Safety and efficacy of resmetirom in the treatment of patients with non-alcoholic steatohepatitis and liver fibrosis: a systematic review and meta-analysis.

Introduction: Non-alcoholic fatty liver disease (NAFLD), spanning from non-alcoholic steatohepatitis (NASH) to liver fibrosis, poses a global health challenge amid rising obesity and metabolic syndrome rates. Effective pharmacological treatments for NASH and liver fibrosis are limited. Objective: This study systematically reviews and meta-analyzes the safety and efficacy of resmetirom, a selective thyroid hormone receptor-ß agonist, in NASH and liver fibrosis treatment. By analyzing data from clinical trials, we aim to offer evidence-based recommendations for resmetirom's use in managing these conditions and identify avenues for future research. Methods: Electronic databases (PubMed, Scopus, Science Direct, Google Scholar, ClinicalTrials.gov, and Cochrane CENTRAL) were systematically searched, supplemented by manual screening of relevant sources. Only English-language randomized controlled trials were included. Data extraction, risk of bias assessment, pooled analyses, and meta-regression were performed. Results: Three randomized controlled trials involving 2231 participants were analyzed. Resmetirom demonstrated significant reductions in hepatic fat fraction [standardized mean difference (SMD) -4.61, 95% CI -6.77 to -2.44, P < 0.0001], NASH resolution without worsening fibrosis [risk ratio (RR) 2.51, 95% CI 1.74-3.64, P = 0.00001), and liver fibrosis improvement (RR 2.31, 95% CI 1.20-4.44, P = 0.01). Secondary outcomes showed significant improvements in lipid profiles, liver enzymes, and NASH biomarkers with resmetirom treatment. Meta-regression revealed associations between covariates and primary outcomes. Conclusion: Resmetirom exhibits promising efficacy in reducing hepatic fat, improving NASH resolution, and ameliorating liver fibrosis with a favorable safety profile. Further research is warranted to validate findings and optimize therapeutic strategies for NASH and liver fibrosis management.

Comparative evaluation of the efficacy of the Pro AF Baby Gold and Kedo-S pediatric endodontic files for canal instrumentation, transportation, and centering ratio - A systematic review and meta-analysis.

BACKGROUND: Traditionally, pediatric endodontics lacked access to the full potential of rotary instruments. These instruments, designed for the permanent root canal system, often presented limitations when used in primary teeth. To address this, exclusive pediatric rotary files with regular improvements have been introduced, featuring superior cutting efficiency with a focus on precise alignment. This design offers the advantage of reduced risk of ledges, perforations, instrument separation, and canal transportation. This study aimed to compare and evaluate the effectiveness of Pro AF Baby Gold and Kedo-S rotary files in preparing primary tooth root canals during pulpectomy procedures through a meta-analysis. METHODOLOGY: The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The review searched electronic databases from 2000 to February 2024 for studies evaluating the efficacy of Pro AF Baby Gold and Kedo-S files in terms of canal instrumentation, transportation, and centering ratio. The Cochrane risk of bias (ROB)-2 tool assessed quality, with analyses conducted using RevMan software version 5.3. The standardized mean difference (SMD) served as the summary with a random effects model (P < 0.05). RESULTS: Out of the five studies identified through the eligibility criteria, three were deemed suitable for a meta-analysis, while all five were included in a qualitative synthesis. The quality assessment revealed a presence of moderate-to-low ROB. The pooled analysis using SMD did not show any statistically significant differences between the files, except for the centering ratio in the mesiobuccal canal, where the Kedo-S file performed slightly better. In addition, the absence of any significant asymmetry in the funnel plot suggests that there is likely no publication bias present in the data. CONCLUSION: Pro AF Baby Gold files can be used as an alternative adjunct in pediatric endodontics to Kedo-S files and manual files.Prospero Registration: CRD42023469406.

Effect of Non-Surgical Periodontal Therapy on Chronic Kidney Disease Patients: A Systematic Review

Abstract Objective: To evaluate the effectiveness of "non-surgical periodontal therapy (NSPT)" on periodontal and renal parameters in periodontitis patients diagnosed with chronic kidney disease. Material and Methods: The review protocol has been registered in Prospero (CRD42020150938). Up to November 2019, we searched the PUBMED database without language constraints. We included randomized controlled (parallel-group or cross-over) trials with CKD and chronic periodontitis in adults aged 18 years and above. Three review authors independently assessed the studies. Three review writers gathered data and simultaneously assessed the risk of bias for individual trials using traditional Cochrane procedures. Results: Studies showed high variability. Three randomized clinical trials (RCT) were excluded because of high heterogeneity; meta-analysis could not be performed. Conclusion: Non-surgical periodontal therapy effectively improves periodontal and renal parameters. However, a meta-analysis could not be performed because of the high heterogeneity among the studies.

An Efficient Service-based System for Hierarchical Human Activity Sensing.

In this paper, we propose an end-to-end system, based on SEnsing as Service (SEAS) model, which processes continuous mobility data from multiple sensors on the client edge-device by optimizing the on-device processing pipelines. Thus, reducing the cost of data transfer and CPU usage. We also propose a classification algorithm as a part of the system to recognize Activities of Daily Living (ADL). The results indicate that our proposed system recognizes ADLs with considerable accuracy and flexibility.Clinical relevance- Measurement of Activities of Daily Living has a high correlation with independent living measures for elderly people [1] and post-event rehabilitation where an event may be heart-attack [2], stroke [3], surgical intervention [4], or trauma [5] etc.

Analyzing the Frequency of Premalignant Lesions and Oral Malignancy in Indian Subjects Attending Outpatient Department From the Low Socioeconomic Group.

BACKGROUND:  Oral cancer is a rapidly growing disease among Indian subjects mainly in the low socioeconomic group. Socially and economically marginalized subjects are at high risk for oral cancer because of smoke and smokeless tobacco consumption. AIM:  To evaluate the prevalence of precancerous lesions and oral cancer and evaluate tobacco as a causative factor in Indian subjects visiting the outpatient department of the institute. METHODS:  Around 658 subjects were analyzed for frequency of premalignant lesions and oral malignancy in Indian subjects from the low socioeconomic group. Patients visited for pain, burning, or ulceration in the oral cavity were clinically assessed for any tissue growths, leathery alterations, ulcerative changes, and white or red lesions in the oral cavity.  Results: The overall prevalence of smokeless and smoking tobacco was 78.8% (n=518) and 65.2% (n=429) respectively in the present study. Around 39.8% (n=262) of samples were stained positive for precancerous and cancerous lesions of the oral cavity. The highest number of positive samples were from buccal mucosa with 36.2% (n=238) subjects and 6.1% (n=40) for labial mucosa. CONCLUSIONS:  Oral cancer is highly prevalent in Indian subjects owing to high tobacco consumption rates and habits warranting the cessation center a priority. Also, early detection and screening are vital to attaining better outcomes. More tobacco cessation centers are needed to stop the habit and early diagnosis will prevent dysplastic changes.

Utilization of xylose enriched extract from spent lemongrass hydrolysate for clavulanic acid production using Streptomyces clavuligerus (MTCC 1142).

The main goal of this study was to provide possible alternative production medium containing xylose enriched spent lemongrass hydrolysate with glycerol as a feedstock and corn gluten meal as a nitrogen source for their ability to support the cell growth of the Streptomyces clavuligerus MTCC 1142 for the production of clavulanic acid. The xylose was extracted from spent lemongrass by using 0.25% dilute nitric acid and further partial purification of acid spent hydrolysate was performed using ion exchange resin. The method was optimized using xylose enriched hydrolysate as feed stock combined with glycerol at ratio 1:1 and growing the selected strain aerobically in media at neutral pH containing 5 mM phosphate ion concentration and using corn gluten meal as a nitrogen source, fermenting at a temperature of 28-30 °C for 96 h and 0.59 g/L clavulanic acid was effectively produced. These results demonstrate the feasibility of using spent lemongrass as feedstock for the cultivation of S. clavuligerus to produce clavulanic acid.

Management of Radix Paramolaris With a Distal Canal in the Mandibular First Molar: A Case Report.

Mandibular first molars, also called six-year molars as they appear at around six years of age, are the first permanent teeth to erupt in the oral cavity. They are the teeth most commonly affected by dental caries. Anatomically, the tooth presents with two roots and three canals. In very rare cases, presence of an extra root or a supernumerary root has been associated with the tooth. When this root is present lingual to the distal root, it is called radix entomolaris whereas when it is present buccal to the mesial root, it is called radix paramolaris. The presence of veiled canals is possible due to variation in the anatomy of the tooth. It is therefore necessary to locate, prepare and obturate these hidden canals in order to achieve success in endodontic treatment.

Cystic lymphangioma presenting as an acute abdomen in an adult male with congenital aortic stenosis.

Abdominal cystic lymphangioma rarely presents as an acute abdomen. In this article, we describe a young adult male with congenital aortic stenosis who initially presented with abdominal pain and raised inflammatory markers. The imaging in the form of a computed tomography scan was unfortunately inconclusive. In the evolution of this diagnostic dilemma, we describe the importance of early operative management as well as explore the link between cardiac and lymphatic malformations.

Pedia tricks - Out-of-the-box thinking in paediatric dentistry.

Noncooperative behaviour faced by a paediatric dentist is the most common attribution towards behavioural manifestations of anxiety in children, and it had been observed that these relationships are long-deterministic and form part of the aforementioned belief system of the child. Forehead and Long in their study found that most uncooperative behaviour of the child is due to their strong will and these children are generally confident, persistent and independent. A fruitful method to deal with strong willed children is to violate the causal relationship by some magic tricks from preventive via curative to his/her follow ups visits. Tricks can be applied at three levels of their visit. Level 1 is preoperative tricks, which includes the preventive measures that teach and educate children for good oral health. Level 2 is operative tricks, which involves child preparedness for successful dental procedures. Level 3 is postoperative tricks, which involve positive reinforcement for regular follow ups. The purpose of this review is to make paediatric dentists think like magicians by using the science behind the magic and applying it in their practice for creating a positive attitude of a child toward dentistry and better procedural experience.

Comparing the Effectiveness of Ultrasonic Instruments Over Manual Instruments for Scaling and Root Planing in Patients With Chronic Periodontitis: A Systematic Review and Meta-Analysis.

Periodontal disease is a chronic, complex, and infectious condition that affects the periodontium. Its progressive form can be identified by the loss and destruction of the periodontal ligament and the alveolar bone, respectively. Periodontal disease, one of the most prevalent oral cavity diseases, is responsible for tooth loss. Scaling and root planing (SCRP) is a standard, non-invasive periodontal therapy for treating patients with periodontitis. However, there have also been connections to disputed results. According to reports, SCRP alone is ineffective in removing pathogenic microorganisms and their by-products from periodontal pockets. In light of this, our current study aims to determine if using manual or ultrasonic instruments for SCRP in patients with a clinical diagnosis of chronic periodontitis is preferable. This systematic evaluation compares the effectiveness of manual and ultrasonic devices for SCRP, a line of therapy for individuals with a clinical diagnosis of chronic periodontitis. The databases searched were Prospero, PubMed, MEDLINE, CENTRAL, ClinicalTrials.gov, and Cochrane Library, which exclusively included English-language papers. The articles were also manually searched for any information missed during the search process.

Comparative Analysis of Sedative Efficacy of Dexmedetomidine and Midazolam in Pediatric Dental Practice: A Systematic Review and Meta-Analysis.

Children are particularly terrified of having dental treatment. They are physically resistant, frail, and unwilling to cooperate. This severe distress during the pre-operative phase could cause the dentist to have issues with behavior control. Additionally, it may make pediatric dental treatments less effective. In order to reduce anxiety and control behavior in children receiving dental care, sedation is a pharmacological management technique that supports the provision of effective and high-quality dental services. The aim is to compare and evaluate the efficacy of sedative agents like dexmedetomidine and midazolam in pediatric dental practice. A thorough review of the literature was conducted using electronic databases like "MEDLINE, PubMed, and CENTRAL (Cochrane Central Register of Controlled Trials), as well as the World Health Organization International Clinical Trials Registry Platform, www.clinicaltrials.gov, conference proceedings abstracts, a bibliography of pertinent references, and manual searches of journals, conferences, and books". There were no restrictions on the language or the date of publication when searching the electronic databases. Randomized controlled trials were included which compared dexmedetomidine and midazolam in children up to 16 years of age subjected to dental treatment. Information on procedures, participants, interventions, outcome measures, and results were independently extracted by three review writers (TS, SL, and RO). Trial authors were contacted for papers that were confusing or lacking information. The risk of bias was evaluated for each study. We adhered to the Cochrane statistical recommendations. Three trials totaling 229 participants were included. All three studies were rated as having a low risk of bias, with none of them having a high or unclear risk. Meta-analysis was done for the available data for the primary outcomes like sedation level and recovery time. We searched for randomized controlled trials up to Jan 31, 2020. Participants are randomly assigned to an intervention or control group in randomized controlled trial research. While patients in the control group often get a placebo therapy or procedure, those in the interventional group receive the treatment being studied. We found three studies eligible to include in the review. One study evaluated 73 individuals who received general anesthesia for dental treatment. There were 72 and 84 individuals in the second and third investigations, respectively. All the participants of the three studies were divided randomly into two groups and were subjected to dexmedetomidine and midazolam as sedative agents. We gave the evidence an "extremely low certainty" rating. Because there are just three short trials with unusual parameters for comparison, the results are questionable. Overall, the results do not allow us to draw any firm conclusions. Three randomized controlled trials included in this systematic review reported data with varying conclusions; hence we recommend more randomized controlled trials to be conducted on this subject matter.

Synthesis, Electrochemical Studies, Molecular Docking, and Biological Evaluation as an Antimicrobial Agent of 5-Amino-6-cyano-3-hydroxybenzo[c]coumarin Using Ni-Cu-Al-CO3 Hydrotalcite as a Catalyst.

New insights via a multicomponent cyclocondensation reaction of 2-hydroxy benzaldehyde acetoacetic ester and malononitrile were attained under efficient conditions. A detailed mechanistic study exhibits that the reaction via multicomponent, one-pot, two-step incooperating three-components' reactants under nominal conditions efficiently synthesizes the intermediates in shorter than reported time along with the formation of a novel compound [5-amino-6-cyano-3-hydroxybenzo[c]coumarin] in the presence of Ni-Cu-Al-CO3 hydrotalcite as a heterogeneous catalyst. Hydrotalcite functions as an efficient and versatile catalyst as it is safe, easy to work up, and recyclable many times under ambient conditions, and the reaction time is shorter. The aforementioned conditions make these solid basic heterogeneous catalysts environmentally friendly. The product yield obtained was 89%. The product was characterized using FTIR, LCMS, and NMR. Electrochemical studies were also carried out to check the reduction and oxidation behavior. The synthesized product showed antimicrobial activity. Antimicrobial activity against human pathogens, viz, S. Aureus, P. Aeruginosa, and P. Bulgaria, was studied by using the agar well diffusion method. The molecular docking studies of 5-amino-6-cyano-3-hydroxybenzo[c]coumarin exhibit its suitable attachment at the active center of the type IIA topoisomerases and gyrase enzymes which suggest its potential antibacterial activity when compared using ciprofloxacin drug as the control.

Lysozyme microspheres incorporated with anisotropic gold nanorods for ultrasound activated drug delivery.

We report on the fabrication of lysozyme microspheres (LyMs) incorporated with gold nanorods (NRs) as a distinctive approach for the encapsulation and release of an anticancer drug, 5-Fluorouracil (5-FU). LyMs with an average size of 4.0 ± 1.0 µm were prepared by a sonochemical method and characterized using scanning electron microscopy (SEM), transmission electron microscopy (TEM) and Fourier-transform infrared spectroscopy (FTIR). The LyMs were examined using hydrophobic (nile red) as well as hydrophilic (trypan blue) dyes under confocal laser scanning microscopy (CLSM) to obtain information about the preferential distribution of fluorescent molecules. Notably, the fluorescent molecules were accumulated in the inner lining of LyMs as the core was occupied with air. The encapsulation efficiency of 5-FU for LyMs-NR was found to be ∼64%. The drug release from control LyMs as well as LyMs incorporated with NRs was investigated under the influence of ultrasound (US) at 200 kHz. The total release for control LyMs and LyMs incorporated with gold NRs was found to be ∼70 and 95% after 1 h, respectively. The density difference caused by NR incorporation on the shell played a key role in rupturing the LyMs-NR under US irradiation. Furthermore, 5-FU loaded LyMs-NR exhibited excellent anti-cancer activity against the THP-1 cell line (∼90% cell death) when irradiated with US of 200 kHz. The enhanced anti-cancer activity of LyMs-NR was caused by the transfer of released 5-FU molecules from bulk to the interior of the cell via temporary pores formed on the surface of cancer cells, i.e., sonoporation. Thus, LyMs-NR demonstrated here has a high potential for use as carriers in the field of drug delivery, bio-imaging and therapy.

Impact of Pollutant Load from Textile Dyeing Industry Wastewater on Biometric Growth Profile of Vigna radiata.

The phytoremediation of wastewater has certain advantages, but the interactions of soil and crop properties have not been systematically studied. This study aimed to analyze how different concentrations of textile dyeing industry wastewater (25%, 50%, 75%, and 100%) affected soil qualities, growth, and yield attributes (Vigna radiata). In reaction to dyeing effluent at varying concentrations, the seed germination percentage, growth metrics such as tolerance index, phytotoxicity percentage, relative toxicity, extreme and plumule length were calculated. With increasing effluent concentrations, a gradual decrease in the germination of seed and seedling growth was observed. The maximal relative toxicity and percentage of phytotoxicity was 100%. Interaction of biometric growth profile relative seed germination, relative root growth, relative shoot growth, growth index, and seedling vigor index of V. radiata and physicochemical parameter of textile dyeing industry wastewater were also investigated by using the Pearson correlation co-efficient. Principal component analysis (PCA) is helped to obtain and recognize the factors/sources accountability of different concentrations of textile dyeing industry wastewater. The results of the PCA revealed that four components (PC1 to PC4) out of total principal components retained PC1, PC2, with values of 69.25% and 28.85%, respectively.

A novel algorithm for mask detection and recognizing actions of human.

Face recognition has become a significant challenge today since an increasing number of individuals wear masks to avoid infection with the novel coronavirus or Covid-19. Due to its rapid proliferation, it has garnered growing attention. The technique proposed in this chapter seeks to produce unconstrained generic actions in the video. Conventional anomaly detection is difficult because computationally expensive characteristics cannot be employed directly, owing to the necessity for real-time processing. Even before activities are completely seen, they must be located and classified. This paper proposes an expanded Mask R-CNN (Ex-Mask R-CNN) architecture that overcomes these issues. High accuracy is achieved by using robust convolutional neural network (CNN)-based features. The technique consists of two steps. First, a video surveillance algorithm is employed to determine whether or not a human is wearing a mask. Second, Multi-CNN forecasts the frame's suspicious conventional abnormality of people. Experiments on tough datasets indicate that our approach outperforms state-of-the-art online traditional detection of anomaly systems while maintaining the real-time efficiency of existing classifiers.

Andrographis paniculata mitigates first-line anti-tubercular drugs-induced nephrotoxicity in Wistar rats.

CONTEXT: Anti-tubercular drugs (ATDs) mediated adverse drug reactions are major concerns for clinicians to treat tuberculosis infection. This study aimed to investigate Andrographis paniculata extract-based phytotherapy to combat the nephrotoxic effects caused by ATDs therapy. METHODS: Reno-protective effect of A. paniculata extract in ATDs-induced rats was evaluated through LPO, GSH, CAT, SOD, GST, urea, creatinine, uric acid, and histopathological studies. Standardization of the extract was performed using RP-HPLC and FTIR analysis. Whereas, the effect of A. paniculata extract on ATDs induced genetic perturbation was analyzed using micronucleus assay. Moreover, the expression level of the xenometabolic gene was investigated using RT-PCR to explore the therapeutic mechanism. RESULTS: The nephrotoxic effect of ATDs was indicated by elevated levels of LPO and renal function markers along with the reduced activity of renal antioxidants. An up-regulated expression profile of NAT gene and histological alterations were observed in renal tissue however, micronucleated PCEs were observed in bone marrow cells. Concomitant treatment with A. paniculata extract revealed a noticeable amelioration of elevated oxidative stress markers, gene expression levels, genotoxic perturbation, and histological alterations in a dose-dependent manner. CONCLUSION: Hence, the present study using A. paniculata leaf extract confirmed to play effective phytotherapy against ATDs induced renal toxicity.

Ternion Cusp: An Unusual Variant of Talon's Cusp: A Case Report.

Background: Teeth are hard mineralized anatomical components of the dentofacial skeleton that are developed during the gestation period by odontogenesis. This dental development comprises five stages viz. initiation, proliferation, histodifferentiation, morphodifferentiation, and apposition. Excitation to the dental organ during morphodifferentiation is responsible for the formation of a talon cusp, which manifests as a cusp-like structure of hard tissue projecting from the cingulum to a varying measurable length toward the incisal edge of maxillary and mandibular anterior teeth. Various literature has reported that it comprises enamel, dentine, and an inconsistent amount of pulp tissue. Old literature suggests its occurrence in primary and permanent teeth and mostly on the palatal aspect of teeth as one cusp; therefore, known as a talon cusp (eagle's talon). Case description: An exceptional case of three cusped structures projecting from the palatal side of a maxillary central incisor is thus reported. The rare occurrence of an atypical talon cusp with three well-defined mamelon-like cusps on the palatal surface of the permanent maxillary central incisor is coined as ternion cusp, meaning "three" by authors. Its occurrence is repercussed as attrition of the teeth in the opposite arch. Selective or retruded contact position (RCP) was done, followed by topical fluoride application was rendered. Conclusion: Managing and treating these exceptional cusps depends upon their size, present complications, and patient compliance. How to cite this article: Sharma V, Mohapatra A, Bagchi A. Ternion Cusp: An Unusual Variant of Talon's Cusp: A Case Report. Int J Clin Pediatr Dent 2022;15(6):784-788.

Rapid Formation and Rupture of Multiple Abdominal Pseudoaneurysms: A Life Threatening Case of Segmental Arterial Mediolysis.

We present a 62-year-old gentleman with rapidly forming abdominal pseudoaneurysms due to segmental arterial mediolysis (SAM). With rupture of his pseudoaneurysms, he underwent angiography and successful coil embolisation. In this case, we demonstrate the potential for rapid progression of pseudoaneurysms in SAM, with the need for prompt diagnosis and urgent endovascular intervention.