Assessment inequality in access to public cardiovascular health services in Iran.

Background: Timely access to cardiovascular health services is necessary to prevent heart damages. The present study examined inequality in geographical distribution of cardiovascular health services in Iran. Methods: Present study is a cross-sectional study conducted using demographic data from all Iranian provinces (31 provinces) from 2012 census by the Statistics Center of Iran (SCI). The Gini coefficients of CCU beds and cardiologists were used to assess equality in access to cardiovascular health services in Iran. MS Excel software was used to calculate Gini coefficients. Results: The proportions of CCU bed and cardiologist per 100,000 population were 4.88 and 1.27, respectively; also the Gini coefficients were 0.129 and 0.045, respectively. Conclusion: Descriptive statistics showed a skewness in distribution of pubic cardiovascular health services in Iran, though Gini coefficient revealed no significant inequality. However, equal distribution of CCU beds and cardiovascular specialists does not mean they are sufficiently available in Iran.

Determination of vancomycin minimum inhibitory concentration for ceftazidime resistant Streptococcus pneumoniae in Iran.

BACKGROUND: In the context of growing health concerns over antibiotic resistance, the evaluation of the minimum inhibitory concentration (MIC) of vancomycin for Streptococcus pneumoniae (S. pneumoniae) strains resistant to ceftazidime becomes important for guiding health policy makers. The aim of this study was to determine vancomycin MIC of ceftazidime resistant S. pneumoniae strains. METHODS: Fifty identified serotypes of ceftazidime resistant S. pneumoniae strains were included in the study. The vancomycin MIC of the above mentioned bacteria was determined based on the 0.5 McFarland standards, by using a microdilution broth and the Etest method. RESULTS: The results showed that out of 50 ceftazidime resistant strains of S. pneumoniae, 46 strains (92%) have shown a vancomycin MIC ≤0.19 - 0.1.5 µg/ml and only four strains (8%) have shown a vancomycin MIC equal to 1.5 µg/ml and the related maximum zone of inhibition was of 10 millimeter diameters. CONCLUSIONS: The results of this investigation point out the emergence of S. pneumoniae strains with a vancomycin MIC ≥1.5 µg/ml, which were resistant to ceftazidime. This finding uncovers a major health concern: a vancomycin MIC higher than 1.5 µg/ml and maximum zone of inhibition of only 10 millimeter. These findings represent an important warning for health authorities globally, concerning the treatment of patients, as the occurrence of S. pneumoniae strains with decreased vancomycin susceptibility has been demonstrated.

Bacteriological Aspects of Hand Washing: A Key for Health Promotion and Infections Control.

The aim of this review is to show the historical aspects of hands washing for healthy life and explains how can reduce the transmission of community-acquired infectious agents by healthcare workers and patients. This review article is prepared based on available database. The key words used were hands washing, risk assessment, hands hygiene, bacterial flora, contamination, infection, nosocomial, tap water, sanitizer, bacterial resistance, hands bacterial flora, washing methods, antiseptics, healthcare workers, healthcare personnel, from PubMed, ScienceDirect, Embase, Scopus, Web of Sciences, and Google Scholar. Data were descriptively analyzed. The insistence on hand washing has a history of 1400 years. The research results indicate that the bacteria released from the female washed hands in wet and dry condition was lower than from the male's hands with a significance level (3 CFU vs. 8 CFU; confidence interval 95%, P ≤ 0.001). The valuable results of the study indicated that released amount of bacterial flora from wet hands is more than 10 times in compared to dry hands. In addition, established monitoring systems for washing hands before and after patient's manipulation as well as after toilet were dominant indices to prevent the transfer of infectious agents to the patients. Increasing awareness and belief of the healthcare workers have shown an important role by about 30% reduction in the transfection. Hand washing could reduce the episodes of transmission of infectious agents in both community and healthcare settings. However, hand washing is an important key factor to prevent transmission of infectious agents to patients. There is no standard method for measuring compliance. Thus, permanent monitoring of hand washing to reduce the transmission of infections is crucial. Finally, the personnel must believe that hand washing is an inevitable approach to infection control.

Simultaneous Molecular Detection of Salmonella enterica Serovars Typhi, Enteritidis, Infantis, and Typhimurium.

BACKGROUND: Salmonella enterica serovar Typhi, as causative agent of typhoid fever, is one of the most important endemic pathogens. Non-typhoidal Salmonella serovars, including Typhimurium, Infantis, and Enteritidis are amongst the most prevalent serotypes worldwide and in developing areas such as Iran. The aim of this study was to apply a uniplex PCR for rapid detection of Salmonella spp., and a multiplex PCR for the simultaneous detection of the four most common Salmonella serovars in Iran. METHODS: Current research was done in 2010 at Molecular Biology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. For detection of Salmonella spp a pair of primers was used to replicate a chromosomal sequence. Four other sets of primers were also designed to amplify the target genes of four Salmonella species including S. typhi, and three non-typhoidal Salmonella spp (S. enteritidis, S. infantis, and S. typhimurium). The assay specificity was investigated by testing 15 different Salmonella serovars and 8 other additional non-Salmonella species. RESULTS: The Salmonella genus-specific PCR yielded the expected DNA band of 404 bp in all Salmonella spp., strains tested. The uniplex and multiplex PCR assays produced also the expected fragments of 489 bp, 304 bp, 224 bp, and 104 bp for serovars Typhi, Enteritidis, Typhimurium, and Infantis, respectively. Each species-specific primer pair set did not show any cross-reactivity when tested on other Salmonella serovars or other non- but related- Salmonella strains. CONCLUSION: Both uniplex and multiplex PCR protocols had a good specificity. They can provide an important tool for the rapid and simultaneous detection and differentiation of the four most prevalent Salmonella serovars in Iran.

Carriage rates of Neisseria meningitidis serogroups: determination among freshmen conscripts before vaccination.

BACKGROUND AND OBJECTIVES: Neisseria meningitidis is transmitted from person-to-person. Thus, close contact with a healthy carrier can facilitate the spread of the bacteria and lead to life-threatening meningococcal disease. The aim of this study was to identify oropharyngeal carriers of N. meningitidis in volunteers preparing for military service before vaccination. MATERIALS AND METHODS: In a cross-sectional study, 226 volunteers entering military service were referred to the Shemiranat Health Center for meningococcal vaccination and assayed. Before vaccination, the participants underwent sampling of the throat using separate swabs. Thayer-Martin Agar medium and microbiological standard methods were used for culture and isolation of the organisms. The bacterial isolates were subjected to DNA extraction and polymerase chain reaction. The obtained data were descriptively analyzed. RESULTS: Out of the 226 (100%) young volunteers, only 18 (8%) yielded Gram-negative diplococci. The results showed the presence of N. meningitidis (carriage rate: 8%) in their oropharyngeal regions. The isolated serogroups were C, A, Y, W-135, and X with frequencies of 50, 22.2, 16.6, 5.5, and 5.5, respectively. DISCUSSION: This study showed that the carriage rate in young volunteers for military service is around 8% before vaccination. Although the rates for serogroups A and C were dominant, the existence of serogroups Y and W indicate the necessary revision of the A/C vaccine. More research is needed to determine serogroup diversity and decrease the risk of meningococcal disease in individual groups.

The Social Determinants of Health in Military Forces of Iran: A Qualitative Study.

Providing effective health interventions and achieving equity in health need to apply the community-based approaches such as social determinants of health. In the military organizations, these determinants have received less attention from the military health researchers and policymakers. Therefore, this study aimed to identify and explain the social determinants affecting the health of military forces in Iran. This was a qualitative study which was conducted in 2014. The required data were collected through semistructured interviews and analyzed through Conventional Content Analysis. The studied sample consisted of 22 military health experts, policymakers, and senior managers selected using purposeful sampling method with maximum variation sampling. MAXQDA.2007 was used to analyze the collected data. After analyzing the collected data, two main contents, that is, "general social determinants of health" and "military social determinants of health," with 22 themes and 90 subthemes were identified as the social determinants of military forces' health. Main themes were religious rule, spirituality promotion policies, international military factors, military command, and so forth. Given the role and importance of social factors determining the military forces' health, it can be recommended that the military organizations should pay more attention to these determinants in making policies and creating social, economic, and cultural structures for their forces.

The Social Determinants of Health (SDH) in Iran: A Systematic Review Article.

BACKGROUND: Many studies have been conducted in Iran in order to investigate the status of social determinants of health (SDH) and their associations with health indicators. This study aimed to review the Iranian studies conducted on SDH. METHODS: A systematic review of all Iranian Persian and English languages articles published between 2005 and 2014 on the SDH was conducted using the search of SID, Iran Medex, Iran Doc, Medline, Embase, Scopus, and Google Scholar databases. The eligibility criteria were studies describing SDH status, designed based on the WHO conceptual framework of SDH, published in Persian or English languages, and full text articles. The structured narrative approach was used to synthesize the data. RESULTS: The entire review process led to the selection of 21 papers. Most of studies had been conducted on the intermediary (38%) and structural (33%) components and determinants in Iran, 4 studies (19%) on the study of all components affecting the health and health inequality and, finally, the minimum number of studies (10%) on the context components and determinants. The focus of 43% of selected studies was on the WHO conceptual framework of SDH and had evaluated this model as an appropriate conceptual framework. CONCLUSION: In order to fill the gap in the scientific evidence of SDH and make appropriate policies and plans in Iran, it is needed to conduct studies on all SDH according to the WHO conceptual framework.

The Prevalence of IS Aba 1 and IS Aba 4 in Acinetobacter baumannii Species of Different International Clone Lineages Among Patients With Burning in Tehran, Iran.

BACKGROUND: Multidrug resistant strains of Acinetobacter baumannii (MDR-AB) have emerged as alarming nosocomial pathogens among patients with burning. OBJECTIVES: The current study aimed to determine the susceptibility of A. baumannii species, carbapenems resistance patterns, and their association with IS Aba 1 and IS Aba 4 elements upstream of the bla OXA-like genes, and the distribution of international clone (IC) of A. baumannii isolates among patients with burning in Tehran, Iran. MATERIALS AND METHODS: In the current study, 62 A. baumannii species isolates from patients with burning in Tehran, Iran, in 2012 were evaluated for the antimicrobial susceptibility, genetic relationships, ICs, carbapenemase encoding genes, and insertion elements IS Aba upstream of bla OXA-like genes. RESULTS: The highest rates of susceptibility were observed with colistin (88.7%) and tigecycline (82.2%). The extensively drug-resistance and pan drug-resistance were observed in 37.1% and 8.1% of the isolates, respectively. About 98.3% of 17 genotypes categorized into three distinct clusters. Thirty-six of the 62 isolates (58%) belonged to the IC II lineage. The most prevalent acquired OXA-type carbapenemase was bla OXA-23-like (62.9%). IS Aba 1 and IS Aba 4 were detected upstream of bla OXA-23-like genes in 45.1% and 12.9% of isolates, respectively. In 32.2% of all isolates, IS Aba 1 laid upstream of bla OXA-51-like genes. The PCR results were negative for carbapenemase genes of Ambler class A and B, except bla VIM-2 . (1.6%). CONCLUSIONS: It was the first study that attempted to detect the insertion elements IS Aba and IC lineages in MDR-AB species isolated from patients with burning in Iran.

Challenges of the health research system in a medical research institute in Iran: a qualitative content analysis.

BACKGROUND & AIM: Medical research institute is the main basis for knowledge production through conducting research, and paying attention to the research is one of the most important things in the scientific communities. At present, there is a large gap between knowledge production in Iran compared to that in other countries. This study aimed to identify the challenge of research system in a research institute of medical sciences in Iran. MATERIALS & METHODS: This was a descriptive and qualitative study conducted in the first 6 months of 2013. A qualitative content analysis was conducted on 16 heads of research centers in a research institute of medical sciences. The required data were gathered using semi-structured interviews. The collected data were analyzed using MAXQDA 10.0 software. RESULTS: Six themes identified as challenges of research system. The themes included barriers related to the design and development, and approval of research projects, the implementation of research projects, the administrative and managerial issues in the field of research, the personal problems, publishing articles, and guidelines and recommendations. CONCLUSION: Based on the results of the present study, the following suggestions can be offered: pushing the research towards solving the problems of society, employing the strong executive and scientific research directors in the field of research, providing training courses for researchers on how to write proposals, implementing administrative reforms in the Deputy of Research and Technology, accelerating the approval of the projects through automating the administrative and peer-reviewing processes.

Design of PCR-based method for detection of a gene-encoding Mycoplasma arthritidis mitogen superantigen in synovial fluid of rheumatoid arthritis patients.

BACKGROUND AND OBJECTIVES: Mycoplasma arthritidis mitogen (MAM) superantigen has been shown to induce chronic arthritis, which resembles human rheumatoid arthritis (RA) in a rodent model. However, its role as a causative agent in human RA is not well understood yet. The aim of this study was to investigate the presence of MAM superantigen gene in the synovial fluid (SF) of RA patients. MATERIALS AND METHODS: The MAM superantigen gene a reference was synthesized based on GenBank Data base (Gene ID: 6418105). Specific primer pairs were designed and PCR amplification was performed for MAM superantigen gene detection. A total of 133 SF samples of RA patients were assayed. The PCR products were subjected to sequencing and were descriptively analyzed. RESULTS: The results of the PCR product sequencing showed the method has objective applicability and accuracy. The sensitivity of the PCR reaction for the reference DNA template was 1ng/ml. The PCR results assay of the 133 SF samples raveled that, 9.7% and 22.5% of them were positive for the MAM superantigen gene and Mycoplasma pneumoniae (M. pneumoniae), respectively. CONCLUSION: In this study, two Mycoplasma genomes were detected with increased frequency in RA SF patients' samples. This finding appears to be a promising instrument in the etiological diagnostic of RA patients and could also lead to improved treatment selection. Further research on the other Mycoplasma species present in the SF of RA patients is essential.

Development of Multiplex PCR for Simultaneous Detection of Three Pathogenic Shigella Species.

BACKGROUND: Shigella species are among the common causes of bacterial diarrhoeal diseases. Traditional detection methods are time-consuming resulting in delay in treatment and control of Shigella infections thus there is a need to develop molecular methods for rapid and simultaneous detection of Shigella spp. In this study a rapid multiplex PCR were developed for simultaneous detection of three pathogenic Shigella species. METHODS: For detection of Shigella spp., a pair of primers was used to replicate a chromosomal sequence. Three other sets of primers were also designed to amplify the target genes of three most common species of Shigella in Iran including S. sonnei, S. flexneri and S. boydii. The multiplex PCR assay was optimized for simultaneous detection and differentiation of three pathogenic Shigella species. The assay specificity was investigated by testing different strains of Shigella and other additional strains belonging to non Shigella species, but responsible for foodborne diseases. RESULTS: The Shigella genus specific PCR yielded the expected DNA band of 159 bp in all tested strains belonging to four Shigella species. The standard and multiplex PCR assays also produced the expected fragments of 248 bp, 503 bp, and 314 bp, for S. boydii, S. sonnei and S. flexneri, respectively. Each species-specific primer pair did not show any cross-reactivity. CONCLUSION: Both standard and multiplex PCR protocols had a good specificity. They can provide a valuable tool for the rapid and simultaneous detection and differentiation of three most prevalent Shigella species in Iran.

Invasive Pneumococcal Disease (IPD) Serotype Frequency in Iranian Patients.

BACKGROUND: Streptococcuspneumoniae as a Gram positive diplococcic is a major worldwide causative agent of morbidity and mortality among young children and the aged. In addition, Streptococcus pneumoniae is a versatile human pathogen causing infectious disease ranging from mild infection (i.e. otitis media) to life therating pneumonia and meningitidis in many countries. OBJECTIVES: The aim of this study was to determine the frequency type of Streptococcuspneumoniae in Invasive pneumococcal disease (IPD) in Iranian patients. PATIENTS AND METHODS: A total of 135 Streptococcuspneumoniae strains were isolated from patients infectious suspected of invasive streptococcal disease. They were subjected to PCR and bacteriological methods. Out of which, 134 strains of S. pneumoniae were serotyped and confirmed by PCR method. The data were analyzed by SPSS version 17.0. RESULTS: The results of this study showed some S. pneumoniae serotypes were found in both sexes and some only in one sex invasive infections. For example, serotypes 10, 14, 18 and 22 were only in female patients with infections. CONCLUSIONS: The analysis of the results had suggested that serotypes 6 from Lung and 19 from Eye are the most abundant bacterial strains isolated from patients. The diseases could be prevented by using the Pneumococcal vaccine.

Serotype distribution and antibiotics susceptibility pattern of Streptococcus pneumonia in Iran.

BACKGROUND: The development of antibiotic resistance among Streptococcus pneumoniae strains has caused significant health problems worldwide. OBJECTIVES: The aim of this study was to determine antibiotic resistance pattern and serotypes distribution of Streptococcus pneumoniae strains isolated from clinical specimens. MATERIAL AND METHODS: A total of fifty Streptococcus pneumoniae strains were isolated from Tehran Hospital's laboratory from 2008 to 2012. Antimicrobial susceptibility testing was performed using broth microdilution method and minimum inhibitory concentration (MIC) of each strain was determined. to verify the resistant strains and demonstrate the presence of antibiotic resistant genes, the PCR was performed. RESULTS: The study showed that three strains (6%) and six strains (12%) indicated intermediate resistance and complete resistance to penicillin, respectively, 58% strains were susceptible to ceftazidime, two ones (4%) indicated resistance to ciprofloxacin, one (2%) indicated intermediate resistance to ceftriaxone , two strains (4%) indicated complete resistance and four (8%) strains indicated resistance to vancomycin. CONCLUSIONS: The emergence of Streptococcus pneumoniae strains with multiple resistance needs permanent monitoring of antibiotic susceptibility patterns of clinical isolates. We have found that ceftazidime is not a suitable drug for choosing the treatment of pneumococcal infections.

Bacterial meningitis: a new risk factor.

BACKGROUND: The purpose of this study is to discuss a possible new risk factor for the bacterial meningitis. METHODS: Cerebrospinal fluid collected from 270 patients was assayed. An enzyme immunosorbent assay for the detection of Staphylococcal enterotoxins A to E was used. RESULTS: The results indicated that the frequency of Coagulase Negative Staphylococci (CoNS) was 35 (20.46%). An important finding of this research was that the CoNS isolates produced enterotoxin C and D or enterotoxin C and E. CONCLUSIONS: This is the first report of enterotoxin-producing Coagulase Negative Staphylococci isolated from CSF patients. Therefore, these enterotoxins probably act as risk factors in the bacterial invasion into central nervous system.