OBJECTIVES: Any change in maxilla and mandible position can alter the upper airway, and any decrease in the upper airway can cause sleep disorders. Thus, it is necessary to assess airway changes after repositioning of the maxilla and mandible during orthognathic surgery. The purpose of this study was to evaluate linear and volumetric changes in the upper airway after bimaxillary surgery to correct class III malocclusion via cone-beam computed tomography (CBCT) and to identify correlations between linear and volumetric changes. MATERIALS AND METHODS: This was a prospective cohort study. CBCTs from 10 class III patients were evaluated before surgery and three months after. The Wilcoxon one-sample test was used to evaluate the differences in measurements before and after surgery. Spearman's rank correlation coefficient was used to test the correlation between linear and volumetric changes. RESULTS: The results show that the nasopharyngeal space increased significantly, and that this increase correlated with degree of maxillary advancement. No significant changes were found in volumes before and after surgery. A correlation was found between linear and volumetric oropharyngeal changes. CONCLUSION: Bimaxillary surgical correction of class III malocclusion did not cause statistically significant changes in the posterior airway space.
Cohort Studies ; Cone-Beam Computed Tomography ; Humans ; Malocclusion* ; Mandible ; Maxilla ; Orthognathic Surgery ; Prospective Studies ; Sleep Wake Disorders

The present study aimed to determine the relationship between the level of air pollutants and the rate of ischemic stroke (IS) admissions to hospitals. In this retrospective cross-sectional study, stroke admissions (January-March 2012 and 2013) to an emergency department and air pollution and meteorological data were gathered. The relationship between air pollutant levels and hospital admission rates were evaluated using the generalize additive model. In all 379 patients with IS were referred to the hospital (52.5% male; mean age 68.2+/-13.3 years). Both transient (p<0.001) and long-term (p<0.001) rises in CO level increases the risk of IS. Increased weekly (p<0.001) and monthly (p<0.001) average O3 levels amplifies this risk, while a transient increase in NO2 (p<0.001) and SO2 (p<0.001) levels has the same effect. Long-term changes in PM(10) (p<0.001) and PM(2.5) (p<0.001) also increase the risk of IS. The findings showed that the level of air pollutants directly correlates with the number of stroke admissions to the emergency department.
Air Pollutants ; Air Pollution ; Cross-Sectional Studies ; Emergency Service, Hospital ; Humans ; Male ; Patient Admission ; Retrospective Studies ; Stroke

This study aimed to compare evidence-based medicine (EBM) vs. conventional approaches to journal club sessions in teaching critical appraisal skills in reading papers by emergency medicine residents. This double cut off discontinuation regression quasi-experimental study was conducted among emergency medicine residents. EBM vs. the conventional approach were applied to teach critical appraisal skills for half of the residents as an experimental group and another half as a control group respectively. Both groups participated in one hour monthly journal club sessions for six months. Before and after the study, all participants were examined by two tests: the Fresno Test (FT) [to evaluate their knowledge about EBM] and the Critical Appraisal Skills Test (CAST) [to evaluate their competency with critical appraisal skills]. The allocation of the participants into the experimental or control groups was according to their CAST scores before the study. 50 emergency medicine residents participated. After the study, the scores of both groups in the FT and CAST significantly improved (p<0.01), and the promotion of scores of the FT and CAST in the experimental group were more than that of the conventional group (p<0.0001). The current study indicated that an evidence-based medicine approach in journal club sessions was comparatively more advantageous compared to the conventional approach in teaching critical appraisal skills for reading papers among the residents of emergency medicine.
Emergency Medicine ; Evidence-Based Medicine ; Internship and Residency ; Non-Randomized Controlled Trials as Topic

Objectives: Heart failure (HF) is a common disease with a high hospital readmission rate. This study considered class imbalance and missing data, which are two common issues in medical data. The current study’s main goal was to compare the performance of six machine learning (ML) methods for predicting hospital readmission in HF patients. Methods: In this retrospective cohort study, information of 1,856 HF patients was analyzed. These patients were hospitalized in Farshchian Heart Center in Hamadan Province in Western Iran, from October 2015 to July 2019. The support vector machine (SVM), least-square SVM (LS-SVM), bagging, random forest (RF), AdaBoost, and naïve Bayes (NB) methods were used to predict hospital readmission. These methods’ performance was evaluated using sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Two imputation methods were also used to deal with missing data. Results: Of the 1,856 HF patients, 29.9% had at least one hospital readmission. Among the ML methods, LS-SVM performed the worst, with accuracy in the range of 0.57–0.60, while RF performed the best, with the highest accuracy (range, 0.90–0.91). Other ML methods showed relatively good performance, with accuracy exceeding 0.84 in the test datasets. Furthermore, the performance of the SVM and LS-SVM methods in terms of accuracy was higher with the multiple imputation method than with the median imputation method. Conclusions This study showed that RF performed better, in terms of accuracy, than other methods for predicting hospital readmission in HF patients.

OBJECTIVETo determine the helminth parasites of Anas crecca (A. crecca) in one of proper refuges of Iran, Fereydunkenar.

METHODSA total number of one hundred thirty-six gastrointestinal tracts of green-winged teal (A. crecca) were collected from Fereydunkenar, Mazandaran province during September and October 2011. The gastrointestinal tracts were examined for helminth infection.

RESULTSThe total infection rate was 70.50% (96) that 68.96% (40) of males and 71.79% (56) of females shown helminthes infection. The examined A. crecca harbored one species of Nematoda, Cestoda and two species of Digenea which were as following: Contracaecum larvae (from stomach wall), Diorchis stefanskii (D. stefanskii) (from small intestine), Hypoderaeum conoideum (from small intestine) and Notocotylus attenuatus (N. attenuatus) (from caecum), respectively. There was no significant difference in the prevalence of infection between examined males and females ducks in Hypoderaeum conoideum, D. stefanskii and N. attenuatus (P>0.05) whereas a significant relationship was observed between males and females in Contracaecum larvae (P<0.05).

CONCLUSIONSBased on the results of the present study, we conclude that A. crecca plays a prominent role in transmission of mentioned parasites. In addition, this is the first report of Contracaecum larvae, D. stefanskii and N. attenuatus from A. crecca in Iran.