Background: Zarda is a widely used form of smokeless tobacco in India. Cigarette smoking has extensive effects on cardiovascular functions. Zarda is prepared by a user by mixing tobacco with lime in palm and gives the user the choice to change the combination. This study aims to determine the effect of Zarda on cardiovascular system adaptability to exercise. There are conflicting opinions about the degree of adaptability of the cardiovascular system in delivering the physiological needs in case of severe exercise. A role of the normal cardiovascular system in delivering oxygen to meet the demands of various degrees of exercise has been a topic of considerable debate. The effect of Zarda usage on this phenomenon is studied here. Materials and Methods: Cardiovascular functions were assessed after maximal exercise testing by recording parameters like maximum heart rate, delta heart rate, recovery heart rate and maximum oxygen pulse in two groups, namely Zarda users and non-user controls. Results: On studying the differences in cardiovascular functions in users and controls, there was a significant difference found in maximum heart rate. The other parameters like delta heart rate and maximum oxygen pulse were on the higher side in controls while the recovery heart rate was significantly lower in the control group which was consistently maintained after exercise testing. Based on these findings it is suggested that there is a higher adaptability of the cardiovascular system to the exercise stimulus in the form of better VO ₂ max, faster recovery of the exercise heart rate, and a lesser risk for cardiovascular mortality as suggested by the higher delta heart rate in non-Zarda users.

Factor XI (F XI) deficiency is a rare bleeding disorder with an autosomal inheritance and generally asymptomatic. However, the incidence of primary post-partum hemorrhage and secondary post-partum hemorrhage in F XI deficiency were reported as 16% and 24%, respectively. A 35-year-old primigravida woman diagnosed with F XI deficiency was examined by the maternal-fetal medicine service of our hospital at 37 weeks 5 days' gestation. Her blood levels of F XI and activated partial thromboplastin time were %2 and 116 s, respectively at pre-partum period. We made fresh frozen plasma (FFP) replacement 1 day before surgery and we continued transfusions until post-operative 6 ^th day. The most challenging problems we encountered were hypervolemia and electrolyte imbalance. The management of F XI deficiency necessitates careful consideration and replacement with FFP is believed to be the main approach.

Submandibular gland is the second largest salivary gland and comprised of two parts, superficial and deep part. The medial side of the superficial part of the gland neighbors to several structures like glossophayngeal nerve. It is innervated by lingual nerve (sensorial fibers) tympanic chord (parasympathetic fibers) and sympathetic trunk. During a routine dissection, a variant branch of glossopharyngeal nerve entering submandibular gland was observed in an adult male cadaver. During that surgical procedure in the parapharyngeal and submandibular spaces, preservation of the gland function and innervation has a major physiological importance. We did not have any chance to observe the clinical effect of this variation since it was demonstrated on a cadaver. To the best of our knowledge, there is no study published regarding this variation. To bear in mind that submandibular gland can be innervated from glossopharyngeal nerve as a variation is important to preserve the glandular function and to prevent cutting this nerve accidentally during surgery.

The concept of acculturation is used to describe adjustment of a foreign-born immigrant to their new country of residence by means of the adoption of newer customs, rituals, norms, and behaviors. In today's world, amidst the globalization, various reasons, such as international trade and commerce, industrialization, propagation of religion, education opportunities, vocational openings, and conquest, have facilitated "culture contact". Acculturation tends to have an important influence on health by bringing about alterations in the levels of stress, access to the healthcare delivery system, and by remodeling the general attitude of people towards health. To conclude, acculturation has a significant impact on almost all determinants of the health and it is an important phenomenon in the process of globalization and development of society in the modern era.