محمود موسی زاده

Depression and anxiety disorders are increasing globally and represent major public health concerns. The relationship between fasting and the physical, social, psychological, and mental health of both healthy individuals and those suffering from various diseases has been reported in several studies. This systematic review aims to determine the association between fasting and anxiety.

This systematic review examined studies, including cohort, case-control, cross-sectional, and clinical trials, that explored the relationship between different types of fasting and anxiety. In this study, the population (P) consisted of participants with fasting experience, the intervention (I) was fasting, the comparison (C) was between the periods before and after fasting, and the outcome (O) was the level of anxiety before and after fasting. International databases, including Google Scholar, Medline, Scopus, Web of Science, and ScienceDirect (up to the end of 2021), were searched using the keywords "anxiety" and "fasting" in both English and Persian. The extracted data were entered into a checklist, which included the researcher's name, type of study, year of implementation, instrument used, type of fasting, and the mean and standard deviation of anxiety scores before and after fasting. Data were analyzed using Stata software (version 11). To estimate the difference in standardized means, the number of samples, the mean, and the standard deviation of the anxiety scores were extracted from the primary studies. Using the Metan command, the random-effects model, and Cohen's estimator, the standardized mean difference in anxiety scores with a 95% confidence interval was calculated. Heterogeneity between the results of the primary studies was assessed using the Q statistic and I-squared index, and publication bias was evaluated using the Begg and Egger tests. The NOS checklist was used to evaluate the quality of the included studies.

A total of 1,408 articles were retrieved, of which 13 were related to the topic. Four articles were excluded from the analysis because they did not report the mean. Finally, nine articles were included in the systematic review (nine studies) and meta-analysis (eight studies). The results of the eight studies included in the meta-analysis using the random-effects model showed that the standardized mean difference of the anxiety scores before and after fasting, with a 95% confidence interval (-1.14, -0.21), was estimated to be -0.67. Additionally, the results of the meta-analysis, stratified by the type of fasting and the questionnaire used in the primary studies, indicated that the overall estimate of the standardized mean difference in anxiety scores before and after fasting was not significant when considering the data collection tool and the type of fasting. Based on the heterogeneity indices (I-squared: 93.9%, Q= 114.88, P<0.001), the level of heterogeneity between the results of the primary studies was high. Publication bias was evaluated using the Begg (P=0.322) and Egger (P=0.753) tests, which indicated that publication bias was not significant.

The results of this systematic review and meta-analysis showed that the average anxiety score after fasting decreased by 0.67 units (67%) compared to before fasting, indicating a significant reduction in anxiety following a period of fasting.

Aphthous and oral ulcers are the most common ulcerative conditions of the oral mucosa, presenting as painful sores on the oral or tongue mucous membranes that make eating and drinking difficult. Zataria multiflora Boiss. has demonstrated therapeutic potential and has been used in formulations such as Protact® mouthwash. Recent studies indicate that this plant possesses several therapeutic effects, including alleviating inflammation and promoting healing in oral, digestive, and skin wounds. Given the documented effectiveness of this plant in treating various types of oral wounds and inflammation, along with the availability of Protact® mouthwash in pharmacies nationwide, this study aims to evaluate patient and physician satisfaction with the efficacy of Protact® mouthwash for treating oral ulcers and aphthous ulcers in Sari and Babol, the two largest cities by population in Mazandaran province.

This descriptive, cross-sectional study included a sample of 75 individuals, consisting of 35 physicians and 40 patients from Sari and Babol who either prescribed or used Protact® mouthwash. A convenience sampling method was used, with participants selected based on their willingness to complete a checklist. Data were collected by trained interviewers visiting medical centers, physician clinics, and pharmacies, and inviting participants to complete the checklist. Data were presented as mean ± standard deviation (M ± SD), percentages, median, minimum, and maximum values. Statistical analysis was performed using chi-squared, Kolmogorov–Smirnov, and independent t-tests.

The majority of participants in both groups were men (patients: 52.5%, or 21 out of 40; physicians: 94.3%, or 33 out of 35). The mean, median, standard deviation, minimum, and maximum ages for physicians were 53.94, 56, 7.6, 40, and 68 years, respectively, while those for patients were 40.13, 42, 10.8, 18, and 63 years, respectively. Most patients in this study (75%) reported a high level of satisfaction after using Protact® mouthwash. This mouthwash was mainly used for the treatment of aphthous stomatitis and oral inflammation, with a frequency of 52.5%. Results from the physicians' checklists showed that Protact® mouthwash was most frequently prescribed by dentists (42.9%), followed by general practitioners, hematologists and oncologists, and radiologists (each with a frequency of 11.4%). Additionally, physicians expressed satisfaction with the healing progress in their patients.

The findings support the effectiveness of Protact® mouthwash, a natural product produced in Iran, for the prevention and treatment of oral cavity-related conditions. The efficacy of this product is likely attributed to the presence of major phytochemicals in Zataria multiflora extract and essential oil, including thymol and carvacrol, which possess anti-inflammatory, antioxidant, antimicrobial, and tissue-regenerative properties beneficial to mucosal and skin healing.

Shortly after the emergence of COVID-19, the World Health Organization declared it a pandemic, which brought numerous challenges to the field of education worldwide. Consequently, this study was conducted to explore the teaching and learning processes of officials during the pandemic.

This qualitative research study was conducted using a comprehensive content analysis approach from April to November 2023. The participants included 11 officials from Mazandaran University of Medical Sciences, specializing in the teaching and learning process, who were selected purposefully. Data were collected through semi-structured individual interviews and by evaluating documents from the university's directorate and vice-chancellor. To ensure the validity of the qualitative study, four criteria—credibility, confirmability, dependability, and transferability—were employed. Credibility was established through prolonged engagement and sufficient interaction with participants, gathering accurate information, and validating it with participants. Dependability was ensured through peer review by two qualitative research experts, who confirmed the validity of the data analysis process. Confirmability was obtained through the perspectives of the research team colleagues. All research processes were documented and reported in detail to ensure the transferability of the results.

From the in-depth analysis of interviews and documents, 520 initial codes were extracted. After reviewing and summarizing the codes multiple times, they were classified based on similarities and correlations. The underlying meanings were identified through analysis and comparison, and the codes were conceptually and abstractly named based on their nature. Ultimately, two main categories, "challenges" and "strategies," emerged from the process of code abstraction. The "challenges" category was derived from three sub-categories: psychosocial pressures, challenges in theoretical teaching, and challenges in clinical education. The "strategies" category evolved from eight sub-categories: strategies to improve virtual teaching of theoretical courses, strategies to improve clinical and practical teaching, the formation of virtual groups for students and enhanced communication with them, managing the physical presence of students and professors according to the pandemic situation, providing facilities for students to access virtual education content, emerging educational strategies, facilitating educational regulations with increased flexibility, and providing the necessary resources to adhere to in-person education protocols.

The COVID-19 pandemic introduced various challenges for both professors in adapting their teaching methods and students in adjusting to online learning. However, these challenges also presented opportunities. The pandemic forced changes in educational processes, providing a new experience or opportunity to learn, understand, and adapt to the evolving needs of medical education for all stakeholders. These changes may also have long-term impacts on healthcare. The experiences gained during the pandemic can be used to revise health-related policies, and documenting these experiences can help in better managing future epidemics.

In 2023, the incidence of tuberculosis (TB) in Golestan Province was reported to be 26.1 cases per 100,000 people, which is three times higher than the national average in Iran. The contagious nature of tuberculosis has economic repercussions and indirect effects on the quality of life of affected individuals. The stigma associated with tuberculosis often leads to social isolation, which can hinder TB control efforts. On the other hand, social support from family, friends, healthcare workers, and community leaders improves quality of life, promotes self-care behaviors, and enhances patient adherence to medication regimens. This study aimed to determine the correlation between stigma, social support, and self-care behaviors in patients with tuberculosis.

This cross-sectional (descriptive-analytical) study was conducted in 2023, surveying 325 tuberculosis patients undergoing treatment in Golestan Province. Data were collected using a demographic information questionnaire, a 12-question stigma questionnaire (patients' perceptions of tuberculosis), the Sherborn and Stewart Perceived Social Support Questionnaire, and the self-care behaviors questionnaire for tuberculosis patients by Herandi et al. The data were analyzed using SPSS version 24 software. To investigate the relationship between perceived stigma and social support with the dimensions of self-care behaviors in tuberculosis patients, Spearman and chi-square tests were used. Logistic regression was employed to predict factors affecting self-care in the studied patients.

The average age of the participants was 51.97±17.33 years, with an age range of 19 to 84 years. The overall scores for the stigma questionnaire, perceived social support questionnaire, and self-care behaviors questionnaire were 29.03 ± 5.30, 71.14 ± 14.53, and 84.78 ± 10.17, respectively. Based on the univariate logistic regression model, the variables of race, number of family members, addiction, and age were analyzed for their effects on self-care behaviors. Additionally, the effects of marital status and age on stigma were examined. Significant effects of family size, income, and marital status on social support were observed. Spearman correlation tests showed an inverse and significant correlation between stigma and social support (r= -0.19, P= 0.001), stigma and self-care (r= -0.21, P<0.001), and a direct and significant correlation between social support and self-care (r= 0.55, P<0.001).

As stigma increases, levels of social support and self-care behaviors decrease. Stigma has a significant impact on tuberculosis treatment, while higher levels of social support enhance self-care and accelerate the recovery process. To control tuberculosis effectively, comprehensive support from community leaders, the Ministry of Health, welfare organizations, relief committees, municipalities, and other organizations, as well as from patients' families and surrounding communities, is essential. Additionally, health and medical intervention programs aimed at increasing self-care behaviors, raising awareness among patients, and reducing stigma and misconceptions among families, friends, healthcare workers, and society at large are recommended.

Chronic kidney disease or CKD is defined as functional failure or structural abnormality of the kidney. Diabetes and high blood pressure are the primary causes of this illness. Because the underlying causes of chronic kidney disease are more common now, the disease's financial burden on health systems around the globe has gone up. This disease can cause a wide range of complications, including changes in electrolytes and other known indicators in the blood. One of the less investigated indicators is the serum level of phosphorus in these patients. Therefore, we designed and implemented a study to investigate the relationship between serum phosphorus levels and kidney dysfunction in chronic kidney patients.

This study was a descriptive and retrospective study that was conducted on 110 patients with chronic kidney disease admitted to Imam Khomeini Teaching Hospital in Sari. The census sampling method and data collection tool was a checklist. Phosphorus values ​​obtained by blood tests and recorded in patients' files were studied. The comparison between the grouped variables was done with the chi-score test and Fisher's exact test. Quantitative variables were compared between 2 groups with a t-test and in more than 2 groups with an analysis of variance or their non-parametric equivalent. Also, the correlation between serum phosphorus level and GFR was done with Pearson or Spearman correlation coefficient. Partial Correlation was used to adjust the effect of confounding variables. Also, the normality of quantitative variables was evaluated with Shapiro-Wilks and based on skewness and kurtosis indices. Data analysis was done with SPSS software version 25

Of the 110 individuals that were examined, 51 (46.4%) were female and 59 (53.6%) were male. Of the 110 individuals, 95.5%, or 105 patients, had underlying medical conditions. During their time in the hospital, 21 patients (19.1%) were admitted to the intensive care unit. 19 individuals were in the G3 stage, 41 in the G4 stage, and 50 were in the G5 stage of CKD. Also, 69 patients were diagnosed with diabetes. Of these, 13 patients were in the G3 stage, 28 patients were in the G4 stage, and 28 patients were in the G5 stage of chronic kidney disease. The average level of blood urea and creatinine was reported to be 125.0255 mmol/L and 4.2975 mg/dL, respectively. Also, the calcium serum level was 8.9109 mg/dL and the phosphorus serum level was 4.6873 mg/dL. Also, the average eGFR among 110 evaluated patients was 19.2345 mL/min/1.73m^2. Serum phosphorus levels and eGFR in men are correlated, and this link is significant (P=0.000). However, the P-value of 0.087 indicates that there is no significant association between eGFR and blood phosphorus levels in women. This connection was significant in hypertensive individuals (P=0.003). Furthermore, in contrast to systolic blood pressure, there is a substantial correlation between patients' diastolic blood pressure and eGFR.

Phosphorus serum level plays a role in determining the severity and prognosis of chronic kidney disease. Also, there is a direct relationship between diastolic blood pressure and the severity of this disease.

Osteoporosis is one of the main public health concerns worldwide, which imposes a significant economic burden on the healthcare system. Chronic inflammation might play a role as one of the possible risk factors for osteoporosis and fractures. Also, previous studies have reported that dietary factors are effective in controlling and modulating inflammation. Recently, an index was designed to determine the dietary inflammatory potential (DIP), which estimates the inflammatory potential of diet on a continuous spectrum from anti-inflammatory to pro-inflammatory. There are limited studies investigating the relationship between dietary inflammatory potential (DIP) and the risk of osteoporosis in the Middle East. The present study aimed to explore the relationship between DIP and the risk of osteoporosis in a large population of Iranian adult women.

This study was conducted cross-sectionally using the basic data of the Tabari Cohort Study (TCS). Dietary information of study participants, which included 5417 adult women aged 35-70 living in Mazandaran, was collected using a validated semi-quantitative 119-item food frequency questionnaire. Dietary inflammatory potential was calculated using the method proposed by Shivappa et al. Data on osteoporosis was collected using the self-report method. Information on other variables was collected using standard questionnaires. A binary logistic regression test was used to assess the relationship between DIP and osteoporosis in crude and adjusted models.

The mean ± standard deviation of the age of the study participants was 49.20±9.14 years. The prevalence of osteoporosis in the participants was 9.8% (n=529). The mean±standard deviation dietary inflammatory potential of the study participants was 2.29±0.36. Individuals who were in the highest quartile of the DIP score were older and had higher physical activity than those in the lowest quartile of the DIP score (P<0.001). Moreover, the poor socio-economic status and menopause in these subjects were greater than women in the lowest quartile of the DIP score (P<0.001). In the crude model, no significant relationship was found between DIP and the risk of osteoporosis (OR: 1.19; 95% CI: 0.91-1.55). When this analysis was adjusted for age and energy intake, the association remained non-significant (OR: 0.85; 95% CI: 0.62-1.18). Even after further adjustment for other potential confounding factors, this association remained non-significant (OR: 1.29; 95% CI: 0.87-1.92). When these analyses were done stratified by age, in women under 50 years of age, no significant relationship was found between DIP and risk of osteoporosis either in the crude model (OR: 1.46; 95% CI: 0.80-2.68) or after adjusting for possible confounding factors (OR: 1.69; 95% CI: 0.75-3.81). Similar results were obtained for women over or equal to 50 years. So no significant association was observed between DIP and osteoporosis in the crude model (OR: 0.92; 95% CI: 0.68-1.25). Even after adjusting for potential confounders, this association remained non-significant (OR: 1.11; 95% CI: 0.71-1.73).

In the current study among adult women, no significant association was observed between DIP score and the risk of osteoporosis neither in the crude model nor after controlling for potential confounders. In addition, after stratified analysis by age, no significant relationship was found between DIP and the risk of osteoporosis either in women under 50 years or in women over or equal to 50 years. Further prospective studies are required to elucidate these associations.

Previous reports on the symptoms and quality of life of patients with pituitary adenomas have paid little attention to physical activity. However, numerous studies have shown that physical activity can significantly influence prolactin secretion. Prolactin secretion levels, in turn, can affect various clinical outcomes, including tumor size, sleep quality, and fatigue levels in patients with pituitary adenomas. Given the intricate relationship between these factors, it is crucial to investigate how they interact to impact the overall health and quality of life of these patients. This study aims to bridge this gap by exploring the relationship between tumor size and fatigue levels, sleep quality, and physical activity in patients with pituitary adenomas. Understanding these relationships can provide insights into potential therapeutic strategies to improve patient outcomes.

A total of 116 patients diagnosed with pituitary adenomas from the Neurosurgery and Internal Medicine departments of Imam Khomeini Hospital in Sari were included in the study via census sampling. The inclusion criteria ensured that all participants had a confirmed diagnosis of pituitary adenoma. Demographic characteristics, tumor size (from patients' imaging records), prolactin levels (from patient records), physical activity levels (using the International Physical Activity Questionnaire), sleep quality (using the Pittsburgh Sleep Quality Index), and fatigue levels (using the Multidimensional Fatigue Inventory 20) were measured using checklists and validated questionnaires.

In the present study, 68 participants (58.6%) were female, and 48 (41.4%) were male. A total of 108 participants (93.1%) were aged 55 years or younger, and 8 participants (6.9%) were older than 55, with a mean age of 43.72±7.70 years. Of the participants, 71(61.2%) had prolactinomas, and 39(33.6%) had non-functional tumors. Tumor sizes ranged from 2.1 to 42.9 mm, with a mean size of 16.16±8.71 mm. The mean prolactin level was 561.52±413 ng/mL, with a minimum level of 8 ng/mL and a maximum of 1578 ng/mL. The results showed significant differences in the mean scores of sleep quality (5.81±1.91 vs. 6.73±2.14), fatigue (55.86±8.79 vs. 60.32±8.39), and physical activity (1203.95±258.65 vs. 1085.20±310.99) between patients with microadenomas and macroadenomas (P=0.048, P=0.008, P=0.038). Furthermore, correlation coefficients for age (r=0.415), fatigue (r=0.336), sleep quality (r=0.253), physical activity (r=-0.230), and prolactin (r=0.496) with tumor size were significant. The findings indicated that with increasing age, fatigue scores, sleep quality scores, and prolactin levels, tumor size also increases, while higher physical activity levels are associated with smaller tumor sizes. Additionally, as tumor size increases, prolactin levels, fatigue scores, and sleep quality scores increase, whereas physical activity scores decrease.

The study concludes that with increasing age, fatigue and sleep quality scores worsen, but physical activity levels decrease. Moreover, as tumor size increases, prolactin levels, fatigue scores, and sleep quality scores increase, while physical activity scores decrease. An increase in prolactin levels is also associated with increased fatigue.

One of the response areas of Iran's health system in dealing with the COVID-19 pandemic is the area of health and prevention. In many countries of the world, the primary strategy against COVID-19 is prevention and health, and this issue was considered before treatment. Considering that the COVID-19 pandemic was a new event and a new experience for health systems around the world, there is a need to investigate the different effects of this emerging phenomenon in different populations. Therefore, this study was conducted to explain the experiences of the health management of the COVID-19 pandemic in Mazandaran University of Medical Sciences.

This applied research was conducted in terms of the qualitative paradigm and by the method of summative content analysis. In this study, semi-structured interviews and existing documents of university vice-chancellors during the COVID-19 pandemic were used. In this study, interviews were conducted with 16 officials of Mazandaran University of Medical Sciences (The president of the university, vice president of health, health managers, doctors, experts of health centers, and also experts who worked in the university headquarters in the department of health vice) and a three-hour focus group of 15 people. The participants were selected based on the goal of maximum diversity. For the validity and strength of the study, the criteria proposed by Goba and Lincoln were used. The researcher tried to increase the credibility of the research with long-term involvement and sufficient interaction with the participants, collecting valid information and confirming the information by the participants. The researcher tried to increase the reliability of the data by repeating step by step and collecting and analyzing the data, taking advantage of the review by the experts. To increase the data Confirmability criteria, the approval of the associate professors of the project and their supplementary comments were used. To be able to transfer the data of the study, the researcher tried to provide a rich description of the research report to evaluate and applicability of the research in other fields so that other researchers can also be able to understand the data and achieve the same, as well as the participation quotes. The participants were presented in the same way as said. In this study, MAXQDA software was used for data analysis.

From the data analysis, two main layers (health challenges, preventive and coping strategies) and eight sub-layers (challenge of lack/delay in receiving health-treatment services, epidemiological challenge, health management challenge, vaccination challenge, strategies Receive health-treatment services on time to promote community health, epidemiological strategies, strategies for implementation of health guidelines, strategies for implementation of COVID-19 vaccination) and twenty-six sub-categories were extracted.

Mazandaran University of Medical Sciences faced many challenges during the COVID-19 pandemic, by holding decision-making meetings and coordinating various health units, in line with the policies of the ministry, providing suitable solutions for prevention and countermeasures. The results of this study can be used to teach other university officials to deal with other emerging diseases and the future planning of health policymakers. It is suggested to conduct a study comparing the rate of acceptance of the COVID-19 vaccine in normal people and medical staff and related factors at Mazandaran University of Medical Sciences.

The prevalence of metabolic syndrome in societies is increasing. Metabolic syndrome is a cluster of medical conditions that include obesity, hypertension, dyslipidemia, and insulin resistance. Poor dental care is linked to numerous systemic disorders. Scientific research supports the presence of a relationship between oral hygiene and metabolic syndrome. Therefore, the present study was conducted to determine the relationship between oral hygiene based on DMFT (decayed, missing, filled teeth) and metabolic syndrome in the registration phase data of the Tabari cohort population.

This study was cross-sectional and analytical and included participants from the Tabari cohort population who had performed oral health and metabolic syndrome assessments during the registration phase. Throughout the registration period of the Tabari cohort study (TCS), data was gathered from 10255 individuals ranging from 35 to 70 years old. This data was obtained from both urban and mountainous parts of Sari, Mazandaran, Iran, during the years 2015 and 2017. Data regarding education level, occupation status, residential location, socio-economic status, marital status, mental health history, smoking or hookah habits, daily physical activity, dental hygiene practices (such as tooth brushing and flossing frequency), denture usage and care, mouthwash usage, and DMFT index were gathered during the implementation of TCS through interviews and oral examinations. Metabolic syndrome was diagnosed based on the criteria of the third adult treatment panel (ATP III). Ultimately, SPSS version 27 software was utilized to describe the data using mean, standard deviation, and percentage. The qualitative variables were compared with the metabolic syndrome using the chi-square test, while the quantitative variables were compared using the independent t-test in univariate analysis. Furthermore, the process of adjusting for confounding variables was carried out through the utilization of multivariate logistic regression.

9,939 people were included in the final analysis. Independent T-test result showed that there was no significant relationship between metabolic syndrome and DMFT (P=0.156, T=4.59), so the average DMFT in the group with metabolic syndrome was 17.66±9.07, whereas in the non-affected group, it was 16.81±8.99. Based on chi-square test results, significant relationships with metabolic syndrome were found for the use of dentures (P<0.001), use of dental floss (P<0.001), age (P<0.001), gender (P<0.001), marital status (P=0.05), occupation (P<0.001), place of residence (P<0.001), psychiatric disorders (P<0.001), socio-economic status (P=0.005), smoking (P<0.001), BMI (P<0.001), MET (P<0.001), and education level (P<0.001). Upon adjustment of confounders in the multivariable logistic regression model, only the number of flossing twice a day was significantly associated with metabolic syndrome (OR 1.493 [95% CI 1.008–2.213], P=0.046).

The findings of this study showed that there is no significant relationship between oral and dental hygiene measured by the DMFT index and the presence of metabolic syndrome in the population registration stage data of the Tabari cohort. There was a significant relationship identified alone between flossing twice daily and metabolic syndrome. Further studies are necessary to explore other potential factors that may contribute to the development of metabolic syndrome in this population.

In December 2019, a series of pneumonia cases of unknown origin were reported in Wuhan, China, named by the World Health Organization as COVID-19. The risk factors for developing the disease of COVID-19 are still not well known, but evidence shows that some factors, including respiratory diseases such as tuberculosis, are important risk factors in the disease of COVID-19. It should be noted that tuberculosis, like SARS-COV-2, is mainly transmitted through breathing and affects the lungs. Also, some studies show that infection with Mycobacterium tuberculosis causes more rapid and severe pneumonia symptoms in COVID-19 and is the main cause of death due to severe disease. Considering that the disease of COVID-19 is a newly emerging pandemic and the risk factors related to its incidence and severity are still being investigated and considering that tuberculosis is a curable infectious disease that can affect other respiratory diseases. This study was conducted to investigate the probable and definite frequency of COVID-19 (COVID-19) in the first and second peaks of the coronavirus pandemic among patients with a history of tuberculosis.

This study was descriptive-cross-sectional and the study population included patients with a history of tuberculosis whose diagnosis date was between 2015 and 2020. The number of these samples was equal to 1532. The sampling method was census. The time of investigation in terms of contracting COVID-19 was after the first peak and during and after the second peak of Corona (from the second half of May 2019 to November 2019). The data collection tool included a checklist containing demographic variables and clinical symptoms related to COVID-19. The method of collecting information was in the form of telephone interviews and document review. Data collection was done by trained interviewers. For this purpose, the questioners were first given the necessary training on how to complete the checklist. Data entry was done in Excel software and transferred to SPSS V.16 software for analysis. The description of the variables is presented in terms of number, percentage, mean, standard deviation, and median. A chi-square test was conducted to compare the grouped variables.

In this study, the prevalence of probable and definite cases of COVID-19 among patients with a history of tuberculosis was reported as 5.5% (85 people), and suspected, probable and definite cases were reported as 15.6% (239 people). Also, there was no correlation between age groups, gender, place of residence, type of tuberculosis, marriage, diabetes, kidney disease dialysis, immunodeficiency,, and liver disease with the prevalence of COVID-19 among patients with a history of tuberculosis. It should be noted that in this group of patients, heart disease, lung disease, cancer, chemotherapy, high blood pressure, and brain and nerve diseases were related to the spread of COVID-19. Also, the highest frequency of suspected, probable, and definite COVID among patients with a history of tuberculosis was diagnosed respectively in 2019 with 38.5% (25 out of 65 cases with a history of tuberculosis), in 2014 with 26.7% (63 out of 236 cases with a history of tuberculosis) and 20.8% (58 people out of 279 cases with a history of tuberculosis) in 2018.

Due to the significant difference in the prevalence of Covid 19 in patients who have not received the flu vaccine, it is necessary to inject the flu vaccine in these patients. Advice to quit smoking in these patients should be a priority. Because no independent study on Covid disease was observed in patients with tuberculosis, further studies in this field are necessary.

The presence of the maxillary midline diastema (MMD) is a common aesthetic concern in young children.  The type of the maxillary labial frenum can contribute to the development of MMD. The purpose of this study was to investigate the prevalence and of different types of maxillary labial frenum and MMD in children with primary dentition.

Methods and Materials:

 This cross-sectional descriptive study included children whom were recruited from kindergartens of Sari and Neka cities. Children were examined under sufficient light and in an upright position using a tongue depressor. If present, the MMD was measured and recorded in mm. The maxillary labial frena were categorized based on their connection (papillary, mucosal and gingival) as well as morphology (nodular, simple, and bilateral). Chi-square test, independent T-test and ANOVA were used for statistical analysis. Data analysis was done using SPSS version 25 software. P-value less than 0.05 was considered statistically significant.

A total of 342 children, comprising 186 boys and 156 girls participated in this study. The prevalence of papillary, mucosal and gingival frenum attachments was 16.9%, 26.9% and 56.2%, respectively.  The prevalence of all types of attachments increased with age and was greater among boys compared to girls. This was while the gingival and mucosal connection was less common in 4-year-old children than in 3-year-old children, but this rate increased in 5- and 6-year-old children. All these differences were proven to be statistically significant (P = 0.001).

Simple maxillary labial frenum was the most common type. Increasing age caused an increase in the prevalence of simple, bilateral, and nodular maxillary labial frenum in children. Gingival attachment was the most common type. Moreover, the prevalence of all three types of maxillary labial frenum attachment was higher in boys than in girls.

Being Overweight is a global health problem and is related to important underlying diseases such as cardiovascular disease, malignancy, diabetes, fatty liver, etc. Over the past three decades, obesity has increased globally, especially in low-and middle-income countries. Numerous studies have shown that obesity increases the risk of developing chronic and threatening diseases including diabetes, cardiovascular diseases, blood pressure, and reduces life expectancy. On the other hand, chronic inflammation around fat cells plays an important role in obesity-related diseases. Also, changes in blood parameters are associated with increased body mass and chronic inflammation in obesity, and peripheral blood cells, such as the number of platelets, neutrophils, lymphocytes, and monocytes, are related to the progression of various types of diseases and inflammatory conditions. Therefore, the purpose of this study is to find the relationship between blood count biomarkers and anthropometric indicators in the adult group according to the Tabari cohort data.

Materials and methods:

 In the present study, cross-sectional data from a population-based cohort study called "Tabari Cohort Study" collected from 2014 to 2016 were used. This study is part of a nationwide study called "Epidemiological Prospective Study Group in Iran (Persian Cohort)". In the first phase of the Tabari cohort study, 10,255 participants aged between 35-70 years from urban and rural areas of Sari city were registered. Exclusion criteria in this study were inflammatory diseases, autoimmunity, malignancy, cardiovascular diseases, transplantation, and receiving any type of immunosuppressive drug, and finally 9939 people including 4043 men and 5896 women were included in the study. Age, height, weight, anthropometric measurements (BMI, waist circumference), CBC parameters including leukocytes, platelets, neutrophils, lymphocytes, and monocytes), and platelet distribution width (PDW) were recorded from the participants. By using the histogram drawing method to check whether the variables follow the normal distribution to decide between parametric or non-parametric analysis, T-test and ANOVA statistical tests, and SPSS 21 software, the results were extracted. The significance level in this study was considered to be 0.05 or less.

Waist-to-hip ratio was associated with higher WBC (P<0.001), platelet (P<0.001), and lymphocyte percentage (P<0.001). Higher waist-to-hip ratio was associated with higher WBC (P<0.001), platelet (P<0.001), lymphocyte percentage (P<0.001), and monocyte percentage (P<0.001). Higher BMI values were associated with higher WBC (P<0.001), platelet (P<0.001), lymphocyte (P<0.001) and monocyte (P<0.001) percentages. WBC, platelet, lymphocyte, and monocyte percentage were significantly higher in people who had a higher ratio of waist circumference to height (P<0.001).

The results showed that the relationship between anthropometric indicators and blood findings in favor of inflammatory conditions and obesity can affect indicators related to whole blood count.

Congenital heart defects (CHD) are conditions that arise from birth and affect the structure and function of the baby's heart. Children with CHD have a higher number of decayed, missing, or filled teeth due to caries (DMFT) and have poorer oral health than healthy children. Most researchers believe that knowledge and attitude about oral hygiene are effective factors in oral health-related behaviors. In addition, psychological factors increase a person's willingness to act to observe hygiene. Therefore, the current study aims to compare the deft index as well as the oral health-related quality of life in children aged 3-6 years with congenital heart disease (CHD) and healthy children.

In this case-control study, 28 children aged 3 to 6 years with CHD and 28 healthy children referred to Toubi Clinic were selected by census sampling method. After obtaining informed consent from the parents, the Childhood Oral Health Impact Index (ECOHIS) was provided to them. This questionnaire contained 13 questions and was classified into two areas: child impact scale (CIS) and family impact scale (FIS). The CIS section had 4 components: disease symptoms (1 question), child performance (4 questions), psychological (2 questions), child's self-confidence and social interactions (2 questions). The FIS section also included areas of parents' concerns (2 questions) and family function (2 questions). In general, the total raw scores of this index ranged from 0-52, which was 0-36 in the CIS section and 0-16 in the FIS section. The higher the final number of the ECOHIS index the more oral health problems and the more inappropriate OHRQOL. Statistical analysis was performed using SPSS V.25 software and the Mann-Whitney test.

A total of 56 people participated in this study, of which 24 (42.9%) were girls. The average age of the participants was 4.64 years. Based on the findings of this study, the average dmft index in CHD group children was 6.42 ± 3.27, and in healthy children, this number was 5.92±2.9. The observed differences between the two groups were not statistically significant (P=0.492). The mean score of the CIS section of the questionnaire was 2.57±3.96 in CHD children and 4.64±5.15 in healthy children (P=0.082). In addition, the mean score of the FIS section was 2.5±3.06 in CHD children and 4.4±4.4 in healthy children, which was statistically significant in this study (P=0.026).

In this study, the difference in the dmft index between CHD and healthy children was not statistically significant, but this index was higher in the CHD group. CHD children showed better quality of life related to oral health than healthy children. The quality of life in CHD children can be better than that of healthy children and the higher dmft index in CHD children may be due to the higher number of f and m compared to healthy children, and for this reason, a child with congenital heart disease may experience less dental pain than a healthy child.

The coronavirus epidemic has had a significant impact on people's lives and has created many problems in the economic, scientific, environmental, and personal dimensions of people's lives. Fertility in women was one of the threats addressed during the Covid-19 pandemic. The purpose of this study was to evaluate the quality of life, marital satisfaction, and anxiety, depression, and stress in women of reproductive age referring to medical centers covered by Mazandaran University of Medical Sciences during the COVID-19 pandemic.

The current study was descriptive and analytical in a cross-sectional manner. The statistical population included all women referred to medical centers covered by Mazandaran University of Medical Sciences from March 1399 to March 1400, who were questioned in two periods. Data were collected using a questionnaire that included demographic information, pregnancy, and COVID-19 disease. Also, the information related to the quality of life of the participants in the study was evaluated using the SF-12 questionnaire, anxiety, depression, and stress of the participants with the Lovebond scale (DASS), and marital satisfaction with the Enrich questionnaire. The collected data were analyzed using SPSS 24 software.

1759 women of reproductive age participated in this study. All participants (100%) were married, with an average duration of marriage of 8.5±1.5 years. 14.1% of women were infected with COVID-19 during the study. 7.2% of women had at least one underlying disease, hypothyroidism (4.3%), diabetes (1.3%) and hypertension (0.1%) being the most common cases. There were diseases. The results indicated a decrease in people's physical health and emotional problems due to the changes in their quality of life due to the outbreak of Covid-19. About 99% of women showed mild and moderate symptoms of mental disorders, including depression, anxiety, and stress, during the study. The participants' stress levels decreased over time (9.6±8.83 vs 8.3±69.7), and their marital satisfaction increased (2.91±0.3 vs 2.95±0.31, P=0.0). Also, the findings of the research showed that people's quality of life had a negative and significant relationship with the amount of mental disorders.

The results of the study revealed an increase in marital satisfaction during the Covid-19 period. The study participants' quality of life had a significant difference in the two time periods. Consequently, special attention to Women of reproductive age, increasing their general and sexual awareness, and providing positive psychological programs in crisis conditions are recommended in formulating health policies and programs

Spousal violence is one of the major problems of women. The personality traits of couples have been mentioned as one of the factors related to spousal violence, although there are contradictory results. The present study aims to determine the relationship between the personality traits of couples and spousal abuse against women of reproductive age.

In this cross-sectional study, participants were 156 couples covered by the health centers in Sari, Iran, in 2022, who were selected with a systematic sampling method. The data were collected using a socio-demographic form, the spousal abuse questionnaire, and Goldberg’s international personality item pool. Statistical analysis was done using SPSS software, version 25. The data were reported by using Mean±SD, frequency, and percentage and were analyzed using logistic regression analysis. The significance level was set at 0.05

Mild emotional abuse had the highest prevalence (76.3%). Husband’s conscientiousness trait predicted emotional abuse of women. Husband’s agreeableness trait and wife’s neuroticism trait predicted physical abuse of women, and husband’s neuroticism trait predicted sexual abuse of women. Moreover, husband’s smoking predicted physical abuse of women.

The personality traits of couples can predict spousal abuse of women. Identifying the personality traits of couples, along with individual and social factors, can significantly help in prevention, screening, and developing appropriate treatments for abused women.

Background and

Infertility is defined as the inability to conceive after 12 months of regular coitus. Anovulatory processes are the most common cause of infertility in women. The aim of this study was to compare the efficacy of combination treatment of clomiphene citrate (CC) and letrozole versus letrozole alone for ovulation induction and pregnancy rate in infertile women with polycystic ovarian syndrome (PCOS).

This is a single-blind, controlled trial study. A total of 102 infertile PCOS women were randomly divided into two groups. Group one (n=51) received 100 mg CC plus 5 mg letrozole daily on cycle days 3-7 for a single treatment cycle and group two (n=51) received 5 mg letrozole daily on cycle days 3-7 for a single treatment cycle. When at least one follicle reached a diameter of 18-19 mm, the patients received human gonadotropin hormone (5000 U-IV injection). The couples had regular intercourse, 2-3 times a week, as they had been instructed.

The number of follicles with a diameter of 14 mm was significantly higher in women who received the combination treatment of letrozole and clomiphene compared to the ones who received letrozole treatment (P=0.04). There were no statisticaly significant differences in the number of 18 mm follicles (P=0.07), mean endometrial thickening (P=0.37), clinical pregnancy rate (P=0.99), ongoing pregnancy rate (P=0.59), multiple pregnancy rate (P=0.99), and live birth (P= 0.99) between the two groups.

According to our study, the combination treatment of letrozole and CC is more effective than letrozole and can be used as the first-line therapy for infertility in women with PCOS. Moreover, the cost and risk of this treatment may be lower than other induction ovulation treatments.

Pain management has always been a challenge in dentistry and especially after endodontic treatments. Hence, this study aimed to evaluate the analgesic effect of an herbal medication containing ginger and pineapple extract, curcumin, and bromelain, called Anaheal Plus, after endodontic treatment, compared to Ibuprofen.

In this clinical trial study, 78 patients were randomly selected and divided into two groups. In group A, patients were asked to take 400mg Ibuprofen, whereas patients in group B,took Anaheal Plus before treatment. Pain intensity values were assessed and recorded using VAS scores. Pain was evaluated prior to endodontic treatment, as well as 6, 12- and 24-hours post-treatment. Mann-Whitney, Chi-square, Repeated measure ANOVA and Friedman tests were also applied to analyze the data.

The mean pain scores in groups A and B were 6.46±2.71 and 5.79±2.57 before treatment, 2.95±2.59 and 2.67±2.69 six hours after treatment, 1.49 ± 1.22 and 1.38± 0.79 12 hours after treatment, and 0.65± 0.31and 0.60± 0.28 24 hours after treatment, respectively. Statistical analysis showed no significant difference between Ibuprofen and Anaheal Plus groups in terms of the obtained pain scores during different time intervals.

The findings of this study revealed that both Anaheal Plus and Ibuprofen had similar effects in pain alleviation for patients receiving endodontic treatment. Therefore, Anaheal Plus can be considered as an alternative analgesic drug in endodontic treatment due to its fewer side effects in comparison with Ibuprofen

Coronaviruses are a large family of viruses that cause severe respiratory infections. About 15% of affected patients need hospitalization. By the high number of COVID-19 patients in need of hospitalization a high percentage of beds are occupied, so the management of hospital beds seems necessary.

A descriptive-analytical study was carried out between June 22 and August 22, 2021 in 40 hospitals under the auspices of Mazandaran University of Medical Sciences. Data were extracted from the Patient Information System and the records of patients with COVID-19 who received injectable drugs according to the national treatment protocol for temporary hospitalization. Descriptive statistics were applied in Excel 2010 and SPSS V24.

Total number of COVID-19 patients was 34,835 of whom 14,415 (41.38%) were admitted as temporary patients. Among these, 1802 (12.50%) were permanently hospitalized, of whom 12,536 (86.96%) were discharged with relative improvements and 77 (0.54%) patients died. Most patients aged 41 to 60 years old (44.16%).

The national treatment protocol for temporary hospitalization was found to be highly efficient during crisis and can help in bed management, human resources, surge capacity, and reduce many of the costs of the health system.

Metabolic syndrome is characterized by a cluster of symptoms including insulin resistance, blood pressure, abdominal obesity, defects in glucose metabolism, and dyslipidemia. Considering the increasing prevalence of cardiovascular diseases and metabolic syndrome, the aim of the present study was to investigate the relationship between metabolic syndrome and its criteria with cardiovascular diseases.

The present study was a case-control study that utilized the results of the enrollment phase of the Tabari cohort study. The case group (304 individuals) was randomly selected from participants with cardiovascular diseases (564 individuals). The control group (304 individuals) was randomly selected from among other participants who were matched by age and sex. The comparison of variables between the two groups was done using the chi-square test. Logistic regression test was used to adjust the effect of confounding variables.

Patients with metabolic syndrome were 69.1% (210) in the case group and 55.6% (169) in the control group (P=0.001). The results of the univariate regression test showed that the chance of developing metabolic syndrome in people with cardiovascular diseases was 1.755 times more than people without cardiovascular diseases (95% CI: 1.280-2.418, and P=0.01). Among the diagnostic criteria of metabolic syndrome, the chances of high blood pressure, high triglyceride levels, and decreased HDL were significantly higher in the case group compared to the control group.

The risk of metabolic syndrome is significantly higher in people with cardiovascular diseases compared to the ones without cardiovascular diseases. After adjusting for confounding factors, we found a significant difference between triglyceride level and blood pressure in the two groups.

Palpation of the radial pulse is a valuable clinical tool and one of the most useful physical examinations in medical care. The aim of the present study was to investigate the correlation between the number of pulses measured by the radial artery and the pulses recorded by electrocardiogram (ECG).

We conducted a correlational study and the research population included patients attending Emergency Department in Sari Imam Khomeini Hospital. The pulse rate was recorded by measuring the radial pulse rate of the left hand and the heart rate using an electrocardiogram device. In case of regular rhythm, the number of beats was measured for 15, 30, and 60 seconds using a digital stopwatch and multiplied by 4, 2, and 1, respectively.

There was a slight difference in pulse rate between the radial artery measurement for 15 seconds and the ECG that was statistically significant (P<0.001), but this difference was not significant for 30 and 60 seconds (P>0.05). The ICC correlation coefficient between pulse rates for 15, 30, and 60 seconds and ECG was high (above 0.98).

Based on the present study, instead of electrocardiogram, radial pulse count for 30 seconds multiplied by 2 can be used in clinical conditions, especially in emergency.

During the onset of the COVID-19 pandemic, some studies showed that control of blood pressure reduces the burden of the SARS-CoV-2 virus. The present study was conducted to investigate the effect of antihypertensive drugs on the outcome of COVID-19.

In this cross-sectional retrospective study, we used the medical records of 129 patients with high blood pressure and COVID-19 hospitalized in hospitals affiliated with Mazandaran University of Medical Sciences. The outcome of the disease such as length of stay in hospital, transfer to intensive care units, the need for ventilator, death, etc. were recorded. Data analysis was done in Stata 17. Fisher's exact test, Chi-square, Mann-Whitney, and simple logistic regression were used.

The average age of patients was 64.4±11.3 years and 44.2% had at least one underlying disease. There was no significant relationship between the type of antihypertensive drugs, underlying diseases, gender, age and the outcome of COVID-19 such as ICU admission, use of mechanical ventilation, and death (P>0.05). A significant relationship was observed between hospital length of stay and the dosage of antihypertensive drugs (P<0.01, 95% CI: -0.85, -4.47).

Antihypertensive drugs were not linked to the prognosis of hypertensive patients with COVID-19.

The frequency of traffic accidents is in a critical situation in Iran. This epidemiologic survey aimed at evaluating traffic accident injuries in emergency department at Gorgan 5Azar Hospital.

In this retrospective, cross-sectional descriptive study, the population included all patients who were admitted to the emergency department at Gorgan 5Azar Hospital (The Trauma Center in Golestan Province), 2019-2020 due to road accidents. Data were recorded in a checklist and analyzed in SPSS V20.

There were 1042 people that injured by road accidents with the mean age of 29.7±16.01 years. The patients were 80.1% men. Most of the accidents occurred during the day (63.2%) at summer (29.7%) in August (10.7%). Road accidents were more frequent in rural roads (63.1%) and among vehicle drivers (63.1%) and mainly motorcycle drivers (47.4%). Out of all cases with road injuries 626 (60.1%) fully recovered and 12 cases (1.2%) deceased.

In this study, accidents were more frequent in suburban roads, especially rural roads, in men and young people. Traffic accidents are among the social issues that could be prevented. More attention should be paid to safety and compliance with standards in the construction of roads, especially in villages, as well as education of the youth population.

The tensions in the emergency department can affect job satisfaction and professional values of nurses working in this department which may influence their clinical performance. The present study investigated the performance of emergency department nurses during cardiopulmonary resuscitation (CPR) and its association with professional value and job satisfaction.

This cross-sectional study was conducted in 10 hospitals affiliated to Mazandaran University of Medical Sciences in 2020-2021. The study samples were 258 nurses in emergency department selected via convenience sampling and quota based on the number of emergency department personnel in every hospital. Data were collected using demographic questionnaire, self-performance checklist in CPR, The Minnesota Satisfaction Questionnaire (MSQ), and The Nurses Professional Values Scale--Revised (NPVS-R). Data analysis was carried out in SPSS V22.

The majority of samples (71.7%) were women and the mean age of participants was 31.09±4.7 years. The overall mean scores for professional value, job satisfaction, and nurses' self-performance in CPR were 100.49±14.7, 56.34±12.7, and 30.84±3.0, respectively. Weak direct correlation coefficients were found between nurses' job satisfaction and their performance (r=0.201, P=0.001) and professional values (r=0.339, P=0.001), and also between their professional values and performance (r=0.374, P=0.001).

In this study, direct relationships were found between the performance of emergency department nurses in CPR and professional values and job satisfaction. Measures should be taken so that nurses get more familiar with different dimensions of nursing professional values and internalize these values in a wide range of nursing affairs, thereby having higher job satisfaction and clinical performance.

Pain management is one of the important issues in dental treatments. Fear of pain can make the process of anesthesia injection before dental treatment difficult for both the dentist and the patient. The aim of this study was to compare the effect of Najo-Caine P® with topical Benzocaine in reducing the pain of needle insertion in palatal anesthesia in 9-12 year old children.

In a double-blind clinical trial, 23 children aged 9-12 years were selected via convenience sampling, who needed palatal anesthesia injection on both sides of the jaw, at the Dental Clinic affiliated with Mazandaran University of Medical Sciences, in 2022. The desired areas were air-dried for 5 seconds. Benzocaine was applied with a cotton swab on one side of the jaw, and in the next session with the same preparation on the other side of the jaw, Najo-Caine P® anesthesia (2.5% lidocaine cream and 2.5% prilocaine similar to EMLA) was applied by the injector for 2 minutes.

The Visual Analogue Scale (VAS) scores for Benzocaine and Najo-Caine P® were compared. The VAS score for Najo-Caine P® (3.52) was lower than that of Benzocaine (3.78), but, the difference was not statistically significant (P= 0.488).

Current study suggests that Najo-Caine P®, as a form of EMLA cream, can be used as an alternative to Benzocaine before palatal infiltrate injection to reduce palatal pain in children.

Rheumatoid arthritis is one of the most common chronic inflammatory diseases of the joints that has many effects on oral health. The aim of this study was to evaluate the quality of life (QOL) and oral health indicators in patients with rheumatoid arthritis and healthy subjects.

A case-control study was carried out in Sari Tooba Clinic, 2018-2019. Data of all participants (case group, n=24 and control group, n=24), including demographic data, smoke consumption, and wearing removable dentures were recorded and all participants responded to nine questions about oral dryness and other systemic diseases. The Oral Health Impact Profile-14 (OHIP-14) was used and patients were clinically examined. DMFT was calculated and plaque, gingival, and sulcus bleeding indices were determined on Ramfjord teeth. The flow rate of non-stimulated saliva was investigated using a weight estimation method. Quantitative variables were compared between the case group and control group applying independent T-test or its non-parametric equivalent (Mann-Whitney).

There were two men (8.3%) and 22 women (91.7%) in each group. The mean ages in the case and control groups were 45.62 ± 11.29 and 45.58 ± 10.57 years. The age and gender distribution was not significantly different between the two groups. The mean DMFT, plaque, gingival, and sulcus bleeding indices and non-stimulatory saliva flow rate were higher in case group than the control group, but only the plaque index in the case group (5.62±2.63) was significantly different from the control group (4±2.44) (P=0.026). GI, PI and SBI were found to be significantly associated with oral health-related QOL (P<0.05).

Examination, diagnosis, and treatment of oral health indicators is effective in improving the QOL in patients with rheumatoid arthritis.