Effect of two different concentrations of sodium hypochlorite on postoperative pain following single-visit root canal treatment: a triple-blind randomized clinical trial.

AIM: To compare the effects of two different concentrations of NaOCl solution on postoperative pain following single-visit root canal treatment in mandibular molars with irreversible pulpitis. METHODOLOGY: A total of 122 patients who had mandibular molars with irreversible pulpitis were treated. The patients were randomly divided into two groups according to the concentration of NaOCl used during root canal instrumentation - either 2.5% or 5.25%. RaCe rotary instruments were used for root canal preparation, and all root canals were filled in one visit. Postoperative pain was evaluated using the visual analogue scale. Data were analysed by independent t-test, chi-square and Mann-Whitney tests. RESULTS: Twelve patients were excluded for various reasons. Pain reported by 110 patients who were eligible to be included in the study was analysed. No significant differences were found in the age and gender of the patients between the two groups (P = 0.50, P = 0.51, respectively). The patients who had 5.25% NaOCl reported significantly lower postoperative pain compared to those who had 2.5% NaOCl during the first 72 h following treatment (P = 0.021); however, there was no significant difference in pain felt by the patients during the rest of the study period, that is 4-7 days following treatment (P = 0.185) when the four-level pain categorization method was used. When the two-level pain categorization method was used, the results revealed that patients who had 5.25% NaOCl reported significantly less pain for the first 3 days after treatment (P = 0.026). The number of analgesics taken by patients who had 2.5% NaOCl was significantly higher than that taken by patients who had 5.25% NaOCl (P = 0.001). CONCLUSION: 5.25% NaOCl was associated with significantly lower postoperative pain compared to 2.5% NaOCl during the first 72 h following one-visit root canal treatment of mandibular molars with irreversible pulpitis.

Plasma levels of Transforming Growth Factor Beta in HIV-1 patients with oral candidiasis.

BACKGROUND AND PURPOSE: TGF-ß is a potent regulator and suppressor of the immune system and overproduction of this cytokine may contribute to immunosuppression in HIV-infected patients. Increasing population of immunosuppressed patients has resulted in increasingly frequent of fungal infections, including oral candidiasis. The aim of this study was to evaluate the plasma levels of TGF-ß under in vivo conditions. MATERIALS AND METHODS: Seventy- two samples were obtained from the oral cavities of HIV-positive Iranian patients and cultured on Sabouraud's dextrose agar and CHROMagar. Also blood samples were obtained to assess TGF-ß levels using ELISA technique. RESULTS: Thirty-three out of 72 oral samples yielded candida isolates, Candida albicans in 14 and non-albicans candida in 19.Fungal infection decreased significantly more TGF-ß level than non-fungal infection also HIV negative were significantly more TGF-ß than HIV positive. CONCLUSION: Our findings suggest a significant interaction between fungal infection and HIV on expression of Transforming Growth Factor Beta.

Bacterial contamination of different components of the waterpipe.

SETTING: Waterpipe smoking is an emerging topic in tobacco research that may have unrecognised health hazards. OBJECTIVE: To determine whether waterpipes are a source of bacterial contamination. METHODS: A total of 15 restaurants and waterpipe cafés were randomly selected from the list of locations serving waterpipe tobacco in Kerman city, Iran. Different parts of the waterpipe devices were sampled, including the disposable mouthpiece, the mouthpiece of the hose and the water in the bowl of the waterpipe. The samples were smeared onto bacterial culture media, including eosin methylene blue, blood agar and MacConkey agar growth media, and incubated at 37°C. After 24-48 h, they were examined for colony growth. RESULTS: Of 285 samples from different parts of the waterpipes, 236 (82.8%) showed positive cultures; the rate of contamination ranged from 69% in the fixed mouthpiece to 96% in bowl water. Coagulase-negative staphylococci (32.9%), Streptococcus spp (26.9%), Neisseria spp (13.7%) and Escherichia coli (9.4%) were the most frequent contaminants. CONCLUSION: Waterpipes are frequently contaminated with microorganisms. This study revealed potential microbial hazards in waterpipes that may contribute to respiratory tract colonisation.

Efficacy of supplementary buccal infiltrations and intraligamentary injections to inferior alveolar nerve blocks in mandibular first molars with asymptomatic irreversible pulpitis: a randomized controlled trial.

AIM: This randomized double-blinded controlled trial was performed to compare the efficacy of inferior alveolar nerve block (IANB) injection for mandibular first molar teeth with irreversible pulpitis with or without supplementary buccal infiltration and intraligamentary injection. METHODOLOGY: Eighty-two patients with asymptomatic irreversible pulpitis received either a combination of intraligamentary injection + buccal infiltration+ IANB or with traditional IANB injection in mandibular first molar teeth with irreversible pulpitis. Each patient recorded their pain score on a Heft-Parker visual analogue scale before commencing treatment, in response to a cold test 15 min after the designated anaesthetic injection, during access cavity preparation and during root canal instrumentation. No or mild pain at any stage was considered a success. Data were analysed by chi-square test. RESULTS: At the final stage of treatment, 69 of the 82 patients were eligible to be included in the study. No significant difference was found between age (P = 0.569) and gender (P = 0.570) amongst the patients in the two groups. The success rate of anaesthesia in the IANB and the combination groups were 22% and 58%, respectively. The success rate of anaesthesia in the combination group was significantly higher than the traditional IANB injection (P = 0.003). CONCLUSION: A combination of anaesthetic techniques can improve the success rate of anaesthesia for mandibular first molar teeth with irreversible pulpitis.

Preliminary reliability and validity of Persian version of the Family Dermatology Life Quality Index (FDLQI).

PURPOSE: Family Dermatology Life Quality Index (FDLQI) is an instrument for assessing the quality of life of family members of dermatologic patients. The aim of this study was to describe the cultural adaptation of this questionnaire and to assess psychometric properties of the Persian version. METHODS: At first, the questionnaire was translated into Persian, and then back-translation was performed. The whole cycle was repeated until a consensus was reached about the optimal translation. In the next step, cognitive debriefing was performed, and after approval of the Persian version by FDLQI developers, it was distributed among 100 family members of dermatological patients in order to evaluate its validity and reliability. RESULTS: Mean age of participants was 37.1 years (±12.3). Mean score of FDLQI was 15.4 (±5.5) with maximum and minimum scores of 30 and 6, respectively. The quality of life of studied participants showed no significant difference based on age-group, sex, educational level and the family relationship. Cronbach's alpha was calculated as 0.87. Exploratory factor analysis revealed a one-factor solution that accounted for 40.7 % of the variance. The unidimensional model was supported by confirmatory factor analysis. CONCLUSIONS: The results of the present study showed that the Persian version of FDLQI has acceptable factorial validity and internal consistency reliability.

Necessity of accreditation standards for quality assurance of medical basic sciences.

BACKGROUND: The present article reviews the significance of accreditation standards while emphasizing the necessity of implementation of such standards by basic medical science council, with an eye on such international standards as those published by WFME. This review article had to decide on the key words and expressions, data bases, to review relevant literature, review higher and medical education journals at GOOGLE, ELSEVIER, PUBMED, and such web sites as those of WFME and WMA's. Accreditation is a powerful leverage for institutional change and improvement and must be actively supported by academic and national health authorities worldwide. Considering the mission of the Basic Medical Science, Health and Post grad. Education, Ministry of Health and Medical Education, Tehran, Iran as accountable medical education, all specialists of the spectrum of disciplines agreed on the necessity of formulating the medical education standards for all disciplines of their interest. It is important that all efforts be joined in the endeavor to create effective and reliable instruments for quality assurance of Basic Medical Sciences Education.

Waterpipe tobacco use among Iranian university students: correlates and perceived reasons for use.

SETTING: Waterpipe smoking is becoming a global health crisis among youth. OBJECTIVE: To identify the prevalence of waterpipe use among Iranian university students and to explore perceived reasons for use. METHODS: A random sample of 1024 university students at two major universities in South Iran was enrolled in the study. A three-part questionnaire (baseline data, tobacco smoking status and perceived reasons for waterpipe use) was used. Students filled out the self-administered questionnaire in their classrooms. RESULTS: The prevalence of waterpipe smoking in the respondents' lifetime and in the last 30 days was 42.5% and 18.7%, respectively. The mean age at initiation of waterpipe smoking was 16.3 ± 3.2 years. Ever smoking was positively associated with age and male sex, whereas no association was found regarding marital status. The highest odds of lifetime waterpipe smoking were observed in students with close friends who smoked the waterpipe (5.94, 95%CI 4.26-8.30). The most important perceived reason for waterpipe smoking as stated by students was enjoyment (55.8%). CONCLUSION: Given the alarming prevalence of waterpipe smoking, preventive measures should be adopted among university students taking into account the influence of peers, siblings and parents in the lessening social tolerance of waterpipe smoking.

Validation of a Persian Version of the Oral Health Impact Profile (OHIP-14).

BACKGROUND: The oral health-related quality of life indicators are increasingly used to measure the impact of the oral conditions on quality of life. One of the most used indicators is the Oral Health Impact Profile (OHIP-14), but it has never been applied in Iran. The aim of this study was to validate the usage of OHIP-14 among Iranians. METHODS: A cross-sectional study was performed in Kerman (Iran). A consecutive sample (n= 400) of the Kerman Dental School Clinics attending patients participated in this study. All participants self-completed the translated OHIP-14. Reliability analyses, validity tests, and responsiveness were carried out to evaluate the psychometric properties of the OHIP-14. RESULTS: The reliability coefficient (Cronbach's alpha) of the OHIP-14 was above the recommended 0.7 threshold and considered excellent (alpha: 0.85). The coefficient of the test-retest reliability measured by ICC was 0.88 (CI 95%: 0.80-0.93). Poorer oral condition was strongly associated with OHIP scores of the patients, supporting construct validity. Moreover, for evaluation of responsiveness, the ES was measured to be 0.43 and the SRM was 0.67. CONCLUSIONS: The Persian version of OHIP-14 is a precise, valid and reliable instrument for assessing oral health-related quality of life among Persian population.

Validation of the Edinburgh Postnatal Depression Scale in an Iranian sample.

BACKGROUND: Considering the adverse effects of postpartum depression on both mother and infant, a screening instrument for early diagnosis seems to be of importance. AIMS: To assess the psychometric properties of the Persian version of Edinburgh Postnatal Depression Scale (EPDS) on a sample of Iranian postpartum women. METHOD: The EPDS was translated and back-translated in the standard method. The questionnaire was completed by 600 postpartum women. Hundred cases with an EPDS score of > or =9 and 100 cases with an EPDS of <9 were randomly selected for interview. Sensitivity, specificity, positive likelihood ratio, and receiver operating characteristics were calculated by comparing the EPDS sum score against the DSM-IV diagnoses. The correlation coefficient of the EPDS score with GHQ-12 score was calculated. Principal component analysis and internal consistency were assessed. RESULTS: The best cutoff scores for major depression were 12/13 with a sensitivity and specificity of 95.3% and 87.9%, respectively. The correlation coefficient of the total score of the Persian version of EPDS with the GHQ-12 total score was 0.76 (P < 0.001). A two-factor solution was selected as the most appropriate model based on both values and the score plot. The coefficient alpha for the whole scale was 0.83. CONCLUSION: The Persian version of EPDS is a reliable and valid measure for detecting postpartum depression. Furthermore, it seems acceptable to patients and a valid screening instrument for depression in postpartum women.

Iranian women's perceptions of family-planning services quality: a client-satisfaction survey.

As Iran (IR) is included among the most successful developing countries in family planning, clarification and expression of the ideas and needs of women receiving the services not only have a great positive impact on national policies but also may be of interest to other nations. This research was conducted to clarify the client perceptions of the quality of family planning services in the capital cities of the two largest provinces of Iran. A representative sample of 909 women aged 15-50 referred to health centers were interviewed by skillful interviewers in a private area after obtaining informed consent. A questionnaire consisting of baseline data and 17 five-point Likert-scaled items measuring the satisfaction of clients and perceived importance of each item was developed by investigators. Half were aged 26-35 years, and most (84%) were housewives. The highest percentage of dissatisfaction was reported in relation to 'privacy protection' item. However, when the importance score was included, too, 'provision of sufficient information regarding other contraceptive methods' and 'unavailability of all methods' implicated the areas where priorities should be focused. The satisfaction levels obtained by the survey should be carefully heeded, and the supply chain and provision of information to the clients may be the first priorities in the process of improving the quality of care.

Assessing the cost-effectiveness of contraceptive methods in Shiraz, Islamic Republic of Iran.

To determine the cost-effectiveness of seven contraceptive methods from the providers' perspective, the cost per adjusted couple-years of protection (ACYP) was calculated for each method based on region-specific conversion factors. More than 74,800 ACYPs were provided during March 1999 to February 2000. Intrauterine devices and implants offered the highest and lowest ACYP respectively. Condom was the single most expensive contraceptive method. Vasectomy was the most cost-effective method and implant provided the highest cost per ACYP.

Five-year continuation rate and reasons for early removal of Norplant in Shiraz, Iran.

Norplant has been the focus of controversy in Iran because of its relatively high premature removal rate. This study assessed the reasons for Norplant removal and its 5-year continuation rate to clarify the determining factors on elimination of this method. Subjects were identified via a retrospective chart review of Norplant users in Shiraz, Iran who were followed for 5 years. The mean age and weight of acceptors were 23.6 +/- 4.1 years and 54.4 +/- 8.5 kg, respectively. The most common reasons for removal were menstrual disturbances and personal reasons (each 41%). The 5-year continuation rate was 45%; on average, Norplant capsules were in place for 4.1 +/- 0.09 years. Norplant has been shown to be an acceptable option in other Muslim countries, so the relatively high rate of removal in Iran could not be attributed to the Norplant itself, but is probably linked to other factors that are in need of improvement.

Assessing the cost-effectiveness of contraceptive methods in Shiraz, Islamic Republic of Iran

To determine the cost-effectiveness of seven contraceptive methods from the providers' perspective, the cost per adjusted couple-years of protection [ACYP] was calculated for each method based on region-specific conversion factors. More than 74,800 ACYPs were provided during March 1999 to February 2000. Intrauterine devices and implants offered the highest and lowest ACYP respectively. Condom was the single most expensive contraceptive method. Vasectomy was the most cost-effective method and implant provided the highest cost per ACYP