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e Three clinical Pseudomonas aeruginosa isolates (WCH2677, WCH2813, and WCH2837) isolated from the Women's and Children's Hospital, Adelaide, Australia, produced a metallo-␤-lactamase (MBL)-positive Etest result. All isolates were PCR negative for known MBL genes. A gene bank was created, and an MBL gene, designated bla AIM-1 , was cloned and fully characterized. The encoded enzyme, AIM-1, is a group B3 MBL that has the highest level of identity to THIN-B and L1. It is chromosomal and flanked by two copies (one intact and one truncated) of an ISCR element, ISCR15. Southern hybridization studies indicated the movement of both ISCR15 and bla AIM-1 within the three different clinical isolates. AIM-1 hydrolyzes most ␤-lactams, with the exception of aztreonam and, to a lesser extent, ceftazidime; however, it possesses significantly higher k cat values for cefepime and carbapenems than most other MBLs. AIM-1 was the first mobile group B3 enzyme detected and signals further problems for already beleaguered antimicrobial regimes to treat serious P. aeruginosa and other Gram-negative infections.T he continuing increase in antibiotic resistance in Gram-negative bacteria is of concern, not least because of the increasing lack of therapeutic options available to treat infections caused principally by Pseudomonas aeruginosa and Acinetobacter baumannii (3,17,21). This phenomenon has been exacerbated by the dissemination of metallo-␤-lactamases (MBLs) that can confer resistance to nearly all ␤-lactams, with the exception of aztreonam (4,5,43).Like many resistance mechanisms, MBLs can be encoded by either genes ubiquitously carried on the chromosome or mobile genes (39). The latter genes now include the following subgroups: IMP (15), VIM (26), SPM-1 (36), GIM-1, SIM-1, KMH-1 (25), , and the recently described NDM-1 (44). So far, they all belong to MBL subgroup B1. MBL genes are often embedded in class 1 integrons and are carried as gene cassettes. It has also been shown that while many MBL genes are plasmid mediated, some are carried on the chromosome and can be associated with Tn21-like transposons or Tn402 transposons (30, 34). However, SPM-1 is not associated with a standard integron but is flanked by two genetic elements, designated ISCR4 (18). ISCR elements are IS91-like mobile elements and can potentially mobilize and duplicate bla SPM-1 via rolling-circle replication (33, 37).The B3 subgroup MBLs have hitherto been reported for environmental bacteria, only some of which can cause opportunistic infections. These include Stenotrophomonas maltophilia (L1) (42), Janthinobacterium lividum (THIN-B) (23), Chryseobacterium meningosepticum (GOB-1) (1), Legionella gormanii (FEZ-1) (2), Caulobacter crescentus (CAU-1) (10), CAR-1 from Erwinia carotovora (29), POM-1 (32), and the recently reported ISCR1-associated SMB-1 (38). The MBL genes carried by these environmental bacteria encode subgroup B3 MBLs that are not closely related to the mobile B1 members (43). They are often GC rich and 2 to 3 kDa larger than the B1 subgroup members...

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Lactobacillus GG did not appear to enhance short-term recovery following acute diarrhoeal illness in this setting.

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The SBT was able to discriminate among Aboriginal children with diarrhea, asymptomatic Aboriginal children with an underlying environmental enteropathy, and healthy non-Aboriginal controls. This test provides a noninvasive, easy-to-use, integrated marker of the absorptive capacity and integrity of the small intestine and could be a valuable tool in evaluating the efficacy of interventions aimed at improving gut health.

The 26 December 2004 Tsunami resulted in a death toll of >270,000 persons, making it the most lethal tsunami in recorded history. This article presents performance data observations and the lessons learned by a civilian team dispatched by the Australian government to “provide clinical and surgical functions and to make public health assessments”. The team, prepared and equipped for deployment four days after the event, arrived at its destination 13 days after the Tsunami. Aspiration pneumonia, tetanus, and extensive soft tissue wounds of the lower extremities were the prominent injuries encountered. Surgical techniques had to be adapted to work in the austere environment. The lessons learned included: (1) the importance of team member selection; (2) strategies for self-sufficiency; (3) personnel readiness and health considerations; (4) face-to-face handover; (5) coordination and liaison; (6) the characteristics of injuries; (7) the importance of protocols for patient discharge and hospital staffing; and (8) requirements for interpreter services.Whereas disaster medical relief teams will be required in the future, the composition and equipment needs will differ according to the nature of the disaster. National teams should be on standby for international response.

Summaryobjectives Aboriginal children in tropical Australia have a high prevalence of both iron deficiency and acute infections, making it difficult to differentiate their relative contributions to anaemia. The aims of this study were to compare soluble transferrin receptor with ferritin in iron deficiency anaemia (IDA), and to examine how best to distinguish the effect of iron deficiency from infection on anaemia.methods We conducted a prospective study of 228 admissions to Royal Darwin Hospital in children from 6 to 60 months of age. Transferrin receptor concentrations were measured by a particle-enhanced immunoturbidimetric assay and ferritin by a microparticle enzyme immunoassay.results On multiple regression, the best explanatory variables for haemoglobin differences (r 2 ¼ 33.7%, P < 0.001) were mean corpuscular volume (MCV), red cell distribution width (RDW) and C-reactive protein (CRP); whereas transferrin receptor and ferritin were not significant (P > 0.4). Using ‡2 abnormal indices (MCV, RDW, blood film) + haemoglobin <110 g/l as the reference standard for IDA, transferrin receptor produced a higher area under the curve on receiver operating characteristic curve analysis than ferritin (0.79 vs. 0.64, P < 0.001) or the transferrin receptor-ferritin index (0.77). On logistic regression, the effect of acute infection (CRP) on haemoglobin was significant (P < 0.001) at cut-offs of 105 and 110 g/l, but not at 100 g/l when only iron deficiency indicators (MCV, RDW, blood film) were significant.conclusions Transferrin receptor does not significantly improve the diagnosis of anaemia (iron deficiency vs. infection) over full blood count and CRP, but in settings with a high burden of infectious diseases and iron deficiency, it is a more reliable adjunctive measure of iron status than ferritin.keywords soluble transferrin receptor, ferritin, iron deficiency anaemia, Aboriginal