Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study.

Hospital-acquired infections (HAIs) are considered a major challenge in health care systems. One of the main HAIs, playing an important role in increased morbidity and mortality, is surgical wound infection. Therefore, this study aimed to determine the incidence rate and risk factors of surgical wound infection in general surgery patients. This cross-sectional study was performed on 506 patients undergoing general surgery at Razi hospital in Rasht from 2019 to 2020. Bacterial isolates, antibiotic susceptibility pattern, antibiotic administration, and its type, operation duration and shift, the urgency of surgery, people involved in changing dressings, length of hospitalisation, and levels of haemoglobin, albumin, and white blood cells after surgery were assessed. The frequency of surgical wound infection and its association with patient characteristics and laboratory results were evaluated. The SPSS software package (version 16.0, SPSS Inc., Chicago, IL, USA) was used to analyse the data. Quantitative and qualitative variables were presented using mean (standard deviation) and number (percentage). The Shapiro-Wilk test was used to evaluate the normality of the data in this study. The data did not have a normal distribution. Hence, χ2 and Fisher's exact tests were used to evaluate the relationship between variables. Surgical wound infection occurred in 4.7% (24 cases) of patients with a mean age of 59.34 (SD = 14.61) years. Preoperative (>3 days) and postoperative (>7 days) hospitalisation, history of immunodeficiency (P < 0.001), and interns responsible for changing dressings (P = 0.021) were associated with surgical wound infection incidence. About 9.5% and 4.4% of surgical wound infection cases were significantly associated with pre- and postoperative antibiotic use. Gram-positive cocci were the most prevalent strains isolated from 24 surgical wound infection cases (15/24, 62.5%). Among these, Staphylococcus aureus was the predominant species, followed by coagulase-negative staphylococci. In addition, the most common Gram-negative isolates identified were Escherichia coli bacteria. Overall, administration of antibiotics, emergency surgery, surgery duration, and levels of white blood cells and creatinine were identified as surgical wound infection-associated risk factors. Identifying important risk factors could help control or prevent surgical wound infections.

Frequency and causes of self-medication in patients with chronic rhinosinusitis, North of Iran, 2018-2019.

PURPOSE: Chronic rhinosinusitis (CRS) is a frequent respiratory disease. As self-medication is a common issue in the world, this study aimed to estimate its frequency in patients with CRS. METHODS: 144 CRS patients referred to a university hospital, were evaluated for self-medication, included type, duration, frequency, and its causes, their SNOT-22 questionnaire and Lund-MacKay scores. The data were analyzed using SPSS v.21 and the level of significance was considered as P ≥ 0.05. RESULTS: 30.6% of the cases used self-medication (65.9% used chemical drugs and 63.6% used herbal drugs), not associated with their age, gender, educational or economic level. The most common chemical drugs were antibiotics, analgesics and decongestants (75.9%, 55.2% and 10.3%, respectively) and the most common non-pharmaceutical agents included steam inhalation and herbal infusions (71.4%). The efficacy of self-medication was rated as "none" to "little" in 54.64% of cases. The mean SNOT-22 score was 59.54 ± 10.93 and 73.27 ± 8.12 in cases without and with self-medication (P = 0.034), and the mean Lund-MacKay score was 11.8 ± 5.3 and 17.2 ± 4.3 in cases without and with self-medication, respectively (P = 0.002). The top reasons for self-medication were "considering the disease unimportant" and believing chemical drugs being "harmful", "expensive", or "non-effective". Most patients who used self-medication did "not" advise it to others (80%). CONCLUSION: The high rate of self-medication in CRS patients calls for greater attention to this issue in these patients. It seems that self-medication is significantly associated with more severe grades of disease and lower QOL in CRS cases.

Dermatologic problems associated with personal protective equipment in health-care workers managing COVID-19 patients.

Background: The safety of health-care workers (HCWs) during the COVID-19 pandemic is a major concern worldwide. Dermatological problems due to personal protective equipment are annoying issues. We aimed to evaluate dermatological adverse events following the use of these protections in HCWs managing COVID-19 patients. Materials and Methods: One hundred and fifty-six workers managing COVID-19 patients were enrolled in this cross-sectional study. We conducted face-to-face interviews to collect the data and focused mainly on protection type and mucocutaneous symptoms with new onset or exaggeration after this equipment. Results: Dermatological problems following protective equipment usage occurred mainly during the 1st week (65.4%). The most common site of skin involvement was the nose (82.7%) and the most frequent visible complaints were the pressure effect and erythema on the nose in 80.8% and 57.7% of cases, respectively. There was a significant association between mask type and facial skin problems (P < 0.001). The main symptoms were itching (21.8% scalp, 39.1% face and body) and burning sensation (14.1% scalp, 23.7% face and body). Skin desquamation (37.2%) and dorsal hand dermatitis (41.66%) were significantly more frequent in atopic participants (P = 0.02 and P = 0.01, respectively). Hand involvement was significantly associated with frequency of hand washing (odds ratio = 1.97, 95% confidence interval = 1.04-3.74, P = 0.03). Conclusion: We found that skin problems related to protective equipment were common and frequently located on the face mainly due to facial masks. These complications should be prevented by proper use of this equipment.

Fusion patterns of the spheno-occipital synchondrosis in the age range of 9-22: A computed tomography analysis.

OBJECTIVES: To assess the fusion patterns of the spheno-occipital synchondrosis (SOS) in the age range of 9-22 using CT and CBCT images of an Iranian population. SETTING/SAMPLE POPULATION: Spiral CT and CBCT scans of 763 subjects (459 males and 304 females) aged 9-22 were evaluated. The scans had to cover the cranial base area, and those with diseases affecting the bone density, cranial base masses and history of trauma were excluded. MATERIALS AND METHODS: Two oral and maxillofacial radiologists scored the images with regard to the status of SOS fusion based on a 5-stage system. Mann-Whitney, Kruskal-Wallis and Fisher's exact tests were used for data analysis. Age and SOS fusion stages were evaluated through Spearman correlation and linear regression methods (α = 0.01). RESULTS: The earliest age for onset of SOS fusion was 9 in both sexes. Open SOS could be observed until the age of 15 and 14 in males and females, respectively. The earliest age of complete fusion was 12 in males and 13 in females. Furthermore, there was a significant, positive correlation between age and the different stages of SOS fusion (P < .001). CONCLUSION: A significant correlation exists between age and the fusion stages of SOS, rendering it an appropriate means of age estimation during growth periods. Fusion of SOS begins approximately 2 years earlier in females; however, it ends at the age of 17 in both sexes. The fusion scar can be detected up to the age of 12 and 13 in males and females, respectively.

Quantitative Morphometric Analysis of Anatomical Landmarks Involved in Bilateral Sagittal Split Osteotomy in Different Skeletal Malocclusions Using Cone-Beam Computed Tomography.

BACKGROUND: To assess and compare the anatomical landmarks involved in bilateral sagittal split osteotomy (BSSO) in different skeletal malocclusions quantitatively using cone-beam computed tomography (CBCT). METHODS: This retrospective study evaluated 63 CBCT scans of the three malocclusion classes (n = 21). Twenty-one quantitative variables were measured and compared between different malocclusion classes. One-way ANOVA, Welch test, Kruskal Wallis test and the Mann-Whitney test with Bonferroni adjustment were used for data analysis. The level of significance was set at ≤0.05. RESULTS: The patients had a mean age of 26.35 years (range 18-58 years). The width of the lateral cortex in the posterior third (T1-P) of ramus in the left side, and the mean value in the right and left sides were significantly different between different classes of malocclusion (P = 0.049) such that class II patients had significantly thinner lateral cortex. No other significant differences were noted between different malocclusion classes in other variables. CONCLUSION: The quantitative morphological assessment of the mandible in BSSO of different malocclusion classes did not reveal significant differences. There is no superiority in the dimensions of discussed landmarks involved in BSSO among different malocclusion classes. So the risk or the safety of this kind of surgery is similar for these classes. Thus, diagnostic preoperative workup by CBCT is imperative for selection of a surgical approach with minimal postoperative complications.

Effect of CO2 laser (10.6 µm) and Remin Pro on microhardness of enamel white spot lesions.

This study investigated the combined effect of CO2 laser irradiation and Remin Pro paste on microhardness of enamel white spot lesions (WSLs). Seventy-eight intact premolars were randomly assigned into six groups and then stored in a demineralizing solution to create WSLs. Afterwards, the teeth in group 6 (negative control) remained untreated, while groups 1 and 4 were exposed to CO2 laser irradiation (20 Hz, 1 W, 30 s) and Remin Pro paste, respectively. In groups 2 and 3, the teeth were exposed to laser either before (group 2) or after (group 3) Remin Pro application. The teeth in groups 1 to 5 were then immersed in artificial saliva for 90 days while subjected to fluoride mouthwash and weekly brushing. Finally, the teeth were sectioned, and Vickers microhardness was measured at the enamel surface and at 50, 100, and 150 µm from the surface. One sample of each group was also examined with scanning electron microscope (SEM). Data were analyzed by two-way analysis of variance (ANOVA) and Tukey's test. The significance was set at 0.05. Laser irradiation followed by Remin Pro application (group 2) caused a significant increase in total WSLs' microhardness compared with laser alone (group 1) and control groups (P < 0.05). Microhardness at depths of 100 and 150 µm was also significantly greater in group 2 compared with those of group 3 and control groups (P < 0.05). Combined application of CO2 laser with Remin Pro paste, when laser is irradiated before the paste, is suggested for re-hardening of WSLs in deep layers of enamel.

Evaluation of serum folate level before and after bath PUVA therapy in patients referred to Razi Hospital, Rasht, Iran.

Ultraviolet (UV) radiation could disintegrate folate molecule, so phototherapy may reduce folate levels in the patients. The effect of phototherapy on serum folate in human body is questionable. We investigated the effect of bath PUVA therapy on serum folate level. This study was designed as a before-after study. Thirty-two patients completed study during 2 years. Our variables were demographic data, folate levels before and 8 weeks after treatment and cumulative dosage of UVA during 8 weeks of treatment. Serum folate was evaluated with chemiluminescence immunoassay technique. All data were analyzed using SPSS 18 software. Folate level changes were statistically significant before and after bath PUVA therapy. There was no significant difference in folate levels in psoriasis patients compared with nonpsoriasis patients. In psoriasis patients, folate levels had no significant correlation with psoriasis activity index before treatment. Decrease in folate levels was more significant in fair-skinned patients. There was no association between folate status and cumulative dosage of UVA. Bath PUVA therapy reduced serum folate level in our patients although none of them were folate deficient. Folate deficiency should be evaluated and corrected especially in fair-skinned cases, as it may be aggravated by phototherapy.

Subtypes of Benign Breast Disease as a Risk Factor of Breast Cancer: A Systematic Review and Meta Analyses.

BACKGROUND: Researchers suggest that benign breast disease (BBD) is a key risk factor for breast cancer. The present study aimed to determinate the risk level of breast cancer in terms of various BBD subgroups. METHODS: A meta-analysis was performed to determinate the risk of breast cancer associated with BBD. Observational studies (traditional case-control studies, nested case-control studies, and cohort studies) published from January 2000 to June 2015 were assessed to evaluate the risk of developing breast cancer related to BBD. Various databases such as Medline (PubMed), Web of Science (ISI), Scopus, and Google Scholar were searched. The additional search included the Journal of Breast Cancer Research and Treatment and the Journal of Cancer Research. RESULTS: Twenty studies out of 21 were used to estimate the risk of developing breast cancer related to proliferative disease without atypia versus non-proliferative disease and the reported risk ranged from 1.04 to 1.83. The reported risk of developing breast cancer related to proliferative disease with atypia versus non-proliferative disease in 21 studies ranged from 1.59 to 4.74. Based on 20 studies, the pooled risk estimates for developing breast cancer related to proliferative disease without atypia versus non-proliferative disease was 1.58 (95% CI: 1.51-1.66). Based on 21 studies, the pooled risk estimates for developing breast cancer related to proliferative disease with atypia versus non-proliferative disease was 3.49 (95% CI: 3.23-3.77). CONCLUSION: The overall result of this review showed an elevated risk for breast cancer related to BBD subtypes. We propose better strategies for screening recommendations for such women.

Subtypes of Benign Breast Disease as a Risk Factor for Breast Cancer: A Systematic Review and Meta-Analysis Protocol.

Breast cancer is a multifactorial disease. Benign breast disease (BBD) is one of the most important risk factors for breast cancer. The etiology of BBD is unknown. It is divided into nonproliferative and proliferative diseases. The selection of studies will be based on titles, abstract screening, inclusion and exclusion criteria, and quality assessment. Previous studies have shown that all types of BBD increase the risk of breast cancer, but the risk degree is different for each one. Accurate risk estimation of breast cancer in each category can be very important for proper clinical management. This systematic review and meta-analysis will be conducted on observational studies (traditional case control, nested case control, case cohort, and cohort) published in the Web of Science (ISI), PubMed (MEDLINE), Scopus, Google Scholar, and the key journals of this field such as Breast Cancer Research and Treatment and Cancer Research from January 2000 to June 2015. Reference lists and gray literature will be reviewed too. All the initial retrievals will be performed by 2 researchers independently. The data extraction form will consist of general information concerning the studies, study eligibility, method, risk of bias assessment, and results-including odds ratios, risk ratios, rate ratios, and hazard ratios. The PRISMA and MOOSE guidelines will be used to report our findings. Registration Details: PROSPERO-42016035243.

Therapeutic Effects of Intranasal Administration of Resveratrol on the Rat Model of Brain Ischemia.

Background: Resveratrol is a natural phenolic compound widely found in plants. Previous studies have suggested its neuroprotective role in cerebral ischemia due to its anti-oxidative, anti-inflammatory, and anti-apoptotic effects. Intranasal administration of resveratrol enhances its capacity to penetrate the blood-brain barrier, increasing therapeutic efficacy and safety. Objective: We aimed to examine the therapeutic potential of intranasal administration of resveratrol treatment in rats exposed to cerebral ischemia. Methods: Sixty-four male rats were divided into three groups: the sham group, which was exposed to only surgical stress; the vehicle and resveratrol groups, which received intranasal vehicle or 50 mg/kg resveratrol for 7 days following middle cerebral artery occlusion, respectively. We assessed the modified neurologic severity scores, wire hanging tests, blood-brain barrier disruption, brain water content, and infarct volume. Levels of matrix metalloproteinase-9, nuclear factor-kappa B, B-cell lymphoma protein 2, and B-cell lymphoma protein 2-associated X messenger RNA expression were examined. Results: At 3- and 7-days post-ischemia, rats receiving intranasal resveratrol had lower modified neurological severity scores and a smaller brain infarct volume than the rats receiving vehicle. Additionally, the intranasal resveratrol-treated rats showed significantly prolonged wire-hanging performance at the 7-day mark post-ischemia compared to the vehicle group. The blood-brain barrier disruption and brain water content were significantly lower in the resveratrol group than in the vehicle group. Furthermore, the resveratrol-treated group displayed lower expression of Matrix Metalloproteinase-9 and Nuclear Factor-Kappa B in contrast to the vehicle group, while the difference in expression levels of B-cell lymphoma protein 2-associated X and B-cell lymphoma protein 2 were not significant. Conclusion: Intranasal administration of resveratrol showed neuroprotective effects on ischemic stroke by improving neurobehavioral function, reducing blood-brain barrier disruption, cerebral edema, and infarct volume. This treatment also downregulated Matrix Metalloproteinase-9 and Nuclear Factor-Kappa B expression, indicating its potential as a therapeutic option for ischemic stroke.

Effect of thermocycling and water storage on bond longevity of two self-etch adhesives.

Despite recent improvements in adhesive systems and their bond strength to enamel and dentin, the resin-tooth interface appears to be the weakest part of tooth-colored restorations; in addition, there are concerns regarding bond durability of self-etch adhesives (SEAs). This in vitro study investigated the bond durability of 2 such adhesives following thermocycling and water storage. Forty-eight intact human third molars were sectioned mesiodistally and mounted in acrylic resin so that buccal and lingual surfaces were positioned horizontally. All enamel and dentin surfaces were ground flat and polished on silicon carbide papers. Samples were separated into 2 groups (n = 24). A 1-step SEA was applied to one group, while a 2-step SEA was applied to the other, according to manufacturers' instructions. Half of the specimens in each group underwent shear bond strength (SBS) testing after 24 hours of incubation, while the other half were tested after 3000 thermal cycles and 6 months of water incubation. SBS data were analyzed using 2-way ANOVA, 1-way ANOVA, and a post hoc Tukey test at a significance level of 0.05. Under the limitations of the present study, the 2-step SEA demonstrated higher baselines and aged bond strength to dental tissues compared to the 1-step SEA; in addition, the enamel bond strength of the 2-step SEA improved after aging.

Testosterone or dihydrotestosterone: what should be evaluated in hirsutism?

PURPOSE: Dihydrotestosterone is a more potent androgen derived from testosterone and androstenediones, but its measurement has not been routinely recommended in women with hirsutism, and there is limited information in this regard with equivocal findings. This study aimed to evaluate serum dihydrotestosterone level in patients with hirsutism compared to women without hirsutism. METHODS: In this case-control study (during 2021-2022), serum levels of total testosterone, free testosterone, and dihydrotestosterone were evaluated in 101 women with hirsutism and 101 healthy women. Hormonal levels were measured with chemiluminescent immunoassay method. Age and hormonal levels in each group, body mass index, menstrual status, complaint of decreased scalp hair density, and ovarian ultrasound findings in hirsutism group were collected and analyzed. RESULTS: There was significant difference in free testosterone and dihydrotestosterone levels (P < 0.001) and no significant difference in total testosterone level between two groups (P = 0.628). Dihydrotestosterone level was significantly higher in women with hirsutism with menses irregularity, complaint of decreased scalp hair density, and presence of polycystic ovary on ultrasound (P < 0.05). CONCLUSIONS: Measuring dihydrotestosterone level is not considered in routine evaluation of hirsutism, but we think that this significant difference shows that elevated level of dihydrotestosterone hormone in women with hirsutism is an important factor.

Hepatic encephalopathy complications are diminished by piracetam via the interaction between mitochondrial function, oxidative stress, inflammatory response, and locomotor activity.

Background: of the study: Hepatic encephalopathy (HE) is a complication in which brain ammonia (NH4+) levels reach critically high concentrations because of liver failure. HE could lead to a range of neurological complications from locomotor and behavioral disturbances to coma. Several tactics have been established for subsiding blood and brain NH4+. However, there is no precise intervention to mitigate the direct neurological complications of NH4+. Purpose: It has been found that oxidative stress, mitochondrial damage, and neuro-inflammation play a fundamental role in NH4+ neurotoxicity. Piracetam is a drug used clinically in neurological complications such as stroke and head trauma. Piracetam could significantly diminish oxidative stress and improve brain mitochondrial function. Research methods: In the current study, piracetam (100 and 500 mg/kg, oral) was used in a mice model of HE induced by thioacetamide (TA, 800 mg/kg, single dose, i.p). Results: Significant disturbances in animals' locomotor activity, along with increased oxidative stress biomarkers, including reactive oxygen species formation, protein carbonylation, lipid peroxidation, depleted tissue glutathione, and decreased antioxidant capacity, were evident in the brain of TA-treated mice. Meanwhile, mitochondrial permeabilization, mitochondrial depolarization, suppression of dehydrogenases activity, and decreased ATP levels were found in the brain of the TA group. The level of pro-inflammatory cytokines was also significantly high in the brain of HE animals. Conclusion: It was found that piracetam significantly enhanced mice's locomotor activity, blunted oxidative stress biomarkers, decreased inflammatory cytokines, and improved mitochondrial indices in hyperammonemic mice. These data suggest piracetam as a neuroprotective agent which could be repurposed for the management of HE.

Computed Tomographic Comparison of Length, Width and Angulation of Ethmoidal Infundibulum in Patients With and Without Maxillary Sinusitis.

Ethmoidal infundibulum (EI) is an important part of the osteomeatal complex, which provides the main pathway for the maxillary sinus drainage. This study aimed to compare the length, width, and angulation of EI in patients with/without maxillary sinusitis using computed tomography (CT). This cross-sectional study evaluated 818 spiral CT scans of patients with/without maxillary sinusitis (n = 409 maxillary sinuses in each group) classified according to the clinical symptoms and the Lund-Mackay score for mucosal thickening. The degree of mucosal thickening (on axial and coronal sections), anatomical variations namely concha bullosa (CB), ethmoidal bulla (EB), and Haller cells (HCs), the form of EI (on coronal sections), the length, width and angulation of EI, and degree of nasal septal deviation (on coronal sections) were all evaluated. Data were analyzed by parametric and non-parametric tests (alpha = 0.05). The frequency of EB (P < 0.001), EI form (P < 0.001) and HC (P = 0.011), and the length and width of EI (P < 0.001) were significantly different in patients with and without maxillary sinusitis. The length and width of EI were significantly correlated with the degree of mucosal thickening (P < 0.01). The frequency of CB (P = 0.002), EB (P < 0.001), and HC (P = 0.002), and the EI form (P < 0.001) were significantly different in groups with different degrees of mucosal thickening. EI was wider and shorter in patients with maxillary sinusitis. By an increase in mucosal thickness, the length of EI decreased while its width increased. Also, the frequency of EB and HC, and the EI form were significantly different in the two groups.

The effect of consuming evening primrose oil on cervical preparation before hysteroscopy: An RCT.

Background: Herbal medicine could be effective at treating various illnesses. Hysteroscopy can be an effective method for assessing the uterus in terms of anatomical, physiological and pathological anomalies. Objective: This study aims to evaluate the effect of evening primrose oil (EPO) on cervical preparation in women candidates for hysteroscopy. Materials and Methods: This study was a double-blind, randomized controlled clinical trial including 160 women candidates for diagnostic hysteroscopy who were referred to Alzahra hospital from August 2019-March 2020. They were divided into 2 groups. Group A received 100 mg EPO as a soft gel capsule 6 hr before the hysterectomy in the posterior vaginal fornix. Group B received a placebo. After receiving the treatment, primary and secondary outcomes were evaluated in the groups. Results: The average Hegar size in the EPO group was larger than in the control group (p < 0.001 for both). Also, the need for mechanical dilation, the time taken until the first resistance and the time of dilatation completion in the EPO group were significantly less than in the placebo group (p < 0.008 for all). There was also greater ease of dilatation in the EPO group. Side effects such as uterine rupture, false passage, cervical rupture, allergic reaction, abdominal pain, nausea, diarrhea, headache and increase of bowel movements were not reported in any cases. Conclusion: Based on the findings of the present study, EPO is effective for cervical preparation in women undergoing hysteroscopy.

Comparison of Success Rates of Cone Beam Computed Tomography in the Retrieval of Metal-Ceramic vs All-Ceramic Implant-Supported Restorations: An In Vitro Study.

PURPOSE: To assess the success rates of cone beam computed tomography (CBCT) in identifying the locations and directions of abutment screw access holes (ASAHs) in metal-ceramic and all-ceramic implant restorations. MATERIALS AND METHODS: Thirty-two implants were inserted into four clear acrylic casts. Metal-ceramic and all-ceramic crowns were placed on the inserted implants in two successive tasks. A maxillofacial radiologist determined the locations and angles of the ASAHs based on the CBCT images that were taken from the casts. Locations obtained from the CBCT images were carefully transferred to the crowns as access points. A prosthodontist pierced the crowns along the proposed access points and in the direction determined based on the CBCT images. Proper crown removal was considered to be the mark of success of CBCT in detecting ASAH location and direction. Fisher exact and chi-square tests were used to compare the results between the two types of restoration. RESULTS: Success rates of CBCT for defining ASAH location and direction were, respectively, 96.9% and 93.8% in metal-ceramic restorations and 78.1% and 59.4% in all-ceramic restorations. There were no significant differences between the two restoration types regarding the detection of location in either molar (P = .333) or premolar (P = .226) crowns. Abutment angle did not affect the success rate of CBCT in determining ASAH location or direction in metal-ceramic restorations. CONCLUSION: CBCT images define the locations and directions of ASAHs in metal-ceramic restorations more reliably than in all-ceramic restorations. In contrast to the metal-ceramic crowns, the success rate of CBCT in all-ceramic crowns is more dependent on abutment angle and crown morphology.

Indirect estimation of child mortality using 2011 census data in the Islamic Republic of Iran.

BACKGROUND: Child mortality rates are considered to be one of the key indicators of child health. AIMS: The main objective of this research was to calculate child mortality rates (CMRs) indirectly, using census data, and to investigate using spatial pattern analysis the presence of any clustering patterns among provincial regions. METHODS: The Trussell version of the Brass method and Coale-Demeny West model were used to estimate CMRs and life expectancy (LE) at birth. The analyses were performed using the QFive program of MORTPAK 4 software. For cluster analysis, local and global Moran's I indexes were measured. RESULTS: Infant mortality rate, under-5 mortality rate, 1-4 mortality rate and LE at birth were estimated as 21.9, 26, 4.1 (deaths per 1000 live births) and 72.1 years, respectively. Global Moran's I index was calculated as 0.09, 0.09, 0.08 and 0.12, respectively. CONCLUSION: Special attention must be paid in provinces with high clusters regarding the evaluation of public health programmes, and the cause of failure of these programmes in reduction of childhood mortality indices.

Association between mandibular second molars calcification stages in the panoramic images and cervical vertebral maturity in the lateral cephalometric images.

BACKGROUND: Determination of maturation and evaluation of growth potential is extremely important in clinical orthodontics. The purpose of this study was to evaluate the diagnostic performance of the mandibular second molar calcification stages for identification of growth phases. MATERIAL AND METHODS: In this cross-sectional descriptive study, samples were derived from panoramic radiographs and lateral cephalograms of 125 subjects (61 males and 64 females) with age ranging from 8 to 17 years and estimates of dental maturity (Demirjian Index [DI]) and skeletal maturity (Cervical vertebral maturation indicators CVMI]) were made. Correlations between DI and CVMI were shown by Spearman's correlation. The diagnostic performance of the DI for the identification of the growth phase were evaluated using positive likelihood ratios (LHRs), with a threshold of ≥10 for satisfactory performance. RESULTS: Correlations between second molar calcification and growth phase were 0.819 for females and 0.805 for males (P-value< 0.0001). LHR ≥10 was only observed for the identification of the post-pubertal growth phase for the H stage of the second molar. CONCLUSIONS: In spite of the high correlation coefficients between mandibular second molar calcification stages and skeletal maturity, these stages are reliable only for the identification of the post pubertal growth phase. Key words:Skeletal maturation, demirjian Index, mandibular second molar.

Dermatologic adverse effects of breast cancer chemotherapy: a longitudinal prospective observational study with a review of literature.

BACKGROUND: Breast cancer patients may experience an increased chance of survival with adjuvant chemotherapy. However dermatologic adverse effects can cause major discomfort due to physical or cosmetic problems. This study aims to describe dermatologic complications in breast cancer patients during chemotherapy. METHODS: This longitudinal prospective observational study included data on women with non-metastatic breast cancer whom were treated with AC-T protocol (anthracycline, cyclophosphamide, and taxane) adjuvant chemotherapy and consecutively enrolled during two years. The study was performed in an educational and tertiary referral center. The patients' information including age, body mass index (BMI), past medical history, and different dermatologic complications were collected for all participants. RESULTS: Of 190 enrolled women, all patients experienced alopecia, which occurred in 131 patients (68.9%) after the first cycle. Skin, mucosal, and nail involvement were respectively seen in 46 (24.2%), 51 (26.8%), and 86 (45.2%) cases. Cutaneous complications were observed mainly between the third and sixth chemotherapy cycles. Palmoplantar erythema and palmoplantar dysesthesia were the most common cutaneous complications. Dermatologic adverse effects were significantly more frequent in the patients with an underlying disease. CONCLUSION: These findings suggest that dermatologic adverse effects of adjuvant chemotherapy are common and could be induced by all components of AC-T regimen. These complications should be skillfully managed to increase patients' comfort.

Relationship between cephalometric cranial base and anterior-posterior features in an Iranian population.

BACKGROUND: The relationship between the dimensions of the cranial base and skeletal anterioposterior problem has been controversial for years. The aim of this study was to determine the relationship between the anterioposterior cephalometric indicators and the cranial base cephalometric indicators in an Iranian population. MATERIALS AND METHODS: In this historical cohort cephalograms of 100 skeletal Class I patients, 101 skeletal Class II patients, and 98 skeletal Class III patients were selected. The cephalograms were traced manually and the indicators were measured. Finally, data were analyzed by SPSS software using the Mann-Whitney test and Pearson's correlation test. The significance level was set at 0.05. In cases that the correlation coefficient (r) was 0.6 or higher, linear regression was used. RESULTS: The dimensions of the cranial base are significantly larger in men than that in women. Anterior cranial base length (SN) showed statistically significant difference between Class I and Class II groups (P < 0.05). BaSN, ArSN, and SN-FH showed statistically significant differences between Class II and Class III groups (P < 0.05). CONCLUSION: Smaller cranial base angle in the skeletal Class III malocclusion compared to skeletal Class II malocclusion has been demonstrated in this study. A significant correlation between the cranial base angle, the cranial base dimension, and the effective length of the maxilla was observed, and the smaller cranial base angle in Class III malocclusion was also confirmed. These findings indicate that the cranial base can affect the development of maxilla and mid-face.