Description and plasmid characterization of qnrD determinants in Proteus mirabilis and Morganella morganii.

We investigated the presence of qnrC and qnrD among 756 non-replicate Enterobacteriaceae isolated in Italy, selected for being non-susceptible to fluoroquinolones and/or resistant to third-generation cephalosporins. Four Proteus mirabilis and one Morganella morganii (0.66% of the total) presented a qnrD gene, located in a 2687-base-pair plasmid that was entirely sequenced. The plasmid is un-typable, and contains no known coding region other than qnrD. That the qnrD gene was found in four unrelated P. mirabilis and in one M. morganii isolate might suggest a frequent association of this gene with the tribe Proteeae.

GIS and spatial analysis for costs and services optimization in neurological telemedicine.

Telemedicine is an integrated, biomedical and psychosocial, secondary prevention intervention, where a specialized team guides the patient and his family in the course of the disease by reducing the stress of caregivers and allowing patients to stay longer at home, reducing, consequently, costs related to go to the specialist clinic. Teleneurology is a part of Telemedicine which uses modern communication technologies to allow neurology to be practiced when the doctor and patient are not present in the same place, and possibly not at the same time. This study focuses on identifying regional spots as potential territorial stations for the telemedicine service through the GIS (Geographical Information System), a computerized systems that allows placement of data of different types and sources into one system to manage and form spatial relationships that allow the display and analysis of relationships of geographic, environmental, and population factors (Scholten & de Lepper, 1991). We analyzed the optimal location of territorial telemedicine spots in correspondence of general practitioner clinics. It could be intended as a way to involve general practitioners in the management of those patients. The aim of this study is to improve the quality of life of patients and their caregivers providing a continuity of care through this system that reduces the inconvenience of travel and related costs. We estimated, then, the reduction of costs for patients and care-givers joining the telemedicine service in terms of hours out of work.

Impairment of the mucosal immune system: IgA and IgM cleavage detected in vaginal washings of a subgroup of patients with bacterial vaginosis.

The integrity of the immunoglobulins in vaginal washings of patients with bacterial vaginosis was examined to answer the question of the lack of immune response against Gardnerella vaginalis cytolysin. Clinically diagnosed patients (n=100) were recruited and their vaginal washings examined by Western blotting. Many showed IgA and IgM partially or extensively degraded. According to the degradation pattern, the patients were subdivided into 4 subsets, from intact (score 0) to completely degraded IgA (score +3). Statistical analysis of the data showed a correlation between IgA degradation and absence of immune response to G. vaginalis cytolysin. The extent of IgA degradation correlated also with the sialidase (but not with the prolidase) activity level. All women showed intact IgG and human serum albumin and no trypsin-like activity. Patients with bacterial vaginosis having high sialidase activity and extensive IgA degradation in their secretions could incur more dangerous infections and adverse pregnancy outcomes.

Immunoglobulin A response against Gardnerella vaginalis hemolysin and sialidase activity in bacterial vaginosis.

OBJECTIVE: The aim of this study was to investigate the correlation between the immunoglobulin A immune response to Gardnerella vaginalis hemolysin and sialidase activity in vaginal fluids from patients with bacterial vaginosis. STUDY DESIGN: Nonpregnant women who were examined at a gynecologic clinic, in an age range of 18 to 62 years, were enrolled. The study population comprised 131 healthy volunteers, 32 women with bacterial vaginosis that was positive for immunoglobulin A to Gardnerella vaginalis hemolysin, 40 women with bacterial vaginosis that was negative for immunoglobulin A to Gardnerella vaginalis hemolysin, and 19 women with Candida vaginitis. Bacterial vaginosis was diagnosed by clinical criteria and Gram stain. RESULTS: Sialidase activity was present in 75% (54/72) of patients with bacterial vaginosis. Women having bacterial vaginosis and lacking a specific immunoglobulin A response had a significantly higher level of sialidase activity than patients who had an immune response against Gardnerella vaginalis hemolysin. Sialidase activity was detected in 87% (35/40) of the former subgroup of patients with bacterial vaginosis and in 59% (19/32) of women of the latter subgroup. No sialidase activity was measured in patients with candidiasis. Specificity of the assay for healthy controls was 95% (124/131 women without sialidase activity). CONCLUSIONS: Sialidases produced by Prevotella bivia and other microorganisms present in the microflora of patients with bacterial vaginosis are very likely a virulence factor not only by destroying the mucins and enhancing adherence of bacteria but also by impairing a specific immunoglobulin A immune response against other virulence factors such as cytotoxin from Gardnerella vaginalis.

Possible influence of assay methods in studies of the pharmacokinetics of antibiotics.

In the present research, levels of gentamicin (GM) in serum and carrageenan pleural exudate from the rat have been compared, using three evaluation methods: microbiological assay (MA), enzyme-immunoassay (EMIT) and fluorescence-immunoassay (TDX). In a first study, the evaluations carried out by MA and EMIT have furnished comparable data in serum, while statistically significant differences were verified at all times in pleural exudate. On the contrary, in a second study, while the evaluations carried out by MA and EMIT, at all times and in both biological fluids, have produced similar data, the evaluation carried out by TDX consistently supplied higher results, with statistically significant differences at some times (5 min and 60 min for serum, 30 min and 60 min for exudate). Some possible interpretations of these results are discussed.