Evaluating the Diagnostic Performance of Hemoglobin in the Diagnosis of Iron Deficiency Anemia in High-Altitude Populations: A Scoping Review.

We evaluated the available literature on the diagnostic performance of hemoglobin (Hb) in the diagnosis of iron deficiency anemia (IDA) in high-altitude populations. We searched PubMed, Web of Science, Scopus, Embase, Medline by Ovid, the Cochrane Library, and LILCAS until 3 May 2022. We included studies that evaluated the diagnostic performance (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristic (ROC) curves, and accuracy) of Hb (with and without an altitude correction factor) compared to any iron deficiency (ID) marker (e.g., ferritin, soluble transferrin receptor (sTFR), transferrin saturation, or total body iron (TBI)) in populations residing at altitudes (≥1000 m above sea level). We identified a total of 14 studies (with 4522 participants). We found disagreement in diagnostic performance test values between the studies, both in those comparing hemoglobin with and in those comparing hemoglobin without a correction factor for altitude. Sensitivity ranged from 7% to 100%, whereas specificity ranged from 30% to 100%. Three studies reported higher accuracy of uncorrected versus altitude-corrected hemoglobin. Similarly, two studies found that not correcting hemoglobin for altitude improved the receiver operating characteristic (ROC) curves for the diagnosis of iron deficiency anemia. Available studies on high-altitude populations suggest that the diagnostic accuracy of Hb is higher when altitude correction is not used. In addition, the high prevalence of anemia in altitude regions could be due to diagnostic misclassification.

Acute pneumonitis after subcutaneous injection of BIO-ALCAMID® in breast / Neumonitis aguda secundaria a la inyección subcutánea de gel de polialquilamida (BIO-ALCAMID) en mamas

ABSTRACT: Filling materials are used to correct soft tissue deficits. Local and systemic complications are described when these substances are applied. The polyalkylamide gel (Bio-alcamid) used as filler material has been associated with complications at the facial level, while at the pulmonary level they have not been reported in the literature. We present the case of a patient who consulted due to sudden progressive dyspnea hours after the subcutaneous injection of Bio-alcamid in the breasts. After the clinical evaluation and the result of auxiliary tests, the diagnosis of acute pneumonitis secondary to the injection of this substance is concluded. Follow-up of the case was carried out with favorable evolution and resolution of symptoms after three months. We conclude that Bio-alcamid can generate complications at the pulmonary level, therefore, the intervention of public policies that regulate its use, commercialization and application by non-medical personnel is necessary.

RESUMEN: Los materiales de relleno son utilizados para la corrección de déficit de tejido blando. Se describen complicaciones locales y sistémicas cuando se aplican estas sustancias. El gel de polialquilamida (Bio-alcamid) empleado como material de relleno ha sido asociado a complicaciones a nivel facial, mientras que a nivel pulmonar no han sido informadas en la literatura. Presentamos el caso de una paciente que consultó por presentar disnea súbita progresiva horas después de la inyección subcutánea de Bio-alcamid en mamas. Luego de la evaluación clínica y el resultado de exámenes auxiliares se concluye el diagnóstico de neumonitis aguda secundaria a la inyección de esta sustancia. Se realiza seguimiento del caso con evolución favorable y resolución de síntomas a los tres meses.  Concluimos que el Bio-alcamid puede generar complicaciones a nivel pulmonar, por tanto, es necesario la intervención de políticas públicas que regulen su uso, comercialización y la aplicación por personal no médico.