Evaluation of the Levetiracetam treatment on reduction of epileptic discharges in electroencephalogram in children with epilepsy.

Abstract: Objectives: Epilepsy is a relatively common disease in childhood. In some patients, despite clinical control of seizures, the electroencephalogram (EEG) is clearly abnormal. In some studies, the adverse effects of epileptic discharges on cognition, learning, behavior, and seizure recurrence in children have been identified. In this study, the effect of Levetiracetam on epileptic discharges in the interictal phase of EEG in children with epilepsy was investigated. Materials and Methods: In this clinical trial, 59 children aged 2 to 15 years with epilepsy, whose clinical seizures were controlled by sodium valproate in the last six months, but they still had epileptic discharges in the EEG, were randomly divided into two groups. Intervention group (24 people), whom Levetiracetam was added to sodium valproate, and control group, whom treatment with sodium valproate (35 people) alone was continued, then the patients were followed for one year. Results: The frequency of normalization of epileptic discharges in the intervention and control group was 66.7% and 57.1% (P = 0.500), respectively. The mean time for normalization of epileptic discharges in the interictal phase was 14.55%±14.31%   months in the intervention group and 12.50%±20.18%   months in the control group (P = 0.033). Conclusion: In children with controlled seizures whose EEG was still abnormal, both sodium valproate therapy alone and sodium valproate combined with Levetiracetam were effective in reducing the severity of epileptic discharges. But addition of Levetiracetam to sodium valproate normalizes EEG more rapidly. &nbsp

Efficacy of Sodium Hypochlorite Activated With Laser in Intracanal Smear Layer Removal: An SEM Study

Introduction: The purpose of the present study was to evaluate the different concentrations of sodium hypochlorite activated with laser in removing of the smear layer in the apical, middle, and coronal segments of root canal walls by scanning electron microscopy analysis.Methods: Sixty single-rooted human mandibular teeth were decoronated to a standardized length. The samples were prepared by using Race rotary system to size 40, 0.04 taper and divided into 4 equal groups (n = 15). Group 1, irrigated with EDTA 17% and 5.25% NaOCl, groups 2, 3 and 4, 1%, 2.5%, and 5% NaOCl activated with Nd:YAG laser, respectively. Teeth were split longitudinally and subjected to scanning electron microscope (SEM). Data were analyzed by Kruskal-Wallis, Mann-Whitney tests. P value of <0.05 was considered statistically significant.Results: Five percent NaOCl LAI (laser-activated irrigation) showed best smear layer removal in test groups and the difference was statistically significant (P < 0.001). Control group (EDTA 17% and 5.25% NaOCl irrigation) showed significantly better outcomes in comparative with test groups (P < 0.001). In the apical third, compared to coronal and middle third, the canal walls were often contaminated by inorganic debris and smear layer.Conclusion: All different concentrations of sodium hypochlorite activated with laser have a positive effect on removing of smear layer. Sodium hypochlorite activated with laser removed smear layer more effectively at the coronal and middle third compared to the apical third

Modeling the trajectory of CD4 cell count and its effect on the risk of AIDS progression and TB infection among HIV-infected patients using a joint model of competing risks and longitudinal ordinal data

Background: This study was conducted to better understand the influence of prognostic factors and the trend of CD4 cell count on the risk of progression to acquired immunodeficiency syndrome (AIDS) and tuberculosis (TB) infection among patients with human immunodeficiency virus (HIV) in a developing country.  Methods: The information of 1530 HIV-infected patients admitted in Behavioral Diseases Counseling Centers, Tehran, Iran, (2004-2014) was analyzed in this study. A joint model of ordinal longitudinal outcome and competing events is used to model longitudinal measurements of CD4 cell count and the risk of TB-infection and AIDS-progression among HIV patients, simultaneously.  Results: The results revealed that the trend of CD4 cell count had a significant association with the risk of TB-infection and AIDS-progression (p<0.001). Higher ages (p<0.001), the history of being in prison (p=0.013), receiving antiretroviral therapy (ART) (p<0.001) and isoniazid preventive therapy (IPT) (p<0.001) were associated with the positive trend of CD4 cell count. Higher ages were also associated with higher risks of TB (p<0.001) and AIDS-progression (p<0.001). Furthermore, ART (p=.0009) and IPT (p<0.001) were associated with a lower risk of TB-infection. In addition, ART (p<0.001) was associated with a lower risk of AIDS-progression. Moreover, individuals being imprisoned (p=0.001) and abusing alcohol (p=0.012) were more likely to have TB-co-infection.  Conclusions: The used joint model provided a flexible framework for simultaneous studying of the effects of covariates on the level of CD4 cell count and the risk of progression to TB and AIDS. This model also assessed the effect of CD4 trajectory on the hazards of competing events.&nbsp

Analyzing socioeconomic related health inequality in mothers and children using the concentration index

Background: The effect of socioeconomic inequity on major public health indices such as maternal and child mortality rates in low- and middle-income countries are less understood and needs to be evaluated through the concentration index. Method: This cross-sectional study was conducted in 2012 in Hamadan City, the west of Iran, and 1400 households were enrolled through a stratified cluster random sampling method. The effect of inequity on health outcomes was investigated via a three-stage procedure including: (a) definition of health outcomes; (b) measuring socioeconomic status using an asset index; and (c) measuring inequality of health outcome using concentration index (CI). Results: There was inequality for all outcomes of interest. The CI was negative for low birth weight, underweight, stunting, wasting, minor injuries, moderate injuries, consanguineous marriage, child with disability, short birth spacing, and adolescent pregnancy indicating the disproportionate concentration of the health outcomes among the poor. On the other hand, CI was positive for preterm birth, Nonexclusive breastfeeding, severe injuries, incomplete health care, cesarean section, and advanced maternal age indicating opposite conclusion. Conclusion: According to our results, there is a health inequality between the poor and the rich subgroups which may increase the risk of mothers and infant mortality and morbidity rates among the poor while the majority of the conditions related to the health outcomes are preventable

The Effect of Canal Preparation with Four Different Rotary Systems on Formation of Dentinal Cracks: An In Vitro Evaluation

Introduction: Endodontic rotary systems may result in dentinal cracks. They may propagate to vertical root fracture that compromises the outcome of endodontic treatment. This study aimed to compare Neolix and Reciproc (single-file systems), Mtwo and ProTaper (conventional rotary systems) in terms of dentinal crack formation in root canal walls. Methods and Materials: This in vitro study was conducted on 110 extracted human single-rooted teeth. The teeth were randomly divided into four experimental groups (n=25) for root canal preparation with Neolix, Reciproc, Mtwo and ProTaper systems and two control groups (n=5). The first control group underwent root canal instrumentation with hand files while the second control group received no preparation and was only irrigated. After instrumentation, root canals were horizontally sectioned at 3, 6 and 9 mm from the apex and inspected under a stereomicroscope under 12× magnification for detection of cracks. The data were analyzed using chi-square, GEE test and Bonferroni tests (P<0.05). Results: No crack was found in the control groups. All rotary systems caused dentinal cracks. ProTaper, Reciproc, Mtwo and Neolix caused cracks in 92%, 80%, 68% and 48% of samples. ProTaper caused significantly more cracks than Neolix and Mtwo (P<0.05). No significant differences were noted between other groups (P>0.05). Conclusion: All rotary systems cause dentinal cracks and it is significantly different in apical, middle and coronal third of the root. Neolix appears to be a suitable alternative to other rotary systems since use of this single-file system saves time and cost and minimizes trauma to dentinal walls.Keywords: Dentinal Crack; Endodontics; Root Canal Preparation; Rotary Syste

The Epidemiological Aspects of Tuberculosis in Hamadan Province during 2005–11

Background: Epidemiological information on tuberculosis (TB) is required to plan control and prevention strategies and to inform service delivery systems. The aim of present study was to determine the epidemiological status of TB in Hamadan Province covering a seven-year period. Methods: In this cross-sectional study all registered TB patients suffering from any form of smear-positive, smearnegative or extra pulmonary from 2005 to 2011 were assessed. Age-adjusted incidence trend was studied. The CochranArmitage (C-A) test was used for testing the trends over time. Results: The mean age of TB patients was 57.0 (±21.1), 49.9% were males, 52.8% were aged 61 years or older and 39.7% were rural residents. Previous history of jailed was present in 13 (2.2%) patients and 12 (2.0%) were HIV positive. From all TB patients, 60.8% were smear-positive, 87.6% were new cases, and 87.3% of smear-positive patients were cured cases. Also, 23.6% patients had history of hospitalization for TB. More than half (55.4%) of TB patients were reported by public health system. Age-adjusted incidence rates of all TB cases during 2005–11 was 3.4, 3.2, 3.6, 4.7, 3.3, 4.4 and 7.3 in 100,000 respectively (C-A trend test, P< 0.001). Conclusion: Although, the incidence rate of TB in Hamadan Province is lower than country’s average, increasing trend of TB incidence is not concordant with its decreasing trend in Iran. An epidemiological study is required to evaluate risk factors associated with TB to identify ways to decrease the prevalence of TB

Beliefs about Safe Traffic Behaviors among Male High School Students in Hamadan, Iran: A Qualitative Study Based on the Theory of Planned Behavior

Road traffic injuries are public health challenges with heavy economic and social burdens. Road traffic injuries are common in developing countries and occur disproportionately with adolescents. This study aimed to elicit beliefs about traffic behaviors based on the theory of planned behavior among male high school students in Hamadan, Iran. We used a constructivist-interpretive qualitative design with directional content analysis. Interviews were conducted with 19 adolescent males in Hamadan, Iran. Analysis revealed that theory of planned behavior fit well to explain how perceptions, attitudes, and beliefs influenced traffic behaviors. Perceived subjective norms in the forms of parental encouragement, traffic rules and policies, and media advertising influenced the pursuit of safe traffic behaviors. Control belief factors that impeded safe behaviors included aggressive and/or drunk driving and bad road conditions, distance to bridge crossings, and improper seat belt position. Our results provided a deeper understanding of attitudes, experiences, and intentions that precede adolescents’ traffic behaviors. Understanding precursors to behaviors is necessary for effective intervention. Further exploration of factors that lead youth to engage in unsafe behaviors despite education, knowledge, and presence of influential people that promote safe traffic behaviors is needed

Evaluation of dimensional accuracy of dental bridges manufactured with conventional casting technique and CAD/CAM system with Ceramill Sintron blocks using CMM

Background. Recently, non-presintered chromium-cobalt (Cr-Co) blocks with the commercial name of Ceramill Sintron were introduced to the market. However, comprehensive studies on the dimensional accuracy and fit of multi-unit frameworks made of these blocks using the coordinate measuring machine (CMM) are lacking. This study aimed to assess and compare the dimensional changes and fit of conventional casting and milled frameworks using Ceramill Sintron. Methods. A metal model was designed and scanned and 5-unit frameworks were fabricated using two techniques: (I) the conventional casting method (n=20): the wax model was designed, milled in the CAD/CAM machine, flasked and invested; (II) the milling method using Ceramill Sintron blocks (n=20): the wax patterns of group 1 were used; Ceramill Sintron blocks were milled and sintered. Measurements were made on the original reference model and the fabricated frameworks using the CMM in all the three spatial dimensions, and dimensional changes were recorded in a checklist. Data were analyzed with descriptive statistics, and the two groups were compared using one-way ANOVA and Tukey test (α=0.05). Results. The fabricated frameworks in both groups showed significant dimensional changes in all the three dimensions. Comparison of dimensional changes between the two groups revealed no significant differences (P>0.05) except for transverse changes (arch) that were significantly greater in Ceramill Sintron frameworks (P<0.05). Conclusion. The two manufacturing processes were the same regarding dimensional changes and the magnitude of marginal gaps and both processes resulted in significant dimensional changes in frameworks. Ceramill Sintron frameworks showed significantly greater transverse changes than the conventional frameworks

Evaluating the Effect of Cardiac Rehabilitation Care Plan on Quality of Life of Patients Undergoing Coronary Artery Bypass Graft Surgery

Introduction: Cardiovascular surgeries are among the conventional surgeries aimed at increasing the survival rate and improving the quality of life of patients. This study aimed to evaluate the effect of cardiac rehabilitation on quality of life of patients undergoing Coronary artery bypass graft (CABG) surgery.Methods: This was a semi-experimental study performed on 160 patients undergoing CABG surgery. The rehabilitation program was carried out for 13 weeks (three sessions per week) in 40 sessions, six weeks after the CABG surgery. The MacNew standard questionnaire and the general health questionnaire (S-f 36) were completed before the beginning of rehabilitation sessions as well as after completion of these sessions by patients.Results: According to the results, the quality of life of patients significantly increased in the physical and emotional areas after the rehabilitation program. The results also indicated that there was a significant difference between various levels of research in the physical functioning variables, dysfunction due to physical health, dysfunction due to emotional health, energy/fatigue of individuals, emotional well-being, social functioning, pain, and general health.Conclusions: The present results indicated the improved quality of life of patients in all the areas after cardiac rehabilitation intervention, compared to before that. Therefore, paying more attention to cardiac rehabilitation is necessary due to its positive effects on increasing the quality of life of patients

The epidemiological aspects of tuberculosis in Hamadan Province during 2005–11

Background: Epidemiological information on tuberculosis (TB) is required to plan control and prevention strategies and to inform service delivery systems. The aim of present study was to determine the epidemiological status of TB in Hamadan Province covering a seven-year period. Methods: In this cross-sectional study all registered TB patients suffering from any form of smear-positive, smear- negative or extra pulmonary from 2005 to 2011 were assessed. Age-adjusted incidence trend was studied. The Cochran- Armitage (C-A) test was used for testing the trends over time. Results: The mean age of TB patients was 57.0 (±21.1), 49.9% were males, 52.8% were aged 61 years or older and 39.7% were rural residents. Previous history of jailed was present in 13 (2.2%) patients and 12 (2.0%) were HIV positive. From all TB patients, 60.8% were smear-positive, 87.6% were new cases, and 87.3% of smear-positive patients were cured cases. Also, 23.6% patients had history of hospitalization for TB. More than half (55.4%) of TB patients were reported by public health system. Age-adjusted incidence rates of all TB cases during 2005–11 was 3.4, 3.2, 3.6, 4.7, 3.3, 4.4 and 7.3 in 100,000 respectively (C-A trend test, P < 0.001). Conclusion: Although, the incidence rate of TB in Hamadan Province is lower than country’s average, increasing trend of TB incidence is not concordant with its decreasing trend in Iran. An epidemiological study is required to evaluate risk factors associated with TB to identify ways to decrease the prevalence of TB