In vitro activity of fosfomycin against mucoid and non-mucoid Pseudomonas aeruginosa strains.

OBJECTIVES: Pseudomonas aeruginosa is the most frequent infectious agent in cystic fibrosis patients. P. aeruginosa resistance to first line antibiotics limits therapeutic options, but the therapeutic potential of older generation antibiotics, such as fosfomycin is under investigation. Fosfomycin does not belong to any other antibiotic class and acts by inhibiting the biosynthesis of the bacterial cell wall during the initial phases. A major problem for the use of fosfomycin against P. aeruginosa is the absence of a clinical breakpoint, the last one of 32 µg/mL was proposed in 2013 by the CA-SFM (Comité de l'Antibiogramme de la Société Française de Microbiologie). METHODS: Sixty-one strains of P. aeruginosa (thirty mucoid and thirty-one non mucoid) were collected from respiratory samples of cystic fibrosis patients. All isolates were identified by MALDI-TOF (Bruker, Bremen, Germany). Fosfomycin MICs against P. aeruginosa were measured using an automated system and confirmed by the gold standard method. RESULTS: There was no significant difference between mucoid and non-mucoid strains. MIC distribution and susceptibility rates were obtained by agar dilution method and from this data we measured MIC50 and MIC90 which were equal to 32 µg/mL and 64 µg/mL, respectively. From automated method results we measured a very major error (VME), major error (ME) and categorical agreement (CA) which were equal to 0%, 11% and 89%, respectively. Comparing automated and agar dilution methods, a Cohen's kappa equal to 73% (0.726) was measured. CONCLUSIONS: Our data suggest that fosfomycin has good effect against mucoid and non-mucoid strains of P. aeruginosa and automated systems can be implemented in clinical microbiology laboratories to assess fosfomycin with rapid and reproducible results.

Risk factors including the presence of inflammation at the resection margins for colorectal anastomotic stenosis following surgery for diverticular disease.

AIM: The aim of this study was to investigate risk factors for anastomotic stenosis in patients operated on for diverticular disease. Histological inflammation and diverticula at the resection margins were also considered. METHOD: Patients' characteristics, the surgical technique and postoperative complications were collected from the medical records. Anastomotic stenoses were evaluated prospectively by rigid sigmoidoscopy during follow-up examination. Histological specimens were examined by a single pathologist who investigated inflammation and diverticula at the resection margins. Twenty patients with anastomotic colorectal stenosis from a single tertiary centre were compared with 24 consecutive patients without stenosis. They were all operated on for diverticular disease over a specified time period. RESULTS: Histological inflammation and diverticula were found in 25% and 30% of the resection margins respectively. Univariate analysis showed that age > 71 years (P = 0.0002), female gender (P = 0.0069) and anastomoses located below 12 cm from the anal verge (P = 0.020) were risk factors for stenosis. No correlation was found between anastomotic stenosis and the presence of histological inflammation or diverticula at the resection margins. By multivariate analysis, only age > 71 years was found to be a statistically significant risk factor for stenosis (P = 0.0003, OR = 60.8, 95% CI: 6.4-575.5). CONCLUSION: Anastomotic stenosis is a frequent, long-term complication following surgery for diverticular disease. An analysis demonstrated that age is a risk factor for colorectal stenosis and that histological inflammation and the presence of diverticula near/at the resection margins have no effect on the incidence of stenosis.

Risk factors for colorectal anastomotic stenoses and their impact on quality of life: what are the lessons to learn?

AIM: The aim of the study was to analyse the incidence of benign colorectal anastomotic stenoses in consecutive patients operated on in a single institution and to assess risk factors for their development. Their impact on quality of life was also evaluated. METHOD: Patient characteristics, indications for surgery, surgical technique and postoperative complications were prospectively recorded. Stenosis was evaluated by rectoscopy at regular intervals, and patients were treated only if symptomatic. After at least 6 months following surgery, patients were asked to respond to the Short Form 36-item quality-of-life questionnaire during a telephone interview. RESULTS: Of the original 211 patients considered, 195 underwent a follow-up rectoscopy and were included in the study. Benign stenosis were found in 26 (13%), and 19 (73%) symptomatic patients were treated successfully (15 with endoscopic dilatation and four with radial diathermic surgical incisions). Risk factors for anastomotic stenosis according to univariate analysis were female sex, diverticulitis, mechanical anastomosis, and anastomosis located between 8 and 12 cm from the anal verge. The significant risk factors identified by multivariate analysis were diverticulitis (OR 5, P=0.002) and mechanical anastomosis (OR 9, P=0.04). The self-perceived quality of life of patients with stenosis was significantly worse compared with controls. CONCLUSION: Since diverticulitis and mechanical anastomosis are risk factors for anastomotic stenosis, surgeons should take this into account when they are considering what type of anastomotic technique to utilize.

Binomiomadre niño: un modelo de capacitacion del equipo de salud en atencion primaria / Mother-child binomial: primary health care traning model for health teams

El 60 por ciento de las muerte infantiles se relacionan con la saludmaterna por eso la importancia de trabajar el binomio madreniño.El bajo peso al nacer está relacionado con escasos controlesprenatales, espacios intergenéticos cortos, enfermedadesmaternas como hipertensión, alteraciones de la nutrición y escasaeducación. El objetivo del presente trabajo es presentar un modelo deenseñanza de la pediatría en el post grado que integre el binomiomadre-niño b) Abordar la capacitación y actualizacióninterdisciplinaria del equipo de salud de APS a traves de unamodalidad a distancia c)Favorecer la articulación docenteasistencial. (Universidad, Provincia, Municipio).La modalidad a distancia brinda oportunidad a losprofesionales a actualizarse sin dejar su medio social y laboral.El material de estudio, módulos, se envía por correo electrónicoo en soporte digital (CD). Las actividades que se proponen sonla mayoría de resolución colectiva, lo que permite la integraciónde las diferentes disciplinas del equipo de salud. Se implementóla figura del tutor y dos evaluaciones presenciales, además deuna encuesta de satisfacción.

Highly conserved amino-acid sequence between murine STAT3 and a revised human STAT3 sequence.

Signal transducer and activator of transcription 3 (STAT3) is an important mediator of cytokine signaling, whose cDNA and protein sequences have been fully characterized. We sequenced the whole human STAT3 cDNA isolated from HepG2 cells. The new sequence determined contains 43 nucleotide changes overall, corresponding to six modifications at the amino-acid level. The revised amino-acid sequence of human STAT3 is now completely identical to the mouse sequence, except for a single amino-acid change at position 760. Thus STAT3 now results as one of the most evolutionarily conserved among known proteins. By using specific RT-PCR we could discriminate between the original sequence and the new variant. Amplification of regions within the src-homology domain 2 (SH2) of STAT3, from the RNAs of 11 different tissues or cells, revealed only the expression of the new SH2 variant. Besides, only this SH2 variant was amplified from human genomic DNA. We conclude that the new sequence we have determined in this study represents a revised sequence of hSTAT3 or, less likely, a new predominant allele.

Reduced natural killer cell activity in major depression: neuroendocrine implications.

Natural killer cell activity (NKCA) was significantly reduced in a group of depressed patients, melancholic subtype, compared to sex- and age-matched controls. Corticotropin and cortisol values were significantly higher in the depressed subjects than in the controls, but no correlation between high hormone levels and low immunological activity was found in the patients.