Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Evaluation and comparison of four types of bio-ceramic materials AGM MTA, Ortho MTA, pro root MTA and Cem cement in oral and dental health.

BACKGROUND AND OBJECTIVES: Mineral Trioxide Aggregate (MTA) is one of the main retrograde filling materials that is used today as a root end filling material and perforation repair material. This study was conducted with the aim of investigating the antibacterial and antifungal properties of four types of bio-ceramic materials, AGM MTA, Ortho MTA, Pro root MTA and Cem cement for oral and dental health. METHODS: In this study, the antibacterial activity of four types of bio-ceramic materials against two bacterial strains of Enterococcus faecalis (ATTC 29212), Escherichia coli (ATTC 35318) and antifungal activity against Candida albicans (ATTC 10231) were investigated using the well diffusion method. RESULTS: In the context of the relationship between the type of microorganism and the diameter of the growth inhibitory zone for each type of bio-ceramic material, there was no significant difference for Enterococcus faecalis, and a significant difference was observed for Escherichia coli and Candida albicans (p < 0.05). CONCLUSION: The results show that each of the bio-ceramic materials AGM, Pro root, Cem cement and Ortho have antibacterial and antifungal properties. AGM MTA bio-ceramic material on Candida albicans fungus and Ortho MTA bio-ceramic material had the most effect on Escherichia coli bacteria. Therefore, the mentioned bio-ceramic materials can play a significant role in oral and dental health by providing a suitable material for restoration.

Comparing the prevalence of Helicobacter pylori and virulence factors cagA, vacA, and dupA in supra-gingival dental plaques of children with and without dental caries: a case-control study.

BACKGROUND: Helicobacter pylori infection is one of the most common infectious diseases in humans. Dental plaque is considered as a reservoir of this bacterium, which could play an important role in the development of gastrointestinal problems. Our aim was to investigate the prevalence of H. pylori and its virulence factors in dental plaques in children with and without dental caries. METHODS: Among children aged 6 to 12 years, a total of 72 children were enrolled in the study, including 36 cases with total DMFT/dmft > 3 (case group) and 36 participants with total DMFT/dmft < 1 (control group). After removing supra-gingival plaques from the lower first permanent molar teeth, the samples were examined using PCR method for the presence of H. pylori and some of its virulence factors. Statistical analysis was performed using chi-square, Fisher' exact test, t-tests, and logistic regression. RESULTS: Of 72 participants, 40 cases were male, and 32 cases were female. The minimum and maximum values of total DMFT/dmft indices were zero and ten, respectively, and the mean ± SD value of total DMFT/dmft was 2.78 ± 3.22. Except for vegetable consumption (p = 0.045), there was no significant difference between the two groups regarding gastrointestinal disorders, feeding methods in infancy (p = 0.058), frequency of daily brushing (p = 0.808), frequency of dental visits (p = 0.101), and history of dental scaling (p = 0.246) and professional topical fluoride therapy (p = 0.5). Out of 72 samples, 15 cases were positive for H. pylori DNA (20.8%), and there was no significant association between the presence of this bacterium in dental plaque and dental caries (p = 0.281). The frequency of virulence factors detected in 15 H. pylori cases was as follows: cagA in six cases (40.0%), vacAm1 in three cases (20.0%), and vacAs1 in one case (6.7%). There was no significant difference between the groups regarding the prevalence of virulence factors. CONCLUSION: Our results indicate the presence of H. pylori along with some virulence factors in dental plaques as a reservoir of this bacterium in children in Iran. Although there was no significant association between this bacterium and the incidence of dental caries, dental health in children needs to be seriously taken into consideration.

Estimation of the basic reproduction number (𝑠0) of the COVID-19 epidemic in Iran.

Background: Estimation of the basic reproduction number of an infectious disease is an important issue for controlling the infection. Here, we aimed to estimate the basic reproduction number (𝑅0) of COVID-19 in Iran. Methods: To estimate 𝑅0 in Iran and Tehran, the capital, we used 3 different methods: exponential growth rate, maximum likelihood, and Bayesian time-dependent. Daily number of confirmed cases and serial intervals with a mean of 4.27 days and a standard deviation of 3.44 days with gamma distribution were used. Sensitivity analysis was performed to show the importance of generation time in estimating 𝑅0. Results: The epidemic was in its exponential growth 11 days after the beginning of the epidemic (Feb 19, 2020) with doubling time of 1.74 (CI: 1.58-1.93) days in Iran and 1.83 (CI: 1.39-2.71) in Tehran. Nationwide, the value of 𝑅0 from February 19 to 29 using exponential growth method, maximum likelihood, and Bayesian time-dependent methods was 4.70 (95% CI: 4.23-5.23), 3.90 (95% CI: 3.47- 4.36), and 3.23 (95% CI: 2.94-3.51), respectively. In addition, in Tehran, 𝑅0 was 5.14 (95% CI: 4.15-6.37), 4.20 (95% CI: 3.38-5.14), and 3.94 (95% CI: 3.45-4.40) for exponential growth, maximum likelihood, and Bayesian time-dependent methods, respectively. Bayesian time dependent methods usually provide less biased estimates. The results of sensitivity analyses demonstrated that changes in the mean generation time affect estimates of 𝑅0. Conclusion: The estimate of 𝑅0 for the COVID-19 ranged from 3.94 to 5.14 in Tehran and from 3.23 to 4.70 in nationwide using different methods, which were significantly larger than 1, indicating the potential of COVID-19 to cause an outbreak.

Effect of pentoxifylline on diabetic distal polyneuropathy in type 2 diabetic patients: A randomized trial.

BACKGROUND: Diabetes is one of the most common causes of peripheral neuropathy. There are no known cures for diabetic neuropathy. Pentoxifylline could theoretically be a beneficial treatment for diabetic sensory neuropathy, but there is not enough evidence to prove its effect. The aim of this study was to investigate the effect of pentoxifylline on distal diabetic neuropathy. MATERIALS AND METHODS: In this randomized double-blinded placebo-controlled trial, 60 patients with diabetic peripheral neuropathy were randomized into two groups. The intervention group received Vitamin B1 (100 mg twice daily) and pentoxifylline (400 mg twice daily) and control group received Vitamin B1 (100 mg twice daily) and placebo (twice daily) for 2 months. Before and after the intervention, the symptoms of distal polyneuropathy were recorded by the Michigan Neuropathy Screening Instrument. ANCOVA, Paired t-test, unpaired t-test, Chi-square, and Fisher's exact test were used to compare changes in symptoms and sign of distal polyneuropathy. RESULTS: The mean age of patients was 57.1 ± 8.02 years. There was no significant difference between the two groups in regard to the baseline variables. Blood pressure, body mass index, and blood glucose did not change significantly during the study. In the pentoxifylline group, the symptoms of peripheral neuropathy were significantly improved, in comparison with placebo group (P = 0.042). CONCLUSION: This study showed pentoxifylline could be effective in reducing the symptoms of distal diabetic neuropathy.

Hypoxic Ischemic Encephalopathy Indicators of Sarnat and Sarnat Scoring in Neonatal Subjects with Perinatal Asphyxia.

Objectives: Hypoxic-ischemic encephalopathy (HIE) is still a relevant cause of neonatal mortality and morbidity. HIE severity can predict long-term outcomes. Sarnat staging is one of the most common methods used to evaluate HIE severity. However, an ongoing urge exists to find other accurate and affordable ways to accompany this clinical staging for HIE. This study aimed to evaluate the relationship between cerebral arteries' resistive indices and other hypoxic-ischemic encephalopathy indicators using Sarnat scoring of newborns subjected to perinatal asphyxia. Materials & Methods: In this retrospective study, 76 neonates with gestational age ≥34 weeks affected with HIE were investigated. The patients were categorized into three groups according to Sarnat staging: I, II, and III. Initially, perinatal data were analyzed to assess the correlation between HIE severity and various factors such as gestational age, type of delivery, Apgar scores, necessity for resuscitation, and requirement for respiratory assistance. Notably, these relationships were significant. Results: Examining various symptoms in different HIE stages showed that the incidence of coagulopathy was significantly higher in severe HIE neonates than in mild neonates. Eventually, proposedly, cranial arterial Doppler indices, i.e., the anterior cerebral artery's resistive index (RI), significantly differed between HIE stage groups. Conclusion: This study represented a combination of available and affordable data to achieve early HIE staging, including perinatal data, clinical symptoms, and a bedside Doppler ultrasonography of cerebral perfusion. Higher cranial artery RI was associated with severe HIE and could be considered for therapeutic hypothermia, which may reduce HIE mortality and morbidity.

Association between sleep pattern, salivary cariogenic bacteria and fungi populations, pH and buffering capacity in children: A comparative study.

BACKGROUND: Sleep quality has a significant impact on a child's health and is linked to oral and systemic diseases. It affects the circadian rhythm, which plays a crucial role in regulating the balance of the endocrine and hormonal systems. Current research has focused on exploring its role in the development of caries, which is influenced by inherent oral factors such as the composition of the oral microbiome and pH levels. OBJECTIVES: This study aimed to investigate the relationship between bacterial population, pH, and buffering properties of saliva and sleep patterns in 8- to 12-year-old children. MATERIAL AND METHODS: This cross-sectional study was conducted on 85 elementary school children aged 8-12 years. After obtaining written consent, non-stimulating saliva samples were collected using the spitting method. The participants' sleep pattern information was obtained with the use of the Persian version of the Children's Sleep Habits Questionnaire (CSHQ). Based on the results of the CSHQ, the participants were divided into 2 groups: those with appropriate sleep patterns; and those with inappropriate sleep patterns. The study compared the bacterial population of Streptococcus mutans, Lactobacillus spp. and Candida albicans, as well as the buffering capacity and pH of the saliva between the 2 groups. The statistical analysis employed the χ2 test, the independent samples t-test and Spearman's correlation. RESULTS: The group with inappropriate sleep patterns had significantly lower pH and buffering capacity (p < 0.001) and significantly higher colony counts of Lactobacillus and S. mutans (p < 0.001 and p = 0.012, respectively). There was no association between C. albicans and sleep patterns (p = 0.121). CONCLUSIONS: Inappropriate sleep patterns increase the population of caries-causing bacteria and reduce salivary pH and buffering capacity. This can be a significant factor in the development of dental caries in children aged 8-12 years.

Efficacy and safety of Plantago major seeds in patients with diabetic nephropathy: A randomized open-labeled controlled clinical trial.

BACKGROUND: Diabetic Nephropathy (DN) is characterized by albuminuria and a declining glomerular filtration rate (GFR) in diabetic patients. Plantago major (plantain) seed powder is traditionally used in these patients. Despite emerging and promising pre-clinical evidence, no clinical study investigated the potential efficacy of this intervention in patients with DN, which is the aim of this study. METHODS: In a randomized clinical trial 60 DN patients were recruited from November 2022 to March 2023 and randomly assigned to the plantain group that received standard treatment (Losartan 25 mg twice a day) and plantain seeds' powder (10 gm sachet twice a day) plus sweet almond and the control group was received only standard treatment for 60 days. Proteinuria, as per 24-hour urinary protein, as well as fasting blood sugar (FBS), blood urea nitrogen (BUN), serum creatinine, serum potassium, and quality of life score were measured at baseline and after 60 days as study outcome measures. RESULTS: Proteinuria was significantly decreased from 165.04 mg to 135.84 mg (p = 0.026) in the plantain group. The mean level of proteinuria was significantly lower in the plantain group (135.84 vs. 192.04, p = 0.039) compared to the control group after treatment. The plantain group showed more increase in quality of life score after treatment (33.89±9.67 vs 38.28±10.72, p = 0.041). Other outcomes showed no significant difference between the two study groups. CONCLUSION: Adjuvant supplementation with plantain seeds powder may decrease proteinuria in patients with diabetic nephropathy. Further studies with larger sample sizes and longer duration are needed to confirm these results.

The Association between Dental Caries, Periodontal Status, and Sleep Patterns in Children.

Aim and background: Sleep quality has a significant impact on children's overall health and is associated with oral diseases. This study aimed to investigate the relationship between dental caries, periodontal status, and sleep patterns in 8-12-year-old children. Materials and methods: This cross-sectional study was conducted on 120 children aged 8-12 years. The children's sleep habits questionnaire (CSHQ) was employed to evaluate sleep status. Another questionnaire was used to collect data on lifestyle habits. Dental caries status was evaluated using the decayed, missing, and filled teeth (DMFT) and International Caries Detection and Assessment System (ICDAS) indices. Periodontal status was assessed through the plaque index (PI), probing depth (PD), gingival index (GI), and periodontal screening and recording (PSR). The association between oral health and sleep patterns was evaluated using Spearman's coefficient correlation, independent t-test, and the Chi-squared test. Results: The ICDAS mean was significantly higher in children with improper sleep patterns (p = 0.032). However, there was no statistically significant relationship between DMFT and sleep patterns (p = 0.346). The GI, PD, and PSR mean were significantly higher in the inappropriate sleep pattern group. There was a significant relationship between children's sleep patterns and GI, PD, and PSR indices (p = 0.033, p = 0.020, p = 0.028, respectively). However, there was no significant association between PI and sleep patterns (p = 0.277). Conclusion: Children's sleep patterns were associated with dental caries and periodontal status. Adequate sleep is required to prevent oral diseases such as dental caries and periodontal diseases. Clinical significance: According to this study, it is recommended that children should be encouraged to get adequate sleep by their parents and dentists. How to cite this article: Mehdipour A, Abbasi R, Keykha E, et al. The Association between Dental Caries, Periodontal Status, and Sleep Patterns in Children. Int J Clin Pediatr Dent 2024;17(8):925-932.

Prevalence of Oral Parafunctional Habits in Children and Related Factors: An Observational Cross-sectional Study.

Aim: Parafunctional habits cause movements indicating their effect as functional and structural disorders such as malocclusion and temporomandibular joint changes in the oral and dental organs. This cross-sectional study was conducted to investigate the prevalence and factors associated with parafunctional habits in 6-12-year-old children in Qom, Iran. Materials and methods: This analytical cross-sectional study was performed on 403 6-12-year-old schoolchildren of Qom, Iran. Data collection tools included a demographic questionnaire and a checklist prepared along with a clinical examination. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), with chi-square and analysis of variance (ANOVA) tests. Results: The mean age of children was 8.9 ± 2.03 years. Bruxism was more common than other parafunctional habits (22.6%). There was a significant relationship between oral habits with children's gender and age (p <0.001). However, there was no significant relationship between oral habits and other variables such as underlying disease, economic status and parent's smoking (p >0.05). Conclusions: Given the relatively high prevalence of parafunctional habits in children, it seems that children should be investigated for the presence of such habits in order to provide the necessary education to parents and perform dental interventions to prevent complications from oral habits. Dental interventions at a younger age are easier to conduct and have a more effective preventive role. How to cite this article: Mehdipour A, Aghaali M, Janatifar Z, et al. Prevalence of Oral Parafunctional Habits in Children and Related Factors: an Observational Cross-sectional Study. Int J Clin Pediatr Dent 2023;16(2):308-311.

Evaluation of IL-17F A7488G polymorphism in Helicobacter pylori-infected patients: a case-control study.

Interleukin 17 (IL-17) plays an important role in the inflammation of the gastric mucosa and, in severe cases, the development of gastric cancer. Thus, the authors aimed to evaluate the IL-17F A7488G polymorphism in Helicobacter pylori (H. pylori) patients. Patients and methods: A total of 86 adults (in two H. pylori-positive and H. pylori-negative groups) were included in the study. To identify the infection, rapid urease test and polymerase chain reaction (PCR) were performed. The cagA gene was also evaluated as a bacterial virulence factor. PCR-restriction fragment length polymorphism was used to investigate the IL-17F A7488G polymorphism in gastric biopsies using the NlaIII enzyme. Results: 96.5% of patients in both groups did not show any mutation and had AA genotype, and only three patients infected with cagA-carrying H. pylori strains had polymorphism in the IL-17F A7488G gene, which included AG (one case) and GG (two cases) patterns. No significant relationship was found between these polymorphisms in the two groups of H. pylori-positive and H. pylori-negative patients, while, interestingly, a significant difference was observed between the polymorphisms and the presence of the cagA gene. Conclusion: This report is one of the first to demonstrate the association of IL-17F A7488G polymorphism with H. pylori infection and the presence of the cagA gene. Although no significant association between IL-17F polymorphism and H. pylori infection was found in the population of this study, the patients with mutated genotypes were positive for the cagA gene, which was statistically significant. Therefore, the possibility of the role of pathogenic strains in causing mutations in cytokine genes is more conceivable.

COVID-19 in Patients with Rheumatic Disease Using Immunomodulatory Drugs: Imaging Findings and Predictors of Hospitalization.

Introduction: SARS-CoV-2 causes more severe symptoms in most chronic diseases, and rheumatic disease is no exception. This study aims to investigate whether there is an association between the use of immunomodulatory medications, including conventional disease-modifying agents (csDMARDs), glucocorticoids, and biologic DMARDs, and outcomes such as hospitalization and lung involvement in patients with rheumatic disease with COVID-19. Methods: We performed a cross-sectional study on 177 COVID-19 cases with rheumatologic diseases using immunomodulatory drugs as their regular treatment. All patients were evaluated regarding their initial chest computed tomography (CT) scan, COVID-19 symptoms, and comorbidities. We ran predictive models to find variables associated with chest CT-scan involvement and hospitalization status. Results: CT findings showed lung involvement in 87 patients with chest CT-scan severity score (C-ss) of less than 8 in 59 (33%) and more than 8 in 28 (16%) of our patients. Of all patients, 76 (43%) were hospitalized. Hospitalized patients were significantly older and had more comorbidities (P = 0.02). On multivariate analysis, older age [odds ratio (OR) 1.90, 95% confidence interval (CI) 1.31-3.08] and comorbidity (OR 2.75, 95% CI 1.06-3.66) were significantly associated with higher odds of hospitalization (P = 0.03). On multivariate analysis, older age (OR 1.15, 95% CI 0.94-2.01), pulmonary diseases (OR 2.05, 95% CI 1.18-3.32), and treatment with csDMARDs (OR 1.88, 95% CI 0.37-1.93) were associated with higher C-ss (P = 0.039). Conclusions: This study found that advanced age and comorbidities, similar to the general population, are risk factors for hospitalization in patients with COVID-19 with rheumatic disorders. Administration of csDMARDs, older age, and pulmonary disorders were linked to increased risk of COVID-19 pneumonia in these individuals.

Study of outcomes of delay in referral of patients with acute myocardial infarction.

BACKGROUND: Delay in seeking medical help in patients with acute myocardial infarction (AMI) challenges the patients in terms of diagnosis and treatment. This study aimed to evaluate the outcomes of delay referral (≥12 h) in patients with AMI. MATERIALS AND METHODS: In this retrospective cohort study, the medical records of 252 patients with AMI (2017-2019) admitted to Shahid Beheshti Hospital, Qom, Iran, was reviewed. Data collection tool was a researcher-made data sheet that included demographic characteristics, times, hospitalization costs, risk factors, history of heart disease, results of paraclinical tests, clinical information at the time of admission, and outcomes of delayed referral. Data were analyzed using t-test, Chi-square, Kaplan-Meier estimator, log-rank test, Cox regression by STATA, and SPSS (version 25). RESULTS: The levels of troponin, creatine phosphokinase, lactate dehydrogenase were significantly higher in the delayed referral group (P < 0.05). After treatment, the cardiac ejection fraction was significantly different in the nondelayed referral (41.56 ± 9.16) and the delayed referral group (38.39 ± 11.01) (P < 0.001). There was no significant difference in the percentage of hospital deaths in the groups (P = 0.078). CONCLUSION: Delayed referral of patients with AMI is associated with decreased physiological cardiac function, which complicates recovery for these patients.

The prevalence of thyroid dysfunction and autoimmune thyroid disease in patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is one of the most common chronic non-organ-specific autoimmune diseases; meanwhile, autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disease that can lead to hypo or hyperthyroidism. Although the etiology of both diseases is complex with a combination of genetic and environmental factors, there are overlaps in genes contributing to the pathogenesis of both diseases. Numerous studies found a correlation between thyroid abnormality and RA in different populations, yet some didn't. This study is aimed to evaluate the prevalence of thyroid dysfunction, AITD, and anti-thyroid peroxidase (anti-TPO) positively in Iranian patients with RA. METHODS: A total of 250 RA patients and 248 patients with non-inflammatory rheumatologic disease were included in this case-control study. All participants underwent complete clinical and laboratory assessments. Participants were also assessed for thyroid function testing, including anti-TPO antibodies. RESULTS: Thyroid dysfunction was twice as common in RA patients as in controls (OR = 2.16; P-value > 0.001). Overt hypothyroidism was the most common thyroid dysfunction among RA patients (58 out of 84). Anti-TPO positivity was also significantly more common in RA compared with controls (OR = 2.65; P-value > 0.001). The proportion of controls and RA patients with AITD were 9 and 21.5%, respectively. AITD was found 2.8 times more common in RA group than controls (OR = 2.77; P-value > 0.001). CONCLUSION: It was demonstrated that RA was an independent factor associated with thyroid dysfunction and AITD.

Oral health-related quality of life and dental caries in rheumatoid arthritis patients: a cross-sectional observational study.

Rheumatoid arthritis (RA) is a systemic, chronic, and inflammatory joint disease with oral complications. This research aimed to compare the oral health-related quality of life and decayed, missing and filled teeth (DMFT) index in rheumatoid arthritis patients over 18 years with healthy individuals. In this study, 45 rheumatoid arthritis cases were assigned to the experimental group, and 45 healthy individuals were assigned to the control group. After completing biography forms, the participants filled out two questionnaires. These questionnaires included the Oral Health Impact Profile-14 (OHIP-14) and the Oral Health Assessment Index (GOHAI). Next, their teeth were clinically examined to check for caries. Finally, the data were analyzed statistically. RA and control groups were similar in gender, marital status, age, occupation, and level of education. However, a significant difference was observed between the two groups concerning DMFT (P<0.001) and total OHIP-14 score (P<0.001). Moreover, no significant difference was observed between the groups concerning the total GOHAI score (P=0.526). The oral health-related quality of life in rheumatoid arthritis patients was lower than that in the general population, with the rate of dental caries being higher in these patients.

Short- and Long-term Myocardial Infarction Survival Rate According to the Type of Drugs Prescribed at the Time of Discharge: A Study Using Iran National Registry Data.

BACKGROUND: Coronary artery disease is among the first causes of death in Iran. Secondary prevention with drug therapy is recommended following acute myocardial infarction (MI) to reduce the risk of new cardiovascular events and death. METHODS: This is a retrospective cohort study on data collected from 21181 cases of MI recorded by the MI Registry of Iran from 2013 to 2014. Ten therapies that were prescribed to patients at the time of discharge were divided into 6 groups. Survival rates were estimated using the Kaplan-Meier method and Cox regression analysis. RESULTS: The most common MI location was in the anterior wall (31.87%). Anticoagulants, aspirin, clopidogrel were the most common prescribed medications (94.73%). Overall, 28-day (short-term) and 3-year survival rates were 0.95 (95% CI: 0.95-0.96) and 0.82 (95% CI: 0.81-0.82). In non-ST-elevation myocardial infarction (NSTEMI) patients, the lowest short- and long-term survival rates were observed when diuretic, anticoagulants/ aspirin and clopidogrel, beta-blockers and statins medication were simultaneously taken and the highest short- and long-term survival rates were observed in patients who took anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, beta-blockers and statins medication. In STEMI patients, the lowest short- and long-term survival rates were observed when diuretic, anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) were simultaneously taken. The highest short- and long-term survival rates were observed in patients who received anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, beta-blockers, statins, ACEIs and ARBs. CONCLUSION: Prescription of the best combination of drugs, in addition to adherence to a healthy lifestyle and medication, can improve the survival rates after MI.

Prevalence of enteric adenovirus and co-infection with rotavirus in children under 15 years of age with gastroenteritis in Qom, Iran.

Aim: The current study is the first performed in Qom to determine the prevalence of adenovirus and co-infections with rotavirus in children aged <15 years with gastroenteritis symptoms. Background: Gastroenteritis-associated viral infections are a cause of death among young children worldwide, especially in developing countries. The Adenovirus species F (40 and 41) are responsible for a range of acute diarrhea cases among infants and children. Methods: Over a period of 9 months, a total of 130 children suffering from intestinal problems who referred to the infectious ward of Children's Hospital were enrolled in the current study. After clinical examination and collection of demographic information, fecal samples were obtained from the patients. Viral genomes were extracted with a commercial kit and amplified and typed by adenovirus-specific PCR assay. Adenovirus-positive samples were also evaluated for co-infection with rotavirus. Results: Patients had a mean±SD age of 2.66±2.72 years; 63.1% of patients were male and 36.9% were female. Adenovirus infection was identified in 23 cases (17.7%), 21 (91.0%) and 2 (9.0%) of which were type 41 and type 40, respectively. Fever was the most common clinical manifestation among adenovirus-positive patients. No significant difference was observed between adenovirus infection and clinical symptoms, seasonal pattern, or serum laboratory results. Co-infection was found in only 5 cases (21.7%). Conclusion: This study was the first to demonstrate adenovirus infection with a relatively high prevalence among children, especially infants, in Qom. The findings further revealed co-infection with rotavirus, indicating a health problem in this region.

Comparing the Efficacy and Safety of Dexmedetomidine/Ketamine with Propofol/Fentanyl for Sedation in Colonoscopy Patients: A Doubleblinded Randomized Clinical Trial.

BACKGROUND: In this double-blinded randomized clinical trial, we aimed to compare the safety and efficacy of a combination of Dexmedetomidine and Ketamine (DK) with Propofol and Fentanyl (PF) for sedation in colonoscopy patients. METHODS: In this study, 64 patients who underwent colonoscopy were randomized into two groups: 1) A, which received PF, and 2) B, which received DK for sedation. Among 64 patients, 31 patients were included in PF, and 33 patients were included in the DK group. Both groups were similar in terms of demographics. Patients' sedation score (based on Ramsay sedation scale) and vital signs were recorded at 2, 5, 10, and 15 minutes. Complications including apnea, hypotension, hypoxia, nausea, and vomiting, along with gastroenterologist satisfaction and patients' pain score (based on Wong-Baker faces pain assessment scale), were recorded by a checklist. Data were analyzed by SPSS v.18 software, using chi-square, independent t-tests, and repeated measures analysis with p<0.05 as the criterion for significant differences. RESULTS: The mean score of sedation was 4.82±0.49 in the DK group and 5.22±0.45 in the PF group (p value=0.001). Serious complications, including hypotension (p value=0.005) and apnea (p value=0.10) were significantly higher in the PF group. Satisfaction of gastroenterologist (p value= 0.400) and patients' pain score (p value = 0.900) were similar among groups. CONCLUSION: Combination of DK provides sufficient sedation with fewer complications in comparison with PF in colonoscopy patients.

A prospective population-based study of stroke in the Central Region of Iran: The Qom Incidence of Stroke Study.

OBJECTIVE: Based on the few population-based studies that have been conducted in the Middle East, we determined the incidence of stroke in Qom, one of the central provinces of Iran. METHODS: The Qom province includes an estimated at-risk population of about 1 million. During a 12-month period (November 2018-November 2019), all first-ever strokes occurring in the target population were registered. Hospitalized cases were ascertained by discharge codes. Out-of-hospital cases were ascertained by a prospective screening of emergency medical services, emergency departments, ambulances records, primary care clinics, rural and urban public health centers, primary care physician offices, and neurologists' offices. Crude and age-adjusted incidence rates (per 100,000 person-years) were calculated. RESULTS: During the study period, 1462 first-ever strokes occurred with a mean age of 68.1 (17-103) years; of these 45.2% were females (661 cases). The crude annual incidence rate per 100,000 at-risk populations was 145.4 (95% confidence interval, 138.1-153.0) for all types of stroke (156.5 for males and 134.3 for females), 26.4 (95% confidence interval, 23.5-29.8) for hemorrhagic stroke, and 114 (95% confidence interval, 105-121) for ischemic stroke. The incidence rate adjusted to the world population was 201.4 (95% confidence interval, 193-210) per 100,000 at-risk populations (adj incidence, 218.5 for males vs 187.4 for females). The total fatality rate during the first 28 days was 19.6%. CONCLUSION: This study states that in this region there is a high incidence of stroke, which occurs at a younger age than the global average. There was a high prevalence of underlying stroke risk factors.

Oral health-related quality of life in rheumatoid arthritis: a comparative analysis.

BACKGROUND: Compared to the healthy population, the psychological impact of rheumatoid arthritis(RA) on patients' lives could dramatically lower their oral health-related quality of life (OHRQoL). Our goal is to analyze OHRQoL in RA patients and look into the role of disease activity, dental health index, and Temporomandibular disorders score in maintaining their oral health. METHODS: In a cross-sectional comparative study, we compared a sample of 40 RA patients with 40 age- and gender-matched healthy controls in terms of oral health and OHRQoL. Temporomandibular disorders (TMD), number of decayed, filled, or missing teeth (DMFT), and Oral Health Impact Profile (OHIP) were among the oral health factors studied (OHIP-14). This study also looked at the link between the RA disease activity score (DAS28) and oral health factors. RESULTS: RA patients had a significantly higher mean (poorer OHRQol) than healthy controls in total oral function, total psychosocial impact, OHIP-14 sum score, OHIP-14 extent score, TMD score and the number of missed teeth (Mann-Whitney U test, P-value < 0.05). After adjustment for DMFT, only the oral function score of OHIP-14 had a significant correlation with disease activity (Mann-Whitney U test, P-value < 0.05). The TMD sum score significantly correlated with disease activity regardless of adjustment for DMFT (Spearman's Correlation test, P-value < 0.05 for both). The number of decayed teeth and missed teeth showed a positive correlation with increased disease activity (Coefficient = 0.239 and 0.245, P-value < 0.05 for both). CONCLUSIONS: Patients with RA are less satisfied with their oral health than healthy controls. In RA patients, the number of missing teeth and temporomandibular disorders was substantially greater, and the number of missing teeth and temporomandibular diseases increased significantly with increased disease activity. Although OHRQoL was inversely connected with RA activity, after correcting for decaying, missing, and filled teeth, only the oral function score of OHIP-14 exhibited a slight connection to DAS28.