Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis

Objective: Enterococcus faecalis (E. faecalis) is the most frequently isolated strain in failed endodontic therapy cases since it is resistant to calcium hydroxide (CH). Whether a combination of CH and chlorhexidine (CHX) is more effective than CH alone against E. faecalis is a matter of controversy. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the literature. Material and Methods: A comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO, and BBO databases, Clinical trials registers, Open Grey, and conference proceedings from the earliest available date to February 1, 2013 was carried out and the relevant articles were identified by two independent reviewers. Backward and forward search was performed and then inclusion and exclusion criteria were applied. The included studies were divided into "comparisons" according to the depth of sampling and dressing period of each medicament. Meta-analysis was performed using Stata software 10.0. The level of significance was set at 0.05. Results: Eighty-five studies were retrieved from databases and backward/forward searches. Fortyfive studies were considered as relevant (5 in vivo, 18 in vitro, 18 ex vivo, and 4 review articles). Nine studies were included for meta-analysis. Inter-observer agreement (Cohen kappa) was 0.93. The included studies were divided into 21 comparisons for meta-analysis. Chi-square test showed the comparisons were heterogeneous (

Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis

Objective: Enterococcus faecalis (E. faecalis) is the most frequently isolated strain in failed endodontic therapy cases since it is resistant to calcium hydroxide (CH). Whether a combination of CH and chlorhexidine (CHX) is more effective than CH alone against E. faecalis is a matter of controversy. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the literature. Material and Methods: A comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO, and BBO databases, Clinical trials registers, Open Grey, and conference proceedings from the earliest available date to February 1, 2013 was carried out and the relevant articles were identified by two independent reviewers. Backward and forward search was performed and then inclusion and exclusion criteria were applied. The included studies were divided into "comparisons" according to the depth of sampling and dressing period of each medicament. Meta-analysis was performed using Stata software 10.0. The level of significance was set at 0.05. Results: Eighty-five studies were retrieved from databases and backward/forward searches. Fortyfive studies were considered as relevant (5 in vivo, 18 in vitro, 18 ex vivo, and 4 review articles). Nine studies were included for meta-analysis. Inter-observer agreement (Cohen kappa) was 0.93. The included studies were divided into 21 comparisons for meta-analysis. Chi-square test showed the comparisons were heterogeneous (p<0.001). Random effect model demonstrated no significant difference between CH/CHX mixture and CH alone in their effect on E. faecalis (p=0.115). Conclusions: According to the evidence available now, mixing CH with CHX does not significantly increase the antimicrobial activity of CH against E. faecalis. It appears that mixing CH with CHX does not improve its ex vivo antibacterial property as an intracanal medicament against E. faecalis. Further in vivo studies are necessary to confirm and correlate the findings of this study with the clinical outcomes

Heat transfer enhancement of turbulent nanofluid flow over various types of internally corrugated channels

A numerical study is carried out to investigate the effects of different geometrical parameters and various nanofluids on the thermal performance of rib-grooved channels under uniform heat flux. The continuity, momentum and energy equations are solved by using the finite volume method (FVM). Three different rib-groove shapes are studied (rectangular, semi-circular and trapezoidal). Four different types of nanoparticles, Al2O3, CuO, SiO2 and ZnO with different volume fractions in the range of 1% to 4% and different nanoparticle diameters in the range of 20nm to 60nm, are dispersed in the base fluids such as water, glycerin and ethylene glycol. The Reynolds number varies from 5000 to 25,000. To optimize the shape of rib-groove channels different rib-groove heights from 0.1Dh (4mm) to 0.2Dh (8mm) and rib-groove pitch from 5e (20mm) to 7e (56mm) are examined. Simulation results reveal that the semi-circular rib-groove with height of 0.2Dh (8mm) and pitch equals to 6e (48mm) has the highest Nusselt number. The nanofluid containing SiO2 has the highest Nusselt number compared with other types. The Nusselt number rises as volume fraction increases, and it declines as the nanoparticle diameter increases. The glycerin-SiO2 nanofluid has the best heat transfer compared to other base fluids. It is also observed that in the case of using nanofluid by changing parameters such as nanoparticle diameter, volume fraction and base fluids the skin friction factor has no significant change