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Background: Cigarette smoke releases free radicles that have deleterious effects on the oral mucosa including potentially malignant disorders and oral cancer. In response to cigarette smoking, salivary flow rate increases as a defense activity along with a rise in alpha-amylase levels. Aim: To estimate salivary alpha-amylase levels in smokers with and without leukoplakia and oral cancer cases. Methods: This comparative study was carried out on 120 subjects; 30 subjects each in four groups which include non-smokers, smokers without oral lesions, smokers with leukoplakia, and smokers with oral squamous cell carcinoma (OSCC). Five microliters of unstimulated saliva were collected from the subjects by the spitting method. Alpha-amylase salivary levels were determined by spectrophotometric assay. Data collected were analyzed using a one-way ANOVA test. Results: No significant difference between alpha-amylase values was observed among smokers without oral lesions and smokers with leukoplakia groups when compared with non-smokers, but a significant difference was seen in the OSCC group in comparison with all three groups (smokers without oral lesions group vs OSCC group – P = 0.0045; leukoplakia group vs OSCC group P = 0.0326). Conclusion: Salivary alpha-amylase levels increased in smokers without any lesion and smokers with leukoplakia when compared with nonsmokers, although it was statistically not significant. Salivary alpha-amylase levels in oral cancer were significantly higher when compared with non-smokers, and smokers with and without leukoplakia. Smoking induced a change in salivary antioxidant levels. Changes in antioxidant levels can influence the deleterious effects of smoking on oral mucosa as well as systemic health.

Background: Invasive fungal disease (IFD) is a sinister complication encountered in patients with haematological disorders. When occurring in the central nervous system (CNS), IFDs can have catastrophic outcomes. Objectives: To study the clinical presentation, predisposing etiological factors, and prognosis of a CNS‐IFD in a patient with a haematological disorder. Patients and Methods: This is a retrospective study focusing on the clinical profile, diagnosis, treatment strategy and outcomes of 43 patients with an underlying haematological disorder, who were diagnosed with CNS‐IFD between 2018 and 2022. Results: Of the 43 patients, 18 were chemotherapy recipients, while 23 were stem cell transplant (SCT) recipients and 2 presented with CNS‐IFD at diagnosis. AML/MDS (37.2%) and ALL (18.6%) were the predominant underlying diagnoses. A sudden deterioration in sensorium (53.5%) was the earliest clinical sign, while T2 hyperintensities (26.8%), vascular involvement (26.8%) and ring‐enhancing lesions (16.3%) were the commonest radiological findings, with all patients exhibiting diffusion restriction in diffusion‐weighted images. Microbiological evidence of infection was obtained in all patients; however, culture positivity was established in only 25 patients. Rhizopus spp (23.2%) and Aspergillus spp (20.9%) were implicated in most cases. Overall survival of the cohort was 27.9% at a median follow‐up of 6 months. In patients who succumbed, the median time to death was 4 days (0–46). Conclusion: CNS‐IFD is associated with very poor survival in patients undergoing chemotherapy or an SCT, urging the need for prompt diagnosis and initiation of suitable antifungal therapy. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the probiotic potential of autochthonous Lactobacillus species isolated from buffalo calves against multidrug-resistant Escherichia coli. A total of 252 rectal swabs were collected from healthy neonatal buffalo calves under 30 days old from six districts of Andhra Pradesh, India in a completely randomized design from August 2019 to August 2021, of which 190 Lactobacillus strains were isolated based on cultural, morphological, biochemical and molecular tests. Out of 190 isolates, 57 showed high levels of auto-aggregation (> 80.00%) and hydrophobicity (> 60.00%) and 51 of the 57 isolates had a zone of inhibition greater than 15.00 mm in diameter against multidrug-resistant E. coli in an Agar well diffusion assay. Among the 51 isolates, 36 were found to be acid and bile tolerant and showed varying levels of sensitivity to antibiotics such as erythromycin, clindamycin, tetracycline, chloramphenicol, and ampicillin. Among the 36 isolates, Limosilactobacillus reuteri 178, L. reuteri 209, L. fermentum 182, L. fermentum 211, and Lactiplantibacillus plantarum 34 were non-hemolytic, and none of the isolates were able to hydrolyse gelatine. Therefore, these five autochthonous Lactobacillus species may be used in probiotic or synbiotic formulations against multidrug resistant E. coli in buffalo calves. [ABSTRACT FROM AUTHOR]

Introduction: During normal aging, telomeric DNA is gradually lost in dividing somatic cells, and critically short telomeres lead to replicative senescence, apoptosis, or chromosomal instability. We studied telomere length in bone marrow failure syndromes (BMFS) compared to normal healthy population. Methods: Peripheral blood was collected from the participants, and genomic DNA was extracted. Relative telomere length was measured using a quantitative polymerase chain reaction. Statistical analysis was performed using SPSS and GraphPad Prism 8.2 software. Results: The median age of normal Indian population was 31 (0–60) years. As expected, telomere length (TL) showed a decline with age and no difference in TL between males and females. The median age of 650 patients with aplastic anemia (AA) was 30 (1–60) years. TL was significantly shorter in patients with AA compared to healthy controls (p <.001). In FA and MDS patients, TL was significantly shorter than age‐matched healthy controls (p =.028; p <.001), respectively. There was no difference between the median TL in age‐matched AA and FA patients (p =.727). However, patients with MDS had shorter TL than age‐matched AA (p =.031). Conclusion: TL in BMF syndrome patients was significantly shorter than age‐matched healthy controls. [ABSTRACT FROM AUTHOR]

Introduction: Flexion deformity of the knee is a common complication following recurrent haemarthrosis in persons with haemophilia (PWH) on episodic factor replacement therapy, restricting independent mobility. There is limited literature on the comprehensive management of this condition. This report provides the outcome of a staged multidisciplinary approach for the correction of knee flexion deformity (KFD) even in limited resource settings. Patients and methods: The data of 49 consecutive PWH who were treated for KFD were analysed. The approach included graded physical therapy (PT), followed by serial casting and/or mobilisation under anaesthesia (MUA). MUA was done in carefully selected knees. Surgical correction was opted when non‐surgical methods failed. Results: Of the 49 patients (55 knees), with a median KFD of 40 degrees (range: 10–90), 26/55 (47%) were corrected by graded PT. With serial casting, 9/19 (47%) knees had their KFD corrected. MUA was done for 11 knees of which five achieved correction (45%). Surgical correction was required for only seven knees (12.7%). Following this approach, KFD improved from 40 degrees (range: 10–90) to 15 degrees (range: 0–40), with only minor loss of flexion from 105 (range: 60–155) to 90 degrees (range: 30–150). Out of 55 KFD, 46 (83.6%) KFD were corrected; non‐surgical, 39 (70.9%) and surgery, seven (12.7%). The remaining patients (nine KFD; 16.4%) were able to achieve their functional goal despite not meeting the correction criteria. Conclusion: This study shows that in PWH, functionally significant KFD correction can be achieved in about 71%, through non‐surgical methods, even without prophylactic factor replacement. [ABSTRACT FROM AUTHOR]

The initial idea of a distinct group of T-cells responsible for suppressing immune responses was first postulated half a century ago. However, it is only in the last three decades that we have identified what we now term regulatory T-cells (Tregs), and subsequently elucidated and crystallized our understanding of them. Human Tregs have emerged as essential to immune tolerance and the prevention of autoimmune diseases and are typically contemporaneously characterized by their CD3+CD4+CD25high CD127lowFOXP3+ phenotype. It is important to note that FOXP3+ Tregs exhibit substantial diversity in their origin, phenotypic characteristics, and function. Identifying reliable markers is crucial to the accurate identification, quantification, and assessment of Tregs in health and disease, as well as the enrichment and expansion of viable cells for adoptive cell therapy. In our comprehensive review, we address the contributions of various markers identified in the last two decades since the master transcriptional factor FOXP3 was identified in establishing and enriching purity, lineage stability, tissue homing and suppressive proficiency in CD4+ Tregs. Additionally, our review delves into recent breakthroughs in innovative Treg-based therapies, underscoring the significance of distinct markers in their therapeutic utilization. Understanding Treg subsets holds the key to effectively harnessing human Tregs for immunotherapeutic approaches. [ABSTRACT FROM AUTHOR]

A toxicity‐reduced conditioning regimen with treosulfan, fludarabine, and thiotepa in patients with high‐risk β‐thalassemia major has significantly improved hematopoietic stem cell transplantation (HCT) outcomes. However, complications resulting from regimen‐related toxicities (RRTs), mixed chimerism, and graft rejection remain a challenge. We evaluated the dose–exposure‐response relationship of treosulfan and its active metabolite S, S‐EBDM, in a uniform cohort of patients with β‐thalassemia major to identify whether therapeutic drug monitoring (TDM) and dose adjustment of treosulfan is feasible. Plasma treosulfan/S, S‐EBDM levels were measured in 77 patients using a validated liquid chromatography with tandem mass spectrometry method, and the pharmacokinetic parameters were estimated using nlmixr2. The influence of treosulfan and S, S‐EBDM exposure, and GSTA1/NQO1 polymorphisms on graft rejection, RRTs, chimerism status, and 1‐year overall survival (OS), and thalassemia‐free survival (TFS) were assessed. We observed that treosulfan exposure was lower in patients with graft rejection than those without (1,655 vs. 2,037 mg•h/L, P = 0.07). Pharmacodynamic modeling analysis to identify therapeutic cutoff revealed that treosulfan exposure ≥1,660 mg•hour/L was significantly associated with better 1‐year TFS (97% vs. 81%, P = 0.02) and a trend to better 1‐year OS (90% vs. 69%, P = 0.07). Further, multivariate analysis adjusting for known pre‐HCT risk factors also revealed treosulfan exposure <1,660 mg•h/L (hazard ratio (HR) = 3.23; 95% confidence interval (CI) = 1.12–9.34; P = 0.03) and GSTA1*B variant genotype (HR = 3.75; 95% CI = 1.04–13.47; P = 0.04) to be independent predictors for inferior 1‐year TFS. We conclude that lower treosulfan exposure increases the risk of graft rejection and early transplant‐related mortality affecting TFS. As no RRTs were observed with increasing treosulfan exposure, TDM‐based dose adjustment could be feasible and beneficial. [ABSTRACT FROM AUTHOR]

Purpose: Human teeth are the most stable and durable tissues in the body. Teeth can be identified even after complete decomposition, thus making them invaluable for identification of sex and age from fragmentary adult skeleton. This study aimed to compare the morphological and radiological measurements of canine and investigate its accuracy in sex determination. Materials and Methods: This study involved 60 males and 60 females between the age group of 20 and 30 years. Mesiodistal (MD) widths of mandibular left canines and mandibular inter-canine distance (ICD) were measured and compared both clinically and on digital intraoral periapical and occlusal radiographs. Discriminant function analysis was carried out for gender determination. Discriminant equation and cutoff point were used in determining the gender and the percentage accuracy. Kappa statistics were carried out to assess intra-observer agreement. Results: A definite statistically significant difference in the MD width and ICD was found between males and females. Clinical and radiological measurements were almost equally efficacious in gender determination with an accuracy of 55-75% in both males and females. When all the variables were used, the accuracy of gender determination increased substantially to 94%. k-values suggested a high intra-observer agreement. Conclusion: It can be concluded that both the clinical and radiographic measurements of MD width of canine and ICD are quick and easy methods for determining sex and in identification of an unknown individual with a substantial accuracy.

Introduction: Total marrow lymphoid irradiation (TMLI) can deliver higher doses of irradiation without increasing toxicity compared to Total body irradiation (TBI). Methods: Twenty adult patients undergoing hematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukemia (ALL) and chronic myeloid leukemia with lymphoid blast crises (CML‐LBC) received TMLI and cyclophosphamide for conditioning. Ten patients each received 13.5 or 15 Gy of TMLI. The graft source was peripheral blood stem cells in all, and donors included matched related (n = 15), haplo‐identical (n = 3) or matched unrelated donors (n = 2). Results: The median cell dose infused was 9 × 106 CD34/kg (range 4.8–12.4). Engraftment occurred in all (100%) at a median of 15 days (range: 14–17). Toxicity was low with hemorrhagic cystitis seen in two but no sinusoidal obstruction syndrome. Acute GVHD occurred in 40% while chronic GVHD was seen in 70.5%. Viral infections were seen in 55% while blood stream bacterial infections occurred in 20% and invasive fungal disease (IFD) in 10%. The Day 100 non‐relapse mortality (NRM) was 10%. At a median follow up of 25 months (range 2–48), two patients have relapsed. Overall survival at 2 years is 80% while the disease‐free survival is 75%. Conclusions: The combination of TMLI and cyclophosphamide for myeloablative conditioning is associated with low toxicity and favorable early outcomes in patients undergoing HSCT for ALL and CML‐LBC. [ABSTRACT FROM AUTHOR]

Taenia solium , the larvae of pork tapeworm, can cause the parasitic infection known as cysticercosis. It is commonly seen in developing countries. The World Health Organization estimates that over 50,000 deaths per year are caused by neurocysticercosis worldwide. It can occur anywhere in the body. Cysticerci in the muscles generally do not cause symptoms; they present as nodules and can be felt as lumps under the skin or they can present as muscular pseudohypertrophy. The condition rarely involves musculature of the orofacial region and presents a difficulty in clinical diagnosis. Here, we present a case report of a healthy middle-aged female patient who had a painless swelling below the lower lip. The ultrasound examination revealed an intramuscular cysticercosal cyst. The diagnosis was confirmed using magnetic resonance imaging and by histopathology. The case was managed by conservative enucleation of the cyst.

Background and Objectives: Recurrent aphthous stomatitis (RAS) is one of the most frequently encountered oral mucosal disorders. Despite extensive amount of research, the etiology of RAS remains unclear. Psychological-emotional factors were considered as one of the major predisposing factors. The aim of the study was to assess the levels of anxiety and salivary cortisol levels in patients with RAS and also to determine the association and relationship of salivary cortisol levels to variations of stress. Materials and Methods: A total of 30 patients suffering with RAS, along with the same number of age and sex matched healthy controls were included in the study. Saliva was collected from all the subjects at 9.00 am to avoid diurnal variations of cortisol levels. Salivary cortisol levels were measured by competitive enzyme linked immunosorbent assay. Anxiety levels of both groups were measured by using Hamilton′s anxiety scale. Student′s t-test was used to compare the anxiety and salivary cortisol levels between both groups. Results: The mean salivary cortisol level of the RAS group showed a very highly significant difference (P = 0.000) from the controls. The mean anxiety scores of the RAS group showed a very highly significant difference (P = 0.000) from the controls. The values of Pearson correlation coefficient between anxiety and salivary cortisol was 0.980 and one with a P value of 0.000 showing that there is a highly positive correlation between anxiety and salivary cortisol. Conclusion: Results suggest that anxiety may be involved in the pathogenesis of RAS. Thus besides traditional treatment of RAS patients, our findings suggest that psychological support is also needed.

Lesions of non-endodontic origin may mimic periapical pathosis. Errors in one or more of the clinical reasoning steps of diagnosis of such lesions may ultimately lead to misdiagnosis and ensuing complications. Central giant cell granuloma (CGCG) is one such lesion of non-endodontic origin which can present as periapical pathosis. Here, we present a case of CGCG in a 33-year-old female patient who visited our department with a complaint of growth from the extraction sockets of upper front teeth, which were extracted 1 month back after a misdiagnosis as periapical pathosis. Suspecting a non-endodontic lesion, radiographic examination and incisional biopsy were performed and a final diagnosis of CGCG was made. Biweekly intra-lesional steroids were given for 6 weeks and patient was followed up for 6 months.

Background and Aim: Teeth are excellent material for anthropological, genetic and odontologic investigations in both living and dead population. Canines are the ideal teeth for identification of sex, due to its sexual dimorphism and durability in the oral cavity. This study tests the effectiveness of the canine tooth in predicting sex of an individual. Materials and Methods: This study involved 60 males and 60 females between the age group of 20-30 years. Mesio-distal (MD) widths of maxillary and mandibular right and left canines and inter-canine distance of both arches were measured clinically and on cast for all patients. Standard canine indices were derived from these dimensions and tested for sexual dimorphism and reliability of canine teeth in gender determination by comparison with the known gender of the population under investigation. Results: All measurements showed significant sexual dimorphism. Standard mandibular canine index (CI) was found to be more reliable in gender estimation than the MD width of canine and CI values. Interpretation and Conclusion: Use of the standard mandibular CI in gender determination is recommended for forensic procedures as it was found to have an acceptable accuracy. MD width of canine may be used in a setup when only the single tooth or a fragment of a jaw is available for analysis, with due consideration to its relatively low accuracy.

Immunosuppressive therapy (IST) with anti-thymocyte globulin (ATG) and Cyclosporine (CSA) in aplastic anaemia (AA) results in improvement of blood counts between 3 and 6 months for the majority of patients. Infection is the most lethal complication in aplastic anemia and may arise due to several factors. We performed this study to determine the prevalence and predictors of specific infection types before and after IST. Six hundred and seventy-seven (546 adults; 434 males) transplant ineligible patients received ATG and CSA between 1995 and 2017. All patients who were transplant ineligible and received IST in this period were included. Infections before IST was seen in 209 (30.9%) and in 430 (63.5%) patients post IST. There were 700 infective episodes in the six months post-IST, including 216 bacterial, 78 fungal, 33 viral, and 373 culture-negative febrile episodes. Infections were highest (98, 77.8%) in very severe aplastic anaemia as compared to Severe AA (SAA) and Non-Severe AA (NSAA) (p < 0.001). Infections were also significantly higher in those who did not respond to ATG (71.1% vs. 56.8%, p = 0.003). At six months post-IST were 545 (80.5%) alive, and there were 54 (7.9%) deaths due to infection. Significant predictors of mortality were paediatric AA, very severe aplastic anaemia, pre or post ATG infections, and lack of response to ATG. Mortality was highest in those with combined bacterial and fungal infections post IST (p < 0.001). We conclude that infections are a common complication (63.5%) of IST. Mortality was highest when both bacterial and fungal infections were present. Routine use of growth factors and prophylactic antifungal and antibacterial agents was not part of our protocol, despite which 80.5% of the cohort was alive at the end of six months. [ABSTRACT FROM AUTHOR]

Purpose. Gender determination is considered to be an important step in the reconstruction of the biological profile in forensic medicine. Maxillary sinus can be used for identification of sex when other methods are indecisive. Computed tomography (CT) provides an excellent method for examining maxillary sinuses. Hence the aim of the study was to determine the accuracy of gender determination using maxillary sinus with CT. Materials and Methods. CT images were used to measure the mediolateral, superoinferior, and anteroposterior dimensions and the volume of the maxillary sinuses in 100 patients (50 males and 50 females) to determine the gender of an individual for forensic identification. Discriminative analysis was done using the values derived and the t-test for independent samples was used to compare these values in males and females. Results. The accuracy rate was found to be 84% in males and 92% in females with the mean accuracy of 88%. Conclusion. Our study concludes that gender determination can be done using measurements of maxillary sinus through CT when other methods are unavailable. The prediction rate can be increased by including volume of the maxillary sinus.

Swellings involving palate can be challenging to diagnose for the clinician as they have wide range of origin which can result from developmental, inflammatory, reactive or a neoplastic process. The clinical presentation of these swellings is similar and difficult to differentiate from each other. So it is important to take proper history from the patient and subject the patient to appropriate laboratory and radiographic investigations and finally biopsy is mandatory for accurate diagnosis. Thus, this article highlights on various common palatal swellings, their clinical presentation, and differential diagnosis helpful for proper diagnosis of swellings associated with palate.