To the Editor:
We found the letter from Dr Munusamy and co-workers, titled “Optimizing Recovery in Oral Flap Surgeries: The Undervalued Role of Physiotherapy,” of great value and interest. The letter comprehensively addresses the true outcomes of a surgically treated oral cancer patient, mostly adjunct with postoperative radiotherapy.
Objective: This study examines the interplay between childhood trauma, war exposure, and maladaptive coping mechanisms, with a focus on post-traumatic stress disorder (PTSD) as a mediator and war exposure as a potential moderator in the relationship between childhood trauma and emotional eating.
Methods: Participants completed validated measures of childhood trauma, PTSD, and emotional eating. Statistical analyses included Pearson correlations, stepwise linear regression, and moderated mediation models, adjusting for age and gender.
Results: The study included 426 Hebrew-speaking Israeli adults (52.8% female, 47.2% male, mean age 40). Childhood trauma, particularly emotional abuse, was significantly associated with PTSD and emotional eating. The relationship between childhood trauma and emotional eating was fully mediated by PTSD, with a stronger effect observed for emotional abuse. War exposure significantly predicted PTSD but did not moderate the link between PTSD and emotional eating. Sex differences emerged, with female participants exhibiting higher PTSD levels than males.
Conclusions: The findings emphasize the enduring impact of childhood trauma, particularly emotional abuse, on maladaptive coping mechanisms like emotional eating, mediated by PTSD. While war exposure intensified PTSD symptoms, it did not significantly influence emotional eating. These results highlight the differential effects of early- and later-life traumas, offering insights for targeted interventions in trauma recovery.
Background: Xerostomia, or dry mouth, often intensifies oral health problems like dental caries and periodontitis. Smoking is a key factor influencing salivary flow, potentially leading to these issues. This study assesses the prevalence of xerostomia and reduced salivary flow (hyposalivation) among smokers.
Materials and Methods: As case and control groups, the study groups include 150 smokers and 150 healthy non-smokers. A detailed questionnaire was used to collect data on smoking behaviors and symptoms associated with xerostomia. A modified Schirmer test was conducted at 1, 2, and 3-minute intervals to measure unstimulated salivary flow. Descriptive statistics were calculated for age, sex, type, frequency, and duration of smoking. The Mann–Whitney test was done to compare the salivary flow between smokers and non-smokers and to compare smoking parameters with salivary flow. Correlation was also determined for salivary flow with age and smoking parameters.
Results: All the smokers were males, and most were cigarette smokers (86%). Xerostomia symptoms were reported by 19% of smokers and none by non-smokers, which was statistically significant (P<0.000). Salivary flow rates at 1, 2, and 3 minutes were significantly lower in smokers than in non-smokers. A comparison between the frequency and duration of smoking and salivary flow yielded statistically significant P values of 0.005 and 0.043, respectively. There was a weak negative correlation between age, frequency of smoking, duration of smoking, and salivary flow.
Conclusion: This study found a clear association between long-term smoking and xerostomia, with a notable decrease in unstimulated salivary flow. This highlights the adverse effect of smoking on oral health, which could be used in effective counseling for tobacco cessation.
Introduction: Pulp stones (PS) are incidental, mostly asymptomatic, radiographic findings that may hinder endodontic therapy. They are observed as radiopaque aggregates within coronal or radicular pulp tissue on intraoral periapical, bite-wing, panoramic radiographs, and cone beam computed tomography images. This study aimed to evaluate PS prevalence in patients with cardiovascular disease (CVD), diabetes mellitus (DM), and chronic periodontitis (CP) as compared with controls, as a function of age and sex.
Material and Methods: This cross-sectional study included 200 subjects: 50 healthy controls, and 50 patients each with CVD, DM, and CP. All participants underwent digital panoramic radiograph (orthopantomogram) (OPG) evaluation for the presence/absence, number, and location of PS.
Results: Significant differences in PS prevalence were observed among the groups (P<0.01), with CVD patients showing the highest prevalence. Older individuals (>50 years) and first molars were most frequently affected. The maxillary arch showed a significantly higher prevalence than the mandible (odds ratio [OR]=1.45; 95% CI 1.22–1.72). The strongest risk factor was CVD (OR=7.38; 95% CI 5.20–10.47), followed by DM (OR=4.18; 95% CI 2.91–5.99) and CP (OR=4.16; 95% CI 2.88–6.00). Age was significantly associated with PS, while sex showed no association.
Conclusion: The presence of PS, even among healthy controls, may serve as an adjunctive radiographic marker and could also alert dental practitioners to the possibility of underlying systemic disease.
Dear Editor,
I read “Kidnapped But Not Kids: A Case Series of Three Octogenarian Hostages Held in Captivity by Hamas” by Clarfield and Levine1 with what I can only describe as a mix of disbelief and deep concern. It may well represent one of the starkest instances of elder abuse in recent years, if not modern memory. There’s something particularly troubling, even haunting, about the additional layers of trauma these elderly individuals endured, given both their age and medical vulnerability. The sense of disregard for even the most basic ethical standards is difficult to ignore.
Background: Sarcopenia and frailty are multi-factorial conditions, but few studies have examined their prevalence among older adults with diabetes in the Indian subcontinent. This study aimed to estimate prevalence of sarcopenia and frailty in ambulatory patients ≥65 years with type 2 diabetes mellitus (T2DM).
Methods: Sarcopenia was assessed utilizing the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Frailty was assessed using the Fried Frailty phenotype criteria. The study enrolled ambulatory participants aged 65 years and above with T2DM visiting the outpatient clinic. Patients with degenerative or inflammatory arthritis of the lower limbs, disabling cerebrovascular accidents, Alzheimer’s disease or other cognitive impairment, as well as those with chronic obstructive pulmonary disease, chronic liver disease, or chronic kidney disease were excluded from the study.
Results: Among the 100 outpatients meeting the inclusion criteria, sarcopenia was present in 30% (in-cluding 17% with severe sarcopenia). Frailty was present in 27%, pre-frailty in 59%, and 14% were classified as robust.
Conclusion: This study demonstrated a high prevalence of both sarcopenia and frailty among older adults with T2DM. Routine screening for these conditions may facilitate early identification and intervention in this high-risk population.
[Letter to the Editor] Home-based pulmonary rehabilitation (PR) represents a practical, patient-centered approach to managing chronic obstructive pulmonary disease (COPD), particularly in settings with limited access to conventional center-based programs. In their study, Kasim et al. demonstrated that a structured 12-week home-based PR program improved pulmonary function and disability outcomes, with particular gains in activities of daily living and social participation, as measured by the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). This letter highlights the significance of these findings, emphasizing the multidimensional benefits of PR beyond pharmacological therapy, including physiological, psychosocial, and functional improvements. We also discuss potential limitations, such as the lack of a control group, reliance on self-reported adherence, and the need for long-term and personalized interventions. The integration of tele-rehabilitation, cognitive and mobility-focused exercises, and family involvement may further enhance outcomes. Home-based PR has important implications for low- and middle-income countries, offering a cost-effective strategy to reduce disease burden, improve quality of life, and support sustainable, comprehensive COPD management.
Background: Cardiovascular disease is the leading global cause of death, with lifestyle and sociodemographic factors playing key roles in cardiovascular risk (CVR).
Objective: This two-phase study assessed the associations of alcohol intake, Mediterranean diet adherence, physical activity, and sociodemographic variables with CVR—as measured by the Registre Gironí del Cor (REGICOR) function and Systematic COronary Risk Evaluation 2 (SCORE2) algorithm—in a large cohort of Spanish workers (Phase 1). A secondary aim was to examine CVR trends from 2010 to 2020 (Phase 2).
Methods: A two-phase study was conducted: a cross-sectional analysis of 139,634 workers (Phase 1) and a longitudinal follow-up of 40,431 participants (Phase 2). Anthropometric, clinical, biochemical, and behavioral data were collected using standardized procedures. Multinomial logistic regression was used to evaluate associations.
Results: Phase 1 results showed a higher CVR associated with male sex, older age, lower education, manual labor, smoking, physical inactivity, low adherence to the Mediterranean diet, and alcohol consumption. In Phase 2, CVR increased over the decade, especially among smokers, sedentary individuals, and those with lower education.
Conclusions: Both modifiable behaviors and structural determinants significantly influence CVR. Preventive strategies should integrate lifestyle promotion with measures to reduce social inequalities, with targeted actions for vulnerable groups.
To the Editor,
We commend Cohen et al. for introducing a pragmatic composite—Padua score × D-dimer (PaDd)—designed to refine pulmonary embolism (PE) exclusion in adults aged ≥65 years, a population often characterized by multimorbidity, physiological het-erogeneity, and atypical presentations. Their single-center retrospective cohort (2021–2023) provides a compelling, hypothesis-generating signal: combining a validated venous thromboembolism risk score with D-dimer may enhance specificity without compromising safety.
To the Editor,
We commend Cohen et al. for introducing a prag-matic composite—Padua score × D-dimer (PaDd)—designed to refine pulmonary embolism (PE) exclusion in adults aged ≥65 years, a population often characterized by multimorbidity, physiological heterogeneity, and atypical presentations. Their single-center retrospective cohort (2021–2023) provides a compelling, hypothesis-generating signal: combining a validated venous thromboembolism risk score with D-dimer may enhance specificity without compromising safety.
