Introduction: It was to compare the efficacy of semiannually fluoride varnish application versus pit and fissure sealant to reduce occlusal caries incidence. Materials and methods: A randomized parallel designed study was conducted with 352 children aged 6-7 years. Participants were allocated into biannual application of varnish (n=179) (NaF 5 %(Durafluor, DENTSPLY®, Latin America) or resin-based fissure sealant (n=173) (Eco Seal, Korea®) single application without previous tooth preparation. Two visual-tactile methods including WHO and Nyvad criteria were used for caries detection. The unit of analysis was tooth surface. χ2 test, t-test, Fisher exact, and multivariable logistic regression were used for statistical analysis. Results: Proportion of caries free (DMF=0) were 79.8% and 79.1% among the sealant and varnish groups respectively. By using Nyvad visualtactile criteria 60.4% and 50.2% of surfaces remained sound in sealant and varnish groups respectively (p < 0.001). The prevented fraction of sealant to varnish by two measures was 3.46 and 20.5 respectively. Regression model showed sealant application (OR=0.34) and tooth brushing >2 times/day (OR=0.8) were protective factors while dmfs>4(OR=0.08), and snack consumption >2 times/day (OR=1.3) were risk factors of caries incidence. Conclusion: The results of this study suggest that semiannual fluoride varnish application can be recommended for preventing and reducing occlusal caries in low caries risk population.

The use of mobile applications in chronic disease management has grown significantly over the past decade. When properly designed, these apps provide a convenient, safe, high-quality service to patients. In this study, a health management app was developed, and its usability among patients with diabetes mellitus was examined. A convenience sample of 136 patients, referred to two academic centers from December 2016 to July 2017, was enrolled. Upon completion of informed consent, the participants were asked to install the app on their smartphone. Two weeks later, they were required to complete a postapplication usability questionnaire, comprising 21 questions classified into six domains. The response rate was 89%. The highest scores were given for “ease of use and learnability”; the lowest-scored domains were “interaction quality” and “reliability.” Urban residents, participants with lower educational qualifications, and retirees were significantly more satisfied with the app. Overall, patients with diabetes mellitus perceived the app as useful for disease management. However, the overall usability of health apps is expected to improve when a multidisciplinary team (health professionals, computer engineers, art designers) is involved in the development process.

BackgroundConcentrations of plasma lipids levels during pregnancy clearly increases. According to some studies, dyslipidemia is effective in the incidence of preeclampsia and insulin resistance. Objective: This study aimed to examine the relationship between hyperlipidemia and maternal and neonatal outcomes in pregnant women.Materials and MethodsThis is a cross-sectional study which was conducted on two groups of pregnant women with hyperlipidemia and normal ones to assess maternal and neonatal outcomes. Maternal data including gestational age, mother's age, body mass index, and maternal weight gain during pregnancy, gestational diabetes mellitus, preeclampsia, cholestasis, and delivery method. Also, birth weight and Apgar score were gathered as the neonatal outcomes.Results The results showed that the prevalence of abnormal lipid parameters increased with increasing gestational age. In pregnant women with dyslipidemia in combination with increased triglyceride, cholesterol and Low-density lipoprotein, and decreased High-density lipoprotein, the incidence rates of gestational diabetes (p < 0.001), preeclampsia (p < 0.001), cholestasis (p = 0.041), fetal growth retardation (p < 0.001), and macrosomia (p < 0.001) were statistically higher.ConclusionDyslipidemia was associated with some adverse effects of pregnancy and harmful fetal outcomes. Therefore, it seems that adding laboratory assessment of lipid profiles before and during pregnancy can be effective in early diagnosis of dyslipidemia.

Overhang refers to the extension of restoration material from the cavity. It has an important role in decay, plaque accumulation and periodontal disease, so the aim of this study is determining the frequency of restoration overhang in patients in Anzali, Guilan. Materials and methods: This descriptive cross-sectional study was completed using 293 patients who visited for routine checkups. The overhangs were examined on the basis of the cavity type, restoration type, tooth location, and age by direct observation using an explorer, dental floss. After the initial diagnosis of the overhang, the radiographic reports were examined for final confirmation. Results: 41.2%, 0%, 18.2%, and 38.1% were observed in cavity classes II, III, IV, and V, respectively. 35.8%, 38.2%, 28.1%, and 25% were observed in mesial, distal, buccal, and lingual regions, respectively. The highest rate of overhang frequency in the first molar teeth was 50% and the lowest overhang amount occurred in the lateral and canine teeth at 25% and 27.3%, respectively. Most amalgam restorations had overhang (37.7%) and the highest amount of overhang was in the upper jaw (42.5%). The highest amount of overhang frequency was observed on the left (41.6%). There was no significant difference in overhang frequency between men and women. The lowest and highest amounts of overhang were observed in the age groups of <30 (26.9%) and 30-39 (47.8%), respectively, and was found to be statistically significant. Conclusion: The overall frequency of restoration overhang was 36.6%, most of which was in class II amalgam restoration in the left first molar teeth in 30-39 year-olds.

Guidelines received acceptable scores in all the domains of AGREEII. Based on nurses' opinion, recommendations of guidelines will play an effective role in prevention, treatment, reduction of complication among diabetic foot patients. Therefore, adaptation, implementation, and evaluation of the guidelines were recommended.

Aim:The study determines moral distress and related factors among emergency nurses. Moral distress is one of the recurring issues in the nursing profession that has gained importance by creating changes in the health care system. Materials and Methods:An analytic-descriptive study was conducted, in which all 180 nurses working in emergency education and health centers in were included. Moral distress was measured by questionnaire. Data were analyzed using SPSS 17. Results:The findings showed that moral distress in emergency nurses (4.93±1.08) was high. Most moral distress was in the area of professional-functional competence (5.21±1.17) in the item of "unsafe conditions" (5.55±1.45). No statistically significant correlation was found between age and experience with moral distress among nurses in the emergency department. From the perspective of nurses in the study, organizational factors including barriers to education were the strongest factor influencing moral distress. Conclusion:Given that moral distress in nurses participating in the study was very high, it seems that planning to promote professionalfunctional competency of nursing practice are essential.

Background & objectives: Evaluation of liver and renal function before and after administration of methotrexate (MTX) is recommended in the treatment of molar pregnancy, but the necessity of performing these tests during treatment of ectopic pregnancy (EP) is not clear. The aim of this study was to evaluate the changes of creatinine and AST levels before and after treatment with double (DD) and multiple (MD) doses of MTX in patients with Ep. Methods: This retrospective cross-sectional study performed on 152 patients with an EP during 2007-2013 in Al-Zahra hospital (Rasht). Seventy six patients received DD and 76 cases were treated with MD of MTX. The success rate, side effects of MTX and changes in creatinine and AST levels were compared between the two groups. Results: The mean changes in creatinine level was 0.06±0.08 and 0.16±0.13 in DD and MD groups, respectively and the difference between the two groups was statistically significant (p=0.002). The mean changes in AST level was 5.06±2.47 and 9.63±5.5 in DD and MD groups, respectively which was statistically significant (p=0.002). The success rates were 65.8% and 86.8% in DD and MD groups, respectively with statistically significant difference (p=0.002). The side effects rates were 13.2% and 32.9% in DD and MD groups, respectively with statistically significant difference (p=0.004). Conclusion: It seems that administration of MD of MTX in EP patients leads to an increase in success rate of treatment but also it causes considerable increase in creatinine and AST levels.

BackgroundNeurosurgical treatment and the severity of head injury (HI) can have remarkable effect on patients’ neuropsychiatric outcomes.ObjectivesThis research aimed to study the effect of these factors on cognitive functioning, general health and incidence of mental disorders in patients with a traumatic brain injury (TBI).Patients and MethodsIn this descriptive, longitudinal study, 206 TBI patients entered the study by consecutive sampling; they were then compared according to neurosurgery status and severity of their HI. Both groups underwent neurosurgical and psychological examinations. The mini mental state examination (MMSE) and general health questionnaire–28 items (GHQ-28) were administered to the study participants. At follow-up, four months later, the groups underwent a structured clinical interview by a psychiatrist based on the diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) diagnostic criteria regarding the presence of mental disorders.ResultsAnalysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA) were performed and adjusted for the effect of confounding variables (age, gender, Glasgow outcome scale (GOS) , and level of education). The severity of HI had the most significant effect for the following variables; cognitive functioning and physical symptoms (P < 0.05). The effect of the neurosurgical treatment factor was not significant; however, the interaction effect of the two variables on social dysfunction, and total score of the GHQ-28 questionnaire appeared to be significant (P < 0.05). Fisher's exact test indicated that after a four month follow-up period, no significant differences were seen between the two groups (with or without neurosurgery) in the incidence of mental disorders, while χ2 Test showed that having a more severe HI is significantly correlated with the incidence of mental disorders (P < 0.01).ConclusionsThe implications of this study should be discussed with an emphasis on negative, effective factors on the cognitive – behavioral and neuropsychiatric outcomes of a TBI.