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Introduction: Thirst is one of the main complaints during Islamic fasting. As bread is the staple food among most Muslims, evaluating its impact on thirst is important. In this study, we investigated the effect of licorice-enriched barley bread compared to barley bread and white wheat bread. Methods: This clinical trial was performed on three consecutive days during Itikaf ceremony. Data were garnered by using a checklist including items on demographic data, weight, height, waist circumference, blood pressure, and pulse rate. Blood pressure and pulse rate measurements were repeated at the end of the study. The participants were divided into three groups receiving functional barley bread enriched with licorice, barley bread, and white wheat bread. The thirst sensation was assessed by Fan visual analogue scale. Also, 24-hour dietary recall was obtained on all the three days. Results: Overall, 273 people participated in this study. Thirst sensation in the functional barley bread was lower than that in the wheat bread and barley bread groups, but there were no significant differences between wheat and barley bread groups in this regard. During the fasting period, the greatest increase in thirst was observed during the first five hours of fasting in all the three groups, which was significantly lower in the functional barley bread group than the wheat and barley bread groups; however, there was no significant difference between wheat and barley bread groups in this respect. Finally, similar results were attained following fluid intake adjustment.Conclusion: This study showed that licorice enrichment of barley bread might alleviate thirst sensation among fasting individuals.

Background Cutaneous Leishmaniasis (CL) which is prevalent in all continents and is classified by the WHO as one of the neglected tropical diseases, existed in the past also, and discovered ancient works confirm this issue. The lack of adaptation of diseases between Persian Medicine (PM) and Modern medicine, led to no usage of effective therapeutic experiences of prior physicians. Objective The purpose of this study is finding skin lesions adapted to CL in PM for usage of same disease treatment in the next clinical trials, and the use of approved therapies in CL. Methods In a narrative review, without time limitation, documentary study was conducted for different names and clinical aspects of CL in printed and electronic resources of modern medicine such as: Rook's Textbook of Dermatology, Harper's Textbook of Pediatric Dermatology, PubMed, and Embase. Then, found names were searched in printed and electronic resources of PM such as: Al-Qanun fi al-tibb, Al-Tasrif leman ajeza an-e-Taliff, JamiTib 1.5 published by Noorsoft.org. Then, skin lesions which were similar to CL with these aspects were searched: clinical manifestation and forms, chronicity, curability, mosquito bite, were studied in references of PM. Finally, matching, syllogism and logical inference were performed and conclusion was made. Results Forty-five names for CL were found in the searched resources. However, only Balkhieh, Kheyroonieh and Baghdadi button were names found in PM resources. Also, from 61 studied skin lesions in PM resources, only 6 cases had similarities to CL. Conclusion In spite of the existence of CL's similarity with Balkhieh, Kheyroonieh and the Baghdadi button, there are serious differentiations. Zat-ol-asl rashes and reddish solb rashes, kinds of stranger rashes, probably adapted with CL.

Background: Chemotherapy induced nausea and vomiting (CINV) is a side effect, and has negative effect on quality of life and continuation of chemotherapy. Despite new regimen and drugs, the problems still remain and standard guidelines, effective treatment and supportive care for refractory CINV are still not yet established. Persian medicine, the old Iranian medical school, offer Persumac (prepared from Rhus Coriaria and Bunium Persicum Boiss). Objective: The specific objectives were to assess the effect of Persumac on the number and severity of nausea and vomiting in refractory CINV in acute and delayed phase. Methods: This randomized, double blind, crossover clinical trial study was carried out on 93 patients with breast cancer and refractory CINV, who received outpatient high emetogenic chemotherapy in Imam Reza hospital, Mashhad, Iran from October 2015 to May 2016. The study has three stages: in stage I patients received a questionaire and completed it after chemotherapy. In stage II they were randomly divided into intervention group with Persumac and control group with placebo (lactose were used). In stage III, wash out and crossover was conducted. Both groups in all stages received standard antiemetic therapy for CINV. The following were set as the inclusion criteria of the study: female, Age ≥18 years, clinical diagnosis of breast cancer, history of refractory CINV, normal blood tests and at least three courses of chemotherapy remaining. Exclusion criteria of this study were: Total or upper abdominal radiation therapy along with chemotherapy, drugs/therapy for nausea and vomiting not prescribed in this study, hypersensitivity to Sumac or Bunium Persicum, use of sumac and Bunium Persicum in seven days prior to the intervention, clinical diagnosis of digestion disorders, non-chemotherapy induced nausea and vomiting, milk allergy, loss of two consecutive or three intermittent doses of Persumac or placebo. Outcomes were gathered by Persian questionnaire. Number and severity of nausea and vomiting was measured with a self-reporting tool; visual analog scale. Results: Demographic data and other characters in both groups have no significant diffrence. Eighty of 93 eligible patients in stage I completed the study and in stage II, eleven declined participation for stage III (crossover). P value of carry over, period and treatment effects demonstrated that they had not affected the results before and after crossover. The mean severity of nausea in acute phase was in stage I: 4.83 ± 1.40, stage II: 4.54 ± 2.0 and stage III: 4.15 ± 0.92 in sequence AB (first Persumac and then placebo in crossover), and in sequence BA (first placebo and then Persumac in crossover) was respectively 4.83 ± 1.40, 4.54 ± 2.0, 4.15 ± 0.92 with p value of carry over effect: 0.03 and period effect: 0.22. Except for severity of nausea in acute phase, the mean number http://www.ephysician.ir Page 3536 and severity of nausea and vomiting scores significantly decreased in acute and delayed phase of CINV. Conclusion: Persumac may control the refractory CINV. The implicable and clinical importance of this research is that another option exists for refractory CINV. Higher doses, different cancers, patients with more various features, and more complete methodology and tools can provide appropriate designs for new research on this topic. Trial registration: This trial was registered at the Clinical Trials.gov ID: NCT02787707. Funding: This study is part of a Ph.D. thesis and under grant; No: 930735 of Research Chancellery of MUMS

Introduction Experts consider social accountability as a new paradigm in medical education and a cultural change that is necessary to be studied and understood more deeply. One of the problems of medical education is the inadequacy of medicine graduates to meet the social accountability. Therefore, the aim of this study was to examine the general medicine curriculum for social accountability. Methods This cross-sectional study was conducted on three groups of experts, faculty members, and general physicians working in health centers in Mashhad in 2014. According to the needs assessment and definition of need as a requirement or preference, the research was conducted in three stages using the Delphi method, in which the opinions of experts, lecturers, and practitioners were collected and classified based on the CARE model in four areas, i.e., clinical activities, advocacy, research, and educational categories, and, ultimately, the percentage of agreement was determined. Results As indicated by the results of the need analysis, in order to reach social accountability of medical students of Mashhad University of Medical Sciences, the curriculum should cover four major areas, i.e., clinical activities, advocacy, research, and training. We found 38 items for social accountability that are required in the general medical curriculum, including clinical activities (12 items), advocacy (10 items), and scope of research (8 items). The educational area was comprised of 8 items. In this study, from 30 participants, only 19 people participated in the three-step Delphi, and there was a 70% response rate in the first stage and second stage, but 90.47% in the third stage. Conclusion There is a growing interest around the world for social accountability in medical schools and other health-related schools. It is expected that the results will be of interest to planners and policy-makers in this field so that we will observe a promotion in the culture of social accountability in Mashhad University of Medical Sciences.

Background and aim: Musculoskeletal disease, that is recognized in diabetes and diabetes mellitus (DM) has shown a higher prevalence of chronic musculoskeletal complications. This study aimed at assessing the frequency of upper limb musculoskeletal disorders among patients with diabetes type II with normal cases in Mashhad, Iran. Methods: A cross-section of 100 patients with upper limb musculoskeletal disorders were enrolled in this study. The patients were examined by a unique physician considering carpal tunnel syndrome disorder, trigger finger, adhesive capsulitis, and Dupuytren’s contracture at Ghaem hospital, Mashhad, Iran in 2015. All collected data were recorded by using SPSS version 21 and were analyzed through independent-samples t-test for comparing changes, and Chi-square. Results: In this study, the mean age was 51.7±8.7 years old. Gender frequency was 114 (57%) male, and 86 (43%) female. There was no significant difference between groups in cases of gender frequency and mean of age (p>0.05). In evaluation of association between the two groups, there was significant difference for adhesive capsulitis, (p=0.04). Chi-square test showed significant association for age and adhesive capsulitis between the two groups, (p=0.040); but no other diabetes-related disorders, (p˂0.05). Conclusion: The results of this study showed that in patients with diabetes mellitus and musculoskeletal complications such as upper limb musculoskeletal abnormalities, it will lead to an increase in skeletal muscle effects in DM patients. It is recommended that musculoskeletal examination is done periodically in DM patients for identification of these disorders and necessary actions are carried out for prevention of the disorders as soon as possible.