Managing failed vital pulp therapies in mature permanent teeth in a retrospective cohort study, with success and survival rates of managing protocols

Despite advancements in vital pulp therapy (VPT), a subset of cases fails to achieve desired outcomes. This study based on a previous large-scale cohort study involving 1257 VPT-treated teeth, aiming to describe the demographic data and clinical characteristics of all failed cases and their management protocols. Clinical records/images of 105 failed cases treated by a single endodontist (2011-2022) were examined, including 10 extracted teeth. Asymptomatic cases with PDL widening received no intervention, while others underwent management protocols, including (selective) RCT and (tampon) re-VPT. These retreatments were assessed for success (defined as radiographic evidence of healing) and survival (characterized by the retention/function of the treated tooth) using Kaplan-Meier analysis. While 51.4% of all initial failures were diagnosed due to symptoms, 48.6% were symptom-free. Notably, failed cases with symptomatic irreversible pulpitis, and apical periodontitis/widened PDL before initial treatment significantly outnumbered asymptomatic cases and normal PDL, respectively (P = 0.001). Moreover, most of the initial failures were observed in teeth with composite resin rather than amalgam restorations (P = 0.002). The success and survival rates for the management protocols were 91.78% and 95.79%, respectively, over an average follow-up period of 36.94 (± 23.30) months. RCT and re-VPT procedures provide successful outcomes for managing unsuccessful VPTs.

Home vision therapy and prism prescription in presbyopic persons with convergence insufficiency: study protocol for a randomized controlled trial

BACKGROUND

Convergence insufficiency is a common issue in the field of binocular vision. Various treatment options have been suggested for managing this condition, but their efficacy in individuals with presbyopia remains unclear. The objective of this study is to compare the effectiveness of home-based vision therapy and prism prescription, in presbyopic patients with convergence insufficiency.

METHODS/DESIGN

It is a randomized, prospective, double-blind clinical trial, with total of 150 participants randomly assigned to the three groups. The Control Group will receive a new near glasses as a conventional prescription, along with aimless and random eye movement exercises that do not have any convergence or accommodation effects. The Home Vision Therapy Group will receive new near glasses with accommodative and convergence eye exercises. The Prism Group will receive a near prismatic glasses prescribed using the Sheard's criterion. All treatments will be administered for a period of 2 months, and measurements of the modified convergence insufficiency symptoms survey (CISS), near point convergence, near phoria, and positive fusional vergence will be taken at baseline, one month later, and at the end of the treatment.

DISCUSSION

We aim to identify which component - either the prism prescription or the home vision therapy - is more effective in improving binocular abilities and reducing patients' symptom scores.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05311917 with last update on 04/22/2023.

Comparison of a 30-year trend of incidence, prevalence, and DALY due to low back pain in Iran with Low- and High-SDI countries; Based on GBD study 2019 Data

Introduction

Low back pain (LBP) represents the leading cause of disability worldwide and is a major economic and welfare problem. This study aimed to report incidence, prevalence, and disability-adjusted life years (DALY) rates of LBP in Iran by gender and different sociodemographic index (SDI) countries from 1990 to 2019.

Methods

The age-standardized LBP and incidence, prevalence, and DALY were extracted based on the Global Burden of Disease (GBD) 2019 in Iran for males and females, and low- and high-SDI countries during 1990- 2019.

Results

GBD 2019 data for LBP in Iran indicate a significant downward trend of incidence and prevalence from 1993 to 2019 in males, females, and both, except during the 1999-2002 period for females. A sharp reduction is seen in LBP incidence and prevalence from 1996 to 1999. Gender is not a determining factor in the LBP prevalence in Iran. Regarding the SDI categories, Iran had the highest incidence rate compared to countries with low- and high SDIs. High-SDI countries had the highest prevalence and DALY compared with Iran and low-SDI countries.

Conclusion

The age-standardized incidence and prevalence of LBP in Iran showed a downward trend, from 1993 to 2019, especially from 1996 to 1999. Comparing Iran with low- and high-SDI countries, a heavier incidence of LBP was observed in Iran and heavier prevalence and DALY were seen in high-SDI countries. Therefore, more therapeutic healthcare interventions are required to reduce the LBP burden more effectively.

Outcomes and predictive factors of vital pulp therapy in a large-scale retrospective cohort study over 10 years

This cohort study evaluated the long-term success/survival of vital pulp therapies (VPTs) after carious pulp exposure in adult teeth. Additionally, factors influencing long-term success were identified. Teeth treated during 2011-2022 in a private clinic were studied with clinical/radiographic follow-ups. Data included patient demographics, tooth specifics, and treatment details. Outcomes were classified as success/failure based on clinical/radiographic findings, with tooth functionality determining the survival rate. Encompassing 1149 patients and 1257 VPT-treated teeth, the average monitoring period was 42.2 months. Overall VPTs' survival and success rates were 99.1% and 91.6%, respectively. Success rates for 768 direct pulp cappings, 217 miniature pulpotomies, and 272 full pulpotomies were 91.9%, 92.6%, and 90.1%, respectively (P > 0.05). Influencing factors included symptomatic irreversible pulpitis (SIP; HR 1.974, 95% CI 1.242-3.137; P = 0.004), radiographic signs of apical periodontitis (AP; HR 2.983, 95% CI 1.961-4.540; P < 0.001), restoration type (HR 2.263, 95%CI 1.423-3.600; P = 0.001), and restoration surfaces (HR 1.401, 95%CI 1.034-1.899; P = 0.030). This study concludes that VPT techniques consistently exhibit high long-term success/survival rates in treating carious pulp exposures. Critical predictors include initial clinical signs of SIP/AP, caries extent, and use of composite restorations.

A comparative evaluation of aluminum chloride hexahydrate gel iontophoresis versus tap water iontophoresis in people with primary palmar hyperhidrosis: A randomised clinical trial

Background Primary palmar hyperhidrosis causes a lot of problems for patients and negatively affects their quality of life. Currently, iontophoresis with tap water and aluminum chloride hexahydrate is used for primary palmar hyperhidrosis. Yet, little evidence exists about iontophoresis with aluminum chloride hexahydrate in the form of gel. This study investigated the effect of aluminum chloride hexahydrate gel iontophoresis compared to tap water iontophoresis on primary palmar hyperhidrosis. Methods In this randomised controlled trial study, 32 patients with primary palmar hyperhidrosis were divided randomly into two groups (n = 16). Participants received 7 sessions of iontophoresis with aluminum chloride hexahydrate gel or tap water every other day on the dominant hand. The sweating rate was measured by gravimetry and iodine-starch tests before and after the last treatment session. Results Following the iontophoresis, the rate of sweating in both hands in the two groups was significantly reduced (P < 0.001). However, the sweating rate in the treated hand and the non-treated hand showed no significant difference. There was no significant difference observed in sweating rate reduction between both groups over time, but the larger effect size values observed in the aluminum chloride hexahydrate gel iontophoresis group may suggest the superiority of this gel over tap water in reducing the rate of sweating. Limitations Further investigations with longer follow-up are needed to confirm the hypothesis regarding the effectiveness of aluminum chloride hexahydrate gel iontophoresis over other types of iontophoresis. In addition, contraindications of iontophoresis such as pregnancy, pacemakers, and epilepsy should be considered. Conclusion The present study provides preliminary evidence suggesting that aluminum chloride hexahydrate gel iontophoresis is an effective alternative treatment to decrease sweating rate in extended areas with fewer side effects in patients with primary palmar hyperhidrosis.

The association of endodontic prognostic factors with the presence of periapical lesion, its volume, and bone characteristics in endodontically treated molars: a cross-sectional study

BACKGROUND

This study intended to evaluate the association between several endodontic prognostic factors with the presence of periapical lesions (PLs), their volume, and bone characteristics including cortical bone destruction (CBD) and buccal plate bone height (BPBH) in root-filled molar teeth using cone-beam computed tomography.

METHODS

A collection of 143 scans of endodontically treated maxillary/mandibular first or second molars recorded over 8 years, were obtained from a specialized radiology center. Data on prognostic factors including tooth number, gender, jaw type, the status and number of missed canals, obturation length, restoration type, presence of a separated instrument, presence of a post or screw in the canals, and presence of perforation were collected. The assessed outcomes included PL presence, PL volume, CBD, and BPBH. The association between prognostic factors and outcomes was evaluated using multiple logistic regression models with adjusted covariates and multifactorial ANOVA at a significance level of 0.05.

RESULTS

A total of 282 molars from 82 women and 50 men with a mean age of 40.6 ± 12.27 were included. Among those, 139 teeth presented PL with a mean volume of 18.68 mm3. CBD was prevalent in 137 teeth and the mean BPBH appeared to be 9.45 mm. The presence of a missed canal (OR = 10.022, P < .05), underfilled canal (OR = 3.725, P < .05), overfilled canal (OR = 15.859, P = .018), and perforation (OR = 15.261, P = .013) was significantly associated with PLs. None of the prognostic factors could considerably contribute to the CBD (P > .05). The presence of a missed canal was positively associated with the PL volume (P < .05). Similarly, missed canals (P < .05), perforation (P < .05), and separated instruments (P = .004) were associated with a significantly reduced BPBH.

CONCLUSIONS

Overfillings, perforations, missed canals, and underfillings were identified as remarkable predictors of PL, arranged in descending order of their respective impact. The only factor capable of significantly increasing the PL volume was the missed canal. In brief, obturation length errors, perforations, missed canals, and separated instruments were robustly correlated with endodontic failure, which highlights the importance of mitigating the potential for errors by following the fundamentals of endodontics.

Primary and supplementary anesthetic efficacy of a modified two-step buccal infiltration of 4% articaine in mandibular molars with symptomatic irreversible pulpitis: a randomized clinical trial

OBJECTIVES

To evaluate a modified two-step buccal infiltration (MBI) of 1.7 mL 4% articaine as primary or supplemental anesthesia in mandibular first and second molars diagnosed with symptomatic irreversible pulpitis (SIP).

MATERIALS AND METHODS

One hundred and eight patients with SIP were randomly assigned to one of three groups (n = 36). They were given an inferior alveolar nerve block (IANB) of 2% lidocaine with 1:80.000 epinephrine or a primary MBI of 4% articaine with 1:100.000 epinephrine in the IANB and MBI groups, respectively. Patients in the IANB + MBI group received an IANB followed by an MBI. Pain levels during the injection, access cavity preparation, and initial filing were recorded on the Heft-Parker visual analog scale (HP-VAS). No or mild pain (HP-VAS ≤ 54) upon access cavity preparation and initial filing was considered a success. Chi-square and Kruskal-Wallis tests were used to analyze the data.

RESULTS

MBI (77.8%) and IANB + MBI (94.4%) had both significantly higher success rates than IANB (50.0%) (P < .001). However, when the Bonferroni adjustment was applied, there was no statistically significant difference between the MBI and IANB + MBI techniques (P = .041 > .017). MBI was associated with significantly less injection pain than IANB (P < .001).

CONCLUSIONS

Both primary and supplemental MBI with 4% articaine were superior to IANB with 2% lidocaine in mandibular first and second molars diagnosed with SIP. Further research may be needed to confirm the findings of this study.

CLINICAL RELEVANCE

The findings of this study suggest that supplemental or primary MBI can be a clinically viable alternative to IANB, which has a relatively low success rate when managing mandibular molars diagnosed with SIP.

Comparing the effectiveness of flexi-bar and stability exercises on postural control in chronic nonspecific low back pain: A randomized controlled study

Objectives

This study aimed to compare the effect of flexi-bar and stabilization exercises on static and dynamic postural control in patients with chronic nonspecific low back pain.

Patients and methods

In this randomized controlled study conducted between November 2019 and March 2020, 38 patients (19 males, 19 females; mean age: 33.8±6.2 years; range, 20 to 45 years) were randomly assigned into flexi-bar (n=19) and stabilization (n=19) groups. Both groups received general physiotherapy for three sessions per week, a total of 10 sessions. Besides, the flexi-bar group received flexi-bar exercises, and the stabilization group received stabilization exercises. Postural sway was assessed with a force platform in three difficult conditions, including open eye, close eye, and one-leg standing and dynamic posture with the modified Star Excursion Balance Test.

Results

After the intervention, both groups showed a significant improvement in static and dynamic postural control (p<0.05). However, no significant differences were found between groups after treatment, while only the phase-plane portrait of opened eyes condition was significantly improved (p=0.03), in the flexi-bar group compared to the stabilization group.

Conclusion

Both flexi-bar and stabilization exercises effectively improved static and dynamic postural control, but none of the exercises was superior to the other. Flexi-bar is recommended as an effective tool in low back pain rehabilitation.

Determinants of oral health status: an ecological study in Iran

OBJECTIVES

The aim of this ecological study was to assess the association between behavioral, social position, circumstance factors, and caries experience in 35- to 44-year-old adults in Iran at a provincial level.

MATERIALS AND METHODS

The data from the 2011 Iranian Oral Health Survey were obtained from all 31 provinces across Iran on the population level. Oral health status was measured as the number of decayed, missing (MT), and filled (FT) teeth and the percentage of the population who were edentulous. Data were also gathered from each province on the percentage of smokers (Non-Communicable Diseases Risk Factors Surveillance Provincial Report 2009), per capita consumption of free sugars, concentration of fluoride in the drinking water (National and Sub-national Burden of Disease (NASBOD) Survey), number of dentists per 10,000 people, mean years of schooling of adults, expected years of schooling of children, life expectancy at birth and Gross National Income (Integrated Public Use Microdata Series, Global Data Lab). The data were analyzed using simple and multiple linear regression (α = 0.05).

RESULTS

Mean DMFT was positively associated with the percentage of smokers (B = 0.01 95%CI 0.01-0.14), and negatively with fluoride concentration (B =-2.6 95%CI -4.3- -0.96). The edentulousness percentage was positively associated with smoking (B = 0.2 (with 95%CI: 0.07-0.37) and negatively with mean years of education (B =-1.08 (with 95%CI: -2.04- -0.12). DT was associated with expected years of schooling (B =-0.6 (with 95%CI: -1.07- -0.17), negatively. Mt was negatively associated with life expectancy (B =-0.5 (with 95%CI: -1.1- -0.007), fluoride concentration (B =-3.4 (with 95%CI: -4.5- -1.5) and number of dentists per 10,000 people (B =-0.4 (with 95%CI: -0.8- -0.01). Mean Years of Schooling (B = 0.5 (with 95%CI: 0.2-0.8) and number of dentists per 10,000 people (B =-0.62 (with 95%CI: 0.51 - 0.48) were positively in associated with FT.

CONCLUSIONS

The present findings indicate that there were differences in the oral health measures and their social determinants among the provinces of Iran. Regarding the limitations of the study especially the limitation of the number of independent variables, it seems, this discrepancy could be better explained by social variables of the provinces such as income than by environmental factors.

Correlation of alveolar bone thickness and central incisor inclination in skeletal Class I and II malocclusions with different vertical skeletal patterns: A CBCT study

INTRODUCTION

This study aimed to assess the alveolar bone thickness (ABT) and labiolingual inclination of maxillary and mandibular central incisors in patients with Class I and II skeletal patterns with normal-angle, high-angle, and low-angle vertical patterns.

METHODS

The study sample consisted of 200 cone-beam computed tomography scans of patients with skeletal Class I and II malocclusions. Each group was further divided into low-angle, normal-angle, and high-angle subgroups. Labiolingual inclinations of maxillary and mandibular central incisors and ABT were measured at 4 levels from the cementoenamel junction in the labial and lingual surfaces. The Kolmogorov-Smirnov test, independent t test, 2-way analysis of variance, and Spearman's correlation test were applied for statistical analyses.

RESULTS

The only significant difference between Class I and II groups regarding the ABT was found at the labial side of the maxillary central incisor, 9 mm apical to the crest. At this level, the mean ABT was 0.87 mm in patients with a skeletal Class I malocclusion, which was significantly greater than that in patients with a skeletal Class II malocclusion with a mean ABT of 0.66 mm (P = 0.02). Comparisons among the vertical subgroups revealed that on the labial and lingual sides of the mandible, as well as the palatal side of the maxilla, significantly thinner alveolar bone was found in patients with high-angle growth patterns than those with normal-angle and low-angle patterns in both sagittal groups (P <0.05). Significant weak to moderate correlations were found between ABT and tooth inclination (P <0.05).

CONCLUSIONS

Significant differences in ABT covering central incisors between patients with skeletal Class I and II malocclusion are merely observed at the labial surface of the maxilla, 9 mm apical to the cementoenamel junction. Compared with patients with normal-angle and low-angle, those with a high-angle growth pattern and Class I and II sagittal relationships have thinner alveolar bone support around maxillary and mandibular incisors.

Does Head Tilt Influence Facial Appearance More Than Head Turn?

Purpose

To evaluate the frequency of facial asymmetry parameters in patients with head tilt versus those with head turn.

Methods

This cross-sectional comparative study was performed on 155 cases, including 58 patients with congenital pure head turn due to Duane retraction syndrome (DRS), 33 patients with congenital pure head tilt due to upshoot in adduction or DRS, and 64 orthotropic subjects as the control group. The facial appearance was evaluated by computerized analysis of digital photographs of patients' faces. Relative facial size (the ratio of the distance between the external canthus and the corner of the lips of both face sides) and facial angle (the angular difference between a line that connects two external canthi and another line that connects the two corners of the lips) measured as quantitative facial parameters. Qualitative parameters were evaluated by the presence of one-sided face, cheek, and nostril compression; and columella deviation.

Results

The facial asymmetry frequency in patients with head tilt, head turn, and orthotropic subjects was observed in 32 (97%), 50 (86.2%), and 22 (34.3%), respectively (P < 0.001). In patients with head tilt and head turn, the mean facial angle was 1.78º ± 1.01º and 1.19º ± 0.84º, respectively (P = 0.004) and the mean relative facial size was 1.027 ± 0.018 and 1.018 ± 0.014, respectively (P = 0.018). The frequencies of one-sided nostril compression, cheek compression, face compression, and columella deviation in patients with pure head tilt were found in 19 (58%), 21 (64%), 19 (58%), and 19 (58%) patients, respectively, and in patients with pure head turn the frequencies were observed in 42 (72%), 37 (63%), 27 (47%), and 43 (74%), respectively. All quantitative and qualitative facial asymmetry parameters and facial asymmetry frequencies were significantly higher in head tilt and head turn patients as compared to the control group (P < 0.001).

Conclusion

All facial asymmetry parameters in patients with head tilt and head turn were significantly higher than orthotropic subjects. The quantitative parameters such as relative facial size and facial angle were significantly higher in patients with pure head tilt than pure head turn. The results revealed that pure head tilt was associated with a higher prevalence of facial asymmetry than pure head turn.

A novel multifaceted physical therapy approach for stress incontinence secondary to prostatectomy: Randomized controlled trial

METHOD

40 men with stress urinary incontinence (SUI) secondary to radical prostatectomy were randomly assigned to two groups (control = 20, treatment = 20). The treatment group received a novel multifaceted approach (including interferential therapy, a combination of exercise therapy approaches, and manual therapy) and the control group received sham electrotherapy. Both groups received 12 sessions of treatment in one month. Outcome measures include SF12 form to assess the quality of life and bladder diary to assess incontinence parameters including urination amount, fluid intake, urinary frequency, and incontinence frequency.

RESULT

treatment group shows significant improvement in comparison with the control group in quality of life (control group from 29.6 ± 4.5 to 31.0 ± 4.9 and the treatment group from 30.6 ± 4.4 to 42.2 ± 2.4, P = 0.003), urinary frequency (control group from 10.1 ± 2.0 to 9.2 ± 1.8 and treatment group from 9.7 ± 1.91 to 7.1 ± 1.1, P = 0.038), and incontinence frequency (control group from 7.0 ± 2.2 to 6.4 ± 2.0 and treatment group from 7.8 ± 2.4 to 1.2 ± 1.1, P = 0.003). Also, urination amount (control group from 1621.50 ± 403.7 to 1507.2 ± 402.3 and treatment group from 1638.3 ± 356.1 to 1360.55 ± 360.9, P = 0.503) and fluid intake (control group from 2024.0 ± 595.5 to 1865.2 ± 596.5 and treatment group from 2184.4 ± 484.5 to 1724.2 ± 596.6, P = 0.987) showed no significant difference between the two groups after the treatment sessions.

CONCLUSION

the multifaceted approach presented here, consists of electrotherapy (interferential therapy), exercise therapy, and manual therapy that can improve incontinence and quality of life in patients with stress incontinence secondary to prostatectomy. To determine the long-term efficacy of this approach, studies with long-term evaluation are required.

Reducing pain and discomfort associated with rubber dam clamp placement in children and adolescents: a systematic review and meta-analysis of effectiveness

BACKGROUND

The application of rubber dams is a widely accepted method of tooth isolation in dental practice. Placement of the rubber dam clamp might be associated with levels of pain and discomfort, especially in younger patients. The purpose of the present systematic review is to evaluate the efficacy of the methods for reducing pain and discomfort associated with rubber dam clamp placement in children and adolescents.

MATERIALS AND METHODS

English-language literature from inception until September 6th, 2022 was searched in MEDLINE (via PubMed), SCOPUS, Web of Science, Cochrane, EMBASE, and ProQuest Dissertations & Theses Database Global for articles. Randomized controlled trials (RCTs) comparing methods of reducing the pain and/or discomfort associated with rubber dam clamp placement in children and adolescents were retrieved. Risk of bias assessment was performed using a Cochrane risk of bias-2 (RoB-2) risk assessment tool and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profile. Studies were summarized and pooled estimates of pain intensity scores and incidence of pain were calculated. The meta-analysis was conducted in the following groups according to type of interventions (LA, audiovisual (AV) distraction, behavior management (BM), electronic dental anesthesia (EDA), mandibular infiltration, inferior alveolar nerve block (IANB), TA), outcome (intensity or incidence of pain), and assessment tool (face - legs - activity - cry - consolability (FLACC), color scale, sounds - motor - ocular changes, and faces pain scale (FPS)): (a) pain intensity using (LA + AV) vs (LA + BM), (b) pain intensity using EDA vs LA (c) presence or absence of pain using EDA vs LA (d) presence or absence of pain using mandibular infiltration vs IANB (e) Comparing pain intensity using TA vs placebo (f) Presence or absence of pain using TA vs placebo. Meta-analysis was conducted using StataMP software, version 17.0 (StataCorp, College Station, Texas). Restricted maximum-likelihood random effect model (REML), Mean difference (MD) with 95% confidence interval, and log odds ratio (OR) with 95% CI were calculated were calculated.

RESULTS

Initially, 1452 articles were retrieved. Sixteen RCTs were finally included for reviewing and summarizing. Nine articles with a total of 867 patients were included for quantitative meta-analysis. The differences in pain intensity scores were not significant in any comparison groups (group a: [MD = -0.04 (95% CI =  - 0.56, 0.47), P = 0.87, I2 = 0.00%], group b: [MD = 0.25 (95% CI = -0.08, 0.58), P = 0.14, I2 = 0.00%], group c [MD = -0.48 (95% CI = -1.41, 0.45), P = 0.31, I 2 = 0.00%], group d: [MD = -0.67 (95% CI = -3.17, 1.83), P = 0.60, I 2 = 0.00%], group e: [MD = -0.46 (95% CI = -l.08, 0.15), P = 0.14, I 2 = 90.67%], and group f: [MD = 0.61 (95% CI = -0.01, 1.23), P = 0.06, I 2 = 41.20%]. Eight studies were judged as having some concern for risk of bias and the remaining studies were considered as low risk for bias. The certainty of evidence was considered medium for all comparison groups.

DISCUSSION

In the present meta-analysis, a considerable difference was obtained between the included studies regarding intervention methods and pain assessment tools and the analysis was performed in groups with small numbers of the studies. Owing to the mentioned variabilities and the small number of studies, the results of the analysis should be interpreted with caution. The indistinguishability of the manifestations of pain/discomfort from fear/anxiety, particularly in children, should also be considered while using the results of the present study. Within the limitations of the current study, no significant differences were found between the proposed methods for reducing pain and discomfort associated with rubber dam clamp placement in children and adolescents. A larger number of more homogenous studies regarding intervention methods and pain assessment tools need to be conducted in order to draw stronger conclusions.

TRIAL REGISTRATION

This study was registered in PROSPERO (ID number: CRD42021274835) and research deputy of Mashhad University of Medical Sciences with ID number 4000838 ( https://research.mums.ac.ir/ ).

A Bibliometric Study on the Top 101 Most-Cited Articles of Dental Journals of the Middle East/North Africa Countries From 2011 to 2021

Introduction: This retrospective descriptive study evaluated the Scopus-indexed dental journals and their most-cited documents affiliated with the Middle East and North Africa (MENA) countries from 2011 to 2021. Methods: Dental journals affiliated with MENA countries, their bibliometric indicators (SJR, CiteScore, SNIP, and H-index), and the 101 most cited articles of the considered journals were extracted and studied through descriptive statistics. In addition, the "citation per year" of each top 101 articles was calculated. Spearman's rho test was used for pairwise comparisons of the correlation coefficient values between each two of the considered bibliometric indicators. Results: The number of citations of the 101 most-cited papers ranged from 35 to 203. The mean (SD) citations of studied articles were 61.33 (37.58) and the median was 46. Furthermore, CiteScore had the highest significant correlation with SJR (r=0.828, P˂0.001). Moreover, the citation per year of the top 101 documents had no significant relationship with any of the journals' bibliometric indicators. Conclusion: Because journal performance and citation rate are multi-dimensional concepts, a single metric cannot express them thoroughly despite correlations between indices. "European Journal of Dentistry" from Turkey, "Saudi Dental Journal" from Saudi Arabia, and "Iranian Endodontic Journal" and "Journal of Lasers in Medical Sciences" both from Iran had the highest ranks in the SCImago portal and the highest scores in bibliometric indices amongst the MENA dental journals.

Is Pattern of Acceptable Noise Level Growth for Apparently Normal Contralateral Ear Similar to Affected Ear in Unilateral Meniere’s Disease?

Background and Aim: The Acceptance Noise Level (ANL) which determines the tolerable noise level while listening to running speech, is related to factors such as hearing loss and speech presentation level. This study aims to investigate the effect of speech presentation level on the ANL in people with unilateral Meniere’s Disease (MD) compared to the normal-hearing people. Methods: In this study, 33 people aged 32–60 years with unilateral MD and 38 normal-hearing people aged 20–46 years participated. The ANL growth was evaluated unilaterally at four different speech presentation levels: Most Comfortable Level (MCL), –10 dB lower than the MCL, +10 dB higher than the MCL, and a range between MCL and uncomfortable level. Results: In MD patients, the ANL of the affected ear was significantly different from that of the contralateral ear (p<0.010). Compared to the normal-hearing people, the pattern of ANL growth in MD patients was significantly different, but the ANL growth patterns were similar between the affected and contralateral ears. Conclusion: ANL and its growth pattern are different between the affected and contralateral ears of patients with unilateral MD, but are similar compared to normal-hearing people. Despite the apparently normal hearing thresholds, the performance of the contralateral ear in noise at various speech presentation levels in patients with unilateral MD seems to be similar to that of the affected ear. Keywords: Meniere disease; hearing loss; acceptable noise level

Comparative Evaluation of Canal Transportation and Centering Ratio in Curved Canals: A Study of Cone-beam Computed Tomography and Micro-computed Tomography

Introduction

This study aimed to compare the accuracy and agreement between cone-beam computed tomography (CBCT) and micro-computed tomography (micro-CT) in the assessment of canal transportation and centering ratio following root canal instrumentation with rotary files.

Material and Methods

Twenty mesiobuccal canals of mandibular molars were prepared using the 2Shape sequential rotary system. CBCT and micro-CT scans were performed before and after instrumentation, and the magnitude of transportation and centering ratio were measured. The acceptable transportation was set at ≤0.15 mm. The accuracy and agreement between CBCT and micro-CT were calculated, and the intra-class correlation coefficient (ICC) and kappa coefficient were determined to assess the agreement between the two modalities. Statistical analyses were performed using repeated measures ANOVA.

Results

Transportation was detected by both modalities at all distances from the apex after instrumentation. The agreement between CBCT and micro-CT in assessing canal transportation was observed in 80%, 85%, 75%, and 75% of specimens at 1-, 3-, 5-, and 7-mm from the apex, respectively. The ICC for transportation and centering ratio was much lower than 0.75, indicating poor agreement between the modalities. The kappa coefficient did not show acceptable agreement between the methods.

Conclusions

CBCT and micro-CT demonstrated poor agreement in assessing canal transportation and centering ratio. Micro-CT remains the preferred modality for in vitro investigations, while CBCT should be limited to clinical settings.

Recovery of Quadriceps Strength and Knee Function Using Adjuvant EMG-BF After Primary ACL Reconstruction

Introduction: Immobility and limited usage of operated limbs lead to weakness and atrophy of the muscle after anterior cruciate ligament (ACL) reconstruction. However, training programs for preventing biomechanical risk factors such as lower limb alignment and increased muscular contraction are very limited. Thus, the current study was carried out to evaluate the recovery of quadriceps muscle strength and the improvement of knee function using adjuvant electromyographic biofeedback (EMG-BF) after ACL reconstruction. Methods: This prospective randomized controlled trial was conducted among 40 patients (20=EMG-BF group, 20=Control group) with ACL reconstruction, who were referred to Akhtar Hospital from 2021 to 2022. In the EMG-BF group, EMG BFB was added to the standard rehabilitation protocol, and in the control group, the standard rehabilitation protocol with full postoperative weight-bearing, knee brace (zero degree of extension, 90 degrees of flexion), and electrical stimulation with maximal voluntary isometric knee extension was performed. Each group was intervened for 4 weeks and three sessions of 30 minutes per week. It should be noted that each patient participated in 16 outpatient physiotherapy sessions after surgery. Nicholas Hand-Held Dynamometer (HHD) was used for measuring quadriceps strength, and Knee Outcome Survey-Activities of Daily Living (KOS-ADLs) and Knee Outcome Survey Sports Activities Scale (KOS-SAS) questionnaires were used for assessing the knee function. Results: Four weeks after the treatment, the EMG-BF group showed a significant increase in quadriceps strength (P=0.0001). Quadriceps strength had a significant difference before and after 4 weeks of intervention (P=0.0001), but in the control group, no significant difference was observed (P=0.368). The EMG-BF group had a significant increase in KOS-ADLs and KOS-SAS scores after 4 weeks of intervention (P=0.0001). Conclusion: In our study, isometric strengthening of quadriceps with adjuvant EMG-BF significantly increased the strength of quadriceps and knee function during 4 weeks. EMG-BF is a low risk, low cost, and less invasive intervention and has high safety and adjustment ability. It is a valuable adjuvant method for achieving better functional recovery in a shorter time.

Effects of One Session of Balance Exercises Combined With Olfactory Stimulation on the Static and Dynamic Balance of Patients With Stroke: A Randomized Clinical Trial

Background and Aims: Balance disorder in patients with stroke can cause the loss of independence and increase possibility of falling. The olfactory stimuli can activate the brain areas involved in balance activities. This study aims to investigate the effect of balance exercises combined with olfactory stimuli on the balance of patients with stroke. Methods: In this randomized clinical trial, 32 patients with stroke were randomly assigned into groups of balance+olfactory stimulation and balance. The first group performed the balance exercises while wearing a mask containing the lavender essential oil. The second group performed the balance exercises while wearing a mask containing distilled water. Both groups performed the exercises for 20 min at one session. The timed up & go (TUG) test, 10-m walk test with self-selected speed, and Mini-Balance Evaluation Systems Test (Mini-BEST) were used for assessments. The data were analyzed in SPSS software, version 22. P<0.05 was statistically significant. Results: The mean score of 10-m walk test before and after the intervention was significantly different (decreased) in the combined group (P=0.001) and balance group (P<0.001). The mean TUG score before and after the intervention was also significantly different (decreased) in the combined group (P= 0.008) and balance group (P=0.003). The mean score of mini-BEST before and after the intervention was also significantly different (increased) in the combined group (P=0.001) and balance group (P= 0.008). No significant difference was observed in the mean scores of 10-m walk test (P=0.386), TUG test (P=0.720) and mini-BEST (P=0.152) between the two groups before and after the intervention. Conclusion: One session of balance exercise can improve the static and dynamic balances of patients with stroke. Including the olfactory stimulation by the lavender essential oil in the balance exercise program has no significant effect. It is recommended that the effects of long-term use of different olfactory stimuli on the balance of patients with stroke should be investigated in the future studies.

Effect of ankle-foot orthoses on functional outcome measurements in individuals with stroke: a systematic review and meta-analysis

PURPOSE

To determine and compare the effect of ankle-foot orthosis (AFOs) types on functional outcome measurements in individuals with (sub)acute or chronic stroke impairments.

METHODS

PubMed, Web of Knowledge, Embase, Scopus, ProQuest, and Cochrane were searched from inception until September 2020. Methodological quality assessment of 30 studies was conducted based on the Downs and Black checklist. Functional indices were pooled according to their standardized mean difference (SMD) and 95% confidence intervals (CI) in a random-effect model. A narrative analysis was performed where data pooling was not feasible.

RESULTS

Overall pooled results indicated improvements in favor of AFOs versus without for the Berg Balance Scale (SMD: 0.54, CI: 0.19-0.88), timed-up and go test (SMD: -0.45, CI: -0.67 to -0.24), Functional Ambulatory Categories (SMD: 1.72, CI: 1.25-2.19), 6-Minute Walking Test (SMD: 0.91, CI: 0.53-1.28), Timed Up-Stairs (SMD: -0.35, CI: -0.64 to 0.05), and Motricity Index (SMD: 0.65, CI: 0.38-0.92). Heterogeneity was non-significant for all outcomes (I² < 50%, p > 0.05) except the Berg Balance Scale and Functional Ambulatory Categories. Additionally, there was not sufficient evidence to determine the effectiveness of specific orthotic designs over others.

CONCLUSIONS

An AFO can improve ambulatory function in stroke survivors. Future studies should explore the long-term effects of rehabilitation using AFOs and compare differences in orthotic designs.IMPLICATIONS FOR REHABILITATIONAn AFO can improve functional performance and ambulation in survivors of strokes.Wearing an AFO in rehabilitation care during the subacute phase post stroke may have beneficial effects on functional outcomes measured.There was no evidence as to the effectiveness of specific AFO designs over others.

Anesthetic efficacy of supplemental buccal infiltration versus intraligamentary injection in mandibular first and second molars with irreversible pulpitis: a prospective randomized clinical trial

Background

To compare the anesthetic efficacy of supplemental buccal infiltration (BI) (1.7 ml) versus intraligamentary (IL) injection containing 0.4 ml of 4% articaine with 1:100.000 epinephrine after an inferior alveolar nerve block (IANB) with 1.7 ml 2% lidocaine in the first and second mandibular molars diagnosed with irreversible pulpitis (IP).

Methods

One hundred subjects diagnosed with IP of either the mandibular first (n = 50) or second molars (n = 50) and failed profound anesthesia following an IANB were selected. They randomly received either the IL or BI techniques of anesthesia. Pain scores on a 170 mm Heft-Parker visual analog scale were recorded initially, before, and during supplemental injections. Furthermore, pulse rate was measured before and after each supplemental injection. During the access cavity preparation and initial filing, no or mild pain was assumed to indicate anesthetic success. The chi-square test, Mann-Whitney U test, and independent samples t-test were used for the analyses.

Results

The overall success rates were 80% in the IL group and 74% in the BI group, with no significant difference (P = 0.63). In the first molars, there was no significant difference between the two techniques (P = 0.088). In the second molars, IL injection resulted in a significantly higher success rate (P = 0.017) than BI. IL injection was statistically more successful (P = 0.034) in the second molars (92%) than in the first molars (68%). However, BI was significantly more successful (P = 0.047) in the first molars (88%) than in the second molars (64%). The mean pulse rate increase was significantly higher in the IL group than in the BI group (P < 0.001).

Conclusions

Both the IL and BI techniques were advantageous when used as supplemental injections. However, more favorable outcomes were observed when the second molars received IL injection and the first molars received BI.

Fear of Falling and Balance Confidence in Older Adults with Type 2 Diabetes

Background and Aim: Each year, millions of older people experience falling which can cause serious injuries such as broken bones, head injuries, or even death. Since Diabetes Mellitus can disrupt the balance system and increase falling, and given that fear of falling and balance confidence are critical fall-related psychological concerns that can be the risk factors of falls in the diabetic elderly, this study aimed to compare fear of falling and balance confidence of diabetic and non-diabetic older adults in Iran. Methods: Participants were 63 diabetic older patients and 59 non-diabetic peers aged 60 years and over. Data were collected using the Persian versions of falling efficacy scale-international and activities-specific balance confidence-short form questionnaires. In addition, modified Romberg and timed up and go tests were performed to assess subjective balance performance. Results: The scores of falling efficacy scale-international questionnaire and timed up and go test were significantly higher in diabetic group while the scores of activities-specific balance confidence-short form questionnaire were lower (p<0.001). No significant differences were observed in the modified Romberg test scores between two groups. Conclusion: Fear of falling and low balance confidence are more common in diabetic older adults compared to non-diabetic peers. They have poor performance in timed up and go test and have more falls during the last 12 months. Keywords: Type 2 diabetes mellitus; aging; fear of falling; balance confidence

A survey of coping strategies and resilience in women victims of domestic violence during the COVID-19 pandemic in Tehran, 2020

BACKGROUND

Domestic violence against women is a hidden and global epidemic that has many negative effects. The COVID-19 pandemic, quarantine, and staying at home can lead to violent and domestic violence against women. Due to the importance of the subject, the present study was conducted to investigate the coping strategies and resilience of women victims of domestic violence in the COVID-19 epidemic in Tehran, 2020.

METHODS

The present study is a descriptive-analytical study on 420 women who suffered domestic violence in Tehran, 2020. Data collection tools included a demographic information form, socioeconomic status questionnaire, WHO standardized domestic violence questionnaire, Connor-Davidson Resilience Scale, and Endler and Parker's coping strategies questionnaire. This study was based on the Internet and online. The research poster, the characteristics of the participants, the voluntary participation in the study, the confidentiality of the information, and the link to the online questionnaire were made public through Internet networks.

RESULTS

There was no correlation between resilience with general violence (p =.221), types of physical violence (p =.502), psychological violence (p =.178), and sexual violence (p =.386). The results also showed that there was a statistically significant difference between the women who were using or not using a problem-oriented style with physical violence, using or not using an emotion-oriented style with physical, psychological, sexual violence, and using or not using an avoidance style with physical violence among the samples (p < .05).

CONCLUSION

The use of coping strategies leads to a reduction in domestic violence against women during the COVID-19 pandemic. Therefore, designing and implementing training programs to improve coping styles in women can be effective in dealing with such stressful situations and help prevent injuries caused by violence.

Comparing Sensory Processing and Perceived Motor Competence Between Three Groups of Students with Special Learning Disabilities

Introduction: Identifying the contributing factors to a specific learning disorder and comparing these factors in different types of this disorder will lead to using more proper interventions in the future. Therefore, this study aimed to compare sensory processing skills and perceived motor competence between three groups of students with specific learning disabilities (reading and writing disorders, math disorders, and combination disorders). Materials and Methods: The present study was a cross-sectional descriptive-analytical study. The participants were 48 children (16 in each group, aged 8-12 years). They were selected from Chaharmahal and Bakhtiari Province, Iran, by the simple convenience sampling method. The participants’ sensory processing was measured with sensory profile 2 and their perceived motor competency with Marsh perceived motor competence questionnaire. Results: The results showed a significant difference between the three groups in the sensory sensitivity, low registration sensory patterns and processing of tactile, and body position senses (P <0.05). However, no significant differences were observed between groups in other components of sensory processing and perceived motor competence (P> 0.05). Conclusion: The results indicate that therapeutic interventions in the group with reading and writing disorders should focus on increasing sensory registration and processing of tactile and body position senses and reducing sensory sensitivity in the mathematical group.

Prioritized Commitment-Based Clinical Assessment: A New Method for Assessment of Orthodontic Treatment Outcomes

OBJECTIVE

Quality assessment is an essential part of orthodontic treatment. Most of the current indices are essentially based on occlusal assessment. However, an ideal occlusion is only one aspect of an ideal treatment. The aim of this article is to introduce a new prioritized commitment-based clinical assessment (PCCA) method and present its reliability and linear correlation test in comparison with the comprehensive clinical outcome assessment (CCA).

METHODS

One hundred treated cases were scored with the conventional assessment tool--the CCA--and the newly developed assessment tool--the PCCA--with 2 calibrated examiners at 2 different time intervals. These cases were randomly selected including equal numbers of the main malocclusions managed with fixed conventional edgewise appliances within the past 3 years and had complete pre-treatment and post-treatment routine records. The intraclass correlation coefficient (ICC) was used to assess the intra- examiner repeatability of the total scores of both methods. Pearson's correlation coefficients were computed to assess the linear relationships between the CCA and PCCA scores.

RESULTS

The intra-examiner reliability assessed for CCA and PCCA showed high repeatability for both examiners (ICC: 0.93 and 0.945, respectively). The inter-examiner reliability values for CCA and PCCA, assessed by ICC, were 0.84 and 0.96, respectively. The linear correlation between the 2 methods, assessed by comparing the mean score of each case by the 2 examiners was significant, at 0.01.

CONCLUSION

The PCCA method can be used for quality assessment in treated orthodontic patients. The preliminary test of the new method presented good inter- and intra-observer agreements and a significant linear correlation with the CCA method.

Stroke Patients Showed Improvements in Balance in Response to Visual Restriction Exercise

OBJECTIVE

Several strategies have been designed to improve balance after stroke. Although recent studies have suggested that the balance training in stroke should include exercises that are performed in different sensory conflict conditions, little attention has been paid to manipulation of visual input. This study aimed to compare effects of balance training on an unstable surface with balance training under visual deprivation conditions in persons with stroke.

METHOD

Forty-five stroke patients were randomized into three groups: the visual deprivation- stable based training (VD-SBT); unstable based training (UBT); and control (C) groups. Subjects of the VD-SBT group performed balance training on a stable surface with closed eyes. The UBT group performed balance training on an unstable surface with open eyes. Patients were assessed before and after interventions for Timed Up and Go (TUG), Four Square Step (FSS) and Five Times Sit to Stand (FTSS) tests.

RESULT

There was a significant difference in pre- post intervention time of TUG, FSS and FTSS tests in all three groups. In a comparison of three groups, the UBT and VD-SBT groups had a significant improvement in time of all tests but significant improvement in time of all tests was observed in the VD-SBT group in comparison with the UBT group. In the field of balance training, the manipulation of visual input was more effective than the manipulation of standing surface to reweighting the sensory information.

CONCLUSION

We recommended balance rehabilitation programs after stroke performed under conditions to stimulate the use of underused sensory input.

Acceptable Noise Level in Unilateral Ménière’s Disease

Background and Aim: Noise tolerance and performance in noisy environments are influential factors of hearing aid use in people with hearing loss. One of the causes of hearing loss is Meniere’s disease (MD), which affects speech perception in noise. Acceptable noise level (ANL) is a test that measures the maximum tolerated background noise level (BNL) while listening to the running speech. Since the effect of MD on ANL needs further study, the present study aims to examine the ANL test results in people with unilateral MD, and compare the results between the two ears. Methods: This cross sectional study conducted on 33 individuals with unilateral MD (21 females and 12 males) aged 32–60 years who had the disease for at least one year, who participated in this study. Their most comfortable level (MCL), BNL, and ANL in both ears were then evaluated. Results: The mean MCL and BNL were significantly different between the two ears, where they were higher in the affected ear than in the contralateral ear. There was also a significant difference in the ANL results between the two ears. In the affected ear, a statistically significant relationship was reported between the ANL and the average hearing thresholds at frequencies of 250, 500, and 1000 Hz. Conclusion: MD affects the ANL in the affected ear and causes a deterioration in its level and speech perception in noise.

Effect of Musical Training on Temporal Resolution and Temporal Fine Structure Processing

Background and Aim: Many aspects and features of auditory system can be improved by musical training. This study aimed to investigate the effects of a stringed musical instrument playing course on temporal resolution and temporal fine structure (TFS) processing. Methods: This analytical cross-sectional study was conducted on 44 normal-hearing adults aged 20–40 years divided to two groups. The first group included 22 stringed musical instruments players (13 males) with at least three years of experience, and the second group were 22 non- players (13 males). The random gap detection test (RGDT) was used to measure temporal resolution aspect of hearing. For TFS processing, latest version of temporal fine structure-adaptive frequency (TFS-AF) test was used. Results: The TFS-AF results showed no statistically significant difference between groups in different interaural phase differences (IPDs). The RGDT results showed significant differences between groups at 500, 1000 and 2000 Hz, but not at 4000 Hz. Spearman correlation test results showed no statistically significant correlation between the results of TFS-AF and RGDT. Conclusion: Musical training has no effect on TFS processing but considerably enhances gap detection ability. Their underlying mechanisms for TFS processing and gap detection are different.

Development and Psychometric Evaluation of Persian Dynamic Spatial Quick Speech-in-Noise Test in Adults with Normal Hearing

Background and Aim: Spatial hearing is a prerequisite for the proper function of the listener in complex auditory environments. In the present study, a Persian version of the dynamic spatial-quick speech in noise (DS-QSIN) has been developed with respect to all possible factors affecting the test and to run five lists for normal hearing subjects and assessment of reliability. Methods: To construct five new lists according to the original quick speech in noise (QSIN) test, we used frequent, familiar, and difficult words to construct unpredictable sentences. After determining the content and face validity of the sentences, 30 selected sentences were played using a DS-QSIN software for 35 subjects aged 18–25 years. The reliability of the test was assessed after repeating the test after two weeks. Results: According to expert judges, these 30 sentences showed acceptable  content  and  face validity with the changes. The average signal-to-noise ratio (SNR) loss of five lists was –5.2 dB. No significant difference was seen between men and women in all lists. The results indicate no difference in the average SNR loss between the five lists. Regarding the reliability assessment, the test-retest correlation coefficient was 0.5 to 0.7 (p<0.05). The intra-class correlation coefficient between test-retest was statistically significant (p>0.001) and confirmed that the lists have high reliability and repeatability. Conclusion: DS-QSIN test showed good validity and reliability and can be helpful in diagnosis and selecting the best method for rehabilitation of people with a spatial hearing disorder.

Arm proprioception in lateral epicondylalgia; a cross-sectional study

Introduction: Lateral epicondylalgia is one of the most common injuries due to overuse with inflammation of the elbow on the lateral epicondyle. Although the clinical features of this disorder are well defined, few therapeutic intervention has been effective. Objectives: This study aimed to investigate the proprioception in the upper limb of patients with lateral epicondylalgia, using the sense of joint position and of force reproduction tests. Participants and Methods: Twenty patients with unilateral lateral epicondylalgia and 20 healthy subjects participated in this study. The evaluation of position sense of shoulder, elbow and wrist, and force reproduction sense of shoulder abductor, elbow flexor and wrist extensor were conducted. The proprioceptive performance was determined, using absolute, constant and variable error values. Results: Significant differences were found for the sense of the position of the elbow and wrist between the lateral epicondylalgia and control groups for the variables of absolute error (P=0.003 and P=0.02, respectively) and constant error (P=0.001, P=0.03, respectively). A significant difference was also observed for the sense of force of the elbow flexor and wrist extensor between the two groups for the variables of absolute error (P=0.02 and P=0.02, respectively) and constant error (P=0.016 and P=0.001, respectively). No statistical difference was found for variable errors neither in sense of position nor sense of force (P>0.05). Conclusion: The data confirmed the hypothesis of proprioception deficits in subjects with lateral epicondylalgia, compared to the healthy subjects during the evaluation of the sense of force and position.

Prevalence of refractive errors and color vision deficiency in a population of industry-workers in Abhar, Iran

Visual impairment due to refractive errors and color vision deficiency (CVD) can affect the visual abilities of workers in workplace. Identifying the prevalence of common visual problems helps us to prevent and treat occupational ocular problems.This study was conducted on 2600 males referring from companies for a routine medical exam to Occupational Medicine Center. In all subjects, visual acuity and refraction were measured. Assessment of color vision was performed by Ishihara color test. In present study, right eyes of subjects were selected to statistical analysis.The mean spherical equivalent was -0.19 ± 1.39 diopter with a range of -11.00 to +10.00 diopter. Whereas 71% of persons were emmetropic, 20% and 9% of them were myopic and hypermetropic, respectively. From a total subjects, 164 of them had CVD with prevalence of color blindness of 6.3%. In comparison with normal subjects, CVD had no significant effect on refractive findings of our subjects (P > .05).Our data present the prevalence of refractive errors and color blindness among Iranian industry-workers. Compared with other studies, our subjects have a lower prevalence of refractive errors, and similar rate of prevalence of color blindness.

The Correlation between Hypertropia and Head Tilt in Congenital Unilateral Superior Oblique Muscle Palsy

Purpose:

To evaluate the correlation between the angle of deviation in different gazes and the amount of head tilt in patients with congenital unilateral superior oblique muscle palsy (SOP).

Methods:

This case series study was performed on 20 consecutive SOP patients with head tilt. Based on the Bielschowsky three-step test, the angle of deviation was measured in different gazes. Furthermore, the hypertropia difference between the two lateral gazes (gaze difference) and the two head tilt sides (bilateral head tilt difference) was calculated. For measuring head tilt, close-up pictures from 40 cm with a habitual abnormal head position were captured and analyzed by the Corel Draw X7 software.

Results:

The mean age of patients was 13 ± 9 years (range, 2.5–31 years). The mean angle of hypertropia in ipsilateral and contralateral head tilt was 24.5 Δ ± 7.1 Δ and 6.5 Δ ± 4.2 Δ, respectively (P < 0.001), and in ipsilateral and contralateral lateral gaze positions, it was 8.2 Δ ± 5.5 Δ and 22.5 Δ ± 6.1 Δ, respectively (P < 0.001). The mean of bilateral head tilt hypertropia difference was 18 Δ ± 5.3 Δ and gaze hypertropia difference was 14.3 Δ ± 6.16 Δ. There was a positive correlation between bilateral head tilt hypertropia difference and the amount of head tilt (R = 0.609, R² = 0.371, P = 0.004, the amount of head tilt = 0.39 × [Bilateral head tilt hypertropia difference] +1.77). The amount of head tilt also had a positive correlation with the gaze hypertropia difference (R = 0.492, R² = 0.242, P = 0.028, the amount of head tilt = 0.27 × [gaze hypertropia difference] +4.81).

Conclusion:

In SOP patients, the amount of head tilt had a positive correlation with bilateral head tilt hypertropia difference and also gaze hypertropia difference.

Facial Asymmetry in Unilateral Congenital Superior Oblique Muscle Palsy

SIGNIFICANCE

This study was conducted to evaluate facial asymmetry in unilateral congenital superior oblique muscle palsy (SOP). The results showed that all facial asymmetry parameters had a higher frequency in SOP patients compared with orthotropic individuals.

PURPOSE

This study aimed to evaluate the characteristics of facial asymmetry in unilateral congenital SOP and compare with orthotropic individuals.

METHODS

This cross-sectional comparative case series was conducted in 58 patients with ocular torticollis caused by SOP (mean ± standard deviation age, 18 ± 12 years) and 58 orthotropic individuals (mean ± standard deviation age, 19 ± 13 years). The exact form of torticollis was determined by direct observation from yaw, roll, and pitch axes. Four photographs were taken from patients: (1) with torticollis to calculate the amount of head tilt; (2) with the head in the straight position to calculate the facial angle and relative facial size (RFS); and (3 and 4) with the head positioned downward (to compare the cheek size) and upward (to assess columella deviation and nostril asymmetry).

RESULTS

Twenty-nine patients (50%) had a head tilt, 23 (39.66%) had combined head tilt and a face turn, and 6 (10.44%) had a pure face turn. The mean ± standard deviation of head tilt, facial angle, and RFS was 10.11 ± 6.31°, 1.11 ± 1.67°, and 1.003 ± 0.126 in SOP patients, respectively, and the mean RFS and facial angle were significantly higher in SOP patients compared with orthotropic individuals (both P < .001). Facial hemihypoplasia, unilateral cheek compression, nostril asymmetry, and columella deviation were observed in 43 (74.1%), 31 (53.4%), 39 (67.2%), and 38 patients (65.5%), respectively, which were all significantly more common compared orthotropic individuals (P < .001). Facial asymmetry was seen in 52 patients (91.2%) and 17 orthotropic subjects (29.3%), respectively (P < .001).

CONCLUSIONS

All quantitative and qualitative facial asymmetry parameters had a higher frequency in SOP patients compared with orthotropic subjects.

Mapping the Relative Risk of Congenital Hypothyroidism Incidence via Spatial Zero-Inflated Poisson Model in Guilan Province, Iran

Background:

Congenital hypothyroidism (CH) is one of the most prevalent preventable causes of mental retardation. Studies show that the incidence rate of CH is very high in Iran. Disease mapping is a tool for visually expressing the frequency, incidence, or relative risk of illness. The present study aimed to model CH counts considering the effects of the neighborhood in towns and perform mapping based on the relative risk.

Methods:

In this historical cohort study, data of all neonates diagnosed with CH with TSH level ≥5 mIU/L between March 21, 2017, and March 20, 2018, in health centers in Guilan, Iran were used. The number of neonates with CH was zero in most towns of Guilan Province. The Bayesian spatial zero-inflated Poisson (ZIP) regression model was employed to investigate the effect of the town's neighborhood on the relative risk of CH incidence. Then, the map of the posterior mean of the relative risk for CH incidence was provided. The analysis was performed using OpenBUGS and Arc GIS software programs.

Results:

The relative risk of CH incidence was high in the West of Guilan. Moreover, the goodness-of-fit criterion indicated that it is more appropriate to fit the Bayesian spatial ZIP model to these data than the common model.

Conclusions:

Considering the high relative risk of CH in the Western towns of Guilan Province, it is better to check important risk factors in this region.

Comparison of the effects of instrument assisted soft tissue mobilization and dry needling on active myofascial trigger points of upper trapezius muscle

Background: Myofascial pain syndrome is one of the most common complaints in patients referring to orthopedic treatment centers. The present study aimed to examine the effects of instrument-assisted soft tissue mobilization (IASTM) and dry needling (DN) on active myofascial trigger points (AMTrP) of the upper trapezius muscle (UTM). Methods: The current study was designed as a randomized clinical trial and a total of 81 patients, aged 18-40 years, with active myofascial trigger points in the upper trapezius muscle were randomly divided into 3 groups: group 1 (n = 30) received DN treatment, group 2 (n = 26) received IASTM treatment, and group 3 (n = 25) was considered as the control group (no intervention). The numeric pain scale (NPS), pain pressure threshold (PPT), active cervical contra-lateral flexion (ACLF), neck disability index (NDI), and muscle thickness (MT), according to rehabilitative ultrasonic imaging (RUSI), were measured at baseline, immediately after the last session (session 4 in week 2), and 1 month after the last session. The statistical analysis was conducted at a 95% confidence level. The P values less than.05 were considered as statistically significant. Results: Both techniques were effective in treating active trigger point of the upper trapezius (p<0.05), but there was no significant difference between the treatment groups in terms of any of the above variables except for ACLF (p>0.05) Conclusion: Both IASTM and DN were determined to improve NPS, PPT, ROM, and NDI in participants with active trigger points in the upper trapezius, although IASTM was more effective in increasing ACLF in these patients.

Effect of axial length and anterior chamber depth on the peripheral refraction profile

AIM

To evaluate the effect of axial length (AL) and anterior chamber depth (ACD) on peripheral refractive profile in myopic patients compared to emmetropic participants.

METHODS

This cross-sectional study was conducted in right eyes of 58 participants of whom 38 were emmetropic and 20 were myopic. Central and peripheral refraction were measured at 10°, 20°, and 30° eccentricities in nasal and temporal fields using an open-field autorefractor. The Lenstar LS900 was used to measure ACD and AL. The participants were divided into three groups of short (<22.5 mm), normal (22.5-24.5 mm), and long eye (>24.5 mm) according to AL and three groups of low ACD (<3.00 mm), normal ACD (3.00-3.60 mm), and high ACD (>3.60 mm) according to ACD.

RESULTS

The mean age of the participants was 22.26±3.09y (range 18-30y). The peripheral mean spherical refractive error showed a hypermetropic shift in myopic and emmetropic groups although this shift was more pronounced in the myopic group. The results showed significant changes in the spherical equivalent, J0, and J45 astigmatism in all gazes with an increase in eccentricity (P<0.001). The pattern of refractive error changes was more noticeable in long and short eyes versus normal AL eyes. Moreover, the pattern of peripheral refractive changes was much more prominent in the high ACD group versus the normal ACD group and in the normal ACD group versus the low ACD group.

CONCLUSION

Peripheral refraction changes are greater in participants with AL values outside the normal range and deeper ACD values compared to participants with normal AL and ACD.

Effect of voxel size on detection of fenestration, dehiscence and furcation defects using cone-beam computed tomography

OBJECTIVES

This study aimed to assess the effect of voxel size on detection of fenestration, dehiscence, and furcation defects using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

This in vitro, experimental study evaluated 4 sheep skulls with both the maxilla and mandible accompanied by the surrounding soft tissue. Fenestration (n = 30), dehiscence (n = 65), and furcation defects (n = 46; 18 grade I, 25 grade II, and 3 grade III) were randomly created by round and needle burs in both jaws, and 40 areas served as control sites. CBCT scans were obtained with 0.300 and 0.150 mm³ voxel sizes and 8 × 11cm² field of view (FOV), and were randomly observed by four observers (two oral and maxillofacial radiologists and two periodontists). The kappa values, sensitivity and specificity were calculated for each voxel size and compared using paired t test.

RESULTS

By an increase in image resolution, diagnostic sensitivity increased while specificity decreased. The kappa values for fenestration (0.602-0.623), and grade III furcation defects (0.903-1.00) were optimal (> 0.6), and almost similar for both voxel sizes. The kappa values for dehiscence, and grades I and II furcation defects were unfavorable (< 0.6) and almost similar for both voxel sizes, except for grade I furcation defects, which had a significant difference in kappa values between the two voxel sizes (0.014 and 0.34).

CONCLUSION

Smaller voxel size had higher sensitivity and lower specificity for detection of all defects except for grade I furcation defects, for which the smaller voxel size had higher sensitivity and higher specificity.

Combined Balance Training and tDCS Intervention for the Recovery of Postural Control Following Chronic Stroke: A Study Protocol for A Multi-Centre, Double Blind, Randomized Control Trial

Background: Stroke is one of the most debilitating diseases among the adults around the world which leads to persistent rehabilitation needs even at chronic stage. Achievement of good postural control is a critical requirement for daily activities which enhances quality of life in patients with stroke. There is increasing evidence that transcranial direct current stimulation (tDCS) may be considered as a promising adjunct technique to improve motor recovery after stroke. Evidence of augmented neuroplasticity after tDCS suggests that a paired rehabilitation followed by consecutive use of tDCS may optimize recovery outcomes. Although a few RCTs have been conducted on upper limbs rehabilitation in chronic stroke using tDCS, however no study focused on balance training in chronic stroke patients. This randomized, sham-controlled, double-blinded clinical study aims to address brain stimulation targeting postural control using tDCS in chronic stroke. Methods: The study participants will be chronic ischemic stroke individuals with postural control impairments who meet no exclusion criteria. Active or sham anodal tDCS will delivered to lesioned leg motor cortex combined with balance training. Experimental group receive active anodal tDCS stimulation (2mA) for 20 min, daily for 5 days paired with balance training. Linear and nonlinear approaches will be used to analyse postural sway changes pre and post-intervention. Postural sway fluctuation, Functional balance assessment using Berg balance scale, Timed Up-and-Go Test will be compared in active and sham groups. Conclusions: This trial could have significant implications for balance rehabilitation after stroke in the ambulatory setting. If found to be effective, this novel approach may improve rehabilitation protocol in this population.

Ocular abnormal head posture: A literature review

Purpose:

Methods:

Results:

Conclusion:

Abnormal Head Posture in Unilateral Superior Oblique Palsy

Purpose: To evaluate the manifestations and severity of abnormal head posture (AHP) in unilateral congenital and acquired superior oblique palsy (SOP) patients and to assess the effect of AHP on facial appearance. Patients and methods: This case series study was performed on 60 consecutive SOP patients, which consisted of 47 patients with congenital SOP and 13 patients with the acquired source. The exact type of AHP in congenital and acquired cases was determined based on direct observation. In addition, a close-up picture from 40 cm with habitual AHP was captured from all patients. For evaluation of the severity of AHP and measurement of head tilt, these pictures were analyzed by the Corel Draw X7 software (Corel Corp, Canada). Besides, qualitative and quantitative facial asymmetry parameters were evaluated by the assessment of pictures of patients, which were taken in different gazes. Results: Five different manifestations of AHP were observed to the contralateral side of the palsy; 1 - pure head tilt, 2 - simultaneous head tilt and turn, 3 - pure head turn, 4 - head tilt and chin down, and 5 - head tilt and turn with chin down. The frequency of these five manifestations of AHP in the congenital group were 23 (48.9%), 10 (21.3%), 4 (8.5%), 5 (10.6%), and 5 (10.6%) patients, respectively (P <.001) and in acquired patients, were 1 (7.7%), 8 (61.5%), 2 (15.4%), 2 (15.4%), and 0 (0%), respectively (P =.024). In all SOP patients, the most common manifestations of AHP were pure head tilt (40%), simultaneous head tilt and turn (30%), and head tilt with chin down (11.7%), respectively. The mean degrees of head tilt in congenital and acquired patients were 15.10° ± 9.34° and 9.61° ± 5.84°, respectively (P =.022). Conclusion: The most common type of AHP in congenital SOP patients was contralateral head tilt, but in acquired cases was simultaneous head tilt and turn. The mean amount of head tilt in the acquired group was significantly higher than congenital patients; in contrast, the frequency of facial asymmetry was higher in the congenital group compared with the acquired patients.

Postural Balance Evaluation in Patients with Chronic Obstructive Pulmonary Disease

BACKGROUND

The risk of falling in patients with chronic obstructive pulmonary disease (COPD) is higher than healthy people, imposing a great financial burden on patients due to clinical diagnosis and treatment. This study aimed to compare static balance between two groups of healthy people and COPD patients, based on cognitive tasks and vision tests, using linear and non-linear analyses.

MATERIALS AND METHODS

A total of 15 patients with COPD and 14 age- and gender-matched healthy individuals were recruited in this study. Variations in the center of pressure were recorded in both medial-lateral (ML) and anterior-posterior (AP) directions by implementing visual feedback and cognitive tasks, with the subject standing on a force plate. Data related to the center of pressure were analyzed in the AP and ML directions by linear methods (i.e., standard deviation of displacement, standard deviation of maximum velocity, average velocity, and phase plane). Also, the nonlinear method (Lyapunov exponents) was used in both directions.

RESULTS

The cognitive tasks improved the center of pressure variables in both groups. In association with the vision tests, only lack of vision had a significant effect on the patients. The results of the linear analysis in the ML direction were significantly higher in the COPD group as compared to the healthy group; however, the results were not significant in the AP direction. Also, the non-linear analysis showed significant differences between the groups.

CONCLUSION

Use of both linear and non-linear analyses is necessary for evaluating the balance of patients with breathing difficulties. Balance disorders in COPD patients were mostly in the ML direction; therefore, postural deformities might be one of the reasons for balance problems in the AP direction.

Construct validity and internal consistency of the modified Persian version of the STarT Back Screening Tool

BACKGROUND AND AIM

Considering the importance of non-specific low back pain (NSLBP) and its increasing spread, the need for instruments for the accurate diagnosis of back pain is evident in order to offer more effective treatment. One such instrument is the STarT Back Screening Tool (STarT) which is examined by numerous studies, while some of its psychometric dimensions still require attention. Therefore, the objective of this study was to assess the internal consistency and construct validity of this questionnaire to propose a modified version.

METHOD

In this cross-sectional study, the data of 295 patients with NSLBP were analyzed. Cronbach's alpha was used to assess internal consistency, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to assess construct validity. The Χ2/df, GFI, CFI, and RMSEA indices were also utilized as the goodness-of-fit criteria. Data analysis was performed in SPSS, AMOS, and EQS programs.

RESULTS

Goodness-of-fit indicators were calculated for the original Persian version of the questionnaire, showing an improper fit (RMSEA = 0.162). According to the measures of sampling adequacy (MSA) of the questions, Questions 1 and 8 were deleted, resulting in an improved index (RMSEA = 0.062). All the regression coefficients in the CFA model were significant (p < 0.001for all 7 parameters).

CONCLUSION

Based on the results, the modified Persian version of the STarT is simpler and more practical than the previous version, serving as a valid and reliable tool for assessing patients with low back pain. With respect to the goodness-of-fit indices, we recommend that more studies with larger samples be conducted on different populations.

Effect of bleaching on color change of composite after immersion in chlorhexidine and coffee

Background:

Since the introduction of resin composites, the staining of resin-based materials by colored solutions such as coffee, tea, chlorhexidine (CHX), and other beverages has become a common concern.

Aim:

The aim of this study was to evaluate the effect of home and office bleaching as a treatment for discoloration of composite after immersion in coffee or CHX.

Materials and Methods:

A microhybrid composite (Z250), nanohybrid composite (Z550), and nanofill composite (ultimate, body shade) were selected. Forty disk shape specimens (8 mm diameter and 2 mm thickness) for each composite were prepared then divided into two groups according to staining solutions (25 g of coffee in 250 ml water, 20 min/day or 0.2% CHX, 1 min/day). Following 1 month staining, specimens were divided into two groups again. Half of the specimens was bleached with in office bleaching agent (Opalescence Boost 40% hydrogen peroxide concentration) 3 times in one visit for 15minutes and the others subjected to home bleaching agent(Opalescence 10% carbamide peroxide) 6h/day until 2 weeks both from Ultradent Products, Inc., South Jordan, UT, USA. Color of the specimens was measured with a spectrophotometer using CIELAB color space at baseline, after 1 month staining, and after ending the bleaching process.

Statistical Analysis:

Analysis of variance was used to analyze the data (P < 0.05).

Results:

Coffee and CHX provided significant color changes in all groups (P < 0.05). Z550 was the material more prone to discoloration in coffee in comparison with Filtek Ultimate (P = 0.003). After bleaching, materials showed significant reduction except stained Z550 by coffee in home bleaching groups. Both home and office bleaching provided significant color changes in all CHX groups (P < 0.05).

Conclusion:

Coffee produced more color changes than CHX. The hydrogen peroxide has the same whitening effect in comparison with carbamide peroxide.

Predictive role of individual factors in the leisure preferences of children and adolescents with cerebral palsy: a cross-sectional study in Iran

Background/Aims

The participation of children and adolescents with cerebral palsy in leisure activities is associated with their preferences. A better understanding of their leisure preferences and the factors that influence them can help therapists to promote young patients' participation in leisure activities. The aim of this study was to describe the role of individual factors in the prediction of leisure preferences of children and adolescents with cerebral palsy in Iran.

Methods

A cross-sectional study design was used. A total of 152 children and adolescents with cerebral palsy were selected to complete the Preferences for Activities of Children questionnaire. Simple and multiple linear regression analyses were performed to assess the role of individual factors in the prediction of preferences for leisure activities.

Results

Individual factors played a significant role in the prediction of leisure preferences. Their influence on the preferences for recreational, physical and self-improvement domains (r2=0.215; 0.154; 0.127, respectively) were greater than for social and skill-based domains (r2=0.045; 0.052, respectively).

Conclusions

Preferences for physical activities need to be augmented while a high preference for social and recreational activities could be used to promote participation in leisure activities. Therapists and other healthcare professionals should consider individual factors relating to leisure preferences when devising therapeutic plans that aim to promote participation in leisure activities.

Pulmonary rehabilitation and exercise therapy in a patient with COVID-19: A Case report

Dyspnea, shortness of breath, and inability to perform activities of daily living are the main complaints in patients with COVID-19 and physiotherapy has a vital role in managing such symptoms. We present a case treated with pulmonary and neurological physiotherapy, which improved symptoms and quality of life. In this case report, the importance and potential effect of concise physiotherapy on patients with COVID-19 is presented.

Evaluation of cervical spine muscles thickness in patients with cervical vertigo and healthy controls through ultrasonography

[Purpose] Cervical vertigo as a common complaint is associated with some musculoskeletal disorders. However, to date, ultrasonographical parameters of cervical muscles in patients with cervical vertigo have not been investigated. This study was conducted to investigate size of cervical muscles in patients with cervical vertigo compared to healthy controls. [Participants and Methods] Thicknesses of cervical flexor and extensor muscles were evaluated through ultrasonography and results were compared between the patients and healthy controls by Independent Samples t-test or Mann-Whitney U nonparametric test. [Results] Results showed that, thickness of Longus Colli muscle was significantly different between the patients and healthy controls. [Conclusion] According to findings of the study, size of Longus Colli muscle is likely to be associated with etiology of cervical vertigo.

Comparison of Persian staggered spondaic word test’s scores before and after rehabilitation in children with amblyaudia

Background and Aim: Amblyaudia is a diag­nostic issue in central auditory processing disor­der (CAPD), which is characterized by asymme­try in dichotic listening performance. This disor­der negatively affects the academic performance of children by influencing their information pro­cessing, reading, attention, etc. The present study aimed to investigate the effect of the dichotic interaural intensity difference (DIID) training on all auditory processing categories of the Buffalo Model using the Persian staggered spondaic word (P-SSW) test. Methods: The study was conducted on 17 chil­dren (11 girls and 6 boys) aged 8−12 years old diagnosed with amblyaudia. All children were first evaluated by the P-SSW test, and then parti­cipated in 10−12 sessions of the DIID training. The P-SSW test was taken again after completing the training program in order to evaluate the training effect. Results: The paired t-test results showed a sig­nificant reduction in the mean scores of decoding (p < 0.001) and tolerance fading memory (p < 0.004) categories as well as the total mean score of P-SSW test after training. The Wilcoxon test also showed the effect of this training on the integration category (p < 0.025). The McNemar test, however, showed no statistically significant effect of the DIID training on the organization category. Conclusion: The DIID training causes signifi­cant improvement in some central auditory pro­cessing categories of the Buffalo Model, inclu­ding decoding, tolerance fading memory and integration. Keywords: Dichotic interaural intensity difference; central auditory processing disorder; amblyaudia