---

---

Background and Aim: For decades, using fluoride has been introduced to prevent the development and progression of primary carious lesions. Increased surface microhardness of primary caries is among the essential factors in preventing lesion progression and cavity formation. The present study aimed to compare the microhardness changes of primary caries treated with 3 products, containing fluoride (varnish, toothpaste, & mouthwash) in dental teeth.
Methods & Materials: In this study, 45 extracted human deciduous molars were used. Using a diamond-winning disc, enamel blocks with a dimension of 1 x 4 x 4 mm were prepared from the buccal surface of the teeth, i.e., healthy and without structural defects; they were mounted in acrylic self-adhesive. Initial microhardness test (Vicker’s test) with a force of 300 gr and Dwell time for 15 seconds was applied on samples. Next, artificial caries with the standard solution were created in all samples and the microhardness of samples was recorded at this stage. The study samples were randomly divided into 3 groups of 15, treated with fluoride varnish, mouthwash, and toothpaste. Then, the microhardness of samples was re-measured. The mean surface microhardness was compared between the study groups by Independent Samples t-test and Bonferroni test. All analyses were performed using SPSS at the significance level of P<0.05.
Ethical Considerations: This study was approved by the Ethics Committee of the Arak University of Medical Science (Code: IR.ARAKMU.REC.1397.264).
Results: Increase in surface microhardness of primary caries in fluoride varnish group was statistically significant; in GC MI paste plus toothpaste and Oral B mouthwash was non-significant. The research samples treated by fluoride varnish had a higher surface microhardness, compared to toothpaste and mouthwash.
Conclusion: According to the present research results, fluoride varnish was superior to fluoride mouthwash and toothpaste in improving the microhardness of primary dental caries.

---

Introduction: One of the most common problems in newborns is apnea of prematurity. Given the importance of preventing apnea in very premature infants, the present study was designed and conducted to investigate the preventive effect of caffeine on reducing the frequency of apnea events in very premature infants.
Methods: This randomized, double-blind, controlled clinical trial was conducted on premature infants hospitalized in the neonatal intensive care unit of Shahid Motahari Hospital in Urmia. Infants were randomly divided into two intervention and control groups. The intervention group received intravenous caffeine at an initial dose of 20 mg/kg and a maintenance dose of 5 mg/kg for 14 days. In contrast, the control group received an equal volume of normal saline intravenously for the same period. Apnea events, cyanosis attacks, and bradycardia were recorded by the researchers in a standard checklist.
Results: Of the 50 infants in each group, 2% of the caffeine and 4% of the control group required prolonged oxygen therapy, respectively. Also, 6% of the caffeine group and 4% of the control group experienced intraventricular hemorrhage. In addition, 4% of the caffeine group and 2% of the control group required surgery to close the patent ductus arteriosus, and 14% of the caffeine group and 18% of the control group experienced apneic events. However, there was no statistically significant difference between the two groups regarding the incidence of apneic events (P = 0.58). Ultimately, 20% of the caffeine group and 14% of the control group died.
Conclusions: Although the findings of the present study were not statistically significant, they indicate a decrease in the frequency of apnea events in the group of premature infants receiving caffeine compared to the control group.

---

Introduction: Some intracranial surgeries must be performed while the patient is awake. Awake craniotomy is an intracranial surgical procedure in which the patient remains in a state of controlled consciousness while the surgery is performed. The aim of this study was to present a case of intracranial surgery to remove a tumor in the right frontal cortex using awake craniotomy.
Case Report: This report describes the anesthetic management of a 22-year-old male undergoing craniotomy with a fully awake technique. This was the first case of craniotomy performed entirely awake (from the beginning to the end of the operation) at Arak University of Medical Sciences and Valiasr Hospital in Arak, After preoperative preparation and evaluation, scalp nerve blocks targeting the cranial nerves innervating the scalp and head muscles were administered at specific sites. Mild sedation was provided using oxygen supplementation, followed by surgical incision. The lesion was examined intraoperatively while the patient remained awake, and the tumor was safely excised under full wakefulness. A combination of local and regional anesthesia and light intravenous sedation was utilized. Two types of local anesthetics, lidocaine 1.5% and bupivacaine 2.5%, were used for anesthesia, as well as intravenous sedatives and anesthetics such as propofol, remifentanil, and dexmedetomidine were administered for sedation. Throughout the operation, the patient was awake and breathing spontaneously, and the function of the brain nerves during the operation could be evaluated. Finally, the patient's surgery was performed without any complications and in stable condition, and the patient was transferred to the intensive care unit in good general condition, awake and fully alert.
Conclusions: Although maintaining analgesia and hemodynamic and adequate ventilation during fully awake craniotomy poses challenges, this technique is critical for intraoperative monitoring of cranial nerve function and preventing neurological deficits. By precisely administering scalp nerve blocks and carefully titrating sedatives (propofol, remifentanil, dexmedetomidine), we successfully performed the procedure under full wakefulness. With this method, potential surgical complications are prevented, and the patient also experiences satisfactory painlessness. Applying this technique was satisfactory for our patient.

---

Introduction: This study aims to examine the psychological experiences of adolescent girls coping with Premenstrual Syndrome (PMS) and analyze its psychological, emotional, and social effects on their quality of life. Understanding how PMS influences various aspects of adolescent girls' lives, including academic performance, social relationships, and emotional well-being, is essential for developing appropriate interventions.
Methods: This qualitative study employed a phenomenological approach. A total of 18 adolescent girls, aged 14-18, who had experienced PMS at least once, participated in the study. Participants were selected using purposive sampling. Data were collected through semi-structured interviews, and Colaizzi’s seven-step method was used to analyze the data.
Results: The findings of the study revealed four main themes and twelve subthemes. The psychological impacts included reduced concentration, difficulty in logical decision-making, and mental fatigue. In the emotional domain, participants reported feelings of depression, anxiety, irritability, and mood swings. The social impacts involved withdrawal from others, concealment of symptoms, and reduced interaction with family members. Additionally, participants used coping strategies such as relaxation techniques, stress management, and seeking social support to manage their symptoms.
Conclusions: The results of this study showed that premenstrual syndrome (PMS) has significant psychological, emotional, and social effects on the lives of adolescent girls. Participants reported experiences such as decreased concentration, anxiety, emotional instability, social withdrawal, and efforts to hide their symptoms. Moreover, coping strategies like stress management, mental relaxation, and receiving social support played an important role in helping them deal with their condition. A deeper understanding of these adolescents’ lived experiences can serve as a foundation for awareness-raising efforts, psychosocial support, and educational policy-making within schools and families.