Inhibition and working memory capacity modulate the mental space-time association.

This research aimed to investigate whether the mental space-time association of temporal concepts could be modulated by the availability of cognitive resources (in terms of working memory and inhibitory control capacities) and to explore whether access to this association could be an automatic process. To achieve this, two experiments were carried out. In Experiment 1, participants had to classify words with future and past meanings. The working memory load (high vs. low) was manipulated and the participants were grouped into quartiles according to their visuospatial working memory capacity (WMC). Temporal concepts were displayed subliminally (immediate masking) and supraliminally (delayed masking). The ANOVA showed a performance pattern consistent with the left-past right-future conceptual scheme, regardless of both the type of masking and the working memory load, except in high WMC participants, in which, interestingly, the space-time association effect was absent. In Experiment 2, participants were asked to respond to the colour of the font of the temporal words, and their attentional control capacity was assessed. The results indicated a timeline effect that was irrespective of the WM load and the type of perceptual processing, but not of the WM capacity or the inhibitory abilities. These findings partially endorse the automatic and implicit access to the mental space-time association and suggest the involvement of the availability of cognitive resources. Individual WMC differences appear to modulate the automatic nature of the effect rather than the processing conditions themselves.

Role of Telomere Length in Survival of Patients with Idiopathic Pulmonary Fibrosis and Other Interstitial Lung Diseases.

Interstitial lung diseases (ILDs) constitute a group of more than 200 disorders, with idiopathic pulmonary fibrosis (IPF) being one of the most frequent. Telomere length (TL) shortening causes loss of function of the lung parenchyma. However, little is known about its role as a prognostic factor in ILD patients. With the aim of investigating the role of TL and telomerase activity in the prognosis of patients affected by ILDs, we analysed lung tissue samples from 61 patients. We measured relative TL and telomerase activity by conventional procedures. Both clinical and molecular parameters were associated with overall survival by the Kaplan-Meier method. Patients with IPF had poorer prognosis than patients with other ILDs (p = 0.034). When patients were classified according to TL, those with shortened telomeres reported lower overall survival (p = 0.085); differences reached statistical significance after excluding ILD patients who developed cancer (p = 0.021). In a Cox regression analysis, TL behaved as a risk-modifying variable for death associated with rheumatic disease (RD) co-occurrence (p = 0.029). Also, in patients without cancer, ferritin was significantly increased in cases with RD and IPF co-occurrence (p = 0.032). In relation to telomerase activity, no significant differences were detected. In conclusion, TL in lung tissue emerges as a prognostic factor in ILD patients. Specifically, in cases with RD and IPF co-occurrence, TL can be considered as a risk-modifying variable for death.

Amniotic Membrane Transplantation in the Management of Corneal Ulceration Following Infectious Keratitis.

PURPOSE: To report on the outcomes of amniotic membrane transplantation (AMT) for corneal ulceration following infectious keratitis. METHOD: In this retrospective cohort study of 654 patients with culture-proven infectious keratitis from 8 hospitals in Galicia (Spain), a total of 43 eyes of 43 patients (6.6%) underwent AMT for postinfectious corneal ulceration. The indications for AMT were sterile persistent epithelial defects, severe corneal thinning or perforation. RESULTS: AMT was successful in 62.8% of cases, with 37.2% requiring an additional surgery. Median time to healing was 40.0 days (IQR 24.2-101.7 days) and final BCVA was lower than baseline (p = 0.001). Ulcers were large (>3 mm) in 55.8% of cases. Previous herpetic keratitis and topical steroid use were more common in patients who received AMT (p < 0.001). 49 microorganisms (43 bacteria and 6 fungi) were isolated. CONCLUSIONS: AMT is a therapeutic option for complications following infectious keratitis, which present with a sterile persistent epithelial defect, significant corneal thinning or perforation.

Cognitive inhibition abilities explain inter-individual variability in gender-space associations.

There is a great deal of research describing the close association that exists between numerical and spatial representations, illustrating the SNARC (Spatial-Numerical Association of Response Code) effect. This effect signals the spatial mental representation of small numbers to the left and larger numbers to the right, coinciding with the direction of reading and writing. Subsequent research has found a similar spatial representation for other stimuli (e.g., size of objects and animals, and words associated with time). Some of these spatially represented stimuli are social in nature, even suggesting a spatial mental organization of stimuli based on gender (e.g., the upper part of a vertical axis for males and the lower part for females). The aim of the present study was threefold (1) to replicate and extend results on the existence of a mental gender line (as a function of response hand: female-left hand and male-right hand) when responding simply to gender of stimuli; (2) to explore the influence of inhibitory control; and, (3) to determine whether gender-space associations depend on the explicit or implicit nature of a gender task. Three experiments were designed to pursue these objectives. In Experiment 1, female, male and neutral faces and names were displayed, and the participants were asked to identify their gender. Experiment 2, which also included a Stroop task, followed the same procedure as Experiment 1, but displayed objects that could be designated as female or male and others not related to any gender. Finally, in Experiment 3, in which participants were asked to respond to the direction of an arrow, object gender was not relevant to the task. Consistent with previous research and confirming our hypotheses, the results showed a spatial mental representation of the stimuli based on gender in all three experiments, regardless of whether the stimulus was consciously perceived. Moreover, inhibitory ability showed a relationship with the gender-space line effect. The contributions and implications of this study are discussed, as are possible limitations and future lines of research.

Obesity and metabolic syndrome induce hyperfiltration, glomerulomegaly, and albuminuria in obese ovariectomized female mice and obese male mice.

OBJECTIVE: Obese patients with metabolic syndrome have a high risk of chronic kidney disease. The prevalence of obesity, metabolic syndrome, and insulin resistance increase in women after menopause, as does the risk of chronic kidney disease. This may indicate an interaction between obesity, metabolic syndrome, and menopause in the induction of renal damage. However, the pathogenesis of kidney disease in postmenopausal obese women is poorly understood. METHODS: We investigated the interaction of an obesogenic diet and menopause on renal dysfunction in ovariectomized and non-ovariectomized lean (n = 8 and 17) and obese (n = 12 and 20) female mice. Obese (n = 12) and lean (n = 10) male mice were also studied. Glucose metabolism, insulin resistance, and kidney function were evaluated with gold standards procedures. Changes in kidney histology and lipid deposition were analyzed. Females had a lower number of glomeruli than males at baseline. RESULTS: Only female ovariectomized obese animals developed insulin resistance, hyperglycemia, and kidney damage, evidenced as glomerulomegaly, glomerular hyperfiltration, and increased urinary albumin excretion, despite a similar increase in weight than obese non-ovariectomized female mice. Male obese mice developed hyperglycemia, insulin resistance, and hyperfiltration without major renal histological changes. Males on high fat diet showed higher renal lipid content and females on high fat diet (ovariectomized or non-ovariectomized) showed higher total cholesterol content than males. CONCLUSIONS: In mice, there is a clear interplay between obesity, metabolic syndrome, and menopause in the induction of kidney damage.

Video Summary : http://links.lww.com/MENO/A803 .

Development of Calibration Models to Predict Mean Fibre Diameter in Llama (Lama glama) Fleeces with Near Infrared Spectroscopy.

Llama fibre has the potential to become the most valuable textile resource in the Puna region of Argentina. In this study near infrared reflectance spectroscopy was evaluated to predict the mean fibre diameter in llama fleeces. Analyses between sets of carded and non-carded samples in combination with spectral preprocessing techniques were carried out and a total of 169 spectral signatures of llama samples in Vis and NIR ranges (400-2500 nm) were obtained. Spectral preprocessing consisted in wavelength selection (Vis-NIR, NIR and discrete ranges) and multiplicative and derivative pretreatments; spectra without pretreatments were also included, while modified partial least squares (M-PLS) regression was used to develop prediction models. Predictability was evaluated through R2: standard cross validation error (SECV), external validation error (SEV) and residual predictive value (RPD). A total of 54 calibration models were developed in which the best model (R2 = 0.67; SECV = 1.965; SEV = 2.235 and RPD = 1.91) was obtained in the Vis-NIR range applying the first derivative pretreatment. ANOVA analysis showed differences between carded and non-carded sets and the models obtained could be used in screening programs and contribute to valorisation of llama fibre and sustainable development of textile industry in the Puna territory of Catamarca. The data presented in this paper are a contribution to enhance the scarce information on this subject.

Indicadores de calidad asistencial en patología respiratoria en la Comunidad de Madrid / Respiratory Care Quality Indicators in the Community of Madrid

No disponible

The implementation of expectancy-based strategic processes is delayed in normal aging.

The present research examined if the time needed to implement expectancy-based strategic processes is different in younger and healthy older adults. In four experiments participants from both age groups performed different strategic priming tasks. These included a greater proportion of incongruent (or unrelated; 80%) than of congruent (or related; 20%) trials. With this procedure performance is worse for congruent (less frequent) than for incongruent (more frequent) trials, thus demonstrating that the relative frequency information can be used to predict the upcoming target. To explore the time course of these expectancy-based effects, the prime-target SOA was manipulated across experiments through a range of intervals: 400, 1000 and 2000 ms. Participants also performed a change localization and an antisaccade task to assess their working memory and attention control capacities. The results showed that increases in age were associated with (a) a slower processing-speed, (b) a decline in WM capacity, and (c) a decreased capacity for attentional control. The latter was evidenced by a disproportionate deterioration of performance in the antisaccade trials compared to the prosaccade ones in the older group. Results from the priming tasks showed a delay in the implementation of expectancies in older adults. Whereas younger participants showed strategic effects already at 1000 ms, older participants consistently failed to show expectancy-based priming during the same interval. Importantly, these effects appeared later at 2000 ms, being similar in magnitude to those by the younger participants and unaffected by task practice. The present findings demonstrate that the ability to implement expectancy-based strategies is slowed down in normal aging.

The Influence of Working Memory Load on Expectancy-Based Strategic Processes in the Stroop-Priming Task.

The present study investigated whether a differential availability of cognitive control resources as a result of varying working memory (WM) load could affect the capacity for expectancy-based strategic actions. Participants performed a Stroop-priming task in which a prime word (GREEN or RED) was followed by a colored target (red vs. green) that participants had to identify. The prime was incongruent or congruent with the target color on 80 and 20% of the trials, respectively, and participants were informed about the differential proportion of congruent vs. incongruent trials. This task was interleaved with a WM task, such that the prime word was preceded by a sequence of either a same digit repeated five times (low load) or five different random digits (high load), which should be retained by participants. After two, three, or four Stroop trials, they had to decide whether or not a probe digit was a part of the memory set. The key finding was a significant interaction between prime-target congruency and WM load: Whereas a strategy-dependent (reversed Stroop) effect was found under low WM load, a standard Stroop interference effect was observed under high WM load. These findings demonstrate that the availability of WM is crucial for implementing expectancy-based strategic actions.

Individual Differences in Working Memory Capacity Modulates Semantic Negative Priming from Single Prime Words.

The present study investigated whether semantic negative priming from single prime words depends on the availability of cognitive control resources. Participants with high vs. low working memory capacity (as assessed by their performance in complex span and attentional control tasks) were instructed to either attend to or ignore a briefly presented single prime word that was followed by either a semantically related or unrelated target word on which participants made a lexical decision. Individual differences in working memory capacity (WMC) mainly affected the processing of the ignored primes, but not the processing of the attended primes: While the latter produced reliable positive semantic priming for both high- and low-WMC participants, the former gave rise to reliable semantic negative priming only for high WMC participants, with low WMC participants showing the opposite positive priming effect. The present results extend previous findings in demonstrating that (a) single negative priming can reliably generalize to semantic associates of the prime words, and (b) a differential availability of cognitive control resources can reliably modulate the negative priming effect at a semantic level of representation.

IgG4-related disease: description of a case with pulmonary lesions, mediastinal lymphadenopathies and rapidly progressive renal failure.

This is a case report of a 73-year-old man with new-onset acute renal failure while being investigated for pulmonary infiltrates and mediastinal lymphadenopathies. Urine tests showed tubular range proteinuria with no microhaematuria. Immunology tests showed elevated serum IgG and hypocomplementaemia (classical pathway activation). Renal biopsy and clinical-pathological correlation were crucial in this case, reinforcing their important role in the final diagnosis of acute kidney injury.

Enfermedad relacionada con IgG4: descripción de un caso con lesiones pulmonares, adenopatías mediastínicas e insuficiencia renal rápidamente progressiva / IgG4-related disease: description of a case with pulmonary lesions, mediastinal lymphadenopathies and rapidly progressive renal failure

El caso presentado es el de un paciente varón de 73 años que debuta con un fracaso renal agudo en el contexto de infiltrados pulmonares y adenopatías mediastínicas a estudio. En el análisis de orina destacó proteinuria de rango tubular, sin microhematuria. En el estudio inmunológico se observó únicamente una elevación de los valores normales de IgG, junto con una activación de la vía clásica del complemento. La biopsia renal y la correcta correlación clínico-patológica fueron definitivas en este caso, mostrando una vez más ser una herramienta fundamental en el diagnóstico del fracaso renal agudo de etiología no clara (AU)

A seventy-three year olded man was admitted because of acute kidney failure in the context of pulmonary infiltrates and mediastinic lympadenopathy under study. Urine test showed tubular range proteinuria with no microhematuria. Immunological testing showed an elevated IgG concentration and hypocomplementemia (classical pathway activation). Renal biopsy and clinical-pathologic correlation were crucial in this case, showing once again their important role in the final diagnosis of acute kidney injury (AU)

Temperament and negative semantic priming in children 7 to 12 years old.

The present research assessed whether children with high and low scores on temperament traits differed in their ability to inhibit irrelevant task information in a lexical decision task. Children from 7 to 12 years old were classified based on temperament dimensions measured using a version of the Temperament in Middle Childhood Questionnaire. The participants were instructed to either attend to (and remember) or to ignore a masked prime word followed by a central probe target on which they made a lexical decision. The results revealed several notable outcomes. First of all, recognition memory was better for attended than ignored words, providing further evidence that attention instructions influenced the processing of the primes. Secondly, although no negative priming effect was obtained in the "ignore" condition, 43% of children showed this effect. Thirdly, children scoring high on Inhibitory Control and Impulsivity showed ignored negative priming, whereas children scoring high on Inhibitory Control and low on Impulsivity ignored facilitation. Data are discussed within the framework of negative priming as a complex phenomenon that involves the interaction of different factors such as age, type of task, and certain temperament traits.

High and low schizotypal female subjects do not differ in spatial memory abilities in a virtual reality task.

INTRODUCTION: Schizotypy is a psychological construct related to schizophrenia. The exact relationship between both entities is not clear. In recent years, schizophrenia has been associated with hippocampal abnormalities and spatial memory problems. The aim of this study was to determine possible links between high schizotypy (HS) and low schizotypy (LS) and spatial abilities, using virtual reality tasks. We hypothesised that the HS group would exhibit a lower performance in spatial memory tasks than the LS group. METHODS: Two groups of female students were formed according to their score on the ESQUIZO-Q-A questionnaire. HS and LS subjects were tested on two different tasks: the Boxes Room task, a spatial memory task sensitive to hippocampal alterations and a spatial recognition task. RESULTS: Data showed that both groups mastered both tasks. Groups differed in personality features but not in spatial performance. These results provide valuable information about the schizotypy-schizophrenia connections. CONCLUSION: Schizotypal subjects are not impaired on spatial cognition and, accordingly, the schizotypy-schizophrenia relationship is not straightforward.

Relación entre consumo de drogas y VIH/sida. La Habana, 2012-2013 / Relationship between drug use and HIV / AIDS. Havana, 2012-2013

El consumo de drogas ha estado íntimamente ligado al VIH/sida desde el comienzo de esta epidemia. El vínculo está dado por la tendencia que tienen los consumidores de alcohol y otras drogas a adoptar comportamientos de riesgo lo que hace más probable que los usuarios tengan relaciones sexuales sin protección aumentando la probabilidad tanto de transmitir como contraer el VIH o cualquier otra infección que repercutiría negativamente en su calidad de vida. El Departamento Municipal de ITS/VIH/sida de 10 de Octubre, que atiende a personas diagnosticadas de La Habana, a través del curso Aprendiendo a vivir con VIH, favoreció la realización de esta investigación. Contribuir a la prevención de comportamientos de riesgo asociados con el uso de drogas y el VIH/sida constituyó el objetivo general de esta investigación, que asumió la perspectiva metodológica de la Investigación Acción Participación (IAP). Las técnicas utilizadas fueron la entrevista a informantes claves y los grupos focales. Los principales resultados fueron, por un lado, el análisis de la percepción de los coordinadores de la Línea de personas con VIH/sida acerca de la manifestación del consumo de drogas entre el grupo de personas con VIH/sida y la constatación de la necesidad de capacitarlos en este tema. Por otro, el diagnóstico de las necesidades de aprendizaje de las personas con VIH/sida, la constatación de la ausencia de percepción del riesgo y el desconocimiento de los servicios y mecanismos que brinda el sistema nacional de salud para el tratamiento y rehabilitación de las adicciones, entre otros(AU)

Drug use has been closely linked to HIV / AIDS since the beginning of the epidemic. The link is given by the tendency of consumers of alcohol and other drugs to risky behavior which makes users more likely to have unprotected sex increase the likelihood of both transmitting and acquiring HIV or any other infection that would affect negatively on their quality of life. The Municipal Department of STI / HIV / AIDS on October 10, which serves people diagnosed Havana, through the course Learning to live with HIV, favored the conduct of this research.Contribute to the prevention of risk behaviors associated with drug use and HIV / AIDS was the overall objective of this research, which assumed the methodological perspective of Participation Action Research (PAR). The techniques used were interviews with key informants and focus groups.The main findings were, first, the analysis of the perception of the coordinators of the line of people with HIV / AIDS about the manifestation of drug use among the group of people with HIV / AIDS and the need for finding train them in this area. Furthermore, the diagnosis of learning needs of people with HIV / AIDS, a finding of absence of risk perception and lack of services and mechanisms provided by the national health system for the treatment and rehabilitation of addictions, among others(AU)

Factor de necrosis tumoral como marcador de inflamación precoz en fumadores sanos / Tumor necrosis factor as an early marker of inflammation in healthy smokers

Fundamento y objetivo: El tabaco produce una inflamación que conduce a pérdida de función pulmonar. El tumoral necrosis factor α (TNF-α, «factor de necrosis tumoral α») es una citocina implicada en la patogenia de la enfermedad pulmonar obstructiva crónica. Necesitamos desarrollar métodos que permitan detectar precozmente a los fumadores en riesgo de pérdida de función pulmonar. Los objetivos de este trabajo fueron: demostrar que los fumadores tienen valores más elevados de TNF-α en suero y condensado de aire exhalado (CAE); valorar la influencia de sexo, edad y peso en dichos valores; conocer la relación entre consumo de tabaco y función pulmonar con los valores de TNF-α. Pacientes y método: Grupo estudio y control sin patología. Realización de espirometría con test broncodilatador, recogida de CAE y extracción sanguínea previa al abandono del tabaco. Análisis estadístico con SPSS 11.0. Resultados: Se incluyeron 51 pacientes (60,8% fumadores), un 56,9% mujeres, con una edad media de 39,88 años. Los fumadores tenían un consumo medio de 21,68 cigarrillos/día y una edad media de inicio de 15,77 años. Los fumadores tenían valores significativamente más elevados de TNF-α en suero (p<0,043); los valores en CAE no mostraban diferencias. De los parámetros de consumo de tabaco, solo la edad de inicio y el TNF-α plasmático guardaban correlación. De la función pulmonar, solo la capacidad vital forzada y el volumen espirado durante el primer segundo guardaban relación con el TNF-α plasmático. Conclusiones: Los fumadores tienen valores más elevados de TNF-α en suero. La cuantía de años de consumo de tabaco influye en los valores de TNF-α plasmáticos. Existe una discreta relación de la función pulmonar con los valores de TNF-α en suero. Los valores de TNF en CAE no muestran diferencias ni correlaciones significativas (AU)

Background and objectives: Smoking creates an inflammation that leads to lose of lung function. Tumor necrosis factor alpha (TNF-α) is a cytokine that plays an important role in the pathogenesis of chronic obstructive pulmonary disease. There is a need to develop methods for an early detection of an impaired lung function in smokers. We aimed to show that smokers have higher levels of TNF-α in serum and exhaled breath condensate (EBC). We also analysed the influence of sex, age and weight on TNF-α, and determined the association between smoking, pulmonary function and TNF-α.Patients and methods: Prospective study of smokers and non-smokers without any known disease. Respiratory function tests, EBC and blood samples were performed before smoking cessation. Statistical analysis: SPSS 11.0. Results: Fifty-one patients (60.8% smokers), 56.9% females, mean age 39.88 years old. Smokers initiated at an age of 15.77 years; the mean of cigarettes/day was 21.68. Significant differences in TNF-α serum levels between smokers and non-smokers were observed (P<.043). Differences did not reach significance for EBC. For tobacco consumption data, only age at smoking initiation and serum TNF-α levels had a correlation. A significant relation between TNF-α serum levels and forced expiratory volume in one second and forced vital capacity was found. Conclusions: Smokers show higher TNF-α levels in serum. Number of years of smoking has an influence on TNF-α levels. There is a modest corelation between pulmonary function and plasma TNF-α levels, but not for EBC (AU)

[Tumor necrosis factor as an early marker of inflammation in healthy smokers]. / Factor de necrosis tumoral como marcador de inflamación precoz en fumadores sanos.

BACKGROUND AND OBJECTIVES: Smoking creates an inflammation that leads to lose of lung function. Tumor necrosis factor alpha (TNF-α) is a cytokine that plays an important role in the pathogenesis of chronic obstructive pulmonary disease. There is a need to develop methods for an early detection of an impaired lung function in smokers. We aimed to show that smokers have higher levels of TNF-α in serum and exhaled breath condensate (EBC). We also analysed the influence of sex, age and weight on TNF-α, and determined the association between smoking, pulmonary function and TNF-α. PATIENTS AND METHODS: Prospective study of smokers and non-smokers without any known disease. Respiratory function tests, EBC and blood samples were performed before smoking cessation. STATISTICAL ANALYSIS: SPSS 11.0. RESULTS: Fifty-one patients (60.8% smokers), 56.9% females, mean age 39.88 years old. Smokers initiated at an age of 15.77 years; the mean of cigarettes/day was 21.68. Significant differences in TNF-α serum levels between smokers and non-smokers were observed (P<.043). Differences did not reach significance for EBC. For tobacco consumption data, only age at smoking initiation and serum TNF-α levels had a correlation. A significant relation between TNF-α serum levels and forced expiratory volume in one second and forced vital capacity was found. CONCLUSIONS: Smokers show higher TNF-α levels in serum. Number of years of smoking has an influence on TNF-α levels. There is a modest correlation between pulmonary function and plasma TNF-α levels, but not for EBC.

Refractory iron-deficiency anemia and gluten intolerance - Response to gluten-free diet.

INTRODUCTION: refractory iron-deficiency anemia has a multifactorial origin related to various gastrointestinal conditions, with celiac disease plus malabsorption and IBD together with isolated gluten intolerance being most common. OBJECTIVES: to determine the prevalence of serum, genetic, and histological markers for gluten intolerance, and to analyze the response to gluten withdrawal from the diet in these patients. METHODS: a number of patients with refractory anemia were prospectively and consecutively enrolled. A protocol to measure serum (TGt-2), genetic (HLA-DQ2/DQ8), and histological markers for celiac disease was applied. All followed a gluten-free diet for a median 3.6 years. Sustained remission of anemia during follow-up was interpreted as positive response. RESULTS: ninety-eight patients (84% females) with a mean age of 54 years were studied. Anti-TGt2 antibodies were positive in 5% of cases. A total of 67 cases (68%) were haplotype HLA-DQ2 or -DQ8 (+). We found villous atrophy (Marsh III) in 13% of patients, and an inflammatory pattern (Marsh I or II) in 13%. All remaining 72 patients (74%) had no histological duodenal changes.Age, anemia duration, number of transfusions, number of parenteral iron doses, and time on a gluten-free diet were all compared according to the presence or absence of villous atrophy and HLA-DQ2/8 positivity, and no significant differences were found for any of the analyzed variables. Response was positive in 92% of subjects. CONCLUSIONS: celiac disease with villous atrophy is rarely a cause of refractory anemia. Gluten intolerance with no histological lesions is seen in almost 75% of patients, and therefore plays a relevant role in its development.

Anemia ferropénica refractaria e intolerancia al gluten: respuesta a la dieta sin gluten / Refractory iron-deficiency anemia and gluten intolerance - Response to gluten-free diet

Introducción: la anemia ferropénica refractaria presenta un origen multifactorial, relacionado con diversas enfermedades digestivas, siendo las más frecuentes la enfermedad celiaca con malabsorción y la EII junto con la intolerancia al gluten aislada. Objetivos: determinar la prevalencia de marcadores serológicos, genéticos e histológicos de intolerancia al gluten y analizar la respuesta a la retirada del gluten de la dieta en estos pacientes. Métodos: se incluyeron de forma prospectiva y consecutiva una serie de pacientes con anemia refractaria. Se les aplicó un protocolo consistente en determinación marcadores serológicos (TGt-2), genéticos (HLA-DQ2/DQ8) e histológicos de enfermedad celíaca. Todos siguieron una dieta sin gluten durante una mediana de 3,6 años. Se interpretó como respuesta positiva la desaparición mantenida de la anemia durante el seguimiento. Resultados: se estudiaron 98 pacientes (84% mujeres) con una edad media de 54 años. Los ac. anti-TGt2 fueron positivos en el 5% de los casos. Un total de 67 casos (68%) presentaban el haplotipo HLA-DQ2 o DQ8 (+). Encontramos atrofia vellositaria (Marsh III) en el 13% de los casos y patrón inflamatorio (Marsh I o II) en el 13%. Los 72 casos restantes (74%) no presentaban alteraciones histológicas duodenales. Se compararon la edad, el tiempo de evolución de la anemia, número de transfusiones, número de dosis de hierro parenteral y tiempo en dieta sin gluten, en función de la presencia o no de atrofia vellositaria y de la positividad para el HLA-DQ2/8, sin encontrar diferencias significativas en ninguna de las variables analizadas. La respuesta fue positiva en el 92% de los casos. Conclusiones: la enfermedad celiaca con atrofia vellositaria es causa poco frecuente de anemia refractaria. Las formas de intolerancia al gluten sin lesión histológica asociada, representan cerca del 75% de los casos y desempeñan, por lo tanto, un papel importante en su aparición(AU)

Introduction: refractory iron-deficiency anemia has a multifactorial origin related to various gastrointestinal conditions, with celiac disease plus malabsorption and IBD together with isolated gluten intolerance being most common. Objectives: to determine the prevalence of serum, genetic, and histological markers for gluten intolerance, and to analyze the response to gluten withdrawal from the diet in these patients. Methods: a number of patients with refractory anemia were prospectively and consecutively enrolled. A protocol to measure serum (TGt-2), genetic (HLA-DQ2/DQ8), and histological markers for celiac disease was applied. All followed a gluten-free diet for a median 3.6 years. Sustained remission of anemia during follow-up was interpreted as positive response. Results: ninety-eight patients (84% females) with a mean age of 54 years were studied. Anti-TGt2 antibodies were positive in 5% of cases. A total of 67 cases (68%) were haplotype HLA-DQ2 or -DQ8 (+). We found villous atrophy (Marsh III) in 13% of patients, and an inflammatory pattern (Marsh I or II) in 13%. All remaining 72 patients (74%) had no histological duodenal changes. Age, anemia duration, number of transfusions, number of parenteral iron doses, and time on a gluten-free diet were all compared according to the presence or absence of villous atrophy and HLADQ2/ 8 positivity, and no significant differences were found for any of the analyzed variables. Response was positive in 92% of subjects. Conclusions: celiac disease with villous atrophy is rarely a cause of refractory anemia. Gluten intolerance with no histological lesions is seen in almost 75% of patients, and therefore plays a relevant role in its development(AU)