Search Results for: Anemia sideropenica e carenza marziale senza anemia: senza ferro si sta male

Stroke, Volume 56, Issue Suppl_1, Page ADP31-ADP31, February 1, 2025. Introduction:CT perfusion maps (CTP) can estimate the ischemic core in acute ischemic stroke based on distinctive cerebral blood flow (CBF) thresholds. However, metabolic factors beyond perfusion influence the tissue tolerance to ischemia and the infarct growth rate.Hypothesis:We hypothesize that patients with lower hemoglobin and higher blood glucose levels exhibit reduced cerebral tissue resilience to hypoperfusion and will show larger ischemic core underestimation volume (ICuV) compared to other patients with normal hemoglobin and blood glucose levels.Methods:Large vessel occlusion stroke patients investigated with baseline CTP undergoing thrombectomy with near-complete reperfusion and without parenchymal hemorrhage from the ESCAPE-NA1 trial were included. Patients were subdivided into anemic (Hgb

Stroke, Volume 56, Issue Suppl_1, Page ATP287-ATP287, February 1, 2025. Background:Chronic kidney disease (CKD) is a known risk factor for stroke that leads to significant long-term disability. Efferocytosis, the process by which microglia engulf and clear apoptotic cells, is essential for stroke recovery. However, its impairment can hinder recovery and worsen the outcomes. Desidustat, an oral hypoxia-inducible factor-prolyl hydroxylase inhibitor, has emerged as a promising treatment for anemia associated with CKD. Despite its clinical potential, its effects on microglial efferocytosis and subsequent effects on stroke recovery have not yet been studied.Objective:To evaluate the mechanistic role of desidustat in mitigating CKD-induced defective microglial efferocytosis and enhancing sensorimotor recovery following embolic stroke.Methods:CKD was induced in adult C57BL/6 mice by oral administration of adenine (50 mg/kg) for 28 days. Acute Ischemic stroke was induced in mice with CKD using an embolic model. Sensorimotor function tests (modified neurological severity score and corner test) were performed for up to 4-weeks post-stroke. Inflammation, apoptosis, and the effect of CKD on microglial efferocytosis following stroke were assessed 72 h post-stroke using in vitro and in vivo functional assays. Desidustat 15 mg/kg was administered orally starting on day 14 of adenine treatment and continued for 28 days post-stroke in mice with CKD. Human-induced microglial cells were used to evaluate the mechanistic role of desidustat in promoting efferocytosis of apoptotic neurons.Results:Mice with CKD exhibited elevated blood urea nitrogen and creatinine levels, accompanied by tubulointerstitial abnormalities and vascular fibrosis in the kidneys. Stroke induction in mice with CKD resulted in increased cerebral inflammation and reduced microglial efferocytosis 72 h post-stroke which was concomitant with worse neurological outcomes and sensorimotor function tests for up to 4 weeks as compared to controls. Desidustat treatment significantly reduced cerebral inflammation and enhanced microglial efferocytosis (72 h post-stroke) and improved neurological recovery and sensorimotor function for up to 4 weeks. In vitro mechanistic studies revealed that desidustat directly enhanced efferocytosis in a human microglial-neuronal co-culture assay.Conclusion:Our results demonstrated that desidustat treatment enhances microglial efferocytosis and improves neurological outcomes and sensorimotor deficits following ischemic stroke in mice.

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Introduction
Iron deficiency anaemia (IDA) and dental caries are prevalent diseases among Pakistani children. Limited research has been done to explore their association with permanent teeth. Given the caries susceptibility of permanent first molars and their role in the development of ideal occlusion, this study aimed to estimate caries frequency in these molars and assess its association with IDA in 7–12 year-old children.

Methods and analysis
This analytical cross-sectional study will include 141 children aged 7–12 years visiting physicians in the paediatric OPD of Dr. Ruth K.M. Pfau, Civil Hospital Karachi. Using consecutive sampling, children who met initial screening criteria were further evaluated to determine eligibility for the study. Data collection will involve physical examinations (including weight and height), oral examinations (including the relevant oral hygiene and caries assessments) and laboratory examinations (including the prescribed tests). In addition, questions will be asked about sociodemographic characteristics, history of IDA, oral hygiene habits, smokeless tobacco use and the frequency of cariogenic dietary consumption. Exposure variable will include the presence of IDA, assessed using complete blood count, C-reactive protein and ferritin tests and treated as a dichotomous variable. Outcome variable will include dental caries in at least one permanent first molar, assessed using the Decayed, Missing, and Filled Teeth index and also treated as a dichotomous variable. Analysis will include Poisson regression with robust variance, reporting prevalence ratios with 95% CIs for the association of IDA and dental caries in the permanent first molars. Frequency of children with carious permanent first molars with 95% CIs will also be reported.

Ethics and dissemination
This research has been approved by ethical review committee of Aga Khan University (Reference number: 2024-9692-30593) and the institutional review board of Dow University of Health Sciences (IRB Reference: IRB-3556/DUHS/Approval/2024/196) before participant recruitment. Results will be disseminated through seminars and peer-reviewed publications.

Nella regione di Panzi a 700 chilometri dalla capitale Kinshasa, sono oltre 400 i casi e 31 i decessi. A essere coinvolti sono soprattutto i bambini sotto i 5 anni

Besigye, secondo la moglie, era stato sequestrato in Kenya

Circulation, Volume 150, Issue Suppl_1, Page A4144552-A4144552, November 12, 2024. Background:Heart Failure(HF) significantly deteriorates outcomes in patients with Atrial Fibrillation. Heart Failure with Preserved Ejection Fraction(HFpEF) and Atrial Fibrillation(AFib) share common disease progression pathways and are gradually increasing in prevalence.Aim:We aim to study the variation in characteristics and outcomes based on type of heart failure in patients with AFib using the National Readmission Database(2016-2020).Methods:NRD database was used to identify patients with Atrial Fibrillation using ICD-10 codes. Patients were stratified into two groups based on the presence of systolic dysfunction and diastolic dysfunction. Patients with combined systolic and diastolic dysfunction were excluded. Information was collected on patient demographics, comorbidities, and outcomes. Propensity score matching was performed to compare outcomes among AFib patients with HFrEF and HFpEF.Results:A total of 6,673,080 patients with AFib and isolated systolic or isolated diastolic dysfunction were included in the analysis. 3,914,695(58.66%) had HFpEF and 2,758,385 (41.34%%) had HFrEF. In the HFpEF group 57.8% were females in comparison with 33.12% females in the HFrEF group. HFpEF group had a higher rate of hypertension (84.9% vs 82%, p

Circulation, Volume 150, Issue Suppl_1, Page A4139144-A4139144, November 12, 2024. Background:Iron deficiency anemia (IDA) affects approximately one-third of patients with systolic heart failure, yet comprehensive population-based analyses of its impact on in-hospital outcomes remain limited. This study seeks to examine how IDA influences in-hospital outcomes among individuals with decompensated systolic congestive heart failure (HFrEF).Methods:Using data from the National Inpatient Sample (NIS) database spanning from 2017 to 2021, this study identified patients hospitalized for decompensated systolic congestive heart failure (HFrEF) with a secondary diagnosis of IDA using ICD-10 codes such as I5020-23 and D500, D501, D508, D509. Propensity score matching (PSM) was then employed to create cohorts without and with IDA at a 1:3 ratio. Multivariate regression analyses were conducted to evaluate various outcomes, including in-hospital mortality, cardiogenic shock (CS), acute myocardial injury (AMI), cardiac arrest, ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and total hospitalization charges. Furthermore, the utilization rate of mechanical ventilation and circulatory support, including intra-aortic balloon pump and extracorporeal membrane oxygenation, was evaluated in both cohorts.Results:Among 253,034 HFrEF hospitalizations, 16,200 (6.4%) had a secondary diagnosis of IDA. After PSM, multivariate regression analyses revealed no significant differences in the odds of cardiogenic shock (10% vs. 10%, p=0.86), in-hospital mortality (2.6% vs. 2.8%, p=0.71), and LOS (7.19 vs. 7.27 days) between the two groups. Additionally, the likelihood of cardiac arrest, ventricular arrhythmias, AMI, and utilization of mechanical ventilation and circulatory support did not reach statistical significance. However, patients with IDA and HFrEF had higher hospitalization charges ($85,516 vs. $93,000).Conclusion:HFrEF patients, with or without IDA, had similar odds of cardiogenic shock, in-hospital mortality, mechanical circulatory support utilization, as well as LOS. However, IDA with HFrEF correlated with higher hospitalization charges.

Circulation, Volume 150, Issue Suppl_1, Page A4144512-A4144512, November 12, 2024. Introduction:Transcatheter edge-to-edge repair of the mitral valve with the MitraClip has offered a less invasive percutaneous alternative to surgical repair in select candidates with mitral regurgitation. Various factors impact the outcomes of MitraClip. We investigated the impact of nutritional status on the outcomes of MitraClip.Methods:Utilizing the nationwide inpatient sample data for years from January 1, 2016, and December 31, 2021, patients who underwent MitraClip were identified. They were categorized based on obesity and protein energy malnutrition (PEM). Statistical significance was assigned at p

Circulation, Volume 150, Issue Suppl_1, Page A4145703-A4145703, November 12, 2024. Introduction:Acute coronary syndrome (ACS) is a leading cause of cardiovascular (CV) death. Sickle cell disease (SCD) is the most common inherited blood disorder in the United States and is associated with coronary microvascular dysfunction and impaired myocardial perfusion reserve. However, data on post-ACS outcomes in patients with SCD are scarce.Methods:Patients admitted with ACS from 2014-2020 with and without SCD were identified using the National Readmissions Database. In-hospital outcomes were death, major bleeding, stroke or arterial thromboembolism, and venous thromboembolism (VTE). Ninety-day readmission outcomes were CV-related, heart failure (HF) related, bleeding-related, and all-cause. Multivariable logistic or Cox proportional hazards were utilized with age, sex, chronic kidney disease, prior MI, prior stroke, prior VTE, pulmonary hypertension, STEMI, cardiogenic shock, revascularization, anemia, mechanical circulatory support use, hospital size and teaching status in addition to social factors as co-variables.Results:A total of 2,190,358 patients with ACS were included, of whom 1,471 (0.067%) had SCD. After multivariable adjustment, there was no difference in in-hospital mortality (OR 0.92; 95% CI 0.68-1.26) or major bleeding (OR 1.03; 95% CI 0.82-1.28) between patients with and without SCD. There was no significant difference in 90-day CV-related (HR 1.11; 95% CI 0.94-1.3) or bleeding-related (HR 0.86; 95% CI 0.49-1.52) readmissions between patients with and without SCD. However, SCD was associated with a higher rate of HF-related (HR 1.25; 95% CI, 1.04-1.52) and all-cause 90-day readmissions (HR 1.17; 95% CI, 1.04-1.32).Conclusion:Among patients admitted with ACS, SCD was not associated with increased risk of in-hospital outcomes though there was an association of increased HF-related and all-cause 90-day readmissions with SCD. Further investigation is needed to better characterize and improve outcomes of patients with SCD and ACS.

Circulation, Volume 150, Issue Suppl_1, Page A4131460-A4131460, November 12, 2024. Background:Chronic kidney disease (CKD) is associated with risk of myocardial infarction (MI) and anemia. Among patients with CKD and anemia who experience MI, it remains uncertain if a liberal transfusion threshold (LTT) strategy (hemoglobin cutoff [Hgb] < 10 g/dL) is superior to a restrictive transfusion threshold (RTT, Hgb 7-8 g/dL) strategy.Objectives:To evaluate outcomes of those with CKD randomized to RTT vs. LTT in the Myocardial Ischemia and Transfusion (MINT) trial (NCT02981407).Methods:Among 3,495 MINT participants with non-missing creatinine (99.7%), we compared the baseline characteristics and outcomes at 30 days post-randomization of those individuals without CKD (N = 1279), CKD with eGFR 30-60 mL/min/1.73 m2(N = 999), CKD with eGFR < 30 mL/min/1.73 m2(N = 802), and CKD requiring dialysis (N = 415), both overall and by randomized transfusion strategy. Interaction terms for eGFR category by treatment assignment on each outcome were assessed.Results:Individuals with CKD compared to those without CKD more frequently presented with NSTEMI (all p < 0.001) and had a greater risk of all-cause death, recurrent MI, rehospitalization, and heart failure (all p < 0.05). Compared to a liberal transfusion strategy, a restrictive strategy among non-dialysis dependent individuals with an eGFR < 30 mL/min/1.73 m2was associated with an increased risk of death/recurrent MI (Figure 1) and unplanned rehospitalization (Figure 2). Among individuals with an eGFR 30-60 mL/min/1.73 m2, a restrictive strategy was associated with an increased risk of cardiac death (Figure 1). No eGFR category by treatment assignment interaction terms were significant.Conclusions:In this prespecified analysis, individuals with CKD were at greater risk of death, recurrent MI, heart failure, and unplanned rehospitalization at 30 days post-randomization than those without CKD. In individuals with CKD, a restrictive transfusion strategy was associated with increased risk of adverse outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4139444-A4139444, November 12, 2024. Case Presentation:A 39-year-old Southeast Asian female presented with fatigue and exertional dyspnea. She underwent a myomectomy four years ago. Examination showed vital signs within normal limits, except for an SpO2 of 87%. Blood tests indicated microcytic hypochromic anemia and elevated D-Dimer levels of 1479 ng/mL.A transthoracic echocardiogram revealed a large mass occupying almost the entire right atrium, extending into the inferior vena cava. A CT scan showed a large, low attenuation, and minimally enhanced mass extending from the right atrium into the inferior vena cava and right hepatic vein, possibly invading segments VII-VIII of the liver (Figure 1). Abdominal CT and MR images revealed multiple degenerating uterine fibroids, bilateral dilated uterine tubes, and mild right hydronephrosis (Figure 2).The patient underwent surgical removal of the cardiac mass under general anesthesia with extracorporeal circulation and hypothermia. Pathological examination confirmed a benign tumor characterized by bundles of smooth muscle cells (Figure 3). Immunohistochemical staining with Actin (+), Progesterone receptor (+), Desmin (+), Ki67 (+) was consistent with a diagnosis of benign metastasizing leiomyoma (BML) of the heart. Subsequently, elective hysterectomy and bilateral salpingo-oophorectomy were performed.Discussion:Although rare, uterine leiomyoma can exhibit metastatic behavior, disseminating to extraneous anatomical sites. BML should be considered in the differential diagnosis when patients present with an atypical cardiac mass and have a history of uterine leiomyoma, myomectomy, or hysterectomy.BML of the heart is an exceptionally rare condition, predominantly affecting middle-aged women who have undergone hysterectomy or myomectomy. While BML commonly occurs in pre-menopausal patients and shares a potentially similar mechanism with endometriosis, as indicated by its response to estrogen-blocking agents, the occurrence of BML in post-menopausal women suggests the involvement of other contributing factors.Multiple imaging modalities play a significant role in the diagnosis and preparation for surgical management.

Circulation, Volume 150, Issue Suppl_1, Page A4145056-A4145056, November 12, 2024. Introduction:Iron deficiency anemia (IDA) affects millions of people with heart failure (HF) and is of a higher proportion in patients admitted for HF than those seen as an outpatient. The cause of IDA in patients with HF is postulated to be related to the chronic inflammatory process that occurs resulting in decreased erythropoiesis. This could also be a side effect of the extensive treatment. The fate of patients admitted for exacerbation of heart failure, especially those with IDA could be fatal. This study uses the NIS HCUP database to assess the outcome of patients admitted from 2016 to 2019 with heart failure and co-existing iron deficiency anemia.Research question/ hypothesis:Patients with HF and co-existing IDA have worse outcomes than those without.Method:We used the NIS HCUP 2016 to 2019 database for the analysis. The primary outcome was inpatient mortality. Secondary outcomes such as mean length of hospitalization (LOS), mean total hospital charges (THC) adjusted for inflation and proportion of complications were computed. Data was analyzed using regression models adjusted for significant, confounding, sociodemographic and comorbid conditions.Discussion/ Results::The total population of hospitalizations for HF from 2016 to 2019 was 1270784 with 6.9% having IDA. A higher proportion of hospitalizations with IDA were women. The mortality from the HF admission was 39350 patients. IDA was associated with lower adjusted odds of inpatient mortality (2.5 vs 3.2%, aOR: 0.75, 95% confidence interval (CI) of 0.68-0.84. However, patients with IDA had significantly longer mean LOS and higher THC compared to patients without IDA. Patients with IDA also had increased adjusted odds or requiring pressors, developing acute kidney failure and respiratory failure.Conclusion::Although IDA did not appear to impact mortality in patients with HF, it was associated with higher inpatient complications and higher healthcare cost utilization. Researchers postulate that limitation of different codes being used when data is recorded could have contributed to the unimpacted mortality. Further studies are needed to decipher other factors. Addressing comorbid IDA in the outpatient setting may significantly decrease the cost associated with hospitalization for HF by decreasing the length of hospitalization and the hospital charges associated with those hospitalizations.

Circulation, Volume 150, Issue Suppl_1, Page A4142305-A4142305, November 12, 2024. Background:Demand ischemia is typically ascribed little importance but likely indicates an elevated cardiovascular risk that is more significant than current convention dictates, despite the absence of plaque rupture.Hypothesis:Demand ischemia likely predicts worse 3-month cardiovascular outcomes in patients with nonocclusive CAD admitted for nonsevere sepsis.Methods:We conducted a retrospective cohort study using data from the National Readmissions Database 2017 to 2020 to evaluate whether demand ischemia predicts increased risk of 3-month readmission with adverse cardiovascular outcomes in patients with nonocclusive CAD admitted for nonsevere sepsis. The outcomes of interest were 3-month readmissions with acute heart failure, ventricular tachyarrhythmia, cardiogenic shock, STEMI, acute respiratory failure, AKI and vasopressor use. Multivariate analysis was employed to derive adjusted odds ratios (OR) after accounting for age, Charlson comorbidity index, household income, hospital location and size, hypertension, diabetes mellitus, hyperlipidemia, CHF, atrial fibrillation/flutter, CKD, tobacco use, anemia, malnutrition, obesity, OSA and OHS.Results:Among patients with nonocclusive CAD admitted for nonsevere sepsis, 717,110 did not have demand ischemia, compared to 25,728 patients who did. In patients with demand ischemia, our results showed significantly increased risk of 3-month readmission with acute heart failure (OR 2.10, P < 0.0005, CI 2.00 – 2.19), ventricular tachyarrhythmia (OR 2.51, P < 0.0500, CI 1.19 – 5.34), cardiogenic shock (OR 1.66, P < 0.0005, CI 1.45 - 1.90), acute respiratory failure (OR 1.97, P < 0.0005, CI 1.89 – 2.05), AKI (OR 1.48, P < 0.0005, CI 1.42 – 1.54) and vasopressor use (OR 1.52, P < 0.0005, CI 1.31 – 1.78) There were no cases of 3-month readmissions with STEMI, possibly due to coding.Conclusion:Our results indicate that despite being considered a relatively benign diagnosis, demand ischemia is likely actually a marker for meaningfully elevated cardiovascular risk. Further studies will be needed to support this idea and to identify interventions that mitigate the risk.

Circulation, Volume 150, Issue Suppl_1, Page A4141624-A4141624, November 12, 2024. Introduction:It is estimated that about 30% of patients with heart failure (HF) have iron deficiency anemia that can be masked as chronic normocytic anemia or functional anemia. Currently, the ACC/AHA 2022 heart failure guidelines give IV Iron replacement a Class IIa recommendation. However, many physicians who are regularly involved in the management of HF patients do not assess for or adequately treat iron deficiency anemia in these patients. This project seeks to identify the gaps in physicians’ knowledge on iron deficiency anemia and HF.Method:Over a 2-week period, a 9-item questionnaire was given to a total of 52 Internal Medicine physicians: 9 attendings, 27 residents (2nd and 3rd year) and 16 interns (1st year residents) chosen by convenience sampling. The participants at that time, were regularly involved in the care of patients with HF at a Brooklyn inter-city community Hospital. Data was collected and analyzed using IBM SPSS version 29 data analysis software.Results:All 52 participants completed the survey. When asked if all stages and classification of heart failure can be affected by iron deficiency anemia, 81.3% of interns vs 100% of both residents and attendings answered yes. However, only 18.8% of interns, 22.2% of residents and 11.1% of attendings test every patient with HFrEF

Circulation, Volume 150, Issue Suppl_1, Page A4145118-A4145118, November 12, 2024. Background:Obstructive Sleep Apnea (OSA) is the most common sleep related disorder and shares common pathophysiological mechanisms with Peripheral Arterial Disease (PAD). Studies exploring the influence of OSA on PAD have largely focused on subclinical markers of PAD such as ankle brachial indices and pulse wave velocities. We sought to investigate the association of OSA with Major Adverse Limb Events (MALE) in patients with PAD.Methods:National Inpatient Sample 2018-2020 was utilized for this analysis. MALE was the primary outcome, defined as a composite of Acute Limb Ischemia, Limb Revascularization (either percutaneous or surgical), limb amputation and All-Cause mortality. ICD-10 codes were utilized to identify the diagnoses of choice. Propensity score matching was performed between the 2 groups of OSA and no OSA using the caliper match method for the variables, Age, Gender, Stroke, Obesity, Hypertension, Anemia, Coagulopathy, ESRD, Diabetes, Chronic Pulmonary Disease, Congestive Heart Failure, Cardiac Arrythmias and Valvular Heart Disease. Weighted samples were utilized and p