Methanol mass poisoning in Iran: Role of case finding in outbreak management

Background There are no guidelines addressing the public health aspects of methanol poisoning during larger outbreaks. The current study was done to discuss the role of active case finding and a national guideline that organizes all available resources according to a triage strategy in the successful management of a methanol mass poisoning in Rafsanjan, Iran, in May 2013. Methods A retrospective cross-sectional study was performed reviewing the outbreak Emergency Operation Center files. The objectives were to describe the characteristics, management and outcome of a methanol outbreak using Active Case Finding to trace the victims. Results A total of 694 patients presented to emergency departments in Rafsanjan after public announcement of the outbreak between 29th May and 3rd June 2013. The announcement was mainly performed via short message service (SMS) and local radio broadcasting. A total of 361 cases were observed and managed in Rafsanjan and 333 were transferred to other cities. Seventy-five and 100 patients underwent hemodialysis (HD), retrospectively. The main indication for HD was refractory metabolic acidosis. Eight patients expired due to the intoxication. Except for the deceased cases, no serum methanol level was available. Conclusion In developing countries, where diagnostic resources are limited, use of active case finding and developing national guidelines can help in the management of large outbreaks of methanol poisonings. © 2014 The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: [email protected]

Candidemia and its risk factors in neonates and children

Objectives: The present study was conducted to raise attention to the frequency of Candida spp. and evaluation of risk factors of candidemia in hospitalized neonates and children. Methods: Identification of Candida at species level was done using the PCR-RFLP method. The Candida albicans complex and Candida parapsilosis complex were differentiated using the HWP1 gene amplification and PCR-RFLP with NlaIII restriction enzyme, respectively. Results: Out of 75 blood culture specimens, 42 (84) cases were positive for Candida spp. of whom 30 (71.42) and 12 (28.57) cases were female and male, respectively. Thirty-two (76) candidemia were presented in pediatrics with 6 years up to 12 years, 10 (23.80) in neonates of one month or less. In the present study, Candida parapsilosis (n =25; 59.52) was the most prevalent isolated species followed by C. albicans (n =11; 26.19), C. tropicalis (n =4; 9.52), and Candida glabrata (n =2; 4.76). Conclusions: According to potentially dangerous complications of bloodstream infection by Candida spp. in neonates and children, it is necessary to identify and eliminate the underlying conditions and risk factors of this disease. © 2020, Author(s)

Molecular identification of Palearctic members of Anopheles maculipennis in northern Iran

BACKGROUND: Members of Anopheles maculipennis complex are effective malaria vectors in Europe and the Caspian Sea region in northern Iran, where malaria has been re-introduced since 1994. The current study has been designed in order to provide further evidence on the status of species composition and to identify more accurately the members of the maculipennis complex in northern Iran. METHODS: The second internal transcribed spacer of ribosomal DNA (rDNA-ITS2) was sequenced in 28 out of 235 specimens that were collected in the five provinces of East Azerbayjan, Ardebil, Guilan, Mazandaran and Khorassan in Iran. RESULTS: The length of the ITS2 ranged from 283 to 302 bp with a GC content of 49.33 – 54.76%. No intra-specific variations were observed. Construction of phylogenetic tree based on the ITS2 sequence revealed that the six Iranian members of the maculipennis complex could be easily clustered into three groups: the An. atroparvus – Anopheles labranchiae group; the paraphyletic group of An. maculipennis, An. messeae, An. persiensis; and An. sacharovi as the third group. CONCLUSION: Detection of three species of the An. maculipennis complex including An. atroparvus, An. messae and An. labranchiae, as shown as new records in northern Iran, is somehow alarming. A better understanding of the epidemiology of malaria on both sides of the Caspian Sea may be provided by applying the molecular techniques to the correct identification of species complexes, to the detection of Plasmodium composition in Anopheles vectors and to the status of insecticide resistance by looking to related genes

Prevalence of latent tuberculosis infection in low-risk children using tuberculin skin test: a study in Shiraz

Background: Tuberculin skin test (TST) is a readily available test for the diagnosis of latent tuberculosis infection (LTBI). This study was designed to evaluate LTBI in low-risk children aged 1-15 years.Methods: This cross-sectional study was performed in Shiraz, Iran, over six months during 2009. Totally, 1289 boys and girls were selected by stratified multistage random sampling from four municipality areas before allocating them to 15 groups. Inclusion criteria included age 1-15 years, documented history of BCG vaccination at birth, Iranian nationality and a healthy state of being. Children with acute febrile diseases, immunosuppression, on medication and immigrants were excluded. We considered a TST ≥ 10 mm of induration as positive.Results: The prevalence of LTBI in 1-15 years old children was 4.5%. The percentage was 3.5% in 1-5 year old, 4.1% in 6-10 year old and 5.7% in 11-15 year old children. The highest rate of infection was 9.8% in 15 year olds and the lowest was 2.2% in 3-year old children. Gender had no effect on LTBI rate. There is no significant difference of LTBI prevalence between four municipality areas.Conclusion: The prevalence of LTBI in this study was lower in comparison with other studies performed in Iran. Positive predictive value of TST decreases in low endemic areas for tuberculosis, especially in low-risk groups therefore, most positive results are false-positive created by nonspecific reactions and infection with environmental mycobacteria. Hence, there is a need for new diagnostic tools that are easy and cost-effective

Prevention and control of health care–associated infections in Iran: A qualitative study to explore challenges and barriers

Background Globally, the health and economic burden posed by health care–associated infections (HAIs) remains wide and severe. To curb the burden associated with HAIs, countries, including Iran, aim at HAI prevention and control. This study explores the challenges faced by the Iranian health system in addressing the issues associated with the prevention and control of HAIs. Methods A qualitative research method was adopted in exploring the phenomenon. We used the purposive sampling approach in reaching 24 key informants at the national and subnational levels. The thematic framework analysis was conducted for analyzing the interviews. Results Five main themes emerged from our study demonstrating the obstacles toward the prevention and control of HAIs. They include governance and stewardship, resources, safety culture, monitoring and surveillance systems, and inappropriate prescription of antibiotics. Conclusions Strengthening of reporting and surveillance systems for HAIs coupled with proper governance and stewardship are crucial in order to improve the health and safety of patients. However, the availability of resources, through an intersectoral approach, is essential to achieve sustained output

Molecular characterization and antibiotic resistance pattern of isolated Acinetobacter baumannii in Iran

In this study, the prevalence of efflux pump genes (AdeABC) and genetic association of MDR A. baumanii isolated from intensive care units were investigated. Detection of A. baumanii was performed using species-specific PCR. Disc-diffusion antibiotic susceptibility tests of isolated strains and amplification of AdeABC genes (adeA, adeB, adeC, and adeM) were performed. Isolates were also subjected to the Repetitive Extragenic Palindromic-PCR (rep-PCR) to identify isolates clonality. The highest number of resistant A. baumanii isolates was observed in response to cephalexin, tetracycline, and cefixime (over 80 of isolates). A. baumanii isolates had the highest sensitivity in response to imipenem and amikacin (~ 50 of isolates). The distribution of adeA, adeB, adeM, and adeC in isolates were as follow; 186, 165, 172, and 117 isolates. A. baumanii was observed at an alarming level in this study (183, 93.84). Based on rep-PCR, remarkable interspecific diversity was observed among isolates. © 2021 Elsevier Inc