Prognostic implications of Anemia in patients with acute heart failure in emergency departments. ANEM-AHF Study.

INTRODUCTION: The presence of anaemia leads to a worse prognosis in patients with heart failure (HF). There are few data on the impact of anaemia on mortality in patients with acute heart failure (AHF), and the studies available are mainly retrospective, and include hospitalised patients. OBJECTIVE: Evaluate the role of anaemia on 30-day and 1-year mortality in patients with AHF attended in hospital emergency departments (HEDs). METHODS: We performed a multicentre, observational study of prospective cohorts of patients with AHF. The study variables were: Anaemia (haemoglobin < 12g/dL in women and <13g/dL in men), mortality at 30 days and at 1 year, risk factors, comorbidity, functional impairment, basal functional grade for dyspnoea, chronic and acute treatment, clinical and analytical data of the episode, and patient destination. STATISTICAL ANALYSIS: Bivariate analysis and survival analyses using Cox regression. RESULTS: A total of 13 454 patients were included, 7662 (56.9%) of whom had anaemia. Those with anaemia were older, had more comorbidity, a worse functional status and New York Heart Association class, greater renal function impairment, and more hyponatraemia. The mortality was higher in patients with anaemia at 30 days and 1 year: 7.5% vs 10.7% (P < .001) and 21.2% vs 31.4% (P < .001), respectively. The crude and adjusted hazard ratios of anaemia for 30-day mortality were: 1.46 (confidence interval [CI] 95% 1.30-1.64); P < .001 and 1.20 (CI 95% 1.05-1.38); P = .009, respectively, and 1.57 (CI 95% 1.47-1.68) and 1.30 (CI 95% 1.20-1.40) for mortality at 1 year. The weight of anaemia on mortality was different in each follow-up period. CONCLUSIONS: Anaemia is an independent predictor of mortality at 30 days and 1 year in patients with AHF attended in HEDs. It is important to study the aetiology of AHF since adequate treatment would reduce mortality.

Pediocin production by Pediococcus acidilactici in solid state culture on a waste medium: process simulation and experimental results.

The production of pediocin by Pediococcus acidilactici was comparatively studied in submerged and solid-state culture, using polyurethane foam particles soaked in commercial (MRS) and waste media with various supplements, where product concentrations were 15 times higher in MRS medium. For the solid state analysis, cultures were treated by successive compression and refilling of tubular minireactors equipped with a piston, without the need for reinoculation. This method was found to be simple, reproducible, and easily controllable, allowing culture productivity to be maintained for long periods of time without alterations in the basic properties of the system. In addition, yields were found to be superior compared to those from submerged culture. The system kinetics were modeled on the basis of widely accepted assumptions with a good fit to the experimental results and observed biomass fluctuations less evident than those predicted by the kinetic model.

[Turner's syndrome: growth, endocrinological study and other aspects]. / El síndrome de Turner: Crecimiento, estudios hormonales y otros aspectos.

OBJECTIVE: This was work was designed to analyze, in a group of patients with Turner's syndrome treated at our hospital, the following issues: 1. To follow the evolution of several common values of body growth from birth to adult life, as well as the influence of growth hormone therapy. 2. To determine the changes in gonadotrophins and alterations of the thyroid gland. 3. To define the relationship between the karyotype and the development of menarche. MATERIALS AND METHODS: Neonatal growth values were obtained from 32 patients. Body size before and after the treatment with growth hormone was determined in 20 cases. We determined the values of TSH/T41 and FSH/LH in 35 and 34 cases, respectively. In 34 patients older than 15 years and not treated with estrogens, we evaluated the relationship between the karyotype and the presence of menarche/amenorrhea. RESULTS: Mean values of body length, weight and cranial perimeter were 477 mm, 2,877 g and 335 mm, respectively. These values were below those of the normal population, especially for those patients with a 45.X karyotype. The mean height for adult patients was 141.6 cm (range 133.3- 152 cm). After 2 years of treatment with growth hormone the growth velocity changed from -0.25 to +3.55 SD. We did not find pathological values for TSH or T4 (3.3 mU/l and 1.85 ng%, respectively). The LH and FSH values were higher in 64% and 88% of the patients, respectively. These differences were higher in patients older than 13 years, which showed values of 20 and 60 U/l. Twenty-three percent of the patients had the menarche and none were 45.X. CONCLUSION: The early detection of Turner's syndrome permits the physician to follow these patients, improving their growth and their endocrinological control.