Sterile Water Group Research Articles

Modification of gut and airway microbiota on ozone-induced airway inflammation

Ground-level ozone (O3) has been shown to induce airway inflammation, the underlying mechanisms remain unclear. The aim of this study was to determine whether gut and airway microbiota dysbiosis, and airway metabolic alterations were associated with O3-induced airway inflammation. Thirty-six 8-week-old male C57BL/6 N mice were divided into 2 groups: sterile water group and broad-spectrum antibiotics group (Abx). Each group was further divided into two subgroups, filtered air group (Air) and O3 group (O3), with 9 mice in each subgroup. Mice in the Air and O3 groups were exposed to filtered air or 1 ppm O3, 4 h/d for 5 consecutive days, respectively. Mice in Abx + Air and Abx + O3 groups were exposed to filtered air or O3, respectively, after drinking broad-spectrum Abx. 24 h after the final O3 exposure, mouse feces and bronchoalveolar lavage fluids (BALF) were collected and subjected to measurements of airway oxidative stress and inflammation biomarkers, 16S rRNA sequencing and metabolite profiling. Hematoxylin-eosin staining of lung tissues was applied to examine the pathological changes of lung tissue. The results showed that O3 exposure resulted in airway oxidative stress and inflammation, as well as gut and airway microbiota dysbiosis, and airway metabolism alteration. Abx pre-treatment markedly changed gut and airway microbiota and promoted O3-induced metabolic disorder and airway inflammation. Spearman correlation analyses indicated that inter-related gut and airway microbiota dysbiosis and airway metabolic disorder were associated with O3-induced airway inflammation. Together, inhaled O3 causes airway inflammation, which may implicate gut and airway microbiota dysbiosis and airway metabolic alterations.

The Effect of Oral Colostrum Application on the Condition of the Mouth and Incidence of Late-Onset Sepsis Among Premature Infants: A Randomized Controlled Trial.

Premature infants have higher risks of infection due to their underdeveloped immune systems and changes to the oral cavity's normal flora colonization. To assess the effect of oral colostrum application on the condition of the mouth and the incidence of late-onset sepsis (LOS) among premature infants. In this randomized controlled trial, 70 newborn premature infants were randomly allocated to colostrum or sterile water groups. The Mouth Care Assessment Tool was used to evaluate the condition of the mouth for 5 days after oral colostrum application. The incidence of LOS was measured using clinical and laboratory indicators from 72hours after birth until discharge. The condition of the mouth was significantly different on days 4 and 5, demonstrating that the colostrum group had less need for oral care ( P <.001) compared to the control group. There was no significant difference between the 2 groups in clinical symptoms and laboratory values related to LOS ( P >.05). Oral colostrum application can benefit oral mucosal health and reduce the need for oral care among premature infants. It is also safe alternative oral care for premature infants who cannot breastfeed during the first few days of life. Future research should include infants of different gestational ages and mechanically ventilated infants to assess the effect of oral colostrum application on serum immune factors.

USE OF STERILE WATER FOR INJECTION IN THE MANAGEMENT OF LABOR PAIN: A RANDOMIZED CONTROLLED TRIAL

Objectives: The objectives of the study are to assess the efficacy of sterile water for injection (SWI) in reducing labor pain, compare it with a saline procedure, and see which one is superior. Parameters assessed were pain relief based on the numeric pain rating scale (NPRS) and duration of labor from intervention to delivery associated with administration of subcutaneous SWI versus normal saline injection (NSI). Methods: This is a prospective randomized interventional hospital-based comparative study of mothers who were in active labor with back pain and undergoing treatment in the labor room of Eden Hospital, Medical College and Hospital, Kolkata. The study was conducted on 66 willing pregnant mothers, divided into two groups of 33 each with one injected with normal saline and the other with sterile water. Results: The NPRS score was almost equal in 2 groups at 15 min, but with an increase in duration, it was seen that the score was low in the sterile water group compared to the normal saline group. The association was statistically significant (p&lt;0.05). Conclusion: This study hypothesized that subcutaneous SWI for relieving labor pain is better than subcutaneous NSI. Based on this study, it is concluded that both the SWI and NSI reduce labor pain, but the SWI produced a significantly greater reduction of pain as measured by the numeric pain rating score and also better satisfaction. Therefore, SWI is a safe, simple, and cost-effective method and can be used as a pain-relieving method, especially in the absence of other pain-relieving options.

Sterile Water Versus Glycine in Transurethral Resection of Bladder Tumors—Immunogenic and Clinical Implications

Background and objectiveWe compared the oncologic outcomes of patients with non-muscle invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumor (TUBRT) using sterile water vs glycine irrigation. The tumoricidal and immunogenic effects of these solutions on urothelial cancer cell lines were investigated. MethodsThe medical records of 530 consecutive patients who underwent TURBT using sterile water or glycine irrigation for NMIBC were reviewed. Recurrence and progression rates were evaluated using time dependent analyses.Bladder cancer cell lines (RT4, T24 and 5637) were treated with glycine and sterile water. Cell viability was evaluated with the XTT assay. Cell membrane calreticulin levels were evaluated with flow cytometry. Extracellular high mobility group box 1 (HMGB1) and heat shock 70 (HSP70) protein levels were evaluated using western blots. Key findings and limitationsAfter propensity score matching each study arm comprised 161 patients. Median follow-up was 13.6 months (IQR 6.2, 24.5). The 2-year recurrence free survival was significantly lower in the sterile water vs glycine group (43% vs 71%, respectively, p<0.0001). Similarly, the 2-years progression free survival was significantly lower in the sterile water vs glycine group (85% vs 94%, respectively, p<0.014). Sterile water treatment resulted in the lowest number of viable cells. Early and late immunogenic cell death markers were markedly elevated in cells treated with glycine. Conclusions and clinical implicationsSterile water compared to glycine irrigation during TURBT for NMIBC was associated with higher recurrence and progression rates. Possible explanation for these findings is the diminished immune response associated with sterile water reflected in a comparatively lesser expression of immune response inducers. Patient summaryWe compared two irrigation fluids in non–muscle-invasive bladder cancer surgery: glycine and sterile water. Glycine outperformed sterile water in cancer recurrence, possibly boosting immunogenicity over sterile water.

Can humidifier reservoir bacteria colonize the circuit during mechanical ventilation: An in vitro study.

Although the circuit condensate, an ideal bacterial reservoir during mechanical ventilation, may flow into the humidifier reservoir, no studies have investigated if humidifier reservoir colonized bacteria colonize other circuit locations with airflow. We aimed to prove whether the humidifier reservoir colonized bacteria colonize other circuit locations with airflow and provide some advice on the disposal of condensate in the clinical setting. An in vitro experiment was conducted. Mechanical ventilation simulators (n = 90) were divided into sterile water group (n = 30) and broth group (n = 60). In the sterile water group, sterile water was used for humidification, either Acinetobacter baumannii or Pseudomonas aeruginosa were inoculated to humidifier water in the humidifier reservoir, each accounted for 50% of the simulators. The broth group was performed the same as the sterile water group except for the addition of broth into the humidified water. After 24, 72, and 168 h of continuous ventilation, the humidifier water and different locations of the circuits were sampled for bacterial culture. All bacterial culture results of the sterile water group were negative. Bacteria in the humidifier water continued to proliferate in the broth group. With prolonged ventilation, the bacteria at the humidifier reservoir outlet increased. The bacteria at the humidifier reservoir outlet were much more in the Pseudomonas aeruginosa subgroup than in the Acinetobacter baumannii subgroup and the difference was statistically significant (p < .05). During continuous ventilation, no bacterial growth occurred at 10 cm from the humidifier reservoir outlet and the Y-piece of the ventilator circuits. Sterile water in the humidifier reservoir was not conducive to bacterial growth. Even if bacteria grew in the humidifier reservoir and could reach the humidifier reservoir outlet, colonization of further circuit locations with the airflow was unlikely. During a certain mechanical ventilation time, the amount of bacteria reaching the outlet of the humidifier reservoir varied due to different mobility of bacteria. In a clinical setting, nurses should not worry about a small amount of condensate backflow into the humidifier reservoir. Draining condensate into the humidifier reservoir can be used as a low risk and convenient method in clinical practice.

The effects of antimicrobial peptides buCaTHL4B and Im-4 on infectious root canal biofilms.

The primary cause of pulp and periapical diseases is the invasion of bacteria into the root canal, which results from the continuous destruction of dental hard tissues. Effective management of infections during root canal therapy necessitates effectively irrigation. This study aims to investigate the effects of two antimicrobial peptides (AMPs), buCaTHL4B and Im-4, on root canal biofilms in vitro. Two-species biofilms (Enterococcus faecalis and Fusobacterium nucleatum) were selected and anaerobically cultivated. The following treatments were applied: 10μg/mL buCaTHL4B, 10μg/mL Im-4, 5μg/mL buCaTHL4B, 5μg/mL Im-4, 1μg/mL buCaTHL4B, 1μg/mL Im-4, 1% NaOCl, and sterile water. Each group was treated for 3min. Subsequently, the two strains were co-cultured with 10μg/mL buCaTHL4B, 10μg/mL Im-4, 1% NaOCl, and sterile water for 24, 48, and 72h. The biofilms were examined using confocal laser scanning microscopy (CLSM) with fluorescent staining, and the percentages of dead bacteria were calculated. Quantitative real-time PCR (qRT-PCR) was employed to assess the variations in bacterial proportions during biofilm formation. Compared to 1% NaOCl, 10μg/mL buCaTHL4B or Im-4 exhibited significantly greater bactericidal effects on the two-species biofilms (p < 0.05), leading to their selection for subsequent experiments. Over a 48-hour period, 10μg/mL Im-4 demonstrated a stronger antibiofilm effect than buCaTHL4B (p < 0.05). Following a 24-hour biofilm formation period, the proportion of F. nucleatum decreased while the proportion of E. faecalis increased in the sterile water group. In the buCaTHL4B and 1% NaOCl groups, the proportion of F. nucleatum was lower than that of E. faecalis (p < 0.05), whereas in the Im-4 group, the proportion of F. nucleatum was higher than that of E. faecalis (p < 0.05). The proportions of bacteria in the two AMPs groups gradually stabilized after 24h of treatment. buCaTHL4B and Im-4 exhibited remarkable antibacterial and anti-biofilm capabilities against pathogenic root canal biofilms in vitro, indicating their potential as promising additives to optimize the effectiveness of root canal treatment as alternative irrigants.

A potential mechanism of miana (Coleus scutellariodes) and quercetin via NF-κB in Salmonella typhi infection

PurposeTo prove the effect of Miana (M), Quercetin (Q), and the combination as an anti-inflammatory agent and Cefixime (C) as an antibiotic in Balb/c mice infected with Salmonella enterica serovar Typhi (S. Typhi) and related to the dynamics of NF-κB mRNA expression and NF-κB protein levels. MethodsA cohort study on male Balb/c mice with subjects consisted of 8 groups with 5 each group by administration of M, Q, M + Q, M + C, Q + C, M + Q + C, C only and sterile distilled water group as negative control. The statistical significance of the difference group was defined as P values less than 0.05. ResultsDecreased mRNA expression of NF-κB, NF-κB protein levels, and bacterial load after administration of M + C, Q + C, or M + Q + C showed significant differences when compared to the negative control. The decline in NF-κB was stronger when M + Q + C was given compared to M, Q, M + Q, or C only. ConclusionThe effects of NF-κB suppression appear to be the same between the administration of M, Q and the M + Q when C added. However, the suppression of NF-κB was not significant without adding C.

The effect of roselle (Hibiscus sabdariffa l.) flower petal extract on smear layer removal of crown dentin

One of the initial stages carried out before making a restoration is the tooth preparation. The debris resulting from the preparation process of the tooth structure is called the smear layer. Dentin conditioner is needed to remove the smear layer so that the crown dentin surface is clean and the restoration can adhere well. Roselle (Hibiscus sabdariffa L.) are a herbal ingredient that has acidic properties found in its flower petals. This research was conducted to determine the effect of roselle flower petal extract on the removal of the smear layer on crown dentin. Eight human maxillary first premolars from orthodontic extraction patients were used as samples. This pre-experimental study was conducted with a test group consisted of control group conditioned with sterile distilled water and treatment group with 2,5%, 5%, and 10% of roselle flower petal extract. The research data was obtained through observing the results of scanning Electron Microscope (SEM). Roselle flower petal extracts 5% and 10% were able to clean the smear layer better than extracts with a concentration of 2.5% and the control group. This may be due to the acidic pH of the solution and demineralization process caused by the presence of citric acid and other organic acids in roselle flower petal extract.

The efficacy of intradermal sterile water application in severe renal colic: a randomised clinical trial.

It is important to do a fast and effective treatment for patients with renal colic pain in emergency departments for both patients' comfort and clinicians' patient management. In this study, we aimed primarily to test the efficacy of intradermal sterile water application as a rapid and effective treatment in severe renal colic. This is a single-centre, prospective, randomised controlled trial. Study group consists of patients with severe renal colic related to urolithiasis. Patients were randomly divided into three groups. The first group received only intramuscular diclofenac sodium, the second group received intramuscular diclofenac sodium and intradermal sterile water, and the third group received intramuscular diclofenac sodium together with intravenous fentanyl. Numerical Rating Scale was used to determine the level of pain before and after the treatment at the 1st, 5th, 15th, 30th, 60th and 120th minutes. 95 out of 201 patients with severe renal colic pain randomly divided into 3 groups. The pre-treatment pain severity of the groups was similar (p = 0.228). We found thatthe decrease in pain intensity was significantly faster in the intradermal sterile water group than the other groups even in the first minute. Percentages of patients who had 50% pain reduction, which is considered as successful treatment, was higher in the intradermal sterile water group (which had 75.9% success rate) in the first 5min compared to the IM diclofenac sodium group (which had 7.1% success rate) and IV fentanyl group (which had 25% success rate) (p < 0.001). According to the results, pain control was achieved much faster than the other methods with intradermal sterile water injection. All methods were found to be effective in relieving the pain of the patients.

Long Duration of Oral Care Using Mother's Own Milk Influences Oral Microbiota and Clinical Outcomes in Very-low-birthweight Infants: Randomized Controlled Trial.

Several studies have focused on the clinical outcomes of oral care using colostrum for a limited time (2-5 days) in very-low-birthweight (VLBW) infants. However, the effect of long-term mother's own milk (MOM) on the clinical outcomes and oral microbiota of VLBW infants remains unknown. In this randomized controlled trial, VLBW neonates were randomly assigned to oral care by MOM or sterile water (SW) groups until they started oral feeding. The primary outcome was oral microbiota composition including alpha and beta diversity, relative abundance, and linear discriminant analysis effect size (LEfSe). The secondary outcomes were various morbidities and mortality. The baseline characteristics of the two groups did not differ (63 neonates, MOM group, n = 30, oral care 22 days; SW group, n = 33, oral care 27 days). There was no significant difference in alpha and beta diversities between the groups before and after the intervention. The MOM group had a significantly lower rate of clinical sepsis than the SW group (47% vs. 76%, risk ratio = 0.62, 95% CI: 0.40-0.97). The relative abundance of Bifidobacterium bifidum and Faecalibacterium were maintained after MOM care, especially in neonates without clinical sepsis, but decreased after SW care. LEfSe showed that neonates in the MOM and SW groups with clinical sepsis had the highest abundance of Pseudomonas and Gammaproteobacteria, respectively, compared with neonates without sepsis. A longer duration of oral care using MOM in VLBW infants sustains healthy bacteria and decreases the risk of clinical sepsis.

Efficacy of Enhanced Dose of Expressed Breast Milk in Neonatal Procedural Pain Relief: A Randomised Placebo-controlled Study

Introduction: Procedural pain remedies in neonates is an area of active research due to better understanding of short and long-term outcomes of neonatal painful exposures. Non pharmacological interventions are especially attractive as it avoids unnecessary drug exposure. While dextrose is known to be effective, results with small volumes (2 mL) of Expressed Breast Milk (EBM) are equivocal. There is recent theoretical evidence to show that larger doses of EBM may be more efficacious. Aim: To compare the efficacy of a larger volume of EBM 5 mL and 2 mL of 25% Dextrose (25D) in relief of procedural pain from venipuncture in term and preterm neonates. Materials and Methods: A single center randomised placebo- controlled study was conducted at Bokaro General Hospital, Bokaro Steel City, Jharkhand, India, between March 2014 and February 2016. Neonates ≥34 week gestation, requiring venipuncture in a neonatal care unit were randomly allocated into 3 equal groups using a random number table- Sterile Water (SW), 2mL 25D, 5 mL EBM was given two minutes prior to venipuncture. Video of facial response, cry times, Maximal Heart Rate (MHR), and minimum Oxygen Saturation (SpO2) were recorded till five minutes after venipuncture. The Premature Infant Pain Profile (PIPP) score was used to assess the effect of the interventions on procedural pain. Subgroup analysis was done in term and preterm neonates. Continuous variables were presented as mean±SD or median. Categorical variables were expressed as frequencies and percentages. The comparison of normally distributed continuous variables between the groups was performed using Analysis of Variance (ANOVA). Results: The PIPP score in the 25D group (2.94±1.41) was significantly lower than the EBM (7.42±1.69) and SW (10.56±1.69) groups (p-value&lt;0.001). MHR was significantly lower in the 25D group, but no difference was found between the EBM and SW groups (p-value=0.23). SpO2 was significantly higher in the 25D group but for the initial 2.5 minutes only. Cry times were significantly lower in the intervention groups. There was no difference in outcomes in term vs. preterm infants. Conclusion: The use of 2 mL 25D was more effective in reducing procedural pain from venipuncture compared to 5 mL EBM. The return of physiological markers (MHR and SpO2) to baseline were faster and more complete in the 25D group.

Evaluation of the Analgesic Effect of Oral Sucrose Solution on Neonates Undergoing a Minor Painful Procedure

Background: Pacifying newborns by nonpharmacological methods during painful procedures is a frequent and difficult problem in routine practice. Purpose: The purpose of the study was to determine the analgesic effects of oral sucrose solution in comparison to placebo (sterile water) in neonates. Materials and Methods: A prospective, double-blinded study of 100 neonates who were divided into two groups after simple randomization, to give either 30% sucrose solution (group A) or sterile water (group B) during an intravenous catheterization. Assessment of pain by the Douleur Aigue Nouveau-ne scale (DAN) and changes in the heart rate (HR), respiratory rate (RR), or arterial oxygen saturation (SpO2) during peripheral vein catheterization were analyzed. Results: The mean change of HR, RR, and SpO2 was more in group B compared to group A. The mean DAN scores were 2.24 ± 2.026 and 6.92 ± 2.538 in group A and group B, respectively. None of these results were statistically significant (P &gt; 0.05). Conclusion: There was a less prominent change in HR, RR, and SpO2 with response to noxious stimuli with oral sucrose administration in newborns when compared to placebo.

THE EFFECTIVENESS OF PHALERIA MACROCARPA’S LEAF NANOEMULSION GEL ON STAPHYLOCOCCUS AUREUS BIOFILM THICKNESS (IN VITRO)

Background: Periodontal disease often occurs in the oral cavity with 75.6-78.3% at the age of 35-44 years. One of the causes of periodontal disease is the accumulation of Staphylococcus aureus biofilm in the early colonization of the formation of the dental pellicle. Phaleria macrocarpa, also known as Gods Crown, is a traditional plant with antibacterial properties that can be used in the health sector. Nanoemulsion gel technology has the advantage of increasing the stability of the material. Aim the study to determine the ratio of the effectiveness of Phaleria macrocarpa’s leaf nanoemulsion gel 10%, 20%, 30% to decrease Staphylococcus aureus biofilm thickness. Method: This research method was in vitro experimental laboratory research using a post-test control design. Thirty samples were divided into five groups: Phaleria macrocarpa’s leaf nanoemulsion gel 10%, 20%, 30%, positive control using chlorhexidine gluconate 0.2% and negative control using aqua dest. Samples were incubated for 4 and 8 hours. Optical density readings were carried out to see the biofilm thickness after being given a Gods Crown leaves nanoemulsion gel Results: The mean of Phaleria macrocarpa’s leaf nanoemulsion gel, 30%, produced the lowest average optical density value. The incubation time of 4 hours resulted in a lower optical density value than 8 hours. The Kruskal-Wallis was p&gt;0.05 showed there was no difference in biofilm thickness in each group. Conclusion: the effectiveness of the nanoemulsion group of Dewa crown leaf gel with a concentration of 30% was better than the 0.2% chlorhexidine gluconate gel and sterile distilled water group.

Comparative evaluation of cerium oxide nanoparticles and calcium hydroxide as intracanal medicament against Enterococcus faecalis on tooth substrate: An in vitro study

Aim: The aim of this study is to compare the antibacterial efficacy of cerium oxide nanoparticles and calcium hydroxide as intracanal medicaments against Enterococcus faecalis on tooth substrate – an in vitro study.Materials and Methods: The experiment was conducted in three stages. In Stage 1, antibacterial susceptibility test of three test materials, cerium oxide nanoparticles, calcium hydroxide, and vancomycin against E. faecalis was done using disc diffusion method. In Stage 2, determination of minimal inhibitory concentration and minimum bactericidal concentration of the cerium oxide nanoparticles was done by tube dilution method. In Stage 3, determination of CFU was carried out using dentinal blocks at 1-day and 5-day intervals at two different dentinal depths (200 μm and 400 μm) for calcium hydroxide (Group 1), cerium oxide nanoparticle dispersion (Group 2), a mixture of calcium hydroxide and cerium oxide nanoparticles (Group 3), and sterile water (Group 4).Results: The reduction of E. faecalis achieved by cerium oxide nanoparticles dispersion on day 5 was 66.9% as against 46.7% as shown by mixture of the two medicaments and 34.8% by calcium hydroxide paste alone on day 5 at 400-μm depth.Conclusion: Cerium oxide nanoparticles show a significantly higher antibacterial efficacy when compared to calcium hydroxide and its combination.

Combined Administration of Metformin and Atorvastatin Attenuates Diabetic Cardiomyopathy by Inhibiting Inflammation, Apoptosis, and Oxidative Stress in Type 2 Diabetic Mice.

Diabetic cardiomyopathy (DCM), a common complication of diabetes mellitus, may eventually leads to irreversible heart failure. Metformin is the cornerstone of diabetes therapy, especially for type 2 diabetes. Statins are widely used to reduce the risk of cardiovascular diseases. In this study, we aimed to investigate whether the combined administration of metformin and atorvastatin could achieve superior protective effects on DCM and to elucidate its molecular mechanism. Here, db/db mice (9–10 weeks old) were randomly divided into four groups, including sterile water group (DM), metformin group (MET, 200 mg/kg/day), atorvastatin group (AVS, 10 mg/kg/day), and combination therapy group (MET + AVS). Mice were treated with different drugs via gavage once per day for 3 months. After 3 months of treatment, the pathological changes (inflammation, fibrosis, hypertrophy, and oxidative stress makers) were detected by histopathological techniques, as well as Western blotting. The H9C2 cardiomyocytes were treated with palmitate (PAL) to mimic diabetic condition. The cells were divided into control group, PAL treatment group, MET + PAL treatment group, AVS + PAL treatment group, and MET + AVS + PAL treatment group. The effects of MET and AVS on the cell viability and inflammation of H9C2 cells subjected to PAL condition were evaluated by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay, immunofluorescence staining, and Western blotting. Both MET and AVS prevented diabetes-induced fibrosis, hypertrophy, and inflammation. The combination therapy showed superior effects in protecting myocardial tissue against diabetes-induced injury. Mechanistically, the combination therapy significantly inhibited oxidative stress and the expression levels of inflammation-related proteins, e.g., NLRP3, caspase-1, interleukin-1β (IL-1β), Toll-like receptor 4 (TLR4), and P-p65/p65, in both cardiac tissues and H9C2 cells. TUNEL assay showed that the combination therapy significantly attenuated the apoptosis of cardiomyocytes; decreased the expression level of pro-apoptotic-related proteins, such as cleaved caspase-3 and BAX; and enhanced the expression level of anti-apoptotic protein (Bcl-2). Furthermore, the combination therapy remarkably upregulated the expression levels of 5′-AMP-activated protein kinase (AMPK) and SIRT1. Our findings indicated that the anti-inflammation and anti-apoptosis effects of the combination therapy may be related to activation of AMPK/SIRT1 signaling pathway.

Impact of Lavender on Pain and Anxiety Levels Associated With Spine Procedures

Background: To reduce pain and anxiety associated with interventional pain procedures, sedation is often used, with benzodiazepines, opioids, and propofol the most commonly used classes of drugs for sedation. However, patient coherence and ability to communicate procedural pain and abnormal sensations help prevent adverse outcomes. Therefore, discovering alternative therapies to mitigate the anxiety and pain associated with these procedures and to minimize risk is important. The aim of our study was to investigate whether lavender has an effect on pain and anxiety associated with lumbar epidural steroid injections and lumbar medial branch blocks.Methods: In this randomized controlled study, 54 subjects were randomly assigned to 1 of 3 intervention groups, and 46 patients were included in the final analysis: experimental lavender group (n=17), control almond oil group (n=15), and placebo sterile water group (n=14). Patients wore a mask infused with either lavender, almond oil, or water for 5 minutes prior to and during their procedure. Patients rated their anxiety using the State-Trait Anxiety Inventory prior to and after the procedure based on how they felt during the procedure. Patients rated their pain according to the numerical rating scale. Outcome measures were a comparison of pain among the 3 groups and a comparison of the change in anxiety before and after the procedure among the 3 groups.Results: The lavender group demonstrated the highest mean change in anxiety scores (9.9) compared to almond oil (5.3) and water (3.6) preprocedurally vs postprocedurally. The lavender group also reported the lowest mean pain level (3.8) compared to almond oil (5.6) and water (5.6). However, none of the differences between groups showed statistical significance at the P<0.05 level.Conclusion: Lavender may have a clinically beneficial effect on anxiety levels and pain reduction.

Comparison of subcutaneous sterile water injection versus normal saline water injection over the sacrum in females presenting with severe back pain undergoing normal vaginal delivery at term.

Objectives: Compare the mean pain score with subcutaneous sterile water injection versus normal saline water injection over the sacrum in females presenting with severe back pain undergoing normal vaginal delivery at term. Study Design: Randomized Control Trial. Setting: MCH Centre, Pakistan Institute of Medical Sciences, Islamabad. Period: 21-08-2019 to 20-11-2019. Material &amp; Methods: The non-probability, consecutive sampling technique was used to include patients. In group A, patients injection was given 4 intracutaneous injections of 0.5 ml sterile water in the lumbar- sacral region in the sitting position. One injection was given at the posterior superior iliac spine on both sides and second injection at 1 cm medial, and 1-2 cm inferior to the first point on both the sides using an insulin needle. These points overlie the area called Michaelis' rhomboid. In group B, patients were given injections of 0.5 ml isotonic saline in the same region using an insulin needle. Then patients were followed-up for 90 minutes (1.5hours). After 90 minutes, pain on VAS was again measured. Results: In this study the mean pain score at baseline of the patient was 79.82±12.99 and the mean pain score after the 90 minutes was 54.05±18.52. Statistically there is highly significant difference was found between the study groups and pain after 90 minutes of the patients i.e. p-value=0.000 Conclusion: Our study results concluded that sterile water group patients showed better pain relief as compared to normal saline group in in females presenting with severe back pain undergoing normal vaginal delivery at term.

Antibacterial effectiveness of calcium silicate-based root canal sealer against Enterococcus faecalis biofilms in infected dentinal tubules in vitro

Objective: To evaluate the antiseptic effect of combined using of 5% sodium hypochlorite and calcium silicate-based root canal sealer against Enterococcus faecalis (Ef) biofilms in infected dentinal tubules in vitro. Methods: Cells of Ef were inoculated into the dentinal tubules of single-rooted teeth (without caries, periapical lesions and malformations extracted due to periodontal disease or orthodontic reasons; collected from Department of Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University) with centrifugation and incubated in brain-heart infusion (BHI) to form 3-week-old biofilms. The infected samples were subjected to sodium hypochlorite or sterile water bathing for 10 minutes followed by calcium silicate-based root canal sealer (iRoot SP) (calcium silicate-based group), Gutta-percha group and sterile water group placed on the root canal wall for 1, 4 and 12 weeks. There were two samples in each treatment at each point. The antiseptic effectiveness of combined use of sodium hypochlorite and calcium silicate-based root canal sealer was analyzed by laser scanning confocal microscope (LSCM), ANOVA and LSD-t test. Results: After treatment with 5% sodium hypochlorite, in calcium silicate-based group for 4 and 12 weeks more Ef biofilm cells [(75.3±3.5)% and (74.8±3.8)%] were killed than in Gutta-percha group [(65.9±4.1)% and (63.0±3.7)%] and sterile water group [(63.9±4.0)% and (64.2±3.5)%] (P<0.05). After being treated with sterile water, the proportion of dead bacterial cells in calcium silicate-based group for 1, 4 and 12 weeks [(27.5±4.6)%, (43.0±4.4)% and (40.3±6.1)%] were more than those in Gutta-percha group and sterile water group (P<0.05). After being treated with 5% sodium hypochlorite or sterile water, more biofilm bacteria were killed in calcium silicate-based group for 4 and 12 weeks than in calcium silicate-based group for 1 week (P<0.05). Conclusions: The combined use of sodium hypochlorite and calcium silicate-based root canal sealer kills more biofilm cells in infected dentinal tubules.

Intradermal Sterile Water Injection versus Epidural Bupivacaine in Painless First Stage of Labor

Background: Many women have moderate to severe low back pain during labor. It has been shown that injection of sterile water can reduce the pain of 1ststage. This method is very cheap, easy to learn and can be used as alternative method for reducing the labor pain. Objectives: The aim of this study was to compare the effectiveness, women satisfaction safety and safety of intradermal sterile water injection and epidural bupivacaine in decreasing the pain of1st stage of labor. Patients and Methods: After approval of Institutional Ethical Committee and obtaining written informed consent from eligible parturient women, 120 healthy parturient divided into 3 groups. 1st group epidural bupivacaine plus fentanyl, Initiated with 10 ml of bupivacaine 0.125% with 2 micrograms/ ml of fentanyl and maintained with 10 ml/ h of the same mixture. 2nd group intradermal injection of sterile water 0.1 ml, while 3rd group intradermal injection of 0.1 ml normal saline. Results: The study reported good pain relief in epidural and sterile water group compared to normal saline group. Pain relief was comparable in both the epidural and sterile water group. Complications were more demonstrated in epidural compared to the sterile water and the normal saline groups. A good maternal satisfaction in epidural and sterile water group with no satisfaction in the normal saline group. Conclusion: The evidence from this study suggests that sterile water injections are safe and effective method for relieving pain of the 1st stage of labor similar to epidural bupivacaine analgesia.

INHIBITORY TEST OF FLAVONOID PROPOLIS KELULUT EXTRACTS (G. thorasica) ON Porphyromonas gingivalis AS AN ETIOLOGIC FACTOR OF CHRONIC PERIODONTITIS

Background : Natural ingredients have been used recently for its ability in curing various diseases and reducing the risk of antibiotic resistance . One of these natural ingredients is propolis. Bee propolis Geniotrigona thorasica from South Kalimantan has a strong antibacterial activity with active compounds such as flavonoids. Flavonoids can damage cell membranes and can fight the expansion of β-lactamase enzyme produced by gram-negative bacteria. Porphyromonas gingivalis is a gram-negative bacterium that causes chronic periodontitis with a prevalence of 80%. Objective : This study was to find out the inhibitory test of flavonoid propolis kelulut extract at the concentration of 0.1%; 0.3% and 0.5% on Porphyromonas gingivalis bacteria. Method : This type of research used a pure experimental method with post-test only and control group design. One-way ANOVA statistical test was performed with follow-up test of Post Hoc Dunnet’s T3 . Treatment was given to 4 groups with 5 repetitions. Observations were carried out using digital calipers in all groups after incubation for 24 hours with a temperature of 37℃. Results : One Way Anova and Post Hoc Dunnet's T3 showed significant differences in the diameter flavonoid propolis extract inhibitory zone against Porphyromonas gingivalis . The average value of Flavonoid extract inhibitory zone after 24 hours observation with a concentration of 0.5%; 0.3%; 0.1% and sterile distilled water were 25.24 mm; 18.04 mm; 13.58 mm and there was no inhibitory zone observed in sterile distilled water group . Conclusion : Extract of flavonoid propolis kelulut at the concentration of 0.1%; 0.3% and 0.5% can inhibit the growth of Porphyromonas gingivalis as an etiologic factor of chronic periodontitis.