induced adenoma of the liver, stomach, prostate and sebaceous glands, also forestomach papilloma, liver hamartoma, hepatoma and hemangioma, carcinoma of the forestomach, adenocarcinoma of the lung and liver, and testicularm lymphoma. Neoplastic lesions appeared mainly in the liver (n=13), stomach (n=3) and lung (n=8). Lung adenocarcinoma, the most frequent malignant tumor type, was
observed in 2/120 mice in the intermediate-exposure group and in 8/216 animals in the lifetime-exposure group. Statistical analysis of tumor-induction data revealed a significant dose-related increase in lung adenocarcinomas but not in liver and stomach neoplasms indicating that lung is the major target tissue for the carcinogenic action of pan masala.
BibTeX:
@article{BhiseyRA1999,
  author = {Bhisey RA, Ramchandani AG, D'Souza AV, Borges AM, Notani PN},
  title = {Long-term carcinogenicity of pan masala in Swiss mice.},
  journal = {Int J Cancer},
  year = {1999},
  volume = {83(5)},
  pages = {679-84}
}
Chakrabarti RN, Dutta K, Sikdar K, Ghosh K Smokeless tobacco and premalignant and malignant lesions of the oral cavity 1991 Indian J Med Sci.
Vol. 45(10), pp. 273-5 
article  
Abstract: The paper compares the prevalence of oral carcinoma and dysplasia in smokeless tobacco users and non users. A total of 3205 subjects were studied. Of the smokeless tobacco users, 1.96 percent had oral carcinoma compared with 0.36 percent of non-users. The prevalence of oral dysplasia in the users' group was 14.4 percent as compared with 6.85 percent in the group of non-users.
BibTeX:
@article{ChakrabartiRN1991,
  author = {Chakrabarti RN, Dutta K, Sikdar K, Ghosh K},
  title = {Smokeless tobacco and premalignant and malignant lesions of the oral cavity},
  journal = {Indian J Med Sci.},
  year = {1991},
  volume = {45(10)},
  pages = {273-5}
}
Cogliano V, Straif K, Baan R, Grosse Y, Secretan B, El Ghissassi F Smokeless tobacco and tobacco-related nitrosamines. 2004 Lancet Oncol.
Vol. 5(12), pp. 708 
article  
BibTeX:
@article{CoglianoV2004,
  author = {Cogliano V, Straif K, Baan R, Grosse Y, Secretan B, El Ghissassi F.},
  title = {Smokeless tobacco and tobacco-related nitrosamines.},
  journal = {Lancet Oncol.},
  year = {2004},
  volume = {5(12)},
  pages = {708}
}
DN Rao, LD Sanghvi, PB Desai Epidemiology of esophageal cancer 1989 Semin Surg Oncol.
Vol. 5(5), pp. 351-4 
article  
Abstract: The incidence of cancer of the oesophagus is high in India but not as high as the rates reported from the Caspian Littoral of Iran. Incidence data available for three places in India--Bombay, Madras, and Bangalore--show regional variations. In Bombay, the rates for males are high compared to Madras and Bangalore. A case control study of 503 oesophageal cancer cases in males and 634 controls registered at the Tata Memorial Hospital during the period 1980-84 was carried out to determine the association of oesophageal cancer with two types of dietary practices, viz., vegetarian and non-vegetarian, in addition to tobacco and alcohol habits. In the presence of an alcohol habit, the relative risk for tobacco chewing and smoking was observed to be high in the non-vegetarian group compared to the vegetarian group. A vegetarian diet was protective. Further studies are suggested to confirm this finding.
BibTeX:
@article{D.N.Rao1989,
  author = {D. N. Rao, L. D. Sanghvi, P. B. Desai},
  title = {Epidemiology of esophageal cancer},
  journal = {Semin Surg Oncol.},
  year = {1989},
  volume = {5(5)},
  pages = {351-4}
}
DN Sinha, PC Gupta Tobacco use among teachers [corrected] in Uttar Pradesh & Uttaranchal, India 2004 Indian J Public Health
Vol. 48(3), pp. 132-7 
article  
Abstract: Information about tobacco use prevalence, knowledge and attitude was assessed among school personnel in Uttar Pradesh. A single cluster sample design with probability proportional to the enrolment in grades 8-10 was used. Statistical analysis was done using SUDAAN and the C-sample procedure in Epi-Info. The school response rate was 100%. School personnel response rate ranged from 72- 80%, the proportion of men being 84-92%. Current cigarette smoking and smokeless tobacco use reported by all teachers was 21.9% and 75.6% respectively. The prevalence of daily cigarette smoking was ranged by 12.6-15.1%; bidi and other smoking 4.8-13.4%; smokeless tobacco use 16.3-19.8%. Existing school policy on four measures were reported poor however over 72% school personnel felt need for policy prohibiting tobacco use among students and school personnel. Tobacco prevention instruction by teachers did not fare much better on six different measures (4.9-30.9%). However over 2/3rd school personnel were very supportive on tobacco control issues. There was no training among school personnel on tobacco use prevention skills (3.7%). However most of the school personnel (67.1%) were curious about getting such trainings. A positive environment for tobacco use prevention needs to be created by adopting comprehensive tobacco control policies for schools. First step towards this may be training of school personnel on tobacco use prevention skill and supply of teaching materials.
BibTeX:
@article{D.N.Sinha2004,
  author = {D. N. Sinha, P. C. Gupta},
  title = {Tobacco use among teachers [corrected] in Uttar Pradesh & Uttaranchal, India},
  journal = {Indian J Public Health},
  year = {2004},
  volume = {48(3)},
  pages = {132-7}
}
DN Sinha, PC Gupta Tobacco use among school personnel in Orissa 2004 Indian J Public Health
Vol. 48(3), pp. 123-7 
article  
Abstract: Tobacco use prevalence, knowledge and attitude was assessed among school personnel in Orissa. A single cluster sample design with probability proportional to the enrolment in grades VIII-X was used. Statistical analysis was clone using SUDAAN and the C-sample procedure in Epi-Info. The school response rate was 100%. Over 72% of school personals participated in the survey, the proportion of men being 84%. Current cigarette smoking, bidi smoking and smokeless tobacco use was reported by 26.8%, 30.1% and 38.8% school personnel respectively. Current daily cigarette smoking, bidi smoking and smokeless tobacco use reported by 18.3%, 16.6% and 24.2% school personnel respectively. Men reported significantly more all kinds of daily tobacco use as compared to women. School tobacco control policy on three scales was reported poor (25-39%). However most of the school personnel felt need for such policies (88-98%). Teaching and training on tobacco was reported low (22.7%-35.9%). Most of the school personnel (87- 95%) were supportive on different measures on tobacco control issues. Introduction of comprehensive school policies and enforcement on tobacco use may help to reduce adolescent and school personnel tobacco use.
BibTeX:
@article{D.N.Sinha2004a,
  author = {D. N. Sinha, P. C. Gupta},
  title = {Tobacco use among school personnel in Orissa},
  journal = {Indian J Public Health},
  year = {2004},
  volume = {48(3)},
  pages = {123-7}
}
DNSinha, PC Gupta, CW Warren, S Asma School policy and tobacco use by students in Bihar, India 2004 Indian J Public Health.
Vol. 48(3), pp. 118-22 
article  
Abstract: The association between school tobacco policies and tobacco use prevalence among students were examined. A two stage cluster sample design with probability proportional to the enrolment in grades VIII-X was used. Comparison was made between schools with a tobacco policy (Federal schools) and schools without a policy (State schools). Stratified probability samples of 50 schools each were selected. SUDAAN and the C-sample procedure in Epi-Info was used for statistical analysis. Students from State schools (without tobacco policy) reported significantly higher ever and current any tobacco use, current smokeless tobacco use and current smoking compared to Federal schools (with tobacco policy) both in rural and urban areas. Classroom teaching on the harmful effects of tobacco was significantly higher (17-24 times) in Federal schools than State schools both in rural and urban areas. Parental tobacco use was similar for students in Federal and State schools. Students attending state schools were more likely than students attending Federal schools to have friends who smoke or chew tobacco. These findings suggest that the wider introduction of comprehensive school policies may help to reduce adolescent tobacco use.
BibTeX:
@article{D.N.Sinha2004b,
  author = {D. N. Sinha, P. C. Gupta, C. W. Warren, S. Asma},
  title = {School policy and tobacco use by students in Bihar, India},
  journal = {Indian J Public Health.},
  year = {2004},
  volume = {48(3)},
  pages = {118-22}
}
DN Sinha, PC Gupta, M Pednekar Tobacco use among students in Bihar (India) 2004 Indian J Public Health
Vol. 48(3), pp. 111-7 
article  
Abstract: Determination of the prevalence and attitudes toward tobacco use was assessed among 13-15 years school students in Bihar (India). Settings and design: Schools having grade 8-10 in Bihar. A two stage cluster sample design was used. SUDAAN and the C-sample procedure in Epi-Info was used for statistical analysis. Of the 2636 respondents, 71.8% (76.5% boys, 57.2% girls) were ever tobacco users; of them 48.9% had used tobacco before 10 years of age. Current use was reported by 58.9% (Boys 61.4%, Girls 51.2%); smokeless tobacco by 55.6% (Boys 57.6%, Girls 49.2%); and smoking by 19.4% (23.0% boys, 7.8% girls). Nearly one third (29%) students were exposed to ETS inside their homes and nearly half (48%) outside their homes. Almost all students reported watching cigarette and gutka advertisements in almost all kinds of media and events. Tobacco use by parents and friends, knowledge on harmful effects of chewing tobacco, smoking and environmental smoke, and attitudes on tobacco use by others were strongly associated with student tobacco use. Current tobacco use was reported significantly more by students who received pocket money/or were earning than by students who did not receive any pocket money/or did not earn (p value for trend <0.0001). Over half of current users (56%) bought their tobacco products from stores; of these, over 3/4th (77.2%) of them despite their age, had no difficulty in procuring these products. Teaching in schools regarding harmful effects of tobacco use was non-existent (3%). This urgently requires a comprehensive prevention program in schools and the community especially targeted towards girls.
BibTeX:
@article{D.N.Sinha2004c,
  author = {D. N. Sinha, P. C. Gupta, M. Pednekar},
  title = {Tobacco use among students in Bihar (India)},
  journal = {Indian J Public Health},
  year = {2004},
  volume = {48(3)},
  pages = {111-7}
}
DN Sinha, S Roychowdhury Tobacco control practices in 25 schools of West Bengal 2004 Indian J Public Health
Vol. 48(3), pp. 128-31 
article  
Abstract: Information about tobacco use prevalence, knowledge and attitude was assessed among school personnel in schools of West Bengal. Statistical analysis was done using SUDAAN and the C-sample procedure in Epi-Info. The school response rate was 100%. Current any smoking and smokeless tobacco use was reported by 30.9% and 13.1% school personnel, respectively. Current daily smoking, and smokeless tobacco use reported by 20.4%, and 5.8% school personnel respectively. Men reported significantly more for all kinds of daily tobacco use as compared to women. School tobacco control policy on three scales was reported poor (17.7-30%). However most of the school personnel felt need for such policies (82.7-93.6%). Teaching and training on tobacco was reported low (29.9%-50.4%). However most of the school personnel (79.1-93.6%) were supportive on different measures of tobacco control. Training of school personnel may provide students with essential tools to help them adopt and maintain a smoke free lifestyle.
BibTeX:
@article{D.N.Sinha2004d,
  author = {D. N. Sinha, S. Roychowdhury},
  title = {Tobacco control practices in 25 schools of West Bengal},
  journal = {Indian J Public Health},
  year = {2004},
  volume = {48(3)},
  pages = {128-31}
}
D Saranath, LT Bhoite, MG Deo Molecular lesions in human oral cancer: the Indian scene 1993 Eur J Cancer B Oral Oncol.
Vol. 29B(2), pp. 107-12 
article  
Abstract: Carcinogenesis is a multi-step process including aberrant expression of two interacting classes of genes--oncogenes and tumour suppressor genes. With recent technological advances, it is feasible to identify the various molecular lesions underlying the different stages of neoplasia. Squamous cell carcinomas of the head and neck, although representing 2-4% of the malignancies in the West, comprise a large fraction (40%) of total cancers in India, posing a major health problem. Further, epidemiological and experimental evidence unequivocally confirms a causal association between tobacco chewing habit, highly prevalent in India, and oral cancers. Thus, the oral cancers offer an excellent in vivo system for the study of the environmental tobacco-carcinogen induced molecular alterations in the malignancy, and associated premalignant lesions such as leukoplakia. With a view to elucidating
the molecular lesions involving oncogenes in oral carcinogenesis, we have investigated myc/ras/EGF-R activation by amplification, point mutation, gene
rearrangement and allelic losses. Further, a functionally activated potent transforming gene was detected in a NIH3T3 transfection/tumorigenicity assay,
unrelated to myc/ras/EGF-R. Studies on the involvement of p53 gene in oral cancer, indicates p53 allelic loss as an event observed in leukoplakia and tumour tissues. Advanced oral cancer stages demonstrate cumulative molecular aberrations, with greater than 95% samples showing oncogene involvement, thus indicating a multistep process of oral carcinogenesis. The review presents a comparative picture of the oral malignancies seen in Western countries and India, significance of molecular lesions and future perspectives of oncogenes and tumour suppressor gene involvement in oral cancer.
BibTeX:
@article{D.Saranath1993,
  author = {D. Saranath, L. T. Bhoite, M. G. Deo},
  title = {Molecular lesions in human oral cancer: the Indian scene},
  journal = {Eur J Cancer B Oral Oncol.},
  year = {1993},
  volume = {29B(2)},
  pages = {107-12}
}
D Saranath, SE Chang, LT Bhoite, RG Panchal, IB Kerr, AR Mehta, NW Johnson, MG Deo High frequency mutation in codons 12 and 61 of H-ras oncogene in chewing tobacco-related human oral carcinoma in India 1991 Br J Cancer
Vol. 63(4), pp. 573-8 
article  
Abstract: 57 primary tumour samples from Indian oral cancer patients with a 5-15 year tobacco chewing habit, were examined for mutational activation in codons 12, 13 and 61 of the H-ras, K-ras and N-ras oncogenes. The highly sensitive assay based on specific oligonucleotide hybridisation following in vitro amplification of unique sequences by polymerase chain reaction was employed. Mutations were detected in twenty (35%) of the samples and were restricted to H-ras, codons 12, 13 and 61. Two cases had concurrent mutations in codons 12 and 61. The majority of the mutations were at H-ras 61.2 (Glutamine to Arginine) and H-ras 12.2 (Glycine to Valine). Three of the less frequent mutations are apparently novel. Interestingly, eight of the samples with H-ras mutations also showed loss of wild-type H-ras, as judged by absence of signals for wild-type codons 12 or 61 on dot blots. The specific H-ras mutations in these oral malignancies associated with tobacco chewing, may represent an important example of an environmental carcinogen-induced step, in a pathway leading to malignant transformation.
BibTeX:
@article{D.Saranath1991,
  author = {D. Saranath, S. E. Chang, L. T. Bhoite, R. G. Panchal, I. B. Kerr, A. R. Mehta, N. W. Johnson, M. G. Deo},
  title = {High frequency mutation in codons 12 and 61 of H-ras oncogene in chewing tobacco-related human oral carcinoma in India},
  journal = {Br J Cancer},
  year = {1991},
  volume = {63(4)},
  pages = {573-8}
}
Daniel AB, Nagaraj K, Kamath R Prevalence and determinants of tobacco use in a highly literate rural community in southern India. 2008 Natl Med J India
Vol. 21(4), pp. 163-5 
article  
Abstract: Background: The adverse effects of tobacco use on the health of an individual are well known. It is essential to identify factors leading to tobacco use to plan strategies to limit its use. Education is known to influence the prevalence of tobacco use. We aimed to determine the prevalence and patterns of tobacco use in a rural community with a high literacy rate and to examine the socioeconomic and demographic correlates of tobacco consumption in the area.
Methods: A cross-sectional survey using personal interviews was carried out on 832 individuals >15 years of age. The prevalence of current daily use of tobacco was used as the outcome measure. The main analytical methods used were chi-square test and multiple logistic regression analysis.
Results: The prevalence of tobacco use was 17.5%, being common among older persons, the lower socioeconomic group and those who were less educated. Tobacco was used predominantly in smokeless forms (chewing, snuff or both). The commonest reason cited for initiating tobacco use was to relieve toothache.
Conclusions: Our findings in this rural community suggest that improvement in the educational and socioeconomic status may lead to a decline in the use of tobacco. Health education to improve dental hygiene may also help to reduce tobacco use in this community as it is predominantly used in the chewing form.
BibTeX:
@article{DanielAB2008,
  author = {Daniel AB, Nagaraj K, Kamath R},
  title = {Prevalence and determinants of tobacco use in a highly literate rural community in southern India.},
  journal = {Natl Med J India},
  year = {2008},
  volume = {21(4)},
  pages = {163-5}
}
Dar NA, Mir MM, Salam I, Malik MA, Gulzar GM, Yatoo GN, Ahmad A, Shah A Association between copper excess, zinc deficiency, and TP53 mutations in esophageal squamous cell carcinoma from Kashmir Valley, India-a high risk area. 2008 Nutr Cancer
Vol. 60(5), pp. 585-91 
article  
Abstract: Trace element deficiency or excess is implicated in the development or progression in some cancers. Here we report the elevated level of copper and low level of zinc in the plasma of esophageal cancer patients in Kashmir India--a high incidence area. The average level of copper was significantly higher (P<0.0001) for patients than for controls, with a mean concentration of 169?g/dl and 149?g/dl for patients and controls, respectively. The control group consisted of 55 healthy individuals matched for age, sex, and place of residence of the patients. In contrast, the average level of zinc in patients was significantly lower than in controls (P<0.0001), with a mean concentration of 86.8 ?g/dl and 96.1 ?g/dl for patients and controls, respectively. The levels of both copper and zinc showed significant differences based on gender and age in patients as compared to controls. Similarly, smokers depicted a significant increase in serum copper (N=39, P=0.002) and a decrease in serum zinc approaching level of significance in the patient group as compared to controls. The copper and zinc levels were significantly altered in patients (N=40) when compared to controls as a function of snuff consumption.
The differences in the levels of copper and zinc showed significant association with the consumption of local salted tea up to 1,500 ml per day, but the changes were insignificant beyond that. Patients with poorly differentiated tumors (N=7) had a higher copper concentration than those with moderately or well-differentiated tumors (P<0.0001). To validate the general notion that imbalance in copper and zinc levels may lead to higher prevalence of TP53 mutations, we compared the 3 variables, and no association was found between copper concentration and TP53 mutation status; but patients with TP53 mutant tumor had lower zinc levels than those with no mutation. In conclusion, our results point toward a role of the trace element imbalance in the esophageal tumorigenesis in high-risk Kashmiri population exposed to a range of nitroso compounds or their precursors. Further prospective cohort studies are warranted to determine whether change in the plasma zinc and copper homeostasis may represent an independent risk factor for this malignancy as well as a possible target for preventive intervention.
BibTeX:
@article{DarNA2008,
  author = {Dar NA, Mir MM, Salam I, Malik MA, Gulzar GM, Yatoo GN, Ahmad A, Shah A},
  title = {Association between copper excess, zinc deficiency, and TP53 mutations in esophageal squamous cell carcinoma from Kashmir Valley, India-a high risk area.},
  journal = {Nutr Cancer},
  year = {2008},
  volume = {60(5)},
  pages = {585-91}
}
Das RK , Dash BC Genotoxicity of 'gudakhu', a tobacco preparation. II. In habitual users 1992 Food Chem Toxicol
Vol. 30(12), pp. 1045-9 
article  
Abstract: The genotoxic potential of 'gudakhu', a paste-like tobacco preparation that is used widely in Orissa, India, was evaluated using the micronucleus test in exfoliated cells of the buccal mucosa. Cells from 120 habitual users and from 102 non-users were examined. The incidence of micronuclei (MN) was increased in the mucosa cells of users, and the increase was significant in those who had used gudakhu for more than 5 yr. The increased incidence of MN was significantly correlated with the period of use of gudakhu, as well as with the frequency of daily use. There were no significant differences between the results for men and women.
BibTeX:
@article{DasRK1992,
  author = {Das RK , Dash BC},
  title = {Genotoxicity of 'gudakhu', a tobacco preparation. II. In habitual users},
  journal = {Food Chem Toxicol},
  year = {1992},
  volume = {30(12)},
  pages = {1045-9}
}
Das S, Neogy S, Gautam N, Roy S Economic cost of tobacco use in India, 2004. 2009 Tob Control.
Vol. 18(2), pp. 138-43 
article  
Abstract: Objective: To estimate the tobacco-attributable costs of diseases separately for smoked and smokeless tobacco use in India.
Methods: The prevalence-based attributable-risk approach was used to estimate the economic cost of tobacco using healthcare expenditure data from the National Sample Survey, a nationally representative household sample survey conducted in India in 2004. Four major categories of tobacco-related disease-tuberculosis, respiratory diseases, cardiovascular diseases and neoplasms-were considered.
Results: Direct medical costs of treating tobacco related diseases in India amounted to $907 million for smoked tobacco and $285 million for smokeless tobacco. The indirect morbidity costs of tobacco use, which includes the cost of caregivers and value of work loss due to illness, amounted to $398 million for smoked tobacco and $104 million for smokeless tobacco. The total economic cost of tobacco use amounted to $1.7 billion. Tuberculosis accounted for 18% of tobacco-related costs ($311 million) in India. Of the total cost of tobacco, 88% was attributed to men.
Conclusions: The cost of tobacco use was many times more than the expenditures on tobacco control by the government of India and about 16% more than the total tax revenue from tobacco. The tobacco-attributable cost of tuberculosis was three times higher than the expenditure on tuberculosis control in India. The economic costs estimated here do not include the costs of premature mortality from tobacco use, which is known to comprise roughly 50-80% of the total economic cost of tobacco in many countries.
BibTeX:
@article{DasS2009,
  author = {Das S, Neogy S, Gautam N, Roy S},
  title = {Economic cost of tobacco use in India, 2004.},
  journal = {Tob Control.},
  year = {2009},
  volume = {18(2)},
  pages = {138-43}
}
Das S, Neogy S, Gautam N, Roy S In vitro nicotine induced superoxide mediated DNA fragmentation in lymphocytes: protective role of Andrographis paniculata Nees. 2009 Toxicol In Vitro.
Vol. 23(1), pp. 90-8 
article  
Abstract: Nicotine is a pharmacologically active substance and potent recreational drug present in smoke and smokeless tobacco products. The present study was initiated to investigate the protective role of Andrographis paniculata products (andrographolide and aqueous extract) on in vitro nicotine induced lymphocyte toxicity. Andrographolide and aqueous extract was isolated and characterized by HPLC, FTIR, TLC and biochemical assays. Significant (P<0.05) increase of superoxide anion generation, lipid peroxidation, protein oxidation and DNA fragmentation and decrease of cell viability, SOD and GSH content were observed in both 10mM and 100mM nicotine exposure. Different concentration of andrographolide and aqueous extract from A. paniculata supplement decreased oxidative stress in lymphocytes with the fall in superoxide anion generation, lipid peroxidation, protein oxidation, DNA fragmentation and rise in cell viability and the activities of the antioxidant enzymes; SOD and GSH. The above findings indicate that A. paniculata products modulate the nicotine-induced toxicity in lymphocytes through decreased superoxide mediated oxidative stress and DNA fragmentation. Hence, A. paniculata can be used as therapeutic means against nicotine mediated lymphocytes function.
BibTeX:
@article{DasS2009a,
  author = {Das S, Neogy S, Gautam N, Roy S.},
  title = {In vitro nicotine induced superoxide mediated DNA fragmentation in lymphocytes: protective role of Andrographis paniculata Nees.},
  journal = {Toxicol In Vitro.},
  year = {2009},
  volume = {23(1)},
  pages = {90-8}
}
Dash BC, Das RK Genotoxicity of 'gudakhu', a tobacco preparation. I. In
mice in vivo.
1992 Mutat Res.
Vol. 280(1), pp. 45-53 
article  
Abstract: 'Gudakhu' is a paste-like tobacco preparation used widely in Orissa and neighbouring states of India. During use it is rubbed over the teeth and gum with a finger tip. Besides tobacco, it contains molasses, lime, red soil and water. The genotoxic potential of acetone extract of gudakhu was evaluated in mice in vivo using the chromosome aberration assay, micronucleus test and SCE analysis following single as well as longterm repeated treatment. The animals received an aqueous suspension of the extract via the oral route. Gudakhu extract induced significantly high frequencies, compared to controls, of chromosome aberrations, micronuclei (MN) and SCEs. Single treatment with different doses clearly revealed a distinct dose-dependent increase of the effects in all the assays. Analysis of MN in regenerated hepatocytes also indicated a significant positive correlation between time-course of chronic treatment and frequencies of micronucleated cells. But incidences of chromosome aberrations, MN and SCEs in bone marrow cells following repeated treatment for different periods did not differ greatly from each other; and these repeated treatment data, particularly in the MNT in bone marrow cells and the SCE assay, also did not differ markedly from the respective single treatment data for the same dose. This was probably due to the proliferative nature of
the bone marrow cells.
BibTeX:
@article{DashBC1992,
  author = {Dash BC, Das RK},
  title = {Genotoxicity of 'gudakhu', a tobacco preparation. I. In
mice in vivo.}, journal = {Mutat Res.}, year = {1992}, volume = {280(1)}, pages = {45-53} }
Dave BJ, Trivedi AH, Adhvaryu SG Cytogenetic studies reveal increased genomic damage among 'pan masala' consumers. 1991 Mutagenesis.
Vol. 6(2), pp. 159-63 
article  
Abstract: Pan masala (PM), a dried powdered mixture containing ingredients like areca nut, catechu, lime, cardamom and flavouring agents, is consumed abundantly by Indians and is also exported to Western countries. Pan masala with tobacco (PM-T) is also available on the market. In view of the role of the ingredients of PM in the causation of oral diseases, the possible harmful effects of consuming this complex mixture were analysed in individuals regularly consuming PM and among healthy non-consuming controls without any habit. Three cytogenetic endpoints and two tissues were employed to assess possible DNA damage. Sister chromatid exchange and chromosome aberrations were estimated in the peripheral blood lymphocytes, tissues indirectly exposed to the substance and the frequency of micronucleated cells was scored in the tissue directly in contact with PM, i.e. the exfoliated buccal mucosa cells. All three cytogenetic endpoints demonstrated a statistically significant increase (P less than 0.001) among the PM consumers as compared with the non-consuming controls.
BibTeX:
@article{DaveBJ1991,
  author = {Dave BJ, Trivedi AH, Adhvaryu SG},
  title = {Cytogenetic studies reveal increased genomic damage among 'pan masala' consumers.},
  journal = {Mutagenesis.},
  year = {1991},
  volume = {6(2)},
  pages = {159-63}
}
Didwania Pradid DK, Agrawal SK Pan Masala. 1988 J Assoc Physicians India.
Vol. 36(2)(181) 
article  
BibTeX:
@article{DidwaniaPradidDK1988,
  author = {Didwania Pradid DK, Agrawal SK},
  title = {Pan Masala.},
  journal = {J Assoc Physicians India.},
  year = {1988},
  volume = {36(2)},
  number = {181}
}
Dobe M, Sinha DN, Rahman K Smokeless tobacco use and its implications in WHO South East Asia Region. 2006 Indian J Public Health.
Vol. 50(2), pp. 70-5 
article  
BibTeX:
@article{DobeM2006,
  author = {Dobe M, Sinha DN, Rahman K.},
  title = {Smokeless tobacco use and its implications in WHO South East Asia Region.},
  journal = {Indian J Public Health.},
  year = {2006},
  volume = {50(2)},
  pages = {70-5}
}
Einstein TB, Sivapathasundharam B Cytomorphometric analysis of the buccal mucosa of tobacco users. 2005 Indian J Dent Res.
Vol. 16(2), pp. 42-6 
article  
Abstract: Objectives: This study has been carried out to assess the effect of tobacco smoking and of betel quid chewing with tobacco on buccal mucosa by cytomorphometry, in a south Indian population.
Study design: Cellular diameter (CD) and nuclear diameter (ND) of exfoliated buccal squames obtained from clinically normal appearing buccal mucosa of tobacco smokers, betel quid with tobacco chewers, and those with a combined habit, stained by the Papanicolaou method, were measured. Non-users served as negative controls and oral squamous cell carcinomas in tobacco users served as positive controls. One way ANOVA test of the values obtained followed by multiple range comparison with Tukey-HSD procedure (at p=0.05) was carried out.
Results: A statistically significant reduction in CD and increase in ND in smokers and those with a combined habit were observed.
Conclusions: The use of tobacco in the form of smoking influences the cytomorphology of buccal mucosa.
BibTeX:
@article{EinsteinTB2005,
  author = {Einstein TB, Sivapathasundharam B},
  title = {Cytomorphometric analysis of the buccal mucosa of tobacco users.},
  journal = {Indian J Dent Res.},
  year = {2005},
  volume = {16(2)},
  pages = {42-6}
}
G Harikiran, SK Pallavi, S Hariprakash, KS Nagesh Oral health-related KAP among 11- to 12-year-old school children in a government-aided missionary school of Bangalore city 2008 Indian J Dent Res.
Vol. 19(3), pp. 236-42 
article  
Abstract: Background: To organize community-oriented oral health promotion programs systematic analysis of the oral health situation would be needed, including
information on oral health knowledge, attitudes, and practices (KAP).
Aim: The aim of this study was to assess knowledge, attitude, and practice (KAP) toward oral health among 11 to 12-year-old school children in a government-aided missionary school of Bangalore city.
Materials and Methods: The study group comprised of 212 children (Male: 108; Female; 104) who were in the age group of 11-12 years studying in a governmentaided missionary school of Bangalore city. Data on oral health KAP were collected by means of a self-administered questionnaire. Statistical significance was determined by Chi-square test.
Results: This survey found that only 38.5% of the children brush their teeth two or more times a day. Pain and discomfort from teeth (35.1%) were common while dental visits were infrequent. Fear of the dentist was the main cause of irregular visit in 46.1% of study participants. High proportion of study participants reported having hidden sugar at least once a day: soft drinks (32.1%), milk with sugar (65.9%), and tea with sugar (56.1%). It was found that 5.4% and 3.9% of study participants smoke and chew tobacco, respectively.
Conclusion: Results of this study suggest that oral health KAP of study participants are poor and needs to be improved. Systematic community-oriented oral health promotion programs are needed to improve oral health KAP of school children.
BibTeX:
@article{G.Harikiran2008,
  author = {G. Harikiran, S. K. Pallavi, S. Hariprakash, K. S. Nagesh},
  title = {Oral health-related KAP among 11- to 12-year-old school children in a government-aided missionary school of Bangalore city},
  journal = {Indian J Dent Res.},
  year = {2008},
  volume = {19(3)},
  pages = {236-42}
}
G Thomas, M Hashibe, BJ Jacob, K Ramadas, B Mathew, R Sankaranarayanan, ZF Zhang Risk factors for multiple oral premalignant lesions 2003 Int J Cancer.
Vol. 107(2), pp. 285-91 
article  
Abstract: Oral leukoplakia, oral submucous fibrosis and erythroplakia are 3 major types of oral premalignant lesions. Multiple oral premalignant lesions may possibly develop due to field cancerization, where carcinogenic exposures can cause simultaneous genetic defects to the upper aerodigestive tract epithelium, putting the epithelium at high risk for development of premalignant lesions at different stages of carcinogenesis. There have been no epidemiological studies on risk or protective factors of the disease. A case-control study was conducted with data from the baseline screening of a randomized oral cancer screening trial in Kerala, India. A total of 115 subjects with multiple oral premalignant lesions (8-10% of oral premalignant lesions in our case series) were included: 64 subjects with oral leukoplakia and oral submucous fibrosis, 19 subjects with oral leukoplakia and erythroplakia, 22 subjects with oral submucous fibrosis and erythroplakia and 10 subjects with all 3 lesions. Individuals without oral lesions were considered controls
(n=47,773). The odds ratio (OR) for ever tobacco chewers was 37.8 (95% confidence interval (CI)=16.2-88.1) when adjusted for age, sex, education, BMI, smoking, drinking and fruit/vegetable intake. Dose-response relationships were seen for the frequency (p<0.0001) and duration of tobacco chewing (p<0.0001) with the risk of multiple oral premalignant lesions. Whereas alcohol drinking may possibly be a risk factor for multiple oral premalignant lesions, smoking was not associated with the risk of multiple oral premalignant lesions (OR=0.9, 95%CI=0.5- 1.7). The results suggest that tobacco chewing was the most important risk factor for multiple oral premalignant lesions and may be a major source of field cancerization on the oral epithelium in the Indian population.
BibTeX:
@article{G.Thomas2003,
  author = {G. Thomas, M. Hashibe, B. J. Jacob, K. Ramadas, B. Mathew, R. Sankaranarayanan, Z. F. Zhang},
  title = {Risk factors for multiple oral premalignant lesions},
  journal = {Int J Cancer.},
  year = {2003},
  volume = {107(2)},
  pages = {285-91}
}
Gangane N, Chawla S, Anshu, Gupta SS, Sharma SM Reassessment of risk factors for oral cancer 2007 Asian Pac J Cancer Prev.
Vol. 8(2), pp. 243-8 
article  
Abstract: A total of 140 cases of histologically confirmed oral cancer were evaluated for their demographic details, dietary habits and addiction to tobacco and alcohol using a predesigned structured questionnaire at the Mahatma Gandhi Institute of Medical Sciences, Sevagram in Central India. These cases were matched with three sets of age and sex matched controls. Oral cancer was predominant in the age group of 50-59 years. Individuals on a non-vegetarian diet appeared to be at greater risk of developing oral cancer. Cases were habituated to consuming hot beverages more frequently and milk less frequently than controls. Consumption of ghutka, a granular form of chewable tobacco and areca nut, was significantly associated with oral cancer cases. Cases had
been using oral tobacco for longer duration than controls, and were habituated to sleeping with tobacco quid in their mouth. Most cases were also addicted to smoking tobacco and alcohol consumption. Bidi (a crude cigarette) smoking was most commonly associated with oral cancer. On stratified analysis, a combination of regular smoking and oral tobacco use, as well as a combination of regular alcohol intake and oral tobacco use were significantly associated with oral cancer cases. Synergistic effects of all three or even two of the risk factors - oral tobacco use, smoking and alcohol consumption- was
more commonly seen in cases when compared to controls.
BibTeX:
@article{GanganeN2007,
  author = {Gangane N, Chawla S, Anshu, Gupta SS, Sharma SM},
  title = {Reassessment of risk factors for oral cancer},
  journal = {Asian Pac J Cancer Prev.},
  year = {2007},
  volume = {8(2)},
  pages = {243-8}
}
Ghosh S, Shukla HS, Mohapatra SC, Shukla PK Keeping chewing tobacco in the cheek pouch overnight (night quid) increases risk of cheek carcinoma. 1996 Eur J Surg Oncol
Vol. 22(4), pp. 359-60 
article  
Abstract: Chewing Chewable Indian Tobacco (CIT) is a popular addiction in India. Some of the addicts keep the bolus of chewed tobacco tucked in the gingivo-labial sulcus (cheek pouch) overnight. This is known as the habit of the night quid. To assess the influence of night quid on the development of oral cancer we carried out this case control observational study in the Out Patient Department of Surgery, Sir Sunder Lai Hospital, Varanasi, India. A total of 105 consecutive oral cancer patients (epidermoid carcinoma) and 71 sex- and age-matched CIT addicts of the same duration of addiction were investigated for the habit of the night quid. The habit increased the risk of development of cheek carcinoma significantly at Odd's Ratio of 12.5. Simply giving up the habit of night
quid could help in the reduction of oral cancer in CIT addicts.
BibTeX:
@article{GhoshS1996,
  author = {Ghosh S, Shukla HS, Mohapatra SC, Shukla PK},
  title = {Keeping chewing tobacco in the cheek pouch overnight (night quid) increases risk of cheek carcinoma.},
  journal = {Eur J Surg Oncol},
  year = {1996},
  volume = {22(4)},
  pages = {359-60}
}
Ghoshal S, Mallick I, Panda N, Sharma SC Carcinoma of the buccal mucosa: analysis of clinical presentation, outcome and prognostic factors. 2006 Oral Oncol.
Vol. 42(5), pp. 533-9 
article  
Abstract: Records of 100 consecutive cases of carcinoma of the buccal mucosa treated in our institute between January 2000 and December 2003 were analyzed for clinical presentation, patterns of care, disease-free survival (DFS) and prognostic factors. There were 75 males and 25 females. The mean age was 50 years. Ninety five gave a history of abuse of oral tobacco products. Only 20 patients were in Stage I or II. Sixty one patients had Stage IV disease. Sixty six patients were treated with radical intent while 34 were suitable only for palliative radiation. The 2-year DFS for the entire group was 47.94%. All failures occurred by 12 months. However, the 2-year DFS in radically treated patients was 76.4%. On univariate analysis, late overall stage, T3/T4 disease, node positivity and palliative treatment were significant poor prognostic factors. On multivariate analysis, T3/T4 disease and palliative treatment were independent poor prognostic factors. Early detection can improve outcomes considerably in this disease.
BibTeX:
@article{GhoshalS2006,
  author = {Ghoshal S, Mallick I, Panda N, Sharma SC},
  title = {Carcinoma of the buccal mucosa: analysis of clinical presentation, outcome and prognostic factors.},
  journal = {Oral Oncol.},
  year = {2006},
  volume = {42(5)},
  pages = {533-9}
}
Gupta BK, Kaushik A, Panwar RB, Chaddha VS, Nayak KC, Singh VB, Gupta R, Raja S Cardiovascular risk factors in tobacco-chewers: a controlled study. 2007 J Assoc Physicians India.
Vol. 55, pp. 27-31 
article  
Abstract: Background: Influence of habitual tobacco chewing on cardiovascular risk has not been well studied. To determine prevalence of major cardiovascular risk factors in subjects who habitually chew tobacco we performed a controlled study.
Methods: A population based case-control study was performed in Bikaner in Northwestern India where the prevalence of tobacco-chewing is high. Successive 200 subjects who agreed to participate in the evaluation and had a history of isolated tobacco-chewing (range 10-60 years) were enrolled (Group III). The prevalence of major coronary risk factors- obesity, truncal obesity, hypertension, fasting hyperglycemia, and lipid levels were estimated using current guidelines. Electrocardiogram was also performed in all subjects. Chest radiography and treadmill stress test was done in subjects when indicated by symptoms. 200 age- and gender-matched controls who did not use tobacco in any form (Group I) and 200 subjects who had history of smoking bidis or cigarettes for more than 10 years (range 10-55 years) (Group II) were also evaluated.
Results: The body-mass index and obesity were lowest in smoker group. Tobacco chewers had a significantly higher (p<0.001) systolic blood pressure (BP), diastolic BP, resting heart rate, total cholesterol, LDL cholesterol and triglycerides as compared to controls and was similar to smoker group. There was a significantly greater (p<0.01) prevalence of hypertension, hypercholesterolemia, hypertriglyceridemia, radiographic cardiomegaly and positive stress test in Group III as compared to controls. Prevalence of these risk factors was similar among Group II and Group III subjects. HDL cholesterol levels were the lowest in tobacco-chewing group (44.3?8.1 mg/dl) as compared to the Group I (48.4?7.8) and Group II (47.4?7.5) (p<0.001).
Conclusions: There is a significantly greater prevalence of multiple cardiovascular risk factors obesity, resting tachycardia, hypertension, high total and LDL cholesterol, and low HDL cholesterol, and electrocardiographic changes in tobacco users, chewing or smoking, as compared-to tobacco non-users. Chewing tobacco is associated with similar cardiovascular risk as smoking.
BibTeX:
@article{GuptaBK2007,
  author = {Gupta BK, Kaushik A, Panwar RB, Chaddha VS, Nayak KC, Singh VB, Gupta R, Raja S},
  title = {Cardiovascular risk factors in tobacco-chewers: a controlled study.},
  journal = {J Assoc Physicians India.},
  year = {2007},
  volume = {55},
  pages = {27-31}
}
Gupta PC, Hebert JR, Bhonsle RB, Sinor PN, Mehta H, Mehta FS Dietary factors in oral leukoplakia and submucous fibrosis in a population-based case control study in Gujarat, India 1998 Oral Dis.
Vol. 4(3), pp. 200-6 
article  
Abstract: Objectives: To investigate the relationship of specific nutrients and food items with oral precancerous lesions among tobacco users. DESIGN: A population-based case-control study.
Setting: Villages in Palitana taluk of Bhavnagar district, Gujarat, India. Subjects and methods: An interviewer-administered food frequency questionnaire, developed and validated for this population, was used to estimate nutrient intake in blinded, house-to-house interviews. Among 5018 male tobacco
users, 318 were diagnosed as cases. An equal number of controls matched on age (?5 years), sex, village, and use of tobacco were selected. Main outcome measures: Odds ratios (OR) from multiple logistic regression analysis controlling for relevant variables (type of tobacco use and economic status).
Results: A protective effect of fibre was observed for both oral submucous fibrosis (OSF) and leukoplakia, with 10% reduction in risk per g day-1 (P<0.05). Ascorbic acid appeared to be protective against leukoplakia with the halving of risk in the two highest quartiles of intake (versus the lowest quartile: OR=0.46 and 0.44, respectively; P<0.10). A protective effect of tomato consumption was observed in leukoplakia and a suggestion of a protective effect of wheat in OSF.
Conclusions: In addition to tobacco use, intake of specific nutrients may have a role in the development of oral precancerous lesions.
BibTeX:
@article{GuptaPC1998,
  author = {Gupta PC, Hebert JR, Bhonsle RB, Sinor PN, Mehta H, Mehta FS},
  title = {Dietary factors in oral leukoplakia and submucous fibrosis in a population-based case control study in Gujarat, India},
  journal = {Oral Dis.},
  year = {1998},
  volume = {4(3)},
  pages = {200-6}
}
Gupta PC, Mehta FS, Pindborg JJ, Bhonsle RB, Murti PR, Daftary DK, Aghi MB Primary prevention trial of oral cancer in india: a 10-year follow-up study 1992 J Oral Pathol Med.
Vol. 21(10), pp. 433-9 
article  
Abstract: Oral cancer is caused by chewing and smoking of tobacco. To assess the feasibility of primary prevention of oral cancer, two cohorts were studied in base-line surveys and then followed up annually for 10-yr in Ernakulam district of Kerala state. The intervention cohort consisted of 12212 tobacco users aged 15 yr and over, who were exposed to a concentrated program of education against tobacco use. The control cohort was a non-concurrent cohort of 6075 tobacco users studied using similar methods but with a minimal amount of advice against tobacco use. The stoppage of tobacco use increased and the incidence rate of leukoplakia decreased significantly and substantially in the intervention cohort compared to the control cohort. The decrease in the incidence of leukoplakia was indicative of the decrease in the risk of oral cancer since the two were intimately related. This study demonstrated feasibility
of primary prevention of oral cancer.
BibTeX:
@article{GuptaPC1992,
  author = {Gupta PC, Mehta FS, Pindborg JJ, Bhonsle RB, Murti PR, Daftary DK, Aghi MB},
  title = {Primary prevention trial of oral cancer in india: a 10-year follow-up study},
  journal = {J Oral Pathol Med.},
  year = {1992},
  volume = {21(10)},
  pages = {433-9}
}
Gupta PC, Pednekar MS, Parkin DM, Sankaranarayanan R Tobacco associated mortality in Mumbai (Bombay) India. Results of the Bombay Cohort Study. 2005 Int J Epidemiol
Vol. 34(6), pp. 1395-402 
article  
Abstract: Background: Little is known about the excess mortality from forms of tobacco use other than cigarette smoking that are widely prevalent in India, such as bidi smoking and the various forms of smokeless tobacco use. We report on absolute and relative risks of mortality among various kinds of ever tobacco users vs never-users in the city of Mumbai, India.
Methods: Using the Mumbai voters' list as the selection frame, 99 570 individuals aged ?35 years were interviewed at their homes during 1992-94. At active follow-up (during 1997-99) after 5.5 years, 97 244 (97.7%) were traced. Among these, 7531 deaths (4119 men, 3412 women) were recorded, of which 89% died within study area. It was possible to abstract cause of death information from the records of the municipal corporation for 5470 deaths. These were coded using ICD 10.
Results: The adjusted relative risk was 1.37 (95% CI 1.23-1.53) for (men) cigarette smokers and 1.64 (95% CI 1.47-1.81) for bidi smokers, with a significant dose-response relationship for number of bidis or cigarettes smoked. Women were essentially smokeless tobacco users; the adjusted relative risk was 1.25 (95% CI 1.15-1.35). The risk of deaths from respiratory diseases (RR 2.12, 95% CI 1.57-2.87), tuberculosis (RR 2.30, 95% CI 1.68-3.15), and neoplasms (RR 2.60, 95% CI 1.78-3.80) were significantly high in male smokers than never tobacco users.
Conclusions: Bidi is no less hazardous than cigarette smoking, and smokeless tobacco use may also result in significantly increased mortality.
BibTeX:
@article{GuptaPC2005,
  author = {Gupta PC, Pednekar MS, Parkin DM, Sankaranarayanan R},
  title = {Tobacco associated mortality in Mumbai (Bombay) India. Results of the Bombay Cohort Study.},
  journal = {Int J Epidemiol},
  year = {2005},
  volume = {34(6)},
  pages = {1395-402}
}
Gupta PC, Ray CS Epidemiology of betel quid usage 2004 Ann Acad Med Singapore
Vol. 33(4 Suppl), pp. 31-6 
article  
Abstract: Betel quid chewing is an ancient practice common in many countries of Asia and among migrated communities in Africa, Europe and North America. It enjoys complete social acceptance in many societies and is also popular among women. In its most basic form, betel quid consists of betel leaf (Piper betel), areca nut, the main psychoactive ingredient, and slaked lime (calcium hydroxide). Areca nut is said to be the fourth most commonly used psychoactive substance in the world, after caffeine, nicotine and alcohol. There are a great variety of ingredients and ways of preparing betel quid in different countries. In some, particularly in India, tobacco is added to the quid. In recent years, commercially-manufactured non-perishable forms of betel quid (pan masala or betel quid mixtures and gutka), not containing betel leaf, have been marketed. Within a short period of about 2 decades, this industry has risen in value to several hundred US million dollars. Use of areca nut in any form is not safe for oral health; the use of commercially manufactured forms seems even riskier.
BibTeX:
@article{GuptaPC2004,
  author = {Gupta PC, Ray CS},
  title = {Epidemiology of betel quid usage},
  journal = {Ann Acad Med Singapore},
  year = {2004},
  volume = {33(4 Suppl)},
  pages = {31-6}
}
Gupta PC, Ray CS Smokeless tobacco and health in India and South Asia. 2003 Respirology.
Vol. 8(4), pp. 419-31 
article  
Abstract: South Asia is a major producer and net exporter of tobacco. Over one-third of tobacco consumed regionally is smokeless. Traditional forms like betel quid, tobacco with lime and tobacco tooth powder are commonly used and the use of new products is increasing, not only among men but also among children, teenagers, women of reproductive age, medical and dental students and in the South Asian diaspora. Smokeless tobacco users studied prospectively in India had age-adjusted relative risks for premature mortality of 1.2-1.96 (men) and 1.3 (women). Current male chewers of betel quid with tobacco in case-control studies in India had relative risks of oral cancer varying between 1.8-5.8 and relative risks for oesophageal cancer of 2.1-3.2. Oral submucous fibrosis is increasing due to the use of processed areca nut products, many containing tobacco. Pregnant women in India who used smokeless tobacco have a threefold increased risk of stillbirth and a two- to threefold increased risk of having a low birthweight infant. In recent years, several states in India have banned the sale, manufacture and storage of gutka, a smokeless tobacco product containing areca nut. In May 2003 in India, the Tobacco Products Bill 2001 was enacted to regulate the promotion and sale of all tobacco products. In two large-scale educational interventions in India, sizable proportions of tobacco users quit during 5-10 years of follow-up and incidence rates of oral leukoplakia measured in one study fell in the intervention cohort. Tobacco education must be imparted through schools, existing government health programmes and hospital outreach programmes.
BibTeX:
@article{GuptaPC2003,
  author = {Gupta PC, Ray CS},
  title = {Smokeless tobacco and health in India and South Asia.},
  journal = {Respirology.},
  year = {2003},
  volume = {8(4)},
  pages = {419-31}
}
Gupta PC, Subramoney S Smokeless tobacco use and risk of stillbirth: a cohort study in Mumbai, India. 2006 Epidemiology.
Vol. 17(1), pp. 47-51 
article  
Abstract: Background: Maternal cigarette smoking has been causally associated with an increased risk for stillbirth. Preliminary reports suggest an increased risk for stillbirth with smokeless tobacco use during pregnancy.
Methods: We conducted a population-based prospective cohort study to investigate this association by using a house-to-house approach to recruit 1,217 women who were between 3 and 7 months' gestation. Of these, 96% were contacted after delivery to determine the pregnancy outcome. Demographic and maternal variables which were apparently associated either with stillbirth or with smokeless tobacco use (OR ?1.5) were included as potential confounders. Stillbirth was defined as any delivery of a dead fetus after 20 completed weeks of gestation. We used time-to-event methods to analyze the risk of stillbirth.
Results: Overall occurrence of stillbirth among singleton deliveries in this population was 4.1%. Smokeless tobacco use was reported by 17% of women; 8.9% of smokeless tobacco users had a stillbirth compared with 3.1% among nonusers (life-table adjusted hazard ratio = 3.1; 95% confidence interval = 1.7-5.6). After adjustment by the Cox proportional hazards procedure for age, educational and socioeconomic background, working status of mother, parity, prenatal care variables, and place of delivery, the risk for stillbirth in users was 2.6 (95% confidence interval-1.4-4.8). Most women used mishri (a pyrolyzed tobacco product often used as dentifrice), and there was a dose-response relationship between the daily frequency of use and stillbirth risk. The risk of stillbirth associated with smokeless tobacco use was greater in earlier gestational periods.
Conclusion: Smokeless tobacco use during pregnancy increases stillbirth risk, with a risk at least as great as that associated with maternal cigarette smoking.
BibTeX:
@article{GuptaPC2006,
  author = {Gupta PC, Subramoney S},
  title = {Smokeless tobacco use and risk of stillbirth: a cohort study in Mumbai, India.},
  journal = {Epidemiology.},
  year = {2006},
  volume = {17(1)},
  pages = {47-51}
}
Gupta PC, Sreevidya S Smokeless tobacco use, birth weight, and gestational age: population based, prospective cohort study of 1217 women in Mumbai, India. 2004 BMJ.
Vol. 328 
article  
Abstract: Objectives: To study the effect of using smokeless tobacco during pregnancy on babies' birth weight and gestational age at birth.
Design: Population based, prospective cohort study using a house to house approach. Setting: Eight primary health post areas in the city of Mumbai (Bombay), India.
Participants: 1217 women who were three to seven months pregnant and planning to deliver in the study area. 1167 women (96%) were followed up.
Main outcome measures: Birth weight and gestational age in singleton births.
Results: Smokeless tobacco use was associated with an average reduction of 105 g in birth weight (95% confidence interval 30g -181g) and a reduction in gestational age of 6.2 (3.0 to 9.4) days. The odds ratio for low birth weight was 1.6 (1.1-2.4), adjusted by logistic regression for maternal age, education, socioeconomic status, weight, anaemia, antenatal care, and gestational age. The adjusted odds ratio for preterm delivery (<37 weeks) was 1.4 (1.0-2.1); for delivery before 32 weeks it was 4.9 (2.1-11.8) and before 28 weeks it was 8.0 (2.6 - 27.2).
Conclusion: Consumption of smokeless tobacco during pregnancy decreases gestational age at birth and birth weight independent of gestational age. It should receive specific attention as a part of routine prenatal care.
BibTeX:
@article{GuptaPC2004a,
  author = {Gupta PC, Sreevidya S},
  title = {Smokeless tobacco use, birth weight, and gestational age: population based, prospective cohort study of 1217 women in Mumbai, India.},
  journal = {BMJ.},
  year = {2004},
  volume = {328}
}
Gupta PC, Sinor PN, Bhonsle RB, Pawar VS, Mehta HC Oral submucous fibrosis in India: a new epidemic? 1998 Natl Med J India
Vol. 11(3), pp. 113-6 
article  
Abstract: Background: Oral submucous fibrosis (OSF) is a precancerous condition caused by use of the areca nut. The reported prevalence of OSF in Bhavnagar district during 1967 was 0.16%. We investigated whether the impression of an increase in the incidence of the disease was real.
Methods: A house-to-house survey was conducted in Bhavnagar district, Gujarat state. The use of areca nut-containing products and tobacco was assessed through an interviewer administered questionnaire. The oral examination was done by dentists. The diagnostic criteria for OSF was the presence of palpable fibrous bands.
Results: A total of 11,262 men and 10,590 women aged 15 years and older were interviewed for their tobacco habits. Among 5018 men who reported the use of tobacco or areca nut, 164 were diagnosed as suffering from OSF. All but four cases were diagnosed among 1786 current areca nut users (age-adjusted relative risk: 60.6). Areca nut was used mostly in mawa, a mixture of tobacco, lime and areca nut, and 10.9% of mawa users had OSF (age-adjusted relative risk: 75.6). The disease as well as areca nut use was concentrated (about 85%) in the lower (< 35 years) age group.
Conclusions: An increase in the prevalence of OSF, especially in the lower age groups, directly attributable to the use of areca nut products was ob
BibTeX:
@article{GuptaPC1998a,
  author = {Gupta PC, Sinor PN, Bhonsle RB, Pawar VS, Mehta HC},
  title = {Oral submucous fibrosis in India: a new epidemic?},
  journal = {Natl Med J India},
  year = {1998},
  volume = {11(3)},
  pages = {113-6}
}
Gupta R, Sharma SC, Das SN Association of TNF-alpha and TNFR1 promoters and 3' UTR region of TNFR2 gene polymorphisms with genetic susceptibility to tobacco-related oral carcinoma in Asian Indians. 2008 Oral Oncol.
Vol. 44(5), pp. 455-63 
article  
Abstract: Tobacco-related oral squamous cell carcinoma is a common malignancy in Asian people. It accounts for almost 40% of cancers among Indian men and 3% in the Western world. Smokeless tobacco has been shown to induce tumor necrosis factor-alpha (TNFalpha), which, along with its receptors, is over-expressed in people with oral carcinoma. Single nucleotide polymorphisms (SNPs) in TNF-alpha and TNF receptor genes may affect their expression and may be a potential determinant of susceptibility to tobaccorelated oral carcinomas. We assessed SNPs in TNF-alpha(-308, -238) and TNF receptor 1 (TNFR1; -609) promoters by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and at four sites of TNF receptor 2 gene (TNFR2; exon 9 site 1176; exon 10 sites 1663, 1668 and 1690) by PCR-sequence-specific primers (PCR-SSP) techniques, respectively, in 94 patients and 130 healthy controls. TNF-alpha-308 G allele was significantly lower (Pc=0.004; OR=3.85), whereas A allele was significantly higher (Pc=0.004; OR=0.25) in patients compared with controls. No significant change was observed at -238 promoter site between the two groups. In the case of TNF receptors, both TNFR1 -609 TT (Pc=0.006; OR=15.3) and TNFR2 1690 CT (Pc=0.018; OR=5.6) genotypes were significantly lower in patients compared with controls. It seems that TNF-alpha-308 G/A may be related to susceptibility, whereas - 609 TT TNFR1 and 1690 C/T TNFR2 SNPs may be protective to tobacco-related oral squamous cell carcinoma. These SNPs may be useful as a marker for high-risk groups among Asian Indians.
BibTeX:
@article{GuptaR2008,
  author = {Gupta R, Sharma SC, Das SN},
  title = {Association of TNF-alpha and TNFR1 promoters and 3' UTR region of TNFR2 gene polymorphisms with genetic susceptibility to tobacco-related oral carcinoma in Asian Indians.},
  journal = {Oral Oncol.},
  year = {2008},
  volume = {44(5)},
  pages = {455-63}
}
Gupta PC Mouth cancer in India: a new epidemic? 1999 J Indian Med Assoc
Vol. 97(9), pp. 370-3 
article  
Abstract: Oral cancer has been traditionally described as a major form of cancer in India although on the basis of cancer registry data, it was thought that the incidence has decreased. There are several recent reports in the literature, however, predicting an increase in mouth cancer incidence in India. This prediction is based upon observation of an increasing prevalence of oral submucous fibrosis, especially in younger individuals, caused by gutka, an industrially manufactured food item. A comparison of the age distribution of recently reported oral submucous fibrosis cases and incident cases reported in the past clearly establishes that the disease is now occurring at much younger ages. A comparison of the age specific incidence rates of mouth cancer (ICD 143-5) during 1983-87 and 1995 in the city of Ahmedabad shows that the incidence has significantly increased in the younger population (< 50 years). Since tongue cancer (ICD 141) does not show a similar increase, it is concluded that the increase in mouth cancer incidence is real. Urgent public health measures are required to curb this new but avoidable epidemic.
BibTeX:
@article{Gupt1999,
  author = {P. C. Gupta},
  title = {Mouth cancer in India: a new epidemic?},
  journal = {J Indian Med Assoc},
  year = {1999},
  volume = {97(9)},
  pages = {370-3}
}
H Trivedi, BJ Dave, SG Adhvaryu Monitoring of smokeless tobacco consumers using cytogenetic endpoints 1993 Anticancer Res.
Vol. 16(6A), pp. 2245-9 
article  
Abstract: Smokeless tobacco consumption is causally associated with oral cavity cancers; however, extensive cytogenetic studies have not been done. In the present study, individuals consuming dry snuff or tobacco with lime have been studied for frequency of micronucleated cells (MNC) in exfoliated buccal mucosa and
chromosome aberrations (CA) and sister chromatid exchanges (SCE) in lymphocytes. The significant elevation in the values of all the three cytogenetic
markers among tobacco users compared to the controls reveal the extent of genomic damage on target and nontarget tissues. The findings emphasize the
possible use of cytogenetic endpoints for monitoring smokeless tobacco consumers.
BibTeX:
@article{H.Trivedi1993,
  author = {H. Trivedi, B. J. Dave, S. G. Adhvaryu},
  title = {Monitoring of smokeless tobacco consumers using cytogenetic endpoints},
  journal = {Anticancer Res.},
  year = {1993},
  volume = {16(6A)},
  pages = {2245-9}
}
H Trivedi, BJ Dave, SG Adhvaryu Genotoxic effects of tobacco extract on Chinese hamster ovary cells 1993 Cancer Lett.
Vol. 70(1-2), pp. 107-12 
article  
Abstract: Genotoxic effects of an aqueous extract of Nicotiana tabacum, a variety commonly used in India for chewing purposes, were analysed on CHO cells utilizing two different cytogenetic end-points, namely, chromosome aberration frequency and sister chromatid exchange frequency. Statistically significant elevations in the values of both the markers clearly indicated chromosome damaging effects of the extract. Elevations in chromosome aberration and sister chromatid exchange frequencies are suggestive of intrastrand and interstrand DNA cross-links following exposure to tobacco. The effects observed following treatment with low dose for longer duration are of relevance to the condition of the oral mucosa of the chronic smokeless tobacco users.
BibTeX:
@article{H.Trivedi1993a,
  author = {H. Trivedi, B. J. Dave, S. G. Adhvaryu},
  title = {Genotoxic effects of tobacco extract on Chinese hamster ovary cells},
  journal = {Cancer Lett.},
  year = {1993},
  volume = {70(1-2)},
  pages = {107-12}
}
Hazare VK, Goel RR, Gupta PC Oral submucous fibrosis, areca nut and pan masala use: a case-control study. 1998 Natl Med J India.
Vol. 11(6)(299) 
article  
BibTeX:
@article{HazareVK1998,
  author = {Hazare VK, Goel RR, Gupta PC},
  title = {Oral submucous fibrosis, areca nut and pan masala use: a case-control study.},
  journal = {Natl Med J India.},
  year = {1998},
  volume = {11(6)},
  number = {299}
}
Hazarey VK, Erlewad DM, Mundhe KA, Ughade SN Oral submucous fibrosis: study of 1000 cases from central India. 2007 J Oral Pathol Med.
Vol. 36(1), pp. 12-7 
article  
Abstract: Background: Very few reports have been published on the gender specificity of oral submucous fibrosis (OSF) in relation to habit patterns and the severity of disease in the world literature. The purpose of the study was to ascertain the gender specificity for different habits and severity of OSF.
Methods: A hospital-based cross-sectional study on various habit patterns associated with OSF was performed in Nagpur over a 5-year period. A total of 1000 OSF cases from 266,418 out patients comprised the study sample.
Results: The male-to-female ratio of OSF was 4.9:1. Occurrence of OSF was at a significant younger age group (<30 years) among men when compared with women (OR=4.62, 3.22-6.63, P=0.0001). Reduced mouth opening, altered salivation and altered taste sensation were found to be significantly more prevalent in women when compared with men. Exclusive areca nut chewing habit was significantly more prevalent in women (OR= 44.5, 25.4-79.8, P=0.0001). Whereas significant increase for Gutkha (Areca quid with tobacco) (OR = 2.33, 1.56-3.54, P=0.0001) and kharra/Mawa (crude combination of
areca nut and tobacco) (OR=6.8, 4.36-11.06, P=0.0001) chewing was found in men when compared with women.
Conclusions: There is a marked difference in literacy, socioeconomic status, areca nut chewing habits, symptoms and disease severity in women when compared with men in the central Indian population.
BibTeX:
@article{HazareyVK2007,
  author = {Hazarey VK, Erlewad DM, Mundhe KA, Ughade SN},
  title = {Oral submucous fibrosis: study of 1000 cases from central India.},
  journal = {J Oral Pathol Med.},
  year = {2007},
  volume = {36(1)},
  pages = {12-7}
}
JJ Kayal, AH Trivedi, BJ Dave, J Nair, UJ Nair, SV Bhide, UC Goswami, SG Adhvaryu Incidence of micronuclei in oral mucosa of users of tobacco products singly or in various combinations 1993 Mutagenesis.
Vol. 8(1), pp. 31-3 
article  
Abstract: Frequencies of micronucleated cells (MNCs) were analyzed in the exfoliated buccal mucosa of normal healthy individuals from different parts of India who were regularly using either areca nut alone, mava, tamol, tobacco with lime, dry snuff or masheri. The analyses were also carried out among oral submucous fibrosis patients who had the habit of chewing either mava or areca nut. Compared with 'no habit' healthy individuals, all the groups, irrespective of their type of habit, had significantly higher frequencies of MNCs.
BibTeX:
@article{J.J.Kayal1993,
  author = {J. J. Kayal, A. H. Trivedi, B. J. Dave, J. Nair, U. J. Nair, S. V. Bhide, U. C. Goswami, S. G. Adhvaryu},
  title = {Incidence of micronuclei in oral mucosa of users of tobacco products singly or in various combinations},
  journal = {Mutagenesis.},
  year = {1993},
  volume = {8(1)},
  pages = {31-3}
}
Jain M, Kumar S, Lal P, Tiwari A, Ghoshal UC, Mittal B Role of BCL2 (ala43thr), CCND1 (G870A) and FAS (A-670G) polymorphisms in modulating the risk of developing esophageal cancer. 2007 Cancer Detect Prev.
Vol. 31(3), pp. 225-32 
article  
Abstract: Background: Perturbations in the cell cycle and apoptotic genes have been implicated in human malignancies. A study of BCL2 ala43thr, CCND1 G870A and FAS A-670G gene polymorphisms was undertaken to explore their role in influencing the susceptibility for development of esophageal cancer.
Methods: A total of 151 patients and age and gender matched 201 controls were investigated for BCL2 ala43thr, CCND1 G870A and FAS A-670G polymorphisms by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP).
Results: The ala43ala genotype of BCL2 anti-apoptotic gene was significantly associated with risk of developing esophageal cancer (OR 2.1, 95%CI=1.0-4.4, P=0.03), more so in males (OR 2.6, 95%CI=P=0.03). In CCND1 G870A polymorphism, the AA genotype was marginally associated with higher risk of esophageal cancer (OR 1.5,95%CI=0.98-2.4, P=0.05). No significant differences in genotype frequencies of FAS A-670G polymorphism were seen between esophageal cancer patients and controls (P=0.32). Interaction of BCL2 ala43ala, CCND1 870AA and FAS -670AA genotypes did not increase the risk multiplicatively. Association with clinical characteristics showed BCL2 ala43ala genotype to be at increased risk for developing tumors in the middle third location (OR 2.3, 95%CI=1.0-5.3, P=0.03), while patients with CCND1 870AA genotypes were at higher risk for the development of cancer in the upper third location (OR 3.8, 95%CI=1.6-9, P=0.002). BCL2 ala43ala genotype did not modulate the cancer risk in tobacco users. However, patients with CCND1 870AA and FAS -670AA genotypes were associated with a significantly lower number of smoking and chewing pack-years, suggesting a dose-dependent interaction in the risk for esophageal cancer (P=0.005).
Conclusions: There appears to be an influence of BCL2 ala43ala and CCND1 870AA genotypes on esophageal cancer phenotype, particularly with regard to tumor location, which supports the theory of prevalence of site-specific genetic alterations. FAS A-670G was not associated with the risk of developing esophageal cancer. Gene-environment interaction analysis showed cancer susceptibility in CCND1 870AA and FAS -670AA genotype to be influenced by quantity of tobacco.
BibTeX:
@article{JainM2007,
  author = {Jain M, Kumar S, Lal P, Tiwari A, Ghoshal UC, Mittal B},
  title = {Role of BCL2 (ala43thr), CCND1 (G870A) and FAS (A-670G) polymorphisms in modulating the risk of developing esophageal cancer.},
  journal = {Cancer Detect Prev.},
  year = {2007},
  volume = {31(3)},
  pages = {225-32}
}
Jaju RJ, Patel RK, Bakshi SR, Trivedi AH, Dave BJ, Adhvaryu SG Chromosome damaging effects of pan masala. 1992 Cancer Lett.
Vol. 65(3), pp. 221-6 
article  
Abstract: Effects of aqueous extracts of a popular brand of pan masala with and without tobacco (PM-T and PM) were studied for short duration treatment employing an in vitro system. Metabolic activation with S9 mix was also included. Frequency of all the three cytogenetic endpoints viz., chromosome aberration (CA); sister chromatid exchange (SCE) and % micronucleated cells (% MNC) were found to be elevated significantly in a dose-dependent manner in cultures without metabolic activation. However, addition of S9 activation system resulted in suppression of chromosomal damage. Our findings indicate that pan masalas contain water soluble direct acting mutagens.
BibTeX:
@article{JajuRJ1992,
  author = {Jaju RJ, Patel RK, Bakshi SR, Trivedi AH, Dave BJ, Adhvaryu SG},
  title = {Chromosome damaging effects of pan masala.},
  journal = {Cancer Lett.},
  year = {1992},
  volume = {65(3)},
  pages = {221-6}
}
Jane C, Nerurkar AV, Shirsat NV, Deshpande RB, Amrapurkar AD, Karjodkar FR Increased survivin expression in high-grade oral squamous cell carcinoma: a study in Indian tobacco chewers. 2006 J Oral Pathol Med.
Vol. 35(10), pp. 595-601 
article  
Abstract: Background: Oral cancer is one of the five leading sites of cancer in the Indian population. In the present study we analyzed the expression of apoptosis regulating genes, viz. survivin, Bcl-2, Bax and p53 in precancerous and cancerous lesions of the buccal mucosa of Indian tobacco chewers.
Methods: Paraffin-embedded tissue samples from 38 patients with primary oral squamous cell carcinoma (OSCC) and 17 patients with leukoplakia were used. The expression of survivin, Bcl-2, Bax, and p53 was evaluated using immunohistochemical staining method.
Results: 36% percent OSCC were found to be positive for nuclear p53 staining while none of the precancerous lesions showed p53 positivity. Survivin, Bcl-2 and Bax expression was found to increase with increased grade of malignancy. Increase in survivin expression was statistically most significant (P<0.001).
Conclusion: Increased expression of anti-apoptotic survivin in high-grade tumors suggests that survivin is likely to contribute significantly to apoptosis resistance in response to therapy.
BibTeX:
@article{JaneC2006,
  author = {Jane C, Nerurkar AV, Shirsat NV, Deshpande RB, Amrapurkar AD, Karjodkar FR},
  title = {Increased survivin expression in high-grade oral squamous cell carcinoma: a study in Indian tobacco chewers.},
  journal = {J Oral Pathol Med.},
  year = {2006},
  volume = {35(10)},
  pages = {595-601}
}
RM John Tobacco consumption patterns and its health implications in India 2005 Health Policy
Vol. 71(2), pp. 213-22 
article  
Abstract: The main objective of this paper is to analyze the pattern of tobacco consumption and its health implications in India. We use various rounds of National Sample Survey for this purpose. The paper finds that, though there is a reduction in tobacco consumption in the form of bidi and cigarette in India as a whole, this decrease is compensated for by an increase of pan consumption in rural India. It has also been observed that the consumption of tobacco is more among the poor in India and we argue that the consequent higher health care spending arising out of tobacco related diseases leaves them economically worse off. Thus the paper concludes that, apart from the economic gains that tobacco industry is generating, tobacco use also imposes burden, especially on users, in the form of numerous tobacco related diseases and high health care spending. This, coupled with the fact that the investment on health by government is declining over the years, has the potential to trap the poor in a vicious circle of poverty and ill health. Hence government policy needs to be targeted towards an effective control of tobacco use.
BibTeX:
@article{John2005,
  author = {R. M. John},
  title = {Tobacco consumption patterns and its health implications in India},
  journal = {Health Policy},
  year = {2005},
  volume = {71(2)},
  pages = {213-22}
}
Chaudhry K Is pan masala-containing tobacco carcinogenic? 1999 Natl Med J India.
Vol. 12(1), pp. 21-7 
article  
Abstract: Background: Pan masala-containing tobacco (PM-T) was introduced in the Indian market during the 1970s. It is a mixture of areca nut, tobacco, lime, catechu and spices. Despite mounting evidence of health hazards of tobacco, tobacco manufacturers as well as policy-makers often seek evidence regarding the carcinogenicity of newer tobacco mixtures such as PM-T.
Methods: All the studies on pan masala (with or without tobacco) listed on MEDLARS, and the studies known to the expert committee on the subject constituted by the Directorate General of Health Services, were reviewed. The studies on individual components and PM-T like substances were also reviewed. The interpretation of carcinogenicity of PM-T has been made, based on studies on (i) PM-T; (ii) PM-T like mixtures; and (iii) the effect of individual ingredients of PM-T and the likely effect of theirmcombination.
Results: Studies on Chinese hamster ovary cells and Ames test indicate that PM-T is mutagenic. There is limited evidence that it may be carcinogenic to animals. The proportion of areca nut and tobacco in PM-T is in between the proportion of these substances in two known tobacco-areca nut mixtures of India (Mainpuri tobacco and mawa). Studies on Mainpuri tobacco indicate that it is carcinogenic, while literature suggests an association between mawa use and oral submucous fibrosis.
Conclusion: Human studies on PM-T like mixtures and the limited studies on PM-T suggest that PM-T is likely to be carcinogenic.
BibTeX:
@article{K1999,
  author = {Chaudhry K},
  title = {Is pan masala-containing tobacco carcinogenic?},
  journal = {Natl Med J India.},
  year = {1999},
  volume = {12(1)},
  pages = {21-7}
}
K Jayant, PN Notani, SS Gulati, VV Gadre Tobacco usage in school children in Bombay, India. A study of knowledge, attitude and practise 1991 Indian J Cancer
Vol. 28(3), pp. 139-47 
article  
Abstract: A study of knowledge, attitude and practice with regard to tobacco usage was conducted in 1278 boys and 353 girls studying in the final year in various schools in Bombay. The proportion of boys given to one or the other form of tobacco usage (including experimenters/triers) was significantly higher in private English median schools (22.5%) compared to private Indian language schools (6.9%) or municipal Indian language schools (13.8%). There was also a significant difference between the two types of Indian schools. Girls from only Indian language schools were entered into the study and the proportion of tobacco users in them was very low (1.1%). Most (86%) boys who used tobacco were smokers. Hence the detailed analysis is restricted to smokers. Several probable factors influencing smoking behavior were studied. It was found that significantly higher proportion of boys smoked if their father or best friend smoked. Generally boys were more sensitive to best friend's or elder brother's disapproval than to parental. They were well informed
about harmfulness of smoking but knowledge about specific health hazards was limited. Most of them had a positive attitude towards nonsmoking and smoking control programmes. Tobacco use has been proven to be a major health hazard. Although its use in adults in India is common, prevalence in adolescents in urban schools is not yet high. Before the situation changes we need to mount anti-tobacco educational programmes and work towards a non-tobacco generation to contain the harmful consequences of tobacco usage.
BibTeX:
@article{K.Jayant1991,
  author = {K. Jayant, P. N. Notani, S. S. Gulati, V. V. Gadre},
  title = {Tobacco usage in school children in Bombay, India. A study of knowledge, attitude and practise},
  journal = {Indian J Cancer},
  year = {1991},
  volume = {28(3)},
  pages = {139-47}
}
K Kannan, AK Munirajan, J Krishnamurthy, V Bhuvarahamurthy, BK Mohanprasad, KH Panishankar, N Tsuchida, G Shanmugam Low incidence of p53 mutations in betel quid and tobacco chewing-associated oral squamous carcinoma from India 1999 Int J Oncol
Vol. 15(6), pp. 1133-6 
article  
Abstract: Mutations of the p53 tumor suppressor gene have been found to be the single most frequent event in human cancers. In India and other southeast Asian countries tobacco chewing with betel quid was attributed to be the major factor in oral carcinogenesis. We have analyzed 72 untreated primary oral squamous cell carcinomas (SCCs) for mutations in the tumor suppressor gene p53 exons 4-9 by PCR-SSCP and DNA sequencing. Sequencing analysis revealed 16 missense mutations, one silent mutation in codon 307 and four A to G substitution polymorphism in codon 213. The incidence of p53 mutation was 21% (15 of 72) excluding the polymorphism and the silent mutation. Eight mutations were clustered in codons 266-282 of exon 8. Of the total mutation events 37.5% were G to A transitions and 31.3% were G to T transversions. These results indicate the possible involvement of tobacco derived nitrosamines and their adducts in the genesis of oral cancer among Indians.
BibTeX:
@article{K.Kannan1999,
  author = {K. Kannan, A. K. Munirajan, J. Krishnamurthy, V. Bhuvarahamurthy, B. K. Mohanprasad, K. H. Panishankar, N. Tsuchida, G. Shanmugam},
  title = {Low incidence of p53 mutations in betel quid and tobacco chewing-associated oral squamous carcinoma from India},
  journal = {Int J Oncol},
  year = {1999},
  volume = {15(6)},
  pages = {1133-6}
}
K Shankaran, SV Kandarkar, QQ Contractor, RH Kalro, HG Desai Electron microscopic observations in gastric mucosa of habitual tobacco chewers 1994 Indian J Med Res.
Vol. 99, pp. 267-71 
article  
Abstract: Clinical evaluation, upper gastrointestinal endoscopy and electron microscopy of mucosal biopsies from antrum, body and fundus of stomach were performed in three control subjects and 17 habitual tobacco chewers. Electron microscopic abnormalities such as discontinuous, fragmented basement membrane with reduction in hemidesmosomes, and widened intercellular spaces filled with clusters of desmosomes were found in the gastric mucosa of habitual tobacco chewers; these were similar to those reported in experimental carcinogenesis and leukoplakia. It is concluded that habitual chewing of tobacco produces electron microscopic alterations in the human gastric mucosa which may be important precursors for gastric malignancy.
BibTeX:
@article{K.Shankaran1994,
  author = {K. Shankaran, S. V. Kandarkar, Q. Q. Contractor, R. H. Kalro, H. G. Desai},
  title = {Electron microscopic observations in gastric mucosa of habitual tobacco chewers},
  journal = {Indian J Med Res.},
  year = {1994},
  volume = {99},
  pages = {267-71}
}
K Shankaran, SV Kandarkar, QQ Contractor, RH Kalro, HG Desai Ultrastructural changes in esophageal mucosa of chronic tobacco chewers 1993 Indian J Med Res
Vol. 98, pp. 15-9 
article  
Abstract: Seventeen chronic tobacco chewers and three control subjects underwent clinical evaluation, upper gastrointestinal endoscopy and esophageal mucosal biopsies. The esophageal biopsies were processed and examined under the electron microscope. A large number of ultrastructural abnormalities such as discontinuous, fragmented basement membrane, with reduction in hemidesmosomes, widened intercellular spaces were found in the esophageal mucosa of chronic tobacco chewers which resembled the ultrastructural features of experimental carcinogenesis and leukoplakia. It is concluded that chronic chewing of tobacco produces ultrastructural abnormalities in the esophageal mucosa which could be important precursors for esophageal malignancy.
BibTeX:
@article{K.Shankaran1993,
  author = {K. Shankaran, S. V. Kandarkar, Q. Q. Contractor, R. H. Kalro, H. G. Desai},
  title = {Ultrastructural changes in esophageal mucosa of chronic tobacco chewers},
  journal = {Indian J Med Res},
  year = {1993},
  volume = {98},
  pages = {15-9}
}
Kannan A, Das M, Khanna SK Estimation of menthol in Pan Masala samples by a spectrophotometric method. 1997 Food Addit Contam
Vol. 14(4), pp. 367-71 
article  
Abstract: Recently, the Prevention of Food Adulteration Act of India has fixed the level of menthol addition to Pan Masala at 0.1%, therefore good manufacturing practice (GMP) should be adopted so that the samples do not exceed 0.1% menthol (1 mg/g). The estimation of menthol in Pan Masala samples involves steam distillation followed by reaction with pdimethyl amino benzaldehyde (DMAB) in acidic medium to give a red colour, which is read at 550 nm. The sensitivity of this procedure is 75 micrograms menthol per g sample. Using this method, 130 branded and 53 non-branded samples of Pan Masala
were analysed for menthol content. Almost 25% of branded samples contained less than 1 mg menthol per g while 75% of samples contained 1.1-6.5 mg menthol per g Pan Masala. Non-branded Pan Masala contained 1 mg menthol per g in only 7.6% of samples. However, 92% of samples contained 1.1-6.5 mg menthol per g, suggesting that the addition of menthol is relatively higher in non-branded Pan Masala samples than in branded ones.
BibTeX:
@article{KannanA1997,
  author = {Kannan A, Das M, Khanna SK},
  title = {Estimation of menthol in Pan Masala samples by a spectrophotometric method.},
  journal = {Food Addit Contam},
  year = {1997},
  volume = {14(4)},
  pages = {367-71}
}
Kar P, Supakar PC Expression of Stat5A in tobacco chewing-mediated oral squamous cell carcinoma. 2006 Cancer Lett.
Vol. 240(2), pp. 306-11 
article  
Abstract: Oral squamous cell carcinoma (oscc) is the fifth most common cancer worldwide and the number of cases is increasing regularly in the developing world. The effective detection of oscc at its early stages becomes necessary for proper treatment due to limited understanding of the critical pathways during oncogenesis. Signal transducer and activators of transcription (Stats) are an important group of transcription factors, which contribute to tumorigenesis due to their intimate connection to growth factor signalling, apoptosis, and angiogenesis. They also play a critical role in immune responses and hence defective Stat signalling could favour tumour development by compromising immune surveillance. The role of Stat5A in mammary gland carcinoma and leukaemia has already been reported. We for the first time report here the constitutive activation of Stat5A as one of the early events in tobacco mediated-oscc in the eastern Indian population, which can be used as a potent prognostic molecular marker.
BibTeX:
@article{KarP2006,
  author = {Kar P, Supakar PC},
  title = {Expression of Stat5A in tobacco chewing-mediated oral squamous cell carcinoma.},
  journal = {Cancer Lett.},
  year = {2006},
  volume = {240(2)},
  pages = {306-11}
}
Kaur J, Ralhan R Establishment and characterization of a cell line from smokeless tobacco associated oral squamous cell carcinoma. 2003 Oral Oncol.
Vol. 39(8), pp. 806-20 
article  
Abstract: A cell line, AMOS-III has been established from the surgically resected specimen of an untreated primary human oral squamous cell carcinoma of the floor of mouth from a chronic smokeless tobacco consumer. Immunocytochemical analysis showed epithelial specific antigen, cytokeratins 5, 10, 13 and 16 and integrin alpha(6) markers in AMOS-III cells, confirming the epithelial lineage of the cell line. Analyses of morphology, ultrastructure, karyotype, anchorage independent growth and immunocytochemical properties of the cell line demonstrated the transformed phenotype of epithelial cells. AMOS-III cells have doubling time of 42-44 h. Giemsa-banding patterns of chromosomes confirmed the human origin of the AMOS-III cells. Molecular analysis of
cancer-related gene products, p53 and p21(cip1/waf1) showed the presence of wild type p21(cip1/waf1) and truncated p53 proteins. The molecular mechanism underlying the action of retinoids in preventing the occurrence of second primary tumors in oral cancer patients remain to be clearly defined. Treatment of AMOS-III cells with all-trans retinoic acid (ATRA) at 10(-4) microM resulted in 81% cell death. ATRA treatment resulted in enhanced expression of p21(cip1/waf1), nuclear translocation of retinoic acid receptors and apoptotic cell death. Thus, this cell line provides an in vitro model for elucidating the mechanism involving p53 inactivation and p21(cip1/waf1) overexpression in smokeless tobacco-induced oral cancer. Furthermore, the ATRA responsiveness of the cell line underscores its potential utility in identifying the retinoid responsive molecular targets in oral cancer cells.
BibTeX:
@article{KaurJ2003,
  author = {Kaur J, Ralhan R},
  title = {Establishment and characterization of a cell line from smokeless tobacco associated oral squamous cell carcinoma.},
  journal = {Oral Oncol.},
  year = {2003},
  volume = {39(8)},
  pages = {806-20}
}
Kaur R, Nagpal JK, Das BR Polymorphism in IGF-2 as a surrogate marker for predisposition towards tobacco chewing-mediated oral cancer. 2005 Tumour Biol.
Vol. 26(3), pp. 147-52 
article  
Abstract: Insulin and insulin-like growth factors (IGFs) are major determinants of proliferation and apoptosis, thereby playing a significant role in carcinogenesis. Epidemiological evidence associates high levels of INS and IGFs with an increased risk of cancer. Polymorphism of the genes involved in insulin-signaling pathways has been associated with a variable risk for neoplasms in different ethnic and environmental backgrounds. In this study, using PCR-RFLP-based assays, we investigated the distribution of genetic polymorphism in INS and IGF-2 genes in tobacco chewing-mediated oral cancer patients (n = 60) and
healthy controls (n = 45) of Indian ethnic origin. The genotyping was performed for +1127 INS-Pst1 in INS and +3580 IGF-2-Msp1 in IGF-2. The frequencies of the IGF-2 genotypes AG, GG and AA found in oral cancer patients were 0.68, 0.2 and 0.12,respectively, whereas in noncancer controls these frequencies were 0.27, 0.71 and 0.02. Frequencies of each allele, i.e. CT, TT and CC of INS gene, were found to be nearly equal in the tumor (0.22, 0.75 and 0.03) as well as the normal (0.27, 0.67 and 0.06) population. A significant difference was observed in genotypic frequencies of IGF-2 and INS in the Indian ethnic population as compared to the Caucasian, African and Hispanic populations. Polymorphism at +1127 INS-Pst1 locus of INS gene does not show an
implication in oral cancer, whereas the genotype AG or AA at +3580 IGF-2-Msp1 locus of IGF-2 is associated with progression and increased risk of oral cancer. From our study we can conclude that single nucleotide polymorphisms in the IGF-2 gene can be used as a marker for prediction of the risk of oral carcinogenesis.
BibTeX:
@article{KaurR2005,
  author = {Kaur R, Nagpal JK, Das BR},
  title = {Polymorphism in IGF-2 as a surrogate marker for predisposition towards tobacco chewing-mediated oral cancer.},
  journal = {Tumour Biol.},
  year = {2005},
  volume = {26(3)},
  pages = {147-52}
}
Kausar, S Giri, M Mazumdar, A Giri, P Roy, P Dhar Micronucleus and other nuclear abnormalities among betel quid chewers with or without sadagura, a unique smokeless tobacco preparation, in a population from North East India 2009 Mutat Res.  article  
Abstract: Genotoxicity is one of the important endpoints for risk assessment of various lifestyle factors. The study is the first report on the genotoxic effect associated with sadagura, a unique smokeless tobacco prepared in southern Assam province of North-East India. Sadagura is consumed with or without betel quid and/or smoking. In the present cytogenetic monitoring study, analysis of micronuceus (MN), nuclear bud, binucleated, karyorrhectic, karyolytic and pyknotic cells tests were performed in the exfoliated buccal cells of 75 habituates and compared to controls matched for gender, age, and habit. Significant increase in the frequency of MN was found in sadagura chewers (0.48%, P<0.001), smokers (0.46%, P<0.01), betel quid with sadagura chewers (0.91%, P<0.001) and smokers chewing betel quid with sadagura (0.53%, P<0.001) as compared to the unexposed control group (0.07%). Betel quid chewers showed
significant increase (1.65%, P<0.05) in the frequency of binucleated cells as compared to the control group (0.16%). Results of this study demonstrated that sadagura cosumed as a single agent or in combination with betel quid, leads to a significant induction of cytogenetic damage in the buccal epithelial cells of habituates. We suggest that analysis of other degenerative nuclear changes in addition to MN can provide valuable information while evaluating potential genotoxic agents.
BibTeX:
@article{Kausar2009,
  author = {Kausar, S. Giri, M. Mazumdar, A. Giri, P. Roy, P. Dhar},
  title = {Micronucleus and other nuclear abnormalities among betel quid chewers with or without sadagura, a unique smokeless tobacco preparation, in a population from North East India},
  journal = {Mutat Res.},
  year = {2009}
}
Khrime RD, Mehra YN, Mann SB, Mehta SK, Chakraborti RN Effect of instant preparation of betel nut (pan masala) on the oral mucosa of albino rats. 1991 Indian J Med Res
Vol. 94, pp. 119-24 
article  
Abstract: Paste made out of an instant betel nut preparation was painted into the oral cavity of 21 albino rats on alternate days for a period of six months. Biopsies were taken from the oral mucosa at the beginning of the study and every two months there after and compared histopathologically with those obtained from a control group of 14 albino rats. Mild to moderate loss of nuclear polarity and increase in keratoses, parakeratoses, inflammatory cell infiltration and vascularity were noted when compared to the control group. The increase in mitotic figures was statistically insignificant and no definite changes in pigmentation or atypical cells were seen. These findings suggest the possibility of mild leukoplakia. Submucosal collagen increased steeply and steadily
throughout the study period and at the end of six months, 88.23 per cent of biopsies showed thickened and condensed sub-mucosal collagen, indicating submucous fibrosis.
BibTeX:
@article{KhrimeRD1991,
  author = {Khrime RD, Mehra YN, Mann SB, Mehta SK, Chakraborti RN},
  title = {Effect of instant preparation of betel nut (pan masala) on the oral mucosa of albino rats.},
  journal = {Indian J Med Res},
  year = {1991},
  volume = {94},
  pages = {119-24}
}
Krishnan, B Shah, V Lal, DK Shukla, E Paul, SK Kapoor Prevalence of risk factors for non-communicable disease in a rural area of Faridabad district of Haryana 2008 Indian J Public Health.
Vol. 52(3), pp. 117-24 
article  
Abstract: Background & Objectives: To estimate the prevalence and levels of common risk factors for noncommunicable disease in a rural population of Haryana.
Methods: The study involved a survey of 1359 male and 1469 female respondents, aged 15-64 years. Multistage sampling was used for recruitment (PHCs/subcentres/ villages). All households in the selected villages were covered, with one male and one female interviewed in alternate household. WHO STEP-wise tool was used as the study instrument which included behavioural risk factor questionnaire and physical measurements of height, weight, waist circumference and blood pressure. The age adjusting was done using rural Faridabad data from Census 2001.
Results: The age adjusted prevalence of daily smoked tobacco was 41% for men and 13% for women. Daily smokeless tobacco use was 7.1% and 1.2% for men and women respectively. The prevalence of current alcohol consumption was 24.6% among men and none of the women reported consuming alcohol. The mean number of servings of fruits and vegetables per day was 3.7 for men and 2.7 for women. The percentage of people undertaking at least 150 minutes of physical activity in a week was 77.8% for men and 54.5% for women. Among men 9.0% had BMI ?25.0 compared to 15.2% among women. The prevalence of measured hypertension, i.e. ?140 SBP and/or ?90 DBP or on antihypertensive drugs was 10.7% among men and 7.9% among women.
Conclusion: The study showed a high burden of tobacco use and alcohol use among men, inactivity and overweight among women and low fruit and vegetable consumption among both sexes in rural areas.
BibTeX:
@article{Krishnan2008,
  author = {Krishnan, B. Shah, V. Lal, D. K. Shukla, E. Paul, S. K. Kapoor},
  title = {Prevalence of risk factors for non-communicable disease in a rural area of Faridabad district of Haryana},
  journal = {Indian J Public Health.},
  year = {2008},
  volume = {52(3)},
  pages = {117-24}
}
Kulkarni V, Saranath D Concurrent hypermethylation of multiple regulatory genes in chewing tobacco associated oral squamous cell carcinomas and adjacent normal tissues. 2004 Oral Oncol.
Vol. 40(2), pp. 145-53 
article  
Abstract: The methylation pattern in the promoter region of p16, DAPK, MGMT and GSTP1 genes was investigated in oral cancer tissues and tumor associated adjacent tissues, using methylation specific PCR assay. The samples constituted 60 primary oral tumors and corresponding adjacent clinically and histopathologically normal mucosa, and buccal epithelial scrapings from 20 normal healthy individuals without any tobacco habits. The incidence of hypermethylation in oral tumor and adjacent mucosa for p16 gene was 66.7 and 50%, for DAPK was 68.3 and 60%, and MGMT gene was 51.7 and 26.7%,
respectively. The overall hypermethylation in the three genes in the primary tumor was 86.7%, and corresponding adjacent normal mucosa tissues 76.7%. Hypermethylation was not observed in the promoter region of GSTP1 gene in either the primary tumors or the corresponding adjacent normal mucosa. Absence of aberrant methylation in the four genes was noted in buccal scrapings from normal healthy individuals with no tobacco habits. Thus, a high frequency of promoter region hypermethylation was observed in p16, DAPK and MGMT genes in oral cancer tissues as well as in corresponding adjacent normal mucosa. Our results indicate that epigenetic alteration of these genes is a frequent event in oral cancer, and is an early event observed in normal oral mucosa of the patients, indicating the critical importance of the epigenetic alteration in chewing tobacco associated oral carcinogenesis. 81. Patel MM, Pandya AN. Relationship of oral cancer wit
BibTeX:
@article{KulkarniV2004,
  author = {Kulkarni V, Saranath D},
  title = {Concurrent hypermethylation of multiple regulatory genes in chewing tobacco associated oral squamous cell carcinomas and adjacent normal tissues.},
  journal = {Oral Oncol.},
  year = {2004},
  volume = {40(2)},
  pages = {145-53}
}
Kumar S, Nigam SK, Shaikh SA, Saiyed HN Effect of pan masala on sperm morphology of a mouse. 2003 Bull Environ Contam Toxicol.
Vol. 70(6), pp. 1184-8 
article  
BibTeX:
@article{KumarS2003,
  author = {Kumar S, Nigam SK, Shaikh SA, Saiyed HN},
  title = {Effect of pan masala on sperm morphology of a mouse.},
  journal = {Bull Environ Contam Toxicol.},
  year = {2003},
  volume = {70(6)},
  pages = {1184-8}
}
Kumar S, Pandey U, Bala N, Tewar V, Oanh KT Tobacco habit in northern India. 2006 J Indian Med Assoc.
Vol. 104(1), pp. 19-22 
article  
Abstract: To study tobacco consumption practices in north-Indian population, a community-based, stratified sampling survey using validated interview schedule was performed in rural/urban areas of Lucknow, Uttar Pradesh. There were 432 tobacco users (385 men, 47 women; 276 urban, 156 rural) taken as subjects. Tobacco use practices ie, chewing/smoking/rubbing/snuffing, frequency, starting age, supply, place/context of use, quid habit, affect, facilitating conditions/barriers, tobacco users' opinion on control measures were all taken into consideration. Single mode of tobacco use was reported by
277 subjects (64.1%) and the rest had a plethora of tobacco practices. Chewing was prevalent in 322(74.5%), smoking in 256(59.3%), rubbing in 32(7.4%) and snuffing in 4 subjects (0.9%). Of the 10 preparations in the questionnaire, the "top 5" preferences ranked as tobacco-betel, gutka, cigarette, bidi and khaini that remained unchanged between sexes, rural/urban people and age groups. Women significantly (p<0.00001) preferred smokeless tobacco and perceived social barrier for smoking. Gutka consumption was significantly higher in youngsters (<25 years; p<0.0001). Most subjects (235; 54.3%) used tobacco 7-24 times/day. Majority (259; 60%) users started consuming tobacco before 21 years of age and about a fifth 95(22%) before 15 years. Majority users (232; 53.6%) did not procure tobacco from a fixed shop. The commonest context of tobacco use was with any refreshment (337; 78.0%). Of the 322 tobacco chewers, about half the subjects (178; 52.2%) rotated the quid in their mouth, 313(97.2%) later spat it out, 9(2.1%) swallowed it and 15(4.7%) admitted to sleep with the quid in mouth. Tobacco along with alcohol was consumed by 82(19%) and with opium by 33 subjects (7.6%). Social barrier to tobacco use was perceived by 231 subjects (53.5%), especially by smokers. Majority users (355; 82.2%) did not have negative feelings or embarrassment in using tobacco. Most users (351; 81.4%) said they would welcome legislative control on tobacco use.
BibTeX:
@article{KumarS2006,
  author = {Kumar S, Pandey U, Bala N, Tewar V, Oanh KT},
  title = {Tobacco habit in northern India.},
  journal = {J Indian Med Assoc.},
  year = {2006},
  volume = {104(1)},
  pages = {19-22}
}
J Kuruvilla Utilizing dental colleges for the eradication of oral cancer in India 2008 Indian J Dent Res.
Vol. 19(4), pp. 349-53 
article  
Abstract: Dental education in India has grown in such a way that it ranks first in the world in having the highest number of dental schools. There are 240 dental schools all over the country. Paradoxically, even with this large number of dentists and dental institutions, India contributes to the highest number of incident cases of oral cancer. In India, oral cancer burden approximates to 20-30% of all cancers. The plausible reason for this high incidence of oral cancer could be expounded on the fact that there exists a high usage of tobacco within the country. The evidence for the high prevalence of using chewable tobacco products, especially in the youth, was recently reported in the Global Youth Tobacco Survey. This increasing usage of chewing tobacco and related products will further accrue to the mortality and morbidity figures in the near future. To effectuate a breakthrough in the existing situation, the work force of dental schools could be capitalized on. The aim of this article is to present the burden of oral cancer in the country and identify trends in the prevalence of tobacco usage, which if continues could alert an epidemic of oral cancer in the near future; and how dental schools in the country can be utilized for preventing this upcoming epidemic.
BibTeX:
@article{Kuruvill2008,
  author = {J. Kuruvilla},
  title = {Utilizing dental colleges for the eradication of oral cancer in India},
  journal = {Indian J Dent Res.},
  year = {2008},
  volume = {19(4)},
  pages = {349-53}
}
MM Vaidya, SS Sawant, AM Borges, SB Ogale, AN Bhisey Cytokeratin expression in precancerous lesions of the human oral cavity 1998 Oral Oncol.
Vol. 34(4), pp. 261-4 
article  
Abstract: Cytokeratin (CK) expression was studied in buccal mucosa (BM) from 20 leucoplakia and 7 submucous fibrosis patients using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), immunoblotting and two-dimensional gel electrophoresis with iso-electric focussing (IEF) as the first dimension. Normal BM expresses CK 4, 5, 13, 14 and perhaps 19. Of 20 leucoplakia samples analysed, CK 5 was not detected in 17 samples, while CK 14 was not found in 13 samples. CK 1 and CK 8 were aberrantly expressed in six and seven samples, respectively. CK expression in contralaterally collected uninvolved tissues from 3 patients showed a normal pattern in two samples. Non-expression of CK 5 was observed in five of seven submucous fibrosis samples, while CK 14 was not detected in only two samples. CK 8 was aberrantly expressed in three samples. All the leucoplakia patients were chronic tobacco chewers. Thus, nonexpression of CK 5 may be an early event occurring in tobacco-associated pathological changes in the BM.
BibTeX:
@article{M.M.Vaidya1998,
  author = {M. M. Vaidya, S. S. Sawant, A. M. Borges, S. B. Ogale, A. N. Bhisey},
  title = {Cytokeratin expression in precancerous lesions of the human oral cavity},
  journal = {Oral Oncol.},
  year = {1998},
  volume = {34(4)},
  pages = {261-4}
}
MP Niphadkar, QQ Contractor, RA Bhisey Mutagenic activity of gastric fluid from chewers of tobacco with lime 1994 Carcinogenesis.
Vol. 15(5), pp. 927-31 
article  
Abstract: Although tobacco chewing is strongly associated with a high risk of oral and upper alimentary tract cancers, the nature of mutagenic exposure among users has not been clearly defined. In this study, tobacco-specific and mutagenic exposure of chewers of tobacco with lime was evaluated by analysis of gastric fluid (GF). The pH, nitrite and cotinine levels of GF samples from chewers and non-chewers were determined and the samples were tested for mutagenicity in the Ames Salmonella/microsome assay using Salmonella typhimurium strains TA98, TA100 and TA102. Cotinine was not detected in GF from non-chewers while the levels ranged between 0.4-13.64 ?g/ml in samples from chewers; however, the mean pH values (3.8?0.4 versus 2.8?0.3) and
nitrite levels (29.40?1.51 versus 27.39?0.83 ?M) were similar in both groups. While all GF samples from non-chewers were non-mutagenic, samples from chewers were directly mutagenic or upon nitrosation to all the three tester strains and to TA102 strain in the presence of S9. Experiments using scavengers of reactive oxygen species (ROS) showed that mannitol and benzoate abolished the mutagenic response of TA102, indicating that ROS are principally responsible for oxidative damage. The findings provide specific information regarding the mutagenic exposure among tobacco chewers and suggest that tobacco chewing may be an important risk factor in the development of gastric cancer.
BibTeX:
@article{M.P.Niphadkar1994,
  author = {M. P. Niphadkar, Q. Q. Contractor, R. A. Bhisey},
  title = {Mutagenic activity of gastric fluid from chewers of tobacco with lime},
  journal = {Carcinogenesis.},
  year = {1994},
  volume = {15(5)},
  pages = {927-31}
}
Mahale A, Saranath D Microsatellite alterations on chromosome 9 in chewing tobacco-induced oral squamous cell carcinomas from India. 2000 Oral Oncol.
Vol. 36(2), pp. 199-206 
article  
Abstract: Genomic instability as reflected by microsatellite alterations in specific target regions is an important characteristic of oral squamous cell carcinoma (OSCC). Microsatellite instability (MSI) and loss of heterozygosity (LOH) on chromosome 9 has been reported as an early event in oral cancers, primarily from patients in the USA and UK. Hence, we examined 77 primary oral cancer tissues and corresponding peripheral blood cell (PBC) DNA from Indian oral cancer patients for LOH and MSI, using a panel of 11 microsatellite markers spanning chromosome 9 on p and q arms. The patients were long-time
(minimum 10 years) tobacco chewers. The matched DNA samples were amplified by polymerase chain reaction, resolved on a denaturing polyacrylamide gel and visualized by silver staining. An overall of 62% (48/77 cases) of the patients demonstrated microsatellite alterations including 27% MSI and 52% LOH, although at individual loci MSI was observed in 3-8% patients and LOH in the informative cases ranged from 4 to 41%. A majority of the alterations occurred on the p arm at 9p21-23, with 85% (41/48 cases) genetic alterations concentrated between markers D9S157 and D9S161. Multiple alterations were seen in 56% (27/48) of the affected cases with 17 patients showing microsatellite alterations in three to eight loci. Our data show the incidence of genetic alterations primarily in the chromosomal region 9p21-23, and may be indicative of involvement of p16 (CDKN2) tumor suppressor gene on chromosome 9p21, in a subset of chewing tobacco-induced oral cancers.
BibTeX:
@article{MahaleA2000,
  author = {Mahale A, Saranath D},
  title = {Microsatellite alterations on chromosome 9 in chewing tobacco-induced oral squamous cell carcinomas from India.},
  journal = {Oral Oncol.},
  year = {2000},
  volume = {36(2)},
  pages = {199-206}
}
Mahimkar MB, Buch SC, Samant TA, Kapoor MD, Bhisey RA Influence of smokeless tobacco exposure on detoxification status and chromosomal damage in male and female habitues. 2001 Mutat Res.
Vol. 491(1-2), pp. 111-7 
article  
Abstract: In India, a large number of tobacco chewers and masheri users are chronically exposed to tobacco genotoxicants. Detoxification processes involving cellular glutathione (GSH) and glutathione S-transferases (GST) determine the outcome of exposure to environmental mutagens including those present in tobacco. Hence, in this study, GSH levels, GST activity, GSTM1 genotype and cytogenetic damage were determined using lymphocytes from 114 smokeless tobacco habitues and controls. The study groups comprised of male tobacco chewers, female masheri users, and age- and sex-matched controls. Irrespective of the tobacco habit, GSH levels and GST activity were higher in females than in males. In both the groups of habitues, GSH levels were similar to those in controls, while a significant reduction in GST activity was observed in tobacco chewers only. The frequency of cytogenetic alterations was significantly elevated in both the groups of habitues with respect to controls. However, break-type aberrations were more frequent in tobacco chewers while gaps were commonly observed in masheri users. Differences in the nature of chromosomal alterations in the two groups of habitues appeared to be related to variation in total tobacco exposure and gender-related differences in the efficacy of the GSH/GST detoxification system.
BibTeX:
@article{MahimkarMB2001,
  author = {Mahimkar MB, Buch SC, Samant TA, Kapoor MD, Bhisey RA},
  title = {Influence of smokeless tobacco exposure on detoxification status and chromosomal damage in male and female habitues.},
  journal = {Mutat Res.},
  year = {2001},
  volume = {491(1-2)},
  pages = {111-7}
}
Majumder M, Sikdar N, Ghosh S, Roy B Polymorphisms at XPD and XRCC1 DNA repair loci and increased risk of oral leukoplakia and cancer among NAT2 slow acetylators. 2007 Int J Cancer.
Vol. 120(10), pp. 2148-56 
article  
Abstract: Polymorphisms at N-acetyl transferase 2 locus (NAT2) lead to slow, intermediate and rapid acetylation properties of the enzyme. Improper acetylation of heterocyclic and aromatic amines, present in tobacco, might cause DNA adduct formation. Generally, DNA repair enzymes remove these adduct to escape malignancy. But, tobacco users carrying susceptible NAT2 and DNA repair loci might be at risk of oral leukoplakia and cancer. In this study, 389 controls, 224 leukoplakia and 310 cancer patients were genotyped at 5 polymorphic sites on NAT2 and 3 polymorphic sites on each of XRCC1 and XPD loci by PCR-RFLP method to determine the risk of the diseases. None of the SNPs on these loci independently could modify the risk of the diseases in overall population but variant genotype (Gln/Gln) at codon 399 on XRCC1 and major genotype (Lys/Lys) at codon 751 on XPD were associated with increased risk of leukoplakia and cancer among slow acetylators, respectively (OR=4.2, 95% CI=1.2-15.0; OR=1.6, 95% CI=1.1-2.3, respectively). Variant genotype (Asn/Asn) at codon 312 on XPD was also associated with increased risk of cancer among rapid and intermediate acetylators (OR=1.9, 95% CI=1.2-2.9). Variant C-G-A haplotype at XRCC1 was associated with increased risk of leukoplakia (OR=1.7, 95% CI = 1.2-2.4) but leukoplakia and cancer in
mixed tobacco users (OR=3.1, 95% CI=1.4-7.1, OR=2.4, 95% CI=1.1-5.4, respectively) among slow acetylators. Although none of the 3 loci could modulate the risk of the diseases independently but 2 loci in combination, working in 2 different biochemicalmpathways, could do so in these patient populations.
BibTeX:
@article{MajumderM2007,
  author = {Majumder M, Sikdar N, Ghosh S, Roy B},
  title = {Polymorphisms at XPD and XRCC1 DNA repair loci and increased risk of oral leukoplakia and cancer among NAT2 slow acetylators.},
  journal = {Int J Cancer.},
  year = {2007},
  volume = {120(10)},
  pages = {2148-56}
}
Majumder M, Sikdar N, Paul RR, Roy B Increased risk of oral leukoplakia and cancer among mixed tobacco users carrying XRCC1 variant haplotypes and cancer among smokers carrying two risk genotypes: one on each of two loci, GSTM3 and XRCC1 (Codon 280). 2005 Cancer Epidemiol Biomarkers Prev.
Vol. 14(9), pp. 2106-12 
article  
Abstract: An individual's susceptibility to oral precancer and cancer depends not only on tobacco exposure but also on the genotypes/haplotypes at susceptible loci. In this hospital-based case-control study, 310 cancer patients, 197 leukoplakia patients, and 348 controls were studied to determine risk of the disease due to polymorphisms at three sites on XRCC1 and one site on XRCC3. Independently, variant genotypes on these loci did not modulate risk of leukoplakia and cancer except for the XRCC1 (codon 280) risk genotype in exclusive smokeless tobacco users with leukoplakia [odds ratios (OR), 2.4; 95% confidence intervals (CI), 1.0-5.7]. But variant haplotypes, containing one variant allele, on XRCC1 increased the risk of leukoplakia (OR, 1.3; 95% CI, 1.0-1.7). Among
stratified samples, mixed tobacco users, carrying variant haplotypes, also had increased risk of both leukoplakia (OR, 2.2; 95% CI, 1.3-3.9) and cancer (OR, 1.9; 95% CI, 1.2-3.1). In a previous study on this population, it was shown that the GSTM3 (A/A) genotype increased the risk of oral leukoplakia and cancer among smokers, which has also been substantiated in this study with expanded sample sizes. The simultaneous presence of two risk genotypes in smokers, one on each of two loci, GSTM3 and XRCC1 (codon 280), increased the risk of cancer (OR, 2.4; 95% CI, 1.0-5.8). Again, smokers carrying two risk genotypes, one on each of two loci, GSTM3 and XRCC1 (codon 399), were also overrepresented in both leukoplakia and cancer populations (P(trend) = 0.02 and 0.04, respectively) but enhancement of risks were not observed; probably due to small sample sizes. Therefore, the presence of variant haplotypes on XRCC1 and two risk genotypes, one on each of two loci, GSTM3 and XRCC1, could be useful to determine the leukoplakias that might progress to cancer in a group of patients.
BibTeX:
@article{MajumderM2005,
  author = {Majumder M, Sikdar N, Paul RR, Roy B},
  title = {Increased risk of oral leukoplakia and cancer among mixed tobacco users carrying XRCC1 variant haplotypes and cancer among smokers carrying two risk genotypes: one on each of two loci, GSTM3 and XRCC1 (Codon 280).},
  journal = {Cancer Epidemiol Biomarkers Prev.},
  year = {2005},
  volume = {14(9)},
  pages = {2106-12}
}
Manchanda P, Sharma SC, Das SN Differential regulation of IL-2 and IL-4 in patients with tobacco-related oral squamous cell carcinoma. 2006 Oral Dis.
Vol. 12(5), pp. 455-62 
article  
Abstract: Aim: The aim of the study was to investigate the systemic immunity in terms of major lymphocyte subsets and the expression of IL-2 and IL-4 in T-cell subsets from peripheral blood of patients with tobacco-related intraoral squamous cell carcinoma.
Methods: CD3+, CD4+ and CD8+ T-cell subsets and CD16+ CD56+ natural killer cells, and intracellular cytokines in T-cell subsets were determined by two-colour flow cytometry and confocal microscopy.
Results: Oral cancer patients showed a significantly reduced (P<0.001) CD3+ and CD4+ T-cell subsets with a lower CD4/CD8 ratio when compared with the normal controls. The frequency of CD3+, IL-4+ and CD8+ IL-4+ T cells were significantly higher (P<0.001) while CD4+ IL-2+ were significantly lower (P<0.02) in patients when compared with the normal controls. Late stage of the tumour was associated with reduced expression of IL-2 in both CD4+ (P<0.05) and CD8+ (P<0.03) subsets.
Conclusions: The tobacco-related intraoral squamous cell carcinoma seems to be associated with multiple systemic immune defects particularly, an impaired CD3+ and CD4+ T cells in the peripheral blood as well as a differential regulation of IL-2 and IL-4 in CD4+ and CD8+ T-cell subsets. The cytokine response in these patients seems to be skewed from protective Th1 to immunosuppressive Th2 type. Thus these patients could be ideal candidate for immunomodulation therapy.
BibTeX:
@article{ManchandaP2006,
  author = {Manchanda P, Sharma SC, Das SN},
  title = {Differential regulation of IL-2 and IL-4 in patients with tobacco-related oral squamous cell carcinoma.},
  journal = {Oral Dis.},
  year = {2006},
  volume = {12(5)},
  pages = {455-62}
}
Mehrotra R, Singh M, Gupta RK, Singh M, Kapoor AK Trends of prevalence and pathological spectrum of head and neck cancers in North India. 2005 Indian J Cancer.
Vol. 42(2), pp. 89-93 
article  
Abstract: Background: Head and neck neoplasia constitute one of the commonest cancers in India. Use of smokeless tobacco (Pan masala, Zarda etc.) is on the increase in North India, especially in Uttar Pradesh, and is responsible for the large majority of these
tumours.
Aim: To assess the patients' characteristics, yearly prevalence and histopathological subtypes of the head and neck neoplasia (excluding oral cavity) in Allahabad and surrounding regions.
Setting and designs: A retrospective study of 11 years from 1990 to 2000 was designed. Data was collected year-wise using the tumor registry data.
Material and method: All biopsies submitted for histopathology to the Pathology department were reviewed and analyzed for demographic data, site and diagnosis.
Statistical analysis: The Kolmogorov-Smirnov Two-Sample Test was utilized to determine whether two distributions are the same.
Results: A total of 40559 biopsies were examined in the department, of which, lesions of the head and neck region, excluding the oral cavity, constituted 694 biopsies (409 males and 285 females). One hundred and forty-four malignant lesions were reported, 114 being males and 30 females. A comparison of the age-specific prevalence rates of cancer during the study period showed that the prevalence was highest in patients belonging to the 50-59 years age group and squamous cell carcinoma Grade II was the most prevalent type. On an average, 58 new biopsies per annum were received.
Conclusions: Properly structured site-specific data like this can augment the National Cancer Registry Programme and is an essential indicator for the magnitude and the pattern of the cancer problem in India.
BibTeX:
@article{MehrotraR2005,
  author = {Mehrotra R, Singh M, Gupta RK, Singh M, Kapoor AK},
  title = {Trends of prevalence and pathological spectrum of head and neck cancers in North India.},
  journal = {Indian J Cancer.},
  year = {2005},
  volume = {42(2)},
  pages = {89-93}
}
Mehrotra R, Singh M, Kumar D, Pandey AN, Gupta RK, Sinha US Age specific incidence rate and pathological spectrum of oral cancer in Allahabad. 2003 Indian J Med Sci
Vol. 57(9), pp. 400-4 
article  
Abstract: Background: Cancer of the oral cavity is one of the commonest cancers in India. Use of smokeless tobacco (Pan masala, Zarda etc ) is on the increase in North India and specially in Uttar Pradesh. AIMS: To assess the patients characteristics and histopathological subtypes of the oral cancer in our region.
Setting and design: A single institutional retrospective study of 11 years from 1990 to 2000 was designed. Data was collected year wise using the tumour registry data.
MATERIAL AND METHODS: A total of 40,559 biopsies were examined in the department during 1990-2000, out of which the oral cavity constituted 759 biopsies. The data was analysed with emphasis on age, sex, risk factors, site and histology.
Statistical analysis: The data was analysed utilizing the Kolomogroo-Smirnov two sample test.
Results: A comparison of the age specific incidence rates of oral cancer during 1990-2000 in Allahabad showed that the incidence was maximum in the 50-59 years age group and squamous cell carcinoma grade I was the most prevalent type. Of the total of 759 biopsies from oral cavity, 303 malignant cases. 232 (76.57%) were males and 71 (23.43% were females with a male to female ratio of 3.27:1. The tongue was the most frequently involved site--found in 42.57% cases. On an average, 63 new cases of oral cavity per annum were detected during this period.
Conclusion: Properly structured site specific data like this can augment National Cancer Registry Programme (NCRP) and is an essential indicator for the magnitude and the pattern of the cancer problem in India Urgent public health measures like public education and oral cancer awareness are required to curb this avoidable epidemic.
BibTeX:
@article{MehrotraR2003,
  author = {Mehrotra R, Singh M, Kumar D, Pandey AN, Gupta RK, Sinha US.},
  title = {Age specific incidence rate and pathological spectrum of oral cancer in Allahabad.},
  journal = {Indian J Med Sci},
  year = {2003},
  volume = {57(9)},
  pages = {400-4}
}
Mishra R, Das BR Activation of STAT 5-cyclin D1 pathway in chewing tobacco mediated oral squamous cell carcinoma. 2005 Mol Biol Rep.
Vol. 32(3), pp. 159-66 
article  
Abstract: Cyclin D1 overexpression and upregulation has been reported largely in Oral Squamous Cell Carcinoma (OSCC) but the mechanism behind it is not clear. Here, the transcription and translational upregulation of cyclin D1 was observed in most of the tobacco chewing oral cancer patients where as the gene amplification was limited to only small group (20%) of patients. A transcription factor (TF) binding site has been detected from -483 to -451 by using DNase I foot printing analysis and confirmed by electrophoretic mobility shift assay by using oral tumour nuclear extract (NE). This is a STAT binding sequence
and confirmed as STAT 5a by super shift assay. The binding of STAT 5 was observed in 80% (24/30) oral cancer samples. The co-expression of cyclin D1 with STAT 5 binding was observed in 90% (27/30) of the samples. STAT family of proteins is emerging to play role in oral carcinogenesis. Here, the binding of STAT 5 might up regulate cyclin D1 in most of the samples whereas; the gene amplification events are sporadic in oral carcinogenesis. Our study provides the first evidence of the constitutive activation of STAT 5-cyclin D1 pathway in chewing tobacco mediated OSCC.
BibTeX:
@article{MishraR2005,
  author = {Mishra R, Das BR},
  title = {Activation of STAT 5-cyclin D1 pathway in chewing tobacco mediated oral squamous cell carcinoma.},
  journal = {Mol Biol Rep.},
  year = {2005},
  volume = {32(3)},
  pages = {159-66}
}
Mishra R, Das BR Early overexpression of Cdk4 and possible role of KRF and c-myc in chewing tobacco mediated oral cancer development. 2003 Mol Biol Rep.
Vol. 30(4), pp. 207-13 
article  
Abstract: Cyclin Dependent Kinase 4 (Cdk4) is known to be an oncogene and is involved in various cancers. It is over-expressed either by genomic amplification or by c-myc dependent manner. Our preliminary results indicate high expression of protein and mRNA as well as absence of genomic amplification in early oral cancer development. One transcription factor (TF) binding site has been detected from -281 to -298 by using DNase I foot printing and confirmed by electrophoretic mobility shift assay. This is a novel DNA sequence. The recruitment of this new TF as well as the earlier reported cmyc was analyzed in various stage of oral cancer development. The binding activity of the new TF is present in normal tissues and observed more in initial stage samples whereas c-myc expression was absent in normal and more in higher stage of oral cancer development. On the basis of these findings we propose the new TF to be a possible CdK4 Regulating Factor (KRF). This might maintain the basal level transcription in normal and activates Cdk4 transcription in the initial stage, where as the same role is carried by c-myc in higher stage of chewing tobacco mediated oral cancer development.
BibTeX:
@article{MishraR2003,
  author = {Mishra R, Das BR},
  title = {Early overexpression of Cdk4 and possible role of KRF and c-myc in chewing tobacco mediated oral cancer development.},
  journal = {Mol Biol Rep.},
  year = {2003},
  volume = {30(4)},
  pages = {207-13}
}
Misra C, Majumder M, Bajaj S, Ghosh S, Roy B, Roychoudhury S Polymorphisms at p53, p73, and MDM2 loci modulate the risk of tobacco associated leukoplakia and oral cancer. 2009 Mol Carcinog  article  
Abstract: Polymorphisms at loci controlling cellular processes such as cell cycle, DNA repair, and apoptosis may modulate the risk of cancer. We examined the association of two linked polymorphisms (G4C14-A4T14) at p73 and one polymorphism (309G > T) at MDM2 promoter with the risk of leukoplakia and oral cancer. The p73 and MDM2 genotypes were determined in 197 leukoplakia patients, 310 oral cancer patients and in 348 healthy control subjects. The p73 GC/AT genotype increased the risk of leukoplakia (OR = 1.6, 95% CI = 1.1-2.3) and oral cancer (OR = 2.4, 95% CI = 1.7-3.3) but the 309G > T MDM2
polymorphism independently could not modify the risk of any of the diseases. Stratification of the study population into subgroups with different tobacco habits showed that the risk of the oral cancer is not modified further for the individuals carrying p73 risk genotype. However, leukoplakia patients with smokeless tobacco habit showed increased risk with combined GC/AT and AT/AT (OR = 3.0, 95% CI = 1.3-7.0) genotypes. A combined analysis was done with our previous published data on p53 codon 72 pro/arg polymorphism. Analysis of pair wise genotype combinations revealed increase in risk for specific p73-MDM2 and p73-p53 genotype combinations. Finally, the combined three loci analyses revealed that the presence of at least one risk allele at all
three loci increases the risk of both leukoplakia and oral cancer.
BibTeX:
@article{MisraC2009,
  author = {Misra C, Majumder M, Bajaj S, Ghosh S, Roy B, Roychoudhury S},
  title = {Polymorphisms at p53, p73, and MDM2 loci modulate the risk of tobacco associated leukoplakia and oral cancer.},
  journal = {Mol Carcinog},
  year = {2009}
}
Misra SP, Misra V, Dwivedi M, Gupta SC Oesophageal subepithelial fibrosis: an extension of oral submucosal fibrosis. 1998 Postgrad Med J.
Vol. 74(878), pp. 733-6 
article  
Abstract: Fifty-five patients with oral submucosal fibrosis and an equal number of patients with no evidence of the disease were studied. All patients underwent upper gastrointestinal endoscopy and any abnormality was noted. Multiple oesophageal biopsies were obtained from the upper end of the oesophagus and from any endoscopically observed abnormality. The histological changes in the two groups were assessed blindly by an experienced histopathologist. Histological abnormalities were noted in the oesophageal mucosa in 2% of controls and 66% of patients with oral submucosal fibrosis (p<0.0001).
In the control group, acanthosis was seen in one patient, while in the patient group atrophy of the squamous epithelium was evident in 52%, hyperkeratosis in 52%, parakeratosis in 30%, dyskeratosis in 14%, acanthosis in 14%, and papillomatosis and mild dysplasia in 2% patients. Subepithelial collagenization was seen in 32 (64%) patients. The oesophageal abnormalities were seen more frequently in patients who had consumed Pan masala, Gutka, betel nut, tobacco or a combination of some or all of these, with or without betel leaf, for ?5 years compared to those consuming them for a shorter period of time (91% vs 46%, p<0.001). It is concluded that oral submucosal fibrosis is not a disease confined to the oral cavity; the oesophagus may also be involved in about two-thirds of patients.
BibTeX:
@article{MisraSP1998,
  author = {Misra SP, Misra V, Dwivedi M, Gupta SC.},
  title = {Oesophageal subepithelial fibrosis: an extension of oral submucosal fibrosis.},
  journal = {Postgrad Med J.},
  year = {1998},
  volume = {74(878)},
  pages = {733-6}
}
Mukherjee A, Chakrabarti J, Chakrabarti A, Banerjee T, Sarma A Effect of 'Pan Masala' on the germ cells of male mice. 1991 Cancer Lett.
Vol. 58(3), pp. 161-5 
article  
Abstract: Cytogenetic analyses of meiotic metaphase I germ cells and abnormalities of head morphology of caudal sperms were conducted in male mice following oral feeding of Pan Masala. The substance was ground to a fine powder, dispersed in polysorbate solution and administered via gavage to the animals at 84, 420 and 840 mg/kg body weight at the rate of 10 ml/kg body weight. Polysorbate and cyclophosphamide served as the vehicle control and positive control respectively. The two higher doses, 420 and 840 mg, gave a significant increase in the frequency of X-Y univalents and breaks over those of the vehicle control. Frequency of sperm head abnormalities were significantly high for all the doses tested. The results indicate that Pan Masala is a potent clastogen, reaches the testes and affects the germinal cells.
BibTeX:
@article{MukherjeeA1991,
  author = {Mukherjee A, Chakrabarti J, Chakrabarti A, Banerjee T, Sarma A},
  title = {Effect of 'Pan Masala' on the germ cells of male mice.},
  journal = {Cancer Lett.},
  year = {1991},
  volume = {58(3)},
  pages = {161-5}
}
Mukherjee A, Giri AK Sister chromatid exchange induced by 'pan masala' (a betel quid ingredient) in male mice in vivo. 1991 Food Chem Toxicol
Vol. 29(6), pp. 401-3 
article  
Abstract: Sister chromatid exchange (SCE) induced in vivo by 'pan masala', a betel quid ingredient, was studied in male mice. The mice were injected ip with an aqueous suspension of pan masala at doses of 5, 12.5, 25, 50, 100 or 200 mg pan masala/kg body weight. A significant dose-related increase in SCE was observed (Cochran Armitage trend test). The minimum effective dose was 25 mg/kg. The two highest doses caused significant delays in the cell cycle. These results indicate that pan masala is a potential DNA-damaging agent and cytotoxic to bone marrow cells.
BibTeX:
@article{MukherjeeA1991a,
  author = {Mukherjee A, Giri AK},
  title = {Sister chromatid exchange induced by 'pan masala' (a betel quid ingredient) in male mice in vivo.},
  journal = {Food Chem Toxicol},
  year = {1991},
  volume = {29(6)},
  pages = {401-3}
}
N Sikdar, RR Paul, B Roy Glutathione S-transferase M3 (A/A) genotype as a risk factor for oral cancer and leukoplakia among Indian tobacco smokers 2004 Int J Cancer
Vol. 109(1), pp. 95-101 
article  
Abstract: Polymorphism in glutathione S-transferase (GST) genes, causing variations in enzyme activities, may influence susceptibility to oral cancer and leukoplakia in smokers and/or smokeless tobacco users. In this case-control study consisting of 109 leukoplakia and 256 oral cancer patients and 259 controls, genotype frequencies at GSTM1, GSTT1, GSTM3 and GSTP1 loci were determined by polymerase chain reaction-restriction fragment length polymorphism methods and analyzed by multiple logistic regression to determine the risks of the diseases. There were no significant differences in the distributions of GSTM1, GSTM3 and GSTT1 genotypes in patients and controls when all individuals were compared. In contrast, frequencies of ile/ile genotype at codon 105 and variant val-ala haplotype of GSTP1 was significantly higher (OR = 1.5; 95% CI=1.0-2.0) and lower (OR=1.4; 95% CI=1.0-1.9) in oral cancer patients compare to controls, respectively. The impacts of all genotypes on risks of oral cancer and leukoplakia were also analyzed in patients with different tobacco habits and doses. Increased risks of cancer and leukoplakia were observed in tobacco smokers with GSTM3 (A/A) genotype (OR=2.0, 95% CI=1.0-4.0; OR=2.0, 95% CI=1.0-4.4, respectively). So, GSTM3 (A/A) genotype could become one of the markers to know which of the leukoplakia would be transformed into cancer. Heavy tobacco chewing (>124 chewing-year) increased the risk of cancer in individuals with GSTT1 homozygous null genotype (OR=3.0; 95% CI=1.0-9.8). Furthermore, increased lifetime exposure to tobacco smoking (>11.5 pack-year) increased the risk of leukoplakia in individuals with GSTM1 homozygous null genotype (OR=2.4; 95% CI=1.0-5.7). It may be suggested that polymorphisms in GSTP1, GSTM1, GSTM3 and GSTT1 genes regulate risk of cancer and leukoplakia differentially among different tobacco habituals.
BibTeX:
@article{N.Sikdar2004,
  author = {N. Sikdar, R. R. Paul, B. Roy},
  title = {Glutathione S-transferase M3 (A/A) genotype as a risk factor for oral cancer and leukoplakia among Indian tobacco smokers},
  journal = {Int J Cancer},
  year = {2004},
  volume = {109(1)},
  pages = {95-101}
}
Nagpal JK, Das BR Identification of differentially expressed genes in tobacco chewing-mediated oral cancer by differential displaypolymerase chain reaction. 2007 Eur J Clin Invest.
Vol. 37(8), pp. 658-64 
article  
Abstract: Background: Identification of changes in gene expression that occur in oral squamous cell carcinoma (OSCC), after sufficient characterization, may yield novel molecular markers that may be useful in the diagnosis and disease management of oral cancer.
Materials and methods: We used differential display-polymerase chain reaction (DDPCR) to study critically the global gene expression profile of the oral tumour versus normal epithelium. The differential expression of fished out cDNA were confirmed by Northern blot and reverse transcription-PCR. The differentially expressed cDNA were cloned, sequenced and matched for homology in the GenBank database.
Results: We identified 13 cDNA that showed differential expression. Out of these we selected four cDNA showing consistent reproducibility. One of the cDNA expressed exclusively in tumour had a homology to DEK, a putative oncogene, and is linked to leukaemia, various cancers, HIV infection and several autoimmune disorders. Another cDNA expressed only in tumour had homology to sorcin protein. Sorcin is a 22-kDa calcium-binding protein and is associated with drug resistance in various cell lines. Apparently, sorcin expression might be responsible for drug resistance of OSCC and poor prognosis. Another cDNA showing 10 times overexpression in cheek tumour as compared to normal had homology to CDK6 gene. Hence, it seems from our results that CDK6 is dysregulated during oral carcinogenesis. The fourth cDNA was overexpressed in normal as compared to cheek tumour, but did not show any match in BLAST search.
Conclusions: We conclude that there is an enormous significance of these differentially expressed cDNA in oral cancer progression as they can serve as cancer markers to be used for diagnosis and therapeutic intervention.
BibTeX:
@article{NagpalJK2007,
  author = {Nagpal JK, Das BR},
  title = {Identification of differentially expressed genes in tobacco chewing-mediated oral cancer by differential displaypolymerase chain reaction.},
  journal = {Eur J Clin Invest.},
  year = {2007},
  volume = {37(8)},
  pages = {658-64}
}
Nagpal JK, Mishra R, Das BR Activation of Stat-3 as one of the early events in tobacco chewing-mediated oral carcinogenesis. 2002 Cancer.
Vol. 94(9), pp. 2393-400 
article  
Abstract: Background: The Jak/Stat signaling pathway transmits signals from many cytokines and growth factor receptors to target genes in the nucleus. Constitutive activation of Stat-3 recently has been observed in many tumor cells, and dysregulation of the Stat signaling pathway has been proposed to be implicated in malignant transformation. In the current study for the first time to the authors's knowledge, the expression of STAT-3 was analyzed in various stages and sites of squamous cell carcinoma of the head and neck (HNSCC).
Methods: Tissue samples from 90 patients of tobacco chewing-mediated HNSCC representing various stages, sites, and differentiation states were selected for studying STAT-3 protein and RNA expression. In vivo localization of STAT-3 was studied by immunohistochemistry of paraffin embedded sections. The presence of STAT-3 and its phophorylated and activated form pSTAT-3 was checked by Western blotting. mRNA expression was analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR). Apoptosis analysis was conducted by in situ ENA nick end labeling assay and hematoxylin and eosin staining.
Results: Overall, 58.9% of HNSCC tumors showed very high Stat-3 protein accumulation, and 23.3% showed intermediate accumulation whereas 17.8% of HNSCC tumors were negative for Stat-3. No Stat-3 was detected in normal samples, and only one of eight premalignant lesions showed intermediate Stat-3 accumulation. On immunoblotting, very high protein accumulation was detected in T1 and T2 classification, moderate in T3 and T4 (P = 0.033, chi-square test), whereas no Stat-3 was detected in normal samples. Similar trend also was found in Stat-3 mRNA expression by RT-PCR analysis which was high in T1 and T2 (early stages), moderate in T3 and T4 (late stages), and no expression in normal samples. The mean apoptotic indices were 1.75, 1.88, and 1.66 for normal, premalignant lesions, and HNSCC cases, respectively.
Conclusion: Stat-3 activation is an early event in head and neck carcinogenesis though its role in blocking the apoptosis in vivo in solid tumors was not observed.
BibTeX:
@article{NagpalJK2002,
  author = {Nagpal JK, Mishra R, Das BR.},
  title = {Activation of Stat-3 as one of the early events in tobacco chewing-mediated oral carcinogenesis.},
  journal = {Cancer.},
  year = {2002},
  volume = {94(9)},
  pages = {2393-400}
}
Bansode NN An exploratory study on gutkha and smokeless tobacco Nurs J India.consumption. 2002 Nurs J India.
Vol. 93(6), pp. 127-8 
article  
BibTeX:
@article{NN2002,
  author = {Bansode NN},
  title = {An exploratory study on gutkha and smokeless tobacco Nurs J India.consumption.},
  journal = {Nurs J India.},
  year = {2002},
  volume = {93(6)},
  pages = {127-8}
}
PA Jayalekshmi, P Gangadharan, S Akiba, R R K Nair, M Tsuji, B Rajan Tobacco chewing and female oral cavity cancer risk in Karunagappally cohort, India 2009 British Journal of Cancer
Vol. 100, pp. 848-852 
article  
Abstract: This study examined oral cancer in a cohort of 78 140 women aged 30�84 years in Karunagappally, Kerala, India, on whom baseline information was collected on lifestyle, including tobacco chewing, and sociodemographic factors during the period 1990�1997. By the end of 2005, 92 oral cancer cases were identified by the Karunagappally Cancer Registry. Poisson regression analysis of grouped data, taking into account age and income, showed that oral cancer incidence was strongly related to daily frequency of tobacco chewing (P<0.001) and was increased 9.2-fold among women chewing tobacco 10 times or more a day. The risk increased with the duration of tobacco chewing during the first 20 years of tobacco chewing. Age at starting tobacco chewing was not significantly related to oral cancer risk. This is the first cohort study of oral cancer in relation to tobacco chewing among women.
BibTeX:
@article{PAJayalekshmi2009,
  author = {P A Jayalekshmi, P Gangadharan, S Akiba, R R K Nair, M Tsuji, B Rajan},
  title = {Tobacco chewing and female oral cavity cancer risk in Karunagappally cohort, India},
  journal = {British Journal of Cancer},
  year = {2009},
  volume = {100},
  pages = {848-852}
}
PC Gupta, FS Mehta, JJ Pindborg, MB Aghi, RB Bhonsle, DK Daftary, PR Murti, HT Shah, PN Sinor Intervention study for primary prevention of oral cancer among 36 000 Indian tobacco users 1986 Lancet
Vol. 1(8492), pp. 1235-9 
article  
Abstract: In a house-to-house survey, 36 471 tobacco chewers and smokers were selected from the rural population in three areas of India. These individuals were interviewed for their tobacco habits and examined for the presence of oral leukoplakia and other precancerous lesions, first in a baseline survey, and then annually over a 5-year period. By personal advice and via the mass media they were encouraged to give up their tobacco habits. The follow-up rate was 97%. The control cohort was provided by the first 5-year results from a 10-year follow-up study conducted earlier in the same areas with the same methodology but on different individuals without any educational intervention. In Ernakulam district (Kerala) and Srikakulam district (Andhra) substantially more people stopped their tobacco habit and reduced the frequency of tobacco use in the intervention cohort than in the control cohort; in Bhavnagar district
(Gujarat) the intervention group showed only a slightly higher proportion stopping their tobacco habits and no difference in the proportion reducing them. The 5-year ageadjusted incidence rate of leukoplakia in Ernakulam district was 11.4 in the intervention group versus 47.8 among men, and 5.8 versus 33.0 among women; and for palatal lesions in Srikakulam district the corresponding figures were 59.8 versus 260.8 among men and 289.5 versus 489.5 among women. In Bhavnagar the incidence rate of leukoplakia did not differ between the cohorts. Since most oral cancers are preceded by precancerous lesions, education on tobacco habits should be a feasible and effective approach to primary prevention of oral cancer.
BibTeX:
@article{P.C.Gupta1986,
  author = {P. C. Gupta, F. S. Mehta, J. J. Pindborg, M. B. Aghi, R. B. Bhonsle, D. K. Daftary, P. R. Murti, H. T. Shah, P. N. Sinor},
  title = {Intervention study for primary prevention of oral cancer among 36 000 Indian tobacco users},
  journal = {Lancet},
  year = {1986},
  volume = {1(8492)},
  pages = {1235-9}
}
PC Gupta, MB Aghi, RB Bhonsle, PR Murti, FS Mehta, CR Mehta, JJ Pindborg An intervention study of tobacco chewing and smoking habits for primary prevention of oral cancer among 12,212 Indian villagers 1986 IARC Sci Publ.
Vol. 74, pp. 307-18 
article  
Abstract: In a house-to-house screening survey, 12,212 tobacco chewers and smokers were selected from the rural population in the Ernakulam district, Kerala state, India. These individuals were interviewed for their tobacco habits and examined for the presence of oral cancer and precancerous lesions, first in a baseline survey, and then annually, over a five-year period. They were educated using personal and mass media communication to give up their tobacco habits. The control group was provided from the results of the first five years of a 10-year follow-up study conducted earlier by the authors in the same
area with the same methodology but on different individuals without any educational intervention. The stoppage of the tobacco habit was substantially higher in the intervention group (9.4%) compared to the control group (3.2%). A logistic regression analysis showed that the behavioural intervention was helpful to all categories of individuals, however, the effect was different for different categories: intervention was more helpful to men, chewers, and those with a long duration of the habit. These individuals rarely quit their habit without intervention.
BibTeX:
@article{P.C.Gupta1986a,
  author = {P. C. Gupta, M. B. Aghi, R. B. Bhonsle, P. R. Murti, F. S. Mehta, C. R. Mehta,J. J. Pindborg},
  title = {An intervention study of tobacco chewing and smoking habits for primary prevention of oral cancer among 12,212 Indian villagers},
  journal = {IARC Sci Publ.},
  year = {1986},
  volume = {74},
  pages = {307-18}
}
PC Gupta, RB Bhonsle, PR Murti, DK Daftary, FS Mehta, JJ Pindborg An epidemiologic assessment of cancer risk in oral precancerous lesions in India with special reference to nodular leukoplakia 1989 Cancer.
Vol. 63(11), pp. 2247-52 
article  
Abstract: A cohort of 12,212 tobacco users was followed up annually to assess malignant potential of oral precancerous lesions in the Ernakulam district in Kerala, India. A total of 19 new oral cancers were diagnosed over a period of 8 years, and 15 (79%) of these arose from some preexisting precancerous lesion or condition. Nodular leukoplakia showed highest rate of malignant transformation (16% per year) as six of 13 nodular leukoplakia underwent malignant transformation over a mean follow-up period of 2.8 years. The relative risk (3243.2) compared with individuals with tobacco habits but without any precancerous oral lesion was also the highest for nodular leukoplakia. In addition, nodular leukoplakia was associated with submucous fibrosis in two patients, which progressed to oral cancer and was the clinical diagnosis for four lesions that turned out to be malignant on histopathologic examination. Nodular appearance was noted in two other precursor lesions as well. Thus, 14 of 19 oral cancers (74%) were either preceded by nodular leukoplakia and with lesions showing a distinct nodular appearance, or had the clinical appearance of nodular leukoplakia.
BibTeX:
@article{P.C.Gupta1989,
  author = {P. C. Gupta, R. B. Bhonsle, P. R. Murti, D. K. Daftary, F. S. Mehta, J. J. Pindborg},
  title = {An epidemiologic assessment of cancer risk in oral precancerous lesions in India with special reference to nodular leukoplakia},
  journal = {Cancer.},
  year = {1989},
  volume = {63(11)},
  pages = {2247-52}
}
PK Ghosh, R Madhavi, M Guntur, R Ghosh Sister chromatid exchanges in patients with oral submucous fibrosis 1990 Cancer Genet Cytogenet
Vol. 44(2), pp. 197-201 
article  
Abstract: The incidence of sister chromatid exchange (SCE) was investigated in the lymphocyte chromosomes of 45 patients with oral submucous fibrosis and 56 age- and sexmatched nonsmoking controls. The frequency of SCE was 9.26?2.15 in patients with oral submucous fibrosis, which was significantly higher than the mean SCE value of 5.49?1.24 observed in normal controls. The frequency of SCE in patients with oral submucous fibrosis addicted to the habit of betel with tobacco chewing, "bidi"/cigarette smoking and combined habits of chewing and smoking of tobacco were 8.12?1.69, 9.43?1.87, and 10.06?2.28, respectively. These values were also significantly higher as compared with the SCE values observed in normal controls.
BibTeX:
@article{P.K.Ghosh1990,
  author = {P. K. Ghosh, R. Madhavi, M. Guntur, R. Ghosh},
  title = {Sister chromatid exchanges in patients with oral submucous fibrosis},
  journal = {Cancer Genet Cytogenet},
  year = {1990},
  volume = {44(2)},
  pages = {197-201}
}
PK Nanda, MM Sharma Immediate effect of tobacco chewing in the form of 'paan' on certain cardio-respiratory parameters 1988 Indian J Physiol Pharmacol.
Vol. 32(2), pp. 105-13 
article  
Abstract: Immediate effect of tobacco in the form of chewing was evaluated in 40 healthy males (mean age 26.27 yrs.) not habituated to tobacco, who were given paan containing 200 mg of tobacco to chew (group T). Heart rate (HR), blood pressure (BP), forced vital capacity (FVC), FEV1 and peak expiratory flow rate (PEFR) were measured twice for each subject, once before chewing and again immediately after completion of chewing. Another 24 age and sex matched controls (group C) were given paan without tobacco to chew and cardiorespiratory parameters were recorded as for group T subjects. Electrocardiography was recorded in 10 group T and 10 group C subjects. Effect of tobacco chewing was also evaluated in 10 habitual tobacco chewers. Results showed statistically significant increments in HR and BP as well as a decline in T wave amplitude in ECG following tobacco chewing (group T subjects). The changes in HR and BP lasted for 15-30 mins, as observed in 10 of group T subjects. The FVC, FEV1 and PEFR showed marginal, though
non-significant, increments after tobacco chewing. No significant difference in the cardiorespiratory responses to tobacco chewing could be seen between habitual and nonhabitual (group T) tobacco chewers. The changes in cardiovascular and respiratory parameters following paan (without tobacco) chewing in the control subjects were negligible and nonsignificant.
BibTeX:
@article{P.K.Nanda1988,
  author = {P. K. Nanda, M. M. Sharma},
  title = {Immediate effect of tobacco chewing in the form of 'paan' on certain cardio-respiratory parameters},
  journal = {Indian J Physiol Pharmacol.},
  year = {1988},
  volume = {32(2)},
  pages = {105-13}
}
PN Sinor, PC Gupta, PR Murti, RB Bhonsle, DK Daftary, FS Mehta, JJ Pindborg A case-control study of oral submucous fibrosis with special reference to the etiologic role of areca nut 1990 J Oral Pathol Med
Vol. 19(2), pp. 94-8 
article  
Abstract: A case-control study to elucidate the etiology of oral submucous fibrosis was conducted in Bhavnagar, Gujarat. Sixty consecutively arriving oral submucous
fibrosis patients at a dental clinic were selected as cases. An equal number of controls matched for age, sex, religion and socioeconomic status were selected from individuals who did not exhibit any oral mucosal lesion or condition. Among cases, 98% chewed areca nut regularly in one form or the other whereas among controls 35% chewed areca nut, giving an overall relative risk of 109.6. Areca nut chewing was practiced most commonly in the form of mawa: a mixture containing mainly areca nut (over 90% by weight), some tobacco, and a few drops of lime. Mawa chewers and those who chewed mawa along with other chewing habits showed very high relative risks. The relative risks increased with increase in the frequency as well as the duration of chewing habits. In a bivariate analysis the effect of frequency and duration of chewing appeared to be multiplicative. The present findings confirm areca nut as the most important etiologic factor in oral submucous fibrosis.
BibTeX:
@article{P.N.Sinor1990,
  author = {P. N. Sinor, P. C. Gupta, P. R. Murti, R. B. Bhonsle, D. K. Daftary, F. S. Mehta, J. J. Pindborg},
  title = {A case-control study of oral submucous fibrosis with special reference to the etiologic role of areca nut},
  journal = {J Oral Pathol Med},
  year = {1990},
  volume = {19(2)},
  pages = {94-8}
}
P Pande, M Mathur, NK Shukla, R Ralhan pRb and p16 protein alterations in human oral tumorigenesis 1998 Oral Oncol
Vol. 34(5), pp. 396-403 
article  
Abstract: Cyclin dependent kinase inhibitor 2/multiple tumour suppressor gene 1 (CDKN2/MTS1) and retinoblastoma (Rb) tumour suppressor genes play important
roles in the regulation of the cell cycle. The protein products of these genes p16INK4 (p16) and pRb, respectively, like p53 protein inhibit progression from G1 to S phase. p16 exerts its function through inhibition of CDK4-mediated phosphorylation of pRb. The pRb/p16 pathway is a critical target for molecular aberration at the G1-S checkpoint in a wide range of primary human tumours. The expression of p16 and pRb proteins was analyzed by immunohistochemistry in 35 cases of oral squamous cell carcinomas (SCCs), 22 cases of premalignant oral lesions and 30 normal oral tissues. Lack of pRb expression was observed in 23/35 (66%) oral SCCs and 14/22 (64%) premalignant lesions. Lack of p16 expression was observed in 22/35 (63%)
oral SCCs and 13/22 (59%) premalignant lesions. Weak p16 and pRb immunoreactivities were observed in normal oral mucosal epithelium. The status of
p16 and pRb was correlated with clinicopathological characteristics of the patients. Alteration in p16 expression showed significant correlation with tumour staging and progression (P = 0.024). Alteration in pRb/p16 expression correlated with heavy consumption of betel and tobacco. Our results suggest that alterations in the p16/pRb pathway are early events in oral tumorigenesis and may be involved in the development of betel- and tobacco-related oral malignancies.
BibTeX:
@article{P.Pande1998,
  author = {P. Pande, M. Mathur, N. K. Shukla, R. Ralhan},
  title = {pRb and p16 protein alterations in human oral tumorigenesis},
  journal = {Oral Oncol},
  year = {1998},
  volume = {34(5)},
  pages = {396-403}
}
PR Murti, DK Daftary, RB Bhonsle, PC Gupta, FS Mehta, JJ Pindborg Malignant potential of oral lichen planus: observations in 722 patients from India 1986 J Oral Pathol.
Vol. 15(2), pp. 71-7 
article  
Abstract: The malignant potential of oral lichen planus was assessed on the basis of observations in 722 patients found among 27,599 individuals examined in various epidemiologic studies in Kerala, Ernakulam district, India. 702 patients with oral lichen planus were re-examined annually over a 10-year period with a mean observation period of 5.1 years. Most of the lesions (93%) were observed among tobacco users. Carcinoma developed in 3 (0.4%) patients with oral lichen planus. Clinically, all 3 had atrophic components in their lesions, and all were tobacco users. The relative risk of a lichen planus developing oral cancer compared to a tobacco user was estimated as 3.3. However, this relative risk was not significant. Histologically, 74% of the 94 biopsies from oral lichen planus showed epithelial atrophy. Two of the 3 in whom cancer developed also showed epithelial atrophy. It is felt that epithelial atrophy probably renders the mucosa more vulnerable to the carcinogenic action of tobacco. Although this study could not confirm the precancerous nature of this disease with a high degree of certainty, the disease did not appear to be innocuous either.
BibTeX:
@article{P.R.Murti1986,
  author = {P. R. Murti, D. K. Daftary, R. B. Bhonsle, P. C. Gupta, F. S. Mehta,J. J. Pindborg},
  title = {Malignant potential of oral lichen planus: observations in 722 patients from India},
  journal = {J Oral Pathol.},
  year = {1986},
  volume = {15(2)},
  pages = {71-7}
}
PR Murti, KA Warnakulasuriya, NW Johnson, RB Bhonsle, PC Gupta, DK Daftary, FS Mehta p53 expression in oral precancer as a marker for malignant potential 1998 J Oral Pathol Med
Vol. 27(5), pp. 191-6 
article  
Abstract: The potential of p53 protein expression as a marker for determining which oral precancerous lesions may transform to malignancy with time was assessed. We compared the p53 expression in archival formalin-fixed, paraffin-embedded tissues from 22 baseline biopsies of precancerous lesions that transformed to cancer in 4-25 years against that in 68 similar lesions that did not transform over the same time period. Twenty-nine percent of precancers that transformed were p53-positive at baseline, compared to 31% of the biopsies that did not transform to malignancy. When examined by immunohistochemical methods p53 expression failed to detect potential malignant status of oral precancer. Non-specificity of the assay may
account for this result but overexpression of p53 due to DNA damage by tobacco/betel-quid in non-progressive lesions needs further study. Nine precancerous lesions became p53-immunoreactive from precancer to cancer. This may suggest p53 overexpression peaks close to the time of transition from precancer to cancer rather than early in the natural history of oral precancer.
BibTeX:
@article{P.R.Murti1998,
  author = {P. R. Murti, K. A. Warnakulasuriya, N. W. Johnson, R. B. Bhonsle, P. C. Gupta, D. K. Daftary, F. S. Mehta},
  title = {p53 expression in oral precancer as a marker for malignant potential},
  journal = {J Oral Pathol Med},
  year = {1998},
  volume = {27(5)},
  pages = {191-6}
}
PR Padma, VS Lalitha, AJ Amonkar, SV Bhide Anticarcinogenic effect of betel leaf extract against tobacco carcinogens 1989 Cancer Lett.
Vol. 45(3), pp. 195-202 
article  
Abstract: Epidemiological studies have implicated that betel quid offers some protection to tobacco induced carcinogenesis. Earlier studies in our laboratory have shown betel leaf extract (BLE) to be antimutagenic against standard mutagens and tobaccospecific N'-nitrosamines (TSNA), N'-nitrosonornicotine (NNN) and 4- (methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). In the present study, we have tested the anticarcinogenic effect of BLE using Swiss male mice. Two protocols of study were used to test this effect. In the first protocol, the effect of BLE was tested against the standard carcinogen benzo[a]pyrene (BP) using Wattenberg's stomach tumor model. In this protocol, BLE inhibited the tumorigenicity of BP to a significant extent. In the second protocol, the effect of BLE against the two tobacco-specific nitrosamines, NNN and NNK was studied using long-term studies on Swiss male mice. The nitrosamines were administered on the tongues of the mice, while the BLE was supplied in drinking water. Two doses of NNN (22 mg and 72 mg) and one dose of NNK (22 mg) were used. In this study, it was observed that the number of tumor bearing animals decreased, but the difference was significant only in the group treated with the low dose of NNN in combination with BLE. However, in all the BLE treated animals, irrespective of the dose of nitrosamine, the hepatic vitamin A and C levels were elevated significantly as compared to the corresponding nitrosamine-treated controls. These results indicate that BLE has a
promising anticarcinogenic role to play in tobacco induced cancer.
BibTeX:
@article{P.R.Padma1989,
  author = {P. R. Padma, V. S. Lalitha, A. J. Amonkar, S. V. Bhide},
  title = {Anticarcinogenic effect of betel leaf extract against tobacco carcinogens},
  journal = {Cancer Lett.},
  year = {1989},
  volume = {45(3)},
  pages = {195-202}
}
PS Chandra, MP Carey, KB Carey, KR Jairam, NS Girish , HP Rudresh Prevalence and correlates of tobacco use and nicotine dependence among psychiatric patients in India 2005 Addict Behav.
Vol. 30(7), pp. 1290-9 
article  
Abstract: Tobacco use among psychiatric patients in developing countries has not been wellinvestigated. To address this issue, we screened consecutive admissions to a major psychiatric hospital in southern India, and assessed the prevalence and correlates of tobacco use and nicotine dependence. Patients (n=988) provided information about their use of tobacco products, and participated in an interview that included the Fagerstrom Test for Nicotine Dependence as well as measures of other substance use. Three hundred and fifty-one patients (36%) reported current tobacco use, with 227 (65% of all
users) reporting moderate to severe nicotine dependence. Current tobacco use as well as nicotine dependence were associated with male gender, a diagnosis of bipolar disorder, and risk of other substance use problems. The cultural context of these findings, and the implications for tobacco control among psychiatric patients, are discussed.
BibTeX:
@article{P.S.Chandra2005,
  author = {P. S. Chandra, M. P. Carey, K. B. Carey, K. R. Jairam, N. S. Girish , H. P. Rudresh},
  title = {Prevalence and correlates of tobacco use and nicotine dependence among psychiatric patients in India},
  journal = {Addict Behav.},
  year = {2005},
  volume = {30(7)},
  pages = {1290-9}
}
PS Gijare, KV Rao, SV Bhide Inhibitory effects of snuff extract on ornithine decarboxylase and aryl hydrocarbon hydroxylase activities in relation to cell proliferation of mouse tongue epithelial cells 1990 Indian J Exp Biol
Vol. 28(11), pp. 1012-6 
article  
Abstract: Effect of snuff extract (SE) on cell proliferation as measured by 3H thymidine (TdR) uptake, induction of ornithine decarboxylase (ODC) and aryl hydrocarbon
hydroxylase (AHH) was studied in primary embryonal mouse tongue cultures. Cultures treated with SE in combination with 7,12-dimethylbenz(a)anthracene
(DMBA) showed inhibition of cell proliferation and decrease of ODC and AHH activities, compared to control, DMBA, and DMBA + 12-O-tetradecanoylphorbol 13-acetate treated cultures.
BibTeX:
@article{P.S.Gijare1990,
  author = {P. S. Gijare, K. V. Rao, S. V. Bhide},
  title = {Inhibitory effects of snuff extract on ornithine decarboxylase and aryl hydrocarbon hydroxylase activities in relation to cell proliferation of mouse tongue epithelial cells},
  journal = {Indian J Exp Biol},
  year = {1990},
  volume = {28(11)},
  pages = {1012-6}
}
PS Gijare, KV Rao, SV Bhide Modulatory effects of snuff, retinoic acid, and betacarotene on DMBA-induced hamster cheek pouch carcinogenesis in relation to keratin expression 1990 Nutr Cancer
Vol. 14(3-4), pp. 253-9 
article  
Abstract: The hamster cheek pouch (HCP) serves as an excellent model system not only for the studies on initiation and promotion but also for the modulation of experimental oral carcinogenesis. In our studies, HCPs treated with 7,12-dimethylbenz[a]anthracene (DMBA) showed both cheek pouch and stomach
papillomas. Utilizing this model system, we tested and compared the modulatory effects of snuff, retinoic acid, and beta-carotene on the incidence of tumors and the keratin expression pattern. HCPs treated with snuff, either alone or in combination with DMBA, resulted in stomach papillomas. HCPs treated with snuff showed no cheek pouch tumors, and those treated with snuff and DMBA showed only 10-15% tumor incidence. Both beta-carotene and retinoic acid showed a total inhibition of DMBA-induced carcinogenesis in the HCP as well as in the stomach. The keratin expression pattern showed alterations depending on the experimental conditions.
BibTeX:
@article{P.S.Gijare1990a,
  author = {P. S. Gijare, K. V. Rao, S. V. Bhide},
  title = {Modulatory effects of snuff, retinoic acid, and betacarotene on DMBA-induced hamster cheek pouch carcinogenesis in relation to keratin expression},
  journal = {Nutr Cancer},
  year = {1990},
  volume = {14(3-4)},
  pages = {253-9}
}
PS Patel, MH Shah, FP Jha, GN Raval, RM Rawal, MM Patel, JB Patel, DD Patel Alterations in plasma lipid profile patterns in head and neck cancer and oral precancerous conditions 2004 Indian J Cancer
Vol. 41(1), pp. 25-31 
article  
Abstract: Background: The changes in lipid profile have long been associated with cancer because lipids play a key role in maintenance of cell integrity. AIMS: The present study evaluated alterations in plasma lipid profile in untreated head and neck cancer patients as well as patients with oral precancerous conditions (OPC) and its association with habit of tobacco consumption.
Materials and methods: This hospital-based case control study included 184 head and neck cancer patients, 153 patients with OPC and 52 controls. Plasma lipids including: (i) Total cholesterol, (ii) LDL cholesterol (LDLC), (iii) HDL cholesterol (HDLC) (iv) VLDL cholesterol (VLDLC) and (v) triglycerides were analysed by spectrophotometric kits. Statistical analysis used: Student's t-test was performed to compare mean values of the parameters.
Results: A significant decrease in plasma total cholesterol and HDLC was observed in cancer patients (P=0.008 and P=0.000 respectively) as well as in
patients with OPC (P=0.014 and P=0.000, respectively) as compared to the controls. The plasma VLDL and triglycerides levels were significantly lower in cancer patients as compared to the patients with OPC (P=0.04) and controls (P=0.059). The tobacco habituates showed lower plasma lipid levels than the nonhabituates. Our data strengthen the evidence of an inverse relationship between plasma lipid levels and head and neck malignancies as well as OPC.
Conclusions: The lower levels of plasma cholesterol and other lipid constituents in patients might be due to their increased utilization by neoplastic cells for new membrane biogenesis. The findings strongly warrant an in-depth study of alterations in plasma lipid profile in head neck cancer patients.
BibTeX:
@article{P.S.Patel2004,
  author = {P. S. Patel, M. H. Shah, F. P. Jha, G. N. Raval, R. M. Rawal, M. M. Patel, J. B. Patel, D. D. Patel},
  title = {Alterations in plasma lipid profile patterns in head and neck cancer and oral precancerous conditions},
  journal = {Indian J Cancer},
  year = {2004},
  volume = {41(1)},
  pages = {25-31}
}
Pai SB, Pai RB, Lalitha RM, Kumaraswamy SV, Lalitha N, Johnston RN, Bhargava MK Expression of oncofoetal marker carcinoembryonic antigen in oral cancers in South India--a pilot study. 2006 Int J Oral Maxillofac Surg.
Vol. 35(8), pp. 746-9 
article  
Abstract: Expression of the oncofoetal glycoprotein, carcinoembryonic antigen (CEA), has been observed in a number of malignancies and is also being pursued as a target for anticancer therapy. This study explored the status of this biochemical entity in the oral squamous cell carcinoma (SCC) in South India caused by extensive chewing habits. Squamous cell carcinoma in the study belonged to grade I and grade II. Tumour staging of the patients recruited in the study ranged from T2N1M0 to T4N3M0. Of the grade II cases studied, 88% (7 out of 8) showed expression of CEA. The 2 cases of grade I SCC of buccal mucosa also showed positive anti-CEA staining. If the results from this pilot study can be validated with a larger sample size, a role can be attributed to this tumour marker in oral neoplasia, thereby opening up avenues for using CEA as an additional diagnostic marker in oral SCC in this population and as a possible target for anti-cancer therapy.
BibTeX:
@article{PaiSB2006,
  author = {Pai SB, Pai RB, Lalitha RM, Kumaraswamy SV, Lalitha N, Johnston RN, Bhargava MK},
  title = {Expression of oncofoetal marker carcinoembryonic antigen in oral cancers in South India--a pilot study.},
  journal = {Int J Oral Maxillofac Surg.},
  year = {2006},
  volume = {35(8)},
  pages = {746-9}
}
Pal D, Banerjee S, Indra D, Mandal S, Dum A, Bhowmik A, Panda CK, Das S Influence of regular black tea consumption on tobacco associated DNA damage and HPV prevalence in human oral mucosa. 2007 Asian Pac J Cancer Prev.
Vol. 8(2), pp. 263-6 
article  
Abstract: Black tea is more widely consumed than green tea worldwide, particularly in India. Therefore, it is necessary to focus attention on black tea with respect to its health promoting and anti-cancer actions. In order to establish the concept that black tea is a potential candidate for cancer prevention, it is important to provide epidemiological evidence derived from investigations of human populations. In view of this, the objective of the present study was to determine the correlation between nature of black tea consumption and DNA damage in normal subjects with or without tobacco habit and oral cancer patients, taking the latter as positive controls. Much experimental evidence points to associations between tobacco habit and HPV 16 and HPV 18 (Human Papilloma virus) infection. But no studies have taken into account the possible confounding effect of black tea consumption on DNA damage along with HPV infection. A pilot study was therefore undertaken. Comet assay was used to evaluate the DNA damage among normal subjects including tobacco users (n=86), non-tobacco users (n=45) and Oral cancer patients (n = 37). Percentage of damaged cells was scored in the buccal squamous cells of all subjects mentioned above. HPV analysis was performed on 79 samples (including 37 oral cancer patients). The evaluation of various confounding factors like age, tenure of tobacco habit and tea habit showed significant associations with DNA damage. The observations strongly indicate that regular intake of black tea at least above four cups can reduce tobacco associated DNA damage among normal tobacco users. HPV prevalence was not seen to be associated with age, tenure of tobacco habit or the tea drinking habit.
BibTeX:
@article{PalD2007,
  author = {Pal D, Banerjee S, Indra D, Mandal S, Dum A, Bhowmik A, Panda CK, Das S},
  title = {Influence of regular black tea consumption on tobacco associated DNA damage and HPV prevalence in human oral mucosa.},
  journal = {Asian Pac J Cancer Prev.},
  year = {2007},
  volume = {8(2)},
  pages = {263-6}
}
Pande P, Soni S, Kaur J, Agarwal S, Mathur M, Shukla NK, Ralhan R Prognostic factors in betel and tobacco related oral cancer 2002 Oral Oncol.
Vol. 38(5), pp. 491-9 
article  
Abstract: Paucity of well-defined prognostic molecular markers severely hampers prediction of the clinical course of squamous cell carcinoma (SCC) of oral cavity. The aim of the study was to evaluate the prognostic significance of impairments in the expression of proteins involved in cell cycle regulation and locoregional spread in oral SCC of habitual betel and tobacco chewers. A prospective study was performed in 105 betel and tobacco consumers with oral SCCs during the period 1988-1999, to evaluate the prognostic relevance of impairments in the expression of proteins involved in cell cycle regulation and locoregional spread. Alterations in the expression of p53, pRb, p16, MDM2, p21, and Ets-1 proteins were determined by immunohistochemical analysis in formalin fixed, paraffin embedded tissue sections from oral SCCs. Analysis of multiple molecular biological factors showed overexpression of p53 in 69/105 (66%) cases, MDM2 in 72/105 (69%) cases, p21 in 57/105 (54%) cases and Ets-1 in 64/105 (61%) cases. Loss of pRb was observed in 58/105 (55%) cases and p16 loss was observed in 72/105 (69%) cases. Interestingly, multivariate analysis revealed loss of pRb as the most significant predictor of advanced tumour stage [P=0.001; Odd's Ratio (OR)=3.5] and overexpression of Ets-1 protein was an independent risk factor for lymph node
metastasis (OR: 10.1; P<10(-6)). Multiple logistic regression models showed that pRb loss [Hazard's Ratio (HR): 3.93] and p53 overexpression (HR: 2.97) may serve as adverse prognosticators for disease free survival of the patients. The data demonstrate multiple impairments in p53/MDM2/p21/Ets-1 and p16/pRb pathways in betel and tobacco related oral tumourigenesis
BibTeX:
@article{PandeP2002,
  author = {Pande P, Soni S, Kaur J, Agarwal S, Mathur M, Shukla NK, Ralhan R.},
  title = {Prognostic factors in betel and tobacco related oral cancer},
  journal = {Oral Oncol.},
  year = {2002},
  volume = {38(5)},
  pages = {491-9}
}
Pandey M, Prakash O, Santhi WS, Soumithran CS, Pillai RM Overexpression of COX-2 gene in oral cancer is independent of stage of disease and degree of differentiation. 2008 Int J Oral Maxillofac Surg.
Vol. 37(4), pp. 379-83 
article  
Abstract: The incidence of oral cancer is high in certain parts of the world including Southeast Asia. Smokeless tobacco and areca nut chewing is proposed as a possible factor. Cyclooxygenase 2 (COX-2) receptors are present on neoplastic cells and are proposed to participate in initiation, transformation, progression and metastasis of cancer. In a prospective case-controlled study, 42 cases of squamous cell carcinoma of the oral cavity, 13 cases of oral premalignant lesions, and oral mucosa from 32 normal subjects were evaluated for COX-2 gene expression using reverse transcriptase polymerase
chain reaction. The mean age of the patients with oral cancer was 60.2 years. The majority of cancer patients were males while the majority of controls were females. A significantly higher expression of COX-2 was found in cancer patients compared to both normal controls (p=0.0001) and patients with premalignant lesions (0.015). The expression in premalignant lesions was higher compared to healthy subjects (p=0.05). COX-2 expression in oral cancer was found to be independent of grade of tumor and stage of disease. These results show up-regulation of the COX-2 gene in oral cancer and precancer. This suggests a role for COX2 receptors in oral cancer carcinogenesis, and provides the foundation for a large randomized trial to determine the role COX2
inhibitors may play in prevention of oral carcinogenesis.
BibTeX:
@article{PandeyM2008,
  author = {Pandey M, Prakash O, Santhi WS, Soumithran CS, Pillai RM},
  title = {Overexpression of COX-2 gene in oral cancer is independent of stage of disease and degree of differentiation.},
  journal = {Int J Oral Maxillofac Surg.},
  year = {2008},
  volume = {37(4)},
  pages = {379-83}
}
Parmar G, Sangwan P, Vashi P, Kulkarni P, Kumar S Effect of chewing a mixture of areca nut and tobacco on periodontal tissues and oral hygiene status. 2008 J Oral Sci.
Vol. 50(1), pp. 57-62 
article  
Abstract: The present study was conducted to clarify the effects of chewing a quid containing areca nut and tobacco on periodontal tissue and oral hygiene status. A total of 365 subjects (168 chewers and 197 non-chewers with a mean age of 32.5? 0.7 and 30.4? 0.8 years, respectively) were enrolled. Clinical data on periodontal tissues, oral hygiene status, as well as information on bleeding from gums, ulcers in the oral cavity, or a burning sensation in the soft tissues, were collected as indicators of the possible presence and extent of periodontal lesions. The results indicated that a significantly higher number of quid-chewers suffered bleeding from the gums, halitosis, difficulty in opening the mouth and swallowing solid food, a burning sensation in the soft tissues,
and ulcers in the oral cavity than non-chewers. There was no significant difference between quid-chewers and non-chewers with respect to oral hygiene measures adopted. However, clinical examination using the oral hygiene index score indicated that the oral hygiene status of quid-chewers was significantly deteriorated. The effect of quidchewing on the periodontium, i.e. the occurrence of periodontal pockets, gingival lesions and gum recession, were significantly higher in quid-chewers than in non-chewers. Age, sex and smoking adjusted odds ratios for quid-chewers against non-chewers using
logistic regression analysis indicated that, in general, chewers were at significantly higher risk for various oral complaints and periodontium status. The present data indicate that chewing quid comprising areca nut and tobacco has adverse effects on periodontal tissues, oral hygiene and incidence of oral lesions.
BibTeX:
@article{ParmarG2008,
  author = {Parmar G, Sangwan P, Vashi P, Kulkarni P, Kumar S.},
  title = {Effect of chewing a mixture of areca nut and tobacco on periodontal tissues and oral hygiene status.},
  journal = {J Oral Sci.},
  year = {2008},
  volume = {50(1)},
  pages = {57-62}
}
Patel BP, Rawal UM, Dave TK, Rawal RM, Shukla SN, Shah PM, Patel PS Lipid peroxidation, total antioxidant status, and total thiol levels predict overall survival in patients with oral squamous cell carcinoma. 2007 Integr Cancer Ther.
Vol. 6(4), pp. 365-72 
article  
Abstract: Tobacco is the major etiological factor for oral cancer development through the generation of oxidative stress. Therefore, markers of oxidative stress such as total antioxidant status, lipid peroxidation, and total thiol levels might be useful to monitor oxidative stress and predict overall survival in oral cancer patients. The study included 140 oral cancer patients and 50 healthy controls, who were classified as with the habit of tobacco and no habit of tobacco. Adjacent normal and malignant tissue samples were collected from oral cancer patients. Plasma and tissue levels of lipid peroxidation, thiol, and total antioxidant status were assayed by spectrophotometric methods. Thiol levels were significantly lower in controls with the habit of tobacco (P=0.033), oral cancer patients (P=0.0001), and malignant tissues (P=0.015) as compared to controls with no habit of tobacco, controls with the habit of tobacco, and adjacent normal tissues, respectively. Tobacco exposure was higher in oral cancer patients than controls with the habit of tobacco. Controls with the habit of tobacco who had lower thiol (odds ratio [OR]=10.58, P=0.008) and high tobacco exposure (OR=0.251, P=0.05) showed an elevated risk of oral cancer development. Patients showing a lipid peroxidation level above the cutoff level as compared to patients below the cutoff level showed poor overall survival, whereas those with thiol and total antioxidant status levels below the cutoff level as compared to their respective counterparts showed poor overall survival. In conclusion, lipid peroxidation and thiol could be useful for predicting the risk of oral carcinogenesis in healthy tobacco consumers and predicting overall survival of oral cancer patients.
BibTeX:
@article{PatelBP2007,
  author = {Patel BP, Rawal UM, Dave TK, Rawal RM, Shukla SN, Shah PM, Patel PS},
  title = {Lipid peroxidation, total antioxidant status, and total thiol levels predict overall survival in patients with oral squamous cell carcinoma.},
  journal = {Integr Cancer Ther.},
  year = {2007},
  volume = {6(4)},
  pages = {365-72}
}
Patel MM, Pandya AN Relationship of oral cancer with age, sex, site distribution and habits. 2004 Indian J Pathol Microbiol.
Vol. 47(2), pp. 195-7 
article  
Abstract: Many studies are carried out regarding age incidence, tobacco smoking and sites of oral cancer, but in Gujarat tobacco chewing in form of Gutkha is more common than smoking and start during preteen years. Tobacco chewing causing chronic inflammation, submucous fibrosis and oral cancer. This study was conducted on 504 patients to find out if there is increasing incidence of oral cancer in lower age group and its relation with sex as well which site was commonly affected. There was statistically significant increase in oral cancer in lower age group, and anatomically anterior part of oral cavity showed involvement in 61.32% of cases. Though males were affected more but female cases were 25%. So tobacco chewing has got detrimental effect on oral cavity.
BibTeX:
@article{PatelMM2004,
  author = {Patel MM, Pandya AN},
  title = {Relationship of oral cancer with age, sex, site distribution and habits.},
  journal = {Indian J Pathol Microbiol.},
  year = {2004},
  volume = {47(2)},
  pages = {195-7}
}
Patel RK, Jaju RJ, Bakshi SR, Trivedi AH, Dave BJ, Adhvaryu SG Pan masala--a genotoxic menace. 1994 Mutat Res
Vol. 320(3), pp. 245-9 
article  
Abstract: Cytogenetic markers such as chromosome aberration (CA), sister-chromatid exchange (SCE) and micronucleated cells (MNC) were used to assess the genotoxic potential of dimethyl sulphoxide (DMSO) extract of pan masala with and without tobacco (PM-T and PM). Using in vitro short-term assays, the extracts were tested in the presence or absence of metabolic activation. In cultures without metabolic activation the extracts were found to increase the frequency of all the three parameters tested significantly, however those with activation elicited a weak response, implying that pan masalas contain solvent (DMSO)-soluble direct-acting mutagen.
BibTeX:
@article{PatelRK1994,
  author = {Patel RK, Jaju RJ, Bakshi SR, Trivedi AH, Dave BJ, Adhvaryu SG},
  title = {Pan masala--a genotoxic menace.},
  journal = {Mutat Res},
  year = {1994},
  volume = {320(3)},
  pages = {245-9}
}
Patel RK, Trivedi AH, Jaju RJ, Adhvaryu SG, Balar DB Ethanol potentiates the clastogenicity of pan masala--an in vitro experience. 1994 Carcinogenesis.
Vol. 15(9), pp. 2017-21 
article  
Abstract: The significance of the interaction between alcohol and tobacco in causing head and neck cancers is well documented. Our previous reports on in vitro studies using aqueous and organic extracts as well as cytogenetic studies among pan masala consumers have conclusively shown the genotoxic potential of pan masala--a dry mixture of the areca nut, lime, catechu, unspecified flavouring agents, etc., often containing tobacco in it and is widely consumed in India. Now in the present report, the clastogenic effect of ethanol and pan masala in different combinations was evaluated on Chinese hamster ovary cells
utilizing chromosome aberration (CA) frequency as an endpoint. An ethanol concentration of up to 2.0% had no effect on CA/cell value. The low-dose continuous treatment and high-dose short-term pre-, post- and simultaneous treatment of ethanol and aqueous extract of pan masala with and without tobacco yielded dose-dependent elevations in CA frequency, compared to any of these two substances alone. Thus, these results provide evidence that alcohol consumption may potentially increase the risk of oral cancer among pan masala chewers
BibTeX:
@article{PatelRK1994a,
  author = {Patel RK, Trivedi AH, Jaju RJ, Adhvaryu SG, Balar DB},
  title = {Ethanol potentiates the clastogenicity of pan masala--an in vitro experience.},
  journal = {Carcinogenesis.},
  year = {1994},
  volume = {15(9)},
  pages = {2017-21}
}
Patel RK, Trivedi AH, Jaju RJ, Kukreti MS, Bhatavdekar JM, Shah PM, Patel DD Protection from pan masala induced genomic damage by beta-carotene and retinoic acid--an in vitro experience. 1998 Neoplasma
Vol. 45(3), pp. 169-75 
article  
Abstract: Cytogenetic studies in Chinese hamster ovary (CHO) cells using aqueous and organic extracts of pan masalas, as well as genomic damage observed among pan masala consumers have conclusively shown genotoxic potential of pan masala-a dry complex mixture of areca nut, lime, catechu, cardamom, unspecified flavoring agent, etc., often containing tobacco in it. Tobacco and areca nut, major ingredients of pan masala, are closely associated with oral cancer. The most widely studied group of compounds in the field of chemoprevention is retinoids which includes natural vitamin A, beta-carotene and synthetic derivatives of vitamin A. In the present study, antigenotoxic effect of betacarotene (BC) and retinoic acid (RA) on genotoxic potential of pan masala have been evaluated in CHO cells with the help of sister chromatid exchange (SCE) frequency and chromosome aberration (CA) frequency as cytogenetic markers. The pulse treatment with pan masala plain/pan masala-tobacco (PM/PMT) extract in combination with either BC or RA yielded lower frequencies of CA and SCE in CHO cells as compared to the cultures treated with aqueous extract fo pan masalas alone. This antigenotoxic effect of BC and RA was more pronounced when treatment was given continuously for a longer duration. Thus, these results indicated possibility of using BC and RA to decrease the
risk of oral cancer among pan masala chewers.
BibTeX:
@article{PatelRK1998,
  author = {Patel RK, Trivedi AH, Jaju RJ, Kukreti MS, Bhatavdekar JM, Shah PM, Patel DD},
  title = {Protection from pan masala induced genomic damage by beta-carotene and retinoic acid--an in vitro experience.},
  journal = {Neoplasma},
  year = {1998},
  volume = {45(3)},
  pages = {169-75}
}
Patel RK, Trivedi AH, Roy SK, Bhatavdekar JM, Shah PM, Patel DD Influence of alpha-tocopherol and ascorbic acid on pan masala induced genomic damage. An in vitro experiment. 1998 J Exp Clin Cancer Res
Vol. 17(4), pp. 419-24 
article  
Abstract: Pan masala is a dry complex mixture of areca nut, catechu, lime, cardamon, unspecified flavouring agents etc., with (PMT) or without tobacco (pm). We have previously reported genotoxic potential of tobacco, areca nut and pan masala per se. An antigenotoxic effect of alpha-tocopherol (AT) and ascorbic acid (AA) against the PM/PMT induced genotoxic on Chinese hamster ovary (CHO) cells have been studied using chromosone aberration (CA) assay. AT and AA, per se, had no effect on CA frequency at the concentrations used in the present study. The short-term treatment of AT with aqueous extracts of PM/PMT yielded lower frequencies of CA as compared to the cultures treated with aqueous extracts of PM/PMT alone. However, a statistically significant reduction in CA frequency was observed with continuous treatment only. AA had no statistically significant protective effect except for continuous treatment with 10 ug/ml AA against the aqueous extract of PMT. The results indicate the possible use of AT to reduce the risk of oral cancer among PM/PMT chewers.
BibTeX:
@article{PatelRK1998a,
  author = {Patel RK, Trivedi AH, Roy SK, Bhatavdekar JM, Shah PM, Patel DD},
  title = {Influence of alpha-tocopherol and ascorbic acid on pan masala induced genomic damage. An in vitro experiment.},
  journal = {J Exp Clin Cancer Res},
  year = {1998},
  volume = {17(4)},
  pages = {419-24}
}
Pathak KA,, Gupta S, Talole S, Khanna V, Chaturvedi P, Deshpande MS, Pai PS, Chaukar DA, D'Cruz AK Advanced squamous cell carcinoma of lower gingivobuccal complex: patterns of spread and failure. 2005 Head Neck.
Vol. 37(7), pp. 597-602 
article  
Abstract: Background: Carcinoma of the gingivobuccal complex is commonly associated with the use of smokeless tobacco known as "quid."
Methods: We conducted a retrospective chart review of 511 patients with advanced cancer of gingivobuccal complex surgically treated during 1994 to 1995. We evaluated patterns of disease failure in these patients and correlated disease-free survival with various prognostic factors.
Results: During a median follow-up of 46 months, 159 locoregional recurrences and 11 distant metastases were detected in 148 patients. Seventy-nine percent of the recurrences appeared within 18 months of surgery, and the median survival for patients with recurrent disease was less than 4 months. Two-year and 5-year disease-free survival rates were 64% and 57%, respectively. On multivariate analysis, disease-free survival showed significant correlation with skin involvement and extracapsular spread.
Conclusions: Gingivobuccal cancers usually fail locoregionally. Soft tissue infiltration and extracapsular spread of nodal disease influence disease-free survival.
BibTeX:
@article{PathakKA2005,
  author = {Pathak KA,, Gupta S, Talole S, Khanna V, Chaturvedi P, Deshpande MS, Pai PS, Chaukar DA, D'Cruz AK},
  title = {Advanced squamous cell carcinoma of lower gingivobuccal complex: patterns of spread and failure.},
  journal = {Head Neck.},
  year = {2005},
  volume = {37(7)},
  pages = {597-602}
}
Gupta PC Tobacco control in India. 2006 Indian J Med Res.
Vol. 123(5), pp. 579-82 
article  
BibTeX:
@article{PC.2006,
  author = {Gupta PC.},
  title = {Tobacco control in India.},
  journal = {Indian J Med Res.},
  year = {2006},
  volume = {123(5)},
  pages = {579-82}
}
Pednekar MS, Gupta PC, Hebert JR, Hakama M Joint effects of tobacco use and body mass on all-cause mortality in Mumbai, India: results from a populationbased cohort study. 2008 Am J Epidemiol.
Vol. 167(3), pp. 330-40 
article  
Abstract: The joint effects of tobacco use and body mass on mortality have not been well characterized, although evidence regarding the effect of smoking on the association between body mass and mortality is accumulating. To study the joint effects of these important risk factors, the authors conducted a prospective cohort study of 148,173 men and women aged ?35 years in Mumbai, India. Subjects were recruited during 1991- 1997 and then followed for approximately 5-6 years (1997-2003). During 774,129 person-years of follow-up, 13,261 deaths were observed. Tobacco use increased the risk of death across different categories of body mass, with particularly high risks being observed in extreme body mass categories. Among men, obese smokers and obese never users of tobacco were at 56% and 34% increased risks of death, respectively, compared with overweight never users of tobacco. Similarly, at highest risk were extremely thin males who smoked bidis (relative risk = 3.45) or cigarettes (relative risk = 3.32). Body mass and all forms of tobacco use had independent as well as multiplicative joint effects on mortality risk. Tobacco use and undernutrition are serious problems in India. The current study indicates that obesity may emerge as a serious public health problem with which tobacco use may interact.
BibTeX:
@article{PednekarMS2008,
  author = {Pednekar MS, Gupta PC, Hebert JR, Hakama M},
  title = {Joint effects of tobacco use and body mass on all-cause mortality in Mumbai, India: results from a populationbased cohort study.},
  journal = {Am J Epidemiol.},
  year = {2008},
  volume = {167(3)},
  pages = {330-40}
}
Pednekar MS, Gupta PC, Shukla HC, Hebert JR Association between tobacco use and body mass index in urban Indian population: implications for public health in India. 2006 BMC Public Health.
Vol. 6, pp. 70 
article  
Abstract: Background: Body mass index [BMI, weight (kg)/height (m2)], a measure of relative weight, is a good overall indicator of nutritional status and predictor of overall health. As in many developing countries, the high prevalence of very low BMIs in India represents an important public health risk. Tobacco, smoked in the form of cigarettes or bidis (handmade by rolling a dried rectangular piece of temburni leaf with 0.15-0.25 g of tobacco) or chewed, is another important determinant of health. Tobacco use also may exert a strong influence on BMI.
Methods: The relationship between very low BMI (< 18.5 kg/m2) and tobacco use was examined using data from a representative cross-sectional survey of 99,598 adults (40,071 men and 59,527 women) carried out in the city of Mumbai (formerly known as Bombay) in western India. Participants were men and women aged ?35 years who were residents of the main city of Mumbai.
Results: All forms of tobacco use were associated with low BMI. The prevalence of low BMI was highest in bidi-smokers (32% compared to 13% in non-users). For smokers, the adjusted odds ratio (OR) and 95% confidence interval (CI) were OR = 1.80(1.65 to 1.96) for men and OR = 1.59(1.09 to 2.32) for women, respectively, relative to nonusers. For smokeless tobacco and mixed habits (smoking and smokeless tobacco), OR = 1.28(1.19 to 1.38) and OR = 1.83(1.67 to 2.00) for men and OR = 1.50(1.43 to 1.59) and OR = 2.19(1.90 to 3.41) for women, respectively.
Conclusions: Tobacco use appears to be an independent risk factor for low BMI in this population. We conclude that in such populations tobacco control research and interventions will need to be conducted in concert with nutrition research and interventions in order to improve the overall health status of the population.
BibTeX:
@article{PednekarMS2006,
  author = {Pednekar MS, Gupta PC, Shukla HC, Hebert JR},
  title = {Association between tobacco use and body mass index in urban Indian population: implications for public health in India.},
  journal = {BMC Public Health.},
  year = {2006},
  volume = {6},
  pages = {70}
}
Phukan RK, Ali MS, Chetia CK, Mahanta J Betel nut and tobacco chewing; potential risk factors of cancer of oesophagus in Assam, India. 2001 Br J Cancer
Vol. 85(5), pp. 661-7 
article  
Abstract: Cancer of the oesophagus is the most commonly diagnosed cancer in males in Assam, in north-eastern India, and ranks second for females. The chewing of betel nut, with or without tobacco and prepared in various ways, is a common practice in the region and a case-control study has been designed to study the pattern of risk associated with different ways of preparing and chewing the nuts. 358 newly diagnosed male patients and 144 female have been interviewed together with 2 control subjects for each case chosen at random from among the attendants who accompanied patients to hospital.
There were significant trends in risk ratios associated with the frequency of chewing each day, with the duration of chewing in years and with the age at which the habit was started that were apparent for both males and females and which remained significant after allowance was made for other known risk factors, notably tobacco smoking and alcohol consumption. The adjusted ratios, in comparison with non-chewers, were 13.3 M and 5.7 F for chewing more than 20 times a day, 10.6 M and 7.2 F for persons who had chewed for more than 20 years and 10.3 M and 5.3 F for those who had started before the age of 20. Among the different combinations of ingredients that were chewed the adjusted odds ratios were highest for those who had been using fermented betel nut with any form of tobacco (7.1 M and 3.6 F). The risk associated with tobacco smoking and alcohol consumption, which are high in some parts of the world, were less in Assam than those associated with the chewing of betel nut.
BibTeX:
@article{PhukanRK2001,
  author = {Phukan RK, Ali MS, Chetia CK, Mahanta J},
  title = {Betel nut and tobacco chewing; potential risk factors of cancer of oesophagus in Assam, India.},
  journal = {Br J Cancer},
  year = {2001},
  volume = {85(5)},
  pages = {661-7}
}
Phukan RK, Zomawia E, Narain K, Hazarika NC, Mahanta J Tobacco use and stomach cancer in Mizoram, India 2005 Cancer Epidemiol Biomarkers Prev.
Vol. 14(8), pp. 1892-6 
article  
Abstract: The incidence of stomach cancer in India is lower than that of any other country around the world. However, in Mizoram, one of the north-eastern state of India, a very high ageadjusted incidence of stomach cancer is recorded. A hospital-based case-control study was carried out to identify the influence of tobacco use on the risk of developing stomach cancer in Mizoram. Among the cases, the risk of stomach cancer was significantly elevated among current smokers [odds ratio (OR), 2.3; 95% confidence interval (95% CI), 1.4-8.4] but not among ex-smokers. Higher risks were seen for meiziol (a local cigarette) smokers (OR, 2.2; 95% CI, 1.3-9.3). The increased risk was apparent among subjects who had smoked for >or=30 years. The increased risk was significant with 2- fold increase in risk among the subjects who smoked for >or=11 pack-years. The risk increased with increasing cumulative dose of tobacco smoked (mg). Tuibur (tobacco smoke-infused water), used mainly in Mizoram, was seemed to increased the risk of stomach cancer among current users in both univariate and multivariate models (OR, 2.1; 95% CI, 1.3-3.1). Tobacco chewer alone (OR, 2.6; 95% CI, 1.1-4.2) showed
significant risk. Tobacco use in any form [smoking and smokeless (tuibur and chewing)] increased the risk of stomach cancer in Mizoram independently after adjusting for confounding variables.
BibTeX:
@article{PhukanRK2005,
  author = {Phukan RK, Zomawia E, Narain K, Hazarika NC, Mahanta J},
  title = {Tobacco use and stomach cancer in Mizoram, India},
  journal = {Cancer Epidemiol Biomarkers Prev.},
  year = {2005},
  volume = {14(8)},
  pages = {1892-6}
}
Polasa K, Babu S, Shenolikar IS Dose-dependent genotoxic effect of pan masala and areca nut in the Salmonella typhimurium assay. 1993 Food Chem Toxicol
Vol. 31(6), pp. 439-42 
article  
Abstract: Aqueous extracts of different brands of pan masala and scented supari were tested for mutagenicity by the Salmonella typhimurium assay using tester strains TA98 and TA100. These extracts were found to be mutagenic to both tester strains. The mutagenic effects of pan masala and scented supari extracts were similar to that produced by areca nut extract. The addition of 500 ppm saccharin to the supari extracts did not alter the mutagenic response.
BibTeX:
@article{PolasaK1993,
  author = {Polasa K, Babu S, Shenolikar IS},
  title = {Dose-dependent genotoxic effect of pan masala and areca nut in the Salmonella typhimurium assay.},
  journal = {Food Chem Toxicol},
  year = {1993},
  volume = {31(6)},
  pages = {439-42}
}
RB Govekar, RA Bhisey Mutagenic activity in urine samples from female tobacco habitu�s 1993 Cancer Lett.
Vol. 69(2), pp. 75-80 
article  
Abstract: Since high incidence of oral cancer in India is associated with smokeless tobacco usage, mutagenic exposure of subjects habituated to a pyrolysed tobacco product, masheri (M) and tobacco-containing betel quid (Q) was evaluated in the present study. Urinary cotinine was estimated to ascertain tobacco exposure and urine mutagenicity to Salmonella typhimurium TA98 and TA100 was used to assess mutagenic burden. Urinary cotinine levels were higher in MQ users than in M users. Urine mutagenicity was evident in control samples only upon treatment with S9, beta-glucuronidase or acidified nitrite. However, greater exposure of users to mutagens resulted in additional direct mutagenicity to TA100.
BibTeX:
@article{R.B.Govekar1993,
  author = {R. B. Govekar, R. A. Bhisey},
  title = {Mutagenic activity in urine samples from female tobacco habitu�s},
  journal = {Cancer Lett.},
  year = {1993},
  volume = {69(2)},
  pages = {75-80}
}
R Basu, S Mandal, A Ghosh, TK Poddar Role of tobacco in the development of head and neck squamous cell carcinoma in an eastern Indian population 2008 Asian Pac J Cancer Prev.
Vol. 9(3), pp. Jul-Sep 
article  
Abstract: The head and neck squamous cell carcinoma (HNSCC) accounts for about 30-40% of all cancer types in India and the subcontinent in general. HNSCCs are primarily not hereditary, but rather a disease of older and middle aged adults. Many etiological factors like tobacco, alcohol and HPV infection are known to play important roles. Eastern India, particularly Kolkata, has a population heavily exposed to various types of smoked and smokeless tobacco, with only limited exposure to alcoholic beverages. Since there have been no previous epidemiological studies on tobacco as the main risk factor for head and neck
carcinogenesis in Kolkata, we here carried out a hospital based case control study in the city and its adjoin regions. Data from 110 patients diagnosed with HNSCC and a similar number of matched control samples were analyzed using the chisquare test. Survival status of the patients was also analyzed using the Kaplan-Meier method. A tobacco habit was significantly correlated with the incidence of HNSCC and persons with current addiction had a 2.17 fold increased risk of cancer development. Dose-response relationships were seen for the frequency (p=0.01) and duration (p=0.02) of tobacco exposure with the risk. No significant difference in impact was found with smoked as opposed to smokeless tobacco in the development of the disease. Among HNSCC patients, significant poor survival in cases with tobacco habit than in those with no addiction and in cases with >10 years of addiction than in those with 10 years of addiction. Our data suggest that tobacco in both smoked and smokeless forms is the most important risk factor for both development and prognosis of HNSCCs and may be a major source of field cancerization on the head and neck epithelium in the eastern Indian population.
BibTeX:
@article{R.Basu2008,
  author = {R. Basu, S. Mandal, A. Ghosh, T. K. Poddar},
  title = {Role of tobacco in the development of head and neck squamous cell carcinoma in an eastern Indian population},
  journal = {Asian Pac J Cancer Prev.},
  year = {2008},
  volume = {9(3)},
  pages = {Jul-Sep}
}
R Ghosh, JK Sharma, PK Ghosh Sister chromatid exchanges in the lymphocytes of patients with oral leukoplakia 1988 Cancer Genet Cytogenet.
Vol. 36(2), pp. 177-82 
article  
Abstract: The incidence of sister chromatid exchange (SCE) was investigated in lymphocyte chromosomes of 59 patients with oral leukoplakia and 65 age- and sex-matched nonsmoking controls. The frequency of SCE was found to be 8.61 +/- 1.89 in patients with oral leukoplakia, which was significantly higher than the mean SCE value of 5.58 +/- 1.26 observed in normal controls. The frequency of SCE in patients with oral leukoplakia addicted to the single habit of betel with tobacco chewing, bidi/cigarette smoking, and combined habits of chewing and smoking of tobacco were found to be 7.95 +/- 1.63, 8.17 +/- 1.66, and 9.23 +/- 2.14, respectively. These values were also significantly higher as compared to the SCE values observed in normal controls.
BibTeX:
@article{R.Ghosh1988,
  author = {R. Ghosh, J. K. Sharma, P. K. Ghosh},
  title = {Sister chromatid exchanges in the lymphocytes of patients with oral leukoplakia},
  journal = {Cancer Genet Cytogenet.},
  year = {1988},
  volume = {36(2)},
  pages = {177-82}
}
RK Dikshit, JG Buch, SM Mansuri Effect of tobacco consumption on semen quality of a population of hypofertile males 1987 Fertil Steril.
Vol. 48(2), pp. 334-6 
article  
Abstract: Effect of tobacco use (by chewing or smoking) on semen quality has been seen. Semen analysis of 119 tobacco chewers and 219 smokers was compared with those of 288 control patients. Some decrease in the ejaculate volume, sperm density, and total count was observed in tobacco users, but it was statistically insignificant. No difference was found in other parameters, like motility and morphology. It is concluded that tobacco use by chewing or smoking is not associated with impaired semen quality in males selected from an idiopathically hypofertile population.
BibTeX:
@article{R.K.Dikshit1987,
  author = {R. K. Dikshit, J. G. Buch, S. M. Mansuri},
  title = {Effect of tobacco consumption on semen quality of a population of hypofertile males},
  journal = {Fertil Steril.},
  year = {1987},
  volume = {48(2)},
  pages = {334-6}
}
R Ralhan, N Nath, S Agarwal, M Mathur, B Wasylyk, NK Shukla Circulating p53 antibodies as early markers of oral cancer: correlation with p53 alterations 1998 Clin Cancer Res.
Vol. 4(9), pp. :2147-52 
article  
Abstract: p53 aberrations are early events in the pathogenesis of betel- and tobacco-related oral malignancies. Accumulation of p53 protein in oral lesions may elicit a humoral immune response against p53 protein in these patients. p53 antibodies (Abs) were analyzed in 183 sera obtained from patients with premalignant or malignant oral lesions and normal individuals by enzyme-linked immunoassay using recombinant p53 protein as antigen. These results were correlated with accumulation of p53 protein in patients' matched oral tissue specimens. Circulating p53 Abs were observed in 24 of 70 (34%) cancer patients and 15 of 50 (30%) patients with premalignant oral lesions. p53 Abs showed a significant association with increase in tumor size and dedifferentiation of tumors, factors indicative of poor prognosis. Expression of p53 protein was analyzed in 43 matched oral lesions (18 premalignant
and 25 malignant cases). All the p53-seropositive patients (7 leukoplakia and 11 squamous cell carcinoma) showed elevated levels of p53 protein in matched oral lesions. However, the total number of patients seropositive for p53 Abs was lesser than that of patients exhibiting p53 protein accumulation in oral lesions. Four of the 63 normal healthy individuals who were heavy consumers of tobacco (smoking/chewing) and betel were found to be positive for p53 Abs. Detection of circulating p53 Abs in patients with premalignant oral lesions suggests that humoral immune response against p53 protein is an early event in oral oncogenesis and may be a surrogate marker for both p53 alteration and preclinical cancer.
BibTeX:
@article{R.Ralhan1998,
  author = {R. Ralhan, N. Nath, S. Agarwal, M. Mathur, B. Wasylyk, N. K. Shukla},
  title = {Circulating p53 antibodies as early markers of oral cancer: correlation with p53 alterations},
  journal = {Clin Cancer Res.},
  year = {1998},
  volume = {4(9)},
  pages = {:2147-52}
}
R Sankaranarayanan, SW Duffy, G Padmakumary, NE Day, TK Padmanabhan Tobacco chewing, alcohol and nasal snuff in cancer of the gingiva in Kerala, India 1989 Br J Cancer.
Vol. 60(4), pp. 638-43 
article  
Abstract: A case-control study of cancer of the gingiva was carried out in Kerala, Southern India, using 187 cases and 895 hospital-based controls. We investigated the effects on risk in males of pan (betel)-tobacco chewing, bidi and cigarette smoking, drinking alcohol and taking snuff. In females only pan-tobacco chewing was investigated as very few females indulged in the other habits. Among males, significant positive associations with risk were observed for pan-tobacco chewing (P<0.001), bidi smoking (P<0.001) alcohol drinking (P<0.001) and snuff use (P<0.05). In females, pan-tobacco chewing had a similar predisposing effect (P<0.001). Daily frequency of pan-tobacco chewing was the strongest predictor of risk in males, with a relative risk of 15.07 associated with chewing ten or more quids per day. The corresponding relative risk among females was 13.69. In males a relative risk of 3.20 was associated with smoking more than 20 bidis per day, and relative risks of 2.62 and 3.90 were associated with regular use of alcohol and snuff respectively. Surprisingly high relative risks were observed in association with occasional use of pan-tobacco, bidi, cigarettes, alcohol and snuff. A stepwise logistic regression analysis yielded four predictors: pan-tobacco daily frequency, duration of bidi use, and alcohol and snuff use (regular versus never). There were also significantly elevated risks associated with occasional indulgence in these four habits. Total lifetime exposure was no better at predicting risk than daily frequency or duration of habits.
BibTeX:
@article{R.Sankaranarayanan1989,
  author = {R. Sankaranarayanan, S. W. Duffy, G. Padmakumary, N. E. Day, T. K. Padmanabhan},
  title = {Tobacco chewing, alcohol and nasal snuff in cancer of the gingiva in Kerala, India},
  journal = {Br J Cancer.},
  year = {1989},
  volume = {60(4)},
  pages = {638-43}
}
R Sharma, MS Pednekar, AU Rehman, R Gupta Tobacco use among school personnel in Rajasthan, India 2004 Indian J Cancer
Vol. 41(4), pp. 162-6 
article  
Abstract: Background: A very little information about tobacco use among school personnel is available. This is a step to have cross country and within country data using standardized methodology. AIMS: To obtain baseline information about tobacco use prevalence, knowledge and attitude among school personnel.
Study design: Two stage cluster sample.
Setting: A state of Rajasthan.
Materials and methods: A cross-sectional study, using anonymous selfadministered questionnaire. A sample of schools with probability proportional to the
enrollment in grades 8-10. All school personnel in sampled schools were eligible to participate.
Statistical analysis: Percentage, 95% confidence interval.
Results: School response rate was 97.4% (75/77) and school personnel response rate was 67.2% (909/1352). Majority of school personnel (men 69%, women 31%) were school teachers (78.3%). The prevalence of ever any tobacco use was reported by 35.9%, more among men than women (46.2% vs. 13.0%). The prevalence of current daily smoking was reported by 14.4% (men 20.6%, women 0.8%) and occasional by 7.3%, where as current daily smokeless tobacco use was 11.7% (men 16.4%, women 1.1%) and occasional 13.6%. Current daily tobacco use was significantly more among men than women. Four out of nine reported their schools have a tobacco prohibiting policy for both students (48.4%) as well as for school personnel (44.4%) and about same (47.2%) reported their schools enforce its tobacco policy or rule. Over 85% of all school personnel strongly support the tobacco control policies and wanted training in tobacco cessation and prevention.
Conclusions: First study from Rajasthan to report tobacco use among school personnel. School personnel not only strongly support the tobacco control policies but also ready to work for its successful implementation with proper training.
BibTeX:
@article{R.Sharma2004,
  author = {R. Sharma, M. S. Pednekar, A. U. Rehman, R. Gupta},
  title = {Tobacco use among school personnel in Rajasthan, India},
  journal = {Indian J Cancer},
  year = {2004},
  volume = {41(4)},
  pages = {162-6}
}
Rai R, Kulkarni V, Saranath D Genome wide instability scanning in chewing-tobacco associated oral cancer using inter simple sequence repeat PCR. 2004 Oral Oncol
Vol. 40(10), pp. 1033-9 
article  
Abstract: Genomic instability plays a major role in cancer, facilitating tumour progression and tumour heterogeneity. Inter simple sequence repeat PCR (ISSR-PCR) is a sensitive tool for detection of whole genome scanning. In fifteen oral cancer patients, using tumor tissue and adjacent normal tissue DNA, we investigated genomic instability regions using ISSR-PCR assay. The genomic fragments were cloned, sequenced and identified. Two-anchored dinucleotide repeat primers, (CA)(8)A/GG and (CA)(8)A/GC/T, were used in the study. About 40-50 fragments were observed on polyacrylamide gel
electrophoresis, with 25 distinct fragments of less than 2 kb. The electrophoretic pattern highlighted several distinct fragments in tumor adjacent normal tissues. The distinct fragments of 258, 325, 430, 440, 600 and 900 bp sizes using (CA)(8)A/GG primer, and 300, 475, 675 and 800 bp using (CA)(8)A/GC/T primers, in the normal tissues showed partial (>50%) or complete loss in multiple tumor tissues. These fragments were eluted from the gel, cloned in pMos Blue vector and subjected to nucleotide sequencing. Insilico analysis defined the specific genomic sequences, given as follows: RP11-399D2 () on chromosome (chr)4; RP1-39J2 (), NKp44RG () and RP11-518I13 () on chr6; NC-T-2 () on chr7; RP11-586K2 () and RP11-495O10 () on chr8; RP11-101K10 () on chr9; R-794A8 () on chr14; and RP11-679B19 () on chr16. The sequences of our clones have been submitted to NCBI gene bank, accession numbers to, and the Genomic Instability Index was calculated and ranged from 6% to 28.5% (median 12%) in the oral cancer samples, excluding one case where genomic instability was not observed. Thus, our results indicate presence of widespread genomic alterations in chewing-tobacco associated oral cancers.
BibTeX:
@article{RaiR2004,
  author = {Rai R, Kulkarni V, Saranath D},
  title = {Genome wide instability scanning in chewing-tobacco associated oral cancer using inter simple sequence repeat PCR.},
  journal = {Oral Oncol},
  year = {2004},
  volume = {40(10)},
  pages = {1033-9}
}
Rai R, Mahale A, Saranath D Molecular cloning, isolation and characterisation of ERK3 gene from chewing-tobacco induced oral squamous cell carcinoma. 2004 Oral Oncol.
Vol. 40(7), pp. 705-12 
article  
Abstract: The mitogen activated serine/threonine kinases (MAPKs) constitute extracellular signalregulated protein kinases (ERKs), c-Jun N-terminal kinases (JNKs) and p38 MAPK, with an important role in cell proliferation and transformation. Earlier studies from our laboratory had indicated a role for MAPK pathway in oral cancer. Our current study was aimed at examining the role of a MAPK-ERK3, in chewing-tobacco associated oral squamous cell carcinoma. We constructed a cDNA library from primary oral cancer tissue, cloned and isolated the ERK3 gene. The gene was sequenced and the sequence
submitted to GenBank (Accession number AF420474). The oral cancer ERK3 clone demonstrated 100% homology to human ERK3 isolated from fetal skeletal muscle, with four specific nucleotide alterations in the non-coding region of the gene, comprising deletion of 'TTT' between 2701 and 2705 nt; 'G' to 'T' substitution at 188 nt; insertion of 'A' between 121 and 122 nt, and insertion of 'CTTTA' between 3391 and 3392 nt. Southern analysis of EcoRI genomic digests indicated ERK3 specific fragments of 11, 8.6, 6.5 and 3.2 kb sizes. The mRNA transcript analysis defined a single transcript of 4.5 kb. RT-PCR analysis revealed a three- to eight-fold increase in ERK3 expression in a majority (90%) of oral cancer tissues and peripheral blood cells (61.5%) of the patients, whereas absence or low levels of expression was observed in peripheral blood cells of 74% clinically normal healthy individuals with no tobacco habits, and overexpression in PBC from 26% normal individuals. The alterations in the non-coding region of ERK3 gene cloned from oral cancer tissue, may affect stability or regulation of mRNA, resulting in overexpression in the patient samples. The overexpression of the gene in the normal healthy individuals may be indicative of increased risk of developing oral cancers in this group.
BibTeX:
@article{RaiR2004a,
  author = {Rai R, Mahale A, Saranath D},
  title = {Molecular cloning, isolation and characterisation of ERK3 gene from chewing-tobacco induced oral squamous cell carcinoma.},
  journal = {Oral Oncol.},
  year = {2004},
  volume = {40(7)},
  pages = {705-12}
}
Rajan G, Ramesh S, Sankaralingam S Areca nut use in rural Tamil Nadu: a growing threat. 2007 Indian J Med Sci
Vol. 61(6), pp. 332-7 
article  
Abstract: Background: Areca nut is the fourth main psychoactive substance in the world. In India, tobacco is added to the quid and the commercially manufactured nonperishable forms of betel quid (pan masala or gutkha) are on the rise in the market.
Objective: To find out the prevalence of areca nut among the rural residents of Sriperambudur Taluk.
Setting and design: A community-based survey using pre-tested semi-structured questionnaire.
Materials and methods: The survey was conducted in 2 villages and their colonies, which were randomly selected out of 168 villages. Data was collected from 500 residents of the study population. The survey was conducted for a period of 2 months. Statistical
Analysis: SPSS version 10.0.
Results: The study participants were more likely to initiate areca nut use by 22 years of age. As many as 19.8% (n = 99) of the study participants chewed areca nut products, out of whom 11.2% (n = 56) indulged in chewing habit alone (areca nut products). Areca nut use was higher among male study subjects compared to females. The commercial forms of areca nut products (gutkha) were the most prevalent ones [47.5% (n = 47) of those who used areca nut] observed in the community. Compared to female participants, male participants were more likely to perceive areca nut use as the most
harmful habit draining the community health and wealth.
Conclusion: There seems to be an increase in the prevalence of areca nut use. The community also perceives it to be a harmful habit. Therefore, effective interventions should be targeted towards the high-risk subpopulation of the community to decrease the prevalence of areca nut use in rural Tamil Nadu.
BibTeX:
@article{RajanG2007,
  author = {Rajan G, Ramesh S, Sankaralingam S},
  title = {Areca nut use in rural Tamil Nadu: a growing threat.},
  journal = {Indian J Med Sci},
  year = {2007},
  volume = {61(6)},
  pages = {332-7}
}
Raju P, George R, Ve Ramesh S, Arvind H, Baskaran M, Vijaya L Influence of tobacco use on cataract development. 2006 Br J Ophthalmol.
Vol. 90(11), pp. 1374-7 
article  
Abstract: Aim: To study the influence of tobacco use on cataract formation in a rural South Indian population.
Methods: 3924 subjects from the Chennai Glaucoma Study conducted in rural south India underwent a comprehensive eye examination, including Lens Opacities Classification System II grading. Information on tobacco use, type of tobacco (smoking and smokeless), duration and quantity of use was collected.
Results: 1705 (male:female (M:F) 1106:599) people used tobacco and were significantly older (mean (standard deviation (SD)) age 55.80 (10.64) years) than nonusers (52.23 (10.51); p<0.001). 731 (M:F 730:1) people smoked, 900 (M:F 302:598) used smokeless tobacco, and 74 (M:F, 74:0) used tobacco in both forms. The unadjusted and adjusted (age and sex) odds ratio (OR) for a positive history of tobacco use and cataract was 1.72 (95% confidence interval (CI) 1.51 - 1.96) and 1.39 (95% CI 1.15 -1.68), respectively. The unadjusted OR for smokers and smokeless tobacco users was 1.04 (95% CI 0.88 -1.23) and 2.74 (95% CI 2.31 - 3.26), respectively. The adjusted OR was 1.19 (95% CI 0.89 - 1.59) and 1.54 (95% CI 1.22- 1.95), respectively. No
significant association was noted between smoking and any particular type of cataract. Smokeless tobacco use was found to be significantly associated with nuclear cataract even after adjusting for age and sex (OR 1.67, p = 0.067, 95% CI 1.16- 2.39).
Conclusions: Tobacco use was significantly associated with cataract. Smoking was not found to be significantly associated with cataract formation; however, smokeless tobacco use was more strongly associated with cataract.
BibTeX:
@article{RajuP2006,
  author = {Raju P, George R, Ve Ramesh S, Arvind H, Baskaran M, Vijaya L},
  title = {Influence of tobacco use on cataract development.},
  journal = {Br J Ophthalmol.},
  year = {2006},
  volume = {90(11)},
  pages = {1374-7}
}
Ramachandran S, Ramadas K, Hariharan R, Rejnish Kumar R, Radhakrishna Pillai M Single nucleotide polymorphisms of DNA repair genes XRCC1 and XPD and its molecular mapping in Indian oral cancer. 2006 Oral Oncol.
Vol. 42(4), pp. 350-62 
article  
Abstract: Tobacco users with diminished ability to repair somatic mutations may be more susceptible to tobacco attributable cancers. The distribution of single nucleotide polymorphisms (SNPs) in DNA repair genes XRCC1 and XPD in 110 oral carcinoma cases, 84 leukoplakia and 110 controls belonging to the Travancore South Indian population were examined. SNPs investigated included Arg194Trp, Arg280His, and Arg399Gln of the XRCC1 gene and Lys751Gln of the XPD gene. In addition, one of the variants positions, A399G, was mapped onto the BRCT I domain model built by comparative modeling (threading). Presence of the polymorphic variant of XRCC1 codon 194 and 399 and XPD was associated with increased risk of oral cancer compared to the wild genotype. Smokers and betel quid chewers with the variant allele of XRCC1 399 codon and XPD also exhibited increased risk of oral cancer. The A399G variant position mapped onto the surface of the BRCT I domain provides a possible rationale for altered XRCC1 function. These results suggest that polymorphisms in functionally important repair genes, specifically, those that map onto the protein surface may alter protein function without significantly affecting its structure.
BibTeX:
@article{RamachandranS2006,
  author = {Ramachandran S, Ramadas K, Hariharan R, Rejnish Kumar R, Radhakrishna Pillai M},
  title = {Single nucleotide polymorphisms of DNA repair genes XRCC1 and XPD and its molecular mapping in Indian oral cancer.},
  journal = {Oral Oncol.},
  year = {2006},
  volume = {42(4)},
  pages = {350-62}
}
Ramchandani AG, D'Souza AV, Borges AM, Bhisey RA Evaluation of carcinogenic/co-carcinogenic activity of a common chewing product, pan masala, in mouse skin, stomach and esophagus. 1998 Int J Cancer.
Vol. 75(2), pp. 225-32 
article  
Abstract: Pan masala, a dry powdered mixture of areca nut, catechu, lime, unspecified spices and flavoring agents, has gained widespread popularity as a chewing substitute in India. In this study, the carcinogenic and tumor-promoting potential of an ethanolic pan masala extract (EPME) was determined using skin of S/RVCri-ba mice and forestomach and esophagus of ICRC mice as the target tissues. Carcinogenic activity of pan masala was tested by painting the mouse skin for 40 weeks with EPME or by gavage feeding for 6 months. Following initiation with 9,10- dimethylbenz(a)anthracene (DMBA), carcinogenesis of mouse skin was promoted with different doses of EPME, while gastric- and esophageal-tumor-promoting activity was determined by administering EPME by gavage to animals initiated with diethylnitrosamine (DEN). The ability of EPME to effect progression of skin papilloma to carcinoma and cutaneous alterations after a single or multiple EPME treatment were also evaluated. EPME at 25 mg per dose promoted skin-papilloma formation between 30 and 40 weeks of treatment and enhanced the rate of conversion of papilloma to carcinoma. Induction of mild epidermal hyperplasia, dermal edema, increase in epidermal mitotic activity and the rate of epidermal and dermal DNA synthesis by EPME correlated well with its skin-tumor-promoting potential. In ICRC mice, EPME was inactive as a complete carcinogen, but effectively promoted the development of forestomach and esophageal papilloma and carcinoma in a concentration-dependent manner. The tumor incidence at 25 mg EPME per dose was comparable with that obtained in the 12-O-tetradecanoylphorbol-13 acetate(TPA)-treated group. The findings indicate that habitual pan-masala use may exert carcinogenic and co-carcinogenic influence.
BibTeX:
@article{RamchandaniAG1998,
  author = {Ramchandani AG, D'Souza AV, Borges AM, Bhisey RA},
  title = {Evaluation of carcinogenic/co-carcinogenic activity of a common chewing product, pan masala, in mouse skin, stomach and esophagus.},
  journal = {Int J Cancer.},
  year = {1998},
  volume = {75(2)},
  pages = {225-32}
}
Ranganathan K, Devi MU, Joshua E, Kirankumar K, Saraswathi TR Oral submucous fibrosis: a case-control study in Chennai, South India. 2004 J Oral Pathol Med
Vol. 33(5), pp. 274-7 
article  
Abstract: Background: Oral submucous fibrosis (OSF) is a pre-cancerous condition caused by the use of areca nut in various forms. There are very few published reports on areca nut use and OSF from Chennai, South India.
Methods: A hospital-based case-control study on habits and OSF was performed in Chennai over a 3-year period. A total of 185 consecutive patients with OSF were matched with age- and sex-matched controls. History was recorded in a pre-determined format by qualified dental surgeons.
Results: The male to female ratio of OSF cases was 9.9 : 1. All areca nut products were associated with OSF, with the risk being greatest for pan masala. The duration of the habit was more significant than the frequency of the chewing habit.
Conclusion: The present study confirms the strong association between areca nut use and OSF and the increasing use of pan masala.
BibTeX:
@article{RanganathanK2004,
  author = {Ranganathan K, Devi MU, Joshua E, Kirankumar K, Saraswathi TR},
  title = {Oral submucous fibrosis: a case-control study in Chennai, South India.},
  journal = {J Oral Pathol Med},
  year = {2004},
  volume = {33(5)},
  pages = {274-7}
}
Rao NM Cardiovascular and respiratory manifestations in tobacco chewers 1993 J Assoc Physicians India.
Vol. 41(4), pp. 223-4 
article  
BibTeX:
@article{Rao1993,
  author = {N. M. Rao},
  title = {Cardiovascular and respiratory manifestations in tobacco chewers},
  journal = {J Assoc Physicians India.},
  year = {1993},
  volume = {41(4)},
  pages = {223-4}
}
Sogani RK Pan Masala: is it really safe? A clarification. 1988 J Assoc Physicians India.
Vol. 36(9)(574) 
article  
BibTeX:
@article{RK1988,
  author = {Sogani RK},
  title = {Pan Masala: is it really safe? A clarification.},
  journal = {J Assoc Physicians India.},
  year = {1988},
  volume = {36(9)},
  number = {574}
}
Sogani RK Pan masala: is it really safe? 1987 J Assoc Physicians India.
Vol. 35(4)(317) 
article  
BibTeX:
@article{RK1987,
  author = {Sogani RK},
  title = {Pan masala: is it really safe?},
  journal = {J Assoc Physicians India.},
  year = {1987},
  volume = {35(4)},
  number = {317}
}
Rohatgi N, Kaur J, Srivastava A, Ralhan R Smokeless tobacco (khaini) extracts modulate gene expression in epithelial cell culture from an oral hyperplasia. 2005 Oral Oncol.
Vol. 41(8), pp. 806-20 
article  
Abstract: Smokeless tobacco (ST) usage is a growing public health problem worldwide. Exposure to smokeless tobacco is carcinogenic to humans. The molecular mechanism(s) underlying ST associated oral carcinogenesis remain largely unknown. The major challenge is to identify the key factor(s) involved in malignant transformation of oral lesions. Knowledge of these factors will provide candidate diagnostic biomarkers and targets for early intervention. To identify the molecular targets in ST associated oral lesions, we established and purified cultures of epithelial cells (AMOL-III) from an oral
leukoplakia with histological evidence of hyperplasia with hyperkeratosis from gingivobuccal sulcus of a smokeless tobacco (khaini) consumer. Cell cultures were characterized and modulation of gene expression in response to smokeless tobacco extract (STE) was investigated using confocal microscopy and immunoblotting. AMOL-III cells showed altered expression of cell cycle regulators namely p53, p21waf1/cip1, hdm2, proliferation marker Ki67 and transcription factor Ets-1. These cells did not harbor HPV 16/18. No mutation was detected in H-Ras codon 12/13 or in p53 exons 5-9 in
AMOL-III cells. STE treatment of these cells resulted in loss of pRb, RARbeta, p21 waf1/cip1 and O6-methyl guanine-DNA methyl transferase (MGMT) while the expression of cyclin D1 was increased. To our knowledge this is the first report to demonstrate that khaini modulates expression of multiple cellular targets including proteins involved in cell cycle regulation and DNA methylation, which may lead the oral epithelial cells down the carcinogenic pathway. This in vitro model system assumes importance in unraveling the cellular and molecular mechanisms implicated in smokeless tobacco associated early oral cancer progression.
BibTeX:
@article{RohatgiN2005,
  author = {Rohatgi N, Kaur J, Srivastava A, Ralhan R},
  title = {Smokeless tobacco (khaini) extracts modulate gene expression in epithelial cell culture from an oral hyperplasia.},
  journal = {Oral Oncol.},
  year = {2005},
  volume = {41(8)},
  pages = {806-20}
}
Rohatgi N, Matta A, Kaur J, Srivastava A, Ralhan R Novel molecular targets of smokeless tobacco (khaini) in cell culture from oral hyperplasia. 2006 Toxicology.
Vol. 224(1-2), pp. 1-13 
article  
Abstract: Knowledge of molecular mechanism(s) implicated in smokeless tobacco (ST) associated oral carcinogenesis is meager. In an attempt to identify genes that are modulated by ST, we recently reported establishment of an oral epithelial cell culture, AMOL III from oral hyperplasia with hyperkeratosis of a khaini consumer. Herein we aimed to identify novel molecular targets of ST (khaini) in AMOL III cells using differential display. Fourteen novel differentially expressed genes (12 upregulated and 2 downregulated) were identified. These differentially expressed cDNAs were amplified, cloned, sequenced and confirmed by reverse northern blotting. Mainly these genes are components of transcriptional machinery, cell-cell adhesion, signaling, growth and transformation processes. The important novel molecular targets identified included activated leucocyte cell adhesion molecule (ALCAM), CDP-diacylglycerol-inositol 3-phosphatidyl transferase (phosphatidylinositol synthase), CDIPT, an important enzyme in phosphatidyl inositol biosynthesis, ribosomal protein (RPS23), KIAA0121 and growth and transformation factor, E2IG5. Semi-quantitative RT-PCR analysis of these five genes confirmed overexpression of these genes in oral pre-malignant lesions (OPLs) and oral squamous cell carcinomas (OSCCs) of ST consumers underscoring their biological relevance in STassociated oral tumorigenesis. In depth studies are warranted to determine the functional significance of ALCAM and CDIPT in oral carcinogenesis.
BibTeX:
@article{RohatgiN2006,
  author = {Rohatgi N, Matta A, Kaur J, Srivastava A, Ralhan R},
  title = {Novel molecular targets of smokeless tobacco (khaini) in cell culture from oral hyperplasia.},
  journal = {Toxicology.},
  year = {2006},
  volume = {224(1-2)},
  pages = {1-13}
}
Bhatia RS Pan masala: why not ban it? 1989 J Assoc Physicians India.
Vol. 37(5)(347) 
article  
BibTeX:
@article{RS1989,
  author = {Bhatia RS},
  title = {Pan masala: why not ban it?},
  journal = {J Assoc Physicians India.},
  year = {1989},
  volume = {37(5)},
  number = {347}
}
Warnakulasuriya S Smokeless tobacco and oral cancer. 2004 Oral Dis.
Vol. 10(1), pp. 1-4 
article  
BibTeX:
@article{S2004,
  author = {Warnakulasuriya S},
  title = {Smokeless tobacco and oral cancer.},
  journal = {Oral Dis.},
  year = {2004},
  volume = {10(1)},
  pages = {1-4}
}
SG Adhvaryu, BJ Dave , AH Trivedi Cytogenetic surveillance of tobacco-areca nut (mava) chewers, including patients with oral cancers and premalignant conditions 1991 Mutat Res.
Vol. 261(1), pp. 41-9 
article  
Abstract: Three cytogenetic endpoints were studied in non-chewing healthy controls and 3 groups of tobacco-areca nut chewers, viz. normal chewers, chewers with oral submucous fibrosis and chewers with oral cancer. Frequencies of sister-chromatid exchanges and chromosome aberrations in peripheral blood lymphocytes and of micronucleated cells in exfoliated buccal mucosa were evaluated. All the parameters showed statistically significant elevations in all 3 groups of chewers compared to the controls. The data indicate possible application of the parameters as sensitive endpoints for monitoring tobacco-areca nut chewers, the group of individuals at higher risk of developing oral cancer, the commonest cancer among Indian males.
BibTeX:
@article{S.G.Adhvaryu1991,
  author = {S. G. Adhvaryu, B. J. Dave , A. H. Trivedi},
  title = {Cytogenetic surveillance of tobacco-areca nut (mava) chewers, including patients with oral cancers and premalignant conditions},
  journal = {Mutat Res.},
  year = {1991},
  volume = {261(1)},
  pages = {41-9}
}
S Jhavar, R Sarin, R Mulherkar, A Benner, JP Agarwal, K Dinshaw Glutathione S-transferase M1 or T1 null genotype as a risk factor for developing multiple primary neoplasms in the upper aero-digestive tract, in Indian males using tobacco 2004 Oral Oncol.
Vol. 40(1), pp. 84-91 
article  
Abstract: In this study conducted amongst Indian male tobacco users with upper aerodigestive tract (UADT) squamous carcinoma, 30 patients with multiple primary
neoplasms (MPN) were compared with 28 age and sex matched patients with a single primary neoplasm (SPN) for various environmental factors (form of tobacco use, alcohol, radiotherapy for index cancer) and genetic parameters (family history of UADT cancers and GSTT1/GSTM1 genotype). The GSTM1/T1 null genotype, seen in 60% patients with MPN versus 33% patients with SPN (P=0.03) had an odds ratio of 3.7 [CI=1.14-11.99; P=0.03] for developing MPN. Tobacco use in the form of smoking with or without chewing, as opposed to only chewing, and regular alcohol intake were the two other factors with almost three fold increased risk for the development of MPN, although, the effect was not statistically significant. All three patients with a family history of UADT cancer developed MPN, suggesting an inherited predisposition.
BibTeX:
@article{S.Jhavar2004,
  author = {S. Jhavar, R. Sarin, R. Mulherkar, A. Benner, J. P. Agarwal, K. Dinshaw},
  title = {Glutathione S-transferase M1 or T1 null genotype as a risk factor for developing multiple primary neoplasms in the upper aero-digestive tract, in Indian males using tobacco},
  journal = {Oral Oncol.},
  year = {2004},
  volume = {40(1)},
  pages = {84-91}
}
S Krishnamurthy, S Joshi Gender differences and low birth weight with maternal smokeless tobacco use in pregnancy 1993 J Trop Pediatr
Vol. 39(4), pp. 253-4 
article  
Abstract: A preliminary study of maternal smokeless tobacco use, mostly oral applications of burnt tobacco or 'mishri', in pregnancy showed 65 of 178 singleton liveborns occurred to users and 113 to non-users in Bombay, India. Eighty-three newborns, 42 to maternal tobacco users and 41 to non-users were < 2.5 kg birth weight, i.e. low birth weight (LBW; odds ratio 3.2; confidence interval 1.5-6.9; P < 0.001). Stratifying by gender yielded odds ratios of 1.6 (P > 0.1, NS) for male and 6.96 (confidence interval 2.5-19.4, P < 0.0005), for female newborns compared to normal birthweight boys and girls, respectively. Male:female newborns were 80.6:100 in maternal tobacco users compared to 105.5:100 in non-users. Defining LBW as < 2.0 kg yielded an odds ratio of 5.4 (confidence interval 1.8-15.2, P < 0.005) in maternal tobacco users' offspring. For babies weighing 2-2.5 kg at birth it was 2.76 (confidence interval 1.4-5.5, P < 0.01). Maternal use of 'mishri' tobacco in pregnancy may be associated with (1) the offsprings' low birth weight, (2) low birth weights in girls more than in boys; (3) decreased male:female ratio in live newborns, and (4) low birth weight of < 2.0 kg more than of 2-2.5 kg. Studies are needed to substantiate these findings. Gender differences in outcome suggest the in utero effect of maternal smokeless tobacco use on male and female fetuses may differ.
BibTeX:
@article{S.Krishnamurthy1993,
  author = {S. Krishnamurthy, S. Joshi},
  title = {Gender differences and low birth weight with maternal smokeless tobacco use in pregnancy},
  journal = {J Trop Pediatr},
  year = {1993},
  volume = {39(4)},
  pages = {253-4}
}
S Mohan, P Sankara Sarma, KR Thankappan Access to pocket money and low educational performance predict tobacco use among adolescent boys in Kerala, India 2005 Prev Med.
Vol. 41(2), pp. 685-92 
article  
Abstract: Background: Tobacco use is increasing among adolescents. We conducted this study to find prevalence and correlates of tobacco use among adolescent boys in Trivandrum city, Kerala.
Methods: Using a two-stage cluster sampling technique, 1323 boys (12-19 years) were selected from 14 schools. Information on tobacco use, academic performance, pocket money, and other variables was collected using a questionnaire. Multivariate analyses were done to find associations between current use of tobacco and other variables.
Results: Prevalence of current tobacco use was 11.3% (95% CI 9.6-13.0). Current tobacco use was 2.9 times higher among older boys compared to younger boys (OR 2.9, CI 1.6-5.3), 2 times higher among boys whose fathers used tobacco (OR 2.0, CI 1.3-3.1), 2.9 times higher among boys whose friends used tobacco (OR 2.9, CI 1.6-5.1) compared to their counterparts, 3 times higher among boys securing poor (<40% marks) grade compared to those securing excellent (>80% marks) grade (OR 3.0, CI 1.4-6.6), and 4 times higher among those who received pocket money compared to those who did not (OR 4.0, CI 2.2-7.4).
Conclusions: Health programs to quit tobacco are suggested in schools with special emphasis on poor performers, those receiving pocket money,
and those whose fathers and friends use tobacco.
BibTeX:
@article{S.Mohan2005,
  author = {S. Mohan, P. Sankara Sarma, K. R. Thankappan},
  title = {Access to pocket money and low educational performance predict tobacco use among adolescent boys in Kerala, India},
  journal = {Prev Med.},
  year = {2005},
  volume = {41(2)},
  pages = {685-92}
}
SS Parikh, KB Chopra, RH Kalro, HG Desai The effect of chewing tobacco on portal hypertensive gastric mucosa 1994 J Clin Gastroenterol
Vol. 18(4), pp. 348-50 
article  
BibTeX:
@article{S.S.Parikh1994,
  author = {S. S. Parikh, K. B. Chopra, R. H. Kalro and H. G. Desai},
  title = {The effect of chewing tobacco on portal hypertensive gastric mucosa},
  journal = {J Clin Gastroenterol},
  year = {1994},
  volume = {18(4)},
  pages = {348-50}
}
Samal IR, Maneesh M, Chakrabarti A Evidence for systemic oxidative stress in tobacco chewers. 2006 Scand J Clin Lab Invest.
Vol. 66(6), pp. 517-22 
article  
Abstract: Objective: To evaluate erythrocyte malondialdehyde (MDA) levels and activities of superoxide dismutase (SOD) and glutathione reductase (GR) in tobacco chewers, in view of possible oxidative stress in oral smokeless tobacco.
Materials and methods: 60 healthy male tobacco chewers, aged 30.6?4.7 years with a 3 to 10-year (7.37?2.1) history of tobacco chewing, were included in the study. 32 healthy male volunteers, aged 26.5?4.8 years, served as controls. All the participants were from the same community and of similar dietary habits.
Results: The erythrocyte MDA level and activities of erythrocyte SOD and GR were estimated. There was a significant duration- (tobacco chewing) dependent increase in erythrocyte MDA levels along with a significant duration- (tobacco chewing) dependent decrease in erythrocyte SOD and GR activity.
Conclusion: Oral smokeless tobacco causes a duration-dependent increase in oxidative stress.
BibTeX:
@article{SamalIR2006,
  author = {Samal IR, Maneesh M, Chakrabarti A},
  title = {Evidence for systemic oxidative stress in tobacco chewers.},
  journal = {Scand J Clin Lab Invest.},
  year = {2006},
  volume = {66(6)},
  pages = {517-22}
}
Sankaranarayanan R Oral cancer in India: an epidemiologic and clinical review 1990 Oral Surg Oral Med Oral Pathol
Vol. 69(3), pp. 325-30 
article  
Abstract: This article reviews the epidemiologic and clinical aspects of oral cancer in India, where the disease ranks number one among all cancers in male patients and number three among cancers in female patients. Causal association between oral cancer and the chewing of betel quids containing tobacco leaves or stem and other tobacco habits has been extensively studied. But there is need for more in-depth studies on the role of alcohol, diet, and oral hygiene practices in India. The exciting opportunity provided by the well-established oral precancerous lesions for intervention and early detection programs is also discussed. The peak age frequency of occurrence is at least a decade earlier than that described in Western literature. Sex ratio reveals a 2:1 preponderance of male patients. Only 10% to 15% of cases present in localized stages. The poor survival revealed by existing studies is mainly due to the overwhelming proportion of advanced cases. The excellent opportunity for more research and efforts in prevention and control of oral cancer in India is highlighted in this review.
BibTeX:
@article{Sankaranarayanan1990,
  author = {R. Sankaranarayanan},
  title = {Oral cancer in India: an epidemiologic and clinical review},
  journal = {Oral Surg Oral Med Oral Pathol},
  year = {1990},
  volume = {69(3)},
  pages = {325-30}
}
Saranath D, Tandle AT, Teni TR, Dedhia PM, Borges AM, Parikh D, Sanghavi V, Mehta AR p53 inactivation in chewing tobacco-induced oral cancers and leukoplakias from India. 1999 Oral Oncol.
Vol. 35(3), pp. 242-50 
article  
Abstract: The inactivation of p53 tumour suppressor gene vis-�-vis point mutation, overexpression and degradation due to Human Papilloma virus (HPV) 16/18 infection, was examined in chewing tobacco-associated oral cancers and oral leukoplakias from India. The analysis of mutations was assessed by polymerase chain reaction (PCR) with single strand conformation polymorphism (PCR-SSCP) of exons 5-9 on DNA from 83 oral cancer cases, and the mutations confirmed by direct nucleotide sequencing of the PCR products. p53 protein expression was evaluated by immunohistochemical analysis on
paraffin-embedded sections of 62 representative oral cancer biopsies and 22 leukoplakias, using p53-specific monoclonal antibody DO-7. The presence of HPV16/18 was detected in the 83 oral cancer cases by PCR analysis using HPV L1 consensus sequences, followed by Southern hybridization with type-specific oligonucleotide probes. Forty-six per cent (38/83) of oral cancer tumours showed p53 alterations, with 17% (14/83) showing point mutations, 37% (23/62) with overexpression and 25% (21/83) with presence of HPV16 wherein the E6 HPV16 protein degrades p53. HPV18 was not detected in any of the samples. Ninety-two per cent concordance was observed between missense point mutations and overexpression of p53 protein. A significant correlation was not observed between p53 alterations in oral cancer and clinicopathological profile of the patients. Twenty-seven per cent (6/22) of oral leukoplakias showed p53 overexpression. The overall p53 alterations in oral cancer tissues and oral lesions are comparable to data from the oral cancers reported in the Western countries with smoking and alcohol-associated oral cancers, and suggest a critical role for p53 gene in a significant proportion of oral cancers from India. The overexpression of p53 protein in leukoplakias may serve as a valuable biomarker for identifying individuals at high risk of transformation to malignant phenotype.
BibTeX:
@article{SaranathD1999,
  author = {Saranath D, Tandle AT, Teni TR, Dedhia PM, Borges AM, Parikh D, Sanghavi V, Mehta AR},
  title = {p53 inactivation in chewing tobacco-induced oral cancers and leukoplakias from India.},
  journal = {Oral Oncol.},
  year = {1999},
  volume = {35(3)},
  pages = {242-50}
}
Saraswathi TR, Ranganathan K, Shanmugam S, Sowmya R, Narasimhan PD, Gunaseelan R Prevalence of oral lesions in relation to habits: Crosssectional study in South India. 2006 Indian J Dent Res.
Vol. 17(3), pp. 121-5 
article  
Abstract: Background: Smoking, drinking and chewing tobacco product, common habits in India have been positively associated with oral lesions. No study has been conducted in this part of Tamilnadu regarding the prevalence of oral lesions in relation to habits.
Methods: A hospital based cross-sectional study was carried out at Ragas Dental College, Chennai. Already existing data of two thousand and seventeen consecutive patients from sub-urban areas of Chennai, who attended the outpatient department, at Ragas Dental College, for dental complaints during a period of three months in 2004, who underwent oral examination and interviewer based questionnaire was used.
Results: Oral soft tissue lesions were found in 4.1% of the study subjects. The prevalence of leukoplakia, OSF and oral lichen planus was 0.59%, 0.55%, and 0.15% respectively. The prevalence of smoking, drinking alcoholic beverages and chewing was 15.02%, 8.78% and 6.99% respectively. Smoking and chewing were significant predictors of leukoplakia in this population.
Discussion: The prevalence of leukoplakia, OSF and oral lichen planus in our study population is similar to those found in other populations. The prevalence of consumption of alcoholic beverages in our study population was higher when compared to the Indian National Sample Survey study. However the prevalence of smoking and chewing was found to be lower. Smokers were more likely to develop smoker's melanosis compared to other lesions. Among those who consumed alcoholic beverages alone, the prevalence of leukoplakia was higher compared to other lesions. OSF was the most prevalent lesion among those who chewed panmasala or gutkha or betel quid with or without tobacco.
BibTeX:
@article{SaraswathiTR2006,
  author = {Saraswathi TR, Ranganathan K, Shanmugam S, Sowmya R, Narasimhan PD, Gunaseelan R},
  title = {Prevalence of oral lesions in relation to habits: Crosssectional study in South India.},
  journal = {Indian J Dent Res.},
  year = {2006},
  volume = {17(3)},
  pages = {121-5}
}
Sarma AB, Chakrabarti J, Chakrabarti A, Banerjee TS, Roy D, Mukherjee D, Mukherjee A Evaluation of pan masala for toxic effects on liver and other organs. 1992 Food Chem Toxicol
Vol. 30(2), pp. 161-3 
article  
Abstract: The acute and chronic oral toxicity of pan masala (betel quid without betel leaf) was assessed in gavage studies in rats. Clinical parameters (liver and serum glutamicoxaloacetic transaminase, glutamic-pyruvic transaminase and alkaline phosphatase) and organ weights were measured. The results indicate that chronic feeding of pan masala impaired liver function, as indicated by changes in enzyme activity, and decreased relative weights of the gonads and brain.
BibTeX:
@article{SarmaAB1992,
  author = {Sarma AB, Chakrabarti J, Chakrabarti A, Banerjee TS, Roy D, Mukherjee D, Mukherjee A},
  title = {Evaluation of pan masala for toxic effects on liver and other organs.},
  journal = {Food Chem Toxicol},
  year = {1992},
  volume = {30(2)},
  pages = {161-3}
}
Sawant SS, Naresh KN, D'Cruz A, Ogale SB, Vaidya MM Demonstration of cytokeratin-5 non-expression in tobacco related oral carcinogenesis--use of reverse transcriptase polymerase chain reaction as a sensitive assay. 2003 Oral Oncol
Vol. 39(8), pp. 789-95 
article  
Abstract: Cytokeratins (CK) are the epithelia specific intermediate filament proteins. We have shown consistent non-expression of CK-5 protein in human oral pre-cancer and cancer, in earlier studies. To investigate whether non-expression of CK-5 protein is the result of transcriptional or translational block and to evaluate the possibility if CK-5 nonexpression can be used as a marker for early diagnosis of tobacco related oral cancer, RT-PCR using CK-5 specific primers was conducted. Out of 36 precancerous lesions and 29 squamous cell carcinomas (SCC) of buccal mucosa (BM) samples studied, 11 and 13 samples respectively of precancer and SCC did not show CK-5 product in RTPCR. Down regulation of CK-5 mRNA expression was also observed in some samples. Thus, in conclusion, our results have shown that CK-5 non-expression is the result of transcriptional block. We proposed CK-5 non-expression as a potential marker for the early diagnosis of tobacco related oral cancer.
BibTeX:
@article{SawantSS2003,
  author = {Sawant SS, Naresh KN, D'Cruz A, Ogale SB, Vaidya MM},
  title = {Demonstration of cytokeratin-5 non-expression in tobacco related oral carcinogenesis--use of reverse transcriptase polymerase chain reaction as a sensitive assay.},
  journal = {Oral Oncol},
  year = {2003},
  volume = {39(8)},
  pages = {789-95}
}
Sawant SS, Zingde SM, Vaidya MM Cytokeratin fragments in the serum: their utility for the management of oral cancer. 2008 Oral Oncol.
Vol. 44(8), pp. 722-32 
article  
Abstract: Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy and is a major cause of cancer morbidity and mortality worldwide. Oral cancer is the most predominant malignancy in the Indian subcontinent due to the widespread habits of chewing tobacco and related products. Patients with oral tumours have a high risk of early locoregional relapse. Early detection of disease progression remains a challenging task mainly due to the lack of adequate early prognostic markers. CEA, SCC Ag, CA-125, serum cytokeratin (CK) fragments, Cyfra 21-1 (CK 19), TPS (CK
18), TPA (CK 8, 18, and 19) etc. are being used as serum markers for the prediction of prognosis of various malignancies. This review presents the available literature on serum CK markers in different malignancies evaluates their utility in the management of oral cancer, and identifies the lacunae which need to be addressed to develop sensitive and specific assays for early detection of recurrence, prognosis, and treatment monitoring.
BibTeX:
@article{SawantSS2008,
  author = {Sawant SS, Zingde SM, Vaidya MM},
  title = {Cytokeratin fragments in the serum: their utility for the management of oral cancer.},
  journal = {Oral Oncol.},
  year = {2008},
  volume = {44(8)},
  pages = {722-32}
}
Sawhney M, Rohatgi N, Kaur J, Gupta SD, Deo SV, Shukla NK, Ralhan R MGMT expression in oral precancerous and cancerous lesions: correlation with progression, nodal metastasis and poor prognosis. 2007 Oral Oncol.
Vol. 43(5), pp. 515-22 
article  
Abstract: Alkylation of DNA at the O(6) position of guanine is a critical step in the induction of mutations by carcinogenic and chemotherapeutic alkylating agents. O(6)-methylguanine-DNA methyltransferase (MGMT) is an enzyme that removes mutagenic adducts from the O(6) position of guanine, thereby protecting the genome against guanine to adenine transitions. We hypothesized that alteration in MGMT expression might occur in early stages of development of oral cancer and be associated with disease progression. Immunohistochemical analysis of MGMT expression was carried out in 107 oral squamous cell carcinomas (OSCCs), 78 oral precancerous lesions (OPLs) (58 hyperplasias and 20 dysplasias) and 30 histologically normal oral tissues and correlated
with clinicopathological parameters as well as major risk factors. Decreased MGMT expression was observed as early as in hyperplasia (p=0.003; Odd's Ratio (OR)=5.0). Significant loss of MGMT expression was observed from hyperplasia to dysplasia (p=0.034; OR=4.0). Loss of MGMT expression was associated with late clinical stage of OSCCs (p=0.027, OR=2.0) and nodal metastasis (p=0.031, OR=2.5). Decreased MGMT expression was associated with smokeless tobacco (ST) consumption in patients with OPLs (p=0.017, OR=3.6) and OSCCs (p=0.031, OR=2.8). Significant association was also observed between loss of MGMT expression and poor prognosis of OSCC patients (p=0.02; OR=5.2). The decreased MGMT expression in OPLs suggested that deregulation of MGMT expression is an early event in the development of oral cancer. In OSCCs, its correlation with late clinical stage, and nodal metastasis suggests association with aggressive tumor behavior and cancer progression, underscoring its potential as a candidate predictive marker for nodal metastasis and disease prognosis. Correlation of loss of MGMT expression with ST consumption underscored its significance in ST-associated oral carcinogenesis.
BibTeX:
@article{SawhneyM2007,
  author = {Sawhney M, Rohatgi N, Kaur J, Gupta SD, Deo SV, Shukla NK, Ralhan R},
  title = {MGMT expression in oral precancerous and cancerous lesions: correlation with progression, nodal metastasis and poor prognosis.},
  journal = {Oral Oncol.},
  year = {2007},
  volume = {43(5)},
  pages = {515-22}
}
Sawhney M, Rohatgi N, Kaur J, Shishodia S, Sethi G, Gupta SD, Deo SV, Shukla NK, Aggarwal BB, Ralhan R Expression of NF-kappaB parallels COX-2 expression in oral precancer and cancer: association with smokeless tobacco. 2007 Int J Cancer.
Vol. 120(12), pp. 2545-56 
article  
Abstract: Nuclear Factor-kappaB (NF-kappaB) activation and COX-2 overexpression have been reported in head and neck cancer, but the relationship between these proteins remains to be investigated. To determine the relationship between NF-kappaB and COX-2 in Smokeless Tobacco (ST) associated oral tumorigenesis, we performed immunohistochemistry in serial sections from 107 OSCCs, 78 oral precancerous lesions (OPLs) (58 hyperplasias, 20 dysplasias) and 15 histologically normal oral tissues and correlated with clinicopathological data. Significant increase in NF-kappaB and COX-2 immunopositivity was observed from normal oral mucosa to OPLs to OSCCs (p=0.009 and p=0.002 respectively). Upregulation of NF-kappaB and COX-2 was observed as early as in hyperplasia [p=0.006; OR=6.1 and p=0.003; OR=7.6, respectively]. Expression of both proteins was found to be significantly associated in OPLs (p=0.000; OR=12.6) and OSCCs (p=0.001; OR=4.0). Intriguingly, khaini consumption correlated with NF-kappaB immunopositivity in OPLs (p=0.05, OR=3.8) and OSCCs (p=0.01, OR=3.4) and with COX-2 expression in OPLs (p=0.03; OR=4.3). In vitro experimental system of ST associated oral carcinogenesis was used to demonstrate ST (khaini) and NNK mediated activation of NF-kappaB and COX-2, supporting the clinical data. In conclusion, this study demonstrates correlation between over expression of NF-kappaB and COX-2 in early precancerous stages of development of oral cancer and sustained elevation down the tumorigenic pathway, underscoring their potential as targets for early intervention. In vitro studies demonstrated that NNK may be one of the carcinogenic components of ST (khaini) inducing activation of NF-kappaB and COX-2 in oral precancer and cancer cells, suggesting plausible role in ST-induced oral carcinogenesis.
BibTeX:
@article{SawhneyM2007a,
  author = {Sawhney M, Rohatgi N, Kaur J, Shishodia S, Sethi G, Gupta SD, Deo SV, Shukla NK, Aggarwal BB, Ralhan R},
  title = {Expression of NF-kappaB parallels COX-2 expression in oral precancer and cancer: association with smokeless tobacco.},
  journal = {Int J Cancer.},
  year = {2007},
  volume = {120(12)},
  pages = {2545-56}
}
NIH State-of-the-Science Panel National Institutes of Health State-of-the-Science conference statement: tobacco use: prevention, cessation, and control. 2006 Ann Intern Med.
Vol. 145(11), pp. 839-44 
article  
BibTeX:
@article{SciencePanel.2006,
  author = {NIH State-of-the-Science Panel.},
  title = {National Institutes of Health State-of-the-Science conference statement: tobacco use: prevention, cessation, and control.},
  journal = {Ann Intern Med.},
  year = {2006},
  volume = {145(11)},
  pages = {839-44}
}
Shah N, Sharma PP Role of chewing and smoking habits in the etiology of oral submucous fibrosis (OSF): a case-control study 1998 J Oral Pathol Med
Vol. 27(10), pp. 475-9 
article  
Abstract: Oral submucous fibrosis (OSF), a premalignant and crippling condition of the oral mucous membrane, was studied to identify its relationship to various chewing and smoking habits. Two hundred and thirty-six consecutive cases of OSF were compared with 221 control subjects matched for age, sex and socio-economic conditions. It was found that chewing of areca nut/quid or pan masala (a commercial preparation of areca nuts, lime, catechu and undisclosed colouring, flavouring and sweetening agents) was directly related to OSF. Also, pan masala was chewed by a comparatively younger age
group and was associated with OSF changes earlier than areca nut/quid chewing. However, chewing or smoking tobacco with various other chewing habits did not increase the risk of developing OSF. It was also found that frequency of chewing rather than the total duration of the habit was directly correlated to OSF.
BibTeX:
@article{ShahN1998,
  author = {Shah N, Sharma P. P.},
  title = {Role of chewing and smoking habits in the etiology of oral submucous fibrosis (OSF): a case-control study},
  journal = {J Oral Pathol Med},
  year = {1998},
  volume = {27(10)},
  pages = {475-9}
}
Shaikh MA, Hunt BP, Hall M Prevalence and correlates of tobacco use among class 4 to 9 students in Somaliland. 2008 J Pak Med Assoc.
Vol. 58(11), pp. 656-7 
article  
BibTeX:
@article{ShaikhMA2008,
  author = {Shaikh MA, Hunt BP, Hall M.},
  title = {Prevalence and correlates of tobacco use among class 4 to 9 students in Somaliland.},
  journal = {J Pak Med Assoc.},
  year = {2008},
  volume = {58(11)},
  pages = {656-7}
}
Sharma AK, Gupta R, Gupta HP, Singh AK Haemodynamic effects of pan masala in healthy volunteers. 2000 J Assoc Physicians India
Vol. 48(4), pp. 400-1 
article  
Abstract: Objectives: We studied acute haemodynamic effects of pan masala (powdered mixture of areca nut, slaked lime, catechu, and condiments) in healthy volunteers.
Methods: Fifty one males (mean age 28.6 ?10 years) were evaluated. One pouch (4 g) of pan masala without tobacco was given to each subject under fasting state and effects on pulse and blood pressure (BP) recorded.
Results: At baseline the pulse rate was 75.1?9.0 per minute, systolic BP was 119.1?10.8 mm Hg, and diastolic BP was 78.0?7.5. The pulse rate increased to 87.5?11.4 at ten minutes (+16.9?12.6%, p < 0.001) and fell to 76.7?9.1 at 30 minutes (p=ns). Systolic BP increased to 122.3?11.7 mm Hg at 10 minutes (+2.73?5.1%, p<0.001) and was 120.8?10.8 at 30 minutes; while diastolic BP was 80.8?7.3 at 10 minutes (+3.83?6.1%, p < 0.001) and 79.4?7.6 at 30 minutes.
Conclusion: Pan masala intake causes acute increase in pulse and BP.
BibTeX:
@article{SharmaAK2000,
  author = {Sharma AK, Gupta R, Gupta HP, Singh AK},
  title = {Haemodynamic effects of pan masala in healthy volunteers.},
  journal = {J Assoc Physicians India},
  year = {2000},
  volume = {48(4)},
  pages = {400-1}
}
Sharma C, Kaur J, Shishodia S, Aggarwal BB, Ralhan R Curcumin down regulates smokeless tobacco-induced NF-kappaB activation and COX-2 expression in human oral premalignant and cancer cells. 2006 Toxicology.
Vol. 228(1), pp. 1-15 
article  
Abstract: Smokeless tobacco (ST) consumption is a major cause of oral cancer in South East Asia including India. Recently, we showed that exposure to smokeless tobacco extract (STE) (khaini) results in increased expression and activation of nuclear factor-kappaB (NFkappaB) and its downstream target cyclooxygenase-2 (COX-2) in human oral cell systems in vitro. The present study was designed to test the hypothesis that curcumin may inhibit the activation of NF-kappaB in ST exposed oral premalignant and cancer cells. Exposure of oral premalignant and cancer cells to curcumin resulted in significant decrease in cell viability and induced apoptosis. STE-induced nuclear translocation and DNA-binding activity of NF-kappaB were inhibited in curcumin pretreated oral premalignant and cancer cells in vitro. Curcumin treatment led to decreased expression of NF-kappaB and COX-2. The tobacco specific nitrosamine, 4-(methylnitrosamino-)-1- (3-pyridyl)-1-butanone (NNK), is one of the carcinogenic components of STE (khaini). We demonstrate that curcumin pretreatment abrogated NNK-induced activation of NFkappaB and COX-2 expression, suggesting that NNK is one of the factors in STE (khaini) modulated by curcumin. In conclusion, our findings demonstrate for the first time that curcumin downregulates STE (khaini) or NNK-induced NF-kappaB and COX-2 in oral premalignant and cancer cells in vitro.
BibTeX:
@article{SharmaC2006,
  author = {Sharma C, Kaur J, Shishodia S, Aggarwal BB, Ralhan R},
  title = {Curcumin down regulates smokeless tobacco-induced NF-kappaB activation and COX-2 expression in human oral premalignant and cancer cells.},
  journal = {Toxicology.},
  year = {2006},
  volume = {228(1)},
  pages = {1-15}
}
Sikdar N, Paul RR, Panda CK, Banerjee SK, Roy B Loss of heterozygosity at APC and MCC genes of oral cancer and leukoplakia tissues from Indian tobacco chewers. 2003 J Oral Pathol Med.
Vol. 32(8), pp. 450-4 
article  
Abstract: Background: Loss of heterozygosity (LOH) at tumor suppressor genes, such as adenomatous polyposis coli (APC) and mutated in colon cancer (MCC) genes, is one of the early events in carcinogenesis of oral tissue in Caucasian and Chinese patients. We wanted to check whether it is also true in Indian oral pre-cancer and cancer patients.
Methods: Loss of heterozygosity at APC and MCC genes was investigated in 57 and 40 unrelated primary oral leukoplakia (a pre-cancerous lesion) and squamous cell carcinomas (SCC), respectively, by polymerase chain reaction.
Results: In these samples, most of the leukoplakia patients had tobacco smoking habit whereas majority of cancer patients had tobacco chewing habit. LOH at APC gene was observed in 4 of 16 (25%) and 1 of 29 (3%) informative tumor and leukoplakia DNAs from tobacco chewers, respectively. LOH at MCC gene was not detected either in tumor or in leukoplakia DNAs.
Conclusion: This infrequent LOH at APC gene of pre-cancer and cancer tissues suggests that it may not be an early event in oral carcinogenesis in these patients.
BibTeX:
@article{SikdarN2003,
  author = {Sikdar N, Paul RR, Panda CK, Banerjee SK, Roy B},
  title = {Loss of heterozygosity at APC and MCC genes of oral cancer and leukoplakia tissues from Indian tobacco chewers.},
  journal = {J Oral Pathol Med.},
  year = {2003},
  volume = {32(8)},
  pages = {450-4}
}
Singh A, Singh SP Postnatal effect of smokeless tobacco on phytic acid or the butylated hydroxyanisole-modulated hepatic detoxication system and antioxidant defense mechanism in suckling neonates and lactating mice. 1998 Cancer Lett
Vol. 122(1-2), pp. 151-6 
article  
Abstract: The present study evaluates the potential of smokeless tobacco to translactationally modify the chemopreventive efficacy of phytic acid and butylated hydroxyanisole (BHA) via modulation of the hepatic xenobiotic detoxication system and antioxidant defense mechanism in the murine system. Phytic acid (1000 mg/kg b.w./day) by gavage while BHA (1% w/w) in diet induced a significant increase in the levels of glutathione-Stransferase (GST), acid soluble sulfhydryl (-SH), cytochrome b5 (Cyt. b5) and cytochrome P-450 (Cyt. P-450) in lactating dams and suckling pups. The hepatic levels of GST and -SH were significantly depressed whereas microsomal Cyt. b5, Cyt. P-450 and MDA levels were elevated in groups treated with smokeless tobacco (50 or 100
mg/kg b.w./day). The data reveals the inhibitory potential of smokeless tobacco on phytic acid-induced GST/GSH system efficiency besides the significant augmentation by smokeless tobacco on phytic acid or BHA-induced microsomal phase I enzymes. The direct or translactational modulation in the levels of xenobiotic detoxication system enzymes suggests the potentia
BibTeX:
@article{SinghA1998,
  author = {Singh A, Singh SP},
  title = {Postnatal effect of smokeless tobacco on phytic acid or the butylated hydroxyanisole-modulated hepatic detoxication system and antioxidant defense mechanism in suckling neonates and lactating mice.},
  journal = {Cancer Lett},
  year = {1998},
  volume = {122(1-2)},
  pages = {151-6}
}
Singh A, Singh SP Modulatory potential of smokeless tobacco on the garlic, mace or black mustard-altered hepatic detoxication system enzymes, sulfhydryl content and lipid peroxidation in murine system. 1997 Cancer Lett.
Vol. 118(1), pp. 109-14 
article  
Abstract: The present study evaluates the potential of smokeless tobacco to modify the chemopreventive efficacy of minor dietary constituents, including garlic, mace or black mustard, via modulating the competing pathways of hepatic detoxication system and antioxidant defense mechanism in murine system. Garlic (100 mg/kg b.w. per day) by gavage and mace (1% w/w) or black mustard (1% w/w) in diet induced a significant increase in the levels of glutathione-S-transferase (GST), acid-soluble sulfhydryl (-SH), cytochrome b5 (Cyt.b5) and cytochrome P-450 (Cyt.P-450) in murine liver. The hepatic
levels of GST and -SH were significantly depressed whereas microsomal Cyt.b5, Cyt.P- 450 and MDA levels were elevated in groups treated with smokeless tobacco (50 or 100 mg/kg b.w. per day). The data revealed the inhibitory potential of smokeless tobacco on garlic-induced hepatic GST/GSH system besides the significant augmentation by smokeless tobacco on garlic or mace or black mustard-induced microsomal cytochromes. The possible implications of modulation in competing bioactivation and detoxication pathways in the process of chemical carcinogenesis are discussed.
BibTeX:
@article{SinghA1997,
  author = {Singh A, Singh SP.},
  title = {Modulatory potential of smokeless tobacco on the garlic, mace or black mustard-altered hepatic detoxication system enzymes, sulfhydryl content and lipid peroxidation in murine system.},
  journal = {Cancer Lett.},
  year = {1997},
  volume = {118(1)},
  pages = {109-14}
}
Singh M, Shah PP, Singh AP, Ruwali M, Mathur N, Pant MC, Parmar D Association of genetic polymorphisms in glutathione Stransferases and susceptibility to head and neck cancer. 2008 Mutat Res.
Vol. 638(1-2), pp. 184-94 
article  
Abstract: Polymorphism in glutathione S-transferase (GST) genes (GSTM1, GSTT1 and GSTP1) and interaction with environmental factors such as tobacco (smoking or chewing) and alcohol on susceptibility to head and neck squamous cell carcinoma (HNSCC) was studied in a case-control study. The study group consisted of 175 patients suffering from HNSCC and 200 age matched healthy controls. Statistical analysis showed an increase in risk to HNSCC in the patients with null genotype of GSTM1 (OR: 2.02; 95% CI: 1.32-3.10; P=0.001) or GSTT1 (OR: 1.66; 95% CI: 1.02-2.69; P=0.04), though the risk was
not found to be significant when adjusted for age, sex, smoking, tobacco chewing or alcohol use by multivariate logistic regression model. Our data further showed that combination of deletion genotypes of GST (GSTM1 and GSTT1) confer an even higher risk of HNSCC. Interestingly, GSTP1 wild type genotype in combination with GSTM1 null or GSTT1 null genotype increased susceptibility for HNSCC (OR: 2.49 and 2.75, respectively). Likewise a much greater risk for HNSCC was observed in the patients carrying a genotype combination of GSTM1 null, GSTT1 null and GSTP1 (Ile/Ile) (OR: 4.47; 95% CI: 1.62-12.31; P=0.002). Our data have further provided evidence that tobacco chewing and alcohol consumption are the important risk factors for HNSCC. The interaction between tobacco chewing and null genotype of GSTM1 or GSTT1 resulted in about 3.5- and 2.2-fold increase in the risk respectively in the patients when
compared to those not chewing tobacco. Alcohol use resulted in more than 4-fold increase in the risk in the patients with null genotype of GSTM1 as compared to those who are non-drinkers. Alcohol consumption also increased the risk (approx. 3-fold) in the cases with null genotype of GSTT1, though the association was not found to be significant when compared to non-drinkers. Our data have provided evidence that GST polymorphism modifies the susceptibility to HNSCC and have further demonstrated importance of gene-environment interaction in modulating the risk to HNSCC.
BibTeX:
@article{SinghM2008,
  author = {Singh M, Shah PP, Singh AP, Ruwali M, Mathur N, Pant MC, Parmar D},
  title = {Association of genetic polymorphisms in glutathione Stransferases and susceptibility to head and neck cancer.},
  journal = {Mutat Res.},
  year = {2008},
  volume = {638(1-2)},
  pages = {184-94}
}
Singh RB, Singh S, Chattopadhya P, Singh K, Singhz V, Kulshrestha SK, Tomar RS, Kumar R, Singh G, Mechirova V, Pella D Tobacco consumption in relation to causes of death in an urban population of north India. 2007 Int J Chron Obstruct Pulmon Dis.
Vol. 2(2), pp. 177-85 
article  
Abstract: Background: Noncommunicable diseases have become a public heath problem in India concomitant with economic development, leading to increases in tobacco consumption, obesity, and changes in diet and lifestyle. Although observation suggests that tobacco consumption is a major risk factor for deaths due to circulatory, pulmonary, and malignant diseases, such studies are not available from most populations in developing countries.
Subject and materials: For the period 1999-2001, we studied the randomly selected records of death of 2222 (1385 men and 837 women) decedents, aged 25-64 years, out of 3034 death records overall from the records at Municipal Corporation, Moradabad. All the families of these deceased could be contacted individually to find out the causes of death, by scientist/doctor administered, informed consented, verbal autopsy questionnaire, completed with the help of the spouse and local treating doctor practicing in the appropriate healthcare region. Social classes and tobacco intakes were assessed
by a questionnaire.
Results: The prevalence of tobacco consumption, including chewing + smoking, were 45% (n = 623) among men and 15% (n = 125) among women decedents. However, smoking was observed in 20% and tobacco chewing in 30% of male decedents, while only 6% of female decedents smoked and 10% chewed tobacco. Social class had no impact on tobacco consumption in men but did influence one subgroup >55 years among women, ie, among those who had the highest tobacco consumption. Tobacco intakes were significantly more common among decedents dying due to circulatory, malignant, and pulmonary diseases, compared with other causes (men 61.1%, 76.6%, pulmonary 77.3% vs 31%, P<0.001; women 27.5%, 75.9%, pulmonary 24.6% vs 0.42%, P<0.001) of mortality, respectively. Pulmonary causes included chronic bronchitis and asthma. Circulatory diseases (29.1%, n=646) including heart attacks (10.0%), stroke (7.8%), valvular heart disease (7.2%, n=160), sudden cardiac death and inflammatory cardiac disease, each (2.0%, n=44) were the second most common causes of deaths, after infections (41.1%, n=915). Malignant neoplasm (5.8%, n=131), injury (14.0%, n=313), and miscellaneous causes of deaths, including diabetes mellitus (2.2%, n=49) were noted in 9.1%, (n=202) of death records. Cancers of the lung (1.6%), oral cavity (1.5%), liver (1.1%), stomach (0.9%), breast (0.31%), uterus, cervix, and ovary (0..27%) were relatively common causes for deaths due to malignancy.
Conclusion: This study shows that tobacco consumption appears to be a major contributor to deaths due to circulatory diseases and malignant diseases in India. Social class status had little impact on tobacco consumption in male decedents. Rapid changes in diet and lifestyle, increases in tobacco consumption, and possibly aging of the population, appear to be strongly associated with mortality due to cardiovascular diseases and cancer in this middle-income country.
BibTeX:
@article{SinghRB2007,
  author = {Singh RB, Singh S, Chattopadhya P, Singh K, Singhz V, Kulshrestha SK, Tomar RS, Kumar R, Singh G, Mechirova V, Pella D},
  title = {Tobacco consumption in relation to causes of death in an urban population of north India.},
  journal = {Int J Chron Obstruct Pulmon Dis.},
  year = {2007},
  volume = {2(2)},
  pages = {177-85}
}
Soya SS, Vinod T, Reddy KS, Gopalakrishnan S, Adithan C Genetic polymorphisms of glutathione-S-transferase genes (GSTM1, GSTT1 and GSTP1) and upper aerodigestive tract cancer risk among smokers, tobacco chewers and alcoholics in an Indian population. 2007 Eur J Cancer.
Vol. 43(18), pp. 2698-706 
article  
Abstract: The glutathione-S-transferase (GST) genes are involved in the detoxification of various carcinogens that increase the risk to upper aerodigestive tract (UADT) cancers. In the present study, 408 unrelated histopathologically confirmed cases and 220 population based controls, matched by age and gender, which belonged to the Tamilian population of south India were genotyped for polymorphisms in GSTM1, GSTT1 and GSTP1 using polymerase chain reaction (PCR) based methods. The multivariate logistic regression analyses demonstrated that GSTT1 null genotype was significantly associated with
increased risk for UADT cancers (odds ratio (OR) 2.5; 95% confidence intervals (CIs) 1.3-4.7). The combined effects of GST genes have shown that concurrent lack of GSTM1 and GSTT1 had a significantly increased risk (OR 4.6; 95% CI 1.3-15.6), while GSTT1 null genotype along with GSTP1 polymorphic variants further increased the cancer risk (OR 5.3; 95% CI 2.0-13.6). The most remarkable risk was seen among individuals carrying GSTM1 null, GSTT1 null genotypes and GSTP1 polymorphic variants (OR 7.8; 95% CI 1.0-61.0). Tobacco chewers carrying GSTM1 null genotype had an enhanced risk for UADT cancers. An enhanced risk among tobacco chewers and alcoholics (regular) was noted in individuals with GSTT1 null genotype. Similarly, a
significant interaction was observed among smokers (>40 pack-year (PY)) and tobacco chewers carrying GSTP1 mutant genotypes. Although the null genotype of GSTT1 is a strong predisposing risk factor for UADT cancers, we conclude that the significant genegene and gene-environment interactions of GST genes may confer a substantial risk to UADT cancers in the Tamilian population of south India
BibTeX:
@article{SoyaSS2007,
  author = {Soya SS, Vinod T, Reddy KS, Gopalakrishnan S, Adithan C},
  title = {Genetic polymorphisms of glutathione-S-transferase genes (GSTM1, GSTT1 and GSTP1) and upper aerodigestive tract cancer risk among smokers, tobacco chewers and alcoholics in an Indian population.},
  journal = {Eur J Cancer.},
  year = {2007},
  volume = {43(18)},
  pages = {2698-706}
}
Sreedharan S, Hegde MC, Pai R, Rhodrigues S, Kumar R, Rasheed A Snuff-induced malignancy of the nasal vestibule: a case report. 2007 Am J Otolaryngol.
Vol. 28(5), pp. 353-6 
article  
Abstract: The association between nasal snuff and malignancy is not well established. There is epidemiological evidence suggesting that oral tobacco when mixed with lime and betel leaves causes oral cancer in the Indian subcontinent. Similarly, snuff spiced with dried aloe has been reported to cause upper jaw malignancies in the Bantu tribes. The last reported case of nasal snuff causing cancer of the nose was described by John Hill in 1761. We describe here a case of a 69-year-old woman who developed a nasal vestibular malignancy after 30 years of snuff usage, and this, we believe, is the only reported case of nasal snuff causing cancer in the last 2 centuries.
BibTeX:
@article{SreedharanS2007,
  author = {Sreedharan S, Hegde MC, Pai R, Rhodrigues S, Kumar R, Rasheed A},
  title = {Snuff-induced malignancy of the nasal vestibule: a case report.},
  journal = {Am J Otolaryngol.},
  year = {2007},
  volume = {28(5)},
  pages = {353-6}
}
Sreedharan S, Kamath MP, Khadilkar U, Hegde MC, Kumar RM, Mudunuri RR, Tripuraneni SC Effect of snuff on nasal mucosa. 2005 Am J Otolaryngol
Vol. 26(3), pp. 151-6 
article  
Abstract: Purpose: The inhalation of nasal snuff (powdered tobacco) is a common addiction in the Indian subcontinent. In the western world, there is a resurgence of interest in nasal snuff because it does have the morbidity associated with smoked tobacco. Very few studies have reported the long-term effects of snuff on nasal mucosa. The objective of the present study was to investigate the effect of long-term use of snuff on the nasal mucosa.
Materials and methods: We conducted a retrospective study on 29 snuff users. We investigated the reasons for initiation of this particular form of addiction along with the clinical signs and symptoms of long-term snuff usage. At the time of the study, all patients complained of one or more nasal symptoms. Nasal obstruction and nasal discharge taken together were reported by 62.5% of patients. Gross mucosal edema of the septum and turbinates was the main finding on nasal examination. The absolute eosinophil count and total serum immunoglobulin E were elevated in 62.5% and 66.7% of patients, respectively. On skin prick test, 41% of patients reacted positively to snuff and 25% to tobacco. Histopathologic examination of the turbinates (16 patients) showed squamous metaplasia, capillary proliferation, capillary and venous dilatation, inflammatory cell reaction, subepithelial edema, and fibrosis.
Conclusion: Much has been written about the advantages of nasal snuff over products that deliver tobacco smoke. Our study shows that snuff users, after long-term abuse, develop a form of chronic rhinitis, as a consequence of which they develop blocked and stuffy noses. We conclude that nasal snuff is not a suitable substitute for smoked tobacco because it does not avoid ill health.
BibTeX:
@article{SreedharanS2005,
  author = {Sreedharan S, Kamath MP, Khadilkar U, Hegde MC, Kumar RM, Mudunuri RR, Tripuraneni SC},
  title = {Effect of snuff on nasal mucosa.},
  journal = {Am J Otolaryngol},
  year = {2005},
  volume = {26(3)},
  pages = {151-6}
}
Srinath Reddy K, Shah B, Varghese C, Ramadoss A Responding to the threat of chronic diseases in India. 2005 Lancet.
Vol. 366(9498), pp. 1744-9 
article  
Abstract: At the present stage of India's health transition, chronic diseases contribute to an estimated 53% of deaths and 44% of disability-adjusted life-years lost. Cardiovascular diseases and diabetes are highly prevalent in urban areas. Tobacco-related cancers account for a large proportion of all cancers. Tobacco consumption, in diverse smoked and smokeless forms, is common, especially among the poor and rural population segments. Hypertension and dyslipidaemia, although common, are inadequately detected and treated. Demographic and socioeconomic factors are hastening the health transition, with sharp escalation of chronic disease burdens expected over the next 20 years. A national cancer control programme, initiated in 1975, has established 13
registries and increased the capacity for treatment. A comprehensive law for tobacco control was enacted in 2003. An integrated national programme for the prevention and control of cardiovascular diseases and diabetes is under development. There is a need to increase resource allocation, coordinate multisectoral policy interventions, and enhance the engagement of the health system in activities related to chronic disease prevention and control.
BibTeX:
@article{SrinathReddyK2005,
  author = {Srinath Reddy K, Shah B, Varghese C, Ramadoss A},
  title = {Responding to the threat of chronic diseases in India.},
  journal = {Lancet.},
  year = {2005},
  volume = {366(9498)},
  pages = {1744-9}
}
Subramoney S, Gupta PC Anemia in pregnant women who use smokeless tobacco. 2008 Nicotine Tob Res.
Vol. 10(5), pp. 917-20 
article  
Abstract: A significantly higher mean hemoglobin level in women smokers in comparison to nonsmokers with a generalized rightward shift of the hemoglobin distribution curve has been reported at the population level. Studies on pregnant women, however, have often associated smoking with decreased hemoglobin levels, although not consistently. We examined whether smokeless tobacco use during pregnancy influenced hemoglobin levels in a population-based cohort of 918 pregnant women in Mumbai, India. Mean hemoglobin levels (Hb) were significantly lower in users (10.00 g/dl) compared with nonusers (10.46 g/dl), p<.000. Anemia (Hb<10 g/dl) was significantly associated with smokeless tobacco in the univariate analysis (OR = 1.7, 95% CI 1.2-2.5). There was no change after adjusting odds ratios for potential confounders in multivariate analysis (OR=1.7, 95% CI 1.2-2.5). The odds ratios for anemia were adjusted for age of mother, education, socioeconomic status, type of residence, lower body mass index, parity, vegetarian or nonvegetarian food habit, and hemodilution during pregnancy. The results suggest that smokeless tobacco use during pregnancy is associated with lower hemoglobin levels, as has often been observed with cigarette smoking. Smokeless tobacco use is widely prevalent among women in Southeast Asia and is gaining popularity across the world as a safe alternative to smoking. Further exploration and clarification of this association is therefore of considerable importance to public health.
BibTeX:
@article{SubramoneyS2008,
  author = {Subramoney S, Gupta PC},
  title = {Anemia in pregnant women who use smokeless tobacco.},
  journal = {Nicotine Tob Res.},
  year = {2008},
  volume = {10(5)},
  pages = {917-20}
}
Sumanth S, Bhat KM, Bhat GS Periodontal health status in pan chewers with or without the use of tobacco. 2008 Oral Health Prev Dent.
Vol. 6(3), pp. 223-9 
article  
Abstract: Background: Betel nut and tobacco chewing is a common practice in south-east Asia. In India, betel nut is commonly chewed in the form of pan, with or without tobacco. Numerous studies have shown the carcinogenic potential of betel nut and tobacco. Betel nut and tobacco are also known to have deleterious effects on the oral tissues.
Purpose: The aim of our study was to evaluate and compare the periodontal effects of pan chewing with or without the use of tobacco as an ingredient.
Materials & methods: The periodontal status of 300 subjects (150 subjects were pan chewers with tobacco and 150 subjects were pan chewers without tobacco) was evaluated using the community periodontal index (CPI). The subjects were selected by the stratified random sampling method. The oral hygiene status of the subjects was evaluated using the simplified oral hygiene index.
Results: CPI code-4, with a probing depth of 6 mm or more, was seen in 30% of pan chewers with tobacco compared with 7.3% of pan chewers without tobacco. It was found that pan chewers with tobacco had 4.7 times more risk of having pockets than pan chewers without tobacco. The higher codes of loss of attachment were seen in pan chewers with tobacco compared with pan chewers without tobacco. It was found that pan chewers with tobacco had 7 times more risk of having loss of attachment when compared with the pan chewers without tobacco.
Conclusions: The results show higher incidence of periodontal diseases in pan chewers who use tobacco compared with pan chewers who do not use tobacco. Based on the results, it was concluded that, although betel nut has deleterious effects on the periodontium, the addition of tobacco leads to a synergistic effect between betel nut and tobacco on the periodontal tissues.
BibTeX:
@article{SumanthS2008,
  author = {Sumanth S, Bhat KM, Bhat GS},
  title = {Periodontal health status in pan chewers with or without the use of tobacco.},
  journal = {Oral Health Prev Dent.},
  year = {2008},
  volume = {6(3)},
  pages = {223-9}
}
Sunny L, Yeole BB, Hakama M, Shiri R, Sastry PS, Mathews S, Advani SH Oral cancers in Mumbai, India: a fifteen years perspective with respect to incidence trend and cumulative risk. 2004 Asian Pac J Cancer Prev.
Vol. 5(3), pp. 294-300 
article  
Abstract: Objective: We estimated the time trends in the incidence and the risk of developing an oral cancer in Mumbai, Indian population using the data collected by the Bombay Population Based Cancer Registry during the 15-year period from 1986 to 2000.
Methods: A total of 9,670 oral cancers (8.2% of all neoplasms) were registered, of which 6577 were in males and 3093 in females (10.7% and 5.4% of the respective totals for the two genders). For evaluation of the trend, we applied a linear regression model based on the logarithm of the observed incidence rates. The annual percentage changes were also computed for the incidence rates to evaluate the time trend.
Results: In males, a statistically significant decreasing trend in the overall age-adjusted incidence rates were observed during the period 1986 to 2000, with an yearly decrease of 1.70%. This decrease was significant for men above the age of 40, but for young adult men below the age of 40, there was no significant decrease, the level being stable. In females, the overall decreasing trend in the age-adjusted incidence rates of oral cancers was not significant, but in the age group 40-59, a significant decline was observed. The probability estimates indicated that one out of every 57 men and one out of every 95
women will contract any oral cancer at some time in their whole life and 97% of the chance is after he or she completes the age of 40.
Conclusion: The observed decreasing trend in oral cancers in Indian men may be attributed to a decrease in the usage of pan and tobacco. The high prevalence of the usage of smokeless tobacco among young adult men and women may explain the stable trend in oral cancer incidence in this group. These findings help to strengthen the association between tobacco use and oral cancer risk.
BibTeX:
@article{SunnyL2004,
  author = {Sunny L, Yeole BB, Hakama M, Shiri R, Sastry PS, Mathews S, Advani SH},
  title = {Oral cancers in Mumbai, India: a fifteen years perspective with respect to incidence trend and cumulative risk.},
  journal = {Asian Pac J Cancer Prev.},
  year = {2004},
  volume = {5(3)},
  pages = {294-300}
}
Sushma C, Sharang C Pan masala advertisements are surrogate for tobacco products 2005 Indian J Cancer
Vol. 42(2), pp. 94-8 
article  
Abstract: Background: Pan masala is a comparatively recent habit in India and is marketed with and without tobacco. Advertisements of tobacco products have been banned in India since 1st May 2004. The advertisements of plain pan masala, which continue in Indian media, have been suspected to be surrogate for tobacco products bearing the same name. The study was carried out to assess whether these advertisements were for the intended product, or for tobacco products with same brand name.
Materials and methods: The programme of a popular television Hindi news channel was watched for a 24-h period. Programmes on the same channel and its English counterpart were watched on different days to assess whether the advertisements were repeated. The total duration of telecast of a popular brand of plain pan masala (Pan Parag) was multiplied by the rate charged by the channel to provide the cost of advertisement of this product. The total sale value of the company was multiplied by the proportion of usage of plain pan masala out of gutka plus pan masala habit as observed from a different study, to provide the annual sale value of plain pan masala product under reference.
Results: The annual sale value of plain Pan Parag was estimated to be Rs. 67.1 million. The annual cost of the advertisement of the same product on two television channels was estimated at Rs. 244.6 million.
Conclusion: The advertisements of plain pan masala seen on Indian television are a surrogate for the tobacco products bearing the same name.
BibTeX:
@article{SushmaC2005,
  author = {Sushma C, Sharang C},
  title = {Pan masala advertisements are surrogate for tobacco products},
  journal = {Indian J Cancer},
  year = {2005},
  volume = {42(2)},
  pages = {94-8}
}
TR Sarswathi, SN Kumar, KM Kavitha Oral melanin pigmentation in smoked and smokeless tobacco users in India. Clinico-pathological study 2003 Indian J Dent Res
Vol. 14(2), pp. 101-6 
article  
Abstract: Tobacco used as smoked and smokeless form induces oral mucosal changes in which intra-oral mucosal pigmentation is one of the clinical manifestations. The melanocyte activity responsible for pigment changes is not well documented in the literature. The present study is undertaken to observe clinical and histological changes in oral buccal and labial mucosa of 41 tobacco users and compared with 8 controls. 95.24% of smokers showed pigmentation of both labial and buccal mucosa. Labial mucosa showed a high degree fo pigmentation (81%) than the buccal mucosa (33.3%). 93.3% of alcoholics showed a high degree of pigmentation. Hypermelanocytosis and melanosis were observed in smokers. Pigmentation at the site of quid placement was absent in smokeless tobacco users but mild pigmentation was observed away from the site of quid placement with the concurrent increase in the number of melanocytes and melanocytic activity.
BibTeX:
@article{T.R.Sarswathi2003,
  author = {T. R. Sarswathi, S. N. Kumar, K. M. Kavitha},
  title = {Oral melanin pigmentation in smoked and smokeless tobacco users in India. Clinico-pathological study},
  journal = {Indian J Dent Res},
  year = {2003},
  volume = {14(2)},
  pages = {101-6}
}
Teni T, Pawar S, Sanghvi V, Saranath D Expression of bcl-2 and bax in chewing tobacco-induced oral cancers and oral lesions from India. 2002 Pathol Oncol Res
Vol. 8(2), pp. 109-14 
article  
Abstract: Deregulation of oncogenes and tumor suppressor genes involved in apoptosis has been associated with tumor development and progression. To investigate the involvement of apoptosis regulating proteins in oral cancer in Indian patients, primarily associated with chewing tobacco habits, immunohistochemical expression of bcl-2 and bax was examined in 63 oral squamous cell carcinomas, and 31 putative premalignant lesions. Our studies revealed overexpression of tumor specific cytoplasmic bcl-2 in 56% and bax in 43% oral cancers. The oral cancers in the Indian patients are preceded by premalignant oral lesions; hence oral lesions were examined for bcl-2 and bax expression. We observed aberrant expression of bcl-2 in 16% oral lesions comprising leukoplakias and SMF and bax in 55% oral lesions. We have already reported, p53 expression in these oral cancers and lesions. It was noteworthy that 30% oral cancers demonstrated a p53+bcl2+ pattern, and 14% samples exhibited p53+bcl2+bax+ pattern. However, none of the oral lesions showed concurrent deregulation of p53 and bcl-2 or all the three genes. Interestingly 45% oral lesions were p53-bax+ as compared to 18% oral cancers; while 39% oral lesions were bcl2-bax+ as compared to 14% oral cancers, indicating overexpression of bax in oral lesions, in the absence of p53 and bcl-2 proteins. Significant correlation was observed between positive nodal status and bcl2+ (p=0.047) and p53+bcl-2+ (p=0.01) in oral cancers. Kaplan Meier survival analysis showed significantly (p=0.059) higher survival in patients with p53- oral tumors than with p53+ tumors. Our studies thus indicate frequent overexpression of apoptosis regulators bcl-2, bax and p53 proteins in oral cancers, and a subset of oral lesions, representing early
events in oral car-cinogenesis. The aberrant bcl-2 expression and loss of p53 function observed, may play an important role in the tumorigenesis of oral cancers by allowing escape from apoptosis and enabling additional genetic alterations to accrue.
BibTeX:
@article{TeniT2002,
  author = {Teni T, Pawar S, Sanghvi V, Saranath D.},
  title = {Expression of bcl-2 and bax in chewing tobacco-induced oral cancers and oral lesions from India.},
  journal = {Pathol Oncol Res},
  year = {2002},
  volume = {8(2)},
  pages = {109-14}
}
Thankappan KR, Thresia CU Tobacco use & social status in Kerala 2007 Indian J Med Res.
Vol. 126(4), pp. 300-8 
article  
Abstract: Health indicators of Kerala State such as infant mortality rate (14/ 1000 live births) and life expectancy at birth (71 yr for men and 76 yr for women) are far ahead of the Indian averages (IMR 58, life expectancy men 62 and women 63) and closer to the developed countries. However, tobacco use prevalence is similar to the national average. Smoking is the commonest form of tobacco usage among men in the State whereas chewing tobacco is more common among women and children. Tobacco chewing among men is increasing in Kerala probably due to the smoking ban and industry strategy to focus on smokeless tobacco. Tobacco use is significantly more among the low socio-economic (SE) groups compared to the high SE group. Mortality and morbidity attributed to tobacco is higher among the poorest people in the State. Age adjusted cancer rate of oral cavity and lung cancer has been increasing in the State in recent years. Heart diseases among the young people are increasing in the State. Cancer and heart diseases are chronic illnesses, which may pull the individual and the entire family below the poverty line. Tobacco control therefore should be a top priority not only as a health issue but as a poverty reduction issue. Poverty alleviation is one of the major goals of developing economies. No poverty alleviation programme can ignore the potential impoverishment associated with tobacco use. Kerala with a very strong decentralized government has a very good opportunity to address tobacco control as a priority at the grass root level and reduce the impoverishment due to tobacco use.
BibTeX:
@article{ThankappanKR2007,
  author = {Thankappan KR, Thresia CU},
  title = {Tobacco use & social status in Kerala},
  journal = {Indian J Med Res.},
  year = {2007},
  volume = {126(4)},
  pages = {300-8}
}
Tiwari R, Deb P, Debbarma A, Chaudhuri R, Chakraborty A, Lepcha M, Chakraborty G Tobacco use and cardiovascular disease: a knowledge, attitude and practice study in rural Kerala. 2006 Indian J Med Sci.
Vol. 60(7), pp. 271-6 
article  
Abstract: Background: Tobacco consumption, either in smokeless form or as smoking, is reported to be responsible for major non-communicable diseases, namely, cardiovascular diseases, chronic obstructive pulmonary diseases and cancers. Whatsoever control strategy is being used, the community participation is of utmost importance, which will depend largely on the level of the knowledge in the community.
AIM: To assess the knowledge and attitude of a rural community towards the harmful effects of tobacco use. Setting and design: Venganoor Gram Panchayat of Thiruvananthapuram district of Kerala; cross-sectional study.
Materials and methods: Interview schedule was used to collect the information on predesigned and pre-tested proforma. The information recorded, included the demographic characteristics and socio-economic characteristics. The awareness regarding tobacco use and the attitude towards its non-usage was done, by putting forward, open and closed-ended questions.
Statistical analysis: Percentages and proportions; t-test; chi-square test.
Results: The present study included 302 (64.7%) females and 165 (35.3%) males. Among the males, 44 (38.5%) were ever smokers. Though 451 (96.6%) of the subjects knew that tobacco use is harmful for health, only 101 (22.5%) of the subjects knew that it causes cardiovascular diseases. Electronic and print media were the common source of such knowledge being reported by 265 (58.7%) and 202 (44.7%) subjects, respectively.
Conclusions: The subjects were aware about the harmful effects of tobacco use. However, more efforts are needed to make them aware about the role of tobacco smoking and chewing, in causing cardiac problems.
BibTeX:
@article{TiwariR2006,
  author = {Tiwari R, Deb P, Debbarma A, Chaudhuri R, Chakraborty A, Lepcha M, Chakraborty G},
  title = {Tobacco use and cardiovascular disease: a knowledge, attitude and practice study in rural Kerala.},
  journal = {Indian J Med Sci.},
  year = {2006},
  volume = {60(7)},
  pages = {271-6}
}
Trivedi AH, Balar DB, Shah PM, Patel DD, Patel RK, Bakshi SR, Dinavahi VB Carcinogenic and genotoxic effects of the tobacco substitute pan masala: present status and likely future impact on the Indian population. 1996 Cancer Treat Rev.
Vol. 22(5), pp. 345-54 
article  
BibTeX:
@article{TrivediAH1996,
  author = {Trivedi AH, Balar DB, Shah PM, Patel DD, Patel RK, Bakshi SR, Dinavahi VB.},
  title = {Carcinogenic and genotoxic effects of the tobacco substitute pan masala: present status and likely future impact on the Indian population.},
  journal = {Cancer Treat Rev.},
  year = {1996},
  volume = {22(5)},
  pages = {345-54}
}
Trivedi AH, Patel RK, Rawal UM, Adhvaryu SG, Balar DB Evaluation of chemopreventive effects of betel leaf on the genotoxicity of pan masala. 1994 Neoplasma.
Vol. 41(3), pp. 177-81 
article  
Abstract: The antigenotoxic effect of the aqueous extract of betel leaf (BL-ext.) against the pan masala was tested with the help of cytogenetic endpoints like chromosome aberration (CA) and sister chromatid exchange (SCE) utilizing Chinese hamster ovary (CHO) cells. Compared to the cultures treated with aqueous extract of pan masala alone, a reduction in CA and SCE frequencies in CHO cells was observed following a combined treatment with pan masala (with or without tobacco) extract and BL-ext. The protective effect of BLext. against the genomic damage caused by pan masala was statistically significant only after treating the cells for a longer period.
BibTeX:
@article{TrivediAH1994,
  author = {Trivedi AH, Patel RK, Rawal UM, Adhvaryu SG, Balar DB},
  title = {Evaluation of chemopreventive effects of betel leaf on the genotoxicity of pan masala.},
  journal = {Neoplasma.},
  year = {1994},
  volume = {41(3)},
  pages = {177-81}
}
V Gajalakshmi, RJ Hung, A Mathew, C Varghese, P Brennan, P Boffetta Tobacco smoking and chewing, alcohol drinking and lung cancer risk among men in southern India 2003 Int J Cancer.
Vol. 107(3), pp. 441-7 
article  
Abstract: In India, lung cancer is one of the most common and lethal cancers, and tobacco smoking remains its most important etiologic factors. The objective of our study is to examine the effects of different tobacco consumption forms, including smoking and chewing, on lung cancer risk of men in southern India, especially to compare the effects of bidi smoking to cigarette smoking on lung carcinogenesis. We also evaluated the possible role of Indian alcohol beverages and non-Indian alcohol beverages on lung carcinogenesis. We conducted a case-control study in Chennai and Trivandrum. In total, 778 lung cancer cases and 3,430 controls, including 1,503 cancer controls and 1,927 healthy controls, were recruited. The effects of cigarette, bidi smoking, chewing and alcohol drinking on the risk of lung cancer were estimated from unconditional multivariate logistic regression. We also applied the generalized additive model (GAM) with locally-weighted running-line smoothers (loess) to find the most plausible curve for the dose-response relationship. The results from GAM suggest a plateau after 35 years of smoking or 10 cigaretteequivalent pack-years for both cigarette and bidi. The OR is 4.54 (95%CI=2.96-6.95) and 6.45 (95%CI=4.38-9.50) for more than 30 years of cigarette-only and bidi-only smoking, respectively, and 6.87 (95%CI=4.62-10.2) and 10.7 (95%CI=5.82-19.6) for more than 12 weighted cumulative cigarette-only and bidionly consumption, respectively. The lung cancer risk of former cigarette smokers drops down more quickly after quitting smoking compared to former bidi smokers. There is no evidence for the effect of chewing and lung cancer risk nor clear evidence of an effect of overall alcohol drinking among never-smokers, although Indian alcohol drinking seemed to remain associated with lung cancer risk under limited power (OR=2.67, 95%CI=1.02-7.02). Bidi smoking seems to have a stronger carcinogenic effect than cigarette smoking: this difference holds no matter which aspect of smoking was considered.
BibTeX:
@article{V.Gajalakshmi2003,
  author = {V. Gajalakshmi, R. J. Hung, A. Mathew, C. Varghese, P. Brennan, P. Boffetta},
  title = {Tobacco smoking and chewing, alcohol drinking and lung cancer risk among men in southern India},
  journal = {Int J Cancer.},
  year = {2003},
  volume = {107(3)},
  pages = {441-7}
}
VK Laxman, S Annaji Tobacco use and its effects on the periodontium and periodontal therapy 2008 J Contemp Dent Pract.
Vol. 9(7), pp. 97-107 
article  
Abstract: Aim: The purpose of this article is to present a review of the potential biological mechanisms underlying the effects of tobacco smoking on periodontal health and periodontal therapy.
Background: Periodontitis is the result of complex interrelationships between infectious agents and host factors. Environmental, acquired, and genetic risk factors modify the expression of disease and may, therefore, affect the onset or progression of periodontitis.
Review results: The study of the relationship between periodontal disease and smoking has received increased attention during the last few years. Tobacco smoking has wide spread systemic effects, many of which may provide mechanisms for the increased susceptibility to periodontitis and the poorer response to treatment.
Conclusions: Tobacco smoking is a significant risk factor for periodontal disease. Clinical significance: The role smoking plays in periodontal disease should be considered by clinicians and patients during active periodontal therapy and the oral health maintenance phases of care.
BibTeX:
@article{V.K.Laxman2008,
  author = {V. K. Laxman, S. Annaji},
  title = {Tobacco use and its effects on the periodontium and periodontal therapy},
  journal = {J Contemp Dent Pract.},
  year = {2008},
  volume = {9(7)},
  pages = {97-107}
}
Varma D, Gupta S, Mandal AK Role of p53 and bcl2 as markers of vitamin A response in premalignant lesions of the oral cavity. 2007 Indian J Pathol Microbiol.
Vol. 50(1), pp. 15-7 
article  
Abstract: Oral cancer accounts for 40 to 50% of cancers diagnosed in India. Oral cancer is preceeded in most cases by pre malignant lesions-leukoplakia, submucous fibrosis and lichen planus. Stoppage of causative agents reverts premalignant lesions in some of the cases only. Thus anti oxidant therapy is being used to revert premalignant change to normal. Few studies available, have taken clinical parameters as indicators of response to therapy. Extensive medline search failed to reveal any study at the cellular level. This study attempts to investigate for the first time the role of p53 and bcl2 as markers of prognosis following vitamin A therapy. 24 cases of pre malignant lesions of oral cavity were studied. 1 lakh IU of vitamin A were given orally twice a week for 3 months. Biopsies were done before and after therapy. Haematoxylin and Eosin stain was done to confirm diagnosis. Immunostaining for mutant p53 and bcl2 was done on paraffin sections. 500 cells were counted over an average of 5 HPF and percentage positivity was calculated. Statistical analysis was done by applying the paired t tests. In 19 cases (79.2%) of premalignant lesions mutant p53 expression was zero before therapy, and remained unchanged even after the therapy. 3 cases (12.5%) had high mutant p53 values which reduced following therapy (p = 0.037). Therapy thus proved effective in these cases. However, in 2 cases (8.3%) pre therapy values of zero showed an increase after vitamin A therapy. These were the cases which had dysplasia and were chronic smokers. In 2 cases (8.3%) pre therapy values of bcl2 were zero and remained unchanged even after therapy and these cases did not stop smoking even during the vitamin A therapy. In 12 cases (50.0%) higher pre therapy values were reduced after therapy (p < 0.0001). Vitamin A therapy was effective in these cases. However, in 10 cases (42.0%) expression of bcl2 increased subsequent to therapy. Therapy failed in these cases because of chronic heavy smoking and tobacco chewing. Thus, in the majority of cases vitamin A was effective in preventing mutation of p53 (91.7%) and expression of bcl2 (58.0%). In effect, these two oncoproteins can be used as prognostic markers and follow up for anti oxidant therapy.
BibTeX:
@article{VarmaD2007,
  author = {Varma D, Gupta S, Mandal AK},
  title = {Role of p53 and bcl2 as markers of vitamin A response in premalignant lesions of the oral cavity.},
  journal = {Indian J Pathol Microbiol.},
  year = {2007},
  volume = {50(1)},
  pages = {15-7}
}
Murkibhavi VG Pan Masala--adverse effects. 1987 J Assoc Physicians India.
Vol. 35(8)(610) 
article  
BibTeX:
@article{VG1987,
  author = {Murkibhavi VG},
  title = {Pan Masala--adverse effects.},
  journal = {J Assoc Physicians India.},
  year = {1987},
  volume = {35(8)},
  number = {610}
}
Vora HH, Mehta SV, Shah KN, Brahmbhatt BV, Desai NS, Shukla SN, Shah PM Cytoplasmic localization of BAG-1 in leukoplakia and carcinoma of the tongue: correlation with p53 and cerbB2 in carcinoma. 2007 Int J Biol Markers.
Vol. 22(2), pp. 100-7 
article  
Abstract: Background: The present study evaluated the clinical significance of BAG-1, an antiapoptotic protein, in leukoplakia and carcinoma of the tongue.
Methods: BAG-1 expression was evaluated by immunohistochemistry in paraffinembedded tissues of leukoplakia (n=25) and carcinoma of the tongue (n=61).
Results: Cytoplasmic expression was predominantly seen in 80% and 70% of patients with leukoplakia and carcinoma, respectively. BAG-1 expression was found to be significantly lower in tobacco users than in non-tobacco users. BAG-1 expression in tobacco-using leukoplakia and carcinoma patients was compared by grouping the carcinoma patients according to lymph node status and disease stage. Carcinoma patients with tumor-positive lymph nodes had significantly lower BAG-1 expression than patients with negative lymph nodes and leukoplakia. Further, a trend towards an inverse correlation was observed with p53 and c-erbB2. In univariate and multivariate survival analysis, patient subgroups with 2+ or 3+ marker positivity (BAG-1 negativity, p53 and cerbB2 positivity) had a reduced overall survival compared with patient subgroups with 1+ marker positivity or negativity.
Conclusion: BAG-1 negativity in association with p53 and c-erbB2 positivity identified a subgroup of tongue cancer patients with an aggressive phenotype. Hence, an antiapoptotic protein, BAG-1, was found to be down-regulated in chewing-tobaccomediated tongue carcinogenesis.
BibTeX:
@article{VoraHH2007,
  author = {Vora HH, Mehta SV, Shah KN, Brahmbhatt BV, Desai NS, Shukla SN, Shah PM},
  title = {Cytoplasmic localization of BAG-1 in leukoplakia and carcinoma of the tongue: correlation with p53 and cerbB2 in carcinoma.},
  journal = {Int J Biol Markers.},
  year = {2007},
  volume = {22(2)},
  pages = {100-7}
}
Warke RG, Kamat AS, Kamat MY Irradiation of chewable tobacco mixes for improvement in microbiological quality. 1999 J Food Prot.
Vol. 62(6), pp. 678-81 
article  
Abstract: Microbiological quality of chewable tobacco mixes traditionally known as "Gutkha" was studied. The microbiological analysis of 15 samples analyzed revealed high bacterial and fungal counts. The total viable counts were in the range of 1.8 x 10(4) to 7.2 x 10(4) CFU g(-1) and the yeast and mold count from 3.6 x 10(3) to 7.1 x 10(4) CFU g(-1). The proteolytic and lipolytic counts were 9 x 10(2) to 2.6 x 10(3) CFU g(-1) and 2.6 x 10(3) CFU g(-1), on an average, respectively. Lecithinase-positive Staphylococcus aureus was found in 2 of the 15 samples analyzed; the counts were up to 3.4 x 10(3) CFU g(-1).
Coliform and Salmonella spp. were found to be absent. Aflatoxins B , B2, and G2 were found to be present in all the samples. These samples were exposed to gamma radiation (60Co) at 1-, 2-, 3-, 5-, 10-, and 25-kGy doses. The decrease in total viable count and fungal count was noticed with increase of radiation dose. The 3-kGy dose was observed to be the sterilization dose for Gutkha. At this dose no survival of organisms was noticed and no revival was observed during postirradiation storage at room temperature for 6 months.
BibTeX:
@article{WarkeRG1999,
  author = {Warke RG, Kamat AS, Kamat MY},
  title = {Irradiation of chewable tobacco mixes for improvement in microbiological quality.},
  journal = {J Food Prot.},
  year = {1999},
  volume = {62(6)},
  pages = {678-81}
}
Yadav AK, Kaushik CP, Haritash AK, Singh B, Raghuvanshi SP, Kansal A Determination of exposure and probable ingestion of fluoride through tea, toothpaste, tobacco and pan masala 2007 J Hazard Mater.
Vol. 142(1-2), pp. 77-80 
article  
Abstract: Levels of water soluble and acid soluble fluoride in tea, toothpaste, tobacco and pan masala (mouth freshener) were estimated. These items are, generally, ignored while calculating the total dietary intake of fluoride. Tea, toothpaste, tobacco, pan masala (with tobacco and without tobacco) frequently expose human body to 3.88-137.09, 53.5-338.5, 28.0-113.0, 16.5-306.5 and 23.5-185.0 ?g of fluoride per gram of these items, respectively. An effort was also made to quantify, on the basis of available studies, the probable human ingestion of fluoride through these substances. Increased leaching of
fluoride from some of these substances has been observed in acidic conditions in the present study. The results can be extrapolated to acidic conditions of human stomach.
BibTeX:
@article{YadavAK2007,
  author = {Yadav AK, Kaushik CP, Haritash AK, Singh B, Raghuvanshi SP, Kansal A},
  title = {Determination of exposure and probable ingestion of fluoride through tea, toothpaste, tobacco and pan masala},
  journal = {J Hazard Mater.},
  year = {2007},
  volume = {142(1-2)},
  pages = {77-80}
}
Yadav SS, Ruwali M, Shah PP, Mathur N, Singh RL, Pant MC, Parmar D Association of poor metabolizers of cytochrome P450 2C19 with head and neck cancer and poor treatment response. 2008 Mutat Res.
Vol. 644(1-2), pp. 31-7 
article  
Abstract: A case-control study consisting of 300 patients and an equal number of healthy controls was carried out to investigate the association of polymorphism in cytochrome P450 2C19 (CYP2C19), which results in poor and extensive metabolizers (PMs and EMs) genotypes, with squamous cell carcinoma of head and neck (HNSCC) and treatment response in patients receiving combination of chemo-radiotherapy. A higher frequency of CYP2C19 2 variants was observed in the cases resulting in significantly higher risk to HNSCC (Ad OR 3.36, 95% CI 1.94-5.82, p-value<0.05). The PM genotype of CYP2C193 was also found to be slightly increased in the cases, though the increase in risk was not significant when analyzed by multivariate logistic regression model. Tobacco chewing amongst the cases resulted in almost 13-fold increase in the risk with CYP2C192 (OR: 12.39) and 3-fold with CYP2C19 3 genotype (OR: 2.90) when compared to the tobacco chewers amongst the controls. Likewise, cigarette smoking in the cases increased the risk approximately 9-fold and 3-fold with CYP2C19 2 (OR: 8.93) and CYP2C19 3 (OR: 2.18) genotypes respectively when compared to smokers amongst the controls. Similar increase in risk was associated with alcohol use amongst the cases carrying variant genotypes of CYP2C19 2 (OR: 7.75) or CYP2C19 3 (OR: 2.60), demonstrating the importance of gene-environment interaction in modifying susceptibility to HNSCC. Interestingly, patients with PMs of CYP2C19 (CYP2C19 2 and CYP2C19 3) exhibited little response to the respective chemotherapy than the patients carrying wildtype genotype demonstrating that functional enzyme deficiencies due to polymorphism in CYPs may not only be important in modifying the susceptibility to HNSCC but also in determining chemotherapeutic response.
BibTeX:
@article{YadavSS2008,
  author = {Yadav SS, Ruwali M, Shah PP, Mathur N, Singh RL, Pant MC, Parmar D},
  title = {Association of poor metabolizers of cytochrome P450 2C19 with head and neck cancer and poor treatment response.},
  journal = {Mutat Res.},
  year = {2008},
  volume = {644(1-2)},
  pages = {31-7}
}
(Last Updated Upto:2016)