Evaluation of fluoride levels in areca nut, tobacco, and commercial smokeless tobacco products: a pilot study.

Oral submucous fibrosis (OSMF) is a premalignant condition associated with chewing areca nut and tobacco products. We observed increased fluoride levels in some OSMF-endemic regions,and the observation suggested that fluoride exposure may contribute to its pathogenesis. This study aimed to assess the fluoride content of various smokeless tobacco items as a potential influencing source. Fluoride concentration was analysed in commercial areca nut products, including gutkha, pan masala, and raw areca nut, along with tobacco, slaked lime, and catechu samples from Karnataka, India. Fluoride was measured using alkali fusion and the ion selective electrode method. All products showed high fluoride, with catechu having the highest mean concentration at 51.20 mg/kg, followed by tobacco, gutkha, pan masala, processed areca nut, and raw areca nut. Fluoride was also elevated in soil, but not in water. The findings demonstrate substantial fluoride levels in popular types of smokeless tobacco, and highlight an overlooked source of exposure among consumers of gutkha, pan masala and similar oral tobacco-products. The fluoride content warrants an investigation of potential links with the occurrence and severity of OSMF.

Remote Access Thyroid Surgery: A Review of Literature.

Since the first description of endoscopic thyroid lobectomy in 1997, a variety of techniques have been developed to avoid the visible cervical scar conventionally been associated with thyroidectomy. These "remote access" approaches, which typically use either endoscopic or robotic instrumentation, have successfully avoided the anterior neck scar, which has a measurable impact on the patient's quality of life (Graves and Suh Surgery 168(5):845-850, 2020; Sakorafas World J Surg 34(8):1793-1804, 2010). The main advantage of these techniques is better cosmesis compared to conventional transcervical approaches (Graves and Suh Surgery 168(5):845-850, 2020) However, these techniques have failed to gain widespread acceptance in the surgical community because of the technical challenges, scepticism about oncological safety and cost factors. This review presents an overview of the various methods of remote access thyroid surgery (RATS) and also evaluates the selection criteria, oncological efficacy, training requirements and key advantages of this technique.

Sex differences in SARS-CoV-2 infections, anti-viral immunity and vaccine responses

The COVID-19 pandemic has revealed sex-based differences in anti-viral responses, with a higher rate of SARS-CoV-2 infections as well as a higher rate of morbidity and mortality in men than in women. Males and females also show disparate immune responses to COVID-19 infection, which may be important contributors to lower rates of infection, disease severity and deaths in women than in men. Here, the authors review sex differences in SARSCoV- 2 infections, anti-viral immunity and vaccine responses, putting forth the importance of sex, the underappreciated variables in vaccine response and disease infectivity.

Sex differences in SARS-CoV-2 infections, anti-viral immunity and vaccine responses

The COVID-19 pandemic has revealed sex-based differences in anti-viral responses, with a higher rate of SARS-CoV-2 infections as well as a higher rate of morbidity and mortality in men than in women. Males and females also show disparate immune responses to COVID-19 infection, which may be important contributors to lower rates of infection, disease severity and deaths in women than in men. Here, the authors review sex differences in SARSCoV- 2 infections, anti-viral immunity and vaccine responses, putting forth the importance of sex, the underappreciated variables in vaccine response and disease infectivity.

Are carcinogens electron acceptors? A novel hypothesis.

Carcinogens play a key role in cancer initiation. Conventional theories support the concept of genetic changes inducing tumorigenesis through proteomics and metabolomics which lead to cancer development. Current research provides evidence that metabolic genes may be altered long before mutation of tumour suppressor genes, strongly suggesting that metabolic changes may be preceding the changes seen at a genetic level. Since cancer has long been known to occur through gene regulation, an impaired cellular respiration without utilizing mitochondrial function has been an area of active interest. We hypothesize the activity of carcinogens as electron acceptors to disrupt the normal glycolysis cycle happening in a cell by acting as positive ligands. The continuous restoration of NAD+ to cytosol by oxidation of NADH with carcinogen as electron acceptor creates a metabolic pathway to assist in the carcinogenic process. This metabolic pathway continues through an adaptive process, supplemented by pyruvate converting to lactate providing a constant pool of NAD+ to continue the glycolytic pathway. We also hypothesize that carcinogenesis occurs as a precursor to metabolic stress which may promote altered genetic and protein expression causing aberrant epigenetic and cell signaling pathways.

The E-cigarette ban in India-A step in the right direction?

Electronic cigarettes (e-cigarettes) are a popular method to help quit tobacco smoking. However, there is a paucity of data in the literature on their safety and efficacy. Recently, the Indian Government has called for a ban on all e-cigarettes and taken steps to restrict access to vaping products from the market. This major decision was an attempt to safeguard the younger population from using e-cigarette and their possible longer-term addiction together with its promotions by domestic industries. In this article, we evaluate the role of e-cigarettes to help stop smoking tobacco cessation and consider the factors that have facilitated the ban on e-cigarettes in India.

Small-Sized Thyroid Cancers-a Single Institutional Experience in India.

The incidence of small differentiated thyroid carcinomas is increasing worldwide in the recent years, especially tumours of size less than 2 cm in diameter. In this study, we have analysed the patterns of behaviour of small-sized thyroid carcinomas (<2 cm, T1 tumours) in comparison with large-sized thyroid carcinomas. This is a retrospectively analysed data of patients with thyroid carcinoma. The following parameters were analysed: distribution with regard to age, sex and the presence of metastasis based on radioiodine scan. The following histopathological details were collected: maximal tumour diameter, extrathyroidal extension and lymphovascular invasion. Out of 152 patients, 39 patients were excluded due to the non-availability of complete details. Among the 113 patients of thyroid carcinomas, 43 patients (28%) were presented with small-sized tumours (measuring less than 2 cm). In small-sized thyroid tumours, 21.6% showed extrathyroidal extension. 2.7% of the small-sized thyroid carcinomas showed perineural invasion as compared to 6.3% of the large-sized thyroid carcinomas. Twenty percent of the small-sized thyroid carcinomas showed lymphovascular emboli. 51.2% of the small-sized thyroid carcinomas were presented with nodal metastasis as compared to 40% of the large-sized thyroid carcinomas. 57.5% of the small-sized thyroid carcinomas showed extracapsular extension as compared to 57.8% of the large-sized thyroid carcinomas. Despite small size, thyroid carcinomas have properties to behave aggressively as comparable to large-sized thyroid carcinomas. Taking the above facts into account, the small thyroid cancers should be treated with considerable caution as large thyroid cancers, especially since we have limited tools to predict the preoperative poor prognostic factors.