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Introduction: Tuberculosis (TB) is a serious infectious disease that affects human health globally. The incidence of TB in prisons is usually much higher than the general population in different countries. The aim of this study was to evaluate the incidence of TB among prisoners in Iran, estimating the relative risk factors by performing a systematic and meta-analysis study on the related articles. Methodology: Our systematic and meta-analysis study was performed according to the PRISMA guidelines. Two authors systematically searched Scopus, Iran doc, Cochrane, Pubmed, Medline, Embase, Iran medex, Magiran, SID, Google Scholar, and EBSCO. The quality assessment of articles was performed by using the Newcastle-Ottawa Scale. After article quality assessment, a fixed or random model, as appropriate, was used to pool the results in a meta-analysis. Heterogeneity between the studies was assessed using I-square and Q-test. Forest plots demonstrating the point and pooled estimates were drawn. Results: Overall, data from 19562 prisoners indicated 63 cases of TB. The prevalence of TB in prisoners was reported to range from 0.025% to 52% in eight studies. The highest prevalence of tuberculosis was related to the study of Rasht, 517 in 100,000, and the lowest rate was related to the study of Sought Khorasan, 25 in 100,000. The ES of the random effect model is 0.003 (95% CI, 0.001-0.005) and p-value Conclusion: According to the analysis findings, the frequency of tuberculosis among the prison in Iran was low. The highest prevalence obtained in our systematic study was 517 in 100,000 in Rasht, which was near the world statistics in the systematic review of world studies. Due to significant limitations in this study, it is not possible to indicate the exact prevalence of TB in prisons in Iran and compare this with the general population. However, more studies are needed to assess the related risk factors for designing health intervention plans to decrease the incidence rate of TB among prisoners.

BackgroundEasing renal colic (RC) pain is of the most important issues in the emergency departments. This study was conducted to investigate the analgesic effects of intravenous paracetamol in comparison to acupressure and intramuscular diclofenac in patients with RC.MethodsThis randomized clinical trial was conducted on 96 eligible patients with RC, visiting the Emergency Department of Imam Reza Hospital of Mashhad, Iran. The participants were selected by consecutive non-random sampling method, and were randomized in three groups, each comprising of 32 participants. The first and second groups received 75 mg intramuscular diclofenac and 1g intravenous paracetamol, respectively. In the third group, three acupressure points were manually stimulated for six minutes. The pain score was measured by Visual Analog Scale for pain at baseline and after 10, 30, and 60 minutes. Collected information analyses by SPSS version 20 and interpreted using descriptive statistics (frequency, percentage) and inferential statistics (chi-square test).ResultsThe mean age was 31.60 ± 7.42 years (range:18-50). The two methods (diclofenac and paracetamol groups) were significantly better in pain reduction compared to acupressure after 10 minutes (p

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: Despite numerous studies aimed at finding a new treatment for cutaneous leishmaniasis (CL), glucantime remains the first-line approach. Side effects, drug resistance, and high cost are the challenges of glucantime treatment. A simple treatment method with the fewest side effects, minimum cost, and maximum efficacy is ideal. In Iranian traditional medicine (ITM), dry CL lesions are categorized as rashes, and for treatment, corrosive and keratolytic agents should be used, including garlic. The current study was conducted to assess the effects of an ITM treatment on CL. Methods and Results: In this experimental study, 10 patients with 20 dry CL lesions received treatment based on ITM. For this purpose, some garlic poultices were used. The mean age of the patients was 36.2 years, and the average bout was nearly four months. Based on the findings, garlic poultices could treat all dry skin lesions completely during 14 days. Also, after 40, 70, 100, and 190 days of follow-up, 95% of cases were completely treated. On the 70-day follow-up, a nodule with negative direct smear and PCR results recurred in one patient. Overall, the applied treatment was cost-effective with no systemic side effects. Conclusions: Garlic poultices can be used as an alternative for glucantime. Topical use, shorter course of treatment, and lower number of applications, side effects, and treatment cost are the main advantages of this regimen. We suggest similar multi-centered clinical trials with a larger sample size to further evaluate this treatment regimen.

Samaneh Abolbashari,1,2 Hossein Karimi Moonaghi,3,4 Mojtaba Mousavi Bazzaz5 1Department of Medical Education, Medical Faculty, Mashhad University of Medical Sciences, Mashhad, Iran; 2Students Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran; 3Evidence– Based Caring Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, 4Department of Medical Education, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 5Department of Community Medicine, Medical Faculty, Mashhad University of Medical Sciences, Mashhad, Iran Background: Changes in medical education have drawn attention to student-based learning. It is necessary that teachers’ educational roles be redefined to conform to these changes. While numerous educational activities are listed for medical teachers, it seems that they involve themselves in only some of these roles. We conducted this study to assess the importance of different educational roles in the view of medical faculties.Methods: A questionnaire that consisted of a total of 12 roles classified into six categories including information provider, role model, facilitator, examiner, planner, and resource developer was prepared. Faculty members were asked to score the importance of each role using a 1–10 scale.Results: Participants assigned the highest score to “on-the-job role model” (9.47) and the lowest score to “curriculum planner” (8.31) from their own point of view. They also assigned the highest score to “planning or participating in student exams” (8.10) and the lowest score to “learning facilitator” (6.51) from the perspective of the importance of roles in their school’s programs.Conclusion: Faculty members are generally familiar with different educational roles but they need to be informed about some of the roles which have gained lower scores in this study. Keywords: medical education, faculty member, teacher role

Background & aim: During the postpartum period, women experience physiological changes, which can have negative impacts on their quality of life. Women’s knowledge regarding postpartum complications and care can help them successfully pass this critical period. The aim of this study was to evaluate maternal knowledge on postpartum care in healthcare centers of Mashhad, Iran in 2013. Methods:In this descriptive, cross-sectional study, 500 eligible mothers were randomly selected via multistage sampling from 19 healthcare centers of Mashhad. Data collection tools included a demographic questionnaire and a researcher-made questionnaire for assessing maternal knowledge. Descriptive and analytical statistics, independent t-test, analysis of variance, Pearson’s correlation coefficient and multivariable regression analysis were applied, using SPSS version 16. P-value less than 0.05 was considered statistically significant. Results: Among 500 mothers referring to healthcare centers, 64 (12.8%), 396 (79.2%) and 40 (8.0%) cases had poor, moderate and high levels of knowledge, respectively. The majority of mothers had moderate knowledge about four dimensions of public health, breastfeeding and nutrition, contraceptive methods and infant care. The subjects had the highest and lowest levels of knowledge about public health and contraceptive methods, respectively. The results showed a significant relationship between the mean score of knowledge and demographic characteristics such as educational status, employment status and income level (P

Introduction: Additional to improving health and ensuring equitable financing that are two predominant goals of health system, another important goal of health systems is responsiveness to people’s non-medical expectations. In this study we try to assess the health system’s responsiveness in academic and non-academic hospitals. Methods: This is a cross sectional study done in summer 2014 in Mashhad-Iran, we surveyed a total number of 403 inpatients by multi-stage sampling. A questionnaire of responsiveness and a check list included demographic variables and characteristics of hospitalization were completed by trained interviewers. Scales from 0 to 10 was applied for each questionnaire at the end of assessment of questions. Result: 403 participants Took part in this survey from 10 hospitals (6 academic and 4 non-academic hospitals). 124(30.8%) were from non-academic and 279(69.2%) from academic hospitals 140(34.7%) of patients were male and 263(65.3%) were female. mean age of participants was 36.77 ± 1.52 years. The mean total score of responsiveness was 7.12±1.31 in academic hospitals and 6.99±1.38 in non-academic hospitals, considered as good performance. There was no significant difference between total scores of these two groups (p=0.38). Health care responsiveness score was higher in private (8.35±0.95) than other kinds of hospitals and charity hospitals had the lowest score (5.98±0.51). Conclusion: Responsiveness of health care system at hospitals is an important parameter for measuring patients’ perception of quality of health care. Although responsiveness rate of our hospitals are good but some components such as: choice health care providers, respect to autonomy of individuals, clear communication and confidentiality received lower responsiveness scores, therefore they require more attention and these domains can be the more significant choices that should be considered while designing improvement programs.

BACKGROUND: Driver-related behaviors are substantial causes for motor vehicle accidents. It has been estimated that about 95% of all accidents are due to driver-related dangerous behaviors and approximately 60% of accidents are directly caused by driving behaviors. The aim of this study was to assess driving behaviors and its possible related factors among drivers in Mashhad city, Iran. METHOD: In a cross-sectional design, a total number of 514 drivers in Mashhad, Iran Surveyed. Manchester driver behavior questionnaire with 50 questions evaluated dangerous driving behaviors in 4 categories "aggressive violations", "ordinary violations", "errors" and "lapses". RESULTS: In this study, the median age of drivers was 31. Besides, 58.2% of men mentioned having a history of driving accident. Our study indicated smoking and alcohol drinking as risk factors of having more accidents. Hookah abuse is a predictor of aggressive violations and errors. CONCLUSION: This is the first study to assess the relation of personal car and its market value with the likelihood of having accidents. Due to major influences of driving fines, cigarette smoking, alcohol consumption and addiction on violations and errors, we recommend pivotal measures to be taken by road safety practitioners regarding driving surveillance. Language: en

hunger and because of the consumption of bread as the staple food of most Muslims, it influences the appetite and satiety of fasting individuals. The objective of this study was to investigate the effect of barley bread on appetite and satiety compared with white wheat bread in healthy fasting participants. Methods and Materials: This study was a clinical trial performed for 3 consecutive days during Itikaf ceremony. Demographic and anthropometric characteristics of healthy participants were assessed. 24 hours dietary recall used for dietary intakes. To measure appetite and satiety, FLINT visual analogue scale was used. Results: 184 healthy men and women in Itikaf fasting participated in this study. The results showed that during the fasting period, hunger in the barley bread group was significantly lower than white wheat bread group. Rate of hunger before the Iftar in the barley bread group was significantly lower than wheat bread group. During the time, the sense of hunger decreased before the Sahur in the barley group, but its trend was not statistically significant. During the fasting period, the highest reduction in satiety was observed in the first five hours of fasting, which did not differ significantly between the two groups. Satiety was increased before the Sahur in the barley group, but its trend was not statistically significant. Conclusion: This study show that barley bread decreased appetite and increased satiety during the fasting compared with wheat bread.

Rubber industries workers are at risk of hepatic dysfunction from exposure to rubber dust and a mixture of different hydrocarbons. This study aimed to evaluate the relation between chemical hazards in workplace and serum hepatic transaminases in rubber industry workers in Iran. This historical cohort study was conducted in a rubber-manufacturing industry in Mashhad. It con-sisted of 91 workers with chemical substances exposure and 85 workers not exposed to chemicals. Hepatic transaminases including alanine transaminase (ALT) and aspartate transaminase (AST) were compared between these two groups. Required data were collected through questionnaire, liver enzymes evaluation, and environmental monitoring of chemical substances. The data were analyzed with SPSS 11.5. A total of 176 workers enrolled in this study included 113 (64.2%) male and 73 (35.8%) female. The mean of age and employment duration in exposed group were 29.22 ± 3.99 and 5.41 ± 2.77 and in non-exposed group were 30.33 ± 4.11 and 5.29 ± 2.77 respectively. The mean of ALT in exposed and non-exposed groups was 31.3 ± 8.04 and 23.8 ± 10.42 (p = 0.01) and the mean of AST was 29.6 ± 9.7 and 27.3 ± 8.2 (p = 0.1) respectively. A significant difference was shown between mean of ALT at the date of employment and at the time of the study in exposed group. According to our findings evaluation of serum transaminases is a useful screening method which might be beneficial in early detection of hepatocellular injuries in rubber industry workers.

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.

Regular physical-activity is necessity for a healthy lifestyle. Despite public health efforts, a minority of population are involved in healthy levels of physical-activity. This study provides evidence about exercise patterns and predictors of Mashhad-Iran population according to TTM change stages. In this cross-sectional study, we surveyed a total number of 564 participants from Mashhad in 2014 by using stages of change questionnaire. Analysis showed 23.4% of participants were in pre-contemplation stage, 18 in contemplation, 24.6% in preparation, 8.10% in action, 14.4% in maintenance and 11.5% were in termination phase. Age, gender, BMI, alcohol consumption, sleep duration, having compeer and encouragement were identified as predictors of pre-contemplation stage. Genders, having company and using bicycle for transportation were predictors of termination phase. Tailor interventions based on the predictors to enhance the physical activity among specific subgroups would be of interest.

Biking has proven health, environmental and traffic benefits. To prevail biking at community infrastructures and "Bicycle Sharing Systems (BSS)" have been developed, but their effectiveness is dependent on people's attitudes and perceptions. We aim to investigate attitudes of people toward biking and related infrastructures with regard to demographic factors in Mashhad, Iran-a metropolis with unsuccessful BSS. The present work was conducted as a cross-sectional study at Mashhad, Iran, in 2015. In a multistage sampling, adult inhabitants were selected and data about their perceptions of benefits and barriers of biking were collected through a researcher-designed questionnaire. of 437 study participants with a mean ( ± SD) age of 29.9 ( ± 11.3) years, 250 (57.3%) were female. Only 3 (0.7%) of respondents used bikes. Positive attitudes were significantly associated with gender, marital status and occupation of participants. Car ownership was accompanied by higher perceptions of "tiredness of biking"(p = 0.02), its "low safety" (p = 0.02) and "time wasting" (p = 0.01). According to the results, cultural interventions are needed for biking promotion regardless of their socioeconomic status. Educational programs at academic settings are also valuable. Safety, convenience, and affordability of different groups of populations (like elderly and deprived people) should be regarded during designing and constructing biking infrastructures and setting participation rules.