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We report a case of paraesophageal varices presenting as a posterior mediastinal mass in a patient with long-standing portal hypertension and cirrhosis. The case is unusual because the varices were considerably larger than those usually encountered in portal hypertension. This report is a reminder that portal hypertension with paraesophageal varices can present as a retrocardiac mass on the chest radiogram. We suggest that in diagnostic work-up of patients with cirrhosis and masses in mediastinum modern imaging techniques, such as dynamic CT, color Doppler sonography and MRI, are most helpful (because they can demonstrate the vascular nature of these masses and have multiplanar capabilities) and precutaneous needle biopsy may be hazardous.

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Background and purpose: Presence of behavior-emotional disorder BED at childhood is a very important problem and predisposing factor for mental disorder in adulthood. The aim of the present study was to determine the prevalence of BED and its associated factors in the primary school students in Sari, Iran.
Materials and Methods: Totally, 926 urban and rural students were selected randomly by cluster sampling method. Tools of data collection were: Demographic feature questionnaire divided in two parts of Rater behavior- emotional disorder for parents (31 questions) and teachers (30 questions). Data were analyzed by descriptive tests, X2, t-test using SPSS software.
Results: Findings of this study indicate the general prevalence of BED in the children based on the parent's report (15.8%) and of teacher's 24.9%. The highest rate of BED prevalence based on the parents and teachers reports were the lack of attention deficit disorder 93.3% and absent minding 11.1% respectively. The lowest rate of disorders were antisocial behavior 1.5% and 0.4% respectively based on the parents and teachers reports. Our data showed that the relation between the total prevalence of BED based on the questionnaire of parents with the variables of sex, score of the students, the child number in family, somatic complaints (headache, asthma, stomach pain or nausea, eating problems, sleeping disorders, urine incontinency, stool incontinency) cooperation of parents in keeping the child and school leaving was significant at the level of 5%. Also, based on the teachers reports, the total prevalence of BED at the level of 5% in the students under study was significantly different considering the factors such as educational status, scores average, separation of parents and mistreatment with the child. In addition, there was no significant relationship between the total prevalence of BED in the students based on the reports given by the teachers and parents on the basis of being urban or rural.
Conclusion: Knowing the prevalence of BED is very important for the individual's health in the future and because proper and scientific identification of the children's behavior problems is the first step in the control and treatment of this problem, more research is recommended in this field.

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Background and Purpose: In recent years, the use of online technologies in education, opportunities for the use of modern methods of learning and effective teaching methods has provided. This phenomenon affects on education and learning opportunities to develop and SY, access to educational resources and training has helped facilitate the process-learning using network technologies (e.g. Internet) in order to design, implement and continue to deliver teaching and learning is the learning environment. The main objective of this study views the students about the use of e-learning system and its related factors in the Mazandaran University of Medical Sciences in 1390, respectively. Materials & Methods: This study used a descriptive cross - sectional on all the students spent three semesters were performed. The questionnaire includes 26 questions that Standard by Dawkins and colleagues of the five options (from high to low) and in six dimensions (access to technology, constant communication, motivation, learning through the media, Internet chat and e-learning success) is. Results: The findings indicated that the positive attitude the students about all aspects of electronic learning (access to technology, constant communication, motivation, learning through the media, Internet chat and e-learning success) Dashtndv University School of Pharmacy 3 access to technology, online communities and e-learning success had the most positive, while the 3 'motivation, learning through media and Internet chat group had the least positive. Other findings also suggest that the moderating variables: age, sex and education level of 5% error in the dimensions of e-learning has a significant relationship (p≤ 0/05). Conclusion: : According to the results and positive outlook Medicine and Pharmacy students towards e-learning can be concluded that the students and Pharmacology, Mazandaran University of Medical Sciences ready for the implementation of e-learning are relatively acceptable.

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Background and purpose: The role of head nurses in delivering health care is important and training and making them physically and mentally (attitude and belief) ready to accept the role is also important, so the researchers aimed at identifying and explaining the factors influencing the formation and the maintenance of the nurses’ commitment to clinical nursing identity.
Materials and methods: The participants in this cross-sectional study were 123 male and female head nurses (based on Morgan Table) working in Mazandaran hospitals. The participants were randomly selected and were asked to fill in a questionnaire. For data analysis, Spearman correlation coefficient was used to measure the amount of correlation among variables and multiple regression analysis was employed to determine the variables related to commitment to clinical nursing identity.
Results: There was a significant positive relationship between “self-efficacy” and “attitudes toward the nurse to head nurse role transition” (r = 0.438), the same relationship was found between “social norms” and “attitudes toward the nurse to head nurse role transition” (r = 0.627). Ôn the other hand, there was no meaningful relationship between “attitudes toward the nurse to head nurse role transition” and “behavioral beliefs” (r = 0.437). Çontrary to the expectations, there was a positive relationship between “attitudes toward the nurse to head nurse role transition” and “commitment to clinical nursing identity” (r = 0.369).
Çonclusion: Âccording to the aforementioned findings, nurses should be informed of the effectiveness of the managerial roles in the hospitals and in the clinical improvement of the patients so that the head nurses are provided with their colleagues’ support.

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Background and purpose: Ôral lichen planus (ÔLP), a common disease reported to be a premalignant lesion in some studies, may potentially lead to the development of oral squamous cell carcinoma. This study aims to investigate the prevalence of malignant transformation in patients with ÔLP.
Materials and methods: Ïn this retrospective study, 386 patients diagnosed with ÔLP based on the criteria of the World Health Ôrganization (WHÔ) from 2006 to 2009 in Shiraz were studied.
Results: Four patients (1.03%), one man and three women, showed malignant transformation. Âll malignant transformations occurred in red ÔLP types and tongue was the most common location.
Çonclusion: The findings of this study confirm the hypothesis that patients with ÔLP have a high risk of developing malignant transformations. Hence, it is recommended that ÔLP patients be monitored annually for early detection of possible malignant transformation.

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Background and purpose: The prevalence of behavioral problems in children with mentally ill parents is higher than children with healthy parents. This study focused on the effects of mothers’ obsessive-compulsive disorder on children’s behaviors. Materials and methods: In this case control study, 50 children aged 6-11 years from obsessive-compulsive mothers referred to Bandar Abbas psychiatric centre were compared with 50 children with mentally healthy mothers at the same age based on Achenbach child behavior questionnaire. Results: Somatic complaints, anxiety and depression, social problems, externalization and internalization scores, were meaningfully higher in case group. No significant differences in isolation, attention problems, thought problems, antisocial behaviors were seen in either group. Conclusion: behavioral problems in children from obsessive-compulsive mothers are more common, compared with children from healthy mothers. Child psychological counseling and psychiatric management are required along with mothers’ treatment.

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Background and purpose: Honesty is a character that is confirmed by all human, but sometimes human is placed in a situation to choose one between the two interests of truth and life. Such dilemmas cause human developed and applied white lies. Range of white lies operation became gradually popular in different areas that one of them was medical treatment. Whether or not this type of lies are morality, white lies is considered as one of the controversial topics in the field of applied and functional ethics which unfortunately has not been studied. The spirit of paternalistic authority in medicine has caused that physician got a right to themselves (and sometimes they still do) that decided in instead of their patients in the specific conditions and turn to a tool like lie to keep them, but whether this can be considered an ethic action. Materials and methods: In the present study, the researcher checked to see related articles and texts deleting unrelated, collecting related articles and in survey, necessary cases were extracted and applied. Results: There are several issues between doctors and their patient such as to state a bad news or someone death, miss diagnosis of co-workers, contention with secret, no explaining the complications of drugs and therapy that lead to justify white lies. On the other hand, ethics at the level of communication is in direct proportion to trust. As, it can be claimed if a behavior increases confidence, it can be considered ethical and if not, is unethical. Conclusion: The aim of this study was to assess the applications of white lies via reliability index to identify the right and wrong aspect of the lies in medicine.

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Background and purpose: Oral health is one of the most important branches in public health. Great emphasis has been put on this issue by WHO in the department of Chronic Diseases and Health Promotion (CHP). This issue needs more attention regarding the health of pregnant women and their fetus. Materials and methods: A cross-sectional study was carried out on 340 pregnant women who were selected through multistage random sampling method from Arak health centers. DMFT index and HBM (susceptibility, severity, benefits, barriers and self-efficacy) were evaluated. Results: The mean age of women was 28.2 ± 3.7 years old and the mean of DMFT was 5.4 ± 2.83. Self-efficacy and perceived barriers were the main predictors of oral health behavior in pregnant women. The mean of oral health care performance in women was 43.1 ± 9.7. A significant correlation was found between perceived susceptibility and performance (r= 0.44, P= 0.008), perceived severity and performance (r= 0.51, P= 0.002), and self-efficacy and performance (r= 0.61, P= 0.001). In contrast, a significant negative correlation was observed between the perceived barriers to oral health care and pregnant women’s performances (r= -0.65, P= 0.001). Conclusion: According to this research perceived barriers were associated with oral hygiene behavior (tooth brushing). Therefore, these barriers should receive more attention by oral hygienists to promote educational programs regarding brushing. Moreover, self-efficacy was the most important predictor of oral health behavior in pregnant women. Hence, dental professionals should enhance self-confidence in pregnant women so that they could follow oral health care behavior.

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Background and purpose: Intraoral soft tissue lesions of traumatic-origin and their clinical similarities to neoplastic lesions are of great importance. This study was performed to determine the frequency of these lesions in a population from northern Iran. Materials and methods: This retrospective study was done using existing patient dental records from two referral pathology department for oral lesions in Babol University of Medical Sciences. Patients' demographic criteria, location and characteristics of trauma-related lesions with clinical and histopathological diagnosis were obtained. Results: The subjects were 185 (41.5%) male and 261 (58.5%) female and the mean age of patients was 36.82 ± 0.9 years. Four hundred and forty-six cases associated with trauma were found. They were all created in soft tissues and the most common locations of lesions were gingiva (45.3%) and lip (24.9%). The most prevalent lesion was pyogenic granuloma (25.6%). The mean age of patients with frictional keratosis and epulis fissuratum were higher (57.76 ± 9.89 and 56.22 ± 13.24, respectively), while the mean age of patients affected by mucocele was the lowest (22.98 ± 13.4). Sixty two cases of lesions (14.4%) were seen in people <15 years of age. The most common sites of involvement in this population were the lips and gums with similar rate of incidence and the most prevalent lesion was mucocele. The concordance between histopathological and clinical diagnosis was seen in 54.7% of the cases. Conclusion: Intraoral soft tissue lesions of traumatic-origin have a relatively high prevalence in the oral cavity -probably due to more contact with local stimulus factors- and in the female population. This study found valuable epidemiological evidence that signifies the importance of such lesions in oral diseases.

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Background and purpose: Multiple sclerosis (MS) is one of the diseases of nervous system that is accompanied with destruction of neuron ways corded sheath. The weakening nature of this disease affects all aspects of patient’s life and decreases their life expectancy. This consequence plays a considerable role in accelerating acute diseases such as MS. This study was done to assess the effectuality of cognitive behavioral therapy (CBT) on the life expectancy of patients suffering from MS. Materials and methods: this semi-experimental study included thirty MS patients attending Bou Ali Sina Hospital in Sari who were randomly divided into two groups. (control group=15 and intervention group= 15). The experimental group received CBT for three months during 12 sessions. The control group was placed in treatment waiting list. The data was collected using Hallajian Life Expectancy Questionnaire (2010). Results: The results showed that the mean scores for life expectancy increased significantly in the experimental group in post-treatment and follow up stages (P<0.001). Conclusion: According to his study interventions such as CBT could be of great benefit in in increasing life expectancy among patients with chronic diseases.

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Background and purpose: Planning for oral health requires recognition of effective factors. BASNEF Model helps to find the factors influencing the decision making process for implementing oral health. This study was conducted to find the factors influencing the oral health behavior amongst high school students in Babol and Noshahr according to BASNEF Model. Materials and methods: This periodic study was conducted in 700 students selected through stratified random sampling. A questionnaire was used based on BASNEF Model and the data was analyzed using GLM test. Results: The findings showed that the average score for students' awareness was 70% and the average score for students' attitudes was 76.3%. In subjective norms of BASNEF Model in studied students, the most important reasons for implementing oral health care were parents’ will (65%), following role models (36%), respected people among relatives (18.3%), and teachers (16%). In enabling factors of BASNEF Model, the most influencing factors were the ability to pay for dental services (58%), the high cost of dental services (46%), supplemental health insurance (34%) and highly equipped specialized dental clinics (32%). Conclusion: The subjective norms and enabling factors of BASNEF Model were effective in recognition and implementing oral health among the study population. Therefore, it focusing on this issue could highly enhance the oral health behavior among students.

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Background and purpose: One of the best ways to evaluate the activity and efficiency of a health care system is to consider WHO advised indices. In oral health systems, one of the most important of these indices is DMFT index. The aim of this research was to assess the effects of education on the performance of pregnant women in city of Arak regarding oral health according to the DMFT index and plaque index. Materials and methods: This intervention study was carried out in 130 pregnant women attending health centers in Arak who were divided into case and control groups (n= 65 in each group). Before the intervention the data including the samples’ demographic features, DMFT Index and Plaque Index (PI) check lists and their performance about oral health was recorded. The intervention group attended educational programs and after three months the samples were examined for oral health. Results: The mean ages of samples in case and control groups were 27.1±3.5 and 29.8±4.3 years and the mean of DMFT score was 5.8±2.2 and 5.3±1.8, respectively. There was no significant difference in the mean of DMFT scores before and after the intervention among the two groups (p=0.115) but there was a significant decrease in PI scores (P=0.041). Moreover, the performance of case and control groups were different before and after the intervention (P<0.05). Conclusion: Educational programs are very effective in enhancing oral health among pregnant women. Furthermore, follow up programs on controlling and monitoring are beneficial.

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Background and purpose: Individuals treat the Internet phenomenon differently based on their personalities. Also, personality can predispose individuals for some psychological disorders. Some psychologists state that personality comes from nervous system functions, therefore, this study investigated the personality characteristics caused by brain-behavioral systems and gender on Internet addiction. Materials and methods: This casual-comparison research was performed in 225 people selected through cluster sampling from Internet cafes, libraries and gyms’ clients in Isfahan. The data was collected using Young’s Internet addiction scale and Gray-Wilson Personality Questionnaire. Results: Multivariate Variance Analysis (MANOVA) showed significant differences in brain-behavioral systems of addicted and non-addicted groups. Paired-test showed that these differences were due to differences in passive avoidance, and fight and flight subscales. Independent sample t-test also showed significant differences in Internet addiction between male and female. Moreover, multiple regression analysis confirmed the predicting role of passive avoidance and gender in Internet addiction. Conclusion: Behavioral inhibition system sensitivity could influence the risk factors of internet addiction. This is probably caused by enjoying the nature of Internet activities and delay in the negative outcomes at the same time. These are pleasant for individuals with high behavioral inhibition system sensitivity. Furthermore, males are more prone to Internet addiction that is due to more tendencies to develop social relations and gaining less family support than females.

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Background and purpose: There are remarkable differences in the prevalence of oral lesion throughout the world. The purpose of this study was to evaluate the frequency of oral mucosal lesion among patients referring to Babol Dental School in Iran. Materials and methods: This descriptive study was done in 2010 and census sampling was used to collect the data. The subjects included all the patients aged >15 years old attending Babol Dental School. The participants’ information regarding gender, age, systemic disease, drinking alcohol, smoking, oral lesion, and wearing dentures were recorded through a questionnaire. The data was then analyzed using chi-square test in SPSS. Results: Totally 1870 subjects including 1086 female and 784 male were studied. Frequency of oral lesion was 26.4%. The most prevalent lesions were coated tongue (4.8%), fissured tongue (3.9%), and lichen planus (1.8%). We observed higher frequency of lesions among females. There was a significant correlation between smoking and wearing dentures and the occurrence of mucosal lesion, however, no relation was found between drinking alcohol and mucosal lesion. Conclusion: The findings in this study revealed a high prevalence of oral soft tissue lesions related to smoking and wearing denture. Therefore, awareness programs are needed to enhance the knowledge of people about the risks of smoking and applying dentures correctly.

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Background and purpose: Together with drug treatment can be benefited of Cognitive-behavioral therapy improvement in people with schizophrenia. This study investigates the impact of cognitive-behavioral therapy on patients with positive symptoms of schizophrenia. Materials and methods: The study population includes all women and men who have schizophrenia in the Farabi Hospital in Kermanshah. They were randomly chosen including 31 persons, they were divided into two equal groups. (Control groups n=51 experimental, n=51). Both groups were tested by the test case SAPS. Then, the test group for 51 sessions According to the treatment protocol was the cognitive-behavioral therapyAfter the intervention, the incoming data using analysis of covariance (ANCOVA) was analyzed. Results: After two sessions, the experience group showed positive signs less than the controlling group meaningfully (P<0.001). Conclusion: It means that the behavioral-knowing treatments are known as the influencing treatment to decrease the positive signs of schizophrenia

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Background and purpose: Oral cancer is one of the most prevalent cancers and the 10 most causes of death in the world. Most oral cancers are diagnosed at late stages. Thus, it is an important public health problem in the world. Since dentists play a critical role of oral cancers, they should be knowledgeable and skillful in oral cancer diagnosis. The aim of this study was to evaluate the knowledge of general dentists about oral cancer in Sari. Material and methods: This descriptive analytical cross-sectional study was done on 150 dentists who had private offices in Sari in 2013. A questionnaire including the information and 13 questions regarding oral cancer was prepared. The questionnaires were delivered to dentists at their offices and then gathered. The data were analyzed via SPSS software student's t-test, Pearson correlation coefficients. Results: There were 98 male and 52 female dentists with the mean age of 39.94±7.24 years (P=0.09). The mean score of total dentists' knowledge was 7.27±2.49 out of 13. The mean score of knowledge was 6.91±2.37 and 7.78±2.6, for males and females, respectively. There was significant difference between them (P=0.03). Ninety-One percent of dentists knew the most common types of oral cancer. Conclusion: The results of this study indicate that knowledge of dentists in Sari about oral cancer was not sufficient. Because of the importance of the issue, the application of strategies to increase the knowledge of dentists regarding oral cancer is necessary.

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Background and purpose: Nitrate is one of the pollutants of groundwater resources which is easily found in agricultural and wastewater disposal areas. The aim of this study was to determine the spatial and temporal variations of nitrate and nitrite in drinking water resources of Kohgiluyeh -a city in Iran- using Geographic Information System (GIS). Materials and methods: This cross-sectional study was carried out in 2011 in which 18 sources of drinking water (108 samples) and results of five-year-archived analysis in Water and sewage Co of Kohgiloyeh were studied applying GIS software ver. 9.3, SPSS ver. 16, and Pearson correlation test. Results: The results showed that the mean of nitrate concentration in 2007 was 18.5 ± 1.5 and in the summer and fall of 2011 was 20 ± 4.6 and 20.83 ± 2.2 ppm, respectively which indicates a direct correlation between years and the increase in nitrate concentration (R= 0.92, P= 0.01). However, the nitrite concentration was found steady in most years. The spatial variations represent worse quality of northwest. Ordinary kriging is the best interpolation method for nitrate and nitrite. Conclusion: According to the results, the concentration of nitrite and nitrate has increased during the past years and in some parts are even rising more than the standard levels. The reasons could be regional geology and agricultural and to prevent such problems protecting the wells, using river water for agriculture, and construction of wastewater treatment plants could be of great benefit.

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Background and purpose: There are several oral problems in pediatrics interact with normal functioning, general health and quality of life. The most common problem is tooth decay and periodontal diseases. This study aimed to assess Interns' knowledge level about teeth and mouth health in educational hospital affiliated to Tehran Medical Universities, Iran. Materials and methods: In this cross-sectional descriptive study, 391 interns in educational hospital affiliated to Tehran and Shahid Beheshti Universities of Medical Sciences and Islamic Azad University were studied in 2011. The information was gathered via a researcher-made questioner. Results: The mean age of participants was 25.18 ± 1.25 year 44.2% were men and the others were women. The mean knowledge score was 4.87 ± 1.73 of 15. The age, sex, and duration of education did not have any effect on the interns’ knowledge. Conclusion: According to this study and many other similar studies, it seems that the interns in educational hospital do not have enough information and knowledge about pediatrics teeth and mouth health. It is recommended to insert new learning programs in their educational curriculums to have enough information and proper knowledge about as first line visitors of patients.

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Background and purpose: Violence against children and adolescents is a worldwide concern that has always received much attention. The purpose of this research was to investigate the relationship between child maltreatment in family and behavioral problems in high school adolescents in Kermanshah. Material and methods: In a cross-sectional study, 193 boys and girls studying in high school in Kermanshah were selected through multi Stage sampling. Adolescent self-report form of behavioral problems and self-report scale for measuring child maltreatment was used. Data was analyzed in SPSS using descriptive statistics, Pearson correlation and multiple linear regression. Results: The mean age of the participants was 15.75 ±0.85. There was no significant relationship between gender and child maltreatment (P>0.269). But, significant difference was seen in neglect subscale and gender (P<0.046). All aspects of behavioral problems were observed more in girls. Pearson correlation analysis showed a significant correlation between child maltreatment and behavioral problems and its subscales (P<0.001). Regression analysis showed that 38.1% of the changes related to behavioral problems in students could be explained via a linear combination of emotional and sexual abuse. Conclusion: There was a significant correlation between child maltreatment and behavioral problems. More qualitative studies are recommended to investigate child abuse in different regional and ethnic contexts.

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Background and purpose: To organize oral health promotion programs in Iran, assessing the knowledge, attitude and practice (KAP) of students is important.The aim of this study was to design a comprehensive and validate questionnaire on KAP of oral health in 12-year old children in Iran. Materials and methods: This cross-sectional study included 1554 children aged 12 years old who were selected from 5 provinces in Iran. First, an Internet search of the major databases of medical articles published between 2003 and 2013 was performed. After a systematic review of literature, a questionnaire was prepared in English, and was translated and back-translated using standard methods. Then the face and construct validity of Persian version of the questionnaire were assessed. Internal consistency was performed using Cronbach's alpha coefficients for reliability testing. Results: The final Persian version of the questionnaire was included the most important issues in the field of knowledge (influencing factors, and the effect of carbohydrates on dental caries), attitude (fear of dentist and dental care) and practice (how to brush, diet and dental appointments). The Persian version was consistent with the English version. Participation rate of 92% was reported. Construct validity was assessed using known groups approach, internal consistency and exploratory factor analysis which was found to be in an acceptable level. The Cronbach's alpha for questions, knowledge, attitude and practice, were 0.88%, 0.86%, 0.87% and 0.78%, respectively, indicating an acceptable consistency of the questionnaire. Conclusion: The Persian version of the questionnaire is a precise, valid and reliable instrument for assessing KAP of oral health in 12- year old children.