Sodium Hypochlorite Concentration and Postendodontic Pain - Unveiling the Optimal Balance: A Systematic Review and Meta-Analysis.

INTRODUCTION: This study systematically reviewed literature regarding the effect of different concentrations of sodium hypochlorite (NaOCl) used during root canal treatment (RCT) on postendodontic pain (PEP) and rescue analgesia. METHODS: Following registration with PROSPERO (CRD42023388916), a search was conducted using PubMed, Scopus, Web of Science, and Embase databases. Randomized controlled trials of patients receiving RCT which assessed PEP at different time intervals were included. Following data extraction and Cochrane risk of bias assessment 2, meta-analyses were performed to evaluate PEP during the first 48 hours along with rescue analgesic intake. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: Five randomized controlled trials with 674 patients were included. One study exhibited a low risk of bias, while 4 raised some concerns. Patients treated with low concentrations of NaOCl (≤3%) were significantly less likely to report PEP at 24 hours (OR = 2.32; [95% CI, 1.63-3.31]; P < .05) and 48 hours (OR = 2.49; [95% CI, 1.73-3.59]; P < .05) as compared with high concentrations of NaOCl (≥5%). Furthermore, with low concentrations of NaOCl, significantly lesser moderate-severe PEP was reported at 24 hours (OR = 2.32; [95% CI, 1.47-3.62]; P < .05) and 48 hours (OR = 2.35; [95% CI, 1.32-4.16]; P < .05) and lesser analgesia was needed (OR = 2.43; [95% CI, 1.48-4.00]; P < .05). CONCLUSIONS: While PEP can be influenced by several factors, low certainty evidence suggests that when NaOCl is used as an irrigant during RCT, PEP may be less likely with lower concentrations of NaOCl. Moderate certainty evidence indicates that lesser analgesia may be required with lower concentrations of NaOCl. These results should be cautiously interpreted.

Effects of traditional and novel proteolytic agents on tissue dissolution and dentine microhardness.

The study aimed to evaluate the tissue-dissolving ability of papain and bromelain with respect to that of sodium hypochlorite (NaOCl) at the temperatures of 25°C and 60°C. The study also assessed the effects of these proteolytic agents on radicular dentine microhardness. Warming NaOCl, papain and bromelain solutions resulted in significant tissue dissolution at all time intervals (p < 0.001). At 60°C, bromelain showed significantly higher tissue weight loss at every time interval when compared to NaOCl (p < 0.001). All of the three organic tissue dissolvents reduced the microhardness at 1 hr when compared to their respective baseline values. The reduction in microhardness from the baseline reading was statistically significant only in the papain group at 30 min (p = 0.018) and at 60 min (p = 0.03) when compared to the control group. Hence it was concluded that bromelain exerted superior tissue dissolution action, especially when warmed, with minimal effect on dentine microhardness.

Teleradiology and the Compensation Conundrum in India.

Teleradiology, an established telemedicine practice globally, has significantly enhanced the accessibility of high-quality radiological interpretations in remote areas worldwide, especially in India, thereby improving healthcare outcomes. The utilization of teleradiology services has seen a marked increase, expanding its reach into more distant regions of the country. However, this burgeoning field faces numerous regulatory, financial, and technical challenges. The current scenario regarding teleradiology in India is a double-edged sword. There is an increasing demand for it due to the expanding population, resulting in larger imaging volumes needing radiologist services. This editorial aims to examine the prevailing challenges in teleradiology in India, with an emphasis on the compensation model for teleradiologists, which has not kept pace with the growing demand for services and often remains inequitable.

Post-traumatic hollow viscus perforation with mesenteric and bowel ischemia.

Hollow viscus perforation and acute mesenteric ischemia are life-threatening conditions that must be recognized and managed appropriately. Computed tomography (CT) helps to visualize the bowel wall directly, as well as in the timely diagnosis of secondary signs of bowel ischemia. The radiologist should be familiar with the signs of pneumoperitoneum on supine radiographs for detection of hollow viscus perforation. These must be viewed with an index of high suspicion in symptomatic patients, post-trauma, and, further cross-sectional imaging may still be required.

Comparison of Tracheal Diameter Measurements on Radiograph Versus Computed Tomography at a Tertiary Care Hospital in Pune, Central India.

Background Variations in tracheal diameter with respect to factors like age and gender are one of the major factors affecting the size of the endotracheal tube (ETT) preferred in a patient. It is important to pre-determine this figure because a tube of a larger size predisposes the patient for tracheal mucosal ischemia, while one of a smaller size may not ensure adequate oxygen saturation in the patient. Purpose We undertook this study to assess the accuracy of radiograph versus computed tomography (CT) and comment on whether a CT should be carried out mandatorily in all patients where intubation is needed. Materials and methods The study was undertaken at Dr DY Patil Medical College, Hospital, and Research Center, a tertiary care institute in Pune, India. A total of 217 patients in whom both chest radiograph and chest CT were performed were enrolled in the study and measurements were performed at suitable landmarks which correspond to the position of endotracheal tubes. Results The males had a mean age of 44.2 years and females of 41.7 years. The mean X-ray transverse diameter was 15.4 ± 3.2 (SD) mm, mean CT axial transverse diameter was 15.3 ± 3.4 (SD) mm, mean CT sagittal diameter was 14.8 ± 3.7 (SD) mm, and the mean CT coronal diameter was 15.2 ± 3.5(SD)mm. Conclusions There was a significant difference in mean X-ray transverse diameter (Low kV), CT axial transverse diameter, CT sagittal diameter, and CT coronal diameter between males and females. Mean values were significantly higher in males as compared to females. There was a significant difference in tracheal diameters for different age groups, irrespective of the modality. Bland-Altman analysis revealed no significant difference between chest radiograph and CT for tracheal diameter measurement.