To the Editor, In an era saturated with selfies, filters, and eurocentric beauty ideals, glutathione has undergone a radical transformation–from a cellular antioxidant to a cosmetic commodity marketed as a “skin-whitening miracle.” Clinics from Manila to Mumbai tout their efficacy, often administered through intravenous (IV) infusion or oral supplements. But behind this glow lies a troubling narrative of selective science, cultural exploitation, and ethical collapse. Biochemically, glutathione–a tripeptide composed of glutamine, cysteine, and glycine–serves as a crucial antioxidant, supporting liver detoxification, redox balance, and cellular defense mechanisms. Claims about its skin-lightening effects are based on its proposed ability to inhibit tyrosinase and influence melanogenesis, shifting from eumelanin (dark) to pheomelanin (light). However, most supporting evidence comes from limited in vitro studies and anecdotal reports. Clinical trials are few, small in scale, and often lack rigorous methodology.[1,2] Despite these gaps, the molecule has become a staple in aesthetic dermatology. Influencers showcase postinjection radiance; beauty clinics promote “Snow White drips” and “Korean glass skin shots”–fueled more by digital illusion than clinical validation. Oral glutathione has poor bioavailability, and IV administration has not been approved by regulatory authorities for cosmetic use.[3] More concerning are the ethical violations. Adverse effects, ranging from hepatic dysfunction to hypersensitivity reactions, have been reported, particularly with unsupervised or off-label use.[4] Regulatory bodies like the Philippine FDA and US FDA have warned against its cosmetic application,[5] yet enforcement remains inconsistent, especially in low- and middle-income countries where colorism is deeply entrenched. The billion-dollar skin-lightening industry thrives on insecurity, often targeting young women and socially marginalized groups. The pursuit of fairness is sold not just as beauty, but as status, acceptance, and economic mobility. In doing so, it reinforces harmful ideals and internalized prejudice. Glutathione’s rebranding for cosmetic use exemplifies the hijacking of science by commercial interests. The medical community must advocate for stricter regulation, promote public education, and challenge the normalization of skin lightening. Beauty should reflect authenticity, not artificial standards shaped by postcolonial legacies. Glutathione serves well-established roles as a potent antioxidant and in liver detoxification, with clinically supported efficacy. It is an approved adjunctive in chemotherapy. In contrast, its cosmetic skin-whitening claim lacks robust and conclusive scientific evidence. TOWARD A BETTER ENDING – REWRITING THE SCRIPT – FROM ILLUSION TO EMPOWERMENT The solution is not merely regulatory but cultural. Science must reclaim the narrative from commerce. Ethical medicine must challenge unregulated aesthetics. And society must confront its bias. Medical associations must advocate against the nontherapeutic use of glutathione, educate the public on its risks and false promises, regulate clinics and online sales rigorously, and promote diversity-positive campaigns in the media. Glutathione is a molecule with genuine medical potential. But its misuse as a whitening agent distorts both its purpose and the perception of beauty. In the quest for radiance, let us not lose our reflection. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Abstract Background: Obesity is a major risk factor for metabolic and age-related diseases, yet its association with biological ageing remains unclear. Telomere length is a recognized biomarker of cellular ageing, and adipokines, such as leptin, may play a role in telomere attrition. This study investigates the relationship between leukocyte telomere length (LTL), serum leptin levels, and anthropometric markers of obesity in an adult Indian population. Materials and Methods: A cross-sectional study was conducted among 90 adults, stratified equally into normal-weight, overweight, and obese groups based on the World Health Organization’s Asia-Pacific body mass index (BMI) criteria. Anthropometric parameters were recorded. LTL was measured using quantitative polymerase chain reaction, and serum leptin levels were determined by enzyme-linked immunosorbent assay. Correlation analyses were performed using Spearman’s test. Results: LTL showed significant inverse correlations with BMI ( r = −0.205, P = 0.047), hip circumference ( r = −0.269, P = 0.010), and neck circumference ( r = −0.227, P = 0.032). A paradoxical positive correlation was observed with waist-hip ratio (WHR) ( r = 0.233, P = 0.027). Serum leptin levels showed no significant correlation with LTL or anthropometric variables in the overall cohort. However, participants with normal BMI but elevated WHR exhibited significantly higher leptin levels (8.29 ± 12.51 ng/mL), suggesting leptin resistance. Conclusion: LTL was associated with general adiposity markers, but its relationship with WHR was paradoxical and requires cautious interpretation. Central adiposity, identified by high WHR, was a marker of metabolic dysfunction (hyperleptinemia) independent of BMI. The dissociation between leptin and telomere length highlights the complex interplay between metabolic risk and cellular ageing in this population.

Abstract Background: Glyphosate, a widely used herbicide, is increasingly implicated in intentional self-poisoning cases in India. Despite its extensive use, the literature on clinical presentation and outcomes from glyphosate poisoning in Indian settings remains limited. Materials and Methods: This observational study involved 66 patients admitted with glyphosate poisoning during a specified study period. Data on demographics, time to hospital presentation, clinical features, duration of hospital stay, and outcomes were analyzed. Results: During the study period, 66 patients were diagnosed with glyphosate poisoning, with a mean age of 31.71 ± 11.60 years. Males predominated (75.75%). The majority (95.45%) of the patients were discharged after recovery, with a mortality rate of 4.54%. The average time from poison ingestion to hospital presentation was 5.16 h, and the mean duration of hospital stay was 4.16 days. The most common symptoms were vomiting (63.63%), followed by breathlessness (12.12%), hypotension (9.09%), altered sensorium (6.06%), respiratory failure (6.06%), and acute kidney injury (6.06%). Early supportive management resulted in favorable outcomes for most patients. Conclusions: Glyphosate poisoning, though associated with significant clinical symptoms, has a relatively low mortality rate when treated promptly. Early recognition and supportive care are crucial in improving outcomes. Public health measures are needed to regulate access and educate the population about its toxicity.

Abstract We present the case of a patient with dermatomyositis who developed heart failure and cardiogenic shock as a manifestation of secondary myocarditis, requiring a muscle biopsy, intensive care support, and a multidisciplinary team.

Abstract Background: Diabetes mellitus (DM) is a common chronic condition that requires regular monitoring of blood glucose levels. Saliva contains various biomarkers that can reflect physiological changes in the body, indicating its potential as an alternative source for glucose monitoring. Objective: This study aimed to correlate salivary glucose levels with blood glucose levels in patients with DM at a tertiary care center in North Karnataka. Materials and Methods: A cross-sectional, descriptive observational study was conducted over a 1-year period, involving 100 patients diagnosed with type 2 DM. Data on fasting and postprandial salivary and blood glucose levels, as well as Glycated hemoglobin (HbA1c), were collected. Pearson correlation coefficients were used to evaluate the relationship between salivary and blood glucose levels. P < 0.05 was considered statistically significant. Results: The mean age was 60.6 ± 13.01 years, with 62% males. The majority of the study population was over 60 years old (47%), while those aged 51–60 years comprised 32%. The mean fasting salivary glucose (FSG) was 5.22 ± 3.45 mg/dL, and postprandial salivary glucose (PPSG) was 8.34 ± 4.08 mg/dL. The mean fasting blood glucose was 141.4 ± 41.2 mg/dL, postprandial blood glucose was 213.8 ± 51.6 mg/dL, and the mean HbA1c was 8.2% ±1.7%. Significant positive correlations were observed between FSG levels and both fasting capillary and blood glucose levels (P < 0.05). Similarly, significant correlations were found between PPSG levels and postprandial capillary and blood glucose levels (P < 0.05). FSG also showed a positive correlation with HbA1c, though it was not statistically significant (P > 0.05), while PPSG had a significant correlation with HbA1c (P < 0.05). PPSG levels were significantly higher in patients with severe nonproliferative diabetic retinopathy compared to those with mild or moderate forms (P < 0.05). In contrast, differences in FSG across retinopathy grades were not significant (P > 0.05). Conclusion: The findings indicate that salivary glucose levels are significantly correlated with blood glucose levels in patients with DM, suggesting that saliva can be used as a noninvasive method for glucose measurement.

To the Editor, The study by Koul et al.[1] published in the July 2025–September 2025 issue of the APIK Journal of Internal Medicine is intriguing. Using dual-energy X-ray absorptiometry (DEXA) scans, Koul et al.[1] found that low bone mineral density (BMD) was predominant among Indian patients with chronic liver disease (CLD) of various causes. Moreover, BMD worsened with the progression of liver disease and was associated directly with the Child–Turcotte–Pugh (CTP) score. Koul et al.[1] recommended that CLD patients undergo routine BMD assessment and, if indicated, receive proper treatment for osteoporosis/osteopenia to prevent worsening their CTP score. A few study limitations were mentioned by Koul et al.[1] We hereby address a worthy point that could deliver a new insight into the discussion of the study. BMD reference intervals (BMDRIs) are essential for accurately interpreting BMD estimates obtained from DEXA scans. The criteria established by the World Health Organisation (WHO) in terms of T-scores are widely used to define osteoporosis and osteopenia. Age, gender, race, weight, and socioeconomic class are a few of the factors that impact BMDRIs formulation.[2] As a result, BMDRIs have been developed for specific populations for use in clinical settings and research centres.[3,4] Interestingly, India established BMDRIs for the healthy adult population that have diagnostic and therapeutic implications in the management of osteopenia/osteoporosis.[5] Amazingly, Koul et al.[1] referred to the WHO BMDRs instead of the local one to interpret recorded BMD readings in the study population with CLD. Consequently, Koul et al.’s study findings[1] might become questionable. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Abstract The South African flag sign is an acute, dynamic electrocardiographic (ECG) finding typically associated with first diagonal (D1) artery branch of left anterior descending coronary artery occlusion. We report the case of a 62-year-old female patient who presented with a history of chest pain suggestive of acute coronary syndrome, who exhibited this ECG pattern, and subsequently, angiogram revealed a total block of large diagonal branch which was treated with primary angioplasty.

Abstract Background: Amitraz is a member of formamidine family of pesticides. Its structure is 1,5 di-(2,4-dimethyl phenyl)-3-methyl-1,3,5-triazpenta 1,4 dione. It is used as agriculture insecticide for fruit crops and as an acaricide for dogs and livestock. Amitraz is pharmacologically active with an alpha-2 adrenergic agonist action. Materials and Methods: Patients with amitraz poisoning admitted to the General Medicine Department of Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India, between 2022 March and 2023 December were studied. Patients aged more than 13 years who gave informed consent were included in the study. Results: A total of 78 patients of amitraz poisoning were seen and 60.30% were male and 39.70% were female. Nausea and vomiting were the most common symptoms and were observed in 67.9% of the patients. Respiratory depression was seen in 60.3% of the patients. Loss of consciousness was the most common complication and was seen in 62.8% of the patients. The mortality rate was 5.12% (four patients) and 94.87% (74 patients) were discharged. In our study, 62.8% of the patients required endotracheal intubation and were put on mechanical ventilation. The mean duration of time to death after poisoning was 4 days, one patient died within 24 h of hospitalization and multiorgan dysfunction was the common cause of death. Conclusion: The clinical presentations of most of the patients with amitraz poisoning were relatively severe and required intubation and mechanical ventilation. The prognosis is generally good with supportive treatment.

Abstract Objectives: This study aimed to assess the prevalence of adrenal insufficiency in patients with primary hypothyroidism who continued to be symptomatic despite adequate biochemical correction of hypothyroidism with synthetic levothyroxine. Methods: This cross-sectional study included 160 patients aged 18–70 years and with primary autoimmune hypothyroidism (PAH) for at least 3 months with normal thyroid-stimulating hormone values. Anti-thyroid peroxidase levels, basal cortisol levels, and 60-min postadrenocorticotropic hormone test were done in the 20 patients who continued to be symptomatic on the Zulevski scale despite euthyroid levels. The comparison of various demographic and clinical factors was done with adrenal insufficiency. P <0.05 was considered statistically significant. Results: Among 20 symptomatic AIT patients, 8 (40%) were found to have adrenal insufficiency. There was no statistical difference in the age, gender, body mass index, and duration of disease with adrenal insufficiency (P > 0.05). The mean dose of L-thyroxine with adrenal insufficiency and those without adrenal insufficiency were comparable and the difference was not statistically significant (62.5 vs. 68.75 P = 0.4). Conclusions: Adrenal insufficiency may be present in patients with hypothyroidism who continue to be symptomatic despite euthyroid levels. The investigations in such patients must not be restricted to just thyroid monitoring but must extend to adrenal function assessment to rule out polyglandular involvement.