مجله دانشگاه علوم پزشکی مازندران
پیاپی 212 (شهریور 1401)

In recent years, natural products have been widely used in traditional medicine to treat cardiovascular diseases. The aim of this study was to determine the cardioprotective effect of Achillea millefolium extract against isoproterenol (ISO) induced myocardial infarction (MI) in rats.

In this experimental study, the aerial parts of the plant were extracted with ethanol through maceration and subjected to colorimetry to determine flavonoids and phenolic compounds. The rats were treated with A.millefolium (100, 200, 400 mg/kg) for 14 days. MI was induced by intraperitoneal injection of isoproterenol (85 mg/kg) at days 15 and 16. Twenty-four hours after the second dose of ISO injection, the rats were anaesthetized and electrocardiographic (ECG) parameters were recorded and blood samples were obtained for biochemical assay.

Isoproterenol increased heart weight/body weight ratio, serum levels of CK-MB, LDH, MDA, and decreased serum levels of total antioxidant capacity. In addition, it produced ST-segment elevation, decreased R-wave amplitude, and increased QT interval and heart rate. Pretreatment with A. millefolium at different doses prevented ISO-induced changes. Phenolic and flavonoid contents were 57.37 mg gallic acid/g DW and 6.74 mg quercetin /g DW, respectively. The IC50 value of the extract was 81.54 μg/ ml in DPPH method.

The study showed that yarrow extract (A. millefolium) with its antioxidant properties protects the heart from ischemic damage caused by isoproterenol.

Post-traumatic stress disorder (PTSD) is a mental and physical complication. Fluoxetine (FLX) as a selective serotonin reuptake inhibitor is considered as the first line of treatment for PTSD. Exercise can improve the symptoms of PTSD. The aim of this study was to determine the effects of exercise and FLX on testicular tissue and sex hormones in rats with PTSD.

In this experimental study, 80 adult male rats were divided into two groups: PTSD and healthy. Then, each group was divided into four subgroups: control, exercise, fluoxetine, and fluoxetine + exercise. PTSD was induced by single prolonged stress. Fourteen days after induction of PTSD, moderate forced treadmill exercise was performed for 4 weeks, 5 days/week. Fluoxetine was administered at 10 mg/kg/day dissolved in drinking water for 4 weeks. Four weeks after treatment, the fear extinction test, testicular structure, and testosterone and FSH levels were evaluated.

PTSD decreased testosterone level and fear extinction but increased follicle-stimulating hormone. Fluoxetine and exercise had protective effect on testicular damage and also increased testosterone level and extinction index but decreased FSH level. Findings showed that co-administration of exercise and fluoxetine was more effective on these parameters. Combination of exercise and fluoxetine significantly increased fear extinction in PTSD rats (P<0.05).

Exercise and fluoxetine had a protective effect on testicular tissue structure and hormonal disorders caused by PTSD and also decreased fear caused by stress, which is one of the symptoms of this disease.

The aim of the present study was to investigate the effect of high intensity interval training (HIIT) and Portulaca Oleracea supplementation on fetuin level and insulin resistance of rat with NAFLD.

25 male Wistar rats randomly divided into 5 groups: healthy control (n = 5), fatty liver control (n = 5), supplement. (N = 5), HIIT (n = 5) and HIIT+ supplement (n = 5). To induce NAFLD, rats were fed a high-fat diet for 12 weeks. Portulaca oleracea supplement at a dose of 400 mg/kg was given to the respective groups. The HIIT training protocol was performed for 8 weeks, 5 sessions per week with 7 repetitions of 1 minute with 90% of maximum speed, which was accompanied by active rest intervals including 2 minutes of running with 20% of maximum speed.

Insulin resistance in fatty liver control group was significantly higher than healthy control group (p=0.002). Level of this index in HIIT group (p=0.01), Portulaca supplement group (P=0.037) and HIIT  group (p=0.012) were significantly lower than fatty liver control group. Also fetuin A level in liver of fatty liver control group was significantly higher than healthy control group (p=0.01). Level of this index in HIIT group (p=0.036), Portulaca supplement group (P=0.019) and HIIT combined with Portulaca supplement group (p=0.007) were significantly lower than fatty liver control group.

It seems that HIIT and Portulaca Oleracea supplementation improve insulin resistance in NAFLD by lowering hepatic fetuin A levels.

Increased production of free radicals occurs due to intense and unconventional physical activity. The present study aimed at evaluating the effect of six weeks of high intensity interval training and Matcha green tea on some cellular oxidants (MDA) and glutathione peroxidase (GPX) in women.

A quasi-experimental applied research was performed in 48 untrained women aged 25-35 years in Tehran, Iran. They were randomly divided into four groups, including supplement (n=12), exercise (n=12), supplement + exercise (n=12), and placebo (n=12). High intensity interval training was performed for six weeks at 85% - 95% maximum heart rate. The supplement groups consumed two capsules of Matcha tea (500 mg) orally daily. MDA and GPX measurements were done using 5mL of blood sampling from the brachial vein at pre-test and post-test stages. Data analysis was carried out in SPSS V23.

In current study, high intensity interval training had no significant effect on MDA and GPX indices in inactive women (P>0.05). But, consumption of Matcha tea alone and with exercise showed significant effects on reducing MDA and increasing GPX in women (P< 0.05).

It seems that consuming Matcha green tea alongside high intensity interval training in short term can have effects on oxidative stress and antioxidant capacity.

Wearing face masks has become popular during the COVID-19 pandemic as a measure to prevent the spread of the virus. Some studies have pointed out the intervening role of these masks in the effect of exercise on the cardiovascular system. This study aimed at examining and comparing the effects of masking (N95 respirators and surgical masks) and not wearing a mask during exercise on heart rate variability (HRV) parameters.

In this semi-experimental design, 15 healthy women were randomly placed into three groups: surgical mask, N95 respirators and no mask. The participants took part in a progressive running session and then two weeks of HIIT program (2-4 sets, 20-60 seconds with 15-60 seconds of rest between repetitions and 3-5 minutes between the sets) with 80-90% of HRmax. The time- and frequency-domain parameters of HRV were recorded during rest and recovery after exercises using electrocardiogram and then analyzed in Kubios HRV software.

Progressive running session before two weeks of HIIT training caused a significant decrease in parasympathetic time-domain parameter (RMSSD) and average RR in all groups in the fifth minute of recovery compared with rest values (P≤0.05). In addition, after HIIT training, sympathetic time-domain (SDNN) parameter and average RR significantly increased (P=0.01 and P=0.02, respectively) while a significant decrease was seen in the sympathetic frequency-domain (LF) parameter in rest and recovery compared with baseline values (P=0.01). No significant differences were observed between the two masked groups in parameters studied (P=0.43).

Increase in parasympathetic parameters and decrease in sympathetic parameters improved HRV. Wearing surgical masks or N95 respirators during exercise did not have an intervening effect on the positive results of exercise, including improving the autonomic function of the heart and maintaining sympathovagal balance in healthy women.

Vitamins and minerals play an important role in boosting the immune system, and their poor condition in the body leads to reduced resistance to infections such as COVID-19. In the present study, we aimed at examining and comparing the levels of minerals (iron, zinc, copper, and magnesium) and vitamins (B12, D) in women of reproductive age with COVID-19 and healthy women.

This case-control study was performed in 140 women of reproductive age attending Sari Imam Khomeini Hospital and Qaemshahr Razi Hospital selected via convenience sampling in 2020-2021. The participants included 70 women with COVID-19 and 70 healthy women who were matched according to age groups. Blood sampling was done in all groups and the levels of minerals and vitamins were measured using standard kits. Data were analyzed using t-test and Chi-square.

Most women in both groups were over 35 years of age and multiparous. Vitamin D levels in both groups were insufficient but was higher in women with COVID-19 than healthy women (P=0.03). Vitamin B12 and copper levels in women with COVID-19 were higher than those in healthy women (P<0.001). Magnesium levels were found to be lower in women with COVID-19 than that in healthy women (P<0.001). Iron and zinc levels were lower in women with COVID-19 than healthy women (P=0.09 and P=0.44), respectively.

Due to the insufficient levels of vitamin D in both groups, interventions are necessary to improve this condition. Also, further studies with larger sample size and considering interfering factors are needed to accurately assess the role of vitamins and minerals in COVID-19 and other infections.

Stress and socio-economic and psychological consequences of COVID-19 pandemic have affected family and marital relationships. The present study investigated the frequency of marital conflicts and related factors in Mazandaran province, north of Iran during this pandemic.

In this cross-sectional study, 357 married people were selected by convenience sampling via social networks in 2020. Data were electronically collected using demoghraphic and medical checklist and the Marital Conflict Questionnaire- revised form (MCQ-R). Data were analyzed in SPSS V25.

The average age of participants was 38.2±9.9 years. The average duration of marriage was 14.9±10.7 years. The total mean score for marital conflicts was 103.8±28.3 indicating a moderate level of conflict. The respondents reported mild (n=188, 57.7), moderate (n=132, 40.5), and severe (n=6, 1.8) levels of marital conflicts. Significant direct relationships were found between marital conflicts and age, gender, educational level, remarriage, nuclear family or extended family, history of marital conflict before the pandemic, individual or family history of COVID-19, and number of children (P<0.05).

According to current study, social health authorities are suggested to be prepared to predict the family-marital consequences of a pandemic such as COVID-19 and take necessary preventive and treatment actions.

COVID-19 pandemic caused high workload and led to high levels of burnout in medical staff including emergency medical personnel. Identifying and preventing occupational burnout can efficiently improve mental health in workplace and enhance the quality of services delivered. This research aimed to investigate the relationship between occupational burnout and moral intelligence in emergency medical staff.

This analytical cross-sectional study was conducted in 250 pre-hospital emergency staff in Mazandaran University of Medical Sciences, 2021. The participants were selected from emergency bases using stratified sampling. Data were collected using demographic characteristics checklist, Moral Intelligence Scale (Lennick & Kiel), and Maslach Burnout Inventory (MBI). Structural equation and maximum likelihood model were applied. Data analyses were carried out in SPSS 23 and Amos 24.

The mean scores for moral intelligence and burnout were 81.10±8.30 and 44.41±13.73, respectively. Every one point increase in moral intelligence score decreased burnout score by 1.55 (P=0.054). Significant relationships were seen between all dimensions of Moral Intelligence Scale and moral intelligence (P<0.001). Keeping promises (r=0.82, P<0.001) and the ability to let go of one’s own mistakes (r=0.79, P<0.001) were found to be highly correlated with moral intelligence. In MBI, only personal accomplishment showed a significant positive correlation coefficient with burnout (r=0.41, P=0.026).

In this study, improvements in moral intelligence score decreased the burnout score. Therefore, improving moral intelligence, as an acquired ability, in emergency medical personnel can reduce the levels of burnout experienced.

Kawasaki is an acute childhood vasculitis of unknown cause that if left untreated can cause coronary aneurysms in 25% of cases. The disease is reported as the leading cause of acquired heart disease in children in developed countries. The purpose of this study was to investigate the epidemiological and clinical features of Kawasaki disease in northern Iran.

In this descriptive-analytic review study, all registered cases of Kawasaki disease in Mazandaran province between 2007 and 2019 were investigated. Epidemiological, demographic, clinical, periodical tests, risk factors, disease burden, complications, and follow-up information were collected. Data analysis was done applying descriptive statistics, Chi-square test, and logistic regression.

The data of 136 children with Kawasaki disease were assessed. Clinical symptoms were found to be significantly different between children with complete and incomplete Kawasaki disease (P<0.001). Most children with complete and incomplete Kawasaki disease had heart disease (63.2% and 75.5%, respectively), and coronary artery disease (52.6% and 58.2%, respectively) but no significant differences were found between the two groups in terms of cardiovascular involvement (P>0.05). Multivariate regression analysis showed that fever for more than 5 days is a predictor of coronary artery involvement (P= 0.001).

The study showed that fever for more than 5 days is a risk factor for heart and coronary artery involvement as one of the complications leading to death in these children. Therefore, accurate control of fever and heart examinations are important in children with symptoms of

Dental and skeletal features, unlike soft tissues, remain unchanged in events where most body tissues are destroyed such as car accidents, plane crash, crimes, etc. Panoramic and lateral cephalometric radiographs can provide useful information about dental and cephalometric indicators in human identification.

A cohort retrospective study was carried out in five stages, including collecting the samples, using a specific tooth counting system, identifying the landmarks in panoramic radiographs and designing a dental formula, designing anatomical formula with cephalometric indicators and identifying operator errors, and matching and data analysis.

We studied 180 people, including 97 (54%) women and 83 men aged 15-59 (mean age= 25.5) years in Tehran. Average indexes of missing (M), filled (F), Root Canal Therapy (RCT) teeth, crown (C), (Body/Go-Go), (Mf-Mf/Mf-Go(R+L)), De, P, ER, Go in lateral Cephalometry, SNA, SNB, Basal, N-Ans-Me, Ans-Pns/Go-Me, and S-Go/N-Me were not significantly different between cases by comparing the graphs before and after treatments (P>0.05). Examination of average indices of implant and dilacerated teeth in general and without considering the number of teeth, did not show a significant difference when the pre/post-treatment graphs were compared (P>0.05). In examining the Co-Ans/Co-Gn, Go in panoramic graph, (S-N/S-Ba) and S-N-Ba, no significant difference was observed between the cases (P>0.05).

Panoramic, lateral cephalometric graphs and designing creative formula can be used in human identification.

Pulp stones are calcified masses in the pulp chamber or root canals. Cone-beam computed tomography (CBCT) can identify crown and root anatomy and also detect calcifications which may help to achieve a better diagnosis. The goal of this study was to determine the frequency of pulp stones in CBCT images.

In this cross-sectional study, 500 CBCT images in Babol, north of Iran were included. Pulp stones were detected by NNT viewer software in axial, coronal and sagittal dimensions by the presence of a round or oval appearance of a single dense mass in the pulp cavity or root canals. Parameters such as age, sex, type of tooth and jaw and side involved, condition of the tooth (healthy, decayed/repaired), and location of pulp stone (crown and cervical, middle, apical one third of the root) were identified and recorded in a checklist. Data were analyzed by SPSS V22 applying Independent Samples T-test and Chi-square test.

The mean age of participants was 38.80±14.35 years. Pulp stones were reported in 71 individuals (14.2%) and 119 teeth (0.93%). The frequency of pulp stones was significantly higher in women, maxilla, molars, healthy teeth, and crown pulp (P< 0.05). The frequency of pulp stones was not significantly different between the left and right sides (P= 0.343). Findings showed no significant difference in mean age between people with and without pulp stones (P= 0.334).

In this study, the prevalence of pulp stone was low and they were more common in women, maxillary, molars, healthy teeth, and crown pulp.

Parenting styles predict early maladaptive schemas. The aim of this study was Persian adaptation and standardization of the Young Parenting Inventory-Revised (YPI-R2) among students in Tarbiat Modares University, Iran University of Medical Sciences, Allameh Tabatabai University, and Islamic Azad University, Science and Research Tehran.

The statistical population in this psychometric study included all university students studying in Tehran, 2020-2021 academic year. The samples were 240 people selected by convenience sampling. Data were collected using the Young Parenting Inventory- Revised (YPI-R2), Depression, Anxiety and Stress Scale (DASS-21), and Ryff Psychological Well-Being Scale (RPWBS). Data analysis was performed in SPSS V24 and Liserl-8 applying descriptive and inferential statistics.

Confirmatory factor analysis confirmed the six-factor structure of this scale, including competitiveness and status seeking, degradation and rejection, emotional inhibition and deprivation, overprotection, punitiveness, and controlling. Cronbach's alpha coefficient and test-retest reliability coefficient based on mothers' scores for the whole scale were 0.93 and 0.90, respectively, and Cronbach's alpha coefficient and test-retest reliability coefficient based on fathers' scores for the whole scale were 0.93 and 0.91, respectively. The YPI-R2 was found to have a positive and significant correlation with the components of the DASS-21(P<0.05) and a negative correlation with the components of the RPWBS (P<0.05), which indicated the convergent and divergent validity of the scale.

The Persian version of Young Parenting Inventory-Revised (YPI-R2) showed good validity and can be used as a short and valid diagnostic tool in clinical work and research.

Serum procalcitonin (PCT) indicates a bacterial infection that can reduce the administration of antibiotics. The aim of this study was to compare serum procalcitonin levels in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and asthma and its relationship with lung function and inflammatory factors.

In this cross-sectional study, patients with acute exacerbation of asthma (n= 46) and COPD (n= 23) attending Shahrekord Kashani Hospital were included. After obtaining clinical and demographic information, the participants underwent spirometry and the levels of procalcitonin, ESR, white blood cell and PMN counts were determined. Data were analyzed in SPSS V19.

There were significant differences between patients with exacerbation of COPD and asthma in age, sex, ICU hospitalization, and FEV1 percentage (P <0.05) but no significant differences were seen in mean ESR, WBC and PMN (P> 0.05). PCT results in asthma and COPD patients were 8.7% and 56.5%, respectively (P<0.05). Logistic regression analysis showed that gender and FEV1 had significant effects on PCT level (odds ratio 0.192 and 0.958, respectively (P<0.05).

Procalcitonin in patients with exacerbation of COPD was significantly higher than that in patients with exacerbation of asthma, which indicates the role of exacerbation of bacteria in COPD.

Human papillomavirus (HPV) often infects humans through sexual contact. Men are carriers of the HPV virus and inadvertently transmit the virus to their sexual partners while being asymptomatic. In many countries strategies are focused on controlling the virus in women and the role of men is ignored. The aim of this study was to determine the prevalence of HPV infection and its common genotypes in men in order to facilitate designing and implementing national prevention programs.

In this cross-sectional study, PCR and hybridization methods were used to determine 37 different HPV genotypes. The participants included 188 men attending Central Laboratory of Academic Center for Education, Culture, and Research, Mashhad Branch between autumn 2020 and winter 2021.

In this study, 56.9% of the total population were infected with at least one of the HPV genotypes. Overall, 26 different HPV high-risk and low-risk genotypes were identified. The most common low-risk genotypes were HPV6 (50.5%), 11 (15%), 42 and 91 (11.2%). The most common high-risk genotype was HPV66 (9.3%).

Men play an important role in transmitting the virus and are considered as the reservoir of HPV infection. The prevalence of HPV was high in current population, therefore, HPV screening in men can be very helpful in preventing the spread of infection.

World Health Organization recommends and supports studies about leishmaniasis as one of the six major tropical and subtropical diseases. Iran is one of countries with relatively high infection rate of cutaneous leishmaniasis, so, the purpose of this study was to investigate the epidemiological status of cutaneous leishmaniasis in Kermanshah province, western Iran.

In a cross-sectional study, we investigated the records of all patients with leishmaniasis positive smears between 2011 and 2019 in Kermanshah province. Annual rate of the disease was calculated according to the data obtained from Statistical Center of Iran.

There were 1946 patients with leishmaniasis, including 1477(75.9%) men. The prevalence of leishmaniasis in Kermanshah province was 15.4 in 100,000 people. The prevalence of the disease in men and women was 23.4 and 7.42, respectively. Annual pattern of infection showed that in men the incidence rate was higher between November and January and lower in June, but no specific seasonal pattern was seen in women. The most common lesions were observed in hands and then the foot with an upward trend in recent years (P<0.001). But the trends for number of lesions in the head and body remained unchanged (P=0.7).

According to the seasonal pattern of cutaneous leishmaniasis especially in men and its relationship with their career, educational programs and trainings are recommended to prevent sandfly bites.

Mortality rate due to intentional and unintentional poisoning is higher in vulnerable older adults than the general population. This study was performed to determine the prevalence of acute poisoning and factors associated with the incidence and severity of this condition in aged people.

A retrospective cross-sectional study was conducted using the medical records of all older adults (> 60 years old) admitted to Qaemshahr Razi Hospital, Mazandaran province due to acute intentional or unintentional poisoning during 2013-2020. Demographic characteristics, poisoning motive, occurrence and type of substance leading to poisoning, clinical signs, and treatment outcome were studied. Data were analyzed using STATA14.

There were 200 cases (mean age: 69.84±8.40 years) with poisoning, including 64.5% men. Unintentional poisonings were seen in 77.5% of the cases. Opium and its derivatives were the most common causes of poisoning. The most common toxins were opium and alcohol. Gastrointestinal poisoning was reported in majority of patients (76.5%). Only 0.5% were discharged after outpatient treatment. The mean duration of hospitalization was 2.2 days and this period was longer in patients poisoned due to concomitant use of several drugs or drug abuse. Intubation, ICU hospitalization, and emergency dialysis were required in 1.5%, 4.5%, and 1.5%, respectively. Death occurred in 0.5% of the patients during hospital stay. 

Unintentional poisoning accounts for a significant proportion of older age poisoning. Further studies are recommended to investigate indirect mortality rates, such as death due to complications after discharge, and socioeconomic burden of poisoning in aged people.

E-learning has many strengths and it is easily available, therefore, it received much attention by the Iran Ministry of Health and Medical Education during the COVID-19 pandemic. The present study investigated the level of e-learning readiness and its relationship with demographic factors in medical students of Mazandaran University of Medical Sciences during the COVID-19 pandemic.

This descriptive-analytical study was performed in medical students of Mazandaran University of Medical Sciences in 2019-2020 academic year. Using Morgan table, 263 students were selected. Watkins et al.'s standard E-learning readiness questionnaire was used. Data analysis was done applying Pearson correlation, independent t-test, and ANOVA in SPSS V20.

The overall e-learning readiness was moderate among students (103.30 ± 15.00). The highest and lowest mean scores were associated with skills and continuous communication (38.67 ± 4.50) and motivation (8.14 ± 3.00), respectively. Findings showed a significant relationship between electronic learning readiness and the academic course (P<0.05).

This study showed that general readiness of medical students for electronic learning was at an average level and in the internship period, it was significantly higher than other modules. Therefore, medical educaters are suggested to have powerful presence in order to increase students’ motivation.

Many studies suggest that surgery in patients with COVID-19 increases the risk of complications and mortality after surgery. The purpose of this research was to compare the frequency of outcomes during and after surgery between patients with and without COVID-19 undergoing emergency surgery in Gonbad Kavus hospitals, 2020-2021.

In this cross-sectional study, two groups of adults (n= 114) with and without COVID-19 (group A and group B, respectively) who underwent emergency surgery were examined. Demographic data, laboratory findings, and during and post-operative outcomes were recorded. Data analysis was done in SPSS V26.

Average age and weight in group A (45.5 years, 78.3±16.6 Kg, respectively) were found to be higher than those in group B (39.3 years and 67.9±11.5 Kg, respectively). Significant difference was seen in the percentage of arterial blood oxygen saturation after operations between group A (94.7±1.38) and group B (91.7±2.83) (P<0.0001). Also, mean ICU and hospital length of stay were significantly longer in group A (8.5 and 9.8 days, respectively) compared with group B (5.4 and 6 days, respectively) (P<0.0001). Moreover, death was observed more in group A (76%) than group B (23%) (P=0.041).

All members of the surgical team are required to pay special attention to the increase in the incidence of complications during and after surgery in patients with COVID-19 undergoing emergency surgery in order to take necessary preventive and therapeutic measures.

Some patients need emergency dental care and people with low economic status are more likely to go to hospital emergency departments. There is lack of enough knowledge about dental emergencies and no accurate data is available on this issue. This study aimed at investigating clinical and epidemiological characteristics of patients in dental emergency departments.

A cross-sectional descriptive study was performed in patients with dental complaints attending emergency departments affiliated with Mazandaran University of Medical Sciences, 2017-2018. Data were analyzed in SPSS V 16.

A total of 1660 patients (mean age: 36.80±15.50 years) were studied. The most common reasons for attending the emergency department were dental trauma (n=886) and dental infections (n=353). The highest referral times were evenings and nights (n=1130). Compared with women, men were found with more dental trauma and soft tissue injuries (P= 0.0001).

Special training programs should be provided to the staff in hospital emergency departments so that they can obtain sufficient information and skills about triage, diagnosis, treatment, and follow-up of dental emergencies.

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.