Prediction of preventive behaviors of cutaneous leishmaniasis in the endemic areas of northwest Iran: an application of BASNEF model.

Cutaneous leishmaniasis (CL) is a disease transmitted by mosquitoes and is endemic in many regions of the world and Iran, and annually imposes a large burden on the health system. This study was conducted to identify the effective factors in the preventive behaviors of CL based on the BASNEF model in endemic areas in the northwest of Iran. This cross-sectional study was conducted in Bileh-Savar, 'endemic areas of Ardabil Province, Iran', from June 2022 to October 2022. 200 non-patients were included in the study by a multi-stage sampling method. A standard questionnaire based on the BASNEF model was applied for data collection. The data were analyzed using SPSS version 25. Means and standard deviations were calculated to describe the continuous variables, and multivariate linear regression analysis was used to determine the prediction of intention and behavior by the model structures. The BASNEF constructs predict 27% of behavioral intention changes. Among the constructs, attitude has a greater contribution in predicting changes (R2 = 0.27, p < 0.01). Also, the results showed that the BASNEF constructs predict 23% of behavior changes. Among the constructs, enabling factors have a greater contribution to predicting changes (R2 = 0.23, p < 0.01). This finding shows that behavior is more influenced by environmental factors, and educational interventions based on behavior change models, along with providing environmental conditions, can facilitate behavior change.

Saturation in qualitative research: An evolutionary concept analysis.

Background and Aim: Qualitative research plays an important role in improving nursing knowledge. Understanding the concept of saturation is essential to conducting rigorous qualitative research that contributes to evidence-based practice. The purpose of this study is to clarify the concept of saturation in qualitative research. Method: Evolutionary concept analysis was performed. A literature search was conducted using a variety of online databases for the years 2005- 2023. In total, 33 articles and books were analyzed using thematic analysis to identify the attributes, antecedents and consequences of saturation. The validity of the data was obtained by examining the analysis process by two independent researchers. Results: Saturation in qualitative research is a context-dependent, subjective process that requires detailed systematic analysis. Saturation is used in four ways in qualitative research: theoretical saturation, data saturation, code or thematic saturation, and meaning saturation. The antecedents of saturation were classified into two categories: study related factors and researcher related factors. The consequences of saturation were identified as: ensuring credibility and quality in qualitative research and time, energy and budget saving. Conclusion: This concept analysis serves to enhance the understanding of the concept of saturation, thereby offering valuable resources for qualitative researchers. By gaining a profound comprehension of saturation and its various types, researchers can ensure the validity of their studies while also optimizing time and resource allocation by avoiding redundant data collection. Future investigation warranted to elucidate how factors associated with reaching saturation impact estimations sample size.

The relationship between stress, anxiety, depression and medication adherence behavior in patients with epilepsy: A cross-sectional study.

OBJECTIVE: To investigate the relationships between stress, anxiety, and depression and medication adherence behavior in patients with epilepsy (PEW). METHODS: A cross-sectional study design was conducted on 235 PEW in the Qazvin's Boo Ali Sian Hospital. Data collection tools included socio demographic and clinical data form, morisky medication adherence scale (MMAS-8), depression anxiety stress scales -21(DASS-21). We used adjusted multivariate logistic regression model for statistical analysis. RESULTS: A considerable proportion of patients reported mild, moderate, severe and extremely severe symptoms of depression (177 [75/3%]), anxiety (169 [71.9 %]), and stress (158 [67.2 %]). However, 61/8% of the participant had proper medication adherence and 38/3% had poor medication adherence. The results of adjusted multivariate logistic regression showed that in patients who had severe and extremely severe depression and anxiety, the probability of poor medication adherence was higher (P < 0.05). The levels of stress were not significant predictors for medication adherence behavior (P > 0.05). CONCLUSION: According to this study, severe and extremely severe depression and anxiety can be considered as an important predicting factor in the lack of adherence to antiepileptic medication. PRACTICE IMPLICATIONS: Healthcare professionals can improve care of patients with PEW by considering patients' mental and psychological health problems in educational, counseling and supportive programs.

Characterization of novel bacteriophage PSKP16 and its therapeutic potential against ß-lactamase and biofilm producer strain of K2-Hypervirulent Klebsiella pneumoniae pneumonia infection in mice model.

BACKGROUND: Severe infections caused by ß- lactamase producers, hypervirulent Klebsiella pneumoniae (BhvKp) with K2 serotype, highlight emergency need for new therapeutic strategies against this pathogen. We aimed to assess the efficacy of a novel phage, PSKP16, in the treating of pneumonia induced by BhvKp in mice models. METHOD: Genome sequences of PSKP16 were analyzed, and associated information can be found in NCBI. We applied treatment in two ways: by using mice for immediate and delayed treatments. Moreover, acute pneumonia obtained by BhvKp with intranasal method, was characterized in terms of histopathology of pulmonary lesions, biomarkers of inflammation level, leukocytes cells infiltration extent in mice, and was assessed treatment of them with PSKP16 multiplicity of infection (MOI: 10), either individually or in combination with gentamicin. Assessment of the ability of PSKP16 to inhibit BhvKp biofilm was studied. RESULTS: PSKP16 was associated with the Drexlerviridae family, and had a genome size of 46,712 bp, and 67 predicted ORFs. Herein, prompt phage administration's efficacy to decrease bacterial load and improve the survival rate in pneumonia models was faster than the synergism model with delay, but both almost displayed similar endpoints. The distribution of BhvKp strains in the lung was consistent with the histopathological findings, simultaneous inflammation, and level of serum tumor necrosis factor-α (TNF α). The phage treatment presented a lack of severe lesions and alveolar edema, reduction of inflammatory cell infiltration, which not only was it not associated with an over-inflammation but also provided a faster correction of blood cell count abnormalities compared to gentamicin. Phage with a high concentration in in vitro model effectively eliminated biofilms. CONCLUSION: It is essential to raise clinical awareness and management of BhvKp infections, signaled as the next superbug in waiting. The results of our study underscore the importance of PSKP16 as a phage with promising therapeutic potential in treating BhvKp-induced pneumonia.

A SWOT analysis of the development of health technology assessment in Iran.

BACKGROUND: Health systems need to prioritize their services, ensuring efficiency and equitable health provision allocation and access. Alongside, health technology assessment (HTA) seeks to systematically evaluate various aspects of health technologies to be used by policy- and decision-makers. In the present study, we aim to identify strengths, weaknesses, opportunities, and threats in developing an HTA in Iran. METHOD: This qualitative study was conducted using 45 semi-structured interviews from September 2020 to March 2021. Participants were selected from key individuals involved in health and other health-related sectors. Based on the objectives of the study, we used purposive sampling (snowball sampling) to select individuals. The range of length of the interviews was between 45 to 75 minutes. Four authors of the present study carefully reviewed the transcripts of interviews. Meanwhile, the data were coded on the four domains of strengths, weaknesses, opportunities, and threats (SWOT). Transcribed interviews were then entered into the software and analyzed. Data management was performed using MAXQDA software, and also analyzed using directed content analysis. RESULTS: Participants identified eleven strengths for HTA in Iran, namely the establishment of an administrative unit for HTA within the Ministry of Health and Medical Education (MOHME); university-level courses and degrees for HTA; adapted approach of HTA models to the Iranian context; HTA is mentioned as a priority on the agenda in upstream documents and government strategic plans. On the other hand, sixteen weaknesses in developing HTA in Iran were identified: unavailability of a well-defined organizational position for using HTA graduates; HTA advantages and its basic concept are unfamiliar to many managers and decision-makers; weak inter-sectoral collaboration in HTA-related research and key stakeholders; and, failure to use HTA in primary health care. Also, participants identified opportunities for HTA development in Iran: support from the political side for reducing national health expenditures; commitment and planning to achieve universal health coverage (on behalf of the government and parliament); improved communication among all stakeholders engaged in the health system; decentralization and regionalization of decisions; and capacity building to use HTA in organizations outside the MOHME. High inflation and bad economic situation; poor transparency in decisions; lack of support from insurance companies; lack of sufficient data to conduct HTA research; rapid change of managers in the health system; and economic sanctions against Iran are threats to the developmental path of HTA in Iran. CONCLUSION: HTA can be properly developed in Iran if we use its strengths and opportunities, and address its weaknesses and threats.

The therapeutic effect of larval saliva and hemolymph of Lucilia sericata on the treatment of Leishmania major lesion in BALB/c mice946.

BACKGROUND: Treatment of cutaneous leishmaniasis (CL) remains a major challenge for the public health and medical community. It has been claimed that natural compounds derived from fly larvae have anti-leishmania properties against some species of Leishmania. The present study aimed at assessing the in vitro effects of larval products of Lucilia sericata against the promastigote and intracellular amastigote forms of Leishmania major. Also, the therapeutic effect of larval products on lesions induced by L. major infection was evaluated in BALB/c mice models. METHODS: Parasite specimens and macrophage cells were exposed to varying concentrations of larval products for 24-120 h. Lesion progression and parasite load were investigated in the models to assess the therapeutic effects of the products. RESULTS: The larval products displayed more potent cytotoxicity against L. major promastigotes. The IC50 values for larval saliva and hemolymph were 100.6 and 37.96 ug/ml, respectively. The IC50 of glucantime was 9.480 ug/ml. Also, the saliva and hemolymph of L. sericata exhibited higher cytotoxicity against the promastigotes of L. major but were less toxic to the macrophage cells. Treatment with leishmanicidal agents derived from larvae of L. sericata decreased the infection rate and the number of amastigotes per infected host cell at all concentrations. Lesion size was significantly (F (7, 38) = 8.54, P < 0.0001) smaller in the treated mice compared with the untreated control group. The average parasite burden in the treated mice groups (1.81 ± 0.74, 1.03 ± 0.45 and 3.37 ± 0.41) was similar to the group treated with a daily injection of glucantime (1.77 ± 0.99) and significantly lower (F (7, 16) = 66.39, P < 0.0001) than in the untreated control group (6.72 ± 2.37). CONCLUSIONS: The results suggest that the larval products of L. sericata were effective against L. major parasites both in vivo and in vitro. However, more clinical trial studies are recommended to evaluate the effects of these larval products on human subjects.

Factors Involved in Nurses' Health-Seeking Behaviors: A Qualitative Study.

This study aimed to explore the factors involved in Iranian nurses' health-seeking behavior. In this qualitative exploratory descriptive study, 15 nurses from hospitals affiliated to Iran and Qazvin University of Medical Sciences were interviewed from April to March 2020. Data were collected via purposive sampling by unstructured in-depth interviews and analyzed using thematic analysis. Findings identified 5 main themes, "fear," "trust/distrust," "excuse," "accessibility," and "support" that were involved in nurses' health-seeking behavior. The findings of this study may contribute to a deeper understanding of the factors involved in nurses' health-seeking behavior and pave the way for further research and policy making regarding nursing workforce health.

Evaluation of the Entomopathogenic Fungus Beauveria bassiana on Different Stages of Phlebotomus papatasi (Diptera: Psychodidae), Vector of Zoonotic Cutaneous Leishmaniasis in Iran.

Background: Zoonotic cutaneous leishmaniasis is a major public health problem in Iran with the main vector of Phlebotomus papatasi. The use of entomopathogenic fungi for biological control of the vector is a potential substitute for the current methods which are being used. The purpose of the current study was to assess the virulence of two local isolates of Beauveria bassiana (OZ2 and TV) against Ph. papatasi. Methods: To perform the bioassay test, fungal suspensions were applied for every stage of the sand fly life cycle. The mortality rate, longevity, and number of eggs laid were determined. Also, the probability of fungal survival on the surface of rodent's body was assessed. Results: The longevity of infected adult sand flies with both isolates of B. bassiana was significantly lower (P< 0.05) in comparison to the negative control. The estimated Lethal concentration 50 (LC50) values for adult female and male sand flies treated with OZ2 isolate were 1.4×106 and 2.2×107 conidia/ml, respectively, while they were 6.8×106 and 2.3×108 conidia/ml for TV isolate, respectively. Both isolates of B. bassiana exhibited nonsignificant mortality rates in sand fly larvae and pupae and fecundity rate (P> 0.05). According to our findings for both isolates, the fungus continued to spread throughout the surface of the rodent's body for 144 hours after spraying. Conclusion: The current study demonstrated that both isolates of B. bassiana have considerable biological control capacity against adult sand flies.

Preliminary Analysis of Methamphetamine Detection in Lucilia sericata (Diptera: Calliphoridae) Reared in Methamphetamine-Treated Meat at Various Developmental Stages.

Background: It is possible to identify drugs and poisons present in cadavers by analyzing blowfly larvae and pupae collected during forensic autopsies. The main purpose of this study was to use Lucilia sericata's larvae and pupae to identify drugs and poisons present in human cadavers. Methods: In an investigation, immature L. sericata fed meat treated with methamphetamine (MA) at various concentrations (45, 90, and 180 ng/mg) were analyzed to detect MA. Acetylation derivatization and liquid-liquid extraction (LLE) were used as sample preparation methods prior to gas chromatography-mass spectrometry (GC-MS) analytical instrumentation to find MA. Results: According to this study, L. sericata can be used in toxicological testing to identify MA in a host body. All L. sericata larval stages, particularly the third stage larva, pupa and empty pupa tested were positive for MA. Larvae in their first instar produced weak peaks. The L. sericata post-feeding instar following the 45 ng/mg treatment showed the highest MA concentration. For the first time, derivatization using the acetylation approach was used to prepare samples, and successfully, excellent results were obtained. Conclusion: Low quantities of MA can be easily found in immature fly samples using GC-MS. It is important to analyze all samples including human tissues and insect samples, for postmortem drug testing. They can be utilized to find entire MA before they are excreted in excretory samples such as urine. Also, third instar larvae are a great and reliable sample for toxicological study.

Phenotype and genetic determination of resistance to common disinfectants among biofilm-producing and non-producing Pseudomonas aeruginosa strains from clinical specimens in Iran.

BACKGROUND: Pseudomonas aeruginosa is a common pathogen in Hospitalized patients, and its various resistance mechanisms contribute to patient morbidity and mortality. The main aims of the present study were to assess the susceptibility of biofilm-producing and non-producing P. aeruginosa isolates to the five commonly used Hospital disinfectants, to evaluate the synergistic effect of selected disinfectants and Ethylene-diamine-tetra acetic acid (EDTA), and the effect of exposure to sub-inhibitory concentrations of Sodium hypochlorite on antimicrobial susceptibility test. RESULTS: The results showed that sodium hypochlorite 5% and Ethanol 70% were the most and least effective disinfectants against P. aeruginosa, respectively. The addition of EDTA significantly increased the effectiveness of the selected disinfectants. The changes in the antibiotic-resistance profiles after exposure to sub-inhibitory concentrations of disinfectants were observed for different classes of antibiotics (Carbapenems, Aminoglycosides, Cephalosporins, Fluoroquinolones). As well as near the all isolates harbored efflux pump genes and 117 (97.5%) of isolates produced biofilm. CONCLUSION: In the current study, the mixture of disinfectant and EDTA were the most suitable selection to disinfect Hospital surfaces and instruments. Also, it was clear that exposure to sub-inhibitory concentrations of Sodium hypochlorite results in resistance to some antibiotics in P. aeruginosa species. Strong and intermediate biofilm formers belonged to MDR/XDR strains. Future studies should include more complex microbial communities residing in the Hospitals, and more disinfectants use in Hospitals.

Organ Donation Decision in Families With Brain-Dead Patients: An Evolutionary Concept Analysis.

BACKGROUND AND AIM: Organ donation decision is a complicated process for bereaved families; however, its attributes and associated factors are not clear. Accordingly, the purpose of this study was to analyze the concept of organ donation decision in families with brain-dead patients. METHODS: Concept analysis was performed using Rodgers' evolutionary method. For this purpose, PubMed, OVID, Scopus, and ProQuest databases were searched in English from 1985 to 2019. In total, 54 articles were analyzed using the thematic analysis to identify the attributes, antecedents, and consequences of the concept. The validity of the data was provided by examining the analysis process by 2 independent researchers. FINDINGS/CONCLUSIONS: Organ donation decision in these families is a complicated and conflicting process of vicarious decision-making that begins with an organ donation request: a difficult, painful, and critical experience that requires extensive interpersonal interactions and is ultimately influenced by various factors, leading to the acceptance or refusal. The antecedents include deceased-related factors, family-related factors, the quality of organ donation request, and the quality of health care professionals' interactions. The consequences include the positive outcomes (grief solace, gift of life, and promoting human values) and negative outcomes (ambiguity, doubt and regret, and psychological inconsistency). The results of this concept analysis led to a better understanding of the complexity of an organ donation decision in these families. In this way, in addition to knowledge development, it assists the health care staff to support families in making the organ donation decision. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Although case managers rarely participate in organ donation, they definitely need to understand the concepts related to organ donation decision while advocating for the patients or families. The results of this concept analysis can broaden the case managers' and other health care professionals' knowledge about families' organ donation decision and help them take more effective interventions for management of this process. Case managers and the health care team can use the information of this article for informing families about brain death, negotiating with families for organ donation, preparing information, and caring and facilitating the families in making the clear and unconflicted decision.

A retrospective cross-sectional survey on nosocomial bacterial infections and their antimicrobial susceptibility patterns in hospitalized patients in northwest of Iran.

OBJECTIVE: Nosocomial infections (NIs) are known as one of the remarkable problems in all countries. This study is aimed to estimate the prevalence rate of nosocomial bacterial agents with antimicrobial susceptibility pattern in hospitalized patients. This study was conducted from April 2017 to September 2018, on 4029 hospitalized patients. We set out to recognize the commonest bacterial infections and antimicrobial susceptibility patterns of nosocomial infection. RESULTS: Of the 4029 patients, 509 (12.6%) of them were culture positive. Of these Escherichia coli (E. coli) (98.3%) and Staphylococcus epidermidis (S. epidermidis) (37.5%) were the most abundant bacterial identified in the urinary tract and bloodstream cultures respectively, Moreover, Acinetobacter spp. (100%) and Pseudomonas aeruginosa (22.2%) were the most abundant organisms detected in the respiratory system. According to susceptibility testing results, 370 (80.5%) and 264 (57.3%) in Gram-negatives and 44 (91.7%) and 35 (72.9%) in gram positives isolated strains were classified as multidrug-resistant (MDR) and extensive drug-resistant (XDR) strain respectively. On account of the high prevalence of MDR and XDR bacterial species, there is a pressing need for the expansion of new strategies on antibiotic supervision and infection control to introduce new guideline on empirical antibiotic therapy.

The leishmanicidal effect of Lucilia sericata larval saliva and hemolymph on in vitro Leishmania tropica.

BACKGROUND: Leishmaniasis is a major parasitic disease worldwide, except in Australia and Antarctica, and it poses a significant public health problem. Due to the absence of safe and effective vaccines and drugs, researchers have begun an extensive search for new drugs. The aim of the current study was to investigate the in vitro leishmanicidal activity of larval saliva and hemolymph of Lucilia sericata on Leishmania tropica. METHODS: The effects of different concentrations of larval products on promastigotes and intracellular amastigotes of L. tropica were investigated using the mouse cell line J774A.1 and peritoneal macrophages as host cells. The 3-(4.5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and direct observation and counting method were used to assess the inhibitory effects and cell cytotoxicity of the larval products. The effects of larval products on the amastigote form of L. tropica were quantitatively estimated by calculating the rate of macrophage infection, number of amastigotes per infected macrophage cell, parasite load and survival index. RESULTS: The 50% cytotoxicity concentration (CC50) value of both larval saliva and hemolymph was 750 µg/ml, and the 50% inhibitory concentration (IC50) values were 134 µg/ml and 60 µg/ml for larval saliva and larval hemolymph, respectively. The IC50 for Glucantime, used a positive control, was (11.65 µg/ml). Statistically significant differences in viability percentages of promastigotes were observed for different doses of both larval saliva and hemolymph when compared with the negative control (p ≤ 0.0001). Microscopic evaluation of the amastigote forms revealed that treatment with 150 µg/ml larval hemolymph and 450 µg/ml larval saliva significantly decreased the rate of macrophage infection and the number of amastigotes per infected macrophage cell. CONCLUSION: Larval saliva and hemolymph of L. sericata have acceptable leishmanicidal properties against L. tropica.

Resistant status of Culex pipiens complex species to different imagicides in Tehran, Iran.

BACKGROUND & OBJECTIVES: Insecticides are the most important means of controlling pests in Iran especially for Culex pipiens complex species. The rational use of insecticides largely depends on understanding the susceptibility levels of these species. The study was designed to determine the susceptibility levels of Cx. pipiens complex (field and insectary strains) to various insecticides in the city of Tehran. METHODS: The mortality rates of the field strain of Cx. pipiens complex after different exposure times to DDT (4%), bendiocarb (0.1%), propoxur (0.1%), malathion (5%), fenitrothion (1.0%), permethrin (0.75%), deltamethrin (0.05%), lambda-cyhalothrin (0.05%), etofenprox (0.5%), and cyfluthrin (0.15%) were determined. The mortality rates at the lethal time 50% (LT50) and lethal time 90% (LT90) values were calculated by plotting the regression line using Microsoft Office Excel software. RESULTS: The mortality rates of the Cx. pipiens complex after 1 h exposure to the diagnostic doses of DDT (4%), bendiocarb (0.1%), propoxur (0.1%), malathion (5%), fenitrothion (1.0%), permethrin (0.75%), deltamethrin (0.05%), lambda-cyhalothrin (0.05%), etofenprox (0.5%), and cyfluthrin (0.15%) were 12, 58, 54, 82, 54, 34, 49, 40, 17, and 44%, respectively. According to the WHO classification of susceptibility levels, both field and insectary strains of Cx. pipiens complex in Tehran were resistant to these insecticides. INTERPRETATION & CONCLUSION: The results of this study showed that field Cx. pipiens complex is resistant to all the groups of insecticides used.

Effective factors on brace compliance in idiopathic scoliosis: a literature review.

Objectives: Compliance plays a major role in the success of brace treatment and is influenced by factors such as the kind of brace, measurements method, regimen for brace wear, pattern wearing at night/day or full/part time and another factor is also psychological condition of the wearer. The objective of this review is to assess affecting factors on compliance of spinal braces in idiopathic scoliosis.Materials and methods: The guideline of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) was used for conducting review and assessing the quality of evidence. The search in Pubmed databases had 175 results of which 17 articles met the inclusion criteria. Effective factors on compliance were extracted and categorized into six groups based on type of brace, measurement method, age, day/night time pattern wearing, full/part time wearing and psychological aspect that can improve the result of spinal brace treatment in idiopathic scoliosis.Results: The results demonstrated that the type of braces determines structure and appearance and affects compliance. Psychological aspects, age, brace wear pattern (daytime or nighttime or part-time versus fulltime) and the assessment method (using temperature versus pressure sensors) can affect recorded compliance.Conclusions: Compliance can be augmented by considering factors in the design and delivery of the brace. Superior appearance and comfortable within the brace can improve psychological acceptance and improve the compliance. Lower age, involving the patient in treatment procedure, considering the child habits, and improved family awareness of the treatment plan of idiopathic scoliosis can also improve overall compliance of the brace.Implications for rehabilitationThis article reviews factors that affect compliance with orthotic treatment in idiopathic scoiliosis.

Emergency nurses' knowledge about ventilator-associated pneumonia.

INTRODUCTION: Given the increasing number of patients requiring mechanical ventilation in emergency departments in recent years, prevention of ventilator-associated pneumonia is very important. Nurses play a significant role in prevention of ventilator-associated pneumonia. This study aimed to determine the emergency nurses knowledge about prevention of ventilator-associated pneumonia. METHODS: The present descriptive study was conducted in Iran, from July to October 2018. All the nurses with at least a bachelor degree, who are working in two emergency departments of two teaching hospitals, were asked to participate in this study. The "knowledge about ventilator-associated pneumonia" questionnaire consisting of 9 items was used to assess the knowledge of nurses. The results were analyzed using SPSS-16. RESULTS: In total, 53 nurses participated in this study. The mean score of correct answers of nurses to these 9 items was 4.4 ±â€¯1.6. Nurses give the most correct answer to the item about patient's position on the bed so as to reduce the risk of pneumonia with a correct answer of 72.9%. The least correct answer was also given to the item about how humidifier was changed with a correct answer of 1.9%. None of the nurses participating in the study were able to answer all the items correctly. The mean score of knowledge of nurses who had participated in workshops about taking care of patients on mechanical ventilation was significantly higher than those who had not participated in such workshops (4.8 vs. 3.8) (p = 0.045). The mean score of knowledge in nurses who were familiar with the international guidelines for ventilator-associated pneumonia prevention was significantly higher than those who were not familiar with such guidelines (5.1 vs. 4.1) (p = 0.045). CONCLUSION: Emergency nurses participated in this study had inadequate knowledge about the prevention of ventilator-associated pneumonia. Nurse's knowledge affected by participation in related workshop and familiarity with ventilator-associated pneumonia guidelines. Considering the importance of this issue, it is necessary to improve the knowledge of the emergency nurses in this matter by holding training courses.

Status of Resistant and Knockdown of West Nile Vector, Culex pipiens Complex to Different Pesticides in Iran.

BACKGROUND: West Nile virus (WNV) can cause a fatal disease in humans and it is mainly transmitted to people through the bites of infected mosquitoes. Vector control using insecticides is a very important goal. Study of Culex pipiens resistance towards several insecticides in the city of Tehran, Iran was evaluated. METHODS: Adult females reared from field-caught larvae from southern part of Tehran and lab strain reared in the insectary of Tehran University of Medical Science were determined for resistant status by exposing to 4% DDT, 0.1% bendiocarb, 0.1% propoxur, 1% fenitrothion, 0.05% deltamethrin, 0.75% permethrin, 0.05% lambda-cyhalothrin, 0.5% etofenprox, 5% malathion and 0.15% cyfluthrin papers using the standard WHO susceptibility tests. RESULTS: Results clearly showed resistance development of Cx. pipiens against tested insecticides. Mortalities of Cx. pipiens were less than 90% with high resistance, low knock down rate and knock down time (50%) observed against insecticides. DDT and Malathion showed the most and least lethal time (LT50) values for the field strain. The results of the knockdown test showed that DDT and deltamethrin had the most and least knockdown times (50%) for the field strain, respectively, while DDT and lambda-cyhalothrin had the most and least knockdown times (50%) for the lab strain, respectively. CONCLUSION: Resistance to mentioned insecticides in Cx. pipiens is widely distributed in southern part of Tehran. Regular implementation of susceptibility test in Cx. pipiens mosquitoes will help local public health authorities to develop new and better control strategies.

Growth Rate and Biofilm Formation Ability of Clinical and Laboratory-Evolved Colistin-Resistant Strains of Acinetobacter baumannii.

Two different mechanisms of resistance to colistin in Acinetobacter baumannii have been described. The first involves the total loss of lipopolysaccharide (LPS) due to mutations in the lpxACD operon, which is involved in the lipid A biosynthesis pathway. The second entails the addition of ethanolamine to the lipid A of the LPS resulting from mutations in the PmrAB two-component system. To evaluate the impact of colistin resistance-associated mutations on antimicrobial resistance and virulence properties, four pairs of clinical and laboratory-evolved colistin-susceptible/colistin-resistant (ColS/ColR) A. baumannii isolates were used. Antimicrobial susceptibility, surface motility, in vitro and in vivo biofilm-forming capacity, in vitro and in vivo expression levels of biofilm-associated genes, and in vitro growth rate were analyzed in these strains. Growth rate, in vitro and in vivo biofilm formation ability, as well as expression levels of biofilm-associated gene were reduced in ColR LPS-deficient isolate (the lpxD mutant) when compared with its ColS partner, whereas there were not such differences between LPS-modified isolates (the pmrB mutants) and their parental isolates. Mutation in lpxD was accompanied by a greater reduction in minimum inhibitory concentrations of azithromycin, vancomycin, and rifampin than mutation in pmrB. Besides, loss of LPS was associated with a significant reduction in surface motility without any change in expression of type IV pili. Collectively, colistin resistance through loss of LPS causes a more considerable cost in biological features such as growth rate, motility, and biofilm formation capacity relative to LPS modification. Therefore, ColR LPS-modified strains are more likely to spread and transmit from one patient to another in hospital settings, which results in more complex treatment and control.

Irritability Levels of Field and Laboratory Population of Culex pipiens Complex in Tehran to Different Groups of Insecticides.

BACKGROUND: The irritant effect of some insecticides can cause a proportion of mosquitoes to leave the sprayed rooms before acquiring a lethal dose, so the repeated contact al sub-lethal dose may lead to extent the resistance. METHODS: Larvae and pupae of Culex pipiens complex were collected in mass from open canals of waste water in capital city Tehran and reared to obtain the first generation at laboratory. Sugar-fed 2-3 days female mosquitoes were used for the experiments and compared with laboratory strain. The irritability tests of insecticides impregnated papers were measured in plastic conical exposure chambers placed which implemented at controlled conditions according to the method described by WHO. Number of take-offs were counted during 15 minutes of exposure time. RESULTS: DDT had the most irritancy effect against field population of Cx. pipiens. DDT, permethrin and deltamethrin was moderately irritable against laboratory strain, whereas, addition to three previous insecticides, malathion, cyfluthrin and propoxur should be also considered as moderately irritable insecticides for field population of. Irritability level of etofenprox, fenithrothion, bendiocarb, and lambdacyhalothrin did not differ from control group. CONCLUSION: The irritability response of mosquitoes may have a negative impact on control measures. Periodical execution of irritability tests with insecticides that routinely used in vector control program is highly recommended.