Heat waves and adaptation: A global systematic review.

BACKGROUND: Given the increasing trend of global warming and extreme weather conditions, including heat waves and its effects on health, the present study was done to investigate adaptive behaviors of communities in the world for combating heat waves. METHOD: ology: In this systematic review, out of 1529 results, 57 relevant and authoritative English papers on adaptation to heat waves hazard were extracted and evaluated using valid keywords from valid databases (PubMed, WOS, EMBASE, and Scopus). In addition, multiple screening steps were done and then, the selected papers were qualitatively assessed. Evaluation results were summarized using an Extraction Table. RESULTS: In this paper, the adaptive behaviors for combating heat waves hazard were summarized into 11 categories: Education and awareness raising, Adaptation of critical infrastructure, Governments measures, Health-related measures, Application of early warning system, Protective behaviors in workplace, Physical condition, Adaptive individual behaviors, Design and architecture of the building, Green infrastructure (green cover), and Urban design. CONCLUSION: The findings of this study showed that community actions have significant effects on adaptation to heat wave. Therefore, for reducing heat wave-related negative health effects and vulnerability, more attention should be paid to the above-mentioned actions for mitigation, preparation, and responding regarding heat waves. PROSPERO REGISTRATION NUMBER: CRD42021257747.

Setting the policy agenda for the treatment of substance use disorders in Iran.

BACKGROUND: Drug use is one of the most common public health problems globally. This study was done to analyze the agenda-setting of policies related to substance use disorder treatment in Iran since 1979. METHODS: The current qualitative study was done through document review and interviews with policymakers and executives. Purposive sampling with snowball strategy was considered for sampling. Semi-structured interviews were done. A total of 22 documents were examined, and the data were saturated with 32 interviews. Kingdon's Multiple Streams Framework was used to analyze the data. RESULTS: The results indicated the intersection of problem stream, policy stream, political stream, and opening the opportunity window. In the problem stream, the rapid growth of AIDS among people who inject drugs (PWID), the decrease in the average age of first drug use, the increase in the prevalence of substance use disorder in women, the ineffectiveness of compulsive treatment, and criminological perspectives played key roles. The policy stream included criminological perspective and war on drugs, and harm reduction. The political stream included announcing general anti-narcotics policies by the Supreme Leader of Iran and understanding the need for treatment, rehabilitation, harm reduction, and social support for substance use disorder by officials and policymakers. CONCLUSIONS: For a long time in Iran, policies based on the war on drugs were the dominant approach, and then, policies based on harm reduction and patient-centeredness were considered. The ideology and political parties influenced the executive apparatus's policy stream in this area. In countries with an ideological approach, the political stream plays a critical role in setting issues on the agenda. Therefore, policy entrepreneurs can put the points on the agenda by attracting the attention of political forces to the issue.

Development and validation of a questionnaire to determine medical orders non-adherence: a sequential exploratory mixed-method study.

BACKGROUND: Patients' non-adherence with medical orders of physicians in outpatient clinics can lead to reduced clinical effectiveness, inadequate treatment, and increased medical care expenses. This study was conducted to develop and validate a questionnaire to determine the reasons for patients' non-adherence with physicians' medical orders. METHODS: A sequential exploratory mixed-method study was conducted in two stages. The first stage comprised a qualitative stage to generate the primary items of the questionnaire. This stage provided findings of two sub-stages comprising a literature review and the findings of a qualitative conventional content analysis of 19 semi-structured interviews held with patients, physicians, and managers of the outpatient clinics in Kerman, an area located in southeastern Iran. The second stage comprised a quantitative study aiming evaluation of the instrument psychometric properties, including the face, content, construct, and reliability assessment of the questionnaire. Construct validity assessment was evaluated using exploratory factor analysis (EFA). The reliability assessment was done using assessing internal consistency (Cronbach's alpha). To assess the construct validity of the questionnaire, four hundred and forty patients referred to outpatient clinics in Kerman were selected using stratified convenience sampling to fill out the questionnaire. The sample size was calculated using the Cochran formula. Qualitative and quantitative data were analyzed by MAXQDA 10 and Stata version 14, respectively. RESULTS: The primary items contained 57 items, of which 42 met the minimum acceptable value of 0.78 for item-level content validity index (I-CVI = 1 for 24 items and I-CVI = 0.8 for 18 items). Item-level content validity ratio (I-CVR) was confirmed for 18 items with a minimum acceptable value of 0.99 for five experts. Finally, 18 items obtained the acceptable value for both I-CVI and I-CVR indicators and were confirmed. Using EFA, four factors (intrapersonal-psychological, intrapersonal-cognitive, provider-related, and socio-economic reasons) with 18 items and Cronbach's alpha coefficient of 0.70, 0.66, 0.73, and 0.71, respectively, were identified and explained 51% of the variance. The reliability of the questionnaire (r = 0.70) was confirmed. CONCLUSION: The questionnaire with four dimensions is a valid and reliable instrument that can help determine the perceived reasons for non-adherence with medical orders in the outpatient services system.

Effective factors in non-compliance with therapeutic orders of specialists in outpatient clinics in Iran: a qualitative study.

BACKGROUND: Non-compliance with prescribed treatment is an important cause of preventable mortality and economic burden. Recognition of the factors for non-compliance with the therapeutic orders of specialists from the perspective of patients and health care providers sheds more light on the issue for policymakers and stakeholders. The current study aimed at determining the factors for non-compliance with therapeutic orders in outpatient clinics in Kerman, Iran. METHODS: The current qualitative study was conducted using the phenomenological method and semi-structured interviews with 10 patients, five specialists, and four health care managers and treatment officials in outpatient clinics in Kerman. The interviewees were selected by purposive sampling. The codes extracted from the interviews were transcribed using conventional content analysis to identify the viewpoints. The MAXQDA 10 software was used to analyze the data. RESULTS: The reasons for non-compliance with specialists' orders were categorized into five themes including patient-related (patient-centered), disease-related, therapy-related, the healthcare provider related (healthcare system), and socioeconomic factors. Themes were composed of fifteen categories and forty-one sub-categories. The dominant sub-categories extracted from interviews were health literacy and knowledge of the patient, communication and patients' trust in physicians and direct costs of treatment. CONCLUSION: This study identified a wide range of different individual, disease, treatment, health care provider, and socio-economic factors and the interactions between them which may result into non-compliance with therapeutic orders prescribed by specialists. Therefore, specific attention should be paid to integrate the service provision system into the collaborative approach of the patient and his/her family in order to promote the level of compliance with therapy and care in planning and policy-making to improve the health service provision system.

Psychometric Properties of the Persian Version of the God Locus of Health Control (GLHC): A Study on Muslim Pilgrims.

God Locus of Health Control (GHLC) scale is an instrument for assessing to what extent one believes that God controls his/her health or disease. The aim of this study was to describe the cultural adaptation of this scale and to investigate the psychometric properties of Persian version. At first, the scale was forward-translated to Persian, and then, backward-translation was conducted. Finally, the synthesized back-translated version was prepared and compared to the draft Persian-language version of the GLHC. In the next step, in order to test cognitive debriefing, the Persian-language version of the questionnaire was completed by 20 pilgrims. Final version of Persian GHLC scale was answered by 600 pilgrims attending religious holy places. Mean age of respondents was 33.15 (±11.04) years. There was a positive correlation between six items of GLHC scale and inter-item correlation coefficients. The Cronbach's alpha coefficient was 0.84. Exploratory factor analysis showed that the G LHC scale had a one-factor structure. The factor loadings for all items ranged from 0.57 to 0.77. Residual correlations of all items were between -0.2 and +0.2. The people with lower income had significantly higher score of GLHC scale. GLHC scale score had a significant positive correlation with DUREL subscale and MHLC Chance Externality subscale score. There was no a significant correlation between GLHC scale score and Multidimensional Health Locus of Control (MHLC) Internality and Powerful subscales scores. The results of the present study showed that the Persian version of GHLC scale has acceptable factorial validity and internal consistency reliability.

Effect of sub-MIC of vancomycin and clindamycin alone and in combination with ceftazidime on Clostridium difficile surface layer protein A (slpA) gene expression.

Clostridium difficile (C.difficile) infection is often established in the presence of antibiotics and probably antibiotics can influence surface layer protein A (slpA) expression as a colonization factor. The aim of this study is to evaluate the effect of vancomycin (VAN), clindamycin (CLI) alone and in combination with ceftazidime (CAZ) on slpA gene expression to determine whether such antibiotics can have any effect on slpA expression. About ∼106 CFU/mL was inoculated to medium containing an appropriate concentration of antibiotics alone and in combination. After 24 and 48 h incubation under anaerobic condition, 3 mL of culture was excluded and centrifuged in 8000 × g per 3 min. The pellet was washed and used for RNA extraction. The RNA extraction, Dnase I treatment and cDNA synthesis was performed by RNA extraction, Dnase I, and cDNA synthesis kits, respectively. The real-time PCR were carried out by sybrGreen methods and data were analyzed based on comparative ΔΔCT. All antibiotics alone and in combination, except VAN/CAZ in clinical isolate, decreased the level of slpA gene expression in the 24-h incubation. While the expression profile of slpA was different in the 48-h incubation period. The VAN and CLI decreased the slpA expression, although the template of expression is closed to control medium. CAZ alone and in combination increased slpA expression. C. difficile may down-regulate slpA expression in the early stages of growth in sub-inhibitory concentration of antibiotics. But, over time C. difficile increases or over expresses the slpA expression level. Consequently C. difficile binds strongly to epithelial cells and continues to survive in the presence of sub-MIC concentration of antibiotics. This effect is observed especially with regard to CAZ and probably other third generation cephalosporins or in combination therapy with VAN or CLI, which are prescribed in the clinic. CAZ can interfere with the anti-down regulatory feature of VAN, CLI, and maybe other antibiotics.

Toxin production of Clostridium difficile in sub-MIC of vancomycin and clindamycin alone and in combination with ceftazidime.

Toxin production in Clostridium difficile (C. difficile) is a key process for induction of diarrhea. Several factors such as sub-MIC of antibiotics impact on toxin production. The aim of this research is investigation of sub-minimum inhibitory concentration (sub-MIC) of vancomycin (VAN), clindamycin (CLI) separately and in combination with ceftazidime (CAZ) on toxin production in C. difficile. About ∼106 colony forming units (CFU) from 18-h culture of C. difficile ATCC 9689 and clinical isolates A+/B+/CTD-, were cultured anaerobically in the pre-reduced medium with appropriate concentration of separated and in combination antibiotics. After 24 and 48 h, 1 mL of culture was removed, centrifuged and the supernatant stored at-70 °C for later use. The evaluation of toxin production was carried out by the ELISA technique. All antibiotics alone and in combination formats inhibited toxin production over a period of 24 h. This effect is also observed in presence of VAN and CLI during a period of 48 h. Over a 4 h period, CAZ increased toxin production alone and in combination, especially with CLI. The data showed VAN and CLI decrease the level of toxins. In contrast, the CAZ not only increases the level of produced toxin, but also can interfere with VAN and CLI. Based on the results, combination therapy which is performed for treatment or prevention of other infections may cause toxin production and probably the severity of C. difficile AAD to increase.

Does progesterone improve outcome in diffuse axonal injury?

BACKGROUND AND OBJECTIVE: The benefits of progesterone have been demonstrated in the animal models of traumatic brain injury (TBI). However, the results of clinical studies are conflicting. Considering the heterogenic nature of TBI, the effect of progesterone in patients with diffuse axonal injury (DAI) was investigated in a clinical trial. METHODS: In this study, 48 patients with DAI and Glasgow Coma Scale of 3-12, admitted within 4 hours after injury, were randomly assigned to the progesterone or control group. The dose of progesterone administration was 1 mg kg-1 per 12 hours for 5 days. The effect of progesterone was investigated using extended-Glasgow Outcome Scale (GOS-E), functional independence measure (FIM) scores and also mortality within the follow-up period. RESULTS: The progesterone group exhibited higher GOS-E and FIM scores in comparison to the control group at 6 months post-injury (p < 0.01 and p < 0.05, respectively). Mortality was also found in the control group (p < 0.05). The adverse events attributed to the progesterone administration were not found throughout the study. CONCLUSIONS: Findings of this study suggest that progesterone may be neuroprotective in patients with DAI. However, large clinical trials are needed to assess progesterone as a promising drug in DAI.

Can Religious Beliefs be a Protective Factor for Suicidal Behavior? A Decision Tree Analysis in a Mid-Sized City in Iran, 2013.

This study aimed to assess using tree-based models the impact of different dimensions of religion and other risk factors on suicide attempts in the Islamic Republic of Iran. Three hundred patients who attempted suicide and 300 age- and sex-matched patient attendants with other types of disease who referred to Kerman Afzalipour Hospital were recruited for this study following a convenience sampling. Religiosity was assessed by the Duke University Religion Index. A tree-based model was constructed using the Gini Index as the homogeneity criterion. A complementary discrimination analysis was also applied. Variables contributing to the construction of the tree were stressful life events, mental disorder, family support, and religious belief. Strong religious belief was a protective factor for those with a low number of stressful life events and those with a high mental disorder score; 72 % of those who formed these two groups had not attempted suicide. Moreover, 63 % of those with a high number of stressful life events, strong family support, strong problem-solving skills, and a low mental disorder score were less likely to attempt suicide. The significance of four other variables, GHQ, problem-coping skills, friend support, and neuroticism, was revealed in the discrimination analysis. Religious beliefs seem to be an independent factor that can predict risk for suicidal behavior. Based on the decision tree, religious beliefs among people with a high number of stressful life events might not be a dissuading factor. Such subjects need more family support and problem-solving skills.

Correlates of waterpipe smoking among Iranian university students and the role of religiosity.

Waterpipe smoking among youth and adolescents in Iran has gained in popularity. The aim of this study was to investigate the relationship between waterpipe smoking and different dimensions of religiosity in a sample of students attending two major universities in South East Iran. A total of 682 students completed a waterpipe and cigarette smoking questionnaire along with the Duke University Religion Index. The lifetime prevalence of dual cigarette and waterpipe use was 48.3%, with prevalence of current use (within the last 30 days) of 24.9%. The proportions of lifetime and current waterpipe-only users were 27.0% and 18.8%, respectively. Students who participated more often in private religious activities were less likely to report engaging in waterpipe smoking (odds ratio: 0.82; 95% confidence interval: 0.71-0.98). A higher level of attendance of religious services was negatively associated with dual cigarette and waterpipe smoking (odds ratio: 0.71; 95% confidence interval: 0.54-0.93). Waterpipe-only use was significantly higher among males, students who had lower grade point averages, those who reported having a close friend or a family member who was a waterpipe smoker. To conclude, it is possible that religious observance may have a protective role in lowering waterpipe usage among Iranian university students.

Effect of Aspirin on Spinal Cord Injury: An Experimental Study.

Aspirin is an anti-inflammatory drug, peroxyl radical scavenger, and antioxidant agent that inhibits phospholipases, nitric oxide synthetases, and cyclooxygenase enzymes. The existing literature contains no studies on the effects of various doses of aspirin on spinal cord injury (SCI). Therefore, we sought to investigate the putative effects of aspirin on experimental SCI. The weight-drop injury model was used to produce SCI in 100 albino Wistar rats. The animals were allocated to five groups: a control group, where the rats did not undergo any surgical or medical intervention except for anesthesia; a sham-treated group, where laminectomy was performed without SCI and no further therapy was administered; and three other groups, where the rats with SCI received low-dose aspirin [20 mg/kg], high-dose aspirin [80 mg/kg], and a vehicle, respectively. Half of the rats were sacrificed 24 hours later, and their spinal cords were excised for biochemical studies. The other rats were subjected to Basso, Beattie, and Bresnahan (BBB) locomotor rating scale scoring once a week for 6 consecutive weeks. Aspirin decreased lipid peroxidation following SCI as the mean (± standard error) catalase level was significantly higher in the high-dose aspirin group (46.10±12.01) than in the sham-treated group (16.07±2.42) and the vehicle-treated group (15.31±3.20) (P<0.05; P<0.05, respectively). Both of the groups treated with high-dose and low-dose aspirin demonstrated a higher mean BBB score than did the control group (P<0.001) and the sham-treated group (P<0.001). Our data provide evidence in support of the potential effects of aspirin in biochemical and neurobehavioral recovery after SCI.

Validation of the Persian version of the brief assessment of cognition in schizophrenia in patients with schizophrenia and healthy controls.

AIMS: The Brief Assessment of Cognition in Schizophrenia (BACS) is designed for assessment of cognitive function in patients with schizophrenia. Versions of the BACS in English and other languages have been shown to be as sensitive to cognitive dysfunction as a standard test battery, with the advantage of brief administration and scoring time. The present study aimed to test the concurrent validity of the Persian version of the BACS (Persian-BACS). METHODS: A group of 50 patients with schizophrenia-spectrum disorders and a group of 50 healthy controls received the Persian-BACS in a first session, and in a second session a standard neurocognitive battery. RESULTS: Cronbach's alpha for the Persian-BACS was 0.74. All the Persian-BACS subscales were significantly correlated with the corresponding standard neurocognitive subscales and the Pearson correlation of the composite scores from the two instruments was 0.71. Moreover, a one-factor solution was found that accounted for 67.9% of the variance. Finally, the Persian-BACS demonstrated high ability to discriminate patients with schizophrenia from healthy controls. CONCLUSION: Good psychometric properties of the Persian-BACS suggest that it is a useful tool for assessing cognition in schizophrenic patients with Persian as their primary language.

The effectiveness of court-mandated compulsory treatment in promoting abstinence among people with substance use disorders in Iran.

BACKGROUND: In Iran, people living with substance use disorders who engage in public drug use may be subjected to court-mandated treatment in compulsory drug detention and rehabilitation centers (CDDRC). This study aims to assess residential CDDRC's effectiveness in promoting sustained abstinence among people who use drugs (PWUD) in Kerman, Iran. METHODS: Between October 1, 2021, and September 30, 2022, 1,083 adult male PWUD with a diagnosis of substance use disorders and a history of engagement in public drug use were admitted to the CDDRC in Kerman. They were followed-up for 12 months after discharge. The relationship between baseline variables and abstinence, assessed using rapid urine tests, was examined using crude logistic regression models. RESULTS: Most PWUD were 30 or older (n = 876, 80.9 %) and had a history of previous CDDRC admission (n = 638, 58.9 %). At the end of the 12-month follow-up, only 2.6 % (95 % confidence intervals: 1.7-3.7) were abstinent. Individuals with limited education (Odds ratio [OR] = 3.43; 1.50-7.95) and those with a prior history of admission to the CDDRC (OR = 3.73; 1.55-9.89) had increased odds of relapse. CONCLUSIONS: The effectiveness of CDDRC in promoting abstinence among the participants was minimal. This highlights the necessity of reassessing support and investment in these interventions and considering more evidence-informed alternative approaches in Iran.

Pattern of pediatric eye injuries in Tehran, Iran.

Childhood ocular trauma is a preventable cause of visual impairment and blindness worldwide. This prospective study was conducted to explore the profile of eye injuries in pediatric patients referring to a tertiary eye center in Tehran, Iran. Six hundred consecutive pediatric patients aged 17 or less who presented to emergency department of Farabi Hospital were enrolled. Age and sex of pediatric patients, time of trauma, time between trauma and presentation, place of injury, etiology of eye injury, visual acuity, and type of injury based on Birmingham Eye Trauma Terminology were collected. Mean (±SD) age of cases was 7.9 ± 4.8. Male to female ratio was 2.3:1. More than 70 % of the patients presented less than 12 h after ocular trauma. Most injuries occurred at home (57.7 %) followed by street (20.3 %). Twelve patients had visual acuity lower than 0.1 at initial visit. Projectile trauma was the most common cause (35.8 %) followed by blunt trauma (33.3 %). 86.3 % of traumatic events consisted in closed globe injuries. Parents should be involved more effectively in care and supervision of their children especially for boys, at home and on holidays.

Immediate Antecedents of Intentions for Having Children in Southeast Iranian Women.

BACKGROUND: Over the last decade, Iran has experienced a declining birth trend. Identifying the proximate determinants of fertility intentions among married women is informative for population studies. This study aimed to examine the importance of three immediate antecedents of fertility intention. METHODS: We invited 1,100 married women to complete a well-validated questionnaire based on the theory of planned behavior (TPB). The sampling framework consisted of visitors attending hospitals in two cities in southeastern Iran. Intention for having children was measured using the item "Do you intend to have a/another child during the next 3 years?" Attitude, subjective norms, and perceived behavioral control were measured using eight, three, and three items, respectively. Structural equation modeling was used to specify the model and to test the predictive ability of the TPB constructs. RESULTS: The response rate was 90.7% (N=998), and the mean±standard deviation age of the respondents was 34.8±7.4 years. More than 50% of the respondents reported intending to have a child in the next 3 years. All three TPB model constructs showed significant associations with fertility intentions. The standardized beta coefficients for attitudes, subjective norms, and perceived behavioral control were 0.74, 0.41, and 0.55, respectively. CONCLUSION: The TPB model showed that psychological mechanisms play an important role in predicting the childbearing intentions of married women in Iran. Of the three TPB constructs, attitude was the strongest predictor of the intention to have a child.

Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P).

BACKGROUND: There is a high worldwide prevalence of sleep quality disturbances, and sleep disturbances have been associated with numerous diseases. Thus, it is important to assess sleep quality. The Pittsburgh Sleep Quality Index (PSQI) is a self-rating questionnaire that can be completed within 5 min, but no Persian language version is available. METHODS: We translated the PSQI into Persian and then back into English to ensure the accuracy of the translation. A total of 125 psychiatric patients (generalized anxiety disorder, n = 37; major depression, n = 35; schizophrenia, n = 28; primary insomnia, n = 25) and 133 controls completed our Persian version of this questionnaire. Internal consistency, construct validity, and sensitivity and specificity of the PSQI were assessed. RESULTS: The mean ages (±SD) of the patient and control groups were 36.8 years (±13.9) and 34.2 years (±9.8), respectively (p = 0.08). Cronbach's alpha coefficient for all subjects was 0.77 and was 0.52 for the patient group and 0.78 for the control group. The corrected item-total correlations ranged from 0.30 to 0.75 for the seven component scores of the PSQI. When the general health questionnaire-12 was used as a measure of psychiatric morbidity, it was well correlated with the PSQI scores (r = 0.54, p < 0.001). The sensitivity and specificity of discrimination of insomniac patients from control subjects were 94% and 72% for a PSQI cutoff value of 5 and 85% and 84% for a PSQI cutoff value of 6. CONCLUSION: The psychometric properties of the Persian version of the PSQI were acceptable.

The long-term impact of the earthquake on substance use.

Earthquake is associated with several health conditions such as posttraumatic stress disorder (PTSD), depression, and cardiovascular disease. However, the association between earthquakes and substance use has been less studied to date. We conducted a historical cohort study 17 years after the Bam earthquake by enrolling 818 households using multi-stage cluster sampling. The sample consisted of earthquake-exposed and non-exposed citizens. The ASSIST screening test was used to determine substance use. Logistic regression analysis was used to evaluate the association of variables of interest with substance use. Nearly 60% of the study subjects were female and the mean ± SD age of the sample was 46.6 ± 11.5 years. The prevalence of tobacco, alcohol, and other drug use in the exposed group was 19.5%, 24.9%, and 21.6%, respectively. The corresponding figures in the non-exposed group were 15.6%, 19.3%, and 20.1%, respectively (P > 0.05). The logistic regression model found no association between the history of earthquake exposure and the risk of any current drug use. Our results showed those 17 years after the Bam earthquake, there was no relationship between earthquake exposure and substance use.

Comparing the Efficacy of Premedication with Ibuprofen in Combination with an Inferior Alveolar Nerve Block and Primary Buccal Infiltration in Mandibular Molars with Irreversible Pulpitis: A Triple-blinded Randomized Clinical Trial.

Introduction: This study aimed to determine the success rate of the combination of buccal infiltration (BI) and inferior alveolar nerve block (IANB) injections in irreversible pulpitis in mandibular molars after premedication with ibuprofen. Materials and Methods: From 132 patients participated in the study, 120 patients were included. One hour before root canal treatment, patients with mandibular molars with symptomatic irreversible pulpitis received either a 600 mg ibuprofen capsule or a placebo. All patients received 2% lidocaine with 1:80000 epinephrine and 4% articaine with 1:100000 epinephrine for IANB and BI, respectively. Patients' pain was evaluated using the Heft-Parker visual analog scale during the preparation of access cavity, exposure of pulp, and instrumentation of root canal. The success of anesthesia was defined as the absence of pain or mild pain. The Chi-square and t-test were employed for data analysis. Results: The difference between patient age and gender in the two groups was not significant (P>0.05). The anesthesia success rate was 85% in the premedicated and 70% in the placebo group, with statistically significant results (P=0.049). Conclusion: Based on this triple-blinded randomized clinical study, mandibular molars with irreversible pulpitis were not thoroughly anesthetized by a combination of IANB+BI after premedication with ibuprofen (600 mg), even though anesthesia success was improved significantly by ibuprofen premedication.

The Effect of the Anatomic Variables on the Success Rate of Anesthesia in Maxillary Molars with Irreversible Pulpitis.

INTRODUCTION: Obtaining anesthesia of teeth with irreversible pulpitis is 1 of the most challenging issues in endodontic practice. The aim of this study was to evaluate the effect of anatomic variables on the success rate of anesthesia in maxillary molars with irreversible pulpitis. METHODS: Patients who had maxillary molars with irreversible pulpitis and who had already had a cone-beam computed tomographic (CBCT) scan performed were included in this study. After infiltration injection of an anesthetic solution, the success rate of anesthesia was recorded by asking the patients to rate their pain during access cavity preparation and root canal instrumentation as well as their need for a supplementary injection during the treatment. The distance of the palatal root to the buccal cortical plate was calculated using the Romexis Viewer (Planmeca, Helsinki, Finland) measuring tools in both the axial and coronal views. Data were analyzed by chi-square and t tests as well as receiver operating characteristic curve analysis. RESULTS: Forty-seven maxillary first and second molar teeth were eligible to be included in this study. The overall success rate of anesthesia was 63.80%. The palatal roots that had their apex located more than 12.34 mm from the buccal cortical plate in the axial view, and 12.46 mm in the coronal view had a higher chance of anesthesia failure compared with the teeth with smaller distances. The presence of the maxillary sinus between the cortical plate and roots had no significant impact on the efficacy of anesthesia (P > .05). CONCLUSIONS: The potential of anesthesia failure during the treatment of irreversible pulpitis in maxillary molars with a divergent palatal root is significantly higher than in teeth with shorter distances from the palatal root apex to the buccal cortical plate. If a patient already had a CBCT scan done for other reasons or the CBCT is available in his or her records, a dental practitioner can use it to predict anesthesia success for maxillary molars with irreversible pulpitis.

Mean population salt intake in Iran: A systematic review and meta-analysis.

Introduction: High salt intake has been connected with the increase of many non-communicable diseases (NCDs) worldwide. Like other middle-income countries, Iran is experiencing a considerable increase in NCDs, necessitating attempts to reduce dietary salt intake. As in Iran there is uncertainty about the existing rate of salt intake. The present study aimed to estimate mean salt intake of Iranian population by systematically reviewing existing literature. Methods: This research is a systematic review and meta-analysis (PRISMA Protocol) of published article data, with no time constraint until the end of 2020, to estimate mean salt intake of Iranian population. A comprehensive literature search was performed on international databases of Medline, Science Direct, PubMed, Embase, Scopus, Springer, Online Library Wiley, Web of Science, Cochrane, and Google Scholar and domestic data bases of Iranmedex, Magiran, SID, and Medlib. Subgroup analysis was conducted for gender, region, measurement method, and age group. Research homogeneity was evaluated by I 2 statistic. We reviewed all studies which met inclusion criteria. STATA Ver.13.1 was used to perform meta-analysis. Results: Meta-analysis of data from 32 studies showed that the average salt intake in all ages was 9.674 g/day (95% CI, 9.033-10.316 g/day). The lowest estimation of salt intake was 9.33 g/day (95% CI, 7.75-10.91 g/day) which was estimated from studies which used point collection method, and the highest estimate using the food reminder questionnaire was 10.41 g/day (95% CI, 8.49-12.34 g/day). Also, the average weight salt intake for men over 18 years old in different cities was 10.39 g/day (95% CI, 9.01-11.78 g/day), for women over 18 years in different cities 9.52 g/day (95% CI, 8.42-10.62 g/day), and children and adolescents was estimated at 5.664 g/day (95% CI, 2.91-8.41 g/day). Conclusion: The intake of salt in the Iranian population is near twice the WHO recommendation. Therefore, it is necessary to consider effective strategies and interventions to reduce dietary salt intake in Iran as a health priority.