Intragroup Comparisons Research Articles

Analysis of Effect of Intensity of Aerobic Exercise on Cognitive and Motor Functions and Neurotrophic Factor Expression Patterns in an Alzheimer's Disease Rat Model.

The effect of aerobic exercise at different intensities on Alzheimer's disease (AD) still remains unclear. We investigated the effect of aerobic exercise at different intensities on cognitive and motor functions and neurotrophic factor expression. Thirty-two AD-induced rats were randomly assigned to control (CG), low-intensity (Group I), medium-intensity (Group II), and high-intensity (Group III) exercise groups. Each group, except for the CG, performed aerobic exercise for 20 min a day five times a week. After performing aerobic exercise for 4 weeks, their cognitive and motor functions and neurotrophic factor expression patterns were analyzed and compared between the groups. All variables of cognitive and motor functions and neurotrophic factor expression were significantly improved in Groups I, II, and III compared to those in the CG (p < 0.05). Among the neurotrophic factors, brain-derived neurotrophic factor (BDNF) expression was significantly improved in Group III compared to that in Groups I and II (p < 0.05). In the intra-group comparison of cognitive and motor functions, no significant difference was observed in CG, but the aerobic exercise groups showed improvements. Only Group III showed a significant improvement in the time it took to find eight food items accurately (p < 0.05). Aerobic exercise improved the cognitive and motor functions and neurotrophic factor expression patterns in the AD-induced rat model, with high-intensity aerobic exercise having greater effects on cognitive function and BDNF expression.

The effect of pelvic clock exercises on pain reduction and lumbopelvic proprioception in middle-aged women with chronic nonspecific low back pain (CNSLBP)

IntroductionLow-back pain (LBP) is one of the most common causes of disability in adults. There are many non-invasive interventions to improve this condition, of which the use of exercise therapy is one of the most widely used. But there is contradictory evidence regarding the effectiveness of different types of exercise methods. Therefore, the current research aimed to investigate the effect of pelvic clock exercises on pain reduction and lumbopelvic proprioception in women with chronic nonspecific low back pain (CNSLBP). Materials and methodsThis was a quasi-experimental study with a controlled pre-test-post-test design. The study population included middle-aged women with CNSLBP with an age range of 35–50 years. A total of 30 eligible middle-aged women with CNSLBP were selected using purposive and convenience sampling. The pelvic clock exercise was carried out by the researcher in a gym for eight 45- min sessions each week (three sessions each week). A visual analog scale (VAS) and goniometer were used to measure pain and lumbopelvic proprioception, respectively. However, the control group only participated in the pre-test and post-test stages. For intra-group and inter-group comparisons, paired t-test and independent t-test were used at P < 0.05, respectively. ResultsThe results showed that eight-week pelvic clock exercises had an effect on decreased pain and increase lumbopelvic proprioception in middle-aged women with CNSLBP, but no effect was observed in the control group (P > 0.05). ConclusionAccording to the results of the present study, pelvic clock exercises should be used as a new and practical method to reduce pain and improve lumbopelvic proprioception in middle-aged women with CNSLBP.

Effect of teaching health-promoting behaviors on the care burden of family caregivers of hemodialysis patients: a four-group clinical trial

IntroductionChronic kidney disease could have a profound effect on the life of patients and family caregivers. The caregivers’ care burden increases as the disease progresses. Interventions reducing care burden should be investigated. Educational interventions could affect family caregivers’ care burden among hemodialysis patients. However, most studies and interventions have focused on caregivers. Therefore, this study aims to compare the effect of teaching Health-promoting behaviors on the care burden of family caregivers of hemodialysis patients.Materials and methodsThis trial was conducted using a pretest-posttest design and follow-up after one month. Hemodialysis patients and their family caregivers were selected using convenience sampling method. In total, 124 patient-caregiver pairs were divided into four groups of patient-centered education, caregiver-centered education, Patient and caregiver education and control by block randomization (15 blocks of 8 members and 1 block of 4 members) (n = 31 pairs per group). The intervention (teaching health-promoting behaviors) was performed in 8 sessions using the teach-back method, except for the control. The data were collected by patient and caregiver demographic forms and Novak and Guest care burden inventory as well as following the treatment regimen in three stages (before, immediately after and one month after the intervention). Demographic variables were compared among the four groups using ANOVA, Kruskal-Wallis and Chi-square test. The intragroup comparison of the main variables was made using the repeated measures ANOVA with modified LSD post hoc test. The intergroup comparison was made by one-way ANOVA with LSD post hoc test.ResultsOut of 124 caregivers participating in the study, 68 (54.8%) were female. Also, out of 124 patients participating in the study, 86 (69.4%) were male. The mean age of the caregivers and patients was 39.2 ± 11.31 and 54.23 ± 14.20 years old, respectively. There was a statistically significant difference in the mean total care burden scores of the pre-test and post-test between the four groups (p < 0.001). The total care burden decreased in patient-centered, caregiver-centered and Patient and caregiver education groups. However, this reduction in the caregiver-centered and Patient and caregiver education groups was significantly higher than the patient-centered education group (p < 0.001).ConclusionThe results revealed teaching health-promoting behaviors reduced care burden. Moreover, caregiver-centered approach could reduce care burden more than patient-centered approach. Therefore, this could be used as a supportive method to improve the health of patients and caregivers.Trial registration number (TRN)IRCT20090522001930N4.Date of registration2021-11-12.

AN OPEN-LABELLED CLINICAL TRIAL ON SWARNA PRASHAN AT SPARSH HOSPITAL, PATTANKODOLI

In Ayurveda administration of the gold particles in children’s is considered to be a unique practice termed as Swarna Prashana (SP). The main ingredients include Swarna Bhasma, Goghrita, Honey and other herbal drugs which are useful in enhancing intellectual property. For the past several decades, clinical practices proved that SP has better Immunomodulatory effect by activating both cellular and humeral immunity. Aim: The Present trial was conducted to evaluate and document the effect of Swarna Prashana on children with respect to improvement in general health status and immunity at Swarna Hospital, Pattankodoli. Methodology: The trial was Open label, Prospective and Observational study in 23 children between the age group of 4 months to 60 months, regular follow-ups were taken on 0th, 180th day and 360th day and assessed on the basis of specially prepared Immune status questionnaires and illness dairy. Result: As parameters were ordinal in nature, “Wilcoxon Signed Rank test” is used for intra-group comparison and results were analysed and on 0th, 180th day and 360th day it has shown significant reduction in Illness Dairy. In same way it has also shown significant results in immune status of the child. Conclusion: Swarna Prashana has a unique immune enhancing property along with improvement in general health status and intellectual health.

A structured laughter yoga therapy program on patients with chemotherapy-induced nausea and vomiting: A randomized clinical trial

ObjetiveChemotherapy is a prevalent cancer treatment, often accompanied by debilitating side effects such as nausea and vomiting. This study explores the potential effectiveness of laughter yoga, a combination of exercise and voluntary laughter, in alleviating chemotherapy-induced nausea and vomiting. MethodsThis two-group randomized clinical trial was conducted on 69 cancer patients undergoing chemotherapy at the Reza Chemotherapy and Oncology Center, Mashhad, Iran, in 2018. Patients were randomly divided into intervention and control groups. Both groups received routine self-care training, with the addition of four 20-min to 30-min laughter yoga sessions held immediately before one of their chemotherapy appointments for the intervention group only. Nausea and vomiting were assessed using the Morrow Assessment of Nausea and Emesis questionnaire at two stages, before and after the intervention. Data were analyzed with Chi-square, Independent-t, Mann–Whitney, Wilcoxon, and McNemar tests using Statistical Package for the Social Sciences (SPSS). ResultsThe mean age of patients in the intervention group was 49.0 ± 9.6 years, while in the control group, it was 45.2 ± 12.6 years. The intragroup comparison showed a statistically significant decrease in the severity and duration of nausea in the intervention group and a statistically significant increase in the severity and duration of nausea in the control group from pre-test to post-test (P < 0.05). The intergroup comparison showed no statistically significant difference between the two groups in terms of vomiting conditions. ConclusionsLaughter yoga demonstrates promise in improving chemotherapy-induced nausea, suggesting its potential recommendation for managing this distressing side effect. Further research is warranted to explore its broader application in cancer care. Trial registrationThis study (No. IRCT20180429039463N1) was registered in the Iranian Registry of Clinical Trials on 21/08/2018.

A Randomized Controlled Trial Evaluating the Effectiveness of Nanosilver Fluoride in Arresting Dental Caries in School Children.

The study evaluated the effectiveness of nanosilver fluoride (NSF) in arresting dental caries in 4-8-year-old school children. The two-arm, parallel-group randomized controlled trial included a total of 148 children aged 4-8 years with active carious lesions. Children were randomly divided into two groups: group I-NSF (n = 74); and group II-water (placebo and n = 74). Baseline data were recorded using the International Caries Detection and Assessment System (ICDAS) II criteria, and the teeth were treated with either of the solutions. Later, the teeth were evaluated by two blinded examiners for the lesion activity using ICDAS II criteria at 1, 3, and 6-month intervals. The obtained data were analyzed using the Chi-squared test for intergroup comparison and Cochran's Q test for intragroup comparison. Cohen's κ test was used to check the interexaminer and intraexaminer variability. Carious teeth treated with NSF have shown 56.3, 59.2, and 62% arrested carious lesions, whereas the placebo group has shown 0, 2.9, and 4.4% arrested lesions at 1, 3, and 6-month intervals, respectively. NSF showed a high statistically significant difference (p < 0.001) in arresting dental caries compared to the control group at all the time intervals. Nanosilver fluoride (NSF) is found to be effective in arresting dental caries without staining carious lesions. Therefore, it can be used to reduce the bacterial load for caries stabilization in the initial phase of the comprehensive treatment protocol for the management of children with active caries lesions. Most of the decayed teeth in the primary dentition remain untreated either because of inaccessible dental services or the uncooperativeness of children. Hence, there is an absolute need for a cariostatic agent which arrests the progression of caries in a simple and noninvasive manner. The results of this study evidence that NSF effectively arrests dental caries in primary teeth. Hence, this can be a very economical way of arresting caries in the population who don't have access to regular dental treatment. Devi C, Chandrasekhar R, Vinay C, et al. A Randomized Controlled Trial Evaluating the Effectiveness of Nanosilver Fluoride in Arresting Dental Caries in School Children. Int J Clin Pediatr Dent 2023;16(5):667-670.

Hemodynamic forces from 4D flow magnetic resonance imaging for optimised prediction of cardiac resynchronisation therapy outcome

Abstract Background Patients with heart failure and left bundle branch block (LBBB) may receive cardiac resynchronisation therapy (CRT), but many patients have limited treatment response (1). The use of imaging to optimise patient selection has been repeatedly attempted with some success (2), and scar detected on late gadolinium enhancement (LGE) imaging has been associated with reduced response rates (3). Intraventricular hemodynamic force (HDF) analysis has been suggested as a novel marker for assessment of patients eligible for CRT (4). The aim of this study was therefore to investigate if septal scar from LGE or left ventricular HDF computed from cardiac magnetic resonance (CMR) imaging can improve prediction of CRT outcome. Methods Patients with heart failure, EF&amp;lt;35% and LBBB (n=22) underwent CMR with 4D flow at 1.5T or 3T (Achieva, Philips Healthcare) prior to CRT (Figure 1). Scar was assessed by LGE. Left ventricular HDF were computed based on the Navier-Stokes equations, using a validated module in the software Segment v3.3 R10057 (Medviso, Lund, Sweden) (5). Forces (N) were analysed in three orthogonal directions as root mean square (RMS) and peak values, reported in median [interquartile range]. Transversal/longitudinal HDF ratio was calculated for systole and diastole. Echocardiography was performed before and six months after CRT, and patients with end-systolic volume reduction ≥15% at follow-up were defined as responders. The Mann-Whitney U test was used for group comparisons, Fisher’s exact test for binary categorical data, Wilcoxon test for paired comparisons, and receiver operating characteristic analysis for prediction of CRT response. Results There was no difference between responders and non-responders in LGE (Table 1). Non-responders had smaller HDF than responders in the inferior-anterior direction in systole (RMS: 0.055 [0.027] vs 0.070 [0.032], p=0.04; peak: 0.11 [0.069] vs 0.15 [0.083], p=0.03), and in the apex-base direction in diastole (RMS: 0.087 [0.018] vs 0.11 [0.046], p=0.047). Non-responders had larger diastolic HDF ratio than responders (RMS: 0.89 [0.45] vs 0.67 [0.20], p=0.004; peak: 1.1 [0.51] vs 0.57 [0.40], p=0.01) (Figure 1). Receiver operating characteristic analysis of diastolic HDF ratio found an area under the curve of 0.88 (p=0.005). Identification of non-responders using diastolic HDF ratio with a specificity of 100%, resulted in a ratio of &amp;gt;0.87 for non-responders, with a sensitivity of 57%. Intragroup comparison found higher HDF ratio in systole than diastole for responders but not for non-responders (Figure 1). Conclusions Prediction of left ventricular remodelling following CRT may be optimized by hemodynamic force analysis from 4D flow CMR, while septal scar from LGE was not found indicative of CRT outcome in this pilot study. Larger-scale studies are required before clinical implementation of HDF analysis.Table 1Figure 1

The effect of three different primary teeth rotary instrument systems on the amount of apically extruded debris in pulpectomy of primary teeth.

The objective of this study is to evaluate the amount of apically extruded debris and working time during root canal treatment with three different primary teeth rotary instrument systems. A total of 80 extracted primary second molar teeth were randomly divided into four groups (n=20) stratified by the instruments used: AF Baby Rotary, Easyinsmile Baby Rotary, Endoart Pedo Gold, and hand files. The apical extrusion of debris was collected then dried in Eppendorf tubes that were pre-weighed with 10-4 precision micro-balance. The incubation period was set as 14 days at 37°C. The dry weight was procured by deducting the preoperative weight from the postoperative weight. The systems' working time was calculated by chronometer. Mann Whitney U test with Bonferroni correction was used for pairwise comparison following the variance analysis with Kruskal Wallis test. Wilcoxon test was used for intragroup comparison. Although all instruments caused apically extruded debris (p<0.001), there was no statistically significant difference between the groups in debris extrusion. However, the longest working time was found in the manual K files, the Endoart Pedo Gold system had the shortest working time (p<0.001). Our results demonstrate that all instrument systems caused apical extrusion of debris. Furthermore, the rotary instrument systems designed for primary teeth exhibited significantly shorter working time.

Influence of pH levels and beverage exposure on force decay and color stability of orthodontic elastomeric chains: An experimental study

Aim of studyTo assess the impact of pH level on force decay and color stability of orthodontic elastomeric chains (EOC) after exposure to commonly used beverages. Materials and methodsA total of 120 chain cuts were prepared from 2 different manufacturers (GC Orthodontics Europe GmbH, Breckerfeld, Germany, and FORESTADENT® - Bernhard Foerster GmbH, Pforzheim, Germany). According to the distance between loops, two types of chains were selected from each manufacturer: short and medium ones. Chains were immersed into 10 commonly used beverages with different pH values. After 7 days, force degradation was evaluated with the universal machine for mechanical testing (Model 4411; Instron, Canton, USA) and color change using a VITA Easyshade® digital spectrophotometer. Kruskal-Wallis with post-hoc Dunn's test for intergroup comparison and Wilcoxon rank test for intragroup comparison. ResultsInitial force varied among EOC brands, with GC short chains having the highest force and Forestadent medium chains the lowest. The most pronounced force decay occurred within 24 h, notably affecting Forestadent short chains the most, followed by Forestadent medium, GC short, and GC medium chains. Despite a higher force drop rate over seven days, short EOCs maintained higher forces than medium EOCs. GC EOCs consistently maintained higher forces after seven days compared to Forestadent EOCs. After the immersion of EOC in different solutions for 24 h, only Evian water, Soy milk, and Coconut water did not change color. After 7 days, the greatest color change was recorded in coffee. ConclusionThere is no correlation between pH value and force decay of polyurethane chains. Short chains showed more constant force delivery and greater value of remaining force in comparison to medium ones. Color stability was mostly affected by coffee, followed by matcha tea, soy milk, and apple juice.

Cannabidiol as an Alternative Analgesic for Acute Dental Pain

Odontogenic pain can be debilitating, and nonopioid analgesic options are limited. This randomized placebo-controlled clinical trial aimed to assess the effectiveness and safety of cannabidiol (CBD) as an analgesic for patients with emergency acute dental pain. Sixty-one patients with moderate to severe toothache were randomized into 3 groups: CBD10 (CBD 10 mg/kg), CBD20 (CBD 20 mg/kg), and placebo. We administered a single dose of respective oral solution and monitored the subjects for 3 h. The primary outcome measure was the numerical pain differences using a visual analog scale (VAS) from baseline within and among the groups. Secondary outcome measures included ordinal pain intensity differences, the onset of significant pain relief, maximum pain relief, changes in bite force within and among the groups, psychoactive effects, mood changes, and other adverse events. Both CBD groups resulted in significant VAS pain reduction compared to their baseline and the placebo group, with a maximum median VAS pain reduction of 73–77% from baseline pain at the 180-min time point (P < 0.05). CBD20 experienced a faster onset of significant pain relief than CBD10 (15 versus 30 min after drug administration), and both groups reached maximum pain relief at 180-min. Number needed to treat was 3.1 for CBD10 and 2.4 for CBD20. Intragroup comparisons showed a significant increase in bite forces in both CBD groups (P < 0.05) but not in the placebo group (P > 0.05). CBD20 resulted in a significant difference in mean percent bite force change in the 90- and 180-min time points compared to the placebo group (P < 0.05). Compared to placebo, sedation, diarrhea, and abdominal pain were significantly associated with the CBD groups (P < 0.05). There were no other significant psychoactive or mood change effects. This randomized trial provides the first clinical evidence that oral CBD can be an effective and safe analgesic for dental pain.

Single-facility study of the effectiveness of rehabilitation therapy using wearable hybrid assistive limb for patients with bleeding disorders: study protocol for a randomised controlled trial

IntroductionHaemophilic arthropathy, a serious complication of haemophilia, results from recurrent joint bleeding, causing progressive joint damage and severely impacting patient quality of life. Rehabilitation therapy (RT) effectively addresses declining physical...

Comparison of the effectiveness of DFDBA and T-PRF in the regeneration of intra-bony defects- A randomized split-mouth study

ObjectivesThis research intended to compare and evaluate the effectiveness of titanium-prepared platelet-rich fibrin (T-PRF) over demineralized freeze-dried bone allograft (DFDBA) in treating intra-bony defects based on the clinical and radiographic criteria. MethodsThis is a prospective randomized controlled, single-blinded split-mouth study where 15 patients with 30 intrabony defects were included. Subjects were randomly divided into T-PRF and DFDBA groups respectively. Plaque index (PI), Gingival index (GI), Probing pocket depth (PPD), Relative- clinical attachment- level (R-CAL), Defect depth, Linear amount of bone fill, Percentage of bone fill, Defect angle were assessed at baseline, 3, 6, and 9 months. For intra- and inter-group comparisons, paired and unpaired t-tests were executed. P<0.05 was set as statistically significant. ResultsThere were statistically significant differences (P<0.05) in clinical and radiographic parameters in both T-PRF and DFDBA groups from baseline values to 9 months in intragroup comparisons. However, on intergroup comparison, no statistical significance was seen. ConclusionThe clinical parameters and radiographic outcomes showed marked improvement at 9 months with both T-PRF and DFDBA in the treatment of intrabony defects from baseline values. Clinical relevanceT-PRF has shown favorable results that are comparable to DFDBA for the treatment of intrabony periodontal defects.

Efficacy of a herbal mouthwash for management of periodontitis and radiation-induced mucositis – A consolidated report of two randomized controlled clinical trials

BackgroundOral diseases like periodontitis and mucositis often require home care using topical agents in the form of mouthwashes. Many herbal mouthwashes are found to be beneficial; however lack proper scientific evidence to support their use. ObjectivesStudy 1 evaluated clinical efficacy of herbal mouthwash in the management of chronic periodontitis in comparison with chlorhexidine mouthwash. Study 2 aimed at assessment of herbal mouthwash in patients of radiation-induced mucosititis. MethodsThe novel herbal mouthwash used in the present study wa prepared from extracts of five plants namely Emblica Officinalis, Terminalia chebula, Terminalia bellerica, Glycyrrhiza glabra, and Azadirachta indica. 50 periodontitis patients were randomly allocated to two groups. As per allocation, they were instructed to use either herbal mouthwash or chlorhexidine mouthwash twice daily for two weeks after nonsurgical periodontal therapy. Similarly, patients with radiation-induced mucositis were randomly given herbal mouthwash and soda saline mouthwash. Intergroup and intragroup comparisons of continuous variables were conducted using paired and unpaired t-tests. Categorical variables were compared using the chi-square test. ResultsSignificant reductions in gingival bleeding, plaque accumulation, and pocket depth were noticed in periodontitis patients in both groups. Patients reported acceptable taste, freshness, and satisfaction after the use of herbal mouthwash. The herbal mouthwash group noticed a significant reduction in the severity of radiation-induced mucositis and analgesic requirements. The intensity of pain, dryness of mouth, oral hygiene, and need for the use of antibiotic and antifungal during radiotherapy was not significant among the groups. ConclusionThe results of this preliminary clinical trial support the use of the tested herbal formulation mouthwash as an adjunct in the treatment of periodontitis as well as radiation-induced mucositis. Clinical trial registration NumberFor Study 1: CTRI/2019/10/021574, Study 2: CTRI/2020/04/024851.

Effects of chronic obstructive pulmonary disease stage on muscle oxygenation during exercise

Aims: The aim of this study was to investigate peripheral muscle oxygenation in patients with chronic obstructive pulmonary disease (COPD) at rest, during submaximal exercise, and during recovery, and to determine the effects of disease stage on peripheral muscle oxygenation. &#x0D; Methods: Of the 35 stable COPD patients (62.49±8.45 years), 18 patients in GOLD 1 and 2 were assigned to Group 1 and 17 patients in GOLD 3 and 4 were assigned to Group 2. Dyspnea perception of the patients was evaluated with the Modified Medical Research Council (mMRC) Dyspnea Scale, severity of the disease affecting daily life was evaluated with the COPD Assessment Test (CAT-COPD Assessment Test), respiratory function was evaluated with the Pulmonary Function Test, and quadriceps muscle strength was evaluated with a manual muscle testing device. Muscle oxygenation of the patients was measured with Near-infrared spectroscopy (NIRS) for 5 minutes at rest, 6 minutes during the 6-Minute Walk Test (6-MWT), and 5 minutes during recovery after the end of the test. The results of the two groups were compared.&#x0D; Results: Intragroup comparisons of muscle oxygenation at rest, during 6-MWT and during recovery; in Group 1, there was a statistically significant decrease between resting SmO2 mean and test SmO2 mean (p=0.001), a increase between test SmO2 mean and recovery SmO2 mean (p

Suicidality in the Light of Schema Therapy Constructs, i.e., Early Maladaptive Schema and Schema Modes: A Longitudinal Study.

(1) Background: The search for new strategies to diagnose people at risk of suicide and to help them is highly significant in view of the still high rate of suicidality. Schema therapy and its core constructs, i.e., early maladaptive schemas (EMSs) and schema modes, correspond to both directions. (2) Methods: This study compared the severity of EMSs and schema modes in a clinical group of suicide risk, a clinical non-suicidal group, and a control group. Intragroup comparisons were also conducted between times of crisis and psychological stability. The evaluation was supported by controlling for the psychopathological symptoms presented, following the dimensional concept. (3) Results: The unquestionable relevance of the disconnection/rejection domain in suicidality has been proven. The importance of EMSs from other domains, especially during psychiatric crises, was confirmed. Among the schema modes, child and Punitive Parent modes proved to be the most significant. There were changes in coping modes but of a lesser effect size. The protective importance of the Healthy Adult and Happy Child modes was also proven. (4) Conclusions: The results provide an indication for practitioners about the EMSs and schema modes most associated with suicide risk. They can also serve as a framework for deepening the issue of identifying and preventing suicidality in schema therapy.

The Comparison of the Anti-inflammatory Efficacy of Phytochemical Extracts in Punica granatum and Lawsonia inermis Among Patients Diagnosed With Chronic Periodontitis.

Introduction The oral cavity is the gateway to the human body. Periodontitis is a common inflammatory condition affecting the oral cavity and a known etiological cause of tissue destruction, discomfort, and halitosis. Pomegranate (Punica granatum)and henna (Lawsonia inermis) are herbs known to mankind from timeimmemorial whose extracts are proven to fight inflammation. The current study was done to evaluate the phytochemical anti-inflammatory efficacy of Punica and Lawsonia in patients with chronic periodontitis and test the potency of herbal mouthwashes in fighting the inflammatory condition affecting the oral cavity using distilled water as a control group. Materials and methods A double-blinded randomized control trial was conducted on 60 patients who were recruited and divided into three groups, in which 20 patients were prescribed with pomegranate (Punica: n=20) mouthwash and 20 patients with henna (Lawsonia: n=20) mouthwash along with distilled water (n=20). All patients were randomly allocated using the coin toss methodand advised to use the prescribed mouthwash for a period of two weeks. Unstimulated saliva was collected before using the mouthwash, and salivary enzymes such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) and their levels were assessed spectrometrically using the infrared spectrophotoscopy (IFSC) method. Each patientwas assigned a mouthwash and recalled after two weeks. Unstimulated saliva was again collected, and salivary activity levels of enzymes AST, ALT, and LDH were analyzed after using mouthwash in a similar method as done before. Later on, the salivary levels of enzymes AST, ALT, and LDH were compared before and after the usage of mouthwashes. Statistical significance was seen in the salivary enzymatic activity of AST, ALT, and LDH before and after using Punica and Lawsonia mouthwashes due to their potent phytochemical action in fighting inflammation. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS)22 (IBM SPSS Statistics, Armonk, NY). The Shapiro-Wilk test was used to determine the normality and significance; intragroup comparison was done using the Wilcoxon signed-rank test and Mann-Whitney U test. Intergroup comparison was done using the Kruskal-Wallis test. Results Punica patients had much lower levels ofsalivary AST and ALT (p<0.001) and a decrease in LDH (p=0.002) after the usage of mouthwash for a period of two weeks. Also, patients using Lawsonia as herbal mouthwash had reduction in the values of AST (p=0.001) and LDH (p=0.003) and prominent reduction in ALT (p<0.001) aftera period of two weeks. But in the case of patients using distilled water, there was an increase in the salivary enzymatic activity of AST and ALT, which was statistically significant (p<0.001), and LDH (p=0.006)depicting the disease progression even after using mouthwash for the given time period of two weeks. Conclusion This study demonstrated that both Punica and Lawsonia were effective in reducing the inflammation in patients diagnosed with chronic periodontitis. However, when intergroup comparison was done, the anti-inflammatory efficacy was superior in Punica with significant reductionin the parameters such as ofAST, ALT, and LDHwhen compared to Lawsoniaowing to its potent phytochemical constituency in cutting down the inflammation. Hence,Punica can be used as an implicatedeffective anti-inflammatory herbal mouthwash.

Comparative evaluation of platelet-rich plasma + β-tricalcium phosphate and platelet-rich fibrin + β-tricalcium phosphate for healing periapical lesions, using cone beam computed tomography - an in vivo study.

Platelet concentrates are currently being researched for their potential to enhance bone formation. The aim of this study is to quantitatively evaluate and compare bone regeneration in periapical lesions using a combination of platelet-rich plasma (PRP) + β-tricalcium phosphate (β-TCP) and platelet-rich fibrin (PRF) + β-TCP. Ten subjects with periapical lesions measuring 10-20 mm in relation to maxillary incisors indicated for periapical surgery were selected. Pre-operative bone density values at the periapical region were measured using CBCT. Root canal treatment was completed appropriately in all cases. Under adequate local anesthesia, periapical surgery was performed. The 10 subjects were distributed into two groups of 5 subjects in each group. Group I: Periapical bone defect filled with PRP + β-TCP and Group II: Periapical bone defect filled with PRF + β-TCP. The mucoperiosteal flaps were repositioned and sutured. Bone density evaluation of the periapical region was done 6 months and 1 year after surgery using cone beam computed tomography (CBCT). The Hounsfield unit (HU) values obtained were subjected to statistical analysis by Independent samples t-test for inter-group comparison. The intra-group comparison was done by repeated measure ANOVA and Bonferroni post hoc tests. In Group I and Group II, a statistically significant difference was observed at the end of 6 months and 1 year, when compared to the pre-operative values (P=0.000). There was no statistically significant difference in bone density values between the PRP + β-TCP and PRF + β-TCPgroups at both 6 months and 1-year post-operative observation periods. PRP + β-TCP and PRF + β-TCP were equally effective in promoting bone regeneration and can be considered valuable bioactive surgical additives for enhancement of healing in periapical bone defects.

Effect of audio and virtual reality distraction on the dental anxiety of children with mild intellectual disability.

Intellectual disability, is a neurodevelopmental disorder that typically manifests early in childhood and consists of both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. It can be categorized into mild, moderate, severe, and profound based on its severity. Cognitive impairment may be observed predominantly in children with intellectual disabilities. Marked deficits in areas of learning, planning, communication, social participation, and personal independence in children with mild intellectual disabilities make behavior guidance and communication a challenge during dental treatments. The aim was to evaluate and compare the use of two different distraction tools, audio, and virtual reality (VR) on the dental anxiety of children with mild intellectual disability during dental treatment. Twenty children diagnosed with mild intellectual disability were equally divided into two groups. A cross-over study design consisting of two appointments 1 month apart was employed. In the first appointment, audio and VR distractions were provided to participants in Groups 1 and 2, respectively, and the distraction tools provided to the participants were interchanged in the second appointment. A trained observer recorded physiological parameters (pulse rate and oxygen saturation) and observational parameters (Venham's anxiety rating scale) during both appointments at three-time intervals. Statistical intra-group and inter-group comparison analyses were performed using Friedman's and Mann-Whitney U tests. A decrease in pulse, increase in oxygen saturation levels, and a decrease in Venham's Anxiety Rating Scores (statistically significant p<.05 / highly significant p<.01) was observed on introducing the distraction techniques in Groups 1 and 2 in both appointments. A statistically non-significant difference (p>.05) in physiological and observational parameters was observed between Groups 1 and 2 in both appointments. Audio and VR distraction techniques can be employed for behavior guidance in children with mild intellectual disability during restorative dental procedures.

Cytokine expression of IL-8 before and after root canal treatment in patients with symptomatic apical periodontitis: A clinical trial.

Thirty-six patients were allocated according to their pulp status into two experimental groups (n = 18) receiving the same treatment protocol; group 1: Vital pulps with SAP, and group 2: non-vital pulps with SAP. Conventional endodontic treatment was done on two visits; isolation and disinfection of the operative field were undertaken, and two-stage access cavity preparation was implemented. The first pre-instrumentation peri-apical sample (S1) was collected prior to cleaning and shaping procedures. A 2.5% NaOCl irrigation was used to thoroughly irrigate the canal after performing root canal preparation utilising the ProTaper Next (PTN) rotary system. After 1 week, the second post-instrumentation peri-apical sample (S2) was collected. Using an ELISA kit, the quantity of IL-8 was evaluated following the collection of all samples. In all pre-instrumentation samples, IL-8 was detected (100%). The level of IL-8 expression was significantly decreased from the S1 to S2 of all samples (p < 0.001). The intra-group comparison showed a statistically significant reduction in the level of IL-8 expression between S1 and S2 in both vital and non-vital groups where p < 0.001* in both groups. The inter-group comparison of levels of IL-8 expression (vital and non-vital) revealed a significant difference between both groups regarding the pretreatment sample with the higher levels of IL-8 shown in the non-vital group (p < 0.001). While in the post-treatment sample, both groups showed a significant reduction in the level of IL-8 expression but the difference between them was not statistically significant (p = 0.226). Root canal instrumentation seems to be efficient in decreasing the levels of anti-inflammatory cytokines, namely IL-8. Further research should clarify how intra-canal medicaments affect inflammatory mediator levels.

Hiatal Hernia Repair With Tension-Free Mesh or Crural Sutures Alone in Antireflux Surgery

Antireflux surgery is an effective treatment of gastroesophageal reflux disease (GERD), but the durability of concomitant hiatal hernia repair remains challenging. Previous research reported that the use of a mesh-reinforced, tension-free technique was associated with more dysphagia for solid foods after 3 years without reducing hiatal hernia recurrence rates compared with crural sutures alone, but the long-term effects of this technique have not been assessed. To assess the long-term anatomical and functional outcomes of using a mesh for hiatal hernia repair in patients with GERD. A double-blind, randomized clinical trial was performed at a single center (Ersta Hospital, Stockholm, Sweden) from January 11, 2006, to December 1, 2010. A total of 159 patients were recruited and randomly assigned. Data for the current analysis were collected from September 1, 2021, to March 31, 2022. All analyses were conducted with the intention-to-treat population. Closure of the diaphragmatic hiatus with crural sutures alone vs a tension-free technique using a nonabsorbable polytetrafluoroethylene mesh (Bard CruraSoft). The primary outcome was radiologically verified recurrent hiatal hernia after more than 10 years. Secondary outcomes were dysphagia scores (ranging from 1 to 4, with 1 indicating no episodes of dysphagia and 4 indicating more than 3 episodes of dysphagia per day) for solid and liquid foods, generic 36-Item Short Form Health Survey and disease-specific Gastrointestinal Symptom Rating Scale symptom assessment scores, proton pump inhibitor consumption, and reoperation rates. Intergroup comparisons of parametric data were performed using t tests; for nonparametric data, Mann-Whitney U, χ2, or Fisher exact tests were used. For intragroup comparisons vs the baseline at follow-up times, the Friedman test was used, and post hoc analysis was performed using Wilcoxon matched pairs. Of 145 available patients, follow-up data were obtained from 103 (response rate 71%; mean [SD] age at follow-up, 65 [11.3] years; 55 [53%] female), with 53 initially randomly assigned to mesh reinforcement, and 50 to crural suture alone. The mean (SD) follow-up time was 13 (1.1) years. The verified radiologic hiatal hernia recurrence rates were 11 of 29 (38%) in the mesh group vs 11 of 35 (31%) in the suture group (P = .61). However, 13 years postoperatively, mean (SD) dysphagia scores for solids remained significantly higher in the mesh group (mean [SD], 1.9 [0.7] vs 1.6 [0.9]; P = .01). Findings from this long-term follow-up of a randomized clinical trial suggest that tension-free crural repair with nonabsorbable mesh does not reduce the incidence of hiatal hernia recurrence 13 years postoperatively. This finding combined with maintained higher dysphagia scores does not support the routine use of tension-free polytetrafluoroethylene mesh closure in laparoscopic hiatal hernia repair for treatment of GERD. ClinicalTrials.gov Identifier: NCT05069493.