ABSTRACT
BACKGROUND: Metallo-beta-lactamases (MBL) confer high resistance to carbapenems in Pseudomonas aeruginosa (Psae). They are encoded in mobile elements of different genes (VIM, IMP, SMP, GIM), along with other resistance genes. AIM: To detect the presence of MBL in imipenem resistant Psae strains. MATERIAL AND METHODS: Fifty-nine imipenem resistant Psae strains isolated from January 2004 to August 2005 in a University Clinical Hospital, were included. The presence of MBL was studied by Etest (phenotypic) and genotypic polymerase chain reaction (PCR) methods. To rule out a nosocomial outbreak, MBL positive strains were studied by pulse field gel electrophoresis. RESULTS: The presence of MBL was detected in eleven strains. AH were type VIM and were not clonally related. There was no concordance between phenotypic and genotypic MBL detecting methods. All the strains were also multiresistant. CONCLUSIONS: The presence of MBL was detected in 19% of imipenem resistant Psae strains.
Subject(s)
Anti-Bacterial Agents/pharmacology , Imipenem/pharmacology , Pseudomonas Infections/drug therapy , Pseudomonas aeruginosa/enzymology , beta-Lactamases/genetics , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cross Infection/epidemiology , Cross Infection/genetics , Drug Resistance, Multiple, Bacterial/drug effects , Drug Resistance, Multiple, Bacterial/genetics , Electrophoresis, Gel, Pulsed-Field , Female , Genes, Bacterial/drug effects , Genes, Bacterial/genetics , Humans , Imipenem/analysis , Infant , Infant, Newborn , Male , Microbial Sensitivity Tests , Middle Aged , Polymerase Chain Reaction , Pseudomonas Infections/genetics , Pseudomonas aeruginosa/drug effects , Young Adult , beta-Lactam Resistance/drug effects , beta-Lactam Resistance/genetics , beta-Lactamases/analysisABSTRACT
Background: The early diagnosis and therapy of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency can prevent adrenal crises and erroneous gender assignment in affected newborns. To achieve this goal neonatal mass-screening programs have been developed, measuring blood 17 alpha-hydroxyprogesterone (17OHP). In Chile there is no experience with this type of screening. Aim: To develop a method for measuring 17OHP in filter paper blood specimens. To obtain reference ranges and determine neonatal 17OHP threshold levels according to gestational age and birth weight. To analyze factors affecting the cost-efficiency ratio and suggest recommendations for the organization of a neonatal screening program for CAH in Chile. Material and methods: Nine hundred twenty two newborns were studied. 17OHP was measured using double antibody radioimmunoassay in filter paper blood samples obtained 48 h after birth. Reference ranges were determined according to gestational age and birth weight and a cutoff point of 25 ng/ml was established. Results: Seventeen newborns had 17OHP over the cutoff value. They were assessed by a pediatric endocrinologist and in none of them, CAH was confirmed. Therefore the false positive rate of the determination was 1.8 percent. Among these newborns with elevated 17OHP, 66 percent had a birth weight below 1.5 kg and 5.8 percent, a birth weight between 1.5 and 2.5 kg. The cost per reported result was US $ l. Timing of the recall was between the 3 and 10 days of life. No newborn missed the follow-up. Discussion: To increase the cost-efficiency ratio of an eventual neonatal screening program, newborns with birth weights below 1.5 kg should be excluded and cutoff points should be defined according to birth weight
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , 17-alpha-Hydroxyprogesterone/blood , Adrenal Hyperplasia, Congenital/diagnosis , Pregnancy Complications/diagnosis , Birth Weight , Gestational Age , 17-alpha-Hydroxyprogesterone/metabolism , Prenatal DiagnosisABSTRACT
Immunohistochemical (IH) assessment of nuclear estrogen receptor has been considered an alternative method to conventional biochemical assay. The present work intends to compare specificity and sensitivity of IH and biochemical technique to assess nuclear estrogen receptor in formalin-fixed and paraffin-embedded mammary carcinoma samples. IH positive reaction was defined as 14 percent or more nuclear staining in 100 cells counted under high magnification (400x). Biochemical assay was considered positive over 10 fmol/mg of protein. 66 cases were collected with a mean age of 55.6 years and a mean tumor size of 25.2 mm. Histologically, 62 cases were ductal carcinomas, 2 lobular carcinomas and 2 medullary carcinomas. Biochemical assay for estrogen receptor was positive in 35 cases (63 percent) and IH in 40 cases (71 percent). The present results show that IH assessment of estrogen receptor is highly specific and sensitive. Estrogen receptor present in non-tumor cells and blood vessels walls may disclose false positive biochemical results and false negative result if the tumor mass is small or there are isolated tumor cells. IH assessment of estrogen receptor can be performed in small samples, including in situ lesions. The method is fast, reliable and of lower cost. IH may be considered the method of choice in cases with insufficient samples for biochemical assay and/or tumors containing scant cells
