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Background: Cone beam computed tomography (CBCT) is a valuable imaging modality in dentistry and has a remarkable role in the analysis of the hard tissue of the maxillofacial region. However, the artifact caused by crowns and some other dental interventions reduces its quality and creates problems in the interpretation of the images. Therefore, this research aims to investigate the accuracy of CBCT linear measurement in the presence of porcelain fused to metal (PFM) restorations. Materials and Methods: In this experimental study, 12 sheep mandibles were used. Radiopaque markers (gutta-percha) were located on the buccal and lingual ridges, and the height and thickness of the bone were measured using a digital caliper (direct measurement). Subsequently, the samples were scanned in three steps with the CBCT device: The first scan was performed without placing the crown (the base image), the second scan was performed with one PFM crown, and the third scan was performed in the presence of three side-by-side crowns. The data were analyzed using SPSS software V.22. The significance level was considered 0.05. Findings: There was no significant difference between the direct measurement and the baseline image in the measurement of bone height and thickness. Moreover, increasing the number of crowns did not affect the accuracy of CBCT scans. Conclusion: According to the findings of this study, the presence of metal-ceramic crowns did not reduce the accuracy in the linear measurement of alveolar bone height and thickness.

Abstract Background Learning in the academic setting is influenced by the dynamic interaction between students and teachers. Recognizing and adapting to diverse learning styles is essential for improving instruction, gaining knowledge, and drawing informed conclusions. Therefore, this study investigated learning styles and their effects on students’ academic achievement. Methods In a cross-sectional study in Iran’s Mazandaran province, 238 nursing students were surveyed between October and December 2021 using random sampling. The questionnaire included socio-demographic data, Kolb’s Experiential Learning Model, and students’ academic performance (EPT). Statistical analysis with SPSS version 22 involved descriptive statistics, one-way ANOVA, chi-square tests, and linear regression with statistical significance set at p

Background and Purpose: Diabetes Mellitus is a group of complex, multi-system metabolic disorders that alter many functions of the immune system and are associated with delayed recovery and a reduced immune response. Apical periodontitis is the inflammation and destruction of the periodontium in the apical region of the root, originating from the pulp, and as a result, an inflammatory response creates a radiolucent area at the root apex. In this study, we aimed to investigate the relationship between the presence of pulp and periapical lesions and controlled type 2 diabetes in the radiographic images of patients. Materials and Methods: In this cross-sectional study, 45 patients were included in the case group (patients with controlled diabetes) and 45 in the control group (healthy individuals). Periapical and endodontic status was evaluated based on examinations using panoramic and periapical images. In the dental examinations (excluding third molars), the following were recorded for each patient: the number of teeth in the mouth, the number and location of teeth without root canal treatment with a periapical lesion, the number and location of teeth with root canal treatment, and the number and location of teeth with root canal treatment with a periapical lesion. The periodontal condition was assessed using the periapical index (PAI), with scores greater than 3 considered indicative of periapical pathology. For inferential analysis, chi-square tests and independent t-tests were used. Results: Among the 90 participants, 53 were women and 37 were men. The average age of the participants was 43.6 years, and the average age was higher in the diabetic group. In total, 52.2% of patients had periapical lesions and 63.3% had pulpal lesions, with these two lesions being significantly more common in diabetic individuals(P

Background and purpose: Moral courage is a crucial aspect of the nursing profession that significantly influences the quality of healthcare services. Moral courage refers to the courage or inner strength that an individual exhibits in ethical situations, acting based on their ethical principles, values, and beliefs despite potential negative consequences for themselves. Enhancing moral courage in nurses can lead to better decision-making and improved healthcare quality, thus, the understanding of the various factors related to this characteristic is of great importance. This article aims to investigate the relationship between moral courage and the personal and occupational characteristics of nurses. Materials and methods: This is a cross-sectional descriptive study. The research population in this study consisted of all nurses employed in hospitals affiliated with Mazandaran University of Medical Sciences in the eastern province of Mazandaran. The sample size was determined to be 300 individuals. Sampling was conducted using the convenience sampling method. Data was collected through a questionnaire related to demographic characteristics (age, gender, marital status, education level, type of employment, years of service, service department, shift work, hospital of service, and history of attending ethics courses or seminars), and the Sekerka Ethical Courage questionnaire was utilized. Data analysis was performed using measures of central tendency, standard deviation, independent t-tests, analysis of variance, and multiple linear regression. SPSS 22 software was employed for data analysis, with a significance level of less than 0.05. Results: The average age of the participants was 32.85±7.54 years. The average score of nurses' moral courage was 60.24±4.37 out of (105), indicating a moderate level. The highest score of moral courage was commonly associated with the moral agent dimension (13.87±1.42) and multiple values (13.43±1.54), while the lowest score of ethical courage was related to the threat tolerance dimension (8.82±1.74). Participation in ethics courses had a significant effect on the moral courage score (P=0.004), where nurses with a history of attending ethics courses obtained higher scores in moral courage. Other variables did not have a significant impact on the ethical courage score. Regression analysis results also showed that only participation in ethics courses had a significant effect on the moral courage score, as nurses without a history of attending these courses scored lower (1.26 units). Conclusion: Based on the findings of this study, it was revealed that participation in ethics-related training courses has a significant impact on nurses' ethical courage. These results indicate that ethics-related education (familiarity with professional ethics principles in nursing, values, and ethics in nursing decision-making, ethics in patient confidentiality and privacy, ethical collaboration and interaction with colleagues and other members of the healthcare team, patient involvement in ethical decision-making, ethical relationships with patient's families, and respect for their rights) can help strengthen and enhance nurses' ethical courage. Since ethical courage plays a crucial role in nurses' decision-making in challenging situations, designing effective and appropriate educational programs in this area can contribute to improving the quality of care and fostering a more ethical environment in the nursing setting.

Background and purpose: Diabetes is the most common metabolic disorder associated with chronic hyperglycemia and a disfunction in carbohydrate metabolism, fat, and protein. Oral complications of diabetes include gingival hyperplasia, periodontitis, dental caries, and xerostomia. Although diabetes can be effective on oral and dental health, limited studies have investigated the increase of oral and dental caries in children with type 1 diabetes compared to healthy children. This study compares oral health and quality of life in two to five-year-old children with type 1 diabetes with healthy children in Sari City in 2022. Materials and methods: In this case-control study, 33 children aged 2-5 with type 1 diabetes (case group) and 33 healthy children matched in terms of age and gender (control group) referred to BuAli Hospital in Sari were included using the census method. After obtaining informed consent from the parents, the Early Childhood Oral Health Impact Scale (ECOHIS) was provided to them. This questionnaire was classified into two areas: the child impact section (CIS) and the family impact section (FIS). Generally, the sum of the raw scores of this index varies from 0-52, which includes 0-26 scores for the CIS section and 0-16 for the FIS section. The higher score in the ECOHIS index suggests worse oral health-related quality of life (OHRQOL). Children were examined for dmft index under sufficient light. Data was analyzed using SPSS 22 statistical software. Results: In this investigation, 36 boys (54.5 %) participated, of which 19 (57.6%) were in the case group and 17 (51.5%) were in the control group. The girls also made up 45.5 % (30 cases) of the sample size, of which 42.4 % (14 cases) were in the case group and 45.5 % (16 cases) were in the control group. The findings revealed that the mean FIS, ECOHIS, and dmft scores in the case group were significantly higher than the control group (P0.05). Conclusion: According to the current results, the oral health-related quality of life according to the ECOHIS index in type 1 diabetic children is more inappropriate than healthy patients at the same age. Moreover, as the child with type 1 diabetes grows older, the oral health-related quality of life decreases. The results of the present study also show that children with type 1 diabetes are at risk of dental caries (more dmft), which increases with age but does not have any significant association with sex.

Background: Fatigue is a significant factor that affects nurses and the quality of care they provide.Objectives: This study aimed to compare the effects of foot reflexology (FR) and foot massage (FM) on fatigue and its impacts in female nurses.Methods: A randomized controlled trial was conducted with 60 nurses who were randomly assigned to two groups of 30 to receive either FR or FM, in Buali Hospital (Sari-Iran), from January 2022 to July 2023. Nurses received FR or FM for 10 minutes once a day for three consecutive days. Fatigue and its impacts were assessed before, immediately after, and one week following the intervention. Data were collected using the General Health Questionnaire (GHQ-12), the Chalder Fatigue Scale (CFS), and the Fatigue Impact Scale (FIS).Results: The mean baseline fatigue scores in the FR and FM groups were 23.33±9.69 and 22.07±6.51, respectively (P=0.65). Both groups showed a significant decrease in fatigue scores immediately and one-week post-intervention, with the FM group exhibiting a significantly smaller decrease (P

Background and purpose: Musculoskeletal disorders (MSDs) are becoming increasingly prevalent as a source of occupational disability injuries. Musculoskeletal disorders in midwives are a major concern, as midwifery is one of the professions with a high risk of occupational diseases, in addition to risk factors such as awkward posture, repetition of movements, heavy workload, fatigue, and stress, are also dependent on individual-organizational factors, which can be caused by occupational tensions and may lower the quality of care provided to mothers and newborns. Because there is little research in this field, the current study aimed to determine the prevalence of musculoskeletal disorders among midwives working in public and private hospitals in Sari City, as well as the influence of related risk factors on it. Materials and methods: This descriptive-analytical cross-sectional study was conducted in 2023 (summer) among midwives working in public and private hospitals in Sari City as a census. 193 workers in maternity wards were chosen, with having more than one year of experiencea nd the exclusion being a history of musculoskeletal disorders. The data collection tool included a demographic and organizational information collection form, the Cornell musculoskeletal disorders questionnaire. This questionnaire looks at 12 body areas and the frequency, severity, and impact of discomfort on work abilities throughout the previous working week. Data analysis was done by SPSS statistical software, descriptive statistics, chi-square, and independent t-tests at a significance level of 0.05. Results: The mean and standard deviation of the age and work history of the studied subjects were 35.60±7.74 and 10.42±6.84, respectively. Analysis of the frequency of musculoskeletal problems revealed that the most commonly affected areas were the wrists, shoulders, lower back, and neck. Meanwhile, 79.4% of people have experienced discomfort in at least one of the various organs. In terms of the amount of pain, the highest average pain sensation among participants was reported the highest average pain intensity at night (40.7%). Based on the results, the highest prevalence of MSDs was found in the neck region (58.4%), followed by the lower back (57.6%), shoulder (53.9%), and then one or both wrists (51%). Also, the average age and history of midwives with MSDs had a significant relationship (P

Background and purpose: Reducing the desire to have children is one of the most important concerns and challenges in developed and developing countries. Also, the current policies in these countries try to understand the factors related to it, and until today, through this way, it has led to an increase in the population in countries with an aging population. Considering the importance of this issue, we decided to prepare and compile a study to determine the factors related to the desire to have children systematically. Materials and methods: This study was conducted in 2024, which is a systematic review, and was conducted in five stages, which included designing the study question, searching, extracting related studies, selecting related studies, tabulating information, and reporting the results. Was. Searching in domestic and foreign databases including SID, PubMed, magician, Iran doc, Science Direct, Scopus, and Google Scholar search engine with keywords such as "related factors", "childbearing", "psychological factors", "social factors", Cultural factors, "physical factors", "individual factors", "religious factors", "decrease", "Iran" and "tendency" and their English equivalents were carried out. Studies were reviewed in the period from 2012 to 2024 (the last twelve years, due to major changes in the world). To select studies, inclusion or exclusion criteria were considered. Also, the quality screening of the studies was done by the Newcastle checklist. After selecting and checking the quality, the data in the studies were classified. Results: Based on the answer to the main research question, the findings were classified into three categories: social and environmental factors, psycho-physical factors, and demographic factors. The review of 16 cross-sectional studies showed that factors such as sex, age, marriage, education, race, and place of residence are included in the demographic class. Among other relevant factors is the desire to have children. Religion and religion, technological progress, life experiences, culture and politics governing the society, family structure, peers and economic issues, and access to the media are among other related issues that are included in the category of social and environmental factors and are mentioned in 6 studies. became. The analysis of 7 other cross-sectional studies pointed to the connection of the next class, i.e. psycho-physical factors. In these studies, factors such as personality, depression, self-esteem, underlying disease, and fertility and infertility records were related to having children. It should be noted that some studies were placed in several classes and the classes overlapped. Conclusion: Based on the findings of this study, it can be concluded that there are many factors related to people's desire to have children, which the studies in this research are not sufficient in expressing. But it is possible to take help from these factors that have been mentioned in various studies as a guide to know the related factors and by planning to manage or strengthen some of them, help to increase the desire to have children.

Background and purpose: Aging is a physiological process, but during this period, with the passage of time and the influence of environmental factors and unhealthy lifestyles, the prevalence of diseases, especially chronic diseases, increases. One of these chronic diseases is diabetes. It has negative effects on their physical and mental health and as a result, reduces their quality of life. A relatively new issue that is raised today regarding the quality of life is hope. Because hope can ease the process of facing life's adversities and improve the quality of life. Hope therapy is based on the hope theory of Schneider and colleagues and is based on a positive psychology approach. This study aimed to determine the effect of group hope therapy on the quality of life of elderly women with diabetes. Materials and methods: The study was designed experimentally with a before and after design in two control and intervention groups. Eligible elderly women with diabetes were selected from the diabetes clinic of Imam Khomeini Medical Education Center in Sari and were randomly assigned to intervention (20 people) and control (20 people) groups. The group hopes therapy training was conducted in 8 sessions twice a week for 90 minutes. The quality-of-life questionnaire of Thomas diabetic patients (DQOL) of two groups was measured before, immediately, and one month after the intervention. Data analysis was done using the Mann-Whitney, Friedman, Wilcoxon test and SPSS software version 16 and P

Objective: The present study aimed to determine the prevalence and severity of moral distress (MD) and itsassociated factors among emergency department nurses.Methods: This cross-sectional study was conducted in 2023 on 172 nurses from the emergency departments ofmedical training centers affiliated with Mazandaran University of Medical Sciences. The census method wasused to collect the data, which included demographic variables and Corley’s MD questionnaire. The Data wereanalyzed using SPSS software (version 22), using an independent T-test, analysis of variance (ANOVA), andmultiple regressions.Results: Out of 172 nurses, 60.5% were women, with an average age of 32.52±6.88 years. The resultsdemonstrated an average MD score of 69.73±25.68. In terms of frequency and intensity, around 53.5% ofthe participants experienced MD at a low level (0-72), while the remaining 46.5% reported experiencing itat a medium level (14-73). A significant association was found between MD and age (p=0.037), workplacehospital (p=0.005), and history of mental disorders (p=0.005). Furthermore, linear regression analysis revealeda statistically significant association between MD, marital status, and occupational type (p

Introduction and purpose: The psychological contract of safety can be conceptualized as the beliefs of individuals about mutual safety obligations that are inferred from implicit or explicit promises. The present study aimed to evaluate the psychometric properties of the Persian version of the psychological contract of safety questionnaire. Methods: After forward-backward translation of Walker's safety psychological contract questionnaire (2010), face and content validity assessments were conducted, including the content validity ratio and content validity index with participation of 20 occupational health and safety experts. Its reliability was evaluated using the test-retest method involving 30 participants, and construct validity was assessed through confirmatory factor analysis with 320 participants from the target population. Data analysis was performed in SPSS software (version 22) and AMOS software (version 24). A significance level of less than 0.05 was considered. Results: In terms of face and content validity, one item related to the safety obligations of the employer was removed due to a low impact score and content validity index. The Cronbach's alpha values for the employer and employee safety obligations questionnaires indicated excellent (

Background and purpose: Driving is a crucial ability that can impact the quality of life for elderly individuals. Older adults may rely more on driving compared to other age demographics. As individuals age, there are significant changes in physical, cognitive, intellectual, and emotional abilities that are crucial for driving, a skill essential for accessing healthcare, therapy services, work, and social activities, as well as maintaining independence and autonomy in the elderly. Mobility and physical exertion are crucial aspects of health for older individuals, and driving significantly contributes to their ability to move within society. The increase in the elderly population has led to a rise in the number of older drivers. Proficiency in self-efficacy in driving is a crucial ability in this profession that acknowledges the significant aspects of this issue. This study aimed to investigate the correlation between weariness, self-efficacy, and driving behavior among older drivers in an urban setting. Materials and methods: This study was a progressive and descriptive-analysis study conducted among older drivers aged 60 and older who were members of the taxi association. Three hundred and ten eligible participants were chosen using the convenience sampling approach. The data was collected using the demographic data form, the multidimensional fatigue inventory, and Adele's self-efficacy scale. The data was analyzed using descriptive statistics, multiple linear regression, and Pearson correlation tests. Results: The participants had an average age of 28.3 years with a standard deviation of 9.6 years, and their ages ranged from 60 to 75 years. 42% of the participants had university degrees. They mostly had 30 to 50 years of driving experience. The average self-efficiency in driving among older drivers was 101.87±15.74. The Pearson correlation test indicated a significant and inverse relationship between age factors, the history of the driving license, and the self-efficacy score. In other words, as age and years of driving experience increase, the likelihood of self-efficacy driving reduces substantially. The correlation between the fatigue questionnaire scores and self-driving efficiency was significant(P

Background and purpose: Hemodialysis patients often face various psychological challenges that can significantly affect their overall health. Alexithymia is a construct that refers to the inability to distinguish between emotions and bodily reactions, difficulty describing emotions to others, and a cognitive style that is driven by reality and concrete situations. Various studies have shown that alexithymia is significantly and positively correlated with many psychiatric disorders. Moreover, as a factor, it hurts mental health (especially anxiety) and the quality of life of hemodialysis patients. Therefore, this research aimed to determine the mediating role of alexithymia in the relationship between social support and death anxiety in hemodialysis patients. Materials and methods: This cross-sectional and analytical study was conducted on 235 patients at Sari Shahrvand dialysis center, Iran 2023. Patients were included in the study by convenient sampling method. Data collection was done using demographic information questionnaires, Templer's Death Anxiety Scale (DAS-15), Zimmet's Multidimensional Scale of Perceived Social Support (MSPSS), and Toronto Alexithymia Scale (TAS-20). Demographic information included gender, place of residence, level of education, duration of hemodialysis treatment, number of visits per week, history of underlying diseases, and history of hemodialysis. Templer's death anxiety scale includes 15 questions in the form of a 5-point Likert scale regarding thoughts of death, fear of death, talking about death, fear, and thinking about incurable diseases. Zimmet's multidimensional scale of perceived social support is a 12-question instrument in the form of a 7-point Likert scale, which was used to evaluate perceived social support from three subscales of friends, family, and significant others. The Toronto Alexithymia Scale was a 20-question questionnaire with a five-point Likert scale, with three subscales: difficulty in recognizing emotions, difficulty in describing emotions, and objective thinking (Externally oriented), which was used to evaluate alexithymia. Finally, the data was analyzed by descriptive statistics and structural equation modeling with the bootstrap method, utilizing SPSS 26 and AMOS 22. Results: The study revealed that most participants were male, comprising 58.3% of the statistical population. The average scores for death anxiety, perceived social support, and alexithymia were 38.97±10.31, 4.88±1.26, and 55.72±9.76, respectively. The results suggest that there is no statistically significant relationship between social support scores and death anxiety (B=-0.13 (-0.30, 0.04), P=0.153), nor between social support and alexithymia (B=-0.12 (-0.28, 0.09), P=0.256). However, there is a significant and direct relationship between alexithymia and death anxiety (B=0.66 (0.46, 0.82), P=0.016). Conclusion: Considering the significant and direct relationship between alexithymia and death anxiety, it is recommended that managers and healthcare planners regularly evaluate the presence of death anxiety and alexithymia among individuals and formulate targeted interventions to alleviate these conditions.

Introduction and purpose: Occupational hearing loss is mainly caused by exposure to high noise levels, and many individual and environmental factors playing a role in its development. The present study was conducted with the aim of determining the mediating role of personality traits on the relationship between the perception of noise risk and the degree of occupational hearing loss. Methods: This descriptive cross-sectional study was conducted with 200 workers exposed to noise levels above 85 dB in a manufacturing industry. Risk perception was assessed using a risk perception questionnaire, while personality traits were measured using the HEXACO personality questionnaire. The degree of hearing loss was measured using a MEVOX-SA900 audiometric device. Data analysis was performed using SPSS version 25 software, which included calculations of means, standard deviations, Pearson correlation coefficients and structural equation modeling using AMOS version 24. Results: The average total hearing loss was 8.61 dB, and 79% of workers had normal hearing. The average score for workers' overall risk perception was 73.95±6.19. Among the personality traits, emotionality had the highest score, while honesty had the lowest score. Two components of general risk perception, including risk perception and attitude, as well as the personality trait emotionality, showed a positive and significant correlation with hearing loss. However, personality traits did not show a significant correlation with risk perception. Conclusion: Higher risk perception does not necessarily mean less hearing loss, therefore other variables such as employee personality traits should also be considered when planning hearing protection programs.

The increasing popularity of Electric Vehicles (EVs) can be attributed to recent advancements in highly efficient power conversion technology, as well as a desire to reduce reliance on fossil fuels. As a result, bidirectional DC-DC converters have gained significant interest and importance in the field of electric vehicle applications. This paper introduces an enhanced DC-DC converter, the Bidirectional Dual-Input Single-Output (BDISO) converter for the Electrical Vehicle application, which combines multiple energy sources for efficient power delivery to a load. The converter offers versatile operational modes and employs a Passivity-Based Control (PBC) strategy for stable closed-loop control. A mathematical model is developed and analyzed to understand its behavior. In addition, rigorous evaluations of reliability and efficiency demonstrate robust performance and high operational efficiency across various conditions in comparison with exciting systems. Finally, the proposed converter with its controller is validated through simulation and experimental results.

Background and purpose: The antibacterial properties of pomegranate have been investigated in numerous studies. The aim of this study was to compare the antimicrobial effect of pomegranate seed extract (PSE) with Minnimally Invasive (MI) fluoride varnish and also to investigate their synergistic effect on the caries-causing bacteria Streptococcus mutans and Lactobacillus acidophilus bacteria. Materials and methods: In this in-vitro study, the antibacterial properties and the minimum inhibitory and bactericidal concentrations (MIC and MBC, respectively) of the the compounds were investigated using the disk agar diffusion test (growth inhibition halo) and the micro broth dilution test. The antibacterial activity of the methanolic extracts was studied in 5 groups: PSE, PSE and varnish, MI varnish, positive control (ampicillin and erythromycin) and negative control (sterile physiological serum). The data were analyzed using SPSS ver22 software. Results: The largest diameter of growth inhibition in S. mutans and L. acidophilus was observed in the combination of two extracts (12±0.22mm) and varnish (12±1.22mm), respectively, while the smallest diameters were recorded in PSE (8.0±1.0mm and 4.0±1.5mm, respectively). Varnish showed the lowest MICs and MBCs for both types of bacteria tested. PSE and varnish showed similar results in inhibiting the growth of S. mutans (P=0.588); however, the simultaneous use of two extracts showed significant synergistic effects (P

Background and purpose: Metals are widely influenced in environmental pollution and disease development in humans. Since children are exposed to chemicals in the environment more than adults, risk assessment should be taken into consideration. Therefore, the investigation of the difference in children's contact levels in environments with different pollution and monitoring the concentration of metals through tissue sampling are essential for identifying and preventing such effects. Materials and methods: Teeth were collected according to the inclusion criteria from dental clinics in Sari and Tehran. The samples were completely turned into powder by a grinder and prepared using an acid dissolution process to determine the concentration of metals by inductively coupled plasma mass spectrometry (ICP-MS). Moreover, the maximum, minimum, mean, median and standard deviation values of the data were calculated. The normality of the data was determined by the Kolmogorov-Smirnov test. All statistical analyses were conducted using SPSS statistical software (v. 16). Results: The average concentration of Pb, Cd, Cr, Cu, Zn, Al, Mn, Ba and Sr in two cities had a significant difference (P0.05). Additionally, in terms of tooth type a significant difference was observed among all these elements except Ba (P

Background and purpose: Pedestrians are the most vulnerable people in the traffic system, and every year, thousands of pedestrians are injured or killed due to traffic accidents. The behavior of pedestrians is one of the human factors involved in traffic accidents. In the meantime, the damage is more in the age groups of 60 years and older. Therefore, the present study was conducted to determine the relationship between fear of falling and functional status with the traffic behavior of older pedestrians in Sari City. Materials and methods: The present study is a descriptive-analytical cross-sectional study conducted in Sari City in 2022-2023. The research population included all the older adults aged 60 years and above receiving care in the health centers of Sari City. Considering the inclusion and exclusion criteria and using multistage random sampling, 630 people were determined as the sample size. In order to collect information, a demographic characteristics questionnaire, Womac functional status questionnaire, fear of falling (FES), and traffic behavior were used. The data was analyzed using SPSS-22 statistical software. The significance level of the tests was considered to be 0.05. Results: The average age of the older participants was 67.34±7.61 years. 53.2% of the participants were male, and 71.4% were married. The mean and standard deviation of functional state scores, fear of falling, and traffic behavior were 56.65±17.62, 30.69±12.56, and 106.06±12.01, respectively. Correlation results showed that functional status has a significant inverse correlation with fear of falling (P

Background and purpose: Low frequency noise (LFN), even at low levels, can have an adverse effect on individual's mental health and performance. However, personality trait is one of the most important influencing factors. Therefore, the aim of this study was to investigate the perception of loudness, sensitivity, and annoyance of LFN in relation to personality traits. Materials and methods: This semi-experimental research was conducted on 40 students of Mazandaran University of Medical Sciences in 2022. The Eysenck Personality Questionnaire‐Revised (EPQ‐R) was used to assess personality traits. Participants were exposed to LFN at Equivalent continuous sound level (Leq=65 dB in A-weighted) for one hour in an acoustic room. Then questionnaires of noise annoyance, Weinstein noise sensitivity, and loudness perception were used, respectively. Finally, statistical analysis was performed using SPSS V25 and applying Chi-square, independent t-test, and multivariate analysis of variance (MANOVA). Results: The mean value of annoyance, sensitivity, and noise perception were 5±2.05, 65.2±14.88, and 3.55±0.68, respectively. The results of the study indicated that extroverted and introverted personality traits did not have a significant correlation with annoyance, sensitivity, or perception of loudness (P>0.05) while the results of the MANOVA test showed that neuroticism was the most influential factor on sensitivity (P

Background and purpose: This study aimed to localize impacted maxillary canines and root resorption of neighboring incisors using cone beam computed tomography (CBCT) in 12-20-year-old patients referred to two private oral and maxillofacial radiology centers in Sari. Materials and methods: In this descriptive-analytical study, 89 CBCT images were included. Of which, 31 images related to unilateral buccal impaction of the maxillary canine and 58 images related to unilateral palatal impaction of the maxillary canine were analyzed in order to measure the parameters of central and lateral resorption and the amount of resorption of these teeth. Data were analyzed in SPSS software (version 21) at a significance level of 0.05. Results: Findings revealed no statistically significant relationship between gender and the side of indentation (buccal and palatal). Moreover, the highest position was related to the palatal site in both genders. Based on the chi-square test, there was no significant relationship between gender and latent canine position. Nonetheless, there was a significant relationship between age and latent position, as well as the occurrence of decayed lateral and the position of the impacted canine, which is the opposite of the lateral tooth in the central tooth. Conclusion: This investigation revealed that the incidence of lateral tooth resorption was associated with the latent canine position, while the incidence of central tooth resorption did not demonstrate a significant correlation

Background and purpose: Patients undergoing hemodialysis experience many problems, both physically and mentally, which lead to low quality of sleep, and subsequent changes in the quality of their life. In addition, dialysis adequacy plays a pivotal role in the quality of their life. Therefore, the present study was conducted to determine the relationship between dialysis adequacy and quality of life with the mediating effect of sleep quality. Materials and methods: A descriptive, analytical, correlational study was performed on 208 patients undergoing hemodialysis in medical education centers of Mazandaran using head count sampling. The implemented tools included demographic information checklist, WHOQOL quality of life questionnaires, Pittsburgh sleep quality (PSQI), and dialysis adequacy checklist. The data were analyzed using SPSS V22 and performing the statistical tests of t-test (comparing the mean of two groups), analysis of variance (comparing the mean of more than two groups), and Pearson correlation (to check the correlation between two quantitative variables). Multiple linear regression was used to identify factors affecting the score of dependent variables and to control confounding variables. Structural equation analysis was also used to investigate the relationship between dialysis adequacy and quality of life with regard to the mediating effect of sleep quality. Results: The mean and standard deviation of quality of life, sleep quality, and dialysis adequacy were 48.43±17.14, 5.52±3.46, and 1.28±0.30, respectively. Based on the results of correlation coefficient and structural equations, no statistically significant relationship was found between dialysis adequacy and quality of life (P=0.114). There was a significant inverse relationship between dialysis adequacy and the score of sleep quality (a score of less than 5 is desirable) (r=0.15, P=0.034), so that the quality of sleep improved as the dialysis adequacy increased. There was a statistically significant and inverse relationship between sleep quality score and quality of life (r=-0.53, P

Background and purpose: Given the importance of virtual education, either on its own or in conjunction with face-to-face education, the present study aimed to compare face-to-face and virtual education from the perspective of students of Mazandaran University of Medical Sciences along with investigating the factors affecting the effectiveness of these two educational methods in 2022. Materials and methods: In this cross-sectional analytical study, the opinions of students regarding the quality of face-to-face and virtual education were investigated. To compare the average scores, we used independent t-tests and analysis of variance (ANOVA). Moreover, the Pearson correlation test and linear regression were used to investigate the relationship between the teaching method and also the scores of face-to-face and virtual educations with quantitative independent variables, respectively. All analyses were performed using SPSS V22. Results: According to the results, the total average scores for face-to-face and virtual education were 68.65±14.65 and 55.90±17.39, respectively. Employment status, faculty, the number of face-to-face semesters, and the skill level in using equipment had a significant relationship with face-to-face education score. Also, marital status and the number of face-to-face semesters were significantly associated with the virtual education score (‌P

Abstract Aim This study aims to investigate the relationship between nurses' self‐efficacy and self‐esteem, and their job satisfaction. Design A cross‐sectional study was conducted. Methods Employing a random sampling method that included 234 nurses from three hospitals in Iran enrolled. This study utilized the General Self‐Efficacy Questionnaire, Coppersmith Self‐Esteem Inventory, and Minnesota Job Satisfaction Questionnaire. Descriptive analysis, independent t‐tests, Pearson correlation analyses, and linear regression were employed for data analysis. Results The mean self‐efficacy score for nurses was 26.73 ± 5.62 (out of 40), while self‐esteem and job satisfaction scored 37.13 ± 6.87 (out of 50) and 68.27 ± 12.65 (out of 100), respectively. Significant correlations were found between self‐efficacy, self‐esteem, and job satisfaction. Moreover, self‐esteem and the age group >40 years were identified as important predictors of nurses' job satisfaction. This study highlights the influential role of self‐esteem in determining nurses' job satisfaction.

Abstract Integrating Power Electronics Converters (PECs)‐based renewable energy sources can establish a weak grid due to the substantial inertia reduction leading to severe frequency fluctuations. In this paper, a control strategy based on the Virtual Synchronous Generator (VSG) concept is designed for a three‐phase Modular Multilevel Converter (MMC) connected to a weak grid. The proposed VSG control approach improves the frequency response during transient mode, resulting in a 66.7% enhancement at the Point of Common Coupling (PCC). The proposed strategy is shaped within four control loops wherein the VSG‐dependent output current control possesses the duty of enriching the MMC output current tracking capability. Focusing on the MMC output current‐based transfer function, the effectiveness of this capability is guaranteed using the frequency domain analysis including the Nyquist and Bode diagrams. Moreover, a comprehensive discussion was carried out regarding the impact of VSG on the voltage of submodule capacitors and the circulating current. Simulation results in MATLAB/Simulink environment validate the accuracy and weak grid‐connected MMC performance under the proposed VSG‐based control technique. To further verify the superiority of the proposed strategy, two control techniques including Droop and SEBIR are compared with the VSG proposed controller.

Background: One of the factors affecting deciduous occlusion is infant feeding modes. The objective of this research was to identify and document the malocclusions that arise due to various approaches of infant feeding, and to assist in clarifying ambiguities surrounding skeletal growth complications that result from infant feeding practices.Materials and Methods: This cross-sectional descriptive-analytical study was conducted in 2021 on 284 children with an age range of 4-5 years who were selected from kindergartens and preschools in Sari by cluster sampling and then systematic sampling. After obtaining written consent from the parents and recording the child's personal information in the demographic checklist, the surface of the teeth was cleaned with a sterile gauze and then examined. The relationship of deciduous molars, overjet and overbite, open bite, posterior crossbite, and the relationship of deciduous canines were recorded. Data analysis was performed by Chi-square and one-way ANOVA using SPSS software (version 22). P-values of

BACKGROUND: The risk is on the level of blood pressure, and blood pressure is one of the prominent characteristics of preeclampsia. The aim of this study is to assess the effect of hypnosis on the pressure and blood pressure of pregnant women with preeclampsia. MATERIALS AND METHODS: In this controlled clinical trial study, 44 pregnant women from 20 to 32 weeks referred to Shahid Akbarabadi Hospital in Tehran in 2022 were randomly assigned to two intervention and control groups. Hypnotherapy was conducted individually and online for five sessions. Evaluation of performance and blood pressure (primary outcome) was done using the DASS-21 questionnaire and sphygmomanometer before, during maintenance, and 4 weeks after the intervention. Twenty people in each group entered the analysis stage. Independent t-test, Chi-square, analysis of variance with repeated measures and mixed model were used, and effect size (Cohen’s D) was used to evaluate the strength of the intervention effect. The data were entered into the SPSS software version 22 and a significance level of 0.05 was considered. RESULTS: The results showed that the two groups did not differ in terms of background changes (P = 0.757). The score after the intervention decreased by 10.25 (P < 0.001) and the time 1 month after the intervention decreased by 9.93 (P < 0.001). The blood pressure after the intervention was reduced by 7.90 (P < 0.001) and the blood pressure 1 month after the intervention by 7.52 (P < 0.001). CONCLUSION: It is suggested to use hypnotherapy as a complementary treatment to reduce anxiety and preeclampsia symptoms.

Introduction: Considering the priority of supporting vulnerable groups when fighting against COVID-19, the present study aimed to evaluate the levels of COVID-19-induced anxiety and depression in two vulnerable groups: medical staff and pregnant women.Methods: The present study is a descriptive cross-sectional study performed on 140 treatment staff and 338 pregnant women. The questionnaire used in this study includes demographic characteristics and the Hospital Anxiety and Depression Scale- modified. Univariate and multiple linear regression analysis and analysis of variance were used to identify the effect of variables on anxiety and depression.Results: Among the staff, 88.6% were women. The mean and standard deviation of their COVID-19-induced anxiety and depression were 12.76 ± 1.78 and 7.75 ± 2.27, respectively. The staff exhibited high levels of abnormal anxiety, with 92.9% reporting symptoms. In contrast, the prevalence of abnormal depression among the staff was lower, with only 11.4% reporting symptoms. Marital status (p=0.05) and exercise (p=0.03) significantly affected the covid-19-induced depression of the medical staff. The mean and standard deviation of COVID-19-induced anxiety and depression in pregnant women were 10.53 ± 2.04 and 11.15 ± 2.09, respectively, and these scores were significantly different compared to the medical staff groups.Conclusion: Vulnerable groups had high levels of anxiety and depression associated with COVID-19. Nurses prioritized psychological programs targeting anxiety reduction, while pregnant women prioritized psychological programs addressing depression reduction.

Background and purpose: Adherence to the principles of personal protection and commitment to health guidelines and principles of prevention perform important roles in controlling COVID-19 in a community. In this re3search we studied necessary measures to prevent COVID-19 in university dormitories at Mazandaran University of Medical Sciences, 2021. Materials and methods: In this descriptive-analytical study, 114 students in active dormitories during the COVID-19 pandemic participated in an online survey and their views and knowledge about COVID-19 preventive measures in the dormitories were examined. The samples were recruited using census method and data were analyzed in SPSS. Results: The results of the Chi-square test showed a significant relationship between adherence to preventive measures and educational level (P=0.015). Following personal hygiene was found to be significantly different according to being a local student, having underlying diseases, and the number of students at rooms (P0.05). Conclusion: The study showed that among the four areas investigated, personal hygiene practices and following the principles of prevention of COVID-19 were in a good condition, while physical distancing and screening were not satisfying. Therefore, university authorities should make serious changes to improve these issues at dormitories.

Background and purpose: Elder abuse is one of the challenges in caring the seniors that can disrupt their general health. The goal of the current study was to determine the relationship between general health and elder abuse among older adults referring to health centers in Sari, Iran 2021. Materials and methods: A descriptive-analytical study was conducted in 347 older people who were selected by cluster random sampling. Data were collected using a demographic questionnaire, General Health Questionnaire–28 (GHQ-28), and Domestic Elder Abuse Questionnaire through interviews. Data analysis was carried out in SPSS V22 applying descriptive statistics, independent t-test, analysis of variance, multiple linear regression, and Pearson correlation coefficient. Results: In this study, the mean age of the older people was 72.86±8.62 years and 53.9% of the participants were men. The highest and lowest prevalence of abuse were associated with emotional neglect (72.9%) and ostracism (9.8%), respectively. According to findings, 57.3% of the older people had poor general health. Significant correlation coefficients were found between most of the components of general health and elder abuse, except between neglect and physical health (P=0.105), anxiety and insomnia (P=0.707), and social functioning (P=0.211) and also between financial abuse and physical health (P=0.156). Conclusion: Considering the high rate of abuse of older adults and its adverse effect on general health, preventive programs are needed to increase awareness and educate the seniors.

Background and purpose: Mizaj (temperament) is an important concept in Persian medicine that has many applications in the diagnosis, prevention, care, and treatment of many diseases. This study aimed to determine the relationship between placenta accreta and the state of the general and uterine temperament and Apgar score of newborns in mothers candidates for cesarean section. Materials and methods: A case-control study was performed in mothers who were candidates for caesarean section. The subjects included expectant mothers with placenta accreta (n= 33) and a control group (n= 66). Current general and uterine temperament were measured using Mojahedi and Tansas questionnaire. Demographic variables and Apgar score of newborns was measured using the Apgar International Standard Checklist Score. T-test and Chi-square were used to compare the data. Results: Demographic characteristics were similar between the two groups. In pregnant mothers with placenta accreta the mean scores for total warm-cold and wet-dry temperaments were 14.81±1.55 and 3.72±1.23, respectively. In the control group, these scores were 16.81±4.38 and 3.39±0.65, respectively (P

Background and purpose: Anxiety before Cesarean section (C-section) is one of the common disorders that is caused by different reasons. According to Iranian traditional medicine, temperament indicates the specific characteristics of each person and its understanding is of great benefit in prevention and treatment of diseases and implementing interventions. The present study was conducted to determine the relationship between temperament and anxiety before C-section. Materials and methods: This descriptive analytical study was conducted in 327 pregnant women candidates for C-section in Kerman, Iran 2020-2021. Spielberger State-Trait Anxiety Inventory and Salmannezhad Temperament (Mizaj) Questionnaire were completed at gynecology ward before C-section. Analysis of quantitative data was done applying ANOVA and T-test and analysis of qualitative variables was done using Chi-square test in SPSS V21. Results: The average age of pregnant women was 29.24±6.33 years and 37.3% were experiencing their second pregnancy. The mean scores for latent anxiety before C-section in cold-tempered mothers and warm-tempered mothers were 54.43±8.29 and 34.44±9.81, respectively, (P=0.001). Conclusion: The level of latent anxiety before C-section was higher in cold-tempered mothers than warm-tempered and moderate-tempered mothers. Therefore, necessary measures considering traditional medicine are recommended for cold-tempered mothers before surgery.

Background and Purpose: We measured the psychometric properties i.e., validity, reliability, and stability of the Persian 10-item Kessler psychological distress scale (K10) among older adults in Iran. Materials and Methods: We recruited elderly (60+ years) subjects (20 per item of the questionnaire) from various sampling units in the general population of Gorgan district, Golestan, Iran. After the translation/back-translation process, the questionnaire underwent various forms of validity and reliability, including Cronbach alpha (overall, by items, and by group of yes to an item and no to an item). The intra-class correlation coefficient was measured at a two-week interval, and inter-rater agreement was also determined. Both exploratory and confirmatory factor analyses were also conducted, along with receiver-operator characteristics vis-à-vis hospital anxiety and depression scale. Results: In total, 190 subjects (47.3% males, mean age: 70.3, 95% CI: 69.2-71.4) participated in the study. A total of 35.8% had psychological distress (PD) (i.e., score >20). The alpha coefficient was 0.88 with no item below 0.86. The alpha coefficients to report a yes to an item (α=0.85) or no to an item (α=0.90) were similar to each other. The intra-class coefficient for test-retest at a two-week interval was 0.90. Exploratory factor analysis showed a one-factor structure of the underlying construct, with a cumulative variance of 97.1%. Confirmatory factor analysis showed high fit indices for the questionnaire (0.91) and a low standardized residual of 0.05. Conclusion: We measured psychometric parameters of the Persian version of the K10 scale for detecting PD among older adults, which was found to be adequately valid, reliable, and stable. Our questionnaire fills the prior gaps regarding the lack of validated tools for the timely detection and management of PD among older adults in the Persian-language cultural contexts. Our study emphasizes that the Kessler questionnaire is a unidimensional scale, and detects non-specific PD with all items indicating a single underlying construct of “distress”.

Background and purpose: Garlic and cinnamon extracts, like fluoride varnish, play a role in caries control due to their antimicrobial effect and controlling demineralization. This analytical laboratory study was conducted in 2021 to investigate the antimicrobial effect of garlic and cinnamon extracts compared with fluoride varnish in controlling the infection of oral Lactobacillus acidophilus and Streptococcus mutans. Materials and methods: The disk diffusion, minimum inhibitory concentration and the minimum bactericidal concentration tests were used to check the antimicrobial effect. Ampicillin and Erythromycin discs were used for positive control and sterile physiological serum was used for negative control. Data were analyzed using analysis of variance (ANOVA) and Bonferroni post hoc test. Results: In disk diffusion test, cinnamon along with fluoride varnish (10.0±1.0mm) caused a significant increase in the diameter of the growth inhibition halo of L. acidophilus (P

Background and purpose: 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. Materials and methods: 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. Results: 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

Introduction: The factors which lead to a reduction in pain and length of labor with minimal intervention have always been of interest to researchers. The present study was performed aimed to compare the effect of TENS with psychological supportive intervention on labor pain and maternal and neonatal outcomes in pregnant women referring to the maternity ward. Methods: This clinical trial study was performed in 2021 on 90 pregnant women admitted to the delivery block of Payambar Azam hospital of Kerman. The subjects were randomly divided into three groups of TENS (n=30), psychological supportive intervention (n=30) and control (n=30). In the active labor phase, TENS was applied for the TENS group, the psychological supportive intervention was performed in the counseling group, and routine care was performed for the control group. Scores of pain during the active phase of labor (4 cm and 10 cm dilatation) and maternal and neonatal outcomes were compared in the three groups. Data were analyzed by SPSS statistical software (version 21) and Fisher's exact and variance analysis tests. P< 0.05 was considered statistically significant. Results: There was no significant difference between the three groups in the scores of labor pain in 4 cm dilatation, maternal complications, Apgar scores 1 and 5 minutes, and type of delivery (p> 0.05). However, the score of pain in 10 cm dilatation in the TENS group and counseling group similarly was significantly reduced compared to the control group. The duration of the first stage of active phase labor was not significantly different between the three groups (p> 0.05), but the difference between the duration of the second stage of the active phase and the total duration of the active phase was significant between the three groups (p >0.05). Conclusion: Both methods of psychological supportive counseling and transcutaneous electrical nerve stimulation (TENS) are equally effective in reducing labor pain and length of labor; considering the safety of both methods, it is recommended to use these two methods to facilitate the birth process.

Introduction: Introduction: The present study aimed to evaluate the coronal discoloration of human teeth induced by using a new Endoseal MTA compared to an AH Plus Sealer. Methods: A total of 40 premolars extracted for orthodontic reasons were used in the present study. Then, the teeth were incised in the coronal third of the root 3 mm below the cementoenamel junction. Samples were randomly allocated to two experimental groups (group 1: AH Plus sealer, group 2: Endoseal MTA) and 6 teeth as the negative control group. The color evaluation was determined at four different times: before placing sealers (T0), 1 month (T1), 3 months (T2), and 6 months (T₃) after that with an intraoral spectrophotometer. Data were analyzed using Multivariate Test and Hotelling's Trace. A P-value

Background and purpose: Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system. The purpose of this study was to report the information of MS patients registered in Mazandaran MS Registry System between 2019 and 2021. Materials and methods: This retrospective study was performed in patients with MS living in Mazandaran province using the MS national registry system in Iran. Results: A total of 2211 patients were found, including 72.8% females and the mean age of patients was 36.97±9.47 years. Most of the patients had Relapsing remitting (RR) MS (61.2%) followed by Secondary progressive (SP) MS (19.6%) and a family history of the disease was seen in 16.2%. Most of the patients lived in populated cities; Sari and Amol. Interferons, Rituximab, and Fingolimod were found to be the most widely used drugs. The mean score for Expanded Disability Status Scale (EDSS) was higher in men than women. The mean EDSS scores were the lowest in clinically isolated syndrome (CIS) type of the disease and the highest in the SP and RP types. The level of disability was significantly higher in men than women (P

Background and Objective: Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age. Therefore, in this study, the prevalence of hirsutism, overweight and menstrual disorders, which have a high comorbidity with this syndrome, and its relationship with age, marriage, and the use of related medications were investigated among students in the dormitory of Kerman University of Medical Sciences. Methods: This cross-sectional study was conducted among students in the dormitory of Kerman University of Medical Sciences in 2019-2020. The prevalence of hirsutism, menstrual disorders, polycystic ovary syndrome (based on NIH criteria) and overweight were calculated. The polycystic ovary syndrome screening questionnaire was used for screening and its relationship with age, marriage and the use of related medications was measured. Findings: 636 students with an average age of 21.99±3.61 participated in this study. 13.9% of students had a menstrual cycle of more than 35 days. 70.6% had a menstrual cycle of 25 to 34 days. In terms of the growth of thick dark hair, 17.1% experienced hair growth in more than two areas of the body, and most reports of hair growth were related to chin, chest, and abdomen with 31.4%, 29.9%, and 23.2%, respectively, and 45.3% of subjects did not report hirsutism. Moreover, 30.8% were overweight and 4.7% had galactorrhea. With a confidence interval of 95%, the prevalence of polycystic ovary syndrome was 10.6 (3.2-18.0). Age and the use of medications had a significant relationship with these symptoms. Conclusion: The results of this study showed that the prevalence of polycystic ovary syndrome among students is not higher than the average of the society, and it occurs more in people over 22 years of age and people who take medications.

Background: Stressors during the COVID-19 pandemic, led to lack of concentration and lack of energy to achieve career goals, fatigue, poor performance, burnout and reduced quality of life of people, especially nurses. Methods: This descriptive-analytical study was done with the aim of determining the relationship between perceived stress and quality of life of nurses working in the care wards of patients with COVID-19 in hospitals affiliated to Mazandaran University of Medical Sciences (Mazandaran, Iran) during 2020-2021. Inclusion criteria included willingness to participate in the study, having at least a bachelor's degree in nursing and working in the care wards of patients COVID-19. Data collection tools included demographic information questionnaire, Cohen Perceived Stress Questionnaire and WHO Quality of Life Questionnaire. Frequency, percentage, Mean and standard deviation indices were used to describe the variables. Also, Mann-Whitney, Kruskal-Wallis and Spearman correlation coefficients were used to ass the relationship between variables. Results: The Mean (SD) age of participants was 33.48 (6.64) years. Most were female (%73.3). The total scores of quality of life and perceived stress variables of nurses were 47.63±24.31 and 27.62±4.61, respectively. Nurses' scores of quality of life domains included Physical Health, Psychological, Social Relationships and environmental domain were 46.52±12.69, 46.57±12.70, 46.39±19.45 and 50.52±10.52, respectively. Nurses' quality of life had a direct significant relationship with the variables of sleep quality and job satisfaction (P

Background. The ability to control pain is an essential part of dental procedures and the need for optimal pain control and reduction of discomfort is the primary concern of every dentist. This study aims to compare the pain and vital signs during inferior alveolar nerve block between conventional and a new modification of the two-step injection techniques. Methods. In this institutional single-blind randomized clinical trial, attendees of dental school at Mazandaran University of Medical Sciences from February to May 2022 were included. Inclusion criteria were 20–60 years old and healthy (ASA1) individuals who were willing to participate in this study. Individuals who were taking medications affecting their understanding of pain and patients with active infections at the injection site were excluded. These individuals were divided into two groups. First, superficial anesthesia was performed and afterward, conventional and two-step injection techniques were performed. For the two-step injection method, 6 mm of the needle was injected into the mucosa and one-third of the local anesthetic solution was released from the computer-controlled injection toolkit. Afterward, a 25 mm 30-gauge needle was reinserted into the previous hole delivering the remaining local anesthetic. The pain during injection was measured by a patient-reported numerical rating scale (NRS). Moreover, vital signs were monitored immediately before and after the injection. Kolmogorov–Smirnov test, Mann–Whitney U test, independent T-test, and Fisher’s exact χ2 test were performed for statistical analysis (α = 0.05). Results. This study involved 32 adults aged between 20 and 50 years old with 1 : 1 female/male sex distribution. The pain score was significantly higher in the conventional injection technique compared to the two-step injection technique in all sex and age groups. There were no significant differences in vital signs between the conventional and two-step injection techniques. There was no significant difference in the mean pain scores of females and males, regardless of their injection techniques. Conclusion. Utilizing the two-step injection technique in patients for inferior alveolar block reduces pain during injection without altering patients’ vital signs significantly. This trial is registered with IRCT20220106053646N1.

Introduction: This study aimed to assess the cytotoxicity of Duraflur fluoride varnish as root canal sealer against L929 mouse fibroblasts in comparison with four commonly used conventional endodontic sealers in the first 48 hours of exposure. Methods: In this in vitro, experimental study, L929 mouse fibroblasts were exposed to 1/1, ½, ¼ , and 1/8 concentrations of Duraflur fluoride varnish, AH Plus, Fill Canal, MTA Fillapex, and AH26 sealers. After 48 hours, the methyl thiazolyl tetrazolium (MTT) assay was performed to assess the cytotoxicity of sealers. Cell viability was determined as the percentage of viable cells compared with the control group. The results were analyzed using one-way ANOVA followed by the Tukey’s post hoc test for multiple comparisons.. Results: MTA Fillapex had the lowest and AH26 had the highest cytotoxicity (p