Outbreak of high-risk XDR CRAB of international clone 2 (IC2) in Rio Janeiro, Brazil.

OBJECTIVES: Among the high-risk clones of Acinetobacter baumannii, called international clones (ICs), IC2 represents the main lineage causing outbreaks worldwide. Despite the successful global spread of IC2, the occurrence of IC2 is rarely reported in Latin America. Here, we aimed to evaluate the susceptibility and genetic relatedness of isolates from a nosocomial outbreak in Rio de Janeiro/Brazil (2022) and perform genomic epidemiology analyses of the available genomes of A. baumannii. METHODS: Sixteen strains of A. baumannii were subjected to antimicrobial susceptibility tests and genome sequencing. These genomes were compared phylogenetically with other IC2 genomes from the NCBI database, and virulence and antibiotic resistance genes were searched. RESULTS: The 16 strains represented carbapenem-resistant A. baumannii (CRAB) with an extensively drug-resistant profile. In silico analysis established the relationship between the Brazilian CRAB genomes and IC2/ST2 genomes in the world. The Brazilian strains belonged to three sub-lineages, associated with genomes from countries in Europe, North America, and Asia. These sub-lineages presented three distinct capsules, KL7, KL9, and KL56. The Brazilian strains were characterised by the co-presence of blaOXA-23 and blaOXA-66, in addition to the genes APH(6), APH(3"), ANT(3"), AAC(6'), armA, and the efflux pumps adeABC and adeIJK. A large set of virulence genes was also identified: adeFGH/efflux pump; the siderophores barAB, basABCDFGHIJ, and bauBCDEF; lpxABCDLM/capsule; tssABCDEFGIKLM/T6SS; and pgaABCD/biofilm. CONCLUSION: Widespread extensively drug-resistant CRAB IC2/ST2 is currently causing outbreaks in clinical settings in southeastern Brazil. This is due to at least three sub-lineages characterised by an enormous apparatus of virulence and resistance to antibiotics, both intrinsic and mobile.

Acquired Elastotic Hemangioma: A Case Report and Review of 49 Previously Reported Cases.

In the past decades, there was a considerable advance in regard to recognition of morphologic findings and classification of several benign and malignant vascular proliferations. In 2002, attention was called by Requena et al to a new variant of cutaneous hemangioma named acquired elastotic hemangioma. In this article, a case of acquired elastotic hemangioma is reported with documentation of clinical, dermatoscopic, histopathological, and immunohistochemical findings. A systematic review of the previously 49 reported cases is provided. The criteria for clinical and histopathological diagnosis are highlighted.

Immobilization of chlorophyll by using layer-by-layer technique for controlled release systems and photodynamic inactivation.

The development of systems for the controlled release of drugs is important because they allow the control of drug absorption and tissue distribution and also can reduce local toxicity. This study aimed to assemble and characterize two types of release systems, consisting of layer-by-layer films obtained from poly(allylamine) hydrochloride with chlorophyll (PAH/CHL films) or chlorophyll incorporated into dipalmitoylphosphatidylcholine liposomes (PAH/Lip+CHL films). For these systems, the molecular aggregation, growth process, thermally stimulated desorption, wettability, and controlling release of CHL was studied by using UV-vis spectroscopy and wetting contact angle analysis. In addition, experiments of photodynamic inactivation using PAH/CHL or PAH/Lip+CHL films with a 633-nm laser light were performed and the susceptibility of Candida albicans (C. albicans) to this approach was examined. Fluorescence and atomic force microscopies were used to investigate the surface morphology after the application of the photoinactivation procedure. A redshift of the UV-vis spectrum associated to films when compared with the spectrum of the CHL solution indicated a molecular aggregation of CHL molecules in the films. The film growth process was determined by a nucleation and a growth of spheroids or rods for either PAH/Lip+CHL or PAH/CHL films, respectively. Thermally activated desorption experiments indicated that interactions between CHL and PAH (126kJ/mol) in PAH/CHL or between Lip+CHL and PAH (140kJ/mol) in PAH/Lip+CHL films may be governed by electrostatic interactions. The wettability of PAH/Lip+CHL films was larger than that for PAH/CHL films, which can be attributed to hydrophilic groups on the surface of the DPPC liposomes. Release experiments revealed that free CHL in PAH/CHL films was released more slowly than its partner incorporated into liposomes. After the photodynamic inactivation, results of survival fraction and fluorescence microscopy revealed that C. albicans presented similar susceptibility for the two kinds of films. AFM supported the fluorescence one suggesting that cell death of C. albicans may occur due to damages to its cell wall by C. albicans.

Bone marrow mononuclear cell therapy for patients with cirrhosis: a Phase 1 study.

BACKGROUND: Bone marrow-derived cell therapy has been investigated in patients with severe liver disease. AIMS: To assess the feasibility, safety and cell kinetics of autologous bone marrow-derived mononuclear cells (BMMCs) infusion in cirrhotic patients. METHODS: BMMCs were isolated from autologous bone marrow and 10% of the cells were labelled with (99m)Tc-SnCl2. Whole body scintigraphy (WBS) was performed 3 and 24 h after infusion via the hepatic artery. Liver function and image were followed during 1 year. RESULTS: Eight patients received 2.0-15.0 × 108 cells. Three and 24-h WBS showed mean hepatic radiotracer retentions of 41 and 32% respectively. One case of dissection of the hepatic artery and one case of Tako-tsubo syndrome occurred as early complications. A patient developed a cutaneous immunomediated disorder and another patient developed hepatocellular carcinoma (HCC) 12 months after infusion. A reduction in bilirubin was shown at 1 week while serum albumin increased above baseline up to 1 month after infusion (P<0.05). CONCLUSIONS: BMMCs infusion is feasible and practical in a clinical setting. In vivo tracking of labelled cells demonstrated that the hepatic artery route successfully delivered BMMCs to the liver. The early improvement of laboratory indices of liver function should be interpreted with caution, because this study was not designed to evaluate efficacy. The median Model for End-Stage Liver Disease score had not deteriorated 1 year later. The occurrence of a graft-versus-host disease-like phenomenon highlights the importance of sustained vigilance even when giving autologous cells. Controlled studies are needed to determine whether BMMCs infusion affects HCC development in cirrhosis.

Ensaio imunoenzimático (ELISA) para detecçäo de toxina botulínica tipo D / Enzyme-linked immunosorbent assay (ELISA) for the detection of botulinum typy D toxin

Foi desenvolvido um teste imunoenzimático (ELISA) capaz de detectar toxina botulínica tipo D. A técnica empregada foi a de Duplo Anticorpo (ELISA "Sandwich") utilizando-se antitoxinas botulínicas tipo D de referência (Statens Seruminstitut, Dinamarca) tanto na fase de sensibilizaçäo das microplacas de polivinilcloreto como para a produçäo do conjugado imunoenzimático (antisoro botulínico tipo D ligado à peroxidase). A sensibilidade do teste foi verificada através de titulaçöes de toxina botulínica tipo D em fluidos de cultura e adicionada a "pool" de soro bovino normal, resultando em reatividade correspondendo respectivamente a 15,6 DL50/ml e 31,2 DL50/ml para camundongos, determinada espectrofotometricamente em leitor de microplacas. A especificidade, por sua vez, foi demonstrada pela ausência de reatividade com os diferentes tipos de toxinas botulínicas A, B e E, toxinas tetânica e deftérica. Entretanto, foi observado reatividade cruzada parcial com a toxina botulínica tipo C, devido às semelhanças antigênicas entre as toxinas tipos C e D. A partir dos resultados obtidos, concluiu-se que o referido teste pode ser utilizado como um método de triagem, sensível, rápido e eficaz para a detecçäo de toxina botulínica tipo D, embora, especificamente para o diagnóstico direto do botulismo do bovino, o método tem as mesmas limitaçöes do bioensaio em camundongos por causa da baixa concentraçäo de toxina circulante