Beneficios del uso del hierro parenteral como alternativa eficaz en el manejo de la anemia gestacional en Colombia / Benefits of the Use of Parenteral Iron as an Efficient Alternative in the Management of Gestational Anemia in Colombia / Benefícios do uso de ferro parenteral como alternativa eficaz no manejo da anemia gestacional na Colômbia

Introducción. La Organización Mundial de la Salud (OMS) estima que más del 40% de las mujeres embarazadas a nivel mundial tienen anemia, y la mitad de estas padecen deficiencia de hierro. La prevalencia en América Latina es del 40% y en Colombia del 44.7%. Fisiológicamente en el embarazo se produce una mal llamada "anemia dilucional", existen condiciones en la embarazada que la predisponen a tener una anemia patológica. Esta última es causada principalmente por un déficit de hierro, de allí la importancia de diagnosticar a tiempo esta entidad e iniciar el manejo. La administración de hierro es la base del tratamiento de la anemia por deficiencia de hierro. Puede ser administrado por vía oral, la cual es la preferida en la mayoría de las pacientes; sin embargo, cuando este no es posible administrarlo, es esencial recurrir al hierro parenteral. No obstante, el hierro parenteral es poco usado como primera línea en el manejo de la anemia gestacional. El presente artículo tiene como objetivo realizar una revisión que permita identificar la terapia con hierro parenteral como una alternativa eficaz de manejo para la anemia gestacional, teniendo en cuenta las características farmacológicas, la administración y el uso entre las diferentes moléculas disponibles en Colombia. Metodología. Corresponde a un estudio de revisión de literatura en bases de datos y bibliotecas electrónicas, los criterios que se tuvieron en cuenta fueron textos publicados entre 1996 y 2020, en español e inglés. Se obtuvo un resultado de 95 artículos, de los cuales se seleccionaron 49. Las palabras clave para su búsqueda fueron fisiología, hierro parenteral, anemia gestacional, déficit de hierro, complicaciones del embarazo, compuestos de hierro, farmacocinética, diagnóstico y tratamiento. División de temas tratados. Fisiología; ayudas diagnósticas; características farmacológicas del hierro parenteral; ventajas, indicaciones y contraindicaciones del hierro parenteral; efectos secundarios y forma de aplicación. Conclusiones. El hierro parenteral es un tratamiento seguro y eficaz para manejar la anemia en el embarazo, se debe tener en cuenta las indicaciones y la farmacología de las moléculas para elegir la más adecuada. Además, repone más rápidamente las reservas de hierro y los niveles de hemoglobina.

Introduction. The World Health Organization (WHO) estimates that more than 40% of pregnant women worldwide have anemia, and that half of them suffer from iron deficiency. The prevalence of this in Latin America is 40%, and in Colombia, 44.7%. Physiologically, a problem called "dilutional anemia" occurs during pregnancy. There are conditions in pregnant women that predispose them to suffering from pathological anemia. The latter is mainly caused by iron deficiency, hence the importance of diagnosing this entity on time and starting treatment. Iron administration is the basis of treatment of anemia caused by iron deficiency. It can be administered orally, which is the preferred option in the majority of patients. However, when this is not possible, parenteral iron must be used. However, parenteral iron is rarely used as the first line of treatment of gestational anemia. The objective of this article is to carry out a review that allows for the identification of therapy with parenteral iron as an efficient alternative for the treatment for gestational anemia, considering the pharmacological characteristics, administration, and use among the different molecules available in Colombia. Methodology. We carried out a search in databases and electronic libraries. The criteria considered were texts published between 1996 and 2020 in Spanish and English. 95 articles were obtained, of which 49 were selected. The keywords for their search were physiology, parenteral iron, gestational anemia, iron deficit, pregnancy complications, iron compounds, pharmacokinetics, diagnosis, and treatment. Division of Covered Topics. Physiology; diagnostic aids; pharmacological characteristics of parenteral iron; advantages, indications, and contraindications of parenteral iron; secondary effects and application method. Conclusions. Parenteral iron is a safe and efficient treatment to handle anemia during pregnancy. The indications and pharmacology of the molecules must be considered to choose the most appropriate option. In addition, it replaces iron reserves and hemoglobin levels more quickly.

Introdução. A Organização Mundial de Saúde (OMS) estima que mais de 40% das mulheres grávidas em todo o mundo são anêmicas, e metade delas sofre de deficiência de ferro. A prevalência na América Latina é de 40% e na Colômbia de 44.7%. Fisiologicamente na gravidez ocorre a chamada "anemia dilucional", e existem condições na gestante que a predispõem a ter uma anemia patológica. Esta última é causada principalmente por deficiência de ferro, daí a importância de diagnosticar esta entidade a tempo e iniciar o manejo. A administração de ferro é a base do tratamento da anemia por deficiência de ferro. Pode ser administrado por via oral, o que é preferido pela maioria das pacientes; porém, quando não for possível administrá-lo dessa forma, é imprescindível recorrer ao ferro parenteral. No entanto, o ferro parenteral é raramente usado como primeira linha no manejo da anemia gestacional. O objetivo deste artigo é realizar uma revisão que permita identificar a terapia com ferro parenteral como uma alternativa eficaz de tratamento da anemia gestacional, levando em consideração as características farmacológicas, administração e uso entre as diferentes moléculas disponíveis na Colômbia. Metodologia. Foi realizada uma busca em bases de dados e bibliotecas eletrônicas, os critérios levados em consideração foram textos publicados entre 1996 e 2020, em espanhol e inglês. Foi obtido um total de 95 artigos, dos quais 49 foram selecionados. As palavras-chave para a busca foram fisiologia, ferro parenteral, anemia gestacional, deficiência de ferro, complicações na gravidez, compostos de ferro, farmacocinética, diagnóstico e tratamento. Divisão dos temas abordados. Fisiologia; auxiliares de diagnóstico; características farmacológicas do ferro parenteral; vantagens, indicações e contraindicações do ferro parenteral; efeitos colaterais e método de aplicação. Conclusões. O ferro parenteral é um tratamento seguro e eficaz para o manejo da anemia na gravidez, as indicações e farmacologia das moléculas devem ser levadas em consideração a fim de escolher a mais adequada. Além disso, reabastece mais rapidamente as reservas de ferro e os níveis de hemoglobina.

Role of preoperative erythropoietin in the optimization of preoperative anemia among surgical patients — A systematic review and meta-analysis

Abstract Preoperative anemia is a common finding. Preoperative allogeneic transfusion, iron therapy, vitamin supplementation and erythropoietin therapy are the current management strategies for preoperative anemia. Previous reviews regarding erythropoietin were limited to specialties, provided little evidence regarding the benefits and risks of erythropoietin in managing preoperative anemia and included non-anemic patients. The purpose of our systematic review was to determine the role of erythropoietin solely in preoperatively anemic patients and to investigate the complications of this treatment modality to produce a guideline for preoperative management of anemic patients for all surgical specialties. The PubMed/Medline, Google Scholar, and Cochrane Library were searched for randomized trials evaluating the efficacy of erythropoietin in preoperative anemia. The risk ratio (RR) and standardized mean difference (SMD) was used to pool the estimates of categorical and continuous outcomes, respectively. Allogeneic transfusion and complications and the 90-day mortality were the primary outcomes, while the postoperative change in hemoglobin, bleeding in milliliters and the number of red blood cell (RBC) packs transfused were the secondary outcomes. Results: Eight studies were included, comprising 734 and 716 patients in the erythropoietin group and non-erythropoietin group, respectively. The pooled estimate by RR for allogeneic transfusion was 0.829 (p = 0.049), while complications and the 90-day mortality were among the 1,318 (p = 0.18) patients. Conclusion: Preoperative erythropoietin provides better outcomes, considering the optimization of preoperative anemia for elective surgical procedures. The benefits of erythropoietin are significantly higher, compared to the control group, while the risks remain equivocal in both groups. We recommend preoperative erythropoietin in anemic patients.

Unveiling neotropical serpentine flora: a list of Brazilian tree species in an iron saturated environment in Bom Sucesso, Minas Gerais

Serpentine soils are those holding at least of 70% iron-magnesium compounds, which make life intolerable for many species. Although plant's adaptation to environmental toughness is widely studied in tropics, virtually nothing is known about Brazilian serpentine flora. Our aim was to bring up and characterize the serpentine flora in Bom Sucesso, Minas Gerais state, Brazil. We performed expeditions utilizing rapid survey sampling method to identify the arboreal compound in the area. Plants within circumference at breast high (CBH) up to 15,7 cm were included in our study. A specialist identified all the individuals to species level. We found 246 species located in 59 botanical families. Fabaceae, Myrtaceae and Melastomataceae were the most representative families in the area. Serpentine areas usually present a few species capable to survive to adverse conditions, contrasting the high number found in our study. To our knowledge, this is the first floristic survey in serpentine areas in the neotropics, reinforcing the need for more studies about plant diversity in those areas. It seems that serpentinites is not the key factor influencing plant diversity in the neotropics. The high diversity found in our study strengthens serpentine areas as a place for conservation concern.

The uptake of different iron salts by the yeast Saccharomyces cerevisiae

Yeasts can be enriched with microelements, including iron; however, special physicochemical conditions are required to formulate a culture media that promotes both yeast growth and iron uptake. Different iron sources do not affect biomass formation; however, considering efficacy, cost, stability, and compatibility with Saccharomyces cerevisiae metabolism, ferrous sulphate is recommended.

Anemia, insuficiência cardíaca e manejo clínico baseado em evidências / Anemia, heart failure and evidence-based clinical management

A anemia é uma comorbidade prevalente e marcadora de pior prognóstico em pacientes com insuficiência cardíaca (IC). Sua relevância clínica, bem como a fisiopatologia e abordagem terapêutica nesses pacientes são temas de destaque na literatura especializada. Nessa revisão são descritos os conceitos atuais sobre a fisiopatologia da anemia na IC, os critérios diagnósticos e as indicações da suplementação de ferro, ao mesmo tempo em que são analisados criticamente os principais estudos que ofereceram evidências sobre os benefícios dessa suplementação. São abordados os quatro componentes principais da anemia: doença crônica, dilucional, "renal" e disabsortiva. Nos pacientes com IC, os critérios para o diagnóstico são os mesmos utilizados na população geral: níveis de ferritina sérica inferiores a 30 mcg/L em pacientes não nefropatas e menores que 100 mcg/L ou ferritina sérica entre 100-299 mcg/L com saturação de transferrina menor que 20% em pacientes com doença renal crônica. Finalmente, são discutidas as possibilidades terapêuticas da anemia nessa população específica de pacientes.

Anemia is a prevalent comorbidity and marker of a poorer prognosis in patients with heart failure (HF). Its clinical relevance, as well as its pathophysiology and the clinical management of these patients are important subjects in the specialized literature. In the present review, we describe the current concepts on the pathophysiology of anemia in HF, its diagnostic criteria, and the recommendations for iron supplementation. Also, we make a critical analysis of the major studies showing evidences on the benefits of this supplementation. The four main components of anemia are addressed: chronic disease, dilutional, "renal" and malabsorption. In patients with HF, the diagnostic criteria are the same as those used in the general population: serum ferritin levels lower than 30 mcg/L in patients without kidney diseases and lower than 100 mcg/L or serum ferritin levels between 100-299 mcg/L with transferring saturation lower than 20% in patients with chronic kidney diseases. Finally, the therapeutic possibilities for anemia in this specific patient population are discussed.

Evaluation and biochemical characterization of a distinctive pyoverdin from a pseudomonas isolated from chickpea rhizosphere

Microbial siderophores confiscate the available ferric ions around the roots and trigger a reaction resulting in plant growth promotion. In our study, a high level of siderophore production was observed from a newly isolated Pseudomonas sp. from the rhizosphere of Chickpea plants. Under an iron depleted condition in Standard Succinic acid medium a 1000 µgmL-1 of siderophore production was achieved. Increasing the concentration of iron showed an inverse relationship between growth and siderophore production. Fourier Transform Infrared Spectroscopy (FTIR) analysis of the purified crystals, its UV spectral analysis and High Pressure Liquid Chromatography (HPLC) revealed the identity of the siderophore as similar to that of pyoverdin with distinctive characters. Electron spray ionization mass spectroscopy (ESIMS) shows presence of abundance of A1 ions (419 m/z) and branching of amino acids from B1-B5. This pyoverdin contains a cyclic tetra peptide but Serine and Arginine are missing. Based on our analysis and deviations from the reported structure of pyoverdin it is suggested that this pseudomonas produces distinctly characterized pyoverdin siderophore.

Tratamiento de la anemia con eritropoietina y hierro en enfermedad renal crónica / Erythropoietin and iron in anemia management in chronic renal failure

Anemia is one of the most common manifestations of Chronic Renal Failure (CRF), specially during the dialysis period. Growth failure and a high cardiovascular morbimortality are 2 of the most important consequences. Objective: To present a review of the current concepts in diagnosis and management of anemia in pediatric CRF patients. Erythropoietin (EPO) deficit is the main cause of anemia, requiring exogenous replacement through intravenous or subcutaneous route, in hemodialyzed or peritoneodialyzed patients respectively. A longer half-life allows to use EPO one or twice weekly when given by intraperitoneal route, in order to reach a target hemoglobin between 11-12 gr/dl, a level that avoids the cardiovascular risk associated to higher levels as described in adult CRF population. In pediatrics, 100-300 U/kg/weekly can be used to reach the desired hemoglobin levels, always monitoring about the potential complications of EPO, specially arterial hypertension. If anemia seems to be resistent to EPO therapy, iron deficit should be considered and properly treated, as described in this article. Ferritin and saturation of hemoglobin need to be routinely monitored to diagnose iron status in these patients, values less than 100 ng/ml and 20 percent respectively require exogenous suplementation. Iron doses in pediatrics still need to be defined. Anemia needs to be evaluated and treated in all CRF children, properly management must always be instaured in order to prevent its undesired effects.

La anemia es una de las complicaciones más frecuentes en los pacientes pediátricos con Enfermedad Renal Crónica (ERCR), especialmente en etapa de diálisis. Sus consecuencias van desde un aumento de la morbilidad cardiovascular, hasta retraso del crecimiento en algunas experiencias analizadas. Se presenta una revisión de las recomendaciones actuales del diagnóstico, evaluación y tratamiento de la anemia en ERCR. Su principal causa es el déficit de la hormona Eritropoietina, la cual debe ser administrada en forma exógena para lograr una respuesta óptima. En los pacientes en hemodiálisis (HD) se prefiere la vía intravenosa, una dosis en cada sesión de HD, dado su mejor tolerancia, aunque esta vía requiere dosis mayores, su vida media es más corta, y representa costos más elevados. En niños en diálisis peritoneal (DP) la vía de elección es subcutánea, de mayor duración que la vía i.v., y puede ser administrada 1-2 veces por semana. En pediatría, dosis de mantención entre 100 - 300 U/kg/semana han demostrado ser eficaces para lograr una hemoglobina entre 11 y 12 gr/dl, nivel considerado seguro desde el punto de vista cardiovascular, requiriendo sin embargo, una estricta supervisión médica dado las potenciales complicaciones, entre las que destaca la hipertensión arterial de difícil manejo y que requiere disminución o suspensión de la terapia. Entre las causas más frecuentes e importantes de una respuesta terapéutica insuficiente está el déficit en los depósitos de fierro del organismo. Estos depósitos se consideran adecuados al presentar el paciente una ferritina >100 ng/ml y una saturación de hemoglobina >20 por ciento. Bajo estos valores se hace necesario el aporte exógeno para lograr una ferritina ideal entre 200 y 500 ng/ml, aporte cuya dosificación en el caso de niños en diálisis está aún por definirse. Se recomienda que el control de exámenes para evaluar anemia y la respuesta al tratamiento se realice, al menos, de forma trimestral.

The effect of change in pH on the solubility of iron bis-glycinate chelate and other iron compounds

The effect of a pH change from 2 to 6 was tested on the solubility of ferrous sulfate, ferrous fumarate, iron bis-glycine chelate (Ferrochel) and sodium-iron ethylenediaminetetraacetic acid (NaFeEDTA). It was found that at pH 2 ferrous sulfate, Ferrochel and NaFeEDTA were completely soluble and only 75 of iron from ferrous fumarate was soluble. When pH was raised to 6, iron from amino acid chelate and NaFeEDTA remained completely soluble while solubility from ferrous sulfate and ferrous fumarate decreased 64 and 74, respectively compared to the amount of iron initially soluble at pH 2. These results suggest that iron solubility from iron bis-glycine chelate and NaFeEDTA is not affected by pH changes within the ranges tested, probably because iron remained associated to the respective compounds.

Efeito protetor de carotenoídes em lipoperoxidação, danos oxidativos em DNA e lesões histológicas induzidas por ferro / Protective effect of carotenoids in lipid peroxidation, oxidative damage to DNA and histologicals changes induced by iron

Evidências experimentais e epidemiológicas sugerem que o licopeno e o "BETA"-caroteno, presentes em tomates, produtos de tomates, muitas frutas e vegetais, podem prevenir certos tipos de câncer em seres humanos. Entretanto, para estabelecer firmemente as relações do licopeno com a prevenção de doenças, maiores informações sobre os possíveis mecanismos bioquímicos associados a esses processos são necessárias. Com este intuito, investigamos o efeito do licopeno em células de mamífero e em ratos submetidos a excesso de ferro, sistema conhecido por promover o estresse oxidativo gerando lesões em biomoléculas. Inicialmente investigamos o efeito protetor do licopeno em lipoperoxidação e danos oxidativos em DNA...

Uptake of iron from different compounds by enteroinvasive Escherichia coli

This work aimed the study of acquisition of iron from different compounds by EIEC strains. Seven serotypes were studied (028ac.H-, 029:H, 0136:H-, 0144:H-, 0152:H-, 0164:H- and 0167:H7-), in a total 0f 31 strains. All serotypes were able to use distinct iron sources: hemin, hematin, hemoglobin, ovotransferin, lactoferrin, transferrin and ferritin.

Determinación de hierro sérico, transferrina, capacidad latente de fijación de hierro y por ciento de saturación de la transferrina en vegetarianos / Seric iron determination, transferrin, latent capacity of iron fijaction and transferrin saturation in vegetarians

Se determina hierro sérico, capacidad total de fijación de hierro, capacidad latente de fijación de hierro y por ciento de saturación de la transferrina en 30 vegetarianos y en 18 no vegetarianos hombres y mujeres adultos. No se han encontrado diferencias estadísticamente significativas para los exámenes realizadas en vegetarianos. Sin embargo el reducido número de muestras realizadas no permite dar una conclusión definitiva.