Complete substitution of the Brazilian endemic clone by other methicillin-resistant Staphylococcus aureus lineages in two public hospitals in Rio de Janeiro,Brazil

Staphylococcus aureus is an important cause of bloodstream infections. Therefore, the main purpose of this work was to characterize a collection of 139 S. aureus isolates from bloodstream infections in two public hospitals in relation to their antimicrobial susceptibility profile, staphylococcal cassette chromosome mec types, and clonal relationship. Methicillin resistance and resistance to other 12 agents were accessed by the disk diffusion test. Minimum inhibitory concentration to mupirocin was also determined. The SCCmec types were accessed by multiplex PCR, and the clonal relationship was determined by pulsed field gel electrophoresis method and restriction modification system characterization. Besides, multilocus sequence typing was performed for representative methicillin-resistant S. aureus isolates. The military hospital showed a dissemination of the New York/Japan (USA100/ST5/CC5/SCCmecII) lineage associated to multidrug resistance, including mupirocin resistance, and the teaching hospital presented polyclonal and non-multidrug resistant MRSA isolates. Complete substitution of the Brazilian endemic clone by other lineages was found in both hospitals. These findings can highlight differences in policy control and prevention of infections used in the hospitals and a change in the epidemiological profile of MRSA in Brazilian hospitals, with the replacement of BEC, a previously well-established clone, by other lineages.     

Uterine relaxant effects of Curcuma aeruginosa Roxb. rhizome extracts

The effects and plausible mechanism of action of Curcuma aeruginosa Roxb. (Zingiberaceae) rhizome chloroform and methanol extracts on the uterine contraction were investigated using isolated uterus strips from estrogen primed rats. The contractile responses were recorded isometrically with a Grass FT03 force transducer connected to a MacLab system. The experiments were carried out on both nonstimulated, agonist- and KCl-stimulated uteri. In the nonstimulated uterus, the two extracts (10–400 μg/ml) had no significant effect. In contrast, in the stimulated uterus, the chloroform and methanol extracts exerted concentration-dependent inhibition of the contractions induced by oxytocin (1 mU/ml), prostaglandin F_2α (PGF_2α, 0.5 μg/ml), ACh (3 × 10⁻⁶ M) and KCl (40 mM) with the IC₅₀ (inhibition of force) of 31.4, 58.59, 56.21 and 29.28 μg/ml; and 57.79, 69.3, 223.8 and 69.19 μg/ml, respectively. Verapamil, the reference L-type calcium channel blocker, exhibited a similar pattern of inhibition with the IC₅₀ of 0.03, 0.25, 0.35 and 0.04 μg/ml. The IC₅₀ of diclofenac against a PGF_2α-induced contraction was 31.36 μg/ml. It is known that the contraction induced by agonists and KCl is mainly due to calcium influx through the voltage-gated L-type calcium channels opened indirectly or directly by agonist–receptor activation and KCl. Thus, it is speculated that the two plant extracts might inhibit uterine contraction by interrupting the influx of Ca²⁺ probably through voltage-gated L-type calcium channels. This possibility was further substantiated by the ability of the extracts to shift the CaCl₂–contraction curves to the right. As the methanol extract also reduced the contraction of oxytocin in Ca²⁺-free EDTA solution; thus, it is suggested that part of its action may be involved with an intracellular mechanism. The effect of the two extracts did not involve the activation of β₂-adrenoceptors since their effects were unaffected by propranolol. Based on the inhibitory effect of the extracts on the oxytocin-induced contraction, it is concluded that the extracts might be useful as tocolytic agents for the prevention of preterm labor. Their effects on the inhibition of PGF_2α-induced contractions also seem useful for the treatment of dysmenorrhea. There are reports by others that the plant rhizome contains β-pinene and sesquiterpenes. In addition, there is evidence that these compounds possess spasmolytic effects in the rat intestine and uterus. Therefore, the uterine relaxant effect of the plant extracts could be due to β-pinene and some sesquiterpene lactones contents. The methanol extract is less potent than the chloroform extract, and this might be due to the lower amount of terpene compounds or different compounds may involve in this action.     

A morpholinocatechol compound (UK42620) with clonidine‐ and tyramine‐like actions

1 The actions of a morpholinocatechol (UK42620) were studied in rat isolated atria preparations consisting of spontaneously beating left and right atrial pairs. 2 UK42620 produced positive inotropic and chronotropic responses and, in atria that were incubated with [³H]‐noradrenaline, it also produced a massive increase in the release of radioactivity. 3 These actions of UK42620 were similar to those of tyramine and were blocked by the β‐adrenoceptor antagonist propranolol (0.3 μM ) and by the neuronal uptake blocker desipramine (1 μM ). 4 In the presence of desipramine, UK42620 but not tyramine produced a decrease in the stimulation‐induced efflux of radioactivity that was antagonized by idazoxan. 5 Thus, UK42620 had prejunctional α₂‐adrenoceptor activity like that of clonidine‐ and tyramine‐like activity releasing large amounts of noradrenaline.     

Acromegaly and pregnancy: a systematic review and meta-analysis

Pituitary - To evaluate the association between acromegaly and pregnancy in terms of disease activity, maternal and fetal outcomes. This systematic review was conducted according to the Joanna...     

Effects of omega-conotoxin GVIA on autonomic neuroeffector transmission in various tissues.

1. The effects of omega-conotoxin GVIA (conotoxin), a potent inhibitor of neuronal N-type Ca2+ channels, have been examined on responses to stimulation of noradrenergic, cholinergic and non-adrenergic, non-cholinergic (NANC) nerves in a range of isolated tissues to investigate the role of conotoxin-sensitive Ca2+ channels in neurotransmission. 2. Contractions elicited by field stimulation of noradrenergic nerves in rat and mouse anococcygeus muscles, rabbit ear artery and rat vas deferens (epididymal portion) were inhibited by conotoxin. Responses to noradrenaline, and to adenosine triphosphate in the vas deferens, were not affected. 3. Positive chronotropic responses to field stimulation of noradrenergic nerves were inhibited by conotoxin in rat and mouse atria, but responses to noradrenaline and tyramine were not affected. 4. The stimulation-induced release of noradrenaline was inhibited by conotoxin in the rabbit ear artery and in rat and mouse atria. 5. Relaxations in response to stimulation of the noradrenergic perivascular mesenteric nerves were reduced or abolished by conotoxin in rat and rabbit jejunum. The response to noradrenaline in rat jejunum was not affected. 6. Contractions elicited by stimulation of cholinergic nerves were inhibited by conotoxin in rat jejunum and mouse ileum (perivascular mesenteric nerves), and in guinea-pig taenia caeci (field stimulation). Responses to acetylcholine in rat jejunum and mouse ileum were not affected. 7. Contractions elicited by stimulation of the cholinergic plus NANC pelvic nerves were inhibited by conotoxin in rabbit colon, and to a lesser extent in guinea-pig colon. The stimulation-induced contraction of the guinea-pig colon was inhibited by conotoxin by a greater proportion in the presence than in the absence of atropine. Responses to acetylcholine were not affected in the rabbit colon but were slightly reduced in the guinea-pig colon. 8. Relaxations in response to field stimulation of NANC nerves were inhibited by conotoxin in guinea-pig taenia caeci and rat gastric fundus strips, and in rat anococcygeus muscle when the tone was raised by guanethidine but not when it was raised by carbachol. The relaxations produced by sodium nitroprusside in the rat gastric fundus and anococcygeus were not affected. 9. Contractions of the rat bladder elicited by stimulation of the peri-urethral nerves, which are NANC- and cholinergically mediated, were relatively insensitive to inhibition by conotoxin. The response were almost completely abolished by tetrodotoxin. 10. The conotoxin-induced inhibitions of responses to nerve stimulation developed slowly and persisted after removal of conotoxin.(ABSTRACT TRUNCATED AT 400 WORDS)     

A morpholinocatechol compound (UK42620) with clonidine- and tyramine-like actions

1. The actions of a morpholinocatechol (UK42620) were studied in rat isolated atria preparations consisting of spontaneously beating left and right atrial pairs. 2. UK42620 produced positive inotropic and chronotropic responses and, in atria that were incubated with [(3)H]-noradrenaline, it also produced a massive increase in the release of radioactivity. 3. These actions of UK42620 were similar to those of tyramine and were blocked by the beta-adrenoceptor antagonist propranolol (0.3 microM) and by the neuronal uptake blocker desipramine (1 microM). 4. In the presence of desipramine, UK42620 but not tyramine produced a decrease in the stimulation-induced efflux of radioactivity that was antagonized by idazoxan. 5. Thus, UK42620 had prejunctional alpha(2)-adrenoceptor activity like that of clonidine- and tyramine-like activity releasing large amounts of noradrenaline.     

Effects of some imidazolidine α2-adrenoceptor agonists in rat isolated atria

1 The prejunctional α₂-adrenoceptor agonist activity of four imidazolidines (UK14819, UK14304, UK15121 and UK11957) were compared to that of clonidine in rat isolated atrial preparations. 2 The preparations consisted of spontaneously beating left and right atrial pairs that were incubated with [³H]-noradrenaline. The efflux of radioactivity induced by electrical field stimulation of intramural sympathetic nerves was used as an index of neurotransmitter release and inotropic and chronotropic responses were recorded. 3 Two quinoxalinyl imidazolidines (UK14819 and UK14304 which have chloride and bromide substitution, respectively, in the phenyl moiety) caused decreases in the efflux of radioactivity with stimulation at 2 Hz and 10 Hz but not at 20 Hz. These effects were antagonised by the α₂-adrenoceptor antagonist idazoxan (0.3 μm ) but they were not affected by the α₁-adrenoceptor antagonist prazosin (0.1 μm ). 4 The third halogenated quinoxalinyl imidazolidine analogue (UK15121, which has an iodide substitution in the phenyl ring) and a quinolinyl imidazolidine (UK11957) have actions similar to clonidine. They decreased the efflux of radioactivity with stimulation at 1 Hz (for UK11957) or 2 Hz (for UK15121) and enhanced it at higher frequencies of stimulation. Both the inhibitory and enhancing effects were antagonised by idazoxan but they were not affected by prazosin. 5 Unlike the other three imidazolidines in the present study, the quinolinyl imidazolidine (UK11957), caused a decrease in resting release of radioactivity and this effect was prevented by the monoamine oxidase inhibitor pargyline (30 μm ). 6 These findings suggest that the 5-chloro-or 5-bromo substituted quinoxalinyl imidazolidines (UK14819 and UK14304) are full agonists at prejunctional α₂-adrenoceptors, but the 5-iodo-substituted quinoxalinyl imidazolidine (UK15121) and the quinolinyl analogue of UK14304 (UK11957), like clonidine, appear to be partial agonists at these receptors.     

An exploration of the ethical, legal and developmental issues in the care of an adolescent patient

Providers of health care to adolescent patients face numerous challenges. In addition to increased risk for many health problems, adolescent patients may bring complex ethical, legal and developmental questions to bear as they seek medical services. This article describes the case of one such adolescent patient and discusses some of the attendant issues faced by her physician. For example, providing reproductive health care to teenage patients without the knowledge of parents or guardians requires familiarity on the part of providers with relevant state and federal law. Additionally, providers must be aware of financial barriers and they need to acquaint themselves with available services such as New York State's Family Planning Benefit Program. Attention to their patients' stages of cognitive and emotional development should inform providers' advice to adolescents, and an understanding of the importance that supportive adult relationships play during adolescence is essential to fostering healthy development. Open communication between adolescent patients and their parents or guardians should be encouraged, while maintaining the primary obligation of providing confidential care.     

Staphylococcus aureus binds to the N-terminal region of corneodesmosin to adhere to the stratum corneum in atopic dermatitis

Staphylococcus aureus colonizes the skin of the majority of patients with atopic dermatitis (AD), and its presence increases disease severity. Adhesion of S. aureus to corneocytes in the stratum corneum is a key initial event in colonization, but the bacterial and host factors contributing to this process have not been defined. Here, we show that S. aureus interacts with the host protein corneodesmosin. Corneodesmosin is aberrantly displayed on the tips of villus-like projections that occur on the surface of AD corneocytes as a result of low levels of skin humectants known as natural moisturizing factor (NMF). An S. aureus mutant deficient in fibronectin binding protein B (FnBPB) and clumping factor B (ClfB) did not bind to corneodesmosin in vitro. Using surface plasmon resonance, we found that FnBPB and ClfB proteins bound with similar affinities. The S. aureus binding site was localized to the N-terminal glycine–serine-rich region of corneodesmosin. Atomic force microscopy showed that the N-terminal region was present on corneocytes containing low levels of NMF and that blocking it with an antibody inhibited binding of individual S. aureus cells to corneocytes. Finally, we found that S. aureus mutants deficient in FnBPB or ClfB have a reduced ability to adhere to low-NMF corneocytes from patients. In summary, we show that FnBPB and ClfB interact with the accessible N-terminal region of corneodesmosin on AD corneocytes, allowing S. aureus to take advantage of the aberrant display of corneodesmosin that accompanies low NMF in AD. This interaction facilitates the characteristic strong binding of S. aureus to AD corneocytes.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder, affecting 15 to 20% of children (1, 2). During disease flares, patients experience painful inflamed skin lesions accompanied by intense itch. Epidermal barrier dysfunction, increased type 2 immune responses, and recurrent skin infections are features of AD (3). The most common cause of infection is Staphylococcus aureus. This bacterium colonizes the skin of the majority of AD patients (4, 5). Isolates representing several S. aureus lineages are recovered from AD skin; however, strains from the clonal complex 1 (CC1) lineage are the most frequently isolated (6–9). The burden of S. aureus on lesional and nonlesional skin correlates with severity of the disease (10, 11). S. aureus directly influences pathogenesis, and several factors produced by the bacterium increase inflammation and exacerbate AD symptoms, including staphylococcal superantigen B and delta-toxin (12–15).Despite the clear association between S. aureus colonization and AD disease severity (11), the bacterial and host factor determinants underlying colonization are poorly understood (16). Adhesion is a critical early step in the colonization process. S. aureus adheres to corneocytes in the stratum corneum of AD skin (6, 17, 18). We previously found that clumping factor B (ClfB), a cell wall-anchored protein displayed on the surface of S. aureus, can mediate adhesion to corneocytes from AD patients (6). ClfB also binds to the alpha chain of fibrinogen and to the cornified envelope proteins loricrin and cytokeratin 10 (K10) in desquamated nasal epithelial cells (19–21). To date, ClfB is the only bacterial factor known to promote adherence to corneocytes in AD. However, a ClfB-deficient mutant retained the ability to bind to corneocytes (6), suggesting that additional bacterial factors are at play.Filaggrin deficiency is common in patients with established AD and is either genetic or caused by down-regulation of gene expression by Th-2–type cytokines (22–24). Filaggrin deficiency causes epidermal barrier defects and a loss of the hygroscopic filaggrin breakdown products that normally contribute to the natural moisturizing factor (NMF) in corneocytes (25). NMF comprises a collection of humectants, including filaggrin breakdown products urocanic acid and pyrrolidone acid, along with urea, citrate, lactate acid, and sugars, and is responsible for regulating hydration in the skin (26). Low-NMF levels are associated with a loss of hydration, increased disease severity, and abnormal corneocyte morphology (27). We showed recently that S. aureus binds more strongly to low-NMF AD corneocytes than to corneocytes with normal levels of NMF (18).Corneocytes with low NMF have very different surface topography when compared with corneocytes with normal levels of NMF (27). Aberrant “villus-like” projections (VPs) protrude from the surface of low-NMF corneocytes (18, 27). The protein corneodesmosin (CDSN) is confined to the cell–cell junctions between corneocytes in healthy skin, where homophilic interactions between the CDSN proteins on adjacent cells facilitate cell–cell cohesion (28). In AD patients, however, CDSN decorates the tips of the VPs on low-NMF corneocytes (27).This study aimed to elucidate a key component of S. aureus colonization by identifying the molecular determinants of adherence to AD corneocytes. We recognized that the occurrence of VPs on low-NMF corneocytes presents a different colonization surface to the bacterium and postulated that the accessibility of CDSN on the tips of VPs could influence pathogen adherence. We show that S. aureus can interact with CDSN and identify the S. aureus proteins promoting adherence to this host protein. We use single-cell and single-molecule atomic force microscopy (AFM), surface plasmon resonance (SPR), and ex vivo bacterial adherence studies with patient corneocytes to characterize this interaction. This study expands the repertoire of ligands for S. aureus and, crucially, links bacterial interactions with a host protein (CDSN) to binding to corneocytes taken from patients. Thus, our findings provide insights into the adhesion process and develop our understanding of the mechanisms underlying colonization of the skin of AD patients by S. aureus.