مجله دانشگاه علوم پزشکی بابل
سال بیست و پنجم شماره 1 (پیاپی 140، فروردین 1402)

Diabetic macular edema (DME) is one of the common complications of diabetes which significantly accounts for preventable visual impairment and blindness. Central macular thickness (CMT) is a feature found in DME patients. This study aims to determine the relationship between optical coherence tomography (OCT)-measured CMT and visual acuity (VA) in patients with DME before and after intravitreal injection of bevacizumab.

This cross-sectional study was conducted on 100 patients with diabetic macular edema with involvement of both eyes referred to the Ophthalmology Department of Rouhani Hospital in Babol who underwent intravitreal injection of Bevacizumab. VA (measured by Snellen chart), CMT (measured by OCT), clinical and paraclinical factors (including the duration of diabetes, glycosylated hemoglobin (HbA1c), fasting blood sugar (FBS), hypertension, and smoking history data) were evaluated and compared among all patients just before and 45 days after Bevacizumab injection.

Before the injection of Bevacizumab in 200 eyes, the mean value of VA (letter score) and mean value of CMT (µm) were 36.83±12.73 and 425.48±85.18 µm, respectively (p<0.001, 95% CI=12.5 – 17.5 and 95% CI=-71.5 – -55.5, respectively). 45 days after Bevacizumab injection, the mean value of absolute VA changes was 15.24±10.16, and the mean value of absolute CMT changes was -67.83±43.08 µm (coefficient=-0.18, 95% CI=-0.39 – 0.05).

Although VA was correlated moderately with CMT and the polynomial regression model enhanced the predictive ability, it remains fully obvious that CMT and clinical factors could play an essential role as VA surrogates.

There are an increasing number of cardiac electronic device implantation with an expansion of their indications. Axillary vein puncture guided by contrast venography has grown in popularity due to its effectiveness and low complication rate. Venous spasm has been reported previously. The aim of this study was to determine the rate of axillary venous spasms during real-time contrast venography-guided puncture as well as its effect on puncture success.

In this cross-sectional study, 137 consecutive patients admitted for permanent pacemaker or implantable cardioverter-defibrillator ‎implantation utilizing real‑time contrast venography were included in the ‎study. After the success of puncture or a period of five minutes had been passed, the venography was repeated. Axillary venous spasm is characterized by a lumenal diameter reduction of more than 50%. Grade I (50-90%) ‎and Grade II (>90%) spasm were classified as a percentage decrease in lumenal diameter.

The axillary venous puncture within five minutes was successfully done in 124 patients (90.5%) and was ‎done using the subclavian access in the others. The overall incidence of axillary venous spasm more than 50% was 33.6% (46 patients; 32 female and 14 male). ‎Grade I spasm was observed in 38 patients (27.8%) and Grade II spasm ‎observed in 8 patients (5.8%). Successful puncture within five minutes was significantly less in patients with ‎venous spasm (‎37 (80.4%)‎ vs 87 (95.6%)‎‎, p=0.010)‎.

According to the results of this study, spasm of the axillary vein is not uncommon during real-time contrast venography-guided axillary venous puncture and occurs more in older age and females and it has a significant unfavorable impact on puncture duration, the number of attempts, and puncture success.

The simultaneous occurrence of ectopic pregnancy in both fallopian tubes and a live intrauterine fetus is very rare. The increase in the use of reproductive technology methods has caused an increase in the prevalence of this type of pregnancy. The aim of this study is to report a case of simultaneous occurrence of ectopic pregnancy in both fallopian tubes and live intrauterine fetus following the use of ovulation induction medications.

Case Report: 

The patient was a 29-year-old pregnant woman in her 7th week of pregnancy with a one-year history of infertility and the use of ovulation induction medications, with a transvaginal ultrasound report a week ago, live intrauterine pregnancy (6th week) and normal fallopian tubes, and complaints of vaginal bleeding. In repeated ultrasound, a live fetus was seen in the uterus (7 weeks and three days) and a live fetus in the left adnexa (7 weeks and three days), and the right adnexa was normal. The patient underwent laparoscopy. An incidental finding during surgery was the presence of ectopic pregnancy in both tubes. Left salpingectomy and right salpingostomy were performed and progesterone suppositories were prescribed to maintain intrauterine pregnancy. One week after the surgery, the fetus was observed without a heartbeat in the control ultrasound.

Based on the results of this report, the correct use of assisted reproductive methods, control of infertile patients under the supervision of infertility centers, and accurate ultrasounds due to the possibility of heterotopic pregnancy in high-risk patients are necessary.

Due to the importance of primary anterior teeth in chewing, pronunciation of words, self-confidence, facial appearance of children, efforts to preserve these teeth continue. The aim of the present study was to evaluate the push-out bond strength of 5th, 6th, 7th, and 8th generation bonding agents to intracanal dentin of primary anterior teeth which are reconstructed with the composite posts.

The present experimental in vitro study was conducted on 60 extracted primary anterior teeth with at least two-thirds of the root length remaining. The teeth were randomly divided into five groups: 5th generation (3M Adper single bond 2 Adhesive-USA), 6th generation (clearfil SE bond, Japan), 7th generation (kerr-optibond all in one Adhesive-Italy), and 8th generation total-etch and 8th generation self-etch (GC-G permio bond-Japan) bonding agents. After root canal preparation, prepared canals were filled with Metapex. The coronal 3mm of the canals was etched and impregnated with the dentin bonding agents. Then, they were restored with composite. The push-out test was performed to evaluate the bond strength of adhesives. Accordingly, by a light microscope the failure modes were determined.

The mean bond strength of 5th, 6th, 7th, and 8th generation (self-etch, total-etch) bonding agents was 4.36±2.15, 3.88±1.55, 4.29±2.02, 12.84±3.62, and 7.77±3.81 MPa, respectively. The push-out bond strength of the 8th generation bonding agent using both self-etch (p=0.000) and total-etch techniques was higher than the 5th, 6th, and 7th generation bonding agents (p=0.032, 0.01, 0.027, respectively). No significant difference was found between the bond strength of the 5th, 6th, and 7th generation bonding agents.

The push-out bond strength of the 8th generation bonding system was higher than the other groups. Therefore, the 8th generation bonding agents can be used to bond composite posts to intracanal dentin of primary anterior teeth. Also, self-etch (8th generation) has higher bond strength compared to the total-etch technique.

There is increasing desire for pleiotropic plant-based remedies for the treatment of peptic ulcer disease due to its prevalence and the challenges associated with existing therapies. This research was conducted to investigate the effect of aqueous extract of Pleurotus tuber-regium (PT) on ethanol induced peptic ulcer in male Wistar rats.

This animal experiment used 30 male Wistar rats. They were divided into five groups (6 rats each) namely: Normal control (Group A), Ulcer control (Group B), Ulcer+omeprazole treatment (Group C), PT pre-treatment ulcer (Group D), and Ulcer+PT treatment (Group E). Peptic ulcer was induced by administration of 1 ml of 80% ethanol orally to each animal from group B to E. Four hours after the induction of gastric ulcer, the rats were sacrificed, the abdomen was opened to remove the stomach for histological study and gastric content to determine the gastric juice volume (ml/4 h). Data were analyzed using IBM SPSS Version 25.

Treatment of ulcer with PT in group E and omeprazole (group C) significantly decreased the free acidity (E=0.83±0.20, C=1.20±0.11, p<0.05), total acidity (E=3.10±0.60, C=9.10±0.32, p<0.05) and ulcer index (E=5.00±2.02, 7.83±4.04, p<0.05) in comparison with group B (free acidity=3.06±1.09, total acidity=22.86±2.51 and ulcer index=32.83±1.74) and group D (free acidity=4.16±0.69, total acidity=17.06±1.91 and ulcer index=35.66±1.96). Group E showed higher percentage of ulcer inhibition (84.77%) than group C (76.15%), while group D showed no inhibition. Also, there were improvements in the macroscopic and microscopic structure of the stomach tissue‎.

The results of this study showed that P. tuber-regium extract could serve as a better alternative to standard anti-ulcer drugs and considering that it is nutraceutical, it is a safe and more affordable alternative for the treatment of peptic ulcer.

The growth of aging reveals the importance of paying attention to the health needs of the elderly. According to some studies, falls and its consequences are more common in the individuals with knee osteoarthritis (KOA) than those without KOA, but due to lack of evidence, its related factors are still unknown. Thus, the aim of this study was to compare the falls and its determinants in the elderly with and without KOA.

In this case-control study, 700 older adults in two groups of elderly with and without KOA were compared in terms of falls and some variables including KOA, sex, age, body mass index, living status, quadriceps femoris muscle strength, hand muscles strength, balance, number of comorbidities, number of drugs used, walking duration, physical activity and frailty. KOA was diagnosed based on The American College of Rheumatology (ACR) criteria.

In this study, falls were 1.90 times higher in the elderly with KOA than elderly without KOA. Although all variables were significantly different in case and control groups, only female gender (p=0.035) and KOA (p=0.012) were significantly associated with falls.

These findings suggest that variables in combination may increase the risk of falls in the elderly with KOA, while each of them alone may not be associated with falls.

Management of deep caries and pulp exposures depends on the severity of the disease. The rapid development of preventive materials and techniques has significantly influenced restorative treatment methods. Therefore, the aim of this study is to produce and evaluate a type of bioactive glass containing Zn (Zn-BAG= Zinc-doped Bioglass) and to investigate its performance on the pulp and the formation of dental bridges following direct pulp capping in comparison to the standard gold material MTA (Mineral Trioxide Aggregate).

The conventional sol-gel method synthesized bioglass 45S5 with 2%mol zinc. In this experimental animal study, 10 maxillary first molars of 10 Wistar rats were subjected to direct pulp capping and divided into two groups of five according to the materials used: group 1 (DPC [Direct pulp cap] + MTA) and group 2 (DPC + Zn-BAG). After 8 weeks of direct pulp capping, the rats were sacrificed, and teeth were sectioned and prepared for histological analysis. The degree of inflammatory pulpal response (no inflammation, mild inflammation, moderate inflammation, severe inflammation, necrosis), location of a dentin bridge (at the site of pulp exposure, not adjacent to the site of exposure, and combination), percentage of dentin bridge formation (%) (25%>, 25%-50%, 50%-75%), and the quality of dentin bridge formation (without tubules, irregular tubular pattern, regular tubular pattern) were analyzed and scored.

In the electron microscope view, Zn-BAG particles exhibited a plate-like shape with less than 100 nm particle size. The EDS analysis confirmed the presence of zinc in the Bioglass structure. There was no significant difference between the type of pulp capping agent and the degree of inflammatory pulpal response, location of a dentin bridge, percentage of dentin bridge formation, and the quality of dentin bridge formation.

Zn-BAG and MTA pulp capping materials showed similar desirable cellular and inflammatory responses over pulpal exposure. Zn-BAG is a promising candidate for pulp capping material.

The first month of life is a significant period for child survival. The highest rate of death was reported in the neonatal period in the world. This study was conducted to estimate the mortality rate in neonates and to determine the main causes and their demographic characteristics in Misan Hospital for Child and Maternity in Iraq.

This cross-sectional study was performed in Misan Hospital for Child and Maternity. The required data were collected from the files in the neonatal and obstetrical units for two consecutive years (2018 and 2019). Any neonatal death in time period from 0 to 28 days was enrolled in this study whether preterm or term. Causes and time of neonatal death were studied based on demographic characteristics (gender, gestational age, type of delivery, and type of pregnancy). The neonatal mortality rate was calculated according to the recommendation of the World Health Organization and expressed per 1000 live births in each year.

The total live birth was 11343 and 11063 in 2018 and 2019, respectively. The mortality rate among neonates was 14.8 and 12.8 deaths per 1000 live births in 2018 and 2019, respectively. The major cause of neonatal mortality was respiratory distress syndrome with approximately similar rates in both years (65.5% vs 63.4%). The subsequent causes were birth asphyxia, congenital anomalies, meconium aspiration, and sepsis. The mean gestational age was 32.33±4.065 weeks in 2018 and it was 32.40±4.339 weeks in 2019.

The results of the study showed that the mortality rate in babies of Misan hospital is high. Premature birth and its complications had led to the highest rate of death among neonates. Therefore, focusing on prenatal care is still a big challenge.

It is very important and necessary to use certain methods in order to prevent or reduce the intensity of pain after surgery. Of all known methods, those that avoid the dangerous side effects of opioids or nonsteroidal anti-inflammatory drugs (NSAIDs) can be useful. The present study was conducted with the aim of investigating the effect of topical dexamethasone on postoperative pain intensity in patients undergoing dacryocystorhinostomy (DCR).

This double-blind randomized clinical trial was conducted on 80 patients aged 18-75 who were candidates for DCR and referred to Khatam Al-Anbia Hospital in Mashhad. Patients were randomly divided into control and intervention (dexamethasone) groups. In the intervention group, at the end of the procedure, a tampon impregnated with dexamethasone was placed in the upper part of the middle concha. In the control group, a tampon washed in distilled water was placed in the same place. Pain intensity was recorded on a verbal rating scale (VRS) 0, 3, 6, 12, 18 and 24 hours after the operation.

There was no significant difference in pain intensity at different time points in the two groups of intervention and control; the frequency of severe pain during recovery was equal to 22.5% and 15.7%, within 3 hours after the operation was equal to 17.5% and 10.0%, within 6 hours after the operation was equal to 12.5% and 0.5%, within 12 hours after the operation was equal to 12.5% and 2.5%, within 18 hours after the operation was equal to 0% and 2.5% and within 24 hours after the operation was equal to 0% and 0%, respectively. There was no significant difference in the process of changes in pain intensity during the 24 hours of the study based on the follow-up test.

The results of the study showed that topical use of a single dose of dexamethasone (8 mg) could not reduce postoperative pain as well as the need for opioids in DCR surgery.

Traditional methods of medical education, despite being easy to implement, do not have long-lasting efficiency. The main aim of this study is to use the help of the learners to teach parts of the medical pharmacology course using role-playing pedagogy. This was done for the first time in Babol University of Medical Sciences with the cooperation of medical students who entered the university in 2016.

Students were divided into 5 groups and a group leader was introduced for each group. Five topics were selected and corresponding scenarios were written. There were three to seven people in each group. The physician together with the hypothetical resident or student examined the patient's problems and prescribed medicine and gave them the necessary recommendations. All participants were given a pre-test and a post-test, and then the findings were statistically analyzed.

101 students (49 girls and 52 boys) with a mean age of 21.43±1.14 years participated in the study. Except for the topic of poisoning, the mean difference in pre- and post-test scores of female students was lower than that of male students. For example, this difference was observed in the topic of Parkinsonism (p<0.0001). All students involved in the performance obtained better grades in the same topics compared to other students (88.15 vs. 59.71 out of 100). 74% of female students and 79% of male students expressed satisfaction with the implementation of this method.

According to the findings, this method has increased the motivation to learn the medical pharmacology course and stabilize the course topics. Therefore, its implementation in difficult courses with diverse and voluminous content not only helps them to learn better, but also helps them maintain their enthusiasm and increase motivation to learn more and consolidate what they have learned.

Type 1 diabetes mellitus (T1DM) as an autoimmune disease is associated with hyperglycemia and pseudohypoparathyroidism with hypoglycemia. In this study, we report a rare case of association between type 1 diabetes and pseudohypoparathyroidism.

Case Report: 

A 12.5-year-old female patient with a one-month history of polyuria and polydipsia was admitted with severe lethargy and vomiting, and due to high blood sugar and metabolic acidosis, Diabetic Ketoacidosis (DKA) was diagnosed. She was first treated with DKA protocol and then Basal- Bolus Protocol of insulin. The patient had a history of seizures due to hypocalcemia at the ages of 8 days and 2 months. In re-examination during hospitalization due to hypocalcemia-hyperphosphatemia and high parathyroid hormone, the diagnosis of false hypoparathyroidism was proposed and treatment with oral calcium tablet and calcitriol capsule was done and she was discharged after seven days with a good general condition.

In patients with pseudohypoparathyroidism, in the event of a disturbance in glucose status, the pattern is usually hypoglycemia, but in our patient, this association was in the form of hyperglycemia and DKA in the context of T1DM, which is an indication of the rare association of these two diseases. Therefore, one should think about early diagnosis and proper treatment of this rare association.

Along with the steady growth of the population, the widespread use of systemic fungicides, which leads to increased productivity and higher yield of food products, has been given a lot of attention. Therefore, considering the cytotoxic effects of systemic fungicides tricyclazole and thiophanate methyl, the present study was conducted with the aim of investigating the neurotoxicity caused by the use of fungicides tricyclazole (TCZ) and thiophanate methyl (TM) in Wistar rats.

In this experimental study, 32 male Wistar rats were randomly divided into 4 groups of 8 including: control group, groups receiving pesticide mixtures orally at doses of (A) TM 664 + TCZ 25, (B) TM 498 + TCZ 19 and (C) TM 332 + TCZ 13 (mg/kg body weight) and brain tissue sampling was done after 28 days. Nissl and hematoxylin-eosin staining were used for qualitative assessment of pathological lesions and quantitative counting of brain cells.

In the histopathological examinations of the groups that received toxins, it was observed that the neurons became necrotic, and the increase of microglia cells in the hippocampus and cerebral cortex was also observed. The results of cell counting indicated the lowest number of neurons in group A in the cerebral cortex (171.40±4.88), CA1 (152.80±5.99), CA2,3 (127.90±8.36) and CA4 (59.20±3.86), which showed a significant decrease compared to the control group (p<0.05).

The results of the study showed that the mixture of tricyclazole and thiophanate methyl caused damage to brain neurons in the cerebral cortex and different areas of the hippocampus and subsequently caused a decrease in the number of neurons in these areas; Of course, the amount of damage was directly related to increase in the dose.

As an autoimmune disease, celiac is often caused by the environmental factor of gluten and the genetic factor of HLA. Considering the immunological role of blood groups, this study was designed to evaluate the distribution of ABO and Rh blood groups in patients with celiac disease in West Azerbaijan Province, Iran.

In this cross-sectional study, all 199 cases recorded in the registry system of celiac patients of West Azerbaijan Province between 2015 and 2021 were included in the study. Demographic variables, disease duration, blood group, disease status, and disease complications were extracted from the electronic file of patients. According to the severity of the disease, the patients were classified into three groups: mild (no symptoms), moderate (subclinical) and severe (classic celiac symptoms).

In this study, 125 patients (62.8%) were women and the mean age of the patients was 37.15±15.65 years. 71 people (35.7%) had blood type O and 171 people (58.9%) had Rh+. Patients with blood type O and A most commonly suffered from mild (80.8%) and moderate (50.9%) types of disease, respectively (p<0.001). There was no significant difference between the severity of the disease and blood groups and Rh positive and Rh negative.

According to the results of the present study, blood group O is the most frequent among celiac patients. In addition, the severity of the disease in people with blood group O is less than other blood groups.

Ethical sensitivity is one of the criteria regarding the professional competence of researchers, which affects the ethical performance of the researcher. Since compliance with the principles and rules of ethics is an effective factor in providing high quality research results, the present study was conducted to investigate the ethical sensitivity and its associated components on the quality of research among academic personnel of universities of medical sciences in metropolitan area No. 1 in Iran.

This cross-sectional study was conducted on 320 academic personnel of universities of medical sciences in metropolitan area No. 1 (Guilan, Mazandaran, Golestan, Babol, Shahrud, and Semnan) who were selected by stratified random sampling. Data were collected using ethical sensitivity and research quality questionnaires. The ethical sensitivity questionnaire includes 50 questions and two dimensions of "functional and individual", each of which includes 4 fields. The researcher-made questionnaire of research quality includes 31 questions and 4 fields. The questionnaires were rated from 1 to 5 according to Likert scale. Ethical sensitivity was compared between researchers based on work experience, academic degree and gender. Then, the effect of each component of ethical sensitivity on the quality of the research was evaluated.

Out of 320 studied samples, 223 were male (69.7%) and 97 were female (30.3%). In people with experience of less than 10 years, the mean score of honesty was 15.74±3.21, ethical behavior was 30.50±5.74, accountability was 33.81±5.64, decision-making was 23.62±4.28, and interpersonal communication was 18.66±3.56, indicating higher values compared to people with an experience of more than 10 years (p<0.01). Among the dimensions of ethical sensitivity, the dimensions of honesty and discipline showed positive and significant effects on the quality of research. However, the effect of respect for the client, ethical behavior, professional knowledge, accountability, decision-making and interpersonal communication was not statistically significant despite the effect on the quality of the research. Discipline had the greatest effect on research quality (β=0.293). The R2 value (0.489) shows that about 49% of the variance of the research quality score is explained by the dimensions of ethical sensitivity. Ethical sensitivity with a standard coefficient of 7.758 had an effect on the quality of research.

The results of the present study showed that ethical sensitivity, especially the dimensions of honesty and discipline, has an effect on the quality of research.

The performance quality of peripherally inserted central catheter (PICC) by nurses has a direct effect on the improvement of patient care and safety. The aim of this study is to audit the placement and nursing care of PICC in infants.

This cross-sectional study was conducted on 130 PICC procedures in the neonatal intensive care units of Rouhani and Amirkola hospitals in Babol in 2018-2021. All infants who needed PICC placement for any reason were selected. In order to collect the data, the observational researcher-made checklist and the infant demographic characteristics questionnaire were used. The checklist included 44 questions and four parts of nursing care before catheter insertion, hand washing, nursing care during the procedure, and nursing care after catheter placement. The scores obtained from the checklist were classified into conversion percentage and two groups of unfavorable placement (less than 67) and favorable placement (68-100). To confirm its reliability, intraclass correlation coefficient was used (ICC=0.90).

A total of 130 cases of PICC placement and nursing care were audited (Rouhani Hospital 98 cases 75.4%, Amirkola 32 cases 24.6%). In the studied sample, 83 (63.8%) were boys and 53 (43.1%) were diagnosed with prematurity. The most common PICC location was the armpit (42.3%). The percentages of compliance of nursing care before PICC insertion according to the standard (97.43%), hand washing (100%), nursing care during the procedure (87.14%) and nursing care after PICC insertion (94.84%) were favorable. Nurses did not use glasses and ultrasound guidance during PICC insertion; (85.4%) and (90%), respectively.

According to the results of this study, although the quality of PICC insertion and care in three stages was at a favorable level, nurses need training regarding the use of glasses and ultrasound guidance during PICC insertion.

The use of Focused Assessment with Sonography in Trauma (FAST) in blunt abdominal trauma has various advantages and disadvantages. Considering the importance of timely diagnosis of blunt abdominal traumas, the question is whether it is possible to manage these patients only by performing FAST in the emergency room? Therefore, this study was conducted with the aim of comparing the diagnostic accuracy of FAST with CT-Scan in patients with blunt abdominal trauma.

This cross-sectional study was conducted on 400 patients with blunt abdominal trauma referred to the emergency department of affiliated teaching hospitals of Kerman University of Medical Sciences in 2020. Data were obtained by examining the medical records of the patients. The results of FAST were compared with the results of abdominal and pelvic CT scan (as a gold standard), diagnostic peritoneal lavage (DPL) and laparotomy results (as a gold standard in case of unclear CT-Scan results) and the sensitivity, specificity, the positive and negative predictive value and its accuracy were determined.

The mean age of the participants was 36.27±10.44 years. 72.5% of them were men. The most common organ involved was the liver (73%). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FAST were equal to 75.1 (73.4-79.6), 91.7 (89.4-94.7), 94.1 (92.7-96.3), 77.2 (75.7-79.6) and 83.7 (80.3-85.5), respectively. Also, the odds ratio of FAST in detecting free fluid was 1335.3, injury to intra-abdominal organs was 7.53 and it was 28.9 for all cases.

The results of the study showed that FAST sonography in the emergency room is a suitable method for diagnosing free intra-abdominal fluid following blunt trauma, but it cannot properly diagnose the location of the injury.

Stability is one of the major issues in orthodontics. The purpose of this study is to investigate the effect of Low-Level Laser Therapy on the rate of relapse of mandibular incisors.

This Single-blinded Randomized Controlled Trial consisted of twenty patients (aged 12-18 years) seeking orthodontic treatment. The subjects were divided into two groups with randomly permuted blocks (n=10): experimental and control groups. The Little’s irregularity index was measured on plaster models prior to treatment using American Board of Orthodontic Measuring Gauge. After unraveling of initial crowding, archwires on mandibular anterior segments of both groups were removed. The experimental group received Low-Level Diode Laser at 808 nm wavelength, 250 mW power, 4J energy and continuous wave mode, on coronal third of lower central and lateral incisors and canines’ roots for sixteen seconds three times a week, within a four-week period. The relapse rate was quantified on each plaster model using Little’s irregularity index at the end of first (T1), second (T2), third (T3), and fourth (T4) weeks.

The study population consisted of twenty patients aged 12-18 years who had 5-9 mm crowding and proper oral hygiene. At T1, the relapse rate was 0 mm and 0.05±0.15 mm in experimental and control group, respectively, which was not statistically significant (p=0.343). Over the following weeks, however, there was statistically significant difference between the relapse rate of the two groups (p=0.003). The mean rate of relapse percentage was 4.48±4.31 mm in experimental and 12.06±5.52 mm in control group, which was significantly lower in Low-Level Laser Therapy group.

The application of Low-Level Laser Therapy at 808 nm wavelength on mandibular incisors during orthodontic retention phase may slow down the relapse rate. Therefore, it could be considered as an effective adjunct to reduce immediate relapse.

Historical criticism requires expertise and proficiency in general knowledge of history. Without historical knowledge, it is wrong to write a review. In writing the critique of the article "Abu al-Hasan Ahmad ibn Muhammad al-Tabari Toranji; the famous Iranian physician", year 2022, volume 24, number 1, none of the principles of historiography criticism have been observed. With a focus on historical geography, there is apparently a difference of opinion between the critics and the author of the article. Therefore, the aim of this article is critical discourse analysis of historiography and the birthplace of  Abu al-Hasan Ahmad ibn Muhammad al-Tabari Toranji.

Respecting the patient's rights is one of the most important components of providing humanistic care and a priority in the field of medical ethics in Iran. Therefore, the charter of patients' rights in Iran was announced in 2009 as a practice guide in this field. This study was conducted with the aim of investigating the realization of patient rights from the viewpoint of doctors, nurses and patients hospitalized in selected departments of Shariati Hospital affiliated to Tehran University of Medical Sciences.

This cross-sectional study was conducted in Tehran in 2016-2017 on 487 participants who were selected by convenience sampling method. The data collection tool was the questionnaire of patients' rights awareness. The scores obtained were based on the individual's point of view regarding the observance of the right in question and ranged from 1 (not observed at all) to 5 (completely observed).

Based on the results of this study, doctors and nurses have reported less realization of patients' rights compared to patients. Patients, nurses and doctors, respectively, agree with the greater realization of patient rights in the areas of observance of justice (4.54±0.96), being polite to the patient (4.17±0.90), and quality of service in a scientific sense (3.37±0.85). In addition, patients reported less realization of patients' right in the areas of responsibility and accountability (3.03±1.59) (p=0.000), and nurses and doctors reported less realization of patients' rights in the areas of attention to the patient's well-being and comfort (3.45±0.99) and (2.48±0.84) (p=0.000).

The findings of the study showed that, in general, the attitude of the patients indicated that the patient's rights were better fulfilled compared to the doctors and nurses. of course, the views of service receivers and service providers were different regarding the degree of compliance with different dimensions of patient rights in the hospital, and it is necessary to prioritize the views of patients as service receivers and main beneficiaries in the interventions, and the service providers should be informed about it and the solutions to solve the existing shortcomings should be identified and appropriate action should be taken to solve them.

Neuropathic diseases are neurodegenerative conditions and a wide and difficult group of peripheral nerve diseases in humans. Since well-being therapy emphasizes the high levels of six domains of psychological well-being, this study was conducted to investigate the effectiveness of well-being therapy on pain coping strategies and self-efficacy of patients with chronic neuropathic pain.

This clinical trial was conducted on 30 chronic neuropathic patients referred to Ayatollah Rouhani hospital in Babol and a neurologist's private office in two groups of experimental and control (n=15). Well-being therapy was performed in 8 sessions of 120 minutes, once a week for the experimental group, while the control group received the routine treatment. After the follow-up period, the control group also underwent psychotherapy. Both groups completed questionnaires of pain coping strategies (Rosenstiel and Keefe, 1985) and pain self-efficacy (Nicholas, 1989) in the pre-test, post-test and follow-up (two months after the post-test) and were compared.

The results showed that there was a statistically significant difference between the two experimental and control groups in the score of the subscales of pain coping strategies in distraction from pain (23.13±3.88 versus 11.47±7.34) (p<0.001), reinterpretation of pain (17.33±5.56 versus 13.0±8.65) (p=0.114), catastrophizing (10.0±6.24 versus 16.33±5.4) (p<0.001), ignoring pain (24.4±6.67 versus 12.6±5.11) (p<0.001), hoping/praying (29.13±9.97 versus 22.4±5.7) (p=0.031), self-talk (25±4.03 versus 21.2±4.79) (p=0.026), behavioral activation (20.47±4.43 versus 11.20±4.94) (p<0.001) and pain self-efficacy (43.2±9.45 versus 33.33±13.34) (p=0.027). These results were maintained in the follow-up period.

The present study showed that wellness therapy can be an effective intervention in improving pain coping strategies and increasing pain self-efficacy in chronic neuropathic patients.

Systemic embolism can be one of the unfortunate side effects of left ventricular thrombus following acute heart infarction, and its timely diagnosis and treatment is very important. In this report, a patient with saddle embolism in the abdominal aorta due to the complete separation of the left ventricular thrombus following acute anterior infarction is presented.

Case Report: 

The patient is a 60-year-old man who referred to the emergency room complaining of severe retrosternal chest pain, nausea and cold sweats. In the ECG, he had ST segment elevation in leads V1-V5, and with the diagnosis of acute anterior infarction with ST segment elevation (acute anterior STEMI), he underwent primary angioplasty with stent placement (Primary PCI) on the left anterior descending artery. In transthoracic echocardiography three days later, a large thrombus was seen in the apex of the left ventricle. Seven days after stent implantation, the patient experienced severe pain and paraplegia of the lower limbs. In Doppler ultrasound, bilateral iliac artery occlusion was seen. Despite treatment with aspirin, clopidogrel, and anticoagulants, the left ventricular thrombus was embolized to the bifurcation of the abdominal aorta and caused bilateral acute ischemia of the lower limbs. The patient underwent emergency embolectomy and was discharged one week later with a stable condition and two antiplatelets and warfarin. Three months later, warfarin was discontinued.

According to this case report, abdominal aortic saddle embolism following acute myocardial infarction may rarely be seen. Paying attention to clinical symptoms, careful examination and quick diagnosis and treatment can improve the prognosis. In any patient with a left ventricular thrombus following an acute myocardial infarction, the possibility of systemic embolism should be considered.

The level of patient adherence to treatment and medication orders is one of the important factors influencing the effectiveness of medical treatments. The aim of this study is to investigate the relationship between doctor-patient communication skills and the level of adherence to medication orders after discharge from the hospital.

This cross-sectional study was conducted on 284 patients admitted to the surgery and urology departments of Shahid Beheshti Hospital in Babol, where at least 48 hours had passed since their admission. Patients completed two questionnaires of doctor-patient communication skills (range 21-70) and Burton communication skills (range 18-90) in the hospital. Then, two weeks after discharge, the patients answered the two questionnaires of general adherence and the Morisky Medication Adherence Scale online or by telephone contact, and the results were analyzed.

The mean age of the participating patients was 50.65±18.20 years and the score of general adherence to treatment orders was 24.26±5.77 (range 7-30) and medication adherence was 8.54±2.91 (range 1-11). 222 patients (78.2%) had high adherence to treatment orders. Stepwise regression analysis showed that doctors’ communication skills were a positive factor in medication adherence (p<0.001, ß=0.336) and adherence to treatment orders (p<0.001, ß=0.331). Moreover, patients’ communication skills had a positive effect on medication adherence (p=0.01, ß=0.137) and general adherence to treatment orders (p<0.001, ß=0.205).

The results of the study showed that the communication skills of doctors and patients is a positive predictor of adherence to treatment and medication orders after discharge from the hospital.

Mesenteric lymphadenitis is an inflammatory process that has similar clinical symptoms to appendicitis among diseases associated with acute abdominal pain. Therefore, the aim of this study was to compare clinical and paraclinical findings in children with appendicitis and mesenteric lymphadenitis.

This cross-sectional study was conducted on 214 children who were admitted to Amirkola Children's Hospital in 2011-2021 with the diagnosis of appendicitis (112 people) or mesenteric lymphadenitis (102 people). Appendicitis and mesenteric lymphadenitis were diagnosed based on pathology and ultrasound, clinical symptoms, laboratory parameters and ultrasound of children were compared in two groups.

Out of 214 children, 112 (52.15%) were girls and the mean age of the children was 7.53±3.19 years. Children with appendicitis compared to children with mesenteric lymphadenitis were more likely to have tenderness (42.2% vs 85.7%, p<0.001), rebound tenderness (40.2% vs 4.9%, p<0.001), vomiting (79.5% vs 61.8%, p=0.004) and pain shift (11.8% vs 25%, p<0.013). Also, WBC (9774.51±3971.35 vs 15358.04±4635.20, p<0.001), neutrophil (63.42±17.05 vs 77.02 ± 10.51, p<0.001), ESR (19.73±18.56 vs 38.57±27.29, p<0.001) and CRP (18.00±27.98 vs 52.77±40.30, p<0.001) were significantly higher in children with appendicitis. Ultrasound sensitivity (0.73-0.88) was 80.4% in diagnosing appendicitis and rejected mesenteric lymphadenitis with 100% probability.

The results of the study showed that some clinical symptoms with leukocytosis, neutrophilia and high CRP can help differentiate appendicitis from mesenteric lymphadenitis. But ultrasound can have a more definitive result in this regard.

Basal cell carcinoma is the most common human malignancy that has been increasing in recent years. The aim of this study is to determine the demographic and histopathological pattern of this malignancy in the pathology departments of state hospitals in Babol from 2013 to 2020.

In this retrospective study, after reviewing the existing files with the final diagnosis of basal cell carcinoma from 2013 to 2020, the patients' information including age, gender, lesion location and microscopic subgroup were recorded and analyzed.

In this study, 367 cases were obtained from Shahid Beheshti and Shahid Yahyanejad Hospitals in Babol with the diagnosis of basal cell carcinoma. The mean age of people in both genders was 67±10.89 years. 69% of the samples were men and 31% were women (p<0.001). The highest frequency was from the scalp area (134 samples) and the lowest frequency was related to the chest (3 samples). The most common histopathology subtype was nodular type and the rarest types were metatypical and clear cell carcinoma. A statistically significant relationship was observed between the location of the sample and gender (p=0.023); the cheek in men and the nose in women were more common than the other gender. The highest incidence was seen in 2017 with 83 cases, which was a significant increase compared to the previous year.

Based on the results of this study, the high incidence of basal cell carcinoma in the head and face area of elderly people, especially men, reveals the need to inform high-risk communities and to be more familiar with therapists, especially dentists who are in close eye contact with the face.

Diabetes affects many physiological systems of the body and can lead to fertility disorders. Since catechin, as a strong antioxidant, can improve sperm parameters and increase fertility, this study was conducted to investigate the effect of catechin on oxidative stress, sperm parameters and in vitro fertilization (IVF) of diabetic mice.

In this experimental study, 48 adult male NMRI mice were divided into 6 groups of 8: oral control, injection control, diabetic, diabetic with a low dose of catechin (25 mg per kilogram of body weight), diabetic with a medium dose of catechin (50 mg per kilogram of body weight) and diabetic with a high dose of catechin (100 mg per kilogram of body weight). Diabetes was induced via intraperitoneal injection of streptozotocin (50 mg per kilogram of body weight) and after the 30-day treatment period, sperm parameters, testosterone hormone level, catalase level, total oxidative capacity, malondialdehyde and IVF were evaluated.

In diabetic mice, sperm count (28.63±1.24) and sperm motility percentage (53.47±1.46) and live sperms (55.96±1.34), as we as zygote (57.68±1.56), two-cell embryos (62.93±3.92), blastocysts (41.69±1.49) and hatched embryos (34.51±2.98) were significantly reduced compared to the control group (p<0.05). In the diabetic group, the percentage of immature sperm (13.41±0.30) and damaged DNA (8.35±0.42) increased. Administering catechin improved sperm parameters, fertilization rate and embryo growth.

Considering the harmful effects of diabetes on fertility, catechin can increase conception and fertility due to its antioxidant ability and inhibition of free radicals.

Adenoid cystic carcinoma (ACC) of the maxilla is a rare malignancy arising from minor salivary glands. The clinical and radiological appearance may be similar to any odontogenic/nonodontogenic pathology. This study aims to report a rare case of primary central ACC of the anterior maxilla.

Case Report: 

A 31-year-old man was referred to the Department of Oral and Maxillofacial Surgery complaining of swelling and pain in the right anterior maxilla for 3 months. The patient has noticed swelling and pain in this side since about five months before and instead of diagnosing this tumoral lesion, false diagnosis and unsuccessful root canal therapy were considered. A biopsy was performed in the central region and microscopically, the lesion showed tumor cells arranged in sheets in fibrous stroma islands of epithelial cells showing a classical “Swiss cheese” pattern. Based on clinical, radiographic, and CBCT evaluation and positive immunohistochemistry of CD63, and C-Kit confirmed ACC diagnosis. After the diagnosis, the lesion was completely removed by enucleation and curettage performed by the surgeon. Postoperative radiotherapy was performed. Follow-up within 3 years since the initial diagnosis showed no sign of recurrence.

Based on the results of this study, early diagnosis and treatment of ACC can lead to successful treatment and patient survival.

To reduce microbial contamination in cases such as perforation treatment, it is necessary to use irrigants after cement placement. The aim of the present study is to investigate the effect of intracanal irrigants on the push out bond strength of CEM, Root MTA and Angelus MTA cements to the dentin wall.

In this laboratory research, 150 cross-section samples from the mid-root region of single canal teeth without caries with a thickness of 1 mm, which were randomly divided into 3 groups of 50 and filled with CEM cement, Root MTA or Angelus MTA, were examined. After the cements were set, the samples of each group were divided into 5 subgroups of 10; 4 subgroups were cleaned with sodium hypochlorite, EDTA, normal saline, 2% chlorhexidine for 30 minutes, and one subgroup was not cleaned as a control group. Then, the push out bond strength of cement with the dentin wall (MPa) and the failure pattern of the samples were evaluated.

Different cleaning methods did not show any significant effect on the bond strength of CEM, Root MTA and Angelus MTA cements. In the cleaning method with saline, the bond strength of Angelus MTA (6.3±1.98) was higher than Root MTA (2.1±3.61) (p=0.004). In the cleaning method with 2% chlorhexidine, the bond strength of Angelus MTA cement (8.72±3.13) was higher compared to CEM (3.87±1.35) and Root MTA (4.66±1.76) (respectively p<0.001 and p=0.001). The most common type of failure in the Angelus MTA group was of the adhesive type, and in the CEM cement and Root MTA groups, it was of the mixed type.

The results of the study showed that different cleaning methods have no effect on the push-out bond strength of the examined cements.

Food insecurity is defined as limited or uncertain access to adequate and healthy food in terms of nutrition or limited ability to obtain food in socially acceptable ways, which can affect the health of the elderly. The aim of this research is to investigate the state of food insecurity and the factors affecting it and its role in physical and mental health in the elderly.

This cross-sectional study was conducted on 550 elderly people aged 60 years and older who referred to 10 health centers in Sanandaj, and were selected via random cluster sampling. Demographic information questionnaire, HFIAS food security questionnaire (8 questions with a score range of 0 to 24) and Goldberg General Health Questionnaire (28 questions with 4 subscales) were completed and reviewed.

In this study, 324 elderly women and 224 men were evaluated, 75.6% were married and 73.6% were illiterate. The findings showed that 59.1% (325 people) of the elderly had some degree of food insecurity and severe insecurity was observed in 62 people (11.3%). Food insecurity in people with moderate to severe physical symptoms (OR=7.33), anxiety and sleep disorder (OR=8.63), functional disorder (OR=6.78), depression (OR=21.12) and in general, moderate to severe general health disorder (OR=11.85) was seen more. In addition, food insecurity, not being married, being illiterate, living alone, and low income were observed to a greater extent in women.

The results of the study showed that the prevalence of food insecurity among the elderly in Sanandaj is significant and is related to factors such as general, physical and mental health disorders.

People who are infected with Human Immunodeficiency Viruses (HIV) are more prone to opportunistic fungal infections than other patients. The immune system of these patients becomes weaker when they are also infected with Coronavirus disease (COVID-19). Involvement of the central nervous system caused by fungal infections in these patients is of concern and fatal if diagnosed late. The aim of this research is to investigate a woman with COVID-19 and HIV who was diagnosed with cryptococcal meningitis.

Case Report:

 The patient is a 53-year-old woman who complained of severe headache and nausea after infection with COVID-19. White blood cells, erythrocyte sedimentation rate, lymphocyte, creatinine, aspartate aminotransferase, alanine aminotransferase and blood urea nitrogen were increased compared to the standard level. Cerebrospinal fluid testing showed that glucose was lower and protein was higher than normal. Microscopic examination, staining and culture of cerebrospinal fluid deposits showed the presence of double wall yeasts similar to Cryptococcus. The patient was positive for COVID-19 and HIV. The level of CD4 (cluster of differentiation 4) was lower than the standard. The patient was treated with amphotericin B at a dose of 100 mg for two weeks and was discharged from the hospital after the conditions were stabilized.

Cryptococcal meningitis can often occur in immunosuppressive conditions such as HIV. Therefore, quick follow-up, diagnosis and treatment should be considered in these patients.

Responsiveness is one of the important properties of health-related questionnaires in demonstrating the changes in a patient's clinical conditions before and after therapy. The present study was carried out with the aim of assessing the responsiveness of the Western Ontario Meniscal Evaluation Tool (WOMET) and determining its minimal clinically important difference in patients undergoing physical therapy interventions after meniscus injuries.

This cross-sectional methodological study was performed on 100 patients aged 18-70 years with meniscus injuries who underwent physical therapy interventions. Patients completed WOMET and Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaires in the first and tenth sessions. The minimum score obtained from the WOMET questionnaire was zero and the maximum was 1600, and the minimum score obtained from the KOOS questionnaire was zero and the maximum was 168. Internal and external responsiveness were the primary outcomes, and effect size tests, ROC curves, and correlation coefficients were used to examine them. The relationship between the WOMET and KOOS questionnaires were considered as secondary outcomes, which were evaluated by calculating the correlation coefficient.

The results of internal responsiveness showed that the standardized response mean for the entire WOMET questionnaire was 0.11 (insignificant) and Cohen's d score for the entire WOMET questionnaire was -1.586 (large). The difference in the mean internal responsiveness between recovered (20%) and unrecovered (80%) patients reached a significant level (p<0.001). This questionnaire had an acceptable external responsiveness; the area under the curve of the ROC curve was greater and equal to 0.7 and the optimal cut-off point was 20.031 (p<0.001). The Pearson correlation coefficient between WOMET and KOOS questionnaires (except the emotions subscale) was moderate to large (0.5-0.8) with p<0.001.

The findings of the study showed that the Persian version of the WOMET questionnaire has a high level of responsiveness and is a suitable tool for evaluating the quality of life among patients suffering from meniscus injury.

Coronary artery bypass surgery in a patient with post-cardiac injury syndrome (PCIS or sever pericarditis following myocardial infarction) is very rare and extremely difficult. The risk of incomplete and unsuccessful revascularization and cardiac damage is high. Incomplete surgery can lead to increased mortality and postoperative complications. A case of emergency coronary artery bypass surgery in a patient with post-cardiac injury syndrome is reported.

Case Report: 

A 64-years-old man was admitted to Seyed-al-Shohada Heart Center of Urmia with chest pain and exertional dyspnea from two weeks before. His comorbidities included diabetes mellitus (type II), hypertension, smoking and obesity. The electrocardiogram showed atrial fibrillation with rapid ventricular response.  Echocardiographic study demonstrated 50% ejection fraction and mild to moderate pericardial effusion.  In laboratory tests, low hemoglobin and high serum creatinine were seen. Coronary angiography showed 50% distal stenosis of left main coronary artery as well as involvement of three heart vessels. During urgent coronary artery bypass surgery, we found severe and diffuse inflammation of cardiac surface and thickening of the pericardium. In the probable coronary artery route, limited release of visceral pericardial adhesions was performed. Coronary artery bypass graft surgery was performed. Weaning from cardiopulmonary bypass (CPB) was done with normal sinus rhythm and low dose inotrope. The only postoperative complication of the patient was exacerbation of preoperative renal failure. So, hemodialysis was performed once on the second postoperative day. The patient was discharged from the hospital on the 8th postoperative day. Follow up examination on the 12th months following operation revealed no clinical problems and echocardiographic study showed no pericardial effusion.

Based on the results of our report, limited and carefully release of inflammatory epicardial adhesions should be done to find the target coronary arteries and to avoid heart failure.

Control of hyperglycemia after meals is an important strategy in the management of type II diabetes, and the reduction of chronic complications associated with it. Therefore, inhibitors of carbohydrate-degrading enzymes such as α-glucosidase can be useful in the treatment of this disease. The aim of this study was to evaluate the α-glucosidase inhibitory activity in some traditional medicines in Sulaymaniyah province of Iraq.

Eight plant species were prepared with advisory from authentic spiceries in Sulaymaniyah. After air drying and preparation of their methanolic extracts, enzyme microplate assay was conducted on them in four different extract concentrations (1, 0.1, 0.01 and 0.001 mg/ml) along with negative and positive controls. Finally, enzyme kinetic analysis was performed on effective extracts.

Among the eleven studied plant species, Rubus idaeus L., Rheum ribes R. and Salix alba L. extracts at 1 mg/mL concentration showed highest inhibitory activity (98.13±1.05% (IC50=0.046 mg/mL), 93.39±2.11% (IC50=0.085 mg/mL) and 84.46±1.12% (IC50=0.125 mg/mL), respectively) against α-glucosidase,. After kinetic analysis of α-glucosidase inhibition, Rubus idaeus L., Rheum ribes R. extracts showed mixed type of inhibition (competitive- uncompetitive) while extract of Salix alba showed uncompetitive type of inhibition.

The leave extract from both Rubus idaeus, Salix alba and root extract of Rheum ribes are remarkable α-glucosidase inhibitors, and may be used in the treatment of type II diabetics after clinical tests.

A proper bond between enamel and bracket is essential in orthodontic treatment. Recently, a new type of adhesive (universal adhesive) has been introduced, which has been claimed to present the ability to bond with metal surface. The aim of this study was to evaluate the effect of universal adhesives on shear bond strength (SBS) and adhesive remnant index (ARI) of orthodontic brackets to enamel surfaces.

In this experimental in-vitro study, 56 intact human premolars were randomly divided into four groups according to the adhesives used. All teeth were etched by 37% phosphoric acid. Then, in Group 1 (control), Transbond XT primer was only applied on the enamel surface. Group 2: Transbond XT primer applied on both enamel and bracket base. Group 3: Single Bond Universal adhesive was applied on both enamel and bracket base. Group 4: G-Permio Bond was applied on both enamel and bracket base. Then, the brackets were bonded to teeth with Transbond XT composite. After storing samples in water for 24 hours and thermocycling (2000 cycles), SBS was recorded using a Universal Testing Machine. The debonded samples were examined under the stereomicroscope at 10x magnification to check the amount of remaining adhesives on teeth (ARI).

Group 3 showed the highest SBS (25.4±8.7 Mpa) and group 2 showed the lowest SBS (16±5.3 Mpa). The SBS of group 3 was significantly more than group 2 (p=0.03) and there was no significant difference between the other groups. There was no significant differences among the four groups in term of ARI score.

The bond strength values of orthodontic brackets to enamel using universal adhesives (Single Bond Universal and G-Permio Bond) are similar to the conventional adhesive (Transbond XT).

More than 80% of women experience physical, vasomotor, sexual and psychological symptoms after menopause, and in 10-20% of women, the severity of menopause symptoms affects their quality of life. Due to the complications of using chemical drugs, this study was conducted to compare the effectiveness of evening primrose oil and soybean oil in postmenopausal women.

In this randomized controlled prospective study, 40 postmenopausal women were assigned into two groups of 20, 500 mg of evening primrose oil and 233 mg of soybean oil extract twice a day for 8 weeks. Measurement of serum hormones (follicle stimulating hormone, luteinizing hormone, estradiol), lipid profile, fasting blood glucose, and high sensitivity C-reactive protein were performed. Moreover, menopausal symptoms were analyzed and compared based on the evaluation score of menopausal symptoms (range 0-3).

The mean age of women was (51.65±3.7) years. After 2 months of treatment with evening primrose oil, there was a decrease in follicle stimulating hormone, luteinizing hormone levels concurred with increase in estradiol levels (-10.64%) (-8.09%) (7.47%), respectively (p<0.05). Meanwhile, women receiving the soybean oil revealed increase in all the three hormones (5.77%) (12.73%) (13.39%), respectively (p<0.05). Total cholesterol and triglycerides decreased in both study groups after treatment (p<0.05), fasting blood glucose level decreased in group 1 only (-1.39%), and high sensitivity C-reactive protein decreased in group 2 only (-22.33%) (p<0.05). In both groups, women presented with mild to moderate pre-treatment menopausal symptoms (Menopause Symptom Assessment score ranging from 0.75 to 2.25) showed significant decrease in their score up to no symptoms in each study group after 2 months (less than 0.75) (p<0.01)‎.

The results of the study showed that both evening primrose oil and soybean oil supplements improve menopausal symptoms.

Congenital hypothyroidism is one of the most common endocrine diseases and one of the main causes of mental disability and delayed sensory and motor development in infants. The aim of this review article is to determine the general prevalence of congenital hypothyroidism in Iranian infants.

In this systematic review and meta-analysis, a comprehensive review of the Scientific Information Database (SID), Medline (PubMed), ScienceDirect and Google Scholar was conducted using the keywords “congenital hypothyroidism”, “infants” and “screening” until November 2022. The extracted data were entered into the Comprehensive meta-analysis software (Version 2) and the meta-analysis was analyzed using the random-effects model in the studies.

248 articles were initially found in the search of the investigated databases. After removing 169 duplicate articles and removing them based on the inclusion and exclusion conditions of the studies, 79 articles were included in the secondary evaluation and finally, after omitting 60 irrelevant articles, 17 articles were included in the meta-analysis review. In a review of 17 studies with a sample size of 674,466 Iranian infants, based on a meta-analysis, the prevalence of congenital hypothyroidism in Iranian infants was 0.002 (95% CI= 0.002-0.003), and in terms of percentage was reported 0.2% and 2 per 1000 live births.

The results of the present study show that the prevalence of congenital hypothyroidism in Iranian infants is 2 per 1000 live births, which indicates the high prevalence of this disease in infants in the country, and it is necessary to inform pregnant mothers and to continue screening at birth.

Otosclerosis is caused by abnormal bone remodeling in the middle ear, which is associated with dizziness and lightheadedness. An underlying cause of dizziness in this disease can be the presence of an enlarged vestibular aqueduct. In this study, the prevalence of enlarged vestibular aqueduct in these patients compared to the normal population has been investigated.

In this cross-sectional study, 26 people with bilateral otosclerosis and 26 people with at least one healthy ear requiring a CT scan were compared. Vestibular aqueduct was tested by evaluating the two factors of the midpoint width between the external diaphragm and the common crus, and its width in the external diaphragm region and comparing the two groups. Bone conduction, speech detection threshold, and gap between bone conduction and air conduction were calculated and compared in otosclerosis patients with enlarged versus normal vestibular duct.

The median width of the vestibular aqueduct in the area of the external aperture in patients with otosclerosis (1.2 mm) was significantly greater than that of healthy subjects (1 mm) (p=0.046). Regarding the size of the vestibular aqueduct in otosclerosis patients, 5 patients (9.6%) were found with enlarged vestibular aqueduct in radiological findings. However, this difference was not statistically significant. In otosclerosis patients, bone conduction threshold in all frequencies was significantly higher in people with enlarged vestibular aqueduct compared to other patients (p<0.001).

Based on the results of this study, the prevalence of enlarged vestibular aqueduct in patients with otosclerosis is considerable, and it is better to pay enough attention to the CT scan of patients before surgery to prevent possible complications.

Xanthogranuloma is an uncommon and chronic inflammatory reaction characterized by the accumulation of foamy macrophages in various body tissues such as the skin, gallbladder, and kidney, and is often mistaken for malignancy. The aim of this report is to introduce a case of severe xanthogranulomatous reaction in the thyroid bed following previous lobectomy treatment of papillary thyroid carcinoma, which has now been re-operated with a clinical diagnosis of tumor recurrence.
Case Report: The patient is a 42-year-old woman who underwent subtotal thyroidectomy (lobectomy) two years ago due to a neck mass and was diagnosed with papillary thyroid carcinoma. Now, the patient referred with a sore throat. During the examination, the mass was felt at the previous thyroidectomy site, which was re-operated after ultrasound and CT scan with the diagnosis of recurrence of the previous tumor. In the evaluation of the pathology of the thyroid tissue along with the surrounding adhesive tissues, and in the initial sections of the cell plates, abundant clear and granular cytoplasm between the muscles and CD connective tissue as well as extensive infiltration of fat were observed. After the examination and performing immunohistochemistry for CD68, S100 and CK markers, all negative cases, except the marker CD68, which is specific for macrophages, were positive, suggesting the diagnosis of xanthogranuloma. Then, all tissues were checked for recurrence of papillary carcinoma, and the result was negative.

Based on the results of this reported case, xanthogranuloma should be considered in patients undergoing thyroid lobectomy with recurrence of papillary thyroid carcinoma.

Cervical cancer is the fourth most common cancer in the world. The most important issue in cancer treatment is the destruction of cancer cells in the presence of normal cells. For this reason, it is necessary to use natural resources such as plants to treat cancer. The aim of this study is to evaluate the antibacterial effects of the ethanolic extract of Alhagi maurorum on Staphylococcus aureus and Pseudomonas aeruginosa and cytotoxicity on HeLa cervical cancer cell line.

In this experimental study, first the ethanolic extract of Alhagi maurorum was prepared, and then the two standard strains of Staphylococcus aureus (ATCC: 25923) and Pseudomonas aeruginosa (ATCC: 27853) were lyophilized by culturing in nutrient medium. In order to confirm the standard strains, biochemical tests were performed. Microdilution method was used to determine the minimum inhibitory concentration and after obtaining the minimum inhibitory concentration, the minimum bactericidal concentration was evaluated. Furthermore, the effects of the cytotoxicity of the extract at concentrations of 0.1, 10, 50, 100, 500 and 1000 μg/ml was evaluated on the HeLa cell line in a period of 48 hours using the MTT method and comparing its toxicity with the cisplatin group (positive control group).

Ethanol extract of Alhagi maurorum at a concentration of 50 μg/ml reduced the growth of cancer cells, and in the statistical comparison, 50, 500 and 1000 μg concentrations revealed significant differences (p<0.05). According to minimum inhibitory concentration results, the minimum growth inhibitory concentration of the extract on the standard strain of Staphylococcus aureus and Pseudomonas aeruginosa was reported to be 4000 and 16000 μg/ml, respectively, and according to minimum bactericidal concentration results, the minimum bactericidal concentration of the extract was found 4 times the minimum inhibitory concentration (16000 μg/ml) in Staphylococcus aureus (ATCC: 25923), but it was not lethal in Pseudomonas aeruginosa (ATCC: 27853).

The results of the study showed that the ethanolic extract of Alhagi maurorum affected HeLa cells through antioxidant activity and inhibited their growth, and according to minimum inhibitory concentration and minimum bactericidal concentration results, it was also shown that the most inhibitory effect was on the standard strain of Staphylococcus aureus while it showed no effects on the strain of Pseudomonas aeruginosa.

Urinary reflux is the most common urological abnormality in children. About half of the children with urinary infection have urinary reflux at the same time. Considering the importance of urinary reflux in children and contradictory results reported regarding the relationship between different grades of vesicoureteral reflux and recurrent urinary tract infection, this study was conducted with the aim of comparing recurrent urinary tract infection in children with different grades of vesicoureteral reflux.

This cross-sectional study was conducted on 150 children with pyelonephritis and vesicoureteral reflux who refered to Amirkola Children's Hospital in 2011-2019. Reflux grades were determined by voiding cystourethrogram (VCUG) or direct radionuclide cystography (DRNC). Children were followed up for 2 years and in case of clinical symptoms with positive urine culture, they were considered as recurrent urinary tract infection.

Of the 150 children studied, 126 (84%) were girls and 24 (16%) were boys with a mean age of 27.17±11.53 months. 95 people (63.3%) had once, 37 people (24.7%) twice, 8 people (5.3%) three times, and 10 people (6.7%) four times experience of recurrent urinary tract infection. The odds ratio of recurrent urinary tract infection was more than two times higher in children with grade 3 and 4 reflux involvement than in children with grade 1 and 2 reflux (OR=3.20, 95% CI=1.05-9.75, p=0.041). However, there was no significant difference in recurrent urinary tract infection in children based on age at diagnosis, gender, and whether the reflux was unilateral or bilateral.

The results of the study showed that children with moderate and severe involvement of vesicoureteral reflux experience higher recurrent urinary tract infection compared to mild involvement.

The use of mechanical perforation as an alternative to radiofrequency wire in the treatment of pulmonary valve atresia with an intact ventricular septum, which is a duct-dependent cyanotic congenital heart disease. We share our experience with this method, which is especially relevant for centers that do not have access to radiofrequency wires.

This cross-sectional study was conducted between October 2011 and August 2022 on all infants referred to Shaheed Almehrab cardiac surgery and Catheterization Center‎ in Babylon, Iraq whose severe cyanosis and patent ductus arteriosus (PDA) dependent pulmonary valve atresia with an intact ventricular septum were confirmed by transthoracic echocardiography. A chronic total occlusion (CTO) wiring procedure was used to create perforation through the atretic pulmonary valve with subsequent pulmonary valve balloon dilation, through an antegrade (n=18) or retrograde approach (n=10).

A total number of 28 infants with 14 infants younger than one month and 14 infants older than one month of age were included. 15 cases (53%) were male. The mean oxygen saturation before the intervention was 44.48±7.43% which significantly improved to 88.35±7.71% (p<0.001). Tripartite ventricles were found in 56.5% of patients. Successful perforation with subsequent balloon valvuloplasty was achieved in 23 cases (82.1%) and death as a complication of perforation was reported in 5 cases. The antegrade operation was associated with higher survival than the retrograde (p=0.041). There were 21.5% of patients who required an additional procedure including a bidirectional cavopulmonary shunt (Glenn shunt) or Blalock-Taussig (BT) shunt to augment pulmonary blood flow. Tricuspid regurgitation improvement was confirmed in 87% of patients‎.

In conclusion, transcatheter perforation of atretic pulmonary valves followed by balloon valvuloplasty is a feasible and effective treatment option for pulmonary atresia and intact ventricular septum.

Children may insert foreign objects into their oral cavity, which can lead to hard and soft tissue injuries. These foreign bodies can act as a potential source of infection and later lead to painful conditions in the child. The purpose of this article is to report an unusual case of oral swelling due to an embedded foreign body.
Case Report: The patient is a 13.5-month-old boy who referred with his parents complaining of a bright red swelling measuring about 1×1 cm in the area of the first molar on the right side of the mandible. This bump appeared suddenly, had a firm consistency and a smooth surface and was painless. In the periapical radiograph, the deciduous first molar tooth was seen growing and no abnormality was seen. Due to the strong adhesion of the lesion to the underlying mucosa, the attempt to isolate the lesion using a catheter was not successful. Due to the unusual appearance of the lesion and the child's non-cooperation, a conservative approach was adopted and follow-up for the lesion was considered. In the follow-up within two weeks, the foreign body was separated from the gingival tissue by itself, and the eruption of the lower tooth took place naturally two weeks later.

The results of this study show that in clinical conditions with an unusual appearance and unknown etiology, foreign bodies should be considered as a differential diagnosis in children and early invasive treatments should be avoided as much as possible.

General anesthesia and tracheal intubation activate the sympathetic nervous system that might affect the innervation of the heart. The aim of study is to look for the incidence of myocardial injury (MI) in intubated adult patients in the Intensive Care Unit (ICU).

This cross-sectional study was conducted on all intubated patients during four months in Imam AL Sadeq Teaching Hospital's ICU, from January 2022 to May 2022. Patients were‎ selected by the census sampling method. Electrocardiograms (ECG), echocardiograms (echo), blood pressure monitoring, other vital signs, and high-sensitivity serum troponin I testing were used to detect myocardial damage. Patients were divided to normal and high troponin groups. Primary diagnosis of admission to ICU was recorded.  Patients were followed after 60 days by visits or phone call.

This study included 40 patients with a mean age of 56.6±7.3 years. There were 17 (42.5%) cases of new MI in the ICU. Troponin levels were found to be significantly associated with age, hypertension, and atrial fibrillation (p<0.05), but not with gender or the type of illness. Patients with elevated troponin levels were three times more likely to experience mortality within 60 days compared to those with normal levels (0.0247). Logistic regression analysis confirmed a significant positive association between troponin levels and mortality, controlling for age, hypertension, and atrial fibrillation (odds ratio=5.49, 95% CI= 1.15-27.15, p=0.033). Age, hypertension, and atrial fibrillation were not significant predictors of mortality.

In conclusion, our study showed a high rate of MI in non-cardiac ICU patients and also a significant association between elevated troponin levels and increased mortality within 60 days in ICU patients. The findings of this study show the importance of monitoring troponin levels as a prognostic indicator in critically ill patients.

Papillary thyroid carcinoma (PTC) can be affected by underlying diseases. There is controversy about whether PTC and Hashimoto's thyroiditis are connected. The present study was conducted to evaluate the effect of Hashimoto's thyroiditis on papillary thyroid carcinoma.

This retrospective study was conducted on 100 cases of total thyroidectomy (TT) referred to pathology centers of public and private hospitals of Kurdistan Region, Iraq, from 2019 to 2021. Data about histopathological findings such as pathology diagnosis, Hashimoto's thyroiditis (HT), toxic goiter, multinodular goiter (MNG), diagnosis based on the physician’s report and FNAC (fine needle aspiration cytology) results were collected and compared.

Out of 100 TT cases examined, 41 cases were diagnosed as HT, 22 cases of PTC were identified, 11 of which were associated with HT background. Out of 100 TT, non-toxic goiter was found in 54 cases and toxic goiter in 5 cases. The most common indication for TT was multinodular goiter, which was found among 10 cases of PTC. There was a significant association between HT and PTC (p=0.036) with Odds ratio of 1.87 (95% CI: 1.19-2.82). FNAC was malignant or suspicious for PTC in 7 cases and histological diagnosis was malignant in 5 cases. Fourteen surgeries were performed depending on the radiological findings of suspicious nodules with the diagnosis of thyroid cancer in 6 cases‎.

The results of the study showed a potential relationship between Hashimoto's thyroiditis and papillary thyroid carcinoma.

Alzheimer's disease is the most common destructive brain disease which is associated with cognitive disorders. Considering the protective role of insulin in the functions of the nervous system, the present study was conducted to investigate the effect of intranasal insulin administration on cognitive disorders and neurogenesis in rats treated with streptozotocin (STZ).

In this experimental study, 32 male Wistar rats were divided into 4 groups of 8: control, STZ, STZ + insulin and insulin. The model of Alzheimer's disease was induced by intraventricular injection of STZ (3 mg/kg; 3 μl in each ventricle). Two weeks after STZ injection, cognitive functions were evaluated using Elevated Plus Maze (EPM) and Passive Avoidance (PA) tests. Insulin treatment (2 IU daily; 10 μl in each nasal passage) was performed after STZ injection for 14 consecutive days. The change in the expression of genes involved in neurogenesis (Nestin, DCX and Ki67) in the hippocampus area was investigated by Real-time PCR technique.

STZ caused longer animal stay in open arms in acquisition phase (64.5±5.24) and recall phase (60.25±5.55) compared to the control group (33±2.17 and 26.38±2.06) in the EPM test (p<0.05 and p<0.01, respectively). In addition, it caused a decrease in learning recall 90 minutes (77.57±6.03) and 24 hours (90.25±7.25) after training, compared to the control group (254.38±3.19 and 238.13±3.46) in the PA test (p<0.001 and p<0.05, respectively). Insulin treatment improved the above parameters in EPM test (41.88±4.14 and 31.5±4.16, respectively) and PA (278.88±2.32 and 218.5±2.12, respectively) compared to the STZ group. STZ also led to a decrease in Nestin gene expression (0.46±0.04), DCX (0.35±0.04) and Ki67 (0.41±0.05) compared to the control group (1.02±0.11, 1±0.04 and 1.01±0.08, respectively) (p<0.01, p<0.001 and p<0.001, respectively), while insulin treatment could increase the expression of these genes (0.87±0.09, 0.78±0.02 and 0.69±0.08, respectively) (p<0.05).

The results showed that insulin improved cognitive functions and increased neurogenesis in rats treated with STZ. Therefore, insulin can be considered as an effective therapeutic target in Alzheimer's disease.

Surgical site infection (SSI) after open appendectomy (OA) is a common healthcare-associated infection. The most common form of SSI is superficial (SSSI) which is associated with substantial morbidity and mortality. The aim of the study is to assess factors contributing to SSSI in emergency OA.

This is a retrospective cohort study on patients who had emergency OA at Shar teaching hospital in Sulaimani City, Iraq for 6 months; from March to September 2022. Wound assessment was done by Centers for Disease Control and Prevention SSI Criteria (only skin of surgery site be affected, symptoms of pain or tenderness and erythema, purulent drainage, or organisms be found in wound culture). Demographic information, medical history, and preoperative and postoperative variables were compared and collected.

Of 320 participants, 51.6% were men and their mean age was 21±12.2. Total number of SSIs were 35 (10.9%). There were no differences between groups based on gender. Age, obesity, smoking, chronic illness, multiple intraoperative and preoperative factors were associated with SSI in the bivariable analysis. However, after adjusting for predictors, only use of subcuticular suturing techniques was associated with a significantly higher risk of SSI compared to simple interrupted suturing (p=0.004, OR=20.184, 95%CI [2.673-152.437]); and proper bathing within first 5 days after surgery had a significantly lower risk of SSI compared to others (p=0.025, OR=0.042, 95% CI [0.004-0.417]). No significant association was found between presence or timing of drain removal, postoperative length of stay, changing of dressing, antiseptics, or suture removal day.

The results of the study showed a wide range of effective factors in superficial surgical site infection in patients undergoing open appendectomy.

Periodontal diseases are chronic inflammatory diseases leading to damage to soft and hard tissue. Due to the importance of periodontal health in people, this study was designed to investigate the association between changes in the inflammatory mediators with the development of periodontal disease.

The case-control study was conducted on 120 individuals who referred to University of Baghdad, Dentistry School, Department of Periodontics in three groups: healthy group, periodontitis group, and gingivitis group, every group containing 40 individuals (20 men and 20 women). The demographic data of all individuals were recorded in the information form. Periodontal parameters, including bleeding on probing (BOP), plaque index (PI), clinical attachment loss (CAL), probing pocket depth (pd) and the serum levels of Interleukin-6 (Il-6), Immunoglobulin G (IgG) by ELISA technique, C-reactive protein (CRP) were evaluated using colorimetric technique.

The mean range of IL-6 was 17.3940±1.509, 17.1432±2.214, 11.3846±1.119, for periodontitis, gingivitis, and healthy groups, the mean range of CRP was 5.4477±3.771, 3.5853±3.483, 2.3813±1.134 for periodontitis, gingivitis, healthy groups, and the mean range of IgG was 12.3875±2.073, 15.0109±2.380, 9.4851±1.081 for periodontitis, gingivitis, healthy groups, respectively. Biochemical and periodontal parameters showed highly significant increase in periodontitis and gingivitis groups compared to healthy group (p<0.05).

According to the results of this study, the high levels of inflammatory mediators are associated with periodontal disease, and increase with the progression of periodontal disease, and the transition from gingivitis to periodontitis, and the study's cutoff values can be applied to estimate healthy cases or patients with periodontal disease.

Liver damage is one of the common complications after ulcerative colitis. The aim of this study is to compare liver protective effects of sulfasalazine and shilajit after ulcerative colitis.

In this experimental intervention study, 49 male Wistar rats weighing 200-250 grams were used in seven groups of 7: sham, ulcerative colitis, oral solution, oral Shilajit, sulfasalazine, rectal solution, and rectal Shilajit. To induce ulcerative colitis, after anesthetizing the animal, 2 cc of acetic acid (4%) was used by rectal administration. Four days after the development of colitis, Shilajit was administered for four days at a dose of 250 mg/kg by gavage and rectal methods. In each group, the levels of liver enzymes (SGPT, SGOT, ALP), direct bilirubin, total, and serum albumin were evaluated eight days after the induction of ulcerative colitis.

Sulfasalazine decreased total bilirubin (0.5967±0.04) and SGOT (113.3±12.7). Administering Shilajit rectally reduced direct bilirubin (0.10±0.02), albumin (3.17±0.2), SGOT (156.2±12.7) and administering Shilajit by gavage reduced SGOT (125.0±12.7), direct bilirubin (0.094±0.02), SGOT (125.0±12.7) and SGPT (93.8±7.5).

The results of the study showed that oral administration of Shilajit has more protective effects on liver damage caused by ulcerative colitis than rectal Shilajit, and this result is comparable to sulfasalazine.

</span> Retinopathy of Prematurity (ROP), as a retinal vasoproliferative disease, is affected by the incomplete development of the respiratory system of premature babies. Since premature babies suffering from ROP have a lower level of partial pressure of oxygen (PO2</sub>), the present study was conducted to investigate the effect of PO2</sub> and venous oxygen saturation in treatment response of ROP patients.</span></span></span>
</span> This retrospective cohort study (2010-2020) was conducted in the neonatal intensive care unit of Ayatollah Rouhani hospital in Babol among 502 premature babies (less than 34 weeks of pregnancy and with a birth weight of less than 2500 grams). ROP was diagnosed and determined by an ophthalmologist based on the ICROP index on the first day of birth. Data related to PO2</sub> and venous oxygen saturation were collected from patients' files. After receiving standard treatment for ROP, patients were examined and compared in two groups of “completely cured” and “other patients” (including partial recovery, no change, and disease progression) in terms of the effect of PO2</sub> and venous oxygen saturation on the decrease or increase in stage (I to IV) and zone (I, II, III).</span></span></span>
</span> Of the 502 babies examined, 193 had stage I, 232 had stage II, 76 had stage III, 1 had stage IV, and 55 had zone I, 245 had zone II, and 202 had zone III involvement. The mean level of PO2</sub> and oxygen saturation between the two groups of “completely cured” patients and “other patients” did not have a statistically significant difference. The mean level of PO2</sub> and oxygen saturation between the three groups of patients with partial recovery, patients with no change and patients with disease progression did not show a statistically significant difference. Furthermore, the levels of PO2</sub> and venous oxygen saturation were not related to the change of stage and zone in patients with ROP.</span></span></span>
</span></span> The results of the study showed that lack of oxygen is effective in causing ROP and oxygen therapy has an effective role in the treatment of ROP patients, but the amount of oxygen at the beginning of ROP diagnosis is not related to the treatment process of ROP.</span></span></span></div>

</span> Cesarean Scar Pregnancy (CSP) is a rare and life-threatening complication that involves implantation of a gestational sac at the location of a previous cesarean scar. The presence of a cesarean scar in the uterus can have a significant effect on the placental implantation location. Knowing more about the location of placental implantation in CSP can help manage and prevent the threatening complications of this disorder. The aim of this study is to investigate the placental implantation location in cesarean scar pregnancies.</span></span></span>

</span> This cross-sectional study was conducted on 44 patients diagnosed with CSP in the first trimester of pregnancy at Imam Khomeini Hospital in Ahvaz from March 2020 to February 2022. Demographic and clinical information of mothers, number of pregnancies and previous cesarean deliveries, and ultrasound results and placental location were reviewed based on the patients' medical records. The location of the placenta was determined and checked based on four anatomical locations in the endometrial cavity by transabdominal ultrasound between the 11th and 14th weeks of pregnancy.</span></span></span>

</span> The mean age of the patients was 33.95±5.09 years. The number of previous cesarean sections was between 1 and 4 and the average was 2.32±0.93. The most common location of the placenta was anterior (61.4%), followed by fundal (29.5%) and posterior (9.1%). The number of previous cesarean deliveries did not have a significant effect on the placental implantation location.</span></span></span>

</span></span> The results of this study showed that although the most common placental implantation location in CSP is the anterior location, the posterior placenta can also be present in scar pregnancy and it is not necessary to be in the anterior placenta to make the diagnosis of CSP.</span></span></span></div>
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</span> Periapical surgery is a reliable method for treating teeth with periapical lesions for which conventional root canal treatment methods are not effective. The aim of this study is to investigate the results of periapical surgical treatment after a follow-up period of one to five years and the factors related to the success rate of the treatment.</span></span></span>
</span> In this cross-sectional study, complete clinical and radiographic examinations were performed on 128 patients who underwent periapical surgery in the endodontics department of Mashhad Dental School. The success of the treatment was evaluated based on radiographic and clinical criteria for three groups: recovered, recovering and non-recovering. The patients were examined in terms of the relationship between the success rate of periapical surgery and the variables of age, gender, type of tooth, type of jaw, presence of post, type of coronal restoration and the presence of preoperative symptoms.</span></span></span>
</span> From a total of 128 patients, 64 patients including 35 women and 29 men were studied. The results showed that the number of successful treatments is higher in women and in anterior teeth, although their difference was not statistically significant. In the age range of 11 to 30 years, all treatments were successful, with a treatment success rate of 89% in the recovered and recovering groups. In addition, there was no statistically significant difference in the success rate of periapical surgery in terms of factors such as the type of jaw, the presence or absence of a post, the presence of symptoms before treatment, and the type of tooth restoration.</span></span></span>
</span></span> The results of this study showed that periapical surgery can be considered as an effective treatment method for patients. In addition, factors such as age, gender, type of jaw, presence or absence of post, presence of symptoms before treatment and type of tooth restoration do not have a significant effect on the treatment result.</span></span></span></div>

</span> Correction of vertical maxillary excess (VME) via superior surgical repositioning of the maxilla can lead to counterclockwise rotation of the mandible along with alteration of jaw relationship and dental occlusion. The aim of this study was to determine the interrelationship between surgical superior repositioning of the maxilla and lower incisors inclination change after mandibular autorotation.</span></span></span>
</span> In this correlational study, 13 patients with Class II malocclusion, mandibular plane angle greater than 27 degrees, and fully-erupted lower second molars were examined. Superior maxillary repositioning of 4mm was simulated on lateral cephalometric radiographs and maxillary dental models. Degree of mandibular autorotation was then predicted on lateral cephalograms, considering radiographic center of the condyle as the center of rotation, and on semi-adjustable articulator, measuring the articulator’s upper arm inclination change in degrees by digital inclinometer. As lower incisors rotate on the same arc of rotation as the mandible, measuring mandibular autorotation also indicates the amount of change in lower incisors’ inclination.</span></span></span>
</span> Mean (standard deviation) values of mandibular autorotation and lower incisors’ inclination change after 4mm superior repositioning of the maxilla were 3.38±0.93 and 2.63±0.83 degrees based on Prediction Planning and Model Planning techniques, respectively. The difference between two methods was statistically significant (p<0.05).</span></span></span>
</span></span> After superior repositioning of the maxilla, the counterclockwise rotation of the mandible causes the retroclination of the lower incisors, which should be considered in the cephalometric prediction before surgery.</span></span></span></div>

</span> Obesity has produced conflicting results on various indices of prostate cancer diagnosis. Since the effect of body mass index (BMI) on Gleason score and prostate specific antigen (PSA) as well as the overall classified risk of prostate cancer results is important, the present study was conducted to investigate the association of BMI and age with Gleason score and PSA in Patients with prostate cancer.</span></span></span>
</span> In this cross-sectional study, 310 prostate cancer patients referred to the affiliated hospitals of Babol University of Medical Sciences from 2011 to 2021 were evaluated in terms of age, height, weight, PSA and Gleason score. Based on BMI, the patients were divided into three groups: obese (BMI≥30), overweight (BMI=25-30) and normal weight (BMI<25) and according to the Gleason score into three low grades (G/S<7), medium grade (G/S=7), high grade (G/S>7) and were divided into three categories based on PSA: 4-10, 10-20 and more than 20. Then, the association of BMI and age with Gleason score and PSA was investigated.</span></span></span>
</span> The mean BMI of the patients was 26.3±3.77 kg/m2</sup>. The mean PSA was 35.72±8.5 ng/dL and the mean Gleason score was 7.1±1.11. The mean Gleason score increased with increasing age (p<0.001, r=0.307). A higher Gleason score had a significant relationship with PSA increase (p<0.001, r=0.485). BMI had no significant association with Gleason score (r=0.072, p=0.102). PSA decreased slightly with increasing BMI (p=0.006, r=0.157).</span></span></span>
</span></span> The results of the study showed that increasing age is associated with a higher Gleason score. But the increase in BMI is not related to increased risk of prostate cancer and increased Gleason score.</span></span></span></div>

</span> Considering the prevalence of gastrointestinal cancers in the region and the importance of helpful criteria in the diagnosis of the disease, the present study was conducted to compare the blood parameters neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) in gastric cancer patients in Mazandaran province and its comparison with non-affected people.</span></span></span>
</span> This cross-sectional study was conducted in 2019 and 2020 on 62 cancer patients referred to Imam Hospital in Sari in the case group and 124 non-patients from the community in the control group. Convenience sampling was used in the case group and random sampling was used in the control group from among the Tabari Cohort Population. The two groups were matched in terms of age and gender. The required data including age, gender, LMR, NLR and PLR for all subjects as well as pathological indices and chemotherapy status were recorded for the case group.</span></span></span>
</span> The gender ratio in both groups was 69.4% males and 30.6% females. The mean age of the examined subjects in the group of cancer patients and the control group was 62.3±12.53 and 51.7±9.02 years, respectively (p=0.105). The mean NLR (2.14 vs. 1.62, p=0.000) and PLR (9.48 vs. 6.27, p=0.000) in the group with gastric cancer were significantly higher than the healthy control group, and the mean LMR (3.42±2.12 vs. 10.9±2.99, p=0.000) was significantly lower than the healthy control group.</span></span></span>
</span></span> The results of high NLR and PLR and low LMR showed that these indices can be used in gastric cancer screening studies.</span></span></span></div>

</span> Retinopathy of prematurity is a complex developmental disease of retinal vessels in premature infants. Improvements in preterm care services are associated with an increased risk of advanced stages of retinopathy of prematurity. The aim of this study is to investigate the effect of treated retinopathy of prematurity in premature infants on ocular structural outcomes.</span></span></span>

</span> This cross-sectional study was conducted on 962 infants with retinopathy of prematurity referred to Al-Zahra Ophthalmology Hospital from 2018 to 2021. Based on the severity of the disease, the patients were followed up or treated with laser and intravitreal injection. In treated retinopathy of prematurity, structural outcomes of the eye were recorded as favorable and unfavorable outcomes. The favorable outcome was considered as regression of plus and new vessels, and unfavorable outcomes were considered as lens opacity and retinal detachment. Birth weight, gender, gestational age, mechanical ventilation, duration of oxygen use, history of radiation therapy, sepsis, respiratory distress, blood transfusion, and age at diagnosis of retinopathy of prematurity were recorded and analyzed for each patient. </span></span></span>

</span> The mean birth weight and gestational age at birth were 1760.65±457.90 grams and 32.37±2.39 weeks. 869 eyes were untreated and 93 eyes were treated. The incidence of adverse outcomes in those who were treated was 5.37%. Logistic regression test showed that gestational age, birth weight, stage of disease and area of retinal involvement had a significant relationship with adverse treatment outcomes (p=0.001).</span></span></span>

</span></span> Based on the results of this study, in retinopathy of prematurity requiring treatment, lower gestational age, lower birth weight, more severe disease stage and more central involvement area should be considered as risk factors for adverse structural outcomes of treatment.</span></span></span></div>

</span> Oral candidiasis is one of the most common oral manifestations of acquired immunodeficiency syndrome (AIDS). This condition affects the patients’ quality of life. This study aims to assess the effect of probiotic dietary supplements on oral Candida albicans (C. albicans) colonization in AIDS patients.</span></span></span>
</span> This randomized clinical trial was conducted on 30 AIDS patients with less than 100 CD4 cells per mm3</sup>, who were under anti-retroviral therapy. The patients were then randomly divided into two groups of intervention and control (n=15), based on their medical file number (even, odd). The intervention group received probiotic tablets (2 tablets/day for 1 month) along with anti-retroviral therapy (ART). The control group only received ART. One mL of saliva was collected from each patient on the first day of study and after intervention and was cultured on Sabouraud dextrose agar to quantify the number of C. albicans colonies in colony forming units/milliliter (CFUs/mL).</span></span></span>
</span> The two groups were initially identical in terms of CD4 count. Nine patients were withdrawn from the control, and 8 patients from the intervention group. Thus, 13 patients were analyzed (4 females, 2 males in the control group, and 4 females, and 3 males in the intervention group). The C. albicans colony count was significantly higher in the test group before the intervention (CFUs/mL=47714±40372, p=0.038). The difference in C. albicans colony count was not significant between the two groups after the intervention. In the control group, the C. albicans colony count did not change significantly (7833±1722 before, 7666±2160 after) while in the intervention group, the number of C. albicans significantly decreased after the intervention (47714±40372 before, 14571±25683 after, p=0.02).</span></span></span>
</span></span> According to the results of this study, it appears that probiotic dietary supplements can decrease C. albicans colonization.</span></span></span></div>

One of the most important factors in the success of anterior composite restorations is color stability in different situations in mouth. The aim of this study was to evaluate the color stability of four anterior composites in the staining solutions (tea and coffee) and under Ultra-Violette (UV) accelerated aging using spectrophotometer.

This in-vitro study was conducted on 80 samples of four composites (Grandio, G-aenial, Kalore and Estelite Σ quick). Samples were divided into four subgroups (5 samples in each subgroup): immersion in coffee (for 48 hours), tea (for 48 hours), distilled water (as the control group) and exposure to UV for 168 hours. The color of the samples was evaluated by the spectrophotometer before and after the various conditions using the CIE Lab system and color changes (ΔE*ab) were calculated.

In all composites, the maximum and minimum levels of color changes were related to the groups immersed in coffee and distilled water, respectively. The significant color change was observed in all subgroups (ΔE*ab>3.3), except for the control groups and tea-Estelite Σ quick (ΔE*ab=2.79). The highest color change was related to immersion in coffee-Grandio (ΔE*ab=9.084) and the lowest observed in immersion in distilled water-Estelite Σ quick (ΔE*ab=0.836). In coffee immersion subgroups of Grandio and Kalore, higher color change was seen compared to Estelite Σ quick (p=0.02 and p=0.028, respectively).

Long-term exposure to tea and coffee and UV accelerated aging leads to clinical color change in Grandio, G-aenial, Kalore and Estelite Σ quick composites.

The COVID-19 pandemic has caused numerous cases of respiratory failure and death. Due to the little information available about the disease treatment, we decided to evaluate the effectiveness of pentoxifylline and colchicine in preventing the progression of the disease to the stage of deterioration in hospitalized patients with COVID-19.

In this double-blind randomized clinical trial, 120 patients (60 in the control group and 60 in the intervention group) with COVID-19 over 40 years of age with moderate and severe disease were examined in Shafa Khorramabad Hospital. The intervention group received pentoxifylline at a dose of 400 mg every 12 hours and colchicine at a dose of 0.5 mg daily in addition to standard treatment, and the control group received the standard treatment regimen alone. In both groups, clinical and laboratory criteria in blood were compared. Also, the duration of hospitalization, the duration of the intensive care unit admission, the rate of recovery (reduction of disease symptoms and increase of blood oxygen), and death were compared.

There was no significant difference between the age, weight, gender, medical history and early symptoms of the two groups. The two groups differed significantly in the number of people hospitalized in the ICU (17 patients, 28.3% in the control group) and (6 patients, 10% in the intervention group) and the number of people with persistent fever (24 patients, 30% in the control group), and (12 patients, 20% in the intervention group) (p<0.05). However, there was no significant difference between the two groups in terms of mortality, clinical and laboratory results.

Based on the results of this study, prescribing the two drugs, pentoxifylline and colchicine, may prevent the critical stage of the disease.

Dental caries is the most common disease worldwide, and is a major healthcare problem. Streptococcus mutans is considered as the main factor causing dental caries. This study was conducted to assess Streptococcus mutans by its 16S rRNA gene and adhesin gene (spaP) as an early predictor of caries development.

This case-control study was conducted on 80 Iraqi pre-school children aged 3-5 years old. Subjects were divided into two groups: the case group, which included 40 children with severe caries, and the control group, which included 40 caries-free children. A dental examination was performed by diagnostic criteria of World Health Organization (WHO). Unstimulated salivary samples were taken from all children, and DNA of Streptococcus mutans was extracted from the all saliva samples. The 16S rRNA and spaP genes were detected using polymerase chain reaction (PCR), and their presence was compared to dental caries severity.

The age and gender of the children had no significant effect in this study. The prevalence of the Streptococcus mutans 16SrRNA gene was 98.8% positive and 1.2% negative in all study groups. Regarding spaP, a significant difference discovered between the case (92.5%) and control (50%) groups (p≥0.05).

The results showed that the presence of spaP gene of Streptococcus Mutans can predict caries development. Therefore, more dental care is emphasized in these people.

Gestational trophoblastic disease refers to a specific range of trophoblast proliferative disorders that originate from the placental epithelium. Recently, hematological indices are being researched and discussed as an easy and accessible method to identify patients and monitor disease progression. Therefore, the present study was conducted to investigate the relationship between the levels of hematological indicators and hydatidiform mole progression.

This cross-sectional study was conducted on 164 patients diagnosed with hydatidiform mole in two groups: complete hydatidiform mole (132 people) and partial hydatidiform mole (32 people). The diagnosis of the disease was made based on the pathology results recorded in the patients' files. Information related to hematological, biochemical and hormonal indices was collected and analyzed.

In general, there was no statistically significant difference between the group of complete hydatidiform mole and partial mole in terms of age, body mass index, uterine size, incidence rate of Theca lutein cyst and cyst size, gravida, parity, miscarriage, and history of previous mole. Of all laboratory markers evaluated (such as WBC, PLT, MPV/PLT, AST/PLT, RDW/PLT), only the mean level of triiodothyronine (free T3) in the complete mole group (1.50±2.40 pmol/L) was significantly lower compared to the partial mole group (1.90±1.30 pmol/L) (p=0.004). Free T3 threshold (1.54±0.87 pmol/L) showed good sensitivity (74.60%), specificity (51.50%) and 50% accuracy to distinguish complete moles from others.

This study showed that a high level of free T3 may be a good marker for the diagnosis of hydatidiform mole, which may be useful in the early detection of moles undetectable on ultrasound.

The need to perform an abortion in the first three months of pregnancy with an effective and safe drug therapy is more important than other methods. The purpose of this study is to compare the effects of letrozole and misoprostol versus misoprostol alone on abortion.

In this clinical trial, 114 candidates for legal abortion in the first trimester of pregnancy were randomly assigned to three groups of 38 people receiving sublingual misoprostol alone with placebo (same amount of letrozole), misoprostol with letrozole 10 mg daily for 3 days and the third group was given misoprostol along with letrozole with a daily dose of 5 mg for 3 days. In addition to the demographic and obstetrical information of the patients, the primary outcome including complete and incomplete abortion, misoprostol dosage and side effects were compared in patients of three groups.

The mean gestational age of the patients was 73.1±9.2 days. A total of 84 (73.7%) patients had complete abortion, including 28 patients (73.7%) in the letrozole 5 mg group, 32 patients (84.2%) in the letrozole 10 mg group, and 24 patients (63.2%) were in the placebo group. In the letrozole 10 mg group, with a statistically significant difference, the rate of complete abortion was higher in them than in the placebo group (84.2 vs. 63.2%, p=0.037). 20 patients in the letrozole 5 mg group, 16 in the letrozole 10 mg group, and all patients in the placebo group received misoprostol, and the difference between the two groups of letrozole 10 mg and placebo was significant in terms of misoprostol intake (p=0.001). The most common side effect in patients of all three groups was nausea and vomiting, which did not have a statistically significant difference between all three groups.

The findings of the present study showed that letrozole 10 mg along with misoprostol is effective in patients who need legal abortion in the first trimester.

Women's self-efficacy makes them feel better about motherhood and improve general health. Incentives for having children are one of the basic solutions for correcting population decline. This study was conducted with the aim of investigating the relationship between maternal self-efficacy and attitude towards childbearing incentives and associated factors.

This cross-sectional study was conducted on 384 women between the ages of 18 and 40 who referred to health and treatment centers of Babol University of Medical Sciences from 2020 to 2022. Data were collected using questionnaires of socio-demographic and fertility characteristics, attitudes towards childbearing incentives and maternal self-efficacy. Childbearing incentives questionnaire included 15 items with a range of scores from 15 to 75 and maternal self-efficacy questionnaire included 9 items with a range of scores from 9 to 45.

The mean age of women was 30.99±5.42 years. The mean number of desired children was 2.20±1.02 and the mean time of the first desired child after marriage was 2.96±1.89 months. The mean score of childbearing incentives was 50.45±15.36 and the mean score of maternal self-efficacy was 31.47±5.72. The results of the multiple linear regression test, after adjusting other variables, indicate the presence of a significant positive association between the attitude towards childbearing incentives and the age of marriage (β=0.177, p=0.001), the desired number of children (β=0.179, p=0.001), and the time of the first desired child after marriage (β=0.116, p=0.029) and there was a significant negative association with the duration of marriage (β=-0.329, p=0.023).

The result of the study showed that childbearing incentives have a positive role on mothers' attitudes toward childbearing. It is suggested that these incentives be considered in the design of programs to increase childbearing.

Multinodular goiter (MNG) is the most common systemic endocrine disease, with a gender ratio (women to men) of 3:1. Incidental thyroid malignancy, preoperatively diagnosed as benign tumor, is a common problem after thyroid surgery. Therefore, the present study was conducted to investigate the role of total thyroidectomy in the diagnosis of types of thyroid cancer after surgery, preoperatively diagnosed as multinodular goiter, and to determine the risk factors of thyroid malignancy in multinodular goiter.

This prospective study was conducted on 120 patients who were divided into malignant and benign groups based on thyroid tumor diagnosis. All patients underwent total thyroidectomy under general anesthesia. Patients were selected based on complete history, clinical examination, laboratory and radiological findings, as well as ultrasound-guided FNA and ultrasound machine used to confirm the diagnosis of thyroid cancer and lymph node metastasis.

Among the 120 selected patients, 20 patients were excluded and the remaining 100 patients were divided into two groups: 13% malignant and 87% non-malignant group, which were involved in nodular hyperplasia, inflammatory and benign tumors. The median age for the malignant group (40 years) was higher than the non-malignant group (30 years). Thyroid carcinoma was diagnosed in 46.2% of men and 53.8% of women (p=0.045). In addition, male gender compared to female gender has 2.7 times the analysis as a risk factor for thyroid cancer (relative risk=2.714).

According to the results of this study, total thyroidectomy in patients with multinodular goiter lowers the risk of reoperation because of the presence of hidden malignancy in this benign disease (MNG). Male gender is an important risk factor for thyroid cancer and age factor has no significant association with thyroid cancer post-operatively. Ultrasonography-guided FNA, ultrasound machine, and clinical examinations are not enough for final diagnosis of thyroid cancer preoperatively.

Head injury is caused by server physical force to the head, and it can be open or closed. In a closed trauma, the skull is not broken, but the impact may damage the brain, skull, scalp and underlying tissue and blood vessels of the head. Therefore, the aim of this study is to find the relationship between head injury and several parameters including the serum level of interleukin-6, interleukin-8 and copper (Cu) in these patients.

This study was conducted at the Neurosurgical Teaching Hospital in Baghdad/Iraq and comprised 60 patients with head injuries in the age range of 20-80 years, who were matched to 30 healthy controls. Five mL blood samples were taken around 8 hours after the injury. Serum IL-6 and IL-8 were measured by the Enzyme Linked Immunosorbent Assay (ELISA), whereas Cu was measured by the Atomic Absorption Spectrophotometer (AAS). The results were compared withween the two groups.

The results revealed that there were no significant differences in age (p=0.169), gender (p=0.434) and BMI (p=0.102) between head injury patients and healthy subjects. The results revealed a significant increase in serum IL-6 (177.45±55.12 & 83.43±22.98) and IL-8 (181.19±61.77 & 49.99±15.32) levels in patients as compared to healthy subjects (p<0.001), and a significant decline in Cu levels in patients (0.84±0.16) compared to the healthy group (1.34±0.15) (p<0.001).

Based on the results of this study, increased levels of interleukins and copper element can be used as markers related to head injury.

Stroke is one of the main causes of death and disability in the world, and its treatment includes the re-supply of blood to the brain tissue using different methods, including alteplase injection. The aim of this study is to determine the outcome of treatment with intravenous alteplase.

This cross-sectional study was conducted on all stroke patients referred to Babol Rouhani Hospital in 2019-2021. Patients were divided into two groups receiving intravenous alteplase and routine and supportive treatment groups. Demographic information and the scores of National Institutes of Health Stroke Scale (NIHSS) to evaluate the improvement of stroke symptoms and Modified Rankin Scale (mRS) to evaluate the severity of disability in three periods of 7, 30 and 90 days were investigated and compared.

Out of 100 studied patients, 49 people were in alteplase group and 51 people were in routine and supportive treatment group. In examining the NIHSS scale of patients in three follow-up periods, there was a significant difference in the alteplase group compared to the routine and supportive treatment group (p<0.001). Moreover, regarding the mRS scale, on the 90th day (0.65±0.80 vs. 1.55±1.11) unlike the 30th day (1.65±1.07 vs. 1.31±0.92), there was a significant difference between the two groups receiving alteplase and the routine and supportive treatment group (p<0.001).

The results of the study showed that treatment with intravenous alteplase can have a suitable effect on neurological disorders after a stroke and can improve the level of disability in daily functioning in the long term, up to the 90th day of patient follow-up.

Methotrexate (MTX) is a chemotherapy drug that has destructive effects on body tissues, including the male reproductive system. Since coenzyme Q10 is an antioxidant that can reduce its destructive effects to some extent, this study was conducted to investigate the effects of the simultaneous use of methotrexate and coenzyme Q10 on testis tissue structure and sperm parameters in male mice.

In this experimental study, 24 male NMRI mice were divided into four groups of six: the control group received 0.2 ml of distilled water intraperitoneally, the MTX group received 20 mg/kg methotrexate once a week intraperitoneally, the CoEnQ10 group received coenzyme Q10 orally at a dose of 200 mg/kg three times a week, and the MTX+CoEnQ10 group, in addition to receiving methotrexate 20 mg/kg intraperitoneally once a week, also received coenzyme Q10 orally at a dose of 200 mg/kg three times a week. All groups were treated for five weeks. After sacrificing the animals, epididymal cauda and testis tissue were sampled and analyzed respectively in order to check sperm parameters and histomorphometry changes and the process of spermatogenesis.

After treatment with MTX, viability, motility, tubule differentiation index, spermatic index, sperm repopulation index, mean seminiferous tubules diameter, seminiferous tubules lumen diameter, and germinal epithelium height decreased significantly compared to the control group (p<0.05). Furthermore, the treatment with MTX significantly led to DNA damage, an increase in the mean diameter of the testicular capsule and the percentage of tubular degeneration, and an increase in the number of abnormal sperms compared to the control group (p<0.05). Simultaneous use of coenzyme Q10 with MTX resulted in significant improvement of the mentioned parameters.

The results of the present study showed that MTX has a negative effect on the metabolic activity of sperm, integrity of membrane and DNA, causing a decrease in sperm parameters and changes in testicular tissue and the process of spermatogenesis. Significant improvement of coenzyme Q10 and MTX co-administration enhances the protective effect of coenzyme Q10.