Comparison of Antimicrobial Effects of 445 and 970 nm Diode Laser Irradiation with Photodynamic Therapy and Triple Antibiotic Paste on Enterococcus faecalis in the Root Canal: an In Vitro Study.

Background and aim: Colonization of residual organisms in the root canal are major causes of root canal treatment failure. Therefore, the effective removal of organisms during root canal cleaning stages is of great importance. In this study, we aimed to investigate and compare the antimicrobial effects of several methods including high power laser irradiation, photodynamic therapy and triple antibiotic paste (TAP) on Enterococcus faecalis in the root canal. Materials and methods: For the present laboratory study, 80 anterior single canal teeth were randomly divided into seven experimental groups (970 nm diode laser irradiation, 445 nm diode laser irradiation, 660 nm photodynamic therapy with doxycycline as a photosensitizer, TAP, 970 nm diode laser combined with TAP, 445 nm diode laser combined with TAP and sodium hypochlorite groups), each containing 10 teeth, and two positive and negative control groups, each containing five teeth. Afterwards, an E. faecalis suspension was prepared and injected into the root canals of all groups (except the negative control group), and after using the desired lasers or drugs and incubating for the necessary time, the grown colonies were counted and significance level of less than 0.05 was considered. Results:Among seven experimental groups, in those that included triple antibiotic paste (TAP, 970 nm diode laser with TAP, and 445 nm diode laser with TAP groups), no bacteria grew, while the 970 nm and 445 nm diode laser groups had the highest bacterial growth. Statistically, all studied groups were effective, and the results showed a statistically significant difference between groups (P value < 0.05). Conclusion: The findings of the present study show that all of the above-mentioned methods were effective enough for bacterial reduction. Triple antibiotic paste was proved to achieve complete bacterial elimination. Photodynamic therapy with doxycycline as a photosensitizer was shown to provide significant results of bacterial reduction and diode laser irradiation at both wavelengths (970 nm and 445 nm) were also reported to have antibacterial effect, although slightly lower than the previous methods.

Force attenuation performance in sandwich structures with STF and M-STF encapsulation.

In this study, we investigate the role of adding shear thickening fluids (STFs) and multi-functional shear thickening fluids (M-STFs) to the core of a sandwich-structured composite made of aluminum facesheets and XPS foam cores with different geometries on force attenuation performance. Six different core designs were machined, and all designs had the same space for adding STFs and M-STFs. STF with 40 wt% SiO2 in PEG 400 was selected and fabricated. M-STFs were made by adding multi-walled carbon nanotubes (MWCNTs) up to 1.5 wt%. The effects of MWCNTs on the rheological and electrical properties of the STF were investigated. The force attenuation tests were performed with an impact drop tower test system at three different heights with 5, 10, and 15 J energy levels. According to the results, V6_STF (with 16 holes with a diameter of 6 mm) and H6_STF (with 16 rectangular cubic column with cross-sections of 6 × 6 mm) designed sandwich structures showed better performance in terms of force attenuation compared with the other samples. Next, these two sandwich structures were filled again with M-STF (0.5 wt% MWCNT), and the force attenuation performance of the structures showed an improvement further, and the H6_STF_CNT sample improved by 24.8% compared to the clean sandwich structure sample. These results demonstrate the potential of STFs and M-STFs in strengthening the force attenuation performance of sandwich structures with XPS foam cores, mainly when used with appropriate core geometry.

Thermodynamics, Environmental and Sustainability Impacts of a Turbofan Engine Under Different Design Conditions Considering Variable Needs in the Aviation Industry.

In this study, thermodynamic analysis is implemented to the kerosene-fuelled high by-pass turbofan (HBP-TF) engine to assess entropy, exergy, environmental, and sustainability metrics for different design variables such as pressure ratio of high-pressure compressor (HPC-PR) ranging from 7.5 to 8.5 and turbine inlet temperature (TIT) varying from 1400 to 1525 K considering variable needs in the aviation industry. As a novelty, entropic improvement potential (EIP) index for turbomachinery components and specific irreversibility production for the whole engine are calculated. Sustainability-based parameters for different cases are compared with the baseline values of the HBP-TF engine. The combustor has the highest entropy production of 44.4425 kW K-1 at the baseline. The higher TIT increases the entropy production of the combustor by 16.56%, whereas the higher HPC-PR decreases it by 5.83%. The higher TIT and HPC-PR favorably affect the sustainable efficiency factor of the engine, which is observed as 1.5482 at baseline and increases by 4.5% and 0.058% with the increment of TIT and HPC-PR, respectively. The higher TIT and higher HPC-PR results in lowering sustainability of the engine. The specific irreversibility production of the engine decreases by 3.78% and 0.1171% respectively, as TIT and HPC-PR reach the highest point considered in the study.

Intelligent Polymers for Multi-Functional Applications: Mechanical and Electrical Aspects.

In this study, we fabricated an intelligent material, shear stiffening polymer (SSP), and reinforced it with carbon nanotube (CNT) fillers to obtain intelligent mechanical and electrical properties. The SSP was enhanced with multi-functional behavior, such as electrical conductivity and stiffening texture. Various amounts of CNT fillers were distributed in this intelligent polymer up to a loading rate of 3.5 wt%. The mechanical and electrical aspects of the materials were investigated. Regarding the mechanical properties, dynamic mechanical analysis was carried out, as well as conducting shape stability and free-fall tests. Viscoelastic behavior was investigated in the dynamic mechanical analysis, whereas cold-flowing and dynamic stiffening responses were studied in shape stability and free-fall tests, respectively. On the other hand, electrical resistance measurements were carried out to understand the conductive behavior of the polymers of the electrical properties. Based on these results, CNT fillers enhance the elastic nature of the SSP while initiating the stiffening behavior at lower frequencies. Moreover, CNT fillers provide higher shape stability, hindering the cold flow in the material. Lastly, SSP gained an electrically conductive nature from the CNT fillers.

GeSbSeTe-based high extinction ratio optical modulator.

In this paper, a design for a high extinction ratio Mach-Zehnder optical modulator is proposed. The switchable refractive index of the germanium-antimony-selenium-tellurium (GSST) phase change material is employed to induce destructive interference between the waves passing through Mach-Zehnder interferometer (MZI) arms and to realize amplitude modulation. A novel, to the best of our knowledge, asymmetric input splitter is designed for the MZI to compensate for unwanted amplitude differences between MZI arms and increase the modulator performance. Three-dimensional finite-difference-time-domain simulations show a very high extinction ratio (ER) and low insertion loss (IL) of 45 and 2 dB, respectively, for the designed modulator at the wavelength of 1550 nm. Moreover, the ER is above 22 dB, and the IL is below 3.5 dB in the wavelength range of 1500-1600 nm. The thermal excitation process of GSST is also simulated using the finite-element method, and the speed and energy consumption of the modulator are estimated.

Efficient binary and QAM optical modulation in ultra-compact MZI structures utilizing indium-tin-oxide.

A design for a CMOS-compatible active waveguide is proposed in which the epsilon-near-zero (ENZ) property of the indium-tin-oxide (ITO) is used to induce large variations in the real and imaginary parts of the waveguide effective index. The proposed waveguide comprises a TiN/HfO2/ITO metal-oxide-semiconductor (MOS) structure where the speed and power consumption are significantly improved by the application of the TiN and realization of double accumulation layers in the ITO. Simulations show the insertion loss (IL) of 0.38 dB/µm, extinction ratio (ER) of 11 dB/µm, the energy consumption of 11.87fJ/bit and electrical bandwidth of 280 GHz when the designed waveguide is used as an electro-absorption modulator. The waveguide is then used in an MZI structure to design binary and quadrature-amplitude-modulator (QAM) modulators. For binary modulator, the IL, ER, and VπLπ figures of merit are found to be 1.24 dB, 54 dB, and 6.4 V µm, respectively, which show substantial improvement over previous ITO-based designs. In the QAM design, the symmetry in the real and imaginary parts of the waveguide effective index is employed to obviate the need for additional phase shift elements. This considerably reduces the overall length of the proposed QAM modulator and improves efficiency. Simulations show the energy consumption and bit rate, of 2fJ/bit and 560 Gbps, respectively in a 4-QAM modulator with the overall length of 6.2 µm. The symmetry properties of the proposed waveguide can be further exploited to realize quadrature-phase-shift-keying (QPSK) modulators which here is used in combination with the 4-QAM to propose a design for the more advanced modulation scheme of 16-QAM. The design of ITO-based QAM modulators is here reported for the first time and the abovementioned performance parameters show the unique properties of these modulators in terms of footprint, energy consumption and modulation-speed.

High-performance electro-optical switch using an anisotropic graphene-based one-dimensional photonic crystal.

A novel electro-optical switch is proposed and investigated using the transfer matrix method (TMM) and three-dimensional finite-difference time-domain (3D FDTD) analysis at the near-infrared range. The structure is made of a defect at the middle of a one-dimensional photonic crystal. The defect consists of two anisotropic graphene (AG) sheets separated by a dielectric layer. As a result, a sharp transmission peak with a high quality factor of 5000 appears at the wavelength of 1552.4 nm where light is trapped by the defect. When an external voltage is applied across the AG sheets, their chemical potentials shift in such a way that the trapped photons are absorbed and the switch changes to ON state. According to the presented results, a high extinction ratio of 14.26 dB with a very low insertion loss of 0.18 dB are obtained. The required switching voltage and energy consumption are as low as 4.68 V and 226 fJ/bit, respectively. The 3 dB bandwidth is also calculated to be as high as 17.5 GHz, which makes our proposed switch promising for high speed optical systems.

Analysis of the early mother-child relationship in schizophrenic patients.

BACKGROUND AND AIM: The mother as the first caregiver plays a significant role in the formation of the child's behavior, growth, and communication. The present study aimed to analyze the early mother-child relationship in schizophrenic patients. MATERIALS AND METHODS: This qualitative study employed a descriptive phenomenological approach. The participants were male patients with schizophrenia who were hospitalized in Qazvin Bahman Psychiatric Hospital from March to September 2020 with an age range of over 18 years. Given the objective of the study, the data were collected using semi-structured interviews. The participants were selected using purposive sampling and the sampling procedure continued until data saturation as the point when no new information is observed in the data. Accordingly, the data were saturated after interviewing 15 participants. The data were analyzed using Colaizzi's seven-step method. RESULTS: The analysis of the data revealed four main themes including ambivalent attachment to the mother, feelings of constant fear and worry, a sense of constant care for the mother, and a cold and emotionless relationship with the child. CONCLUSION: The present study suggested that schizophrenia is a disorder that affects the mother-child relationship, and does the term "schizophrenic mothers" need to be reconsidered? However, the result of this research has been done according to the nature and cultural context of Iranian society.

Control of managed pressure drilling systems using nonlinear predictive generalized minimum variance approach based on a Volterra model.

This paper proposes a nonlinear predictive generalized minimum variance (NPGMV) control scheme for automatic control of the managed pressure drilling (MPD) systems in the presence of disturbances. Since the exact model of the system is not usually available in practice, the hydraulic flow model of MPD is described by an autoregressive second-order Volterra model. The conventional least-squares method is applied to input-output data, thereby identifying the Volterra model. Bottom-hole pressure regulation and kick handling are achieved through the control scheme. To deal with a reservoir kick, the proposed method switches to flow control mode automatically, and prevents the reservoir fluid influx into the well surface. The proposed method also has the capability to keep the bottom-hole pressure above the reservoir pressure during a formidable scenario such as pipe connection. In addition, the robustness of the controller in the face of heave disturbance and uncertainty is investigated. To show the effectiveness of the proposed method, the comparison study of several scenarios with a switching PI controller is provided and demonstrates the NPGMV control outperforms other approaches with respect to steady-state performance.

An investigation of the effectiveness of oral cyclosporine on perioperative myocardial injury (PMI) in patients who undergo the surgical procedure of coronary artery bypass graft (CABG): A Randomized Controlled Clinical Trial.

BACKGROUND: Routine clinical strategies for the prevention of myocardial infarction (MI) during the surgical procedure of CABG include cross-clamp fibrillation and cardioplegia have failed to decrease the risk of perioperative myocardial injury (PMI). Cyclosporine-A (CsA) might be able to prevent mitochondrial dysfunction and PMI. METHODS: In the present clinical trial, patients were divided into two groups (Case receive 2.5 mg/kg CsA and Control receive a placebo) randomly. Moreover, patients were controlled by placebo through a double-blind, single-center trial 4-12 h before anesthesia. Perioperative blood tests include bilirubin, complete blood count, the amount of hemoglobin in whole blood, liver transaminases, and glomerular filtration rate (GFR). Blood samples were taken before surgery and at 24, 48, and 72 h after surgery and serum Troponin-I and CK-MB levels were determined in all blood samples using ELISA. RESULTS: There were no significant differences between the two groups in the results of routine pre-operative blood results, intraoperative variables, and baseline characteristics (P > 0.05). There are significant correlations between cross clamp time and cTnI and CKMB levels in patients taking CsA. In patients with both diabetes and hypertension, postsurgical cTnI and CKMB levels decrease significantly in CsA compared to placebo group on 24, 48, and 72 h (P < 0.05). Moreover, patients with old MI, both postsurgical cTnI and CKMB levels decrease significantly in CsA compared to placebo group on 24 h and 48 h (P < 0.05). CONCLUSIONS: In patients with a long cross-clamping period, using an oral CSA single dose before conducting CABG surgery, the risk of PMI could be decreased. Also, oral CsA has protective effect for CABG in diabetic patients with hypertension.

Design and numerical analysis of a high-performance optical modulator based on Si-VO2 Bragg grating waveguide.

Design and numerical characterization of a high-performance VO2-based optical modulator are proposed. The modulation is achieved by the phase transition of VO2 in a Bragg grating which can be formed by the selective VO2 deposition on a silicon strip waveguide. The interplay of the Bragg reflection and the inherent loss of the metal phase VO2 is used to increase the extinction ratio (ER) while the similarity of the refractive indices of the silicon and insulator phase VO2 resulted in a low insertion loss (IL). ER and IL of the modulator are 34.5 dB and 3.4 dB, respectively, at the wavelength of 1.55 µm, and they are, respectively, above 33 dB and below 3.5 dB across the entire optical C-band. The ER can be improved to 110 dB at the expense of an increased IL of 7.3 dB. The energy consumption and the modulation speed are estimated by considering different VO2 triggering schemes, and it is shown that the energy consumption of 91.7fJ/bit and the speed of 14 THz can be achieved with the proper VO2 stimulation. Furthermore, the robustness of the device performance to fabrication errors is studied by simulating the effect of the variation in different geometrical parameters.

Graphene Decorated with Silver Nanoparticles as a Low-Temperature Methane Gas Sensor.

This paper is devoted to an investigation on the methane sensing properties of graphene (G), decorated with silver nanoparticles (AgNPs), under ambient conditions. To do so, we first present an effective modification in the standard manner of decorating graphene by AgNPs. From structural analysis of the product (AgNPs/G), it is concluded that graphene is indeed decorated by AgNPs of a mean size 29.3 nm, free of aggregation, with a uniform distribution. The so-produced material is then used, as a resistivity-based sensor, to examine its response to the presence of methane gas. Our measurements are performed at relatively low temperatures, for various silver-to-graphene mass ratios (SGMRs) and methane concentrations. To account for the effects of humidity, we have made the measurements, at room temperature, for different levels of humidity. Our results demonstrate that an increase in the SGMR enhances the response of AgNPs/G to methane with an optimum value of SGMR ≅ 12%. It is also illustrated that for methane concentrations less than 2000 ppm, the maximal response increases linearly and rapidly, even at room temperature. Moreover, we demonstrate that AgNPs/G is of low limit of detection, highly stable, selective, reversible, repeatable, and sensor-to-sensor reproducible, for methane sensing. The results thus promise a low-cost and simple-to-fabricate methane sensing device.

Spiritual well-being and moral distress among Iranian nurses.

BACKGROUND: Moral distress is increasingly recognized as a problem affecting healthcare professionals, especially nurses. If not addressed, it may create job dissatisfaction, withdrawal from the moral dimensions of patient care, or even encourage one to leave the profession. Spiritual well-being is a concept which is considered when dealing with problems and stress relating to a variety of issues. OBJECTIVE: This research aimed to examine the relationship between spiritual well-being and moral distress among a sample of Iranian nurses and also to study the determinant factors of moral distress and spiritual well-being in nurses. RESEARCH DESIGN: A cross-sectional, correlational design was employed to collect data from 193 nurses using the Spiritual Well-Being Scale and the Moral Distress Scale-Revised. ETHICAL CONSIDERATIONS: This study was approved by the Regional Committee of Medical Research Ethics. The ethical principles of voluntary participation, anonymity, and confidentiality were considered. FINDINGS: Mean scores of spiritual well-being and moral distress were 94.73 ± 15.89 and 109.56 ± 58.70, respectively. There was no significant correlation between spiritual well-being and moral distress (r = -.053, p = .462). Marital status and job satisfaction were found to be independent predictors of spiritual well-being. However, gender and educational levels were found to be independent predictors for moral distress. Age, working in rotation shifts, and a tendency to leave the current job also became significant after adjusting other factors for moral distress. DISCUSSION AND CONCLUSION: This study could not support the relationship between spiritual well-being and moral distress. However, the results showed that moral distress is related to many elements including individual ideals and differences as well as organizational factors. Informing nurses about moral distress and its consequences, establishing periodic consultations, and making some organizational arrangement may play an important role in the identification and management of moral distress and spiritual well-being.

Tunable graphene plasmonic Y-branch switch in the terahertz region using hexagonal boron nitride with electric and magnetic biasing.

A tunable graphene plasmonic Y-branch switch at THz wavelengths is proposed. The effects of magnetic and electric biasing are studied to harness the transmission of the transverse electric and magnetic guided mode resonances. In the structure, hexagonal boron nitride is utilized as a substrate for graphene. The application of hexagonal boron nitride, with the advantages of high mobility and ultralow ohmic loss, introduces a promising alternative substrate for graphene. Analytical and numerical results show that, by slight variation of the doping level in graphene through magnetic and electric biasing, the characteristics of the propagation of the guided mode resonances can be manipulated. A large extinction ratio of 40 dB at a wavelength of 60 µm is obtained. Besides, the proposed switch shows a low insertion loss of about 1 dB and a relatively large optical bandwidth of 1 µm. The electric biasing is of the order of 0.1 mV. Additionally, with the presence of magnetic biasing, a compact switch with a size of 25 µm is achieved. Showing a high extinction ratio, low insertion loss, and compact size, the proposed switch can find potential applications in graphene plasmonics integrated devices.

High Efficiency MAPbI3 Perovskite Solar Cell Using a Pure Thin Film of Polyoxometalate as Scaffold Layer.

Here, we successfully used a pure layer of [SiW11 O39 ]8- polyoxomethalate (POM) structure as a thin-film scaffold layer for CH3 NH3 PbI3 -based perovskite solar cells (PSCs). A smooth nanoporous surface of POM causes outstanding improvement of the photocurrent density, external quantum efficiency (EQE), and overall efficiency of the PSCs compared to mesoporous TiO2 (mp-TiO2 ) as scaffold layer. Average power conversion efficiency (PCE) values of 15.5 % with the champion device showing 16.3 % could be achieved by using POM and a sequential deposition method with the perovskite layer. Furthermore, modified and defect-free POM/perovskite interface led to elimination of the anomalous hysteresis in the current-voltage curves. The open-circuit voltage decay study shows promising decrease of the electron recombination in the POM-based PSCs, which is also related to the modification of the POM/ perovskite interface and higher electron transport inside the POM layer.

Risks of on-pump coronary artery bypass grafting surgery in patients with chronic obstructive pulmonary disease due to sulfur mustard.

Sulfur mustard (SM) is a toxic chemical agent that belongs to a class of vesicant compounds. In the 1980s it was used by the Iraqi army against Iranian forces. Sulfur mustard severely irritates the skin, eyes and lungs. The highest side effects seen in patients affected by this gas are pulmonary complications including different types of lung diseases such as bronchiolitis. It has also led to a certain type of chronic obstructive pulmonary disease called mustard lung. Similar extra-pulmonary, molecular and hormonal effects can be observed in these patients and patients with chronic obstructive pulmonary disease. Here cardiovascular complications may be one of the most dangerous visible effects. And atherosclerosis is probable following the direct effects or consequential long-term effects of SM. The development of atherosclerosis in these patients is associated with an increased risk of cardiovascular and coronary artery disease. Coronary artery bypass grafting surgery is the treatment of coronary artery disease. Doing this surgery by bypass pump has its own morbidity and due to local and systemic inflammation changes in patients with SM pulmonary disorders it may have more side effects. Therefore, detailed knowledge of inflammatory diseases as well as the serum level or even the local lung fluid of the inflammatory factors in these patients before surgery are needed so that it would be possible to reduce the rate of morbidity and mortality by normalizing the inflammatory conditions of the patients before cardiac surgery.

Applications of cardiotoxicity in breast cancer: a meta-analysis.

INTRODUCTION: Breast cancer is the most common type of cancer in women. Many antineoplastic agents used to treat breast cancer have potentially cardiotoxic effects and may lead to chemotherapy induced cardiomyopathy and heart failure. We conducted a meta-analysis to clarify the applications of cardiotoxicity in breast cancer. EVIDENCE ACQUISITION: A published literature search was performed through PubMed, Cochrane Library, Medline, and Science Citation Index Expanded databases for articles published in English. Pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using random or fixed effects models. Heterogeneity was assessed using χ2 and I2 statistics. We performed a formal meta-analysis using summary measures from these studies. EVIDENCE SYNTHESIS: In total, 9 published studies were included in the final analysis. The combined analysis revealed that there was non-significant regardless of the statistical ejection fraction (OR=0.98, 95% CI: 0.63-1.54, P=0.96) and left ventricular ejection fraction (OR=1.04; 95% CI: 0.69-1.56, P=0.85) decline method used. Additionally, the pooled OR was 0.99 (95% CI: 0.79-1.28) for the trastuzumab plus lapatinib combination, and 1.00 (95% CI: 0.88-1.13) for the trastuzumab plus pertuzumab combination. CONCLUSIONS: In this meta-analysis, there was evidence indicated that there was not a significant decrease on LVEF and EF in patients who received trastuzumab plus lapatinib and trastuzumab plus pertuzumab combination. Our study suggests that the combination of two anti-HER2 agents does not significantly increase the risk for adverse compared with anti-HER2 monotherapy in patients with adequate cardiac function prior to start of therapy.

Spectral response, dark current, and noise analyses in resonant tunneling quantum dot infrared photodetectors.

Reduction of dark current at high-temperature operation is a great challenge in conventional quantum dot infrared photodetectors, as the rate of thermal excitations resulting in the dark current increases exponentially with temperature. A resonant tunneling barrier is the best candidate for suppression of dark current, enhancement in signal-to-noise ratio, and selective extraction of different wavelength response. In this paper, we use a physical model developed by the authors recently to design a proper resonant tunneling barrier for quantum infrared photodetectors and to study and analyze the spectral response of these devices. The calculated transmission coefficient of electrons by this model and its dependency on bias voltage are in agreement with experimental results. Furthermore, based on the calculated transmission coefficient, the dark current of a quantum dot infrared photodetector with a resonant tunneling barrier is calculated and compared with the experimental data. The validity of our model is proven through this comparison. Theoretical dark current by our model shows better agreement with the experimental data and is more accurate than the previously developed model. Moreover, noise in the device is calculated. Finally, the effect of different parameters, such as temperature, size of quantum dots, and bias voltage, on the performance of the device is simulated and studied.

Skills Required for Nursing Career Advancement: A Qualitative Study.

BACKGROUND: Nurses require certain skills for progression in their field. Identifying these skills can provide the context for nursing career advancement. OBJECTIVES: This study aimed to identify the skills needed for nurses' career advancement. MATERIALS AND METHODS: A qualitative approach using content analysis was adopted to study a purposive sample of eighteen nurses working in teaching hospitals affiliated with the Qazvin, Shahid Beheshti, and Iran Universities of Medical Sciences. The data were collected through semi-structured interviews, and analyzed using conventional content analysis. RESULTS: The three themes extracted from the data included interpersonal capabilities, competency for career success, and personal capacities. The results showed that acquiring a variety of skills is essential for career advancement. CONCLUSIONS: The findings showed that personal, interpersonal, and functional skills can facilitate nurses' career advancement. The effects of these skills on career advancement depend on a variety of conditions that require further studies.

Alternative Methods to Treat Nausea and Vomiting from Cancer Chemotherapy.

Chemotherapy Induced Nausea and Vomiting (CINV) is among the most intensive side effects and critical concerns for patients with cancer. Most of these patients experience nausea and vomiting after chemotherapy. Sometimes, this is so annoying that it may prevent them from continuing the therapy. With the recent advances, a variety of therapeutic methods are innovated and applied to control CINV. Among them, the main methods include medicinal therapy, relaxation, and herbal therapy. Yet, using dexamethasone together with massage therapy and ginger is identified as the most effective method.