qnrVC occurs in different genetic contexts in Klebsiella and Enterobacter strains isolated from Brazilian coastal waters.

OBJECTIVES: In contrast to other qnr families, qnrVC has been reported mainly in Vibrio spp. and inserted in class 1 integrons. This study aimed to identify the variants of qnrVC genes detected in Klebsiella pneumoniae carbapenemase-2-producing Enterobacter and Klebsiella strains isolated from Brazilian coastal waters and the genetic contexts associated with their occurrence. METHODS: qnrVC variants were identified by Sanger sequencing. Stains were typified by pulsed-field gel electrophoresis. Antimicrobial susceptibility testing, conjugation assays, and whole genome sequencing (WGS) were applied to identify the strains' antimicrobial resistance profile, qnrVC and blaKPC-2 co-transference, and qnrVC genetic context. RESULTS: qnrVC1 was identified in 15 Enterobacter and 3 Klebsiella, and qnrVC4 in 2 Enterobacter strains. Pulsed-field gel electrophoresis revealed 12 clonal profiles of Enterobacter and one of Klebsiella. Strains were resistant to aminoglycosides, beta-lactams, fosfomycin, quinolones, and sulfamethoxazole-trimethoprim. Co-transference of qnrVC and blaKPC-2 were obtained from five representative Enterobacter strains, which showed resistance to ampicillin and amoxicillin-clavulanate, and reduced susceptibility to extended-spectrum cephalosporins, meropenem, and ciprofloxacin. WGS analysis from representative strains revealed one K. quasipneumoniae subsp. similipneumoniae, one E. soli, four E. kobei, and seven isolates belonging to Enterobacter Taxon 3. Long-read WGS showed qnrVC and blaKPC-2 were carried by the same replicon on Klebsiella and Enterobacter strains, and the qnrVC association with not previously described genetic environments composed of insertion sequences and truncated genes. These contexts occurred in small- and high-molecular-weight plasmids belonging to IncFII, IncP6, pKPC-CAV1321, and IncU groups. CONCLUSION: Our results suggest that the dissemination of qnrVC among Enterobacterales in Brazilian coastal waters is associated with several genetic recombination events.

Laserterapia no tratamento de déficit neurossensorial decorrente de procedimento cirúrgico em Implantodontia / Laser therapy in neurosensory deficit due to odontological implantes

Neste estudo clínico prospectivo avaliamos a eficácia da laserterapia no tratamento de déficit neurossensorial de curto e longo período de existência, decorrente de procedimento cirúrgico em Implantodontia. Foram tratados um total de 51 pacientes, com Laser díodo de GaAlAs, com comprimento de onda de 830 nm, potência nominal de 40 mW, modo de emissão contínuo, dosagem total aportada por sessão terapêutica de 18 joules. Os pacientes foram divididos em dois grupos de acordo com o tempo de existência da lesão. Um grupo, com 28 pacientes, denominado de imediato, que apresentava lesão neurossensorial de dois a 15 dias e outro grupo, identificado como tardio, com 23 pacientes, onde o tempo de existência da lesão era de 30 a 365 dias. No grupo imediato, 72,7 por cento da amostra apresentou melhora absoluta; 18,3 por cento conseguiram melhora relativa da sensibilidade; 9 por cento não responderam ao tratamento. No grupo tardio, 27,7 por cento dos pacientes apresentaram melhora absoluta; 55,6 por cento conseguiram melhora relativa da sensibilidade; 16,7 por cento não responderam ao tratamento.