Efficacy of Triple Antibiotic Paste and Bromelain Paste As Intracanal Medicament Against Enterococcus faecalis: An In-Vivo Study.

Introduction Microorganisms are pivotal contributors to pulp and periapical pathology, often culminating in endodontic treatment failures. The successful outcome of such treatment hinges on the effective eradication of microbial flora through various interventions, including intracanal medicaments (ICMs). However, Enterococcus faecalis (E. faecalis), a highly adaptive Gram-positive bacterium, exhibits remarkable resilience and can persist even after rigorous disinfection efforts. This study explores the efficacy of two ICMs, calcium hydroxide-based triple antibiotic paste (TAP) and a novel alternative containing bromelain, derived from pineapples, in combating E. faecalis infections in vivo. Methodology This in-vivo study was conducted at Sharad Pawar Dental College and Hospital, Wardha, India, and ethical approval was obtained from the institutional ethical committee. The sample size was calculated using the OpenEpi program (version 3.04.04, Open Source Epidemiologic Statistics for Public Health, www.OpenEpi.com), resulting in 15 participants per group. Inclusion criteria encompassed mandibular premolars with carious involvement but no prior restorations, diagnosed with necrotic or infected pulp, and no significant medical history. Exclusion criteria included systemic conditions, pregnancy, retreatment cases, recent antibiotic therapy, calcified canals, and other contraindications. After proper patient consent, access opening and chemomechanical preparation were performed, and root canals (RCs) were randomly divided into two groups: TAP and bromelain paste (BP). TAP was prepared using ciprofloxacin, metronidazole, and minocycline, while BP comprised bromelain powder mixed with saline. Both groups received intracanal medicaments, followed by temporary sealing. Microbiological samples were collected before and after treatment for analysis. Results E. faecalis count (CFU/mL) before instrumentation for the TAP group was (1.94 x 105 [Formula: see text] 7.45 x 103) and for BP group was (1.97 x 105 [Formula: see text] 7.70 x 103) with p-value 0.26 [Formula: see text] p=0.05, so no significant difference was found between them. E. faecalis count (CFU/mL) after instrumentation for the TAP group was (7.70 x 103 [Formula: see text] 9.11 x 102) and for the BP group was (7.26 x 103 [Formula: see text] 8.43 x 102) with p-value 0.18 [Formula: see text] p=0.05, so no significant difference was found between them. However, the E. faecalis count obtained after seven days of intracanal medicament for the TAP group was (3.63 x 101 [Formula: see text] 5.60) and for the BP group was (3.13 x 101 [Formula: see text] 4.55) with p-value 0.012 < p=0.05, so a significant difference was found between them. This means that when compared with the TAP group, there was a greater amount of reduction in E. faecalis count (CFU/mL) for the BP group seven days after the placement of intracanal medicament, and this reduction was statistically significant. Conclusion This in-vivo study highlights the potential of BP as a more effective intracanal medicament against E. faecalis when compared to the conventional TAP. Bromelain's selectivity for Gram-positive bacteria and its diverse therapeutic properties make it a promising natural alternative for endodontic treatment. Further research is warranted to optimize bromelain's clinical application and assess its potential to enhance endodontic outcomes, potentially revolutionizing the field of endodontics.

A protocol for the development of PhyCaRe: An extension of the CARE guideline for physiotherapy using the Delphi method.

Background: Case reports are one of the important forms of documentation and publication of clinical physiotherapy presenting the first line of evidence in scientific literature. In order to provide a systematic and precise structure for reporting and presenting cases, the CARE guidelines were established in 2013. However, these guidelines present limitations as while reporting require items of specific specialties following the checklist. Authors from different specialities have developed CARE extensions specifying the characteristic features of corresponding fields, however, an extension dealing with physiotherapy assessment and line of management in the CARE guidelines is proposed as PhyCaRe. Method: After consulting with the advisors, a draft will be prepared of the specific elements that should be included in the PhyCaRe using web Delphi methodology considering CARE statement as the source and SurveyMonkey will be used to undertake the web Delphi questionnaire. The web Delphi methodology will be assumed for three rounds and will be open to physiotherapists and others with substantial experience in reviewing case reports. Subsequently, an online consensus meeting, pilot testing, and submission of the CARE extension for physiotherapy will be conducted for publication. Dissemination: The 2010 "Guidance for Developers of Health Research Reporting" and instructions from the EQUATOR Network will be followed in the preparation of PhyCaRe guidelines. The guidelines will be propagated at different platforms and journals will be requested to adopt the guidelines. Registration: The reporting guideline under development is prospectively registered on the EQUATOR Network website on PhyCaRe - Reporting guideline for physiotherapy case reports.

Physiotherapy Interventions for Preventing Spinal Curve Progression in Adolescent Idiopathic Scoliosis: A Systematic Review.

Adolescent idiopathic scoliosis (AIS) is an abnormal curvature of the spine that appears in late childhood or adolescence. The aim of this systematic review was to present and synthesize the most relevant therapeutic advice and evidence on the efficacy of physiotherapy exercises for preventing the growth of spinal curvature caused by adolescent idiopathic scoliosis. "Adolescent idiopathic scoliosis," "exercise," "Cobb angle," and "physiotherapy" were the sole keywords used for the published research. Using these keywords and a combination of them, electronic resources such as PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), Elton B. Stephens Company (EBSCO) host, and ScienceDirect (Elsevier) were searched. The search was restricted to studies that were conducted in English between 2010 and 15 January 2022 that were controlled, randomized, and non-randomized. Studies were selected based on their titles and abstracts, with the exception of any that did not pertain to the study's goals. The Cobb angle was the important outcome measure. For each intervention, the Cobb angle's mean change score, the difference between the final and baseline scores, was determined. Nine studies were evaluated to be of outstanding quality out of a total of 20 studies that were reviewed for eligibility. With an exercise regimen of at least seven weeks, controls on lowering the Cobb angle in patients with AIS would provide encouraging outcomes. It also shows that bracing can strengthen the Cobb angle compared to exercise in the community. However, long-term orthotic activity ultimately results in trunk resistance and muscle loss in the center of the back. The combination of techniques and treatment methods seems to have better results in treating scoliosis, particularly using exercises involving the Schroth and scientific exercise approach to scoliosis (SEAS).

Gamification for Distal Radius Fracture Rehabilitation: A Randomized Controlled Pilot Study.

Introduction Gamification is a novel interventional approach to functional recovery and rehabilitation. A significant impact has been observed with the application of gamification on non-traumatic conditions and chronic neurological and musculoskeletal illnesses; however, the implication of gamification on the functional recovery of patients with distal radius fractures (DRF) is yet to be explored.  Methodology This pilot study included 20 post-DRF patients aged 18-65 years with unilateral DRF, managed with closed reduction and K-wire internal fixation. The patients were assigned to group A (gamification) and group B (conventional rehabilitation) in a 1:1 ratio. Group A patients played Racket: NX game, Until you fall game, and Holofit game on Oculus Quest head-mounted display (HMD) (Oculus, USA), while group B patients received a conventional rehabilitation program. Both groups underwent a rehabilitation program for 60 min/day, five days a week, for four weeks. The visual analogue scale (VAS), universal goniometer, Jamar dynamometer, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire were used as outcome measures at baseline, at the end of the second week, and at the end of treatment. Results There were significant improvements in pain, range of motion (ROM), grip strength, and functional independence in both groups. However, improvements in hand function and functional independence were significantly greater in the gamification group than in the conventional physiotherapy rehabilitation group. Conclusion The study concluded that gamification appears to have a significant impact on post-DRF rehabilitation in terms of pain, ROM, grip strength, and functional independence. Further research with larger sample sizes is required to confirm the preliminary findings.

Test-Retest Reliability and Internal Consistency of the Coronary Artery Disease Education Questionnaire Short Version in the Marathi Language.

Introduction Patient education specific to the disease must be incorporated into the management of coronary artery disease (CAD) or any other disease as the patients understand the education provided in their native language better. The brief version of the CAD education questionnaire is a valid and reliable instrument for evaluating patients' understanding of the condition. To the best of our knowledge and understanding from the literature review, no questionnaire evaluating the knowledge of CAD in the Marathi language had been found because of which this study was carried out. Methods For the process of translation and cross-cultural adaptation, the framework for self-report measures was taken into consideration in which qualified translators translated both ways forward into the Marathi language and backward into the English language. The translators and a recording observer combined their efforts to create one synthesized version. The questionnaire was fine-tuned by the expert group to produce the final version and 30 diagnosed cases of CAD were tested with the pre-final version. The Marathi version of the questionnaire's validity and reliability were evaluated using Cohen's kappa (k) and Cronbach's alpha (α). Results Thirty individuals with CAD were recruited (mean age 68±12.36, consisting of 22 males and 08 females) to test the pre-final version, and equivalence was tested for every item by probing the participants for the understanding of the item. The Likert scale demonstrated that patients understood the purpose of each question. A total of 200 participants - 153 males population and 47 females with a mean age of 66.64±5.6094 years who can read and speak in the Marathi language were considered to assess the test-retest reliability and internal consistency who completed the questionnaire twice, with a gap of two weeks but only 188 participant's data was analyzed as twelve participants dropped out of the study because they could not report due to transportation and health-related issues. The obtained α value demonstrated satisfactory internal consistency, while the k value indicated almost perfect agreement. Conclusion The study concluded that the Marathi version of the CAD education questionnaire short version is reliable and cross-culturally adapted; therefore, it is an effective tool for evaluating the knowledge of CAD among Marathi language-speaking patients.