CRISPR elements and their association with antimicrobial resistance and virulence genes among vancomycin-resistant and vancomycin-susceptible enterococci recovered from human and food sources.

We aimed to investigate the occurrence of CRISPR elements in the genomes of vancomycin-resistant (VRE) and vancomycin-susceptible (VSE) enterococci and their association with the presence of antimicrobial resistance and virulence genes. We analyzed 180 isolates, including 91 VRE and 89 VSE. Isolates were identified by PCR or MALDI-TOF. Antimicrobial susceptibility and MICs for vancomycin were determined by the disk-diffusion method and E-test®, respectively. The presence of resistance and virulence genes, as well as CRISPR elements, was investigated by PCR. We identified 95 (53%) E. faecalis, 78 (43%) E. faecium, five (2.8%) E. gallinarum, and one (0.6% each) E. casseliflavus and E. durans. The highest and the lowest non-susceptibility frequencies were observed for erythromycin (n = 152; 84.4%) and fosfomycin (n = 5; 2.8%), respectively. Most erythromycin-resistant isolates had the erm(B) gene (106/152; 69.7%). Of 118 (65.6%) isolates with high-level resistance to aminoglycoside, 69 (58.5%) had at least one aminoglycoside resistance gene, mostly ant(6)-Ia and aac(6')-Ie + aph(2″)-Ia. We found at least one virulence gene among 135 (75%) isolates, mostly gelE (79/180; 43.9%). Ninety-two (51.1%) isolates had at least one CRISPR element, especially CRISPR3 (62/92; 67.4%). CRISPR elements were more common among E. faecalis, in which we observed a relationship between the absence of CRISPR and the presence of the vanA resistance gene, and the hyl and esp virulence genes. Among VRE. faecium, a relationship was found between the absence of CRISPR and the hyl gene. In conclusion, we found evident associations between the lack of CRISPR elements with species, multidrug resistance, and major resistance- and virulence-associated genes.

Serotypes, antimicrobial resistance and genotypes of Streptococcus pneumoniae associated with infections in cancer patients in Brazil.

We sought to characterize pneumococcal isolates associated with bacteremia, pneumonia and meningitis in cancer patients and to estimate the coverage of the available pneumococcal vaccines. Fifty isolates recovered from 49 patients attending a cancer reference center over a 1-year period were analyzed. The prevalent serotypes were: 23F (12%), 6A (8%), 3, 4, 20, and 23A (6% each). All isolates were susceptible to chloramphenicol, levofloxacin, rifampicin, and vancomycin. Resistance or reduced susceptibility to penicillin made up 14%, and one isolate was also intermediately resistant to ceftriaxone. The three (6%) erythromycin-resistant isolates presented the M or cMLSB phenotypes and harbored the mef(A/E) gene exclusively or along with the erm(B) gene. Twenty-two (44%) isolates were closely related to 11 international clones, being strongly associated with penicillin non-susceptibility. Combined immunization with the 13-valent conjugate and the 23-valent polysaccharide vaccines might contribute to reduce (76%) the burden of the pneumococcal infections in the population investigated.

Avaliação do perfil tegumentar do terço inferior da face em leucodermas brasileiros portadores de padrão I / Evaluation of soft tissue profile alteration on the lower face in Brazilian Caucasian patients with leucoderma type I

O estudo do perfil facial tem despertado grande interesse nos profissionais da área da Ortodontia. Dessa forma, a avaliação da estética do terço inferior, bem como estabelecimento de padrões aceitáveis facilitam tanto o diagnóstico, quanto o tratamento. Este trabalho objetivou avaliar as medidas do terço inferior do perfil tegumentar de brasileiros leucodermas, portadores do padrão I, considerados agradáveis por 30 avaliadores, e compará-los com as medidas padrões. Um álbum contendo 19 fotografias do terço inferior de indivíduos, em norma lateral, evidenciando da ponta do nariz (pronasal) até a parte mais anterior do mento (pogônio mole) foi avaliado por 30 indivíduos, entre estudantes, professores de Odontologia e leigos, onde cada examinador classificou os perfis de acordo com escala padronizada em: desagradável, agradável e muito agradável. Os resultados foram inseridos em tabelas e as amostras classificadas como agradável e muito agradável foram comparadas com as medidas do perfil do terço inferior da face preconizadas na literatura científica. Foram aplicados os testes estatísticos Wilcoxon para comparar a medida de tendência central e Kruskal-Wallis para avaliar as diferenças dos grupos em cada categoria. O perfil do gênero feminino foi considerado mais agradável; as médias encontradas na amostra para as medidas estudadas foram diferentes das preconizadas na literatura, porém com alto desvio padrão; Conclui-se que os indivíduos portadores de padrão I não possuem necessariamente um perfil agradável; a influência cultural brasileira revela preferência por um perfil convexo enquanto o padrão revela um perfil reto.

The study of the facial profile has aroused great interest among professionals in the field of Orthodontics. Thus, the assessment of the aesthetics of the lower and setting acceptable standards facilitates both the diagnosis and the treatment. The aim of this study was to evaluate the measures of the lower face of the soft tissue profile of Brazilian Caucasian, pattern I considered pleasant by 30 evaluators, and compare them with the standard measures. An album containing 19 photographs of the lower face of individuals in lateral view, showing the tip of the nose (pronasal) to the most anterior chin (pogonion mole) was rated by 30 individuals, including students, dental school’s professors and laity, in which each examiner classified the profiles according to standardized scale in: unpleasant, pleasant, and very pleasant. The results were entered into tables and samples classified as very pleasant and enjoyable were compared with measurements of the profile of the lower face recommended in scientific literature. We applied the Wilcoxon statistical tests to compare the measure of central tendency and Kruskal-Wallis test to assess group differences in each category. Female profile was considered more pleasant, the averages found in the sample for the measures studied were different from those recommended in the literature, but with high standard deviation. It was concluded that individuals with pattern I do not necessarily have a pleasant profile. The Brazilian cultural influence reveals a preference for a convex profile while the pattern shows a straight profile.