Oral mucositis (OM) is described as inflammation of the mucosa in the oral cavity which is caused by destruction of the oral mucosal epithelial cells and growth suppression secondary to cancer treatment in the form of radiotherapy or chemotherapeutic drug substances. It is the most debilitating condition and the most common complication in cancer patients. It appears first by thinning of oral tissues which leads to erythema. As these tissues become thinner, ulceration eventually occurs. Potential complications include pain, increased risk of local and systemic infections, bleeding and insufficient food intake and may lead to breaks in treatment sessions. It is usually associated with pain, increased risk of infection and dysphasia and may lead to inadequate hydration and impaired nutritional status. Traditional management of OM has involved patient compliance and education, hydration, nutritional support, use of saline rinses, topical and systemic pain relief and infection surveillance and treatment. The PubMed, Medline, Ovid, Science Direct and Google were searched from 1998 to 2015. The search terms used for medical subject heading were 'oral mucositis' and 'new treatments of mucositis'. Unfortunately, there is not a single method which is capable of preventing or eliminating OM in an efficient way. In this article, we reviewed new therapeutic methods of OM including cryotherapy, honey and coffee, propolis, low-level laser therapy, growth factors, stem cell therapy, hyaluronic acid-based substances and matrix metalloprotease blockers.

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Aim: This study was an in vitro study done to evaluate and compare the flexural strength (FS) of heat polymerised polymethyl methacrylate (PMMA) denture base resins after reinforcement with nylon fibres and different concentration of glass fibres (GFs). Materials and Methods: Fifty heat-cured PMMA resin samples were fabricated using a die and divided into five groups, having ten samples in each group. All the samples were tested on universal testing machine and three point bending test was done. Then, FS of each sample was calculated. Mean value of FS of each group was used for statistical analysis. One-way analysis of variance test was used for statistical analysis. Results: Results showed that the fibres significantly affected the FS of PMMA. FS increases to the maximum with 5% GFs as compared to 2% glass, 2% nylon and 10% GFs. Conclusion: Polymers used in denture base fabrication, reinforced with GFs have shown to have a positive effect on the fracture resistance of dentures as compared to unreinforced PMMA.

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Aim: Coffee extract has demonstrated significant antimicrobial properties against various Gram-positive and Gram-negative bacteria. 0.2% chlorhexidine, a potent allopathic reagent, in the mouthwash form is considered the gold standard of chemical plaque control. The aim of this study was to evaluate the antimicrobial efficacy of different concentrations of coffee extract with 0.2% chlorhexidine mouthwash on the following Gram-negative periodontal pathogens: Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum and Aggregatibacter actinomycetemcomitans under in vitro conditions. Materials and Methods: Bacterial suspensions of P. gingivalis, P. intermedia, F. nucleatum and A. actinomycetemcomitans were inoculated in agar plates with four, 5 mm diameter wells. Various concentrations of coffee extract and chlorhexidine mouthwash were added into wells in different plates and then incubated at 37°C for 48 h. The diameter of zones of inhibition was measured, and statistical analysis was done. Results: 0.2% chlorhexidine mouthwash showed greatest zone of inhibition against all periodontal pathogens. Coffee at a concentration of 20% and 15% showed activity against P. gingivalis, P. intermedia and A. actinomycetemcomitans. F. nucleatum was resistant to all concentrations of coffee extract. Conclusion: Coffee extract possesses antimicrobial activity against the various periodontal pathogens though not as efficacious as the standard chlorhexidine.

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Background: For understanding injuries in paediatric elbow and checking the degree of reduction after manipulation, various radiological criteria using anthropometric parameters are used. Since anthropometric parameters of Caucasians are different from European and Mongoloids, their parameters cannot be applied on our population. Hence, there is a need to characterise anthropometric parameters of elbow among children in the Indian population. Materials and Methods: The study population comprised all cases of injury to the elbow joint between 3 and 13 years of age reporting to the Department of Orthopaedics during the study. The X-rays films were preserved, and the angles and lines (as anthropometric parameters) were drawn on the radiographs. Results: Mean ± (standard deviation [SD]) for Baumann angle in children included in this study was 75° ± 4.70°. Mean ± (SD) of Baumann angle in males was 76° ± 4.44° and females was 74° ± 5.37°. Mean ± (SD) for lateral capitellohumeral angle in children from 3 to 13 years of age was 49 ± 5.75. Conclusions: As the values of normal side have been found to affect the functional and cosmetic outcome of the affected extremity, slight changes in values of our population in comparison to that of the Western population can significantly affect the outcome.

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Background: Klebsiella pneumoniae causes community and nosocomial infections. Drug treatment of extended-spectrum beta-lactamases (ESBLs) by K. pneumoniae isolates is costly, long, and sometimes problematic. Objectives: The aim of this study was to determine the antibiotic resistance patterns and the occurrence of bla CTX-M, bla TEM and bla SHV genes in the third-generation cephalosporin-resistant K. pneumoniae isolated from urinary tract infection in Kermanshah region, Iran. Materials and Methods:Fifteen K. pneumoniae isolates were collected and confirmed by the analytical profile index-20E system. Phenotypic confirmatory test was performed using combination disk method. The genes of bla CTX-M, bla TEM and bla SHV were investigated by polymerase chain reaction. SPSS version 20 (IBM, Chicago, IL, USA) was used for sample analysis. Results: Resistant isolates to ampicillin and imipenem represented 96% and 4%, respectively, which were the highest and lowest resistance. Seventeen (34%) out of the 50 isolates were ESBL producers by the synergy test. The prevalence of bla CTX-M, bla TEM and bla SHV among these isolates was 88% (n = 15), 70% (n = 12) and 58% (n = 10), respectively. Conclusions: Our research showed a possibility of the spread of multidrug-resistant ESBL-producing isolates. Monitoring control of risk factors and drug-resistant patterns with the use of phenotypic and/or genotypic analyses are very important to prevent the occurrence and dissemination of resistant strains due to ESBL-producing K. pneumoniae in hospital settings.

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Dental anomalies are usual congenital malformation that can happen either as isolated findings or as a part of a syndrome. Developmental anomalies influencing the morphology exists in both deciduous and permanent dentition and shows different forms such as gemination, fusion, concrescence, dilaceration, dens evaginatus (DE), enamel pearls, taurodontism or peg-shaped laterals. All These anomalies have clinical significance concerning aesthetics, malocclusion and more necessary preparing of the development of dental decays and oral diseases. Through a search in PubMed, Google, Scopus and Medline, a total of eighty original research papers during 1928-2016 were found with the keywords such as dental anomaly, syndrome, tooth and hypodontia. One hundred review titles were identified, eighty reviews were retrieved that were finally included as being relevant and of sufficient quality. In this review, dental anomalies including gemination, fusion, concrescence, dilaceration, dens invaginatus, DE, taurodontism, enamel pearls, fluorosis, peg-shaped laterals, dentinal dysplasia, regional odontodysplasia and hypodontia are discussed. Diagnosing dental abnormality needs a thorough evaluation of the patient, involving a medical, dental, familial and clinical history. Clinical examination and radiographic evaluation and in some of the cases, specific laboratory tests are also needed. Developmental dental anomalies require careful examination and treatment planning. Where one anomaly is present, clinicians should suspect that other anomalies may also be present. Moreover, careful clinical and radiographical examination is required. Furthermore, more complex cases need multidisciplinary planning and treatment.

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Background: Brain tumours (BTs) constitute approximately 88% of all central nervous system tumours. The present study aimed to determine the age-standardised rate (ASR) of BTs in Iran. Methods: A comprehensive search was conducted on all studies of BTs incidence using Medline/PubMed, Scopus, Embase, Google Scholar and Web of Sciences as international databases and Scientific Information Database, MagIran, IranMedex and IranDoc as Iranian databases until April 2018. This systematic review was done based on the preferred reporting items for systematic reviews and meta-analyses. Results: The primary search yielded 312 relevant studies. A total of 17 studies were included after more detailed retrieval. The results of the random-effect model were demonstrated the ASR of BTs was 4.16 (95% confidence interval [CI], 3.20–5.12) for males and 3.40 (95% CI, 2.67–4.13) for females. Conclusion: The incidence of BTs is lower in Iran compared to other parts of the world. The incidence of nervous system cancers is increasing base on region, geographical, and economic conditions in Iran. Hence, training programmes can be considered to reduce the risk factors, complications of nervous system cancers and early diagnosis of nervous tumors.

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Foreign object embedded in a tooth is not an uncommon finding, especially in children undergoing root canal therapy or who has experienced trauma leading to teeth fracture. Many children with a habit of placing various objects in the oral cavity eventually end up with foreign body lodgement into the pulp chamber or root canal leading to pain and infection. Parental negligence is responsible to a great extent in such kind of accident as they fail to keep watch on their children and their teeth. A number of foreign objects have been reported to be lodged in the pulp chamber and root canals of both deciduous and permanent teeth. Various instruments and kits have been used on retrieval of foreign objects lying in the pulp chamber or canal.

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Background and Aim: Cardiovascular autonomic function tests (CAFTs) are non-invasive tests that can assess both sympathetic and parasympathetic autonomic functions. Autonomic dysfunction may be considered as a risk factor for obesity and vice versa. For measurement of obesity, body mass index (BMI) is a simple, valid and inexpensive method. Hence, this study was designed to evaluate the effect of obesity based on BMI criteria on autonomic nervous system based on CAFT in young adult males. Methods: A cross-sectional study was carried out on 43 young adult males in the age group of 18–25 years with an age-matched control (n = 43) group. After initial screening, anthropometric measurements were recorded. CAFTs were performed and recorded by the Cardiac Autonomic Neuropathy Analysis System (CANWin). Unpaired t- test was done to compare the parameters of study and control groups in Microsoft Excel^® 2010. Results: Parasympathetic test parameters of study and control groups when expressed in mean ± standard deviation were not found statistically significant (P > 0.05). The fall in systolic blood pressure (BP) in orthostatic test of study group (12.19 ± 4.8 mmHg) was significantly (P = 0.0001) higher than that of control group (7.33 ± 5.16 mmHg). Increase in diastolic BP in isometric handgrip exercise test of study group (11.84 ± 5.39 mmHg) was significantly less (P = 0.004) than that of control group (16.39 ± 8.71 mmHg). Conclusion: Overweight young males have altered sympathetic activity but parasympathetic activity did not show any significant difference when compared to normal weight males.

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Introduction: Pharmacovigilance (PV) plays an important role in generating adverse drug reaction (ADR) data. However, the practice of PV is still very low among health-care professionals due to lack of knowledge and awareness. Internship is the phase when medical graduates work for the first time under supervision of the seniors. At present, we have little knowledge about awareness of PV among interns in India. Hence, this study was planned to assess the level of knowledge awareness and practice of PV among interns and subsequent change in these after PV training session. Materials and Methods: A cross-sectional descriptive questionnaire-based study was conducted among interns of a tertiary health care and teaching institute. Participants were given descriptive questionnaire; they completed the questionnaire before and after undergoing training program in PV. The impact of the effectiveness of educational intervention among interns was evaluated by Chi-square test. Results: Out of 150 participants, 120 interns completely filled the questionnaires before and after the educational intervention. Educational program on PV was found to increase knowledge and positive attitudes towards various aspects of PV. Conclusion: Training program on PV may help increase the knowledge as well as awareness about principles and techniques of PV, which will increase the credibility of health care in the country.

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Introduction: Much attention has been devoted to the management of post-operative pain. Pain reduction brings more comfort and leads to faster recovery and mobilisation of a patient. In addition, it reduces thromboembolic events and eventually the length of hospital stay and cost of treatment. This study was conducted to compare the efficacy of gabapentin versus paracetamol for post-operative analgesia after tibial fracture surgery. Materials and Methods: This study was designed as a randomised, controlled clinical trial, in which 96 patients undergoing elective tibial fracture surgery under general anaesthesia were divided into three groups (gabapentin, paracetamol and placebo). Half an hour before induction of anaesthesia, patients received 300 mg oral gabapentin or 1000 mg paracetamol or 100 ml normal saline (these two latter as intravenous infusions) according to their groups. Surgery was performed under general anaesthesia, with similar anaesthetic regimen for all patients. The pain intensity was measured using a visual analogue scale ruler at 2, 4 and 6 h after operation. Collected data were recorded then and analysed using the statistical software SPSS. Results: At 2, 4 and 6 h after surgery, no significant differences were observed between the two paracetamol and gabapentin groups in terms of pain intensity. Pain intensity in the placebo group was significantly higher than the two case groups. Mean opioid consumption as a rescue intervention was not significantly different between the three groups. However, the placebo group included a larger number of patients requiring opioid analgesics, which was significantly different. Conclusion: A significant pain reduction was observed in both case groups as compared to placebo. Gabapentin and paracetamol had similar efficacies in post-operative analgesia after tibial fracture surgery. No difference was found between the three groups in terms of mean opioid analgesic requirements.

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Background: Physical and mental comfort is known to have a crucial influence on health and performance amongst medical students. Very often, medical students suffer from poor quality of life (QOL) related to the work-life balance due to the lack of sleep, nutritional and dietary disorders and low physical activity, resulting in a negative impact on their academic performance. This study aims to determine the potential academic/non-academic factors and extra-curricular activities influencing the performance of medical students in Universiti Sultan Zainal Abidin (UniSZA). Materials and Methods: This was a cross-sectional study conducted on medical students at the Faculty of Medicine, UniSZA, Terengganu, Malaysia. A sample size of 300 respondents were recruited from Year I to V medical students. The questionnaire was adopted, modified and validated from a similar study in Saudi Arabia. Results: Majority of the students enjoy medical education are self-motivated, have a good command of English, non-smokers and have a sufficient sleep. Conclusion: University medical students possess good QOL within the optimum educational environment.

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Background: Pittsburgh Sleep Quality Index (PSQI) assesses perceived quality of sleep. Bengali is the 6^th language in the world according to the number of first language speakers. PSQI is presently not available in Bengali. Poor quality of sleep affects work efficiency and health of individual and it is increasing in urban as well as in rural population. Aim: The aim of the study was (1) to adapt PSQI in Bengali Language and (2) to find the prevalence rate of poor quality of sleep among urban and rural populations and to compare the rate. Materials and Methods: First, Bengali PSQI (BPSQI) was adapted by linguistic validation methods. Then, a cross-sectional survey was conducted among sample in a municipal ward and in a village by BPSQI. The prevalence of poor sleep quality among the sample was ascertained. Data were presented in percentage, mean and standard deviation. Chi-square test and unpaired t-test were used according to necessity with α = 0.05. Results: Adapted BPSQI instrument was found of acceptable internal consistency (Cronbach's α = 0.816). The prevalence rate of poor sleep quality in urban adult population was 42.58% and rural population was 35.89% (χ² = 4.004, P = 0.0454). Adult females in urban area showed more prevalence rate of poor sleep quality (58.74%) than those of adult females in rural area (45.96%). Conclusion: Adapted BPSQI can be used as a self-administered questionnaire among Bengali native speakers. A significant percentage of urban and rural adult population suffers from poor quality of sleep. Adult population in urban area, especially adult females, suffers more from poor quality of sleep than rural population.

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Background: This study aimed to estimate the prevalence of complications and in β-thalassemia patients, to identify its related risk factors and to determine the optimal thresholds of serum ferritin and disease duration as a predictor of the endocrine disease. Materials and Methods: A total of 140 patients with β-thalassemia major, 65 (46.4%) male with a mean age of 21.4 ± 7.5 (range 8–39) years were enrolled in this study. Logistic regression and receiver operating characteristic curve were used to estimate the diagnostic power of ferritin level and determine the optimal cut points. Results: The serum ferritin level was 3395 ± 2611 μg/L with stable trend across the last 5 years. Puberty delay was the most common complication with the prevalence of 33.6%. There was a significant association between ferritin levels and hypocalcaemia (odds ratio [OR] = 1.29, P = 0.001), short stature (OR = 1.04, P < 0.001) and puberty delay (OR = 1.02, P = 0.002). A >2100 μg/L and >3400 μg/L optimal cut-off values of serum ferritin level for puberty delay was 2100 area under the curve (AUC = 0.78, P = 0.004) and 3400 for short stature (AUC = 0.74, P < 0.0001). Conclusions: Progressive deterioration of endocrine dysfunction and inadequacy of chelation therapy in older patients are endocrine complications amongst beta-thalassemia major patients that need more attention. Prosperous control of the ferritin levels before puberty with deferoxamine appeared to be an effective treatment to prevent and reduce diabetes and hypothyroidism. The serum ferritin >1500 μg/L along with early second decade of illness is the best predictor for the development the endocrinopathy.

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Background: Microorganism transmission is an important route for the outbreak of microbial pathogens in outdoor and indoor environments. Objectives: In this study, we performed air sampling and analysis of various bio-aerosol particles (bacteria and fungi) by a passive method in order to measure the level of contaminant particles. Materials and Methods: Air sampling was done in five hospitals in Iran, which included Imam Ali Hospital (IAH), Taleghani Hospital (TH), Imam Khomeini Hospital (IKH), Farabi Hospital (FH) and Imam Reza Hospital (IRH). In each hospital, units such as surgery, intensive care unit, angiography, emergency, oncology, nursing station, pathology laboratory, microbiological laboratory, operating room, isolation room (infectious section), delivery room and outdoor environment were investigated. Results: The total counts for viable bacteria and fungi in the sampled air from the hospitals were as follows: IAH (bacteria 0–>100 colony-forming unit [CFU]/m³;fungi 0–14 CFU/m³), FH (bacteria 1–18 CFU/m³; fungi 0–7 CFU/m³), IRH (bacteria 0–14 CFU/m³; fungi 4–>100 CFU/m³), TH (bacteria 4–>250 CFU/m³; fungi 0–43 CFU/m³) and IKH (bacteria 11–1766 CFU/m³; fungi 0–25 CFU/m³). Conclusions: Results showed that microbial counts following the air sampling are strongly dependent on the environment. However, a low number of air microorganisms do not mean a clean and healthy environment.

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Background: Prostate cancer is one of the most common cancers in men and is the second leading cause of death, especially in developed countries. Therefore, the aim of this study was to investigate the incidence and mortality of prostate cancer and its relationship with the human development index (HDI). Materials and Methods: This is an ecological review of the incidence of prostate cancer and its relation with HDI and its components in 2018. Data about the incidence and mortality rate of breast cancer for the year 2018 were obtained from the global cancer project for 185 countries. To analyse data, correlation test and regression tests were used to evaluate the correlation between the incidence and mortality with HDI. The statistical analysis was carried out by Stata-14, and the significance level was estimated at the level of 0.05. Results: The result showed that there is a positive and significant correlation between the incidence (R = 0.531,P < 0.001) and mortality (R = −0.219,P < 0.001) of prostate cancer with HDI. The linear regression model showed that the increase in HDI, mean years of schooling (MYS), expected years of schooling (EYS), life expectancy at birth (LBE) and gross national income was associated with an increase in the incidence of prostate cancer in men, but it was statistically significant only in MYS (B = 3.6,P < 0.05) and EYS (B = 4.8,P < 0.05). Furthermore, the increase in life expectancy at birth (B = −0.45,P < 0.05) significantly decreased mortality. Conclusion: By increasing the HDI the incidence of prostate cancer increases, but the mortality rate decreases. Therefore, HDI can be used to provide a clear picture of the distribution of this cancer. Having a comprehensive picture of the epidemiological features and changes of prostate cancer has a significant role to play in preventing, diagnosing and treating early, and reducing mortality.

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Objectives: The current study aimed to classify study population in homogenous groups based on musculoskeletal complaints and investigate the association of common psychological disorders with musculoskeletal complaints in a large sample of Iranian adults. Methods: Using data from a cross-sectional sample of adult Iranian population (n = 4762), individuals were classified in meaningful subgroups based on their musculoskeletal complaints and the association of common psychological disorders with musculoskeletal complaints was investigated in identified classes using structural equation mixture model. Musculoskeletal complaints score extracted through eight items concerning site-specific or widespread musculoskeletal symptoms. Psychological distress was measured by General Health Questionnaire (GHQ-12). Depression and anxiety were measured using Persian validated version of the Hospital Anxiety and Depression Scale (HADS). Results: Two classes characterised by high (15.5%) and low (84.5%) levels of musculoskeletal complaints, were identified using structural equation mixture modeling. All musculoskeletal symptoms had a higher prevalence among participants allocated to 'high musculoskeletal complaints' class compared to 'low musculoskeletal complaints' class. Severe fatigue and back pain were the most reported complaints. Anxiety, depression and psychological distress were positively associated with musculoskeletal complaints score in identified classes, controlling for sex and age. Anxiety showed a stronger association with musculoskeletal complaints score compared to depression and psychological distress. Conclusions: Musculoskeletal complaints can be summarised in a categorical and dimensional structure in the adult study population. Common psychological disorders including anxiety, depression and psychological distress are significantly associated with musculoskeletal complaints. These findings could be useful for dealing with prevention and treatment programmes.

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The meta-analysis of case–control and cohort studies was conducted to obtain the association between breech presentation and the risk of autism spectrum disorder (ASD) among children. The search for relevant studies in major electronic databases was performed including; Web of Science, PubMed and Scopus up to May 2018. The odds ratio (ORs) with 95% confidence intervals (CI) was extracted from eligible studies. The pooled estimate of OR was not indicated a significant association between breech presentation and risk of ASD among children (OR = 1.15, 95% CI = 0.93–1.37), but this association was significant in the unadjusted analysis (OR = 1.32, 95% CI = 1.05–1.58). Our findings were not showed that breech presentation is associated with increased risk of ASD among children.

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Objective: Testicular cancer (TC), although it is one of the most unusual cancers, seems to be increasing. There is no accurate information on the incidence of this cancer in Iran. The present study is conducted to evaluate the incidence rates of TC in Iran. Methods: A systematic search was conducted on all published studies of TC incidence using Medline/PubMed, Scopus, Embase, Web of Science, Google Scholar and four Iranian databases (Scientific Information Database, MagIran, IranMedex and IranDoc) until June 2018. This systematic review was done according to the preferred reporting items for systematic reviews and meta-analyses. Result: The database searching yielded 132 potentially relevant studies. A total of 11 studies were included in the study. The results of the random-effects model were demonstrated that the age-standardised rate (ASR) of TC was 1.13, 95% confidence interval (0.97–1.29) among Iranian males. Conclusion: ASR for TC in Iran is lower than the world average; however, it has a higher incidence than other Asian countries.

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The human body is a permissible medium, and radiofrequency electromagnetic field (RF-EMF) waves pass through this medium. The effects exerted by RF-EMF devices such as mobile phones on brain tissues are categorised into thermal and non-thermal effects. The aim of this review was to analyse the interactions and interface between RF-EMF exposure and the nervous system, to ascertain any negative impact on the nervous system at both cellular, molecular and systems level. Original studies that reported on the effects of RF-EMF exposure on the brain function and nervous system from inception to 20 August 2019 were searched online. The PubMed database was utilised. The MeSH system was used to excerpt relevant research studies from PubMed using the following keywords: electromagnetic field, radiofrequency, mobile phone, brain, central nervous system, radiation and neurophysiology. All selected articles were published in the English. Full articles were assessed, and relevant information was extracted. RF-EMF exposure significantly altered several neurophysiological mechanisms based on electroencephalogram studies and molecular and biochemical analysis. However, there was no substantial evidence linking RF-EMF exposure to the pathogenesis of brain tumour.

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Background: Statins are drugs used for locking the synthesis of cholesterol as it inhibits 3-hydroxy-3-methylglutaryl coenzyme A reductase. Besides action on cholesterol, statins also possess multiple pleiotropic actions such as anti-inflammatory, immunomodulatory, antioxidant, antithrombotic, angiogenesis promotion and increase in bone formation; other new pleiotropic effects of statins are continuously being described, but their clinical relevance has not been established. Objective: This systematic review and meta-analysis was planned to assess the effect of systemic or local statin therapy on clinical as well as radiographic periodontal parameters in patients with chronic periodontitis. Methodology: A search was performed in the electronic databases of MEDLINE/PubMed, EBSCO and Cochrane databases for randomised controlled trial on humans, and hand search was also carried out. The included articles were screened for their risk of bias and data extracted in predefined format. The meta-analysis was performed using comprehensive meta-analysis. Software: Random effects model was used for pooled analysis. Results: Six studies were included in systematic review having moderate to low risk of bias. Four studies were included in meta-analysis. Results of meta-analysis for clinical parameters such as clinical attachment level (1.95 mm), probing depth (2.28 mm) and marginal sulcular bleeding index (1.10) as well as for radiographic parameters such as intrabony defect (1.90 mm) were statistically significant for locally applied statins. Conclusion: As statins are effective and safe in short-term use and locally delivered and user-friendly, they can be more widely used in periodontal treatment.

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