Objectives:Despite the adverse effects of chlorhexidine (CHX) in the oral cavity, it is still the most commonly prescribed mouthrinse for halitosis control due to its excellent results. The purpose of this study was to compare the efficacy of a mouthrinse with herbal formulation for halitosis control with 0.2% CHX gluconate containing rinse and to simultaneously assess adverse effects caused by the herbal mouthrinse if any.Materials and Methods:Ninety-six systemically healthy subjects with chronic generalized gingivitis were recruited in the study and divided into three groups receiving 0.2% CHX gluconate mouthrinse, herbal mouthrinse, or negative control, respectively as Group A, B, and C. The halimeter scores and organoleptic scores were recorded for each subject at baseline and after scaling. Others parameters recorded were plaque index and gingival index. All scores were reassessed on the 7th and 14th day, respectively. Statistical analysis was performed using Kruskal–Wallis ANOVA, Mann–Whitney U-test, and Wilcoxon matched pairs test.Results:There was an overall reduction in the halimeter scores both in Group A and B subjects which were not statistically significant within the groups; this was in accordance with the decrease in the mean organoleptic scores. Reduction in Group C scores was the least and differed statistically from both Group A and B scores.Conclusions:The results indicate an equivalent reduction in breath odor by both the herbal mouthrinse and CHX. Furthermore, side effects were less, and patient compliance was more with the herbal mouthrinse, which can thus be prescribed more safely and with predictable outcomes for oral malodor.
Introduction: Despite the rising prevalence of liver fibrosis and its potentially life-threatening complications, there are currently no recommendations or guidelines to screen individuals with diabetes mellitus (DM) or high body mass index (BMI) for non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH). This is mainly due to the uncertain performance and feasibility of presently available screening tools. This research was carried out to assess the diagnostic accuracy of non-invasive screening tools in predicting liver fibrosis in individuals with DM and metabolic syndrome.Methods: For this study, 140 patients with DM and metabolic syndrome were identified between March 2020 and October 2021. Liver stiffness measurement by point shear wave elastography was considered the gold standard in our study. Five non-invasive scores such as aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, aspartate aminotransferase to platelet ratio index (APRI) score, fibrosis-4 (FIB-4) index, BARD score, and NAFLD fibrosis score were determined in all of the participants. Using receiver operator characteristic (ROC) curve analysis, sensitivity, specificity, both negative predictive value (NPV) and positive predictive value (PPV) were calculated for each of these scores. The area under the ROC curve (AUROC) was used to calculate the diagnostic accuracy of these scores.Results: Of the 507 individuals screened, 140 were enrolled for the study. Among the 140 participants, 83 were male (59.29%), 30 (21.43%) had liver fibrosis as per liver stiffness measurement by point shear wave elastography, and 110 (78.57%) did not have fibrosis. The mean age and mean BMI were 54.53±12.42 and 27.37±2.73 respectively in the 'Fibrosis' group and 56.20 ±11.76 and 27.10±4.22 in the 'No fibrosis' group. The major finding of our study was that all these scores had relatively high NPV (>85 %) for predicting liver fibrosis in our cohort. The AST/ALT ratio had the highest NPV (90.28%) followed by APRI Score (88.94%). The AUROC for FIB-4 Score, NAFLD-fibrosis score, APRI score, AST/ALT ratio, and BARDd score were 0.6669, 0.657, 0.655, 0.637 and 0.599, respectively. The FIB-4 index (p=0.005) had the highest AUROC, followed by the NAFLD-fibrosis score (p =0.009). But all the scores had relatively low specificity (<60 %), PPV (<35 %), and accuracy (<63 %). Conclusion:The FIB-4 index and NAFLD-fibrosis score can be used reliably to exclude liver fibrosis in individuals with DM and metabolic syndrome in the Indian population, but may not be useful in accurately diagnosing liver fibrosis. Utilization of these non-invasive and cost-effective screening tools in routine practice may have promising results in predicting liver fibrosis in 'at risk' populations.
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