Seroprevalence of Toxoplasma infection in individuals occupationally exposed to livestock and raw meat: A case-control study.

BACKGROUND: The expectancy of Toxoplasma gondii transmitted from livestock and raw meat to humans is a public health problem and is an example of the One Health theory. OBJECTIVES: This survey aimed to determine the seroprevalence and risk factors related to this common infection in individuals occupationally exposed (IOE) to livestock, raw meat and viscera in industrial slaughterhouses and livestock fields in Isfahan province, central Iran. METHODS: This study is a case-control survey carried out on the 401 serum samples of IOE (including slaughterhouse workers, butchers, veterinarians, veterinary technicians, livestock farmers and farm workers) compared to 401 archived samples of the general population (that all matched with cases by region, age and gender). All 802 samples were investigated for anti-T. gondii IgM and anti-T. gondii IgG using enzyme-linked immunosorbent assay. RESULTS: A statistically significant higher anti-T. gondii IgG occurrence (p < 0.001) was observed in IOE compared to the control group (46.1% vs. 31.4%). According to our knowledge, this is the first case-control study on the seroprevalence of anti-T. gondii in IOE to livestock in central Iran. CONCLUSIONS: These findings show a potentially significant association between T. gondii seropositivity and occupational exposure to livestock. Therefore, it is essential to develop guidelines for preventing disease transmission among IOE to livestock, raw meat and viscera in industrial slaughterhouses and livestock fields.

A large-scale study on the seroprevalence of Toxoplasma gondii infection in humans in Iran.

It is estimated that nearly one-third of the world's human population is infected with Toxoplasma gondii (Nicolle et Manceaux, 1908). Human infection is commonly asymptomatic, multifaceted, and can manifest in severe pathological forms in congenital toxoplasmosis and immunocompromised individuals. This study attempted to recognise the seroprevalence of T. gondii infection in Iranian residents referred to medical laboratories for toxoplasmosis tests throughout the country. This retrospective cross-sectional study was conducted from 2015 to 2019 on individuals referred to diagnostic laboratories in 26 provinces, and these laboratories sent their samples to the referral centres. Accordingly, data associated with serodiagnosis of toxoplasmosis, age, sex, anti-T. gondii IgG, and IgM status in Iranian residents were collected from two referral diagnostic laboratories. All individuals were evaluated using the antibody immunocapture-chemiluminescence assay (CLIA) method with the Immulite®2000s XPi system. In this study, the first large-scale assay of T. gondii infection in Iran, an overall seroprevalence of 30.4% was among 35,047 patients examined. The highest IgM seropositivity rate was in the 10-20 years old patients. In addition, this study showed a very different prevalence of T. gondii across the country, highest in the humid areas, such as the Caspian Sea basin in the North, and the North West with seroprevalence of 48.6%.

Evaluation of the antileishmanial effect of polyclonal antibodies and cationic antimicrobial peptides.

Leishmaniasis is one of the tropical and subtropical diseases which, according to WHO, has the priority of control. The list of anti-leishmanial drugs is limited and requires side effects, high costs, and long-term treatments. Various species, parasite resistance, and simultaneous diseases are among the factors that affect the effectiveness of treatment. Due to these problems and based on satisfactory records of previous studies using antimicrobial peptides (AMPs) against infectious diseases, this study aimed to evaluate the antileishmanial effect of Leishmania-infected macrophage polyclonal antibody (LIMPA) with or without different concentrations (2, 4, 6, 8, 10, 20, 40, 60, and 100 µg/ml) of CM11 and (40, 80, and 100 µg/ml) BufIIIb, two AMPs, in vitro and their therapeutic effects against CL of Balb/c mice. Results showed that LIMPA induced an anti-proliferative effect on Leishmania major growth in macrophages in vitro and intramacrophage-amastigotes in vivo. CM11 with IC50 of 8.73 and 10.10 µg/ml at 48 hours, and BufIIIb with IC50 of 66.83 and 80.26 µg/ml, at 24 hours showed the most significant inhibition of L. major promastigotes and amastigotes. In addition, the CM11 and BufIIIb, with a CC50 of 9.7 µg/ml and 40.34 µg/ml, showed the most significant inhibition effect on the J774.A1 cell line at 48 hours, respectively. In addition, in vivo experiments using LIMPA with a 0.01 mg/kg dosage showed a significant difference (p < 0.001) in the last week of the measurement compared to the control. The results of this study may be a promising prospect for further investigations.

Induction of apoptosis by essential oil of Dracocephalum kotschyi on Trichomonas vaginalis.

BACKGROUND: Trichomonas vaginalis is a protist parasite that causes trichomoniasis, a sexually transmitted disease. Metronidazole is the current treatment for trichomoniasis. However, this drug can provoke severe side effects, and some strains present resistance, making the development of alternative treatments for trichomoniasis urgent. OBJECTIVES: We investigate the use of essential oil obtained from Dracocephalum kotschyi on T. vaginalis. D. kotschyi has antispasmodic and analgesic properties and is well known in Iran. METHODS: The essential oil was obtained by hydrodistillation from 1000 g of the powdered plant. Gas chromatography-mass spectrometry analysis was used for the chemical composition of the essential oil, and 11 substances were identified, corresponding to 91.5% of the oil. Copaene (22.15%), Methyl geranate (16.31%), Geranial (13.78%) and Carvone (11.34%) were the main substances. A cell viability test was used to determine the percentage of growth inhibition (GI%) and the half-maximal inhibitory concentration (IC50) on T. vaginalis after incubation with the prepared essential oil. RESULTS: The oil induced an IC50 of 84.07 µg/ml after 24 h contact with trophozoites. Cytotoxicity was determined by MTT assay on the J774.A1 haematopoietic cell line. In addition, the initial stage of apoptosis was assayed using the fluorescein isothiocyanate Annexin V Apoptosis Detection Kit. Evaluation of the in vitro anti-trichomonal properties of D. kotschyi essential oils showed that it effectively induces apoptosis on T. vaginalis between 100 and 700 µg/ml after 48 h without toxicity on haematopoietic cells, suggesting that D. kotschyi essential oil can induce programmed death in T. vaginalis. CONCLUSIONS: The anti-trichomonal properties of D. kotschyi essential oil indicate that they could be suitable for new pharmacologic studies after new tests with human vaginal epithelial cells.

An observational study to assess circulating nurses' non-technical skills.

BACKGROUND: Non-technical skills are cognitive and social skills that are necessary for safe and efficient practices in operating theatre. These skills are inseparable parts of circulating nurses' duties and help them have a good performance during surgical processes. Circulating nurses' non-technical skills have not been closely measured, and much uncertainty still exists about the quality of their skills. This study aimed to assess circulating nurses' non-technical skills. METHODS: A cross-sectional study was conducted on 300 circulating nurses who worked in four public hospitals in Iran, during 2020. The data of demographics of the studied population were collected using a demographic questionnaire. Kalantari et al's Circulating Practitioner's List of Non-Technical Skills was used to assess the circulating nurses' non-technical skills. RESULTS: The situational awareness domain had the highest score, while leadership was the domain with the lowest mean score. There was a moderate positive relationship between the mean score of non-technical skills and the number of working years as a circulating nurse. CONCLUSION: Although the circulating nurses had a moderate level of non-technical skills, they had low scores in several behaviours. However, they did well in some other behaviours. Educational interventions and policymaking solutions can help improve circulating nurses' non-technical skills.

Molecular characterization and genotyping of Toxoplasma gondii in free-living animals in Iran: Effect of One Health.

To understand the transmission of Toxoplasma gondii, this parasite's genetic diversity distribution in free-living hosts is essential. This research's objective is the molecular genotyping of T. gondii isolates from the brain and muscles of Columbidae, Corvidae, Rattus, and Felidae of Mianeh County, East-Azerbaijan Province, Northwest Iran. Three hundred fifty samples were taken. For the genotyping of T. gondii, the GRA6 gene was amplified and digested by the Tru1I (MseI) enzyme. Results of RFLP were confirmed by sequencing and phylogenetic analysis. In total, 52%, 34%, 24%, and 50% of Columbidae, Corvidae, Rattus, and Felidae were positive for T. gondii DNA, respectively. All isolated Columbidae were identified as genotype III (100%). Also, 94.1% and 5.9% of Corvidae isolates, 84.4% and 15.6% of the Rattus isolates, and 51.7% and 48.3% of the Felidae isolates belonged to genotypes III and II, respectively. This study is the first to evaluate genetic similarity and phylogenetic analysis between many definitive and intermediated hosts in northwestern Iran. The finding indicates that the T. gondii cycle is maintained among these hosts. As a result, their presence in the environment can be a risk factor for transmitting the infection to humans. Due to demographic and geographic differences in various regions, further studies are required to determine the genetic population structure.

The Effect of Educational Intervention on the Improvement of Nontechnical Skills in Circulating Nurses.

BACKGROUND: Nontechnical skills are necessary for clinicians' safe performance and prevention of errors in the operating room. Educational intervention is a useful way to improve these skills, which are a vital area for improvement. Circulating nurses are surgical team members whose work depends heavily on using nontechnical skills. This study is aimed at assessing the effect of an educational intervention on the improvement of circulating nurses' nontechnical skills. METHODS: This semiexperimental study was conducted on 300 circulating nurses divided into the intervention and no intervention groups each containing 150 participants. The nontechnical skills were assessed using the circulating practitioners' list of nontechnical skills. Then, the intervention group received training regarding these skills, and the two groups were evaluated again. After all, the data were entered into the SPSS 24 software and were analyzed using descriptive statistics and Wilcoxon and Mann-Whitney tests. Furthermore, Kendall's tau, independent sample t-test, and one-way ANOVA were used for assessment of relationship between median scores and demographics. RESULTS: The results revealed a significant improvement in the scores of all domains of nontechnical skills in the intervention group (p < 0.05). The highest and lowest improvements were observed in teamwork (42%) and situational awareness (16.7%), respectively. After the intervention, the scores of some of the behaviors were still below the average level or were not improved significantly. CONCLUSIONS: Circulating nurses' nontechnical skills can be improved by educational interventions. However, regarding the low scores or no improvements in the scores of some behaviors, other intervention types such as policymaking and correcting the existing hierarchies in the operating room can be useful to complete the educational interventions.

Concerns About Verbal Communication in the Operating Room: A Field Study.

OBJECTIVE: To assess verbal communication patterns which could contribute to poor performance among surgical team members in an operating room. BACKGROUND: There exist certain challenges in communication in health care settings. Poor communication can have negative effects on the performance of a surgical team and patient safety. A communication pattern may be associated with poor performance when the process of sending and receiving information is interrupted or the content of conversation is not useful. METHOD: This cross-sectional field study was conducted with 54 surgical teams working in two Iranian hospitals during 2015. Two observers recorded all verbal communications in an operating room. An in-depth assessment of various annotated transcripts by an expert panel was used to assess verbal communication patterns in the operating room. RESULTS: Verbal communication patterns which could contribute to poor performance were observed in 63% of the surgeries, categorized as communication failures (17 events), protests (23 events), and irrelevant conversations (164 events). The anesthesiologists and the circulating nurses had the most concerning communication patterns. The failure of devices and poor planning were important factors that contributed to concerning patterns. CONCLUSION: Concerning patterns of verbal communication are not rare in operating rooms. Analyzing the annotated transcripts of surgeries can conduce to identifying all these patterns, and their causes. Concerning communication patterns can be reduced in the operating room by providing interventions, properly planning for surgeries, and fixing defective devices. APPLICATION: The method used in this study can be followed to assess communication problems in operating rooms and to find solutions.

Translation and Psychometric Properties of the Persian Version of Oxford Non-technical Skills 2 System: Assessment of Surgical Teams' Non-technical Skills in Orthopedic Surgery Wards.

BACKGROUND: Non-technical skills are interpersonal and cognitive skills involved in safe performance and preventing adverse events during surgery. it is necessary to dominate the non-technical skills to ensure patient safety. This study has aimed to assess the validity and reliability of Oxford Non-technical skills 2 system (Oxford NOTECHS 2) in Iran and to evaluate surgical teams' non-technical skills in orthopedic surgery wards. METHODS: This cross-sectional study was conducted in Tehran, Iran during 2015. The level of evidence is III based on Canadian Task Force on the Periodic Health Examination. We followed the Beaton's guideline for Persian translation and cross-cultural adaptation of the checklist. In this study, 60 orthopedic surgical team members working in two selected public hospitals were selected by cluster random sampling method.Oxford NOTECHS 2 system which is consisted of four subscales including leadership and management, teamwork and collaboration, decision-makingand problem-solving, and situational awareness was used to collect the data. RESULTS: The overall mean score of non-technical skills was 69.52±6.64. The mean score for surgery, anesthesia, and nursing sub-teams were 24.98±3.71, 21.12±4.29, and 23.42±3.60, respectively. The teams' scores in total, leadership and management, teamwork and collaboration, problem solving and decision making, and situational awareness at the standard level were 74.70%, 76.95%, 73.75%, 66.87%, and 74.70% of maximum score, respectively. CONCLUSION: The validity and reliability of the Persian version of Oxford NOTECHS 2 scale in Iran was confirmed. The results of this study showed that surgical teams' non-technical skills were at a moderate level in orthopedic surgery wards. The minimum score of the surgical teams' non-technical skills belonged to anesthesia and maximum to surgery sub-team. Using the training programs and setup workshop is recommended to improve the surgical teams' non-technical skills, especially surgery-nursing sub-team.

Design and ergonomic assessment of an infusion set connector tool used in nursing work.

Nursing is a physically demanding job characterized by a high prevalence of fatigue and musculoskeletal disorders. One of the high-exertion and repetitive nursing tasks is the manual connection of an infusion set to a medical fluid bottle. Such physical work can be eased by the design of new hand tools. Correspondingly, this study designed and ergonomically assessed an infusion set connector tool (ISCT) and compared it with that of manual connection. First, a prototype of ISCT was designed to perform infusion set connecting task in the mechanical form. Subsequently, 12 nurses were asked to connect an infusion set to medical bottle in the form of manual and mechanical tasks and these tasks were evaluated using ergonomic indices including muscular activity level, force, posture, and subjective (Borg scale CR10) measures. Results showed that the activity levels (root mean square) of the extensor digitorum communis, flexor carpi radialis, biceps, triceps, and deltoid muscles remarkably decreased when the nurses used the ISCT. The postures of the wrist, arm, and shoulder regions were corrected from Rapid Upper Limb Assessment action level 3 to 2 when the designed tool was used. Additionally, the subjective perception of exertion was significantly lower with the use of the prototype.

Molecular Identification and Phylogenetic Classification of Leishmania spp. Isolated from Human Cutaneous Leishmaniasis in Iran: A Cross-sectional Study.

BACKGROUND: In Iran, both forms of cutaneous (CL) and visceral leishmaniasis (VL) have been reported; so the accurate species identification of the parasite(s) and the analysis of genetic diversity are necessary. METHODS: The smears were collected from lesions samples of 654 patients with CL, who attended local health centers in 12 provinces of Iran during 2013-2015. The smears were checked for the presence of amastigotes by light microscopy. DNA of 648 Leishmania isolates, amplified by targeting a partial sequence of ITS (18S rRNA-ITS1-5.8S rRNA-ITS2) gene. Twenty-five of all the amplicons were sequenced and analyzed with restriction fragment length polymorphism (RFLP) using the Taq1 enzyme. RESULTS: All the smears were positive microscopically. The PCR-RFLP analysis revealed that 176 (27%) CL patients were infected with L. tropica and, 478 (73%) with L. major. The dominant species in all over Iran is L. major. The sequencing results of all CL patients and RFLP analysis confirmed each other. Based on our phylogenetic tree, 25 ITS DNA sequences were grouped into two clusters representing L. major and L. tropica species. Phylogenetic tree derived from the ITS sequences supports a clear divergence between L. major from the other species. CONCLUSION: Discrimination of Iranian Leishmania isolates using ITS gene gives us this opportunity to detect, identify, and construct the phylogenetic relationship of Iranian isolates.