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Knee ligament injuries associated with long bone fractures
Kaseb M.h, Moharrami M.r, Mortazavi S M.j,
Volume 65, Issue 1 (3-2008)
Abstract
Background: Tibial and femoral fractures, commonly seen in emergency departments, may be associated with various knee ligament injuries. The aim of this study was to determine the prevalence of such fracture-associated knee ligament problems, with especial attention to rapid diagnosis.
Methods: This study was carried out in patients with femoral or tibial fractures who were operated on in Imam Khomeini Medical Center from March 2003 to March 2005. All patients underwent surgical repair immediately after acute fracture, followed by a thorough knee examination. Patients with positive clinical findings were further evaluated using the stress view and arthroscopy.
Results: We enrolled 470 cases in this study, of which 266 were tibial and 204 were femoral fractures. There were 404 men and 67 women, with an average age of tibial fracture patients was 34.5 and 44.6 years for those with femoral fractures. Of all fractures, 66% were due to car accidents, 16% to industrial accidents and 8% due to falling. The overall prevalence of ligament injuries in tibial fractures was as follows: 6.58% ACL tearing, 2.5% PCL, 21.95% MCL and 14.63% LCL. The overall prevalence of ligament injuries in femoral fractures was as follows: 6% ACL tearing, 3% PCL, 14% MCL and 8% LCL.
Conclusion: The prevalence of ligament injuries of the knee was highest in distal femoral and tibial plateau fractures. It is prudent to perform a thorough knee examination once the fracture is stabilized in the operating room for the early detection of ligament injuries and prevention of further complications.
Oral desensitization in children with IgE-mediated cow's milk allergy: a prospective clinical trial
Mansouri M, Movahhedi M, Pourpak Z, Akramian R, Shokohi Shormasti R, Mozaffari H, Farhoudi A,
Volume 65, Issue 5 (8-2007)
Abstract

Background: Cow's milk protein allergy (CMPA) is the most common food allergy during the first year of life. Strict avoidance of specific foods is the only accepted treatment for food-induced allergic reactions. This is often an unrealistic therapeutic option, since cow's milk is a basic food that is extensively used in infant formula. The recent preliminary experience of oral desensitization to cow's milk by Meglio & Patriarca seems promising. The object of this study was to investigate the desensitization of children with CMPA to cow's milk.

Methods: All the patients referred to the Allergology Department of the Children's Medical Center Hospital, Tehran from March 2004 to November 2005 suspected to have CMPA were evaluated. The patients were included in the intervention or control groups of the study. For the intervention group, Meglio's protocol was performed. We observed and examined the control group for at least 6 months. Eventually both groups were reevaluated for the symptoms and persistence of positive specific IgE for cow milk proteins.

Results: We enrolled 20 patients for oral desensitization and 13 patients were enrolled in the control group. Both groups were similar with regard to the mean age, sex and clinical symptoms. In 18 (90%) of the intervention subjects, oral desensitization with cow's milk was successfully performed. The entire protocol was completed by 14 (70%) of the intervention subjects. At the end of the six-month observation period, all the patients in the control group were still symptomatic after ingestion of cow's milk. The levels of specific IgE for cow's milk in the intervention group decreased significantly, which was not observed in the control group.

Conclusion: We successfully desensitized 90% of our CMPA patients. Considering that all the patients in the control group remained symptomatic after the period of observation and our promising results in oral desensitization with cow's milk, we can safely propose this protocol as a hopeful alternative in the treatment of CMPA. We speculate that oral desensitization to cow's milk does not alter the natural outcome of CMPA, but substantially increases the threshold dose necessary to elicit allergic symptoms.


Congenital heart defects in children with oral clefts
Nahvi H, Mollaeian M, Kazemian F, Hoseinpoor M, Keiani A, Khatami F, Khorgami Z, Goodarzi M, Ebrahim Soltani A, Ahmadi J,
Volume 65, Issue 6 (9-2007)
Abstract
Background: Oral clefts are among the most common congenital anomalies. Infants with oral clefts often have other associated congenital defects, especially congenital heart defects. The reported incidences and the types of associated malformations and congenital heart defects vary between different studies. The purpose of this study was to assess the incidence of associated congenital heart defects in children with oral clefts.
Methods: All infants with cleft lip and palate referred to the Children's Medical Center and Bahramy the teaching Hospitals of the Tehran University of Medical Sciences from 1991 to 2005 were prospectively enrolled in this study group. All patients were examined and noted by an academic cleft team contain a pediatrician and a pediatric surgeon, and received cardiac consultation and echocardiography by a pediatric cardiologist. non cardiac associated anomalies, still born and patients without echocardiography were excluded from the study. Data including age, gender, exposure to contagions and high risk elements ,consanguinity and familial history of oral cleft, type of oral cleft, results of cardiac consultation and echocardiography and associated cardiac anomalies were cumulated and analyzed by SSPS version 13.5
Results: Among the 284 infants with oral clefts, 162 were male (57%) and 122 were female (43%). Seventy-nine patients (27.8%) had cleft lip, 84 (29.5%) had cleft palate and 121 (42.6%) had both cleft lip and palate. Of all the patients, 21.1% had congenital heart defects. the most common type Of these congenital heart defects(28.3%) was atrial septal defect.
Conclusions: For patients with cleft lip and palate, we recommend preoperative cardiac consultation, careful examination and routine echocardiography for associated cardiac anomalies, as well as appropriate management and prophylactic antibiotic therapy for those with associated congenital heart anomaly.
Emotional and behavioral problems of single parent vs. two parent children: Imam Khomeini Charity
Hakim Shooshtray M, Panaghy L, Hajebi A, Abedi Sh,
Volume 66, Issue 3 (6-2008)
Abstract

Background: The aim of this survey is to compare the emotional and behavioral problems of children with only one parent versus those from two-parent families. We analyzed behavioral problems such as aggression, delinquency and socialization issues, as well as emotional problems such as depression, anxiety, and somatic complaints.
Methods: Using a multi-stage cluster sampling, 10 of the 20 geographic regions covered by Imam Khomeini Charity were selected. Using systematic random sampling, 460 families with children aged 4-18 years were selected. All children were evaluated using the Child Behavior Check List (CBCL) to determine behavioral and emotional problems. Logistic regression tests were conducted to measure the effects variables, including age, gender, number of parents in the family, psychiatric history of each child and history of parental psychiatric treatment, on the internalizing, externalizing and total CBCL scores. A cut-off score of 64 was used to convert raw scores.
Results: No differences were observed in CBCL subscales between single-parent children vs. children of two-parent families.
Conclusion: Regarding the two-parent families among the study population, the results could not be generalized. As these families have qualified for assistance, the father cannot manage the family because of his disability, such as physical or mental problems. This minimizes the effect of having a father in a two-parent family, rendering them similar to single-parent families. Thus, differences were not observed between the two types of families. Further studies are necessary to compare single-parent families with two-parent families among the community.


Determination of upper incisor- vocal cords and upper incisor- carinal distance: fiberoptic bronchoscopy
Noyan Ashraf Ma, Azargoon Ar, Abtahi Ha, Safavi E, Piroozbakhsh Sh, Peiravi Sereshke H,
Volume 66, Issue 6 (9-2008)
Abstract

Background: The insertion of endotracheal tube is essential for most surgical operations, mechanically ventilated patient in ICU wards, During cardiopulmonary resuscitation and so for transport of patients. The aim of this study was determination of airway related distances in Iranian patients.

Methods: In a cross- sectional study during year 2007 in Imam Khomeini university Hospital a total of 75 ASA class I and II patients who were admitted to pulmonary ward evaluated for determination of incisor-vocal cord and incisor- carina distances. The nasal nare- vocal cord distance was determined too.

Results: A total of 71 patients, 45(63%) male and 26(36.6%) female were evaluated. The Incisor-vocal cord distance in males and females was 16.83±0.75mm against 15.04±1.12mm (P=0.03). The difference of nare-vocal cords and Incisor- vocal cord  distances was 2-3Cm

Conclusions: There was direct association between height and tracheal length in the study patients. The tracheal length (suitable insertion depth) in our patients was different from the recommendations (23 & 21 Cm for men and women) for non- Iranian, 25.9 versus 22.6 for Iranian men and women respectively. The difference of nasal nare-vocal cord and upper incisor-vocal cord distances in our patients was 2-3 cm, the lower range of accepted or reported one. We offer to do another experience with larger study group to apply the data to Iranian population.


Prevalence of oral lichen planus in HCV infected patients: the effective factors
Khatibi M, Ahmadinejad Z, Nasiri-Toosi M, Hajibaygi B, Zahedipour H,
Volume 66, Issue 8 (11-2008)
Abstract

Background: Hepatitis C is a major cause of chronic liver disease and hepatocellular carcinoma. Hepatitis C infection also has extrahepatic manifestations, including cryoglobulinemia and lichen planus. Lichen planus is a relatively common mucocutaneous disorder, and, due to its chronic pattern and increased incidence of malignancy, diagnosis and treatment of this disease are very important. The aim of the present study was to investigate the prevalence of oral lichen planus in HCV-infected patients.

Methods: In this cross sectional- descriptive study, the prevalence of oral lichen planus was evaluated by means of observation, clinical examination, questionnaire and evaluation of the medical records of 150 patients referred to the hepatitis clinic, gastrointentrology and infectious disease wards of Imam Khomeini Hospital and the Iran Blood Transfusion Organization, Tehran, Iran. We used a sequential method for sampling. Data were analyzed using statistical software (SPSS ver. 11) and the chi-square test.

Results: From a total 150 patients, 133 were male and 17 female. Six cases (4%) had oral lichen planus. All patients with oral lichen planus were male and the buccal mucosa was the most common site.

Conclusions: According to this study, the prevalence of oral lichen planus in patients afflicted with HCV is higher than in the normal population. We should pay more attention to oral lichen planus as one of the extrahepatic manifestations of hepatitis C.


Oral candidiasis in Human Immunodeficiency Virus (HIV) infected individuals in Iran
Farzad Katiraee, Ali Reza Khosravi, Vahid Khalaj, Mahboubeh Hajiabdolbaghi, Ali Asghar Khaksar, Mehrnaz Rasoulinejad, Mir Saeed Yekani Nejad,
Volume 68, Issue 1 (4-2010)
Abstract

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Oropharyngeal candidiasis is the most frequent fungal infection in HIV patients. The aims of this study were to appraise prevalence of oropharyngeal candidiasis and to determine factors associated with oropharyngeal candidiasis and oral yeast colonization among Iranian HIV patients.
Methods: The patients were composed 150 Iranian HIV positive individuals referred to Iranian Research Center for HIV & Aids (IRCHA), Imam Khomeini Hospital complex in Tehran, Iran. Oral samples were obtained and cultured on mycological media. TCD4 lymphocyte count/percentage was measured and patients were categorized. Patients evaluated for some risk factors for oropharyngeal candidiasis and oral candida colonization.
Results: Fifty nine percent of patients were presented with oropharyngeal candidiasis and the carriage rate of yeasts was 116 (77.2%). The most frequent isolated candida species were Candida albicans (102) 50.2% and Candida glabrata (45) 22%. Thrush in 57(38%), perleche in 30(20%) and erythematous lesions in 7(4.7%) of patients were observed. Significant differences in TCD4 count (p=0.01), gender (p=0.02), antifungal therapy (p=0.001), smoking (p=0.02), and intravenous drug use (p=0.03), between asymptomatic and symptomatic patients were observed.
Conclusion: Oral candidiasis is a frequent complication among Iranian HIV individuals. C. albicans and C. glabrata are most important etiologic agents of oral candidiasis. In Iranian HIV individuals TCD4 count, antifungal therapy, gender, smoking and intravenous drug use are important risk factors for oropharyngeal candidiasis. Denture wearing and age are predisposing factors for oral colonization.


Rupture of pectoralis major muscle: review article
Guity Mr, Farhoud Ar,
Volume 68, Issue 2 (5-2010)
Abstract

Background: Rupture of pectoralis major muscle is a very rare and often athletic injury. These days in our country this injury occurs more frequently. This could be due to increase in professional participation of amateur people in different types of sport, like body building and weight-lifting (especially bench-pressing) without adequate preparation, training and taking necessary precautions. In this article, we have tried to review several aspects of complex anatomy of pectoralis major muscle, epidemiology, mechanism, clinical presentations, imaging modalities, surgical indications and techniques of its rupture. Complex and especial anatomy of pectoralis major muscle, in its humeral insertion particularly, have a major role of its vulnerability to sudden and eccentric contraction as the main mechanism of rupture. Also, restoration of this complex anatomy seems to be important during surgical repair to have normal function of the muscle again.


Correlation of atherosclerotic changes in peripheral arteries with pathological involvement of aortic arch in coronary bypass patients
Eshraghi N, Tarzamni Mk, Afrasiabi A, Safaie N, Halimi M, Eshraghi A,
Volume 68, Issue 7 (10-2010)
Abstract

Background: A correlation between coronary artery disease (CAD) and atherosclerosis of peripheral arteries and the determination of noninvasive indexes for its existence and extent have been sought by many researchers. Some studies report that the intima-media thickness (IMT) of peripheral arteries could play this role. This study evaluated the correlation between the IMTs of common carotid and common femoral arteries and the degree of atherosclerosis in aortic arch and to evaluate the severity of CAD in candidates of coronary artery bypass grafting (CABG).

Methods: In a cross-sectional analytic-descriptive study, The severity of CAD, the grade of atherosclerosis of the aortic arch, and the IMTs of the common carotid and common femoral arteries were determined.

Results: There was a significant weak positive correlation between the IMT of common carotid artery (ρ = 0.193, p = 0.039) and common femoral artery (ρ = 0.206, p = 0.028) with the number of involved carotid vessels the mean of these two parameters was not significantly different between the three CAD groups. There was not any significant relation between the IMTs of common carotid and common femoral arteries with the severity of atherosclerosis in the aortic arch too. There was not any significant relation between the presences of atherosclerotic plaque in the common carotid or the common femoral arteries with the severity of CAD. The severe atherosclerosis of the aortic arch was significantly higher in patients with three vessel disease.

Conclusion: According to our results, the IMTs of common carotid and/or common femoral arteries may increase with the severity of CAD however, these parameters are not a surrogate for predicting the CAD severity.


Knee stabiligy after ACL reconstruction through graft fixation in femoral tunnel: transfemoral pinning versus endobutton techniques
Tahmasebi Mn, Ayati Firoozabadi M, Panjavi B, Kaseb Mh,
Volume 69, Issue 2 (5-2011)
Abstract
Background: One of the most common orthopedic complaints is direct or indirect trauma to the knee with torn anterior cruciate ligament (ACL). Reconstruction of the torn ACL is emphatically offered in active individuals as by this operation, we prevent osteoarthritis, knee instability and injury to the meniscus. There are numerous methods for graft fixation in the femoral tunnel in ACL reconstruction. If the graft proves to be stable after the operation, patients would not complain of giving way knee joints. In this clinical trial, we compared transfemoral pinning with endobutton fixation of hamstring graft in arthroscopic ACL reconstruction by examining knee stability and use of other relevant functional tests. Methods: Fourteen Patients who had undergone arthroscopic ACL reconstruction in Shariati Hospital during the years 2008-2009 and were being followed up were evaluated at least 15 months post-operatively by physical examination and the use of an arthrometer made by the Faculty of Mechanics of Sharif Technical University. Results: The results showed that two out of seven patients in which their ACL had been reconstructed by hamstring graft fixation by endobutton technique, and in one out of seven patients who had undergone ACL reconstruction by hamstring graft fixation through transfemoral pinning, Lachmann test (in 25 position) was greater than 5 mm but there were not any complaints of giving way knee joints. Conclusion: The clinical results of ACL reconstruction by transfemoral pinning technique seems to be superior to the reconstruction by endobutton technique.
In vitro antifungal susceptibility of oral candida species from Iranian HIV infected patients
Katiraee F, Khosravi Ar, Khalaj V, Hajiabdolbaghi M, Khaksar Aa, Rasoulinejad M,
Volume 70, Issue 2 (5-2012)
Abstract

Background: Oropharyngeal candidiasis and antifungal drug resistance are major problems in HIV positive patients. The increased reports of antifungal resistance and expanding therapeutic options prompted the determination of antifungal susceptibility profile of Candida species isolates in Iranian patients living with HIV/AIDS (PLWHA) in the present study.

Methods: One hundred fifty oral samples from Iranian HIV positive patients were obtained and cultured on CHROMagar and Sabouraud's dextrose agar. All isolates were identified according to assimilation profile, germ tube, colony color and other conventional methods. Disk diffusion testing and Broth Microdilution of six antifungal agents were performed according to the methods described in CLSI.

Results: Candida albicans (50.2%) was the most frequent isolated yeast, followed by C. glabrata (22%). Non-Candida albicans species were isolated from 71 (61%) positive cultures. 25.7% of Candida albicans isolates were resistant to fluconazole (MIC≥64 µg/ml) as were 21.9% and 16.4% to ketoconazole and clotrimazole (MIC>0.125 µg/ml), respectively. Resistance to polyene antifungals including amphotericin B and nystatin, and caspofungin were scarce. 57.7% of candida glabrata isolates were resistant to fluconazole, 31% to ketoconazole and 35% to clotrimazole.

Conclusion: Screening for antifungal resistant candida isolates by disk diffusion or broth dilution methods in clinical laboratories is an ideal surveillance measure in the management of oral thrush in patients with HIV/AIDS. Although nystatin is widely used in clinical practice for HIV positive patients, there was no evidence of enhanced resistance to it. Regarding no resistance to caspofungin, its administration is suggested.


Tumoral Calcinosis: case report
Farhad Tafaghodi , Ali Zamani , Seyede Sabereh Mousavi ,
Volume 72, Issue 12 (3-2015)
Abstract
Background: Tumoral calcinosis is a hereditary disorder of metabolic dysfunction of phosphate regulation. It is an idiopathic calcinosis that characterized by the deposition of calcium phosphate in periarticular tissues that causes typically lobulated, well demarcated calcification around large joints particularly the extensor surfaces. It is usually painless. It is common in puberty age and adolescents. The involvement of the hand phalanges is very rare that can make a mistake in diagnosis if it is infected. Tumoral calcinosis is seen the same in both sexes. The electrolyte levels of calcium and phosphorus is normal and sometimes is hyperphosphatemia. It is the first report of tumoral calcinosis in Iran. Case report: A 7-year-old girl presented with redness, yellowish discharge and painful swelling of the left hip and the third web space of left hand admitted to Vali-e-Asr Hospital, Tehran, Iran, in 2013. The onset of the disease was 3.5 years ago. She did not mention the family history of the disease. The pain was at the left hip first. Six months later the third and fourth phalanges of the left hand was swollen. Physical examination revealed an erythematous mass in the extensor surfaces of the third and fourth metacarpals of the left hand. It was tender in palpation. The smear and culture of discharge was staphylococcus aureus. X-rays revealed calcification of the third and fourth metacarpals of the left hand. The entire lesion was managed by surgical excision. Successful postoperative medical management in the form of low calcium and low phosphorus diet and oral cloxacillin was performed. Conclusion: Tumoral calcinosis involves rarely the interphalangeal joints of hand. Because of its compression over adjacent nerves, it is painful. Sometimes it has a sterile discharge and rarely superimposed infections may occur. Radiologists can play a major role in early diagnosis and probable complications.
Comparison of the electrical activity of trunk core muscles and knee muscles in subjects with and without patellofemoral pain syndrome during gait
Raheleh Dorosti , Mehri Ghasemi , Khosro Khademi-Kalantari, Alireza Akbarzadeh-Baghban ,
Volume 75, Issue 7 (10-2017)
Abstract
Background: Patellofemoral pain syndrome (PFPS) is known as one of the most frequent knee diseases and is the most frequent cause of anterior knee pain. Despite the high prevalence of the disease, its predisposing factors are not clearly known. Neuromuscular control disorders of hip and lumbopelvic complex and instability of core redounds to instability of whole movement pack chain. The aim of the present was to comparing the electromyographic activities of core muscles and muscles around the knee joint during gait in patients with PFPS with healthy subjects.
Methods: This descriptive-analytic case-control study was carried out in School of Rehabilitation in Shahid Beheshti University of Medical Sciences, Tehran, Iran. The present study was carried out during 10 months (April to February in 2016). Thirty-two subjects containing 17 patients with patellofemoral pain syndrome (10 females and 7 males) and 18 healthy subjects (10 females and 8 males) participated in this study. In both groups the electrical activities of some of the muscles around the knee joint and the core muscles containing vastus medialis (VM), adductor longus (AL), gluteus maximus (G Max), external oblique abdominis (EOA), internal oblique abdominis (IOA), transverse abdominis (TA) and multifidus (M) were recorded during gait. Onset and offset time, duration and intensity of muscles activities were compared between two groups.
Results: The results of the study showed that duration and intensity of the electrical activity of the gluteus maximus (respectively P=0.03, P=0.035) and offset time of electrical activity of the internal oblique abdominis (P=0.04) and the transverse abdominis (P=0.03) during gait, were significantly different between two groups. The external oblique abdominis and the multifidus electrical activities had not any significant differences between two groups (P>0.05).
Conclusion: It seems that electromyographic activities of some of core muscles in patients with patellofemoral pain syndrome in comparison with healthy subjects are different. However, there was no differences in electromyographic activities in some of the muscles around the knee between patients and healthy subjects.

The effectiveness of cognitive-behavioral therapy on mental toughness and life expectancy of patients with multiple sclerosis
Fatemeh Khayat Sarkar , Mahmoud Shirazi ,
Volume 75, Issue 8 (11-2017)
Abstract
Background: Multiple sclerosis (MS) is one of the most common chronic diseases creating major psychological challenges. Hence, the purpose of this study was to investigate the effectiveness of cognitive-behavioral therapy (CBT) on mental toughness and life expectancy of MS patients.
Methods: The design of this quasi-experimental study has been with pre-test, post-test and follow-up with control group that was performed in Zahedan MS community, Iran, from September to November 2016. The sample of the study was selected voluntarily from 30 MS patients which were randomly divided into two experimental and control groups. Among 200 patients, 80 patients had the required qualifications to participate in the study and 38 patients volunteered to enter the study. At last, only 30 patients were selected and put randomly into two experimental and control group. The experimental group received treatment in 8 weekly sessions (90 to 120-minute-long sessions with the classroom task and homework and group discussion) but the control group did not go under such treatment. The research instrument being used in this study was Halajian life expectancy questionnaire and mental toughness questionnaire (MTQ-48).
Results: For the groups to be homogeneous in age and the level of education, T-test and chi-squared test were used respectively, which did not show a meaningful difference between experimental and control group. The analysis of covariance showed that cognitive-behavioral therapy (CBT) group has resulted in meaningful increase in mental toughness and life expectancy of patients. The results showed the average of mental toughness to be 1.05 in for the experimental group in the pre-test, 1.24 in the post-test, 1.21 in the follow-up and the average of life expectancy 4.56 before treatment, 7.20 after treatment and 7.01 in the follow-up (P<0.001).
Conclusion: Practicing group cognitive-behavioral therapy in the process of MS patients’ treatment led to the increase in their mental toughness and life expectancy.
 

Practice of oral and maxillofacial surgeons in bisphosphonates users in Tehran: brief report
Mohadeseh Heidari, Avideh Maboudi, Sepideh Motevali , Farhad Sobouti, Mahmood Moosazadeh,
Volume 76, Issue 11 (2-2019)
Abstract
Background: Although the treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is very difficult, it can be prevented. The aim of this study was to investigate the knowledge and practice of oral and maxillofacial surgeons in the treatment of bisphosphonates user patients.
Methods: This was a cross-sectional study carried out by census sampling of oral and maxillofacial surgeons in Tehran, Iran from March to June 2016. The employed instrument was a questionnaire including 4 sections. The first section was to collect the demographic information of the participants. In the second part including 7 questions, the knowledge of the participants was measured. The third section with 6 questions was to assess the participants’ practice in the treatment of patients using bisphosphates. Finally, the last sections contained 4 questions. The content validity of the questionnaire was evaluated by 5 specialists in the field (two oral and maxillofacial surgeons, two periodontists, and one endodontist). To assess the reliability of the questionnaire, it was given twice with a 10-day interval to 10 of target group members. The calculation of Spearman-Brown formula revealed a correlation coefficient of 0.79.
Results: In the treatment of BRONJ, most subjects responded to risk, 1 and 2 stages patient education and symptom relief. Treatment with antibiotics and debridement surgery was chosen for patients with higher stages. From 123 oral and maxillofacial surgeons, 102 answered the questionnaires. 77.2% of the surgeons answered correctly to questions about implant insertion. This percentage was higher than other therapeutic procedures.
Conclusion: The knowledge of oral and maxillofacial surgeons as final line of referral and treatment of patients using bisphosphonates should be increased.

Clinical guideline for prevention and control of alcohol consumption
Farzad Tajdini, Reza Shekarriz-Foumani , Parinaz Rezapour , Kambiz Abachizade, Maryam Mohseni ,
Volume 76, Issue 12 (3-2019)
Abstract
Background: Using alcohol is one of the most important death factors that can be prevented. Lifestyle-related diseases are at the top cause of mortality and burden of disease, whereas most of them can be prevented. Considering the growing importance of diseases related to lifestyle (including alcohol abuse), providing evidence-based clinical guidelines for diseases and life-style related conditions which are in accordance with the newest scientific findings and with cultural and economic conditions in each country are required. The aim of this study was to develop a clinical guideline for prevention and control of alcohol consumption.
Methods: The type of study is initiation of a method or a scientific/administrative system (health system management studies) that uses the National Pattern of Localization of Clinical Guidelines in 2017 in Taleghani Hospital of Shahid Beheshti University of Medical Sciences, Tehran, Iran, by using the reviewed clinical guidelines, which was conducted by the end of 2017 based on organizational criteria, the availability of the full version of the clinical guideline and its up-to-datedness, and the appraisal of guidelines for research and evaluation (AGREE) scoring system. This clinical guideline was developed based on 5A Model (Assess, Advise, Agree, Assist and Arrange).
Results: In order to prevent and control alcohol abuse, a clinical guideline was developed based on five clinical guidelines including United States Preventive Services Task Force (USPSTF), Healthy lifestyle guideline (ICSI), the guidelines for preventive activities in general practice in Australia (RACGP), The Australian population health guide to risky behavioural risk factors in general practice (SNAP), and the guidelines related to lifestyle and wellbeing by the National Institute of Clinical Excellence of England (NICE) in the form of 5A model.
Conclusion: The best practice is according to the existing clinical guidelines for prevention and control of alcohol use screening, brief intervention (1-2 sessions) and behavioral counseling, treatment with cognitive behavioral interventions (2-6 sessions) and, if necessary, referrals to higher treatment centers. Referral is recommended for patients who have signs of substance dependence and need a level of care beyond brief service.

Spatial, temporal, and spatiotemporal analysis of cutaneous leishmaniasis in North Khuzestan Province, Iran, from 2011 to 2015: brief report
Behzad Jafarinia, Roya Rashti, Razieh Halvaei Zadeh , Javad Moazen, Hamid Kalantari ,
Volume 76, Issue 12 (3-2019)
Abstract
Background: Leishmaniasis is a zoonosis disease. About 350 million people are at risk of developing a disease, with 1.5 to 2 million new cases every year in the world. The aim of this study was to determine the space-time clusters of cutaneous leishmaniasis in north of Khuzestan Province, Iran.
Methods: In this cross-sectional study, the annual cutaneous leishmaniasis incidence per 100,000 individuals in each county was determined for the past five years. Reported from 2011 to 2015 in North of Khuzestan Province, Iran. Geographical information system (GIS) and spatial scan statistic method were used to identify spatial clusters of cutaneous leishmaniasis cases at the county level. Pure retrospective temporal analysis scanning was performed to detect the temporal clusters of cutaneous leishmaniasis cases with high rates using the discrete Poisson model. The space-time cluster was detected with high rates through the retrospective space-time analysis scanning using the discrete Poisson model.
Results: The overall cutaneous leishmaniasis incidence increased from 2011 to 2015. A total of 3 high-risk counties were determined through Local Moran’s I analysis from 2011 to 2015. Local Moran’s I enabled the detection of the spatial autocorrelation for a county with its adjacent county. The method of spatial scan statistics identified different 11 significant spatial clusters. The space-time clustering analysis determined that the most likely cluster included 11 counties, and the time frame was October 2014. The secondary cluster included one counties in October 2014. The tertiary cluster included six counties, and the time frame was from June 2014 to November 2015.
Conclusion: Spatial and temporal clusters of cutaneous leishmaniasis have increased in the northern region of Khuzestan Province, and most clusters have occurred in November.

Efficacy of chlorhexidine solution on oropharyngeal bacterial colonization in hospitalized patients of intensive care units
Hesamodin Askari Majdabadi , Mohsen Soleimani , Majid Mirmohammadkhani , Elham Zamanipoor,
Volume 78, Issue 11 (2-2021)
Abstract
Background: Infection is a vital problem in intensive care units. Currently, chlorhexidine solution is used to reduce oral colonization. This study aimed to determine the efficacy of chlorhexidine solution on oropharyngeal bacterial colonization in hospitalized patients in the intensive care units.
Methods: This descriptive study (from August 2018 to May 2019) was performed on 60 patients who administered in medical and surgical intensive care units (ICUs) in one of the university hospitals in Semnan city. Patients admitted to (ICUs) were selected according to inclusion criteria. At the time of admission to the intensive care unit, oropharyngeal colonization of patients was assessed. Forty-eight hours after admission and using the chlorhexidine solution 0.2% three times a day, oropharyngeal colonization was assessed again. Data analysis was performed with SPSS software, version. 22 in the significant level of 0.05.
Results: This study showed most of the patients in this study were male (80%) with mean age of 45.23±15.19 years. Most patients were transferred from the emergency department to intensive care units and had endotracheal tubes. At the time of admission to the intensive care unit, 8 patients were infected with E. coli and 6 patients were infected with Klebsiella. The results also showed that the use of chlorhexidine 0.2% had no significant effect on the reduction of micro-organisms in the oropharyngeal area. Forty-eight hours after admission to ICUs, the incidence of E. coli infection increased (P=0.01) but there was no significant increase in the klebsiella infection rate (P=0.25).
Conclusion: This study showed that the use of chlorhexidine solution 0.2% did not affect the reduction of micro-organisms in the oropharyngeal areas of patients. Therefore, oral care protocols that include mechanical movements and toothbrushing should be considered to reduce the occurrence of micro-organisms. This study also found that most patients who were referred to the intensive care unit were contaminated with pathogenic micro-organisms. Therefore, consideration should be given to appropriate strategies to reduce infections in the emergency department.

Primary intraosseous squamous cell carcinoma of mandible: a case report
Zohreh Dalirsani, Atessa Pakfetrat, Nasrollah Saghravanian, Negin Samiee, Elahe Vazavandi,
Volume 79, Issue 8 (11-2021)
Abstract
Background: Primary intraosseous squamous cell carcinoma (PIOC) of the mouth is a very rare but well-known carcinoma. It is locally invasive and its prognosis is quite poor. It may originate from the walls of an odontogenic cyst or de novo from the remnant epithelium at this region. Because the early symptoms of such malignancies are sometimes similar to those of inflammatory or periodontal diseases, early diagnosis is the most important step toward appropriate treatment.
Case Presentation: The case was a 46-year-old female with a sudden luxation of two posterior mandibular molars referred to a general dentist in May 2019. With diagnosis of periodontitis, the teeth were extracted without finding the cause of the tooth luxation. After four months, because of pain, swelling and non-healing socket of extracted teeth she referred to the department of Oral medicine in Mashhad Faculty of Dentistry. The patient was healthy with no systemic disease, drug history or familial history of cancer and no history of trauma, habits, tobacco, alcohol, and smoking. ln clinical examination, a nodular swelling with extensive ulcer and rolled borders along with hyperkeratosis and erythema on the posterior part of the right mandibular ridge was observed. The Extraoral examination revealed a tender mobile lymph node in the right submandibular region. After radiographic evaluation, with an initial diagnosis of SCC originated from the socket of extracted mandibular molars, incisional biopsy was performed, and histopathological analysis of the specimen revealed a primary intraosseous squamous cell carcinoma (grade II) and then necessary treatments (surgery, radiotherapy, chemotherapy) were performed.
Conclusion: Dentists should know that any sudden changes in the mouth or teeth such as tooth luxation should be considered as a possible sign of malignancy. With proper diagnosis and early initiation of treatment, the prognosis of the disease can be improved and the patient can be treated with minimal complications of necessary treatments of surgery, radiotherapy, or chemotherapy.

Management of left ventricular thrombus: diagnostic and therapeutic methods: a review article
Maryam Mehrpooya, Zahra Sadeghi,
Volume 81, Issue 8 (11-2023)
Abstract
Left ventricular thrombosis (LVT) is a very serious condition and life-threatening complication that usually occurs after acute occlusion of the left anterior descending (LAD) coronary artery followed by acute myocardial infarction with ST-segment elevation (STEMI), which leads to significant regional wall motion abnormality (RWMA). It should be noted that its diagnosis, treatment, and management are challenging now and depend on various factors such as the type of thrombus, time of percutaneous coronary intervention (PCI), and underlying disease. The preferred diagnostic method is cardiovascular magnetic resonance imaging (CMR), but transthoracic echocardiography (TTE) is routinely used for diagnostic and screening purposes also follow-up of response to treatment. It is worth mentioning that when the diagnosis of left ventricular thrombus is not clear with conventional echocardiography, contrast echocardiography is used for more resolution and detailed information. Left ventricular thrombosis can appear in both acute and chronic forms and lead to significant complications, the most important of them are stroke and systemic arterial embolism (SE). According to previous studies, vitamin K antagonist (warfarin) by keeping INR within the therapeutic range currently used to treat left ventricular thrombosis. Although the use of direct oral anticoagulants (DOAC) has brought excellent outcomes, but due to the lack of large clinical trials, the routine use of these agents is controversial, and only in case of warfarin intolerance or contraindications, DOACs can be used as an alternative. Generally, the best way to prevent left ventricular thrombosis is primary percutaneous coronary angioplasty (primary PCI) which preserves left ventricular function. Depending on the sensitivity of the diagnostic method, thrombus will likely resolve in >50% of patients by six months after the MI. On the other hand, in rare cases, surgery is indicated if a thrombosis remains despite the medical treatment especially if it is accompanied by a left ventricular aneurysm. The purpose of this narrative review is to evaluate the latest evidence in the field of left ventricular thrombosis management and to adopt the best approach for these patients.

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