Molecular pathogenesis of chewable tobacco

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

frequency of shisha [waterpipe] smoking in students of different age groups

To determine the frequency of waterpipe smoking in students of different age groups. Cross-sectional survey. Karachi, Pakistan, from February 2012 to February 2013. The subjects were divided into two age groups. Group-I comprised of 13 - 17 years old randomly selected students from O' Level schools in Karachi and group-2 included 23 - 27 years old undergraduate and postgraduate students again randomly selected from various institutions in Karachi. A questionnaire was filled with prior consent, basic education on waterpipe smoking was given, and all the questions of the survey form were explained to the subjects according to context. In group-1, 39% students smoked waterpipe. Most students had been smoking waterpipe for the last 2 years. In group-2, 48% individuals smoked waterpipe, majority of smokers indulged in the last 5 years and among them, most were falling within the last 2 years. The frequency of waterpipe smoking in teenage students was 39% and older students for 48%. Social and recreational use of waterpipes is widespread among both groups despite being acknowledged by majority as a health hazard.