Impacts of educational interventions on the knowledge of prevention and emergency management of traumatic dental injuries in 11-17-year-old martial arts athletes: a randomized controlled trial.

PURPOSE: We compared the effect of an educational pamphlet and a mobile application regarding prevention and emergency management of sport-related traumatic dental injuries (TDIs) on knowledge and self-reported preventive practice of 11-17-year-old Karate and Taekwondo athletes. METHODS: Participants were invited through an online link published by the Public Relations of the corresponding federations. They completed an anonymous questionnaire consisting of demographics, self-reported experience of TDIs, knowledge of emergency management of TDIs, self-reported preventive practice of TDIs, and the reason for not using mouthguard. The respondents were randomly allocated to pamphlet or mobile application group with the same content. Three months after the intervention, the questionnaire was completed by the athletes again. Repeated measures ANOVA and a linear regression model served for statistical analysis. RESULTS: In pamphlet group, 51 athletes and in mobile application group 57 athletes completed both baseline and follow-up questionnaires. At baseline, the mean score was 1.98 ± 1.20 and 1.82 ± 1.24 (out of 7) for the knowledge and 3.70 ± 1.64 and 3.33 ± 1.95 (out of 7) for practice in the pamphlet and application group, respectively. In 3-month follow-up, the mean score of knowledge and self-reported practice was significantly higher compared to baseline in both groups (p < 0.001) with no statistically significant difference between the two groups (p = 0.83 and p = 0.58, respectively). Most of the athletes were very satisfied or satisfied with both types of the educational intervention. CONCLUSION: Both pamphlet and mobile application seem to be useful to improve awareness and practice regarding TDI prevention in adolescent athletes.

Totally endoscopic transcanal facial nerve decompression in patients with traumatic facial nerve paralysis: from geniculate ganglion to mastoid segment.

OBJECTIVE: The current study evaluated the effectiveness of endoscopic transcanal facial nerve decompression in patients with post-traumatic facial nerve paralysis. METHODS: This retrospective study included 10 patients with post-traumatic complete facial nerve paralysis who underwent endoscopic transcanal facial nerve decompression. The surgical technique was explained step by step, and the surgical complications, hearing status and facial nerve function 12 months post-operatively were reported. RESULTS: Endoscopic transcanal facial nerve decompression allowed exposure of the geniculate ganglion to the mastoid segment. The facial nerve function improved from House-Brackmann grade VI to grades I and II in 8 of 10 (80 per cent) patients, and 2 patients experienced partial recovery (House-Brackmann grades III and IV). No severe complication was reported. CONCLUSION: Endoscopic transcanal facial nerve decompression, involving the nerve from the geniculate ganglion to the mastoid segment, is a safe and effective approach in patients with post-traumatic facial nerve paralysis.

Impact of smartphone application usage by mothers in improving oral health and its determinants in early childhood: a randomised controlled trial in a paediatric dental setting.

PURPOSE: Integration of smartphones has overcome barriers in traditional education; this trial aimed at exploring this ubiquitous platform in oral health education. A smartphone application promoting preschooler's oral health was designed and its effectiveness was compared with that of common oral health education delivered in paediatric dental settings. METHODS: This controlled clinical trial was performed on preschooler-mother dyads referring to the clinic of Tehran School of Dentistry in 2019-2020. Initially, the dyads were randomly partitioned to application intervention or common training groups. The mothers answered an interviewer-administered questionnaire on paediatric dentistry knowledge, attitude and practice regarding children's oral health; modified plaque index (m-PI) and modified gingival index (m-GI) of children were measured. Subsequently, the smartphone application was installed for application intervention group and an educational pamphlet and verbal explanations were given to common training group. In 1-month and 3-month follow-ups, the questionnaires and clinical measurement were re-done. A generalized estimating equation (GEE) was used to investigate the effect of training methods. RESULTS: Among the participants 51 dyad attended baseline and follow-up assessments. The preschoolers mean age was 4.6 ± 1.2 years and 54.4% were girls. Both trainings improved mothers' knowledge and practice regarding children's oral health and reduced children's m-PI and m-GI (p < 0.050). The 3-month follow-up revealed a better m-GI in application intervention group (p < 0.001). CONCLUSIONS: Considering the greater improvement of paediatric gingival status in the application intervention group, it appears that smartphone applications may provide a promising tool for more prolonged impacts in children oral health care. TRIAL REGISTRATION: IRCT, IRCT20131102015238N3. Registered 28 July 2019 https://en.irct.ir/trial/40933.

Effectiveness of smart phone application use as continuing medical education method in pediatric oral health care: a randomized trial.

BACKGROUND: Continuing education aims at assisting physicians to maintain competency and expose them to emerging issues in their field. Over the last decade, approaches to the delivery of educational content have changed dramatically as medical education at all levels is now benefitting from the use of web-based content and applications for mobile devices. The aim of the present study is to investigate through a randomized trial the effectiveness of a smart phone application to increase public health service physicians' (PHS physicians) knowledge regarding pediatric oral health care. METHOD: Five of all seven DHCs (District Health Center) in Tehran, which were under the supervision of Tehran University of Medical Sciences and Iran University of Medical Sciences, were selected for our study. Physicians of one DHC had participated in a pilot study. All PHS physicians in the other four centers were invited to the current study on a voluntary basis (n = 107). They completed a self-administered questionnaire regarding their knowledge, attitudes, practice in pediatric dentistry, and background. PHS physicians were assigned randomly to intervention and control groups; those in the intervention group, received a newly designed evidence-based smartphone application, and those in the control group received a booklet, a CME seminar, and a pamphlet. A post-intervention survey was administered 4 months later and t-test and repeated measures ANCOVA (Analysis of Covariance) were performed to measure the difference in the PHS physicians' knowledge, attitude and practice. RESULTS: In both groups, the mean knowledge scores were significantly higher (p-Value < 0.001) in post-intervention data compared to those at baseline. Similar results existed in attitude and practice scores. Although the scores in knowledge in the intervention group indicating potentially greater improvement when compared to those of the control group, the differences between the two groups were not statistically significant (dif: 0.84, 95% CI - 0.35 to 2.02). CONCLUSION: In the light of the limitations of the present study, smart phone applications could improve knowledge, attitude and practice in physicians although this method was not superior to the conventional method of CME. TRIAL REGISTRATION: Our clinical trial had been registered in Iranian Registry of Clinical Trials (registration code: IRCT2016091029765N1).

Infectious etiology of chronic diarrhea in patients with primary immunodeficiency diseases.

Summary: Background.Primary immunodeficiency diseases (PIDs) are life-threatening disorders, which manifest commonly with gastrointestinal (GI) signs, mainly as chronic diarrhea. Objective. To investigate and compare infectious etiology of chronic diarrhea in different PIDs. Patients and methods. Assessing clinical features, obtaining immunological profiles, as well as characterizing infectious etiology of diarrhea were performed in 38 PID patients with chronic diarrhea. Stool samples and/or biopsy specimens were checked using culture, microscopic examination, RT-PCR, and PCR, as appropriate. The patients were diagnosed to have common variable immunodeficiency (CVID), severe combined immunodeficiency (SCID), X-linked agammaglobulinemia (XLA), and hyper-IgM (HIgM) syndrome. Results. In 32 patients we identified 41 infectious agents including 16 parasitic (39.0%, the most common Giardia lamblia), 11 bacterial (26.8%, the most common salmonella spp), 8 viral (19.5%, the most frequent group A rotavirus), and 6 fungal organisms (14.7%, the most common Candida albicans). From 6 of the patients, no infectious agent was isolated. In CVID bacteria and parasites, in SCID bacteria and viruses, in XLA parasites, and in individuals with HIgM syndrome parasites were the leading causes of chronic diarrhea. Infection with giardia and cryptosporidium were more frequent in XLA and HIgM, respectively. Conclusion. The current study suggests considering both usual and unusual pathogens in laboratory investigation and in the empiric treatment of chronic diarrhea. Opportunistic pathogens should be taken into account when no other pathogen is identified, especially in patients on long-term treatment or prophylaxis with antifungals/antibiotics and in those from geographical locations that favor pathogenicity of these organisms.

Dental fear and its determinants in 7-11-year-old children in Tehran, Iran.

AIM: To assess dental fear and its determinants in 7-11-year-old children. METHODS: In this cross-sectional (descriptive-analytical) study, the standard Persian version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) questionnaire was completed by 240 parent-child (children aged 7-11 years) pairs referred to dental clinics in Tehran city, Iran. Background characteristics were also inquired. RESULTS: An equal number of boys and girls participated in the study. The mean score of fear among the children was 21.66 ± 8.33. The causes of fear among the children were, first, injection, and then, seeing the dentist's drill, choking feeling, and finally, filling the tooth. There was a significant correlation between the scores of children's dental fear and their experience of meeting with the dentist (p = 0.001). The result of the regression test showed that the age of the children (p = 0.022) and high levels of dental fear among their fathers (p < 0.001) was related to high levels of dental fear among the children. CONCLUSIONS: The present children revealed a moderate level of dental fear. Taking children's age into account in behavioural management and challenging father's fear seemed to play a key role to reduce the child's fear and prevent its long-term consequences.

Oral health-related quality of life in patients with temporomandibular disorders: A case-control study considering psychological aspects.

OBJECTIVES: This case-control study aimed to compare patients with temporomandibular disorders (TMD) and healthy controls in terms of oral health-related quality of life (OHRQoL) considering Graded Chronic Pain Scale (GCPS) scores, pain duration, psychological impairment and demographic characteristics. METHODS: A total of 75 patients with TMD and 75 healthy controls were recruited. The short version of Oral Health Impact Profile (OHIP-14) was administered for evaluating the OHRQoL. Psychosocial impairments were assessed using the General Health Questionnaire-28 (GHQ-28). The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis I and II were also used for patient diagnosis and collecting GCPS scores, pain duration, age and gender. Independent-sample t tests, Pearson's chi-square tests and multiple logistic and linear regression models were applied for statistical analysis. RESULTS: The mean age of the patients was 34.3±12.4 years. A female-to-male ratio of 6:1 was seen in the TMD group. The prevalence and severity of the OHIP were significantly different between the TMD and control groups (66.7% vs 12.0% and 18.0 vs 9.2, respectively). According to multiple logistic regression for OHIP prevalence and multiple linear regression for OHIP severity in the TMD group, GCPS scores and pain duration, followed by psychological impairment, were the most important predictors of the OHRQoL. CONCLUSION: TMD negatively affected the OHRQoL, particularly in patients with psychological impairments. Meanwhile, age and gender did not seem to have a serious effect. Hence, promoting the quality of life of patients with TMD requires emphasis on chronic pain management and maintaining good mental health.

Differential expression of innate immune response genes in clinical phases of chronic hepatitis B infection.

We investigated innate immune gene expression in clinical phases of chronic hepatitis B infection, including immune tolerant (IT), immune active (IA), inactive carrier (IC) and hepatitis B e antigen (HBeAg)-negative phases, as well as healthy controls. Expression levels of interferon types I, II and III, their receptor subunits, IRFs, TLRs and other IFN-induced genes in peripheral blood mononuclear cells were compared. Forty HBsAg-positive treatment-naïve subjects without co-infection with HIV, HCV or HDV were enrolled. To complement the viral load, the expression levels of 37 innate immune genes were measured by qPCR. The highest response of the innate immune system was observed in the IT and HBeAg-negative phases, and the IC phase had the lowest response; 31 of the 37 studied genes reached their maximum mRNA expression levels in the IT and HBeAg-negative phases, and the minimum expression levels of 23 genes were found in the IC phase. The highest mRNA expression levels of IFNs, IFN receptor subunits, IRFs and TLRs genes in all clinical phases were IFN-λ2 and 3, IFN-γR2, IRF7 and TLR7, and the lowest levels of mRNA expression were observed for IFN-α, IFN-λR1, IRF8 and TLR2. We conclude that innate immune response genes are expressed differentially among chronic HBV phases, and this difference may help to develop new precise and noninvasive methods to determine the progression of disease in chronic HBV patients.

Effectiveness of training senior dental students on oral health care for disabled patients.

INTRODUCTION: Studies in several countries have shown that dental students need an improved educational programme concerning management of disabled patients. We aimed to study the effect of providing a course entitled 'Oral health care of disabled patients' on knowledge and attitudes of senior dental students at Tehran University. MATERIALS AND METHODS: A total number of 70 students (n=70) were asked to fill in a questionnaire regarding their background, knowledge and attitudes, before and after the programme. The intervention group of 36 students (n=36) received a four-session course consisting of lectures, group discussion, screening and fluoride varnish provision for disabled patients. Statistical analysis was performed using the Mann-Whitney U-test, the chi-square test and linear regression modelling. RESULTS: Amongst all the participants, 36% had previously treated a disabled patient and 58% believed that merely specialists should treat disabled patients. Twenty-seven percentage of participants believed that hospital is the only proper facility for treating disabled patients. A considerable improvement in both knowledge and attitudes of students was observed following the intervention (P<0.05). CONCLUSIONS: Our findings indicate that a short-term training programme on oral health care has an immense impact on students' adherence to treating disabled patients. These results provide evidence to support the necessity of enrichment of the dental curriculum regarding oral health care for disabled patients.

Molecular identification of animal isolates of Echinococcus granulosus from Iran using four mitochondrial genes.

Mitochondrial genes have more power than nuclear genes in reconstructing phylogenetic relationships among closely related species because of their faster sequence evolution. The aim of this study was to use the complete or near-complete sequences from three mitochondrial genes (cox1, nad1 and atp6) and partial sequences of the 12S rRNA gene to infer relationships among isolates of Echinococcus granulosus from Iran. Two hundred and twenty-nine isolates of E. granulosus were collected from cattle, camels, sheep, buffalo and goats from different geographical areas. Most individuals were found to possess the G1 genotype but some of the camel samples belonged to the G6 genotype. Newly designed primers for cox1, nad1 and atp6 genes amplified bands of 1830, 708 and 1157 bp for the G1 genotype and 1856, 705, 1054 bp for the G6 genotype, respectively. The result of this survey showed that atp6 and nad1 genes are good molecular markers for identifying E. granulosus isolates from a range of hosts in Iran.

A cluster randomised trial of effectiveness of educational intervention in primary health care on early childhood caries.

Early childhood caries (ECC) remains a serious problem in several developing and developed countries. This cluster randomised trial evaluated the impact of a 6-month educational intervention on ECC. The trial targeted 12- to 15-month-old children (n = 242) and their mothers in Tehran, Iran, visiting 18 public health centres, randomly selected and assigned to two intervention groups and one control group. At baseline, each mother was interviewed and each child underwent a dental examination of all teeth for the number of decayed teeth (dt) and of upper central incisors for the number of teeth with enamel caries (de). All mothers in the two intervention groups (A and B) received oral health instructions from the vaccination staff. In addition, group A received extra reminders. The outcome was defined as increments in the number of teeth with dt or de, as percentages of children developing new dt or de, and as the number needed to treat (NNT). No new de appeared in group A, the mean de increment in group B was 0.2 (SD = 0.6), and in the controls, it was 0.4 (SD = 0.7) (p < 0.05). The percentages of children developing new de were 0, 14, and 26%, respectively. No differences in dt increments were found. Regarding de, NNT for group A was 4 and for B 9; the figures for dt were 13 and 17, respectively. In conclusion, oral health education given to mothers by general health staff is a valuable tool to prevent caries in infants and toddlers.

Molecular epidemiology of hepatitis B virus in Iran.

Hepatitis B virus (HBV) infection is a major cause of liver disease worldwide. Eight genotypes and 24 subgenotypes of HBV have been identified. The aim of this study was to determine the distribution of HBV genotypes, subgenotypes and subtypes, and to understand HBV genetic variability in the HBV genome circulating in Iranian provinces. Two hundred and forty-nine sera from HBV-infected patients living in 25 provinces of Iran were collected (2004-2007). A part of the HBV S/pol and whole BCP/C genes were amplified, sequenced and then subjected to phylogenetic, recombination and genetic variability analysis. Results revealed genotype D of HBV in all samples and subgenotypes D1 (98.52%), D2 (0.74%) and D3 (0.74%) among Iranian patients living in different provinces of Iran. Subtypes ayw2 (94.4%), ayw1 (2.8%), ayw3 (2%) and ayw4 (0.4%) were deduced, on the basis of HBV small surface antigen (HBsAg) amino acid sequences. The mean percentage intra-genotypic distance of S plus core regions was 2.8%; the mean percentage inter-genotypic distance of this region between Iranian strains and genotype D isolates was 3.1%; and this rate for other genotypes was 5.2-11.4%. Various rates of point mutations have been found within different HBV genes, e.g. HBsAg (17.2%), precore-G1896A (59.5%) and Basal core promoter (BCP) double mutations (49.2%), whereas no recombination was found. In conclusion, these results indicate that the only genotype circulating in the provinces of Iran is genotype D. There exist high genetic variabilities in the S/pol and BCP/C regions among the Iranian HBV isolates.

Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm.

OBJECTIVES: To investigate the impact of feeding habits and daytime sugar intake on the prevalence of early childhood caries in a population where prolonged breastfeeding is a norm. METHODS: A cross-sectional study was carried out at 18 of 102 public health centers in Tehran. During a 4-day period at each center, between 20 and 35 children aged 1-3 years were enrolled, resulting in a sample of 504 children. In structured interviews, mothers were asked to give information about their child's feeding habits, daytime sugar intake, and their family's background. Sugar intake during the night was operationalized as separately calculated burdens of nighttime breastfeeding and bottle-feeding. Clinical dental examinations followed the World Health Organization criteria. Data analysis included chi-square test, t-test, ANOVA, and logistic regression modeling. RESULTS: Of the children, 56% were solely breastfed (mean duration 16.6 months; 95% CI 16.0-17.2), 42% were both breastfed and bottle-fed, and 2% were solely bottle-fed. Mean duration of breastfeeding for the solely breastfed 24- to 36-month olds was 22.8 months (95% CI 21.8-23.9). At bedtime, 69% were breastfed, 11% bottle-fed, and 20% were not fed at all. With respect to feeding during the night, 72% of children were breastfed, 12% were bottle-fed with milk, 1% received a bottle with water, while 15% were not fed. Early childhood caries (ECC) occurred in 3-26% of the children, depending on age group (P < 0.001). The burden of milk-bottle feeding at night was a clear determinant for ECC (OR = 5.5) whereas breastfeeding per se, its duration, the burden of breastfeeding at night, and daytime sugar intake were not. CONCLUSION: On account of its association with ECC, milk-bottle feeding at night should be limited, whereas prolonged breastfeeding appears to have no such negative dental consequences.