Resistance of Bacteroides isolates recovered among clinical samples from a major Costa Rican hospital between 2000 and 2008 to ß-lactams, clindamycin, metronidazole, and chloramphenicol.

OBJECTIVE: To assess the susceptibility of 100 isolates of Bacteroides spp. recovered in a major Costa Rican hospital between 2000 and 2008 to several ß-lactams, chloramphenicol, clindamycin and metronidazole. METHODS: Susceptibility to amoxicillin, amoxicillin with clavulanic acid, piperacillin, piperacillin with tazobactam, ticarcillin, ticarcillin with clavulanic acid, cefoxitin, cefotetan, imipenem, chloramphenicol, clindamycin, and metronidazole was determined with the ATB ANA® system. In addition, minimum inhibitory concentrations (MIC) of clindamycin and metronidazole were determined with the broth microdilution method because these drugs are the treatment of choice for anaerobic infections in Costa Rica. Reference strains ATCC® 25285 and ATCC® 29741 were employed as indicated. RESULTS: According to the ATB ANA® system, 93 isolates were resistant to at least one antibiotic. Resistance to ß-lactams was common. By contrast, resistance to ß-lactams supplemented with ß-lactamase inhibitors was rare. All of the strains were inhibited by imipenem and chloramphenicol. By a broth microdilución test, resistance to clindamycin was 20%, with MIC ranging from 64 mg/L to 256 mg/L; all of the strains were susceptible to metronidazole. CONCLUSIONS: The high MIC for clindamycin obtained for the majority of the resistant strains is highly suggestive of the presence of mechanisms of acquired resistance among the isolates, therefore surveillance studies are required to determine its efficacy. The low resistance to metronidazole observed underlines its value as a first-line drug. On the other hand, imipenem could be used to treat infections that do not respond well to metronidazole or clindamycin.

Phenotypic identification of over 1000 isolates of anaerobic bacteria recovered between 1999 and 2008 in a major Costa Rican hospital.

Because of limitations in infrastructure, the aetiology of infections caused by anaerobic bacteria is seldom determined in clinical laboratories of developing countries. This study reports on the identification of 1010 anaerobic bacterial isolates collected between 1999 and 2008 in a major Costa Rican hospital with the use of two commercial phenotypic systems (RapID 32A and API 20A). Approximately 60% of the isolates were Gram-positive and, among the 35 species of Gram-positive bacteria found, the genera Clostridium, Propionibacterium and Eggerthella, and anaerobic cocci predominated. Twenty eight species were found among 395 isolates of Gram-negative bacteria. Species of Bacteroides were very frequent, followed by species of Prevotella, Veillonella, Fusobacterium and Porphyromonas.

The combination of yondelis and cisplatin is synergistic against human tumor xenografts.

Yondelis (trabectidin, ET-743) is a marine natural product that has shown activity both in preclinical systems and in human malignancies such as soft tissue sarcoma and ovarian cancers that are resistant to previous chemotherapies. Molecular pharmacological studies indicated that Yondelis interacts with DNA and DNA repair systems in a way that is different from Cisplatin (DDP). The current study was designed to investigate the effects of the combination of Yondelis and DDP in human cancer cell lines and in xenografts derived from different tumours. The in vitro studies performed in human TE-671 rhabdomyosarcoma, Igrov-1 and 1A9 human ovarian carcinoma cell lines showed additive effects or slight synergism. Several human tumour xenografts, such as TE-671 rhabdomyosarcoma, SK-N-DX neuroblastoma, FADU head and neck, LX-1 non-small cell lung cancer (NSCLC), H-187 melanoma and SKOV HOC 8 ovarian carcinoma, showed an antitumour effect for the combination that was greater than that of each drug when given as a single agent. No consistent changes in the activity were observed if Yondelis and DDP were given 1 h apart in sequence or simultaneously. An orthotopically transplanted human ovarian cancer HOC 8 growing in the peritoneal cavity of nude mice was used that is insensitive to Yondelis alone and only moderately sensitive to DDP alone. The combination of the two drugs produced a dramatic increase of survival lasting several months. In conclusion, the combination of Yondelis and DDP is synergistic in vivo (i.e. the antitumour effect is greater than that of each drug used as a single agent at the maximum tolerated dose (MTD)) in different human tumour xenografts. The two drugs can be combined at the MTD of each drug, thus indicating there are no overlapping toxicities. These results provide a rationale for testing the combination of Yondelis and DDP in the clinic.

[School performance: a question that divides. Analysis of learning difficulty]. / Il rendimento scolastico: una questione che divide. Analisi delle difficoltà di apprendimento.

The difficulty of learning is getting always more important, also in relation of a better knowledge of these problems. One factor which has to be taken in consideration as the behaviour of the school.

[They way adolescents live at home]. / Come l'adolescente vive la casa.

The kids, observing the relationship of their parents, are learning from them. Today the home is less home for everyone. At home you are eating, you are learning, especially you are watching a lot of TV. Often there is non a lot of trust between each other. Because of this the conversation is necessary and not the control of the adolescent secretly.

[Adolescence and family life cycle. Role of the pediatrician]. / L'adolescenza e il ciclo di vita della famiglia. Il ruolo del pediatra.

Adolescence observed as one of the step of the life cycle from the point of view of changes in the family. The role of paediatricians in the conversation with the adolescent and his parents is to pay attention to the influence that the whole family system could have on producing symptoms.

[Eating disorders in adolescence: anorexia in children]. / I disturbi alimentari in adolescenza: l'anoressia nel bambino.

When doctor visits adolescents have to pay attention to the massage of body like a mirror of difficulty about growth. Adolescents change their eating habits because they need to distinguish to the family. The doctor have to see first signals of more serious behaviour join to eating: anorexia nervosa.

[Advanced adolescence]. / L'adolescenza avanzata.

The advanced adolescence is the one after the eighteenth birthday. The adolescent tries to accomplish 3 engagements: 1. social and economic stability, 2. the research of a system of values, 3. record of concepts.

[Adolescence and alcohol abuse. Relevance of information given by the pediatrician]. / Gli adolescenti e l'abuso di alcol. L'importanza dell'informazione per il pediatra.

Often we don't see alcohol abuse among adolescents, but this kind of drug, easy to find, could be used to trying their limits. Contemporary group has an important role in the habit of drinking. Often family don't think that it's real problem and it's important that paediatrician grasp this dangerous signals.

[Children are born twice: at birth and in adolescence. The adolescent, his/her parents, and the pediatrician]. / Il bambino nasce due volte: quando viene alla luce e all'adolescenza. L'adolescente, i suoi genitori ed il pediatra.

We know the young's problem often depended to family and to society. In these years we have seen important changes of the family, that is no more a "patriarchal family" but is a "nuclear family". In general we can say that there is a change of the social levels of the family; in particular the Mass-media (especially television-set) are the most important factors responsible of these changes in fact they block the dialogue between family's members. In Italy we can found about 4.500.000 of adolescents (with age between 14 and 20 years). If we observe recent epidemiological data, we can suppose that: about 500.000 of young men have or will have problems that block them to live serenely their adolescence about 70.000 of young men have had a so important problem than they have a psychiatric personality in the future about 4.000 of young men will die for suicide, drugs or for road's incidences. For adolescents is necessary a doctor with multiple competence. We think that this doctor can be pediatrician because he is the doctor that visit children from neonatal age and, for this reason, ha can identify the "family with problems". In conclusion we can say that the pediatrician could say to adolescent's patents that "it is born a new child" with personal idea and with different attitudes, for these reason they must change the rules that they used before puberty because now the same rules are no more valid!