غلامرضا بیاضیان

Obstructive sleep apnea (OSA) is a sleep-related respiratory disorder that has a relatively high prevalence among children and adults. OSA has several anatomical and pathophysiological etiologies and is characterized by recurrent periods of narrowing of the pharynx and airway, increased resistance to airflow, and decreased or interrupted airflow during sleep. This disease has several complications which lead to decreased quality of life. Once diagnosed, orthodontists are able to prescribe various methods to treat the disease. The aim of the present study was to review effective orthodontic treatments and their advantages and disadvantages in treatment of OSA. PubMed, Scopus, Web of Science, and Cochrane Library databases were searched for relevant articles published in English until April 30, 2022. Articles on orthodontic treatments in patients with OSA were included. After assessment of studies, 60 articles were included in current review. Findings showed that treatment with oral appliances is effective in OSA patients. Due to the unwanted dental and skeletal side effects of oral appliances in long-term use, it seems better to have this treatment performed by an orthodontist to regularly monitor the occlusion of the teeth and, if necessary, to change the settings of the appliances. In patients with severe OSA, it is better to evaluate the effectiveness of appliance therapy and, if needed, perform surgical treatments.

Cleft lip and palate is a common birth defect that is caused by abnormal facial growth in early embryonic stage. The disease complex causes are associated with various environmental and genetic factors (1, 2). The prevalence of cleft lip with or without cleft palate is one in 700 live births, annually (5). In Iran the prevalence of orofacial clefts is 1.4 per 1000 live births (6). Children with cleft lip and palate may have a variety of impairments including dental problems, persistent otitis media, nutritional problems, and learning, speech, and language disorders (9, 10). Due to the complex nature of facial clefts and the numerous medical problems that patients are involved with, treatment management is required with a team consisting of several specialties (11, 12). This multidisciplinary team usually includes: speech therapists and audiologists, clinical nurse specialists, orthodontists, ENT specialists, clinical, genetic and psychological counsellors. Initial treatment starts prenatally or shortly after birth and may continue into early adulthood (12, 13). Helping parents of newborns with cleft lip and palate in terms of feeding methods plays a significant role in proper weight gain. (3) In addition, in the age of preschool, improving oral health behavior can lead to plaque control in children with cleft lip and palate (15). Information which people obtain through information technologies affects their health-related behaviors and decisions in 33 to 48% of cases (18). Health information technology may provide unique opportunity to improve self-care behaviors, so patients can easily exchange information with healthcare providers and access their necessary information in a timely manner (20). Çınar et al reported that parents of children with cleft lip and palate tended to seek information about cleft lip and/or palate disease on virtual networks such as Facebook (21). Hemati et al showed that happiness-training program had a positive effect on improving mothers' performance in caring of their children with cleft lip and palate (30).
 The main purpose of this study was to develop a mobile application for self-care of patients with cleft lip and palate in order to increase the awareness of parents and patients and reduce their unnecessary visits to medical centers.

This research was a developmental-applied study, consisted of two stages: the first was to determine educational content requirement, and second a mobile based self-care application was developed and evaluated. The sample in first stage comprised 20 specialists in Otorhinolaryngology, maxillofacial and Plastic surgery, and Speech therapy who were employed in the hospitals of Hazrat Rasool, Ali Asghar, and Imam Khomeini. Data collection has been done using a questionnaire developed to determine the educational content. Two answers were considered for each question: necessary and unnecessary to identify the necessity of software options from specialists’ point of view. Each option that received positive feedback more than 60 percent was included in the application. At the second stage, based on the results obtained from first stage, an application was designed using Kotlin programming language in Android environment. The prototype was then sent to 30 patients with cleft lip and palate or their parents to use it for at least one week. Finally, the standard Questionnaire for User Interface Satisfaction (QUIS) version 5.5 was used to evaluate user satisfaction and application usability. This 10-choice Likert scale questionnaire with a score of zero to nine consists of six sections including: user's personal information, overall reaction to the software, screen, terminology and system information, learning, and system capabilities. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) software. The scores of each part of the questionnaire were classified into three levels as "not good" (0-3), " medium" (3.1-6) and "good" (6.1-9).

Based on results (descriptive statistics) of the first stage of this study, physicians considered all items as necessary with the average score more than 60 percent. These items have three main topics including: different types of cleft lip and palate, disease management at different ages, and parent guide. Each of which includes sub-categories that are all listed in the software. After developing of application, we sent to 30 parents of children with cleft lip and palate who had smartphone through WhatsApp. User must register and enter his/her personal and clinical data first. After one week, an electronic questionnaire link has been sent for users that patients or their parents could fill and submit their comments. The results of usability evaluation questionnaire showed that users evaluated the software at "good" level.

One of the best tools to raise awareness and improve people's self-care skills are mobile-based applications. Studies showed that mobile health could be an effective way to facilitate disease management, treatment follow up, access to information anywhere and anytime, and lower excess health care costs (20). Nabovati et al. reported that using mobile based applications had a positive effect on the health outcomes of patients with asthma. They concluded that all applications included in their study, recorded user data and half of them were educational with reminder (28). In our study, according to participants’ answer, we found out that this self-care application has a positive effect on patients with cleft lip and palate. So, such application could be a practical and satisfying option in order to improve the knowledge level of parents having children with cleft lip and palate, in terms of caring of their children and reduce their anxiety.

Laryngectomy is the only known treatment for laryngeal cancer. The objective of this study was to design and develop a self-care application for patients undergoing laryngeal resection surgery.

This study was an applied-developmental one conducted in two stages. The first stage included assessing the need for data elements using questionnaire by 14 ear, nose, and throat (ENT) specialists. Then, the application prototype was developed in Java. In the second stage, the usability of the application was evaluated using standard questionnaire of usability evaluation.

The results of the first stage included two main parts of clinical information and application capabilities. The clinical information consisted of 14 main groups and 35 subgroups with a mean score of 9.9. The application capability also included alarm, reminder, messaging, social networks, clinic reservation, and Internet connection. According to the participants, all information items of the questionnaire were declared as necessary. The usability of the application was also evaluated at a good level with an overall average of 7.6.

Using a self-care application for post-laryngectomy patients will help increase their knowledge and facilitate self-care. Thus, it could be expected that using self-care technology and applications would reduce patients’ visits to health care centers as well as the number of their educational and care questions asked from health care staff. However, it is suggested that further studies be conducted with larger population and in different provinces.

Objective (s):

Children are one of the most vulnerable groups in falls from hospital beds, because usually this might cause head injurie. There are limited researches to prevent children from falling. Therefore, this study was performed to analyze the roots cause factors affecting the fall in children.

This was a cross-sectional study. First the adverse events were measured using a monthly error recording form, then the root cause analysis of the problem was performed in six steps, problem identification, team formation, preparation of initial information and final map, identification of causes and drawing tables, identification of solutions and implementation and assessment of solutions.

Lack of effective training of patient companions, old hospital beds, short, and long distance between bed railings, training of nurses, and controlling of the restless children were obtained as a root causes based on futuristic barrier analysis. The solutions were identified and implemented and the comparison of statistics before and after the implementation of the strategies showed that the rate of falling from the bed in the third quarter of the year has reached to zero percent.

Educating the patient companions about the keeping of the bed railings high and not leaving the child can have a great impact on reducing falls. Also, standardizing hospital beds, providing fall prevention guidelines for nurses, training the effective communication skills, and identifying high-risk children can help to reduce falls and injuries.

Biofilm, is an organized complex of bacteria that aggregates in an extracellular matrix enriched of polysacchrids, acid nucleic and proteins. Due to this evolved structure, the bacteria in the biofilm becomes highly resistant to the hostchr('39')s defense system and can adhere to the mucosal surface, leading to defects in the hostchr('39')s immune response. At first, bacteria with or without movement, reversibly adhere to the surfaces and then with the multiplication of glycocalyx by bacteria, this connection becomes irreversible. Biofilm growth progresses with the proliferation of baseless bacteria and gradually increases with the addition of other bacteria in the environment. These accumulations act as a chronic bacterial reservoir resistant to common antibiotics, and its debridement appears to justify the patientchr('39')s clinical symptoms.Biofilm formations have been observed and reported on the surface of adenoids and tonsils, especially in children with recurrent infections. The adenoid contains a large number of pathogenic bacteria and is more commonly known as a source of bacteria in children with rhinosinusitis than as a cause of mechanical obstruction. Studies have shown that culture of the sample prepared with swab and adenoidectomy is closely related with aerobic and anaerobic flora have been observed in both samples. Most aerobic strains were Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, Moraxella catarrhalis, and most anaerobes were Staphylococcus aureus, Peptostreptococcus, Prevotella and Fusobacterium.Our sudy aims to evaluate the association between adenoid tissue cultures and microorganisms with biofilms grades in children with upper airway obstruction.

This cross-sectional study was conducted among the children referred to the ENT clinics of Ali Asghar Children hospital. We included patients with symptoms of nasal obstruction who were candidates for adenoidectomy. Indication of adenoidectomy in this study (inclusion criteria) was existence of confirmed adenoid hypertrophy on examination and lateral neck X-ray (Adenoid view) with symptoms of chronic upper airway obstruction including obstruction sleep apnea, snoring, open mouth breathing, adenoid face, speech disorders and restlessness during sleep (if accompanied by night snoring). Exclusion criteria also included cystic fibrosis, immunodeficiency, respiratory disorders including asthma, and the use of antibiotics during the two weeks prior to surgery. Demografic data of patients were gathered on questionnaire. At this stage, according to the patient history accuracy based on the number of upper airway infections in the past year, patients were divided into five groups less than 5 infections, between 5-8, between 8-12, between 12-15 infections and more than 15 infections per year. After removing the adenoid tissue of the patients by the ENT surgeon in the operating room, a sample was sent to laboratory for culture in normal saline solution and the rest of the sample was cut from several places with a knife after washing with normal saline solution and placed in 2.5% glutaraldehyde solution for fixation. Samples were dried in vacuo, then, after coating the surface of the samples with a layer of gold with a thickness of 30-50 nm (voltage 800v, ​​100 mA), the samples were classified according to the presence and size of biofilm using Philips XL30 Environmental Scanning Electron Microscope (ESEM). Based on the degree of bacterial biofilm in the electron microscope samples , the amount less than 20%  was named as Grade I, 20-40% as Grade II, 40-60% as Grade III, 60-80% as Grade IV and we considered more than 80% as Grade V. Statistical analysis was done by SPSS.

Fifty-one children with a mean age of 7.31 years were enrolled in the study. The average rate of upper airway infection during last year was 9.58. In terms of accompanying symptoms, noctornal snoring and open mouth breathing were seen in all cases. The mean duration of symptoms from onset was 2.5 years (ranging from 2 months to 7.5 years). 30 patients had Grade IV adenoid size in their graphy and noone were graded as grade 1. Biofilm structures in 100% of samples were observed.According to the achived data, the highest frequency of the organisms was in the biofilm with the grade of 60-80%. Also, biofilm grade above 60% had the highest number of positive cultures. Alpha hemolytic Streptococcus viridans was resulted for 26 samples of adenoid tissue culture and just one sample did not show any bacterial growth. The mean number of infections in different culture groups did not differ significantly (p=0.985, Krusskal Wallis). The mean duration of symptoms did not differ significantly in different culture groups (p=0.159, Krusskal Wallis). There was no statistically significant difference between the gender and different culture groups (p=0.701, Chi2). There was a statistically significant difference between adenoid grade and various groups of bacterial culture (p=0.003, Chi2), the larger the size of the adenoids, the more likely the culture to be positive. As other studies have only examined the most common microorganisms, this study is in fact the first study to evaluate both types of organisms and its comparison with the degree of biofilm. Streptococcus alpha is a hemolytic microorganism that oxidizes RBC hemoglobin to cause a green color in the culture medium. Streptococcus alpha hemolytic viridans is the oral type of this organism, which is a type of normal flora. Studies have shown that the same microorganism can cause pathogenicity.Disagreement for surgery by parents of some patients was one of the our study limitations. Another limitation of our current study was the difficulty of accurate history of the number of upper airway infections in the past year due to the lack of a recorded medical registry system.

In this study, as presented before, there was a significant relationship between the increase in the surface grade of adenoid biofilm and the number of upper airway infections. Also, the highest frequency of the organisms was observed in biofilms with higher grades, and biofilms above 60% had the highest amount of positive culture. Therefore, this study also confirms that the presence of biofilm in the adenoid as a reservoir of infection causes inflammation and can justify the effectiveness of adenoidectomy as an acceptable therapeutic approch for children with recurrent upper airway infections.