Anatomical and molecular characterization of some rhigonematid parasites of millipedes in Nigeria, with new insights into their phylogeny.

Parasitic nematodes of millipedes from Nigeria are molecularly characterized for the first time. During nematode surveys on live giant African millipedes from several localities in Nigeria, 4 species of rhigonematids were identified by application of integrative taxonomical approaches (morpho-anatomy and molecular markers), including Brumptaemilius sp., Gilsonema gabonensis, Obainia pachnephorus, and Rhigonema disparovis. The results of morphometric and molecular analyses of D2-D3 28S, ITS, partial 18S rRNA, and cytochrome oxidase c subunit 1 (COI) gene sequences further characterized the rhigonematid species, and clearly separated them from other related species. Phylogenetic relationships based on 28S and 18S rRNA genes suggest that genera within Ransomnematoidea (Ransomnema, Heth, Carnoya, Brumptaemilius, Cattiena, Insulanema, Gilsonema) and Rhigonematoidea (Rhigonema, Obainia, Xystrognathus, Trachyglossoides, Ichthyocephaloides) clustered rather closer than could be expected in view of their morphological differences. Phylogenetic relationships based on ITS and COI are congruent with those of other ribosomal genes; however, they are not conclusive due to the scarcity of available sequences of these genes for these genera in NCBI.

Morphological and molecular characterization of Aporcelinus abeokutaensis sp. n. (Dorylaimida, Aporcelaimidae) from Nigeria.

A new species of dorylaimid nematode, Aporcelinus abeokutaensis sp. n., collected from a watermelon field in Nigeria, is described, illustrated and molecularly (D2-D3 28S ribosomal DNA) studied. It is characterized by its 1.18-1.52-mm-long body, lip region offset by weak constriction, 15.5-17.5 µm broad with perioral liplets, odontostyle 18-21.5 µm long at its dorsal side or 1.1-1.3 times the lip region diameter, neck 333-401 µm long, pharyngeal expansion occupying 45-51% of total neck length, uterus simple and 0.7-1.5 times the corresponding body diameter long, V = 48-53, tail conical with finely rounded tip (33-52 µm long, c = 26-41, c' = 1.3-1.9) and a variably distinct dorsal concavity, and male unknown. Molecular analysis reveals that the new species grouped with other species of Aporcelinus in a highly supported clade, confirming the monophyly of the genus.

Morphological and molecular characterization of Aporcella femina sp. n. (Dorylaimida, Aporcelaimidae) from Nigeria.

A new species of the genus Aporcella collected from a watermelon field in Nigeria is described, including its morphological and molecular (small subunit (SSU) and large subunit (LSU) ribosomal DNA (rDNA)) characterization. Aporcella femina sp. n. is distinguished by its 3.21-3.64 mm-long body, inner cuticle layer with fine but distinct transverse striation, lip region offset by deep constriction, 22-25 µm broad, odontostyle 20-26 µm, neck 661-811 µm long, pharyngeal expansion occupying 52-56% of the total neck length, female genital system didelphic-amphidelphic, uterus 191-350 µm or 1.9-3.3 mid-body diameters long, V = 52-57, tail short and convex conoid (35-48 µm, c = 72-98, c' = 0.7-0.9) and males absent. Phylogenetic analyses based on the partial sequence of SSU and LSU (D2-D3) rDNA revealed a close relationship of A. femina sp. n. with other Aporcella species, confirming the monophyly of the genus as well as its association to a clade made of several taxa characterized by the absence of pars refringens vaginae.

Late-life depression in sub-Saharan Africa: lessons from the Ibadan Study of Ageing.

The population surviving to old age in sub-Saharan Africa (SSA) is increasing rapidly in consonance with the rest of the world. Nevertheless, the sub-region offers unique challenges to survival across the lifespan. The determinants of health and ageing in SSA are thus likely different from those in higher income countries. The need to explore pressing epidemiological and health service challenges of older people living in SSA in the context of multiple social changes and rapid ageing of the population provided the rationale for the Ibadan Study of Ageing (ISA). This article appraises ISA findings in relation to late-life depression. It concludes that healthcare policies in SSA need to deliberately prioritise the treatment of depression and other mental health problems in late-life in order to stem the neglect of older people's mental health in the region.

Butylated hydroxytoluene protects bull sperm surface protein-P25b in different extenders following cryopreservation.

AIM: The aim of this study was to investigate the effects of different concentration of butylated hydroxytoluene (BHT) on sperm membrane surface protein "P25b" from cryopreserved bull semen in either lecithin based Bioxcell® (BX) or two egg-yolk based extenders, tris-egg yolk (TEY), and citrate-egg yolk (CEY). MATERIALS AND METHODS: Forty-five semen samples, 15 each were extended with either BX, TEY, or CEY extender which contained different concentrations (0.0 - control, 0.5, 1.0, 1.5, 2.0, and 3.0 mM/mL) of BHT. The extended semen samples were frozen at a concentration of 20×106/mL in 0.25 mL straws and stored in liquid nitrogen for 2weeks. The frozen samples were thereafter thawed, proteins extracted and analyzed for quantities of protein P25b through direct sodium dodecyl sulfate-polyacrylamide gel electrophoresis gel densitometry. Peptides were confirmed by Western blotting (WB). RESULTS: Results showed that supplementation of BHT improved (p<0.05) quantity of protein P25b at concentrations of 0.5mM/mL for BX and at 1.0 mM/mL for TEY and CE when compared with the controls and other treatments. CONCLUSION: BHT supplementation at 0.5 in BX and 1.0 mM/mL in TEY and CEY has protected bull sperm fertility marker protein P25b in frozen-thawed bull sperm.

Acute angle closure following hemodialysis in a 34-year-old Nigerian female.

Studies have reported that intraocular pressure (IOP) might change markedly during hemodialysis. We report the case of a 34-year-old Nigerian female with a 3-year history of chronic kidney disease secondary to chronic glomerulonephritis who presented with acute symptomatic elevation of IOPs following hemodialysis. She had no ocular complaints immediately before undergoing hemodialysis. She presented with a history of pain, redness, and mild blurring of vision in the left eye about 15 min after hemodialysis. Examination revealed circumciliary injection, shallow anterior chambers, and closed angles on gonioscopy in both the eyes. She was treated with pilocarpine (4%) four times daily and dorzolamide/timolol (2%/0.5%) twice daily combination eye drops with subsequent relief of symptoms and IOP reduction from an initial 48 and 74 mmHg to 10 and 12 mmHg for the right and left eyes, respectively. This case highlights the need for sensitization and awareness among renal physicians and ophthalmologists of the possibility of extremely high IOP during or immediately following hemodialysis. It also emphasizes the importance of gonioscopy and treatment of at-risk patients with narrow angles before hemodialysis.

MAGNETIC RESONANCE IMAGING PATHOLOGICAL EVIDENCE IN PATIENTS WITH LOW BACK PAIN IN SOUTHWEST NIGERIA.

BACKGROUND: Low back pain, a condition that affects many individuals worldwide during their lifetime is receiving increasing attention due to the attendant chronic disability, absenteeism from work, loss of earning power, loss of quality of life and finances. Recently focus has been on the rising prevalence and search for steps to address low back pain risk factors now known to be modifiable. For the evaluation of low back pain, magnetic resonance imaging (MRI) has emerged as the imaging modality of choice. AIM: To determine the prevalence and distribution of lumbosacral spine discs, osseous, ligamentum flavum and facet joint changes evaluated by MRI. And to further understand the lumbosacral spine biomechanics of MRI-related disco-osseous abnormalities among native African population with low back pain. STUDY DESIGN: This was a retrospective study. SETTING: University College Hospital, Ibadan, Nigeria. METHODOLOGY: The Lumbosacral spine T1W and T2W sagittal and axial images and post gadolinium contrast images generated using a low field MRI scanner and body surface coil, in patients with low back pain, were evaluated in line with pre-defined spinal changes. RESULTS: There were a total of one hundred and eight low back pain patients who had Magnetic resonance imaging between March 2015 and August 2016 in this study with a mean age of 49.9 years and a range of 8 to 77 years. There were 28(25.9%) patients aged 50 - 59 years; this age bracket had the highest number while those aged 20 years and below were 3.7%. In all, 80(74.1%) subjects had chronic low back pain. Abnormal Magnetic resonance findings were reported in 96.3%. Multiple disc affectation was seen in 75.3%; disc bulge (79.8%) was the commonest disc findings followed by dehydration in 74.0%. The L4/5 discs were commonly affected in disc dehydration in 59(76.6%) cases, anterior herniation in 22(61.1%) cases, ventrolateral herniations in 9(81.8%) cases, nerve root compression in 21(60%) cases, facet joint hypertrophy in 17/24(70.8%) cases and spinal canal stenosis in 32/47(68.1%) cases. Vertebral end plate changes occur mostly at L4 and L5 (74% at each level). CONCLUSION: This study has shown that Magnetic Resonance Imaging changes in low back pain involved multiple discs and multilevel osseous pathologies, however, disc abnormalities are predominant. The L4-5, L5-S1 disc levels and L4 vertebra body were the most commonly affected sites among a native African population.

Antidiabetic and antidyslipidemic activities of aqueous leaf extract of Dioscoreophyllum cumminsii (Stapf) Diels in alloxan-induced diabetic rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Dioscoreophyllum cumminsii (Stapf) Diels leaves are used in the management of diabetics in Nigeria. Thus, the antidiabetic activity of aqueous D. cumminsii leaf extract and its capability to halt oxidative stress and dyslipidemia in alloxan-induced diabetic rats was investigated. METHODOLOGY: Antidiabetic was evaluated in alloxan-induced diabetes rats. Diabetic rats were treated with 50, 100 and 200mg/kg body weight of the extract. RESULT: The aqueous extract of D. cumminsii leaves significantly reduced blood glucose level in a dose dependent manner with highest dose producing 72% reduction after 21 days administration, which was compared significantly (P<0.05) with the control group and glibenclamide treated groups. Similarly, aqueous extract of D. cumminsii significantly reversed reduction in insulin in alloxan-induced diabetic rats. Alloxan-induced diabetic mediated alterations in liver and serum cholesterol, triacylglycerides, high-density lipoprotein cholesterol (HDLc), low density lipoprotein cholesterol (LDLc) and very low-density lipoprotein cholesterol (VLDLc) were significantly (P<0.05) restored by the extract. Aqueous extract of D. cumminsii leaves significantly attenuated the decrease in the activities of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase and glucose 6-phosphate dehydrogenase in the liver and pancreas of alloxan-induced diabetic rats. Elevation in the concentration of malondialdehyde was significantly (P<0.05) lowered by D. cumminsii leaves extract. The diabetic-mediated alteration in the architecture of liver was alleviated by the extract. CONCLUSION: Overall, aqueous extract of D. cumminsii leaves at all doses investigated reduced blood glucose level and prevented oxidative stress and dyslipidemia in alloxan-induced diabetic rats.

Stroke among young adults at the LAUTECH Teaching Hospital, Osogbo, Nigeria.

BACKGROUND: Stroke in young adults is relatively rare and there are very few hospital reports about it in Nigeria. The aetiologic mechanisms of stoke among young adults are quite distinct from those of the adults' populations. OBJECTIVE: The purpose of this retrospective study was to determine the frequency, aetiologic mechanisms and prognosis of stroke among young adults at the LAUTECH Teaching Hospital Osogbo Nigeria. METHODS: The study was both retrospective and descriptive. Case notes of stroke patients aged 16-45 years managed at the LAUTECH Teaching Hospital Osogbo from June 2005 till February 2008 were retrieved. Demographic data, clinical profile of stroke, laboratory investigation results and treatment outcomes were collated. Clinical diagnosis and classification of stroke was mainly clinical using the WHO clinical criteria. Only 3 patients had cranial CT scan. RESULTS: Out of the total number of 208 stroke patients managed during this period, 27(12.9%) were aged 45 years and below. This comprised of 17 males and 10 females. The age range was between 23-45 years. Using the WHO clinical criteria, there were 14 cases of heamorrhagic CVD and 13 cases of ischaemic CVD. The three cranial CT scan that were done revealed cerebral infarction which was consistent with the clinical diagnosis. Severe hypertension was found in 16 (59.2%) patients on admission. 3 patients had clinical and electrocardiographic evidence of rheumatic heart disease with infective endocarditis. Other risk factors included Sickle cell disease, cardiac arrhythmias etc. 8 out of the 27 patients died giving a percentage mortality of 29.6% and 7 patients were discharged against medical advice. CONCLUSION: Heamorrhagic stroke was slightly more frequent than ischaemic CVD. Systemic hypertension was also found to be prevalent among these young Nigerian adults with stroke. However, it was difficult to unravel the aetiologic mechanisms of stroke in this study because of paucity of investigations.

Caracterización clínica y molecular de bacteriemias causadas por enterobacterias productoras de β -lactamasas de espectro extendido: 2004-2007 / Clinical and molecular characterization of ESBL-producing enterobacteria isolated from bacteremia in a university hospital

Introduction: Extended-spectrum-β-lactamases (ESBL) are plasmid-encoded enzymes that confer resistance to multiple antimicrobials. ESBL-producing enterobacteria that cause bacteremia limit therapeutic options and increase mortality. Objective: To perform a clinical and molecular description of bacteremia caused by ESBL-producing enterobacteria. Method: We retrospectively studied the cases of bacteremia due to ESBL-producing Escherichia coli, Klebsiella pneumoniae and Proteus spp in adults admitted to a university hospital during the years 2004-2007. We reviewed the clinical records and antimicrobial susceptibility patterns. Molecular typing was performed by polymerase chain reaction and study of clonality by pulsed-field electrophoresis. Results: We found a prevalence of 9.8 percent ESBL in enterobacteria causing bacteremia. Decreased susceptibility to quinolones and aminoglycosides was observed, without resistance to carbapenems. The predominant ESBL types were CTX-M (96 percent), TEM (62 percent) and GES (28 percent). 79 percent of the strains presented more than one type of ESBL. Clinical analysis revealed high prevalence of risk factors, previous use of antimicrobials and of invasive devices. There was no significant clonality. Conclusion: The presence of ESBLs in bloodstream infections is a clinical problem that must be considered when choosing empiric therapy.

Introducción: β-lactamasas de espectro extendido (BLEE) son enzimas plasmidiales que confieren resistencia a múltiples antimicrobianos. Las bacteriemias por enterobacterias productoras de BLEE restringen las opciones terapéuticas y aumentan la mortalidad. Objetivo: Realizar una descripción clínica y molecular de las bacteriemias causadas por enterobacterias productoras de BLEE. Método: Se estudiaron retrospectivamente los casos de bacteriemia por Escherichia coli, Klebsiella pneumoniae y Proteus spp. confirmadas para BLEE, en adultos ingresados en un hospital universitario durante los años 2004-2007. Se revisaron los registros clínicos y de susceptibilidad. Se realizó tipificación molecular por reacción de polimerasa en cadena y estudio de clonalidad por electroforesis de campo pulsado. Resultados: Se identificó una prevalencia de BLEE de 9,8 por ciento en enterobacterias causantes de bacteriemias. Se observó susceptibilidad disminuida a quinolonas y aminoglucósidos, sin resistencia a carbapenémicos. Los tipos de BLEE predominantes fueron CTX-M (96 por ciento), TEM (62 por ciento) y GES (28 por ciento). El 79 por ciento de las cepas presentó más de un tipo de BLEE. El análisis clínico reveló alta frecuencia de patologías de riesgo, uso previo de antimicrobianos y uso de dispositivos invasores. No se encontró clonalidad significativa. Conclusión: La presencia de BLEE en bacteriemias constituye un problema clínico que debe ser considerado al elegir la terapia empírica.

Awareness and breast cancer risk factors: perception and screening practices among females in a tertiary institution in Southwest Nigeria.

AIMS AND OBJECTIVES: this study is aimed at assessing the practices of breast cancer screening and risk perception of women of reproductive age group in a tertiary institution in Osun state. SUBJECTS AND METHODS: It was a descriptive cross sectional study carried out at the Federal polytechnic, Ede. A total of 393 eligible respondents recruited using a stratified random sampling technique, were interviewed using semi-structured questionnaire after obtaining a verbal consent from them. RESULTS: About two thirds (67.9%) of those who had heard of breast cancer knew that there were screening methods available. Of these 91.6% knew breast self examination, 93.2% knew clinical breast examination and only a third 32.8% knew mammography as a screening method. About half of respondents who were aware of breast cancer practice breast self examination. Only 28 (7.6%) of the respondents had ever visited any clinic for breast cancer screening, and 85.7% (24) of the visit was for clinical breast examination while mammography was rarely done (14.3%). Eighty one per cent of those who were aware of breast cancer believed that screening had a role to play. CONCLUSION: The study shows that though awareness of breast cancer among respondents was good, the practice of breast cancer screening was poor among the respondents and even worse with screening with mammography. A major recommendation is that initiatives to reduce morbidity and mortality due to breast cancer among young females in the southwest Nigeria should include education on risk factors, early signs and methods of screening for breast cancer.

Knowledge and practice of breast cancer screening among female nurses and lay women in Osogbo, Nigeria.

BACKGROUND: Breast cancer is the most common cancer among African women. Most researchers have attributed the late presentation to poor knowledge of breast cancer symptoms. OBJECTIVE: This study was designed to evaluate the relationship between knowledge and practice of breast cancer screening in two groups of women with different levels of knowledge of breast carcinoma. METHODS: A cross-sectional study was conducted using self administered questionnaire to assess the knowledge, attitudes and practice of breast cancer and screening programmes among nurses in a university teaching hospital, and women in non health professionals in south-western Nigeria. RESULTS: The mean knowledge score for the nurses was 10.9%±3.6 whereas the mean score for non-health professionals was 3.5%±4.1 (p value < 0.001). In those above the age of 40 years, comprising 141 subjects, 35 nurses and 106 women in non-health professionals, 22.9% and 15% respectively had had a mammogram (p=0.289,1.123). CONCLUSION: Good knowledge does not imply better screening rates in south-western Nigeria.

[Clinical and molecular characterization of ESBL-producing enterobacteria isolated from bacteremia in a university hospital]. / Caracterización clínica y molecular de bacteriemias causadas por enterobacterias productoras de β -lactamasas de espectro extendido: 2004-2007.

INTRODUCTION: Extended-spectrum-ß-lactamases (ESBL) are plasmid-encoded enzymes that confer resistance to multiple antimicrobials. ESBL-producing enterobacteria that cause bacteremia limit therapeutic options and increase mortality. OBJECTIVE: To perform a clinical and molecular description of bacteremia caused by ESBL-producing enterobacteria. METHOD: We retrospectively studied the cases of bacteremia due to ESBL-producing Escherichia coli, Klebsiella pneumoniae and Proteus spp in adults admitted to a university hospital during the years 2004-2007. We reviewed the clinical records and antimicrobial susceptibility patterns. Molecular typing was performed by polymerase chain reaction and study of clonality by pulsed-field electrophoresis. RESULTS: We found a prevalence of 9.8% ESBL in enterobacteria causing bacteremia. Decreased susceptibility to quinolones and aminoglycosides was observed, without resistance to carbapenems. The predominant ESBL types were CTX-M (96%), TEM (62%) and GES (28%). 79% of the strains presented more than one type of ESBL. Clinical analysis revealed high prevalence of risk factors, previous use of antimicrobials and of invasive devices. There was no significant clonality. CONCLUSION: The presence of ESBLs in bloodstream infections is a clinical problem that must be considered when choosing empiric therapy.

[Antimicrobial susceptibility, capsular serotypes and clonal relationship of invasive streptococcus pneumoniae isolates in adult population of the Bio-Bio region, Chile. 2005-2006]. / Susceptibilidad antimicrobiana, serotipos capsulares y relación clonal entre cepas invasoras de streptococcus pneumoniae aisladas de pacientes adultos de la Región del Bío-Bío, Chile. Periodo 2005-2006.

Streptococcus pneumoniae infections constitute a public health problem. In our country there is scarce information regarding isolates from bacteraemic episodes in adult population. The antibiotic susceptibility, serotypes and clonal relationship of 56 isolates of S. pneumoniae from adult patients with bacteraemic infections in Concepcion-Talcahuano, Bio-Bio Region, Chile, were studied. Resistance to tetracycline (21.4%), trimethoprim/ sulfamethoxazole (18%), erythromycin (18%), chloramphenicol (7%) and 1 penicillin resistant isolate from a meningeal focus (2%) was found. Also, all the isolates were susceptible to cefotaxime, levofloxacin, moxifloxacin and vancomycin. A wide variety of capsular serotypes was demonstrated, with predominance of serotypes 1, 5, 23F, 7F and 3. The macrorestriction analysis by pulse field electrophoresis revealed 31 electrophoretic patterns and 12 clonal groups, discarding a predominant clone. According to the results, at least, 80% of the S. pneumoniae serotypes isolated from bacteraemic adult patients are included in the available commercial vaccine.

Cranial computerised tomographic assessment of cerebrovascular disease in Osogbo, Nigeria.

BACKGROUND: cerebrovascular disease (CVD) is a leading cause of morbidity and mortality in Nigeria. Non-contrast computerized axial tomography (CT) is the routine imaging modality of choice for acute stroke evaluation, because it is widely accessible, convenient, has a short imaging time, and is sensitive for detection of haemorrhage. OBJECTIVE: to evaluate the pattern of stroke by computerised tomography (CT) and to relate the clinical diagnosis of stroke to the radiological features. METHODS: a retrospective study of 86 patients with suspected stroke who had CT of the brain from October 2005 to December 2008 were studied. The type and location of the stroke were documented and correlated with the age and sex. RESULTS: Sixty-five (75.6%) out of the 86 patients had CVD. Normal study was noted in 7(8.12%) patients and 14(16.3%) patients had other intracranial conditions wrongly diagnosed clinically as stroke. Ischaemic CVD was the most common [43(66.2%)], haemorrhagic CVD [21(32.3%)] and combined ischaemic and haemorrhagic, one(1.5%). Most [26(60.5%)] of the ischaemic stroke lesions were localized to the region of the middle and anterior cerebral arteries. There were no differences based on gender in the distribution of stroke pattern within the brain or the type of cerebrovascular disease. CONCLUSION: ischaemic CVD is the most common stroke. The rate of misdiagnosis of stroke is high in the Osogbo environment.

Susceptibilidad antimicrobiana, serotipos capsulares y relación clonal entre cepas invasoras de Streptococcus pneumoniae aisladas de pacientes adultos de la Región del Bío-Bío, Chile: Período 2005-2006 / Antimicrobial susceptibility, capsular serotypes and clonal relationship of invasive Streptococcus pneumoniae isolates in adult population of the Bio-Bio Region, Chile: 2005-2006

Las infecciones ocasionadas por Streptococcus pneumoniae constituyen un problema de salud pública. En nuestro país existe escasa información sobre aislados de procesos bacteriémicos en población adulta. Se estudió la susceptibilidad, serotipos y relación clonal de 56 aislados de S. pneumoniae desde hemocultivos, entre enero 2005 y agosto 2006, de pacientes adultos de la intercomuna Concepción-Talcahuano, Región del Bío-Bío, Chile. Se encontró resistencia a tetraciclina (21,4 por ciento), cotrimoxazol (18 por ciento), eritromicina (18 por ciento), cloranfenicol (7 por ciento) y a penicilina en un solo aislado procedente de un foco meníngeo (2 por ciento). La totalidad mostró susceptibilidad a cefotaxima, levofloxacina, moxifloxacina y vancomicina. Se demostró una amplia variedad de serotipos capsulares, con predominio de los serotipos 1, 5, 23F, 7F y 3. El análisis de macrorestricción y electroforesis en campo pulsado reveló 31 patrones electroforéticos con 12 grupos clona-les, descartando un clon predominante. De acuerdo a los resultados, al menos 80 por ciento de los serotipos de aislados de S. pneumoniae de procesos bacteriémicos están incluidos en la vacuna comercial disponible.

Streptococcus pneumoniae infections constitute a public health problem. In our country there is scarce information regarding isolates from bacteraemic episodes in adult population. The antibiotic susceptibility, sero-types and clonal relationship of 56 isolates of S. pneumoniae from adult patients with bacteraemic infections in Concepcion-Talcahuano, Bio-Bio Region, Chile, were studied. Resistance to tetracycline (21.4 percent), trimethoprim/ sulfamethoxazole (18 percent), erythromycin (18 percent), chloramphenicol (7 percent) and 1 penicillin resistant isolate from a meningeal focus (2 percent) was found. Also, all the isolates were susceptible to cefotaxime, levofloxacin, moxifloxacin and vancomycin. A wide variety of capsular serotypes was demonstrated, with predominance of serotypes 1, 5, 23F, 7F and 3. The macrorestriction analysis by pulse field electrophoresis revealed 31 electrophoretic patterns and 12 clonal groups, discarding a predominant clone. According to the results, at least, 80 percent of the S. pneumoniae serotypes isolated from bacteraemic adult patients are included in the available commercial vaccine.

Bombas de expulsión multidrogas en Acinetobacter baumannii y resistencia a antimicrobianos / Multi-drug efflux pumps and antibiotic resistance in Acinetobacter baumannii

Los sistemas multidrogas bacterianos contribuyen al desarrollo del fenotipo de multi-resistencia presentado por cepas de Acinetobacter baumannü, patógeno intrahospi-talario, que durante los últimos años ha incrementado su importancia por la creciente resistencia a carbapenémicos. El fenotipo de multi-resistencia está otorgado por la combinación de varios mecanismos de resistencia entre los cuales se encuentran estos sistemas de bombas de expulsión. El sistema multidroga AdeABC se ha detectado en muchas de estas cepas multi-resistentes de A. baumannü y, se ha relacionado con resistencia a diversos grupos de antimicrobianos, incluidos tigeciclina y meropenem. La inhibición de dichos sistemas multidrogas permitiría aumentar la eficacia de la terapia antimicrobiana. La siguiente revisión se enfoca en las bombas de expulsión multidrogas presentes en A. baumannü, con particular énfasis en el sistema AdeABC.

Bacterial multi-drugs systems contribute to the development of multi-resistance patterns of Acinetobacter baumannii, a nosocomial pathogen of increasing importance due to its emerging resistance to carbapenems. The multi-resistance phenomena is generated by a combination of mechanisms, one of which the efflux pump system. Many of these multiresistant isolates of A. baumannii harbor genes for the AdeABC multi-drug efflux system, related with resistance to various groups of antibacterial agents, including tygecicline and meropenem. Inhibition of these systems would allow to increase the efficacy of this antimicrobial. This review focuses on the multi-drug efflux pump system oí A. baumanni with special emphasis in the AdeABC system.

Kidneys from elderly deceased donors discarded for transplantation.

Although deceased donors older than 60 years of age (D > 60) are increasing in number, little information exists on the rate of discarded kidneys from these aged individuals. This study sought to analyze causes of discard of kidneys from D > 60. Since 1997, we have transplanted kidneys from D > 60 into elderly recipients after assessing their functional and anatomical viability. Among 3444 renal offers for transplantation between 1997 and 2005, 1967 (57%) came from D > 60. Of these, 1145 offers were discarded, because the kidney donor was not adequate (n = 470) or because there was no elderly recipient on our waiting list (n = 675). We also examined 1745 kidneys, 822 (47%) of which came from D > 60. The percentage of discarded kidneys due to macroscopic or microscopic alterations was 46% in the D > 60 group compared with 14.7% in the donor group younger than 60 years of age (D < 60; P < .01). We transplanted 443 kidneys from D > 60 (85 dual, 273 single) to 358 recipients of matching age and 900 kidneys from D < 60. Three-year death-censored actuarial graft survival rate was 83% for D > 60 compared with 89% for D < 60 transplant (P = not significant). In conclusion, kidneys from D > 60 were discarded for transplantation mainly because there was no elderly recipient on the waiting list and due to macroscopic or microscopic alterations. Given the increasing offer of kidneys from D > 60 and the good results of transplantation with these aged kidneys in elderly recipients, the indications for kidney transplantation should be expanded to include more of the elderly population on dialysis to the waiting list.