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Abstract Background and objectives Medical students experience different types of challenges during their MD program, which become more challenging when it comes to the internship, putting too much pressure on them. This study aimed to explore the challenges of medical interns of Shiraz University of Medical Sciences (SUMS), Shiraz, Iran. Methods In this qualitative research, which was conducted from September 2023 March 2024, medical interns of SUMS were selected using purposeful sampling method. The data were collected through deep and semi-structured interviews, and it was continued until data saturation was achieved. The data analysis was performed through thematic content analysis. Results A total of 13 participants (6 men and 7 women) with a mean ± SD age of 25 ± 1.6 years were interviewed. The challenges of medical interns consisted of 423 meaning units, 79 open codes, 14 subthemes, and 6 main themes; the main themes consisted of educational challenges, challenges following university regulations, health and behavioral issues, economic/employment-related issues, sociocultural and recreational challenges, and ethical issues. Conclusion The results of this study highlight the necessity for reforms in the medical internship phase aiming to tackle interns’ issues and establish a supportive and nurturing environment for future medical doctors.

Abstract Background Community Mental Health Centers (CMHCs) offer affordable mental health services in a less stigmatized environment, in a domiciliary setting. This study aimed to shed light on the epidemiological factors of patients attending CMHCs of Mashhad, their referral status, and treatment. Methods This study was conducted over the medical records of patients seen by psychiatrists between January 2014 and December 2021 in Mashhad's CMHC, the northeast of Iran. A detailed questionnaire was used to extract data from medical records about the epidemiological characteristics, diagnosed mental illnesses, referral status, and how often they visited the psychiatrist. The association between epidemiological findings and patient referral (referral system or self-referral) as well as the association between epidemiological findings and the number of psychiatric revisits were examined using the Chi-square test. Results Out of 662 patients, 472 (71%) were female and 190 (29%) were male, with an average age of 29 years. Among the 475 adult patients, 367 (77.3%) were married, with the majority being homemakers (56.4%). Major Depression Disorder (MDD) (32%) and Generalized Anxiety Disorder (GAD) (18.3%) were the most prevalent mental health conditions among patients. The majority of patients (74.9%) were referred to the CMHC of Mashhad from Primary Healthcare centers (PHCs) and psychiatric hospitals. Furthermore, female gender and patients with lower level of education were associated with more referral through from referral system. Of note, 431 patients (65.1%) did not return for a second visit, the ratio of treatment dropout was higher for patients with lower education levels. Conclusions Referral system should be more practical in Iran to enhance health services in CMHCs. It is recommended that PHCs undergo certain modifications to enhance the referral process for patients with mental health conditions, focusing on common mental disorders and individuals with low socioeconomic level.

Abstract Background Primary healthcare centers (PHCs) serve as the cornerstone of accessible medical services in society, playing a crucial role in screening, detecting, and treating various health issues. This study aimed to investigate the prevalence of psychiatric disorders in middle-aged individuals who refer to PHCs and the potential of PHCs in diagnosing mental disorders. Methods This cross-sectional study was implemented at PHCs under the supervision of Mashhad University of Medical Sciences (MUMS) in northeast Iran in 2018. The enrolled subjects were middle-aged adults who had electronic medical records in SINA, an integrated health management system, and the electronic medical records of MUMS. The prevalence of psychiatric disorders by type and their relationship with demographic information was evaluated by a Chi-square test using SPSS 22. Results This study involved 218,341 middle-aged participants. Prevalence of psychiatric disorders was 8.59%, and depression (53.72%) and anxiety (42.02%) were the most common psychiatric disorders in both males and females. The prevalence of mental disorders was significantly higher in females than in males (88.18% vs. 18.81%; P

Abstract Global food security requires food production to be increased in the future decades. Agro-Ecological Zones (AEZ) methodology is a successful approach used in land evaluation studies to support sustainable agricultural development. This approach can facilitate finding suitable areas for wheat production on a global scale. This study was conducted based on a climate zone map, soil data, wheat cultivation area, yield, and production under irrigated and rainfed conditions, worldwide. The results for irrigated wheat indicated that there is an area of 59.5 Mha with an average yield of 4.02 t/ha which leads to the production of about 239.6 Mt of grain yield. Furthermore, climate zones (CZs) of 8002, 5203, 5302, 5403, and 8102 have the highest wheat production with an average of 20.7, 14.2, 13.3, 11.8, 11.5 Mt, respectively. The highest amount of irrigated wheat production has been achieved in soil type code 17 (Loam LF120), which has a cultivation area of around 23.6 Mha and a production of about 106.8 Mt. Rainfed wheat production is 410 Mt, and the cultivation area is 160.2 Mha. The highest rainfed wheat production with an average of 17 Mt was related to the 3702 CZ, followed by the other CZs (3802, 1303, 1203, 3602, 4602, etc.). The soil codes 11 (Loam HF120), 10 (Loam HF180), and 14 (Loam MF120) showed the highest rainfed wheat production. The findings of this study can be useful for agricultural scientists, authorities, and decision-makers around the world to find suitable lands to expand wheat cultivation and also to find new locations for increasing global wheat production to feed the increasing population in the world.

Background: We reported a case of gastric obstruction in a body packer who swallowed a large number of opium packets. Case Report: A 36-year-old man opium addict visited the emergency department with epigastric pain for three days. He swallowed nearly 90 packets of opium for smuggling purposes four days earlier. He self-administered laxatives. In contrast, many times vomiting, he defecated only four packets and vomited one packet. The abdominal X-rays showed some amounts of fluid-air levels and multiple cylindrical opacities with the double-condom sign, corresponding to the distended stomach. Due to the worsening of his abdominal symptoms, he underwent an urgent laparotomy and 84 packets (4-6 cm in size and 8-10 g/ packet of opium) with a total weight of 870 g. They were wrapped in some layers of plastic and tied at the ends. He was discharged in stable condition. Conclusion: A large number of ingested drug packets can induce gastrointestinal obstruction.

Introduction: Currently, humankind is facing a COVID-19 pandemic that has spread worldwide. This is the first study conducted during the first phase of the COVID-19 outbreak in Mashhad, Iran, to describe the clinical, therapeutic, and laboratory findings of survivor and non-survivor patients with COVID-19.Methods: This retrospective study included a total of 191 confirmed COVID-19 patients aged ≥18 who were admitted to an intensive care unit in the northeast of Iran in 2020. Clinical, therapeutic, and laboratory findings were recruited. The data were analyzed using SPSS software (version 23) through the Mann-Whitney U test, Chi-Square test, independent sample t-test, as well as a single variable and multivariable logistic regression.Results: Out of a total of 191 hospitalized patients, 137 (71.7%) survived and 54 (28.2%) expired. The mean age of non-survived patients was 17 years higher than that of survived patients (P24/min, heart rate>125/min, platelet count 133 μmol/L, LDH >245 U/L, WBC count >10*109/L, lymphocyte count 1 μg/mL were frequently observed in non-survivor patients (P

SV (sodium valproate) is an antiepileptic drug that is often prescribed for epilepsy, bipolar disorders, and migraine. We reported an SV intoxicated case that cardiac and neurologic abnormalities were promptly responded to hemodialysis (HD). She ingested a large amount of SV (150 pills of SV 200mg) for a suicide attempt. She was initially alert but her Glasco coma scale (GCS) decreased to 6 thought 11 hours. However, valproate (>150mg/l) and ammonia serum (164µg/dL) levels were not excessively elevated. The serial electrocardiography (ECG) showed QT prolongation and a signs of sodium channel block such as dominant R wave in AVR lead and T-wave inversion in the precordial leads. She had low level of calcium and potassium serum levels. Supportive treatment, charcoal, and L-carnitine, were not effective and HD was started due to the resistant cardiac and neurologic symptoms. After a 3-hour HD session, decreased GCS, pathological ECG findings, and laboratory abnormalities dramatically disappeared. In conclusion, HD is an effective and rapid response treatment for Valproate-induced loss of consciousness and life-threatening cardiac abnormality.

Background and Objectives: The purpose of training and applying family physicians in the health system is to optimize rating the services and referral system. The purpose of this study was to explanation of the expected outcomes of family medicine graduates from the viewpoints of professors, assistants and senior managers of the health system and its comparison with the defined consequences in the curriculum of this major at Tabriz University of Medical Sciences. Material and Methods: This is a qualitative study with the content analysis approach. Sampling method is non-random and purposive. Three focus group discussions and six semi-structured interviews conducted with 31 participants, including three groups of professors, assistants and senior managers of the health system by FGD method and also including 25 participants and 6 individuals were used for individual interview. Interviews continued until data saturation. Content analysis method used for data analysis. Results: After conceptualizing, extracting and coding themes into 56 themes, the findings were categorized into three general themes: Occupational status (such as: Conscientious physician, policy maker, supervisor or provider), job duties (Education, research, management, consulting and visit) and employment outcomes (such as: Cost reduction, unnecessary refer and population health promotion). Conclusion: The use of specialist family physicians in positions such as the physician in charge of the health complex and service provision in comprehensive health centers can have outcomes such as appropriating referrals, reducing costs and preventing overuse, and reducing the workload of levels 2 and 3.

Seed size, sowing depth, and seed disinfection can affect seed germination and seedling establishment, which, in turn, can directly affect crop growth and yield. The current study was comprised of two experiments, the first of which was conducted in the laboratory, and a second which was performed under glasshouse conditions. The objective of these experiments was to investigate the effects of seed size, sowing depth, and seed disinfection on seed germination and initial seedling growth of selected wheat (Triticum aestivum L.) cultivars. The treatments in laboratory experiment were arranged in a completely randomized design, which included: (Ι) four wheat cultivars (Pishgam, Haydari, Soissons, and Mihan), (ΙΙ) two seed size classes (x < 2.25 mm, and x > 2.25 mm), and two disinfection treatments (no-disinfection and disinfection), (ΙΙΙ) with five replicates. In addition to the aforementioned treatments, the effect of planting depth (4, 6, and 8 cm) was also investigated in the subsequent glasshouse experiment. The best results were obtained at a sowing depth of 4 cm, in the non-disinfected treatment, using large seeds. In contrast, the lowest percentage and speed of seed germination and vigor index were observed in seeds sown at 8 cm depth, in the disinfected seed treatment, using small seeds. Large seeds contain larger nutrient stores which may improve seed germination indices, which would therefore result in improved percentage and speed of seed germination, followed by faster coleoptile and seedling growth, higher seedling dry weight and seed vigor. These data also illustrated that seed disinfection in the Pishgam and Haydari cultivars had inhibitory effects upon coleoptile growth and seedling length, which could be related to the fungicide’s chemical composition. Unlike other cultivars, disinfection did not show a significant effect on the Soissons cultivar. Based on our data, in order to improve both the speed of wheat seed germination and subsequent plant growth and development; it is necessary to select high-quality, large seeds, planted at a specific planting depth, which have been treated with an effective disinfectant; all of which will be specific for the wheat cultivar in question. Overall, the current study has provided useful information on the effect size seed, sowing depth, and disinfection have upon germination characteristics and seedling growth of wheat cultivars, which can form the basis for future field scale trails.

Without any doubt nowadays marketing is one of the necessary things for every organizations which are involved in competition with other companies.In this way One of the strategies is suitable mixed marketing strategies. The purpose of this study was to represent an appropriate model in the fundamental teaching institutes which was done after identifing the mixed factors and characteristics of service marketing for non-profit organizations, especially for the non-profit schools, and to investigate the effects of each factor on the performance of these organizations. This study’s data has been collected through a questionnaire with 35 questions between 196 customers who were selected as a random sample of statistical population answered.In this regard,modeling was done with AMOS software and based on the effects of each of these mixed marketing factors on organization’s performance are examined by the SPSS software. Based on the results of data analysis, it was found that the seven service marketing mix factors affect on non-profit organization’s performance and the effects rate of each factor were identified. Thus, according to these results, process, physical evidence, product, and people factors were priority of these affecting and promotion, price, and place factors were on lower priority.

Drought monitoring needs comprehensive and integrated meteorological and hydrologic data. However, such data are generally not available in extensive catchments. The present study aimed to analyze drought in the central plateau catchment of Iran using the terrestrial water storage deficit index (TSDI). In this arid catchment, the meteorological and hydrologic observed data are scarce. First, the time series of terrestrial water storage changes (TWSC) obtained from the gravity recovery and climate experiment (GRACE) was calculated and validated by the water budget output. Then, the studied area was divided into semi-arid, arid, and hyper-arid zones and the common drought indices of SPI and RDIe within a timescale of 3, 6, and 12 months were calculated to compare the results obtained from the TSDI by using the meteorological data of 105 synoptic stations. Based on the results, the study area experienced a drought with extreme severity and expansion during 2007−2008. The drought spatial distribution map obtained from three indices indicated good conformity. Based on the maps, the severity, duration, and frequency of drought in the semi-arid zone were greater than that in other zones, while no significant drought occurred in the hyper-arid zone. Furthermore, the temporal distribution of drought in all three zones indicated that the TSDI could detect all short- and long-term droughts. The study results showed that the TSDI is a reliable, integrated, and comprehensive index. Using this index in arid areas with little field data led to some valuable results for planning and water resource management.