Changes in nasal septum morphology after rapid maxillary expansion: a Cone-Beam Computed Tomography study in pre-pubertal patient

ABSTRACT Introduction: Nasal septum deviation (NSD) is the most common structural cause of nasal obstruction, affecting around 65-80% of the adult population. Rapid maxillary expansion (RME) is currently used for treatment of maxillary transverse deficiency, but can also influence nasal cavity geometry. Objective: The present study aimed at evaluating the changes in NSD by using Cone-Beam Computed Tomography (CBCT) scans in pre-pubertal patients treated with RME. Methods: This retrospective exploratory study evaluated 20 pre-pubertal patients (mean age 10 ± 2 years) who were treated for transverse maxillary constriction with RME and presented mild/moderate NSD as an incidental finding. The outcome measures were NSD tortuosity and area. These measures were obtained from transverse and coronal views of records taken before and after RME treatment. Intra-rater reliability was also assessed with intraclass correlation coefficient. Results: NSD was mild in thirteen patients (65%) and moderate in seven (35%). NSD tortuosity index did not significantly change over time (mean difference 0.002 mm/year, 95% CI; p = 0.58). NSD area did not significantly change over time (mean difference 2.103 mm2/year, 95% CI; p = 0.38). Intraclass correlation coefficient was 0.73 (95% CI) for NSD tortuosity and 0.84 (95% CI) for NSD area. Conclusions: NSD tortuosity and area suggested potential changes in NSD with small clinical relevance in pre-pubertal patients who were treated with RME. Additional studies using CBCT scans in larger samples are required to clarify the role of RME in NSD treatment.

RESUMO Introdução: O desvio de septo nasal (DSN) é a causa estrutural mais frequente de obstrução nasal, afetando de 65% a 80% da população adulta. A expansão rápida da maxila (ERM), atualmente utilizada para o tratamento da deficiência transversa da maxila, também pode influenciar na geometria da cavidade nasal. Objetivos: O presente estudo teve como objetivo avaliar, usando tomografia computadorizada de feixe cônico (TCFC), as mudanças no DSN após o tratamento com ERM em pacientes pré-púberes. Métodos: Esse estudo exploratório retrospectivo avaliou 20 pacientes pré-púberes (idade média de 10 ± 2 anos) com deficiência transversa da maxila tratados com ERM, e que apresentavam DSN de leve a moderado, como um achado incidental. Foram realizadas medições da tortuosidade e área do DSN. Essas medições foram feitas em cortes transversais e coronais das TCFCs pré- e pós-tratamento com ERM. A confiabilidade intraexaminador também foi aferida por meio do coeficiente de correlação intraclasse. Resultados: O DSN era leve em 13 pacientes (65%) e moderado em 7 (35%). O índice de tortuosidade do DSN não mudou significativamente ao longo do tempo (diferença média = 0,002 mm/ano, IC 95%; p= 0,58). A área do DSN não mudou significativamente ao longo do tempo (diferença média = 2,103 mm2/ano, IC 95%; p= 0,38). O coeficiente de correlação intraclasse foi igual a 0,73 (IC 95%) para a tortuosidade do DSN e 0,84 (IC 95%) para a área do DSN. Conclusões: Os valores de tortuosidade e da área do DSN sugeriram potenciais mudanças no DSN, mas com pequena relevância clínica, nos pacientes pré-púberes tratados com ERM. Estudos adicionais utilizando TCFC em amostras maiores são necessários para esclarecer o papel da ERM no tratamento do DSN.

Incorporation of international risk management standards into federal regulations / Incorporación de modelos internacionales de gestión de riesgos en las reglamentaciones federales / Incorporação de modelos internacionais de gerenciamento de riscos na normativa federal

Abstract The issue of risk management has gained attention in the field of administration due to the dissemination of international frameworks. In Brazilian federal public administration, risk management is a recent and expanding practice. This research analyzes how international corporate risk management frameworks have been adopted by the federal government through regulations and guidelines. The study adopts the concepts of coercive, normative, and mimetic forces from the neo-institutional theory, and examines the presence of international norms in the Brazilian regulations. Through a qualitative approach, content analysis in documents, norms, interviews, and seminars was used to identify traits of the COSO ERM and ISO 31000/2009 frameworks, which were chosen based on relevance. Results identify important actors pushing for the use of international frameworks, such as international organizations, professional associations, and public agencies, especially those related to government audits. Despite the strong international influence, the Brazilian norms are adapted to the organizations' context and allowing the maintenance of national autonomy.

Resumen El interés en la gestión de riesgos ha crecido de manera constante, fortalecido por la difusión de modelos internacionales. En la administración pública federal de Brasil, el uso de la gestión de riesgos es reciente y se está expandiendo. Esta investigación analiza cómo las normas y directrices del gobierno federal adoptan los modelos internacionales de gestión de riesgos corporativos. Siguiendo la teoría neoinstitucional, se investigó la exposición a fuerzas coercitivas, normativas y miméticas, y la presencia de conceptos de normas internacionales en la reglamentación brasileña. Se utilizó el análisis de contenido en documentos, normas, entrevistas y seminarios para identificar los rasgos de los modelos COSO ERM e ISO 31000/2009, adoptados por su relevancia. Los resultados identifican actores importantes que ejercen presión para la adopción de modelos internacionales, como organizaciones internacionales, asociaciones profesionales y agencias públicas, especialmente las vinculadas a la auditoría gubernamental. A pesar de la fuerte influencia, la estructuración de estándares permite el mantenimiento de la autonomía nacional y su personalización en el contexto de las organizaciones.

Resumo O interesse no gerenciamento de riscos tem crescido continuamente, fortalecido pela disseminação de modelos internacionais. Na administração pública federal brasileira, o uso da gestão de riscos é recente e encontra-se em expansão. Esta pesquisa analisou como modelos internacionais de gerenciamento de riscos corporativos são adotados pelas normas e orientações do Governo Federal. Aplicam-se os conceitos de forças coercitivas, normativas e miméticas da teoria neoinstitucional e observa-se a presença de conceitos das normas internacionais na normativa brasileira. Aplicou-se a análise de conteúdo em documentos, entrevistas, normas e palestras, a fim de identificar traços do modelo do Comitê das Organizações Patrocinadoras de Treadway (Committee of Sponsoring Organizations of the Treadway Commission [COSO]) para Gerenciamento de Riscos Corporativos (Enterprise Risk Management [ERM]), conhecido como modelo "COSO ERM", e do modelo da Organização Internacional de Normalização (International Organization for Standardization [ISO]), conhecido como Norma ISO 31000:2009, adotados por sua relevância. Os resultados identificam que importantes atores exercem pressões para adoção dos modelos internacionais, como os próprios organismos internacionais, associações profissionais e órgãos públicos, em especial aqueles ligados à auditoria governamental. Apesar da forte influência verificada, a estruturação das normas permite a manutenção da autonomia nacional e sua customização no contexto das organizações.

La inhibición de Rho quinasa post infarto mejora el remodelado y la función ventricular: mecanismos involucrados a nivel preclínico / Rho-kinase inhibition post myocardial infarction improves remodeling and systolic function: a preclinical study of intervening factors in a pre-clinical study

Resumen: Objetivo: Determinar algunos mecanismos moleculares por los cuales la activación de ROCK cardíaca post infarto del miocardio (IAM) participa en el remodelado y en deterioro de la función sistólica. Métodos: Determinación simultánea de niveles de proteínas blanco de ROCK cardíaca, de función sistólica in vivo del ventrículo izquierdo (VI) y de fibrosis e hipertrofia cardíaca en ratas con IAM en condiciones de inhibición de ROCK con fasudil. Resultados : Siete días post IAM la masa ventricular relativa aumentó significativamente en un 30% en el grupo MI y se redujo con fasudil. La disfunción sistólica VI mejoró significativamente con fasudil mientras que la activación de ROCK cardíaca se redujo a niveles del grupo control. El inhibidor de ROCK también redujo significativamente los niveles cardíacos elevados de las isoformas ROCK1 y ROCK2, de MHC-β y del colágeno miocárdico. En el grupo con IAM aumentaron significativamente los niveles de fosforilación de ERK 42 y ERK 44 (en 2 veces y en 63%, respectivamente), mientras que en el grupo IAM tratado con fasudil estos niveles fueron similares a los del grupo control. El IAM aumentó significativamente los niveles fosforilados del factor de transcripción GATA-4, que se normalizaron con el inhibidor de ROCK. Conclusiones: La disfunción sistólica post IAM se asoció fuertemente con la activación del ROCK cardíaca y con la fosforilación de proteínas río abajo de ROCK que promueven remodelado cardíaco como β-MHC y la vía ERK / GATA-4.

Abstracts: Objective: to determine some molecular mechanisms by which cardiac ROCK activation after myocardial infarction (MI) intervene in cardiac systolic function decline and remodeling. Methods: simultaneous measurement of different cardiac ROCK target proteins levels, in vivo left ventricular (LV) systolic function, myocardial fibrosis, and hypertrophy in rats with MI under ROCK inhibition with fasudil were performed. Results: seven days after MI the relative ventricular mass increased significantly by 30% in the MI groupand was reduced with fasudil. LV systolic dysfunction improved significantly with fasudil whereas at the same time cardiac ROCK activation was reduced to sham levels. The ROCK inhibitor also reduced increased cardiac levels of both ROCK1 and ROCK2 isoforms, β-MHC levels and myocardial collagen volume fraction decline. MI significantly increased phosphorylation levels of ERK 42 and ERK 44 by 2-fold and 63% respectively whereas in the fasudil-treated MI group these levels were similar to those in the sham group. MI significantly increased phosphorylated levels of the transcription factor GATA-4 which were normalyzed by the ROCK inhibitor. Conclusion: LV systolic dysfunction after MI was strongly associated to cardiac ROCK activation and subsequent phosphorylation of ROCK target proteins that promote ventricular remodeling, such as β-MHC and the ERK/GATA-4 pathway. ROCK inhibition with fasudil significantly improved systolic function, diminished myocardial fibrosis, and normalized β-MHC and ERK/GATA-4 phosphorylation levels.

Lack of association between rrl and erm(41) mutations and clarithromycin resistance in Mycobacterium abscessus complex

BACKGROUND Mycobacterium abscessus complex (MABC) includes species with high resistance rates among mycobacterial pathogens. In fact, MABC infections may not respond to clarithromycin treatment, which has historically been very effective against MABC infection. Molecular markers have been proposed to detect both acquired (rrl polymorphisms) and inducible (erm(41) polymorphisms) clarithromycin resistance in MABC isolates. OBJECTIVES This study aimed to evaluate the susceptibility profile and molecular markers of clarithromycin resistance in MABC. METHODS The clarithromycin susceptibility profile was determined by broth microdilution with reads on days 3, 5, 7 and 14. Mutations in the rrl and erm(41) genes were evaluated by polymerase chain reaction (PCR) using specific primers, followed by sequencing. FINDINGS A total of 14 M. abscessus subsp. abscessus isolates and 28 M. abscessus subsp. massiliense isolates were evaluated, and clarithromycin resistance was observed in all isolates for up to three days of incubation. None of the 42 isolates exhibited a point mutation in the rrl gene, while all the isolates had a T28 polymorphism in the erm(41) gene. Moreover, all 28 M. abscessus subsp. massiliense isolates had a deletion in the erm(41) gene. MAIN CONCLUSIONS While all the MABC isolates exhibited acquired clarithromycin resistance, no isolates exhibited a point mutation in the rrl gene in this study. The M. abscessus subsp. massiliense isolates demonstrated clarithromycin resistance, which is an uncommon phenotype. The molecular data for the rrl and erm(41) genes were not consistent with the phenotypic test results of clarithromycin susceptibility, indicating a lack of correlation between molecular clarithromycin resistance markers for both acquired and inducible resistance.

Antimicrobial susceptibility profile and research of mec A and erm genes in coagulase-negative staphylococci isolated from platelet concentrates bags

Abstract In recent years, several studies have described the clinical impact of bacterial infection associated with transfusion of platelet concentrates (PCs). Among the blood components, PCs are responsible for the highest rates of bacterial contamination as well as septic transfusion reactions. We assessed antimicrobial susceptibility profile, resistance to methicillin (MRCoNS), and resistance to macrolides, lincosamides and streptogramins of group B (MLSB) of 16 coagulase-negative staphylococci (CoNS) isolates from an investigation in 691 PCs bags. We then compared conventional and automated phenotypic methods, disc diffusion test (DD) and VITEK(r) 2, respectively as well as phenotypic and genotypic methods (Polymerase Chain Reaction - PCR). All CoNS were susceptible to vancomycin. The disc diffusion test characterized 18.75% as MRCoNS and 37.5% with inducible resistance to MLSB (iMLSB), and with VITEK(r) 2, 6.3% and 31.25%, respectively. The mecA gene was detected in 18.75% and the erm gene in 31.25% of the isolates. In this study, we found equal percentage values between presence of the mecA gene by PCR and resistance to methicillin using cefoxitin by DD test, evidence of the erm gene by PCR, and iMLSB resistance by automation (VITEK(r) 2). Moreover, we identified three strains with beta-lactamase overproduction, and the occurrence of a bigger mistake was verified when automation was compared with DD test. And we observed that D-test was the most reliable for the detection of iMLSB resistance in Staphylococcus sp.

Allele‑specific duplex polymerase chain reaction to differentiate Mycobacterium abscessus subspecies and to detect highly clarithromycin‑resistant isolates.

On the basis of the structural differences of erm, we used a duplex polymerase chain reaction (PCR) to differentiate Mycobacterium abscessus subsp. abscessus and subsp. massiliense isolates and to detect the point mutations of 23S rRNA gene that confer a high level of resistance to clarithromycin. Subsp. massiliense strains occupying almost half of the clinical isolates can be simply identified, and their clarithromycin susceptibility can be rapidly determined.

Phenotypic and molecular characterization of resistance to macrolides, lincosamides and type B streptogramin of clinical isolates of Staphylococcus spp. of a university hospital in Recife, Pernambuco, Brazil

Abstract Introduction There is a mechanism of macrolide resistance in Staphylococcus spp. which also affects the lincosamides and type B streptogramins characterizing the so-called MLSB resistance, whose expression can be constitutive (cMLSB) or inducible (iMLSB) and is encoded mainly by ermA and ermC genes. The cMLSB resistance is easily detected by susceptibility testing used in the laboratory routine, but iMLSB resistance is not. Therapy with clindamycin in cases of infection with isolated iMLSB resistance may fail. Objective To characterize the phenotypic (occurrence of cMLSB and iMLSB phenotypes) and molecular (occurrence of ermA and ermC genes) profiles of MLSB resistance of clinical isolates of susceptible and methicillin-resistant Staphylococcus aureus and CNS (coagulase-negative Staphylococcus) from patients of a university hospital, in Pernambuco. Methods The antimicrobial susceptibility of 103 isolates was determined by the disk diffusion technique in Mueller–Hinton agar followed by oxacillin screening. The iMLSB phenotype was detected by D test. Isolates with cMLSB and iMLSB phenotypes were subjected to polymerase chain reaction (PCR) for the detection of ermA and ermC genes. Results The cMLSB and iMLSB phenotypes were respectively identified in 39 (37.9%) and five (4.9%) isolates. The iMLSB phenotype was found only in four (10.8%) methicillin-susceptible S. aureus and one (4.5%) methicillin-resistant S. aureus. In the 44 isolates subjected to PCR, four (9.1%) only ermA gene was detected, a lower frequency when compared to only ermC 17 (38.6%) gene and to one (2.3%) isolate presenting both genes. Conclusion In the Staphylococcus spp. analyzed, the ermC gene was found more often than the ermA, although the iMLSB phenotype had been less frequent than the cMLSB. It was important to perform the D test for its detection to guide therapeutic approaches.

Study on clindamycin resistance and molecular epidemiology of bloodstream infection by Staphylococcus aureus / 国际检验医学杂志

Objective To understand the clindamycin resistance gene and molecular epidemic of Staphylococcus aureus in the pa‐tients with bloodstream infection in our hospital during 2014 .Methods The clinical isolates of Staphylococcus aureus in clinical bloodstream infection were collected during 2014 .The phenotype of erythromycin to clindamycin induced resistance was assessed by D test .The erm gene was detected by PCR .The different erm types of the molecular epidemiology of Staphylococcus aureus were studied by spa and MLST typing .Results In 33 strains of Staphylococcus aureus ,the isolation rate of MRSA strains were 78 .79% ,moreover all of MRSA strains carried ermA gene .In 7 strains of methicillin sensitive Staphylococcus aureus(MSSA) ,4 strains respectively carried ermB or ermC gene .The results of MLST and spa results showed that the main type of MRSA in our hospital was ST239‐t030 .But MSSA had more types ,such as ST59‐t437 ,ST398‐t3625 and so on .Conclusion MRSA has higher i‐solation rate in our hospital ,which is dominated by ST239‐t030 type .For the detection of gene erm ,ermA (86 .67% ) is the main type .The strains are obviously resistant to antibacterial drugs .The laboratory should strengthen the detection of clindamycin in‐duced resistance for guiding the clinical rational use of antibacterial drugs .

Erythromycin resistance in propionibacteria isolated from patients with acne in Wuhan city is associated with mutations in 23S rRNA gene and presence of erm genes / 中华皮肤科杂志

Objective To determine whether erythromycin-resistant propionibacteria isolated from patients with acne in Wuhan city harbor 23S rRNA gene mutations as well as the transposon Tn5432 carrying ermX genes.Methods Twenty-nine Propionibacterium strains isolated from outpatients with acne in Wuhan city were included in this study.The E-test method was used to determine the susceptibility of these strains to erythromycin and clindamycin.PCR was performed to amplify the 23S rRNA,ermX,ermX (cj),IS1249a and IS1249b genes from resistant strains followed by DNA sequencing and nucleotide alignment.Results Among the 29 Propionibacterium strains,19 were identified as P.acnes and 10 as P.avidum.All of these Propionibacterium strains were resistant to erythromycin (MIC ＞ 256 μg/ml) and clindamycin (MIC ＞ 256 μg/ml),except for 3 P.acnes strains sensitive to clindamycin.Seven P.acnes strains resistant to both antibiotics exhibited an A→G transition at a position cognate with Escherichia coli 23S rRNA 2058.An A→G transition at a position cognate with E.coli 23S rRNA 2059 was identified in one clindamycin-resitant and three clindamycin-sensitive P.acnes isolates.The ermX gene was found in the remaining 8 P.acnes isolates and 2 P.avidum isolates,with the sequence 100％ identical to the reference sequence of the ermX gene of P.acnes in Genbank.Meanwhile,the ermX (cj) gene was successfully amplified from the other 8 P.avidum isolates,which showed 99％ sequence homology with the ermX (cj) gene of Corynebacterium jeikeium,but 94％ homology with the ermX gene of P.acnes in Genbank.Both IS1249a and IS1249b genes were amplified in the 10 ermX gene-positive Propionibacterium strains,but not in the other ermX gene-negative strains.Conclusions The erythromycin resistance in Propionibacterium isolates from Wuhan city may be associated with the A→G transition at the E.coli equivalent bases 2058 and 2059 of the 23S rRNA gene,as well as the presence of the erm X (transferred through the transposon Tn5432) and ermX (c j) genes.

Genotyping of erythromycin resistant group C & G streptococci isolated in Chennai, south India.

Background & objectives: Increasing resistance to erythromycin has been observed worldwide in group C and group G streptococci (GCS/GGS). The information available from India is scanty. The aim of the study was to identify erythromycin resistant GCS/GGS isolates in Chennai, south India, and to compare erythromycin resistant genotypes with emm types. Methods: One hundred and thirty one GCS/GGS isolates were tested for erythromycin resistance by disc diffusion and agar dilution methods. Erythromycin resistance genotypes [erm(A), erm(B) and mef(A)] were determined by a multiplex PCR. emm types of erythromycin resistant GCS/GGS isolates was also assessed using emm gene sequencing method. Results: Sixteen of the 131 isolates (12.21%) were resistant to erythromycin. Majority of the isolates were GGS (15/16). Eight of the 16 (50%) were S. dysgalactiae subsps. equisimilis. Twelve isolates (75%) were MLSB phenotype and four (25%) were M phenotype. Of the 12 isolates which exhibited MLSB resistance, seven showed cMLSB phenotype and were positive for erm(B) gene. The remaining five were iMLSB phenotype of which three were positive for erm(A) gene and two for erm(B) gene. erm(A) was common among carriers whereas erm(B) was common among clinical isolates. Interpretation & conclusions: MLSB was the predominant phenotype and erm(B) was the common genotype in the present study. The emm type stC1400.0 was frequently associated with erythromycin resistant GCS/GGS in our study.

Diferenças metabólicas no hipocampo contralateral entre pacientes concordantes e discordantes na esclerose mesial temporal (EMT): avaliação com espectroscopia de protóns por ressonância magnética (1H-ERM) / Metabolic differences in the contralateral hippocampus of concordant and discordant mesial temporal sclerosis (MTS) patients: evaluation with proton magnetic resonance spectroscopy (1H-MRS)

OBJETIVO: Pacientes com esclerose mesial temporal (EMT) são clinicamente classificados como concordantes ou discordantes de acordo com a extensão da atividade epileptogênica. O objetivo desse estudo é verificar se as alterações metabólicas no hipocampo são diferentes nos dois grupos. MATERIAIS E MÉTODOS: Foram avaliados 33 pacientes diagnosticados com EMT, 23 concordantes (33±9 anos) e 10 discordantes (33±10 anos), e 28 controles (33±10 anos). Foi obtida espectroscopia por ressonância magnética de ambos os hipocampos (ipsi e contralateral) com aparelho de 3T e com a sequência PRESS de vóxel único com TE/TR=135/1500ms. Os principais metabólitos foram quantificados com o LCModel. Para a comparação entre os grupos foram realizados testes estatísticos com nível de significância de 0,05. RESULTADOS: Para todos os pacientes foi observada redução de NAAipsi e Cr ipsi quando comparado com o lado contralateral, porém esta diferença foi significativa apenas para o grupo de pacientes concordantes. Quando comparado com o grupo controles houve uma redução significativa de Cr ipsi e NAAipsi para os dois grupos e da relação NAA/Cr ipsi para o grupo de pacientes concordantes enquanto que a relação NAA/Cr contra estava diminuída apenas no grupo de pacientes discordantes. CONCLUSÃO: Nossos achados sugerem uma maior diminuição do NAA/Cr ipsi no grupo de pacientes concordantes e da relação NAA/Cr contra no grupo de pacientes discordantes apontando para um padrão diferente de alteração metabólica para os dois grupos. Porém é preciso aumentar o tamanho da amostra para confirmar estes resultados.

PURPOSE: Patients with mesial temporal sclerosis (MTS) are clinically classified as concordant or discordant according to the extent of epileptogenic activity. The aim of this study is to determine whether the metabolic changes in the hippocampus are different in the two groups. MATERIALS AND METHODS: 33 patients diagnosed with MTS, 23 concordant (33±9 years old) and 10 discordant (33±10 years old) and 28 controls (33±10 years old) were evaluated. We obtained magnetic resonance spectroscopy of both hippocampi (ipsilateral and contralateral) on a 3T scanner with single voxel PRESS sequence with TE/TR=135/1500ms. The main metabolites were quantified with LC Model. For comparison between groups statistical tests were performed with a significance level of 0.05. RESULTS: In all patients a reduction of NAAipsi and Cr ipsi was observed, when compared to the contralateral side, but this difference was only significant for the group of concordant patients. In comparison with controls a significant reduction of Cr ipsi and NAAipsi was observed for both groups and for Naa/Cr ipsi in the group of concordant patients while NAA/Cr contra was reduced only in the group of discordant patients. CONCLUSION: Our findings suggest a stronger decline of NAA/Cr ipsi in the group of concordant patients and of NAA/Cr contra in discordant patients, suggesting a slightly different metabolic pattern for both groups. However, we need to increase the sample size to confirm these findings.

Amphetamine-induced ERM Proteins Phosphorylation Is through PKCbeta Activation in PC12 Cells

Amphetamine, a synthetic psychostimulant, is transported by the dopamine transporter (DAT) to the cytosol and increases the exchange of extracellular amphetamine by intracellular dopamine. Recently, we reported that the phosphorylation levels of ezrin-radixin-moesin (ERM) proteins are regulated by psychostimulant drugs in the nucleus accumbens, a brain area important for drug addiction. However, the significance of ERM proteins phosphorylation in response to drugs of abuse has not been fully investigated. In this study, using PC12 cells as an in vitro cell model, we showed that amphetamine increases ERM proteins phosphorylation and protein kinase C (PKC) beta inhibitor, but not extracellular signal-regulated kinase (ERK) or phosphatidylinositol 3-kinases (PI3K) inhibitors, abolished this effect. Further, we observed that DAT inhibitor suppressed amphetamine-induced ERM proteins phosphorylation in PC12 cells. These results suggest that PKCbeta-induced DAT regulation may be involved in amphetmaine-induced ERM proteins phosphorylation.

Distribution of erm genes and low prevalence of inducible resistance to clindamycin among staphylococci isolates

INTRODUCTION: Resistance to macrolides, lincosamides and streptogramins B (MLS B antibiotics) in staphylococci may be due to modification in ribosomal target methylase encoded by erm genes. The expression of MLS B resistance lead to three phenotypes, namely constitutive resistance (cMLS B), inducible resistance (iMLS B), and resistance only to macrolides and streptogramins B (MS B). The iMLS B resistance is the most difficult to detect in the clinical laboratory. OBJECTIVE: This study investigated the expression of MLS B resistance and the prevalence of the erm genes among 152 clinical isolates of Staphylococcus aureus and coagulase-negative Staphylococcus (CNS) from Hospital de Clínicas de Porto Alegre. METHODS: Primary MLS B resistance was detected by the disk diffusion method. Isolates with iMLS B phenotype were tested by double-disk induction method. All isolates were tested by a genotypic assay, PCR with specific primers. RESULTS: A total of 46.7 percent of staphylococci were positive for cMLS B; 3.3 percent for iMLS B and 3.3 percent for MS B. One or more erm genes were present in 50.1 percent of isolates. The gene ermA was detected in 49 isolates, ermC in 29 and ermB in 3. CONCLUSION: The prevalence of the ermA, ermB and ermC genes were 29.6 percent, 17.1 percent and 0.66 percent respectively, and constitutive resistance was the most frequent as compared to the other two phenotypes.

Antimicrobial susceptibility of Streptococcus pneumoniae and genotypic characterization of erythromycin-resistant strains in Porto Alegre, Brazil

The antimicrobial susceptibility of 64 strains of S. pneumoniae obtained from three hospitals in Porto Alegre, Brazil, isolated between 2004 and 2005, was determined, using the agar-dilution method. The prevalence of resistant (intermediate and full resistance) strains to trimethoprim/sulphamethoxazole, penicillin, tetracycline, erythromycin, chloramphenicol, and ceftriaxone were 68 percent, 28 percent, 18 percent, 15 percent, 3 percent, and 1 percent, respectively. All strains were susceptible to vancomycin. Among 18 penicillin-resistant strains, 7 were resistant to at least two other antimicrobial drugs. All erythromycin-resistant strains, except one, contained the erm(B) and/or mef(A/E) genes, with a predominance of the former. The resistance rate to penicillin and erythromycin in Porto Alegre remained stable. The combination of trimethoprim/ sulphamethoxazole should not be recommended to treat pneumococcal infections, because of the high rate of resistant strains.

Prevalence of mef and ermB genes in invasive pediatric erythromycin-resistant Streptococcus pneumoniae isolates from Argentina / Prevalencia de los genes mef y ermB en aislamientos invasivos de Streptococcus pneumoniae resistentes a eritromicina recuperados de pacientes pediátricos en Argentina

During the period 1993-2001, a total of 1,499 pneumococci isolates were recovered through the Argentinean surveillance of Streptococcus pneumoniae causing invasive disease in children under 6 years of age, 3.5% of which were erythromycin resistant. Among the 50 erythromycin-resistant strains available, 58% (n=29) harbored mefA/E genes (15 mefA, 30%; and 14 mefE, 28%), 34% (n=17) ermB, and 6% (n=3) both mefA/E plus ermB genes, while one isolate was negative for all the acquired genes studied. The England14-9 (42%), Poland6B-20 (20%) and Spain9v-3 (16%) clones were responsible for the emergence of pneumococcal macrolide resistance in pediatric population from Argentina.

En el marco del programa de vigilancia regional SIREVA, se analizaron 1499 aislamientos de Streptococcus pneumoniae causantes de enfermedad invasiva en menores de 6 años, recuperados entre 1993 y 2001. Se detectó un 3,5% de resistencia a eritromicina. De los 50 aislamientos resistentes a eritromicina que pudieron ser estudiados, el 58% (n=29) tenían los genes mefA/E (15 mefA, 30% y 14 mefE, 28%), el 34% (n=17) el gen ermB y el 6% (n=3) la combinación de genes mefA/E y ermB. Sólo un aislamiento fue negativo para todos los genes analizados. Los clones internacionales England14-9, Poland6B-20 y Spain9v-3 representaron el 78% del total de aislamientos resistentes (42, 20 y 16%, respectivamente) y se consideraron los responsables de la emergencia de la resistencia a macrólidos entre los neumococos que afectan a la población pediátrica de Argentina.

Colonization Rate, Serotypes, and Distributions of Macrolide-Lincosamide-Streptogramin(B) Resistant Types of Group B Streptococci in Pregnant Women / 대한임상미생물학회지

BACKGROUND: The prevalence of neonatal group B streptococcal infection depends mainly on the colonization rate of pregnant women by group B streptococci (GBS). Although the colonization rate of Korean women by GBS is considered lower than in other countries, recent data on the maternal colonization rate of GBS are sparse. METHODS: From August 2008 to June 2009, swab specimens from the anorectus, vagina, and urethral orifice of a sample of 234 pregnant Korean women were placed in new Granada medium (NGM-H), tube medium (NGM-T), commercial NGM (NGM-B), and selective Todd-Hewitt broth (S-THB) for 18~24 hours in 5% CO2 at 35degrees C. Agar dilutional antimicrobial susceptibility tests, serotyping, and PCR were performed for GBS isolates. RESULTS: The colonization rate of GBS in pregnant women was 11.5% (27/234). Of the specimen cultures, 9.8% of anorectal cultures were positive, 8.1% of urethral orifice cultures were positive, and 7.3% of vagina cultures were positive. The detection rate of GBS in the different culture media was S-THB (96.3%), NGM-B (92.6%), NGM-H (88.9%), and NGM-T (85.2%). The distribution of GBS serotypes was as follows: III (29.6%), V and VI (22.2%), Ib and II (11.1%), and Ia (3.7%). 33.3% of GBS isolates were resistant to erythromycin and 44.4% to clindamycin. Among the nine erythromycin-resistant isolates, eight were serotype V and VI, which are erm(B) positive serotypes. CONCLUSION: The colonization of pregnant women by GBS, and the incidence of resistance of the GBS isolates to erythromycin and clindamycin were higher than those previously reported. Serotypes V and VI, GBS serotypes that carry the erm(B), are novel serotypes that have not previously been identified in pregnant Korean women.

Antimicrobial Susceptibility Patterns and Macrolide Resistance Genes of beta-Hemolytic Viridans Group Streptococci in a Tertiary Korean Hospital

The aim of this study was to investigate antimicrobial susceptibilities and macrolide resistance mechanisms of beta-hemolytic viridans group streptococci (VGS) in a tertiary Korean hospital. Minimum inhibitory concentrations (MICs) of seven antimicrobials were determined for 103 beta-hemolytic VGS isolated from various specimens. The macrolide resistance mechanisms of erythromycin-resistant isolates were studied by the double disk test and polymerase chain reaction (PCR). The overall resistance rates of beta-hemolytic VGS were found to be 47.5% to tetracycline, 3.9% to chloramphenicol, 9.7% to erythromycin, and 6.8% to clindamycin, whereas all isolates were susceptible to penicillin G, ceftriaxone, and vancomycin. Among ten erythromycin-resistant isolates, six isolates expressed a constitutive MLSB (cMLSB) phenotype, and each of the two isolates expressed the M phenotype, and the inducible MLSB (iMLSB) phenotype. The resistance rates to erythromycin and clindamycin of beta-hemolytic VGS seemed to be lower than those of non-beta-hemolytic VGS in our hospital, although cMLSB phenotype carrying erm(B) was dominant in beta-hemolytic VGS.

Drug-resistance and Gene erm Existing in Meticillin-resistant Staphylococcus aureus / 中华医院感染学杂志

OBJECTIVE To investigate the resistance of meticillin-resistant Staphylococcus aureus(MRSA) and the occurrence of gene erm.METHODS ATB Staph and microdilute tests were performed to detect the susceptibility to 15 kinds of antibiotics in 50 strains of the S.aureus(SAU).Gene erm of these strains was detected by polymerase chain reaction(PCR).RESULTS There were no strains resistant to vancomycin,teicoplanin,fusidic acid and quinupristin-dalfopristin in 42 strains of MRSA detected.There were no strains sensitive to penicillin,oxacillin,gentamicin,tetracycline,ciprofloxacin and levofloxacin.Thirty-five strains habored gene erm in 42 strains of MRSA.The positive rate of gene erm was 83.3%.CONCLUSIONS The multiple-resistance of the MRSA is a serious issue.The resistance to erythromycin in MRSA is mediated by gene erm which encodes the methylase and changes the target site of drug action.

Macrolide Resistance in beta-Hemolytic Streptococci: Changes after the Implementation of the Separation of Prescribing and Dispensing of Medications Policy in Korea

This study evaluated the antimicrobial susceptibilities and macrolide resistance mechanisms of beta-hemolytic streptococci (BHS), and an additional objective was to assess the effects of 'the separation of prescribing and dispensing (SPD) of medications' on bacterial resistance rate and distribution of phenotypes and genotypes of erythromycin-resistant BHS by comparing the antimicrobial susceptibility data before (1990- 2000) and after the implementation of SPD at one tertiary care hospital in South Korea. Between the period of January 2001 and December 2002, the minimal inhibitory concentrations of six antimicrobials were determined for 249 clinical isolates of BHS. Resistance mechanisms of erythromycin-resistant (intermediate and resistant) isolates were studied by using the double disk test and PCR. Overall, the resistance rates to tetracycline, erythromycin, and clindamycin were 75.5%, 32.9%, and 32.5%, respectively. Sixty-seven (81.7%) of 82 erythromycin- resistant isolates expressed constitutive resistance to macrolide- lincosamide-streptogramin B antibiotics (a constitutive MLSB phenotype) ; 11 isolates (13.4%) expressed an M phenotype; and four isolates (4.9%) had an inducible MLSB resistance phenotype. erm (A) was found in isolates with constitutive/ inducible MLSB phenotypes, erm (B) with the constitutive/ inducible MLSB phenotype, and mef (A) with the M phenotype. We found that resistance rates to erythromycin and clindamycin among S. agalactiae, S. pyogenes, and group C streptococci isolates were still high after the implementation of the SPD policy in Korea, and that the constitutive MLSB resistance phenotype was dominant among erythromycin- resistant BHS in this Korean hospital.

Factors Associated with Recurrence after Surgery for Epiretinal Membrane

PURPOSE: To evaluate the factors associated with the recurrence of epiretinal membrane (ERM) after surgery for ERM METHODS: We reviewed patients' medical records who received vitrectomy for ERM. The preoperative findings, best postoperative and final visual acuity, and intraoperative findings of eyes with recurred ERM were compared with those of eyes without recurrence after removal of ERM. RESULTS: Recurrence of ERM was high in eyes with ERM associated with chronic uveitis, compared with the eyes with idiopathic ERM (p=0.030, Cox regression analysis). Neither the type of membrane nor incomplete membrane removal during pars plana vitrectomy was correlated with the recurrence of ERM. CONCLUSIONS: Considering the recurrence of ERM after surgical removal being high in eyes with chronic uveitis, close follow up is recommended in these patients.