Tracking melioidosis in Iran: Utilizing abattoir-based surveillance as a One Health approach.

BACKGROUND: Burkholderia pseudomallei, an environmental saprophyte bacterium, causes melioidosis in humans and animals. It was first discovered in Iran between 1967 and 1976 in small ruminants, equines, environments and humans. No subsequent studies have been conducted to determine the existence and prevalence of this pathogen in the country. OBJECTIVES: The present study aims to monitor the presence of B. pseudomallei in the ruminant population of the Golestan province of Iran, which largely depends on pastures. The ruminants can serve as sentinels to indicate the presence of the bacteria in the environment and its potential impact on human health in the One Health triad. METHODS: Liver and lung abscesses from domestic sheep, cattle and goats in three industrial and three conventional slaughterhouses were sampled and analysed using 23S ribosomal DNA polymerase chain reaction (rDNA PCR) with primers CVMP 23-1 and CVP-23-2 for B. pseudomallei, Burkholderia cepacia and Burkholderia vietnamiensis, as well as B. pseudomallei-specific TTS1 real-time PCR, along with microbiological and biochemical assays. RESULTS: Out of the 97 animals sampled, only 14 (15%) tested positive for 23S rDNA PCR. However, the follow-up evaluation using TTS1 real-time PCR and microbiological and biochemical assays did not confirm the presence of B. pseudomallei in the samples. CONCLUSIONS: Although B. pseudomallei was not detected in the current survey, conducting abattoir-based surveillance of ruminants is a cost-effective One Health approach to monitor pathogenic Burkholderia. Developing standards of clinical and laboratory good practices for Burkholderia infections is crucial for One Health surveillance.

A novel biphasic approach to reactivation of dormant Mycobacterium avium subspecies paratuberculosis.

A new culture technique that involves a potato slice and enriched Middlebrook 7H9 in a two-part glass tube has been developed to revive dormant or persistent Mycobacterium avium subspecies paratuberculosis and acclimate it to Middlebrook 7H9 liquid media. This method is more efficient than directly introducing the bacteria into the liquid medium.

Evaluation of tuberculin skin test (TST) in vervet monkeys (Chlorocebus pygerythrus) using experimentally tuberculin sensitized animals.

BACKGROUND: Nowadays, several test methods with different useful values are available for diagnosis of the tuberculosis (TB) in non-human primates (NHPs). Despite some limitations of tuberculin skin test (TST), it is still the most commonly used method for TB testing of NHPs. METHODS: During this investigation, TST was performed upon three groups of experimentally tuberculin sensitized and one group of non-sensitized vervet monkeys (Chlorocebus pygerythrus) by means of two types of old tuberculin (OT) and two types of purified protein derivative (PPD) tuberculin. RESULTS: The data obtained from this study revealed that PPD tuberculin prepared from both Mycobacterium tuberculosis and Mycobacterium bovis has more advantages over OT in tuberculin testing of the vervet monkeys. The potency of the PPD tuberculin prepared from M bovis was estimated almost twice as much of the M tuberculosis. CONCLUSIONS: Intrapalpebral injection of 0.1 mL of a concentration of ≥1 mg/mL of PPD tuberculin prepared from M bovis is the preferred method for TST of vervet monkeys.

Barriers of clinical practice guidelines development and implementation in developing countries: a case study in iran.

BACKGROUND: Knowledge products such as clinical practice guidelines (CPG) are vitally required for evidence-based medicine (EBM). Although the EBM, to some extent, has been attended during recent years, no result has achieved thus far. The current qualitative study is to identify the barriers to establishing development system and implementation of CPGs in Iran. METHODS: Twelve semi-structured, in-depth interviews were conducted with a purposive sample of health policy and decision makers, the experts of development and or adaptation of CPGs, and the experts of EBM education and development. In addition, 11 policy-makers, decision-makers, and managers of the health system participated in a focus group discussion. The analysis of the study data was undertaken by thematic framework approach. RESULT: Six themes emerged in order of their frequency include practice environment, evidence-based health care system, individual professional, politician and political context, innovation (CPG) and patients. Most of the indications in the treatment environment focused on such sub-themes as regulations and rules, economical factors, organizational context, and social context. While the barriers related to the conditions of treatment environment, service provider and the features of innovation and patients had been identified before in other studies, very little attention has been paid to the evidence-based health care system and politician and political context. CONCLUSION: The lack of an evidence-based healthcare system and a political macro support are mentioned as the key barriers in Iran as a developing country. The establishment of a system of development and implementation of CPGs as the evidence-based practice tools will not be possible, unless the barriers are removed.

How to implement clinical practice guidelines in iran.

BACKGROUND: Evidence-based medicine would come to the result by evidence-based implementation. Clinical Practice Guidelines (CPG) as one of the evidence-based knowledge products requires appropriate interventions after being produced to be applied. OBJECTIVES: The aim of this qualitative study was to identify the strategies for application of CPGs produced in Iran. MATERIALS AND METHODS: The purposive snowball sampling was performed and it continued until reaching the theoretical saturation. In-depth semistructured individual interviews and Focus Group Discussion (FGD) were performed aiming at triangulation. The thematic framework approach was used for the analysis. RESULTS: Twelve interviews were conducted with three health system policy makers and decision makers, four experienced in the production or adaptation of clinical practices, and five experts in evidence-based medicine development and education. In addition, 11 policy makers, managers, and decision makers of the health system took part in FGD. The proposed interventions were classified in the following themes: Health professionals-oriented, Financial, Organizational, Regulatory, and Multifaceted interventions. CONCLUSIONS: Along with adaptation and development process of CPGs, their utilization should also be planned; otherwise spent time and money would be in vain. Certainly, imposing above-mentioned interventions with the ultimate goal of sustainable behavior change in health system service providers is beyond the capacity of specific groups or few academic centers. It requires the participation of all practitioners under the monitoring and support of the Ministry of Health and Medical Education. Deployment of the family physician plan and referral system is an opportunity which must be considered a trophy.