Publications

Smokeless tobacco (SLT), particularly chewing tobacco, is an underrecognized public health concern. Its long-term burden and trends, especially in China, remain incompletely quantified.

Tobacco use among youth in low- and middle-income countries (LMICs), particularly India, remains a critical public health challenge. However, limited research has examined how different geographic determinants distinctly contribute to smoked and smokeless tobacco use among young men in India.

Endoscopic full-thickness resection (EFTR) for gastric submucosal tumors (SMTs) presents a technical challenge for defect closure. This study aims to evaluate the feasibility and efficacy of a novel mucosal traction-assisted clip closure (MTCC) technique compared to conventional clip closure (CCC). In this multi-center retrospective study of 218 patients undergoing EFTR for gastric SMTs at seven hospitals (June 2020-June 2025), patients were divided into MTCC (n = 32) and CCC (n = 186) groups. To minimize selection bias, 1:2 propensity score matching (PSM) yielded a matched cohort of 96 patients (MTCC, n = 32; CCC, n = 64). Primary outcomes were defect closure success rate and closure time. Secondary outcomes included postoperative complications, fasting time, and hospital stay. Subgroup analyses were performed by defect diameter (≤ 2.5 cm vs. >2.5 cm) and tumor location (gastric fundus). Defect closure was successfully achieved in all patients in the MTCC group. After PSM, baseline characteristics were well-balanced between the two groups. The MTCC group continued to demonstrate superior closure efficiency compared to the CCC group, with a significantly shorter median defect closure time (7.0 min vs. 17.0 min, P < 0.001) and fewer titanium clips used (8.0 vs. 12.0, P < 0.001). The median total procedure time was also significantly reduced in the MTCC group (47.0 min vs. 53.0 min, P = 0.027). Postoperatively, patients in the MTCC group had a shorter median fasting time (2.0 days vs. 3.0 days, P = 0.001), while complication rates remained comparable between groups. The advantages of MTCC were consistently observed across subgroups stratified by defect size and tumor location. After adjusting for potential confounders using PSM, the MTCC technique appears to be a feasible method for managing post-EFTR defects. In this cohort, it was associated with significantly enhanced closure efficiency and accelerated postoperative recovery.

Smokeless tobacco use remains highly prevalent among adolescents in many regions, driven by complex socio-cultural influences that extend beyond individual choice. Understanding the perceived social, cultural, and familial factors that contribute to initiation is essential for informing effective prevention strategies.

Ischemic stroke (IS), characterized by high rates of disability and mortality, is among the most severe cerebrovascular diseases affecting the elderly. Shuanglu Tongnao Formula (SLT), a traditional Chinese Zhuang medicine, has been proposed as a prospective therapeutic agent for IS. However, the potential mechanism of the treatment of IS by SLT remains largely unknown. This study aimed to evaluate the therapeutic effect of SLT on IS and its possible mechanisms.

IntroductionTobacco consumption was leading global risk factor for mortality in 2023. This study aimed to assess rural-urban inequalities in lifetime tobacco consumption among Indian adults aged 45 years and above, alongside socioeconomic inequalities.

The tobacco-specific nitrosamine, 4-(methyl-nitrosamino)-1-(3-pyridyl)-1-butanone has been identified as potent lung carcinogen in laboratory animals. Bioactivation of nicotine-derived nitrosamine ketone occurs cytochrome P450-mediated hydroxylation of carbon atoms adjacent to the nitrosamino group, generating reactive methylating and pyridyloxobutylating intermediates. NNK can be metabolically reduced to NNAL, which retains carcinogenic potential and undergoes similar activation. Like NNK, NNAL also requires the metabolic activation to DNA alkylating agents. When NNAL is methyl hydroxylated, pyridinyl-hydroxy-butyl DNA adducts are formed, and methylene hydroxylation results in DNA methyl adducts. NNK's metabolic complexity leads to a variety of DNA lesions, increasing its overall carcinogenic potency. From this angle, the chemistry and genotoxic properties of many DNA adduct generated from NNK are discussed. Adducts that contribute to the genotoxic effects of NNK include the gene targeted for mutation, amounts, and genetic variants of critical repair enzymes. NNK, present in modern smokeless tobacco products, plays a central role in cancer risk among users. The mechanisms by which NNK induces cancer in humans are discussed in this paper, along with the factors influencing NNK development at various phases of tobacco manufacturing.

Eels are valued for their nutrition and flavor, but their fishy odor limits consumer acceptance. This study evaluated the effects of different deodorization methods on eel flavor using electronic nose (E-nose), gas chromatography-ion mobility spectrometry (GC-IMS), and headspace solid-phase microextraction gas chromatography-mass spectrometry (HS-SPME-GC-MS). Samples included untreated eel (CK), and those subjected to acetic acid soaking (YS) and microbial fermentation using Saccharomyces cerevisiae (JM), Lactobacillus plantarum (ZW), Lactobacillus rhamnosus (SLT), and Staphylococcus nepalensis (T13) respectively. Key volatile organic compounds (VOCs) were identified based on relative odor activity value (ROAV >1) and variable importance in projection (VIP > 1). The sample YS showed the highest volatile content and most distinct flavor profile, whereas biologically treated samples (JM, SLT, T13) exhibited similar compositions. 12 key VOCs were identified, primarily alcohols, aldehydes, and ketones, with 1-octen-3-ol, 1-heptanol, 1-octanol, 1-octanal, 1-nonanal, and 2,3-pentanedione being the key contributors to the fishy odor. Staphylococcus nepalensis fermentation significantly reduced these compounds by metabolizing polyunsaturated fatty acids, whereas acetic acid treatment increased their levels due to pH-induced changes. These findings demonstrate that microbial fermentation, particularly using Staphylococcus nepalensis, effectively improves eel flavor, providing a scientific basis for deodorization strategies in aquatic product processing.

Anti-tuberculosis drug-induced liver injury (AT-DILI) is a major adverse event associated with significant morbidity and mortality. Limited real-world evidence exists in India on the incidence and risk factors of AT-DILI after switching over from an intermittent to a daily regimen involving the 4-drug fixed-dose combination (4FDC-ATT) in India. This study aimed to estimate the incidence and predictors of AT-DILI.

To compare outcomes of single(SLT) versus bilateral(BLT) lung transplantation among dually listed recipients hypothetically eligible for either treatment.

Smokeless tobacco (SLT) use remains prevalent globally and is associated with cardiovascular disease (CVD). However, variations in product composition, particularly between Scandinavian snus and alkaline, unfermented preparations such as Nawar, may influence risk profiles.

Intravenous administration of anti-CTLA4 with anti-PD1 provides durable tumour responses but causes severe treatment-related adverse events in patients with cancer. Intratumoural administration at lower doses but high local concentrations could enhance antitumour efficacy while minimizing systemic exposure and toxicity. Here we report the randomized multicentre phase 1b NIVIPIT trial (ClinicalTrials.gov: NCT02857569 ), which enrolled 61 patients with untreated metastatic melanoma, randomly assigned 2:1 to receive intravenous nivolumab (anti-PD1; 1 mg kg) combined with either intratumoural ipilimumab (anti-CTLA4; 0.3 mg kg) or intravenous ipilimumab (3 mg kg). The primary end-point was met with significantly lower incidence of grade 3 or 4 treatment-related adverse events at 6 months in the intratumoural versus intravenous arm (22.6% versus 57.1%), equivalent to anti-PD1 monotherapy. RECIST (response evaluation criteria in solid tumours) best objective response rate reached 65.7% for anti-CTLA4 injected lesions and 50% for uninjected lesions, confirming the relationship between intratumoural exposure to anti-CTLA4 and efficacy. Baseline tumour immune profiling revealed that protumoural activated regulatory T (T) cells and M2 macrophages predict durable clinical benefit, regardless of the anti-CTLA4 administration route. A decrease in activated intratumoural T cells occurred only in patients who showed durable clinical benefit, who also presented high intratumoural Fcγ receptor (FcγR) expression. Our results provide a rationale for intratumoural anti-CTLA4 strategies in oligometastatic and early-stage cancers and indicate that high intratumoural activated T cell and FcγR M2 macrophage numbers are prerequisites for efficacy of combined anti-CTLA4 and anti-PD1.

Oral manifestations often reflect underlying immune suppression and disease progression. These lesions can profoundly affect the quality of life, leading to pain, difficulty in eating, and social stigma. In the lesbian, gay, bisexual, transgender, and queer (LGBTQ) population living with human immunodeficiency virus (HIV), additional sociobehavioral factors, such as discrimination, mental health challenges, and barriers to healthcare access, may exacerbate oral health issues.

Oral squamous cell carcinoma (OSCC) poses a major public health burden in South Asia, particularly in Northeast India, where exposure to smokeless tobacco and areca nut is highly prevalent. Epithelial cell adhesion molecule (EpCAM), a transmembrane glycoprotein involved in tumour proliferation and signalling pathways, has been implicated in the pathogenesis across multiple epithelial malignancies. This pilot study aimed to evaluate the immunohistochemical expression pattern of EpCAM in OSCC and to explore its association with clinicopathological parameters.

In this study, we describe a rationally designed light-inducible RNA-releasing protein (LIRP) capable of inhibiting mRNA translation in the dark while permitting gene expression upon exposure to blue or ambient light. This LIRP-dependent gene switch is compatible with various delivery routes of gene- and cell-based therapy, such as subcutaneous implantation of microencapsulated light-sensitive cells or expression in various light-accessible body sites using single adeno-associated virus (AAV) vectors. To exemplify a gene therapy approach that directly harnesses ambient light as a natural illumination source to induce therapeutic action, we show how intradermal delivery of AAV2 vectors carrying a LIRP-regulated gene switch controlling murine thymic stromal lymphopoietin expression was effective in enabling light-dependent prevention and treatment of diet-induced obesity. To describe another therapeutic scenario, we engineered AAV2 vectors for LIRP-dependent expression of Vascular endothelial growth factor (VEGF) inhibitors for the treatment of retinal neovascular diseases. Upon intravitreal delivery into mice suffering from wet macular degeneration, VEGF inhibitors were constantly produced when animals were exposed to daylight, but therapeutic actions could be flexibly interrupted either by exposure to dark environments or by administration of a selective blue light filter at any point in time. When compared to conventional treatment strategies based on constitutive VEGF inhibition over the course of 3 months, we show that a regulated gene therapy approach through LIRP-dependent optogenetics was advantageous in maintaining a normal retina thickness. This work not only provides a valuable addition to the optogenetic toolbox but also offers a perspective to translate light-dependent gene switches toward therapeutic usage.

The South-East Asia Region (SEAR) faces a growing burden of non-communicable diseases (NCDs), shaped in part by complex commercial determinants of health (CDoH). This analysis considers how aggressive marketing, policy interference and addictive product design by the tobacco, alcohol and ultra-processed food (UPF) industries contribute to this burden. SEAR's distinctive demographic, cultural and economic conditions create both vulnerabilities and opportunities. Rapid urbanisation, high population density, rising disposable incomes and uneven policy enforcement create environments in which commercial actors can expand market reach and influence consumption patterns. These industries frequently target youth and lower socioeconomic groups through tailored marketing, sponsorships, digital engagement and strategic product placement. Cultural norms further shape consumption in SEAR, including the longstanding use of smokeless tobacco, socially embedded alcohol consumption in several countries and the growing incorporation of UPFs into daily diets. These patterns are strengthened by expanding digital and e-commerce ecosystems that increase exposure, accessibility and the normalisation of health-harming products across diverse populations. Despite challenges, the region can address CDoH by adapting evidence-based strategies like marketing restrictions, excise taxes on sugar-sweetened beverages and safeguards against industry interference to local policies.Strengthening regulatory frameworks, enforcing comprehensive marketing restrictions and adopting WHO 'best buy' interventions are critical steps. In parallel, international cooperation and capacity building in low- and middle-income countries are essential, as is the engagement of civil society and academia to enhance accountability and support effective policy implementation. Collectively, these strategies can help SEAR accelerate progress in reducing NCD risks and improving population health.

Tobacco use imposes significant economic burden, particularly in low and middle-income countries, diverting household income from essential needs. This study estimates the potential economic uplift of Indian households through tobacco cessation, informing tobacco control and poverty alleviation policies aligned with SDG 1 (No Poverty) and SDG 3 (Good Health and Well-being).

This study aimed to evaluate the effects of acidic and alkaline staining solutions on the optical-mechanical properties of feldspathic (Vitablocs Mark II) Computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic materials after 4 weeks of immersion in media. Specifically, this investigation focused on assessing mean colour change (ΔE*), the translucency parameter (TP), the opalescence parameter (OP), surface roughness, and bacterial adhesion by colony-forming unit (CFU) count. A total of 96 Vitablocs Mark II CAD/CAM ceramic specimens were prepared and assigned to eight groups (A-H) according to the type of immersion solution: smokeless snuff, Black Shammah, Yerba mate, Saudi Coffee, MIRINDA Citrus, CodeRed, Nescafe, and normal saline (control group). The specimens were immersed for 4 weeks at 37 °C, with solutions replaced according to manufacturer instructions. Optical parameters, including ΔE*, TP, and OP, were measured using a spectrophotometer (VITA Easyshade V). Surface roughness was analysed through white light interferometric microscopy, and the bacterial adhesion of Streptococcus mutans was quantified by calculating colony-forming units (CFUs) per square millimetre. Statistical analysis included Shapiro-Wilk tests for normality, one-way ANOVA, Tukey HSD post-hoc comparisons, and paired t-tests, with significance set at p < 0.05. The recorded pH values of the staining solutions ranged from acidic (MIRINDA Citrus: 3.25) to alkaline (Black Shammah: 9.45). Black Shammah exhibited the highest ΔE* value (6.75 ± 5.21), followed by smokeless snuff (6.53 ± 3.59). The lowest value (2.41 ± 1.04) was observed for Yerba mate, and significant differences were observed across staining solutions (p < 0.001). TP significantly decreased post-immersion, and the highest mean reduction was observed in CodeRed (5.87 ± 0.92; p < 0.001). By contrast, OP increased significantly, with the most significant mean increase observed in Black Shammah (6.93 ± 5.38; p = 0.001) and the smallest in Saudi coffee (1.19 ± 1.77; p = 0.040). Surface roughness varied among groups, ranging from 0.458 ± 0.04 (CodeRed) to 0.739 ± 0.03 µm (smokeless snuff). Bacterial adhesion was the highest in CodeRed (480.08 ± 40.77 CFUs) and lowest in normal saline (273.00 ± 42.29 CFUs; ANOVA, p < 0.001). Exposure to staining media significantly decreased translucency and increased opalescence, surface roughness, and bacterial adhesion in feldspathic CAD/CAM ceramic. Acidic solutions promoted greater Streptococcus mutans adhesion, while alkaline tobacco products caused the highest color change.

Smokeless tobacco (SLT) use during pregnancy remains a significant yet underrecognized public health concern, particularly in low- and middle-income countries. Despite its wide prevalence and potential for adverse maternal and foetal outcomes, SLT has received comparatively less attention than smoking in prenatal health initiatives. This systematic review and meta-analysis aimed to estimate the global and regional prevalence of SLT use among pregnant women and examine associated sociodemographic patterns.

Varicella-zoster virus (VZV), the cause of shingles, remains a significant health issue worldwide, particularly among aging populations. The recombinant zoster vaccine (Shingrix, RZV) is the only approved vaccine in many countries and has demonstrated >90% efficacy with durable protection lasting over a decade, highlighting the value of subunit vaccines targeting VZV glycoprotein E (VZV gE). Although RZV provides durable and highly effective protection, alternative vaccine platforms remain important for advancing antigen design and improving immune presentation. Advances in nanoparticle technology now enable antigens to be displayed in highly ordered, repetitive arrays, offering new opportunities to strengthen antiviral immunity. Here, we developed a novel nano-vaccine named Nano-gEVZV, which employs the antigen from the licensed Hepatitis E vaccine (Hecolin) as a nanoparticle scaffold and uses a nano-binder (NB) to display VZV gE in a repetitive arrangement. Nano-gEVZV demonstrates enhanced antigen uptake by antigen-presenting cells (APCs), improved lymph node retention, and stronger B- and T-cell responses compared with Shingrix in mouse models. While RZV remains the gold standard for herpes zoster prevention, we explored a nanoparticle-based gE display platform as a complementary approach to improve manufacturability and immune presentation.

Objectives: We aimed to understand tobacco use and treatment patterns among adults starting care in a Chennai HIV clinic. Methods: Cross-sectional survey of adults initiating HIV care with biochemical verification of tobacco exposure. Results: Among 154 adult patients (10/2019-12/2021) initiating HIV care, 37.7% ( = 58) self-reported current tobacco use (13.6% [ = 21] smoking, 17.5% [ = 27] smokeless tobacco [SLT], 6.5% [ = 10] dual use) and 7.8% ( = 12) reported former use (5.8% [ = 9] smoking, 1.3% [ = 2] SLT, 0.6% [ = 1] dual), none reported using cessation medications, two reported counseling. Cotinine levels indicating current use varied by tobacco product (smoking: 66.7% had cotinine ≥ 50ng/ml; SLT: 70.4%; dual: 80.0%, no current tobacco: 44.8%,  = 0.02). Conclusion: Smoking and SLT use are common and underreported and evidence-based cessation treatment use was rare prior to HIV care initiation.

Oral cancer is a major public health concern in South Asia, particularly in Pakistan, India, and Bangladesh, largely due to the widespread use of smokeless tobacco (SLT) products. The World Health Organization (WHO) classifies SLT as a Group 1 carcinogen. These products contain glycotoxins, such as methylglyoxal (MGO) that is well-known to cause genotoxicity by reacting with DNA. One of the most stable MGO-derived DNA adducts is N-(1-carboxyethyl)-2′-deoxyguanosine (CEdG), which has been reported to cause DNA damage and genetic instability. However, the role of CEdG in the pathogenesis of oral cancer remains unstudied, and the MGO content in various SLT has not been previously determined. To our knowledge, this study represents one of the first investigations into the abundance of CEdG in oral cancer and its association with chromatin organization, while also quantifying MGO levels in SLT. CEdG was detected using a semi-quantitative in situ immunofluorescence assay and correlated with chromatin computational morphometry to evaluate CEdG-associated alterations in chromatin organization. Using ELISA, we also assessed MGO levels in various SLT, revealing elevated concentrations in commonly used products such as gutka, naswar, and khaini. Our results demonstrated significantly higher levels of CEdG in cancerous nuclei and were strongly correlated with disorganized chromatin texture. Together, these findings suggest that exposure to MGO-rich SLT is associated with CEdG accumulation and subsequent chromatin disorganization, which may be relevant to tobacco-associated oral carcinogenesis.

Squamous cell carcinoma of oropharynx (OPSCC), a head and neck squamous cell carcinoma (HNSCC) subtype, exhibits a remarkably high incidence rate in the North-Eastern regions of India. The development of OPSCC is associated with the exposure to smokeless tobacco with or without consumption of alcohol and smoking tobacco. Despite advanced treatment modalities, OPSCC patients still face a dismal prognosis, necessitating a deeper exploration of the underlying molecular characteristics of the disease. While promoter CpG methylation-driven gene expression alterations in OPSCC have been studied, DNA methylation within gene bodies and its biological significance in this cancer subtype remain largely uncharted. This study represents the first endeavour to investigate gene-body specific DNA methylation-driven transcriptome alterations leading to immune response modulation on a genome-wide scale in OPSCC.

Regular dental visits are key to early oral cancer detection, especially for tobacco users. Effective dentist-patient communication about oral cancer examinations (OCEs) and quitting tobacco could influence patients' actual OCE behavior. This study investigated the association of dental visits and dentist-patient communication with OCE behavior among tobacco/nicotine product users in Western India. A cross-sectional study was conducted among 350 current tobacco/nicotine product users from a dental hospital and 15 dental camps in Daman, India, between July 2023 and January 2024. The outcome variable was OCE behavior; the explanatory variables included past dental visits and dentist-patient communication about the benefits of quitting tobacco and importance of OCEs; and the covariates were socio-demographic factors and past 30-day smoking and smokeless tobacco use. The data was analyzed using bivariate and multivariable logistic regression models. Only 8.7% of participants reported having undergone an OCE. Those who visited a dentist within the past year were approximately 10 times more likely to have had an OCE (OR = 9.95, = 0.01). Participants whose dentist discussed the importance of OCE (aOR = 2.59, = 0.04) and the benefits of quitting tobacco (OR = 2.45, = 0.04) were 2.5 times more likely to have had an OCE. Our findings highlight the important role of dental visits and effective dentist-patient communication in promoting OCEs among tobacco/nicotine product users. Public health campaigns should prioritize enhancing dental visits and dentist-patient communication to emphasize the benefits of tobacco cessation and regular OCEs to reduce the oral cancer burden in this population.

This study aimed to evaluate and compare salivary Malondialdehyde (MDA) levels in tobacco chewers with and without oral submucous fibrosis, and healthy individuals, and correlate the levels with stages of oral submucous fibrosis.

Tobacco use is a significant public health concern globally. In India, tobacco-related behaviors are increasing in a worrying pattern and such burden is highly prevalent among tribal and indigenous populations. This present study, conducted in Odisha, the state with the highest number of tribal communities in India, examines the factors that explain tobacco use behavior, its initiation, and continuation among two of the largest tribes in Odisha: the Santal and Bhumij communities.

This study introduces a SMARTphone-based, expert annotated dataset of Oral Mucosa images (SMART-OM), collected to facilitate the development of Artificial Intelligence and Machine Learning (AI/ML) technologies for automated diagnosis of Oral Cancer (OC) and Oral Potentially Malignant Disorders (OPMD). The dataset consists of 2,469 images from 331 subjects from four distinct classes: healthy/normal, variations from normal, OPMD, and OC. The images are captured using Android and iOS smartphone cameras under real-world clinical conditions in visible light. Each image is annotated by expert dental surgeons using the open-source VGG image annotator. Elaborate patient metadata, including clinical diagnosis, age, sex, and lifestyle-based risk indicators such as smoking, smokeless tobacco usage, alcohol consumption, and areca nut chewing, are recorded via a customized Jotform. The data collection and handling procedures are adhered to the ethical guidelines outlined in the Declaration of Helsinki and its amendments for research involving human subjects, with informed consent obtained from each subject. The SMART-OM dataset is intended to advance research and development of AI/ML algorithms for automated oral lesion detection.

To determine whether patients who use smokeless tobacco have different clinical and angiographic profiles of coronary artery disease (CAD) compared with smokers.

This study investigates the application of NDTs for the detection of sub-surface defects in an ancient book, with the aim of improving conservation methods in the field of cultural heritage. A sequence of thermographic images in a solar loading thermography (SLT) scenario was acquired during a diagnostic campaign in Harbin, China, to identify four distinct fabricated dowels made of Wool, Rubber, Teflon, and Synthetic material. The images were processed in two ways: the first combined advanced image-processing methods: pre-processing via MdFIF, post-processing, PCT and RPCT, applied both to the original sequence and to the MdFIF-filtered thermograms. The second approach employed numerical simulations in COMSOL Multiphysics to develop a predictive thermal model. The comparison of localized thermal anomalies obtained from the two approaches demonstrated the capability of NDTs to reliably reveal artificial defects, confirming their suitability for diagnostic conservation. Overall, the integration of advanced image processing with numerical simulation enhances diagnostic accuracy, particularly for subtle or low-contrast anomalies, thereby enabling more informed condition assessment and supporting rapid, targeted, and preventive conservation strategies.

There is limited literature on tobacco use among tribal communities in Jharkhand, despite the state having a significant tribal population. This study aims to estimate the prevalence of current use of any form of tobacco (AFT) and identify associated sociocultural factors using nationally representative data.

Categorizing nicotine dependency among smokeless tobacco (SLT) users in India by the modified Fagerstrom test for nicotine dependence (FTND) scale is not always straightforward.

Globally, tobacco use is one of the biggest public health threats. It is one of the major causes of preventable morbidity and mortality in India and accounts for nearly 1.35 million deaths every year. Patterns of tobacco use in India are myriad which include smoking as well as smokeless tobacco.

Cognitive-communication disorders (CCD) are common after acquired brain injury (ABI) and can have a negative impact on a person's life. Training a communication partner can improve the communication skills of the person with ABI; however, families are dissatisfied with existing communication partner training (CPT) and support. There is emerging evidence for the effectiveness of training for communication partners (CPs), though there is variability in the content, dosage and delivery of training; and published programmes are rarely used by speech and language therapists in practice. The strongest evidence is for a single programme, TBI Express, which has three different versions. Therefore, the aim of this study is to identify and describe the active components of existing training programmes for people with CCD.

To evaluate the association between and c-Myc expression in Oral Potentially Malignant Disorders (OPMDs) and Oral Squamous Cell Carcinoma (OSCC) and to explore its potential role in oral carcinogenesis.

Social learning theory (SLT) and social cognitive theory (SCT) are frequently invoked in simulation-based education (SBE), particularly when explaining observational learning and the educational value of observer roles. However, the theories are often treated as interchangeable, and conclusions about the superiority of one theory over the other have occasionally exceeded the available evidence.

The occurrence of acute coronary syndrome (ACS) among individuals under 40 years has increased markedly, yet current atherosclerotic cardiovascular disease risk prediction models are primarily validated in older adults, leading to underrecognition of risk and missed prevention in the young.

Speech and language therapists (SLTs) working in dysphagia care regularly navigate complex ethical dilemmas involving clinical risk, patient autonomy and cultural considerations. While ethical principles are well-recognized in the field, consolidated evidence mapping how these principles and ethical reasoning components have been represented in the literature over time remains limited. This review offers a comprehensive synthesis of ethical challenges in dysphagia management across decades and contexts, uniquely structured using Rest's Four-Component Model of ethical behaviour.

Oral squamous cell carcinoma (OSCC) dominates oral malignancies in Eastern Uttar Pradesh, India, driven by high smokeless tobacco use and late-stage presentations causing substantial mortality. Hence, this case-control study integrated mitochondrial DNA (mtDNA) profiling and whole exome sequencing (WES) in 98 participants (47 OSCC cases, 51 matched controls) from this high-burden region. mtDNA analysis revealed significant depletion of the 16223C polymorphism in cases (53.2% vs 90.2% controls; χ=16.74, p=0.0001), indicating potential protective effects against OSCC development. WES identified case-enriched driver variants, including NOTCH1 p.R2156H (15.0% cases) and truncating FAT1 mutations (10.0% cases), highlighting key oncogenic pathways. These findings advance precision oncology by establishing population-specific genomic markers for risk-stratification and targeted prevention of tobacco-related OSCC in Northern India.

Even though breast cancer (BC) is the most common female cancer worldwide, the role of tobacco, specifically chewing tobacco in the development of BC has not been widely studied. This study is aimed at assessing this association.

Particularly vulnerable tribal groups (PVTGs) in India constitute a socioeconomically marginalized population, often residing in remote regions with limited access to basic health services, including oral healthcare. Despite their vulnerability, comprehensive data on their oral health status remain scarce. This study aimed to evaluate the prevalence of oral diseases-particularly dental caries, periodontal conditions, and tobacco use-among PVTG populations in India.

Substance abuse is a growing public health challenge in India with significant oral health implications. Oral mucosal lesions (OMLs) are frequently observed among substance users due to the direct toxic effects and associated lifestyle factors. Despite this, oral screening is rarely integrated into de-addiction programmes.

Tobacco use during pregnancy is a significant public health issue associated with adverse outcomes, including low birth weight (LBW) in infants. This study investigates the association between tobacco use and pregnancy outcomes, specifically LBW, among women of prime childbearing age (20-34 years) by using nationally representative data.

Tobacco use during pregnancy poses both immediate and long-term health risks to mothers and their fetuses/new-borns. International guidelines recommend psychosocial interventions to treat tobacco dependence during pregnancy. Tobacco cessation counseling, including brief advice by healthcare providers, has proven effective in supporting quit attempts. This article presents findings from a study conducted among pregnant tobacco users who received tailored behavior change interventions during routine antenatal care (ANC) check-ups. In-depth interviews of successful quitters ( = 9) were conducted during the postpartum period. The interviews were audio-recorded, transcribed, and translated into English. Inductive approach was used to code data, which was analyzed thematically by two researchers independently. Five key facilitators enabled successful tobacco cessation during pregnancy: improved risk perception through targeted counseling, uptake of culturally appropriate healthier alternatives, visible health benefits postquitting, strong social support from family members, and profound fear of harming the unborn child, which served as the primary motivator. ANC visits represent valuable opportunities to screen and counsel women tobacco users who are otherwise overlooked by the health system. Integrating tailored cessation counseling into routine maternal healthcare can effectively support quit attempts during this critical period, with potential for significant public health impact.

Tobacco smoking remains the most consistent and preventable risk factor for oral cancer, driven by exposure to combustion-derived toxins that promote DNA damage, inflammation and microbiota dysregulation. Global data show substantial geographic variability in disease burden, with particularly high incidence and mortality especially in South and Southeast Asia, where culturally reinforced and deeply embedded forms of high-nitrosamine smokeless tobacco and areca nut continue to drive risk. In this evolving landscape, nicotine pouches have rapidly expanded as tobacco-free oral products manufactured to deliver nicotine without combustion. Toxicological analyses reveal significantly lower levels of harmful constituents relative to cigarettes and traditional smokeless tobacco, and short-term clinical studies report reductions in oral mucosal irritation and gingival inflammation among exclusive users. However, no long-term epidemiological evidence is currently available to assess their potential impact upon oral carcinogenesis, and existing human studies remain few, small and heterogeneous. This mini review highlights critical priorities for research, including the need for long-term prospective studies, standardized product testing, independent toxicological assessments and surveillance of patterns of use, dual use and youth uptake. The integration of harm reduction approaches with established prevention strategies may offer opportunities to mitigate oral cancer risk in adults who smoke and/or consume unregulated smokeless tobacco products with high risk profiles that are very common in Asia, the Middle East and Africa. However, this approach requires cautious interpretation of the current evidence and ongoing monitoring of emerging products.

Nicotiana tabacum is a cash crop that originated in America and was introduced to the world by Christopher Colombus. It is now cultivated in many countries with major producers including China, the USA, India, and Brazil. The plant was widely used by the indigenous people of America for different reasons (spiritual, hallucination, and medical). The medicinal usage of the plant was confirmed by many phytochemical and pharmacological studies on different parts of the plant. The plant essentially contains alkaloids (nicotine is the major component) and phenolic compounds such as flavonoids, tannins, and many phenolic acids. Glycosides and terpenes are also present in N. tabacum. These components are responsible for many pharmacological effects. Besides the therapeutic usage of the plant, the leaves of the plant served as a hallucination agent; they were either smoked or chewed. Nowadays tobacco products are universally used. Smokeless tobacco products are numerous and diversified; they can be handmade or manufactured. Unlike the plant, smokeless tobacco products are harmful to health. Many products exist around the world with different compositions and names, such as paan, zarda, toombak, khaini, naswar, loose leaf, moist snuff, snus, and shammah. These products have been confirmed to cause many serious pathological conditions. In addition to being addictive, they can lead to various types of cancer especially oral cancer, hypertension, cardiovascular diseases, fertility issues, and fetal damage when consumed by pregnant women. They also increase the risk of thrombosis and so on. While the harmful effects of some products have been scientifically proven, others (e.g., chemma) have not. This highlights the importance of scientific investigation to confirm their potential risks.