RESUMO
Background & objectives: The growing incidence and the wide diversity of carbapenemase-producing bacterial strains is a major concern as only a few antimicrobial agents are active on carbapenem-resistant bacteria. This study was designed to study molecular epidemiology of carbapenem-resistant Gram-negative bacterial (GNB) isolates from the community and hospital settings. Methods: In this study, non-duplicate GNB were isolated from clinical specimens, and phenotypic test such as modified Hodge test, metallo ?-lactamase E-strip test, etc. were performed on carbapenem-resistant bacteria. Multiplex PCR was performed to identify the presence of blaIMP, blaVIM, blaKPC, blaOXA48, blaOXA23, blaSPM, blaGIM, blaSIM and blaNDM. Minimum inhibitory concentration (MIC) of colistin, fosfomycin, minocycline, chloramphenicol and tigecycline was also determined. Results: Of the 3414 GNB studied, carbapenem resistance was 9.20 per cent and maximum resistance (11.2%) was present at tertiary care centre, followed by secondary care (4%) and primary centre (2.1%). Among the carbapenem-resistant bacteria, overall, the most common isolate was Pseudomonas aeruginosa (24%). On multiplex PCR 90.3 per cent carbapenem-resistant isolates were positive for carbapenemase gene. The blaNDM(63%) was the most prevalent gene followed by blaVIM(18.4%). MIC results showed that 88 per cent carbapenem-resistant Enterobacteriaceae were sensitive to fosfomycin, whereas 78 per cent of P. aeruginosa and 85 per cent Acinetobacter spp. were sensitive to colistin. Interpretation & conclusions: Carbapenem resistance in GNB isolates from the community and hospital settings was found to be on the rise and should be closely monitored. In the absence of new antibiotics in pipeline and limited therapeutic options, prudent use of antibiotics and strict infection control practices should be followed in hospital to limit the emergence and spread of multidrug-resistant bacteria.
RESUMO
Epidermal calmodulin (CaM) levels were measured in the involved and uninvolved skin in 26 psoriasis patients before and after treatment either with dithranol topically or methotrexate orally. The mean epidermal calmodulin levels (+/- SD) in the involved and uninvolved psoriatic skin before treatment were 21.99 +/- 10.22 and 11.97 +/- 3.50 in the patients to be treated with short contact dithranol therapy (SCDT) while it was 19.46 +/- 8.13 and 11.27 +/- 7.23 in the patients to be treated with systemic methotrexate. Clearance of psoriatic lesions was associated with a significant fall (P less than 0.05) in epidermal calmodulin, activity irrespective of the treatment modality used. Also, there was a significant reduction (P less than 0.05) in the calmodulin levels in the epidermis of uninvolved skin following successful treatment.