Carcinoma of buccal mucosa in smokeless tobacco users: a preliminary study of the use of cytology for early detection

Peripheral and Central Smell Regions in Migraine Patients using Maraş Powder (Smokeless Tobacco): A Magnetic Resonance Imaging Evaluation

Objective In the present study, we investigated the efficacy of Maraş powder (smokeless tobacco) use on smell regions in migraine patients.

Methods The cranial magnetic resonance imaging images of 58 adult patients were included in this retrospective study. Thirty-eight of them were migraine patients (18 of them using Maraş powder and 20 of them not using Maraş powder) and 20 of them were healthy controls. Bilateral peripheral (olfactory bulb [OB] volume and olfactory sulcus depth) and central smell regions (insular gyrus area and corpus amygdala area) as well as nasal septal deviation were evaluated.

Results In migraine patients (using or not using Maraş powder), OB volumes, and in Maraş powder using migraine patients, corpus amygdala areas were lower than those in the control group (p < 0.05). In Maraş powder-using migraine patients, left insular gyrus areas of the females were significantly lower than the males (p < 0.05).

Conclusion We concluded that the peripheral smell region of the OB volume decreased in migraine patients (using or not using Maraş powder). However, the central smell region of corpus amygdala area decreased in Maraş powder using migraine patients. Maraş powder usage may increase vascular shrinkage, and the decrease in OB volume and corpus amygdala area becomes prominent. It can be said that Maraş powder usage may cause a size decrease in the peripheral and central smell regions in migraine patients. Therefore, migraine patients and non-migrainous people should be noticed for the harmful effects of Maraş powder on the vascular system and smell system in the aspects of OB volume and corpus amygdala area decrease.

A Systematic Review of Oral Biopsies, Sample Types, and Detection Techniques Applied in Relation to Oral Cancer Detection

Background: Early identification of the stage of oral cancer development can lead to better treatment outcomes and avoid malignant transformation. Therefore, this review aims to provide a comprehensive overview that describes the development of standardized procedures for oral sample collection, characterization, and molecular risk assessment. This can help investigators to choose the appropriate sampling method and downstream analyses for different purposes. Methods: This systematic review was conducted according to the PRISMA guidelines. Using both PubMed and Web of Science databases, four independent authors conducted a literature search between 15 and 21 June 2021. We used key search terms to broaden the search for studies. Non-conforming articles were removed using an EndNote-based and manual approach. Reviewers used a designed form to extract data. Results: This review included a total of 3574 records, after eliminating duplicate articles and excluding papers that did not meet the inclusion criteria. Finally, 202 articles were included in this review. We summarized the sampling methods, biopsy samples, and downstream analysis. The biopsy techniques were classified into tissue and liquid biopsy. The common sequential analysis of tissue biopsy includes histopathological examination such as H&E or IHC to identify various pathogenic features. Meanwhile, liquid samples such as saliva, blood, and urine are analyzed for the purpose of screening to detect mutations in cancer. Commonly used technologies are PCR, RT-PCR, high-throughput sequencing, and metabolomic analysis. Conclusions: Currently, tissue biopsies provide increased diagnostic value compared to liquid biopsy. However, the minimal invasiveness and convenience of liquid biopsy make it a suitable method for mass screening and eventual clinical adoption. The analysis of samples includes histological and molecular analysis. Metabolite analysis is rising but remains scarce.

The effect of Maras powder and smoking on the microRNA deregulation of oral mucosa

Objective

This study aimed to investigate the effects of Maras powder (a type of smokeless tobacco obtained from Nicotiana rustica Linn and mixed with the ashes of wood, especially from oak, walnut or grapevine) on the microRNA (miRNA) deregulation of oral mucosa, and it compares these effects with those of smoking.

Methodology

Oral mucosal samples were collected from 74 patients, consisting of 16 nonusers, 26 smokers, and 32 Maras powder users. Genes associated with oral cancer were selected and 90 microRNAs targeting these genes were identified. MicroRNA were isolated and purified using the microRNA isolation kit. MicroRNA were expressed using Fluidigm RT-PCR.

Results

A positive correlation between the duration of Maras powder use with miR-31 expression levels, and a negative correlation between the Maras powder chewing time and miR-372 expression levels was found. In addition, there is a negative correlation between the amount of Maras powder consumed and expression levels of miR-375, miR-378a, miR-145, and miR-10b; moreover, another negative correlation is observed between the number of cigarettes consumed and the expression levels of miR-23a, miR-23b, miR-203a, miR-200b, and miR-375. However, miR-200b and miR-92a levels were downregulated significantly more in Maras powder users when compared with smokers and nonusers (p<0.05).

Conclusion

The results show both chewing Maras powder and smoking have an effect on deregulation of miR-200b and miR-92a expressions. This leads to the belief that assessing the expression of these two miRNAs is a promising noninvasive method of analysis, especially in mutagen exposures. Finally, large-scale and high-throughput studies may help to identify an extensive miRNA expression profile associated with tobacco use and improve the understanding of oral malignancies.

Otorhinolaryngological symptoms among smokeless tobacco (Maras powder) users

OBJECTIVE:

This study aims to investigate the relationship between smokeless tobacco (maras powder) consumption and otorhinolaryngological symptoms.

METHODS:

This descriptive study was carried out on 599 participants. The participants were divided into two groups. Of these, 299 (49.9%) patients aged over 18 years were the first group; they used smokeless tobacco for at least 5 years. The remaining patients comprised the second group, which included 300 (50.1%) healthy volunteers who did not use tobacco or its products and demonstrated some similarities with the first group. For the purpose of data collection, a questionnaire consisting of 45 questions was administered to the participants.

RESULTS:

Cough, sputum, shortness of breath, dysphagia, snoring, and apnea-hypopnea were found to be significantly increased in smokeless tobacco users. The highest odds ratio (OR) found was for sputum at 2.615. Similarly, other oral cavity symptoms such as mouth tickling, dryness of throat, mouth sores, halitosis, taste disorders, and toothache were found to be significantly increased in smokeless tobacco users. It is noteworthy that halitosis was 9.4 times more prevalent among smokeless tobacco users than in the non-tobacco users. Sinonasal symptoms such as sneezing, headache, facial fullness, and anorexia were found to be significantly increased in smokeless tobacco users. However, there were no differences between the groups in terms of ear symptoms.

CONCLUSION:

This study demonstrated that the negative effects of smokeless tobacco consumption were particularly higher in the oral cavity, which in turn gave rise to a number of serious upper respiratory tract complaints.

Oral Candida carriage and prevalence of Candida species among Maras powder users and non-users

INTRODUCTION

The aim of this study was to investigate Candida carriage and species in Maras powder users and non-users.

MATERIAL AND METHODS

This study included 100 volunteering men in 12 cafés in the city of Kahramanmaras, Turkey. A questionnaire composed of questions about socio-demographic features and Maras powder use was filled in by the participants. Culture specimens were obtained from bilateral buccal mucosa and dorsum of the tongue with a sterile cotton-tipped swap. The specimens were inoculated in Sabouraud Dextrose Agar (SDA).

RESULTS

The mean age of the participants was 48.0 ± 12.5 years (min = 20, max = 70). Fifty-four percent of the Maras powder users and 22% of the non-users were Candida carriers. The difference between the groups was significant (P = 0.001). The most frequently isolated species was Candida albicans at a rate of 44% in the Maras powder users and at a rate of 18% in the non-users. Other frequent species were Candida glabrata at a rate of 6% in the Maras powder users and 2% in the control group and Candida tropicalis at a rate of 4% in the Maras powder users and 2% in the nonusers.

CONCLUSION

We found that a significantly high rate of the Maras powder users was Candida carriers. It should be kept in mind that opportunistic infections may be caused by Candida species in Maras powder users especially with immunosuppressive conditions since Candida species are likely to lead to such infections in cases of immunosuppressive diseases.

Adjunctive diagnostic techniques for oral lesions of unknown malignant potential: Systematic review with meta-analysis

BACKGROUND

The purpose of this study was to critically review the published evidence concerning adjunctive diagnostic techniques in the diagnosis of oral lesions of unknown malignant potential.

METHODS

We conducted a systematic literature review with meta-analysis using PubMed to search for articles published from June 1993 through June 2013 to identify prospective studies evaluating any diagnostic method, with tissue biopsy confirmation, in clinically evident oral lesions of unknown malignant potential. Aggregate weighted totals and SEs for true, false-positive, false-negative, and inadequate results were calculated and compared among subgroups.

RESULTS

Forty-eight articles satisfying inclusion criteria were identified. Twenty-five were included in quantitative synthesis.

CONCLUSION

Oral cytology holds higher diagnostic value than specialist's oral examination, which holds higher value than in vivo toluidine blue staining. This study does not support the use of computer-aided or liquid-based cytology. Future studies should be designed to test multiple methods in the same patient population to allow direct comparison among various techniques.

Maras powder usage among Turkish psychiatric outpatients

A kind of smokeless tobacco known as Maras powder, which is used in the southeastern region of Turkey, causes nicotine dependence. The aim of this study was to determine the usage of Maras powder among psychiatric outpatients and nonpsychiatric controls. The study group consisted of 276 psychiatric patients and 283 nonpsychiatric patients from psychiatry and family medicine outpatient clinics. A socio-demographic form, the Fagerström Test for Nicotine Dependence, and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders?4th Edition were given to the participants. The rates of Maras powder usage in the patient group (10.1%) were significantly higher than those in the control group (5.6%). Men were found to use Maras powder at a higher rate in both groups. The rates of Maras powder usage according to the psychiatric diagnosis were evaluated. This is the first study estimating Maras powder usage rates among psychiatric patients in Turkey. The study's limitations are noted.

Comparison of genotoxic effect between smokeless tobacco (Maras powder) users and cigarette smokers by the alkaline comet assay

Maras powder (MP) is a kind of smokeless tobacco used in the south-eastern region of Turkey and in several other countries of Middle and Far East. The present study was performed to assess the impacts of MP and cigarette smoking on the possible DNA damaging effect. Alkaline comet assay, which is a reliable and an important tool in human biomonitoring studies in the area of genetic toxicology, was used in peripheral lymphocytes of MP users, cigarette smokers, and non-smokers while their frequencies of total comet scores (TCS) were evaluated. The mean TCS (+/-SD) frequency in the peripheral lymphocytes was 14.4 (+/-10.04) for MP users and 8.26 (+/-5.38), 5.94 (+/-3.87) for cigarette smokers (P < 0.05) and non-smoking control subjects, respectively (P < 0.001). There was no significant effect of daily consumption of MP and the duration of MP usage on comet frequencies. In reply to a wrong belief among MP users ("the use of smokeless tobacco product is substantially less hazardous than cigarettes"), the present study shows that the oral use of smokeless tobacco represents a genotoxic hazard which is even higher than the DNA damage observed in cigarette smokers. Therefore, habitual use of MP should be taken into account and could be considered unsafe, equally harmful, and it should not be viewed as a safe alternative to cigarettes.

Effects of Smokeless Tobacco "Maras Powder" Use on Respiratory Functions

In Turkey, "Maras Powder," which is a kind of powder yielded from the shields of tobacco, is widely used as smokeless tobacco through buccal mucosa or together with cigarette. Maras powder, composed of ash and a plant named Nicotiana Rustica Linn, is sometimes used to give up smoking. The present study was aimed to investigate the effects of Maras powder use on respiratory functions of healthy subjects who do not have any chronic disease. We found statistically significant differences in percentage of forced expiratory volume in the first second (FEV(1)%) (p = 0.001), the ratio of FEV(1) to forced vital capacity (FEV(1)/FVC) (p = 0.024), percent of maximum expiratory flow rate (FEF(25-75)%) (p = 0.002) and percent of peak expiratory flow (PEF%) (p = 0.037) between cigarette smokers with Maras powder use (n = 23) and control subjects (n = 24). Likewise, when cigarette smokers (n = 24) and control subjects were compared, the differences for all these parameters were significant (p = 0.022, p = 0.048, p = 0.011 and p = 0.047, respectively). Only FEV(1)% and FEF(25-75)% were significantly lower in cigarette smokers with Maras powder use than in Maras powder users (n = 28) (p = 0.011 and p = 0.022, respectively). There was a negative correlation between forced vital capacity and Maras powder use (r = -0.315, p = 0.03). The present study suggests that Maras powder does not cause serious bronchial obstruction. This may be due to usage of the smokeless tobacco through buccal mucosa but not through inhalation as in case of cigarette smoking.

Urinary cotinine levels of smokeless tobacco (Maraş powder) users

Smokeless tobacco is used in various forms in some countries of the world. "Maraş otu" is a kind of smokeless tobacco usage in the Southeastern region of Turkey. The use of smokeless tobacco causes nicotine addiction and dependence. Moreover this type of smokeless tobacco usage is one of the risk factors for oral cancers and genotoxic damages for users. Cotinine is widely used as a biomarker of tobacco consumption and intake of nicotine. Therefore, urine samples were collected from people who are using Maraş powder and smoking cigarettes, and passive smokers, and the levels of cotinine investigated. The purpose of this study is to determine the cotinine levels of Maraş powder users and to compare the results with cigarette smokers and passive smokers. Urinary cotinine levels of subjects were determined by using capillary gas chromatography with FID detection. The mean (+/- SD) urinary cotinines have been determined as 6467.35+/-3198 microg/g creatinine for 26 Maraş powder users, 1943.92+/-1443 microg/g creatinine for 26 cigarette smokers and 198.62+/-420.82 microg/g creatinine for 26 passive smokers. A significant difference has been found between cotinine levels of Maraş powder users and cigarette smokers, which is three times higher in Maraş powder users (p<0.001). The present study suggests that smokeless tobacco poses a threat to public health and it should not be viewed as a safe alternative to cigarettes.