The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: (“novel coronavirus” Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates. Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.

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

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Background and Aim: Academic burnout is the feeling of inadequacy and mental fatigue induced by chronic stress in students lacking the necessary resources to carry out their duties and tasks assigned to them. This study aimed to determine academic burnout and some related factors in medical students of Islamic Azad University of Mashhad in 2015-2016. Materials and Methods: In this cross-sectional study, 181 medical students in degrees of basic sciences, traineeship, and internship were selected by convenience sampling. The data collection instrument was the Persian version of the Maslach Burnout Inventory Student Survey and a checklist of demographic variables. The collected data were analyzed using SPSSv. 18 software, descriptive and analytical tests, such as t-test and ANOVA. Results: The mean total score of academic burnout was 34.69 ± 14.69. It was concluded that 23.2% of the subjects had a high level of burnout and 51.4% a moderate level. No significant relationship was found between age, marital status, having the second job, and the educational level without any of the dimensions and the total score of the burnout questionnaire (P>0.05). The mean of academic dissatisfaction was higher in men than in women (p = 0.01). With regard to the place of residence, the mean score of inefficiency in the student home was significantly higher than that of the dormitory (p = 0.04). Conclusion: The results of the study showed that a significant percentage of students suffer from academic burnout. In this study, female gender played a protective role in the dimension of academic dissatisfaction and living in a dormitory in the area of inefficiency.

Background:The responsibility of breaking bad news (BBN) to patients is one of the most difficult tasks of a medical profession.Aim:The current study aimed to investigate the preferences of mothers of children with cancer about BBN.Materials and Methods:In this cross-sectional study was conducted in Mashhad during years of 2016, 62 mothers of children with cancer at Dr-Sheikh hospital were recruited by convenience sampling and completed a questionnaire including demographic data and 20 questions about the mothers’ preferences to BBN. Data displayed as percent by SPSS V20 software.Results:Mothers preferred that BBN conducted by their child's doctor (93.5%), with an emotional and compassionate way (83.9%), and in a private setting (90.3%). Be told completely about the process of diagnosis (98.4%), meet people with similar conditions (83.9%), receive psychological (85.5%), and religious (79%) support after getting bad news, being in touch with a close relative (82.3%) and applying another term-like malignancy instead of cancer (95.5%).Conclusion:We tried providing helpful information for developing national guidelines about how to breaking news in Iran, by doing this study.