The prevalence of osteoporosis and its association with serum testosterone and serum vitamin D in the elderly male population: A cross-sectional study.

Background: Male osteoporosis is under-diagnosed and poorly studied. With the ageing population, osteoporotic fracture in men is an emerging health problem. The aim of this study was to study the prevalence of osteoporosis and its association with serum testosterone and serum vitamin D in elderly men (>60 years old) attending the outpatient department (OPD). Methods: An observational cross-sectional study was performed in elderly men (>60 years old) attending OPD of a tertiary care hospital of Western Maharashtra between April 2017 and June 2019. Patients with rheumatological disorders, history of vertebral/femoral fractures, chronic kidney disease, chronic liver disease, thyroid disorders and alcohol dependence were excluded. Data were analysed using the chi-square test and descriptive statistics. Results: In total, 408 male patients were included. The mean age was 68.33 years. Osteoporosis was seen in 39.5% of patients (161/408) with a T score of ≤2.5. Osteopenia was noted in 48.3% of patients (197/408). T and Z scores had significant correlation (p = <0.001). Only 12% of elderly men had normal bone mineral density score. Serum testosterone, chronic obstructive pulmonary disease (COPD) and benign prostatic hypertrophy (BPH) were significantly associated with male osteoporosis with a p-value of 0.019, 0.016 and 0.010, respectively. Vitamin D levels, type 2 diabetes mellitus, hypertension and coronary artery disease did not show any significant association with male osteoporosis. Conclusion: Osteoporosis was noted in 39.5% of the elderly men. In addition, decreased testosterone, COPD and BPH were significantly associated with male osteoporosis. It is important to screen elderly men to diagnose osteoporosis early and prevent osteoporotic fractures.

Thermal imaging in rheumatoid arthritis knee joints and its correlation with power Doppler ultrasound.

Background: Power Doppler ultrasound (PDUS) is an established non-invasive modalities for quantification of inflammation, which has a bearing on the assessment of disease activity in rheumatoid arthritis (RA). However, PDUS has several disadvantages including cost of equipment, steep learning curve and inter-observer variability. Thermal imaging has emerged as a simple, powerful tool for mapping the heat distribution pattern and has the potential to document and quantify disease activity in RA. The objective was to study the thermal imaging pattern of inflamed knee joints in cases of RA and its correlation with PDUS. Methods: This pilot case-control study was carried out at the rheumatology centre in India including 100 subjects (50 controls and 50 RA patients). All participants underwent thermal imaging and PDUS for the knee joints. The mean temperatures in area of interest in knee, thigh and knee-thigh differential were analysed in comparison with PDUS findings. Results: RA subjects had significantly higher mean knee temperature and mean knee-thigh temperature differential compared with controls (p value < 0.00001). PDUS documented inflammation strongly correlated with knee-thigh temperature differential. Conclusion: There was a statistically significant difference in mean knee temperature as well as mean knee-thigh temperature differential of inflamed versus control knees. Thermal imaging has the potential to become simple, objective, cost-effective and reliable tool for diagnosis and assessment of disease activity in inflammatory arthritis.

Anaesthetic efficacy of incorporating different additives into lidocaine for the inferior alveolar nerve block: A systematic review with meta-analysis and trial sequential analysis.

BACKGROUND: Incorporating an additive into lidocaine is a method to enhance the efficacy of the inferior alveolar nerve block (IANB) in mandibular posterior teeth. OBJECTIVES: To assess the efficacy of incorporating additives into lidocaine in the success rate of IANB for teeth with the diagnosis of normal pulp (NP) or symptomatic irreversible pulpitis (SIP). METHODS: Randomized controlled trials (RCTs) assessing the incorporation of additives into lidocaine on the pulpal anaesthesia success rate of mandibular posterior teeth were searched in PubMed, Scopus, Web of Science, Ovid, EBSCO, Embase, and Cochrane databases up to 1 December 2021. The risk of bias (RoB) was assessed by the Cochrane Risk of Bias Tool. A random-effects model was employed to calculate the pooled risk ratio (RR) with a 95% confidence interval (CI), using STATA 16. The trial sequential analysis (TSA) was applied to calculate the required information size (RIS). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to assess the certainty of the evidence. RESULTS: Of 6966 records retrieved initially, 14 trials (8 for NP and 6 for SIP groups) were included in qualitative and quantitative syntheses. All trials were categorized as low and unclear RoB for NP and SIP groups, respectively. In the NP group, with 307 participants, no significant effect was observed for additives incorporated into lidocaine (RR: 0.84; 95% CI: 0.53-1.32; I2  = 98%). Subgroup analysis revealed that adding mannitol led to a higher success rate (RR = 1.24; 95% CI: 1.15-1.34; I2  = 7.16%). In the SIP group, with 434 participants, no significant effect was shown when the additives were incorporated (RR = 1.22; 95% CI: 0.98-1.52; I2  = 0%). Likewise, in subgroup analysis, incorporating mannitol or sodium bicarbonate demonstrated no significant effect (RR = 1.76; 95% CI: 0.93-3.32; I2  = 18.41% and RR = 1.06; 95% CI: 0.65-1.72; I2  = 53.5%, respectively). DISCUSSION: TSA revealed that the outcome was "inconclusive" for each group. The certainty of the evidence was graded as "very low" and "low" for NP and SIP groups, respectively. CONCLUSIONS: The very low to low certainty of evidence indicated that incorporating additives into lidocaine did not increase the efficacy of IANB and supplemental injections are still necessary to help practitioners achieve painless dentistry. REGISTRATION: PROSPERO database (CRD42020132585).

Comparative evaluation of the force required to fracture coronal segments reattached using different methods.

BACKGROUND/AIM: Anterior teeth are prone to traumatic injuries. Their management is necessary in order to maintain the pulp and esthetics. Various methods have been reported for fragment reattachment of fractured teeth but there is no consensus on which is the best technique. The aim of this study was to compare the force required to fracture reattached fragments using polyethylene fibers in vertical grooves on the external surface of teeth, fiber-reinforced composite post and circumferential chamfer. MATERIAL AND METHODS: Forty-eight extracted maxillary central incisors were sectioned using a disk and randomly divided into 4 groups (n = 12): Group 1: control group, Group 2: reattachment followed by placement of two external vertical grooves on the labial surface and restored with polyethylene fibers and hybrid composite, Group 3: reattachment followed by two external vertical grooves and filled with fiber posts and composite, and Group 4: reattachment followed by circumferential chamfer at the fracture line and restored with composite. The forces required to fracture the reattached fragments were measured using a Universal testing machine. Data were analyzed using the Kruskal-Wallis test. Pairwise multiple comparison procedure was done using the Student-Newman-Keuls Method. RESULTS: The highest values for force required to fracture were observed in the fiber post group and the lowest in the Ribbond group (p < .05). The fiber post group had significantly different results compared to the Ribbond and Chamfer preparation groups (p < .05). However, the difference of rank between the fiber post and control groups was not significantly different (p > .05). CONCLUSION: The force required to fracture the fiber post group was closest to that of intact teeth followed by the chamfer and Ribbond groups, respectively.

An unusual case of pedal edema.

A 40-year-old male patient reported to medical outpatient department with bilateral pedal edema of 15 days duration which was progressive, bilaterally symmetrical, pitting and with minimal pain and redness. Examination revealed pallor and bilateral pitting pedal edema with mild tenderness. Investigations revealed dimorphic anemia with reduced vitamin B12 levels. All other biochemical and radiological including radiograph of the chest, ultrasonography of abdomen, color doppler of the both lower limbs, and two dimensional echocardiography were normal. For the next one month, the patient showed significant improvement and was discharged. Fifteen days later, the patient was again readmitted with progressively worsening breathlessness with orthopnea and increasing pedal edema of two days duration. Clinically and radiologically, patient had features of congestive cardiac failure which was corroborated with markedly raised levels of NT pro brain natriuretic peptide. He also had other organ involvement with raised serum creatinine (1.9 mg/dl) and elevated transaminases of >300 IU/L. Patient was managed with high flow oxygen, ventilatory support, intravenous loop diuretics, low-dose angiotensin-converting enzyme inhibitors, and supportive care. The next day, patient's son and wife also reported with bilateral pedal edema and breathlessness. Based on this history, the diagnosis of epidemic dropsy was suspected. Mustard oil from their kitchen tested positive for nitric oxide test which was later confirmed at Public Health Laboratory. The index case showed progressive downhill course and died after 3 days. Both son and wife recovered over the next few months.

Prevalence of Vitamin B12 deficiency in elderly population (>60 years) presenting with dementia to outpatient department.

BACKGROUND: Vitamin B12 deficiency is an easily treatable cause of reversible dementia. It is likely to be more common in Indian population due to traditionally vegetarian culture. This study was conducted to estimate the prevalence of Vitamin B12 deficiency in elderly patients (>60 years) with dementia attending outpatient department. METHODS: This study was conducted in two phases. The first phase was a cross sectional observational study to estimate the prevalence of Vitamin B12 deficiency in the elderly population with dementia. The second phase was a pilot study done in subjects with Vitamin B12 deficiency to assess the change in cognition following Vitamin B12 supplementation. RESULTS: Out of 2920 study eligible subjects, 200 were diagnosed as dementia with Mini Mental Status Examination (MMSE) score of ≤ 24. Vitamin B12 deficiency was seen in 7.5% of patients. Vitamin B12 deficiency was associated with shorter and more severe dementia. Macrocytosis was more common in Vitamin B12 deficiency (p value < 0.001) where as vegetarian diet did not show significant correlation (p value 0.69). There was significant improvement in the median MMSE score in the intervention group with increase in MMSE by 2 points at 6-8 weeks and 3 points at 12 weeks (p value 0.009 and 0.003 by Mann Whitney test). CONCLUSION: Prevalence of Vitamin B12 deficiency in dementia was 7.5%. It was associated with macrocytosis, shorter duration and more severe dementia. There was a significant improvement in median MMSE score at 6 weeks and 12 weeks following Vitamin B12 supplementation.

Anaesthetic efficacy of 2% lidocaine with different concentrations of epinephrine (1:80,000 and 1:200,000) in intraligamentary injection after a failed primary inferior alveolar nerve block: a randomized double-blind study.

Introduction: The present study evaluated the anaesthetic efficacy of 2% lidocaine with 1:80,000 epinephrine vs. 2% lidocaine with 1:200,000 given as supplemental intraligamentary injections after a failed inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. The effect of these solutions on the heart rate was also evaluated.Methods: One-hundred-eighteen adult patients with symptomatic irreversible pulpits in a mandibular first or second molar, received an initial IANB with 2% lidocaine with 1:80,000 epinephrine. Pain during the endodontic treatment was assessed using a visual analogue scale (Heft-Parker VAS). Eighty-eight patients with unsuccessful anaesthesia were randomly allocated to one of the two treatment groups: one group received 0.6 mL/root of supplementary intraligamentary injection of 2% lidocaine with 1:80,000 epinephrine; while the second group received 2% lidocaine with 1:200,000 epinephrine. Endodontic treatment was re-initiated. Success after primary injection or supplementary injection was defined as no or mild pain (pain score ≤54 mm on HP VAS) during access preparation and root canal instrumentation. Heart rate was monitored using a finger pulse oximeter. The anaesthetic success rates were analyzed with the Pearson chi-square test at 5% significance levels. The heart rate changes were analyzed using the t-test.Results: The anaesthetic success rate in patients receiving supplementary intraligamentary injections in 1:80,000 epinephrine group was 82%, while the intraligamentary injections with 2% lidocaine with 1:200,000 epinephrine were successful in 57% of cases. The difference was statistically significant (χ2=6.4, p = .011). There was no significant effect of both the anaesthetic agents on the mean heart rate.Conclusions: Both 2% lidocaine with 1:80,000 epinephrine and 2% lidocaine with 1:200,000 epinephrine improved the success rates after a failed primary anaesthetic injection. The 1:80,000 epinephrine group was significantly more successful.

Study of transesophageal echocardiography in young patients (<40 years) with acute arterial ischemic stroke: A pilot study.

BACKGROUND: The aim is to study cardiac abnormalities as detected by transesophageal echocardiography (TEE) in young patients (<40 years) presenting with acute ischemic arterial stroke. METHODS: A cross-sectional observational study was conducted in young patients aged <40 years presenting with acute arterial ischemic stroke without any valvular heart disease, prosthetic valve, or previously diagnosed atrial fibrillation (AF). TEE was performed in all eligible patients preferably within the first week of the onset of ischemic arterial stroke. All patients with normal TEE underwent holter to rule out paroxysmal AF. RESULTS: Totally, 40 young patients were included in the study. Mean age was 35.17 (SD [standard deviation] ± 2.99) years. TEE abnormalities were noted in total 13 (32.5%) patients, of which patent foramen ovale was the most common cardiac abnormality in eight (20%) patients followed by left atrial appendage clot in three (7.5%) and atrial septal aneurysm in two (5%) patients. One patient (2.5%) was observed with atrial septal aneurysm along with a sieved septum. All the patients with normal TEE underwent holter, and four of 27 (14.8%) of these patients were noted to have paroxysmal AF. CONCLUSION: Cardiac abnormalities on TEE and holter were detected in 42.5% of the young patients with idiopathic arterial stroke. TEE abnormality was noted in 33% (13/40), whereas AF on holter was seen in 14.8% (4/27) with normal TEE. Thus, probable cardioembolic stroke was responsible for acute ischemic stroke in 42.5% (17/40) of young patients in the absence of valvular heart disease, prosthetic valves, and persistent/permanent AF.

Effect of polyethylene fiber reinforcement on marginal adaptation of composite resin in Class II preparations.

The aim of this study was to evaluate the effect of polyethylene fibers incorporated in a composite resin matrix on the gingival marginal adaptation of Class II slot restorations. Sixty Class II slot cavity preparations were divided into 2 groups. A fiber-reinforced resin (FRR) group received restorations of composite resin mixed with strips of polyethylene fiber, and an unreinforced resin (UR) group was restored with only composite resin. The groups were subdivided on the basis of the adhesive system (etch-and-rinse or self-etch) that was used. Shrinkage stress was evaluated by placing a strain gauge at the buccal surface of the teeth. A scanning electron microscope was used to evaluate marginal adaptation in terms of a continuous margin (CM) at the gingival margin. Statistical analysis included a 2-way analysis of variance with the Holm-Sidak correction for multiple comparisons at a significance level of 0.05. The mean strain value was significantly smaller in the FRR group (185 [SD 37] µm/m) than in the UR group (295 [SD 21] µm/m). The FRR group presented with a mean CM value of 80.2% (SD 4.6%), which was significantly higher than that of the UR group, which had an overall CM value of 64.4% (SD 4.2%). There was no statistically significant difference between the adhesive subgroups with regard to strain or percentage of CM. The results showed that the incorporation of polyethylene fibers in a composite resin matrix can help to improve gingival marginal adaptation in Class II cavities.

Effect of root canal obturation with calcium silicate materials on pH change in simulated root resorption defects.

This study evaluated the effect of 3 commercially available calcium silicate materials (CSMs) on pH changes in simulated root resorption defects. Simulated root resorption defects were prepared on the facial root surface of 40 mandibular premolars. The depth of each defect was individually calculated to standardize the remaining dentin thickness to 1 mm. Prepared canals were obturated with the 3 CSMs. Ten specimens were kept as controls, filled with unbuffered normal saline. The pH measurements were taken at 1 hour, 6 hours, 1 day, 1 week, 2 weeks, 3 weeks, 1 month, and 2 months. All CSM groups exhibited an initial alkaline pH of 9.0-9.7. The pH decreased to 8.0-8.5 after 2 months of storage. There were no significant differences between pH measurements at other time intervals. The CSM groups exhibited higher pH levels than the control group. The results showed that intracanal placement of the CSMs maintained initial pH levels of 9.0-9.7 inside the simulated resorption defects; these measurements gradually decreased to 8.0-8.5 over the span of 2 months.

Post procedural complications of cardiac implants done in a resource limited setting under 'C' arm: A single centre experience.

BACKGROUND: Cardiology interventions in peripheral hospitals is a challenging task where cardiologist have to fight against time and limited resources. Most of the sudden cardiac deaths occur due to arrhythmia and heart blocks/sinus node dysfunction. Our study is a single peripheral center experience of cardiac devices implantation using a 'C' Arm. The aim of this study was to post procedural complications of cardiac implants done in aresource limited setting under 'C' arm. METHODS: This study is done at a peripheral cardiology center with no cardiac catheterization laboratory (CCL) facilities. Consecutive patients reporting to cardiology center, between Jan 2015 and Oct 2016, with a definite indication for cardiac device implant were included in the study. All the procedure of implantation was done in the operation theatre under 'C' arm under local anesthesia with continuous cardiac monitoring and critical care back up. RESULTS: Total 58 device implantations were done from Jan 2015 to Oct 2016. The mean age of the patients was 67.15 ± 10.85 years. Males constituted almost two third (68.9%) of patients. The commonest indication for device implantation was sinus node dysfunction in 60.34% followed by complete heart block in 25.86% and ventricular tachycardia in 12.06%. No post procedure infection was observed in our study. CONCLUSION: Device implantation constitute a major group of life saving interventions in cardiology practice. Our study has emphasised that when appropriate aseptic measures are taken during device implantation at peripheral centres, the complications rate are comparable to interventions done at advance cardiac centres.

Marginal Adaptation Evaluation of Biodentine and MTA Plus in "Open Sandwich" Class II Restorations.

PURPOSES: This study aimed at evaluation of two different commercially available calcium silicate materials (Biodentine and mineral trioxide aggregate [MTA] Plus) used as dentin substitute. MATERIALS AND METHODS: Sixty Class II cavities were prepared in extracted mandibular third molars, with margins extending 1 mm below the cementum-enamel junction. The samples were divided into three groups on the basis of dentin substitute used: resin modified glass ionomer cement, Biodentine, and MTA Plus. Cavities were restored with composite resins in an "open sandwich" technique. The samples were subjected to alternate aging in phosphate buffered saline and cyclic loading. Marginal adaptation was evaluated in terms of "continuous margin" at the gingival margin, using a low vacuum scanning electron microscope. Statistical analysis was done with two-way analysis of variance with Holm-Sidak's correction for multiple comparisons. RESULTS: The glass ionomer group and Biodentine group presented an overall 83% and 91% of continuous margins, with no difference between them. MTA Plus showed least values of continuous margins. Granular deposits were seen over the surface of Biodentine and MTA Plus. CONCLUSIONS: Biodentine and resin-modified glass ionomer cement, when used as a dentin substitute under composite restorations in open sandwich technique, gave satisfactory marginal adaptation values. CLINICAL SIGNIFICANCE: Contemporary calcium silicate materials can be used as dentin substitute materials in "open sandwich" Class II restorations. This study evaluates the marginal adaptation of Biodentine, MTA Plus, and resin modified glass ionomer cement used as dentin substitutes and reports better adaptation obtained with Biodentine and glass ionomer cement.

Effect of Preoperative Pain on Inferior Alveolar Nerve Block.

The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1-54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55-114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis.

Effect of Intraligamentary Tramadol Hydrochloride on Anesthetic Success During Endodontic Management of Mandibular Molars: A Randomized Clinical Controlled Trial.

OBJECTIVE: Tramadol hydrochloride has shown local anesthetic properties similar to lidocaine, apart from a central analgesic effect. The present study evaluated the effect of the administration of tramadol alone or in addition to 2% lidocaine, as supplementary intraligamentary injections. METHODS: One hundred and five patients, with a failed primary inferior alveolar nerve block (IANB), were randomly allocated to one of the three supplementary intraligamentary groups: 2% lidocaine with 1: 80,000 epinephrine; tramadol hydrochloride (50 mg/mL); and 2% lidocaine with 1: 80,000 epinephrine plus tramadol hydrochloride. Patients received 1.2 mL doses (0.6 mL of each root). Patients reporting pain ≤54 on Heft Parker visual analogue scale (Heft-Parker VAS), were categorized as successful anesthesia. A finger pulse oximeter was used to measure the heart rates. The anesthetic success rates, gender, and type of tooth were compared using the Pearson chi-square test. The heart rates and age were statistically evaluated using the one-way analysis of variance test. The level of significance was set at 0.05 (p=0.05). RESULTS: The initial IANB was successful in 31% of cases. There were significant differences in the anesthetic success rates of different supplementary intraligamentary injections (χ2= 33.6, p<0.001, df=2). The 2% lidocaine-plus-tramadol resulted in significantly higher success rates than the two groups. There were no significant changes in the baseline heart rates of all groups (p>0.05). CONCLUSION: The addition of tramadol to 2% lidocaine with 1: 80,000 epinephrine, given as supplementary intraligamentary injection, can help in achieving successful anesthesia during the endodontic management of mandibular molars with irreversible pulpitis resistant to IANB injections.

Effect of Back-Pressure Anesthesia on Postoperative Pain after the Endodontic Treatment in Patients with Symptomatic Irreversible Pulpitis: Randomized Double-Blind Clinical Trial.

INTRODUCTION: The present study evaluated the effect of 2 different back pressure-based supplemental anesthesia on postoperative pain in patients receiving endodontic treatment for a mandibular molar with symptomatic irreversible pulpitis. METHODS: One-hundred-thirty-five adult patients with symptomatic irreversible pulpits in a mandibular first or second molar, received an initial inferior alveolar nerve block (IANB) injection with 2% lidocaine with 1:80,000 epinephrine. Ten minutes following the injection, access to cavity preparation began. Lip numbness was a must for all patients. The Heft-Parker visual analogue scale (HP-VAS) was used to measure pain during endodontic therapy. Success of primary injections was defined as no or mild pain (less than 55 mm on HP-VAS) during access preparation. The patients with initial successful anesthesia served as control and received endodontic treatment. Ninety-five patients with unsuccessful primary anesthesia randomly received either intraligamentary injections of 2% lidocaine with 1:80,000 epinephrine or intrapulpal injections with similar anesthetic solution. Endodontic treatment was re-initiated and canals were instrumented till working length under copious irrigation. Intracanal medicament of calcium hydroxide was placed and teeth received a temporary restoration. Postoperative pain was measured at 2 hours, 4 hours, 6 hours, 24 hours, and 3 days. Data were analyzed using the Pearson chi-square test, one-way analysis of variance, and one-way repeated measures analysis of variance. RESULTS: The initial initial inferior alveolar nerve block was successful in 40 cases (out of 135). The intraligamentary injections were successful in 33 out of 47 cases (70%), and intrapulpal injections were successful in all cases (45/45). The patients receiving intraligamentary injections reported significantly higher pain scores at all intervals till 24 hours. After 3 days, the pain significantly reduced in all the groups with no significant difference between them. CONCLUSIONS: Patients receiving supplementary intraligamentary injections can experience increased postoperative pain till 24 hours after the endodontic treatment. The pain scores reduced to the level of the control group after 3 days.

Erratum: Addendum: Effect of pre-operative medication with paracetamol and ketorolac on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a double-blind randomized clinical trial.

[This corrects the article on p. 441 in vol. 21, PMID: 34703893.].

Effect of Cooling of Lidocaine with Epinephrine on the Anesthetic Success of Supplementary Intraligamentary Injection after a Failed Primary Inferior Alveolar Nerve Block: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this prospective, randomized clinical trial was to evaluate the effect of cooling a 2% lidocaine solution with 1: 200,000 epinephrine, administered as a supplementary intraligamentary injection to overcome a failed primary inferior alveolar nerve block (IANB). METHODS: The study was preceded by a pilot study to evaluate the anesthetic efficacy of plain lidocaine solutions given as intraligamentary injections. In the subsequent randomized clinical trial, one hundred and thirty-eight patients received IANB with 2% lidocaine with 1: 80,000 epinephrine for endodontic man- agement of a mandibular molar with symptomatic irreversible pulpitis. Eighty-eight patients reported pain greater than 54 mm on a visual analog scale (Heft-Parker VAS) were categorized as unsuccessful anesthesia. These patients received either of the following intraligamentary injections: 2% lidocaine with 1: 200,000 epinephrine at room temperature; or 2% lidocaine with 1: 200,000 epinephrine at 4°C. Anes- thetic success was again evaluated after re-initiation of the endodontic treatment. The heart rates of the patients were measured using a finger pulse oximeter. The categorical success rates were statistically analyzed with the Pearson chi-square test at 5% significance levels. The heart rate measurements were analyzed using a t-test. RESULTS: The intraligamentary injections with anesthetic solutions at room temperature presented a suc- cess rate of 59.1%, while the injections with a solution at 4°C gave a success rate of 52.27%. There were no significant differences between the success rates of the groups (χ2=0.41, p=0.52). Regarding the heart rates, there were no differences between the two solutions at baseline (T=1.2, p=0.2) or after injections (T=0.64, p=0.52). CONCLUSION: Reducing the temperature of 2% lidocaine with 1: 200,000 epinephrine to 4°C does not affect the anesthetic efficacy of supplemental intraligamentary injections, given after a failed primary IANB. (EEJ-2023-03-044).

Evaluation of postoperative pain using warm versus room temperature sodium hypochlorite as an irrigant in mandibular molars with irreversible pulpitis: A randomized controlled trial.

Introduction: The study evaluates and compare the effect of 3% warm NaOCl with NaOCl at room temperature in root canal irrigation on postoperative pain. Materials and Methods: In this randomized controlled trial, mandibular molars with symptomatic irreversible pulpitis in healthy 18-year-old patients and above were included. The sample consisted of 56 patients evaluating the postoperative pain, allocated randomly into 2 groups of 3% NaOCl at two different temperatures, i.e. at room temperature and at 60°C. Endodontic treatment was initiated for each group and instrumentation was done using MTwo rotary files. The final irrigation was performed according to the groups assigned. For each included tooth, preoperative and postoperative pain scores at 6, 12, 24, 48, and 72 h were collected through the Heft Parker Visual Analog Scale. Statistical analysis was performed using independent t-test, Chi-square test, Mann-Whitney U-test, and Friedman test followed by Wilcoxon test. Results: The mean percentage reduction in pain scores was significantly higher among the warm NaOCl group as compared to the control group at different time intervals (P < 0.001). The mean number of analgesics taken was significantly lower among the warm NaOCl group as compared to the control group (P < 0.001). Conclusion: The warm NaOCl group recorded less postoperative pain than the control group during the first 72 h following single-visit endodontic therapy.

Erratum: Addendum: Addition of 2 mg dexamethasone to improve the anesthetic efficacy of 2% lidocaine with 1:80,000 epinephrine administered for inferior alveolar nerve block to patients with symptomatic irreversible pulpitis in the mandibular molars: a randomized double-blind clinical trial.

[This corrects the article on p. 305 in vol. 22, PMID: 35991360.].

Performance investigations for sustainability assessment of Hastelloy C-276 under different machining environments.

Hastelloy is categorized as difficult to cut superalloy widely used in aerospace, nuclear reactor components and chemical industry because of its magnificent strength and higher heat efficiency. Since, the machining of this material is quite difficult and hence suitable cooling systems are required to achieve sustainable manufacturing goals. The present investigation has been focused on the machining performance and sustainability assessment of turning Hastelloy C-276 in dry, flood and minimum quantity lubrication (MQL) environments. Taguchi L-9 array has been utilized to conduct and record the experimental output along with TOPSIS approach to evaluate the sustainability. The output responses viz. cutting forces, surface roughness, cutting temperature, energy consumption and carbon emission have been recorded at various levels of input variables. The experimental results revealed that MQL has minimized the cutting forces, surface roughness and temperature by margin of 20-38%. Likewise, energy expenditure and carbon emission was declined by 9-27% respectively compared to other conditions. Sustainability analysis explored best performance index during equal weightage criteria at 125 m/min, 0.246 and 0.8 mm doc under MQL. However, implementing assigned weightage system evaluated best condition for dry machining as 88 m/min and 0.246 mm/rev having same doc. SEM analysis of insert reported mainly abrasion and adhesion type of tool wear at all parametric range and machining conditions.