Current Status and Future Direction of Hepatic Radioembolisation.

Radioembolisation is a locoregional treatment modality for hepatic malignancies. It consists of several stages that are vital to its success, which include a pre-treatment angiographic simulation followed by nuclear medicine imaging, treatment activity choice, treatment procedure and post-treatment imaging. All these stages have seen much advancement over the past decade. Here we aim to provide an overview of the practice of radioembolisation, discuss the limitations of currently applied methods and explore promising developments.

High frequency of carbapenem-resistant Acinetobacter baumannii in patients with diabetes mellitus in Saudi Arabia.

Carbapenem-resistant Acinetobacter baumannii is becoming increasingly prevalent in patients with diabetes mellitus in the Middle East. We examined the relationship of these bacteria and their resistance mechanisms to the diabetic disease status of patients in Saudi Arabia. Susceptibilities of 271 isolates to carbapenems, tigecycline and colistin were determined, followed by detection of carbapenemase genes. A blaVIM gene was detected in ~95 % of isolates; blaOXA-23 and blaOXA-40 genes were also prevalent. Diabetic patients were significantly more likely to carry carbapenem-resistant isolates. Carbapenem-resistant A. baumannii is a serious problem in diabetic patients, and molecular detection of resistance mechanisms in these isolates is required.

Acinetobacter baumannii: emergence of four strains with novel bla(OXA-51-like) genes in patients with diabetes mellitus.

UNLABELLED: Diabetic patients are 10 times more likely to develop Acinetobacter baumannii infections than the rest of the population. Carbapenems are considered one of the very few antibiotics left to treat infections caused by this organism. the aim of this work was to characterise A. baumannii strains isolated from diabetic patients and to investigate whether there is a relationship between certain strains and low-level-carbapenem resistance. METHODS: Clinical samples were collected from diabetic patients in hospitals throughout Saudi Arabia from December 2006 to April 2007. API 20 Ne, polymorphisms in the 16S-23S-rRNA intergenic region and the presence of a bla( OXA-51-like )gene were all used for identification. Susceptibility to antimicrobials was determined using agar dilution and disk diffusion methods. pulsed-field gel electrophoresis (pfGe) coupled with sequence analysis of the bla(OXA-51-like )genes were used for strain characterization. Polymerase chain reaction (pCR) and multiplex pCR were used to screen for the presence and location of ISAba1 elements and bla(OXA-23-like), bla(OXA-40-like), and bla(OXA-58-like )genes respectively. RESULTS: Twenty isolates were identified as A. baumannii and were all highly resistant to 38% of the antibiotics tested and the majority of isolates were also resistant to 50% of the remaining antibiotics. four strains had low-level meropenem resistance (MIC 4-8 mg/l). All isolates were sensitive to imipenem and colistin. Nine strains possessed four novel bla( OXA-51-like )genes encoding beta-lactamases designated OXA-90, OXA-130, OXA-131 and OXA-132, and four strains contained bla(OXA-131 )with ISAba1 upstream of the gene structure. PFGE showed five separate clusters of OXA-51-like enzymes and the dissemination of strains carrying the four novel enzymes was clonal. this study showed that new strains of A. baumannii characterised by their new bla(OXA-51-like )gene have emerged. No genes encoding OXA-23-like, OXA-40-like, or OXA-58-like beta-lactamases were found. Surveillance of A. baumannii harbouring the bla( OXA-131-like )gene may be an essential step in monitoring their carbapenem resistance phenotype and may assist in preventing their spread in diabetics.