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Background: Due to the progressive decline in β-cell function, it is often necessary to utilize multiple agents with complementary mechanisms of action to address various facets and achieve glycemic control. Thus, this study aimed to evaluate the efficacy and safety of a fixed-dose combination (FDC) of metformin/sitagliptin/pioglitazone (MSP) therapy vs. metformin/sitagliptin (MS) in type 2 diabetes mellitus (T2DM)., Methods: In this phase 3, multicenter, double-blind study, patients with T2DM who exhibited inadequate glycemic control with HbA1c of 8.0-11.0% while taking ≥1500 mg/day metformin for at least 6 weeks were randomized to receive either FDC of MSP (1000/100/15 mg) or MS (1000/100 mg) per day for 24 weeks. The primary outcome measure was the change in HbA1c, and secondary outcomes included changes in fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and body weight from baseline to 24 weeks along with safety and tolerability., Results: Among the 236 patients randomized, 207 (87.71%) successfully completed the study. All baseline characteristics were comparable between the FDC of MSP and MS groups. There was a subsequent significant reduction of HbA1c in FDC of MSP (- 1.64) vs. MS (- 1.32); between groups was [- 0.32% (95% CI, - 0.59, - 0.05)], P = 0.0208. Similar reductions were found in FPG [- 13.2 mg/dL (95% CI, - 22.86, - 3.71)], P = 0.0068, and PPG [- 20.83 mg/dL (95% CI, - 34.11, - 7.55)], P = 0.0023. There were no significant changes in body weight. A total of 27 adverse effects (AEs) and one severe AE were reported, none of which were related to the study drug., Conclusion: The FDC of MSP demonstrated significant efficacy in managing glycemic indices and could serve as a valuable tool for physicians in the management of Indian patients with T2DM., Trial Registration: Clinical Trials Registry of India, CTRI/2021/10/037461., (© 2024. The Author(s).)

Interactions between plants and herbivores are central in most ecosystems, but their strength is highly variable. The amount of variability within a system is thought to influence most aspects of plant-herbivore biology, from ecological stability to plant defense evolution. Our understanding of what influences variability, however, is limited by sparse data. We collected standardized surveys of herbivory for 503 plant species at 790 sites across 116° of latitude. With these data, we show that within-population variability in herbivory increases with latitude, decreases with plant size, and is phylogenetically structured. Differences in the magnitude of variability are thus central to how plant-herbivore biology varies across macroscale gradients. We argue that increased focus on interaction variability will advance understanding of patterns of life on Earth.

Metal Organic Frameworks (MOFs) with natural clay materials is a relatively new research avenue that appears to reduce high production costs and address the instability issues of pure MOFs. A novel MOF and natural clay composites of MOF@Sp_n (n = 1-4) were fabricated by the in situ precipitation of stable MOF, Zr 6 O 4 (OH) 4 (ABDC) 6 (where ABDC = 2-aminobenzene-1,4-dicarboxylic acid), over natural sepiolite (Sp) clay and used as a photocatalysts for elimination of organic dyes in aqueous media. The formation of MOF@Sp_n due to its strong electrostatic interactions between the positively charged MOF and the negatively charged sepiolite. Optimizing the Sp content in the composite strongly influenced the dispersibility, crystallinity of MOFs, resulting in progressively functional hybrid materials with an excellent optoelectronic properties. The composites lessened the shortcomings of the individual components and made them suitable as a visible light-active, highly efficient, standalone photocatalyst material that can degrade RhB., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Pain is a multidimensional construct that involves sensory, emotional, and cognitive processes. It is an essential component of child behavior guidance. The injection of a local anesthetic agent during pediatric dental treatment is one of the most painful and distressing procedures performed, stimulation of acupoint LI4 provides an analgesic effect in the orofacial region, thus decreasing the pain during injection., Aims and Objectives: To compare and evaluate the effect of low-level laser on LI4 acupoint and surface-acting 20% benzocaine gel during local anesthesia., Materials and Methods: Children of age-group between 5 years and 9 years receiving bilateral local anesthesia were scheduled for dental treatment. Split-mouth cross-over study was planned and was divided into two groups, receiving low-level laser acupuncture on LI4 acupoint with placebo as a moist cotton swab in the first visit and 20% benzocaine gel with placebo as low-level laser acupuncture off mode in second visit and vice versa. Pain intensity was evaluated using the sound eye motor scale as subjective scale, Wong-Bakers pain rating scale. Pulse rate was measured before, during, and after the procedure using a pulse oximeter., Results: The average heart rate, Wong-Bakers pain rating scale, and Sound Eye Motor scale were significantly lower in the group having low-level laser when compared with the group having placebo low-level laser therapy., Conclusion: The low-level laser can be used to control pain during local anesthesia in children., How to Cite This Article: Sandhyarani B, Pawar RR, Patil AT, et al. Effect of Low-level Laser on LI4 Acupoint in Pain Reduction during Local Anesthesia in Children. Int J Clin Pediatr Dent 2021;14(4):462-466., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.)

The toxic heavy metals contamination in water bodies is one of the major concerns in many countries. Copper and lead are the two common toxic metals present in aquatic environments due to their extensive usage in various industries for diverse applications. The present study deals with the removal of these two toxic heavy metal ions using activated bentonite-alginate (ABn-AG) composite beads which are easily separated and recovered after adsorption reaction. Composite beads were prepared by adapting the ionic gelation method and the materials; i.e., raw bentonite (BnR), activated bentonite (ABn) and ABn-AG were characterized by XRD, BET surface area, TGA-DTA, FT-IR, SEM analyses. The nitrogen adsorption-desorption isotherm obtained for the materials were the type IV isotherm with characteristics H 3 hysteresis loops indicating the presence of mesopores with slit-shaped pores. Batch experiments showed that reasonably high percent removal was achieved even at highly acidic conditions, i.e., 58% of Cu 2+ and 77% of Pb 2+ were removed at pH 2.0. The removal was fast during the initial contact time and the adsorption data obtained at various contact time were fit well to the pseudo-second order kinetic model. The maximum sorption capacity for Cu 2+ was found to be 17.30 mg/g whereas Pb 2+ was found to be 107.52 mg/g. The presence of MgCl 2 , NaCl and KCl did not cause significant influence on the removal of Cu 2+ and Pb 2+ using ABn-AG. Binary adsorption study suggested that Cu 2+ and Pb 2+ were removed through different binding sites present in ABn-AG. Reusability test showed that removal of Cu 2+ and Pb 2+ decreased by 10% only after the same material was reused for 5 times indicating that ABn-AG is a highly robust material and can be reuse for several times without losing its efficiency. Thus, this study suggested that ABn-AG composite beads can be employed as an efficient adsorbent for the removal of Cu 2+ and Pb 2+ from aqueous waste., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The development of high-quality photocatalytic materials for the degradation of organic pollutants under visible light irradiation is a vital field of research. In the present study, a composite of natural sepiolite clay and synthetic graphitic carbon nitride (CN) mixed with dispersed palladium nanoparticles was developed for the efficient photocatalytic degradation of ciprofloxacin (CIP) under visible light irradiation. The sepiolite, CN, and composite materials were characterized by several techniques. The sepiolite/CN composite (SC30%) displayed superior activity than pristine sepiolite and CN, resulted from the generation of new electron trap states in the interfacial contract between sepiolite and CN to suppress the charge recombination of CN. Furthermore, the well-dispersed of 1 wt% Pd-nanoparticles in the SC30% composite collectively enhanced CIP degradation by avoiding the recombination of photogenerated electrons and holes. Additionally, the electron trap states on the surface of all samples were studied using novel reversed double-beam photoacoustic spectroscopy to understand electron transfer in the composites related to the photocatalytic degradation mechanism of CIP. The developed sepiolite/CN/Pd(0) composite can act as a potential catalyst for the degradation of organic pollutants in wastewater under visible light irradiation., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Inc. All rights reserved.)

We report for the first time to our knowledge the identification of heteroatom-doped and undoped C 3 N 4 with the energy-resolved distribution of electron traps (ERDT) near the conduction band bottom position (CBB) using reversed double-beam photoacoustic spectroscopy. The ERDT/CBB pattern is used to classify the type of elemental doping in C 3 N 4 , related to photocatalytic efficiency.

The present study deals with the preparation and characterization of mesoporous synthetic hectorite (MSH) clay which further encapsulated with Na-alginate for the preparation of mesoporous synthetic hectorite-alginate beads (MSH-AB) where Ca 2+ act as a cross-linking agent. The detail characterization of MSH and MSH-AB were carried out by various physicochemical techniques. The thermogravimetric analysis study showed better thermal stability results for MSH-AB. The textural properties results of MSH and MSH-AB showed the high surface area 468, 205m 2 /g, and the pore volume of 0.34, 0.29cm 3 /g respectively. The applicability of powder MSH and MSH-AB in wet (W) and dry (D) forms were assessed for the removal of cationic dye, methylene blue (MB) by optimizing various batch adsorption parameters. The Langmuir monolayer adsorption capacity obtained for MSH-AB-W showed significant high adsorption efficacy (i.e., 785.45mgMB/g) compared to the MSH-AB-D (357.14mgMB/g) and powder MSH materials (196.00mgMB/g). The adsorption isotherm studies showed that the Langmuir isotherm model was best suitable for MSH, whereas the Freundlich model was utilised to describe the adsorption behavior of organized hydrogel composite beads. The pseudo-second-order kinetics model was observed best for MB sorption onto MSH, whereas pseudo-first order useful to describe the kinetic behavior of MSH-AB. The regeneration experimental results revealed that MSH-AB-W could be recycled more than six cycles with high MB removal efficiency. Furthermore, the adsorption property of the MSH-AB-W was examined for the binary mixture of MB with other dye solutions such as Methyl Red (MR), Methyl Orange (MO), Alizarine Yellow (AY), and Remazol Brilliant Blue (RBB) to evaluate the selective adsorption efficiency. The MSH composite beads were found potentially suitable as an efficient, selective and recyclable adsorbent for the removal of MB from the aqueous solutions., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The purpose of these case reports is to emphasize the importance of knowledge regarding the root canal morphology and current diagnostic aids one should have as both of these important factors going to affect the prognosis of the endodontic treatment. These two case reports describe the maxillary and mandibular first molars with multiple canals. After clinical and radiographic diagnosis, additional help of cone-beam computed tomography (CBCT) of mandibular molar has been taken to evaluate the morphology and canal pattern; while maxillary molar was evaluated using CBCT scan to evaluate the canal configuration and obturation. In CBCT evaluation, the mandibular molar was diagnosed with six separated canals with three mesial and three distal canals and with radix paramolaris and radix entomolaris. The maxillary molar had five canals with three mesiobuccal (MB) canals. Both molars were instrumented with conventional hand and rotary file systems and obturated by conventional lateral compaction method. The axial images from CBCT show Vertucci Type VIII canal pattern in both roots of first mandibular molars and in MB root of maxillary first molar Sert and Bayirli Type XVIII canal configuration and no accessory canal in distobuccal and palatal root. With the recent innovations in diagnostic and operating aids, we can come across many variations in the root canal morphology of both mandibular and maxillary teeth, especially multi-rooted one (i.e., molars), and the knowledge of which leads to successful endodontic treatment with an excellent prognosis., Competing Interests: There are no conflicts of interest.

The study aimed to utilize the domestic wastewater as nutrient feedstock for mixotrophic cultivation of microalgae by evaluating appropriate carbon source. The microalgae Chlorella vulgaris was cultivated in municipal wastewater under various carbon sources (glucose, glycerol, and acetate), followed by optimization of appropriate carbon source concentration to augment the biomass, lipid, and carbohydrate contents. Under optimized conditions, namely of 5 g/L glucose, C. vulgaris showed higher increments of biomass with 1.39 g/L dry cell weight achieving biomass productivity of 0.13 g/L/d. The biomass accumulated 19.29 ± 1.83% total lipid, 41.4 ± 1.46% carbohydrate, and 33.06 ± 1.87% proteins. Moreover, the cultivation of Chlorella sp. in glucose-supplemented wastewater removed 96.9% chemical oxygen demand, 65.3% total nitrogen, and 71.2% total phosphate. The fatty acid methyl ester obtained showed higher amount (61.94%) of saturated fatty acid methyl esters associated with the improved fuel properties. These results suggest that mixotrophic cultivation using glucose offers great potential in the production of renewable biomass, wastewater treatment, and consequent production of high-value microalgal oil., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The separation of fine spent sorbents from treated water after remediation is a major difficulty associated with phosphate wastewater treatment technology. In this study, a novel aluminium-pillared acid activated bentonite powder (Al-ABn) and alginate immobilized aluminium-pillared acid activated bentonite beads (Al-ABn-AB) were synthesized and used for the removal of aqueous phosphate. The phosphate removal behaviour of adsorbents were evaluated by batch experiments as a function of various parameters such as pH, initial concentration, contact time, temperature, adsorbent dose and presence of coexisting ions. The sorption isotherm studies by Langmuir model showed 12.87 and 11.11 mgP/g maximum phosphate uptake capacity for Al-ABn and Al-ABn-AB, respectively. The kinetic studies confirm that the adsorption of phosphate by Al-ABn and Al-ABn-AB follows a pseudo-second-order model. The feasibility of Al-ABn-AB was also assessed in continuous mode in fixed bed column and the loading capacity obtained was 4.55mg/g. The adsorption capacity of Al-ABn-AB beads remained at relatively high even after four regeneration cycles. Furthermore, the applicability of the synthesized adsorbents towards real municipal wastewater confirmed that novel synthesized Al-ABn and Al-ABn-AB are the promising adsorbents for the removal of phosphate from contaminated water., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Introduction: Handheld X-ray devices are now offered in dental practice. Handheld X-ray units challenge the concept of a restricted access to the "controlled area" as they are held by the operator. Although an integral lead shield is provided, the distance from the body is variable, dependent on how the device is held. The aim of this article was to investigate the level of operator dose when using a handheld X-ray device in various positions., Material and Methods: A NOMAD Pro™ Handheld X-ray system (Aribex Inc., Charlotte, NC) fitted with a remote control and mounted on a tripod was used in this study. A maxillofacial phantom ATOM(®) Max Dental and Diagnostic Phantom, model 711 HN (CIRS Inc., Norfolk, VA) was used to simulate the patient's head position. A mannequin was used to represent the operator. Pre-calibrated thermoluminescent dosemeters (TLDs) (Qados, Agar Scientific, Stansted, UK) were placed on the mannequin close to the eyes and at the level of thyroid, trunk, waist, hand (right finger + left palm) and feet, and three TLDs were used for background radiation. Three test scenarios were investigated; Position 1, close to operators' body and parallel to the ground; Position 2, away from the body with the arms fully extended (approximately 40 cm distance) and parallel to the ground; Position 3, perpendicular to the ground while the arms are partially extended. 30 exposures each of 1 s were performed in each test., Results: Background radiation was measured at 0.0110 mGy. The highest exposure after subtracting background radiation was recorded on the palm of the left hand (0.0310 mGy) at Position 3. The estimated dose to the operator was calculated based on an average workload of 100 intraoral radiographs weekly for a dental practitioner working 46 weeks a year., Conclusions: There is a negligible increase in operator exposure levels using handheld X-ray devices which remain well below the recommended levels of the Ionizing Radiation Regulations 1999. They could however represent an increase from what should be a nil exposure when using a wall-mounted machine. The position of the device relative to the operator has a significant effect on the overall operator's radiation exposure. The use of personal dosemeters is highly recommended to ensure a continuity of low radiation dose exposure. Furthermore, guidance, training and protocols on usage must be in place, strictly adhered to and regular audits are necessary to ensure compliance.

Aim: To evaluate the anatomical relationship between the roots of mandibular second molars and the inferior alveolar nerve (IAN) in relation to the risk of potential nerve injury during root canal treatment., Methodology: Cone-beam computed tomography (CBCT) images from the patient record database at a dental hospital were selected. The anonymized CBCT images were reconstructed and examined in three planes (coronal, axial and sagittal) using 3D viewing software. The relationship between each root apex of mandibular second molars and the IAN was evaluated by measuring the horizontal and vertical distances from coronal CBCT sections, and the actual distance was then calculated mathematically using Pythagoras' theorem., Results: In 55% of the 272 mandibular second molar roots evaluated, from a total of 134 scans, the distance between the anatomical root apex and the IAN was ≤3 mm., Conclusions: In over 50% of the cases evaluated, there was an intimate relationship between the roots of mandibular second molars and the inferior alveolar nerve (IAN). Therefore, root canal treatment of mandibular second molars may pose a more significant potential risk of IAN injury; necessary precautions should be exercised, and the prudent use of CBCT should be considered if an intimate relationship is suspected., (© 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

To identify the incidence of different causes of benign obstruction of the salivary glands, we retrospectively analysed 788 anonymised sialography reports of 719 patients referred to the department of dental and maxillofacial radiology between 2006 and 2012. Reports that showed evidence of benign obstruction were included (n=493). Salivary stones were identified in 151 (31%), ductal strictures in 115 (23%), and mucus plugs in 295 (60%). In 67 cases (14%) there was evidence of 2 or 3 causes of obstruction. As previously reported, mucous plugs were the most common finding, possibly because of the use of fluoroscopy or digital subtraction sialography, or both. These methods enable images to be captured during the initial filling of the main duct and are likely to prevent mucus plugs from being obscured by the contrast medium, which is the case in conventional sialography when a single image is produced after the contrast has been injected., (Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Cosmopolitan cities have become a pool of migrants from different parts of the world, who carry their cultural beliefs and superstitions with them around the globe. Canine gouging is a kind of infant oral mutilation (IOM) which is widely practiced among rural population of Africa where the primary tooth bud of the deciduous canine is enucleated. The belief is that the life threatening illnesses in children like vomiting, diarrhoea, and fevers are caused by worms which infest on tooth buds. This case report is of a 15-year-old Somalian born boy, who presented at the dental institute with intermittent pain in his lower right permanent canine which was associated with a discharging intra oral buccal sinus. The tooth was endodontically treated and then restored with composite. General dental practitioners need to be vigilant when encountered with tooth presenting unusual morphology, unilateral missing tooth, and shift in the midline due to early loss of deciduous/permanent canines. Identification of any such dental mutilation practice will need further counselling of the individual and family members. It is the duty of every dental professional to educate and safeguard the oral and dental health of general public.

The organized mesoporous matrices with large surface area and large pore volumes are potential drug carriers and hence find good applications in the field of controlled and sustained drug delivery. Two novel mesoporous synthetic hectorite (MSH) materials, namely, MSH3 and MSH4 with diverse composition and pore performance have been synthesized by a template free route and studied for the controlled drug delivery applications. MSH3 with 0.14LiF:5.93Mg(OH)2:8 SiO2 synthetic composition exhibited higher quinine adsorption than that by MSH4 (2.8LiF:4.6Mg(OH)2:8SiO2). In vitro studies at 37±0.5°C temperature under sequential buffer conditions showed controlled drug release with respect to the variation in pH values while following Eudragit VR L100 coated gelatin capsules; however, dialysis bag technique do not show such pH controlled delivery. Kinetic data suggest the release of QUI from the nanocomposite follows dissolution diffusion model., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Objectives: The aim of this study was to determine the prevalence of incidental findings in MRI of the temporomandibular joint (TMJ)., Methods: MRI reports of 730 patients were assessed. The reports were analysed by one consultant and one clinical lecturer in dental and maxillofacial radiology. The prevalence of intracranial and extracranial incidental findings was recorded and categorized., Results: There were 53 (7.3%) incidental findings, of which 11 (1.5%) were intracranial and 42 (5.7%) were extracranial (divided into paranasal sinuses, mastoid air cells, muscle hypertrophy, lymphadenopathy and salivary glands). A total number of eight intracranial findings needed further dedicated imaging and/or specialist clinical opinion. Only one tumour (a meningioma) was found and required surgical intervention., Conclusions: Incidental findings on TMJ MRI are rare but not unheard of. The clinical relevance of incidental findings can be significant, and it is therefore important to ensure that the full data set of images is inspected, including any scout slices. A close working relationship between the areas of dental and maxillofacial radiology and neuroradiology is essential in expediting a second opinion relating to intracranial findings. All incidental findings should be communicated to referring clinicians in a timely manner, based on their urgency and clinical significance.