Nursing experiences of COVID-19 outbreak in Iran: A qualitative study

Aim

The global outbreak of coronavirus in 2020 was considered as a serious risk for healthcare providers, especially nurses. This study aimed to investigate nurses’ perceptions and experiences of COVID‐19 outbreak in Iran.

Design

This thematic analysis study was conducted in March 2020.

Method

Semi‐structured interviews were conducted with 24 nurses in Qazvin, Arak, Shiraz and Kashan cities of Iran.

Results

It was found out that all the participants had faced a mysterious world created by the virus. No one had clear understanding of the new virus and knew how to tackle with such a virus. In this case, the main experiences were related to defected preparedness, the worst perceived risk, family protection, social stigma and sacrificial commitment. Urgent preparedness of facilities in such outbreaks is inevitable. Accordingly, psycho‐social support of nurses and their families and strengthening their sacrificial commitments are proposed in these conditions.

Financing of physical rehabilitation services in Iran: a stakeholder and social network analysis

Background

Inadequate financing is one of the major barriers in securing equitable access to high-quality physical rehabilitation services, without imposing financial hardship. Despite this, no sufficient attention has been paid to physical rehabilitation services and no specific financial resources have been allocated to such services in many countries including Iran. Owing to the fact that effective decision- and policy-making requires identifying possible stakeholders and actors and their characteristics, in the current study a stakeholder analysis and also a social network analysis (SNA) was conducted to identify the potential stakeholders and also their characteristics involved in physical rehabilitation financing (PRF)-related policies in Iran.

Methods

The present study was performed in two phases. Firstly, semi-structured interviews and relevant document review were conducted to identify the stakeholders. Then, the position, power, interest, and influence of each stakeholder were determined using a web-based questionnaire. Secondly, SNA approach was utilized to map and visualize the interactions among stakeholders.

Results

The findings showed that there are different stakeholders in PRF-related decision- and policy-making processes in Iran. In addition, the position, power, interest, and influence level of the identified stakeholders were varied. Moreover, although some stakeholders, like the Ministry of Health and the parliament have the highest level of power and position, they lack sufficient interest to participate in PRF-policies. Furthermore, SNA demonstrated that social network density was low, which indicates the lack of proper collaboration and interaction among the stakeholders.

Conclusion

As many powerful and influential stakeholders had low interest levels to warrant participate in the FPR-related decision- and policy-making processes in Iran, employing careful and effective strategies, that is ongoing negotiations, receiving advocacy, and making senior managers and policy-makers aware can be helpful.

Viral metagenomic analysis of fecal samples reveals an enteric virome signature in irritable bowel syndrome

BACKGROUND

Changes in the enteric microbiota have been suggested to contribute to gastrointestinal diseases, including irritable bowel syndrome. Most of the published work is on bacterial dysbiosis with meager data on the role of the virome in irritable bowel syndrome and other gastrointestinal diseases. In the current study, we therefore aimed to investigate the viral community composition of the gut and test for potential dysbiosis linked to irritable bowel syndrome.

RESULTS

A metagenomics analysis on fecal samples of 50 individuals - 30 of whom met the Rome IV criteria for IBS and 20 healthy controls- was conducted. There was a noticeable alteration in viral taxa observed in association with irritable bowel syndrome when compared to healthy individuals - where some eukaryotic viral taxa noticeably prevail over others. We observed a significant decrease in the diversity and abundance of enteric virome particularly in eukaryotic viruses of Megavirales in patients with irritable bowel syndrome.

CONCLUSIONS

These findings shed light on a new hypothesis that the alteration of the viral taxa contributes to the pathogenesis of irritable bowel syndrome and related symptoms, and therefore, pave the way for developing a new diagnostic biomarker or anti-viral drugs for the treatment of irritable bowel syndrome.

Pathophysiological role of Atg5 in human ulcerative colitis

Background/Aims

Ulcerative colitis (UC), along with Crohn’s disease, is one of the main types of inflammatory bowel disease (IBD). On the other hand, deregulated autophagy is involved in many chronic diseases, including IBD. In this study, we aimed to investigate the role of Atg5 and microRNA-181a (miR-181a) in the pathophysiology of UC.

Methods

Colon biopsy, stool, and blood samples of 6 men and 9 women were confirmed for UC. Also, 13 men and 17 women were selected as healthy control (HC). Enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry were used to measure the Atg-5 content of the colon biopsies. Besides, the serum and stool levels of Atg5 were measured using ELISA. Moreover, the total RNA of blood cells was extracted and evaluated for the expression of miR-181a.

Results

We found 1.2 ng/mL versus 0.46 ng/mL, 0.34 ng/mL versus 0.24 ng/mL, and 0.082 ng/mL versus 0.062 ng/mL of Atg5 in stool, intestinal tissue, and serum of UC and HCs, respectively. There was no significant difference in the expression of miR-181a in the blood samples of UC and HCs. Immunohistochemistry showed high positivity without any significant difference between the 2 groups in the quantitative analysis.

Conclusions

The significant difference observed between the stool Atg5 content of the HCs and UC patients may provide new insight into using this protein as a diagnostic biomarker, however, considering the small size of our studied population further studies are needed.

A preliminary report on the use of Midodrine in treating refractory gastroesophageal disease: Randomized Double-Blind Controlled Trial

Background:

Gastroesophageal reflux disease (GERD) is a common disease with various clinical presentations. Acid suppression with proton pump inhibitors and lifestyle modification may not lead to satisfactory response in a substantial portion of patients. We investigated the possible effect of midodrine in patients with refractory GERD.

Methods:

Patients suffering from GERD and were refractory to one-month course of pantoprazole 40mg twice daily entered the study. This was a pilot, randomized, double-blind, and placebo-controlled study. After randomization, one group received Midodrine 5mg before meals for one month, and the other group received placebo for the same period. Meanwhile, pantoprazole was continued 40mg twice daily in both arms. The severity of symptoms was evaluated by the visual scoring system. Quality of life (QoL) in both groups was measured using a standardized version of Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD).

Results:

A total of twenty patients were enrolled in this study. There was a significant interaction between the groups and time on all measured scores based on QOLRAD questionnaire. All the markers in the Midodrine group had significant improvement over time, but the placebo group did not show any significant improvement. Both visual severity score and total QoL score in Midodrine arm showed a U shape change during 6 weeks.

Conclusions:

Midodrine before a meal could be useful in alleviating symptoms and improving QoL in the patients with refractory gastroesophageal disease. (www.actabiomedica.it)

A Systematic Review of Nutrition Recommendation Systems: With Focus on Technical Aspects

Background:

Nutrition informatics has become a novel approach for registered dietitians to practice in this field and make a profit for health care. Recommendation systems considered as an effective technology into aid users to adjust their eating behavior and achieve the goal of healthier food and diet. The purpose of this study is to review nutrition recommendation systems (NRS) and their characteristics for the first time.

Material and Methods:

The systematic review was conducted using a comprehensive selection of scientific databases as reference sources, allowing access to diverse publications in the field. The process of articles selection was based on the PRISMA strategy. We identified keywords from our initial research, MeSH database and expert’s opinion. Databases of PubMed, Web of Sciences, Scopus, Embase, and IEEE were searched. After evaluating, they obtained records from databases by two independent reviewers and inclusion and exclusion criteria were applied to each retrieved work to select those of interest. Finally, 25 studies were included.

Results:

Hybrid recommender systems and knowledge-based recommender systems with 40% and 32%, respectively, were the mostly recommender types used in NRS. In NRS, rule-based and ontology techniques were used frequently. The frequented platform that applied in NRS was a mobile application with 28%.

Conclusion:

If NRS was properly designed, implemented and finally evaluated, it could be used as an effective tool to improve nutrition and promote a healthy lifestyle. This study can help to inform specialists in the nutrition informatics domain, which was necessary to design and develop NRS.

Preventive Efficacy of Dried Lime (Citrus aurantifulia) in Common Cold Among Hajj Pilgrims: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

Background

Dried lime (Citrus aurantifulia) is one of the herbal preparations used especially by Iranian pilgrims as a preventative agent and self-remedy for respiratory tracts symptoms in folklore medicine. Therefore, we evaluated the preventive efficacy of dried lime preparation in common cold among Iranian pilgrims.

Materials and Methods

In this randomized, double-blinded, clinical trial patients in the drug group received dried lime capsules, 500 mg in a single dose per day for four weeks. In the placebo group, the patients received placebo capsules using the same method. The primary outcome measure in this trial was the severity of cold symptoms assessed by a self-administered questionnaire.

Results

There were no significant differences between the two groups in terms of the trend of cold symptoms severity during the study period. However, in the second week, the severity of all the cold symptoms in the drug group was less, compared to the placebo, but at the end of the study, comparison of the two groups revealed no significant difference in any of the investigated options.

Conclusion

The findings revealed that although the severity of all the cold symptoms in the drug group was less as compared to the placebo group, the dried lime capsule showed no statistically significant effect on the control of these symptoms in Iranian pilgrims.

Results of a Campaign for Motorcycle Helmets Advocacy in a City in Southwest of Iran; A Population-Based Intervention Study

Objective:

We conducted a triple phase project for motorcycle helmets advocacy in Darab, a city in southwest Iran. The aim of this study was to evaluate the effect of the project on decreasing the hazards of motorcycle accidents.

Methods:

Using a questionnaire, data for ICU admission rates, hospital costs for patients who required ICU admission, rate of helmet usage, mortality and the duration of ICU care for patients admitted to Darab hospital due to motorcycle accidents in Winter 2015 (before conducting the project) and Winter 2016 (after conducting the project) were gathered and compared. This feature was also separately done for patients younger than 17 years.

Results:

The rate of wearing helmets increased significantly in winter 2016 (from 3.4 % to 33%). Also ICU admission rate due to head trauma was significantly decreased after the project was done (from 14.5 % to 4%). However, hospital costs for patients required ICU admission were increased in winter 2016. This increase, though not significant, seems to be due to an increase in health service expenses in the year 2016 as compared with the year 2015. The mortality rate was not significantly changed between the two mentioned years results. For patients younger than 17 years, no ICU admissions were needed in winter 2016.

Conclusion:

Even a short period of intervention can have positive effects on increasing the safety of motorcycle drivers.

Systematic review and meta-analysis of the incidence and prevalence and 30-year trend of inflammatory bowel diseases in Asia: a study protocol

INTRODUCTION

Inflammatory bowel diseases, including ulcerative colitis (UC), Crohn's disease (CD) and inflammatory bowel disease type unclassified (IBDU), are debilitating conditions that are rapidly growing in developing countries. Given the absence of a comprehensive systematic review and meta-analysis containing a rigorous pooled estimate of incidence and prevalence of UC, CD and IBDU, this study was conducted to determine the incidence and prevalence of these conditions in Asia and their 30-year trend.

METHODS AND ANALYSIS

Based on predefined criteria, electronic databases, including PubMed/MEDLINE, Scopus, WoS (Clarivate Analytics), Embase and Google Scholar, and some databases pertaining to Asian countries will be searched for population-based cross-sectional studies and the baseline data and final reports of population-based cohort studies involving paediatric and adult patients, with no language restrictions, from 1 January 1988 to 30 December 2018. Any disagreement in the stages of screening, selecting, quality assessment and data extraction between the two independent reviewers will be resolved by consensus, and if the disagreement is not resolved, a third expert opinion will be sought. The combination method will be used based on methodological similarities in the included studies by the Fixed Effect Model or the Random Effect Model. Forest plots will be plotted for all the studies to show the separated and pooled incidence and prevalence and their corresponding 95% CIs. The Q-statistic test and I² statistic will be used to assess statistical heterogeneity. Funnel plots will be used to assess potential reporting bias and nonsignificant study effect. Begg's and Egger's tests will also be performed, and significant results (p>0.1) shall suggest a publication bias, in which case the 'trim and fill' method will be used. The time trends for UC, CD and IBDU will be calculated using a cumulative meta-analysis.

ETHICS AND DISSEMINATION

Since this review will use previously published studies, it will not require the consent of an Ethics Committee. The results will be prepared and disseminated through a peer-reviewed journal and will be presented in relevant conferences.

PROSPERO REGISTRATION NUMBER

CRD42019131477.

Violence against Nurses: A Neglected and Health-threatening Epidemic in the University Affiliated Public Hospitals in Shiraz, Iran

Background:

Nurses are more likely to be exposed to violence at their workplace in comparison with other employees.

Objective:

To determine various aspects of violence against nurses in Shiraz public hospitals.

Methods:

This cross-sectional study was conducted from 2017 to 2018, using a multistage random sampling method. Violence including verbal threats, verbal abuse, physical and sexual abuse as well as ethnical types, violence from patients, patients' companions and coworkers, and causes of violence were investigated using a checklist.

Results:

405 nurses with a mean age of 30.2 (SD 7.1) years and female to male ratio of 4.2 were interviewed. 363 (89.6%) nurses had experienced at least one kind of violence; 68.4% suffered from more than one type of violence. Verbal abuse (83.9%), verbal threats (27.6%), physical violence (21.4%), sexual abuse (10.8%), and ethnical harassment (6.1%) were the most common types of violence experienced by the nurses. Patients' companions, patients, and physicians were reported as the sources of violence in 70.6%, 43.1%, and 4.1% of cases, respectively. Nurses with non-official employment status and non-Farsi ethnicity, having a disease, with non-evening shift work, and those with short or long employment period were more affected. Unrealistic expectations by patients' companions and long working hours were the most common attributing factors.

Conclusion:

Violence against nurses, as a strenuous and health-threatening crisis, has become epidemic in public hospitals in our region. Effective interventions are warranted to sort out these problems.

From Iceberg of Pre-diabetes to Poor Glycemic Control in Diabetics: An Elderly Based Study in Shiraz, South of Iran

Background:

Delay in diagnosis of diabetes mellitus (DM) in older adults is more catastrophic than other age groups. This study investigated the prevalence of pre-diabetes, DM, and glycemic control in the elderly.

Methods:

In this cross-sectional study, a sample of 412 older adults >60 years from Shiraz, Iran, were recruited through a multistage cluster random sampling. Demographic, clinical, and laboratory information were collected by interview, physical examination, and reviewing the medical records. Data were analyzed using SPSS 20.

Results:

Mean age was 68.1 ± 6.2 years and female-to-male ratio was 1.1. Out of all, 137 (33.2%) were diagnosed as diabetic including 128 (31%) as known cases and 9 (2.2%) as new cases of DM, whereas 275 (66.7%) were diagnosed as new cases of pre-diabetes. Multivariable analysis showed that low level of education (OR = 5.2, 95% CI: 1.5–16.6), hyperlipidemia (OR = 3.5, 95% CI: 2.1–5.8), liver disease (OR = 3.1, 95% CI: 1.4–6.9), and hypertension (HTN) (OR = 1.9, 95% CI: 1.1-3.2) were the most common predictors of DM in the elderly, respectively. Out of all diabetics, 33.6% had FBS >130 mg/dL and 25.5% had HbA1c >8%, whereas these figures were ≥100 mg/dL and ≥5.7% in 36.7% and 21.4% of pre-diabetics, respectively.

Conclusions:

The pre-diabetic elderly were mostly undiagnosed, while one-third to one-fourth of DMs had poor glycemic indices. These figures show the need for pre-diabetes and diabetes screening in the elderly, especially in those with low level of education, hyperlipidemia, liver disease, or HTN. Furthermore, regular monitoring of glycemic indices in the diabetic and pre-diabetic elderly is recommended.

Prevalence and risk factors of alcohol and substance abuse among motorcycle drivers in Fars province, Iran

Background:

Motorcycle accidents are the most common cause of injuries, accounting for 49.1% of all trauma cases each year worldwide. Different risk factors for incidence of motorcycle accidents have been identified. Two main factors that increase the risk of traffic accidents among motorcyclists are alcohol and substance abuse. The aim of this present study is to investigate the prevalence of alcohol and substance abuse and its relationship with other risky driving behaviors among motorcycle drivers in Fars province.

Methods:

This is a cross sectional study which is performed at Fars province of Iran in 2017. Data from motorcycle drivers were collected using a standard questionnaire in three major cities of Fars province including Shiraz, Jahrom, and Darab at different times of the day. The data includes consumption of alcohol and other substances two hours before driving and some of the risky behaviors during driving.

Results:

A total of 1195 drivers with a mean ± SD age of (28.3 ± 8.56) years participated in the study. The prevalence of alcohol, opium, and amphetamines consumption among participants was 13.2%, 4.6% and 1.3% respectively. Prevalence of alcohol or substance consumption two hours before driving was 17.5%. Consumption of alcohol or substance two hours before driving was significantly associated with risky driving behaviors such as using mobile phone during driving, maneuvering while driving, history of driving fines in the past year, and driving over the speed limit (P <0.001). It was also associated with carelessness about safety such as driving with technical defects, not wearing a crash helmet, and history of accident in the past year (P <0.008).

Conclusions:

It seems that alcohol and substance abuse has association with other risky driving behaviors among motorcycle drivers. Thus, it is suggested to screen motorcycle drivers for substance and alcohol abuse in order to identify motorcycle drivers at a higher risk of road traffic accidents more efficiently while taking the cost-effectiveness of any ASA assessment program into consideration.

Keywords:

Alcohol drinking, Substance-related disorders, Motorcycle, Iran

Attention Deficit Hyperactivity Disorder as a determinant of motorcycle accidents in Fars province of Iran

Background:

Road traffic accident is a serious public health problem in the world. Iran is among the countries with the highest rate of traffic accident causing high mortality and morbidity. Although the number of motorcycle drivers is less than car drivers in Iran, a major part of mortality and morbidity belongs to motorcycle drivers especially in rural areas. Attention Deficit Hyperactivity Disorder is one of the predicting factors for risky behaviors and accidents among the motorcyclists. The aim of this study was to investigate the relationship between motorcycle accidents and attention deficit hyperactivity disorder in Shiraz, Iran.

Methods:

In this cross sectional study was done in 2017 total number of 1195 motorcyclist from Fars province were included. In this study we collected the data using the Persian version of Conners Adult Attention Deficit Hyperactivity Disorder (ADHD) Rating Scales (CAARS) 30-item questionnaire and a checklist designed by the researchers for demographic variables. SPSS 22 was used to analyze the data.

Results:

All the study participants were male and the mean age was 28.28±8.56 years. 16.7% of the motorcyclists had motorcycle driving license, 25.4% and 23.3% had the experience of driving fines and history of accident respectively. The mean score of hyperactivity disorder was 32.3±16.8. The mean score of ADHD was higher among the motorcyclists with the history of accident in the past year (P=0.018), those with speeding over the limit, those with maneuvering while driving, drivers who used mobile phone during driving, and those who had more pleasure while driving motorcycle (p<0.001).

Conclusions:

Findings of this study indicated that traffic accidents increased with the higher scores of ADHD in motorcyclists, and hyperactivity may be considered as a risk factor of driving risky behaviors such as exceeding the speed limits, illegal overtaking, and maneuvering while driving and finally accidents of motorcyclists.

Keywords:

Traffic Accident, Motorcyclists, Attention Deficit/Hyperactivity Disorder

Factors associated with Motorcyclist risky riding behaviors in southern Iran

Background:

Methods:

Results:

Conclusions:

Keywords:

What do hospital doctors and nurses think wastes their time?

Objective

With regard to limitation in national budget, the relevant authorities of healthcare and treatment throughout the globe are seeking the use of available resources in a way that no wastage of money or time-which is, of course, convertible to money-is acceptable. This study sought the opinions of hospital doctors and nurses on those activities at work that wasted their time.

Methods

A questionnaire designed to identify activities that waste time during hospital care was completed based on the review of previous studies and including hospital wastes items. The authors designed a questionnaire, which was filled out by 209 nurses and 30 doctors in the surgery wards in hospitals affiliated to Shiraz University of Medical Sciences (SUMS). The items for time wasting activities were extracted from previous studies, and the reliability of the questionnaire was more than 0.785 using Cronbach's alpha. The response rate was more than 60%.

Results

The mean age of the participating nurses and doctors was 30.24 ± 6.85 and 32.77 ± 7.05 years. In all aspects, more time was wasted during the morning and evening shifts in comparison with the night shifts. The activity that was thought to waste time in hospital care the most was paper-based documentation. Preventable wasted time during the shift was 16%-30% in the nurses' view and 18%-34% in the doctors' view. For both nurses and doctors, the highest-rated preventable wasted time was related to time spent waiting in ward for lab data responses, transfer of patients, or delivery of care.

Conclusion

Hospital working environment is complex, and opportunities for improvement of the efficiency of the nurses' and doctors' workload should be analyzed, case by case, in each hospital and work group. Process change (for the decrease in the wasted time for waiting in wards), simple innovative ways (for the decrease in the wasted time for searching the needed equipment), using hospital information system technology for documentation, communication, and the better design of the wards (to decrease the wasted time due to transfer between the ward and restroom) could be helpful for improving efficiency and for a safer and acceptable delivery of care.

Outcome of Liver Transplant Patients With Intraoperative-Detected Portal Vein Thrombosis: A Retrospective Cohort Study in Shiraz, Iran

OBJECTIVES

We aimed to determine outcomes and predictors of intraoperative-detected portal vein thrombosis in liver transplant recipients.

MATERIALS AND METHODS

We retrospectively analyzed 806 adult liver transplant recipients from Shiraz, Iran, to determine those with intraoperative-detected portal vein thrombosis. Patients with this complication were compared with age- and sex-matched patients without this complication. Background diseases, surgery parameters, hospital admission, reoperation, rethrombosis, acute rejection, and use of antico-agulants were assessed. Cox proportional hazards, logistic regression, and random classification forest and random survival forest plots were used for data analyses.

RESULTS

Mean age of patients was 44.7 ± 13.2 years. Patients with intraoperative-detected portal vein thrombosis (n = 91; 11.3%) had mortality ratio of 2.9 (range, 1.0-8.6) and 2-year survival of 78% versus 2-year survival rate of 92% in patients without this disease. Median time of survival in patients with this complication who died was 2 weeks versus 10 months in patients who died and did not have this complication. Random classification forest plots showed that high fasting blood sugar, autoimmune hepatitis, low prothrombin time, and cryptogenic cirrhosis were (in order) the main predictors of this complication. Random survival forest plots revealed that low prothrombin time, having intraoperative-detected portal vein thrombosis, Model for End Stage Liver Disease score, primary sclerosing cholangitis, diabetes mellitus, and hepatocellular carcinoma were (in order) the main predictors of death in liver transplant recipients. Low body mass index was associated with mortality in patients with intraoperative-detected portal vein thrombosis (by Cox proportional hazards).

CONCLUSIONS

One of every 9 liver transplant patients had intraoperative-detected portal vein thrombosis. Hazard of death was 2.9, and death occurred far earlier in patients with this complication. Improvements in diabetes mellitus care, prothrombin time, Model for End-Stage Liver Disease score, and body mass index may improve outcomes of these patients.

A Population-Based Study on the Prevalence and Risk Factors of Chronic Kidney Disease in the Adult Population of Shiraz, Southern Iran

Background:

Currently, we are facing a significant increase in the new cases of the end-stage renal disease in developing countries. Hence, it seems vital to work on strategies aimed at reducing its development and progression. Determining the related risk factors can provide an insight into achieving these policymaking goals. Therefore, this study was conducted to identify risk factors associated with chronic kidney disease (CKD) in the Iranian adult population.

Materials and Methods:

This cross-sectional study was performed in Shiraz, Southern Iran, through a cluster random sampling technique that involved 819 subjects, including 340 male and 479 female adult participants. Factors such as the body mass index, waist circumference, blood pressure, and biochemical profile were determined. We evaluated the prevalence of CKD according to the glomerular filtration rate (GFR), as well as possible risk factors associated with it. GFR was calculated on the basis of the "Chronic Kidney Disease Epidemiology Collaboration" creatinine equation.

Results:

The cluster comprised 58.5% females and 41.5% males. The mean age of our participants was 43.0 ± 14.0 years. Our results showed that 16.6% of adult urban inhabitants in Iran had CKD (stages 3 to 5, eGFR ≤60), that is, GFR less than 60 mL/min/1.73 m2. The proportion of participants having hypertension, obesity, high waist circumference, diabetes mellitus, and history of cardiovascular disease was 17.3%, 19.3%, 35%, 9.4%, and 5.3%, respectively. Multiple regression analysis indicated an independent correlation between age, sex, dyslipidemia, and hypertension with CKD.

Conclusion:

This study indicates that CKD is a substantial health burden in Iranian adult population. Additionally, the results of this study addressed the importance of integrated strategies that aimed to identify, prevent, and treat noncommunicable diseases fueling the development of CKD.

Biomarker-guided antifungal stewardship policies for patients with invasive candidiasis

Invasive fungal infections (IFIs) are among the life-threatening issues in patients with impaired immune system. High administration of antifungals in these patients imposes a heavy economic burden on the national health system. In addition, despite the usually expensive antifungal regimens, the mortality rate due to fungal infections is still high, resulting in the loss of hundreds of lives per year. Survival rate is an indicator of the success of national healthcare policies. Early diagnosis of IFI is critical because any delays may be fatal. The weakness of the old-fashioned culture-based diagnostic methods lies in their time-consuming laboratory procedures. To overcome this problem, several diagnostic approaches have been developed to facilitate the early diagnosis of invasive candidiasis as the most prevalent IFI. These methods are based on the detection of serologic and molecular footprints. However, nowadays, antibiotic resistance and proper and cost-effective use of antibiotics are given special attention in national healthcare policies. The instructions for controlling these indices have been collected under the name of antibiotic stewardship. The present review study was targeted toward providing insight into novel diagnostic biomarkers and antifungal stewardship programs. The simultaneous investigation of these two issues facilitates the achievement of a novel health policy for the treatment of systemic candidiasis in immunocompromised patients.

Designing a psycho-educational cohort system in Shiraz Medical School

This article was migrated. The article was not marked as recommended.

A Qualitative Study on the Importance and Value of Doctor-Patient Relationship in Iran: Physicians' Views

BACKGROUND:

Doctor-patient relationship [DPR] refers to verbal and non-verbal communication between doctor and patient, which is of great importance in consultation sessions.

AIM:

Therefore, the present study attempts to explore the importance and value of DPR in Iran.

MATERIAL AND METHODS:

The method used in the study was conventional content analysis. The data were collected from 21 faculty members (FMs) of Shiraz University of Medical Sciences (SUMS), Shiraz, Iran, who participated in three focus group discussions (FGDs). Transcribed data were analysed using Conventional Content Analysis (CCA) which identified condensed meaning units, subthemes, and themes.

RESULTS:

Four themes were extracted from 198 meaning units, 87 condensed meaning units, and 17 subthemes. These included gateway [the role of DPR]; nonlinearity [the nature of DPR]; distortion (quality of DPR in the context); and dysfunctional system (weakness in health system). Generally, results showed DPR to be the gateway to consultations based on non-verbal communication and doctor empathy. The study showed distorted DPR which was due to the dysfunctionality of the health care system.

CONCLUSION:

As indicated DPR plays an important role in medical contexts, but if distorted it leads to an unsuccessful outcome. Therefore, to promote DPR, it is necessary to reinforce its structure. Thus, the infrastructure has to be modified and developed at all levels.

A systematic review of human pathogens carried by the housefly (Musca domestica L.)

BACKGROUND

The synanthropic house fly, Musca domestica (Diptera: Muscidae), is a mechanical vector of pathogens (bacteria, fungi, viruses, and parasites), some of which cause serious diseases in humans and domestic animals. In the present study, a systematic review was done on the types and prevalence of human pathogens carried by the house fly.

METHODS

Major health-related electronic databases including PubMed, PubMed Central, Google Scholar, and Science Direct were searched (Last update 31/11/2017) for relevant literature on pathogens that have been isolated from the house fly.

RESULTS

Of the 1718 titles produced by bibliographic search, 99 were included in the review. Among the titles included, 69, 15, 3, 4, 1 and 7 described bacterial, fungi, bacteria+fungi, parasites, parasite+bacteria, and viral pathogens, respectively. Most of the house flies were captured in/around human habitation and animal farms. Pathogens were frequently isolated from body surfaces of the flies. Over 130 pathogens, predominantly bacteria (including some serious and life-threatening species) were identified from the house flies. Numerous publications also reported antimicrobial resistant bacteria and fungi isolated from house flies.

CONCLUSIONS

This review showed that house flies carry a large number of pathogens which can cause serious infections in humans and animals. More studies are needed to identify new pathogens carried by the house fly.

The concept of portal system obstruction in Avicenna's canon of medicine

Historical literature on portal hypertension is mainly focused on the contemporary advances in therapeutic methods, especially surgical ones. However, it seems that the origin of the human knowledge on the portal system, its association with the caval system, obstructive pathologies in this system and the gastrointestinal bleeding due to hepatic diseases might be much older than previously believed. Avicenna provided a detailed anatomy of the portal venous system and its feeding branches in the Canon of Medicine. Soddat al-Kabed va al-Masarigha (liver and mesenteric occlusion) is also a disease presented by Avicenna with clinical, etiological and therapeutic descriptions suggesting the fact that Soddat al-Kabed va al-Masarigha has multiple similarities with the currently identified concept of "portal hypertension". He presented sense of heaviness in the liver area with or without mild pain, anemia, pale and inappropriate body color, and loose stool which can be complicated with ascites, infection, fever and abdominal pain as clinical manifestations of this disease. He has also suggested therapeutic approaches including laxative and diuretic herbs to help excreting the obstructive material into stool or urine.

Diagnosis of cholangiocarcinoma in primary sclerosing cholangitis

Primary sclerosing cholangitis (PSC) is a chronic inflammatory disease of the hepatobiliary system characterized by chronic inflammation, progressive fibrosis, stricture formation and destruction of extrahepatic and intrahepatic bile ducts. Areas covered: The increased incidence of cholangiocarcinoma (CCA) in PSC has been well documented and can be explained by the continuous inflammation in the biliary tree leading to an enhanced dysplasia-carcinoma sequence. Although PSC patients may progress to liver cirrhosis; CCA most commonly occurs between the ages of 30 and 45 years when cirrhosis has not yet developed. Therefore, CCA in patients with PSC occurs earlier than in patients without PSC. Expert commentary: Despite improvement in diagnostic methods and devices, the dilemma of diagnosing CCA in patients with PSC has not been solved yet and needs further investigation.

Five Years after Implementation of Urban Family Physician Program in Fars Province of Iran: Are People's Knowledge and Practice Satisfactory?

Introduction:

Urban family physician program (UFPP) was launched in Fars province of Iran in 2012. We aimed to assess the knowledge and practice of people toward this 5-year-old program.

Methods:

In this population-based study, through a multistage random sampling from 6 cities of Fars province, 1350 people older than 18 years were interviewed. For data collection, a questionnaire consisting of sociodemographic characteristics and items about knowledge and practice toward UFPP was used.

Results:

The mean age of the interviewees was 42.4 ± 14.2 years; male (674; 49.9%)-to-female (651; 48.2%) ratio was 1.03. Mean score of knowledge was 4.2 ± 1.7 (out of 14), while 961 (71.1%) had < 50% of the desirable knowledge. Mean score of practice was 4.4 ± 1.3 (out of 9), while only 443 (32.8%) had a good performance toward this program. Knowledge and practice did not show a significant correlation (r = 0.06, P = 0.05). Among cities, the highest and the lowest mean of knowledge belonged to Pasargad (5.6 ± 2.1) and Lar (3.0 ± 1.0) (P < 0.001), respectively. Pasargad (4.8 ± 1.4) had also the highest level of practice compared to Farashband (3.8 ± 1.4) which had the lowest score (P < 0.001). Multivariable analysis showed that supplemental insurance coverage (odds ratio [OR] = 2.5, %95 confidence interval [CI]: 1.6–3.9), female gender (OR = 1.9, %95 CI: 1.2–2.9) and higher level of education (OR = 1.7, %95 CI: 1.1–2.5) were the significant determinants of knowledge, while practice in those who were not covered by supplemental insurance was better (OR = 1.6, 95% CI: 1.2-2.5).

Conclusions:

After 5 years of implementation of UFPP, knowledge and practice of people toward UFPP are not satisfactory. This finding calls for a serious revision in some aspects of UFFP.

The impact of environmental and demographic factors on nursing job satisfaction

Objective

This study aims to evaluate all aspects of job satisfaction in registered nurses working in different hospitals in Shiraz, Iran.

Methods

This cross-sectional study was performed during February to August 2015 in Shiraz, Iran. It comprised of 371 registered nurses working in government and private hospitals using multi-stage cluster sampling. Job satisfaction was evaluated using 5 items of the Job Descriptive Index (JDI) consisting of 63 questions developed by Smith, Kendall, and Hulin (1969). Statistical tests including independent sample t test and one-way analysis of variance (ANOVA) were used in order to identify the relation between job satisfaction, and demographic features and work environment. Data were analyzed by SPSS version 15.0, using descriptive statistics, independent-samples t-test, and ANOVA.

Results

Our findings showed no relationship between demographic variables and job satisfaction. However, a significant association was observed between environmental aspects such as work rotation (fixed versus rotating) nurse’s status (staff vs. supervisors), type of hospitals (governmental vs. private) and work (p<0.01), promotion (p<0.02) and pay (p<0.01) items respectively; however, type of hospital was deemed exempt regarding promotion. Also regarding the number of shifts per week, nurses with more than eight shifts present a lower mean score of satisfaction about pay significantly (p=0.03).

Conclusion

The results concerning younger nurses have different types of satisfaction based on several environmental factors. Nurses’ policy makers must pay more attention to nurses’ satisfaction and focus on reducing the various inequalities.

Risk Factors for Gastric Cancer: A Systematic Review

Objective: Gastric cancer is one of the leading causes of death worldwide, with many influences contributing to the disease. The aim of this study was to identify the most important risk factors. Methods: This study was conducted in 2017 with a structured overview in the Science Directe, Scopus, PubMed, Cochrane, Web of Science (ISI) databases. In the first step, articles were extracted based on their titles and abstracts; the quality of 43 articles was evaluated using the STORBE tool. Inclusion criteria were studies carried out on human, English language (first step), year of the study and the study type (second step). Results: Finally, 1,381 articles were found, of which 1,269 were excluded in primary and secondary screening. In reviewing the references of the remaining 44 papers, 4 studies were added. Finally, 43 articles were selected for the quality assessment process. A total of 52 risk factors for gastric cancer were identified and classified into nine important categories: diet, lifestyle, genetic predisposition, family history, treatment and medical conditions, infections, demographic characteristics, occupational exposures and ionizing radiation’. Conclusion: Several environmental and genetic factors are involved in the development of gastric cancer. Regarding the role of changes in ‘diet and lifestyle’, considering appropriate nutrition and improving the level of education and awareness of people is vital for early diagnosis and timely treatment of this disease, especially in people with a family history and genetic predisposition.

Prevalence of sleep quality disorder among Iranian drivers: a systematic review and meta-analysis

Background:

Sleep Quality Disorder (SQD) plays a major role in road accidents. So, this study was carried out to determine the prevalence of SQD among occupational drivers using systematic review and meta-analysis in Iran.

Methods:

All Persian and English articles between January, 2000 and October, 2015 which had reported the SQD prevalence in Iranian drivers by Pittsburgh Sleep Quality Index (PSQI) with cross-sectional design, after the quality evaluation process and achieving the required score, were selected. The heterogenic index of the studies was distinguished by using Cochran (Q) and I2 tests. Based on heterogeneity results, a random effects model was used to estimate pooled prevalence of SQD. Meta-regression was also used to investigate the heterogeneity of suspected factors.

Results:

In total, 936 articles were found from national and international databases. Ten articles entered to meta-analysis process, ultimately. Since heterogeneity index suggested that there is a consider-able heterogeneity among the results of primary studies (I-squared = 98.8%, Q= 754.1, p less than 0.001), the overall estimation of SQD among Iranian drivers was conducted using random-effects model and its rate was estimated to be 53.4% (95% CI: 38.9-67.8).

Conclusions:

Our study demonstrated that more than half of Iranian drivers have SQD. Identifying the drivers with SQD by periodic examinations and providing advice and health care among occupational drivers could be appropriate solutions for decreasing the accident risks.

False negative and false positive rates in common bile duct brushing cytology, a single center experience

AIM

In this study we tried to find out the accuracy of biliary tract brushing cytology in our center as the largest referral center in the south of Iran.

BACKGROUND

Common bile duct brushing cytology has been introduced as the method of choice for the diagnosis of pancreaticobiliary malignancies. However, there have been controversial reports about the sensitivity, specificity and overall accuracy of this method in the English literature.

METHODS

During the study period (2012-2016) there has been 166 cases of common bile duct brushing cytology taken during endoscopic retrograde cholangiopancreatography (ERCP). One case has been excluded because of inadequate number of cells in the cytology smear. All the smears have been stained by routine cytologic stains and screened by cytotechnologists and diagnosed by expert cytopathologist. Final diagnosis by biopsy has been considered as the gold standard.

RESULTS

According to the final histologic diagnosis as the gold standard, there were 22 false negative and 7 false positive cases. All of the false positive cases have been suspected cases in the background of primary sclerosing cholangitis. The most common final diagnosis of false negative cytologic diagnoses has been intrahepatic cholangiocarcinoma in which no malignant cell has been identified in the presence of adequate number of normal ductal epithelial cells.

CONCLUSION

Common bile duct brushing cytology is the method of choice for the diagnosis of pancreaticobiliary tract malignancies; however, having high specificity (90%), the sensitivity is low (56%). Cytologic diagnosis of biliary tract malignancies should be made with caution in the patients with primary sclerosing cholangitis. Also it is important to know that high false negative rate is present in common bile duct brushing cytology especially in the cases of intrahepatic cholangiocarcinoma without extension into extrahepatic ducts.

Health literacy in patients with epidermolysis bullosa in Iran

INTRODUCTION

Health literacy is a set of different skills, including reading, listening, analyzing, deciding, and applying these skills related to health status. Epidermolysis bullosa (EB) is a rare hereditary genetic disease which affects several aspects of the life of patients and their families. The aim of this study was to assess the health literacy of patients with EB in Iran.

MATERIALS AND METHODS

Thirty-three patients from Iran with EB, aged above 15 years-old, were enrolled in the study. Iranian Health Literacy Questionnaire, which measures health literacy in five domains including reading, access, perception, assessment, and decision-making skills, was used for collecting the data. SPSS analytical software, version 22, was used for statistical analysis.

RESULTS

In total, 19 (57.6%) patients were male and 14 (42.4%) female with an age range of 15-41 years. Nineteen (57.6%) patients had inadequate health literacy in reading skills. One-third of patients had enough health literacy in the realm of access, and two-thirds were excellent in perception. Overall, there was no significant correlation between the level of health literacy with age (P = 0.92), sex (P = 0.55), race (P = 0.58), and educational level (P = 0.51) of the patients.

CONCLUSION

The majority of the patients had inadequate health literacy in reading skills while these patients had acceptable health literacy in perception, assessment, and decision-making skills. Improvement of health literacy of these patients should be a priority for health policy makers with the aim of increasing their quality of life and decreasing their personal and social problems.

Aneurysmal subarachnoid haemorrhage (aSAH): Five consecutive years' experience of Fars province, Iran

OBJECTIVE

Subarachnoid haemorrhage (SAH), caused by the rupture of intracranial aneurysms, is a devastating event with high rates of morbidity and mortality. Aneurysmal subarachnoid haemorrhage (aSAH) plays a critical role in the potential loss of life as its sufferers are usually of a young age. We aimed to investigate the incidence of aSAH along with the patients' characteristics over five consecutive years in Fars, a large province located in Southern Iran.

METHODS

In this prospective study, anonymous data of all patients diagnosed with aSAH in Fars province were collected after patient admission and surgery. Data from the last national census in 2011 were used to calculate the incidence. The data were analysed using SPSS software version 18 using independent sample t test, chi square test and ANOVA. The significance level was set at 0.05.

RESULTS

The number of aSAH cases identified in Fars, Iran, each year varied between 78 (2011) and 98 (2015) for a total of 421 aSAH cases within the 5-year study period. The annual aSAH incidence estimates showed no differences and were 1.65 [95% confidence interval (CI): 1.58-1.72], 1.70 (95%CI: 1.68-1.72), 1.71 (95%CI: 1.63-1.78), 1.82 (95%CI: 1.74-1.9), and 2.05 (95%CI: 1.97-2.13) per 100,000 persons, respectively, for the five consecutive years from 21 March 2011 to 20 March 2016. Hypertension was the most common risk factor, and was found in 198 (48%) aSAH patients. Ninety-four (22.5%) patients had moderate hydrocephalus on admission. Middle cerebral artery and anterior communicating artery were the most common sites of aneurysms. On admission, 351 (83%) patients had a Glasgow Coma Scale score >7, 197 (47%) presented with Hunt and Hess score of 1, and 365 (87%) had a Fisher score of ≤3. Multiple aneurysms were found in 59 (14%) of the 421 cases and the most common risk factors in multiple aneurysms were hypertension in 30 (51%) and smoking in 26 (44%) cases. Survival data were available only on patients diagnosed in year 2015, and the six-month survival rate was 89.8%.

CONCLUSIONS

This study revealed that although the incidence of aSAH remained stable, the survival of aSAH patients who reached the hospital alive and were operated on, improved in Shiraz (the six-month survival rate was 89.8% in year 2015). The incidence and survival study on aSAH in other geographic areas of Iran as a multi-centre study is recommended. There is a need to inform primary healthcare workers regarding the possibility of aSAH in a patient with signs of the sentinel headache.

The pattern of educator voice in clinical counseling in an educational hospital in Shiraz, Iran: a conversation analysis

Doctor-patient interaction (DPI) includes different voices, of which the educator voice is of considerable importance. Physicians employ this voice to educate patients and their caregivers by providing them with information in order to change the patients' behavior and improve their health status. The subject has not yet been fully understood, and therefore the present study was conducted to explore the pattern of educator voice. For this purpose, conversation analysis (CA) of 33 recorded clinical consultations was performed in outpatient educational clinics in Shiraz, Iran between April 2014 and September 2014. In this qualitative study, all utterances, repetitions, lexical forms, chuckles and speech particles were considered and interpreted as social actions. Interpretations were based on inductive data-driven analysis with the aim to find recurring patterns of educator voice. The results showed educator voice to have two general features: descriptive and prescriptive. However, the pattern of educator voice comprised characteristics such as superficiality, marginalization of patients, one-dimensional approach, ignoring a healthy lifestyle, and robotic nature. The findings of this study clearly demonstrated a deficiency in the educator voice and inadequacy in patient-centered dialogue. In this setting, the educator voice was related to a distortion of DPI through the physicians' dominance, leading them to ignore their professional obligation to educate patients. Therefore, policies in this regard should take more account of enriching the educator voice through training medical students and faculty members in communication skills.

An Evidence-based Review of Medicinal Herbs for the Treatment of Gastroesophageal Reflux Disease (GERD)

BACKGROUND

Gastroesophageal reflux disease (GERD) is one of the most common diseases in society, affecting up to 40% of the population. It has major impact on the quality of life and a high burden on medical expenditure. In this work, herbs used by ancient Iranians to treat GERD have been introduced.

METHODS

Different well-known Persian textbooks and recent electronic databases were searched to explore the treatment of GERD and the pharmacological mechanisms of the identified medicinal plants.

RESULTS

GERD has been known for many centuries, and many herbal remedies for its treatment have been elucidated in traditional medical literature. We found 25 medicinal herbs in Persian medicine books and searched for evidence to support them in the current literature.

CONCLUSION

Although their active components or the mechanism of action were not known by the ancient Persians at that time, their persistent use during different centuries might indicate their effectiveness. Owing to their potential, medicinal herbs are a viable option for the treatment of diseases like GERD even today.

Burden of traffic accidents among pedestrians of Fars province, southern Iran; estimate of years of life lost in a sample of Iranian population from 2009 to 2013

PURPOSE

Traffic injuries are among the leading causes of mortality and morbidity worldwide. Pedestrians have been considered as a high-risk group among road users, especially in middle- or low-income communities. This study attempted to determine the burden of pedestrians' fatalities in Fars, the southern province of Iran using years of life lost (YLL) approach.

METHODS

The data used in this study were retrieved from Fars Forensic Medicine Organization database on pedestrian traffic accidents. The YLL from 2009 to 2013 was estimated using the method presented by World Health organization. Some epidemiological characteristics of pedestrians' fatalities were analyzed by SPSS.

RESULTS

Although YLL among 1000 male pedestrians decreased from 2.5 in 2009 to 1.5 in 2013, it increased from 0.9 to 2.1 among 1000 females during the same period. Higher proportion of death was found in female, illiterate, and married pedestrians (p < 0.001). In addition, mortality was higher in pedestrians living the cities, during daytime, at home, and in hospitals (p < 0.001).

CONCLUSION

Consistent with the global trends, burden of pedestrian accidents in Fars was also exceptionally high. Considering the national and cultural aspects of different countries, improving the safety of pedestrians demands a multi-dimensional approach with interventional factors concerning policies, rules, pedestrians, motor vehicles and environmental conditions taken into consideration.

Strategies to Reduce HIV Transmission amongst Prisoners; Lessons Learned From Iran

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Genistein supplementation improves insulin resistance and inflammatory state in non-alcoholic fatty liver patients: A randomized, controlled trial

BACKGROUND & AIMS

The beneficial effect of genistein has indicated on metabolic disorders and inflammatory state. The aim of this study was to investigate the effect of genistein supplementation on non-alcoholic fatty liver disease (NAFLD) as the hepatic manifest of metabolic syndrome.

METHODS

In the present randomized double-blind controlled trial, patients with NAFLD were daily supplemented with either 250 mg genistein (n = 41) or placebo (n = 41) for 8-weeks. Both groups were instructed to follow an energy-balanced diet and physical activity recommendations. And their anthropometric and biochemical indices were assessed before and after the intervention.

RESULTS

At the end of the study, the genistein group had lower level of serum insulin (p = 0.001) and homeostasis model assessment for insulin resistance (HOMA-IR) (p = 0.041) compare to the placebo group. In addition serum malondialdehyde (MDA) (p = 0.004), tumor necrosis factor-α (TNF-α) (p = 0.045) and interleukin (IL)-6 (p = 0.018) also were lower in the genistein group. Compare with placebo, genistein supplementation significantly reduced waist to hip ratio (p = 0.021), body fat percentage (p = 0.015) and triglyceride (p = 0.018). However, there were no significant changes in BMI, fasting blood glucose (p = 0.122), alanine aminotransferase (ALT) (p = 0.536), aspartate aminotransferase (AST) (p = 0.265) between the two groups.

CONCLUSIONS

Oral supplementation with 250 mg genistein for 8-weeks can reduce insulin resistance, oxidative and inflammatory indices along with improvement in fat metabolism in patients with NAFLD. Studies with longer duration and larger samples might be needed to reveal other beneficial effects of genistein.

The incidence of hip fracture in Shiraz, Iran: a promising rate comparing to previous studies

We evaluate the incidence of hip fracture in 50 years old or above in southwest of Iran. Age-adjusted incidence rates of hip fracture, standardized to the 2000 US white population, were 79.55 per 10⁵ in total and 66.51 and 92.37 per 10⁵ in male and female, respectively.

INTRODUCTION

Osteoporosis-related hip fracture is associated with considerable morbidity, mortality, and costs in older people. The aim of this study was to evaluate the incidence rate of hip fracture in the capital of Fars Province, southern Iran.

METHODS

This study was conducted in Shiraz, Iran, from September 1, 2011, to August 30, 2012. All 50-year-old or above patients with hip fracture diagnosis, lived in Shiraz at least 6 months prior to hospital admission, were included in this study. All statistical analyses were performed using SPSS, version 18.0, and Microsoft Excel 2007 software.

RESULTS

The mean age of 608 patients was 75.95 ± 11.07 and 353 (58.3%) were female. Age-adjusted incidence rates of hip fracture, standardized to the 2000 US white population, were 79.55 per 10⁵ in total and 66.51 and 92.37 per 10⁵ in male and female, respectively. The adjusted incidence rate of neck of the femur fracture (30.62 per 10⁵ versus 23.49 per 10⁵, p = 0.61) and intertrochanteric fracture (40.48 per 10⁵ versus 28.5 per 10⁵, p = 0.74) were higher in females than males but the differences were not statistically significant. Under the age of 65 years, the incidence rate of hip fracture was significantly higher in men, but after 65 years, it was higher among women.

CONCLUSION

The rate of osteoporotic hip fracture was relatively low in southern Iran. However, by aging population, this rate will increase and health policy makers should implement targeted osteoporosis screening and management programs.

The Mechanisms Underlying Helicobacter Pylori-Mediated Protection against Allergic Asthma

Helicobacter pylori, a gram negative pathogen, infects the stomach and gastrointestinal tract and causes pathological damage to these organs. H. pylori infection is more prevalent among people living in developing countries. Allergic asthma is a chronic inflammatory disease of the airways. Hyperinflation, hyperresponsiveness, and abnormal immunological and inflammatory processes in respiratory airways typically occur during an asthma attack. The results of recent studies have suggested an association between H. pylori and asthma risk. However, the role of H. pylori infection in the pathophysiology of asthma is still a matter of debate. The results of some studies indicate an association between H. pylori infection and protection against allergic asthma. Exposure to infectious agents might educate the immune system and provide protection against allergic diseases. H. pylori inflammation also changes gastric hormonal levels and could influence the autonomic nervous system. T-regs could be influenced by the immunological response to H. pylori and then inhibit the Th-2-mediated allergic response. Therefore, H. pylori might play a protective role against asthma. H. pylori can also reduce gastro-esophageal reflux, which is an asthma stimulator. High loads of H. pylori are not always present during infection. It is not definitely clear whether H. pylori is a pathogen or simply an opportunist. It has been suggested that early exposure to H. pylori prevents development of pediatric asthma. Therefore, it is possible that therapeutic products made from H. pylori can be used for the treatment or prevention of asthma.

From good to great physician: a critical ethnography based on patients' views

The doctor-patient interaction (DPI) plays an important role in the way patients view physicians. Thus, response to the question of ''Who is a great physician?'' is related to DPI experiences of patients. The aim of this qualitative study was to explore patients' views regarding this subject. Based on critical ethnography in one educational hospital in Shiraz, Iran, the study was performed based on 156 clinical consultations, 920 hours of participant observations, and 6 focus groups with patients and their relatives. The results revealed that asymmetrical power relationships exist in this context. Based on the general views of participants and their recent DPI experiences, a great physician should be kind, empathetic, friendly, and a good listener. Considering the presence of an asymmetrical power relationships in this context, results showed that doctors do not participate in an active interaction. Based on sociological theories, it can be concluded that the concept of a great physician is not only limited to obligations as in the Parsonian view, but is also related to active communication between both sides which is presented in the critical view. Through active communication‎, asymmetrical power relationships can be reduced. Thus, if a physician wants to become a great physician, he/she must strengthen his/her humanistic dimensions and communicative skills alongside his/her medical skills.

Prevalence of malocclusion among Iranian children: A systematic review and meta-analysis

BACKGROUND

The high prevalence of malocclusion is a public health problem in the world and the third priority in oral care. Numerous primary studies have presented reports on the prevalence of malocclusion among Iranian children. In combination, the results of these studies using meta-analysis are highly valuable for health policy-making. Similarly, this study aimed at determining the prevalence of different types of malocclusion among Iranian children.

MATERIALS AND METHODS

Using relevant keywords, national and international databases were explored. After narrowing down the search strategy and leaving out the duplicates, the remaining articles were screened based on titles and abstracts. To increase search sensitivity, reference lists of the papers were examined. To identify unpublished articles and documentations, a set of negotiations were done with the people involved and research centers. Finally, the heterogeneity index between the studies was determined using Cochran (Q) and I2 tests. According to the results of heterogeneity, the random effects model was used to estimate the prevalence of malocclusion in Iran.

RESULTS

In total, 25 articles were included in the meta-analysis process. The prevalence of dental malocclusion was estimated in 28,693 Iranian children aged 3-18 years. The total prevalence of Class I, II, and III malocclusion was 54.6% (46.5-62.7), 24.7% (20.8-28.7), and 6.01% (4-7.1), respectively. The prevalence of Class I, II, and III malocclusion was 44.6% (32.9-56.2), 21.5% (18.01-25.1), and 4.5% (3.2-5.9) in boys and 48.8% (36.8-60.8), 21.5% (16.9-25.1), and 5.5% (3.9-7.1) in girls, respectively.

CONCLUSION

This study showed a high prevalence of malocclusion among Iranian children. Also, the results indicated that the prevalence is higher in girls.