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1.  Framingham risk score for estimation of 10-years of cardiovascular diseases risk in patients with metabolic syndrome 
Background
There are a few studies evaluating the predictive value of Framingham risk score (FRS) for cardiovascular disease (CVD) risk assessment in patients with metabolic syndrome in Iran. Because of the emerging high prevalence of CVD among Iranian population, it is important to predict its risk among populations with potential predictive tools. Therefore, the aim of the current study is to evaluate the FRS and its determinants in patients with metabolic syndrome.
Methods
In the current cross-sectional study, 160 patients with metabolic syndrome diagnosed according to the National Cholesterol Education Adult Treatment Panel (ATP) III criteria were enrolled. The FRS was calculated using a computer program by a previously suggested algorithm.
Results
Totally, 77.5, 16.3, and 6.3% of patients with metabolic syndrome were at low, intermediate, and high risk of CVD according to FRS categorization. The highest prevalence of all of metabolic syndrome components were in low CVD risk according to the FRS grouping (P < 0.05), while the lowest prevalence of these components was in high CVD risk group (P < 0.05). According to multiple logistic regression analysis, high systolic blood pressure (SBP) and fasting serum glucose (FSG) were potent determinants of intermediate and high risk CVD risk of FRS scoring compared with low risk group (P < 0.05).
Conclusion
In the current study, significant associations between components of metabolic syndrome and different FRS categorization among patients with metabolic syndrome were identified. High SBP and FSG were associated with meaningfully increased risk of CVD compared with other parameters.
Trial registrations
The study is not a trial; the registration number is not applicable.
doi:10.1186/s41043-017-0114-0
PMCID: PMC5682637  PMID: 29132438
Framingham risk score; Metabolic syndrome; Cardiovascular disease
2.  E6-Specific Detection and Typing of Human Papillomaviruses in Oral Cavity Specimens from Iranian Patients 
Iranian Biomedical Journal  2017;21(6):411-416.
Background:
Detection and quantification of human Papillomavirus (HPV) genome in oral carcinoma play an important role in diagnosis, as well as implications for progression of disease.
Methods:
We evaluated tissues from 50 esopharyngeal cancers collected from different regions of Iran for HPV E6 using the two type-specific primers sets. E6 gene of HPV genotypes was amplified by specific primers. The sensitivity of PCR assay was analyzed and determined using HPV-DNA-containing plasmids. Real-time PCR was utilized to determine the prevalence and HPV viral load in patients with oral cavity squamous cell carcinoma.
Results:
Eighteen (36%) specimens were positive for HPV. Among the 18 positive specimens, 10 showed HPV-18 (55.55%), and 8 specimens were positive for HPV-11 (44.44%). Of the 18 infected specimens, 6 (33.32%) and 12 (66.65%) were identified as high-titer and low-titer viral load, respectively.
Conclusions:
The PCR-based assay, developed in the current study, could be used for HPV detection, quantification, and genotyping in epidemiological and clinical studies.
doi:10.18869/acadpub.ibj.21.6.411
PMCID: PMC5572438
Real-time PCR; Genotyping; Iran
3.  The inhibitory effect of cromolyn sodium and ketotifen on Toxoplasma gondii entrance into host cells in vitro and in vivo 
Toxoplasma gondii is a protozoan with worldwide distribution and in spite of increasing information about its biology, treatment of toxoplasmosis is restricted to a few drugs and unfortunately using of each of drugs is associated with significant side effects in patients. This study was designed to evaluate the efficacy of cromolyn sodium and ketotifen as alternative drugs for the treatment of toxoplasmosis. In vitro; in case group, concentrations of 1, 5, 10 and 15 µg/ml of ketotifen and cromolyn sodium were added to RPMI medium containing peritoneal macrophages. After 1 h incubation and adding tachyzoites to medium, efficacy rate of these drugs in entrance inhibition of Toxoplasma tachyzoites into macrophages were evaluated after 30 and 60 min. In vivo; case groups received ketotifen and cromolyn sodium with different concentrations at various times. Control groups received none of drugs. We found that in vitro; after 60 min the best efficacy of these drugs in inhibition of cell entrance of Toxoplasma was observed at 15 µg/ml (78.9 ± 1.70 and 91.97 ± 0.37 %, respectively) (P < 0.05). In vivo; after 60 min ketotifen at 2 mg/kg in 3 h before tachyzoite injection (69.83 ± 2.25 %), and cromolyn sodium, at 10 mg/kg in 6 h before tachyzoite injection (80.47 ± 2/49 %) had the best effect on inhibition of Toxoplasma entry into the cells (P < 0.05). Our findings show that ketotifen and cromolyn sodium are suitable drugs for entrance inhibition of tachyzoites into nucleated cells in vitro and in vivo.
doi:10.1007/s12639-014-0623-3
PMCID: PMC4996236  PMID: 27605827
Toxoplasma gondii; Ketotifen; Cromolyn sodium; Entrance inhibition; Nucleated cells; Mouse
4.  Study on Physio-chemical Properties of plasma polymerization in C2H2/N2 plasma and Their Impact on COL X 
Scientific Reports  2017;7:9149.
Nitrogen-containing plasma polymerization is of considerable interest for tissue engineering due to their properties on cell adhesion and mesenchymal stem cells (MSCs) response. In this study, low-pressure RF plasma of acetylene and nitrogen was used to deposit nitrogen-containing plasma polymerized coatings on several substrates. Deposition kinetics and surface characteristics of coatings were investigated in terms of RF power and gas flow ratio. OES was used to monitor the plasma process and investigate the relation between the film structure and plasma species. Presence of several bonds and low concentration of amine functional groups were determined using FTIR and Colorimetric methods. Contact angle goniometry results indicated about 30% increase in surface hydrophilicity. Stability of coatings in air and two different liquid environments was examined by repeating surface free energy measurements. Deposited films exhibited acceptable stability during the storage duration. Surface roughness measured by AFM was found to decrease with growing concentration of nitrogen. The deposition rate increased with increasing RF power and decreased with growing concentration of nitrogen. Zeta potential measurements of coatings revealed the negative potential on the surface of the thin films. Temporary suppression of collagen X in the presence of plasma coatings was confirmed by RT-PCR results.
doi:10.1038/s41598-017-09747-4
PMCID: PMC5567319  PMID: 28831135
5.  Evaluation of Salivary Cortisol Changes and Psychological Profiles in Patients with Recurrent Aphthous Stomatitis 
Contemporary Clinical Dentistry  2017;8(2):259-263.
Background and Objective:
Some studies suggest that psychological condition and stress can play role in the development of recurrent aphthous stomatitis (RAS). The purpose of this study was to evaluate salivary cortisol changes and psychological conditions in patients with RAS.
Materials and Methods:
Twenty-seven patients (13 males and 14 females, mean age of 32.8 (±10.2) years) with minor RAS and 27 age- and sex-matched controls without RAS participated in this study. The concentration of cortisol (nanomole/L) was measured in samples of unstimulated saliva from patients and controls two times; once during the presence of active lesions and once again when the lesions had healed by immunologic assay. The Hospital Anxiety and Depression Scale was employed to determine psychological condition. Visual analog scale for pain severity was recorded for patients with active lesions episode. Data were analyzed by the SPSS software (version 18.0) using paired and unpaired t-tests and Pearson correlation coefficient.
Results:
Salivary cortisol level was lower in patients during active lesions (12.4 ± 5.1) and healing (10.5 ± 3.9) episodes compared to the controls (13.1 ± 3.6) (P = 0.583, P = 0.015; respectively). There was no significant difference in salivary cortisol between active lesions and healing episodes (P = 0.943). Anxiety and depression represented no significant differences between active lesions and healing episodes (P > 0.05). Anxiety and depression levels in patients were significantly higher than in controls (P < 0.05). Pain severity in active lesions was not significantly correlated to salivary cortisol level, and anxiety or depression scores (P > 0.05).
Conclusion:
The findings showed that occurrence of RAS was associated with anxiety and depression but not with alterations of salivary cortisol level.
doi:10.4103/ccd.ccd_165_17
PMCID: PMC5551332
Cortisol; recurrent aphthous stomatitis; saliva; the hospital anxiety and depression scale
6.  Overcrowding in emergency departments: A review of strategies to decrease future challenges 
Emergency departments (EDs) are the most challenging ward with respect to patient delay. The goal of this study is to present strategies that have proven to reduce delay and overcrowding in EDs. In this review article, initial electronic database search resulted in a total of 1006 articles. Thirty articles were included after reviewing full texts. Inclusion criteria were assessments of real patient flows and implementing strategies inside the hospitals. In this study, we discussed strategies of team triage, point-of-care testing, ideal ED patient journey models, streaming, and fast track. Patients might be directed to different streaming channels depending on clinical status and required practitioners. The most comprehensive strategy is ideal ED patient journey models, in which ten interrelated substrategies are provided. ED leaders should apply strategies that provide a continuous care process without deeply depending on external services.
doi:10.4103/1735-1995.200277
PMCID: PMC5377968
Emergency department; overcrowding; patient flow; patient journey; patient safety
7.  Rehabilitation of vulnerable groups in emergencies and disasters: A systematic review 
BACKGROUND:
Natural and man-made disasters, especially those occurring in large scales not only result in human mortality, but also cause physical, psychological, and social disabilities. Providing effective rehabilitation services in time can decrease the frequency of such disabilities. The aim of the current study was to perform a systematic review related to rehabilitation of vulnerable groups in emergencies and disasters.
METHODS:
The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The key words “recovery”, “rehabilitation”, “reconstruction”, “transformation”, “transition”, “emergency”, “disaster”, “crisis”, “hazard”, “catastrophe”, “tragedy”, “mass casualty incident”, “women”, “female”, “children”, “pediatric”, “disable”, “handicap”, “elder”, “old” and “vulnerable” were used in combination with Boolean operators OR and AND. ISI Web of Science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, Google Scholar were searched.
RESULTS:
In this study a total of 11 928 articles were considered and 25 articles were selected for final review of rehabilitation of vulnerable groups based on the objective of this study. Twenty-five studies including six qualitative, sixteen cross-sectional and three randomized controlled trials were reviewed for rehabilitation of vulnerable groups in emergencies and disasters. Out of the selected papers, 23 were studied based on rehabilitation after natural disasters and the remaining were man-made disasters. Most types of rehabilitation were physical, social, psychological and economic.
CONCLUSION:
The review of the papers showed different programs of physical, physiological, economic and social rehabilitations for vulnerable groups after emergencies and disasters. It may help health field managers better implement standard rehabilitation activities for vulnerable groups.
doi:10.5847/wjem.j.1920-8642.2017.04.002
PMCID: PMC5675965
Rehabilitation; Vulnerable group; Emergencies; Disasters
8.  Methodology and Early Findings of the Fifth Survey of Childhood and Adolescence Surveillance and Prevention of Adult Noncommunicable Disease: The CASPIAN-V Study 
Background:
This paper presents the methodology and early findings of the fifth survey of a school-based surveillance program in Iran.
Methods:
This nationwide study was conducted in 2015 as the fifth survey of a surveillance program entitled “Childhood and Adolescence Surveillance and PreventIon of Adult Non- communicable disease” (CASPIAN-V) study. The protocol was mainly based on the World Health Organization-Global School student Health Survey. We studied 14400 students, aged 7-18 years, and their parents living in 30 provinces in Iran. Fasting blood was obtained from a sub-sample of 4200 randomly selected students.
Results:
The participation rate for the whole study and for blood sampling were 99% and 91.5%, respectively. The mean (SD) age of participants was 12.3 (3.2) years, consisting of 49.4% girls and 71.4% urban residents. Overall, 16.1% were underweight (17.4% of boys and 14.8% of girls), and 20.8% had excess weight consisting of 9.4% (8.7% of boys and 10.2% of girls) of overweight and 11.4% (12.5% of boys and 10.3% of girls) of obesity. Abdominal obesity was documented in 21.1% of students (21.6% of boys and 20.5% of girls). Low HDL-C was the most prevalent abnormality of the lipid profile (29.5%) followed by high serum triglycerides (27.7%). Of students, 59.9% consumed whole wheat bread; and 57% reported that they never or rarely added salt to table. The reported daily consumption of fresh fruits, vegetables, and milk was about 60%, 32% and 40%, respectively. 13.7% of participants had at least 30-min daily leisure-time physical activity.
Conclusions:
The current findings provide an overview of the current health status and lifestyle habits of children and adolescents. This surveillance program would help planning preventive programs at individual and community levels.
doi:10.4103/2008-7802.198915
PMCID: PMC5288959
Children and adolescents; methodology; prevention; surveillance
9.  Prevalence of cardio-metabolic risk factors in a nationally representative sample of Iranian adolescents: The CASPIAN-III Study 
Introduction: The aim of the present study is to explore the prevalence and mean of cardiometabolic risk factors and liver enzymes of Iranian adolescents living in regions with different socioeconomic status (SES). To the best of our knowledge this is the first study reporting these data at sub-national level in Iran.
Methods: This multi-centric study was performed in 2009-2010 on a stratified multi-stage probability sample of 5940 students aged 10-18 years, living in urban and rural areas of 27 provinces of Iran. Trained healthcare professionals measured anthropometric indices, systolic and diastolic blood pressures (SBP, DBP) according to standard protocols. Fasting venous blood was examined for fasting blood sugar (FBS), lipid profile and liver enzymes including alanine aminotransferase (ALT) and aspartate aminotransferase (AST). We classified the country into four sub-national regions based on criteria of the combination of geography and SES. Mean and frequency of risk factors were compared across these regions.
Results: The mean of body mass index had linear rise with increase in the regions’ SES (P for trend <0.001). The mean levels of DBP, total cholesterol (TC), high-density lipoproteincholesterol (HDL-C), triglycerides (TG), FBS, ALT, and AST had linear association with regions’ SES in the whole population and in both genders (P for trend < 0.05), whereas the corresponding figure was statistically significant for the mean SBP only in girls (P for trend: 0.03) and for the mean of LDL-C in the whole population and in boys (P for trend <0.001). In total and in both genders, there was an escalating trend in the prevalence of elevated FBS, TC and liver enzymes, low HDL-C, and metabolic syndrome by increase in the SES of the region(P for trend <0.01).
Conclusion: This study proposes that in addition to national health policies on preventing cardiometabolic risk factors, specific interventions should be considered according to the regional SES level.
doi:10.15171/jcvtr.2017.02
PMCID: PMC5402022
Cardio-metabolic Risk Factors; Liver Enzymes; Socioeconomic Status; Adolescents
10.  Physical inactivity and associated factors in Iranian children and adolescents: the Weight Disorders Survey of the CASPIAN-IV study 
Introduction: This study aims to assess the associated factors of physical inactivity among Iranian children and adolescents at national level. The second objective is to assess the relationship of physical inactivity with anthropometric measures.
Methods: Along with a national surveillance program, this survey on weight disorders was conducted among a nationally-representative sample of Iranian children and adolescents, aged 6-18 years. Students were selected by multi-stage cluster sampling from rural and urban areas of 30 provinces of Iran. The Physical Activity Questionnaire for Adolescents (PAQ-A) was used to assess physical activity (PA). Using PAQ-A instrument, PA of past week categorized as; low PA level, that included those who scored between 1 to 1.9 on the PAQ-A instrument and high PA level that included participants with estimated scores between 2-5 PAQ-A.
Results: Participants were 23183 school students (50.8% boys) with a mean age of 12.55 ± 3.3 years, without significant difference in terms of gender. Totally, 23.48% of participants (13.84% of boys and 33.42% of girls) were physically inactive. In multivariate logistic regression model, with increased age in children and adolescence, the odds of a physically inactivity increased (OR: 1.08; 95% CI: 1.07-1.10). The odds of prevalence of both obesity and underweight were high in children and adolescents with low PA. There was a decreasing trend in PA in higher school grades.
Conclusion: We found a considerably high prevalence of physical inactivity in Iranian children and adolescents, with higher rates among girls and older ages. However, we did not find correlation between PA and socioeconomic status (SES). Because of the positive relationship between PA and ST, future studies should consider the complex interaction of these two items. Multidisciplinary policies should be considered in increasing PA programs among children and adolescents.
doi:10.15171/jcvtr.2017.06
PMCID: PMC5402026
Physical inactivity; Anthropometric Measures; Screen Time; Children and Adolescents
11.  Knowledge About Chronic Orofacial Pain Among General Dentists of Kermanshah, Iran 
The Open Dentistry Journal  2017;11:221-229.
Background and Objective:
Diagnosis and treatment of chronic orofacial pain are one of the most challenging issues in dentistry. The purpose of this study was to assess the knowledge of general dentists regarding orofacial pain in Kermanshah, Iran.
Methods:
This cross-sectional study was conducted in 2016 including general dentists of Kermanshah city. A researcher-designed questionnaire was administered to collect demographic data as well as measuring knowledge of the dentists in four sections including etiology, clinical presentations, physical examination, and treatment of chronic orofacial pain. The questionnaire had acceptable validity (content validity > 0.9) and reliability (intraclass correlation coefficient= 0.857 for test re-test; Cronbach’s alpha= 0.72 for internal consistency). The data were analyzed by the SPSS software (ver. 18.0) using Spearman’s correlation coefficient (P < 0.05).
Results:
There were 121 male (72.9%) and 45 female (27.1%) dentists with mean (SD) age of 40.55 (8.03) years and mean (SD) practice history of 13.28 (8.43) years. Mean (SD) knowledge score was 10.54 (2.36) (maximum possible score= 15). 48.2% of dentists had good knowledge in overall. 48.2% about etiology, 45.2% about clinical presentations, 36.1% about physical examination, and 7.8% about treatment had good knowledge. Knowledge had direct and significant relationship with age (r = 0.179; P = 0.022) and practice history (r = 0.18; P = 0.021).
Conclusion:
The results showed that the studied dentists did not have enough knowledge about chronic orofacial pain especially in the treatment field. Therefore, it is recommended to implement educational programs to improve their knowledge.
doi:10.2174/1874210601711010221
PMCID: PMC5427728
Chronic pain; Orofacial pain; Knowledge; General dentist; Canthomeatal line
12.  Association of birth weight with abdominal obesity and weight disorders in children and adolescents: the weight disorder survey of the CASPIAN-IV Study 
Introduction: This study aims to evaluate the association of birth weight (BW) with weight disorders in a national sample of Iranian pediatric population.
Methods: This nationwide survey was conducted among 25000 student’s aged 6-18 year-old students, who were selected using multistage cluster random sampling from 30 provinces of Iran in 2011-2012. Anthropometric measures were measured under standard protocols by using calibrated instruments. Abdominal obesity was defined based on waist circumference (WC) ≥90th percentile value for age and sex. The WHO criterion was used to categorize BMI. Students’ BW was asked from parents using validate questionnaire and was categorized as low BW (LBW) (BW <2500 g), normal BW (NBW) (BW: 2500-4000 g) and high BW (HBW) (BW>4000 g).
Results: This national survey was conducted among 23043 school students (participation rate: 92.6%). The mean age of participants (50.8% boys) was 12.54 ± 3.31 years. Results of multivariate logistic regression show that LBW increased odds of underweight (OR [odds ratio]: 1.61; 95% CI: 1.37, 1.89) and students with HBW had decreased odds of underweight (OR: 0.74; 95% CI: 0.58, 0.93) compared to students with NBW. Students with LBW compared to student with NBW had decreased odds of overweight (OR: 0.83; 95% CI: 0.69, 0.98) and general obesity (OR: 0.73; 95% CI: 0.56, 0.95). On the other hand, HBW increased odd of overweight (OR: 1.28; 95% CI: 1.09, 1.50), generalized obesity (OR: 1.59; 95% CI: 1.29, 1.96) and abdominal obesity (OR: 1.29; 95% CI: 1.11, 1.49) compared to NBW group.
Conclusion: BW is a determinant of weight disorders and abdominal obesity in childhood and adolescence. This finding underscores the importance of prenatal care as well as close monitoring of the growth pattern of children born with low or high BW.
doi:10.15171/jcvtr.2017.24
PMCID: PMC5670335
Birth Weight; Obesity; Overweight; Underweight; Children; Adolescents
13.  The Effect of Scaling and Root Planning on Salivary TNF-α and IL-1α Concentrations in Patients with Chronic Periodontitis 
The Open Dentistry Journal  2017;11:573-580.
Objective:
Periodontitis is one of the main diseases in the oral cavity that causes tooth loss. The host immune response and inflammatory factors have important role in periodontal tissue. The current study was done with the objective to determine the effect of scaling and root planning on the salivary concentrations of tumor necrosis factor-alpha (TNF-α) and interleukin-1-alpha (IL-1α).
Methods:
In this quasi-experimental clinical trial, 29 patients with chronic periodontitis and 29 healthy subjects without periodontitis were studied. Clinical examination findings and salivary TNF-α and IL-1α (using ELISA method) were compared before and after scaling, root planning.
Results:
Before starting treatment, salivary TNF-α and IL-1α concentrations were higher in healthy control group than in periodontitis group (P< 0.05). Non-surgical treatment increased the concentration of these two biomarkers in the saliva. However, increase in IL-1α concentration was not statistically significant (P= 0.056). There was a negative relationship between TNF-α and IL-1α levels with pocket depth and attachment loss (P< 0.05).
Conclusion:
Scaling and root planning improved periodontal disease indices and salivary TNF-α and IL-1α levels.
doi:10.2174/1874210601711010573
PMCID: PMC5712651
Chronic periodontitis; Non-surgical treatment; Saliva; TNF-α; IL-1α; ELISA method
14.  Solitary Plasmacytoma in the Mandible Resembling an Odontogenic Cyst/Tumor 
Case Reports in Dentistry  2016;2016:3629047.
A 46-year-old male patient referred to Department of Oral Medicine, with the primary chief complaint of a painless swelling in the right side of mandibular. A panoramic radiograph revealed a well-defined, multilocular radiolucent bony lesion with thin and straight septa in the right side of mandible extending from distal of canine to mesial of third molar. Histological examination showed a solid proliferation of atypical plasmacytoid cells, which was indicative of plasmacytoma. A systemic workup for the final diagnosis was performed to rule out multiple myeloma.
doi:10.1155/2016/3629047
PMCID: PMC5204110  PMID: 28078146
15.  In vitro protoscolicidal effects of fungal chitosan isolated from Penicillium waksmanii and Penicillium citrinum 
Hydatidosis is caused by a tapeworm which infects humans by the larval stage. In humans, the disease is so serious that it requires surgery for treatment. Documents show that there have been many efforts in finding new scolicidal agents for reducing the rate of the infection. The objective of this study was determination of the scolicidal effect of two fungal chitosan types, produced from Penicillium spp. and commercially chitosan (CC) on Echinococcus granulosus protoscolex. Protoscolices were aseptically aspirated from sheep livers hydatid cysts. Four concentrations (50, 100, 200, 400 μg/ml) of each type of prepared chitosan were used for 10, 30, 60 and 180 min. Viability of protoscolices was detected by 0.1 % eosin staining. Fungal chitosan which was the most bioactive type with higher degree of deacetylation showed stronger scolicidal activity in vitro (P < 0.05). Fungal chitosan could be recommended, as good as CC for hydatid cysts control and is a noble alternative for synthetic and chemical scolicidal.
doi:10.1007/s12639-013-0300-y
PMCID: PMC4456528  PMID: 26063992
Chitosan; Protoscolices; Echinococcus granulosus; Penicillium
16.  Joint Association of Screen Time and Physical Activity with Cardiometabolic Risk Factors in a National Sample of Iranian Adolescents: The CASPIANIII Study 
PLoS ONE  2016;11(5):e0154502.
Metabolic syndrome (MetS) and its contributing factors are considered important health problems in the pediatric age group. This study was designed to assess the joint association of ST and PA with cardiometabolic risk factors among Iranian adolescents. A representative sample of 5625 (50.2% boys) school students with a mean age of 14.73 (SD: 2.41) were selected through multistage random cluster sampling method from urban and rural areas of 27 provinces in Iran. ST and PA were assessed by self-administered validated questionnaires. Anthropometric measures (height, weight and waist circumference (WC)) and MetS components (abdominal obesity, elevated blood pressure (BP), low high-density lipoprotein cholesterol (HDL-C), elevated triglycerides (TG) and high fasting blood sugar (FBG)) were measured according to standardized protocols. MetS was defined according to the Adult Treatment Panel III criteria modified for the pediatric age group. Moreover, elevated total cholesterol (TC), elevated low-density lipoprotein cholesterol (LDL-C), and generalized obesity were considered as other cardiometabolic risk factors. Students with high ST levels had significantly higher body mass index z-score (BMI z-score), WC, TG, LDL-C, and BP as well as lower HDL-C level; whereas those with high PA levels had significantly higher HDL-C levels as well as lower BMI z-score, TC, and BP. Adolescents with low PA/ high ST levels had significantly higher BMI, WC, LDL-C levels, as well as higher SBP and DBP compared to their other counterparts. In Multivariate model, joint effect of low PA/ high ST (compared to the high PA/low ST group) increased the odds of overweight, abdominal obesity and low HDL-C and decreased the odds of elevated TC. The findings of this study showed that joint association of high ST and low PA have direct association with abdominal obesity, overweight and low HDL-C and indirect association with elevated TC.
doi:10.1371/journal.pone.0154502
PMCID: PMC4864273  PMID: 27167372
17.  The Study of Prescribing Errors Among General Dentists 
Introduction:
In dentistry, medicine often prescribed to relieve pain and remove infections. Therefore, wrong prescription can lead to a range of problems including lack of pain, antimicrobial treatment failure and the development of resistance to antibiotics.
Materials and Methods:
In this cross-sectional study, the aim was to evaluate the common errors in written prescriptions by general dentists in Kermanshah in 2014. Dentists received a questionnaire describing five hypothetical patient and the appropriate prescription for the patient in question was asked. Information about age, gender, work experience and the admission in university was collected. The frequency of errors in prescriptions was determined. Data by SPSS 20 statistical software and using statistical t-test, chi-square and Pearson correlation were analyzed (0.05> P).
Results:
A total of 180 dentists (62.6% male and 37.4% female) with a mean age of 8.23 ± 39.199 participated in this study. Prescription errors include the wrong in pharmaceutical form (11%), not having to write therapeutic dose (13%), writing wrong dose (14%), typos (15%), error prescription (23%) and writing wrong number of drugs (24%). The most frequent errors in the administration of antiviral drugs (31%) and later stages of antifungal drugs (30%), analgesics (23%) and antibiotics (16%) was observed. Males dentists compared with females dentists showed more frequent errors (P=0.046). Error frequency among dentists with a long work history (P>0.001) and the acceptance in the university except for the entrance examination (P=0.041) had a statistically significant relationship.
Conclusion:
This study showed that the written prescription by general dentists examined contained significant errors and improve prescribing through continuing education of dentists is essential.
doi:10.5539/gjhs.v8n4p32
PMCID: PMC4873578  PMID: 26573049
errors in prescribing; medication; general dentists
18.  Evaluation of Total Antioxidant Capacity of Saliva in High School Students 
Background and Objective:
Imbalance between oxidative stress and saliva antioxidants plays a major role in initiation and spread of dental caries. The aim of this study was to evaluate the total antioxidant capacity (TAC) of saliva in dental caries.
Methods:
In this case-control study which employed high school students (14-18 years), the un-stimulated saliva samples of 60 students without dental caries (control group) and 60 students with dental caries (with at least 5 teeth levels of dental caries) were gathered. Each group comprised of males (half of cases) and females (half of cases). TAC of saliva was measured by Zellbio® (Netherlands) in terms of micmol/L. The data were analyzed using the SPSS software (ver. 17.0) and t-test with considering significance level at 0.05.
Results:
TAC of saliva was significantly lower in cases with dental caries (0.256±0.106) compared to those without dental caries (0.396±0.077); P< 0.001. There was no statistically significant difference of TAC of saliva between males (0.319±0.119) and females (0.333±0.113) irrespective of dental caries (P=0.507).
Conclusion:
The results of the study indicated that there was a reverse association between dental caries and TAC of saliva.
doi:10.5539/gjhs.v8n4p89
PMCID: PMC4873587  PMID: 26573023
Dental caries; total antioxidant capacity; oxidative stress
19.  Risk assessment of the emergency processes: Healthcare failure mode and effect analysis 
BACKGROUND:
Ensuring about the patient’s safety is the first vital step in improving the quality of care and the emergency ward is known as a high-risk area in treatment health care. The present study was conducted to evaluate the selected risk processes of emergency surgery department of a treatment-educational Qaem center in Mashhad by using analysis method of the conditions and failure effects in health care.
METHODS:
In this study, in combination (qualitative action research and quantitative cross-sectional), failure modes and effects of 5 high-risk procedures of the emergency surgery department were identified and analyzed according to Healthcare Failure Mode and Effects Analysis (HFMEA). To classify the failure modes from the “nursing errors in clinical management model (NECM)”, the classification of the effective causes of error from “Eindhoven model” and determination of the strategies to improve from the “theory of solving problem by an inventive method” were used. To analyze the quantitative data of descriptive statistics (total points) and to analyze the qualitative data, content analysis and agreement of comments of the members were used.
RESULTS:
In 5 selected processes by “voting method using rating”, 23 steps, 61 sub-processes and 217 potential failure modes were identified by HFMEA. 25 (11.5%) failure modes as the high risk errors were detected and transferred to the decision tree. The most and the least failure modes were placed in the categories of care errors (54.7%) and knowledge and skill (9.5%), respectively. Also, 29.4% of preventive measures were in the category of human resource management strategy.
CONCLUSION:
“Revision and re-engineering of processes”, “continuous monitoring of the works”, “preparation and revision of operating procedures and policies”, “developing the criteria for evaluating the performance of the personnel”, “designing a suitable educational content for needs of employee”, “training patients”, “reducing the workload and power shortage”, “improving team communication” and “preventive management of equipment’s” were on the agenda as the guidelines.
doi:10.5847/wjem.j.1920-8642.2016.02.003
PMCID: PMC4905876  PMID: 27313803
Emergency; Risk assessment; Healthcare failure mode
20.  Relation between Resistance to Antipseudomonal β-Lactams and ampC and mexC Genes of Pseudomonas aeruginosa 
Iranian Journal of Pathology  2016;11(1):47-53.
Background:
In order to select a better antibiotic choice for treatment of Pseudomonas aeruginosa infections, this study was conducted to determine the frequency of resistance to some antipseudomonal β-lactams in P. aeruginosa isolates from patients in Tehran, Iran. In addition, the relation between presence of genes known to be responsible for resistance to β-lactams (ampC, mexC1,2, and mexC3,4 genes) and resistance phenotype among P. aeroginosa isolates was evaluated.
Methods:
P. aeruginosa strains were isolated and identified by routine methods and PCR for oprL gene. Disk diffusion method was employed to determine the antimicrobial susceptibility pattern according to CLSI recommendations. PCR was used to detect the resistance genes.
Results:
Among 100 isolates of P. aeruginosa, 82% had ampC, 86% mexC1,2 and 89% mexC3,4 genes and combinations of these genes were seen in most of isolates and only 3% of isolates had none of these genes. Resistance to mezlocillin, cefepime, ceftazidime and piperacillin/ tazobactam was seen in 46%, 41%, 36% and 29% of isolates, respectively. Significant relation (P value ≤0.05 by Chi-square or Fisher Exact test) was observed between the presence of ampC gene and resistance to all the studied β-lactams in this study. No relation was observed for mexC genes, although many of isolates containing these two genes were phenotypically resistant.
Discussion:
This study had shown for the first time, the presence of ampC and mexC genes in significant percent of clinical isolates of P. aeruginosa in Tehran, Iran, and relation between presence of ampC gene and resistance to β-lactams.
PMCID: PMC4749195  PMID: 26870143
Pseudomonas aeruginosa; β-lactams; mexC; ampC
21.  Prevalence of Geographic Tongue and Related Predisposing Factors in 7-18 Year-Old Students in Kermanshah, Iran 2014 
Geographic tongue is a benign lesion at the dorsum and margins of the tongue that sometimes causes pain and burning sensation. This lesion is characterized by an erythematous area with white or yellow folded edges. The predisposing factors of this lesion include heredity, allergies, psoriasis, stress, fissured tongue and consumption of some foods. The present study was conducted to investigate the prevalence of geographic tongue and its related factors among the 7-18 year-old students in Kermanshah, Iran. This descriptive cross-sectional study was carried out in three schools in Kermanshah using multi-stage random cluster sampling method. A total number of 3600 students were examined (1800 girls and 1800 boys). Demographic data and the results of examinations were recorded in a questionnaire. The factors affecting the incidence of geographic tongue were analyzed by the SPSS-20 software and the Chi-square test. The prevalence of geographic tongue was 7.86% (283 individuals). The incidence of this lesion was significantly higher in males than in females (p<0.01). There was no relationship between geographic tongue and psoriasis or fissured tongue. Pain and discomfort during eating was more prevalent in those with geographic tounge compared to those without this condition (p<0.02). The prevalence of geographic tongue among the studied population was 7.86%, and the prevalence of geographic tongue in male students was higher than in female students.
doi:10.5539/gjhs.v7n5p91
PMCID: PMC4803890  PMID: 26156909
benign migratory glossitis; fissured tongue; geographic tongue; psoriasis
22.  Personal Exposure to Polycyclic Aromatic Hydrocarbons in Newsagents in Tehran, Iran 
Iranian Journal of Public Health  2015;44(5):665-672.
Background:
Vehicle exhaust is a major source of exposure to Polycyclic Aromatic Hydrocarbons (PAHs) found in the urban atmosphere. Newsagents usually work close to heavy traffic flow. The purpose of this study was to assess the breathing zone exposure of newsagents to PAHs found in the urban atmosphere of Tehran City during summer and autumn seasons and comparing the levels of exposure in both seasons.
Methods:
Fifteen non-smoking newsagents were randomly selected from north, south, east, west, and center of Tehran. Particle and gas phases PAHs were collected on polytetrafluoroethylene (PTFE) filter and XAD-2 adsorbent. Gas chromatography–mass spectrometry (GC/MS) was used to determine PAHs concentrations in newsagent’s breathing zone samples.
Results:
The highest and lowest values of exposures during summer and autumn in all sampling stations were recorded for benzo[a]anthracene and benzo[ghi]perylene, respectively. Mann-Whitney test results showed that seasonal variation had significant influence on concentrations of all studied PAHs (P= 0.001) except benzo[ghi]perylene (P= 0.089). An increase in concentrations of PAHs was observed in autumn.
Conclusion:
The workers of the newsstands in the south area of Tehran City were experiencing higher levels of exposures to PAHs. Newsagents’ breathing zone exposures to PAHs during the cold period were two to three folds higher than those during the warm period were. The levels of exposures in all sampling stations were below the OSHA and NIOSH’s recommended exposure limits.
PMCID: PMC4537624  PMID: 26284208
Polycyclic aromatic hydrocarbons; Newsagents; Exposure; Breathing zone; Seasonal variation
23.  Comparison of the Effects of Heparin and 0.9% Sodium Chloride Solutions in Maintenance of Patency of Central Venous Catheters 
Background
Occlusion of central venous catheters is one of the limiting factors in using them. Heparinized saline solution is the standard solution used for keeping the catheters open.
Objectives
This study aimed to determine the effect of heparin saline solution and normal saline in maintenance of patency of central venous catheters.
Patients and Methods
This double-blind study was performed on 84 patients of intensive care unit who had central venous catheters. The patients were randomly divided into two groups of heparin saline receivers and normal saline receivers. In the heparin group after each drug injection into the lumen, 3 mL of heparin saline solution was injected in the catheter as well. The other group only received 10 mL of normal saline instead. The catheters were examined for blood return and flushing every eight hours for 21 days. Data was analyzed using SPSS software version 20 and descriptive and analytic statistics were studied.
Results
There was no significant difference in the rate of flushing (P = 0.872) and possibility of taking blood samples from catheters (P = 0.745) in the two groups of heparin and normal saline receivers. Furthermore, using heparin had no effect on prolonging the survival of catheters.
Conclusions
Considering possible side effects of heparin and the increase in treatment charges and the fact that using heparin did not have a significant effect on patency and survival of catheters in the studied patients, it is recommended to use normal saline solution to maintain the patency of central venous catheters.
doi:10.5812/aapm.22595
PMCID: PMC4389103  PMID: 25866710
Central Venous Catheter; Heparin; Sodium Chloride
24.  Checking the relationship between physicians’ communication skills and outpatients’ satisfaction in the clinics of Isfahan Al-Zahra(S) Hospital in 2011 
Introduction:
The quality of communication skills of health care providers has a significant impact on patient treatment consequences.
Aims:
The present research has been conducted to check the relationship of communication skills on the rate of patients’ satisfaction in the clinics of one of the hospitals in Isfahan.
Settings and Design:
The checking list was completed by the researcher in the clinics by using the comments of patients or their relatives. Sampling was performed by using the regular random sampling method.
Materials and Methods:
This research was a descriptive-analytical study. The used tool was a standard checking list for evaluating the patients’ satisfaction and also the researcher-made checking list for the measurement of effective communication skills.
Statistical Analysis:
The researcher-made checking list for the measurement of effective communication skills was confirmed by the experts with the face validity, structure, content, and reliability (α =87%). After visiting the patient by the physician, the mentioned list was filled by using the patients’ comments, and the collected data was analyzed by SPSS software version 16 with calculating the Pearson correlation coefficient and α2.
Results:
The study showed that there was a significant relationship between the application of communication skills in the five areas of verbal, body language, effective communicating, establishment, patient privacy and patient participation, except for eye communication of the physician with patients’ satisfaction (P < 0.05).
Conclusion:
Using the communication skills by physicians is associated with patients’ satisfaction, and it is the cause of increasing the acceptance of the physician by the patient. Therefore, it is suggested that the opportunity to improve the communication skills should be provided in addition to clinical skills in continuing education programs for the medical community.
doi:10.4103/2277-9531.139697
PMCID: PMC4165094  PMID: 25250371
Communication skills; physician; satisfaction; service recipients
25.  Comparison of acidic and neutral PH root conditioners prior to a coronally positioned flap to treat gingival recession 
Dental Research Journal  2014;11(3):309-315.
Background:
Localized gingival recession can be treated successfully via coronally positioned flap (CPF) and additional use of root surface demineralization agents. The purpose of this study was to evaluate the effects of additional use of ethylene diamine tetraacetic acid (EDTA) and citric acid as a root conditioner in association with CPF to cover localized buccal gingival recessions.
Materials and Methods:
Twenty-seven patients with 66 Miller class I buccal gingival recession ≥ 2 mm on single-rooted teeth were studied. Patients were randomly assigned: CPF with EDTA gel (test 1) and CPF with saturated citric acid (test 2) or CPF alone (control). Clinical parameters were measured at baseline and 1, 2, 3 and 6 months after surgery; assessment included recession depth (RD), clinical attachment level (CAL), probing depth (PD) and height of keratinized gingiva (HKG). SPSS version-20 was used to perform all statistical analyses. Data was reported as Mean ± SD. Age, RD, CAL, PD, and HKG before treatment and after 6 months among study groups were compared by one-way ANOVA followed by the Tukey test. The level of significance was considered to be less than 0.05.
Results:
At 6 months, all treatment modalities showed significant root coverage and gain in CAL. RD was reduced from 2.86 ± 0.76 mm to 0.55±0.53 mm in the EDTA group and from 2.37±0.57 mm to 1.03±0.43 mm in the acid group and from 2.37±0.54 mm to 0.85±0.49 mm in the control group. The average percentage of root coverage for the EDTA, acid, and control groups were 80.73%, 52.16%, and 64.50%, respectively. At 6 months, there was a significant difference (P < 0.05) in all parameters for the EDTA group (except HKG that did not vary among the groups).
Conclusion:
Root preparation with EDTA was an effective procedure to cover localized gingival recessions and significantly improved the amount of root coverage obtained.
PMCID: PMC4119362  PMID: 25097639
Citric acid; EDTA; gingival recession; periodontal plastic surgery; root coverage

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