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Objective: This study aims to validate a protocol for a multidisciplinary management of delusional halitosis and to assess their outcome of treatment. Method: A prospective study of 61 patients with complaint of chronic bad breath and initial diagnosis of psychological halitosis after assessment with halitosis questionnaires and clinical examination. A final diagnosis of pseudo halitosis or delusional halitosis was made based on the patients’ response to oral hygiene prophylaxis, antimicrobial treatment and counseling for 2 weeks. The delusional halitosis patients were treated in a ‘Joint Clinic’ of oral medicine physician and mental health experts, using a 5-step treatment protocol over a 4-week period. Treatment outcomes for the delusional halitosis patients were evaluated using patient’s self-assessment, WHO well-being index, psychological score and other mental health instruments. Results: There were 33 (54.1%) delusional halitosis patients among the psychological halitosis patients. Twenty (60.6%) patients out of the 33 (100%) delusional halitosis patients attended the ‘joint clinic’. Six (30.0%) of the 20 treated patients had improved self-esteem, while only 1 (5.0%) and 3 (15.0%) showed improvement in state anxiety and trait anxiety respectively. Normal psychological score was found in 1 (25.0%) out of 4 (100%) patients that claimed to be ‘cured’, and 3 (50.0%) out of 6 (100%) patients had ‘improved’ final self-assessment. Conclusion: Preliminary findings suggest early signs of recovery, with improvement in self-esteem, anxiety and psychological problems in delusional halitosis patients.

TLRs initiate innate immune signaling pathways via Toll/IL-1R (TIR) domains on their cytoplasmic tails. Various bacterial species also express TIR domain-containing proteins that contribute to bacterial evasion of the innate immune system. Bacterial TIR domains, along with the mammalian sterile α and TIR motif-containing protein 1 and TIRs from plants, also have been found to exhibit NADase activity. Initial X-ray crystallographic studies of the bacterial TIR from Acinetobacter baumannii provided insight into bacterial TIR structure but were unsuccessful in cocrystallization with the NAD+ ligand, leading to further questions about the TIR NAD binding site. In this study, we designed a Course-Based Undergraduate Research Experience (CURE) involving 16-20 students per year to identify amino acids crucial for NADase activity of A. baumannii TIR domain protein and the TIR from Escherichia coli (TIR domain-containing protein C). Students used structural data to identify amino acids that they hypothesized would play a role in TIR NADase activity, and created plasmids to express mutated TIRs through site-directed mutagenesis. Mutant TIRs were expressed, purified, and tested for NADase activity. The results from these studies provide evidence for a conformational change upon NAD binding, as was predicted by recent cryogenic electron microscopy and hydrogen-deuterium exchange mass spectrometry studies. Along with corroborating recent characterization of TIR NADases that could contribute to drug development for diseases associated with dysregulated TIR activity, this work also highlights the value of CURE-based projects for inclusion of a diverse group of students in authentic research experiences., (Copyright © 2024 The Authors.)