Tehran University Medical Journal

Background: Anemia is one of the most important nutritional disorders among children and adolescent in Iran and developing countries. Despite the possibility of anemia prevention, there is a high proportion of this problem in school children and especially infants. The aim of this study was to determine the prevalence rate of anemia in 6 to 12 months old children.
Methods: This was a cross-sectional study that conducted between May 2016 and October 2016 in Tabas health centers, South Khorasan, Iran. In this study 911 infants aged 6 to 12 months were enrolled by census method. Demographic variables and all blood factors were collected through interviews and laboratory tests in Tabas health centers, respectively. In this study, cut-off point of <11 g/dl for hemoglobin was considered as anemia index. All Statistical analyses were done using descriptive statistics, chi-square tests and Pearson correlation in SPSS software, version 22 (SPSS Inc., Chicago, IL, USA). P-value of 0.05 was considered as level of statistical significance.
Results: The mean age of individuals was 9±1.5 months, the mean current weight and the mean weight at birth time were 8678±1112.1 g and 3090±467.9 g, respectively. According to World Health Organization (WHO) criteria, the prevalence rate of anemia in Tabas City was estimated 37.1%. The prevalence rate of anemia in age groups based on hemoglobin, mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) indices had a significant decreasing trend (P=0.001). Prevalence rate of anemia in males and females was not significantly different (P=0.27). Moreover prevalence rate of anemia was higher in rural areas rather than urban areas (P=0.009).
Conclusion: This is the first assessment of anemia prevalence among children in east of Iran. As a result of estimated prevalence of anemia, based on WHO definition, revealed moderate public health importance among infants aged 6 to 12 months old. The deceasing trend of anemia based on age groups indicates the importance of iron supplementation in Iran, especially in developing countries.

Background: Due to the incidence and recurrence of bladder cancer (BC), it could be categorized as a clinical and social problem that often occurs at an advanced age. This study was designed to determine the incidence of BC in Isfahan, Iran.
Methods: A retrospective descriptive survey of information based on bladder cancer (ICD-O, third edition; C67) was obtained from the Isfahan Deputy of Health. The study was in conducted to the department of Urology and Kidney Transplantation Research Center and approved by the University Ethics Committee. The Isfahan Cancer Program is intended to record all cancer cases in the Isfahan. From 20 March 2016 to 19 March 2017, records with linkage to using of pathology, demographic and clinical information were recorded in Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA) and analyzed by SPSS statistical software, version 22 (IBM, Armonk, NY, USA). The incidence rates (Irs) were calculated by dividing new cases of BC during the year of study to the population at risk during the same time period×100000.
Results: A total of 417 patients that corresponded to Irs of 8 per 100000 persons were studied. The overall recorded number was comprised of 361 males (IRs of 13.9 per 100000) and 56 females (Irs of 2.2 per 100000). The mean±SD age of patients was 64.7±13 years. The minimum age in males versus females was 12 versus 25 years old respectively. Age in the most patients (80% of cases) was more than 50 years old. The invasion of the muscle was recorded in 44% of cases. Geographical distribution in 65% of cases was related to Isfahan City as a place of birth-residence and in the next categories were Khomeinishahr (7.6%), Najafabad (6.8%), Lenjan (4.5%), Mobarekeh (3.7%) and Felavarjan (2.8%) respectively.
Conclusion: Comparison of BC incidence rate between the year 2014 and 2016 showed that incidence rates decreased by 18.2%. In the 44%, invasive neoplasm of BC was recorded for the population studied. The highest frequency of BC was associated with Isfahan City and then Khomeinshahr, Najaf abad, Lenjan, Mobarakeh and Falavarjan.

Background: The new version of relative values of diagnostic medical services was published in 2014. It was criticized that the previous edition was suffering from an imbalance between relative values related to various specialties and sub-specialties. The main aim of the new edition of the book was to address this problem by providing more balance relative values related to various specialties and sub-specialties. So far, there have not been studies to analyze to what extent the new addition has been succeeded to reach its main goals. The aim of this study was to provide a cross-specialty analysis of the new edition of Iranian relative values for physicians. To our knowledge, this analysis has been performed for the first time in Iran.
Methods: Having reviewed description for each relative value, each of them has been assigned to one or more corresponding specialty or subspecialty. Only relative values for surgical operations were considered and finally 3238 procedures have been recognized to be included in the analysis. The latest version of Iranian relative values for physician was considered for this analysis. In order to compare the average relative values among various specialties and subspecialties, analysis of variance (ANOVA) and Tukey's post-hoc test was used.
Results: Oral and maxillofacial surgery and neurosurgery get the highest (62.81, 60.47 (P<0.001)) and ophthalmology and obstetrics and gynecology get the lowest (28.95, 28.81 (P<0.001)) average relative value. Cardiovascular surgery and plastic surgery get the highest and the lowest (85.25, 50.51 (P<0.001)) average among subspecialties, respectively.
Conclusion: The average relative values are significantly different among specialties and subspecialties. Seeing the difference, itself sounds logical as the job of relative values are to make a difference based on various criteria such as the time and skill needed for each operation, the potential risk for patient and provider it may have, etc. The results of this study provide evidences on how much these differences are. However, if these differences are as there should be needs to be analyzed by further research.

Background: With increasing immunocompromised patients, fungal infections especially lung infection, have also increased. In this study, fungal contamination of the respiratory system in immunocompromised patients was evaluated.
Methods: This descriptive cross-sectional study was conducted in immunocompromised patients suspicious of pulmonary infections referring to specialized lung clinic of Amir-Al-Momenin University Hospital in Arak City, Iran, from April 2017 to June 2018. Of these 64 patients, including 35 women and 29 men, were selected. After recording the demographic information, a bronchoalveolar lavage (BAL) sample was prepared by the physician from these patients and was immediately sent to the medical mycology laboratory, school of medicine. Bronchoalveolar lavage specimens were investigated by Grocott-Gomori's methenamine silver (GMS) staining and culture method. Data were analyzed by SPSS software, version 16 (IBM SPSS, Armonk, NY, USA).
Results: Of 64 patients, 9 (14%) were infected with pulmonary fungal infections. Among the patients infected with fungal infection, 9 (100%) were positive in the culture examine and 8 (72%) by GMS staining. Among infected people, 7 (77.8%) were female and 2 (22.2%) were male. The most common isolated fungi were Candida albicans, Aspergillus fumigatus and Mucor species (2 cases). The highest infection was seen in the age group of less than 60 (33.3%). 66.7% of infections were among the unemployed persons and 33.3% of other cases of infection were seen in people with free jobs, workers and employees. The most important factors in the development of pulmonary fungal infections in the patients were: 5 cases of malignancy (33.3%), corticosteroid use in 2 cases (33.3%), tuberculosis in 1 case (22.2%) and diabetes mellitus in 1 case (11.2%). There was no significant relationship between fungal contamination with sex, age, occupation, marriage and type of disease.
Conclusion: The results of this study showed that immunocompromised patients are prone to fungal infections, especially Candidiasis and Aspergillosis. Therefore, the use of control methods to reduce the probability of such patients to fungal infections should be considered.

Background: Unnecessary patient admission to a hospital refers to the hospitalization of a patient without clinical indications and criteria. Various factors related to the patient (e.g., age, disease severity, payment method, and admission route and time), the physician and the hospital and its facilities and diagnostic technologies affect a patient unnecessary admission in a hospital. Unnecessary patient hospitalization increases nosocomial infections, morbidity and mortality, and decreases patient satisfaction and hospital productivity. This study aimed to measure unnecessary patient admissions in hospitals in Iran.
Methods: This study was conducted using a systematic review and meta-analysis at Tehran University of Medical Science in August 2019. Seven electronic databases were searched and evaluated for original research papers published between March 2006 and 2018 on patients’ unnecessary admission to a hospital. Finally, 12 articles were selected and analyzed using comprehensive meta-analysis software.
Results: All studies used the appropriateness evaluation protocol (AEP) for assessing patients’ unnecessary hospitalization in the hospitals. Overall, 2.7% of hospital admissions were rated as inappropriate and unnecessary (CI 95%: 1.5-4.9%). The highest unnecessary patients’ admissions were 11.8% in a teaching hospital in Meshginshahr city in 2016, (CI 95%: 8.8%-15.8%) and the lowest unnecessary patients’ admissions was 0.3% in a teaching hospital in Yasuj city in 2016 (CI 95%: 0%-3.6%). Unnecessary patient admission in public hospitals was higher than private hospitals. A significant statistical correlation was observed between unnecessary patient admission, and sample size (P<0.05).
Conclusion: The rate of unnecessary hospital admission in Iran is low. However, hospital resources are wasted due to unnecessary admissions. Expanding the primary health care network, reducing hospital beds, introducing an effective and efficient patient referral system, using a fixed provider payment method, and promoting residential and social services care at macro level, and establishing utilization management committee, using the appropriateness evaluation protocol, establishing short-stay units, and implementing quality management strategies at the hospital level are useful strategies for reducing avoidable hospital admissions.

Background: One of the most important criteria of the development of countries at the national and international levels is the survey of scientific productions indexed in authentic databases. This study aimed to analyze the scientific productions by Iranian researchers on gastroenterology and hepatology in the Web of Science (WOS) database.
Methods: This applied study used a scientometric approach to review the scientific productions by Iranian researchers on gastroenterology and hepatology in the WOS database. Therefore, the total number of scientific documents related to the category of gastroenterology and hepatology, Iran, and other countries were recovered. The time frame was until the end of 2017. Data were collected in April 2018. This research was conducted at the Clinical Research Unit in Afzalipour Medical Center in Kerman, Iran.
Results: The results showed that during 1983 to 2017, the total number of 2180 scientific productions (0.31%) on gastroenterology and hepatology were published in Iran, ranking the country 34th in the world. Compound annual growth rate (CAGR) in Iranian scientific publications was 9.5%. The «Tehran University of Medical Sciences» was identified as the most productive center in gastroenterology and hepatology field with a contribution rate of 35.69%. The results also showed that the most international collaboration of Iranian researchers on gastroenterology and hepatology field was with the United States of America (USA) scientific centers (5.82%). Most articles in the field of gastroenterology and hepatology (26.69%) were published in the «Hepatitis Monthly» journal. Most scientific productions in this field were related to the microbiology. The majority of scientific productions on gastroenterology and hepatology field were published in the form of article. Most scientific productions by Iranian researchers on gastroenterology and hepatology in the Web of Science (WOS) database were in English language.
Conclusion: Results showed that although compound annual growth rate (CAGR) in Iranian gastroenterology and hepatology publications was high rather than gastroenterology and hepatology scientific productions CAGR in the world, it’s not satisfying. Most articles have published in journals with low impact factor. Therefore, we should resolve the problems and increase the scientific level of researches.

Background: The position of each subject area in scientific production can indicate the ability of the scientific performance of that subject field. Since obstetrics and gynecology is one of the most important clinical sciences discipline of medical science, this study aimed to evaluate the scientific production in the field of obstetrics and gynecology before and after the Iran health reform plan.
Methods: This study is a scientometrics, time interval in the study was from 2008 to 2017 on Iranian articles based on the indexes of the number of documents, the number of citations received, the number of citations to each article, and the H-index of obstetrics and gynecology field based on the Web of Science database. It Indicators investigated, was extracted separately from the analysis section of the database.
Results: The average citation per article, the number of documents and the number of citations in the 5 years before the health reform plan respectively in the field of obstetrics and gynecology equal to 10.44, 196.6, 1750.6 and after the implementation of the health reform plan, equal to 3.89, 282.6, 1031.4. Also, the level of international collaboration before and after the project is 13.06 and 13.25, respectively. Also in the field of gynecology and obstetrics, Ramezani Tehrani, with 1.91% of all articles was the most reproductive writer, and Tehran University of Medical Sciences, with the highest scientific productions in the field of obstetrics and gynecology by 23.77% of all productions. Finally, the field of obstetrics and gynecology had the highest share of scientific production by 66.88%.
Conclusion: The findings showed that the scientific production of obstetrics and gynecology, in terms of quantity (number of documents), after the health reform plan, has been growing, but the quality (citation, H-index) is decreasing. Also, international collaboration has grown after the health reform plan. The findings also showed that before and after the health reform plan, the most cooperation was with the United States and the rate has been lower with Asian countries.

Background: AIDS is an emerging disease, and despite the fact that it has not been recognized for the first half-century since its inception, it has been known as a century-old disaster. This disease, by proliferation in immune cells and ultimately by weakening the immune system, makes people vulnerable to diseases. Our study seeks to examine existing cases of HIV/AIDS patients in East Azerbaijan province in Iran and provides useful guidance for patient diagnosis, treatment, and care.
Methods: This is a descriptive-analytic study in which the target group includes all HIV-positive or AIDS patients identified or reported from 2004 to 2014 in Tabriz Medical Sciences or Health Centers of East Azerbaijan province. The demographic information of all patients were recorded by a researcher-made questionnaire during visiting the disease-management counseling centers. All data including transmission of the illness (including all possible ways), the diagnostic date, the onset of treatment and the date of death were collected, and then entered into the software Stata, version 11.0 (Stata Corp., College Station, TX, USA). The information were imported in the ArcGIS software, version 10.7.1 (ESRI Inc., Redlands, CA, USA), maps were created, and geographic and spatial data were analyzed.
Results: According to the results of this study, most patients with 89.9% were male, 28.9% were under the age of 36 years, 32.3% had elementary education, and the most common way of transmission with 42.3% is through the shared infusion.
Conclusion: According to the results of this study, the highest prevalence of AIDS in East Azerbaijan province was observed in men under the age of 36 years and primary and lower secondary education in Tabriz and Maragheh cities.

Background: Discharge with personal satisfaction means the patient's withdrawal from the permission that had previously been given to the care unit for services. Discharge with personal satisfaction is initiated with the untimely termination of treatment by the patient or parents and in some cases leads to hospitalization or even death of the patient. This study aimed to determining the main causes of discharge with personal satisfaction in hospitalized patients.
Methods: The present cross-sectional study examines at hospitalized patients of Amiralmomenin Hospital in Zabol, Iran, to examine the reasons discharge with personal satisfaction in relation to the patient, hospital staff and the housing status of the hospital during the period from April 2017 to March 2018. All clearance patients with personal satisfaction entered the study. Demographic data, insurance status, type of insurance (social security, health services, resettlement, relief, armed forces, maternity, maternity, other supplementary insurance), number of admission days, hospital admission (morning, evening, night), type of illness or cause of referral (multiple trauma, surgery, orthopedics, neurology, neurology), the reason for possible re-admittance within the next two weeks and the main reasons for clearance with personal consent was collected and recorded using a pre-designed checklist.
Results: The most of the cases of which were due to neurological complaints (51%). 803 (80%) of patients referred back to the hospital due to self-correlated problems, 163 (16%) patients were hospital left with satisfaction due to the hospital-made staffing problem (P=0.001). The results of the study showed that the highest frequency was related to male (67%) and most of them were married (84%), while most of them had insurance (74%), especially army and municipality insurance (34%).
Conclusion: Based on the results of the present study, most cases of discharge were patient related. Adequate recovery feeling and the desire to continue treatment in private centers were the main causes.

Background: Today, due to changes in human lifestyle and consumer demand incidence of foodborne diseases is on the rise. The aim of this study was to investigate the mortality rate of foodborne diseases and their related factors.
Methods: In this cross-sectional study, data on deaths registered according to the International Classification of Diseases (ICD-10th revision) were extracted from death registration and classification of causes system in the Ministry of Health and Medical Education of Iran from 2011 to 2018. Data on deaths from food and water borne diseases including Salmonella, Shigella, Escherichia coli O157:H7, Staphylococcus aureus, Clostridium botulinum, and other foodborne diseases were extracted from database of death registration and classification of causes system. The demographic variables of dead people considered in this study include age (under 5 years, 5-20 years, 20-40, 40-60s and over 60 old), gender, nationality, and the location where people died (urban, rural and unknown).
Results: The majority of deaths cases occurred at the age of 60 years and in older age groups (P<0.001). The results show that across all the age groups mortality rate from foodborne diseases was higher among men than among women (P=0.110). Most of foodborne diseases were reported by people living in urban areas (P<0.0001). The results of this study showed that most of the deaths from these diseases occur in the warm seasons. In this study, the crude death rate was 10 cases per one million inhabitants.
Conclusion: The results of this study showed that there was a significant difference between the mortality rate due to different bacterial agents. This study suggests that demographic variables are important predictors of mortality from foodborne illness and should be further investigated.

Background: Long after the implementation of the “Health System Transformation Project”, no comprehensive assessment of patient and nurse satisfaction rate has been carried out in Iran based on available databases. Thus, this review study was designed and performed to answer this question: “How is the evaluation of the Health System Transformation Project in nurse and patient satisfaction dimensions.”
Methods: A systematic review of related studies based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was performed via keywords such as “Health System Transformation Project”, “Transformation Project”, “health”, “Iran”, “challenges”, “physician”, “nurse”, “patient”, and “satisfaction” to search Iranian (Magiran and Scientific Information Database, SID) and international databases (PubMed, ISI web of knowledge, Scopus, Google Scholar, and ProQuest) with OR and AND operators from March 2014 to April 2019. Also the quality of studies was assessed using STROB checklist (special for cross-sectional studies). Then required information (for example type of studies, sample size, mean age of participants and satisfaction score) were gathered from studies.
Results: From 43 articles that were gathered from primary stages, 18 articles were selected after passing different screening levels. On average, the level of patiaent satisfaction with the Health System Transformation Project was acceptable. Ghazvin province was seems more successful in satisfaction of patients against of other provinces. However, various positive and negative reports were found about the satisfaction of nursing groups. Generally, it seems that Tehran province (at the center of Iran) was more successful in performing the Health System Transformation Project (from the aspect of satisfaction of different groups).
Conclusion: Based on obtained results, patient’s satisfaction was appropriate in most of studies and also in nursing group was under average level.

Background: Guillain-Barré syndrome is an autoimmune inflammatory disease, which manifests itself as an acute motor weakness of the organs, diagnosed as affecting the motor spinal nerve roots generally and causing muscle and motor weakness, the cause of this disease is the presence of active antibodies against the myelin sheath around the spinal nerve roots. Guillain-Barré syndrome is the most common and most severe unpleasant neuropathy that affects about 100,000 people worldwide annually.
Methods: This is a descriptive analytical study, the data of 354 admitted patients were reviewed and 262 cases, which matched the criteria for entering the study, was included. The criterion for entering the study was clinical diagnosis.Required information were included age, sex, complaints of disease, and visitation period. Data was analyzed by using Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA) and study was performed on Imam Reza and Farabi Hospitals of Kermanshah in Iran, from March 1993 to February 2013.
Results: 59.5% were male and 40.5% female, and the mean age of the patients was 44.6±22.9. The most affected individuals were at the age of 30-50 and the highest prevalence was observed in spring. Acute inflammatory demyelinating poly-radiculoneuropathy with 53.4% was the most common backward disorder in patients and 5.7% among deaths among patients.
Conclusion: The results of the present study showed that Acute inflammatory demyelinating poly-radiculoneuropathy had the highest prevalence in patients and decreased with increasing age, and this syndrome was more prevalent in the spring.

Background: Studying and evolution of medical sciences is so important to draw up the future path with a view to per capita of science production. The purpose of this study was to clarify the status and position of Iran in science production and compare it with four competitor countries of the region for 2025.
Methods: This research is conducted using the scientometric method our ranked citations and ranked document data collection source is the SCImago database. The statistical population is the priority fields of Iran health program, which has 25 field names In three categories: infrastructure, survival, perfection, compared with the four competitor countries in the Middle East. The evaluated time period is examined are from 2010 to 2017. Data analysis is performed using Excel software.

Background: Infectious diseases in the pandemic stage have significant life-threatening, psychological and social effects. Identifying the characteristics associated with people's cooperation in self-care leads to greater immunity for themselves and others. Therefore, this study was conducted to predict the self-care of the Iranian people according to their individual and social characteristics in face of the Covid-19 pandemic.
Methods: A survey study was conducted on 1056 adults aged 18 and over in different provinces of Iran through a form of answering online researcher-made questions (n=40, α=0.9) in social networks in four days. This paper studies the level of self-care of people against Covid 19 pandemic which was conducted with the support of Isfahan University of Medical Sciences in April 2016. Data were analyzed using Student t-test and variance. Moreover, "decision tree technique" was used to identify communication patterns.

Background: Health insurance literacy is a nascent concept that has emerged mainly after the implementation of the law known as Obamacare in the United States. This study seeks to identify the themes of health insurance literacy in Iranian society.
Methods: The study approach is qualitative. Data were collected using nine semi-structured interviews, ten focal group meetings with the presence of 86 experts of an insurance organization and a specialized meeting with fifteen academic experts, from September to December 2018 at the organization's location. MAX QDA10 software was used to organize the data. Qualitative data analysis was performed using continuous comparison analysis and in the form of directional qualitative content analysis based on the conceptual model (Paez et al 2014). Coding was performed independently by two researchers and then collected. Results were reviewed by an external observer. Finally, in a specialized meeting with the participation of representatives of specialized (groups secretaries) and academic experts(participants in the initial interviews), the findings of the study were re-examined and confirmed

Background: Medical malpractice is a serious problem in the health care system. This study aimed to review the medical negligence in Iran.
Methods: Based on the PRISMA checklist, a search for scientific records was done separately by two researchers. All the articles that had selection criteria were evaluated in terms of methodological quality. Medical malpractice was assessed in four main divisions including negligence, Lack of skill, Carelessness and non-compliance with government regulations). The bias test was performed using the Egger’s test. Revman software was used to analyze the data.
Results: In the present study, 25 studies that examined the country's medical malpractice from April 1994 to March 2018 were included in the meta-analysis. Negligence has been implicated in 1,105 cases of the 2,068 claims. Lack of skill in 255 out of 2068 cases, 432 cases of carelessness and 244 cases of non-compliance with government regulations Were recorded the results of the meta-analysis showed that OR negligence was 0.76 (CI 95%: 0.66-0.87), lack of skill was 0.61 (CI 95%: 0.49-0.76), carelessness was 0.62 (CI 95%: 0.50-0.76) and non-compliance with government regulations was 0.66 (95% CI: 0.60-0.73). In the review of the confirmed negligence ratio of the registered complaint files, only 19 studies mentioned this ratio. The results of the meta-analysis of these 19 studies showed that the OR ratio of the confirmed negligence of complaints was 0.6 (95% CI: 0.41-0.86). From all claims, General surgeons had OR of confirmed medical malpractices, equal to 0.47 (CI 95%: 0.37-0.60), gynecologists with OR equal to 0.49 (CI 95%: 0.36-0.66), general practitioners with OR equal to 0.43 (CI 95%: 0.30-0.63) and orthopedic specialists with an OR of 0.44 (CI 95%: 0.32-0.61).

Background: Hospital accreditation is a systematic external evaluation of a hospital's structures, processes, and outcomes by an independent professional accreditation body using published optimum, evidence‐based, and achievable standards. Accreditation is a strategy for ensuring the quality, safety, and productivity of hospital services. Implementing accreditation standards imposes a high cost on hospitals. Therefore, this cost should be offset by increased hospital efficiency. Hence, this study aimed to examine the relationship between the Iranian public hospitals’ efficiency and their accreditation status.
Methods: This descriptive and cross-sectional study was conducted in May 2019. The efficiency of general hospitals in Iran was assessed using the Pabon Lasso chart and three performance indicators of bed occupancy rate, average patient length of stay and hospital bed turnover. Then, the relationship between the efficiency of hospitals and their accreditation grade was examined. Descriptive statistics and ANOVA tests were used for data analysis using SPSS software.

Background: Asthma is the most prevalent chronic disease in childhood and has been growing globally over the last three decades. Studies in this regard indicate different and irrelevant results in Iran. Different prevalence of asthma has been reported in industrialized countries, prevalence of 25.9% in the United Kingdom, 12.8% in Spain and 31% in Australia. This study aimed to evaluate asthma in Iranian children through systematic review and meta-analysis.
Methods: This study was performed as a systematic review and meta-analysis from January 2001 to December 2018. Related articles to the reviewed subject were obtained through searches of Scopus, ScienceDirect, Magiran, SID, Medline (PubMed), and Google Scholar databases. Cross-sectional studies were selected for inclusion in the study and observational studies as well as review studies were excluded from the study. Searches on Google search engine and the inspection of sites related to the topic were also incorporated to examine the grays literature. Duplicate articles and articles that were similar and obtained from the same source were removed through the EndNote software. The total number of articles was 896. Subsequently, the number of articles and studies that met the requirements of the first stage was 274. Ultimately after the elimination of 236 irrelevant articles and the elimination of 5 articles in the secondary examination, eventually 33 articles were added to the final stage. By the I² index, the heterogeneity of the studies was investigated and reported.

Background: Neck mass is one of the most common clinical findings in all age groups. Differential diagnosis of masses includes a range of pathologies from congenital to infectious or neoplasm. Understanding the risk factors of neck masses can help us to assess them properly. The purpose of this study is to obtain the epidemiological and clinical features of different neck masses in Kerman, Iran.
Methods: This research was a descriptive, retrospective and cross-sectional study. 120 Patients that have been biopsied from neck masses during March 2014 to March 2018  in the otorhinolaryngology department of Shafa hospital of Kerman (referral center of otorhinolaryngology disease of southeastern Iran), were the participants of the study. Data regarding age, sex, history of addiction, smoking and definite pathologic diagnosis were collected and analyzed with SPSS 20^th version.
Results: Of 120 cases, 57.5 % were male and 42.5% were female. In the malignant masses group, the male to female ratio was 4.1 to 1. The average age of patients was 39.44 years old. From them, 20.83 percent had a history of smoking but 79.17 percent had never experienced smoking. In addition, 77.5% of the patients have not experienced opium consumption and 22.5% were addicted to opium regularly. There was a significant relationship between smoking and opium consumption and the incidence of malignant cervical masses (P<0.05). In the pathological study, inflammatory and infectious masses with 48.33 percent were in the head of pathology; malignant neoplasm with 25 percent, benign neoplasms with a prevalence of 12.5 percent and congenital masses with a prevalence of 9.7 percent were in the next ranks.