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Background and purpose : Ârterial embolism is one of the most prevalent cause of transient ischemic attack (TÏÂ) and other types of brain ischemias and about 5o% of TÏÂ patiens have vascular stenosis. Therefore the presence of mild atherosclerotic plaques in carotid arteries, as a source of embdlism in causing TÏÂ and other brain strokes are of a great importance. Ïn present study the stroke patients were survaied specially for the size of infarct region by carotid arteries Doppler sonography. The relationship between the size of infarct region and degree of stenosis and tye of carotid arteries plaque were analysed.
Materials and Methods : This cross sectional study, was conducted on 100 patients with cerebral infarction in the region of anterior circulation referred to radiology department of Sina hospital. Patients selection was based on the date of admission and after Ç.T scanning, extracranial carotid arteries were survaied by Doppler sonography (Âloka-SSD-1700). Registration of results of this study was done in the year 2000.
Results : Plaques were seen in ipsilateral carotid artery in 49% of patients. Proximal internal carotid artery was the most common site of involvement (34%) and carolid bifurcation and distal common carolid artery were involved consequently. Frequency of stenosis, specially the compelete sterosis, increased proportionately with the size of infarct area. The occlusion with small, medium and large sized infarction were zero, 16 and 33.3 percent respectively.
Çonclusion : Frequency of stenosis, specially ipsilateral carotid stensis was strongly associated with large than small infarct (25% VS 3.3% p<0.05).

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Background and purpose : Ëxclusive breastfeeding for under six months infants is one of the most important elements in ensuing their health. Breasfeeding has many advantages for infant, mother, family and society. Therefore it is equally important to understand the reasons for formula milk consumption in the society.
Materials and methods : Â descriptive study was conducted on 462 cases under 6 months in 13 cities of Mazandaran province in 2003. Data were collected from all cases that have used formula milk (complete or partial). Questionnaires were filled in, mothers were interviewed, family folders were checked and finally the data were analyzed using t-test and chi square.
Results : The data showed that 59.5% percent of infants exclusively used formula milk and 40.5% partially used it. Form 25 reasons for formula consumption, the most significant reasons were 23.8% twin birth (23.8%) lack of breast milk and failure to thrive (13.4%).
Çonclusion : This study showed that twin birth, lack of breast milk and failure to thrive were the most prevalent reasons (50.8%) for formula consumption. 27.4% of the cases of formula consumption were absulute indication and the rest of the reasons need more elucidation.

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Background and purpose: To analyze the data in which the correlation between observations are to be considered, a general method is using marginal model with repeated measures, yet there is another method called conditional model with random clusters. Âccording to the binary responses, the aim of the present study is to compare the efficiency of these two models in studying the risk factors affecting hypertension in Mazandaran province.
Materials and methods: This cross-sectional study is part of research studying the risk factors of the non-infectious diseases in Mazandaran province in 2007 with a sample size of 1000 cases. First, stratified sampling was employed and then random cluster sampling was used in each stratum. Ïn all cases, blood pressure was measured three times through standard methods. The obtained data were analyzed using test and fitting marginal and conditional logistic models.
Results: Ôf the total of 1000 (500 male and 500 female) cases, 38 percent had high blood pressure. Ïn both models four variables of age, physical activity, body-mass-index, and the consumption of fruits and vegetables were identified as factors affecting hypertension. Ïn addition, gender and fasting blood sugar were statistically significant only in marginal logistic model. Üsing goodness-of-fit criteria, values of all the statistics for conditional logistic model with random effects of individuals were lower in comparison with the marginal logistic model with repeated measures.
Çonclusion: Ït can be concluded that although one cannot decisively select a model as the most appropriate one, conditional logistic model fits were somewhat better than the marginal logistic model with repeated measures, so it can be used to analyze such data.

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Background and purpose: One of the health concerns is sports injury which is also the most issues for sports medicine specialists. Due to the effect of acute or chronic sports injuries in professional life and even individuals, the occurrence of sports injuries in Mazandaran the province was studied. Materials and methods: This is a cross-sectional study. Data were derived from hospitals and outpatient records which were sent to province sports medicine board during 2011-2012. The nature of sports injuries was classified according to the International Classification of Disease (ICD-10). Various sports were divided into pairs grouping and individually. Results: During 1 year, 288 records in which 188 (%65.3) were outpatients and 100 (%43l7) inpatients. The median of age was 21±8 years. Most of the nature of injuries was fractures 140 (48.6%), the injured site was the upper limb 98 (34%), upper limb 91 (31.6), multiple sites 51 (17.5 %), head and neck 38 (13%), and 10 (3.5%) cases were related to spine. The most cause of injuries of 191 cases (66.3%) was due to other causes such as bad nutrition, spasm, no prepration, non standard equipment, spoiled flooring, error in landing. Conclusion: The results showed that the fracture which is a severe injury and need more cost for treatment was the most sports injury. For prevention programs we need to have a systemic method of recording and reporting of injuries.

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Background and purpose: Monitoring quality of rivers water and awareness of its health status over time and identifying vulnerable zones are considered as essential steps towards sustainable development and efficient management of the environment. This study used multivariate statistical methods for analyzing water quality and awareness of rivers state in the Mazandaran province, Iran. Materials and methods: The monthly data of the rivers water quality parameters including electrical conductivity (EC), pH, NO3-, PO43-, CO32-, HCO3-, SO42-, Ca2+, Mg2+, K+, Na+, sodium absorption rate (SAR), Na%, permanent hardness (Per.H) and temporary hardness (Tem.H) during the 2011-2012 was collected. The principal components analysis, cluster analysis and spatial analysis were used to provide better results. Results: There were overlapped between many of the measured parameters. TDS, pH, SO42-, NO3-, and PO43- were optimization variables that could describe the water quality with 94.96% of variance. Results of grouped stations showed the relative quality of rivers water was lower in the western areas of the Mazandaran province. Relative situation of some stations including Baliran, Doab, Pol Mergen, Pol Sefid and Kercha was critical. Conclusion: Multivariate statistical analysis is able to process vast amounts of data, simultaneously. Determining important rivers water quality parameters can reduce costs and identification of homogeneous regions can play a significant role in integrated environmental management.

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Background and purpose: Heavy metals are released to the environment as a result of industrial, urban and agricultural sewages. They are usually resistant to chemical dissociation. They can easily contaminate aquatic animals especially fishes which are amongst the food chains of human. This study evaluated the concentration of heavy metals in the tissues of different types of Clupeonella cultriventris and Gasterosteus aculeatus in the waters of Caspian Sea in Mazandaran Province. Material and Methods: This cross-sectional descriptive study was performed on 50 Clupeonella cultriventris and 50 Gasterosteus aculeatus obtained from Mazandaran coastal by multi mesh gill nets in 2012. The samples were digested by concentrated 65% nitric acid, and were analyzed for Pb in a graphite furnace atomic absorption spectrophotometer and for Cd and Cr in a flame atomic absorption spectrophotometer. Results: Mean concentration of Pb, Cr and Cd in Gasterosteus aculeatus was 0.113, 5.28 and 0.046 and mean concentrations of Pb, Cr and Cd in Clupeonella cultriventris were 0.126, 4.29 and 0.096 (μg/g dry weight), respectively. The results showed no significant correlation between the concentrations of these metals and length of fish and different tissues of the fish. Conclusion: We found the concentration of heavy metals including Pb and Cr in both types of the fishes less than the amounts reported by WHO, so they do not bare considerable health risk. However, the concentration of Cd is more than the recommended consumption limit for human which could lead to many diseases. We believe that these fishes could be used as a bioindicator for assessing the pollution load of sea water and rivers.

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Background and purpose: Exclusive breastfeeding for the first six months after birth has an important role in preventing children morbidity and mortality. Understanding the factors that influence exclusive breastfeeding is critical in promoting this behavior. This study aimed to determine the factors predicting exclusive breastfeeding among children of mothers attending primary health centers in Sari. Material and methods: In a cross-sectional study 400 mothers with children under one year were randomly selected. Data was collected using a researcher-made questionnaire. The questionnaire’s content validity and reliability was previously approved. A multivariate logistic regression analysis was used to identify the predictors of exclusive breastfeeding. Results: The prevalence of exclusive breastfeeding for the first six months after birth was 86.20% . The mean duration of exclusive breastfeeding was 3.2±1.08 months. Also, the prevalence of breastfeeding after six months was 81.6%. Living in their own house and having a supportive husband were independently associated with exclusive breastfeeding. Conclusion: Promotion of exclusive breastfeeding as a maternal child health index in Sari shows that breastfeeding behavior is well established in this region. High rate of exclusive breastfeeding signifies the role of family health programs in this region.

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Background and purpose: Health quality of fish as an important source of protein for human has received increasing attention. This study, examined the concentrations of chromium, nickel, zinc, and copper in the muscle and skin tissues of two edible fish species of Alosa Caspica and Clupeonella cultiventris caspia in the southern Caspian Sea in 2013. Also, the risk assessment of consumption of these species was done. Materials and methods: After biometric analysis, C. cultiventris caspia (n=50) and A. Caspia (n=17) were prepared for analysis by acid digestion method. Concentrations of the studied metals in digested samples were determined using an atomic absorption spectrophotometer (GFS97, Thermo Electron, Cambridge, UK). Results: The results showed that the level of chromium in the skin tissue of A. Caspia was significantly higher than that of the C. cultiventris caspia (P<0.05). In the C. cultiventris caspia and A. Caspia concentrations of zinc in the skin were higher than what has been found in the muscle. In the C. cultiventris caspia the muscle showed high concentrations of chromium than skin (P<0.05). In the studied specimens the concentrations of chromium and nickel exceeded the WHO threshold Conclusion: Human health risk assessment of heavy metals via consumption of studied species showed that consuming these species with current rate of contamination is not a risk for consumers

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Background and purpose: Violence against children is one of the most important social and public health problems that affect people in different age, racial, cultural and religious groups. The aim of this study was to determine and compare the prevalence of violence against children in provinces of Iran.

Materials and methods: This ecological study used the cluster analysis of data from Demographic and Health Survey (DHS) conducted in 2010 among 31 provinces of Iran.

Results: After integration of indicators of violence against children, the highest and lowest mean values of indices in all provinces were verbal punishment (76.99) and corporal punishment (13.12), respectively. In cluster analysis five clusters were formed in which the worst was seen in Golestan province (cluster 2) and the best were observed in Guilan, South Khorasan, Yazd, Ilam, Tehran, Khorasan Razavi, Isfahan, Semnan, Hormozgan, Khoozestan, Alborz, and North Khorasan (cluster 1). According to the results of ANOVA, four indicators of violence against children including inadequate care, exposure to smoking, child labor and believe in disciplinary action against children showed significant differences, but no significant difference was found between corporal punishment and verbal punishment.

Conclusion: This study showed that the overall rate of violence against children was high and a wide variety of violence is seen against Iranian children.

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Background and purpose: Malocclusion which has great hazardous effects on oral function seems to have become more prevalent in recent years therefore, the present study was carried out to assess the prevalence of different malocclusions among 13-15 year-old female adolescents in Sari, Iran.

Materials and methods: This study was conducted in September 2014 to March 2015. A total of 485 school girls aged 13-15 were randomly selected from 11 schools to determine the status of their occlusion. Students who had previous orthodontic treatment or extraction of any permanent teeth and craniofacial syndrome and mixed dentition were excluded from the study. Angle's classification was used to describe the type of malocclusion.

Results: According to the results, only 12% of studied adolescents had normal occlusion, whereas 53% had Class I, 19.4% had Class II and 15.6 % had Class III malocclusion.

Conclusion: Class I malocclusion was the most prevalent, while Class III malocclusion was the least prevalent among female students in Sari.

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Background and purpose: Population aging is one of the most important issues in demography that has attracted much attention. In Iran, the population is changing from young structure to an old structure. This fast transition calls for designing studies about population ageing in all provinces. This study was conducted to determine the population structure in Mazandaran province. 

Materials and methods: Four census data sources (1986 to 2011) were used and population ageing index was calculated by median age, fertility and mortality rates. Hierarchical cluster analysis which is an unsupervised classification method was used for grouping the cities in R package version 3.1-2 and thematic mapping was prepared using GIS software 10.

Results: The number of clusters of cities considering population aging index, median age of the indices, general fertility and mortality rates in the census of 1986 and 1996 was 6 and in next censuses was 5. In all four censuses the highest aging index and the least number of cluster index were greater than the value of country’s old population. Bar graph indicator of the aging population showed a significant increase in the index during the 1986-2011 censuses.

Conclusion: According to the results, population aging was found to have a dramatic increase in Mazandaran province during the censuses. This increase may have different reasons and could not be only due to decline in fertility rate. In some towns such as Savadkuh emigration from the region could be responsible for the increase of ageing population. Another cause of this increase in the province could be increase of life expectancy. Therefore, appropriate planning is required on this subject.  

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Background and purpose: Unusual enlargement of nose and pharyngeal (nasopharynx) can disrupt the flow of air through the nose. The aim of this study was to investigate the cephalometric parameters in the upper airways.

Materials and methods: A retrospective descriptive study was performed using the digital lateral cephalometric radiographs of 32 adults with class I (CL I) malocclusion and no history of night apnea. The radiographs were obtained from the archives in Qazvin Orthodontics Department of Dentistry School and private clinics. Coefficient of variations and Pearson correlation were calculated in SPSS. 

Results: There was positive Significant correlation (r= 0.761) between tongue length and tongue height, length of the soft palate, and maximum thickness of the soft palate but negative significant correlation was found between tongue length and hypo pharnzhyal air space (r= -0.422) (P= 0.01). There was positive significant correlation (r= 0.444) between tongue height and length of the soft palate and maximum thickness of the soft palate. Also, there was positive significant correlation between over pharyngeal air space and hypo pharyngeal air space and posterior air space (r= 0.551) (P= 0.014). There was positive significant correlation between hypo pharyngeal air space and posterior air space, vertical position of vallecula, and horizontal position of vallecula (P= 0.017). Posterior air space had a positive significant correlation with horizontal position of vallecula but had a negative significant correlation with length of the soft palate. There was positive significant correlation between length of the soft palate and maximum thickness of the soft palate, and vertical position of vallecula and horizontal position of vallecula.

Conclusion: There was no significant difference in cephalometric parameters of the upper air ways in adults in Qazvin with CL I malocclusion. Genetic and environmental effects are the most important factors in these cases.

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Background and purpose: Temporomandibular disorders (TMD) are manifested as a group of signs and symptoms diagnosed by pain, and malfunction of temporomandibular joint (TMJ) and masticatory muscles. The role of etiologic factors such as stress and occlusal interferences has gained much attraction. In this study, we assessed the incidence of TMD and its relationship with stress and occlusal interferences in individuals attending Sari Dental School Clinic, 2014-2015.

Materials and methods: In this descriptive-analytical study 68 people (41 females and 27 males) were selected. Occlusal interferences were assessed by clinical examinations and the stress levels of the participants were determined by The Taylor Manifest Anxiety Scale (TMAS). The relation between TMD and other variables were analyzed by Chi-square and exact fisher tests. Data was analyzed in SPSS V. 22.

Results: Of the total population studied 51 (75.0%) had TMD. Among TMD patients one (1.9%) had low-level stress, 30 (58.8%) had moderate-level, and 20 (39.2%) were found to have high-level stress. No significant relationship was found between TMD and stress. In TMD group, 13.7% did not have centric interferences; 70.6% showed interferences up to arch of closure, and 15.7% had interferences up to line of closure. Significant relationships were found between TMD and interferences of working side (P<0.03), protrusions (P<0.0001), arch of closure interferences (P<0.03), and interferences of nonworking side (P=0.01).

Conclusion: Temporomandibular disorders were found to be more prevalent among the population studied. No relations were found between TMD and stress while TMD incidence was related to some occlusal interferences.

(Clinical Trials Registry Number: IRCT2014113020158N1)

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Background and purpose: Irrational beliefs are among the factors affecting the tendency to use tobacco. Today, there is a growing trend of waterpipe (hookah) smoking among the youth in Iran. This study aimed at comparing irrational beliefs among young adult hookah smokers and young athletes.

Materials and methods: This descriptive study was conducted in 600 individuals who were selected using stratified random sampling, in Zahedan, Iran, 2015. The participants included 300 hookah smokers in traditional teahouses and 300 individuals attending bodybuilding gyms. Data collection was performed using the Jones’ Irrational Beliefs Test (IBT).

Results: The mean ages of the young hookah smokers and athletes were 23±6 and 22±2 years, respectively. The results of MANOVA test indicated a statistically significant difference between the two groups in terms of all irrational beliefs. Accordingly, the mean score of irrational beliefs score in the hookah smokers was much higher than that of the young athletes (F=71.42, Wilks lambda=0.452, P=0.00).

Conclusion: Irrational beliefs are believed to be amongst the main factors affecting the tendency of young people to smoke hookah.

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Background and purpose: Breastfeeding self-efficacy is the feeling of confidence of the mother to experience exclusive breastfeeding. The aim of this study was to compare the effect of talks and motivational interviews on breastfeeding self-efficacy in primiparous women.
Materials and methods: This randomized controlled clinical trial was conducted in 210 primeval pregnant women attending Torbat Heydarieh health centers, Iran 2017-2018. Random block method was used and the subjects were assigned into three groups (n=70 per group), including those participating in motivational interviews, attending the talk session, and controls. Motivational interview was carried out in five sessions (two hr) and three telephone follow ups were made. The talk group were given a two- hour talk about breastfeeding and received relevant trainings, while the control group only received routine care. The groups were evaluated for breastfeeding self-efficacy at two, four, and six months after childbirth. Data were analyzed applying Chi-square and ANOVA.
Results: Demographic variables were not significantly different between the groups (p>0.05). Six months after childbirth, the mean scores for breastfeeding self-efficacy were 63.97±0.89, 50.02±0.91, and 41.77±0.95 in the group participating in motivational interviews, the talk group, and controls, respectively. The score revealed significant differences between the three groups in breastfeeding self-efficacy (p<0.001).
Conclusion: Motivational interview was found to be more effective in enhancing breastfeeding self-efficacy, therefore, it is suggested as an effective and inexpensive method, especially in primiparus women.
 
(Clinical Trials Registry Number: IRCT IRCT2014122220394N1)
 

 

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Background and purpose: Muscular atrophy is a condition derived from different diseases and aging. Molecular study of the disease condition can help in developing diagnostic methods and treatment approaches. In this study, protein interaction network was analyzed to understand molecular events at protein levels.
Materials and methods: In this experimental study, the network was constructed and analyzed using Cytoscape and its plug-in STRING. In addition, Network Analyzer and MCODE were applied to analyze the centrality and clustering, respectively. Bingo explored the gene ontology of the determined protein complexes.
Results: The findings showed five key genes in the network of atrophy including AKT1, ALB, DMD, SMN1, and SMN2. Furthermore, six clusters of proteins were obtained from which two significant ones were considered for gene ontology analysis.
Conclusion: All the central proteins, AKT1, ALB, DMD, SMN1, and SMN2 are present in the clusters of our interests. It can be concluded that the panel of biomarkers introduced could be of great help in understanding the pathology of muscular atrophy.
 

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Background and purpose: Malocclusion is the most prevalent dental anomaly that influences the function of affected people. As a common orthodontic index, the Index of Orthodontic Treatment Needs (IOTN) classifies the malocclusions according to occlusal indexes of an individual. This research aimed at evaluating the need for orthodontic treatment in students aged 12-14 years old in Sari using IOTN Index in academic year 2016-2017.
Materials and methods: In this descriptive cross-sectional study, the IOTN was used for 576 students in six different schools. The IOTN index includes two components which are closely related; in current study, only the dental health component (DHC) was assessed. Data analysis was done in SPSS V21 applying Chi-square.
Results: A total of 576 students was studied of whom most (29.2%) were in grade 2, which showed little need for treatment (30% males and 28% females). Only 2.8% were graded as 5 on the IOTN scale meaning serious need for orthodontic treatment. Male and female students were homogeneous in grading distribution and there was no significant difference between the two groups (P< 0.75). The frequency of need for orthodontic treatment was 25.35%.
Conclusion: In this study, most of the individuals showed little need of orthodontic treatment and there was no significant difference between the two groups in grading distribution.
 

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     Background and purpose: Respiratory function of patients is a major part of orthodontic diagnosis and treatment planning. It is affected by the dimensions of the pharyngeal airway. In this study, these dimensions were compared in patients with different skeletal patterns.
Materials and methods: This cross-sectional descriptive-analytical study was performed studying the cephalograms of patients attending the Orthodontic Clinic affiliated with Mazandaran University of Medical Sciences 2016-17. After tracing, 144 cephalograms were divided into three groups: class I, II, and III (n= 48 per group) based on the ANB angle. The nasopharyngeal, oropharyngeal, and hypopharyngeal dimensions were measured. Data were analyzed using SPSS V24.
Results: The highest mean dimensions amongst nasopharyngeal, oropharyngeal, and hypopharyngeal spaces were found in class I (21.25mm), III (10.49mm), and III (15.89mm), respectively. There was no significant difference between class I and II in the nasopharyngeal space (P=0.108). There were significant differences in the mean dimensions of all three spaces studied between class I and III and class II and III (P <0.05).
Conclusion: Airway dimensions seem to vary among different classes of sagittal malocclusion. The dimensions of oropharyngeal and hypopharyngeal airways decrease with increase in ANB angle, but the dimensions of the nasopharyngeal airway are not associated with the changes in ANB angle and are higher in people with class I skeletal occlusion.

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Background and purpose: Acquisition of basic skills and professionalism in medicine depends on the quality and quantity of education in clinical settings. This study aimed at assessing the quality of clinical education in different departments of Mazandaran University of Medical Sciences.
Materials and methods: This descriptive study was conducted in medical clerkships and interns (n=175). The participants were selected via census sampling in 2019. Data were collected using a checklist based on clinical education standards of Iran Ministry of Health and Medical Education. Written comments from clerkships and interns on the compliance of morning report training programs, clinical trainings, clinical rounds, grand rounds, journal club, and clinical skills center with clinical training standards were received. Data analysis was performed in SPSS V16.
Results: The morning report program and clinical skills center program had the highest (85.1%) and lowest (72.2%) scores in clinical education. We observed significant differences between these scores and the scores for other clinical programs (P>0.05). The quality of all clinical education programs was similar according to men and women. The clerkship and interns had different ideas about the status of all clinical education programs except in the morning report program and the clerkship were more satisfied with clinical education programs.
Conclusion: From the students' point of view, the morning report program was of acceptable quality, but the clinical training programs, club journal, grand rounds, and clinical skills center had some drawbacks. Training workshops for clinical professors is recommended to enhance the standards of clinical training programs.
 

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Background and purpose: Occlusal plane in edentulous patients is lost and needs to be reconstructed. The most common method for reconstructing occlusal plane is to make it parallel to the ala-tragus line. There are disagreements about the posterior reference of ala-tragus line. The aim of this study was to determine the best posterior reference of ala-tragus line (superior, middle and anterior references) for reconstructing occlusal plane.
Materials and methods: In this descriptive-analytical study, 150 dentate patients with class I relationship enrolled. Patients were placed 1.5 meters from the camera and their head was in NHP mode and symmetrical to the line perpendicular to the horizon. Fox-plane was placed in contact with central incisors and first molars of maxilla and imaging was performed from the right side of the face. The angles required were then measured using AutoCAD 2020.
Results: There were 75 male and 75 female patients (mean age= 23.05±1.69 years) and the mean OT1-OP angle was 8.75, which was the closest to the mean OT1-AT3 angle (8.85). This finding also was repeated in both men and women. Among all patients, OT1-AT3 angle was found to have the highest proximity to the occlusal plane (61. 33%), 53.34% in men and 69.33% in women.
Conclusion: Inferior point on the tragus of the ear in ala-tragus is the best reference for reconstructing the occlusal plane during construction of a removable denture for male and female edentulous patients.