Preoperative hemogram as a predictive factor for iron deficit and/or transfusion in patients scheduled for arthroplasty.

INTRODUCTION: anemia and iron deficiency predispose to an increased risk of transfusion with a consequent increase in morbidity and mortality. The study analyzes whether blood cell count parameters in addition to detecting anemia can predict iron deficiency and/or transfusional risk in patients undergoing mostly to scheduled primary hip and knee arthroplasty. OBJECTIVE: To analyze how blood cell count parameters predict iron deficiency and/or transfusional risk in patients undergoing programmed arthroplasty. MATERIAL AND METHODS: The analytical and transfusion results of 522 patients undergoing arthroplasty have been prospectively collected between 2013 and 2019 and the discriminative and predictive capacity of the basic parameters of the red cells have been analyzed; hemoglobin (Hb), mean cell volume, mean cell hemoglobin (HCM) and red blood cell distribution width (RDW) for the identification of presurgical iron deficiency and postsurgical transfusion. RESULTS: Anaemia was detected in 6.6%, "suboptim" Hb (<13 g/dL) in 14.5% and iron deficiency in 32.4%. Anemia detects only 13.8% of ID. After logistic regression analysis, the multivariate model significantly related Hb (p = .004), mean corpuscular hemoglobin (MCH) (p = .026), and the red cell distribution width (RDW) (p = .001) with ID; but mean corpuscular volume (MCV) is not significant. Hb, age and transferrin saturation index have been the only risk factors for transfusional risk of the parameters analyzed. CONCLUSIONS: The hemogram contains parameters that correlate with iron deficiency, however, mean cell volume, so widely used for the orientation of iron deficiency, is not valid as a discriminator of iron deficiency in this group of patients. Low Hb and transferrin saturation index are modifiable predictors for transfusion risk.

Preoperative hemogram as a predictive factor for iron deficit and/or transfusion in patients scheduled for arthroplasty. / El hemograma como factor predictivo de déficit de hierro y/o transfusión en paciente pendiente de artroplastia.

INTRODUCTION: Anemia and iron deficiency predispose to an increased risk of transfusion with a consequent increase in morbidity and mortality. The study analyzes whether blood cell count parameters in addition to detecting anemia can predict iron deficiency and/or transfusional risk in patients undergoing mostly to scheduled primary hip and knee arthroplasty. OBJECTIVE: To analyze how blood cell count parameters predict iron deficiency and/or transfusional risk in patients undergoing programmed arthroplasty. MATERIAL AND METHODS: The analytical and transfusion results of 522 patients undergoing arthroplasty have been prospectively collected between 2013 and 2019 and the discriminative and predictive capacity of the basic parameters of the red cells have been analyzed; hemoglobin (Hb), mean cell volume, mean cell hemoglobin (HCM) and red blood cell distribution width (RDW) for the identification of presurgical iron deficiency and postsurgical transfusion. RESULTS: Anaemia was detected in 6.6%, "suboptim" Hb (<13g/dL) in 14.5% and iron deficiency in 32.4%. Anemia detects only 13.8% of ID. After logistic regression analysis, the multivariate model significantly related Hb (p=.004), mean corpuscular hemoglobin (MCH) (p=.026), and the red cell distribution width (RDW) (p=.001) with ID; but mean corpuscular volume (MCV) is not significant. Hb, age and transferrin saturation index have been the only risk factors for transfusional risk of the parameters analyzed. CONCLUSIONS: The hemogram contains parameters that correlate with iron deficiency, however, mean cell volume, so widely used for the orientation of iron deficiency, is not valid as a discriminator of iron deficiency in this group of patients. Low Hb and transferrin saturation index are modifiable predictors for transfusion risk.

Estudio de la ferropenia en el laboratorio clínico / Laboratory evaluation of iron deficiency

El hierro es un elemento químico esencial para todos los organismos vivos, necesario para un amplio espectro de funciones metabólicas vitales. La exploración del metabolismo del hierro puede ser difícil en algunas situaciones, tales como en el paciente con una enfermedad crónica, por la respuesta de los biomarcadores frente a la inflamación. En los últimos años el laboratorio clínico ha incorporado nuevos biomarcadores a los tradicionalmente empleados, con el fin de mejorar su contribución al diagnóstico y seguimiento de la ferropenia. Se ha realizado una búsqueda sistemática de la evidencia científica publicada en los diez últimos años para los siguientes biomarcadores: el diagnóstico morfológico de la sangre periférica, los índices hematimétricos, y las concentraciones plasmáticas de transferrina (y sus índices), ferritina, receptor soluble de transferrina y hemoglobina, en la ferropenia. Se emiten recomendaciones para estos biomarcadores en relación al diagnóstico y manejo del paciente ferropénico

Iron is an essential chemical element for all living organisms, and is required for a broad spectrum of vital metabolic functions. The study of iron metabolism can be challenging in some situations, such as in patients with chronic diseases, due to the effect of inflammation response. In recent years, clinical laboratory research has introduced new biomarkers to those commonly used, with the aim of improving the diagnosis and management of iron deficiency. In this work, a systematic search of the scientific evidence reported during the last decade has been made for the following biomarkers: morphological diagnosis of peripheral blood, hematimetric indices, and plasma concentrations of transferrin (and its indices), ferritin, transferrin receptor, and haemoglobin, in iron deficiency. Recommendations are made for these biomarkers related to the diagnosis and management of the iron-deficient patient

Resistance to powdery mildew in Spanish barley landraces is controlled by different sets of quantitative trait loci.

Twenty-two landrace-derived inbred lines from the Spanish Barley Core Collection (SBCC) were found to display high levels of resistance to a panel of 27 isolates of the fungus Blumeria graminis that exhibit a wide variety of virulences. Among these lines, SBCC145 showed high overall resistance and a distinctive spectrum of resistance compared with the other lines. Against this background, the main goal of the present work was to investigate the genetic basis underlying such resistance using a doubled haploid population derived from a cross between SBCC145 and the elite spring cultivar Beatrix. The population was genotyped with the 1,536-SNP Illumina GoldenGate Oligonucleotide Pool Assay (Barley OPA-1 or BOPA1 for short), whereas phenotypic analysis was performed using two B. graminis isolates. A major quantitative trait locus (QTL) for resistance to both isolates was identified on the long arm of chromosome 6H (6HL) and accounted for ca. 60% of the phenotypic variance. Depending on the B. graminis isolate tested, three other minor QTLs were detected on chromosomes 2H and 7H, which explained less than 5% of the phenotypic variation each. In all cases, the alleles for resistance derived from the Spanish parent SBCC145. The position, the magnitude of the effect observed and the proportion of phenotypic variation accounted for by the QTL on 6HL suggest this is a newly identified locus for broad-based resistance to powdery mildew.

Distribution of MWG699 polymorphism in Spanish European barleys.

The STS marker MWG699/TaqI is closely linked to the vrs1 locus and has been proposed as a marker of domestication in barley. This study included 257 cultivated barleys of both two- and six-rowed varieties, mainly from the western Mediterranean region. These included many landraces from the Spanish barley core collection, Moroccan landraces, and a set of accessions from other European countries. Restriction analysis of amplified DNA revealed three alleles, as previously described. Most of the two-rowed entries had the same allele, type K. Six-rowed entries showed both types A and D. Indeed, type D was widespread among Spanish landraces and commercial varieties from central Europe. It was also found in some two-rowed landraces originating from Spain and Morocco. Barleys with the D haplotype were predominantly winter types, whereas the A haplotype was evenly distributed among spring and winter types. These results support the existence of two different genetic sources among six-rowed Spanish landraces.

Morphological and agronomical diversity patterns in the Spanish barley core collection.

Seven thousand years of barley cultivation under the environmental hardships typical of the Mediterranean climate have generated genetic singularity of the Spanish barleys, consistently reported in the literature. From the Spanish National Collection of 2289 accessions, a core subset with 159 landraces and 16 old varieties was constituted. Twenty-seven characters were evaluated for the core collection, to define the structure of the diversity. Several evaluation trials were carried out in 1999-2000, whereas yield trials were performed in earlier years. Phenotypic diversity was large for most of the characters studied. Comparisons of genetic diversity between the core and the original collections suggested that the core is a good representation of the existing diversity in the BNG. Comparisons with results of studies on Spanish materials from other collections seem to indicate that the Spanish diversity is not well represented in some world collections. Principal component analyses for quantitative and qualitative characters revealed a clear distinction between two- and six-row cultivars, and also between landraces and commercial varieties. Geographical origins of the landraces were correlated with grain yield, heading date, duration of grain filling period, and growth class. In relation to diseases, altitude played an important role on the resistance to powdery mildew and brown rust. For brown rust, all the resistant landraces came from low altitudes. These geographical gradients seemed consistent with prior knowledge about barley adaptation, and would confirm the agreement between passport data and true adaptive origin of these landraces from a geographical point of view.

[Distribution of the genotypes of hepatitis C virus in intravenous drug addicts in Argentina]. / Distribución de los genotipos del virus de la hepatitis C en una población Argentina de drogadictos endovenosos.

Intravenous drug addiction (IVD) is an unfrequent risk factor in Argentina, representing less than 10% of patients (pts) with chronic HCV infection seen in our Unit. In order to study the genotypes (Gt) in IVD and compare them with a non drug addicted control population, 68 pts with a history of IVD were enrolled in this study and compared with 68 non drug addict (NDA) pts with chronic HCV, with similar age and gender distribution. In all pts a liver biopsy was performed. Genotyping was done by INNO LiPA (Innogenetics, Belgium). Mean age in both groups was 35 +/- 7.8 years and 50 were males. No difference was observed between both groups in the prevalence of Gt1a, Gt2a/c and in those with mixed infections. The prevalence of Gt1b in IVD was 19.1% and in NDA 38.2% (p = 0.0228). A highly significant difference was also observed in the prevalence of Gt3a, of 42.6% in IVD and only 11.8% in NDA (p = 0.0001). Gt1a was the second most frequent genotype in IVD pts (26.5%). Simultaneous HIV infection was present in 8 IVD pts (11.8%) and in none of NDA group. Liver biopsies showed a higher prevalence of mild chronic hepatitis in NDA (57.3%) than in IVD (32.4%) (p = 0.0058). Severe chronic hepatitis with advanced fibrosis or cirrhosis was more frequent in the Gt3 of the group with IVD when compared with Gt3 of the NDA group. It can be concluded that in accordance with other geographical areas, Gt3a is far more prevalent in intravenous drugs addicts than in the general population in Argentina where Gt1b is more frequent. Mild forms of chronic hepatitis are less frequent in IVD. In spite of the relatively small group with HCV co-infection with HIV, it seems important to note that 2/8 (25%) showed severe hepatitis C or cirrhosis.

RFLP markers associated with major genes controlling heading date evaluated in a barley germ plasm pool

Adjustment of crop phenology to resources and constraints of the production environment is crucial for barley adaptation to dry-land environments. The aims of this study were to characterize (under field and under controlled conditions) the diverse heading responses of barley cultivars grown in Spain, and to identify phenotypic trait-molecular marker associations with restriction fragment length polymorphism (RFLP) probes which are linked to major loci controlling vernalization (Sh and Sh2) and photoperiod (Ppd-H1 and Ppd-H2) sensitivities in barley. Thirty-two cultivars were sown in field trials for 3 years in four locations in northern Spain (10 autumn and nine winter sowings), and for 1 year in southern Spain (autumn sowing), and 2 years in Scotland (spring sowings); they were also studied under four glasshouse treatments, combining presence/absence of vernalization and short/long photoperiod. These cultivars were examined for the presence of RFLP polymorphisms with four probes and three restriction enzymes. Analyses of variance detected a number of associations which were quite consistent with expectations, suggesting that marker-loci associations found in mapping populations are, to some extent, maintained in a germ plasm pool, and may be useful for germ plasm characterization and marker-assisted selection in breeding programmes. Two possible epistatic interactions among the probes were detected, one of them possibly related to a short-day vernalization response.

Distribución de los genotipos del virus de la hepatitis C en una población Argentina de drogadictos endovenosos. / [Distribution of the genotypes of hepatitis C virus in intravenous drug addicts in Argentina]

Intravenous drug addiction (IVD) is an unfrequent risk factor in Argentina, representing less than 10

of patients (pts) with chronic HCV infection seen in our Unit. In order to study the genotypes (Gt) in IVD and compare them with a non drug addicted control population, 68 pts with a history of IVD were enrolled in this study and compared with 68 non drug addict (NDA) pts with chronic HCV, with similar age and gender distribution. In all pts a liver biopsy was performed. Genotyping was done by INNO LiPA (Innogenetics, Belgium). Mean age in both groups was 35 +/- 7.8 years and 50 were males. No difference was observed between both groups in the prevalence of Gt1a, Gt2a/c and in those with mixed infections. The prevalence of Gt1b in IVD was 19.1

and in NDA 38.2

(p = 0.0228). A highly significant difference was also observed in the prevalence of Gt3a, of 42.6

in IVD and only 11.8

in NDA (p = 0.0001). Gt1a was the second most frequent genotype in IVD pts (26.5

). Simultaneous HIV infection was present in 8 IVD pts (11.8

) and in none of NDA group. Liver biopsies showed a higher prevalence of mild chronic hepatitis in NDA (57.3

) than in IVD (32.4

) (p = 0.0058). Severe chronic hepatitis with advanced fibrosis or cirrhosis was more frequent in the Gt3 of the group with IVD when compared with Gt3 of the NDA group. It can be concluded that in accordance with other geographical areas, Gt3a is far more prevalent in intravenous drugs addicts than in the general population in Argentina where Gt1b is more frequent. Mild forms of chronic hepatitis are less frequent in IVD. In spite of the relatively small group with HCV co-infection with HIV, it seems important to note that 2/8 (25

) showed severe hepatitis C or cirrhosis.

Ketoconazole-induced liver damage.

Five cases (four females, one male) of ketoconazole-related liver damage are presented, two of whom died. All patients received ketoconazole (400 mg/day) for various mycoses. In the four women the first signs of hepatotoxicity appeared after four weeks of therapy. One fatal case developed massive necrosis with fulminant liver failure and the other, submassive necrosis. In four cases cholestasis was a prominent finding. Biochemical evidence of biliary stasis may persist for several months, as occurred in the three surviving patients of our series. The two fatal cases continued receiving the drug in spite of its adverse effects. Consequently, repeated evaluation is recommended to detect early signs of liver environment.

Choice of selection environment for improving crop yields in saline areas.

Spatial variability in salt-affected fields is normally very high. Thus, most salinity affected lands are actually comprised of many micro-environments, ranging from low to high salinity in the same field. The evidence on testing genotypes across a broad range of salinity levels shows that the genotype-by-salinity level interaction is commonly large. Thus, breeding for saline areas can be compared to what has been known as breeding for 'wide adaptation'. The target environments both for breeding for saline soils or for wide adaptation are actually a population of many possible environments, for which there exists a significant component of genotype-by-environment(G x E) interaction. Thus it is possible to study the merit of potential strategies for breeding for salinity tolerance using the tools that have been developed for the study of breeding for wide adaptation. The evidence from selection and breeding experiments for wide adaptation seems to favour testing on a representative subset of environments, including stress and non-stress locations; but the choice of these locations is complicated by the multidimensional nature of G x E. However, in the case of salt stress, the crop-yield response functions to salinity are well known. This paper presents an attempt to systematise the choice of the optimum environment(s) to select for improved yield under saline soil conditions, based on the three-piece linear equation presented by Maas and Hoffman (1977) and the theory of direct and indirect responses to selection. It is proposed that three saline levels should be enough to make a valid estimation of the suitability of a number of selection strategies. A worked example with data from a set of grain sorghum inbred lines tested on ten saline levels shows that the same selection strategies would be chosen using the information from the ten saline levels as that obtained using the two extremes and one intermediate level.

Latent distal renal tubular acidosis (dRTA) in primary biliary cirrhosis (PBC) and chronic autoimmune hepatitis (CAH).

In an attempt to evaluate the latent distal renal tubular acidosis (dRTA7) in patients with primary biliary cirrhosis (PBC), and chronic autoimmune hepatitis (CAH), and differences between them in relation to the sodium urinary excretion ([Na]u), thirty four patients divided in two groups were studied. Group A: 17 patients who fulfilled criteria for PBC diagnosis (clinical and humoral evidence antimitochondrial antibody titles of 1/80 or above by indirect immunofluorescence technique, and liver biopsy). Group B: 17 patients who fulfilled criteria for CAH diagnosis (clinical and humoral evidence, antinuclear and smooth muscle antibody titles of 1/80 or above and liver biopsy). Patients with ascitis and/or edema were excluded from the study. Ability to acidify urine was evaluated by gradient between pC02 in urine and blood (U-BpC02) after alkali infusion. Five patients in Group A (29.4%7) and six in Group B(35.2%) had dRTA, (p = 0.49). When analyzing patients with dRTA in both groups, the mean [Na]u in Group A was 152.2 +/- 33.8, versus 50.8 +/- 8.1 mEq/l, in Group B. (p = 0.00016). We concluded that the prevalence of dRTA was similar in patients with PBC and CAH but the urinary acidifications impairment of the former did not correlate with [Na]u, as it did with the latter.

Latent distal renal tubular acidosis (dRTA) in primary biliary cirrhosis (PBC) and chronic autoimmune hepatitis (CAH).

In an attempt to evaluate the latent distal renal tubular acidosis (dRTA7) in patients with primary biliary cirrhosis (PBC), and chronic autoimmune hepatitis (CAH), and differences between them in relation to the sodium urinary excretion ([Na]u), thirty four patients divided in two groups were studied. Group A: 17 patients who fulfilled criteria for PBC diagnosis (clinical and humoral evidence antimitochondrial antibody titles of 1/80 or above by indirect immunofluorescence technique, and liver biopsy). Group B: 17 patients who fulfilled criteria for CAH diagnosis (clinical and humoral evidence, antinuclear and smooth muscle antibody titles of 1/80 or above and liver biopsy). Patients with ascitis and/or edema were excluded from the study. Ability to acidify urine was evaluated by gradient between pC02 in urine and blood (U-BpC02) after alkali infusion. Five patients in Group A (29.4

7) and six in Group B(35.2

) had dRTA, (p = 0.49). When analyzing patients with dRTA in both groups, the mean [Na]u in Group A was 152.2 +/- 33.8, versus 50.8 +/- 8.1 mEq/l, in Group B. (p = 0.00016). We concluded that the prevalence of dRTA was similar in patients with PBC and CAH but the urinary acidifications impairment of the former did not correlate with [Na]u, as it did with the latter.

Ictericia por metimazol / Jaundice due to methimazole

Se presentan 3 pacientes de sexo femenino que bajo tratamiento con metimazol instituido a raíz de hipertiroidismo presentaron un cuadro caracterizado por ictericia, intenso prurito e hipocolia. Ninguna de las pacientes presentó antecedentes de alcoholismo o ingesta de drogas potencialmente hepatotóxicas. El laboratorio se caracterizó en todos los casos por una elevación de la bilirrubina con un máximo de 14.5 mg% a predominio de la fracción conjugada, aumento de la fosfatasa alcalina y de la gamma glutamil transpeptidasa con una sola moderada movilización de las aminotransferasas no superando el nivel sérico de 10 veces su valor normal. Los marcadores virales fueron reiteradamente negativos para los virus A y B de hepatitis en las tres pacientes. La biopsia hepática reveló en todos los casos una intensa colestasis con reacción inflamatória de grado moderado en los campos portales. La ictericia apareció aproximadamente al mes de instituído el tratamiento y desapareció al cabo de la suspensión del mismo en forma lenta, demorando en un caso hasta un año

Ictericia por metimazol / Jaundice due to methimazole

Se presentan 3 pacientes de sexo femenino que bajo tratamiento con metimazol instituido a raíz de hipertiroidismo presentaron un cuadro caracterizado por ictericia, intenso prurito e hipocolia. Ninguna de las pacientes presentó antecedentes de alcoholismo o ingesta de drogas potencialmente hepatotóxicas. El laboratorio se caracterizó en todos los casos por una elevación de la bilirrubina con un máximo de 14.5 mg% a predominio de la fracción conjugada, aumento de la fosfatasa alcalina y de la gamma glutamil transpeptidasa con una sola moderada movilización de las aminotransferasas no superando el nivel sérico de 10 veces su valor normal. Los marcadores virales fueron reiteradamente negativos para los virus A y B de hepatitis en las tres pacientes. La biopsia hepática reveló en todos los casos una intensa colestasis con reacción inflamatória de grado moderado en los campos portales. La ictericia apareció aproximadamente al mes de instituído el tratamiento y desapareció al cabo de la suspensión del mismo en forma lenta, demorando en un caso hasta un año (AU)

[Prevalence of antibodies against hepatitis C virus (anti HCV) in different populations with chronic liver disease using the first generation test]. / Prevalencia de anticuerpos anti virus de la hepatitis C (anti HCV) en diferentes poblaciones de hepatopatiás crónicas con una prueba de primera generación.

UNLABELLED: In order to evaluate the prevalence of antibodies IgG against the virus of hepatitis C (anti HCV) in different forms of chronic liver disease negative for virus B markers of alcoholism, we studied 148 patients (pts) divided into several groups. Group I: Composed of 35 pts. with chronic active hepatitis (CAH) with definite evidence of parenteral exposure to blood. Group II: included 39 pts. with CAH without immune markers or evidence of possible parenteral transmission. Group III: Included 37 pts. with the diagnosis of CAH of autoimmune type with positivity of antinuclear, anti smooth muscle or both antibodies with range of positivity of 1:80 or higher. Group IV: was composed of 31 pts. with the diagnosis of primary biliary cirrhosis (PBC). Finally group V included 6 pts. with an overlap syndrome between CAH and PBC. The prevalence of anti HCV in the different groups was as follows: [table: see text] Two of the pts. positive for anti HCV in group III and 1 in group IV revealed parenteral exposure to blood or blood product. CONCLUSIONS: The determinations of anti HCV in order to characterize the posttransfusional NANB chronic hepatitis is of value. Positivity of anti HCV is high in cryptogenic chronic hepatitis and rare in PBC. In CAH of autoimmune type and in the overlap syndrome the prevalence was higher than expected. The question if we are dealing with false positivity or an uncertain diagnosis of autoimmunity is raised.

[Jaundice caused by methimazole]. / Ictericia por metimazol.

Three female patients with cholestatic jaundice related to methimazole therapy are presented. The jaundice appeared after more or less 30 days of therapy. Markers for hepatitis A and B were negative in all. None of them had previous history of alcoholism or ingestion of potentially hepatotoxic drugs. Characteristically there was a marked elevation of alkaline phosphatase and gamma-glutamyltranspeptidase with only moderate increase of the aminotransferases. Liver biopsy performed in all showed intensive cholestasis with low degree of inflammatory reaction confined to the portal tracts. The three patients presented a prolonged duration of the liver injury in spite of the interruption of the drug lasting in one of them up to one year, but all ultimately resolved.