[Identification and ranking of factors affecting quality improvement of health and treatment services using multiple attribute decision making [MADM]: a case study]

The sector of health services has a special status compared to other sectors in which even minor mistakes can be irreparable. Therefore, offering services with optimum quality and professional standards is of great importance. The purpose of this study was to identify and prioritize the factors affecting the quality improvement of services in health and treatment centers of Yazd using multiple attribute decision making. The study was descriptive and cross-sectional in nature. 55 health care receivers, who were referred to health care centers of Yazd at least once, were selected. A questionnaire, with alpha Cronbach coefficient slope of 78%-86%, including all aspects of the service quality was used. The factors affecting quality improvement were identified and subsequently ranked using the techniques of TOPSIS, SAW, and ELECTERE. Considering the fact that the results of the implementation of the above-mentioned methods did not reach a general consensus, Copeland merging technique was applied. The results of the ranking showed that the staff's knowledge and capability enjoyed more priority than the other factors. The managers of health and treatment centers will be able to prioritize the factors affecting quality improvement of health and treatment services using multiple attribute decision making. This can lead to the quality improvement of health care services

Relationship between serum zinc and insulin concentration, insulin resistance and oxidative stress in postmenopausal diabetic women

The metabolism of Zine [Zn], an essential nutrient, changes in diabetes. It has been shown that there is a relationship between Zn and both, type 1 or insulin-dependent diabetes mellitus [IDDM] and type 2 or non-insulin-dependent diabetes mellitus [NIDDM]. Increased lipid peroxidation in diabetic patients leads to MDA production. This study aimed to investigate relationships between serum Zn concentration and insulin, insulin resistance and oxidative stress in postmenopausal diabetic women. We studied 45 diabetic women and 45 healthy ones [controls] with BMI 25-30 kg/m2 and age 45-60 y. Fasting blood sugar [FBS], serum zinc, insulin, insulin resistance and MDA were determined in both groups. There were non significant correlations between Zn, insulin [r= -0.06] and insulin resistance [r = -0.027] and MDA [r = -0.09] as well in diabetic group. There were no significant relationships between serum zinc and insulin, insulin resistance and MDA in postmenopausal diabetic women

[ relation between serum ferritin and glycemic status in patients with type 2 diabetic and healthy individuals]

Alghough some studies report an association between ferritin and glycemic status, data from Iran is limited. This study was designed to assess the relation between serum ferritin and glycemic status in type 2 diabetic and healthy individuals, aged 45-60 years, in Tehran. This cross-sectional study was performed on 54 type 2 diabetic patients and 53 healthy subjects, aged 45-60 years. The diabetic patients were members of the diabetes society in Tehran and healthy subjects were employees of Tehran University of Medical Sciences. Serum ferritin, fasting blood glucose [FBS], HbA1C, serum insulin and insulin resistance were analyzed in all participants. Statistical analyses were done using regression and independent sample t-test. Serum ferritin levels were within normal range in both groups. Positive correlations between ferritin and FBS, HbA1C, insulin and insulin resistance were found, which were significant in diabetic patients and non-significant in healthy subjects. There was significant correlation between insulin resistance and serum ferritin in diabetic patients; however the correlation was non-significant in healthy subjects. There were positive correlations between ferritin with serum insulin and insulin resistance in patients with type 2 diabetes and the positive correlation was present even in normal ranges of serum ferritin. Since ferritin has a wide normal range, it may be better to reassess it, especially in patients with type 2 diabetes

[Canal configuration of maxillary second molars]

Missed canal is one of the main reasons of the failure of root canal therapy. Poor knowledge of root canal anatomy may result in this problem. Each tooth has specific anatomical characteristics which could relatively be assessed by radiography. This study aimed to survey the variety of second maxillary molar root canal anatomy in Mashhad population. In this descriptive study, 103 human adult second maxillary molar extracted in different districts in Mashhad were chosen. After preparation of the access cavity, the teeth were embedded in Naocl 5.25% for resolution of the pulp tissue. For decalcification, the teeth were soaked in HCL 10% for 24 hours and washed in running water for 12 hours. They were dehydrated in alcohol 70-100% and finally cleared by Methylsalicylate and pure alcohol after 3 hours of soaking. Methylene blue 2% was injected to the canals and immediately evaluated with 8x magnification. The root canals were classified by Vertucci category. Different types of canals in mesiobuccal root were as follows: 45.7% type I, 16.5%type II, 5.8% type III, 12.6% type IV, 6.9% type V, 4.9% type VI and 3.9% type VII. In two teeth, the distobuccal and palatal root were fused, having a C-Shaped canal, and 2 teeth had only two roots [buccal and palatal]. Therefore, type I was seen 96% and 98% in the distobuccal and palatal roots, respectively. Due to the high prevalence of extra canal in the mesiobuccal root of the second maxillary molar [52.5%], the clinicians have to carefully explore the four canals in radiography and perform clinical evaluation; otherwise, treatment failure is inevitable

[ invitro investigation on the incidence of apical leakage after using calcium hydroxide as an intracanal dressing]

Background and aim: nowadays Calcium hydroxide is used as a dressing for canal sterilization and repair progression of apical lesions. The aim of this study was to determine the incidence of apical leakage after susing Calcium hydroxide as an intracanal dressing and filling the canal with gutta percha and AH,, sealer

Materials and Methods: the crowns of fifty-eight single-root extracted human teeth were resected and then divided into three test groups and two control groups [test groups=15teeth, positive control =3 teeth, negative control=10 teeth]. The canal of each tooth was prepared using step-back technique up to 50= k-file and MAF=30 in groups A and C, MAF = 30 in-group B. The teeth of groups B and C were filled with Calcium hydroxide for one week and then the paste was removed by 35$ file and irrigated with normal salin in group B and sodium hypochlorite in group C. Then canals of test groups and negative control were obturated with gutta percha and AH, sealer using lateral condensation technique. Following this, teeth were centrifuged in India ink before floating in it for three days. Specimens were sectioned vertically and examined under a stereomicroscope to measure dye - penetration level. The results were analyzed using ANOVA statistical test

Results: dye - penetration of group C in which calcium hydroxide. paste had been removed with sodium hypochlorite was less than two other groups, however, no statistically significant difference was found between three experimental groups of A, B and C in dyepenetration

Conclusion: it can be concluded that using calcium hydroxide for canal sterilization has no effect on the level of apical leakage