Increased risk of depression in patients with rheumatoid arthritis: a seven-year population-based cohort study

OBJECTIVE: Rheumatoid arthritis (RA) is a costly and crippling autoimmune disease that can lead to the development of depression, contributing to suboptimal clinical outcomes. However, no longitudinal studies have identified an association between rheumatoid arthritis and subsequent depression. This study aimed to investigate the incidence and risk factors of depression among RA patients in Taiwan. METHODS: Using Taiwan's National Health Insurance Research Database, we identified 3,698 newly diagnosed RA patients aged 18 years or older, together with 7,396 subjects without RA matched by sex, age and index date, between 2000 and 2004. The incidence of depression and the risk factors among RA cases were evaluated using Cox proportional-hazard regression. RESULTS: The incidence of depression was 1.74-fold greater in the RA cohort than in the non-RA cohort (11.80 versus 6.89 per 1,000 person-years; p<0.01). Multivariate analysis showed that RA subjects who were female, were older, or had comorbidities such as stroke, chronic kidney disease, or cancer had a significantly greater risk of depression compared with those without these conditions. CONCLUSION: This population-based cohort study showed a strong relationship between RA and a subsequent risk of depression. The findings could be beneficial to healthcare providers for identifying individuals with a higher predisposition for depression, thereby possibly facilitating the provision of an appropriate rehabilitation intervention after RA onset to support the patient's adaptation. .

Multiple antibiotic susceptibility of polyphosphate kinase mutants (ppk1 and ppk2) from Pseudomonas aeruginosa PAO1 as revealed by global phenotypic analysis

BACKGROUND: Pseudomonas aeruginosa is known to be a multidrug resistant opportunistic pathogen. Particularly, P. aeruginosa PAO1 polyphosphate kinase mutant (ppk1) is deficient in motility, quorum sensing, biofilm formation and virulence. FINDINGS: By using Phenotypic Microarrays (PM) we analyzed near 2000 phenotypes of P. aeruginosa PAO1 polyP kinase mutants (ppk1 and ppk2). We found that both ppk mutants shared most of the phenotypic changes and interestingly many of them related to susceptibility toward numerous and different type of antibiotics such as Ciprofloxacin, Chloramphenicol and Rifampicin. CONCLUSIONS: Combining the fact that ppk1 mutants have reduced virulence and are more susceptible to antibiotics, polyP synthesis and particularly PPK1, is a good target for the design of molecules with anti-virulence and anti-persistence properties.

Percepção dos receptores sanguíneos quanto ao processo transfusional / Blood transfusion receivers' perception of the transfusion process / Percepción de transfusión de sangre en el caso de los receptores

Pesquisa qualitativa, exploratória descritiva, que objetivou conhecer a percepção dos receptores sanguíneos quanto ao processo transfusional. A pesquisa foi realizada em uma unidade de hemoterapia de um município da região sul do Brasil e os dados foram analisados por meio do Discurso do Sujeito Coletivo. Foram entrevistados, por meio de instrumento semiestruturado, onze pacientes, homens e mulheres entre 30 e 95 anos, em recuperação pós-cirúrgica de cirurgia cardíaca, submetidos à transfusão sanguínea. Emergiram quatro Ideias Centrais: Perda e reposição sanguínea; Preservação da vida; Reconhecimento do processo transfusional e Segurança transfusional. A percepção sobre a mudança que os pós-transfundidos começam a vivenciar a partir do processo transfusional traz à tona uma ressignificação da própria vida. Este estudo mostrou que os pacientes transfundidos percebem o processo transfusional como uma alternativa de sobrevivência e, mesmo tendo conhecimento sobre o processo e seus significados, permanecem receios e angústias que podem ser minimizados pela equipe multiprofissional.

Qualitative research, descriptive exploratory, aimed to know the perception of blood transfusion recipients as to the process. The research was carried out at a blood bank in a city in southern Brazil, and the data were analyzed using the Collective Subject Discourse. Were interviewed using a semistructured instrument, eleven patients, men and women between 30 and 95 years, post-surgical recovery of cardiac surgery, underwent blood transfusion. Four central ideas emerged: loss and blood replacement; Preservation of life; Recognition of the transfusion process; and transfusion safety. The perception about the change that post-transfusion begin to live from the transfusion process raises a reframing of life itself. This study showed that transfused patients perceive the transfusion process as a means of survival, and even having knowledge about the process and their meanings, there is the permanence of fears and anxieties that can be minimized by the multidisciplinary team.

Investigación cualitativa, de tipo exploratorio descriptivo, con el objetivo de conocer la percepción de los receptores de transfusiones de sangre en cuanto al proceso. La investigación se llevó a cabo en un banco de sangre en una ciudad en el sur de Brasil, y los datos fueron analizados utilizando el Discurso del Sujeto Colectivo. Fueron entrevistados mediante un instrumento semi-estructurado, once pacientes, hombres y mujeres de entre 30 y 95 años de recuperación post-quirúrgica de la cirugía cardíaca, se sometió a una transfusión de sangre. Cuatro ideas centrales surgieron: la pérdida y reemplazo de sangre; La preservación de la vida; Reconocimiento del proceso de transfusión; y seguridad de las transfusiones. La percepción sobre el cambio que después de la transfusión comenzar a vivir desde el proceso de transfusión plantea una reformulación de la vida misma. Este estudio mostró que los pacientes transfundidos perciben el proceso de transfusión como un medio de supervivencia, e incluso tener conocimiento sobre el proceso y sus significados, no es la permanencia de los temores y ansiedades que pueden minimizarse por el equipo multidisciplinario.

Histological evaluation of bone response to pediatric endodontic pastes: an experimental study in guinea pig

This study aimed to evaluate by the intra-osseous implant technique the most commonly used materials for pulp therapy in pediatric dentistry: calcium hydroxide (CH), Guedes Pinto paste and CTZ paste, according to FDI (1980) and ANSI/ADA (1982) recommendations. Thirty guinea pigs, 10 for each material, divided into experimental periods of 4 and 12 weeks received one implant on each side of the lower jaw symphysis. The external lateral tube wall served as control for the technique. At the end of the observation periods, the animals were euthanized and specimens were prepared for routine histological examination. It was observed that CH and CTZ paste induced severe inflammation, a large amount of necrotic tissue, lymphocytes, foreign body cells and bone resorption, while Guedes Pinto Paste induced little or no inflammation in the 4-week observation period. After 12 weeks, the reactions to CH and Guedes Pinto paste were also absent/mild, presenting a general pattern of replacement by recently formed bone tissue while a moderate to severe inflammatory response was observed with CTZ paste. Guedes Pinto paste presented acceptable biocompatibility levels in both analyzed periods; CH only showed acceptable biocompatibility in the 12-week period while CTZ paste showed no biocompatibility in both periods. Among the tested materials, only Guedes Pinto paste presented an acceptable biocompatibility.

A pesquisa teve como objetivo avaliar a biocompatibilidade através da técnica de implantes intra-ósseos dos materiais utilizados em odontopediatria para tratamento pulpar: hidróxido de cálcio, pastas Guedes Pinto e CTZ, de acordo com as recomendações da FDI (1980) e ANSI/ADA(1982). Trinta guinea pigs, dez para cada material, divididos em períodos experimentais de 4 e 12 semanas receberam um implante em cada lado da sínfise mandibular. A parede lateral externa do copo serviu como controle para a técnica. No final dos períodos experimentais, os animais foram sacrificados e os espécimes preparados para o exame histológico de rotina. Observou-se que o hidróxido de cálcio e a pasta CTZ mostraram reação inflamatória severa, grande quantidade de tecido necrosado, linfócitos, células de corpo estranho e reabsorção óssea; enquanto a pasta Guedes Pinto induziu pouca ou nenhuma inflamação no período de 4 semanas. Após 12 semanas as reações para o hidróxido de cálcio e pasta Guedes Pinto foram ausentes/suaves apresentando um padrão geral de substituição por tecido ósseo neoformado, enquanto uma resposta inflamatória de moderada a severa foi observada para a pasta CTZ. A pasta Guedes Pinto apresentou níveis aceitáveis de biocompatibilidade nos dois períodos analisados; hidróxido de cálcio apresentou biocompatibilidade aceitável somente no período de 12 semanas e a pasta CTZ não mostrou biocompatibilidade em ambos os períodos. Entre estes, apenas a pasta Guedes Pinto apresentou níveis de biocompatibilidade nos dois períodos analisados.

Biomasa fúngica y bacteriana como indicadoras del secuestro de C en suelos de sabanas sustituidos por pinares en Uverito, Venezuela

Fungal and bacterial biomass as indicators of soil C sequestration in savannas soils substituted by pine plantations. A transformation of any natural ecosystem to an agricultural or forest system leads to an important soil modification, not only in the total carbon pool, but also in the carbon associated to the microbial biomass. This way, carbon quantification on soil quality is important for the determination of impacts of agricultural practices and land use changes. The aim of this study was to the determine, through the selective inhibition technique, the fungal and bacterial biomass, and fungal-to-bacterial ratio (F:B) in pine plantations (Pinus caribaea var. hondurensis), to establish if these parameters are sensible indicators of changes in the carbon content in Uverito soils (Venezuela). Furthermore, the inhibitor additivity ratio (IAR) and total combined inhibition (TCI) were carried out to determine if the antibiotics caused non-target inhibition. The quantification of fungal and bacterial biomass was carried out by using of cyloheximide as fungal inhibitor, and streptomycin and chloranphenicol as specific bacterial inhibitors. This research evidences that this land use change exerted a significant effect on soil microbial biomass, and shows that in pine plantations there is a dominance of the fungal component, in contrast to the native savanna, in which the bacterial biomass dominates. The substitution of native savanna by pine plantation in Uverito promotes a major soil carbon sequestration. The values of the inhibitor additivity ratio (IAR) as for native savanna as pine system, were both>1.0. The total combined inhibition (TCI) was smaller in the pine systems, from which it is possible to infer that a high proportion of microbial biomass was affected by the combination of the inhibitors. Rev. Biol. Trop. 58 (3): 977-989. Epub 2010 September 01.

Cualquier transformación de un ecosistema natural a un sistema agrícola o forestal conduce a una modificación importante no sólo del pool del carbono total, sino también del carbono asociado con la biomasa microbiana. Su cuantificación es importante en la determinación del impacto de las prácticas agrícolas y el cambio de uso de la tierra sobre la calidad del suelo. El objetivo de este estudio fue determinar, a través del método de inhibición selectiva, la biomasa fúngica y bacteriana y la relación (H:B) en suelos de sabana nativa sustituidos por pinares (Pinus caribaea var. hondurensis), para establecer si éstos parámetros son indicadores sensibles de cambios en el contenido de carbono en suelos de Uverito, Venezuela. La relación de aditividad del inhibidor (RAI) y la inhibición total por efecto combinado del inhibidor (ITC) se llevaron a cabo para determinar, si los inhibidores microbianos tuvieron actividad sobre otros organismos para los cuales éstos no estaban destinados. La cuantificación de la biomasa fúngica y bacteriana se llevó a cabo mediante el uso de la cycloheximida como inhibidor fúngico, y la estreptomicina y el cloranfenicol como inhibidores bacterianos. Esta investigación evidencia que este cambio de uso de la tierra ejerció un efecto significativo sobre la biomasa microbiana del suelo, y muestra que en el sistema de pinares existe una dominancia del componente fúngico, en contraste con la sabana nativa, en la cual domina la biomasa bacteriana. La sustitución de la sabana nativa por plantaciones de pino en Uverito, promueve un mayor secuestro del carbono en el suelo. Los valores de la relación de aditividad del inhibidor (RAI) tanto para la sabana nativa como para el sistema de pinares, resultaron ambos >1.0. La inhibición total combinada (ITC) resultó menor en el sistema de pinares; a partir de lo cual, es posible inferir que una elevada proporción de la biomasa microbiana fue afectada por la combinación de los inhibidores.

Beneficial effect of Berberis buxifolia Lam, Ziziphus mistol Griseb and Prosopis alba extracts on oxidative stress induced by chloramphenicol / Efecto benéfico de extractos de Berberis buxifolia Lam, Zizyphus mistol Griseb y Prosopis alba sobre el estrés oxidativo inducido por cloramfenicol

The chemiluminescence of luminol, a measure of oxidative stress, increased immediately as a consequence of reactive oxygen species (ROS) stimulated by this antibiotic. The effect of Ch was dose dependent with maximum stimulus at 8 mg/ml (Vmax); above this concentration the cells began to reduce the production of ROS. The oxidative injury of Ch was counteracted by water extracts of Berberis buxifolia lam, Zizyphus mistol Griseb and Prosopis alba, indigenous fruits from Argentina. The relatively light units (RLU) emitted decreased immediately as a consequence of a protective effect exerted by the extracts of these fruit extracts on blood cells. The three indigenous fruit extracts reduced to a different extent the oxidative injury caused by Ch. B.buxifolia lam exhibited the highest antioxidant capacity followed by Z.mistol Griseb. Water extracts of both fruit extracts were the most effective against the oxidative stress, while P.alba presented better antioxidant capacity in the ethanolic fraction obtained. Hexane extracts showed low protective action on blood cells, with little reduction of area under curve (AUC) of RLU plotted versus time. Leukocytes remained viable in blood samples incubated for 3h with Ch and water extracts of B. buxifolia lam or Z. mistol Griseb (97.1% and 92.5% viability by Trypan blue exclusion, respectively); whereas with Ch only the cells were stressed and viability decreased to 30%. The three fruit extracts protected the viability of leukocytes in parallel with the decrease of ROS. Erythrocytes were not lysed in the presence of Ch.

Se estudió el efecto antioxidante de tres extractos de frutas autóctonas, Berberis buxifolia lam (michay), Zizyphus mistol Griseb (mistol) and Prosopis alba (algarrobo). Las células sanguíneas humanas sufrieron estrés oxidativo por acción de cloramfenicol (Ch), con un aumento inmediato de especies reactivas del oxígeno (ERO), que fue determinado por quimioluminiscencia con luminol. La respuesta fue dependiente de la dosis, con un máximo a 8 mg/ml. Los extractos de frutas autóctonas de la Argentina fueron capaces de contrarrestar el estrés generado por el antibiótico. El michay y el mistol resultaron más efectivos en la fase acuosa, y el algarrobo fue más antioxidante en extractos etílicos, mientras que las fracciones obtenidas con hexano no fueron activas. La viabilidad de los leucocitos se mantuvo elevada con Ch en presencia de extractos, entre 92.5 y 97.1%, cayendo hasta un 30% con Ch solo. Tanto los eritrocitos como los leucocitos fueron protegidos del efecto estresante por la capacidad antioxidantes de los extractos de las tres frutas investigadas, lo que podría ser importante a considerar en la dieta de niños, y pacientes en general, sometidos a Ch u otras terapias causantes de estrés oxidativo.

Flora conjuntival y sensibilidad antibiótica en pacientes a ser sometidos a cirugía de catarata y LASIK / Antibiotic susceptibility of bacterial conjunctival flora isolated from patients undergoing LASIK and cataract surgery

Objetivo: Conocer y proveer de evidencia acerca de la sensibilidad de la flora bacteriana normal de la superficie ocular aislada en dos diferentes grupos sociales y etáreos de pacientes prontos a someterse a cirugía de Catarata y LASIK en nuestro país. Materiales y Métodos: Se cultivaron muestran conjuntivales de 221 pacientes previo a LASIK y de 180 pacientes de un grupo de Cataratas. De haber un cultivo positivo se realizó aislamiento e identificación bacteriana utilizando la técnica de difusión en disco de Kirby-Bauer para doce antibióticos. El análisis estadístico se hizo con chi-cuadrado y el test exacto de Fisher. Resultados: Hubo 66,8 por ciento de cultivos positivos, más frecuentemente gran positivos. SCN fue el aislado en mayor porcentaje (92,2 por ciento) y mostró una alta sensibilidad a Cloramfenicol, Tobramicina, Moxifloxacino y Gatifloxacino, intermedia para Levofloxacino, Gentamicina y Ciprofloxacino y menor para Eritromicina, Oxacilina, Cefalotina y Ceftriaxona (p<0,01). Todos los cultivos fueron sensibles a Vancomicina. No hubo diferencia estadísticamente significativa entre ambos grupos. Conclusiones: 1. Por primera vez nuestros resultados muestran que la flora y sensibilidad antibiótica son similares en pacientes a ser sometidos a LASIK y Catarata, siendo los SCN los más frecuentemente encontrados en ambos grupos de pacientes. 2. Las bacterias más comúnmente aisladas permanecen altamente sensibles a Cloramfenicol, Tobramicina, Moxifloxacino y Gatifloxacino.

Purpose: To know and provide a background on antibiotic susceptibility of normal ocular surface bacterial flora isolated from two different social and age groups of patients undergoing LASIK and cataract surgery in our country. Material and Methods: Conjunctival samples of 221 patients in a LASIK group and 180 patients in a cataract surgery group were cultivated. When there were a positive cultures, isolation and identification of the bacteria were made and antibiotic susceptibility tests were carried out, using the Kirby-Bauer disc diffusion technique for twelve antibiotics. Statistical analysis was performed using chi-square and exact Fisher test. Results: There were 66.8 percent of positive cultures, most of them gram positives. The most frequently isolated bacteria were the CNS (92,2 percent) that showed high sensitivity for Chloramphenicol, Tobramycin, Moxifloxacin and Gatifloxacin, intermedia for Levofloxacin, Gentamicin and Ciprofloxacin and lowest for Erytomycin, Oxacillin, Cefalotin and Ceftriaxone (p<0,01). All the cultures were susceptible to Vancomycin. There was not statistically difference between LASIK and cataract group. Conclusions: 1. For the first time, our results have shown that the conjunctival flora and its sensitivity to antibiotics are similar in the conjunctival flora of the patients undergoing LASIK surgery and Cataract, being CNS the bacterium most frequently found in both different groups of patients. 2. The most frequently isolated conjunctival bacteria remained highly sensitive to Chloramphenicol, Tobramycin, Moxifloxacin and Gatifloxacin.

An increase in enteric fever cases due to Salmonella Paratyphi A in & around Chandigarh.

BACKGROUND & OBJECTIVE: Enteric fever is a major public health problem in India. It is classically caused by Salmonella enterica serotype Typhi. Salmonella enterica serotype Paratyphi A which had been reported less frequently from cases of enteric fever has shown an increasing trend since 1996 in India. There is also variation in the antimicrobial susceptibility of Salmonella Paratyphi A from different parts of the country. An attempt is therefore made to study the rate of isolation and antimicrobial susceptibility pattern of Salmonella Paratyphi A from cases of enteric fever coming to a tertiary care hospital at Chandigarh. METHODS: The blood samples of patients suspected of having enteric fever and admitted to Government Medical College and Hospital, Chandigarh, from January 2006 to April 2007 (11,240) were processed by conventional methods. Antimicrobial susceptibility was tested by Kirby-Bauer disc diffusion method. The minimum inhibitory concentration to two antibiotics- ciprofloxacin and chloramphenicol was determined by agar dilution technique. Simultaneously, retrospective analysis was done from January 2003-December 2005 to study any difference in the incidence and antimicrobial susceptibility pattern of Salmonella Paratyphi A among enteric fever patients. RESULTS: Of 305 total isolates, 231 were S. Typhi and 84 S. Paratyphi A rise. The number of Salmonella Paratyphi A cases rose from 27 in 2006 (34.18%) to 13 (40.63%) in four months of 2007. All were sensitive to ciprofloxacin and cefotaxime but MIC to ciprofloxacin was raised (0.125-0.5 microg/ml). Resistance to nalidixic acid was 92.5 per cent. Chloramphenicol sensitivity re-emerged with 90 per cent isolates sensitive to it while sensitivity to ampicillin dropped (72.5%) as compared to previous years. Only one isolate was multi-drug resistant. INTERPRETATION & CONCLUSION: The present study conferencing Salmonella Paratyphi A as the rapidly emerging pathogen of enteric fever. With increasing resistance to fluoroquinolones and possibility of re-emergence of sensitivity to chloramphenicol, the policy of empirical treatment of enteric fever needs to be rationalized.

Resistance Trends of Bacteroides fragilis Group Over an 8-Year Period, 1997-2004, in Korea / 대한진단검사의학회지

BACKGROUND: Bacteroides fragilis group organisms are the most frequently isolated anaerobes in human infections. Increasing resistance to various antimicrobial agents is a significant problem in choosing appropriate antimicrobial agents to treat anaerobic infections. Periodic monitoring of the regional resistance trends of B. fragilis group isolates is needed. METHODS: A total of 466 nonduplicate clinical isolates of B. fragilis group organisms (276 B. fragilis, 106 Bacteroides thetaiotaomicron, and 84 other B. fragilis group organisms) were collected during the 8-yr period from 1997 to 2004 in a Korean university hospital. Minimum inhibitory concentrations to various antimicrobial agents were determined by the CLSI agar dilution method. RESULTS: Eight isolates were resistant to imipenem. Additionally, the resistance rates to cefotetan were decreased in B. thetaiotaomicron, while those for clindamycin were significantly increased compared to the rates found in previous studies. Depending on species, resistance rates were 1-4% for imipenem, 1-6% for piperacillin-tazobactam, 4-11% for cefoxitin, 33-49% for piperacillin, 14-60% for cefotetan, and 51-76% for clindamycin. No isolates were resistant to chloramphenicol or metronidazole. CONCLUSIONS: Piperacillin-tazobactam, cefoxitin, imipenem, chloramphenicol, and metronidazole are still active against B. fragilis group isolates, while clindamycin no longer has a value as an empirical therapeutic agent in Korea. Furthermore, this study identified the first imipenem-resistant B. fragilis group isolates in Korea.

Multiple antimicrobial resistance in Enterobacteriaceae isolates from pristine freshwater

A freshwater enterobacterial population (N = 111) was studied for antimicrobial and mercury resistance patterns, and for its possible association with biotic and abiotic factors in that environment. Conventional biochemical tests identified Klebsiella sp, Morganella sp, Serratia sp, Escherichia sp, Enterobacter sp, Edwarsiella sp, Proteus sp, Citrobacter sp, Providencia sp, and Kluyvera sp. There was no correlation between antimicrobial resistance patterns of isolates and bacterial genera, but resistance patterns varied among water samples and between seasons. Resistance to multiple antimicrobials was common (61%). The percentage of bacteria resistant to at least one antimicrobial differed between the rainy (100%) and dry seasons (89%). Resistance to â-lactams and chloramphenicol was the most frequent and resistance to amikacin, gentamicin and kanamycin was less frequent. The main water variables examined (abiotic factors pH and temperature; biotic factor chlorophyll a concentration) did not influence antimicrobial resistance. Significant impact on freshwater enterobacteria, as evidenced by antimicrobial-multiple resistance and by the presence of blaTEM gene, may point to the fact that it has an important role in horizontal spread of resistance.

Antimicrobial susceptibility and molecular detection of chloramphenicol and florfenicol resistance among Escherichia coli isolates from diseased chickens

Seventy Escherichia coli isolates recovered from diseasedchickens diagnosed with colibacillosis in Henan Province,China, between 2004 and 2005 were characterized forantimicrobial susceptibility profiles via a broth doublingdilution method. Overall, the isolates displayed resistanceto trimethoprim-sulfamethoxazole (100%), oxytetracycline(100%), ampicillin (83%), enrofloxacin (83%), and ciprofloxacin(81%), respectively. Among the phenicols, resistance wasapproximately 79% and 29% for chloramphenicol andflorfenicol, respectively. Molecular detection revealed thatthe incidence rates of the floR, cmlA, cat1, cat2 and cat3were 29, 31, 16, 13, and 0%, respectively. Additionally,10% of the isolates were positive for both floR and cmlA.As these antimicrobial agents may potentially inducecross-resistance between animal and human bacterialpathogens, their prudent use in veterinary medicine ishighly recommended.

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.

Aeromonas spp em diferentes pontos do fluxograma de beneficiamento do leite tipo A e susceptibilidade a antimicrobianos / Aeromonas spp in the line production of pasteurized type A milk and their antimicrobial susceptibility

Com o objetivo de verificar os possíveis pontos de contaminação e disseminação de bactérias do gênero Aeromonas em diferentes pontos do fluxograma de beneficiamento do leite tipo A, foram analisadas 120 amostras. Foi verificada a presença de Aeromonas spp. em 38 amostras, sendo identificadas as espécies A. sobria (40 por cento), A hydrophila (22 por cento), A. cavie (26 por cento), A. veronii (19 por cento) e A.schubertii (3 por cento). Das 37 amostras de espécies bacterianas avaliadas quanto à susceptibilidade aos antimicrobianos, foi observada múltipla resistência a drogas em 94 por cento das cepas testadas. As maiores sensibilidades foram observadas frente ao cloranfenicol, netilmicina, amicacina e gentamicina (80 por cento). A presença no leite das espécies deste gênero, comumente associadas com gastrenterites e as altas resistências observadas frente a múltiplos princípios ativos, devem ser levadas em consideração, pois podem representar um sério risco para a saúde dos consumidores, na eventual necessidade da instituição de um regime terapêutico em casos de infecção por Aeromonas spp.

Treatment of enteric fever in children on the basis of current trends of antimicrobial susceptibility of Salmonella enterica serovar typhi and paratyphi A.

PURPOSE: Recent reports indicate decreased susceptibility of S. typhi to fluoroquinolones, especially ciprofloxacin. Chloramphenicol has been suggested as first line therapy of enteric fever in many studies. This is a prospective study that describes the trends of antimicrobial susceptibility of S. typhi and S. paratyphi A causing bacteraemia in children and reports therapeutic failure to ciprofloxacin and evaluates the possible use of chloramphenicol, ampicillin, ciprofloxacin and third generation cephalosporins as first line therapy in the treatment of enteric fever in children. METHODS: The present study was conducted from April 2004 to March 2005 in a superspeciality children hospital at New Delhi. A total of 56 S. typhi and five S. paratyphi A isolates were obtained among the 673 blood cultures performed. Antimicrobial testing was done using disk diffusion technique (NCCLS method) for 13 antimicrobials and MICs were calculated for ampicillin, ciprofloxacin, chloramphenicol and cefotaxime. Analysis of data was done using WHONET software. RESULTS: All 56 isolates of S. typhi were sensitive to amoxycillin+clavulanate, gentamicin, cefixime, cefotaxime and ceftazidime. Multidrug resistance (MDR, resistance to three drugs) was seen in 22 cases (39%) and resistance to five drugs was seen in 12 cases (21%). Only two isolates were resistant to chloramphenicol (3%). MIC 90 for ampicillin, chloramphenicol, ciprofloxacin and cefotaxime were 1.0 microg/ml, 4.0 microg/ml, 64 microg/ml and 0.125 microg/ml respectively. All S. paratyphi A isolates were sensitive to ampicillin and chloramphenicol and resistant to nalidixic acid. MIC distribution data for chloramphenicol revealed elevated MIC but still in susceptible range. CONCLUSIONS: There is an urgent need for further clinical studies to evaluate response to chloramphenicol in such cases. Antimicrobial susceptibility data and MIC distribution favour use of ampicillin as a drug of choice for the treatment of enteric fever. Third generation cephalosporins are also useful but their use should be restricted for complicated cases.

Susceptibilidad in vitro de bacterias anaeróbicas en infecciones pleuropulmonares / In vitro antimicrobial susceptibility of anaerobic bacteria isolated from pleuropulmonary infections

Background: Aspirative pleuropulmonary infections are usually caused by anaerobic flora of the mouth, mainly Prevotella, Fusobacterium and Peptostreptococcus spp. Penicillin in high doses is the traditional treatment for this type of infections but the rising resistance developed in recent years has induced the empiric use of clindamycin, increasing treatment costs. Aim: To study antimicrobial susceptibility of anaerobic bacteria isolated from pleuropulmonary infections. Material and methods: Thirty two strains obtained from bronchoalveolar lavage and 15 strains isolated from pleural effusions between 2000 and 2002, were studied. The phenotype of strains was identified using the semiautomated API 20 A method and their susceptibility to penicillin (PNC), clindamycin (CM) and chloramphenicol (CAF) was tested using the E test methods. Results: All the strains were susceptible to CAF, 95% to CM and 74.4% to PNC. The predominant genus was Prevotella, which also exhibited the higher resistance. Conclusions: As CM and CAF are active "in vitro", high rates of clinical response should be expected. In contrast, PNC is less effective, especially against pigmented Prevotella.

Antimicrobial analysis of different root canal filling pastes used in pediatric dentistry by two experimental methods

The objective of this study was to compare, by two experimental methods, the antimicrobial efficacy of different root canal fillingpastes used in pediatric dentistry. The tested materials were: Guedes-Pinto paste (GPP), zinc oxide-eugenol paste (OZEP), calcium hydroxide paste (CHP), chloramphenicol + tetracycline + zinc oxide and eugenol paste (CTZP) and Vitapex®. Fiven microbial strains (S. aureus, E. faecalis, P. aeruginosa, B. subtilis and C. albicans) obtained from the American Type Culture Collection were inoculated in Brain Heart Infusion (BHI) and incubated at 37°C for 24 h. For the direct exposure test (DET), 72 paper points were contaminated with the standard microbial suspensions and exposed to the root canal filling pastes for 1, 24, 48 and 72 h. The points were immersed in Letheen Broth (LB), followed by incubation at 37°C for 48 h. An inoculum of 0.1 mL obtained from LB was then transferred to 7 mL of BHI, under identical incubations conditions and the microbial growth was evaluated. The pastes showed activity between 1 and 24 h, depending on the material. For the agar diffusion test (ADT), 30 Petri plates with 20 mL of BHI agar were inoculated with 0.1 mL of the microbial suspension, using sterile swabs that were spread on the medium. Three cavities were made in each agar plate (total = 90) and completely filled with one of the filling root canal pastes. The plates were pre-incubated for 1 h at room temperature and then incubated at 37°C for 24 to 48 h. The inhibition zone around each well was recorded in mm. The complete antimicrobial effect in the direct exposure test was observed after 24 h on all microbial indicators. All root canal filling materials induced the formation of inhibition zones, except for Vitapex® (range, 6.0-39.0 mm).

O objetivo do presente estudo foi comparar o efeito antimicrobiano de diferentes pastas obturadoras do canal radicular usadas na Odontopediatria, por dois métodos experimentais. Os materiais testados foram: pasta Guedes Pinto, pasta de óxido de zinco e eugenol, pasta de hidróxido de cálcio, pasta CTZ e Vitapex®, sobre cinco microrganismos (S. aureus, E. faecalis, P. aeruginosa, B. subtilis e C. albicans) obtidos do American Type Culture Collection. As cepas foram inoculadas no Brain Heart Infusion (BHI) e incubadas a 37°C por 24 h. Para o teste de contato direto, 72 pontas de papel foram contaminadas com suspensões padrão dos microrganismos e expostas às pastas obturadoras por 1, 24, 48 e 72 h. As pontas foram imersas em Letheen Broth (LB), seguido de incubação a 37°C por 48 h. Um inóculo de 0,1 mL obtido do LB foi transferido para 7 mL de BHI, sobre condições idênticas de incubação e o crescimento microbiano foi avaliado. As pastas mostraram ação entre 1 e 24 h, dependendo da pasta testada. Para o teste de difusão em ágar, 30 placas de Petri com 20 mL de agar BHI foi inoculada com 0,1 mL da suspensão microbiana, utilizando-se de swab esterilizado, semeado de modo confluente no meio. Três cavidades foram feitas em cada placa de ágar (total = 90) e completamente preenchidas com uma das pastas obturadoras. As placas foram pré-incubadas por 1 h em temperatura ambiente e então incubadas a 37°C por 48 h. As zonas de inibição em torno das cavidades foram mensuradas. O efeito antimicrobiano completo obtido pelas pastas analisadas, por meio do teste por contato direto, foi observado após 24 h em todos os microrganismos. No teste por difusão em ágar, todos os materiais induziram a formação de zonas de inibição, exceto o Vitapex® (variando de 6,0 - 39,0 mm).

Superficial corneal foreign body: laboratory and epidemiologic aspects

OBJETIVOS: Identificar por meio de cultura e bacterioscopia os microrganismos veiculados por corpo estranho corneal e sua sensibilidade aos antibióticos em teste de antibiograma. MÉTODOS: Foi realizado estudo prospectivo em 101 pacientes que procuraram o Pronto-Socorro de Oftalmologia do Hospital São Paulo-UNIFESP/EPM, com diagnóstico de corpo estranho corneal. Previamente a qualquer tratamento o corpo estranho e amostra do fundo de saco conjuntival ipsilateral foram coletados em tubos separados com tioglicolato. Realizou-se semeadura em meios sólidos de ágar sangue, chocolate, Sabouraud e exame bacterioscópico com as colorações de Gram e Giemsa e antibiograma. Culturas positivas para o corpo estranho foram comparadas com as de fundo de saco conjuntival para excluir contaminação com flora normal. RESULTADOS: Cerca de 92% dos pacientes foram do sexo masculino, com idade média de 35 anos. O olho direito foi acometido em 62,4% (intervalo de confiança 95%: 52,2 - 71,8%) da amostra e 32,7% (intervalo de confiança 95%: 23,7 - 42,7%) apresentou crescimento bacteriano positivo em cultura. Os microrganismos encontrados nas culturas dos corpos estranhos foram: Streptococcus, alpha-hemolytic (n=4), Staphylococcus aureus (n=4), Staphylococcus, coagulase-negative (n=4), Corynebacterium xerosis (n=3), bacilo gram-positivo não identificado (n=2), Moraxella sp (n=1), Serratia sp (n=1), Acynetobacter sp (n=1). O antibiograma revelou que 95% dos casos foram sensíveis ao cloranfenicol e 90% a ciprofloxacina, antibióticos usados na rotina de nosso serviço. CONCLUSÃO: O corpo estranho corneal foi importante vetor de contaminação, porém a grande maioria dos microrganismos isolados foi sensível a antibioticoprofilaxia empregada no tratamento.

Study of clinical profile and antibiotic response in typhoid fever.

The objective of the present study is to evaluate the clinical profile and pattern of various drugs used in the treatment of typhoid fever. A retrospective analysis of adult patients suffering from typhoid fever was done at Kasturba Medical College hospital, Attavar during the year 1999-2001. Diagnosis of patients was based on clinical features, widal test and blood culture. The sensitivity pattern of isolates from blood culture was recorded. The mode of presentation, clinical course, treatment history, laboratory investigations reports, antibiotic administered, response to therapy and the complications were recorded. Total number of 44 cases of typhoid fever were studied. Out of these 21(47.7%) were males and 23(52.3%) were females. Average age of presentation was 23.9 years. Average duration of hospital stay was 10.8 days. Fever was present in all patients. Resistance of S. typhi to amoxicillin, chloramphenicol, ampicillin and co-trimoxazole were significantly high. Ciprofloxacin also showed resistance in 18.1% of cases. Sensitivity to cephalosporin was 100% in our study. Ciprofloxacin was the most commonly used antibiotic in our study (23 patients). Chloramphenicol alone was used in 2 patients and in 3 patients it was given after 6 days of ciprofloxacin treatment. Third generation cephalosporins (ceftriaxone) alone were used in 16 patients. Indiscriminate use of drugs in typhoid fever should be discouraged. Appropriate antibiotic as indicated by sensitivity tests should be employed to prevent the development of resistant strains of S. typhi.