A randomized clinical trial on the effect of foot reflexology performed in the fourth stage of labor on uterine afterpain.

BACKGROUND: Uterine afterpains are among the most prevalent complaints after natural vaginal delivery. Non-pharmacological treatment modalities to relieve afterpains are an important care priority. This study was conducted to investigate the effect of foot reflexology in the fourth stage of labor on afterpains in multiparous women. METHODS: This single-blind, randomized, clinical trial recruited 80 eligible pregnant women presenting to Allameh Bohlool Hospital in Gonabad and 17-Shahrivar Hospital in Mashhad, Iran, in 2019. In the first and second hours postpartum, the reflexology group received 10 min of general massage and specific reflexology massage on each foot on the uterine, pituitary, and solar plexus points. The control group received 10 min of general massage, and then rotational massage on a neutral point on the lateral side of the heel. The pain was measured every hour up to 4 h postpartum using a visual analogue  scale. The collected data were analyzed in SPSS-16 software at a significance level of P < 0.05. RESULTS: The median of the afterpain score in the first hour (P = 0.05) and second hour (P = 0.274) postpartum did not differ significantly between the two groups, but this score was lower in the reflexology group at the third hour (P < 0.001) and fourth hour (P < 0.001) postpartum. The mean total afterpain score in the 4 h postpartum was significantly lower in the reflexology group (P < 0.001). CONCLUSION: The results revealed that foot reflexology in the fourth stage of labor has positive effects on relief from uterine afterpain. Reflexology is therefore recommended as a measure to reduce postpartum uterine afterpains.

Assessing Heavy Metal Burden Among Cigarette Smokers and Non-smoking Individuals in Iran: Cluster Analysis and Principal Component Analysis.

Smoking is one of the major causes of mortality and numerous diseases, both directly and indirectly. The role of smoking as a significant risk factor is already known in several human diseases such as cardiovascular diseases, lung cancer, and chronic obstructive pulmonary disease. We aimed to compare the toxicity of heavy metal levels in the two groups of cigarette smokers and non-smokers in Birjand during 2018. In this case-control study, 70 smokers were enrolled as the case group and 70 individuals with no history of smoking as control group. The cases were selected from among those who smoked 10 cigarettes per day without a drug use history. Heavy metal concentrations were collected in participants' serum samples. Cluster analysis and principal components analysis were employed to compare heavy metal toxicity between the groups. The duration of smoking and the number of cigarettes consumed per day were 14.36 ± 12.75 years and 11.32 ± 7.23, respectively. The concentration of thallium (Ti), arsenic (As), manganese (Mn), and copper (Cu) was significantly higher in the smoker group than that in the non-smoker group (p < 0.05). Lead (Pb), cadmium (Cd), and cobalt (Co) are among the most important metals accumulated in smokers' blood, and 21.6% of our study's total data was associated with them. Cluster analysis in the smoker group, including A1 (Cd), A2 (Co, Pb), B1 (Ti), B2 (mercury (Hg), As, chromium (Cr), iron (Fe), nickel (Ni), and zinc (Zn)) and C (Mn and Cu). In our study, cluster analysis showed a different grouping of elements in patient and control groups. Lead, cadmium, and cobalt were the most critical metals accumulated in the blood of cigarette smokers.

Relation of hepcidin gene expression in blood mononuclear cells with iron overload severity among ß-thalassemia major patients.

Iron overload is the main cause of morbidity and mortality in ß-thalassemia major patients, and cardiac iron overload is the most common reason for death in these transfusion-dependent patients. Hepcidin, a liver-derived peptide hormone, plays a key role in plasma iron levels regulation by controlling two main stages, digestive iron absorption in enterocytes, and iron recycling in macrophages. Although hepcidin is mainly secreted from hepatocytes in the liver, it is also synthesized from mononuclear cells consisting of monocytes and lymphocytes. Binding of this molecule to ferroportin, a specific cellular exporter of iron, leads to degradation of the ligand-receptor complex, which reduces the iron overload by lowering the amounts of iron released into the plasma. Likewise, the same mechanism has been proved to be true for lymphocyte-drived hepcidin. The expression levels of hepcidin mRNA were evaluated using quantitative real time PCR (qRT-PCR) in 50 ß-thalassemia major patients, as well as 25 healthy volunteers as the group of control. There was a significantly positive correlation between the cardiac iron concentration, showed by higher T2 values, and hepcidin levels in the patients (p = 0.028; r = 0.311). However, hepcidin expression levels did not significantly correlate with ferritin and liver iron concentrations. Hepcidin can act as a beneficial marker to determine iron overload degrees, particularly in the heart, in ß-thalassemia major patients and be used as a logical therapeutic agent for treatment of ß-thalassemia disorders.

A Comparison between Decision Tree and Random Forest in Determining the Risk Factors Associated with Type 2 Diabetes.

BACKGROUND: We aimed to identify the associated risk factors of type 2 diabetes mellitus (T2DM) using data mining approach, decision tree and random forest techniques using the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) Study program. STUDY DESIGN: A cross-sectional study. METHODS: The MASHAD study started in 2010 and will continue until 2020. Two data mining tools, namely decision trees, and random forests, are used for predicting T2DM when some other characteristics are observed on 9528 subjects recruited from MASHAD database. This paper makes a comparison between these two models in terms of accuracy, sensitivity, specificity and the area under ROC curve. RESULTS: The prevalence rate of T2DM was 14% among these subjects. The decision tree model has 64.9% accuracy, 64.5% sensitivity, 66.8% specificity, and area under the ROC curve measuring 68.6%, while the random forest model has 71.1% accuracy, 71.3% sensitivity, 69.9% specificity, and area under the ROC curve measuring 77.3% respectively. CONCLUSIONS: The random forest model, when used with demographic, clinical, and anthropometric and biochemical measurements, can provide a simple tool to identify associated risk factors for type 2 diabetes. Such identification can substantially use for managing the health policy to reduce the number of subjects with T2DM .

Identifying Risk Factors for Drug Use in an Iranian Treatment Sample: A Prediction Approach Using Decision Trees.

INTRODUCTION AND AIM: Substance abuse exacts considerable social and health care burdens throughout the world. The aim of this study was to create a prediction model to better identify risk factors for drug use. DESIGN AND METHODS: A prospective cross-sectional study was conducted in South Khorasan Province, Iran. Of the total of 678 eligible subjects, 70% (n: 474) were randomly selected to provide a training set for constructing decision tree and multiple logistic regression (MLR) models. The remaining 30% (n: 204) were employed in a holdout sample to test the performance of the decision tree and MLR models. Predictive performance of different models was analyzed by the receiver operating characteristic (ROC) curve using the testing set. Independent variables were selected from demographic characteristics and history of drug use. RESULTS: For the decision tree model, the sensitivity and specificity for identifying people at risk for drug abuse were 66% and 75%, respectively, while the MLR model was somewhat less effective at 60% and 73%. Key independent variables in the analyses included first substance experience, age at first drug use, age, place of residence, history of cigarette use, and occupational and marital status. DISCUSSION AND CONCLUSION: While study findings are exploratory and lack generalizability they do suggest that the decision tree model holds promise as an effective classification approach for identifying risk factors for drug use. Convergent with prior research in Western contexts is that age of drug use initiation was a critical factor predicting a substance use disorder.

Critical appraisal of fundamental items in approved clinical trial research proposals in Mashhad University of Medical Sciences.

Background: Writing, designing, and conducting a clinical trial research proposal has an important role in achieving valid and reliable findings. Thus, this study aimed at critically appraising fundamental information in approved clinical trial research proposals in Mashhad University of Medical Sciences (MUMS) from 2008 to 2014. Methods: This cross-sectional study was conducted on all 935 approved clinical trial research proposals in MUMS from 2008 to 2014. A valid and reliable as well as comprehensive, simple, and usable checklist in sessions with biostatisticians and methodologists, consisting of 11 main items as research tool, were used. Agreement rate between the reviewers of the proposals, who were responsible for data collection, was assessed during 3 sessions, and Kappa statistics was calculated at the last session as 97%. Results: More than 60% of the research proposals had a methodologist consultant, moreover, type of study or study design had been specified in almost all of them (98%). Appropriateness of study aims with hypotheses was not observed in a significant number of research proposals (585 proposals, 62.6%). The required sample size for 66.8% of the approved proposals was based on a sample size formula; however, in 25% of the proposals, sample size formula was not in accordance with the study design. Data collection tool was not selected appropriately in 55.2% of the approved research proposals. Type and method of randomization were unknown in 21% of the proposals and dealing with missing data had not been described in most of them (98%). Inclusion and exclusion criteria were (92%) fully and adequately explained. Moreover, 44% and 31% of the research proposals were moderate and weak in rank, respectively, with respect to the correctness of the statistical analysis methods. Conclusion: Findings of the present study revealed that a large portion of the approved proposals were highly biased or ambiguous with respect to randomization, blinding, dealing with missing data, data collection tool, sampling methods, and statistical analysis. Thus, it is essential to consult and collaborate with a methodologist in all parts of a proposal to control the possible and specific biases in clinical trials.

In Vitro Comparison of Dye Penetration through Four Temporary Restorative Materials.

INTRODUCTION: The purpose of this in vitro study was to compare the coronal seal of four temporary filling materials, Coltosol, Zonalin, Zamherir, and Intermediate Restorative Material (IRM) by the India ink dye penetration test. MATERIALS AND METHODS: Endodontic access preparations were prepared in 120 extracted intact human premolars. The teeth were randomly divided into six groups including four experimental and two control groups. The access cavities in each group were sealed with Coltosol, Zonalin, Zamherir, and IRM; subsequently thermocycling was applied for 5-55˚C for 150 cycles. The teeth were immersed in 10% India ink for 72 hours to assess leakage. The teeth were then rinsed, dried, and sectioned mesiodistally and evaluated under a stereomicroscope for dye penetration. Data were analyzed using one-way ANOVA and post hoc Tukey tests. RESULTS: Positive control specimens showed complete dye penetration, while negative controls had no penetration. In the experimental groups, the lowest and highest leakage scores were observed in the Zonalin and Coltosol groups, respectively (P<0.05). There were no statistically significant differences in marginal leakage between Zonalin-Zamherir and Coltosol-IRM groups. CONCLUSION: These results suggest that Zonalin and Zamherir have a superior seal and less micro-leakage into the canals compared to the two other materials.

A comparative study of lidocaine and lidocaine- mannitol in anesthetizing human teeth with inflamed pulps.

INTRODUCTION: Failure to achieve adequate and profound anesthesia in teeth with acute pulp inflammation is a common condition during emergency visits in root canal therapy. Many different anesthetic solutions such as morphine and capsaicin have accordingly been examined. Mannitol- an alcoholic sugar with high osmotic pressure level- is applicated for reducing intracranial and post retinal pressure in medicine. It has also been used for its diuretic effect. In combination with local anesthetic solution, it increases permeability of the nerve fiber sheath and leads to influx of the local anesthetic through cytoplasmic membrane .The purpose of the present study was to compare the efficacy of routine local anesthesia with or without using mannitol in teeth with inflamed pulps. MATERIALS AND METHODS: one hundred patients with acute dental pain in posterior teeth were selected. Vials with 3 ml anesthetic solution containing 2.5% lidocaine with 1/80000 epinephrine or 2.5% lidocaine with 1/80000 epinephrine and 0.5 mol mannitol were used for anesthesia. For each patient, the routine injection technique was applied, during the removal of decay and dentine. Depth of anesthesia was evaluated and the supplementary injection was done in case of pain feeling and then pulpotomy was done. The analysis of data was done using chi-square statistical test. RESULTS: The results showed that complete anesthesia after the first injection was obtained with lidocaine mannitol in 46% and with lidocaine alone in 38% of cases. However, the difference was not significant. CONCLUSION: These finding suggest that the addition of mannitol to the standard anesthetic solution could insignificantly increase the level of anesthesia in teeth with inflamed pulps.