Introduction Maintaining apical patency during root canal therapy remains controversial. While it may aid in debris removal and reduce apical blockage, it has also been implicated in postoperative pain due to potential extrusion of irritants. This study evaluates the effect of apical patency on postoperative pain in patients undergoing root canal therapy. This study seeks to clarify the impact of apical patency on postoperative pain in a well-defined clinical population. Materials and Methods: This was a prospective, randomized clinical study conducted at the Department of Conservative Dentistry and Endodontics, involving 100 patients requiring primary root canal treatment in single-rooted teeth. Patients were randomly assigned into two groups of 50 each: Group A (Patency Group): Apical patency maintained using a #10 K-file extended 0.5–1 mm beyond the working length during cleaning and shaping. Group B (Non-Patency Group): Apical patency was not maintained; instrumentation remained strictly within the canal length. Patients recorded their pain levels using a 10-point Visual Analog Scale (VAS) at 6 hours, 24 hours, 48 hours, and 7 days post-treatment. Flare-ups were defined as severe pain or swelling. Results: Group A consistently reported higher pain scores than Group B at 6 and 24 hours postoperatively, with statistically significant differences (p < 0.05). By 48 hours, the difference in pain scores between the groups became statistically non-significant. At 7 days, both groups had nearly negligible pain, indicating full recovery. A larger percentage of patients in Group A experienced moderate-to-severe pain (VAS ≥ 4) at early time points, especially at 6 hours (30% in Group A vs. 8% in Group B). By 24 hours, this difference narrowed but remained evident. At 6 hours: 30% of Group A had moderate-to-severe pain vs. only 8% in Group B. At 24 hours: 16% of Group A reported pain vs. just 4% in Group B. Females in Group A reported higher pain (VAS 4.7) than males (VAS 4.5) at 6 hours. Females in Group B reported lower pain (VAS 2.8) than males (VAS 3.0). Group A experienced a greater absolute drop in pain (VAS reduced from 4.6 to 0.4) compared to Group B (2.9 to 0.3). Conclusion: Apical patency is associated with increased early postoperative pain but does not influence long-term pain. Clinicians must weigh its mechanical benefits against short-term discomfort.

Facing this problem, we prepared an oral oxygenating airway device, to maintain an open unblocked airway in addition to adequate oxygenation, in the early recovery period for patients undergoing nasal surgery. Our device (Fig 1,2) is an oral airway size 4 or 5 with a siliconised soft endotracheal tube (ETT) size 5.5 mm fixed alongside the airway with its bevel directed laterally to provide easy insertion of the airway. The distal end of the ETT is cut 4-5 cm from the airway to be connected to a breathing circuit through a 15 mm connector or connected directly to tubing of oxygen flow-meter supplying humidified oxygen at a low flow rate of 1-2 L/minute to provide FIO2 35- 40%. This device was tried successfully in 54 patients scheduled to septoplasty and rhinoplasty.

The concept of empowerment, which has been around for decades, also seems to be enjoying a renaissance, being one of the current buzzwords in ‘modern’ health care. Other buzz phrases, among many, include ‘freedom of choice’, ‘equity’, ‘right to participation’, ‘increased role of the consumer.’ Empowerment, theoretically, enables new customers to stand up for themselves, demand their therapeutic rights and choose their own treatment. Fine when you are well. However, should I develop a serious illness, particularly one in which I have no great expertise, and because I cannot conceivably amass the entire body of medical knowledge before I see the doctor or nurse about my condition, I would prefer the physician/nurse to outline the treatment plan. I do not want to be called a client, customer or punter, because such derisory terms are more apt to make me feel, ironically, ‘disempowered’.

The Clinical Assessment of Skills and Competencies (CASC) is the final examination towards obtaining the Membership of the Royal College of Psychiatrists (MRCPsych). It assesses skills in history taking, mental state examination, risk assessment, cognitive examination, physical examination, case discussion and difficult communication.1 The CASC is the only clinical examination, having replaced the earlier format, which had clinical components at two stages.

Problem Based learning (PBL) has redefined the role of a tutor, from being a teacher in the traditional ‘pedagogy’ style of learning to a facilitator in the ‘andragogy’ approach. This has often led to ‘tutor difficulties’ in accepting, and adapting to this transition. Faculty training remains critical for successful implementation of a PBL based curriculum, and considerable resources are exhausted in teaching new tutors the art of facilitating a PBL group. The aim of this article is to explore the concept that a PBL tutor coming from a PBL background may be beneficial compared to faculty training, and this concept is supported by a literature review that identifies common characteristics between a PBL student and a PBL tutor.

Sudden death is known to occur in patients with primary cardiac tumours; however, it is rare and is estimated to constitute 0.005% of all sudden deaths. We report here two cases of sudden death that occurred in patients with left atrial myxoma. We also present a brief review of available literature on this subject

Aorto-enteric fistulas are a rare cause of gastrointestinal (GI) bleeding. The high mortality associated with this condition and relatively low incidence make this a diagnostic and management challenge. This case report describes a classic presentation of such a case along with a discussion on the diagnosis and treatment of this condition. We hope that this will be a clinical reminder to all physicians particularly those involved in managing GI hemorrhage in an acute medical take.

Extrinsic oesophageal compression from vascular structures usually remains asymptomatic. Occurrence of dysphagia is an uncommon problem. We present a rare case of dysphagia lusoria from right sided aortic arch presenting as pill-induced oesophagitis caused by a testosterone pill. A thorough literature review on both the conditions is then presented to address pathogenesis, diagnosis, and management.

Acute lung injury is a syndrome with a diagnostic criteria base on hypoxaemia and a classical radiological appearance, with acute respiratory distress syndrome at the severe end of the disease spectrum. Its incidence is common, it is likely to exist outside the intensive care setting and therefore is a condition relevant to all clinicians. Genetically predisposed individuals are subject to environmental triggers which can be intra or extrapulmonary in nature. An inflammatory response causes damage to alveolar epithelial cells and vasculature, impairing gas exchange and can lead to multiple organ failure. Management centres around supportive care and treating the cause, but evidence supports use of low tidal volume ventilatory settings and conservative intravenous fluid strategies. Long term outcomes are related to neuromuscular, cognitive and psychological issues rather than pulmonary, and rehabilitation during recovery needs to focus on this.