Effects of clear aligners on the vertical position of the molar teeth and the vertical and sagittal relationships of the face: a preliminary retrospective before-after clinical trial Mehrnaz Moradinejad, Ricky E. Harrell, Sayed Mohammad Mousavi, Minoo Alavi, Alireza Darvish Basseri, Arman Feiz, Hanie Daryanavard, and Vahid Rakhshan Springer Science and Business Media LLC Abstract Introduction Despite the popularity of clear aligners, their predictability has not been assessed adequately. Moreover, no study has investigated their effects on numerous dentomaxillary variables. Therefore, this study was conducted for the first time, assessing several new or controversial items. The aim of the study was to evaluate the effects of clear aligners on the vertical position of the molar teeth and the vertical and sagittal relationships of the face. Methods This preliminary retrospective before-after non-randomized clinical trial was performed on 168 observations of 84 patients (33.60±9.28 years, 54 females) treated with 0.75mm Invisalign appliances. Pretreatment and posttreatment values were measured for: mandibular plane angle, occlusal plane angle, Y-Axis, ANB, facial angle, lower anterior facial height, overbite, and the distances of the molars from the palate and mandibular plane were measured. The alterations in parameters caused by treatment (delta values) were calculated for each measurement. Effects of treatment and some parameters on delta values were analyzed statistically (α=0.05). Results Mean±SD of ΔMP-FH, ΔOP-FH, ΔY-Axis, ΔLAFH, ΔNPog-FH, ΔANB, ΔOverbite, ΔSNB, Δ6-PP, Δ7-PP, Δ6-MP, and Δ7-MP were respectively 0.11±1.61, 0.80±1.56, 0.15±1.18, 0.07±0.91, -0.22±1.25, 0.03±0.62, 0.04±1.15, -0.06±1.14, -0.36±0.94, -0.32±1.14, 0.19±0.96, 0.18±1.10. Only the alterations in OP-FH, 6-PP, and 7-PP were significant (P≤0.011). Age, sex, treatment duration, or pretreatment mandibular plane angle were not correlated with any delta values. However, the pretreatment occlusal plane angle was negatively correlated with ΔOP-FH and ΔY-Axis. Crowding was correlated negatively with ΔOP-FH and ΔY-Axis and positively with ΔNPog-FH. Overjet was negatively correlated with ΔANB and ΔOverbite (P≤0.035). Conclusions Invisalign intruded first/second maxillary molars and increased the occlusal plane angle. Age, sex, and treatment duration were not correlated with post-treatment anatomic alterations.
Comparing the Effect of Respiratory Physiotherapy and Positive End-Expiratory Pressure Changes on Capnography Results in Intensive Care Unit Patients with Ventilator-Associated Pneumonia
Assessment of antibiotic resistance changes during the Covid-19 pandemic in northeast of Iran during 2020–2022: an epidemiological study Reza Khoshbakht, Mona Kabiri, Alireza Neshani, Mohammad Navid Khaksari, Sayyed Majid Sadrzadeh, Seyed Mohammad Mousavi, Kiarash Ghazvini, and Mahdis Ghavidel Springer Science and Business Media LLC Abstract Background The coronavirus disease 2019 seems to change antibiotic resistance pattern. Certain conditions in the Covid-19 era may be contributing to the rise of antimicrobial resistance (AMR). Due to the limited information on the impact of Covid-19 on antimicrobial resistance (AMR), the purpose of this research was to investigate the trend in antimicrobial resistance changes of E. coli, P. aeruginosa, K. pneumoniae, and A. baumannii in Hasheminezhad hospital. This hospital was a Corona center in Mashhad at the onset of this epidemic. Methods 1672 clinical samples were collected between January 21, 2020 and January 30, 2022from patients hospitalized at Hasheminezhad Hospital in Mashhad, Conventional microbiological procedures for identifying gram-negative bacteria and antibiotic susceptibility testing were used, according to the clinical and laboratory standards institute (CLSI) 2021. The two years of the pandemic, from the initial stage of the outbreak until the 6th peak, (January 2020 to and January 2022) were divided into 9 periods according to the seasons. Results Highest resistance rates were seen in E. coli (615 samples), K. pneumoniae (351 samples), P. aeruginosa (362 samples) and A. baumannii (344 samples) to Ampicillin (89.6%), Ampicillin (98%), Imipenem (91.8%), and Ceftazidime (94.6%), respectively. The largest change in antibiotic resistance was seen between Summer 2020 and Summer 2021 for K. pneumoniae with about a 30% rise in antibiotic resistance to Ceftriaxone. Conclusions All 4 species evaluated in this study, have shown rising AMR rates during the first year of the pandemic in the northeast of Iran. This study revealed that E. coli, P. aeruginosa, K. pneumoniae, and A. baumannii strains in Northern Iran have a higher level of antibiotic resistance than what was measured in similar studies conducted before the pandemic. This will further restrict treatment choices and jeopardize global public health.
Diagnostic Accuracy of Suprasternal Versus Subxiphoid Ultrasonography for Endotracheal Intubation Seyed Mohammad Mousavi, Maryam Sayyari Doughabadi, Seyed Ali Alamdaran, Sayyed Majid Sadrzadeh, Hosein Zakeri, and Elnaz VafadarMoradi Briefland Background: Airway management is an important skill for emergency physicians, and confirmation of correct endotracheal tube (ETT) placement is a crucial component of airway management. Objectives: Due to the occurrence of incorrect ETT positioning in emergency departments, the present study aimed to compare the diagnostic sensitivity of ultrasound using suprasternal and subxiphoid methods for confirming the correct placement of ETT compared to capnography. Methods: This cross-sectional study was conducted by examining patients requiring intubation. Ultrasound was performed by two independent emergency medical assistants using two suprasternal and subxiphoid methods to confirm correct ETT placement; the results were then interpreted. To observe the tube passage through the vocal cords, capnography and lung auscultation were applied as the gold standards, and the results of two ultrasound methods were compared. Results: A total of 66 patients, who were intubated in the emergency department, participated in this study. The positive and negative predictive values, sensitivity, and specificity of supernatural ultrasound were 96.72%, 80%, 98.33%, and 66.67%, respectively. Also, positive and negative predictive values, sensitivity, and specificity of subxiphoid ultrasound were 97.95%, 29.41%, 80%, and 83.33%, respectively. The diagnostic odds ratios of suprasternal and subxiphoid ultrasounds were 1.026 and 1.024 compared to capnography, respectively. Conclusions: Ultrasonography using the suprasternal method was feasible. Considering the high sensitivity and specificity of this method in confirming correct ETT placement, it produced reliable results. Overall, this modality can be used as one of the main methods to verify correct ETT placement in emergency departments.
Introduction: One of the most common maxillofacial malformations is mandibular advancement, a class II malformation or malocclusion. One treatment is mandibular advancement surgery. This research aimed to investigate the effect of mandibular advancement surgery on upper lip length in class II patients. Methods: This retrospective study was conducted with 16 patients having class II malformations who underwent mandibular advancement surgery. Data analysis was conducted using SPSS 19. Results: Results showed that although height of philtrum increased after surgery, there was no significant difference in the height of the philtrum from before to after the mandibular advancement surgery (p > 0.05). Evaluation of the patients showed that although commissure height and vermilion height decreased after surgery, this difference was not statistically different(p > 0.05). However, there was a statistically significant difference between before and after commissure height (p <0.05) at camouflage in patients. There was also a statistically significant difference in height of philtrum and vermilion between before and after camouflage in patients (p <0.05). Conclusions: The results of this study suggest that mandibular advancement surgery plays a serious role in the clinical appearance of lip soft tissue, which can be used as a predictor of patient profile prior to surgery.
Effects of different stretching extents, morphologies, and brands on initial force and force decay of orthodontic elastomeric chains: An in vitro study Sara Mahboobi, SeyedMohammad Mousavi, and Vahid Rakhshan Medknow Background: Elastomeric chains are of clinical importance to orthodontics. Therefore, their behavior should be assessed under different conditions. Some of their critical aspects remain unstudied (including effects of different elongations and chain forms on their force properties). Therefore, we aimed to assess these factors. Materials and Methods: This in vitro study was performed on 540 observations: first, 90 chains (10 specimens per subgroup of three brands [American Orthodontics, Ortho Technology (OT), and G&H], each from three chain types [closed, short, and long]) were stretched for three extents (40%, 60%, and 100%) and their forces were measured using a universal testing machine. Afterward, 270 new chains of the same brands/types were stretched for the same extents by installing them onto pairs of pins with different interpin distances. Plates holding pins/chains were incubated in artificial saliva at 37°C for 4 weeks. Afterward, their forces were measured and analyzed using partial correlation coefficient, three-way analysis of variance (ANOVA), Tukey, Student's t, and Mann–Whitney tests (α = 0.001). Results: Forces degraded significantly from an overall mean of 3.97 ± 0.97 N to 1.29 ± 0.39 N after 4 weeks (all P = 0.000, t-test/Mann–Whitney). ANOVA showed highly significant differences among brands, types, and elongations, in terms of “initial force, force decay, and residual force” (all P = 0.000). Almost all post hoc pairwise comparisons were significant (Tukey P = 0.000). There was a strong positive correlation between elongation extent and force loss (r = 0.846, P = 0.000). Conclusion: OT might be the most preferable brand. Closed chains might usually show better results, especially in OT chains. Instead of using chains half of the size of the space (to elongate for 100%), longer chains should be used to stretch for lesser extents.
Comparison of ultrasonography and X-ray test for lateral malleolar fracture in ankle sprain Hamideh FeizDisfani, Ehsan Bolvardi, Mohadeseh Shourabi, Mohammad Davood Sharifi, Seyed Mohammad Mousavi, and Roohie Farzaneh Biomedical Research and Therapy Introduction: The use of ultrasonography for diagnosing musculoskeletal injuries, especially fractures, in the emergency department is on the rise because of its good diagnostic value. This study aimed to evaluate the diagnostic value of bedside ultrasonography in detecting the patients suffering from lateral malleolar fractures with an ankle sprain mechanism.
 Methods: This prospective study was conducted on patients having acute ankle injuries with ankle sprain mechanism and diagnosed with lateral malleolar tenderness. All patients underwent bedside ultrasonography with a 7.5 - 10 MHz probe by an emergency medicine specialist who was assisted by a radiologist. Next, they underwent lateral ankle and anteroposterior (AP) X-rays by another emergency medicine specialist who was blinded from the ultrasonography results. The ultrasonography and X-Ray results were then compared.
 Results: A total of 244 patients participated in this study, of whom 92 (37.70%) were diagnosed with lateral malleolar fracture through bedside ultrasonography and X-Ray tests. The results showed that ultrasonography had a sensitivity of 96.84% and a specificity of 97.31%. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 36.07 and 0.0325, respectively, and the positive and negative predictive values of bedside ultrasonography were 95.83% and 97.98%, respectively. Finally, the results indicated a percent agreement (accuracy) of 97.13% between the two tests with Kappa coefficient of 0.94 (z = 14.68, P value < 0.01).
 Conclusion: The results of this study showed that bedside ultrasonography has a high sensitivity and specificity in the diagnosis of lateral malleolar fractures with an ankle sprain mechanism. Conducting further studies will lead to the use of this diagnostic test in the emergency department.
Risk factors contributing to the incidence and mortality of acute childhood poisoning in emergency department patients in Iran: A hospital-based case-control study Hamideh Feiz Disfani, Mostafa Kamandi, Seyed Mohammad Mousavi, Sayyed Majid Sadrzadeh, Roohie Farzaneh, Najme Doolabi, and Kazem Rahmani Korean Society of Epidemiology OBJECTIVES: Since poisoning is one of the most important preventable factors contributing to the hospitalization and death of children who present to emergency departments, this study was carried out to investigate the risk factors contributing to the incidence and mortality of acute childhood poisoning.METHODS: This hospital-based case-control study included 243 cases and 489 controls, drawn from daily admissions to the emergency departments of the included hospitals according to the inclusion and exclusion criteria.RESULTS: Gastrointestinal poisoning was the most common poisoning type, found in 87.7% of subjects, and medications were the most common cause of poisoning (49.8%). Multiple logistic regression analysis showed that a history of poisoning (odds ratio [OR], 10.44; 95% confidence interval [CI], 5.58 to 19.51; p<0.001) and the availability of poisonous substances (OR, 8.88; 95% CI, 5.41 to 14.56; p<0.001) were among the most important predictors of childhood poisoning. Respiratory poisoning (OR, 6.72; 95% CI, 1.40 to 32.07; p<0.05) and the presence of addiction in the family (OR, 4.54; 95% CI, 1.10 to 18.68; p<0.05) were the most important predictors of mortality among children with poisoning.CONCLUSIONS: Addiction and the presence of physical or psychological disorders in family members, a history of poisoning, and the availability of poisonous substances were significantly associated with the incidence of childhood poisoning and resultant mortality.
Introduction: Trauma in pregnancy is a major cause of hospital admission and maternal and fetal mortality. Some of the main complications of trauma in pregnant women are intrauterine death, shock, placental abruption, intraperitoneal hemorrhage, and direct fetal injury. The present study aimed to report some of the cases of trauma in pregnancy and review the previous studies in this regard. Case Presentation: In this case series, we presented the case of four pregnant women with trauma, who referred to various teaching hospitals in Mashhad, Iran. The subjects had blunt abdominal trauma, burn injuries, multiple trauma, and traumatic brain injury. Conclusion: Stabilizing the mother is the primary goal in the management of traumatized, pregnant patients. In many cases, fetal outcome is directly correlated with the rapid, thorough maternal resuscitation. In viable fetuses, fetal monitoring is crucial. On the other hand, due to the high rate of complications during pregnancy, educational interventions should be considered for pregnant women and their families. Furthermore, pregnant women must be aware of risky conditions, such as motorcycle riding and not using seatbelts.