Isolation and characterisation of colistin-resistant Enterobacterales from chickens in Southeast Nigeria.

OBJECTIVES: Resistance to colistin (CST) mediated by mobile genetic elements has had a broad impact worldwide. There is an intensified call for epidemiological surveillance of mcr in different reservoirs to preserve CST for future generations. In Nigeria, the poultry industry is a key livestock sector. This study was undertaken to screen putative colistin-resistant Enterobacterales (CST-r-E) from poultry birds in Southeast Nigeria and to determine the genetic relatedness of mcr-harbouring isolates. METHODS: Faecal and cloacal swab samples (n = 785) were collected from chickens in 17 farms located in three contiguous states in Southeast Nigeria between March-November 2018. Following selective culture, CST-r-E were isolated. Confirmation of CST resistance, antimicrobial susceptibility testing, molecular detection of genes mcr-1 to mcr-10, multilocus sequence typing (MLST) and randomly amplified polymorphic DNA (RAPD) analysis were performed on the isolates. A questionnaire was distributed to investigate the knowledge about CST and its use of chicken farm caretakers. RESULTS: Of the 785 samples evaluated, 45 (5.7%) were positive for 48 CST-r-E, among which 23 harboured the mcr-1 gene (22 Escherichia coli and 1 Klebsiella pneumoniae). In two E.coli isolates, a new allelic variant (mcr-1.22) was detected. RAPD analysis allowed the identification of 11 different fingerprints. MLST also revealed 11 STs, with 3 of them being novel. CONCLUSION: mcr has significantly spread in poultry birds of Southeast Nigeria, which poses a worrisome risk to veterinary and human health. Strategies to prevent indiscriminate use of CST in farms should be quickly adopted before CST resistance becomes a huge global health issue.

Evaluation of carbapenem-resistant Enterobacteriaceae in an Italian setting: report from the trench.

The spread of carbapenem resistant Enterobacteriaceae (CRE) has recently become a matter of concern in public health, mainly due to the wide distribution of carbapenemase genes. Italy is a country considered endemic for the spread of blaKPC Klebsiella pneumoniae (KP). The aim of this study was to depict the epidemiological trend of CRE in one Italian hospital over a long period (3 years surveillance, from May 2011 to April 2014). Based on defined MIC cut-off for specific carbapenems, 164 strains isolated from 146 different patients were analyzed both phenotypically and genotypically to establish the resistance genes. Molecular typing was performed using the RAPD technique. 77 strains were demonstrated to harbor the blaKPC gene (73 KP, 4 Escherichia coli - EC), 51 strains the blaVIM gene (44 KP, 3 EC, 2 Enterobacter cloacae and 2 Klebsiella oxytoca), 8 the blaNDM gene (3 KP, 4 EC and one Providencia stuartii), 3 the blaOXA-48 gene (2 KP, 1 EC), whereas 25 out of the 164 isolates (of different genera and species) had a negative multiplex-PCR amplification for all the targets tested. 39 out of the 164 strains analyzed (23.8%) revealed discrepancies between the MICs obtained with automated instrument and gradient MICs of more than two logs of difference; the broth microdilution provided a better agreement with the results obtained with the gradient MIC. The use of RAPD allowed to distinguish different clusters, closely related, both for blaKPC and for blaVIM KP.

Nedocromil sodium and astemizole, alone or combined, in the treatment of seasonal allergic conjunctivitis. A multicentre double blind clinical trial.

Two hundred and seven patients with active symptoms of allergic conjunctivitis were studied in a four-week multicentre double blind, double dummy, clinical trial comparing efficacy and safety of nedocromil sodium eye drops with oral astemizole, placebo, and the combined active treatments. Clinical signs were evaluated by clinicians after 1, 2 and 4 weeks, while symptoms were recorded by patients on daily diary cards. Overall opinions were recorded at the end of treatment. Nedocromil sodium eye drops and astemizole, alone or combined, significantly reduced ocular symptoms when compared to placebo (diary card total symptom score and patients' opinion). In the clinicians' opinion nedocromil sodium alone or combined (but not astemizole alone) significantly decreased ocular symptoms when compared to placebo. All treatments were safe and well tolerated, drowsiness being the most frequent side effect observed in patients treated with astemizole. These results indicate the effectiveness of nedocromil sodium eye drops in the treatment of seasonal allergic conjunctivitis.

Preferential looking: parameters and preliminary data of a new computerized version.

A computerized version of preferential looking (CPL) was developed by the authors. Formal parameters (spatial frequency, luminance, contrast of the stimuli; randomized procedure; computerized statistical control) and preliminary binocular acuity results in 69 healthy children (6-36 months) are compared to those of OPL, FPL and ACP version. Low cost, standardized procedure, statistical control of visual acuity estimates and the need of one operator only are among CPL advantages.

Preferential looking techniques yield important information in strabismic amblyopia follow-up.

Two groups of monocular strabismic patients were followed-up by means of both PL and orthoptic examinations. The first group underwent a full-day occlusion except 1 to 4 hours; the second was occluded less than 4 hours per day. The first treatment regimen proved to be faster in getting pseudo-isoacuity and alternating fixation, but was followed by relative occlusion amblyopia and/or shifting of the dominant eye in three patients. PL techniques proved to be particularly useful in strictly monitoring these patients.

[The eye and pregnancy]. / Occhio e gravidanza.

The principal effects of pregnancy on the eye are reviewed, these effects being subdivided into three main sections: paraphysiological changes, pathological conditions developing in pregnancy and related to it, pre-existing pathological conditions that are to some extent altered by pregnancy. On the basis of the data supplied, a continuous, increasingly assiduous clinico-experimental give-and-take between oculist and gynaecologist is recommended to prevent possible eye complications.

VEP pattern reversal in the assessment of optic nerve function in diabetics.

The visual evoked potentials (VEP pattern) were studied in a group of 18 type I diabetic subjects. Age of patients, duration of disease, glicosilated hemoglobin, blood sugar were correlated with the modifications in latency and amplitude of visual evoked responses.

Angioma of the iris.

The clinical and anatomopathological features of angioma of the iris are described and the relevant literature is briefly reviewed. A personal case in a 47-year-old woman is presented. Reference is made to the fact that, unlike many of the cases in the literature, histological confirmation of the diagnosis was obtained. Mention is also made of the importance of fluorescein angiography in the differential diagnosis of other forms, particularly melanoma. Fluorescein angiography, for the first time applied to angioma of the iris in the present case, enabled a satisfactory result (follow-up of 8 months) to be obtained by conservative iridectomy, in line with the recent approach to the management of this form.