مجله دانشگاه علوم پزشکی مازندران
پیاپی 224 (شهریور 1402)

Post-traumatic stress disorder (PTSD) is a psychotic disorder that occurs in people who have faced with various types of stressors. However, the efficacy of drug and psychotherapy methods, even in combination is still low. Therefore, complementary treatments are being researched. The relative improvement of PTSD has been observed with the use of Serotonin Selective Reuptake Inhibitors (SSRIs). The effect of exercise has also been determined in improving physical and mental health. But the appropriate exercise intensity is still in question. Therefore, the aim of this study was to investigate the effect of intense exercise, fluoxetine, and their combined treatment on behavioral, molecular, and cellular damages caused by a standard model of PTSD.

Single prolonged stress (SPS) was used as a model to induce PTSD. Exercise (1 hour, 15 m/min) was planned for five days per week and fluoxetine (10 mg/kg/day) dissolved in drinking water was administered for four weeks. After performing the anxiety test, the animals were killed under deep anesthesia and blood samples were collected to measure IGF-1 serum levels by ELISA method and prefrontal cortex was frozen to measure apoptotic factors by RT-PCR method.

SPS rats showed increased anxiety levels and decreased serum IGF-1 levels. Increased Bax and Caspase-3 mRNA expression, and decreased Bcl2 mRNA expression were found in the prefrontal cortex. Exercise, fluoxetine, and their combined intervention increased IGF-1, decreased the expression of pro-apoptotic factors, and increased the expression of anti-apoptotic factors. The results showed that the combined intervention of exercise and fluoxetine could reduce the anxiety caused by SPS.

Considering that fluoxetine was more effective in comparison with high-intensity exercise, it is clear that in the groups that were affected by both interventions; fluoxetine played a more significant role.

Electroconvulsive therapy (ECT) is commonly used in the treatment of psychiatric patients. However, it may cause cognitive disorders in patients undergoing the procedure. The aim of this study was to investigate the effect of memantine on the alleviation of cognitive impairments in patients undergoing ECT.

In this triple-blind clinical trial, 60 patients with depression phase of unipolar or bipolar non polycystic disorder were randomly divided into two groups of 30. In the treatment group, the patients received memantine for the whole period of treatment starting 24 hours before ECT (starting dose 10 mg/day, increased to 20 mg/day within one week) and continuing until the sixth session of ECT. In the control group, the patients received the placebo. The cognitive performance of patients was assessed using the Mini Mental Status Examination (MMSE) and the Addenbrooke's Cognitive Examination (ACE) 24 hours before the first ECT session, 24 hours after the sixth ECT session, and one month after the end of the ECT sessions. The study lasted 1.5 years.

The MMSE score at the end of the study period (one month after the completion of ECT) in the memantine group was significantly higher than the control group (P=0.008). However, there was no significant difference between the scores of ACE-R between the two groups after ECT. No significant relationship was found between the two groups in any of ACE-R items.

According to the MMSE test, it seems that memantine reduces cognitive disorders in patients receiving ECT, but this finding was not observed in ACE-R.

Many obese people have different psychological symptoms such as anxiety, depression, emotional regulation problems, etc., food addiction is also another psychological problem associated with obesity. In this research, for the first time, we investigated the effect of mindfulness-based stress reduction (MBSR) treatment on anxiety, depression, difficulty in emotional regulation, and food addiction in obese people.

In this clinical trial, 40 obese women were selected from urban health centers in Kashan, 2018. They were recruited using purposive convenience sampling. They were then randomly divided into an intervention group (MBSR, n=20) or a control group (educational session without any treatment, n=20). The MBSR was implemented according to the Kabat Ziin protocol during weekly sessions of 90-minute for eight weeks. The participants were evaluated at pre-test, post-test and three-month follow-up using the anxiety, stress, depression scale (DASS-21), difficulty in emotion regulation scale (DERS), and the Yale food addiction scale (YFAS). Data analysis was performed applying repeated measures ANOVA in SPSS16.

The intervention group was found with a significant reduction in the levels of anxiety (P<0.01), depression (P<0.000), difficulty in emotional regulation (P=0.02), and severity of food addiction (P=0.003) compared to the control group at post-test. At follow-up, we observed significant reduction in the levels of anxiety, depression, and food addiction (P=0.003), but emotion regulation did not show a significant reduction compared to the control group (P>0.05).

Mindfulness-based stress reduction treatment could be considered as a part of comprehensive medical care for obese people.

Metabolic syndrome is characterized by a cluster of symptoms including insulin resistance, blood pressure, abdominal obesity, defects in glucose metabolism, and dyslipidemia. Considering the increasing prevalence of cardiovascular diseases and metabolic syndrome, the aim of the present study was to investigate the relationship between metabolic syndrome and its criteria with cardiovascular diseases.

The present study was a case-control study that utilized the results of the enrollment phase of the Tabari cohort study. The case group (304 individuals) was randomly selected from participants with cardiovascular diseases (564 individuals). The control group (304 individuals) was randomly selected from among other participants who were matched by age and sex. The comparison of variables between the two groups was done using the chi-square test. Logistic regression test was used to adjust the effect of confounding variables.

Patients with metabolic syndrome were 69.1% (210) in the case group and 55.6% (169) in the control group (P=0.001). The results of the univariate regression test showed that the chance of developing metabolic syndrome in people with cardiovascular diseases was 1.755 times more than people without cardiovascular diseases (95% CI: 1.280-2.418, and P=0.01). Among the diagnostic criteria of metabolic syndrome, the chances of high blood pressure, high triglyceride levels, and decreased HDL were significantly higher in the case group compared to the control group.

The risk of metabolic syndrome is significantly higher in people with cardiovascular diseases compared to the ones without cardiovascular diseases. After adjusting for confounding factors, we found a significant difference between triglyceride level and blood pressure in the two groups.

The risk of hypertension is increased as people get older. Hypertension and overweight/ obesity are highly prevalent in Iranian older adults and there are limited studies on the association between high blood pressure and visceral fat in this population. This research was conducted to evaluate the correlation between hypertension and visceral fat in older adults.

This case-control study was carried out using the records of people aged ≥ 60 years who enrolled at Phase II of the Amirkola Health and Ageing Project (AHAP). People with hypertension (case group) and those without hypertension (control group) were matched for age and gender. Physical activity was measured using the Physical Activity Scale for Elderly. Visceral fat level was measured by a density meter device.

Out of 700 senior adults, half were found with hypertension. No significant difference was observed between the two groups in age (P=0.684), body shape index (P=0.691), and physical activity (P=0.308). But, a significant difference was observed in mean waist circumference (P<0.001), body mass index (P<0.001), waist circumference to weight ratio (P<0.001), and visceral fat (P<0.001) between the two groups. There was a significant positive correlation between blood pressure and the levels of visceral fat, body mass index, waist circumference, and waist to height ratio in older males and females. Body mass index in male (P<0.001, AUC=0.710) and visceral fat level in female participants (P<0.001, AUC=0.626) were considerably correlated with hypertension.

This study revealed a significant direct correlation between blood pressure and visceral fat level, body mass index, waist circumference, and waist to height ratio in older male and female population. Body mass index in male and visceral fat level in female older adults were strongly associated with hypertension.

Investigation for an accurate, reliable, and non-invasive method for assessing volume responsiveness in septic shock patients is of high priority in the emergency department. Carotid artery Doppler sonography can be easily performed at the bedside. Therefore, this study used carotid Doppler sonographic parameters to determine and evaluate the need for volume in patients with septic shock.

The present single-center, prospective, observational study was performed on all patients with septic shock admitted to emergency department during the study period. Vital signs, diameter of the inferior vena cava (IVC), and the carotid Doppler peak velocity (CDPV) were evaluated on arrival and two hours after resuscitation. Data description and analysis were done using SPSS.

Forty-four patients enrolled in this study, of which 30 (68.2%) were men. The average age of these patients was 62.55±17.91 years.The findings indicated a statistically significant increase in IVC min (P=0.016), CDPV max (P=0.001), and ΔCDPV (P<0.0001) in patients after two hours of treatment.

Carotid Doppler sonographic parameters can be implemented, as a dynamic criterion, to determine the fluid responsiveness in patients.

This study investigated the relationship between oral health related quality of life and hyposalivation and dry mouth in patients with chronic renal failure (CRF) undergoing hemodialysis.

This descriptive-analytical study was conducted in 200 patients with CRF undergoing hemodialysis attending the dialysis department in Sari Imam Khomeini Hospital, 2021. Patients completed oral health-related quality of life questionnaires (OHIP-14) with additive and simple count assessment methods. To diagnose dry mouth, unstimulated saliva was collected and patients were asked nine questions, of which five positive answers indicated dry mouth. Data analysis was done in SPSS V18. Pearson's or Spearman's correlation coefficient were applied to investigate the association between quality of life score and unstimulated salivary flow, and t-test or Mann-Whitney test were used to compare the quality of life scores between the groups with and without dry mouth.

Hyposalivation was observed in 66 patients (33%). The OHIP-14 score was significantly higher in both additive and simple count methods in patients with dry mouth and hyposalivation (P<0.05). Comparing different variables, the findings showed that 66.7% of the patients with hyposalivation were older than 58 years of age (P=0.007). In addition, 60.6% of patients with dry mouth had diabetes (P=0.01).

Dry mouth and hyposalivation reduce the quality of life in patients with CRF undergoing hemodialysis. Also, dry mouth and hyposalivation were relatively common problems in these patients. The treatment of these problems is necessary because of their impact on patients' quality of life.

Psoriasis is a systemically pathogenic immune-mediated, chronic inflammatory disease that mostly affects the skin. Ocular diseases, which are frequently nonspecific or just slightly bothersome in psoriasis, are not well-known. This study investigated ocular manifestations in patients with psoriasis.

This cross-sectional study was conducted at Bu-Ali Sina hospital in Sari, Iran. Seventy-five patients with psoriasis matched by age and sex with 75 non-psoriatic controls were examined. Dermatology life quality index (DLQI) and psoriasis area and severity index (PASI) scores were calculated for every patient with psoriasis. Ocular surface disease index (OSDI) was measured in both groups. We did a slit-lamp examination, Schirmer I test, tear breakup time (TBUT) and fundoscopy in both groups.

The mean age of patients was 40.11±13.88 years. The most common findings on our examinations were conjunctival hyperemia (38%), blepharitis (36%), MGD (33%), and pinguecula (26%). MGD and low TBUT were more common in patients with higher PASI and DLQI scores. OSDI score was also higher in patients with psoriasis.

Ocular surface conditions such as dry eye were more common among the participants and were correlated with duration and severity of the disease. Therefore, psoriasis patients should get frequent and routine eye exams to detect ocular disorders quicly and avoid their unintended effects.

Ventilator-associated pneumonia (VAP) is of special importance among nosocomial infections. We aimed to study the bacterial profile of VAP and their drug susceptibility pattern among intensive care unit patients at teaching hospitals affiliated with Mazandaran University of Medical Sciences.

In this retrospective cross-sectional study, the records of patients in the intensive care unit with ventilator-associated pneumonia were reviewed. After the growth of the bacteria, the colony identification of the grown bacteria were done based on microbiological and biochemical standard tests. To investigate the antimicrobial susceptibility pattern of isolates, the disk diffusion method was used according to the CLSI guidelines.

Out of 107 patients, 14 (13%) had a history of hospitalization over the last three months. The most common underlying diseases were ischemic heart disease (IHD), hypertension, and diabetes. The most common causes of hospitalization included cardiac diseases, COVID-19, and sepsis. The most common microorganism isolated was Enterobacter (23.4%), and the least abundant microorganisms were Proteus (n=1) and Staphylococcus saprophyticus (n=1). In general, colistin was the most sensitive among the examined gram-negative organisms.

Identifying the pattern of antibiotic resistance and the risk factors for ventilator-associated pneumonia are effective in delivering more efficient treatments and reducing the complications of this disease. Local epidemiological data should be collected at all centers as this information guides the initial empirical treatment with antibiotics, thereby preventing the development of more resistant strains. All these measures will reduce the morbidity and mortality of ventilator-associated pneumonia.

Adverse drug reaction (ADR) is one of the main causes of mortality and morbidity and can contribute to high costs in healthcare system of a country. This study was conducted to evaluate ADRs in the Food and Drug deputy at Mazandaran University of Medical Sciences.

This retrospective descriptive study was carried out after collecting the reports of yellow cards sent to the Center for Registration and Investigation of Adverse Drug Reaction in the Food and Drug Deputy of Mazandaran and the reports registered in the online system for registering medical complications and errors in 2019-2021. We analyzed data, including the frequency of the drugs with side effects, the frequency of routs of administration, number of reports per year, patient characteristics (gender and age), as well as the frequency of the organs damaged, and the reporters.

A total of 2122 reports of adverse drug reactions were submitted to the Adverse Drug Reactions Center at Mazandaran Food and Drug Department. Nurses reported 52.78% of the side effects and 44.82% of the ADRs were seen in women. Injectable drugs were found with high rate of ADRs (87.40%) and the most prevalent side effects were associated with skin and hair disorders (28.07%). Anti-infective agents were the most common drugs that caused ADR (47.10%) and Vancomycin was found to be more prevalent than other drugs.

Adverse drug reactions were reported at a good level in Mazandaran province. It is believed that training the medical staff about pharmacovigilance and appropriate reporting, will bring us closer to world standards.

Depth perception (stereopsis) is the ability to perceive depth in visual space through sensory integration of retinal images in both eyes and is achieved through binocular perception in specific visual pathways in the cerebral cortex. Medical students use a variety of diagnostic tools during their training, and a lack of normal stereoacuity can affect their professional performance. Understanding the appropriate stereopsis also plays a crucial role in their future careers. The purpose of this study was to determine stereopsis using the Titmus test in subjects with and without refractive errors.

In this cross-sectional study, 115 students at Mazandaran University of Medical Sciences who met the inclusion criteria were randomly selected. Based on the presence or absence of refractive errors through retinoscopy, they were divided into symptomatic and asymptomatic groups. The stereopsis was measured by the Titmus test. Data were analyzed in SPSS V 21, and the frequency of stereoacuity was reported.

A total of 115 people enrolled in this study. Males accounted 55.7% (n=64) of the subjects and 44.3% (n=51) of the subjects were females. The mean age of male and female participants were 25.20±1.88 and 24.15±1.79 years, respectively (P>0.05). There were 40 (34.8%) students with refractive errors and 75 (65.2%) without refractive errors. The mean values for stereopsis in symptomatic and asymptomatic subjects were 42.90±29.59 and 29.24±12.96 seconds/arc, respectively(P=0.001). These values in males and females were 32.12±20.73 and 36.33±21.85 seconds/arc, respectively (P=0.293). The mean test time was 57.75±18.43 and 56.0±18.49 seconds in symptomatic and asymptomatic subjects (P=0.629), and 54.45±17.82 and 59.31±18.94 seconds in males and females (P=0.160), respectively.

Titmus stereo test was found to be an effective test for evaluating the depth perception of symptomatic and asymptomatic subjects. There was no difference in the stereopsis between males and females in this study.

Human health is negatively affected by increase in concentration of carbon dioxide in indoor air due to the lack of proper ventilation. The aim of this study was to remove carbon dioxide from a closed space using sodium hydroxide nanofluid and determining the effect of absorbent concentration, carbon dioxide concentration, and titanium dioxide nanoparticles.

The experiments were conducted in a closed chamber on a laboratory scale. An air suction pump was connected to the absorption reactor and the carbon dioxide measuring device was installed inside the chamber. By injecting carbon dioxide gas inside the chamber, different concentrations in the range of 500, 2000 and 5000 ppm were created. Sodium hydroxide absorbent solution at 0.1, 0.2, and 0.4% were examined. Titanium dioxide nanoparticles (0.008%) and surfactant (0.003%) were used to prepare nanofluids. The absorption fluids’ pH, electrical conductivity, and total inorganic carbon (TIC) were measured before and after carbon dioxide absorption.

By using 0.4% sodium hydroxide solution containing 0.008% titanium dioxide nanoparticles, the carbon dioxide removal efficiency at 500 and 5000 ppm were 72% and 44%, respectively, that were higher than the solution without nanoparticles (20% and 10%, respectively). At 5000 ppm carbon dioxide, increasing the concentration of absorption solution from 0.1 to 0.4% doubled the removal efficiency. The average amount of total inorganic carbon (TIC) in nanofluids increased by about 20% compared to the base fluids. The average reduction of EC in nanofluid was about 25% higher than the base fluid. The average reduction in pH value was less than one unit.

Sodium hydroxide nanofluid containing 0.008% of titanium dioxide nanoparticles is effective in removing carbon dioxide from the air.

Hypoxia can lead to body function impairment. It is linked to the pathology of acute mountain sickness, cardiovascular disease, and stroke. Colchicine, an anti-inflammatory drug, is used chiefly in treatment of gout, but it is also valuable in other inflammatory conditions. Preliminary data shows that colchicine has beneficial effects on COVID-19. Nothing is known about the protective effect of this drug against hypoxia-induced lethality in mice.

Protective effects of colchicine against hypoxia-induced lethality in mice at 0.5, 1, and 1.5 mg/kg, P.O. were evaluated in three experimental models of hypoxia.

Colchicine showed good activity in some models. In the circulatory model, at 0.5 mg/kg, it significantly prolonged mice survival time for 4.5 min (P<0.05). At this dose, it showed similar activity to propranolol 30 mg/kg which was used as the positive control. At 1.5 mg/kg, it was more effective than propranolol (P<0.0001). In the haemic antihypoxic model, colchicine at 1 mg/kg, significantly increased survival time and showed the same activity as propranolol (P>0.05). In the asphyctic model, colchicine did not show any activity.

Colchicine showed good protective effects against hypoxia in circulatory and haemic models where the drug at 1.5 mg/kg, was more effective than the positive control, propranolol at 30 mg/kg.

Recurrent aphthous stomatitis (RAS) is one of the most common recurrent ulcers in the oral mucosa and its etiology is not yet elucidated, but the immune system dysfunction and oxidative stress may play a role in the pathogenesis of RAS. Selenium has regulatory role in the immune system and oxidative stress. This study aims to compare serum levels of selenium between patients with RAS and healthy controls.

This case-control study was performed in 50 patients with minor RAS and 53 healthy controls that were matched for age and sex. Blood samples were obtained from all participants and selenium serum levels were measured. Data were analyzed in SPSS V17 applying independent sample t-test and Chi-square.

The average age of the controls and case group was 34.77±8.21 and 37.68±9.69 years, respectively and women included 67.9% and 74%, respectively .The mean serum level of selenium in the control group (49.16±17.03 µg/L) was significantly higher than that of the case group (31.09±17.74µg/L) (P<0.001).

Serum levels of selenium are lower in patients with RAS than healthy controls.

Coronaviruses are a large family of viruses that cause severe respiratory infections. About 15% of affected patients need hospitalization. By the high number of COVID-19 patients in need of hospitalization a high percentage of beds are occupied, so the management of hospital beds seems necessary.

A descriptive-analytical study was carried out between June 22 and August 22, 2021 in 40 hospitals under the auspices of Mazandaran University of Medical Sciences. Data were extracted from the Patient Information System and the records of patients with COVID-19 who received injectable drugs according to the national treatment protocol for temporary hospitalization. Descriptive statistics were applied in Excel 2010 and SPSS V24.

Total number of COVID-19 patients was 34,835 of whom 14,415 (41.38%) were admitted as temporary patients. Among these, 1802 (12.50%) were permanently hospitalized, of whom 12,536 (86.96%) were discharged with relative improvements and 77 (0.54%) patients died. Most patients aged 41 to 60 years old (44.16%).

The national treatment protocol for temporary hospitalization was found to be highly efficient during crisis and can help in bed management, human resources, surge capacity, and reduce many of the costs of the health system.

Crimean-Congo hemorrhagic fever (CCHF) is one of the viral hemorrhagic fevers caused by Nairovirus group. Epidemiological investigation and clinical symptoms of the disease in each region can help to identify disease-prone foci and early diagnosis of the disease in epidemic cases. Therefore, the purpose of this study was to investigate the clinical, epidemiological, and laboratory symptoms of patients with CCHF in Mazandaran province in 2014-2018.

In this cross-sectional epidemiological survey, 135 patients with proven CCHF in Mazandaran province were enrolled in a census manner. The clinical, epidemiological, and laboratory findings in these patients were determined.

In this study, 23% were younger than 30 years of age and 80.7% were men. In hospitalized patients, 33.3% had high risk jobs linked to the disease and 39.3% had livestock exposure. The patients were most affected in spring (45.9%) and summer (42.2%) and less during fall (5.9%), and winter (5.9%). Clinical manifestations, including fever, rash, abdominal pain, bleeding, epistaxis, headache, musculoskeletal pain, cough, and menorrhagia were observed in 88.1%, 11.1%, 23%, 28.9%, 7.4%, 52.6%, 69.7%, 0%, and 0% of the infected subjects, respectively. Thrombocytopenia were seen in 51.9% of the patients and about other laboratory results there were no any specific findings in 29.6%. According to laboratory findings, LFT raise, anemia, leukopenia, leukocytosis, LTF raise plus anemia, and LFT raise plus leukopenia were seen in 13.3%, 5.2%, 27.4%, 9.6%, 3.7%, and 11.1%, respectively.

According to the present study, although the clinical, epidemiological, and laboratory findings in CCHF cases in Mazandaran province are similar to other studies worldwide, so, the regular analysis of CCHF patients is highly recommended.

Nosocomial infections are considered as a significant problem in medical centers, causing a high mortality rate among hospitalized patients, increasing the duration of hospitalization and treatment costs. Most nosocomial infections are caused by gram-negative bacteria. These bacteria are resistant to a wide range of antibiotics through changing their genetics and structure. The purpose of this study was to investigate the prevalence and pattern of antibiotic resistance of nosocomial bacterial infections at Imam Khomeini Hospital in Sari, during 2019.

This retrospective descriptive cross-sectional study was performed at Imam Khomeini Hospital in Sari during 2019. All isolated positive samples were selected from hospitalized patients. Antibiotic resistance pattern was investigated using disk fusion method (Kirby-Bauer).

In this study, the most frequent nosocomial infection was observed in the intensive care unit (ICU), with respiratory infection (42%), as the most frequent one, caused by Escherichia coli (25%) with the highest resistance to ciprofloxacin.

The findingins showed that gram-negative bacteria, more specifically those resistant to cephalosporins, are the most common cause of nosocomial infections. Irrational and imprudent prescription of cephalosporins and carbapenems may be a significant contributor to antibiotic resistance and the main challenge for treating.

Acute ischemic stroke is one of the main causes of death and long-term disability worldwide. Prehospital emergency diagnosis and subsequent transfer of stroke patients to the nearest stroke center for starting an appropriate treatment are critical steps in stroke rescue chain. In Iran, emergency medical technicians implement the SAMA code, following the diagnosis of acute stroke using FAST protocol, to manage the patients.

This retrospective cross-sectional study was conducted on patients who were referred to the prehospital emergency department of Hazrat Rasool Akram Hospital with the announcement of the SAMA code in 2019. The aim of this study was to evaluate the positive predictive value of the prehospital emergency technicians in the announcement of the SAMA code.

Of the 95 patients referred with the SAMA code, 19 patients diagnosed with hemorrhagic stroke (based on brain CT-scan) were excluded from the study. In 17.1% of the remaining 76 patients, diagnoses other than acute ischemic stroke were proposed. Ultimately, diagnosis of acute ischemic stroke was confirmed in 63 patients, and 25% of them were eligible for intravenous thrombolytic therapy, however, merely 5.26% of the eligible patients received the treatment. The positive predictive value of prehospital emergency service in referring patients diagnosed with acute ischemic stroke was determined to be 86.3%. Additionally, the positive predictive value for identifying acute cerebral stroke patients eligible for intravenous thrombolytic therapy was calculated to be 25%.

This study revealed that prehospital emergency's positive predictive value for acute ischemic stroke identification was adequate. However, activating the SAMA code with greater diagnostic accuracy can save time and costs.

Cleft lip and palate as one of the most common congenital malformations of the oral cavity is affected by genetic and environmental factors. Subsequent aspiration during feeding, aesthetic, speech, or functional problems, and dental malformations are the main problems of neonates born with cleft lip and palate. The management of neonates with cleft lip and palate has been remarkably improved in recent years. The use of modern surgical techniques and its combination with such methods as presurgical nasoalveolar molding (NAM) is on the rise. The efficacy of preoperative casting in repairing deformed nasal cartilage in neonates with cleft lip and palate has been confirmed based on the literature. Here, we present the case of a 20-day-old neonate with bilateral cleft lip and palate who underwent presurgical nasoalveolar molding to facilitate feeding and recover facial appearance. The bony cleft of maxillary segments in the child was molded and repositioned with a combination of extra-oral elastic and intra-oral appliances. Elastic forces caused backward pressure against the protruding pre-maxilla  and careful use of forces on the cleft segments improved their positions and allowed definitive muscles and lip repair. In this technique, a nasal stent was attached to the intra-oral mouth plate and was designed to improve nasolabial anatomy.

Vocal nodules are the main cause of voice disorders in children, which can be caused by several behaviors such as excessive speaking and yelling, and can significantly impact their overall communication development. Different nonmedical treatments exist for vocal nodules, but there is no consensus on the most effective methods. The aim of the present systematic review was to study the nonmedical interventions for vocal nodules in children.

The systematic search was performed in electronic databases, including PubMed, Scopus, Science Direct, ISI (Web of Science), Cochrane Database of Systematic Reviews, and Google Scholar. The search involved articles published between 2000 and 2022. The following terms were used as keywords: vocal nodule, vocal fold nodules, therapy, treatment, intervention, voice disorder, pediatric, and telepractice. Studies were selected if they 1) had examined 0-18-year-old subjects with vocal fold nodules; 2) had obviously stated the kind, process, and evaluation tools and also 3) the kind and the process of the interventions and the intervention groups; 4) had provided nonmedical interventions; 5) had been published in English and after 2000; and 6) presented the outcome data.  The methodological quality of the papers was evaluated using the Physiotherapy Evidence Database scale.

We identified 729 articles, of which 11 met the inclusion criteria. These studies were different in the study design, participant characteristics, types of assessments, types of interventions, and follow-up periods. According to findings, nonmedical treatments of vocal nodules were successful in elimination of/decreasing the vocal nodules sizes (four studies), improving the quality of life (two studies), and improving acoustic parameters of voice (nine studies).

The present systematic review showed the effectiveness of nonmedical treatment of vocal nodules in children, despite being challenging. Further researches are required to have higher levels of evidence, more accurate methodological quality, and long-term follow-up evaluations to draw more accurate conclusions.

Plants have been known and used by different societies since ancient times. The most important applications include nutrition, medicine, and industry. Acorus calamus L. (Acoraceae), is one of the medicinal plants that exists in the Iran and some other ecotypes and is used as a medicinal plant also in China, India, and Greece. Recently, it received attention, however there is lack of information about this medicinal plant. 

We performed a search in Scopus, Web of Science, PubMed, and Google Scholar and also traditional medicine books using the following keywords: A. calamus, traditional medicine, modern medicine, laboratory studies, and biological effects.

In reliable articles and traditional medicine books, A.calamus was found with many different properties. The aerial parts, roots, and rhizome were reported to have antioxidant, antibacterial, anti-fungal, and anti-inflammatory activities. A.calamus is also used in treating nervous system disorders and in production of nanoparticle and pharmaceutical products.

According to many studies, A. calamus has many beneficial properties, but in vitro and in vivo studies are required to investigate its medicinal effects. Also, the plant is originally found in Mazandaran province, north of Iran and it can be used in medicinal and health products.