Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : ZC21 - ZC26 Full Version

Prevalence of Oral Precancerous Lesions in Tobacco and Areca Nut Habituated Patients in Barpeta District, Assam, India: A Cross-sectional Study


Published: December 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/60168.17310
Debojyoti Roy, Balmiki Datta, Bahnisikha Pathak

1. Associate Professor, Department of Dentistry, Fakhruddin Ali Ahmed Government Medical College and Hospital, Barpeta, Assam, India. 2. Professor, Department of Pathology, Fakhruddin Ali Ahmed Government Medical College and Hospital, Barpeta, Assam, India. 3. Registrar, Department of Dentistry, Fakhruddin Ali Ahmed Government Medical College and Hospital, Barpeta, Assam, India.

Correspondence Address :
Dr. Debojyoti Roy,
Associate Professor, Department of Dentistry, Fakhruddin Ali Ahmed Government Medical College and Hospital, Barpeta, Assam, India.
E-mail: roypappa123@gmail.com

Abstract

Introduction: Oral cancer has become one of the leading causes of death and disease globally as well as in India. Tobacco consumption is responsible for nearly half of all cancers in men and nearly one-fourth of cancers in women in India and more than two-third of oral cancers are directly attributable to tobacco use. Early detection of precancerous lesions and tobacco cessation activities, if conducted together can have high impact on reducing incidence of oral cancer.

Aim: To study prevalence of oral precancerous lesions in tobacco and areca nut habituated patients in Barpeta district, Assam, India.

Materials and Methods: The present observational, cross-sectional, hospital-based study was conducted on Outpatient Department (OPD) patients of Dentistry Department of Fakhruddin Ali Ahmed Government Medical College. College, Barpeta, Assam, India, from June 2021 to June 2022. Patients with tobacco and areca nut chewing habits were selected as study participants. Total number of study participants were 404. Oral cavity screening was done to detect oral precancerous lesion. History of tobacco and areca nut chewing habits were recorded in terms of gender, age, form of tobacco, duration and frequency. Chi-square test was used for statistical analysis.

Results: Prevalence of oral precancerous lesions in tobacco consuming patients was 3.46% in smoke form and 9.9% in smokeless form. Premalignant lesions had been seen predominantly in male. Among the premalignant lesions prevalence of oral leukoplakia was highest (22.27%) followed by erythroplakia (4.46%). Overall, prevalence of precancerous lesions in tobacco and areca nut habituated patient in the present study was 37.62%. The association between prevalence of oral precancerous lesion with frequency and duration of habits was statistically insignificant (χ2=7.167, p-value=1.000).

Conclusion: In the present study, prevalence of oral precancerous lesion in tobacco and areca nut consuming patients in Barpeta district was quite high. The findings from this present study can be used to design cohort study to further understand the relation between precancerous lesions in tobacco and areca nut habituated patients.

Keywords

Oral cancer, Oral leukoplakia, Smokeless tobacco

Oral cancer is a significant global health issue and according to global health statistics 2020, total number of new cases were 377,713 and, 177,757 deaths occurred due to oral cancer (1). More than two-third of the oral cancer cases are reported from Asia (2). India alone accounts for one-third of the world’s oral cancer and according to latest Indian Council of Medical Research (ICMR) cancer statistics and Globocan 2020 data, 135,929 people registered with new cancer and mortality due to tobacco use in India is estimated at 75,290 person in 2020 (3).

The concept of certain precancerous lesions proceeding into oral cancer has long been accepted. According to a workshop coordinated by World Health Organisation (WHO) in May 2005 at London the use of the term potentially malignant disorders was recommended. The usage of this terminology conveys that not all lesions and conditions described under this term may transform to cancer, instead there is a family of morphological alterations amongst which some may have an increased potential for malignant transformation (4). There are many factors causing precancerous lesions among which tobacco, snuff, gutkha, betel nut in quid form (pan), alcohol, spicy food, malnutrition, poor oral hygiene, malocclusion, sharply broken tooth, ill-fitting dentures etc., are common predisposing factors. Also, we know that the most common oral precancerous lesions are oral leukoplakia, erythroplakia, nicotina palati and oral sub mucous fibrosis. Other oral precancerous lesions include candidiasis, recurrent herpes labialis, hairy tongue, lichen planus etc. Tobacco has become a global epidemic and the abuse of tobacco is a worldwide health problem. The Indian situation as far as tobacco consumption is concerned is far worse because of the prevalence of the tobacco chewing habit, which covers a spectrum of socio-economic and ethnic groups and is spread over urbanised areas as well as remote villages. In case of north eastern states tobacco use remains a challenge as the prevalence rate is still quite high (5). In India, tobacco consumption is one of the common causes of oral cancers. It has been reported that 28.6% of Indian population use tobacco and 800,000 people die every year in India due to tobacco related diseases (6). The WHO predicted that tobacco deaths in India may exceed 1.5 million annually by 2020 (7). Tobacco use in India differs from the globe.

The documented form of tobacco used globally is the cigarette, however in India, only 20% of tobacco is consumed as cigarette, 40% is consumed as bidi and rest in the form of smokeless tobacco such as khaini, zarda which are mixtures of powdered tobacco and slaked lime and mishri, a powdered form of tobacco which is rubbed on the gums (8). Tobacco in smoke and smokeless forms used in chewing/snuff contain hydrocarbons and several potent nitrosamines which are DNA toxic carcinogens and play a key role in initiation and promotion of oral cancers (9). On the other hand, areca nut is a major concern in India and many South East Asian countries. Chewing of betel nut, which comes from the Areca catechu palm tree that contains alkaloids (particularly arecoline) and tannins is practiced by 10-20% of the world’s population (10). Betel nut chewing is considered the fourth most commonly used addictive substance in the world after tobacco, alcohol and caffeine (11).

Since the number of studies on prevalence of precancerous lesion in lower region of Assam is inadequate, such type of regional databases will be helpful in understanding the severity of the problem at state level as well as at national level (12). Oral screening for precancerous lesions and tobacco cessation activities, if conducted together can have high impact on reducing incidence of oral cancer. The aim of the present study was to find out the prevalence of oral precancerous lesions in tobacco and areca nut habituated patients in Barpeta district in Assam, India.

Material and Methods

The present observational, cross-sectional, hospital-based study was conducted in the Department of Dentistry, Fakhruddin Ali Ahmed (FAA) Government Medical College and Hospital, Barpeta district, Assam, India, from June 2021 to June 2022. An ethical clearance (FAAMC&H/IEC/498/2019/4656) was obtained from Institutional Ethical Committee (dated 26-07-2019) and written informed consent was obtained from each participants. A total of 404 subjects were selected for the study. The study subjects were selected from the Outpatient Department (OPD) of Dentistry.

Inclusion criteria: Tobacco and areca nut in smoke and smoke free form habit history patients, consuming for at least six months with frequency of consuming tobacco and areca nut atleast once a day were included in the study.

Exclusion criteria: Participants with the previous history of hospitalisation for any systemic illness, immunecompromised patients, patients with recurrence of the primary lesion, patients suffering from dental pain, patient having orofacial injury and patients having ill-fitting dentures were excluded from the study.

Study Procedure

Simple random sampling technique was used in this study. The total number of 404 participants were selected as per availability of tobacco and areca nut habituated patients attending Dental OPD of FAA Medical College between June 2021 and June 2022. Standardised interviewer administered questionnaire based on Global Adult Tobacco Survey-2 was used to collect data on tobacco and areca nut habituation which is depicted in (Table/Fig 1) (13). Total number of questions in questionnaire were seven.

All 404 subjects were divided into four groups:

Group 1: Smoke form tobacco habit subjects
Group 2: Smokeless form tobacco habit subjects
Group 3: Areca nut consuming subjects
Group 4: Mixed subjects with more than one if the above habits.

All study subjects were informed about the study and a detailed case history proforma was duly filled. Data was collected using a combination of clinical oral examination and standardised interviewer based questionnaire. Patients were asked to rinse mouth thoroughly with water and then examination was done under an incandescent light. All oral examinations were done by specialist examiners who are familiar with oral mucosal lesions. A sterile mouth mirror was used for retraction of tissues and examination was done using a gloves. In clinical examination the features of the lesion, anatomical location, extension, aetiological factors if any, related factors etc., were recorded. The clinical diagnosis was done as per WHO (1997 and 2017) criteria (14),(15). In case of suspected cancer lesion biopsy was done to confirm histopathologically (16).

Statistical Analysis

Statistical analysis was performed using Statistical Package for Social Science (SPSS) software version 22.0. The association of oral precancerous lesions in relation to age, gender, use of various tobacco habits, frequency and duration of various tobacco habits was studied by Chi-square test. For graph Microsoft Excel software version 2019 was used. A p-value <0.05 was considered statistically significant.

Results

The age group of total 404 subjects was in the range of 20-90 years, of which 261 (64.6%) were males and 143 (35.4%) were females. Regarding distribution of study population by age, majority of male population was seen in the age group of 41-50 years. On the other hand, majority of female population was also seen in age group 41-50 years. There was significant association of habit with age group of study population (p-value <0.000) (Table/Fig 2).

Out of total 404 tobacco consuming population, 28 (6.93%) were using tobacco in smoke form, 70 (17.32%) were using smokeless forms of tobacco, 104 (25.74%) were areca nut consuming patients and 202 (50%) were mixed users which is shown in (Table/Fig 3).

In the present study, the total numbers of leukoplakia subjects were 90, so the prevalence rate of leukoplakia was 22.27%. The incidence of leukoplakia was highest in group 4 followed by group 2. The prevalence rate of erythroplakia was 4.46%. The incidence was highest in mixed user (group 4). In case of Oral Submucous Fibrosis (OSMF), prevalence was 3.47% and the incidence being highest in group 4. In case of OSMF along with leukoplakia, the prevalence rate was 0.49%. Out of 404 subjects, 230 (56.93%) tobacco and areca nut users showed no lesions (Table/Fig 4).

Group 1 showing frequency of 14 and prevalence of precancerous lesion as 3.46%. Group 2 showing frequency of 40 and prevalence of precancerous lesion as 9.90%. Group 3 showing frequency of 12 and prevalence of precancerous lesion as 2.97%. Group 4 showing frequency of 86 and prevalence of precancerous lesion as 21.28%.

In relation to age, leukoplakia was predominating in the age group of 41-50 years and in case of OSMF maximum number of cases were found in the age group of 51-60 years. Therefore, strong association was present between age group and different types of lesion (p-value=0.001) (Table/Fig 5). In relation to gender, leukoplakia was predominantly seen in male patients while OSMF and erythroplakia was predominantly found in female patients. Over all the precancerous lesions were predominantly found in male patients (47.50%). Correlation of gender with prevalence of oral precancerous lesions is depicted in (Table/Fig 6).

Regarding relation of precancerous lesion with duration of habits, in the present study it was found that majority of precancerous lesions were found in subjects with habit history for >15 years group followed by 11-15 years age group. Most of the cases of leukoplakia (n=30) were found in >15 years age group (Table/Fig 7).

Regarding relation of precancerous lesion with frequency of habits, in this study, it was found that majority of the patients had a habit frequency of >15 times per day (n=66) followed by 10-15 times per day (n=39) which is depicted in (Table/Fig 8).

Discussion

As per Global Adult Tobacco Survey (2017), more than one-forth (28.6%) of adults in India are tobacco users (17). As per WHO report, the most significant risk factor of cancer is tobacco use, which alone is responsible for death of >9.5% mortality rate in India (18). According to National Oral Cancer Registry India, oral cancer is the most common cancer in India amongst men (11.28% of all cancers) and fifth most frequently occurring cancer amongst women (4.3% of all cancers) and about 80% of oral cancers are directly attributed to tobacco use (19),(20). On the other hand, areca nut is used by an estimated 600 million people globally, is of major concern in India and many South East Asia countries and is the fourth most commonly used addictive substance after tobacco, alcohol and caffeine (21). In Assam, areca nut (Tamul) plays an important, ceremonial and cultural role. It is common practice to offer these products to guest at important social gatherings, weddings and other religious events. Due to this cultural tradition, the use of the areca nut is widespread and considered as a part of daily life (22).

In the present study it was found that out of 404 patients, 114 male patients have precancerous lesions and 38 female patients have precancerous lesions, therefore the prevalence in males (47.50%) was higher than prevalence in females (26.76%). The present study was similar to the study done by Srivastava R et al., in population of Kanpur city in which premalignant lesions and malignant lesions were predominantly seen in males (76.3%) (23). Saraswati TR et al., Sujatha D et al., and Behura SS et al., also similarly reported the male predominance in deleterious oral habits (24),(25),(26). The prevalence of precancerous lesion in present study was 37.62%, which was less than the study done by Narasannavar A and Wantamutte AS et al., which reported prevalence of 51.12% and study done by Jacob LB et al., in which prevalence of oral mucosal lesion was found as 60.1% (27),(28).

In the indexed study, the most frequently occurring precancerous lesion associated with tobacco and areca nut consuming patients was oral leukoplakia (22.27%) followed by smoker’s palate (4.46%) and erythroplakia (4.46%). In the present study it was found that the prevalence of leukoplakia was 22.3% which was higher than the study conducted by study conducted by Jacob LB et al., which reported prevalence of leukoplakia as 15.9% (28). Also, the prevalence of leukoplakia of the present study was higher than the study conducted by Krishna Priya M et al., and Balsaraf S et al., in Bhopal India in which prevalence of oral leukoplakia was 5.3% and 9.75%, respectively (29),(30). Also, the present study was similar to the study done by Srivastava R et al., in population of Kanpur city in which the prevalence of leukoplakia was 23.7% (23).

The present study showed prevalence of oral carcinoma in tobacco and areca nut habit history patients as 5.4%. The prevalence of oral cancer in present study was also similar to the study done by Shrivastava R which reported 5.62% of oral cancer in study group, but somewhat different to Mishra G et al., study which reported prevalence of oral cancer in tobacco habituated patients up to 20.3% which was quite high (23),(31).

In this study, it was found that the prevalence of oral precancerous lesion was highest (21.28%) in mixed group (Group 4). These findings were different from the study done by Uplap PA et al., and Thomas G et al., in which the prevalence of oral precancerous lesion was highest (65%) in smokeless form group (32),(33).

In this study, no association was found between duration of tobacco use and the occurrence of oral precancerous lesion (χ2=7.167, p-value=1.000). Although majority of the precancerous lesions were seen in >15 years age group, but p-value is equal to 1. Therefore, this proves that statistically there was no significant association between duration of tobacco use and the occurrence of oral precancerous lesions. The present study findings was different to the study done by Sujatha D et al., Ambedkar DM et al., and Mahawar P et al., where it was reported as the duration of tobacco habits increased there were more chances of development of precancerous lesions (25),(34),(35).

The present study results showed that most of the precancerous lesions were seen in >15 times group but statistically the association between the frequency of habits and chances of developing precancerous lesion was insignificant (χ2=29.721, p-value=0.194). This findings of the study was different to the findings observed by Sujatha D et al., Ambedkar DM et al., Mahawar P et al., and Maher R et al., which reported that the risks increases with frequency of habits and patients with habits of 5-10 times had maximum number of precancerous lesions (25),(34),(35),(36). However, the present study results were similar to study done by Hallikeri K et al., which reported that association between the frequency and chances of developing precancerous lesion was statistically insignificant where p-value is 0.3310 (37).

This study also revealed that areca nut plays a significant role in developing precancerous lesions which was similar to study done by Shrikrishna BH and Jyoti AC which reported significant association between consumption of areca nut and oral submucous fibrosis with prevalence rate of 18.71% (38). In this present study, it was found that the prevalence of precancerous lesions in group 3 was 2.97% which was less then the study done on areca nut by Mishra SS et al., which reported prevalence of 22.7% (39). Findings of similar studies have been compared in (Table/Fig 9) (23),(25),(28),(34),(40).

Limitation(s)

The present study was an observational, cross-sectional, hospital-based study done on a small population group therefore a more detailed cohort study on a large population is required to get a more detailed and accurate picture. Moreover, in this study detailed information was not gathered on other predictors of oral precancerous lesion such as nutritional status, body mass index, lifestyle etc.

Conclusion

In the present study, the prevalence of precancerous lesion was 37.62%. Tobacco both in smoke and smokeless form and also areca nut are strong risk factor for developing oral precancerous lesions. Also, in this study premalignant lesions had been seen predominantly in men. The findings of the study emphasise on the need of reviewing the policy governing the contexts, sales and uses of these mixtures and to educate the people about the hazards and adverse effect of these habits. The public should be made aware of the high risk of oral malignancy in oral lesions induced by tobacco, areca nut and different habits. To decrease the burden of this eminently preventable cancer, a multifaceted approach that integrates health education, tobacco and alcohol control, early detection, and early therapy is required. The findings from this present study can be used to design cohort study to further understand the relation between precancerous lesions in tobacco and areca nut habituated patient.

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DOI and Others

DOI: 10.7860/JCDR/2022/60168.17310

Date of Submission: Sep 10, 2022
Date of Peer Review: Oct 21, 2022
Date of Acceptance: Nov 23, 2022
Date of Publishing: Dec 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 21, 2022
• Manual Googling: Nov 19, 2022
• iThenticate Software: Nov 22, 2022 (12%)

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