Personal exposure to radiofrequency electromagnetic fields: A comparative analysis of international, national, and regional guidelines.

A worldwide overview and analysis for the existing limits of human exposure to Radiofrequency Electromagnetic Fields (RF-EMF) is given in this paper. These reference levels have been established by different national and even regional governments, which can be based on the guidelines provided by the recommendations of the International Commission on Non-Ionizing Radiation Protection (ICNIRP), the International Committee on Electromagnetic Safety of the Institute of Electrical and Electronics Engineers (IEEE), and even in the United States of the Federal Communications Commission (FCC), as well as, are based on the so-called precautionary principle. Explicit reference is made to the exposure limits adopted in countries or regions, such as Canada, Italy, Poland, Switzerland, China, Russia, France, and regions of Belgium (Brussels, Flanders, Wallonia), where the limits are much lower than the international standards. The limits are compared to a selected set of in-situ measurements. This clearly shows that the measured values are typically very small compared to the international standards but could be somewhat higher compared to the reduced limits. Based on this observation and the reasonable assumption that the sensitivity of people to Electromagnetic Fields (EMF) is the same everywhere (whole-body), we propose the idea to establish a worldwide reference limit for the general public, thus applicable in all countries, if the ICNIRP considers it appropriate. Research must continue to generate measurement data that demonstrate the levels of exposure to which we are really exposed, and with this, provide arguments to the organizations that established the guidelines, especially the ICNIRP, to evaluate whether the current limits are too much. High and can be modified when considered pertinent. To the best of our knowledge, at no time has the reference level for the general public been exceeded.

Aptamers: A Cutting-Edge Approach for Gram-Negative Bacterial Pathogen Identification.

Early and accurate diagnoses of pathogenic microorganisms is essential to correctly identify diseases, treating infections, and tracking disease outbreaks associated with microbial infections, to develop precautionary measures that allow a fast and effective response in epidemics and pandemics, thus improving public health. Aptamers are a class of synthetic nucleic acid molecules with the potential to be used for medical purposes, since they can be directed towards any target molecule. Currently, the use of aptamers has increased because they are a useful tool in the detection of specific targets. We present a brief review of the use of aptamers to detect and identify bacteria or even some toxins with clinical importance. This work describes the advances in the technology of aptamers, with the purpose of providing knowledge to develop new aptamers for diagnoses and treatment of different diseases caused by infectious microorganisms.

Measurement studies of personal exposure to radiofrequency electromagnetic fields: A systematic review.

The last 25 years have seen an increase in the number of radiofrequency sources with the global adoption of smartphones as primary connectivity devices. The objective of this work was to review and evaluate the measured studies of personal exposure to Radiofrequency Electromagnetic Fields (RF-RMF) and meet the basic quality criteria eligible for inclusion in this Review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, following the eligibility criteria of the PECO (Population, Exposure, Comparator, and Outcome) methodology, and the instrument for critical reading Critical Appraisal Skills Programme Español (CASPe). We systematically reviewed the works published between January 1, 1998, and December 31, 2021, yielding 56 publications. Of the different types of studies in which personal exposure to RF-EMF has been measured with two measurement methodologies can be highlighted: Personal measurements with volunteers and Personal measurements with a trained researcher (touring a specific area, one or several microenvironments, an entire city, walking or in some means of transport). Personal exposimeters were used in 83% of the studies. The lowest mean was measured in Egypt with a value of 0.00100 µW/m2 (1.00 nW/m2) in 2007 and the highest mean was measured in Belgium with a value of 285000 µW/m2 (0.285 W/m2) in 2019. The results of our study confirm that RF-EMF exposure levels are well below the maximum levels established by the ICNIRP guidelines.

Disability and cognitive impairment are interdependent in primary antiphospholipid syndrome.

BACKGROUND: Cognitive impairment (CI) occurs at a high frequency in primary antiphospholipid syndrome (PAPS). Its psychosocial-related factors are of interest. OBJECTIVE: We aimed to determine disability and perceived stress and their correlation with CI in PAPS. METHODS: First study phase: a longitudinal study including patients with PAPS and paired controls for cardiovascular risk factors, age, and sex, determining CI with Montreal Cognitive Assessment (MoCA) and then repeating the measurement 1 year later. Second study phase: a cross-sectional analytical study by quantification of disability with the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and perceived stress with the Perceived Stress Scale (PSS-14). Descriptive statistics and Spearman correlation coefficient were used. RESULTS: Sixty-three patients with PAPS and 60 controls were studied. In PAPS, age (range, 48.0 ± 13.5 years), thrombotic artery events (TAE) (44.4%), and stroke/TIA (42.8%) were found. Disability was documented in the majority of WHODAS 2.0 domains and the total score for this was higher in participation and mobility, the stress level was normal, and 65.1% had CI. PAPS exhibited greater deterioration in the WHODAS 2.0 total score (p .017) and the MoCA test (p < .0001). Personal domains and the total WHODAS 2.0 score correlated inversely with MoCA. Life activities (rho = -0.419) and self-care (rho = -0.407) were those that correlated to the greatest degree. Stroke conferred risk for CI. CONCLUSIONS: Disability in PAPS and CI are interdependent. New treatment options and neurocognitive stimulation strategies are necessary to maintain functionality and prevent further cognitive dysfunction in PAPS patients.

Comparative Proteomics of Potato Cultivars with a Variable Dormancy Period.

The control of the duration of the dormancy phase is a significant challenge in the potato industry and for seed producers. However, the proteome landscape involved in the regulation of the length of the dormancy period over potato cultivars remains largely unexplored. In this study, we performed for the first time a comparative proteome profiling of potato cultivars with differential duration of tuber dormancy. More specifically, the proteome profiling of Agata, Kennebec and Agria commercial potato varieties with short, medium and medium-long dormancy, respectively, was assessed at the endodormancy stage using high-resolution two-dimensional electrophoresis (2-DE) coupled to reversed-phase liquid chromatography-tandem mass spectrometry (LC-TripleTOF MS/MS). A total of 11 proteins/isoforms with statistically significant differential abundance among cultivars were detected on 2-DE gels and confidently identified by LC-TripleTOF MS/MS. Identified proteins have known functions related to tuber development, sprouting and the oxylipins biosynthesis pathway. Fructokinase, a mitochondrial ADP/ATP carrier, catalase isozyme 2 and heat shock 70 kDa were the proteins with the strongest response to dormancy variations. To the best of our knowledge, this study reports the first candidate proteins underlying variable dormancy length in potato cultivars.

Comparison of statistic methods for censored personal exposure to RF-EMF data.

Several studies have characterized personal exposure to RF-EMF, which allows possible effects on health to be studied. All equipment has a detection limit, below which we obtain nondetects or censored data. This problem is a challenge for researchers as it makes the analysis of such data complex. We suggest reconsidering the statistical protocols of the nondetects analysis by comparing four different methods. Three of them substitute censored data using different approaches: regression on order of statistics (ROS) to simulate data below the detection limit (Method 1), substituting nondetect values by the detection limit divided by 2 (Method 2), a naïve calculation (Method 3) using the detection limit as a valid measurement. The fourth method consists of considering censored data to be missing values (Method 4). This article examines how these methods affect the quantification of personal exposure. We considered data from 14 frequency bands from FM to WiMax measured in Albacete (Spain) for 76 days every 10 s by a personal exposimeter (PEM) Satimo EME Spy 140.Methods 3 and 2 gave similar mean and median values to Method 1, but both underestimated the mean values when high nondetects records occurred, which conditioned the physical description of the real situation. The mean values calculated by Method 4 differed from those obtained by Method 1 but were similar when the percentage of nondetects was below 20%.Our comparison suggests that nondetects can be neglected when the percentage of censored data is low to provide a more realistic physical situation.

The first evidence of global meat phosphoproteome changes in response to pre-slaughter stress.

BACKGROUND: Pre-slaughter stress (PSS) impairs animal welfare and meat quality. Dark, firm and dry (DFD) are terms used to designate poor quality meats induced by PSS. Protein phosphorylation can be a potentially significant mechanism to explain rapid and multiple physiological and biochemical changes linked to PSS-dependent muscle-to-meat conversion. However, the role of reversible phosphorylation in the response to PSS is still little known. In this study, we report a comparative phosphoproteomic analysis of DFD and normal meats at 24 h post-mortem from the longissimus thoracis (LT) bovine muscle of male calves of the Rubia Gallega breed. For this purpose, two-dimensional gel electrophoresis (2-DE), in-gel multiplex identification of phosphoproteins with PRO-Q Diamond phosphoprotein-specific stain, tandem (MALDI-TOF/TOF) mass spectrometry (MS), novel quantitative phosphoproteomic statistics and bioinformatic tools were used. RESULTS: Noticeable and statistically significant differences in the extent of protein phosphorylation were detected between sample groups at the qualitative and quantitative levels. Overall phosphorylation rates across significantly changed phosphoproteins were about three times higher in DFD than in normal meat. Significantly changed phosphoproteins involved a variable number of isoforms of 13 myofibrillar and sarcoplasmic nonredundant proteins. However, fast skeletal myosin light chain 2 followed by troponin T, F-actin-capping and small heat shock proteins showed the greatest phosphorylation change, and therefore they were the most important phosphoproteins underlying LT muscle conversion to DFD meat in the Rubia Gallega breed. CONCLUSIONS: This is the first study reporting global meat phosphoproteome changes in response to PSS. The results show that reversible phosphorylation is a relevant mechanism underlying PSS response and downstream effects on meat quality. This research opens up novel horizons to unravel the complex molecular puzzle underlying muscle-to-meat conversion in response to PSS.

Characterisation of personal exposure to environmental radiofrequency electromagnetic fields in Albacete (Spain) and assessment of risk perception.

In the last decades, exposure to radiofrequency electromagnetic fields (RF-EMF) has substantially increased as new wireless technologies have been introduced. Society has become more concerned about the possible effects of RF-EMF on human health in parallel to the increase in their exposure. The appearance of personal exposimeters opens up wide-ranging research possibilities. Despite studies having characterised personal exposure to RF-EMF, part of the population is still worried, to the extent that psychogenic diseases ("nocebo" effect) appear, and patients suffer. It could be interesting to share personal exposure results with the population to better understand and promote public health. The main objective was to characterise personal exposure to environmental RF-EMF in Albacete (166,000 inhabitants, SE Spain), and assess the effect of sharing the results of the study on participants' risk perception. Measurements were taken by a personal Satimo EME SPY 140 exposimeter, which was programmed every 10 s for 24 h. To measure personal exposure to RF-EMF, we worked with 75 volunteers. Their personal exposure, 14 microenvironments in the city, e.g., home, outdoors, work, etc., and possible time differences were analysed. After participating in the study, 35 participants completed a questionnaire about their RF-EMF risk perception, which was also answered by a control sample to compare the results (N = 36). The total average exposure of 14 bands was 37.7 µW/m2, and individual ranges fell between 0.2 µW/m2, recorded in TV4&5, and a maximum of 264.7 µW/m2 in DECT. For Friday, we recorded a mean of 53.9 µW/m2 as opposed to 23.4 µW/m2 obtained on Saturday. The recorded night-time value was 27.5 µW/m2 versus 43.8 µW/m2 recorded in the daytime. The mean personal exposure value also showed differences between weekdays and weekend days, with 39.7 µW/m2 and 26.9 µW/m2, respectively. The main source that contributed to the mean total personal exposure was enhanced cordless telecommunications (DECT) with 50.2%, followed by mobile phones with 18.4% and mobile stations with 11.0% (GSM, DCS and UMTS), while WiFi signals gave 12.5%. In the analysed microenvironments, the mean exposure of homes and workplaces was 34.3 µW/m2 and 55.2 µW/m2, respectively. Outdoors, the mean value was 34.2 µW/m2 and the main sources were DECT, WiFi and mobile phone stations, depending on the place. The risk perception analysis found that 54% of the participants perceived that RF-EMF were less dangerous than before participating in the study, while 43% reported no change in their perceptions. Only 9% of the volunteers who received information about their measurements after the study assessed the possible RF-EMF risk with a value over or equal to 4 (on a scale from 1 to 5) versus 39% of the non-participant controls. We conclude that personal exposure to RF-EMF fell well below the limits recommended by ICNIRP and showed wide temporal and spatial variability. The main exposure sources were DECT, followed by mobile phones and WiFi. Sharing exposure results with participants lowered their risk perception.

Personal RF-EMF exposure from mobile phone base stations during temporary events.

BACKGROUND: In recent years, radiofrequency electromagnetic fields (RF-EMF) exposure has increased owing to new communication technologies. Simultaneously, increased exposure to RF-EMF has led to society's growing concern about the possible effects they may have on human health. Many studies have described personal RF-EMF exposure by using personal exposimeters to know a population's daily exposure to mobile phone base stations and to other sources whose installations tend to be permanent. Nonetheless during special events like concerts or fairs, where many people gather, permanent installations might not suffice to cover demand. So telephone companies install temporary stations for these events, and modify the exposure pattern of these areas or populations. OBJECTIVE: To study if installing temporary antennae for large events, and high concentrations of mobile phones, modify the exposure pattern compared to usual situations. METHODS: Personal RF-EMF exposure from mobile phones (uplink) and mobile phone base stations (downlink) installed at the 2017 Albacete Fair (Spain) was recorded. Between 7 and 17 September, more than 2,500,000 people visited this Fair. Measurements were taken by two Satimo EME SPY 140 personal exposimeters, placed one each side of a research team member's waist. These exposimeters were programmed to take measurements every 4 s at different time of day; morning, afternoon and night; and in several places, around the Fair Enclosure (zones Ejidos and Paseo) and inside the enclosure (Interior). These measurements were repeated on a weekday, at the weekend and the day after the Fair ended after temporary base stations had been removed. They were also taken for 1 h in all three zones, for each time of day; that is, 9 h were recorded for each study day. RESULTS: The mean RF-EMF recorded exposure from base stations (downlink-DL) on the days the Fair opened (morning, afternoon and night) for the three studied zones was 791.8 µW/m2, while the exposure produced by mobile phones (uplink-UL) was 59.0 µW/m2. These values were 391.2 µW/m2 (DL) and 10.3 µW/m2 (UL) a few days after the event ended. In study zones Ejidos and Paseo, both outside, the highest mean exposure was recorded at the weekend as 1494.1 and 848.1 µW/m2 respectively. For the Interior zone, the mean value recorded during the Fair was 354.8 µW/m2. These values contrast with those recorded in the three zones after the event ended: 556.37 (Ejidos), 144.1 (Paseo); 473.21 µW/m2 (Interior). The fact that the mean exposure recorded at Interior was slightly higher after the Fair could be due to signal shielding by so many people. The reduction in exposure in Paseo after the Fair was outstanding, probably due to the antennae being placed on low towers. Major differences were also found in the RF-EMF exposure from UL. In this case, the weekend values taken during the Fair were between 28.2 µW/m2 at Interior (weekday) and 98.1 µW/m2 at Ejidos (weekend), which dropped to 5.5 at Paseo after the Fair, to 11.7 µW/m2 at Interior and to 13.6 µW/m2 at Ejidos. CONCLUSIONS: Installing mobile phone base stations, and a dense public using mobile phones, imply a significant increase in personal RF-EMF exposure compared to that recorded during normal periods in the same area. However, the recorded measurements were below legally established limits.

Combining evolutionary and metabolic engineering in Rhodosporidium toruloides for lipid production with non-detoxified wheat straw hydrolysates.

Improving the yield of carbohydrate to lipid conversion and lipid productivity are two critical goals to develop an economically feasible process to commercialize microbial oils. Lignocellulosic sugars are potential low-cost carbon sources for this process but their use is limited by the toxic compounds produced during biomass pretreatment at high solids loading, and by the pentose sugars (mainly xylose) which are not efficiently metabolized by many microorganisms. Adaptive laboratory evolution was used to select a Rhodosporidium toruloides strain with robust growth in non-detoxified wheat straw hydrolysates, produced at 20% solids loading, and better xylose consumption rate. An arabinose-inducible cre-lox recombination system was developed in this evolved strain that was further engineered to express a second copy of the native DGAT1 and SCD1 genes under control of the native xylose reductase (XYL1) promoter. Fed-batch cultivation of the engineered strain in 7-L bioreactors produced 39.5 g lipid/L at a rate of 0.334 g/Lh-1 and 0.179 g/g yield, the best results reported in R. toruloides with non-detoxified lignocellulosic hydrolysates to date.

Diagnostic utility of PET/CT with 18F-DOPA and 18F-FDG in persistent or recurrent medullary thyroid carcinoma: the importance of calcitonin and carcinoembryonic antigen cutoff.

PURPOSE: This study sought to evaluate and compare the utility of 18-F-fluorodihydroxyphenylalanine (18F-DOPA) and 18-F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for identification of lesions in patients with recurrent medullary thyroid carcinoma (MTC). In addition, we analyzed the correlation between the calcitonin (Ct), carcinoembryonic antigen (CEA) levels, each doubling time (DT), and PET positivity. We evaluated the reliability of the 150 pg/mL Ct cutoff set by the American Thyroid Association guidelines for further imaging (including 18F-DOPA PET/CT). METHODS: We prospectively recruited 18 patients with recurrent MTC, identified by elevation of Ct or CEA. Each patient underwent a 18F-FDG PET/CT and a 18F-DOPA PET/CT. RESULTS: Abnormal uptakes were detected with 18F-DOPA (n=12) and 18F-FDG (n=9), (sensitivity of 66.7% vs. 50%; p<0.01). Twenty-eight lesions were detected with 18F-DOPA vs. 16 lesions with 18F-FDG (1.56±1.5 vs. 0.89±1.18 lesions per patient; p=0.01). None of our patients showed additional lesions with 18F-FDG in comparison to 18F-DOPA. Patient-based detection rate increased significantly with Ct levels ≥150 pg/mL vs. Ct<150 pg/mL for both 18F-DOPA (sensitivity 90.9% vs. 28.6%; p=0.013) and 18F-FDG PET/CT (sensitivity 72.7% vs. 14.3%; p=0.025). Using a CEA cutoff of ≥5 ng/mL, detection rates of 18F-DOPA and 18F-FDG PET/CT were 81.1% and 72.7%, respectively. No correlation between Ct-DT or CEA-DT and PET positivity was found. Histological confirmation was obtained in eight patients. CONCLUSIONS: 18F-DOPA PET/CT appears to be superior to 18F-FDG PET/CT in detecting and locating lesions in patients with recurrent MTC. This technique tends to be especially useful in patients with negative results in other imaging modalities and Ct≥150 pg/mL or CEA≥5 ng/mL.

Pheochromocytoma in neurofibromatosis type 1 during pregnancy.

Pregnant women with neurofibromatosis type 1 (NF-1) have increased complications during gestation, including hypertensive disorders that are sometimes caused by pheochromocytoma. Pheochromocytoma is an extremely rare condition during pregnancy, and the main clinical manifestation is hypertension. If not properly treated, pheochromocytoma has high maternal and fetal mortality rates. Early recognition and adequate clinical management before delivery have led to better outcomes in the last few decades. Despite the association of NF-1 and pheochromocytoma, there are few clinical reports of these two conditions in pregnant patients. We present a rare case of pheochromocytoma diagnosed during pregnancy in a patient with NF-1, and we describe the treatment and the obstetric and fetal outcomes. We also review other medical conditions related to NF-1 that complicated this patient's pregnancy.

Correlation between diet and gut bacteria in a population of young adults.

Dietary habits strongly influence gut microbiota. The aim of this study was to compare and correlated the abundance of Firmicutes and Bacteroidetes phyla, some representative bacteria of these phyla such as Bacteroides thetaiotaomicron, Prevotella, Faecalibacterium prausnitzii, Clostridium leptum and Bifidobacterium longum as a member of Actinobacteria phylum in young adults with their food intake. Faecal samples used came from lean subjects (BMI = 19.83 ± 0.94 kg/m(2)), overweight (BMI = 27.17 ± 0.51 kg/m(2)) and obese (BMI = 41.33 ± 5.25 kg/m(2)). There were significant differences in total studied gut microbiota between the overweight and lean groups. Members of the Firmicutes phylum, and Bifidobacterium longum, were more abundant in the lean group. The results suggest that diet rich in unsaturated fatty acids and fibre promote an abundant population of beneficial bacteria such as B. longum and Bacteroidetes. However, it has been considered that the results may be biased due to the size of the individuals studied; therefore the results could be only valid for the studied population.

The lack of consensus in management of malignant struma ovarii.

Struma ovarii is a rare variant of teratoma characterized by the presence of thyroid tissue in more than 50%. Malignant transformation is rare (less than 5%) and the criteria to classify this condition have changed over time. Nowadays it must fulfill the histological categories of differentiated thyroid carcinoma. Its treatment is controversial and there is no unanimous management. We present three cases of women with malignant struma ovarii, diagnosed by the surgical specimen.

Advanced thyroid carcinoma in pregnancy: case report of two pregnancies.

Differentiated thyroid carcinoma is one of the most frequently diagnosed cancers during pregnancy, second only to breast cancer. Therefore, it would be of value to determine if there are pregnancy-related physiological effects that impact long-term prognosis for patients with this disease. Hormone effects attributable to ß-human chorionic gonadotropin and estrogens seem particularly likely. We present a case of a 40-year-old woman with thyroid follicular carcinoma with accompanying bone metastases. The cancer was discovered immediately after childbirth and the woman became pregnant again when the disease was in an advanced stage. We describe the cancer evolution and present the maternal and fetal results. Pregnancy in women with advanced thyroid carcinoma could affect long-term prognosis. However, more studies are needed to evaluate this hypothesis. In this unique case, there were two pregnancies and the second occurred in an advanced state of the disease. We evaluated how these pregnancies could affect short-term prognosis of the disease.

Alemtuzumab induces severe orbitopathy in relapsing-remitting multiple sclerosis.

CONTEXT: Treatment with Alemtuzumab (ALZ) in patients with Relapsing-Remitting Multiple Sclerosis (RRMS) is associated with the development of ALZ-induced Graves' disease (GD-ALZ). Some cases may develop associated Graves´ Orbitopathy (GO-ALZ), with possible visual compromise. AIM: The aim of this study was to describe the main clinical and biochemical characteristics of GD-ALZ, as well as the clinical course of a case series of GO-ALZ METHODS: This study is a retrospective observational study, carried out in a reference hospital for the care of patients with RRMS in Spain. Cases treated with ALZ in the period 2014-2022 were included. GO-ALZ cases were identified among those with clinical symptoms compatible with thyroid eye disease after initiating ALZ treatment. RESULTS: A total of 135 cases, with a mean follow-up of 69.6 months after the first ALZ cycle, were included. The incidence of GD-ALZ was 32.6% (44/135), with a predominance of women (77.3%) and mean age of 41.9 years. The presence of first-degree relatives with hypothyroidism was identified as risk factor for the development of GD-ALZ (adjusted P-value: 0.02). GO-ALZ was diagnosed in 6 cases (incidence: 13.6%), of which 3 had severe clinical forms of GO, requiring anti-IL-6 treatment. A favorable response was reported in all of them, with a significant decrease in disease activity and improvement in proptosis. CONCLUSIONS: We report one of the largest cohorts of GD-ALZ and GO-ALZ cases. The diagnosis of these entities should be taken into account in patients treated with Alemtuzumab, given the risk of developing severe clinical forms. In moderate-severe forms of GO-ALZ, drugs with anti-IL-6 activity are a safe and effective option.

Detection of mecA Genes in Hospital-Acquired MRSA and SOSA Strains Associated with Biofilm Formation.

Methicillin-resistant (MR) Staphylococcus aureus (SA) and others, except for Staphylococcus aureus (SOSA), are common in healthcare-associated infections. SOSA encompass largely coagulase-negative staphylococci, including coagulase-positive staphylococcal species. Biofilm formation is encoded by the icaADBC operon and is involved in virulence. mecA encodes an additional penicillin-binding protein (PBP), PBP2a, that avoids the arrival of ß-lactams at the target, found in the staphylococcal cassette chromosome mec (SCCmec). This work aims to detect mecA, the bap gene, the icaADBC operon, and types of SCCmec associated to biofilm in MRSA and SOSA strains. A total of 46% (37/80) of the strains were S. aureus, 44% (35/80) S. epidermidis, 5% (4/80) S. haemolyticus, 2.5% (2/80) S. hominis, 1.25% (1/80) S. intermedius, and 1.25% (1/80) S. saprophyticus. A total of 85% were MR, of which 95.5% showed mecA and 86.7% ß-lactamase producers; thus, Staphylococcus may have more than one resistance mechanism. Healthcare-associated infection strains codified type I-III genes of SCCmec; types IV and V were associated to community-acquired strains (CA). Type II prevailed in MRSA mecA strains and type II and III in MRSOSA (methicillin-resistant staphylococci other than Staphylococcus aureus). The operon icaADBC was found in 24% of SA and 14% of SOSA; probably the arrangement of the operon, fork formation, and mutations influenced the variation. Methicillin resistance was mainly mediated by the mecA gene; however, there may be other mechanisms that also participate, since biofilm production is related to genes of the icaADBC operon and methicillin resistance was not associated with biofilm production. Therefore, it is necessary to strengthen surveillance to prevent the spread of these outbreaks both in the nosocomial environment and in the community.

Renin as a Biomarker to Guide Medical Treatment in Primary Aldosteronism Patients. Findings from the SPAIN-ALDO Registry.

INTRODUCTION: Primary aldosteronism (PA) is associated with several cardiometabolic comorbidities. Specific treatment by mineralocorticoid receptor antagonists (MRA) or adrenalectomy has been reported to reduce the cardiometabolic risk. However, the cardiovascular benefit could depend on plasma renin levels in patients on MRA. AIM: To compare the development of cardiovascular, renal and metabolic complications between medically treated patients with PA and those who underwent adrenalectomy, taking the renin status during MRA treatment into account. METHODS: A multicenter retrospective study (SPAIN-ALDO Register) of patients with PA treated at 35 Spanish tertiary hospitals. Patients on MRA were divided into two groups based on renin suppression (n = 90) or non-suppression (n = 70). Both groups were also compared to unilateral PA patients (n = 275) who achieved biochemical cure with adrenalectomy. RESULTS: Adrenalectomized patients were younger, had higher plasma aldosterone concentration, and lower potassium levels than MRA group. Patients on MRA had similar baseline characteristics when stratified into treatment groups with suppressed and unsuppressed renin. 97 (55.1%) of 176 patients without comorbidities at diagnosis, developed at least one comorbidity during follow-up (median 12 months vs. 12.5 months' follow-up after starting MRA and surgery, respectively). Surgery group had a lower risk of developing new cardiovascular events (HR 0.40 [95% CI 0.18-0.90]) than MRA group. Surgical treatment improved glycemic and blood pressure control, increased serum potassium levels, and required fewer antihypertensive drugs than medical treatment. However, there were no differences in the cardiometabolic profile or the incidence of new comorbidities between the groups with suppressed and unsuppressed renin levels (HR 0.95 [95% CI 0.52-1.73]). CONCLUSION: Cardiovascular, renal, and metabolic events were comparable in MRA patients with unsuppressed and suppressed renin. Effective surgical treatment of PA was associated with a decreased incidence of new cardiovascular events when compared to MRA therapy.