Assessment of the Preventive Effect of Pilocarpine on Radiotherapy-Induced Xerostomia in Patients with Head and Neck Cancers

Introduction Xerostomia is one of side-effects of radiotherapy for head and neck cancers. No definitive method has been proposed for the treatment of this condition. However, pilocarpine is considered effective for the management of chronic xerostomia. The purpose of the present study was to assess the preventive effect of pilocarpine. Materials and Methods This study was performed on 34 patients with head and neck cancers, undergoing radiation therapy (5000 cGy). The patients were randomly divided into two groups. The case group was administered 16 drops of pilocarpine (2%) eye drops per day, while the control group received normal saline; the treatment plan continued for four weeks. Unstimulated whole saliva flow rate was measured at four stages: two weeks before radiotherapy (baseline), the first day of radiotherapy, and two and four weeks after the initiation of radiotherapy. Results At baseline and the first day of radiotherapy, no significant differences were observed in the amount of saliva between the case and control groups (P<0.76 and P<0.054, respectively). However, by starting radiotherapy, a statistically significant improvement was reported in saliva production in the case group, compared to the control group (P<0.00); this trend continued during the next four weeks of radiotherapy (P<0.003). Generally, a significant difference was observed between the two groups at all stages of data evaluation (P<0.00). Conclusion According to the findings, pilocarpine was found to be effective for the prevention of xerostomia. Moreover, it could restrain the decline in the amount of saliva and reduce the rate of xerostomia

Thermal Scanning of Dental Pulp Chamber by Thermocouple System and Infrared Camera during Photo Curing of Resin Composites

Introduction: Due to thermal hazard in composite restorations, this study was designed to scan the pulp temperature by thermocouple and infrared camera during photo polymerizing different composites. Methods and Materials: A mesio-occlso-distal (MOD) cavity was prepared in an extracted tooth and the K-type thermocouple was fixed in its pulp chamber. Subsequently, 1 mm increment of each composites were inserted (four composite types were incorporated) and photo polymerized employing either LED or QTH systems for 60 sec while the temperature was recorded with 10 sec intervals. Ultimately, the same tooth was hemisected bucco-lingually and the amalgam was removed. The same composite curing procedure was repeated while the thermogram was recorded using an infrared camera. Thereafter, the data was analyzed by repeated measured ANOVA followed by Tukey’s HSD Post Hoc test for multiple comparisons (α=0.05). Results: The pulp temperature was significantly increased (repeated measures) during photo polymerization (P=0.000) while there was no significant difference among the results recorded by thermocouple comparing to infrared camera (P&gt;0.05). Moreover, different composite materials and LCUs lead to similar outcomes (P&gt;0.05). Conclusion: Although various composites have significant different chemical compositions, they lead to similar pulp thermal changes. Moreover, both the infrared camera and the thermocouple would record parallel results of dental pulp temperature.Keywords:Exothermic Reaction; Infrared Camera; Light Curing Unit; Pulp Temperature; Resin Composite; Thermocouple

Tramadol Poisoning: A Systematic Review of Studies in Iran

Background: According to statistics, tramadol use is extremely prevalent in Iran. Besides, tramadol overdose is mostly observed in young individuals. Given the significance of this issue and the increasing prevalence of tramadol use in Iran, this study aimed to systematically review tramadol poisoning in Iran.Methods: In this review, a search was conducted in Persian databases of IranMedex, SID, Medlib, Magiran, as well as Google Scholar using the keywords of “poisoning and tramadol” without a time limitation.Results: Some of the main issues related to tramadol poisoning were as follows: the majority of cases consumed tramadol to commit suicide; most tramadol consumers were aged below 30 years; the majority of patients with tramadol poisoning were single and male; tramadol was mostly used orally; in most studies, patients were hospitalized for &gt;24 hours; the majority of patients concomitantly took other medications with tramadol; in most studies, patients had a history of tramadol use; most studies reported a relationship between tramadol dose and seizures, and the most common cause of hospital referral was decreased consciousness level.Conclusion: Tramadol misuse and poisoning could lead to seizures and often death. Besides, most cases with tramadol poisoning were aged below 30 and consumed tramadol to commit suicide. Thus, it is crucial to improve the youth’s awareness about tramadol use, develop methods to prevent suicides, and limit access to this drug, especially in young adults

A randomized clinical trial on the anti-tumoral effects of low molecular weight heparin in the treatment of esophageal cancer

The current treatment approaches for esophageal cancer are associated with poor survival, and there are ongoing efforts to find new and more effective therapeutic strategies. There are several reports on the antitumoral effects of low‐molecular‐weight heparins (LMWHs). We have assessed the possible survival benefit of LMWHs in esophageal malignancies. This was a randomized, single‐blind, multicenter, Phase II clinical trial on nonmetastatic esophageal cancer candidate for neoadjuvant chemoradiotherapy. Patients were randomly assigned to the chemoradiotherapy‐only arm or chemoradiotherapy plus enoxaparin arm using 1:1 allocation. Radiotherapy was delivered in 1.8‐Gy daily fractions to a dose of 50.4 Gy in both groups. Paclitaxel 50 mg/m2 and carboplatin (AUC 2) were administered weekly, concurrent with radiotherapy. In the intervention group, patients received enoxaparin (40 mg) and chemoradiation daily. 4–6 weeks after treatment, all patients underwent esophagectomy. After a median follow up of 7 months, estimated 1 year disease‐free survival (DFS) in the intervention group was 78.9% and was 70% in the control groups ( p = 0.5). Toxicity from the experimental treatment was minimal, and there were no treatment‐related deaths. A pathologically complete response in intervention and control group was 64.8% and 62.5%, respectively ( p = 0.9). There was a nonsignificant trend toward improved survival by the addition of enoxaparin to the concurrent chemoradiotherapy regimen. However, 1 y DFS of both groups were high as expected. A longer follow‐up and a larger sample size are required.delivered in 1.8-Gy daily fractions to a dose of 50.4 Gy in both groups. Paclitaxel 50 mg/m2 and carboplatin (AUC 2) were administered weekly concurrent with radiotherapy. In the intervention group, patients received enoxaparin (40 mg) daily as well as chemoradiation. Four to six weeks after treatment, all patients underwent esophagectomy. After a median follow up of 7 months,estimated one year disease free survival (1y DFS) in the intervention group was 78.9% and in the control groups was 70% (p=0.5). Toxicity from the experimental treatment was minimal and there were no treatment-related deaths. A Pathologically complete response in intervention and control group was 64.8% and 62.5%, respectively (p=0.9). There was a non-significant trend toward improved survival by the addition of enoxaparin to the concurrent chemoradiotherapy regimen. However, 1y DFS of both groups were high as expected. A longer follow-up and larger sample size is required

A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs).&nbsp;Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings.&nbsp;Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran.&nbsp;Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p&lt;0.001).&nbsp;Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions

Review Paper: Sexual and Reproductive Health Challenges in Women With Physical-Motor Problems and Their Solutions

Objective The purpose of this study is to identify the sexual and reproductive health challenges in women with physical-motor problems in five domains of sexual health, screening for common diseases, maternal health, prevention of unwanted pregnancy, and sexually transmitted diseases. Materials & Methods This review study was conducted in 2016. Articles on the related topic &nbsp;were searched in the following databases: Proquest, Scopus, Springer, Cochrane, ScienceDirect, Iranmedex, MagiranIrandoc, SID, and Ovid. A total of 61 related research papers, including quantitative and qualitative researches in English and Persian, from the last 15 years papers (from 18 different countries since 2000) were included in this study. Articles with unknown sample size and methodology or those conducted only on mentally handicapped individuals or men were excluded. In addition, articles with no full text access were also excluded. Results It was found that, in the majority of communities, there was a lack of knowledge about disabilities and how to provide health services to women with physical-motor problems. Insurance and financial problems were the most common reasons for inaccessibility to health care. Other problems included the lack of physical access to health centers, negative attitudes of service providers, lack of effective communications, unfriendly physical structure, and lack of equipments. The Pap smear and mammography screening services were very poor; most of these services did not have the necessary approval from doctors. Other causes included lacking necessity of performing the test, physical and cognitive limitations, and lacking access to the facilities. In addition, low knowledge and poor family planning care were also evident. In Iran, people with disabilities had received significantly less care and family planning. Most of these women considered pregnancy and childbirth to be normal . Despite the differences in the provision of services in pregnancy and childbirth, the participants expressed positive experience during this period, although they did face increased complications of pregnancy and delivery. These women are at risk for sexually transmitted diseases and are provided with weak sexual counseling about sexuality because most of the doctors believed that they have no sex.&nbsp; Conclusion Thus, due to the low knowledge and received &nbsp;sexual-reproductive health care in this group, community awareness, particularly for those related to the disabled individuals, is one of the main programs that can lead to the understanding and proper achievement of techniques for family and community adaptation. This will also improve the rehabilitation services. It is important to devise a way to increase the attention of the concerned authorities toward the people with disabilities for better implementation of health policies for such individuals

Designing a closed-loop blood supply chain network considering transportation flow and quality aspects

Managing blood and its sub-products is one of the challenging problems in healthcare management, where the managers attempt to solve them by designing appropriate supply chain networks. Although previous authors tried to enhance the performance of the blood supply chain, some critical concepts such as reusable blood transportation boxes were rarely considered. These boxes are the crucial apparatus in the transmission of products along the supply chain. As such, it is vital to discuss the related flow and quality features in the network using a mathematical formulation. Moreover, a closed-loop network design to achieve more economical and environmental benefits than a traditional design is a more efficient approach. Regarding these concerns, a closed-loop supply chain of blood products that considers blood transportation equipment and the relevant quality features is formulated in this paper first. Then, a differential evolution algorithm (DE), boosted by extending two new versions of DE, is used for solving the problem. Finally, some sensitivity analyses on the parameters of the model are performed to report some managerial insights

System Risk Importance Analysis Using Bayesian Networks

International audienc