Socioeconomic status and COVID-19-related cases and fatalities in the world: A cross-sectional ecological study.

Background and Aims: The COVID-19 pandemic poses an extraordinary threat to global public health. We designed an ecological study to explore the association between socioeconomic factors and the COVID-19 outcomes in 184 countries, using the geographic map and multilevel regression models. Methods: We conducted a cross-sectional ecological study in 184 countries. We performed regression analysis to assess the association of various socioeconomic variables with COVID-19 outcomes in 184 countries, using ordinary least squares and multilevel modeling analysis. We performed two-level analyses with countries at Level 1 and geographical regions at Level 2 in multilevel modeling analysis, using the same set of predictor variables used in ordinary least squares. Results: There was a significant relationship between COVID-19 cases rate (Log) per 100,000 inhabitants-day at risk with human development index (HDI), percentage of the urban population, unemployment, and cardiovascular disease prevalence. The results displayed that the variances are varied between Level 1 (country level) and Level 2 (World Health Organization [WHO] regions), meaning that the geographic distribution represented a proportion of the changes in the COVID-19 outcomes. Conclusion: The study suggests that in addition to the socioeconomic status affects the COVID-19 outcomes, countries' geographical location makes a part of changes in outcomes of diseases. Therefore, health policy-makers could overcome morbidity and mortality in COVID-19 by controlling the socioeconomics factors.

Professional legislation knowledge of dentists and psychological effects of negligence.

INTRODUCTION: The aim of the present study was to evaluate the extent to which a group of general dentists and specialists had knowledge of the professional laws and psychological effects of negligence on them. MATERIALS AND METHODS: The sample in this cross-sectional study consisted of 400 dentists (General dentists and specialists) in Isfahan city, Iran. Having designed the questionnaire and confirmed its validity and reliability, we published online to be completed by the dentists. The obtained data were analyzed using descriptive statistics, t-test, and ANOVA test. Optimal knowledge was determined to be 75%, and P-value<0.05 was considered to be statistically significant. RESULTS: The majority of the dentists (75%) had poor and very poor knowledge. The mean score of knowledge (range: 0-21, maximum obtainable: 24) was 9.58 ± 4.5. Sixty dentists (15%) reported they had experienced negligence. Further, 278 (69.5%) reported they had somehow experienced the occurrence of malpractice during their practical experience. Legal negligence was more prevalent among the general dentists than specialists (17.8 VS 8%, p < 0.001). Regarding the legal complaint history, a significant difference was observed between the males and females (P = 0.015) and among different categories of work experience years (P = 0.000). Moreover, among those who had a history of a legal complaint, 96.7% showed psychological symptoms, 70% had physical symptoms, and 80% displayed social symptoms related to the stress following legal complaints. CONCLUSION: Findings of this study indicated that refining the knowledge of the rules and regulations of the dental profession should be enhanced by considering appropriate training courses in the curricula and continuous education programs. More than half of the participants considered themselves guilty of negligence in this regard.

Prediction and control of stroke by data mining.

BACKGROUND: Today there are abounding collected data in cases of various diseases in medical sciences. Physicians can access new findings about diseases and procedures in dealing with them by probing these data. This study was performed to predict stroke incidence. METHODS: This study was carried out in Esfahan Al-Zahra and Mashhad Ghaem hospitals during 2010-2011. Information on 807 healthy and sick subjects was collected using a standard checklist that contains 50 risk factors for stroke such as history of cardiovascular disease, diabetes, hyperlipidemia, smoking and alcohol consumption. For analyzing data we used data mining techniques, K-nearest neighbor and C4.5 decision tree using WEKA. RESULTS: The accuracy of the C4.5 decision tree algorithm and K-nearest neighbor in predicting stroke was 95.42% and 94.18%, respectively. CONCLUSIONS: The two algorithms, C4.5 decision tree algorithm and K-nearest neighbor, can be used in order to predict stroke in high risk groups.

Evaluation of intima media thickness of carotid arteries in 40-60 years old persons with type d personality and its comparison with normal ones.

BACKGROUND: In some studies, the involvement of dangerous psychological and behavioral factors in etiology and physiotherapy of vascular disturbances have been shown. In other studies, the relationship between the personality type and increase in cardiovascular disease has been demonstrated. The type D personality is defined as having two characteristics of negative affect and social inhibition. It is thought that individuals with type D personality are at increased risk of carotid artery intima-media thickening which predisposes them to vascular disease that is one of the most important factors for the stroke. In this study, we try to determine whether type D personality is a contributing factor to an increase in the intima-media of the carotid artery. This study was done in 2012 in the teaching hospital of Alzahra in Isfahan Iran. METHODS: This is a case/control study which is done at Alzahra hospital in Isfahan in 2011-12. The statistical population in this study is composed of individuals who do not have any risk factors for stroke and are randomly selected among the hospital staff or the patient's family members who accompanied the patient at the hospital. They filled out a questioner that would assist in detecting type D personality. A carotid Doppler ultrasound that measures the intima-media thickness in the selected individuals was performed. The information obtained from the study was evaluated by Statistical Product and Service Solutions (SPSS) software and the intima-media thicknesses were compared in two groups of patients. RESULTS: The average thickness of intima media in two groups, consist of placebo and patients, was 0.739 ± 0.12 and 0.759 ± 0.14 millimeter, respectively. There was no meaningful difference between the two groups based on t-test values (P = 0.19). It is important to note that based on the results, 22.9% of placebos and 48.6% of individuals with type D personality presented with abnormal thickness. The difference between the two groups were meaningful based on Chi-Squared test (P = 0.001). CONCLUSIONS: We conclude that type D personality increases the risk of cardiovascular diseases specially the stroke and myocardial infarction due to the higher prevalence of hormonal imbalances leading to arterial vasospasm and atherosclerotic disease. As a result, it is necessary to evaluate and treat these patients due to increased risk of atherosclerotic diseases, stoke, and myocardial infarction.

Comparison of changes in serum fibrinogen level in primary intracranial hemorrhage (ICH) and ischemic stroke.

BACKGROUND: There is a growing body of evidence indicating that increase in fibrinogen is associated with increased risk of stroke. This study aimed to determine the type of stroke and the role of fibrinogen in stroke type. METHODS: This case-control study comprised 58 hospitalized patients with intracranial hemorrhage (ICH) and ischemic stroke. Demographic and clinical characteristics, type of stroke and fibrinogen level were collected after starting the treatment. RESULTS: The prevalence of ICH was higher in men than in women so that 60% of men and 39.3% of women in this study were diagnosed with this type of stroke. In contrast, the corresponding figures for ischemic stroke were 40% and 60.7%, respectively. Statistical analysis by chi-square test revealed significant difference in the type of stoke in terms of gender (P = 0.026). The mean fibrinogen levels was lower in patients with ICH (348 ± 96 mg/dl) than in patients with ischemic stroke (381 ± 126 mg/dl), however this difference was not statistically significant (P = 0.12). Fibrinogen levels were significantly higher in women than in men (390 ± 111 vs. 340 ± 110 mg/dl, respectively, P = 0.017). CONCLUSION: Although the mean fibrinogen level was not significantly different in ICH and ischemic stroke patients, it is recommended to examine the serum fibrinogen and its related factors at least for those patients with non-modifiable risk factors and in particular for those with family history and genetic background.

A novel approach to determine the effect of irrigation on temperature and failure of Ni-Ti endodontic rotary files.

BACKGROUND: Nickel-titanium (Ni-Ti) rotary instrument files are important devices in Endodontics in root canal preparation. Ni-Ti file breakage is a critical and problematic issue and irrigation techniques were applied to decrease risk of file failure root. The aim of the present study was to compare the temperature gradient change of different irrigation solutions with Ni-Ti rotary instrument system during root canal preparation and also to define their effects on the file failure. MATERIALS AND METHODS: A novel computerized instrumentation was utilized and thirty standard (ProFile #25/.04) files were divided into three groups and subjected to a filing in the root canal test. Changes in temperature on teeth under constant instrumental conditions with custom-designed computerized experimental apparatus were measured by using a temperature sensor bonded to the apical hole. A rotary instrument for canal preparation in three series of solution was used and the changes in temperature after each solution were compared. Finally, the file failure results were mentored according to each step of test. Comparisons were performed between group status clinically by using ANOVA (t) test, once the sample showed up normal and differences of P<0.01 were considered significant. All data collected were computerized and analyzed for frequency, distribution, and statistical description. RESULTS: There was a decrease in the temperature of the instruments, which were immersed in 5% NaOCl, when compared with the water group (P<0.01). There was also a decrease in the temperature of the instruments immersed in water, when compared with the no solution group (P<0.01). Test results showed that sodium hypochlorite, water, or air of root canals does alter the properties of gradual temperature change and contributes to the failure of the instruments. CONCLUSION: By immersing the file in 5% NaOCl, the temperature gradient decreased and instrument failure was reduced.

Comparison between efficacy of imipramine and transcutaneous electrical nerve stimulation in the prophylaxis of chronic tension-type headache: a randomized controlled clinical trial.

BACKGROUND: Chronic tension-type headache (CTTH) is recognized as the most common type of headache and can be further defined as either episodic or chronic. Regarding the chronic nature of CTTH and intolerance or side effects of drugs that are used for treatment, other methods of treatment such as Transcutaneous Electrical Nerve Stimulation (TENS) has been used as a convenient and available method for treatment and prevention of CTTH. In the current study, we evaluated the efficacy of the imipramine versus TENS in the prevention of the CTTH as a prospective clinical trial. METHODS: In this study, 138 patients with confirmed CTTH were randomized to be treated either with imipramine or TENS method. Sixty nine patients were treated with TENS and 69 cases were regarded as controls and were treated with imipramine. In the Imipramine group, treatment was performed by imipramine tablet, 25mg, twice daily. In the TENS group, patients were treated thrice weekly for ten weeks, each lasting 15 minutes in temporal and occipital regions. RESULTS: Three months after treatment, both the TENS and imipramine significantly reduced the severity of tension headache (p < 0.05). However, imipramine was significantly more effective than TENS in reduction of the headache severity (p < 0.05). CONCLUSIONS: It appears that TENS method may be a good alternative method for patients suffering from CTTH. To better evaluate the efficacy of this method in the prevention and treatment of CTTH, more studies are recommended.