Prevalence, risk factors and evolution of diabetes mellitus after treatment in primary aldosteronism. Results from the SPAIN-ALDO registry.

PURPOSE: To evaluate the prevalence, risk factors and evolution of diabetes mellitus (DM) after targeted treatment in patients with primary aldosteronism (PA). METHODS: A retrospective multicenter study of PA patients in follow-up at 27 Spanish tertiary hospitals (SPAIN-ALDO Register). RESULTS: Overall, 646 patients with PA were included. At diagnosis, 21.2% (n = 137) had DM and 67% of them had HbA1c levels < 7%. In multivariate analysis, family history of DM (OR 4.00 [1.68-9.53]), the coexistence of dyslipidemia (OR 3.57 [1.51-8.43]) and advanced age (OR 1.04 per year of increase [1.00-1.09]) were identified as independent predictive factors of DM. Diabetic patients were on beta blockers (46.7% (n = 64) vs. 27.5% (n = 140), P < 0.001) and diuretics (51.1% (n = 70) vs. 33.2% (n = 169), p < 0.001) more frequently than non-diabetics. After a median follow-up of 22 months [IQR 7.5-63.0], 6.9% of patients developed DM, with no difference between those undergoing adrenalectomy and those treated medically (HR 1.07 [0.49-2.36], p = 0.866). There was also no significant difference in the evolution of glycemic control between DM patients who underwent surgery and those medically treated (p > 0.05). CONCLUSION: DM affects about one quarter of patients with PA and the risk factors for its development are common to those of the general population. Medical and surgical treatment provides similar benefit in glycemic control in patients with PA and DM.

Thyrotoxicosis following SARS-COV-2 vaccination: a case series and discussion.

AIM: To describe a case series of thyrotoxicosis likely triggered by SARS-CoV-2 vaccination and to warn physicians about this potential correlation. To report clinical, laboratory and imaging findings and provide further information that goes in line with the underlying mechanisms. METHODS: Single-center case series based on all the information collected in the hospital medical records, as well as the temporal sequence between the onset of symptoms and COVID-19 vaccination. RESULTS: We report 8 cases with thyrotoxicosis after SARS-CoV-2 vaccination. 4 cases of Graves' disease (GD), 2 cases of subacute painful thyroiditis (SAT), 1 case of concurrent GD and SAT and 1 case of atypical subacute thyroiditis. Five patients received BNT162b2 mRNA vaccine, 3 patients 1273 mRNA vaccine. The onset of symptoms following vaccination ranged from 10 to 14 days in six of eight patients and from 7 to 8 weeks in two patients. CONCLUSIONS: Several hypotheses have been proposed to explain the potential correlation between SARS-CoV-2 vaccination and thyrotoxicosis, including immune system hyper-stimulation, molecular mimicry and Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA). We should pay greater attention to thyroid disorders in patients receiving vaccine against SARS-CoV-2.

Raltegravir resistance in the cerebrospinal fluid.

We report the first published case of integrase inhibitor resistance in the central nervous system compartment in the absence of evidence of integrase inhibitor resistance in the plasma of a patient without human immunodeficiency virus (HIV)-encephalitis in the context of other HIV-associated central nervous system infections.

Focalidad neurológica en una paciente con lupus eritematoso sistémico / No disponible

No disponible

Staphylococcal infections in rabbit does on two industrial farms.

The main reasons for culling adult rabbit does on two Spanish rabbit farms were investigated for a year. The most important conditions were mastitis (33.3 per cent), followed by subcutaneous abscesses (9.9 per cent) and pyometra (8.7 per cent). Staphylococcus aureus infections were the most severe problem, the organism being isolated from 69.2 per cent of infected animals. Pasteurella species were more prevalent in cases of pyometra and pneumonia. Two strains of S aureus were identified by using polymorphism of the coagulase gene as the criterion. One of these strains was responsible for the majority of the staphylococcal infections and was isolated from several pathological processes.

Pathological and aetiological studies of multifocal interstitial nephritis in wasted pigs at slaughter.

Multifocal interstitial nephritis in pigs has been associated with several infectious agents. The objective of the present study was to investigate several different potential infectious agents associated with "white-spotted" kidneys in pigs suffering from wasting at slaughter (aged 6-8 months). Twenty-nine case kidneys (with a "white-spotted" gross appearance) classified into 3 macroscopic lesional grades, and 15 control kidneys (lacking gross lesions), were obtained from a pig abattoir. Laboratory analyses to detect potential associations with the aforementioned pathological condition with Leptospira spp., porcine circovirus type 2 (PCV2), porcine parvovirus (PPV), porcine reproductive and respiratory syndrome virus (PRRSV), and bacteria, were carried out. Microscopically, interstitial nephritis with a lymphofollicular inflammatory pattern (follicular nephritis) was observed in both case and control kidneys, with a higher frequency seen in the former ones. No leptospires were identified, although antibodies to the Pomona and Bratislava serovars were detected. Some pyogenic bacteria were also isolated from both case and control kidneys. PCV2 nucleic acid was only detected in 1 case kidney. PRRSV antigen was not found in any tested sample. Some pigs were tested positive for PPV by serology. Apparently, none of the studied agents were specifically associated as being the potential cause of the renal lesions in the studied wasted pigs. The fact that these chronic lesions may have been the consequence of a previous infection with one of these studied microorganisms, or more, and eventually with other non-tested infectious agents during the growing-finishing period, cannot be ruled out.

[Implication of ermX genes in macrolide- and telithromycin-resistance in Corynebacterium jeikeium and Corynebacterium amycolatum]. / Implicacion de los genes ermX en la resistencia a los macrolidos y la telitromicina de Corynebacterium jeikeium y Corynebacterium amycolatum.

The activity of seven macrolides, clindamycin and telithromycin against clinical isolates of Corynebacterium spp. was studied. Of these, 36 isolates were identified as C. jeikeium and 57 as C. amycolatum. The frequency of resistance to erythromycin and other macrolides as well as clindamycin was high, with CMI(90) >256 microg/ml. Telithromycin showed the best activity, with 52.3% of C. amycolatum and 70% of C. jeikeium erythromycin-resistant strains susceptible to this ketolide. All strains had the MLSb constitutive phenotype. The ermX gene was present in all erythromycin-resistant strains, and in C. amycolatum was 100% homologous with that of C. striatum and C. diphtheriae.

Implicación de los genes ermX en la resistencia a los macrólidos y la telitromicina de Corynebacterium jeikeium y Corynebacterium amycolatum / Implication of ermX genes in macrolide- and telithromycin- resistance in Corynebacterium jeikeium and Corynebacterium amycolatum

Se ha estudiado la actividad de siete macrólidos, clindamicina y telitromicina frente a aislamientos clínicos del género Corynebacterium. Deéstos, 36 pertenecían a la especie C. jeikeium y 57 a C. amycolatum. Todos los macrólidos estudiados y la clindamicina presentaron escasaactividad, con CMI90 >256 mg/l. La telitromicina presentó mejor actividad, siendo sensibles un 52,3% de C. amycolatum y un 70% de C.jeikeium resistentes a la eritromicina. El fenotipo de resistencia fue de tipo MLSb constitutivo en todos los aislamientos. El gen ermX fue detectadoen el 100% de las cepas resistentes a eritromicina, presentando una homología, en el caso de C. amycolatum, de un 100% con elde C. striatum y C. diptheriae

The activity of seven macrolides, clindamycin and telithromycin against clinical isolates of Corynebacterium spp. was studied. Of these, 36isolates were identified as C. jeikeium and 57 as C. amycolatum. The frequency of resistance to erythromycin and other macrolides as wellas clindamycin was high, with CMI90 >256 ìg/ml. Telithromycin showed the best activity, with 52.3% of C. amycolatum and 70% of C. jeikeiumerythromycin-resistant strains susceptible to this ketolide. All strains had the MLSb constitutive phenotype. The ermX gene was presentin all erythromycin-resistant strains, and in C. amycolatum was 100% homologous with that of C. striatum and C. diphtheriae

Pneumatosis cystoides intestinalis in a rabbit doe (Oryctolagus cuniculus).

Pneumatosis cystoides intestinalis (PCI) is an infrequent condition of animals characterized by the existence of numerous thin-walled, gas-filled cystic structures within the intestinal wall and adjacent lymph nodes. Microscopically, the cystic structures appear to be dilated lymphatics located in the lamina propria, submucosa, muscularis, subserosa, mesentery, and mesenteric lymph nodes. This report describes a case of pneumatosis cystoides intestinalis in a rabbit doe from an organic farm where 20 rabbit does were fed ad libitum with a natural diet consisting of whole barley, pea beans, alfalfa hay, and a pelleted vitamin-mineral blend. A combination of nutritional, bacterial, and other factors are hypothesized as possible predisposing factors in the development of PCI.

In vitro activity of newer antibiotics against Corynebacterium jeikeium, Corynebacterium amycolatum and Corynebacterium urealyticum.

The in vitro activity of ciprofloxacin, erythromycin, telithromycin, teicoplanin, linezolid and quinupristin-dalfopristin was tested against human derived pathogenic corynebacteria. The MICs of these antibiotics were measured using the agar dilution method against 31 strains of Corynebacterium jeikeium, 58 Corynebacterium amycolatum (including 33 multidrug-resistant strains) and 64 Corynebacterium urealyticum clinical strains. A high resistance rate to ciprofloxacin and erythromycin was found in the three species. Telithromycin was much more active than erythromycin (MIC(90) of erythromycin >or=128 mg/l for all three species; MIC(90) of telithromycin: 4 mg/l for C. jeikeium, 64 mg/l for C. amycolatum and 1 mg/l for C. urealyticum). There were no teicoplanin-resistant (MIC(90) 1, 0.5 and 1 mg/l, respectively) or linezolid-resistant strains (MIC(90) 1, 0.2 and 0.5 mg/l, respectively). Quinupristin-dalfopristin was active against most strains with an activity similar to linezolid, but three C. jeikeium and one C. amycolatum showed MICs >or=4 mg/l. Telithromycin showed much better activity against corynebacteria than older macrolides. Synercid and linezolid were active against most isolates tested, including multidrug resistant strains.

[Hemorrhagic cystitis caused by BK and JC polyomavirus in patients treated with bone marrow transplantation: clinical features and urologic management]. / Cistitis hemorrágica por poliomavirus BK y JC en pacientes sometidos a transplante de médula ósea: aspectos clínicos y manejo urológico.

INTRODUCTION: Differential diagnosis of hematuria after bone marrow transplantation (B.M.T.) may include polyomavirus (BK and JC)-associated haemorrhagic cystitis. Many reports have implied BK virus as the major pathogen in the development of hemorrhagic cystitis after BMT. BK viruria is also associated with ureteric stenosis in renal allografts recipients. Viral urinary tract infections are uncommon in healthy individuals, but we can find them frequently in patients under immunosuppressive conditions. MATERIAL AND METHODS: Retrospective study of 123 consecutive B.M.T. recipients in the period from 1995 to 2000, evaluating those with polyomavirus-associated hemorrhagic cystitis. We present patient's characteristics, primary disease, clinical features, diagnosis aspects and treatment of these "hidden hosts of urinary tract". RESULTS: 7 patients (5.7% of B.M.T.) developed BK or JC virus-associated hemorrhagic cystitis; 3 men and 4 women; median patient age was 29 years (range 14 to 45 years). Bacterial, mycobacterial and parasitic urine cultivates had negative results in all of them. The clinical course was characterized by a late onset of haemorrhagic cystitis (days +30 to +132 after BMT). All 7 patients developed macroscopic haematuria (duration 3 to 30 days). In 6 cases Graft Versus Host Disease (G.V.H.D.) criteria were found. Ultrasonographic studies revealed diffuse thickening of bladder wall in 5 patients. Hematuria was managed by hyperhydratation, blood transfusions, transurethral catheter and evacuation of blood clots, continuous bladder irrigation, urine alkalinization and antiviral therapy. No other more aggressive measures were required to stop the bleeding. Only 1 case of transient elevated creatinine. CONCLUSIONS: Polyomavirus-associated haemorrhagic cystitis must be considered in differential diagnosis of hematuria in bone marrow transplantation recipients. Urological management, according with the severity and duration of hematuria, is frequently required.

Cistitis hemorrágica por poliomavirus BK y JC en pacientes sometidos a trasplante de medula osea: aspectos clínicos y manejo urológico / Polyomavirus BK and JC associated haemorrhagic cystitis in patients under bone marrow transplantation clinical features and urological management

INTRODUCCION: Dentro del diagnóstico diferencial de la hematuria en pacientes receptores de un trasplante de médula ósea (T.M.O.) debemos considerar la cistitis hemorrágica por poliomavirus BK y JC. Algunos han implicado al virus BK como el principal agente en su desarrollo. La viruria por BK también se ha asociado a estenosis ureteral en pacientes sometidos a trasplante renal. Las infecciones urinarias virales, excepcionales cuando existe indemnidad del sistema inmune, pueden aparecer con frecuencia en situaciones de inmunocompromiso.MATERIAL Y MÉTODOS: Estudio retrospectivo de 123 pacientes consecutivos sometidos a trasplante de médula ósea (1995-2000). analizando los casos en que se presentó cistitis hemorrágica con aislamiento de poliomavirus BK y JC en orina. Se estudian: características poblacionales, enfermedad de base, manifestaciones clínicas y radiológicas, métodos diagnósticos y medidas terapéuticas. Realizamos una revisión de los principales aspectos de estos "desconocidos huéspedes del aparato urinario".RESULTADOS: Se presentó cistitis hemorrágica asociada a poliomavirus en 7 casos (5,7 por ciento de los TMO), 6 por BK y 1 por JC. Corresponden <: a 3 varones y 4 mujeres, con una edad media de 29 años (14-45). Todos los pacientes con urocultivos bacteriológicos, micóticos y parasitológicos negativos. Presentación clínica como hematuria macroscópica en todos los casos (aparición entre los días +30 y+132 post-trasplante), cuya duración osciló entre 3 y 30 días. En 6 casos existían criterios de Enfermedad de Injerto Contra Huésped. Eeográficamente, en 5 pacientes se evidenció un engrosamiento difuso de la pared vesical. En todos se instauró tratamiento mediante hiperhidratación, sondaje vesical y extracción de coágulos, lavado endovesical continuo, alcalinización urinaria y antivirales sistémicos. No fueron necesarias actuaciones " más agresivas. Como complicación, un caso de insuficiencia renal leve, reversible.COMENTARIOS: La cistitis hemorrágica por poliomavirus es una entidad que considerar en pacientes que han recibido un T.M. O., debiendo realizar diagnóstico diferencial ante toda hematuria que se presente en estos casos. Es necesario un adecuado manejo urológico de la hematuria, que puede llegar a comprometer la vida del paciente. (AU)

Molecular diversity of quinolone resistance in genetically related clinical isolates of Staphylococcus aureus and susceptibility to newer quinolones.

The genes encoding topoisomerases (gyrA and grlA) and the norA promoter of 100 fluoroquinolone-susceptible and -resistant Staphylococcus aureus clinical isolates obtained in two geographically distant hospitals were analysed. The relationship between mutations found and the susceptibility to newer quinolones was determined. Thirty-nine strains were grouped in seven clones by pulsed-field gel electrophoresis (PFGE). The remaining 61 strains were classified as unrelated strains. In three clones, all strains showed the same grlA-gyrA-norA mutation profiles. Strains in the rest of the groups showed different mutation profiles, even though PFGE indicated that they possessed genetically similar populations. One cluster showed a high level of diversity; five different mutation profiles were detected in the six isolates belonging to this pattern. Two isolates had a Glu84 to Lys mutation in grlA and another isolate had this mutation combined with a Ser84 to Leu mutation in gyrA. Combination of a Ser80 to Phe mutation in grlA and a Ser84 to Leu in gyrA was found in the two other isolates. One of these also had a thymine to a guanine transversion at a position 89 nucleotides upstream of the norA start codon in the norA promoter. These results show that fluoroquinolone resistance in clinical S. aureus strains does not necessarily result from the spread of resistant clones. Fluoroquinolone resistance may develop independently in strains belonging to the same PFGE pattern by accumulation of different mutations over a quinolone-susceptible ancestor wild type or single grlA mutant.