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Abstract Objective Over the last two decades one of the main surgical treatment for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) surgery was the insertion of non-absorbable mesh to restore continence and prolapse respectively. Over time complications arose including mesh-associated pain syndrome (MAPS), mesh exposure, mesh, erosion, chronic bladder/vaginal infections, and dyspareunia. Consequently, women chose surgical mesh removal to counter these problems. However, little is known about the demographics, medical co-morbidities, mesh types involved and the timing from mesh insertion to mesh removal. This retrospective study will look at which of these factors may be closely associated with mesh removal surgery. Design Retrospective evaluation. Setting Female Pelvic Medicine and Reconstructive Surgery (FPMRS) Clinic at University College London Hospitals NHS Foundation Trust. Population All patients presenting to the FPMRS Clinic between June 2011 to December 2019, requesting mesh removal surgery with a history of MAPS and other mesh complications were included in this study. Methods Patient demographics including age, ethnicity, obstetric history, and medical co-morbidities; type of mesh/anatomical route used; onset of symptoms; and time from insertion to removal were recorded. Main Outcome Measures Determination of correlation coefficients between patient demographics, patient reported symptoms and mesh removal surgery. Results Three hundred and forty-five women with a history of MAPS were included in the study. Women in the 40–60 year old cohort accounted for 54.4% of mesh removal surgery; 54.8% had a BMI under 30 and almost 90% were Caucasian. 96.5% had had children, with over 77% having had a vaginal delivery. 91.9% of patients reported other health conditions including 18.8% with a concomitant history of mental health problems and 15.4% with a history of heart disease. Over 80% of women undergoing mesh removal surgery had a continence mesh (49% retropubic and 32% obturator continence mesh) removed, whereas 20% had an abdominal prolapse and/or vaginal prolapse mesh removed. The average time from mesh insertion to mesh removal was seven years, with the prevalence of mesh removal surgery averaging 85% (range 50–100%) depending on the comorbidity determined. Conclusions All women presented to the clinic with a history of MAPS and other comorbidities which may have influenced their decision to pursue mesh removal surgery. There were no specific predictors, other than chronic pain associated with mesh, determining which women underwent surgery, though those with continence mesh were more likely to do so.

Introduction The Nepal Family Cohort study uses a life course epidemiological approach to collect comprehensive data on children’s and their parents’ environmental, behavioural and metabolic risk factors. These factors can affect the overall development of children to adulthood and the onset of specific diseases. Among the many risk factors, exposure to air pollution and lifestyle factors during childhood may impact lung development and function, leading to the early onset of respiratory diseases. The global incidence and prevalence of respiratory diseases are rapidly increasing, with the rate of increase in Nepal being the highest. Although the cohort will primarily focus on respiratory health, other health outcomes such as cardiovascular, metabolic and mental health will be assessed to provide a comprehensive overall health assessment. All other health outcomes are self-reported following doctor diagnosis. Some of these health outcomes will be quality controlled during the follow-up by measuring disease specific markers. Our cohort study will likely provide evidence of risk factors and policy recommendations.Methods and analysis Using a life-course epidemiology approach, we established a longitudinal study to address the determinants of lung health and other health outcomes from childhood to adulthood. The baseline data collection (personal data anonymised) was completed in April 2024, and 16 826 participants (9225 children and 7601 parents) from 5829 families were recruited in different geographical and climate areas (hills and plains) of Nepal. We plan to follow up all the participants every 2–3 years.Descriptive analysis will be used to report demographic characteristics and compare rural and semi-urban regions. A linear regression model will assess the association between air pollution, particularly household air pollution (HAP) exposure, and other lifestyle factors, with lung function adjusted for potential confounders. A two-stage linear regression model will help to evaluate lung development based on exposure to HAP.Ethics Ethical approval was obtained from the Nepal Health Research Council, Kathmandu, Nepal, and McMaster University, Hamilton, Canada. Permissions were obtained from two municipalities where the study sites are located. Parents provided signed informed consent and children their assent.Dissemination Findings will be disseminated through traditional academic pathways, including peer-reviewed publications and conference presentations. We will also engage the study population and local media (ie, research blogs and dissemination events) and prepare research and policy briefings for stakeholders and leaders at the local, provincial and national levels.

Abstract Whilst. pharmacological therapies remain the cornerstone of pain management in chronic pain, factors including the current opioid epidemic have led to non-pharmacological techniques becoming a more attractive proposition. We explored the prevalence of medical device use and their treatment efficacy in non-cancer pain management. A systematic methodology was developed, peer reviewed and published in PROSPERO (CRD42021235384). Key words of medical device, pain management devices, chronic pain, lower back pain, back pain, leg pain and chronic pelvic pain using Science direct, PubMed, Web of Science, PROSPERO, MEDLINE, EMBASE, PorQuest and ClinicalTrials.gov. All clinical trials, epidemiology and mixed methods studies that reported the use of medical devices for non-cancer chronic pain management published between the 1st of January 1990 and the 30th of April 2022 were included. 13 studies were included in systematic review, of these 6 were used in the meta-analysis. Our meta-analysis for pain reduction showed that transcutaneous electrical nerve stimulation combined with instrument-assisted soft tissue mobilization treatment and pulsed electromagnetic therapy produced significant treatment on chronic lower back pain patients. Pooled evidence revealed the use of medical device related interventions resulted in 0.7 degree of pain reduction under a 0–10 scale. Significant improvement in disability scores, with a 7.44 degree reduction in disability level compared to a placebo using a 50 score range was also seen. Our analysis has shown that the optimal use of medical devices in a sustainable manner requires further research, needing larger cohort studies, greater gender parity, in a more diverse range of geographical locations.

Aim: The aim of this study was to assess the effect of XP-Endo Finisher (XPF) in conjunction with three different chelating agents, namely, 0.2% chitosan nanoparticles (CNP), 17% ethylenediaminetetraacetic acid (EDTA), and 7% maleic acid (MA) on residual debris and smear layer on the root canal walls of the mandibular premolars. Methods: Eighty extracted human mandibular premolars were used in the study. Canals were prepared using an XP-Endo Shaper, and the final finishing was done with an XPF file. Teeth were randomly divided into four experimental groups based on chelating agents, Group I (XPF + 0.2% CNP), Group II (XPF + 17% EDTA), Group III (XPF + MA), and Group IV XPF + 2.5% sodium hypochlorite (NaOCl) (control group). Teeth were longitudinally split and prepared for scanning electron microscopy analysis. For comparing the smear layer and debris score between groups, the Kruskal–Wallis ANOVA was used, followed by the post hoc Bonferroni test. The level of significance was set at P < 0.05. Results: Group I (XPF + 0.2% CNP) gave the best results (P = 0.001) in all the thirds of root canal, followed by Group II (XPF + 17% EDTA) with P = 0.001. Group III (XPF + MA) showed results similar to that of the control group (XPF + NaOCl) with P = 0.001. There was a significant difference in the scores between Group I (XPF + CNP) and the other three groups. Conclusion: In all three-thirds of a root canal, the use of XPF + 0.2% CNP performed best at removing the smear layer. This was followed by XPF + 17% EDTA and XPF + 7% MA. For all groups, smear layer removal was less efficient in the apical third.

Abstract It is estimated 1.5 billion of the global population suffer from chronic pain with prevalence increasing with demographics including age. It is suggested long-term exposure to chronic could cause further health challenges reducing people’s quality of life. Therefore, it is imperative to use effective treatment options. We explored the current pharmaceutical treatments available for chronic pain management to better understand drug efficacy and pain reduction. A systematic methodology was developed and published in PROSPERO (CRD42021235384). Keywords of opioids, acute pain, pain management, chronic pain, opiods, NSAIDs, and analgesics were used across PubMed, Science direct, ProQuest, Web of science, Ovid Psych INFO, PROSPERO, EBSCOhost, MEDLINE, ClinicalTrials.gov and EMBASE. All randomised controlled clinical trials (RCTs), epidemiology and mixed-methods studies published in English between the 1st of January 1990 and 30th of April 2022 were included. A total of 119 studies were included. The data was synthesised using a tri-partied statistical methodology of a meta-analysis (24), pairwise meta-analysis (24) and network meta-analysis (34). Mean, median, standard deviation and confidence intervals for various pain assessments were used as the main outcomes for pre-treatment pain scores at baseline, post-treatment pain scores and pain score changes of each group. Our meta-analysis revealed the significant reduction in chronic pain scores of patients taking NSAID versus non-steroidal opioid drugs was comparative to patients given placebo under a random effects model. Pooled evidence also indicated significant drug efficiency with Botulinum Toxin Type-A (BTX-A) and Ketamine. Chronic pain is a public health problem that requires far more effective pharmaceutical interventions with minimal better side-effect profiles which will aid to develop better clinical guidelines. The importance of understanding ubiquity of pain by clinicians, policy makers, researchers and academic scholars is vital to prevent social determinant which aggravates issue.

Abstract Background Ongoing symptoms or the development of new symptoms following a SARS-CoV-2 diagnosis has caused a complex clinical problem known as “long COVID” (LC). This has introduced further pressure on global healthcare systems as there appears to be a need for ongoing clinical management of these patients. LC personifies heterogeneous symptoms at varying frequencies. The most complex symptoms appear to be driven by the neurology and neuropsychiatry spheres. Methods A systematic protocol was developed, peer reviewed, and published in PROSPERO. The systematic review included publications from the 1st of December 2019–30th June 2021 published in English. Multiple electronic databases were used. The dataset has been analyzed using a random-effects model and a subgroup analysis based on geographical location. Prevalence and 95% confidence intervals (CIs) were established based on the data identified. Results Of the 302 studies, 49 met the inclusion criteria, although 36 studies were included in the meta-analysis. The 36 studies had a collective sample size of 11,598 LC patients. 18 of the 36 studies were designed as cohorts and the remainder were cross-sectional. Symptoms of mental health, gastrointestinal, cardiopulmonary, neurological, and pain were reported. Conclusions The quality that differentiates this meta-analysis is that they are cohort and cross-sectional studies with follow-up. It is evident that there is limited knowledge available of LC and current clinical management strategies may be suboptimal as a result. Clinical practice improvements will require more comprehensive clinical research, enabling effective evidence-based approaches to better support patients.

Abstract Background This systematic review aims to explore the prevalence of the impact of the COVID-19, MERS, and SARS pandemics on the mental health of pregnant women. Methods All COVID-19, SARS and MERS studies that evaluated the mental health of pregnant women with/without gynaecological conditions that were reported in English between December 2000 – July 2021 were included. The search criteria were developed based upon the research question using PubMed, Science Direct, Ovid PsycINFO and EMBASE databases. A wide search criterion was used to ensure the inclusion of all pregnant women with existing gynaecological conditions. The Newcastle-Ottawa-Scale was used to assess the risk of bias for all included studies. Random effects model with restricted maximum-likelihood estimation method was applied for the meta-analysis and I-square statistic was used to evaluate heterogeneity across studies. The pooled prevalence rates of symptoms of anxiety, depression, PTSD, stress, and sleep disorders with 95% confidence interval (CI) were computed. Results This systematic review identified 217 studies which included 638,889 pregnant women or women who had just given birth. There were no studies reporting the mental health impact due to MERS and SARS. Results showed that women who were pregnant or had just given birth displayed various symptoms of poor mental health including those relating to depression (24.9%), anxiety (32.8%), stress (29.44%), Post Traumatic Stress Disorder (PTSD) (27.93%), and sleep disorders (24.38%) during the COVID-19 pandemic. Discussion It is important to note that studies included in this review used a range of outcome measures which does not allow for direct comparisons between findings. Most studies reported self-reported measure of symptoms without clinical diagnoses so conclusions can be made for symptom prevalence rather than of mental illness. The importance of managing mental health during pregnancy and after-delivery improves the quality of life and wellbeing of mothers hence developing an evidence-based approached as part of pandemic preparedness would improve mental health during challenging times. Other The work presented in this manuscript was not funded by any specific grants. A study protocol was developed and published in PROSPERO (CRD42021235356) to explore several key objectives.

Aim: Caries or traumatic injuries affecting young permanent teeth during root development usually result in an open apex which is highly challenging to treat. The aim of this study was to evaluate the push-out bond strength of apical plugs of Mineral Trioxide Aggregate (MTA) Plus, Biodentine, and calcium-enriched mixture (CEM) after premedication with chlorhexidine, triple antibiotic paste (TAP), and calcium hydroxide. Methods: Fifty-four extracted intact anterior teeth were decoronated and 3 mm was sectioned from the apex. The canals were rendered parallel using #80 K-files and #3, #4 Peeso reamers to mimic an open apex situation. The samples were divided into 3 groups containing 18 samples each for the three intracanal medicaments. After premedication, the samples were stored for 2 weeks at 37°C, following which the canals were cleaned using #80 K-file along with ethylenediaminetetraacetic acid and sodium hypochlorite irrigation. The samples were further divided into three subgroups, each containing six samples for the three calcium silicate cement used in this study. They were later subjected to push-out bond strength testing. Results: Regardless of the type of intracanal medicament used, Biodentine had significantly higher bond strength than MTA Plus and CEM. The highest push-out bond strength results were obtained in samples premedicated with chlorhexidine. Compared to TAP and calcium hydroxide (Ca(OH) 2), this value was statistically significant (P < 0.001). Conclusion: Within the limitations of this study, Biodentine showed the highest push-out bond strength as compared to MTA Plus and CEM. Chlorhexidine may be superior to calcium hydroxide and TAP medicaments when used for apexification procedures with calcium silicate cement.

Aims: The aim is to evaluate the retreatability of BioRoot RCS (BCS)/Gutta-percha (GP) as compared to AH Plus/GP with and without a solvent using cone-beam computed tomography (CBCT). Materials and Methods: Mesio-buccal canals in 48 first mandibular molars were instrumented using iRace rotary files up to size 25.4% and obturated with GP using one of the following sealers, BCS and AH Plus. Post obturation, the teeth were scanned using a CBCT. All samples were divided into four groups (n = 12). Group 1: GP/BCS was removed using D-Race retreatment files and xylene as a solvent; Group 2: GP/BCS was removed using D-Race retreatment files without xylene; Group 3: GP/AH Plus was removed using D-Race retreatment files with xylene; Group 4: GP/AH Plus was removed using D-Race retreatment files without xylene. Time taken to reach the working length (WL) was recorded. Samples were again scanned using CBCT and the remaining filling material was calculated in the coronal, middle, and apical thirds. Data were tabulated and analyzed via Kruskal–Wallis and Mann–Whitney Post hoc test (P < 0.05). Results: Group 3 exhibited significantly less time to reach WL as compared to Group 1. There was no significant difference between Group 2 and Group 4. In all groups, the apical third had the most remaining filling material (Group 1 – 13.75 ± 4.83, Group 2 – 18.33 ± 3.26, Group 3 – 10.42 ± 3.34, Group 4 – 15.42 ± 3.34). WL and patency were re-established in all the samples. Conclusions: Irrespective of the retreatment technique employed complete removal of both the sealers could not be achieved. However, retreatability of AH Plus with xylene was superior to that of BioRoot RCS.

Aim: The aim of this study was to compare the biomechanical strength properties of the mandibular first molar with truss and conventional endodontic access cavities using the finite element method. Methods: Two finite element analysis (FEA) models of a mandibular first molar were designed and constructed with truss endodontic cavity (TREC) and Conventional endodontic cavity (CEC). Each model was subjected to three different force loads directed at the occlusal surface. The stress distribution patterns and the maximum von Mises (VM) stresses were calculated and compared. FEM software ANSYS was used for evaluation. Results: The peak VM stress on both models was at the site of the force load. The occlusal stresses were spread in an approximate actinomorphic pattern from where the force was loaded, and the stress was much higher when the force load was close to the access cavity margin. The peak root VM stresses on the root-filled teeth occurred at the apex and were significantly higher than that on the intact tooth, which appeared on the pericervical dentin. The area of pericervical dentin experiencing high VM stress increased as the cavity size increased and became concentrated in the area between the filling materials and the dentin. Conclusion: Under all loading conditions, the TREC model showed low-stress concentration compared to the CEC model. With enlargement of the access cavity, the stress on the pericervical dentin increased significantly.

ImportancePain is a silent global epidemic impacting approximately a third of the population. Pharmacological and surgical interventions are primary modes of treatment. Cognitive/behavioural management approaches and interventional pain management strategies are approaches that have been used to assist with the management of chronic pain. Accurate data collection and reporting treatment outcomes are vital to addressing the challenges faced. In light of this, we conducted a systematic evaluation of the current digital application landscape within chronic pain medicine.ObjectiveThe primary objective was to consider the prevalence of digital application usage for chronic pain management. These digital applications included mobile apps, web apps, and chatbots.Data sourcesWe conducted searches on PubMed and ScienceDirect for studies that were published between 1st January 1990 and 1st January 2021.Study selectionOur review included studies that involved the use of digital applications for chronic pain conditions. There were no restrictions on the country in which the study was conducted. Only studies that were peer-reviewed and published in English were included. Four reviewers had assessed the eligibility of each study against the inclusion/exclusion criteria. Out of the 84 studies that were initially identified, 38 were included in the systematic review.Data extraction and synthesisThe AMSTAR guidelines were used to assess data quality. This assessment was carried out by 3 reviewers. The data were pooled using a random-effects model.Main outcome(s) and measure(s)Before data collection began, the primary outcome was to report on the standard mean difference of digital application usage for chronic pain conditions. We also recorded the type of digital application studied (e.g., mobile application, web application) and, where the data was available, the standard mean difference of pain intensity, pain inferences, depression, anxiety, and fatigue.Results38 studies were included in the systematic review and 22 studies were included in the meta-analysis. The digital interventions were categorised to web and mobile applications and chatbots, with pooled standard mean difference of 0.22 (95% CI: −0.16, 0.60), 0.30 (95% CI: 0.00, 0.60) and −0.02 (95% CI: −0.47, 0.42) respectively. Pooled standard mean differences for symptomatologies of pain intensity, depression, and anxiety symptoms were 0.25 (95% CI: 0.03, 0.46), 0.30 (95% CI: 0.17, 0.43) and 0.37 (95% CI: 0.05, 0.69), respectively. A sub-group analysis was conducted on pain intensity due to the heterogeneity of the results (I2 = 82.86%; p = 0.02). After stratifying by country, we found that digital applications were more likely to be effective in some countries (e.g., United States, China) than others (e.g., Ireland, Norway).Conclusions and relevanceThe use of digital applications in improving pain-related symptoms shows promise, but further clinical studies would be needed to develop more robust applications.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42021228343.

In this study, we investigated the effects of treating Al-12 wt% silicon alloy with an equimolar composition mixture of NaCl, KCl, and NaF on various aspects of the alloy’s properties. Key findings of the research indicate that the flux treatment had significant effects on the alloy. It led to increased nucleation temperatures and reduced undercooling, thereby facilitating nucleation sites and grain refinement. Additionally, the inclusion of flux reduced the entrapment of inclusions in the melt, which can potentially enhance the mechanical properties of the alloy. However, it also led to a larger and more widely distributed gas porosity in the solidified samples, as gas evolved from the flux trapped during solidification. Moreover, the flux treatment had noticeable impacts on the morphology of eutectic silicon particles, reducing their aspect ratio. These findings offer valuable insights into the potential benefits and challenges of sodium-based flux melt treatment in optimizing the quality of Al-12Si alloy castings, particularly in die-casting applications.

Background: Gestational diabetes mellitus (GDM) is a common complication of pregnancy and is associated with an increased risk of mental health (MH) disorders including antenatal and postnatal depression (PND), anxiety and post-traumatic-stress-disorder (PTSD). We hypothesized GDM and MH disorders will disproportionately affect individuals from Black, Asian and Minority Ethnic backgrounds. Methods: A systematic methodology was developed, and a protocol was published in PROSPERO (CRD42020210863) and a systematic review of publications between 1st January 1990 and 30th January 2021 was conducted. Multiple electronic databases were explored using keywords and MeSH terms. The finalised dataset was analysed using statistical methods such as random-effect models, subgroup analysis and sensitivity analysis. These were used to determine odds ratio (OR) and 95% confidence intervals (CI) to establish prevalence using variables of PND, anxiety, PTSD and stress to name a few. Findings: Sixty studies were finalised from the 20,040 data pool. Forty-six studies were included systematically with 14 used to meta-analyze GDM and MH outcomes. A second meta-analysis was conducted using 7 studies to determine GDM risk among Black, Asian and Minority Ethnic women with pre-existing MH disorders. The results indicate an increased risk with pooled adjusted OR for both reflected at 1.23, 95% CI of 1.00–1.50 and 1.29, 95% CI of 1.11–1.50 respectively. Interpretation: The available studies suggest a MH sequalae with GDM as well as a sequalae of GDM with MH among Black, Asian and Minority Ethnic populations. Our findings warrant further future exploration to better manage these patients. Funding: Not applicable

Background: It is important to evaluate sequalae for complex chronic health conditions such as endometriosis and mental health disorders. Endometriosis impacts 1 in 10 women. Mental health outcomes can be a primary determinant in many physical health conditions although this is an area not well researched particularly in women’s health. This has been problematic for endometriosis patients in particular, who report mental health issues as well as other key comorbidities such as chronic pelvic pain and infertility. This could be partly due to the complexities associated with comprehensively exploring overlaps between physical and mental health disorders in the presence of multiple comorbidities and their potential mechanistic relationship. Methods: In this evidence synthesis, a systematic methodology and mixed-methods approaches were used to synthesize both qualitative and quantitative data to examine the prevalence of the overlapping sequalae between endometriosis and psychiatric symptoms and disorders. As part of this, an evidence synthesis protocol was developed which included a systematic review protocol that was published on PROSPERO (CRD42020181495). The aim was to identify and evaluate mental health reported outcomes and prevalence of symptoms and psychiatric disorders associated with endometriosis. Findings: A total of 34 papers were included in the systematic review and 15 were included in the meta-analysis. Anxiety and depression symptoms were the most commonly reported mental health outcomes while a pooled analysis also revealed high prevalence of chronic pelvic pain and dyspareunia. Interpretation: It is evident that small-scale cross-sectional studies have been conducted in a variety of settings to determine mental health outcomes among endometriosis patients. Further research is required to comprehensively evaluate the mental health sequalae with endometriosis.

To evaluate and holistically treat the mental health sequelae and potential psychiatric comorbidities associated with obstetric and gynaecological conditions, it is important to optimize patient care, ensure efficient use of limited resources and improve health-economic models. Artificial intelligence applications could assist in achieving the above. The World Health Organization and global healthcare systems have already recognized the use of artificial intelligence technologies to address ‘system gaps’ and automate some of the more cumbersome tasks to optimize clinical services and reduce health inequalities. Currently, both mental health and obstetric and gynaecological services independently use artificial intelligence applications. Thus, suitable solutions are shared between mental health and obstetric and gynaecological clinical practices, independent of one another. Although, to address complexities with some patients who may have often interchanging sequelae with mental health and obstetric and gynaecological illnesses, ‘holistically’ developed artificial intelligence applications could be useful. Therefore, we present a rapid review to understand the currently available artificial intelligence applications and research into multi-morbid conditions, including clinical trial-based validations. Most artificial intelligence applications are intrinsically data-driven tools, and their validation in healthcare can be challenging as they require large-scale clinical trials. Furthermore, most artificial intelligence applications use rate-limiting mock data sets, which restrict their applicability to a clinical population. Some researchers may fail to recognize the randomness in the data generating processes in clinical care from a statistical perspective with a potentially minimal representation of a population, limiting their applicability within a real-world setting. However, novel, innovative trial designs could pave the way to generate better data sets that are generalizable to the entire global population. A collaboration between artificial intelligence and statistical models could be developed and deployed with algorithmic and domain interpretability to achieve this. In addition, acquiring big data sets is vital to ensure these artificial intelligence applications provide the highest accuracy within a real-world setting, especially when used as part of a clinical diagnosis or treatment.

Introduction: The primary objective in Endodontics has been to disinfect the root canal space, by both mechanical and chemical means. Clinicians rarely give a thought to the fact that contamination can happen from all sorts of instruments, materials and the by clinical setup itself. When disinfection of the root canal is been spoken, studied and researched so extensively, gutta percha cones which are the most commonly used root canal filing material for over 100 years, thanks to its malleability and biocompatibility. They may be contaminated right from the manufacturing process, packaging and use. Aim: This study intended to compare the efficacy of berberine as a more biocompatible alternative to sodium hypochlorite and chlorhexidine cetrimide as a chairside disinfectant for gutta percha cones. Materials and Methods: 180 gutta percha cones collected from freshly opened boxes were contaminated with Microbial suspensions of E. Faecalis (ATCC29212) and S. aureus (ATCC 6538) of approximately 108 CFU/mL artificially. Split into three groups with three different disinfecting agents (6% NaOCl, vista dental products, USA, berberine chloride 2 mg/ mL, Chlorhexidine 2% and cetrimide 0.2%) further subdivision was done based on exposure time (one minute, three minutes, five minutes) respectively, After disinfection in chemical agents, the cones were washed in 10 mL of detergent solution (3% Tween 80 and 5% sodium thiosulfate) for five minutes. The cones were rinsed in 10 mL of sterile distilled water, transportation to sterile test tubes containing 10 mL of thioglycollate media and incubated at 37°C for seven days, then were transferred from the 10 mL thioglycollate media to a petridish containing brain heart infusion agar, incubating for 48 hours aerobically at 37°C and the colony forming units were graded under light microscope. Results: Statistical analysis was done with Tukeys HSD test. The mean bacterial count of E. Faecalis or S. aureus was found to be significantly lesser after treating the cones with 6% sodium hypochlorite when compared with other disinfecting solutions for all time intervals tested. Berberine was found to be mildly effective against S. aureus but not effective against E. Faecalis even at the five minute stage. Conclusion: Within the limitations of the study, Sodium Hypochlorite is still the disinfectant to beat, further research is needed with berberine along with concentration modifications and duration.

This report presents a rare case of polymorphous low‐grade adenocarcinoma (PLGA) in the anterior maxilla, mimicking a periapical lesion. A 56‐year‐old male reported with a painless swelling in the maxillary right canine‐premolar region. The patient gave a history of root canal therapy for the same teeth one month ago. On intraoral examination, the involved teeth were restored with ceramic crowns. Radiographic examination revealed inadequate obturation with an ill‐defined radiolucency in the periapical region. 3D cone beam computer tomography (CBCT) revealed erosion of the buccal cortical plate near the apices of the roots. Endodontic re‐treatment was performed on both the teeth. Following this, the lesion was excised and submitted for histopathological analysis wherein it was identified as PLGA. Computerised tomographic (CT) scan and positron emission tomography scan (PET) results showed no regional or distant metastasis. Under general anaesthesia, the teeth were extracted, and wide surgical excision of the anterior maxilla was done till the healthy bone was exposed. Healing was uneventful during the follow‐up period. [ABSTRACT FROM AUTHOR]

Aim: Arthrocentesis of the temporomandibular joint traditionally involves irrigation of the upper joint space and manipulation of the joint, using 2 needles inserted through two separate puncture sites. The blind insertion of the second needle is often challenging. The surgeon may lose the right place during the procedure. So it may need manipulation and sometimes even multiple punctures. This often leads to extra -articular leak of the lavage solution which decreases the intra-articular pressure required for lysis. To overcome this unwanted clinical situation, a simple technique of introducing both the needles through a single puncture to accomplish the procedure of arthrocentesis more effectively has been followed in this study. Materials and Method: This study was conducted on 20 patients diagnosed with inflammatory conditions of the temporomandibular joint. Patient underwent arthrocentesis using a modified dual needle device with Ringer′s lactate as a lavage solution. Pre-op and post-op data were recorded over three months and analyzed statistically. Results: Mouth opening and visual analogue score for pain which were analyzed by student paired t test revealed that mouth opening increased and pain decreased significantly (p