Sustained Release of Liposomal Curcumin: Enhanced Periodontal Outcomes in Diabetic Patients.

OBJECTIVE: To evaluate the effect of entrapment of curcumin within liposomal formulation and the sustained release attitude of the formulated liposomal gel on periodontal defects in diabetic patients in clinical and biochemical terms. METHODS: Thirty diabetic patients with periodontitis were randomly assigned to three equal groups and ten healthy participants were assigned as the control group. Group I was subjected to scaling and root planing (SRP) with application of sustained release liposomal curcumin gel. Group II was subjected to scaling and root planning with application of curcumin gel. Group III was subjected to scaling and root planning with application of placebo gel. Group IV (control group), no intervention was done. The following parameters were evaluated before treatment and after 6 and 12 weeks: plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), tumour necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1ß) and total antioxidant capacity (TAC). RESULTS: All study groups showed improvement in clinical and biochemical parameters that are statistically significant. Upon comparing the results of treatment modalities, the highest improvement was achieved in group I followed by group II then group III. CONCLUSION: Sustained release liposomal curcumin gel enhanced the antioxidant capacity, decreased the inflammatory mediators and showed more improvement in clinical outcome for treatment of periodontitis in diabetic patients.

Medications and Orthodontic Tooth Movement: What Accelerates and Diminishes Tooth Movement?

The biological aspect of orthodontic tooth movement is influenced by the magnitude and duration of the applied force. This initiates signaling cascades essential for bone remodeling, which involve activating various cell signaling pathways that enhance the metabolism of the periodontal ligament, leading to localized bone resorption and deposition. This process facilitates tooth movement on the pressure side and promotes healing on the tension side. The remodeling associated with orthodontic tooth movement is an inflammatory reaction involving mediators. Key components in this process include hormones, systemic influences, cyclic adenosine monophosphate, specific cytokines like interleukin 1, colony-stimulating factors, calcium, collagenase, and prostaglandins, all of which are essential for the biological adjustments necessary for tooth movement. Medications that influence molecular pathways critical for the homeostasis of periodontal tissues or that affect changes during orthodontic tooth movement and clastic cell regulation can potentially modulate tooth movement. With the recent increase in prescription medication use, it is essential for clinicians to be aware of medication consumption in prospective patients and understand its potential impact on orthodontic treatment. This review aimed to explore the effects of commonly prescribed medications on the rate of orthodontic tooth movement, thoroughly review the existing evidence on this topic, and identify potential areas for future research.

Recent advancements in wastewater treatment via anaerobic fermentation process: A systematic review.

This manuscript delves into the realm of wastewater treatment, with a particular emphasis on anaerobic fermentation processes, especially dark, photo, and dark-photo fermentation processes, which have not been covered and overviewed previously in the literature regarding the treatment of wastewater. Moreover, the study conducts a bibliometric analysis for the first time to elucidate the research landscape of anaerobic fermentation utilization in wastewater purification. Furthermore, microorganisms, ranging from microalgae to bacteria and fungi, emphasizing the integration of these agents for enhanced efficiency, are all discussed and compared. Various bioreactors, such as dark and photo fermentation bioreactors, including tubular photo bioreactors, are scrutinized for their design and operational intricacies. The results illustrated that using clostridium pasteurianum CH4 and Rhodopseudomonas palustris WP3-5 in a combined dark-photo fermentation process can treat wastewater to a pH of nearly 7 with over 90% COD removal. Also, integrating Chlorella sp and Activated sludge can potentially treat synthetic wastewater to COD, P, and N percentage removal rates of 99%,86%, and 79%, respectively. Finally, the paper extends to discuss the limitations and future prospects of dark-photo fermentation processes, offering insights into the road ahead for researchers and scientists.

Intra-individual Dose Escalation of Abiraterone According to Its Plasma Exposure in Patients with Progressive Metastatic Castration-Resistant Prostate Cancer: Results of the OPTIMABI Trial.

BACKGROUND AND OBJECTIVE: Trough abiraterone concentration (ABI Cmin) of 8.4 ng/mL has been identified as an appropriate efficacy threshold in patients treated for metastatic castration-resistant prostate cancer (mCRPC). The aim of the phase II OPTIMABI study was to evaluate the efficacy of pharmacokinetics (PK)-guided dose escalation of abiraterone acetate (AA) in underexposed patients with mCRPC with early tumour progression. METHODS: This multicentre, non-randomised study consisted of two sequential steps. In step 1, all patients started treatment with 1000 mg of AA once daily. Abiraterone Cmin was measured 22-26 h after the last dose intake each month during the first 12 weeks of treatment. In step 2, underexposed patients (Cmin < 8.4 ng/mL) with tumour progression within the first 6 months of treatment were enrolled and received AA 1000 mg twice daily. The primary endpoint was the rate of non-progression at 12 weeks after the dose doubling. During step 1, adherence to ABI treatment was assessed using the Girerd self-reported questionnaire. A post-hoc analysis of pharmacokinetic (PK) data was conducted using Bayesian estimation of Cmin from samples collected outside the sampling guidelines (22-26 h). RESULTS: In the intention-to-treat analysis (ITT), 81 patients were included in step 1. In all, 21 (26%) patients were underexposed in step 1, and 8 of them (38%) experienced tumour progression within the first 6 months. A total of 71 patients (88%) completed the Girerd self-reported questionnaire. Of the patients, 62% had a score of 0, and 38% had a score of 1 or 2 (minimal compliance failure), without a significant difference in mean ABI Cmin in the two groups. Four patients were enrolled in step 2, and all reached the exposure target (Cmin > 8.4 ng/mL) after doubling the dose, but none met the primary endpoint. In the post-hoc analysis of PK data, 32 patients (39%) were underexposed, and ABI Cmin was independently associated with worse progression-free survival [hazard ratio (HR) 2.50, 95% confidence interval (CI) 1.07-5.81; p = 0.03], in contrast to the ITT analysis. CONCLUSION: The ITT and per-protocol analyses showed no statistical association between ABI underexposure and an increased risk of early tumour progression in patients with mCRPC, while the Bayesian estimator showed an association. However, other strategies than dose escalation at the time of progression need to be evaluated. Treatment adherence appeared to be uniformly good in the present study. Finally, the use of a Bayesian approach to recover samples collected outside the predefined blood collection time window could benefit the conduct of clinical trials based on drug monitoring. OPTIMABI trial is registered as National Clinical Trial number NCT03458247, with the EudraCT number 2017-000560-15).

How Effective Are the Nance Appliance and Transpalatal Arch at Reinforcing Anchorage in Extraction Cases?

OBJECTIVE: This narrative review aimed to evaluate, based on current evidence, whether the transpalatal arch (TPA) and Nance appliance can effectively reinforce anchorage during fixed orthodontic treatment while also offering a comprehensive and in-depth overview of the existing literature on this subject. MATERIALS AND METHODS: A thorough literature search was performed across multiple electronic databases to identify peer-reviewed articles relevant to the review. RESULTS: Evidence suggests that the Nance appliance does not provide absolute anchorage. Additionally, patients experienced discomfort and inflammation of the palatal tissues. The transpalatal arch is also insufficient for maximum anteroposterior anchorage, and existing studies on its effectiveness in vertical anchorage control are inconsistent with conflicting data. CONCLUSIONS: For patients with critical anchorage demand, mini-screws may be the method of choice, either solely or in combination with Nance or transpalatal arch, though they carry a risk of failure.

Urinary Tract Infections among Febrile Infants in Qatar: Extended-Spectrum-Beta-Lactamase (ESBL)-Producing Versus Non-ESBL Organisms.

BACKGROUND: The escalating prevalence of ESBL-producing Enterobacteriaceae in Qatar's pediatric population, especially in community-onset febrile urinary tract infections (FUTIs), necessitates a comprehensive investigation into this concerning trend. RESULTS: Over the course of one year, a total of 459 infants were diagnosed and subsequently treated for UTIs. Cases primarily occurred in infants aged over 60 days, predominantly non-Qatari females born from term pregnancies. Notably, E. coli and K. pneumoniae were the most frequently identified organisms, accounting for 79.7% and 9.8% in the ESBL group and 57.2% and 18.7% in the non-ESBL group, respectively. Interestingly, hydronephrosis emerged as the most prevalent urological anomaly detected in both ESBL (n = 10) and other organism (n = 19) groups. METHODS: In this retrospective cohort study conducted in Qatar, we meticulously evaluated the prevalence of pediatric FUTIs. Our study focused on febrile infants aged less than 1 year, excluding those with urine samples not obtained through a catheter. CONCLUSIONS: E. coli and K. pneumoniae prevailed as the predominant causative agents in febrile children in Qatar, with hydronephrosis being identified as the most common urological anomaly. Moreover, our findings suggested that gentamicin served as a viable non-carbapenem option for hospitalized ESBL cases, while oral nitrofurantoin showed considerable promise for uncomplicated ESBL UTIs.

Altered brain perfusion and oxygen levels relate to sleepiness and attention in post-COVID syndrome.

OBJECTIVE: Persisting neurological symptoms after COVID-19 affect up to 10% of patients and can manifest in fatigue and cognitive complaints. Based on recent evidence, we evaluated whether cerebral hemodynamic changes contribute to post-COVID syndrome (PCS). METHODS: Using resting-state functional magnetic resonance imaging, we investigated brain perfusion and oxygen level estimates in 47 patients (44.4 ± 11.6 years; F:M = 38:9) and 47 individually matched healthy control participants. Group differences were calculated using two-sample t-tests. Multivariable linear regression was used for associations of each regional perfusion and oxygen level measure with cognition and sleepiness measures. Exploratory hazard ratios were calculated for each brain metric with clinical measures. RESULTS: Patients presented with high levels of fatigue (79%) and daytime sleepiness (45%). We found widespread decreased brain oxygen levels, most evident in the white matter (false discovery rate adjusted-p-value (p-FDR) = 0.038) and cortical grey matter (p-FDR = 0.015). Brain perfusion did not differ between patients and healthy participants. However, delayed patient caudate nucleus perfusion was associated with better executive function (p-FDR = 0.008). Delayed perfusion in the cortical grey matter and hippocampus were associated with a reduced risk of daytime sleepiness (hazard ratio (HR) = 0.07, p = 0.037 and HR = 0.06, p = 0.034). Decreased putamen oxygen levels were associated with a reduced risk of poor cognitive outcome (HR = 0.22, p = 0.019). Meanwhile, lower thalamic oxygen levels were associated with a higher risk of cognitive fatigue (HR = 6.29, p = 0.017). INTERPRETATION: Our findings of lower regional brain blood oxygen levels suggest increased cerebral metabolism in PCS, which potentially holds a compensatory function. These hemodynamic changes were related to symptom severity, possibly representing metabolic adaptations.

Multiple sclerosis: economic burden, therapeutic advances, and future forecasts in the Middle East and North Africa region.

INTRODUCTION: Multiple sclerosis (MS) is a persistent condition characterized by immune-mediated processes in the central nervous system, affecting around 2.8 million individuals globally. While historically less prevalent in the Middle East and North Africa (MENA) region, recent trends mirror the global rise in MS. AREA COVERED: The impact of MS is substantial, particularly in the MENA region, with costs per patient surpassing nominal GDP per capita in certain countries. Disease-modifying therapies aim to alleviate MS effects, but challenges persist, especially in managing progressive MS as it shifts from inflammatory to neurodegenerative phases. Limited resources in the MENA region hinder care delivery, though awareness initiatives and multidisciplinary centers are emerging. Contrary to global projections of a decline in the MS market, the MENA region is poised for growth due to increased prevalence, healthcare expenditures, and infrastructure investments. EXPERT OPINION: This review underscores the urgent necessity for effective treatments, robust disease management, and early diagnosis in tackling MS's repercussions in the MENA region. Bolstering resources tailored to MS patients and elevating the quality of care stand as pivotal strategies for enhancing health outcomes in this context. Taking decisive action holds the key to enhancing the overall well-being of individuals grappling with MS.

Fronto-thalamic networks and the left ventral thalamic nuclei play a key role in aphasia after thalamic stroke.

Thalamic aphasia results from focal thalamic lesions that cause dysfunction of remote but functionally connected cortical areas due to language network perturbation. However, specific local and network-level neural substrates of thalamic aphasia remain incompletely understood. Using lesion symptom mapping, we demonstrate that lesions in the left ventrolateral and ventral anterior thalamic nucleus are most strongly associated with aphasia in general and with impaired semantic and phonemic fluency and complex comprehension in particular. Lesion network mapping (using a normative connectome based on fMRI data from 1000 healthy individuals) reveals a Thalamic aphasia network encompassing widespread left-hemispheric cerebral connections, with Broca's area showing the strongest associations, followed by the superior and middle frontal gyri, precentral and paracingulate gyri, and globus pallidus. Our results imply the critical involvement of the left ventrolateral and left ventral anterior thalamic nuclei in engaging left frontal cortical areas, especially Broca's area, during language processing.

Efficacy of Lasers in Debonding Ceramic Brackets: Exploring the Rationale and Methods.

The development of ceramic brackets in orthodontics three decades ago emerged as a response to the increasing patient demand for less visible orthodontic appliances. While these brackets provide superior aesthetics, they are characterized by lower fracture toughness and higher bond strength in contrast to metal brackets. These properties present challenges during the debonding step, including the risk of enamel micro-fractures and cracks. Historically, various strategies have been developed to address challenges associated with debonding, reduce patient discomfort, and ensure that the bond failure site is confined to the bracket-adhesive interface. This included the use of specially designed debonding pliers, electrothermal debonding, ultrasonic technique, and chemical agents. Recently, there has been a shift towards utilizing different types of laser irradiation for this purpose. The burgeoning strategy, however, requires diligent scientific scrutiny to establish a standardized protocol with particular laser parameters and ultimately achieve the goal of enhancing the patient experience by reducing discomfort. This article offers a narrative review of laser-aided debonding of ceramic brackets, aimed at comparing different laser types, presenting their benefits and downsides, validating the efficiency of each method, and summarizing the published literature on this subject. It also provides insights for orthodontists on reducing patient discomfort that usually accompanies debonding ceramic brackets by delving into the science behind the use of lasers for this purpose.

Potent neutralization by a receptor binding domain monoclonal antibody with broad specificity for SARS-CoV-2 JN.1 and other variants.

SARS-CoV-2 continues to be a public health burden, driven in-part by its continued antigenic diversification and resulting emergence of new variants. While increasing herd immunity, current vaccines, and therapeutics have improved outcomes for some; prophylactic and treatment interventions that are not compromised by viral evolution of the Spike protein are still needed. Using a rationally designed SARS-CoV-2 Receptor Binding Domain (RBD) - ACE2 fusion protein and differential selection process with native Omicron RBD protein, we developed a recombinant human monoclonal antibody (hmAb) from a convalescent individual following SARS-CoV-2 Omicron infection. The resulting hmAb, 1301B7 potently neutralized a wide range of SARS-CoV-2 variants including the original Wuhan and more recent Omicron JN.1 strain, as well as SARS-CoV. Structure determination of the SARS-CoV-2 EG5.1 Spike/1301B7 Fab complex by cryo-electron microscopy at 3.1Å resolution demonstrates 1301B7 contacts the ACE2 binding site of RBD exclusively through its VH1-69 heavy chain, making contacts using CDRs1-3, as well as framework region 3 (FR3). Broad specificity is achieved through 1301B7 binding to many conserved residues of Omicron variants including Y501 and H505. Consistent with its extensive binding epitope, 1301B7 is able to potently diminish viral burden in the upper and lower respiratory tract and protect mice from challenge with Omicron XBB1.5 and Omicron JN.1 viruses. These results suggest 1301B7 has broad potential to prevent or treat clinical SARS-CoV-2 infections and to guide development of RBD-based universal SARS-CoV-2 prophylactic vaccines and therapeutic approaches.

Integrating sustainability into higher education challenges and opportunities for universities worldwide.

This paper undertakes a comprehensive investigation into incorporating sustainability within higher education, aligning with the United Nations' Sustainable Development Goals (SDGs). Utilizing quantitative and qualitative research methods, our study delves into the status quo, methodologies, and impacts of sustainability education across a spectrum of international and local settings, with a specific lens on the United Arab Emirates. Our analysis spans various topics, from best practices in sustainability integration and educational frameworks to the influence of global initiatives like the Impact Ranking on promoting SDG-aligned transformations within academic institutions. Highlighting case studies from the UAE, we provide concrete evidence of successful sustainability strategies and interventions. These are juxtaposed with a global overview that uncovers the varying challenges and opportunities present in implementing sustainability education worldwide. Among our key findings is the essential role of interdisciplinary approaches and the critical need for active faculty involvement in fostering sustainability education. Drawing from a rich compilation of data and narratives, the paper presents a set of strategic recommendations designed to enhance the efficacy and reach of sustainability education. These recommendations are informed by the challenges observed and the success stories identified during our investigation. Ultimately, our research underscores the indispensable role that higher education plays in preparing future generations to navigate and address the complexities of sustainability challenges effectively.

Optimization of isotropic MoS2/PES membranes for efficient treatment of industrial oily wastewater.

Elimination of tiny oil droplets nearly miscible with wastewater can be realized using membrane technology through ultrafiltration. The novelty of this work was to blend different phases of molybdenum disulfide (MoS2) in isotropic polyethersulfone (PES). We prepared isotropic PES membranes by optimizing nonsolvent vapour-induced phase separation (VIPS). Membranes were blended with MoS2 nanosheets of different phases to promote separation performance and antifouling resistance. FE-SEM revealed the flower-like surface morphology of MoS2 nanosheets. HR-TEM of MoS2 revealed 2H domains in the monolayer, flakes of a few layers and a d-spacing of 0.22 nm. Raman spectroscopy could be used to distinguish mixed-phase MoS2 from single-phase MoS2. Isotropic PES membranes modified with 70% 1T/2H MoS2 had a significantly high permeance to pure water (6911 kg m-2 h bar). The same membrane possessed a high efficiency of oil rejection of 98.78%, 97.85%, 99.83% for emulsions of industrial crude oil at 100, 1000 and 10 000 mg L-1, respectively. Removal of oil droplets from wastewater was dominated by a mechanism based on size exclusion. Isotropic PES modified with 2H MoS2 possessed superior oleophilicity, which resulted in low rejection of crude oil. Modified membranes showed excellent fouling resistance for three successive filtration cycles, as evidenced by enhanced antifouling parameters. Our study reveals how the phase composition of MoS2 nanosheets can significantly affect the performance of isotropic PES membranes during the ultrafiltration of oily wastewater.

Recent advances in functional micro/nanomaterials for removal of crude oil via thermal effects.

Crude oil is one of the most widely used energy and industrial raw materials that is crucial to the world economy, and is used to produce various petroleum products. However, crude oil often spills during extraction, transportation and use, causing negative impacts on the environment. Thus, there is a high demand for products to remediate leaked crude oil. Among them, oleophilic and hydrophobic adsorbents can absorb crude oil through thermal effects and are research hotspots. In this review, we first present an overview of wettability theory, the heating principles of various thermal effects, and the theory of reducing crude oil viscosity by heating. Then we discuss adsorbents based on different heating methods including the photothermal effect, Joule heating effect, alternating magnetic field heating effect, and composite heating effect. Preparation methods and oil adsorption performance of adsorbents are summarized. Finally, the advantages and disadvantages of various heating methods are briefly summarized, as well as the prospects for future research.

Parliamentary question: Insights from the Federal National Council in the UAE.

This paper highlights the paramount role of parliamentary questioning as a control mechanism exercised by the Federal National Council (FNC) in the United Arab Emirates (UAE). The surge in its utilization, attributed to heightened awareness among FNC members and ministers, has significantly enhanced the Council's control capabilities, especially in the absence of alternative parliamentary control instruments such as interpellations. The paper underscores the simplicity and adaptability of parliamentary questioning, which spans diverse topics and addresses everyday state matters, rectifies errors, monitors law implementation, and fills legislative gaps. The structure of the paper comprises two sections: the first scrutinizes procedural requirements within the UAE's Constitution and the FNC's Bylaw, while the second section explores practical examples, offering insights into the distinctive nature of the FNC's parliamentary questioning compared to regional practices.

Outcomes of Percutaneous Image-Guided and Laparoscopic Cholecystostomies in High-Risk Patients With Acute Calculus Cholecystitis: A Five-Year District General Hospital Experience.

Introduction Acute cholecystitis (AC), inflammation of the gall bladder, is one of the most common emergency surgical presentations. In the UK, approximately 15% of the population is estimated to have gallstones, and approximately 20% of them can develop AC. Laparoscopic cholecystectomy (LC) is considered the definitive management of AC. However, cholecystectomy carries a very high risk of morbidity and mortality in high-risk frail patients with multiple comorbidities who are deemed unfit for surgery. Percutaneous cholecystostomy (PC), both image-guided and laparoscopic, is generally acknowledged as an interim treatment measure before definitive management, which is the LC. Materials and methods This is a retrospective study from the Royal Albert Edward Infirmary, a district general hospital (DGH) based in Wigan, UK. The medical records of all the patients who were admitted to the surgical department and underwent PC between January 2017 and December 2022 were analyzed. Patients with previous hepato-pancreato-biliary (HPB) malignancy, who underwent open cholecystostomy, or those with abdominal ascites were excluded from the study. Information was collected regarding the age, gender, American Society of Anaesthesiologists (ASA) grades, success rates of both procedures as temporary or definitive management, duration of hospital stay, 30-day and 1-year mortality after the procedure, timing of the procedure, and long-term complications after the procedure, particularly those related to cholecystostomy tube dislodgment or blockage. Results Twenty-seven patients who underwent PC were divided into two groups: group A, consisting of 10 patients who underwent laparoscopic cholecystostomies, and group B, consisting of 17 patients who had ultrasound (US)-guided cholecystostomies. The mean age of the patients in group A was 66.7 as compared to 75.1 in group B. Most of the patients were in ASA groups III (14) and IV (10). About 74% of patients had procedures done during the day and 26% had PC at night time. The mean hospital stay was 13.5 days. About 55% of patients had planned elective LC as a definitive management. Following the treatment, two patients died within 30 days, and eight patients passed away within a year. About 40% of the patients had complications related to the tube dislodgment and blockage. Conclusion This study concludes that PC, using both laparoscopic and US-guided techniques, can serve as an interim as well as a definitive measure, particularly in patients who are at high risk for anesthesia and the procedure itself and have multiple comorbidities.

Loss of GIPR in LEPR cells impairs glucose control by GIP and GIP:GLP-1 co-agonism without affecting body weight and food intake in mice.

OBJECTIVE: The glucose-dependent insulinotropic polypeptide (GIP) decreases body weight via central GIP receptor (GIPR) signaling, but the underlying mechanisms remain largely unknown. Here, we assessed whether GIP regulates body weight and glucose control via GIPR signaling in cells that express the leptin receptor (Lepr). METHODS: Hypothalamic, hindbrain, and pancreatic co-expression of Gipr and Lepr was assessed using single cell RNAseq analysis. Mice with deletion of Gipr in Lepr cells were generated and metabolically characterized for alterations in diet-induced obesity (DIO), glucose control and leptin sensitivity. Long-acting single- and dual-agonists at GIPR and GLP-1R were further used to assess drug effects on energy and glucose metabolism in DIO wildtype (WT) and Lepr-Gipr knock-out (KO) mice. RESULTS: Gipr and Lepr show strong co-expression in the pancreas, but not in the hypothalamus and hindbrain. DIO Lepr-Gipr KO mice are indistinguishable from WT controls related to body weight, food intake and diet-induced leptin resistance. Acyl-GIP and the GIPR:GLP-1R co-agonist MAR709 remain fully efficacious to decrease body weight and food intake in DIO Lepr-Gipr KO mice. Consistent with the demonstration that Gipr and Lepr highly co-localize in the endocrine pancreas, including the ß-cells, we find the superior glycemic effect of GIPR:GLP-1R co-agonism over single GLP-1R agonism to vanish in Lepr-Gipr KO mice. CONCLUSIONS: GIPR signaling in cells/neurons that express the leptin receptor is not implicated in the control of body weight or food intake, but is of crucial importance for the superior glycemic effects of GIPR:GLP-1R co-agonism relative to single GLP-1R agonism.

Exploring the impact of diet and nutrition on vitiligo: A systematic review of dietary factors and nutritional interventions.

BACKGROUND: Vitiligo, an autoimmune skin disorder linked to hormonal and genetic factors, results in reduced pigmentation due to a gradual decline in melanocyte activity. This systematic review delves into the role of dietary intervention and nutrition in managing vitiligo. METHODS: A comprehensive search on PubMed, Google Scholar, and European PMC identified 214 studies, with 14 meeting inclusion criteria post-screening. The selected studies primarily explored the impact of dietary supplements on disease activity. RESULTS: Heavy metal exposure, specifically Cd, Pb, and Hg, indicated potential links to heightened reactive oxygen species and vitiligo development. Conflicting evidence emerged regarding the role of trace minerals (Zn and Cu), with some studies suggesting deficiencies and others proposing excesses in vitiligo patients. Vitamins with anti-inflammatory properties like vitamin C, D, and B12, along with antioxidants, were investigated for their potential in repigmentation strategies. Additionally, polyunsaturated fatty acids (PUFAs), especially in varying types of fat consumption, were implicated. Emphasizing the need to reduce reliance on pharmacological and phototherapy interventions, the review uncovers novel roles for dietary supplements as adjuncts or flare reducers. CONCLUSION: While dietary interventions cannot be thought of as a standalone therapy, they still make a case for being used as adjuncts. Large scale clinical trials are warranted to establish strong evidence and protocols, and might also help reduce the dependency on pharmacological methods, which come with their adverse effect profiles.

Comparative Effectiveness and Safety of Direct Oral Anticoagulants Compared with Warfarin in Patients with Low Bodyweight who have Atrial Fibrillation: A Systematic Review and Meta-analysis.

INTRODUCTION: oral anticoagulant (DOAC) agents are becoming the anticoagulation strategy of choice for most clinical risks for which they are indicated. However, residual uncertainty remains regarding their use in preventing stroke in patients with low bodyweight [< 60 kg or body mass index (BMI) < 18 kg/m2]. We have carried out pooled systematic analyses of published studies to determine the efficacy and safety of these agents compared with warfarin in stroke prevention in patients with low bodyweight. METHODS: We carried out a comprehensive search of electronic databases from inception to June 2023 for eligible studies reporting on the efficacy and safety of direct oral anticoagulants versus warfarin in patients with atrial fibrillation who had low bodyweight. These include PubMed, EMBASE, the Cochrane Database of Systematic Reviews, the Science Citation Index, and the Database of Abstracts of Reviews of Effectiveness. Using the random effects model, derived pooled odd ratios (with their corresponding confidence intervals) of mortality outcomes in patient cohorts exposed to direct oral anticoagulants versus warfarin in patients with atrial fibrillation who had low bodyweight. RESULTS: Nine studies (n = 159,514 patients) were included in our meta-analysis. DOAC analogs were associated with lower stroke recurrence compared with warfarin [odds ratio (OR) 0.66, 95% confidence interval (CI) 0.49-0.9]; however, there was no significant difference in the composite outcome (OR 0.81, 95% CI 0.59-1.09) and mortality (OR 0.82, 95% CI 0.48-1.41). Additionally, DOAC analogs showed a significant reduction in major bleeding events by 30% compared with warfarin (OR 0.70, 95% CI 0.62-0.80). CONCLUSION: In this pooled meta-analytical synthesis of studies comprising both real-world and randomized controlled data, the use of DOAC analogs in patients with atrial fibrillation and low bodyweight (< 60 kg or BMI < 18 kg/m2) was associated with a significant reduction in risks of stroke and major bleeding compared with patient cohorts stabilized on warfarin-based therapy. There was uncertainty regarding the composite outcome and mortality point estimate between these two anticoagulation strategies. This finding helps to resolve the uncertainty associated with the use of DOACs in this cohort. Additionally, it suggests the need for confirmatory non-inferiority randomized controlled trials evaluating DOACs versus warfarin in this cohort of patients.

Antiviral responses versus virus-induced cellular shutoff: a game of thrones between influenza A virus NS1 and SARS-CoV-2 Nsp1.

Following virus recognition of host cell receptors and viral particle/genome internalization, viruses replicate in the host via hijacking essential host cell machinery components to evade the provoked antiviral innate immunity against the invading pathogen. Respiratory viral infections are usually acute with the ability to activate pattern recognition receptors (PRRs) in/on host cells, resulting in the production and release of interferons (IFNs), proinflammatory cytokines, chemokines, and IFN-stimulated genes (ISGs) to reduce virus fitness and mitigate infection. Nevertheless, the game between viruses and the host is a complicated and dynamic process, in which they restrict each other via specific factors to maintain their own advantages and win this game. The primary role of the non-structural protein 1 (NS1 and Nsp1) of influenza A viruses (IAV) and the pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), respectively, is to control antiviral host-induced innate immune responses. This review provides a comprehensive overview of the genesis, spatial structure, viral and cellular interactors, and the mechanisms underlying the unique biological functions of IAV NS1 and SARS-CoV-2 Nsp1 in infected host cells. We also highlight the role of both non-structural proteins in modulating viral replication and pathogenicity. Eventually, and because of their important role during viral infection, we also describe their promising potential as targets for antiviral therapy and the development of live attenuated vaccines (LAV). Conclusively, both IAV NS1 and SARS-CoV-2 Nsp1 play an important role in virus-host interactions, viral replication, and pathogenesis, and pave the way to develop novel prophylactic and/or therapeutic interventions for the treatment of these important human respiratory viral pathogens.