Carcinogenic and genotoxic effects of the tobacco substitute pan masala: present status and likely future impact on the Indian population

Chromium Exposure in the Adult Population, Consuming Different Types of Smokeless Tobacco Products in Pakistan

The pervasive smokeless tobacco (SLT) consumption and diseases related to its use is a hot topic for the public discussion. In this study, concentrations of chromium (Cr) were measured in different SLT products [snuff (dry and moist), mainpuri, and gutkha] offered and used in Pakistan. The current study was also designed to assess the Cr levels in the biological (scalp hair and blood) samples of male and female subjects, age ranged from 25 to 60 years, chewing different SLT products. For comparative purpose, the healthy persons of the same age group, who did not consume any SLT products, were selected as referents. The concentrations of Cr in SLT products and biological samples were measured by electrothermal atomic absorption spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked by certified reference materials (CRMs). The resulted data indicated that the adult persons, who consumed different SLT products, have 2-3 fold higher levels of Cr in biological samples as compared to referent subjects (p < 0.01). The persons, who chew/sniff different SLT products, have 50-80 and 42-82 % higher levels of Cr in their scalp hair and blood samples as related to referents. The daily intake of Cr is lower as compared to the recommended value of 50-200 μg/day. It was expected that 10 g consumption of various kinds of SLT products (snuff, mainpuri, and gutkha) may subsidize 21.2-220, 17.7-122, and 18.4-273 % of the recommended daily intake of Cr, respectively.

Vortex-assisted ionic liquid-based dispersive liquid-liquid microextraction for assessment of chromium species in artificial saliva extract of different chewing tobacco products

A novel dispersive liquid-liquid microextraction (ILDLLμE) method using an extracting solvent (ionic liquid) and dispersant (Triton X-114) was developed for the separation and preconcentration of hexavalent chromium (Cr⁶⁺) in artificial saliva extract (ASE) of chewing tobacco products, gutkha, and mainpuri (n = 23). In the proposed method, the extraction of Cr⁶⁺ was accomplished by using ammonium pyrrolidinedithiocarbamate (APDC) as complexing agent and 1-butyl-3-methylimidazolium hexafluorophosphate [C₄MIM] [PF₆] as extracting solvent. The tiny droplet of metal chelate was then dispersed into TX-114 emulsion, using vortex mixer. Various parameters such as concentration of APDC, pH of the solution, volume of [C₄MIM] [PF₆], and TX-114 as well as extraction time were studied. Under the most favorable conditions, the limit of detection was found to be 0.068 μg/L with the relative standard deviation <5 %. The enrichment factor of developed method was found as 62.5, and method has been effectively applied for the analysis of Cr species in artificial saliva extract of gutkha and mainpuri products. The Cr⁶⁺ was quantitatively recovered (<97 %) under optimal conditions, while the recovery of trivalent specie (Cr³⁺), at the same experimental conditions, was observed to be <5 %. The Cr³⁺ was determined by the difference of total Cr and Cr⁶⁺ in artificial saliva extract of selected STP. Health risks associated with the intake of total Cr in gutkha and mainpuri were assessed in terms of estimated daily intake, such as carcinogenic and noncarcinogenic risks. Estimated daily intake of Cr via chewing 10 g/day of gutkha and mainpuri was found to be below the maximum tolerable daily intake, whereas the calculated risk of cancer for Cr was observed in the acceptable range of 10E^-6-10E^-4, except some brands of gutkha. Graphical Abstract ᅟ.

Estimation of Nickel in Different Smokeless Tobacco Products and Their Impact on Human Health of Oral Cancer Patients

It has been extensively investigated that the chewing of smokeless tobacco (SLT) products may enhance the inflammation of the oral cavity. The aim of the present study is to evaluate the relationship between nickel (Ni) exposure via different SLT products with oral cancer (different sites) incidence in the population of Sindh, Pakistan. The different brands of SLT products (mainpuri, gutkha, and moist snuff) commonly consumed by the studied population were analyzed for Ni contents. The biological samples of oral cancer patients and noncancerous control subjects of both genders, who have or have not consumed SLT products, were collected. The concentration of Ni in biological samples and SLT products were measured by electrothermal atomic absorption spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked by using certified reference materials. The results of this study showed that the Ni level was significantly higher in scalp hair and blood samples of oral cancer patients compared to controls (P < 0.01). The study suggested that exposure of Ni as a result of chewing different SLT products may be synergistic with risk factors associated with oral cancer.

Determination of nickel in blood and serum samples of oropharyngeal cancer patients consumed smokeless tobacco products by cloud point extraction coupled with flame atomic absorption spectrometry

Oropharyngeal cancer is a significant public health issue in the world. The incidence of oropharyngeal cancer has been increased among people who have habit of chewing smokeless tobacco (SLT) in Pakistan. The aim of present study was to evaluate the concentration of nickel (Ni) in biological samples (whole blood, serum) of oral (n = 95) and pharyngeal (n = 84) male cancer patients. For comparison purposes, the biological samples of healthy age-matched referents (n = 150), who consumed and did not consumed SLT products, were also analyzed for Ni levels. As the Ni level is very low in biological samples, a preconcentration procedure has been developed, prior to analysis of analyte by flame atomic absorption spectrometry (FAAS). The Ni in acid-digested biological samples was complexed with ammonium pyrrolidinedithio carbamate (APDC), and a resulted complex was extracted in a surfactant Triton X-114. Acidic ethanol was added to the surfactant-rich phase prior to its analysis by FAAS. The chemical variables, such as pH, amounts of reagents (APDC, Triton X-114), temperature, incubation time, and sample volume were optimized. The resulted data indicated that concentration of Ni was higher in blood and serum samples of cancer patients as compared to that of referents who have or have not consumed different SLT products (p = 0.012-0.001). It was also observed that healthy referents who consumed SLT products have two to threefold higher levels of Ni in both biological samples as compared to those who were not chewing SLT products (p < 0.01).

Evaluation of cadmium and zinc in biological samples of tobacco and alcohol user male mouth cancer patients

There is compelling evidence in support of positive associations between zinc (Zn) deficiency and high accumulation of cadmium (Cd) in biological samples of different cancerous patients. The incidence of mouth cancer has been increased among people who possess habit of drinking alcohol, tobacco smoking and chewing with gradients in Pakistan. In the present study, Cd and Zn contents of blood and scalp hair samples of 92 male mouth cancer patients and 78 referents of same age group (range 35-65 years), socio-economic status, localities and dietary habits. Among referent male subjects, 56 consumed tobacco (smoking/chewing), 22 had none of smoking and chewing tobacco habits, while none of them admitted for alcohol drinking. The scalp hair and whole blood samples were oxidized by 65% nitric acid and 30% hydrogen peroxide (2:1) ratio in microwave oven. The Zn in digests was determined by flame atomic absorption while Cd was determined by electrothermal atomic absorption spectrometry. The average Cd concentration was higher, while level of Zn was lower in the blood and scalp hair samples of mouth cancer patients as compared to referent subjects (p < .001). The male referents consuming tobacco (chewing and smoking) have high level of Cd in both their biological samples as compared to those not smoking or chewing tobacco (p < .012). The Cd/Zn ratio in both biological samples was found to be higher in patients than in referent subjects.

Substance abuse: a pediatric concern

Use of alcohol, tobacco, and other drugs is a worldwide problem and affects many children and adolescents. The use of opiates, cannabis, tobacco, and alcohol have been well recognized for centuries in India. Abuse of alcohol is widespread in college campuses. In the United States, in 1997, 54.3% of high-school students had used an illicit drug by the time they entered 12th grade. In India the use of drugs and alcohol within the context of religious beliefs and local traditions has been historically documented. Children & adolescents are exposed to alcohol, cannabis products, and tobacco product. Several risk factors and protective factors have been identified. A screening psychosocial history is the most useful tool to identify non-specific indicators of substance abuse. In India the use of pan masala, and home brewed products containing marijuana and alcohol have special significance. Pan masala is shown to have carcinogenic, genotoxic, and clastogenic properties. The pediatrician can play a vital role in the appropriate recognition and early referral.