Taste Changes and Salivary Flow Rate Disparities in Premenopausal and Postmenopausal Women: Exploring the Zinc Connection.

INTRODUCTION: Menopause triggers hormonal changes that can manifest in oral symptoms like dysgeusia, xerostomia, and burning sensations, substantially impacting daily life, including chewing, swallowing, and taste perception. Menopausal women are particularly susceptible to nutritional fluctuations, including variations in zinc levels, which are believed to be linked to taste perception. Taste alterations can render food unappetizing, leading to malnutrition and diminished quality of life. The study aims to assess taste alterations, salivary flow rate, and zinc levels in premenopausal and postmenopausal women, investigating the correlation between these factors. MATERIALS AND METHODS: This research involved 30 premenopausal and 30 postmenopausal women randomly selected from outpatients at the Department of Oral Medicine and Radiology, Panineeya Institute of Dental Sciences and Research Centre, Hyderabad, India. Saliva samples were collected, unstimulated salivary flow rates were measured, taste perception was evaluated using a whole mouth threshold taste test, and serum zinc levels were assessed. RESULTS: The study revealed that a significantly higher percentage of postmenopausal women could not identify sucrose taste at concentrations 1 (76.7%, p = 0.017) and concentrations 2 (56.7%, p = 0.007) compared to premenopausal women (43.3%, 20%, respectively). A statistically significant number of postmenopausal women also couldn't identify the bitter taste at concentration 1 (43.3%, p=0.047) compared to premenopausal women. No significant difference in taste perception of salt and sour was observed between both groups at all tested concentrations. In both groups, mean taste perception rankings were similar, with salt being most perceived, followed by sour bitter, and at least with sucrose. Salivary flow rates and zinc levels did not significantly differ between premenopausal and postmenopausal women. The correlation between zinc levels and taste perception was weak and non-significant, indicating that zinc levels were not significant predictors of taste perception in either group. CONCLUSION: Postmenopausal women exhibited reduced perceptions of sucrose and quinine hydrochloride, potentially impacting eating habits, while taste perception of sodium chloride and citric acid remained relatively consistent. Salivary flow rates and zinc levels were within the normal range for postmenopausal women up to 60 years of age included in the study. The study demonstrated that zinc levels did not significantly influence perception among postmenopausal women, suggesting that taste impairment is a multifactorial phenomenon.

Allelic variations in the chpG effector gene within Clavibacter michiganensis populations determine pathogen host range.

Plant pathogenic bacteria often have a narrow host range, which can vary among different isolates within a population. Here, we investigated the host range of the tomato pathogen Clavibacter michiganensis (Cm). We determined the genome sequences of 40 tomato Cm isolates and screened them for pathogenicity on tomato and eggplant. Our screen revealed that out of the tested isolates, five were unable to cause disease on any of the hosts, 33 were exclusively pathogenic on tomato, and two were capable of infecting both tomato and eggplant. Through comparative genomic analyses, we identified that the five non-pathogenic isolates lacked the chp/tomA pathogenicity island, which has previously been associated with virulence in tomato. In addition, we found that the two eggplant-pathogenic isolates encode a unique allelic variant of the putative serine hydrolase chpG (chpGC), an effector that is recognized in eggplant. Introduction of chpGC into a chpG inactivation mutant in the eggplant-non-pathogenic strain Cm101, failed to complement the mutant, which retained its ability to cause disease in eggplant and failed to elicit hypersensitive response (HR). Conversely, introduction of the chpG variant from Cm101 into an eggplant pathogenic Cm isolate (C48), eliminated its pathogenicity on eggplant, and enabled C48 to elicit HR. Our study demonstrates that allelic variation in the chpG effector gene is a key determinant of host range plasticity within Cm populations.

Role of Triamcinolone Acetonide in the Maturation of Scars.

Background: Surgeons have tried various measures to achieve a minimum and aesthetically appealing scars after wound healing at surgical sites. Various regimens have been recommended to minimize scars both intraoperatively and postoperatively. Our study aims to assess the outcome of the injection of triamcinolone acetonide used intraoperatively on a normal surgical suture line. Methods: This is a prospective, observational study of 21 patients (divided into test and control groups with a single scar at the same site) treated with or without injection of triamcinolone acetonide, and outcomes were assessed using Vancouver Scar Scale and Stony Brook Scar Evaluation Scale. Results: We found a significant difference (P > 0.05) between the median of vascularity, pigmentation, and total score on the Vancouver Scar Scale, whereas there was significant difference between height, color, and overall appearance according to the Stony Brook Scar Evaluation Scale between the test and the control group. We could not find a significant difference in outcome with varying, increasing doses of triamcinolone acetonide. Conclusion: A low dose of triamcinolone acetonide is an effective drug that tends to improve the outcome of a scar in terms of vascularity, pigmentation, height, and overall appearance of the postoperative surgical scar and helps in the maturation of a normal scar.

Gastroesophageal reflux following per-oral endoscopic myotomy: Can we improve outcomes?

This editorial is an analysis the review article by Nabi et al recently published in this journal. Achalasia Cardia is a disease whose pathophysiology is still unclear. It is known that there is inflammation of unknown aetiology leading to loss of ganglion cells in the muscularis propria. The end result is lower oesophageal sphincter spasm, loss of receptive relaxation, decreased oesophageal peristalsis, all leading on to varying degrees of dysphagia. The treatment of this condition is palliative in nature, performed by myotomy of the lower oesophagus either surgically or endoscopically. Gastroesophageal reflux disease (GERD) has been associated with the myotomy performed, particularly with the Peroral Endoscopic Myotomy (POEM) procedure. Nabi et al have provided an excellent overview of the latest developments in predicting, preventing, evaluating, and managing GERD subsequent to POEM. Based on this theme, this review article explores the concept of using histology of the oesophageal muscle layer, to grade the disease and thereby help tailoring the length/type of myotomy performed during the POEM procedure. In the future, will a histology based algorithm available preoperatively, help modify the POEM procedure, thereby decreasing the incidence of GERD associated with POEM?

Evaluating Yoga-Based Intervention Versus the American Diabetes Association Exercise Regimen in Conjunction With Standard Care for Autonomic Neuropathy in Diabetes Mellitus: An Exploratory Clinical Trial.

INTRODUCTION: Diabetic autonomic neuropathy (DAN) is a prevalent yet often overlooked complication of diabetes mellitus (DM), impacting multiple organs and substantially elevating the risk of morbidity and mortality. This study aimed to assess the effectiveness of yoga-based intervention (YBI) compared to the American Diabetes Association exercise regimen (ADA Ex. Regime) and standard care for treating autonomic neuropathy in type 2 DM. METHODS: This open-label exploratory clinical trial featured two parallel study arms: Group A (Intervention), which received YBI alongside standard care, and Group B, which adhered to the ADA Ex. Regime in conjunction with standard care. A total of 80 participants aged 35-60, diagnosed with type 2 DM and autonomic neuropathy, were equally allocated to both groups. Data collection included nerve conduction velocity (NCV) tests, autonomic function tests (AFTs), as well as evaluations of depression and quality of life. RESULTS: YBI demonstrated a drop in parasympathetic tone compared to the ADA Ex. Regime. Following a six-month intervention, the sympathetic activity indicator (SD2) exhibited a significantly lower value in the YBI group than in the ADA Ex. Regime group, indicating a positive effect (p < 0.05), while the ADA Ex. Regime showed more improvement in certain areas of NCV (e.g., left and right peroneal NCV, right and left peroneal F-latency), notable differences were observed in alkaline phosphatase levels, depression scores, and WHO-5 wellness, all reaching statistical significance at p < 0.05. CONCLUSIONS: The study findings observed that a 24-week YBI significantly reduced in symptoms of diabetic neuropathy and stress. Although the ADA Ex. Regime demonstrated greater improvement in specific aspects of NCV compared to YBI, YBI outperformed the ADA Ex. Regime in enhancing WHO-5 wellness and reducing depression symptoms.

Carcinosarcoma of breast - A chimera among breast neoplasms.

Malignant phyllodes, along with ductal carcinoma, is known as metaplastic cancer of the breast. This tumor is additionally known as breast carcinosarcoma. Malignant phyllodes in conjunction with ductal carcinoma is a rare finding in routine clinical practice. We describe the case report of a 47-year-old female patient who arrived with a large right breast mass. A core biopsy was performed, and histopathological examination indicated that the tumor was a malignant phyllodes tumor. A positron emission tomography (PET) scan revealed hyper-metabolic and hypo-metabolic tumors with perilesional stranding and satellite nodularity. There were a few metastatic right axillary nodes visible. There was no indication of distant metastases. Due to the presence of both components, a modified radical mastectomy surgery with axillary dissection was undertaken for this patient. Histopathological analysis of paraffin sections revealed ductal carcinoma in situ (DCIS) comedo-epithelial component and spindle-shaped cells with hyper-chromatic oval nuclei and scanty cytoplasm.

AMPK pathway: an emerging target to control diabetes mellitus and its related complications.

Purpose: In this extensive review work, the important role of AMP-activated protein kinase (AMPK) in causing of diabetes mellitus has been highlighted. Structural feature of AMPK as well its regulations and roles are described nicely, and the association of AMPK with the diabetic complications like nephropathy, neuropathy and retinopathy are also explained along with the connection between AMPK and ß-cell function, insulin resistivity, mTOR, protein metabolism, autophagy and mitophagy and effect on protein and lipid metabolism. Methods: Published journals were searched on the database like PubMed, Medline, Scopus and Web of Science by using keywords such as AMPK, diabetes mellitus, regulation of AMPK, complications of diabetes mellitus, autophagy, apoptosis etc. Result: After extensive review, it has been found that, kinase enzyme like AMPK is having vital role in management of type II diabetes mellitus. AMPK involve in enhance the concentration of glucose transporter like GLUT 1 and GLUT 4 which result in lowering of blood glucose level in influx of blood glucose into the cells; AMPK increases the insulin sensitivity and decreases the insulin resistance and further AMPK decreases the apoptosis of ß-cells which result into secretion of insulin and AMPK is also involve in declining of oxidative stress, lipotoxicity and inflammation, owing to which organ damage due to diabetes mellitus can be lowered by activation of AMPK. Conclusion: As AMPK activation leads to overall control of diabetes mellitus, designing and developing of small molecules or peptide that can act as AMPK agonist will be highly beneficial for control or manage diabetes mellitus.

Investigating the preferential interaction between imatinib mesylate and VEGF G-quadruplex DNA as therapeutic strategies for cancer treatment: Biophysical and molecular modelling approaches.

G-Quadruplex DNA (GQ-DNA) is one of the most important non-canonical nucleic acid structures. GQ-DNA forming sequences are present in different crucial genomic regions and are abundant in promoter regions of several oncogenes. Therefore, GQ-DNA is an important target for anticancer drugs and hence binding interactions between GQ-DNA and small molecule ligands are of great importance. Since GQ-DNA is a highly polymorphic structure, it is important to identify ligand molecules which preferentially target a particular quadruplex sequence. In this present study, we have used a FDA approved drug called imatinib mesylate (ligand) which is a selective tyrosine kinase inhibitor, successfully used for the treatment of chronic myelogenous leukaemia, gastrointestinal stromal tumours. Different spectroscopic techniques as well as molecular docking investigations and molecular simulations have been used to explore the interaction between imatinib mesylate with VEGF GQ DNA structures along with duplex DNA, C-Myc, H-Telo GQ DNA. We found that imatinib mesylate shows preferential interaction towards VEGF GQ DNA compared to C-Myc, H-Telo GQ and duplex DNA. Imatinib mesylate seems to be an efficient ligand for VEGF GQ DNA, suggesting that it might be used to regulate the expression of genes in cancerous cells.

Reviving a Smile: A Multidisciplinary Approach to Dentin Dysplasia.

Dentin dysplasia Type 1 (DD1) is an uncommon inherited condition marked by structural irregularities in dentin, leading to notable dental abnormalities. Clinically, patients typically present with generalized slight yellowish discoloration and tooth mobility, while radiographic examination often reveals a reduced pulp chamber with the absence of pulp stones, a hallmark feature of DD1. Treatment involves a multidisciplinary approach including extraction of affected teeth, direct sinus lift procedure bilaterally, implant placement, and subsequent fixed prosthesis placement. In a recent case, after six months, a patient demonstrated improved oral health-related quality of life with stabilized implant-supported prostheses providing functional and esthetic benefits. This emphasizes the importance of early diagnosis and intervention in managing DD1, underscoring the effectiveness of a multidisciplinary approach in enhancing oral function and esthetics. Further research is warranted to deepen our understanding of the genetic basis of this condition and develop targeted therapies.

A Comparative Evaluation of Clinical Efficacy of Topical Amlexanox and Triamcinolone Acetonide in Oral Lichen Planus.

BACKGROUND: Oral lichen planus (OLP) is a chronic mucocutaneous disease affecting the general population, with its exact etiology remaining unknown. This condition is characterized by T-cell mediated autoimmunity wherein auto-cytotoxic CD8+ T cells precipitate basal cell apoptosis in the oral epithelium. Conventionally, corticosteroids have been the mainstay of treatment for OLP, necessitating the exploration of alternatives to mitigate long-term corticosteroid-related adverse effects. Amlexanox, a topical anti-inflammatory agent, impedes the synthesis and release of histamine, TNF-alpha, and leukotrienes from mast cells, neutrophils, and mononuclear cells, conceivably implicated in OLP pathogenesis. AIMS: The study aims to evaluate and compare the clinical efficacy of topical amlexanox and triamcinolone acetonide in the treatment of OLP. OBJECTIVES: The objectives of this study are (i) to evaluate the lesion size following the topical application of 5% amlexanox paste in the treatment of OLP, (ii) to evaluate the burning sensation of the patient based on the VAS score, and (iii) to compare and evaluate the clinical efficacy of 5% amlexanox with 0.1% triamcinolone acetonide in the treatment of OLP. METHODOLOGY: Forty patients clinically and histopathologically diagnosed with symptomatic OLP were randomly assigned into two groups, each comprising 20 patients. Group A was prescribed topical 5% amlexanox, while Group B received topical 0.1% triamcinolone acetonide with instructions to apply the drug at the site of the lesion intraorally thrice a day after food. The clinical improvement was evaluated using the Thongprasom scale, and the burning sensation was assessed using the visual analog scale (VAS) score weekly over four weeks. RESULTS: The study showed that there was a statistically significant reduction in the VAS score and size of lesion with each drug individually (p=0.000). There was a statistically significant difference in the mean values of VAS scores and size of the lesion between the first visit and fourth week, indicating a gradual reduction of the burning sensation and size of the lesion in both Group A and Group B, respectively. When both the groups were compared, there was no significant difference (p>0.05) in the reduction of burning sensation between Group A and Group B, indicating that amlexanox was as effective as triamcinolone in reducing the VAS score. However in terms of reduction of lesion size during the second week (p=0.022) and the third week (p=0.013), a statistically significant value was seen with a greater reduction in the size of the lesion in Group B compared to Group A. CONCLUSION: Given its anti-inflammatory properties and lower incidence of adverse effects relative to corticosteroids, amlexanox acts as a promising first-line therapeutic option for OLP. In cases of inadequate response, adjunctive therapies can be considered.

Anion-Relay Double Aza-Michael-Michael Cascades to Enone-Tethered Cyclohexadienones: Access to an Intricate Bridged Ring System.

An anion-relay double aza-Michael-Michael addition strategy has been reported for the synthesis of intricate scaffolds from enone-tethered cyclohexadienones and primary amines. This method discloses the base-catalyzed synthesis of highly valued bridged aza-tricyclic frameworks with a high level of product selectivity and stereoselectivity. Gram scale synthesis and synthetic transformation were shown to afford structurally diverse bridged aza-polycyclic amines. Control experiments and the kinetic profile were studied to determine a plausible reaction mechanism.

Recent advancements and applications of ophthalmic gene therapy strategies: A breakthrough in ocular therapeutics.

Over the past twenty years, ocular gene therapy has primarily focused on addressing diseases linked to various genetic factors. The eye is an ideal candidate for gene therapy due to its unique characteristics, such as easy accessibility and the ability to target both corneal and retinal conditions, including retinitis pigmentosa (RP), Leber congenital amaurosis (LCA), age-related macular degeneration (AMD), and Stargardt disease. Currently, literature documents 33 clinical trials in this field, with the most promising results emerging from trials focused on LCA. These successes have catalyzed further research into other ocular conditions such as glaucoma, AMD, RP, and choroideremia. The effectiveness of gene therapy relies on the efficient delivery of genetic material to specific cells, ensuring sustained and optimal gene expression over time. Viral vectors have been widely used for this purpose, although concerns about potential risks such as immune reactions and genetic mutations have led to the development of non-viral vector systems. Preliminary laboratory research and clinical investigations have shown a connection between vector dosage and the intensity of immune response and inflammation in the eye. The method of administration significantly influences these reactions, with subretinal delivery resulting in a milder humoral response compared to the intravitreal route. This review discusses various ophthalmic diseases, including both corneal and retinal conditions, and their underlying mechanisms, highlighting recent advances and applications in ocular gene therapies.

Validation of Gender Identification From Frontal Sinuses Using Yoshino's Classification: A Morphometric Radiographic Study.

INTRODUCTION: Gender determination of deceased individuals may become necessary in scenarios involving sudden and unforeseen fatalities like explosions, fires, transportation accidents, or instances of mutilation or decomposition, which frequently require medicolegal expertise. Forensic radiology is instrumental in identifying gender. The shape of the frontal sinus is considered distinct for every person, differing even among identical twins, much like individual fingerprints and establishing personal identity. AIMS AND OBJECTIVES: This study was designed to validate and determine gender identification by evaluating frontal sinus measurements using digital posteroanterior cephalograms with reference to Yoshino's classification and to determine gender based on measurements of frontal sinus size, bilateral asymmetry, the outline of the upper border of the frontal sinus, partial septa, and supraorbital cells of the frontal sinus. MATERIALS AND METHODS: A total of 300 digital posteroanterior cephalograms (150 males and 150 females) of age groups ranging from 18 to 30 years were collected from the records of the Department of Oral Medicine and Radiology, Panineeya Institute of Dental Sciences & Research Centre, Hyderabad. The parameters that were assessed in a digital radiograph are Yoshino's frontal sinus pattern of the individual, which includes frontal sinus size, bilateral asymmetry, superiority of the side, outline of the upper border, partial septa, and supraorbital cells. The measurements were taken, tabulated, and compared with the standard values of the gender measurement. The values were subjected to statistical analysis. RESULTS: Results showed a statistically significant difference in the mean height (p=0.000), width (p=0.000), area (p=0.000), partial septa (p=0.002), and outline of the upper border on the right side (p=0.011) of the frontal sinus for both males and females. The mean values for length, width, and area of the frontal sinus were higher in males than females. No statistical difference is found on the outline of the upper border on the left side, superiority of the side, and supraorbital cells. The application of discriminative analysis to the data accurately identified gender in 65.3% of the cases. CONCLUSION: Thus, from the above study, the forensic application of frontal sinus morphology can be recommended as an adjunctive tool for gender determination.

"The impact of orthognathic surgery on articulation proficiency and speech intelligibility in skeletal Class III malocclusion: 18 months follow up".

Introduction: Orthognathic surgery results in the positional change of the maxilla and mandible that may affect speech. The present study evaluated the effect of combined maxillary advancement and mandibular setback surgery on articulation proficiency and speech intelligibility in patients with non-syndromic skeletal Class III malocclusion. Methods: In this prospective study, twenty-five patients with skeletal class III malocclusion and consecutively treated with Lefort-1 maxillary advancement and mandibular setback (BSSO) orthognathic surgery were included in this study. The speech sample was recorded with a digital audio tape recorder one day before surgery and at 3, 6, 9, 12 and 18 months after surgery. Three qualified and experienced speech and language pathologists evaluated articulation errors and intelligibility of speech samples. Repeated One-way analysis of variance was used to compare articulation proficiency and speech intelligibility at different time intervals. Results: The substitution, omission, distortion and addition errors showed no significant changes at 3 months and 6 months. The total articulation errors decreased to zero at 9 months and no significant increase was observed till 18 months (P < 0.05). Speech intelligibility showed statistically non-significant improvement at any time interval. Cephalometric skeletal parameters SNA and N l A°. were significantly correlated with addition and total articulation errors at 18 months follow up. Conclusions: The ortho-surgical treatment improves speech (decreases. articulation errors) in most of the patients usually 6-9 months post-surgery. Speech intelligibility is not affected by bimaxillary orthognathic surgery in skeletal class III patients. The articulation errors were correlated to changes in position of maxilla.

Physician Perspectives on the Quality of Dying in Indian ICUs: A Call to Attention.

How to cite this article: Mani RK. Physician Perspectives on the Quality of Dying in Indian ICUs: A Call to Attention. Indian J Crit Care Med 2024;28(5):411-413.

Proteogenomic characterization of difficult-to-treat breast cancer with tumor cells enriched through laser microdissection.

BACKGROUND: Breast cancer (BC) is the most commonly diagnosed cancer and the leading cause of cancer death among women globally. Despite advances, there is considerable variation in clinical outcomes for patients with non-luminal A tumors, classified as difficult-to-treat breast cancers (DTBC). This study aims to delineate the proteogenomic landscape of DTBC tumors compared to luminal A (LumA) tumors. METHODS: We retrospectively collected a total of 117 untreated primary breast tumor specimens, focusing on DTBC subtypes. Breast tumors were processed by laser microdissection (LMD) to enrich tumor cells. DNA, RNA, and protein were simultaneously extracted from each tumor preparation, followed by whole genome sequencing, paired-end RNA sequencing, global proteomics and phosphoproteomics. Differential feature analysis, pathway analysis and survival analysis were performed to better understand DTBC and investigate biomarkers. RESULTS: We observed distinct variations in gene mutations, structural variations, and chromosomal alterations between DTBC and LumA breast tumors. DTBC tumors predominantly had more mutations in TP53, PLXNB3, Zinc finger genes, and fewer mutations in SDC2, CDH1, PIK3CA, SVIL, and PTEN. Notably, Cytoband 1q21, which contains numerous cell proliferation-related genes, was significantly amplified in the DTBC tumors. LMD successfully minimized stromal components and increased RNA-protein concordance, as evidenced by stromal score comparisons and proteomic analysis. Distinct DTBC and LumA-enriched clusters were observed by proteomic and phosphoproteomic clustering analysis, some with survival differences. Phosphoproteomics identified two distinct phosphoproteomic profiles for high relapse-risk and low relapse-risk basal-like tumors, involving several genes known to be associated with breast cancer oncogenesis and progression, including KIAA1522, DCK, FOXO3, MYO9B, ARID1A, EPRS, ZC3HAV1, and RBM14. Lastly, an integrated pathway analysis of multi-omics data highlighted a robust enrichment of proliferation pathways in DTBC tumors. CONCLUSIONS: This study provides an integrated proteogenomic characterization of DTBC vs LumA with tumor cells enriched through laser microdissection. We identified many common features of DTBC tumors and the phosphopeptides that could serve as potential biomarkers for high/low relapse-risk basal-like BC and possibly guide treatment selections.