[Comparison of the substantivity of several mouthwashes and their effect on microbial plaque using epifluorescence microscope]

Several techniques have been used to assess the efficacy and substantivity of mouthwashes. Considering the variability of available mouth rinses, this study aimed to assess the substantivity of several mouthwashes and their effect on microbial plaque using an epifluorescence microscope. This crossover double blind clinical trial evaluated 0.2%, and 0.12% [from 2 different brands] chlorhexidine [CHX], Persica and cetyl pyridinium chloride [CPC] mouth washes as well as normal saline as the negative control. Non-stimulated saliva samples were obtained from 16 candidates at baseline, 30s, 1, 3, 5 and 7h after one time use of mouthwashes. Epifluorescence technique was used to assess the viability of bacteria. For clinical examination following prophylaxis, subjects were asked not to use any oral hygiene measure except for the provided mouthwashes [twice a day] for 4 days. A 10-day washout period was allowed between the use of mouthwashes. Repeated measures ANOVA and Scheffe's test were applied for the comparison of viable bacterial count between the groups and Kruskal Wallis test was used for the assessment of microbial plaque. Persica and 0.12% CHX maintained their substantivity for 3 and 5h, respectively. A significant reduction in bacterial count was observed up to 7h after the use of 0.2% CHX only [P<0.001]. On clinical examination, 0.2% and 0.12% CHX mouthwashes had significant differences with the others but had no significant difference with one another [P<0.02]. Persica and CPC had similar efficacy [P<0.02]. Efficacy of mouthwashes strongly depends on their substantivity. Daily application frequency of other mouth rinses should be increased in order to achieve an efficacy equal to that of CHX

[Evaluation of realization rate of under curriculum at Tehran's universities school of dentistry from 2001-2005]

Considering the number of dental graduates and the increasing trend of their concerns and goals of the educational program, a lack of information about This, and its related problems, the aim of this study was to evaluate student opinions on academic curriculum the following dental schools: Tehran University of Shahid Beheshti Islamic Azad university and Shahed University, from 2001 to 2005.This cross-sectional study was conducted on all graduated students. All students were asked to fill out questionarre, stating their opinion of their academic curriculum, the questionarre included topics and 10 variables which wear classified into 5 categories of completely, Moderately, slightly and insufficiently adequate. Related variables, including school of dentistry and personal attributes were also taken into consideration and chi-2 statestical test was utilized for date analysis. Out of 1481 cases of dental graduated, study was conducted on 662 person Results of realization was 12.3%, 27.4%, 33. 6%, 14.9%, 11. 8% for complete, high medium low very low respectively and there are 60.3% of non realization and in this study. the most non realization was about Basic Sciences [71.8%] and insufficiency of requirement [71.6%] rate of realization was different in the universities and female and single graduated [that living with her family had more non realization] It seems non realization of curriculum and its related problems are worrisome and necessary performance for reduction of these problemsis recommended

[Incidence of relapse in orthodontics treatments and related factors]

In regard to the prevalence of orthodontic treatments, the importance of relapse and complications followed by relapse are overlooked. This is further impacted by information gaps in Iranian Dental Journals and deficiencies in previous studies. In this study we have assessed the outcome of orthodontic treatment, relapse and related factors in patients in the Private orthodontic clinic in Tehran in 2009.This study was performed using a cross sectional technique. The samples consisted of all patients with various kinds of malocclusions and the presence of pretreatment, post treatment dental casts with at least 4 years post treatment. In these patients, we also prepared post retention dental casts. The indexes, including irregularity index, arch length, inter canine width, inter premolar width, and inter molar width in both upper and lower jaws were evaluated. The change in each index out of normal range indicated relapse. The role of related factors such as sex, patient's age at the beginning of the treatment, type of treatment, duration of the treatment, the length of retention, the type of malocclusion, and family history were analyzed using Chi Square test. This study was performed on 52 cases [26%] out of 200 cases which had complete records and positive response to recall. During the study period at least 500 patients were treated. The result of relapse was 61.5% without considering the irregularity index [42.3%]. The most important relapse index was maxillary irregularity index [37%], followed by the mandibular irregularity index [17%] and, the least significant index was mandibular arch length [2%]. Relapse was increased in patients with less than 24 months of treatment. [P<0.0001] Relapse was high regardless of irregularity index. Considering its complications, we suggest further studies to elucidate its etiology. This should be followed by preventive measures to decrease the rate of relapse

[Probing the relation between gene promoters hypermethylation of RARB and p16 among patients with prostatic cancer of different prognosis]

With regard to the increasing prevalence and mortality rate of prostate cancer and several related reports studying the role of promoter Hypermethylation of RARB and p16 in predicting the prognosis, this research is carried out on 3 groups of subjects with; poor prognostic factors [case], good prognostic factors [control-2] and healthy person [control-1], at three general hospitals of Imam Hossein, Modarres and Labbafineyhad, between 2007-2009. The research has case-control Design. All three groups of participants [21 subjects in each group] were analyzed for hypermethylation of RARB- p16. All groups were matched for age, tumor stage, grade and PSA. The technique was methylation specific polymerase chain reaction [MSPCR]. In control-1, no methylation of RARB were observed. In control-2, RARB was positive in 33%. In case group, the RARB was positive for 71.4%. For control 2 and case groups, the RAR positivity was higher than control-1 [P< 0.001], however, that of case group was higher than control-2[p<0.02]. In healthy persons p16 were negative. For good prognosis group p16 were positive in 19%, while for poor prognosis one, p16 were positive in 47.6%. p16 hypermethylation was higher in case and control-2 groups [P<0.001]. Nevertheless, for case group this was higher than control-2 [P< 0.01].:Hypermethylation of promotor RARB and p16 would be a good prognostic factor for early detection and prognosis of prostatic cancer

[Outcomes of open leg fractures treated with external fixator and relating factors]

Open leg fractures are serious problems with high incidence and several complicated consequences in affected patients. There is no reliable record in this regard in Iranian medical literature. This study assesses the results of open leg fractures treated with external fixator in Imam Hossein hospital in a 3 year periods; 2003-2006. At an experimental study, all the patients with open leg fracture, referred to Imam Hossein hospital and treated with external fixator monolateral [AO] evaluated. All the patients were encouraged to bear weight early and dynamization was performed in relation to amount of comminution. Patients were visited every 4 to 6 weeks during the treatment. Minimal follow up was 8 months and the results of treatment were evaluated using a requirement for both secondary procedures and quality of reduction. In addition, effect of age, gender, grade, fracture type and causes of injury on this two problems were calculated with Fisher's exact and Chi-square tests. 58 patients referred to Imam Hossein hospital and 8 ones were excluded from study owing to different intervening causes. 10% of patients needed secondary procedures. Exact reduction was performed at 64%. Fractures with comminution, grade III Gustilo and displacement of more than 2mm had high probability of secondary procedures [P<0.02]. Mean time of union was 22 weeks. Fractures with exact reduction had lesser mean time compared to others. External fixator is a safe implant in treatment of open leg fractures and we recommend further clinical trials with control groups

Diagnostic value of NT-BroBNP in HF patients admitted with dyspnea in Emergency Department

Considering the increasing prevalence of patients with dyspnea and the possibility of heart disease, as well as unavailability of echocardiography specially in primary care situations and unreliability of echocardiography findings in some diseases and finding NTProBNP as a diagnostic factor in heart failure in these patients, this study was done to determine the accuracy of NTProBNP in comparison to echocardiography in the diagnosis of heart failure in Modarress Hospital, in Tehran, between 2006 and 2007. This study, with a clinical trial diagnostic design, was performed on patients with chief complaint of dyspnea. The NTProBNP marker of serum was determined by Elecsys and patients were categorized according to age adjusted reference book values into two groups of with and without heart failure. Then, the patients underwent Simpson Echocardiography and Tissue Doppler; and the positive and negative predictive value for NTProBNP in relation to the echocardiography was determined and analyzed by statistical tests. One hundred patients were analyzed. Mean age was 59 +/- 11.8 years and 70% were male. PPV was 84%, NPV was 70.4%, false positive was 16%, while false negative was 29.5%. Sensitivity was 78%, specificity 77%, and accuracy was equal to 78%. It seems that NTProBNP marker is a good test for screening patients with dyspnea and besides clinical criteria it has an acceptable diagnostic value. It would be good to perform other studies, using more precise laboratory methods and reevaluation of cut point especially for Iranian patients considering factors other than age to obtain a rapid, easy, and costeffective test in primary care

Comparison of glucosamine sulphate glucosamine/MSM in treatment of knee osteoarthritis: signs and symptoms

With regards to the increasing prevalence of knee osteoarthritis [OA], the complaints of these patients from pain, some reports from the positive effects of glucosamine in decreasing pain in these patients and due to some defects in previous researches and for the comparison of the effects of Glucosamine Sulphate and Glucosamine/MSM, this study was done on the quality of pain and sign and symptoms of knee OA in a private clinic in 2008. A randomized matched clinical trial was conducted. Patients over 40 years old with knee OA according to ACR criteria, BMI<30, without history of recent knee surgery [recent one year] and after ruling out secondary OA, were enrolled in our study. The patients were randomly divided into 2 groups: glucosamine 1tab/BID and glucosamine/MSM 1tab/BID for 6 months. Outcome included WOMAC index. The change in pain score was studied in each group under Wilkacson statistic method and between the 2 groups, it was studied using Mann Whitney method. 27 patients were included in glucosamine group and 26 patients in glucosamine/MSM group. The incidence of side effects was similar in both groups [p<0.9]. Pain severity in the beginning, sex, age, and other studied factors were similar too. The decrease in pain score was 27.4 +/- 17.3 in Glucosamine group and 25.5 +/- 15.7 in Glucosamine/MSM group which means 28.8% reduction in Glucosamine group and 26.1% reduction in Glucosamine /MSM group [p<0.005], but in comparison, it was not meaningful statistically [P<0.8]. It seems that these two groups of drugs have similar effects, but due to prices and side effects, Glucosamine is better than Glucosamine/MSM

[Effects of adentonsillectomy on pulmonary function parameters]

Adenotonsillar hypertrophy is a common finding among children which in untreated cases may result in serious cardiopulmonary problems. There are limited studies about the effect of adenotonsillectomy on pulmonary function parameters. Does adenotonsillectomy affect on pulmonary function? This study is performed to reveal this purpose. In a pre- and post-treatment clinical trial on 39 children between 6-13 years old with indication of adenotonsillectomy due to obstructive respiratory symptoms [because of prominent hypertrophy of tonsils and/or adenoid tissue], 5 main Spirometric parameters weere measured before and 2 months after adenotonsillectomy with a standard method and data were analyzed by paired t-test. 39 children [56% male and 44% female] with a mean age of 8.95 +/- 1.93 were evaluated. 4 main Spirometric parameters increased: FEV1/FVC from 89.H12.7 to 97 +/- 4.6, FEV0.5/FVC from 70.9 +/- 15.5 to 81.U11.8, FEV25-75 from 1.9 +/- 0.6 to 2.2 +/- 0.7, MEF50 from 2 +/- 0.6 to 2.4 +/- 0.7 and all the improvement was statistically significant [P<0.0001]. There was no statistically significant change in FEV1/ PEFR index. Due to obvious changes of 4 main Spirometric parameters, it can be deduced that adenotonsillectomy is of effective roles in improvement of pulmonary function

[Comparing the spectrophotometric and potentiometric methods in determining the concentration of fluoride in water]

According to the importance of fluoride in water based on "DMFT" and 2 other reports which indicates that Spectrophotometeric method for measurement the fluoride water can not show the real amount of flouride, Potentiometer seems to be better than Spectrophotometer. To compare these two methods for measuring the amount of flouride, this research carried out in organic chemistry laboratory of Tehran University between 2006 and 2007. In this descriptive study, after obtaining the distilled water, they were prepared in 7 groups with 0, 0.35, 0.67, 0.7, 1, 1.2, 1.5 ppm of fluoride in 14 polyethylene containers and 2 samples were prepared from each type. In following, half of them were measuerd by standard spectrophotometer method [with the use of visible instrument in the same wave length, amount of light coefficient with standard solutions]. Using standard solutions of 10[-1] M up to 10[-5] M fluoride in the other half of samples, the calibration curve according to the findings was drawn. By studying the potentiometer amounts of samples and compare them with calibration curve, sample density were found. At the end, findings were changed to ppm. Therefore, the amount of fluoride in water were determined and the difference to the real fluoride in samples in each method were indicated. This difference in each method was calculated by paired-t test, whereas Mann-Whitney U test evaluated two groups with each other. The research studied 14 water samples with real fluoride of 0.77 +/- 0/58. In spectrophotometer method the fluoride amount was 0.99 +/- 0/58 with the difference of 0/82 +/- 0.23 from real amount [P<0.5]. In potentiometer this amount was 0.77 +/- 0/52 with the difference of 0.02 +/- 0.01. [P<0.4]. Amount of fluoride in spectrophotometer is 19.5% higher than potentiometer. Potentiometer method is better than spectrophotometer for indicating the fluoride in water and this method is, therefore, recommended

[Accuracy assessment of FNA in diagnosis of palpable breast mass]

Due to widespread of palpable breast masses in female and common complications resulted from delayed diagnosis and also with some regards to contradictory reports upon the accuracy of fine needle aspiration [FNA] in comparison with standard method of excisional biopsy this study has been performed on patients with palpable breast mass referred to the Aayatollah Talegheni Hospital between years 2003 and 2005. The present study was based on evaluation of diagnostic methods. Seventy five patients were included in this research and the mean of their age was 44 +/- 10 years [ranged from 20 to 75 years]. FNA was accomplished initially by skin prep with alcohol and holding the lumps between thumb and point fingers. After the needle [No 22-25] was placed into the lump, a continous suction was generated using a 10 ml syring and then multiple in and out needle motions were performed. The collected samples were then smeared on glass slides and allowed to dry out in air and fixed by 96% alcohol. The fixed smears were then stained and examined by a pathologist. Lesions with cystic character were drained and excluded from the study. FNA results were reported according to the latest classification of breast masses as follow c1: inadequate sample, c2: benign, c3: semibenign, c4: semimalignant, c5: malignant [c3 and c4 assumed as indeterminate group]. The total efficiency of FNA for detection of palpable and malignant breast tumor was determined based on, the pathology reports on excisional biopsy [as a gold standard method], the level of sensitivity and specificity, positive and negative predictive values, and also the overall efficiency of FNA. .4 cases of drained cystic lump were eliminated from the study. The amount of sample were inadequate for FNA study in 11 biopsy cases [14.7%]. Nine biopsies [15%] were identified as indeterminate, 43.3% as benign, and 41.7% malignant, which were compatible with the results of excisional biopsy. Therefore 100% [all] of the positive and negative predictive values were obtained. The FNA is a suitable method for diagnosis of malignancy in palpable breast tumor, and hense it can be recommended for this purpose

[Determination of D-Dimer value in diagnosis of atrial thrombus in patients with atrial fibrillation]

Considering the and importance of formation of atrial Thrombus [AT] in patients who had developed atrial fibrilation [AF] and its early diagnosis, and with some regards to several reports on benefits of applying the D-Dimer test in such conditions, this study was carried out to detemine the accuracy and value of this test compared to the gold standard method of Trans-Esophageal Echocardiography [TEE] in patients referring to Modarres hospital. This clinical trial was performed on 73 patients whom were diagnosed as having AF. A more accurate method of TEE was applied to confirm if they had atrial thrombi. For determination of value of D-Dimer test in diagnosis of AT, 5 [cc] of blood was taken from any subjects. The results were regarded normal if the D-Dimer level was less than 500 ng/ml. Then positive and negative predictive values [PPV and NPV] were calculated as diagnostic measurments. Of the 73 subjects of this study [67% women versus 33% men] with mean age of 44.7 +/- 12 years old, there was 53.4% who had the history of Warfarin usage. According to the results of D-Dimer test, 33% had reached to positive levels, whereas 67% revealed to have no thrombus. The PPV of this test was calculated 48.6% and the NPV was 81.6%. Regarding the present condition of our patients and the excessive use of Warfarin among them and also probable failures of D-Dimer test, this test does not have the acceptible capability [particularly duringin these situations] in diagnosing AT

Sphincter preservation and pathologic response in rectal cancer undergoing neoadjuvant chemoradiation with and without oxaliplatin according to thymidilate synthase [TS] expression

Oxaliplatin [OX] significantly enhanced the antitumor activity of 5-FU in patients with advanced colorectal cancer and recently some phase II trials have evaluated the feasibility and efficacy of oxaliplatin in neoadjuvant setting for treatment of locally advanced rectal cancer. On the other hand various studies have demonstrated that the overexpression of thymidylate synthase [TS] can induce resistance to 5-FU in colorectal carcinoma. The aim of this study was to assess the value of TS expression as a predictive factor in the efficacy of neoadjuvant chemoradiation with and without oxaliplatin in rectal cancer. This study was performed in 61 patients [that ultimately 50 patients had including criteria] with locally advanced rectal adenocarcinoma that inferior margin of the tumor had to be located no farther than 6 cm from the anal verge. Preoperative radiotherapy was delivered to the pelvis with CO 60 to 50/4 Gy. All patients received simultaneous chemotherapy: 5-fluorouracil [5-FU], 300 mg/square meter i.v. 24 h infusion during radiotherapy on days 1-5 every week. Thirty patients received oxaliplatin 50-60 mg /square meter weekly during radiotherapy.TS expression was assessed by immunohistochemical staining technique in pretreatment specimen, and the patients were categorized into TS [+] and TS [-] groups. A total of 23 of 50 tumors showed TS positive status at biopsy [46%] . Overall 36 patients [72%] achieved pathologic response [40% complete and 32% partial] that was significantly better in the TS [-] group than in the TS [+] group [85.1 vs 56.5%, p=0.024] and in the OX [+] group than in the OX [-] group [86.6 vs 50%, p=0.005]. Among TS [-] patients there was no difference in pathologic response [88.2 vs 80%, p=0.561] or sphincter preservation [76.4 vs 80%, p= 0.831] as a result of whether oxaliplatin therapy was carried out or not. But among the TS [+] patients there was a significant gain in pathologic response [84.6 vs 20 %, p=0.002] and sphincter preservation [84.6 vs 40 %, p= 0.026] in favor of oxaliplatin group. Our study indicate that oxaliplatin can improves poor outcome of TS positive rectal cancer and TS expression may be used for selecting patients for oxaliplatin containing neoadjuvant chemoradiation protocols that can have major role in the tumor down staging and preservation of sphincter and ultimately better quality of life

[Simultaneous surgical and medical treatment of late filtering bleb leakage]

Purpose: to evaluate the effect of simultaneous surgical and medical treatment on cases with late filtering bleb leakage

Methods: the study was a comparative clinical trial including patients who had late filtering bleb leakage unresponsive to medical treatment after glaucoma filtering surgery with blurred vision and tearing. They underwent surgical bleb revision by conjunctival advancement or free autologous conjunctival graft in association with nonsurgical therapy including pressure patching and systemic acetazolamide 250 mgl6 hrs. for five days. Patients were followed up for at least three months and measures of success were controlled leakage and increase of intraocular pressure to more than 6 mmHg. Complications such as bleb infection, endophthalmitis, etc. were recorded

Results: the study was performed on 12 patients including 7 males and 5 females with a mean age of 5 1.5 +/- 1 0.7 years, and mean follow up of 9 +/- 5.4 months. Postoperatively, leakage ceased perfectly in all patients after a mean duration of 1.7 +/- 1 days. Preoperative intraocular pressure was less than 6 mmHg [2.7 +/- 2.1 mmHg] in all patients which rised to more than 6 mmHg [17 +/- 6.4 mmHg] in all [F'<0. 000 1]. Postoperative intraocular pressure was under control without any medication in 8 cases, with 1 drug in 1 patient, and with 2 drugs in 1 patient, but was not controlled in 2 patients even with 3 drugs. Complications such as bleb infection, endophthalmitis, peripheral anterior synechia, cataract, maculopathy, and permanent hypotonia were not seen during the follow up period

Conclusion: it seems that simultaneous surgical and medical therapy of late filtering bleb leakage is more effective than each alone

[ effect of video-based instruction versus demonstration on learning of clinical skills]

Background and Objective: one of the most important principles in education is adopting a teaching method in concordance with objectives, contents and learners. Teaching and learning clinical skills is a challenging aspect of education in field of medicine and allied health profession. Some of the new researchers have shown that video-based instruction has many advantages in comparative to others. But in the domain of the psychomotor learning there is not enough evidence to show that video-based instruction is an effective teaching method. The current study has compared students learning in video-based and demonstration methods

Materials and Methods: an experimental study was conducted on 40 first year nursing and midwifery students. The students were randomly assigned to case [N=20] and control [N=20] groups based on the their course. The data were collected from a pre-test, a post-test and a questionnaire for demographic information. Pre-test was given 24 hours prior to the presentation sessions. Then each group has received one skill with video-based and another skill with demonstration. Skills included the dressing changing and surgical hand washing. After 24 hours post-test was taken with previous criteria. The differences between the pre-test and post-test scores were considered as they are at learning level

Results: the overall learning in the demonstration method was higher than the video-based method [P<0.05]. However the scores of students in 2 methods was at acceptable level. The scores of students in the cognitive domain of hand washing by the demonstration were 16.20+/-1.5 and by the video-based method were 15.25+/-1. The scores of students in the psychomotor domain of hand washing by the demonstration was 16.85+/-1.4 and by the video-based method was 15.94+/-1.4 [P<0.05]. The scores of students in the cognitive domain of dressing change by the demonstration was 25.60+/-1.8 and by the video-based method was 15.50+/-1. The scores of students in the psychomotor domain of dressing change by the demonstration was 16.78+/-1.3 and with the video-based was 16.12+/-1 [P<0.05]

Conclusion: the results indicated that demonstration method is more effective in the students learning. However, both video-based and demonstration have led to the high level of cognitive and psychomotor learning. It could be concluded that video-based instruction can be an effective method for replacing the demonstration, especially when there is not access to demonstration, in addition according to the findings, video-based education is a effective methods for transporting knowledge, information and other topics in the cognitive domain. Therefore, considering the cost-effectiveness of video-based instruction and its ease of use, this method can facilitate education in where lack of experienced instructors and equipment is most pronounced

clinical effects of topical metronidazole as adjunct therapy to subgingival debridement in adult periodontitis

The purpose of this investigation was to evaluate effect of local antibiotic therapy with metronidazole adjunctively to Scaling and Root Planning [SRP] mechanical or antibiotical treatment alone. This randomised double blind study was carried out in split-mouth design. Ten patients with moderate to severe adult periodontitis were selected. Each patient had to have at least 3 multi-root and 3 single-root nonadjacent teeth with a probing depth >/= 5[mm]. Randomly selected teeth were treated with application of 25% gel metronidazole [SRP+Elyzol]. A total of 141 site [