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

Circulation, Volume 150, Issue Suppl_1, Page A4119891-A4119891, November 12, 2024. Background:Endothelin receptor antagonists (ERAs) demonstrated significant efficiency in delaying clinical deterioration and improving survival of patients with pulmonary arterial hypertension (PAH). However, the frequent occurrence of anemia after ERAs administration has gained clinical attention currently, whereas the etiology of anemia is unclear. The risk factors of ERAs associated anemia remained undefined. Therefore, we aim to investigate risk factors of developing anemia after ERAs treatment and whether iron supplement could correct anemia.Method:A retrospective cohort study was performed among patients with PAH who received ERAs between January, 2017 and December, 2019 in Fuwai hospital. The primary outcome was development of anemia after ERAs therapy and secondary outcome was correction of anemia after iron supplement.Results:A total of 120 patients with PAH were included in the study and 28 patients developed anemia during follow up.Distinctively, all the patients who developed anemia were female. After ERAs administration, iron metabolism (Ferritin 95.29±144.79 μg/L versus 69.9±118.25 μg/L,P

Circulation, Volume 150, Issue Suppl_1, Page A4134655-A4134655, November 12, 2024. Original research:Background:The objective is to evaluate the outcomes of percutaneous coronary intervention (PCI) in patients with alcoholic cirrhosis presenting with ST-segment elevation myocardial infarction (STEMI).Methods:We analyzed data from the National Inpatient Sample (NIS) for the years 2016-2020. Our cohort included patients admitted with STEMI and a secondary diagnosis of alcoholic cirrhosis, excluding those under 18 or those not receiving PCI. Propensity score matching using a kernel method was applied to adjust for 22 variables, including patient demographics, hospital characteristics, and comorbid conditions.Results:Among 119,799 patients, 98 had alcoholic cirrhosis. These patients exhibited higher mortality (18% vs. 5%) and longer hospital stays (5.4 days vs. 3.6 days). They also had increased risks of acute blood loss anemia (13% vs. 3.5%) and gastrointestinal bleeding (18% vs. 2%). Additionally, acute kidney injury was more prevalent in the cirrhosis group (25.5% vs. 14%). Although heart failure exacerbation and cardiac arrhythmias were more common, these were not statistically significant (Table 1).Conclusion:Our study indicates a significantly higher mortality rate among patients with alcoholic cirrhosis undergoing PCI for STEMI. These patients are also at increased risk of postoperative bleeding due to compromised liver function and hemostatic abnormalities, as reflected by higher incidences of acute blood loss anemia and gastrointestinal bleeding. Additionally, there is an elevated risk of acute kidney injury post-PCI, highlighting the need for renal-protective strategies. These findings stress the necessity for specialized care, vigilant monitoring, and tailored protocols to address the unique challenges faced by this population, aiming to reduce morbidity and mortality.

Circulation, Volume 150, Issue Suppl_1, Page A4139537-A4139537, November 12, 2024. Introduction:High output heart failure (HOHF) can be attributed to a wide array of diseases such as severe anemia, hyperthyroidism, arteriovenous fistulas, cirrhosis, chronic lung disease, and morbid obesity. Amongst the causes, obesity is the most common, accounting for 31% of those diagnosed with HOHF; however, there is limited data regarding this topic despite the increasing prevalence of obesity worldwide. We recount a unique case of HOHF in a young woman.Case Description:A 22-year-old woman with a history of class 3 obesity (body mass index 60.1 kg/m2) presented with shortness of breath for 3 weeks and new bilateral lower extremity edema. She was found to have newly reduced left ventricular function of 10-15% with severe dilation of the left ventricle and global hypokinesis. Her cardiac catheterization showed insignificant coronary artery disease. However, hemodynamics showed elevated filling pressures, a cardiac index of 4.6 L/min/m2 and output of 11.9 L/min, both measured by thermodilution; establishing a diagnosis of high output heart failure. The patient’s right ventricular biopsy returned and showed chronic cardiomyopathy, demonstrated by hypertrophied myocytes. Other etiologies of HOHF were ruled out with further workup, including arteriovenous shunting, thyroid disease, liver disease, and pulmonary pathologies. The etiology of her HOHF was ultimately attributed to severe obesity. After diuresis, the patient was discharged on guideline directed medical therapy, which included sacubitril-valsartan, metoprolol succinate, spironolactone, and empagliflozin. She was set to follow up with advanced heart failure and bariatric surgery.Conclusion:HOHF is due to unmet demands by the body, by increased oxygen consumption or by decrease systemic vascular resistance. The pathophysiology for HOHF due to obesity is not entirely understood, however there are several working hypotheses. The pathophysiology stems from obesity causing increased leptin, neprilysin, and decreased adiponectin; increased vasoactive adipokines increasing increased vasodilation; insulin resistance causing cardiac remodeling seen as impaired diastology with low ejection fractions. Treatment of HOHF due to morbid obesity is with bariatric surgery and lifestyle changes. However, given the role of active adipokines in this disease, future studies can aim to investigate intervening at this level to prevent severe consequences, as seen in our patient.

Circulation, Volume 150, Issue Suppl_1, Page A4145632-A4145632, November 12, 2024. Background:High circulating levels of galectin-3 are associated with all-cause and cardiovascular (CV) mortality in patients with coronary artery disease (CAD). However, the impact of anemia on the prediction of galectin-3 with cause-specific mortality in patients with suspected or known CAD is unknown.Methods:Serum levels of galectin-3 were measured in 2,418 patients with suspected or known CAD undergoing elective coronary angiography. The outcomes were all-cause death, CV death, and non-CV death. Patients were divided into 2 groups according to the presence (n=882) or absence (n=1,536) of anemia, and followed up over a 6-year period.Results:During the follow-up, 329 anemic and 207 non-anemic patients died of any cause, 116 anemic and 50 non-anemic patients died of CV diseases, and 187 anemic and 139 non-anemic patients died of non-CV diseases. After adjustment for potential clinical confounders and established CV biomarkers, log-transformed (Ln-) galectin-3 levels were significantly associated with all-cause death (hazard ratio [HR] for 1-SD increase, 1.23; 95% confidence interval [CI], 1.10–1.37) and non-CV death (HR, 1.30; 95% CI, 1.13–1.50), but not with CV death (HR, 1.16; 95% CI, 0.95–1.41) in the entire cohort; significantly associated with all-cause death (HR, 1.20; 95% CI, 1.03–1.41) and non-CV death (HR, 1.49; 95% CI, 1.20–1.85), but not with CV death (HR, 0.95; 95% CI, 0.72–1.24), in anemic patients; and significantly associated with all-cause death (HR, 1.33; 95% CI, 1.13–1.57) and CV death (HR, 1.19; 95% CI, 1.00–1.42), but not with non-CV death (HR, 1.17; 95% CI, 0.95–1.43), in non-anemic patients. We also evaluated the incremental predictive performance of galectin-3 by calculating continuous net reclassification improvement, and integrated discrimination improvement metrics. The addition of Ln-galectin-3 levels to the model with potential clinical confounders and established CV biomarkers further improved the prediction of all-cause death and non-CV death, but not that of CV death, in the entire cohort and in anemic patients, and the prediction of all-cause death and CV death, but not that of non-CV death, in non-anemic patients.Conclusions:In patients with suspected or known CAD, distinct differences were observed between anemic and non-anemic patients, in the prediction for cause-specific mortality by galectin-3 levels, which independently predicted non-CV mortality in anemic patients and CV mortality in non-anemic patients.

Stroke, Ahead of Print. In recent years, stroke incidence in older adults has declined strikingly, but stroke in younger women has become more common. Abnormalities of menstruation, the shedding of the uterine lining at the beginning of each menstrual cycle, may offer clues about stroke risk in young and midlife women. Endometrial and structural uterine abnormalities are associated with anemia and may be associated with hypercoagulability, possibly increasing stroke risk. Patient factors that influence both menstruation and stroke risk include coagulopathies, polycystic ovarian syndrome, endometriosis, migraine, and other systemic disorders, in addition to menopause. Environmental and iatrogenic factors that influence both menstruation and stroke risk include hormonal contraceptives, nicotine, xenoestrogens, phytoestrogens, oophorectomy, and hysterectomy. Importantly, secondary stroke prevention can affect menstruation. Our current review presents literature supporting the idea that abnormal menstruation may indicate elevated stroke risk in premenopausal women.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Volume 177, Issue 11, Page JC126, November 2024.

Osservatorio Nomisma, per 8 medicinali su 10 esiste l’equivalente

“Dovranno tamponare la carenza attuale”, ha detto il ministro Schillaci e torneranno utili per la Sanità territoriale

It’s probably 9 g/dL in patients with MI and anemia.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

The US Preventive Services Task Force (USPSTF) recently released a Recommendation Statement examining the data to support screening for iron deficiency anemia in pregnancy and finding them lacking. It also found insufficient evidence to make a clear recommendation for or against preventive iron supplementation in pregnancy, which has been a routine practice for decades, with up to 77% to 89% of patients reporting supplement use. As highlighted previously by the USPSTF and others, there is an urgent need for studies and clinical trials to support evidence-based medicine in the obstetric population, and this can only be accomplished by ceasing paternalistic approaches that have led to the exclusion of pregnant patients in research. All of this remains true, and there is still so very far to go.

This systematic review to support a 2024 US Preventive Services Task Force Recommendation Statement summarizes published evidence on the benefits and harms of iron supplementation, and screening for iron deficiency and iron deficiency anemia, during pregnancy.

This 2024 Recommendation Statement from the US Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening and routine supplementation for iron deficiency and iron deficiency anemia in pregnant persons to prevent adverse maternal and infant health outcomes (I statement).

This JAMA Patient Page discusses the pros and cons of screening for iron deficiency and iron deficiency anemia during pregnancy.