Syringe Group Research Articles

Assessment of Computer-Controlled Starpen Device and Conventional Aspirating Cartridge on Pain Perception in Paediatric Dental Patients – A Split-Mouth Crossover Study

Abstract Background: Local anaesthesia (LA) is the cornerstone for pain management of invasive dental procedures, but the process of delivering it may itself induce anxiety, especially in paediatric patients that can affect the pain perception. Advances such as the computer-controlled LA delivery system have expanded the horizons of LA and can serve as an alternative for painless injections. Objective: To examine the pain perception and anxiety reduction along with patient preference between computer-controlled Starpen device and conventional aspirating cartridge in LA administration for inferior alveolar nerve block. Materials and Methods: The patients were randomly allotted into two groups: Starpen and Septodont syringe where the LA injections were given using both the methods in the 1st week. After a washout period of 1 week, the crossover was performed and the other mode of LA administration was performed in the 2nd week. Pain scores were objectively recorded by the observer using the Face, Legs, Activity, Cry and Consolability (FLACC) scale during LA administration and extraction. Patients were asked to record the pain scores using the Visual Analogue Scale at three phases: (a) mucosa perforation, (b) needle insertion and (c) solution injection. The effect of pain perception on the vital parameters and the preference between the two techniques were assessed. Statistical Package for the Social Sciences (SPSS) version 23.0, Armonk, NY, USA: IBM Corp was used for statistical analysis, and Mann–Whitney U-test and unpaired t-test were utilised to compare the mean difference of two groups at significance level of 0.05. Results and Observations: Intergroup differences among the Starpen and Septodont syringe groups were found to be statistically significant (P < 0.001) during both LA and extraction when pain was objectively assessed using FLACC. Conclusion: Computerised devices such as Starpen offer controlled release of local anaesthetics, effectively decreasing pain perception in paediatric patients and can form a mainstay for the behaviour management of young patients.

Breastfeeding Success With Use of Electric Breast Pump Versus Inverted Syringe Technique in Lactating Women With Inverted Nipple: Open Labelled Randomized Control Trial.

Background Inverted nipple is a commonly encountered impediment to proper attachment and latch establishment. Correction of inversion using a disposable syringe represents the conventional method of management. However, it is understudied, cumbersome, and inconvenient. Using electric breast pump represents a more physiological method to achieve correction of inversion. This open-label, randomized control trial investigated syringing versus electric breast pump both in terms of effectiveness in achieving correction of inversion of nipple and patient satisfaction with the use of the assigned intervention. Objectives The primary objective of this study was to compare breastfeeding success by Day 3 postnatal age (achieving correction of inversion of nipple and establishment of direct breastfeeding) in syringing versus electric breast pump in mothers with inverted or flat nipples. The secondary objective was to compare the two methods for the pain experienced by the mother while using syringing versus an electric breast pump. Methodology/Design This was a single-center, open-label randomized control trial performed at a tertiary care neonatal unit in Eastern India, from December 2022 to September 2023. 60 healthy mothers with inverted nipples were randomly allocated to one of two interventions: Group A (n=30, syringing); or Group B (n=30, electric breast pump). Both groups were compared for the establishment of breastfeeding by Day 3 postnatal age and daily maximum pain scores till Day 3 (visual analogue scale). Multivariable logistic regression was used to look for factors independently associated with establishment of breast feeding by Day 3 postnatal period. Chi square test was used to compare the proportions of different outcomes between the groups. Results The primary outcome of establishment of breastfeeding by Day 3 postnatal period was achieved in 18 (60%) mothers in syringe group vs. 17 (56.67%) in the breast pump group, with no statistically significant difference (p=0.793). In the first two days the pain score differences were not statistically significant, but on Day 3, 28 (93.99%) mothers in the electric breast pump group had no/mild pain compared to 22 (73.33%) mothers in the syringe usage group. This difference was statistically significant (p= 0.038). Conclusion In hospital settings where electric breast pump is easily available, the same may be preferred over inverted syringe technique for achieving establishment of breastfeeding by Day 3 postnatal period with minimal nipple pain in mothers. However, further large scale studies will be required to confirm these findings.

Analysis of Pain and Effectiveness in Digital Block of the First Toe Using Syringe vs. Carpule: Frost's H vs. Modified Frost's H Randomized Clinical Trial.

Background: Currently, there is no scientific evidence regarding pain in the anesthetic block of the first toe according to the method of application. However, clinical evidence has highlighted the use of the carpule due to the low pain it causes during the administration of the anesthetic. Most studies on anesthesia and pain, especially using the carpule and distraction methods, belong to the field of dentistry. Objective: To compare the pain and effectiveness between the anesthetic block of the first toe using a carpule and syringe with Frost's H technique and the modified Frost's H technique. Method: A total of 564 subjects were selected and divided into four groups. Subjects were subjected to experimental conditions (randomization through the Random Allocation Software program 2.0), and divided into group 1 = 138 subjects, corresponding to the block with syringe and Frost's H, group 2 = 141 subjects, corresponding to the syringe group and modified Frost's H, group 3 = 141 subjects, corresponding to the carpule group and modified Frost's H, and group 4 = 144 subjects, corresponding to the carpule group and Frost's H. The same researcher generated the random allocation sequence, enrolled the participants, and assigned them to the interventions. Each subject was unaware of the anesthetic procedure assigned by the researcher. Outcome parameters were pain after anesthetic infiltration and its effectiveness. Results: The anesthetic block with carpule showed a lower pain score compared to the anesthetic block with syringe (2.8 vs. 5.3; p < 0.001). However, when analyzing effectiveness, a higher efficacy rate was obtained in the anesthetic blocks performed using the modified Frost's H technique (97.5% vs. 88.1%; p < 0.001). Conclusions: The anesthetic block with carpule and the modified Frost's H technique is less painful and more effective than the traditional anesthetic block.

Effect of ultrasonic and Er,Cr:YSGG laser-activated irrigation protocol on dual-species root canal biofilm removal: An in vitro study.

The aim of the study was to investigate the disinfecting efficacy of a standardized irrigating solution activated by ultrasonics or laser irradiation on mature dual-species biofilms at different root levels in vitro. Conventional access cavity preparations were done on 160 single-rooted mandibular premolar teeth with single canals. Freshly extracted oral microbial strains of Staphylococcus aureus, Streptococcus mutans, Enterococcus faecalis, and Candida albicans after biochemical confirmation were used to generate two discrete dual-species microbial inoculums. The sterilized tooth samples were randomly segregated into two groups (n = 80) and inoculated with a mixed inoculum of S. aureus + E. faecalis strains (Group 1) and S. mutans + C. albicans strains (Group 2), respectively. Following the 21-day incubation period under aerobic conditions, the infected specimens in each group were divided into four subgroups (n = 20) and subjected to experimental treatment protocols. This included a positive control (no treatment of biofilms), syringe irrigation alone with TruNatomy needle, passive ultrasonically activated irrigation with 20# Irrisafe tip, and laser agitation of irrigant with Er,Cr:YSGG laser using RFT 2 laser tip. Root canals of experimental specimens (except the control samples) are instrumented with TruNatomy rotary file system using 1:1 mixture of 3% NaOCl and 18% etidronic acid as irrigants. The quantitative assessment of reduction in viable biofilm microbes after treatment was done using colony-forming unit counts and confocal laser scanning microscopy image analysis. The obtained data were analyzed statistically with a significant level set at 0.05. Laser-assisted irrigation has shown a considerably higher mean percentage reduction of microbes compared to ultrasonic agitation and the syringe irrigation showed the least microbial reduction (P = 0.001). No significant difference was noted between the three root regions of ultrasonic and laser groups (P > 0.05), whereas in the syringe groups, apical portions showed higher microbial counts compared to cervical and mid-root regions (P = 0.001). Erbium laser-assisted irrigation has performed superior to ultrasonic agitation against both the experimental dual-species biofilms, while the syringe irrigation showed the least microbial reduction specifically at apical root portions.

Differences in Effectiveness Between Measuring Cuff ETT Using a Syringe and Cuff Inflator on Oxygen Saturation in Pneumonia Patients in the ICU

Inaccuracy of ETT cuff pressure in intubated pneumonia patients will affect changes in oxygen saturation, so it is necessary to measure ETT cuff pressure using appropriate techniques. This study aims to analyze the difference in effectiveness between ETT cuff measurements using a syringe and an inflator cuff on oxygen saturation values in pneumonia patients. Comparative observational design with a cross sectional approach . There were 30 respondents using a total sampling technique, which were then distributed into 2 groups, namely the cuff inflator group and the syringe group with 15 patients each. Data were collected using observation sheets for ETT cuff measurements and oxygen saturation . The results of the Pearson statistical test analysis on ETT cuff measurements measured using a cuff inflator (p=0.01) and a syringe (p=0.004), both showed a p value &lt;0.05, which means there is a significant correlation with the oxygen saturation value. The results of the difference test using the independent t test for the saturation value carried out by measuring the ETT cuff using a cuff inflator using a syringe showed that p=0.854 (&gt;0.05 ) which means there is no difference. The conclusion of this research is that there is no difference between the saturation values of respondents who were measured using the ETT cuff using a cuff inflator and using a syringe. It is recommended that nurses increase their role in observing and maintaining ETT cuff pressure within the ideal range by using a cuff inflator or using a syringe at the service point.

Assessing the efficacy of jet dispenser versus direct syringe injection for calcium hydroxide paste placement in artificial root canals

This study aimed to evaluate the efficacy of a novel jet dispenser (JD) for filling simulated straight and curved canals with calcium hydroxide (Ca(OH)2) paste by comparing the level of intracanal medicament with traditional direct syringe delivery. The Ca(OH)2 paste was delivered into the canals using either a direct syringe with binding tip and unbinding tip or a JD. The analysis of the ratio of the canal filled area (RCFA) in the coronal, middle, and apical thirds was conducted using the Kruskal–Wallis and Mann–Whitney U tests (α = 0.05). The JD resulted in a significantly higher RCFA of 1.00 in the middle and apical thirds in both the straight and curved canals than the direct syringe method (p < 0.001). Voids were frequently observed in the direct syringe group, whereas JD showed no voids within the filled area. In the direct syringe groups, the apical area was more readily filled in both canal types when the tip was bound (p < 0.001). The JD was found to be more effective in filling the entire canal space than the binding and unbinding conditions of the direct injection method, particularly in the apical area.

Efficient Removal of Dental Plaque Biofilm from Training Typodont Teeth via Water Flosser.

Plaque biofilms play critical roles in the development of dental caries. Mechanical plaque control methods are considered to be most effective for plaque removal, such as brushing teeth or using flosser. Recently, water flosser has been paid much attention. Here, we tested the ability of a water flosser to remove the adhered sucrose and the dental plaque biofilms formed by Streptococcus mutans, Streptococcus sanguinis, and Actinobacillus viscosus. We found that the residual sucrose concentration was 3.54 mg/mL in the control group, 1.75 mg/mL in the syringe group (simulating the ordinary mouthwash), and 0 mg/mL in water flosser group. In addition, the residual bacterial concentration was 3.6 × 108 CFU/mL in the control group, 1.6 × 107 CFU/mL in the syringe group, and only 5.5 × 105 CFU/mL in the water flosser group. In summary, water flosser is effective for cleaning the teeth, which may have significant potential in preventing dental caries and maintaining oral health.

Comparison of arterial blood gas results obtained using two types of Heparinized Syringes

Objective: The objective of this study was to compare the arterial blood gas results obtained using syringes heparinized with liquid heparin and syringes containing lyophilized balanced heparin. Study Design: Comparative cross sectional. Place and Duration: This study was conducted in the Chemical Pathology department at Combined Military Hospital, Lahore for a period of six months from November 2022 to March 2023. Methodology: A total of 100 arterial blood samples were taken from 50 patients admitted in ICU using a regular plastic syringe flushed with 5000 IU/ mL liquid heparin and another containing lyophilized heparin. Samples were analyzed immediately after collection on Roche Cobas b121 ABG analyzer. Three of the measured parameters (pH, pCO2 and pO2) were then compared among both syringe groups. pH, pO2 and pCO2 were compared using mean difference. Results: The difference of means for pH was insignificant (p- Value &gt;0.05). But pCO2 and pO2 showed significant difference in means with p- Values &lt;0.05 (0.007 and 0.037, respectively). Bland Altman plots were also plotted for all three parameters. 12% of the pH values, 8% pco2 and 6% pO2 values exceeded the total allowable error. Conclusion: Arterial blood pH was comparable between the two types of syringes used. The pCO2 and pO2 differed significantly and where found to be lower in blood samples collected in the liquid heparin syringes. Keywords: Liquid Heparin, Lyophilized Heparin, Arterial Blood Gas, pH, pO2, pCO2. How to Cite This: Mahmood A, Sattar A, Shaheen S, Ahmad S, Hafeez A. Comparison of arterial blood gas results obtained using two types of Heparinized Syringes. Isra Med J. 2022; 14(4): 161-164. DOI: https://doi.org/10.55282/imj.oa1379

Push-out Bond Strength of Fiber Posts in Long-Term Hypobaric Pressure Changes.

BACKGROUND: The purpose of this study was to evaluate the bond strength of fiber posts with different mixing methods and insertion into root canal techniques in long-term hypobaric pressure changes.METHODS: We chose and decoronated 42 teeth with straight and single root canals. After post-space preparation, the posts were cemented with hand-mixed and auto-mixed resin cements that were inserted into the canals with an endodontic file (lentilo), dual-barrel syringe, and root canal tip (14 for each group). After cementation, each group was divided into two subgroups (N = 7): the control (ambient pressure) group and the hypobaric pressure group. The samples were exposed to hypobaric pressure 90 times. They were cut into 2-mm-thick segments and the push-out bond strength test was performed using a Universal Testing Machine. One-way ANOVA tests, Bonferroni tests, and Student-t-tests were used for statistical analysis.RESULTS: The environmental pressure changes and insertion techniques affected the bond strength values. The auto-mixed with root-canal tip group showed the highest push-out bond strength values in both hypobaric (dual-barrel syringe group: 10.01 MPa; root-canal tip group: 11.61 MPa) and control (dual-barrel syringe group: 12.29 MPa; root-canal tip group: 14.58 MPa) group. In all root segments, the bond strength values of hypobaric groups were lower than atmospheric pressure groups. The most frequent failure type was adhesive between dentin and cement in all groups.DISCUSSION: Dentists should use auto-mixed self-adhesive resin with a root canal tip for post cementations in patients likely to be exposed to hypobaric pressure changes.Ozkan Ata S, Ata N, Yazgan E, Akkor T. Ugurlutan R. Push-out bond strength of fiber posts in long-term hypobaric pressure changes. Aerosp Med Hum Perform. 2023; 94(7):508-513.

Effects of continuous and slow tracheal tube cuff deflation on cough reflex during extubation in noncardiac surgery patients: a randomised clinical trial

BackgroundThe incidence of cough reflex during extubation is 76%. Cough reflex causes severe hemodynamic fluctuations and airway complications. This prospective trial investigated the potential effects of tracheal tube cuff deflation on cough reflex during extubation.MethodsOne hundred and twenty-six patients scheduled for operations within 3 h under general anaesthesia with orotracheal intubation were randomly assigned to one of three groups: control (C), experimental (E) or syringe (S) groups. Patients in group C underwent tracheal tube cuff deflation using a 10-ml syringe in 1 s, patients in group E underwent tracheal tube cuff deflation continuously and slowly in 5 s using a cuff pressure gauge until the pressure was zero and patients in group S underwent tracheal tube cuff deflation using a 10-ml syringe at a speed of 1 ml s−1. The incidence and severity of cough reflexs during extubation and the incidence of postoperative airway complications within 48 h were assessed.ResultsCompared with group C (60.0%), the incidence of cough reflex in group E was 9.8% (p < 0.001) and in group S was 12.5% (p < 0.001). The severity of cough reflex was graded as 2 (1–2) in group C, 1 (1–1) in group E and 1 (1–1) in group S (p < 0.001 for group comparisons). The incidence of hoarseness in group C was 0.0%, in group E was 19.5% and in group S was 5.0% (p < 0.05 for all groups, p = 0.009 between group C and E).ConclusionsCompared with deflating a trachal tube cuff with a 10-ml syringe in 1 s, the use of a 10-ml syringe at a speed of 1 ml s−1 or a cuff pressure guage within 5 s can both reduce the incidence of cough reflex, but deflating with a cuff pressure guage can increase the incidence of postoperative hoarseness.Trial registrationChinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

A comparative assessment of efficacy and preference between needleless device INJEX and insulin syringe for anesthetizing primary maxillary teeth in children aged 4-9 years: A split-mouth crossover randomized clinical study.

This randomized clinical study included 46 children aged 4-9 years. The patients were digitally allotted to receive 4% articaine for extractions of primary maxillary teeth, either using needleless device INJEX or insulin syringe on each side of the maxillary arch, in two different appointments after a 1-week washout period. Pain perception was measured by the subjective (Faces Pain Scale-Revised [FPS-R]) and objective pain scores (Face, Legs, Activity, Cry, and Consolability [FLACC]) and hemodynamic parameters (heart rate and oxygen saturation) during LA administration and during extractions. After the second appointment, children were asked about their preference between needleless device INJEX and insulin syringe. On evaluating subjective pain scores with FPS-R, intergroup differences between the INJEX and insulin syringe groups were found statistically insignificant, both during LA administration (P = 0.101) and extraction (P = 0.080). However, on assessing pain objectively during extraction using FLACC, the mean pain score was less with insulin syringe (2.78) as compared to INJEX (4.72) and the difference was statistically significant (P = 0.000). There was no significant difference in patient preference between the two methods. Pain perception was minimal during local anesthesia administration using needleless device INJEX; however, its clinical efficacy during extractions was reported to be lower than insulin syringe. Managing pain in children is the most challenging task as it forms the foundation for instilling positive behavior toward dental treatment. Adequate local anesthesia (LA) is the cornerstone of pain management. However, the fear of needles, particularly in young children, can result in complete avoidance and refusal of treatment. This study aimed to evaluate and compare the efficacy and preference between needleless device INJEX and.

Evaluation of root-canal isthmus debridement efficacy of 3 kinds of activated irrigation technique.

This study aimed to compare the capabilities of sonic, ultrasonic, and laser-activated irrigation for debris removal in the root canal isthmus. A total of 32 human maxillary first premolars with root canal isthmus were prepared by Reciproc Blue, and were randomly divided into four groups (n=8, each group). The groups were subsequently subjected to different regimens as follows: the conventional syringe group (control group) was irrigated by No.27 side opening syringe, the sonic group with EDDY connected pneumatic motor, the ultrasonic group with IRRI Safe connected to a ultrasonic P5 handle, and the laser group with Er:YAG laser device connected to a 9 mm fiber tip for 20 s in each root canal. The first and last four samples in each group were irrigated for 80 and 120 s, respectively. All samples were fixed, decalcified, embedded, sectioned, and stained with hematoxylin-eosin. Image J software was used for measurement analysis of the isthmus and canal debridement efficacy, and SPSS 25.0 was utilized for statistical analysis of all data. The isthmus debridement efficacy of conventional syringe irrigation, sonic, ultrasonic, and laser groups after 80 s irrigation were 30.91%±3.14%, 52.22%±0.31%, 83.77%±5.64%, and 77.97%±7.97%, respectively. The isthmus debridement efficacy of the three experimental groups were better than the conventional syringe irrigation group (P<0.05). The isthmus debridement efficacies of ultrasonic and laser groups after 80 s were better than that of the sonic group (P<0.01, P<0.05). However, no significant difference was observed between the ultrasonic and laser groups. The isthmus debridement efficacy of conventional syringe irrigation, sonic, ultrasonic, and laser groups after 120 s were 75.72%±2.38%, 85.66%±4.42%, 88.07%±4.09%, and 89.12%±3.63%, respectively. The isthmus debridement efficacies of the three experimental groups were better than that of the conventional syringe irrigation group (P<0.05), but no significant difference was observed among the groups (P>0.05). The root canal debridement efficacy among the four groups also exhibited no significant difference (P>0.05). The debridement efficacies of the root canal and isthmus after 120 s irrigation were better than those after 80 s irrigation (P<0.01, P<0.001). Ultrasonic, sonic, and laser-activated irrigation have better results in removing debris from the isthmus than conventional syringe irrigation. The isthmus debridement efficacy of sonic- and laser-activated irrigation are slightly better than that of ultrasonic activated irrigation. The debridement efficacies of 120 s irrigation are better than those of 80 s irrigaion.

A prospective study to evaluate febrile neutropenia incidence in patients receiving pegfilgrastim on-body injector vs other choices.

PurposeWe evaluated the incidence of febrile neutropenia (FN) and related clinical outcomes among patients treated with myelosuppressive chemotherapy for nonmyeloid malignancies who received pegfilgrastim on-body injector (OBI) or other options (Other) for FN prophylaxis.MethodsIn this prospective observational study, adult patients with breast, prostate, or lung cancer, or non-Hodgkin lymphoma at risk for FN were stratified into subgroups based on FN prophylaxis used in the first chemotherapy cycle: pegfilgrastim OBI vs Other (pegfilgrastim or biosimilar pegfilgrastim prefilled syringe, daily filgrastim, or no granulocyte colony–stimulating factor [G-CSF]) for up to 4 planned chemotherapy cycles.ResultsThis US study enrolled 2575 eligible patients (OBI, 1624; Other, 951). FN incidence was lower in the OBI group (6.4% [95% CI, 5.2–7.6%]) than in the Other group (9.4% [7.5–11.2%]), with a relative risk (RR) of 0.66 (0.47–0.91; p = .006). A decreased risk of dose delays among patients receiving pegfilgrastim OBI vs Other was observed (RR for ≥ 5 days: 0.64 [0.42–0.96], p = .023; RR for ≥ 7 days: 0.62 [0.40–0.91], p = .016). Adherence, defined as G-CSF support for all chemotherapy cycles, was 94.0% (92.9–95.2%) in the OBI group compared with 58.4% (55.2–61.5%) in the Other group. Compliance with pegfilgrastim, defined as administration the day after chemotherapy, was 88.3% in the OBI group and 48.8% in the prefilled syringe group.ConclusionPatients receiving pegfilgrastim OBI had a lower incidence of FN compared with those receiving alternatives. The OBI was associated with improved adherence to and compliance with clinically recommended G-CSF prophylaxis.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-022-07226-9.

Comparison of Efficacy Between Paladai and Syringe Feeding in Stable Preterm Neonates-A Randomized Control Trial.

Background: Feeding abilities of preterm neonates differ based on their gestational and postnatal maturity. Maturity of sucking pattern and improved coordination between sucking and swallowing and breathing, which is seen in babies with a gestation of 32 weeks onward, makes trial of oral feeds more successful in these babies. The oral feeds can be given either with a cup and spoon or a paladai. However, we observed that the milk spilt during feeding was an issue due to a wider spout of the paladai. Feeding through syringe is practiced in many neonatal units. However, there is a lack of scientific literature regarding the syringe feeding of neonates. We hypothesized that giving oral feeds using a syringe could reduce the spillage of milk. This study was done to compare the volume of feeds wasted (spillover) during oral feeding between paladai and syringe feeding. Methods: The order of feeding of 75 nurse baby pairs was randomized to either the syringe or the paladai groups. The volume of milk spilt was assessed by weighing a gauze pad placed under the neck of the baby before and after feeds. Time taken to complete the feeds, the rate of feeding, and events like vomiting and choking after feeding were noted. Feeding satisfaction among the nurses was recorded on a 5-point Likert scale. Results: The average mean time for completion of feeds by paladai was 9 minutes against 8.9 minutes in syringe feeding. The median rate of feeding was 3.57 minutes in the paladai group and 3.5 minutes in the syringe group. The median spillover volume was 3.33 mL in the paladai feeds and 3.23 mL in the intervention group. Seventy percent of the nurses reported better satisfaction with syringe feeds compared to paladai feeds. Conclusion: This study demonstrates that the milk spillover (wastage) during syringe feeding is not different from paladai feeds. However, the majority of nurses felt the syringe feeding was more satisfactory than paladai feeding. CTRI Reg. No: CTRI/2021/05/033479 dated 07.05.2021.

To evaluate the efficacy of XP endo finisher and passive ultrasonic irrigation for smear layer removal using scanning electron microscopy: An in vitro study

Introduction: This study aims to investigate the efficacy of XP endo finisher and passive ultrasonic irrigation for smear layer removal using scanning electron microscopy (SEM).Materials and method: The root canals of 36 extracted single rooted mandibular premolars were selected for the study. All specimens were randomly distributed into the following 3 groups: Group I(Control): conventional irrigation by syringe Group II: passive ultrasonic irrigation (PUI) and, Group III: XP endo finisher. In all groups mechanical instrumentation was done with rotary files iRace. The specimens of all the 3 groups was grooved buccolingually along the entire length, with the help of a high- speed bur without perforating into the root canal space. The roots was then split carefully along the length of the groove and subjected to SEM evaluation.Results: Within the limitation of this study, it can be concluded that XP endo finisher file (XP) was more effective in cleaning the apical area than passive ultrasonic irrigation (PUI) and conventional side vented needle irrigation (CI).

Comparison of Various Root Canal Filling Materials and Obturation Techniques for Primary Teeth Using Microcomputed Tomography

Aim: The aim of this study was to compare the effectiveness of different filling materials and obturation techniques for root canal obturation in primary teeth. Materials and Methods: Eighty maxillary primary incisors were included in this in vitro study. After biomechanical preparation, all samples were scanned using microcomputed tomography (micro-CT) and root canal volumes were calculated. Samples were grouped according to filling materials and obturation techniques, with ten samples in each group. The samples were filled with zinc oxide eugenol (ZOE) and Vitapex using four different obturation techniques (local anesthesia syringe, lentulo spiral, pastinject, and lentulo spiral–ultrasonic activation). After filling, samples were scanned a second time using micro-CT and root canal volumes were calculated. The statistical analysis was performed using SPSS version 24.0. Data were analyzed by Kruskal–Wallis and Mann–Whitney U tests. Results: When the ZOE and Vitapex were compared, it was observed that there were no significant differences between their postobturated volumes, percentage obturated volume (POV), internal void (IV), and percentage of internal void volume (PIV) ( P &gt; .05). The local anesthesia syringe group had a significantly lower postobturated volume and POV, and a significantly higher IV and PIV for both filling materials than that by the other groups ( P &lt; .05). There was no significant difference between the other obturation techniques ( P &gt; .05). For the local anesthesia syringe group, postobturated volume and POV were significantly higher and IV and PIV were significantly lower with Vitapex than with ZOE ( P &lt; .05). There was no significant difference between the other obturation techniques filled either with ZOE or Vitapex ( P &gt; .05). Conclusion: Except for the syringe technique, no difference was observed between the ZOE and Vitapex materials. The syringe technique used in the primary root canal filling was less effective than the other techniques, which had similar efficacy, and in this technique, more effective canal filling was achieved with Vitapex.

Pens versus syringes to deliver insulin among elderly patients with type 2 diabetes: a randomized controlled clinical trial

BackgroundDiabetes mellitus (DM) is a prevalent disease among elderly population. As the disease progresses, insulin may become necessary. The use of pens application seems to be more practical. However, the influence of this method on glycemic control needs to be defined in elderly people.MethodsRandomized clinical trial comparing pens and syringes for insulin application among patients with type 2 DM over 60 years old and Glycated Hemoglobin > 8.5% at baseline. The follow-up was 24 weeks, with monthly medical visits to adjust the treatment. All patients received insulin NPH and, if necessary, insulin Regular. We assessed glycemic control, adherence to treatment, hypoglycemia occurrence, need for adjustment in treatment and impact on quality of life,ResultsWe included 121 patients with mean age of 65.75 years. Sixty-one were randomized for pen group (PG) and 60 patients for syringe group (SG). At baseline, mean HbA1c was 10.34 ± 1.66% and 9.90 ± 1.25% (p = 0.103) in PG and SG respectively. Mean HbA1c was 8.39 ± 1.28% in PG and 8.85 ± 1.74% in SG (p = 0.101) at 24 weeks. However, there was a more significant reduction in PG (− 1.94 ± 1.93% in PG and − 1.04 ± 1.46% in SG, p < 0.05) during follow-up. We found no difference in treatment adherence rates, hypoglycemia, greater need for insulin doses or oral medication, and progression to basal-bolus insulin scheme. We also found no difference in the impact of the disease on quality of life between groups.ConclusionAlthough we did not find any difference in the impact on quality of life, frequency of hypoglycemia or adherence, the PG showed a reduction in HbA1c higher in 24 weeks of follow-up.Clinical trial registration: NCT02517242

Assessment of potential differences between pre-filled and manually prepared syringe use during vascular access device management in a pediatric intensive care unit.

Central line-associated bloodstream infection is one of the four primary health-care-associated infections applicable to pediatric intensive care units defined by The Centers for Disease Control and Prevention. According to current guidelines, it is essential to flush vascular access devices before each infusion to assess catheter function and prevent catheter-related complications. This prospective trial aimed to assess the potential differences between pre-filled and manually prepared saline syringe use during vascular access device management in a pediatric intensive care unit. Volunteered registered pediatric intensive care unit nurses were asked to implement the flushing solution to an extension line of a central venous catheter in vitro. After the randomization process with opaque sealed envelopes, they have started either with manual preparation or used sterile pre-filled saline syringes. Sterile application steps forms were used for monitoring the manual preparation of saline syringes versus the pre-filled saline syringes phase. Each volunteer repeated the steps for 3, 5, and 10 mL syringe volumes with the manually prepared and pre-filled saline syringes. After completing the procedures, failed steps and durations were transferred into a database to be analyzed by a blinded investigator. A total of 41 nurses volunteered and 123 forms for three attempts per one nurse were filled for each group. In the manual preparation group, the number of at least one failure in the necessary steps was 89 (72.3%) and the same number in the pre-filled syringe group was 6 (4.9%), and significantly lower in the pre-filled saline syringe group (p < 0.001). The overall time for preparing to flush was 86.0 ± 22.3 s (ranging from 46 to 173 s) for manual prepared syringes and 35.2 ± 9.4 s (ranging from 18 to 100 s) (p < 0.001) for pre-filled saline syringes. Our results demonstrate that the risk for breaking the aseptic no-touch technic was higher in the manual preparation group. We have also demonstrated that the flushing time was shorter with pre-filled syringes compared to manually prepared ones, which may contribute to decreasing the workload of the nurses and may increase the quality of care in the intensive care units. The use of pre-filled saline syringes may decrease the central line-associated bloodstream infections incidence and may increase the quality of care by saving extra time in the pediatric intensive care unit.

A quantitative analysis of two cementing techniques in total elbow replacement: A cadaveric study.

One of the reasons for failure of total elbow replacement is loosening of the ulnar component. Cementing techniques are often outdated. A special small nozzle is needed for the ulnar component, when a cement gun is used. This may not always be available, or surgeons may prefer to use a syringe. We postulated that the use of a cement gun and smaller nozzle would result in improved filling of the ulnar canal. A cadaveric study was performed in which the ulnas of paired specimens were cemented with a cement gun or with a syringe. A 3D printed ulnar component was inserted and computed tomography scanning was performed on all specimens. Filling of the ulnar intramedullary canal was analysed using 3D reconstructions of the specimens. A greater degree of filling was seen by the use of the cement gun in 85.7%. Filling was 52.7% in the syringe group (25.1-78.7%), compared to 63.3% for the cement gun group (p < 0.05). The use of a small nozzle cement gun provided a significantly higher filling degree of the ulnar canal. We recommend to always use a cement gun with a specific small nozzle to cement the ulnar component in total elbow arthroplasty.

Efficacy of a Nickel-Titanium Ultrasonic Instrument for Biofilm Removal in a Simulated Complex Root Canal.

This study evaluated the effectiveness of NiTi ultrasonic tips for Enterococcus faecalis (E. faecalis) biofilm removal in simulated complex root canals. Sixty root canal models consisting of a 30-degree curved main canal and two lateral canals were constructed from polydimethylsiloxane and incubated with E. faecalis. Irrigants in root canals were activated using a manual syringe (SI), a stainless steel (SS) instrument, a nickel-titanium (Ni-Ti) ultrasonic instrument, or a sonic instrument (EA). Instruments of SI, SS, and NiTi-9 groups were placed 9 mm from the apex, whereas those in NiTi-2 and EA groups were placed 2 mm from the apex. The efficacy of each method was determined as the ratio of fluorescence concentration before and after activation. In the apical curved canal, the highest efficacy was found in the NiTi-2 group (99.40%), followed by SI (84.25%), EA (80.38%), SS (76.93%), and NiTi-9 (67.29%) groups. In lateral canals 1 and 2, the efficacy was the highest in the NiTi-2 group and the lowest in the SI group. The NiTi ultrasonic instrument could effectively remove biofilms in the curved canal and lateral canals. This instrument should be introduced close to the working length. An up-and-down motion of the activation instrument is recommended.