Colour tunable photoluminescence studies of Dy3+/Eu3+ co-doped BaPbAlFB glasses for epoxy-free w-LED applications.

Barium lead alumino fluoroborate (BaPbAlFB) glasses singly and co-doped with Dy3+ and Eu3+ ions were prepared by melt quench method and studied their photoluminescence (PL) properties along with energy migration. Singly doped Dy3+/Eu3+ ions in BaPbAlFB glasses under 365 and 393 nm excitation wavelengths emit the PL bands through Dy: (4F9/2 → 6H15/2 and 4F9/2 → 6H13/2) and Eu: (5D0→7F2) transitions located at (Dy: 483 and 575 nm) and (Eu: 613 nm) respectively. Further, tunability of PL emissions is achieved by exciting the Dy3+/Eu3+ co-doped BaPbAlFB glasses at various wavelengths. The obtained CIE (0.34, 0.33) and CCT value (5080.4 K) of Dy3+/Eu3+ co-doped BaPbAlFB glass produced white light emission under 365 nm excitation wavelength. The corresponding CCT values of Dy3+/Eu3+ co-doped BaPbAlFB glasses varied from 1580 to 5080 K and their corresponding color emission changes from intense red to white light regime quite suitable for fabrication of epoxy-free w-LED devices.

Real-time ultrasound-guided mid-thoracic epidural access using a novel paramedian cross (PX) view and drip infusion technique: a brief technical report.

BACKGROUND: Real-time ultrasound guidance (USG) has been applied for lower thoracic epidural access, but the more challenging mid-thoracic epidural (MTE) access remains underexplored. This report presents a technique of real-time US guidance with a novel paramedian cross view, termed "the PX view," for securing MTE catheters, along with an outcome analysis from a retrospective case series. METHODS: Medical records of patients who underwent USG-MTE catheter placement with the PX view and drip infusion technique from January to December 2022 were reviewed. All catheters were placed with patients in the prone position under mild to moderate procedural sedation. The process of acquiring the PX view, in-plane needling technique, and the use of drip infusion to identify loss of resistance were detailed. The incidence of successful PX view attainment, the number of attempts, redirections, failures, and any technique-related complications were recorded. RESULTS: Fifty-one patients underwent USG-MTE catheter attempts, (42 with median sternotomy, 3 fractured ribs, 3 upper abdominal laparotomies, 2 modified radical mastectomies, and 1 thoracotomy). A satisfactory PX view was obtained in all patients, and the epidural space was identified during the first needle entry in 49 cases, resulting in a 96% first-attempt success rate. Seven patients required needle redirections, while two patients needed a second needle entry. No technique-related complications were documented. CONCLUSION: The combination of the PX view and the drip infusion method proved effective for real-time ultrasound-guided MTE catheter placement.

Is It Feasible to Reduce Academic Stress in Net-Zero Energy Buildings? Reaction from ChatGPT.

We may lessen the detrimental effects of global warming on human thought processes by reducing greenhouse gas emissions, encouraging sustainability, and giving adaption measures top priority. The purpose of the letter is to draw attention to the necessity of net-zero energy buildings (NZEB) in academic institutions in order to reduce academic stress, promote well-being, and improve cognitive functions. While some levels of stress might be advantageous, excessive and mismanaged stress can be detrimental to students' well-being. To foster a healthy academic atmosphere, it is essential to offer resources, support networks, and stress-reduction techniques. As human authors, we thoroughly edited ChatGPT's responses to create this letter.

Detection of water deficit conditions in different soils by comparative analysis of standard precipitation index and normalized difference vegetation index.

The detection of water deficit conditions in different soils of Prakasam district, Andhra Pradesh, India was assessed in consecutive two seasons of 2017-18 to 2019-20 cropping seasons using combined indicators developed from Standard Precipitation Index (SPI) and Normalized Difference Vegetation Index (NDVI). Historical rainfall data during the study period of 56 administrative units were analyzed by using R software and derived three-month SPI. The MODIS satellite data from 2007 to 2020 was downloaded out of which the first ten years' data was used as mean monthly NDVI and the remaining period data was used to derive the anomaly index for the specific month. MODIS satellite data was downloaded, using LST and NDVI, and MSI values were calculated. The NDVI anomaly was derived using MODIS data to study the onset and intensity of water deficit conditions. Results indicated that SPI values gradually increased from the start of the Kharif season, reached their maximum during the August and September months, and decreased gradually with high variation among the mandals. The NDVI anomaly values were highest in October and December the for Kharif and Rabi seasons, respectively. The correlation coefficient between NDVI anomaly and SPI reveals that 79% and 61% of the variation were observed in light and heavy textured soils. The SPI values of -0.5 and -0.75; the NDVI anomaly values of -1.0 and -1.5 and SMI values of 0.28 and 0.26 were established as the thresholds for the onset of water deficit conditions in light and heavy textured soils, respectively. Overall, results suggest that the combined use of SMI, SPI, and NDVI anomaly is capable to provide a near-real-time indicator for water deficit conditions in light and heavy texture soils. Yield reduction was higher in light-textured soils ranging from 6.1 to 34.5%. These results can further be used in devising tactics for the effective mitigation of drought.

Competency-based postgraduate training: Mentoring and monitoring using entrustable professional activities with descriptive rubrics for objectivity- A step beyond Dreyfus.

Background At Sri Balaji Vidyapeeth, a competency-based learning and training (CoBaLT©) model for postgraduate (PG) curriculum, within the regulatory norms, was implemented in 2016 after adequate faculty development programmes. This focused on well-defined outcomes. Methods A review of the outcomes was undertaken in 2018 as part of internal quality assurance receiving feedback from all stakeholders, viz. students, alumni and faculty. Recent publications were also reviewed. A major problem identified was lack of clarity in definition of levels leading to subjectivity in assessment while grading. It was also noted that the process needed to be aligned with the programme outcomes. Further refinements were, therefore, made to align and objectivize formative assessment using entrustable professional activities (EPA) with the aid of descriptive rubrics of sub-competencies and milestones. Addition of detailed rubrics for objectivity takes assessment a step beyond the Dreyfus model, aligning overall to the programme outcomes. Results Achievement of appropriate grades in EPAs by individual candidates ensures entrustability in professional activities by the time of completion of the PG programme. The modification was found more transparent and objective with reference to grading by the teachers and more conducive to reflections by the residents on their performance and how to improve it. Conclusions The use of descriptive rubrics along with EPAs brings transparency and plays a key role as an objective assessment tool, which can lend direction to individual resident learning and entrustability. This is an important component of outcome-based education.

Highly Durable Antimicrobial Tantalum Nitride/Copper Coatings on Stainless Steel Deposited by Pulsed Magnetron Sputtering.

Highly durable and antimicrobial tantalum nitride/copper (TaN/Cu) nanocomposite coatings were deposited on D-9 stainless steel substrates by pulsed magnetron sputtering. The Cu content in the coating was varied in the range of 1.42-35.42 atomic % (at.%). The coatings were characterized by electron probe microanalyzer, X-ray diffraction, scanning electron microscope and atomic force microscope. The antibacterial properties of the TaN/Cu coatings against gram-negative Pseudomonas aeruginosa were evaluated using a cell culture test. The peak hardness and Young's modulus of TaN/Cu with 10.46 at.% Cu were 24 and 295 GPa, respectively, which amounted to 15 and 41.67% higher than Cu-free TaN. Among all, TaN/Cu with 10.46 at.% exhibited the lowest friction coefficient. The TaN/Cu coatings exhibited significantly higher antibacterial activity than Cu-free TaN against Pseudomonas aeruginosa. On TaN, the bacterial count was about 4 × 106 CFU, whereas it was dropped to 1.2 × 102 CFU in case of TaN/Cu with 10.46 at.% Cu. The bacterial count was decreased from 9 to 6 when the Cu content increased from 25.54 to 30.04 at.%. Live bacterial cells were observed in the SEM images of TaN, and dead cells were found on TaN/Cu. Overall, TaN/Cu with 10.46 at.% Cu was found to be a potential coating composition in terms of higher antimicrobial activity and mechanical durability.

Influence of Tin Doped TiO2 Nanorods on Dye Sensitized Solar Cells.

The one-step hydrothermal method was used to synthesize Sn-doped TiO2 (Sn-TiO2) thin films, in which the variation in Sn content ranged from 0 to 7-wt % and, further, its influence on the performance of a dye-sensitized solar cell (DSSC) photoanode was studied. The deposited samples were analyzed by X-ray diffraction (XRD) and Raman spectroscopy, which confirmed the existence of the rutile phase of the synthesized samples with crystallite size ranges in between 20.1 to 22.3 nm. In addition, the bare and Sn-TiO2 thin films showed nanorod morphology. A reduction in the optical band gap from 2.78 to 2.62 eV was observed with increasing Sn content. The X-ray photoelectron spectroscopy (XPS) analysis confirmed Sn4+ was successfully replaced at the Ti4+ site. The 3-wt % Sn-TiO2 based DSSC showed the optimum efficiency of 4.01%, which was superior to 0.87% of bare and other doping concentrations of Sn-TiO2 based DSSCs. The present work reflects Sn-TiO2 as an advancing material with excellent capabilities, which can be used in photovoltaic energy conversion devices.

Statistical Modeling based Directional Pattern Design (SMDPD) feature extraction for coral reef classification.

Coral reefs are a precious ecosystem that supports majority of marine life. The identification of coral species is essential in the conservation and monitoring process. Distinguishing the coral species among the coral reef family is really a challenging task since they have analogous characteristics and have complex spatial borders between the coral classes. This requires experts to identify corals. But due to inconsistency and biasing of manual labelling, the manual annotations of coral reefs are not feasible. The objective of this research work is to identify various types of corals present in the given input video. This work is aimed at identifying thirty-six types of coral by employing a new feature extraction method called Statistical Modeling based Directional Pattern Design (SMDPD) using a new directional pattern. The proposed work outperforms the state-of-art techniques for four coral datasets namely EILAT, EILAT 2 Red Sea, MLC 2010 and RSMAS. Another advantage of this work is the reduction in feature bin size from 255 to just 16 bins.

Correction: G82S RAGE polymorphism influences amyloid-RAGE interactions relevant in Alzheimer's disease pathology.

[This corrects the article DOI: 10.1371/journal.pone.0225487.].

Evaluation of the Efficacy of Liposomal Bupivacaine in Total Joint Arthroplasty.

BACKGROUND: Appropriate pain control is one of the cornerstones necessary to promote positive clinical outcomes. A new bupivacaine liposomal formulation was designed to extend its analgesic effect for up to 72-hours post-surgery, reportedly leading to significant opioid-sparing. METHOD: Retrospective and prospective chart review conducted in a 178-bed academic institution between January 2013 to December 2013 and August 2014 to November 2014, in 115 patients that receive hip and knee arthroplasty. The primary outcome was the measurement of average daily pain score on post-operative days 1 and 2. Secondary outcomes included length of stay, overall opioid use post-surgery and pain control satisfaction using Press-Ganey® scores. RESULTS: The average pain scores in the HCl group were 4.64 and 4.38 (Likert score: 0-10) for POD 1 and POD 2, compared to 4.72 POD 1 and 4.2 POD 2 in the liposome group (POD 1: p = 0.413; POD 2: p = 0.303). The difference in LOS for knee arthroplasty was statistically significant [HCl group: 1.94 days (± 0.66) versus liposome group: 2.27 days (±0.77) p-value = 0.038)] favoring the standard of care. For hip arthroplasty or bilateral knee arthroplasty the differences in LOS were not statistically significant (p = 0.052 and p = 0.484 respectively). 93% of the patients in the HCl group, pain was well controlled, versus 88.5% in the liposome group with similar oxycodone IR use among groups. CONCLUSION: Liposome bupivacaine did not offer a notable benefit compared to the HCl formulation in our study.

G82S RAGE polymorphism influences amyloid-RAGE interactions relevant in Alzheimer's disease pathology.

Receptor for advanced glycation end products (RAGE) has been implicated in the pathophysiology of Alzheimers disease(AD) due to its ability to bind amyloid-beta (Aß42) and mediate inflammatory response. G82S RAGE polymorphism is associated with AD but the molecular mechanism for this association is not understood. Our previous in silico study indicated a higher binding affinity for mutated G82S RAGE, which could be caused due to changes in N linked glycosylation at residue N81. To confirm this hypothesis, in the present study molecular dynamics (MD) simulations were used to simulate the wild type (WT) and G82S glycosylated structures of RAGE to identify the global structural changes and to find the binding efficiency with Aß42 peptide. Binding pocket analysis of the MD trajectory showed that cavity/binding pocket in mutant G82S glycosylated RAGE variants is more exposed and accessible to external ligands compared to WT RAGE, which can enhance the affinity of RAGE for Aß. To validate the above concept, an in vitro binding study was carried using SHSY5Y cell line expressing recombinant WT and mutated RAGE variant individually to which HiLyte Fluor labeled Aß42 was incubated at different concentrations. Saturated binding kinetics method was adopted to determine the Kd values for Aß42 binding to RAGE. The Kd value for Aß42- WT and Aß42-mutant RAGE binding were 92±40 nM (95% CI-52 to 152nM; R2-0.92) and 45±20 nM (95% CI -29 to 64nM; R2-0.93), respectively. The Kd value of <100nM observed for both variants implicates RAGE as a high-affinity receptor for Aß42 and mutant RAGE has higher affinity compared to WT. The alteration in binding affinity is responsible for activation of the inflammatory pathway as implicated by enhanced expression of TNFα and IL6 in mutant RAGE expressing cell line which gives a mechanistic view for the G82S RAGE association with AD.

White light emission from Dy3+-doped ZnO + Bi2O3 + BaF2 + B2O3 + TeO2 glasses: Structural and spectroscopic properties.

The ZnO + Bi2O3 + BaF2 + B2O3 + TeO2 (ZnBiBaBFTe) host glass was prepared by melt quenching technique with the aim of achieving white light emission from Dy3+ ions. Their structural and spectroscopic properties were systemically investigated by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), UV-Visible absorption, emission spectra and decay times. Judd-Ofelt (JO) parameters (Ωλ) evaluated from absorption spectrum were utilized to calculate the radiative parameters for 4F9/2 level of Dy3+ ions. The optical band gap energy of as-prepared glasses were calculated for the indirect, (αhυ)1/2 and direct, (αhυ)2 allowed transitions. The emission spectra of Dy3+:ZnBiBaBFTe glasses showed two intense peaks at 575 nm (4F9/2→6H13/2) and 481 nm (4F9/26H15/2) upon 386 nm excitation. The highest emission intensity was observed at 1.0 mol% of Dy3+ for 4F9/2→6H13/2 transition and the results are used in conjunction with lifetime measurements to derive spectroscopic parameters for the stimulated emission cross-section (25.2 × 10-22 cm2), gain bandwidth (5.86 × 10-28 cm3), and favourable quantum efficiency (74.2%). Moreover, white light can be realized with a CIE coordinates by adjusting the concentration of Dy3+ ions in ZnBiBaBFTe host glass. Efficient spectroscopic values and realizable white lighting in Dy3+-doped ZnBiBaBFTe glasses may have potential applications in laser illumination devices.

Detection and distribution of anti-leptospiral antibody among dogs and their handlers.

The incidence of leptospirosis seems to be on the rise and could be an alarming indirect indication of a global re-emergence. It is a potential public health threat when dogs are speculated to be involved in the transmission of leptospirosis through possible subclinical harbouring of Leptospira spp. and subsequent shedding into the environment. This study aimed to detect anti-leptospiral antibodies among dogs and their handlers using the microscopic agglutination test (MAT). Blood samples from 266 apparently healthy dogs and 194 dog handlers were collected at four working dog organisations and four dog shelters. Serum samples were tested using MAT against 20 leptospiral serovars with a cut-off titre >=1:100 (dog) and >=1:50 (dog handlers). Seventy dogs (70/266; 26.3%) were seropositive mainly against serovars Icterohaemorrhagiae, Ballum, Bataviae and Javanica (titres ranged: 1:100-1:800). Sixty-seven dog handlers (67/194; 34.5%) were seropositive mainly against serovars Grippotyphosa, Icterohaemorrhagiae and Malaysia (titres ranged: 1:50-1:200). Dogs were seropositive due to exposure, vaccination or active infection. Seropositive dog handlers could indicate exposure or active infection. This shows the potential of dogs in maintaining and spreading the infection in Malaysia. Due to the occupational risk as a result of frequent contact with dogs and exposure to contaminated environments, dog handlers should be made aware of the presence of this zoonotic disease.

Prevalence of Toxoplasma gondii in pet and stray cats in Klang Valley, Malaysia.

Toxoplasma gondii, a zoonotic protozoan that has a worldwide distribution, is known to infect many warm-blooded vertebrates. The feline species including domestic cats are the definitive hosts for Toxoplama gondii and shed the infective oocyst. There is lack of information on the prevalence of Toxoplasma gondii in cats in Malaysia. The objective of this study was to determine both the seroprevalence of T. gondii and the prevalence of T. gondii DNA in cats' feces in Klang Valley, Malaysia. 198 blood and 201 fecal samples were collected from pet and stray cats from the local council, Dewan Bandaraya Kuala Lumpur (DBKL) and University Veterinary Hospital, Universiti Putra Malaysia respectively. The overall seroprevalence of Toxoplasma gondii in cats in the Klang Valley was found to be 5.5%. There was a high prevalence (10.5%) of T. gondii DNA detected in the cat fecal samples in both pet and stray cats suggestive of T. gondii oocyst shedding. Stray cats showed a higher seroprevalence and molecular prevalence of T. gondii than the pet cats. However, comparative analysis using Chi-square test showed no significant difference between both groups (P>0.05). Higher prevalence (10.5%) of cats shedding T. gondii DNA as compared to the seroprevalence (5.5%) was found in the cat population in the Klang Valley. The high prevalence of cats shedding T. gondii DNA is alarming as this may directly reflect the number of oocysts excreted into the environment posing a significant public health hazard.

First molecular detection of Tritrichomonas foetus in domestic cats in Klang Valley, Malaysia.

Tritrichomonas foetus is known to cause chronic diarrhea in the feline species in many different regions of the world. However, there is a paucity of information on T. foetus among cats in Malaysia. This study was conducted to determine the prevalence of Tritrichomonas foetus in the pet and stray cat population in Klang Valley, Malaysia. A total of 201 pet and stray cats' fecal samples were collected in Klang Valley. 24 samples were cultured in the InPouch® TF Feline to observe for motile trophozoites. A nested PCR protocol was used to screen for T. foetus in the collected samples. The prevalence of T. foetus in the cat population in Klang Valley was 33%. There was no association between Tritrichomonas infection and age, sex, breed or management of the cats. However, statistical analysis revealed that stray cats were more likely to be infected with T. foetus compared to pet cats. This study confirmed for the first time the presence of T. foetus among the cat population in Klang Valley, Malaysia.

Effect of microwave blanching on antioxidant activity, phenolic compounds and browning behaviour of some fruit peelings.

Fruit peelings are increasingly being used as ingredients for the formulation of functional foods. In this study, the antioxidant activity and browning behaviour of free and bound phenolic fractions of mango, apple, orange and banana peelings microwave-blanched at 720 W for 1, 3 and 5 min were determined. The fractions were equally analyzed for their phenolic content and composition. Generally, increased microwave blanching was accompanied by a significant increase of total phenolics content in free and bound fractions. Increased antioxidant activities at 3 and 5 min of blanching varied with the type of fruit peelings. Browning rates decreased with microwave blanching time except in the case of apple peelings. Epicatechin, ferulic acid, caffeic acid, rosmarinic acid, p-coumaric acid and gallic acid were identified in fruit peelings. Generally, microwave blanching for 3 or 5 min was found to preserve antioxidant activities and reduce the browning rate.

Detection and distribution of anti-leptospiral antibody among dogs and their handlers

@# The incidence of leptospirosis seems to be on the rise and could be an alarming indirect indication of a global re-emergence. It is a potential public health threat when dogs are speculated to be involved in the transmission of leptospirosis through possible subclinical harbouring of Leptospira spp. and subsequent shedding into the environment. This study aimed to detect anti-leptospiral antibodies among dogs and their handlers using the microscopic agglutination test (MAT). Blood samples from 266 apparently healthy dogs and 194 dog handlers were collected at four working dog organisations and four dog shelters. Serum samples were tested using MAT against 20 leptospiral serovars with a cut-off titre >1:100 (dog) and >1:50 (dog handlers). Seventy dogs (70/266; 26.3%) were seropositive mainly against serovars Icterohaemorrhagiae, Ballum, Bataviae and Javanica (titres ranged: 1:100–1:800). Sixty-seven dog handlers (67/194; 34.5%) were seropositive mainly against serovars Grippotyphosa, Icterohaemorrhagiae and Malaysia (titres ranged: 1:50–1:200). Dogs were seropositive due to exposure, vaccination or active infection. Seropositive dog handlers could indicate exposure or active infection. This shows the potential of dogs in maintaining and spreading the infection in Malaysia. Due to the occupational risk as a result of frequent contact with dogs and exposure to contaminated environments, dog handlers should be made aware of the presence of this zoonotic disease.

First molecular detection of Tritrichomonas foetus in domestic cats in Klang Valley, Malaysia

@#Tritrichomonas foetus is known to cause chronic diarrhea in the feline species in many different regions of the world. However, there is a paucity of information on T. foetus among cats in Malaysia. This study was conducted to determine the prevalence of Tritrichomonas foetus in the pet and stray cat population in Klang Valley, Malaysia. A total of 201 pet and stray cats’ fecal samples were collected in Klang Valley. 24 samples were cultured in the InPouch® TF Feline to observe for motile trophozoites. A nested PCR protocol was used to screen for T. foetus in the collected samples. The prevalence of T. foetus in the cat population in Klang Valley was 33%. There was no association between Tritrichomonas infection and age, sex, breed or management of the cats. However, statistical analysis revealed that stray cats were more likely to be infected with T. foetus compared to pet cats. This study confirmed for the first time the presence of T. foetus among the cat population in Klang Valley, Malaysia.

Prevalence of Toxoplasma gondii in pet and stray cats in Klang Valley, Malaysia

@#Toxoplasma gondii, a zoonotic protozoan that has a worldwide distribution, is known to infect many warm-blooded vertebrates. The feline species including domestic cats are the definitive hosts for Toxoplama gondii and shed the infective oocyst. There is lack of information on the prevalence of Toxoplasma gondii in cats in Malaysia. The objective of this study was to determine both the seroprevalence of T. gondii and the prevalence of T. gondii DNA in cats’ feces in Klang Valley, Malaysia. 198 blood and 201 fecal samples were collected from pet and stray cats from the local council, Dewan Bandaraya Kuala Lumpur (DBKL) and University Veterinary Hospital, Universiti Putra Malaysia respectively. The overall seroprevalence of Toxoplasma gondii in cats in the Klang Valley was found to be 5.5%. There was a high prevalence (10.5%) of T. gondii DNA detected in the cat fecal samples in both pet and stray cats suggestive of T. gondii oocyst shedding. Stray cats showed a higher seroprevalence and molecular prevalence of T. gondii than the pet cats. However, comparative analysis using Chi-square test showed no significant difference between both groups (P>0.05). Higher prevalence (10.5%) of cats shedding T. gondii DNA as compared to the seroprevalence (5.5%) was found in the cat population in the Klang Valley. The high prevalence of cats shedding T. gondii DNA is alarming as this may directly reflect the number of oocysts excreted into the environment posing a significant public health hazard.

Comparative Evaluation of Triphala, Aloe vera, and Chlorhexidine Mouthwash on Gingivitis: A Randomized Controlled Clinical Trial.

AIM: The aim of this study was to assess the effectiveness of two herbal mouthwashes in comparison with Chlorhexidine mouthwash on gingivitis. MATERIALS AND METHODS: This is a triple-blind randomized controlled clinical trial, where in 60 patients were randomly allocated into three study groups: Triphala mouthwash (Group A), Aloe vera mouthwash (Group B), and Chlorhexidine mouthwash (Group C). All groups were treated with scaling and asked to rinse with respective mouthwashes twice daily for 1 month. Clinical parameters such as plaque index (PI), gingival index (GI), and bleeding index (BI) were recorded at baseline, 15 days, and 30 days, respectively. RESULTS: Our results suggested that Triphala group effectively demonstrated a higher reduction in GI and BI index scores compared to A. vera group (P ≤ 0.005) and the effect is equivocal to the reduction seen with Chlorhexidine group. However, no statistically significant difference was observed between the mouthwashes in reduction of PI scores (P > 0.005). CONCLUSION: The results of our study evidenced Triphala to be superior in the reduction of plaque, gingival inflammation, and bleeding compared to that of A. vera. However, the results of our study also indicated that Triphala was as effective as chlorhexidine mouthwash in its ability in reducing plaque accumulation, gingival inflammation, and bleeding. Furthermore, Triphala is relatively free of side effects compared to that of chlorhexidine.