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This cross-sectional study was conducted on 359 COVID-19 patients in a public training hospital in Mashhad to assess the level of shared decision-making among the patients with COVID-19 and determine the affecting factors. Shared decision making was evaluated with a questionnaire based on Iranian accreditation standards. Data were analyzed by employing Chi-square test and stepwise logistic. The models were calibrated by the Hosmer–Lemeshow test. The results show that maximum shared decision making does not occur among these patients. 74% of patients stated that they have participated in the doctor's decision for the treatment plan. The results showed that gender, educational status and employment status (had significant relationships with patient participation in physician decisions). [ABSTRACT FROM AUTHOR]

Background The number of deaths among people with coronavirus disease 2019 (COVID-19) does not show the true impact of the disease on communities. Therefore, this study aimed to calculate years of life lost (YLL) due to premature death in patients with COVID-19. Methods We performed a descriptive cross-sectional study based on data from one of the largest provinces of Iran, in the period 13 February 2020 to 17 May 2021. We used WHO proposed guidelines for the calculation of the burden of diseases to calculate the YLL among patients with COVID-19, taking into consideration gender in different age groups. Results Findings showed that 13 628 deaths were due to COVID-19 with associated 249 309 YLL. The study reported higher mortality among men (1222 cases) in the age group over 85 years than in women (840) of the same age group. The minimum number of YLL for men was 1749 in the 5–9 years age group and that for women was 1551 years in the 14–10 years age group. Conclusion The high number of deaths due to COVID-19 has led to high YLL due to premature death. The provision of adequate health care and appropriate policies will bring about a decrease in YLL due to COVID-19. [ABSTRACT FROM AUTHOR]

Background: The safety and mental health issues of frontline nurses working during the coronavirus global outbreak must be a first/top priority. The present study aimed to investigate the association between nurses’ occupation stress and organizational support in both infectious and non-infectious intensive care units (ICUs) wards during the COVID-19 crisis. Methods: This was a descriptive-analytical and cross-sectional study. The study population comprised nurses caring for COVID‐19 patients in Imam Reza Hospital complex in Mashhad City, Iran. The sample size was 129 nurses selected through random quota sampling and examined with a standard questionnaire. To analyze the information and test the hypothesis, the structural equation modeling approach using Smart PLS 2.0 software has been used. Descriptive and analytical statistical tests were used in this study. Results: The results indicated a significant negative correlation between stress and perceived organizational support for ICU nurses (P<0.001). Considering subscales in stress, the highest mean occupational stress scores were related to the “death and dying” dimension (n=21, 13.98%). Also, the difference between the two groups of nurses was statistically significant in different workloads (P<0.001) and lack of support (P<0.001). Conclusion: The results of the present study highlighted the importance of organizational support to reduce stress in nurses. To get through this unprecedented situation, nurses need their employers and organizations to support them with action, planning, and resources. [ABSTRACT FROM AUTHOR]

Background and aims: Evaluation of learners is considered as one of the most important principles in education, especially in the clinical fields. Continuous assessment can be used to provide appropriate feedback to students about their strengths and weaknesses. In this regard, this study is aimed to design a system of continuous assessment of medical residents (SCMARs). Methods: This study was performed using a combination of qualitative methods, including focus group discussion, expert panel, and Delphi technique. The study population consisted of all the stakeholders involved in the evaluation process of medical residents in Imam Reza Hospital Complex (IRHC) in Iran. This study was conducted in three phases, including identification of subthemes and indicators, production of a primary framework for the SCMAR, and agreement on the subthemes of the SCMAR. The nominal group technique was used for generating priority information. Data analysis was performed during the agreement review stage with the Excel software version 2016. Results: The finalized SCMAR consisted of 10 main themes and 38 subthemes. The themes included objectives, evaluators, areas, and indicators of evaluation, evaluation periods, evaluation requirements, data collection, data sources, point assignment and data analysis methods, reporting, and feedback dissemination methods. Five areas of evaluation and 11 indicators of evaluation were proposed. Conclusion: A comprehensive assessment system that continuously evaluates the performance of Medical Residents can be used as a stimulus to improve the quality of educational processes. The present study was aimed to address this need by designing a framework for such a system. [ABSTRACT FROM AUTHOR]

Background: Nurses play a very important role in caring for patients with coronavirus disease-19 (COVID-19). They are on the frontline fighting COVID-19. The objective was to explore the experiences of nurses in the surgical and infectious wards about caring for patients with COVID-19 in a large and tertiary care hospital in Iran. Materials and Methods: This was a qualitative study. Semi-structured qualitative interviews were conducted with 18 nurses in the Imam Reza Hospital Complex from April to May 2020, Mashhad, Iran. Data analysis was performed using the method proposed by Lundman and Granheim. The Maxqda10 software was used. Results: The experiences were summarized into three categories: (1) experiencing new feelings and relationships with colleagues and patients, (2) viewpoints about managers' performance, and (3) concern about getting infected with COVID-19. Findings reflected similar experiences on personal protective equipment between nurses in the surgical and infectious wards. Experiencing new feelings and relationships with colleagues and patients and concern about getting infected and spreading the COVID-19 were mostly expressed by infectious nurses and surgical nurses, respectively. Conclusions: This research results provide evidence of the experiences of infectious and non-infectious disease nurses who are currently caring for COVID-19 patients. Due to some differences between the experiences of these two groups in COVID-19, it is suggested to pay more attention to the needs and required skills in the staff mix during a crisis. [ABSTRACT FROM AUTHOR]

Background: This study aims to assess the productivity loss in diabetic patients living in South Khorasan Province, Iran, in 2017. Methods: This cost of illness and analytical study was performed on 1003 patients with diabetes referred to hospitals and healthcare centers in South Khorasan Province. After being randomly selected, the participants filled the short form health and labor questionnaire by the human capital method to estimate the productivity loss caused by health problems. Data were collected in person or via phone interviews. The collected data were analyzed by data quantile regression model using Stata v. 11. Results: The Mean±SD productivity loss based on actual and labor law income was 19.61±46.24 and 16.61±49.39 dollars, respectively. In addition, the results showed that the Mean±SD number of lost working days is 0.81±2.39 days. According to the regression model, gender, educational levels, marital status, and employment status affected the number of working days lost at 0.25 quantile (P≤0.05). Conclusion: Improving productivity in diabetic patients and consequently reducing the resulting economic burden is essential to promoting their physical, mental, and social health. [ABSTRACT FROM AUTHOR]

Background: Approximately 20 million individuals are afflicted with cancer worldwide. Gastric cancer is the fourth leading cause of death in the world today. The aim of this study was to evaluate the direct medical care costs of gastric cancer patients in a tertiary teaching hospital in Iran.--- Methods: The present study is descriptive-analytical, carried out in two main stages. In the first stage we designed a form based on valid international guidelines. The second step identified the costs of diagnosis and treatment of gastric cancer. To analyze the cost data, descriptive statistics such as mean and standard deviation were utilized. We used nonparametric statistical tests such as Mann-Whitney, Wilcoxon in SPSS 16 software for data analysis. Results: In this study, the records of 449 gastric cancer patients who had referred to Omid tertiary teaching hospital of Mashhad between the years 2005 and 2015 were studied. According to the results, the highest average costs were related to patient hospitalization costs. Based on the significance level of the Mann Whitney test, no remarkable difference could be seen in the total costs of metastatic and non-metastatic patients (P-value: P> 0.05). Conclusion: Organizations such as: insurance agencies, charities and financial institutions need to adopt new policies to reduce patients' expenditures, remove financial barriers and prevent patients from facing catastrophic costs. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is considered one of the most infectious diseases in the world. In this study, we intended to examine the epidemiology of tuberculosis by MIRU-VNTR to define the changes that occur in the transmission of tuberculosis in the region during the COVID-19 era. A total of 120 Mycobacterium tuberculosis isolates were collected from sputum samples of patients referred to East Azerbaijan Center TB from December 2020 to August 2021. Demographic information such as age, sex, place of birth, previous TB history, and relevant medical data was collected. The proportion method was performed for drug susceptibility testing, and the PCR-based MIRU-VNTR method was applied to identify molecular epidemiology relationships. Results: The isolates were collected from 78 male (65%) and 39 female (32.5%) Iranian patients and 3 (2.5%) Azerbaijani patients. Ninety-three distinct patterns were identified including 15 clustered patterns and 36 unique patterns. The largest cluster was composed of seven isolates. Furthermore, one cluster with 5 members, four clusters with 3 members, and nine clusters with 2 members. In MIRU-VNTR typing, 75 clusters belonged to the Tabriz region and just 3 to the Republic of Azerbaijan. All isolates were sensitive to rifampin, isoniazid, and ethambutol. Conclusions: Results of the current study showed COVID-19 pandemic had a direct effect on the transmission and diagnosis of tuberculosis. Less diagnosis and less clustering can indicate public controls and hygiene, and the use of masks had a direct effect on the transmission and diagnosis of tuberculosis. However, misidentification and less focus on other respiratory infections are expected during the pandemic. Studies on the co-infection of COVID-19 and tuberculosis and the role of mask and sanitization against TB are strongly recommended. [ABSTRACT FROM AUTHOR]

Importance: Pyrin-associated autoinflammation with neutrophilic dermatosis (PAAND) is a monogenic autoinflammatory disorder with autosomal dominant inheritance and has been associated with monoallelic p.Ser242Arg and p.Glu244Lys variations in the MEFV gene. This dermatosis shares clinical features and pathogenesis with familial Mediterranean fever, although it is a clinically distinct entity., Objective: To identify the genetic basis of PAAND in a consanguineous family with 2 affected children and to prescribe an effective genotype-guided treatment., Design, Setting, and Participants: This case series study examined 2 siblings who presented with clinical features of PAAND. We sought the genetic basis of this disease with trio whole exome sequencing (trio-WES). Genome-wide homozygosity mapping provided additional evidence for causality of a sequence variant identified by trio-WES., Main Outcomes and Measures: Association of a biallelic MEFV variation with a new form of autosomal recessive PAAND was documented by genetic analysis. Response to treatment with colchicine and a low-dose steroid was assessed clinically and experimentally., Results: Two siblings, a girl (proband; age 5 years) and a boy (age 2.5 years) of Iranian-Azeri ancestry born to first-cousin consanguineous parents presented with clinical features of PAAND-recurrent episodes of maculopapular and pustular rash, gastrointestinal involvement resembling inflammatory bowel disease, and intussusception with generalized mesenteric lymphadenitis. A trio-WES test detected a previously unreported homozygous missense variation, p.Ser242Gly, in both patients' MEFV gene. Genome-wide homozygosity mapping revealed shared regions of homozygosity in the patients' DNA, including 1 on chromosome 16 harboring MEFV. Whole transcriptome sequencing by RNA-sequencing revealed that the variant MEFV transcript, among the inflammasome-associated transcripts, was most upregulated, and the cell-cell receptor interaction and innate immune system pathways were most positively enriched. Under the guidance of MEFV genotype, treatment with colchicine (1 mg/d) and low-dose prednisolone (2.5 mg every other day) was started, and the patients responded well., Conclusions and Relevance: This case series study demonstrated successful genotype-guided treatment with colchicine and low-dose prednisolone, a low-cost therapeutic option with minimal adverse effects, in patients with a novel form of autosomal recessive PAAND. This case report examines the genetic basis of PAAND in a consanguineous family with 2 affected children and seeks to prescribe an effective genotype-guided treatment.

Introduction: The implementation of a dashboard enables managers to make informed and evidence-based decisions through data visualization and graphical presentation of information. This study aimed to design and implement a COVID-19 management dashboard in a third-level hospital in Mashhad, Iran., Materials and Methods: This descriptive developmental applied study was conducted in the second half of 2020 in three stages, using user-centered design methodology in four phases: (1) specification of the application context, (2) specification of requirements, (3) creation of design solutions, and (4) evaluation of designs. Data collection in each phase was performed through holding group discussions with the main users, nominal group techniques, interviews, and questioners. The dashboard prototype for the data display was designed using the Power BI Desktop software. Subsequently, users' comments were obtained using the focus group method and included in the dashboard., Results: In total, 25 indicators related to input, process, and output areas were identified based on the findings of the first stage. Moreover, eight items were introduced by participants as dashboard requirements. The dashboard was developed based on users' feedback and suggestions, such as the use of colors, reception of periodic and specific reports based on key performance indicators, and rearrangement of the components visible on the page. The result of the user satisfaction survey indicated their satisfaction with the developed dashboard., Conclusion: The selection of proper criteria for the implementation of an effective dashboard is critical for the health care organization since they are designed with a high-tech and content-based environment. The dashboard in the present study was a successful combination of clinical and managerial indicators. Future studies should focus on the design and development of dashboards, as well as benchmarking by using data from several hospitals., Competing Interests: None declared., (Thieme. All rights reserved.)

Objectives: Evaluating the costs of illness can provide evidence to improve performance at all levels of health organizations. This study aimed to identify the relationship between the costs of diagnosing and treating patients with gastric cancer and their explanatory variables, using quantile and gamma regressions and comparing the results of the two models., Methods: This was a cross-sectional and descriptive-analytic study carried out in 2016. In total, 449 patients with gastric cancer were selected at a hospital affiliated with Mashhad University of Medical Sciences. Direct costs and other variables were collected from medical documents. Data were analyzed using the STATA 12 software, using quantile and gamma regression analysis, and the results were compared., Results: The highest average cost per patient was related to hospitalization costs in both metastatic (20 911 034 Iranian Rials) and nonmetastatic patients (20 738 062 Iranian Rials). The lowest average cost was related to biopsy services in nonmetastatic patients. The results of the study also showed that quantile regression is an appropriate substitute for gamma regression and, in some cases, can provide more information for the analysis of disease costs. Based on the results of the quantile regression, being a male and having a shorter stay had a positive effect on cost and the age of the patient had a significantly negative effect., Conclusions: Examining the cost of a common illness, such as gastric cancer, is an important economic tool for policy makers and decision makers. It provides evidence-based decision making about resource allocation that they can use for future planning and cost control., (Copyright © 2019 ISPOR--The professional society for health economics and outcomes research. Published by Elsevier Inc. All rights reserved.)

Background: Ankylosing spondylitis (AS) is a prototype of chronic inflammatory arthritis termed seronegative spondyloarthropathies that typically affects the joints. Among the non-Human leukocyte antigen (HLA) loci, the strongest association has been observed with Endoplasmic reticulum aminopeptidase 1 (ERAP1) gene single nucleotide polymorphisms (SNPs). Moreover, the effect of ERAP1 gene SNPs on the pro-inflammatory and anti-inflammatory cytokines in AS disease has still been poorly elucidated. In this study, we aimed to determine the association of ERAP1 gene SNPs (rs30187 and rs2287987) with AS risk as well as their effect on the mRNA expression of pro-inflammatory and anti-inflammatory cytokines, with emphasis on the immunoregulation of the IL-17/IL-23 pathway, in an Iranian population., Methods: We performed Single specific primer (SSP)-PCR for genotyping of 160 AS patients and 160 healthy controls. After isolation of peripheral blood mononuclear cells (PBMCs), total RNA of PBMCs was isolated, complementary DNA (cDNA) was synthesized, and quantitative analyses of mRNA expression of cytokines were performed by Real-time PCR for 40 HLA-B27 positive AS patients and 40 healthy individuals as controls., Results: It was seen that T allele of rs30187 (OR = 1.54, 95% CI = 1.07-2.22, P =  0.017) and C allele of rs2287987 (OR 1.50, 95% CI 1.05-2.14, P = 0.024) were associated with the risk of AS. Both of these alleles were associated more strongly in the HLA-B27 positive AS patients. There was a significant overexpression of mRNAs of pro-inflammatory (IL-17A, IL-17F, IL-23, TNF-α and IFN-γ), while downregulation of anti-inflammatory cytokines (IL-10 and TGF-β) in PBMCs from 40 HLA-B27 positive AS patients in comparison to controls. AS patients with rs30187 SNP TT genotype expressed mRNA of IL-17A, IL-17F, and IL-23 significantly higher than patents with CT and CC genotypes for this SNP., Conclusions: This study represented the association of ERAP1 gene rs30187 and rs2287987 polymorphism with the risk of AS. Additionally, it appears that rs30187 polymorphism may be involved in the immunomodulation of the IL-17/IL-23 pathway in the AS disease., (Copyright © 2019 European Federation of Immunological Societies. Published by Elsevier B.V. All rights reserved.)

Ankylosing spondylitis (AS), an autoinflammatory disease, has been associated with impaired Endoplasmic reticulum aminopeptidase (ERAP) 1 activity, which is involved in priming antigenic peptides. The purpose of this study was to evaluate if the genetic variant of ERAP1 gene could impress the inflammation status of the AS patients. For genotyping, 140 AS cases and 140 healthy controls were enrolled. After isolation of peripheral blood mononuclear cells (PBMCs) and DNA extraction, all the subjects were genotyped for rs27044 polymorphism using SSP-PCR assay. Total RNA of PBMCs was isolated, cDNA was synthesized, and quantitative analyses of mRNA expression of cytokines were performed via Real-time PCR using the SYBR Green Gene Expression MasterMix. To measure the concentration of cytokines in serum of subjects, Enzyme-linked immunosorbent assay (ELISA) was used. It was observed that the G allele of rs27044 polymorphism was significantly prevalent in AS patients. Moreover, the GG genotype and the GG+GC dominant model had significantly different distribution between study groups. There was a significant overexpression of mRNAs of IL-17A, IL-6, IL-33, TNF-α, and IFN-γ, while IL-10 was significantly downregulated in AS patients. The ELISA results were in line with that of the gene expression analysis. No significant differences in mRNA expression and concentration of cytokine were identified among AS patients with three genotypes for rs27044 SNP. This study replicated the association of polymorphisms in ERAP1 gene with the risk of AS in a population from Iranian. However, it did not directly determine the inflammatory profile of the AS patients.

This study was conducted in Iran in order to assess the distribution of CTX-M type ESBLs producing Enterobacteriaceae. From January 2012 to December 2013, totally 198 E. coli, 139 Klebsiella spp, 54 Salmonella spp and 52 Shigella spp from seven hospitals of six provinces in Iran were screened for resistance to extended-spectrum cephalosporins. After identification and susceptibility testing, isolates presenting multiple-drug resistance (MDR) were evaluated for ESBL production by the disk combination method and by Etest using (cefotaxime and cefotaxime plus clavulanic acid). All isolates were also screened for blaCTX-M using conventional PCR. A total of 42.92%, 33.81%, 14.81% and 7.69% of the E. coli, Klebsiella spp, Salmonella spp and Shigella spp isolates were MDR, respectively. The presence of CTX-M enzyme among ESBL-producing isolates was 85.18%, 77.7%, 50%, and 66.7%, in E. coli, Klebsiella spp, Salmonella spp and Shigella spp respectively. The overall presence of CTX-M genes in Enterobacteriaceae was 15.4% and among the resistant isolates was 47.6%. This study indicated that resistance to β-lactams mediated by CTX-M enzymes in Iran had similar pattern as in other parts of the world. In order to control the spread of resistance, comprehensive studies and programs are needed., (Copyright © 2016 Sociedade Brasileira de Microbiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Responsiveness introduced by WHO as a key indicator to assess the performance of health systems and measures by common set of domains that are categorized in to two main categories "Respect for persons" and "client orientation". This study measured importance of client orientation domains in high and low income districts of Mashhad. In this cross-sectional and explanatory study, Sample of 923 households were selected randomly from two high and low income districts of Mashhad. World Health Organization (WHO) questionnaire was used for data collection. Standard frequency analyses and Ordinal logistic regression (OLR) was employed for data analysis. In general, respondents selected quality of basic amenities as the most important domain and access to social support networks was identified as the least important domain. Households in high income area scored higher domains of prompt attentions and choice Compared to low income. There was a significant relationship between variables of ages, having member that need to care and self-assessed health with the ranking of client orientation domains.Study of households' view on ranking of non-clinical aspects of quality of care, especially when faced with limited resources, can help to conduct efforts towards subjects that are more important, and lead to improve the health system performance and productivity.

Background: Physical exercise can induce imbalance of different cytokines by leading them towards an inflammatory and immunosuppressive milieu. Fish-oil (FO) supplementation may modulate the mentioned skewed balance following intense exercise. Therefore, we decided to investigate the effect of intense physical exercise and FO supplementation on cytokine production and helper T (Th) cell phenotype in male elite paddlers., Subjects and Methods: Male elite paddlers consumed 6 g/day of either FO capsules (n=11) containing 3.6 g long chain n-3 polyunsaturated fatty acids (1.2 g docosahexaenoic acid and 2.4 g eicosapentaenoic acid) or placebo capsules (n=11) for 4 weeks. The paddlers simultaneously undertook a program of increasing exercise. Blood samples were taken from all the subjects 48 h before and after the 4 weeks of supplementation., Results: Our results show that while FO supplementation decreases the production of tumor necrosis factor (TNF)-α and interleukin (IL)-1β in the elite paddlers, it increases the production of IL-6. On the other hand, while there was no change in IL-4 secretion, the production of interferon (IFN)-γ was significantly decreased after 4 weeks FO consumption. We also showed that the production of IL-10 was significantly higher in the FO group compared to the placebo. Finally, we found that fish-oil consumption shifts the balance between Th cells towards Th2 phenotype during intensive exercise., Conclusion: Our results suggest that the consumption of n-3 polyunsaturated fatty acids during intense exercise can induce the anti-inflammatory and immunosuppressive cytokine networks that are associated with a reduced Th1/Th2 ratio in elite paddlers., (Copyright © 2015 Elsevier Ltd. All rights reserved.)