Deficiencia de ferritina en gestantes colombianas y factores sociodemográficos asociados / Ferritin deficiency in colombian pregnant women and associated sociodemographic factors / Deficiencia de ferritina en gestantes colombianas y factores sociodemográficos asociados

Objetivo: la ferritina es importante en el almacenamiento de hierro intracelular, en una forma soluble no tóxica. Sus niveles en la gestación se la relacionan con la salud de la madre y con su descendencia. El objetivo es escribir los niveles séricos de ferritina y prevalencia de déficit de ferritina, así como los factores sociodemográficos asociados en gestantes de Colombia. Metodología: estudio transversal; análisis secundario de la Encuesta de Situación Nutricional de Colombia, 2015. Se evaluaron en 1.234 embarazadas con edades entre 12 y 48 años: sus características sociodemográficas y antropométricas, la distribución de los niveles séricos y la prevalencia de déficit de ferritina. Para estimar la asociación entre las diferentes variables sociodemográficas y los niveles séricos, o la prevalencia de déficit de ferritina, se utilizaron modelos de regresión multivariables. Resultados: la prevalencia de deficiencia de ferritina fue de 44.5 % (IC 95 % 40.1 % a 49.0 %), los niveles séricos de ferritina oscilaron entre 4 µg/L y 295,7 µg/L, con un promedio de 29.3 µg/L (IC 95 % 26,5 µg/L-32.2 µg/L). Las gestantes del segundo (OR (OR 2.19 IC 95 % 1.50 a 3.19) y tercer trimestre (OR 3.84 IC 95 % 2.68 a 5.50), aquellas que residen en la región Atlántica (OR 2.18 IC 95 % 1.25 a 3.82) y en la región Orinoquia (OR 2.41 IC 95 %1.19 a 4.88), mostraron asociación con el déficit de ferritina. Conclusión: se halló alta prevalencia en el déficit de ferritina en gestantes colombianas.

Introduction: Ferritin is important in the storage of intracellular iron, in a non-toxic soluble form. Its levels during pregnancy are related to the health of the mother and her offspring. Objective: To describe the serum ferritin levels and the prevalence of ferritin deficiency, and the associated sociodemographic factors in pregnant women in Colombia. Methodology: Cross-sectional study; secondary analysis of the Nutritional Situation Survey of Colombia, 2015. The following were evaluated in 1,234 pregnant women aged between 12 and 48 years: their sociodemographic and anthropometric characteristics, the distribution of serum levels, and the prevalence of ferritin deficiency. To estimate the association between the different sociodemographic variables and serum levels, or the prevalence of ferritin deficiency, multivariate regression models were used. Results: The prevalence of ferritin deficiency was 44.5% (95% CI 40.1% to 49.0%), serum ferritin levels ranged from 4 µg/L to 295.7 µg/L, with a average of 29.3 µg/L (95% CI 26.5 µg/L - 32.2 µg/L). Pregnant women in the second (OR (OR 2.19 95% CI 1.50 to 3.19) and third trimester (OR 3.84 95% CI 2.68 to 5.50), those residing in the Atlantic region ( OR 2.18 95% CI 1.25 to 3.82) and in the Orinoquia region (OR 2.41 95% CI 1.19 to 4.88), showed an association with ferritin deficiency. Conclusion: A high prevalence of ferritin deficiency was found in Colombian pregnant women.

Association between Ferrokinetic and its Prognostic Role in Coronary Artery Disease in a South American Hospital / Asociación entre la ferrocinética y su papel pronóstico en enfermedad coronaria en un hospital suramericano / Associação entre a ferrocinética e seu papel prognostico na doença cardíaca coronária em um hospital da América do Sul

Introduction: Ferrokinetic alterations are associated with the worsening of cardiovascular diseases, their role being unknown in depth. Objective: To determine the association between ferrokinetic with acute myocardial infarction with and without ST elevation in patients with coronary disease. Methods: Analytical observational study in a sample of 72 patients who were admitted to a Coronary Care Unit of a fourth level Institution during the period from July 2017 to May 2018. The statistical association analysis was performed with the Chi-square test. Results: The main gender affected was male, in ages over 56 years. The main comorbidity was arterial hyperten-sion in 53.7% for ST-elevation infarction and in 74.2% for non-ST-elevation infarction. The prevalent ferrokinetic alteration was iron deficiency, in 36.6% of the patients with ST elevation and in 41.9% without ST elevation. Low hemoglobin levels were present on admission in 24.4% of patients with ST elevation and in 32.3% of those without ST elevation, associated with low hemoglobin values on day 7 of hospitalization. Deaths occurred in 2.77%, which presented low iron levels without anemia and infarction with ST elevation and shock. The gender variable presented a statistically significant association (p = 0.034) with the serum iron level. Conclusions: Iron deficiency is a very common disorder with a higher mortality rate, so these parameters should be evaluated in cardiovascular diseases

Introducción: Las alteraciones ferrocinéticas se asocian con un empeoramiento de las enfermedades cardiovasculares, pero se desconoce en profundidad su papel.Objetivo: Determinar la asociación entre la ferrocinética con el infarto agudo al miocardio con y sin elevación del segmento ST en pacientes con enfermedad coronaria. Métodos: Estudio observacional analítico en una muestra de 72 pacientes que ingresaron a una unidad de cuidados coronarios de una institución de cuarto nivel durante el lapso de julio de 2017 a mayo de 2018. El análisis de asociación estadística se realizó con la prueba de chi cuadrado. Resultados: El principal género afectado fue el masculino, en edades superiores a 56 años. La principal comorbilidad fue hipertensión arterial, en un 53,7 % para infarto con elevación del segmento ST, y en un 74,2 % para infarto sin elevación de dicho segmento. La alteración ferrocinética prevalente fue el déficit de hierro, en un 36,6 % de los pacientes con elevación del intervalo ST y en un 41,9 % sin elevación del segmento ST. Las concentraciones bajas de hemoglobina estuvieron presentes al ingreso en el 24,4 % de los pacientes con elevación del ST y en el 32,3 % de aquellos sin elevación del ST, aso-ciado con valores bajos de hemoglobina al séptimo día de hospitalización. Ocurrieron fallecimientos en el 2,77 %, con cantidades bajas de hierro sin anemia e infarto con elevación del segmento ST y choque. La variable género presentó asociación estadísticamente significativa (p = 0,034) con el nivel de hierro sérico. Conclusiones: La ferropenia es una alteración muy frecuente con una relación de mayor mortalidad, por lo que estos parámetros deberían evaluarse en enfermedades cardiovasculares

Introdução: Os distúrbios ferrocinéticos estão associados à piora da doença cardiovascular, mas seu papel é pouco conhecido. Objetivo: Determinar a associação entre a ferrocinética e o infarto agudo do miocárdio com e sem elevação do segmento ST em pacientes com doença cardíaca coronária. Métodos: Estudo observacional analítico em uma amostra de 72 pacientes admitidos em uma unidade de tratamento coronariano de uma instituição de quarto nível durante o período de julho de 2017 a maio de 2018. A análise de associação estatística foi realizada usando o teste do qui-quadrado. Resultados: O principal gênero afetado foi o masculino, com idade superior a 56 anos. A principal comorbidade foi a hipertensão, em 53,7% para infarto do miocárdio com elevação do segmento ST e 74,2% para infarto do miocárdio sem elevação do segmento ST. O distúrbio ferrocinético preva-lente foi a deficiência de ferro em 36,6% dos pacientes com elevação do segmento ST e 41,9% sem elevação do segmento ST. Concentrações baixas de hemoglobina estavam presentes na admissão em 24,4% dos pacientes com elevação do segmento ST e em 32,3% daqueles sem elevação do segmento ST, associadas a valores baixos de hemoglobina ao sétimo dia de hospitalização. Ocorreram mortes em 2,77%, com baixo teor de ferro sem anemia e infarto com elevação do segmento ST e choque. O gênero foi associado de forma estatisticamente significativa (p = 0,034) ao nível de ferro sérico. Conclusões: A deficiência de ferro é um distúrbio muito comum com uma associação com o aumento da mortalidade, por tanto, esses parâmetros devem ser avaliados em doenças cardiovasculares

The Role of Thyroid Hormones, Vitamins, and Microelements in Female Infertility / O papel dos hormônios da tiroide, das vitaminas e dos microelementos na fertilidade feminina

Abstract Objective It is well known that female infertility is multifactorial. Therefore, we aimed to compare the effects of thyroid dysfunction, vitamin deficiency, and microelement deficiency in fertile and infertile patients. Materials and Methods Between May 1st, 2017, and April 1st, 2019, we conducted a retrospective case-control study with of 380 infertile and 346 pregnant patients (who normally fertile and able to conceive spontaneously). The fertile patients were selected among those who got pregnant spontaneously without treatment, had a term birth, and did not have systemic or obstetric diseases. The levels of thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), anti-thyroid peroxidase (anti-TPO), vitamin D, vitamin B12, folic acid, ferritin, and zinc of both groups were compared. Results There was no difference between patients in the infertile and pregnant groups in terms of low normal and high serum T3 and T4 levels (p = 0.938; p > 0.05) respectively, nor in terms of normal and high anti-TPO levels (p = 0.182; p > 0.05) respectively. There was no significant difference regarding patients with low, insufficient, and sufficient vitamin D levels in the infertile and pregnant groups (p = 0.160; p >0.05) respectively. The levels of folic acid, ferritin, and zinc of the infertile group were significantly lower than those of the pregnant group. Conclusion The serum levels of folic acid, ferritin, and zinc in infertile patients presenting to our outpatient clinic were lower than those o the fertile patients.

Resumo Objetivo Sabe-se que a infertilidade feminina é multifatorial. Portanto, nosso objetivo foi comparar os efeitos da disfunção tireoidiana, deficiência de vitaminas e deficiência de microelementos em pacientes férteis e inférteis. Materiais e Métodos Entre 1° de maio de 2017 e 1° de abril de 2019, realizamos um estudo retrospectivo caso-controle com 380 pacientes inférteis e 346 grávidas (normalmente férteis e capazes de conceber espontaneamente). As pacientes férteis foram selecionadas entre aquelas que engravidaram espontaneamente sem tratamento, tiveram parto a termo e não apresentavam doenças sistêmicas ou obstétricas. Os níveis de hormônio estimulante da tireoide (TSH), triiodotironina (T3), tiroxina (T4), antitireoide peroxidase (anti-TPO), vitamina D, vitamina B12, ácido fólico, ferritina e zinco de ambos os grupos foram comparados. Resultados Não houve diferença entre as pacientes dos grupos inférteis e gestantes em relação aos níveis altos de sérumT3 e T4 normais baixos e altos (p = 0,938; p > 0,05), respectivamente nem aos níveis normais e altos de anti-TPO (p = 0,182; p > 0,05), respectivamente. Não houve diferença significativa em relação aos pacientes com níveis baixos, insuficientes e suficientes de vitamina D nos grupos inférteis e gestantes (p = 0,160; p > 0,05), respectivamente. Os níveis de ácido fólico, ferritina e zinco do grupo infértil foram significativamente menores do que os do grupo grávida. Conclusão Os níveis de sérum de ácido fólico, ferritina e zinco nas pacientes inférteis atendidas em nosso ambulatório foram menores do que nas pacientes férteis.

Hiperferritinemia y sospecha de sobrecarga de hierro en pacientes del Hospital Pablo Tobón Uribe, entre los años 2010 a 2020 / Hyperferritinemia and suspected iron overload in patients at the Pablo Tobón Uribe Hospital, between 2010 and 2020

Introducción. El objetivo de esta investigación fue comparar el perfil bioquímico y clínico de los pacientes con hiperferritinemia secundaria a hemocromatosis hereditaria (HH), frente a aquellos con hiperferritinemia por causas sospechosas de sobrecarga de hierro (Fe) diferentes a la HH. Metodología. Se estudiaron 92 pacientes (61 hombres y 31 mujeres), remitidos tras la detección de valores de ferritina >300 µg/L en hombres y >200 µg/L en mujeres. En todos se analizaron datos demográficos generales, comorbilidades, motivo de remisión para estudios de hiperferritinemia, manifestaciones clínicas, antecedente familiar de HH y tratamiento reci-bido. Los resultados de las pruebas de laboratorio, imagenología, hallazgos histopatológicos y estudios genéticos, se describieron según la disponibilidad. Resultados. El 96,74 % de los pacientes fueron evaluados en consulta externa, 86,96 % procedían de Medellín o de otros municipios de Antioquia, Colombia. La edad promedio de los participantes fue de 52 años, la principal razón para ser derivados para estudios fue la elevación de los marcadores de Fe sérico, la causa más frecuente de hiperferritinemia fueron los diagnósticos diferentes a la HH (64,13 %) y entre quienes no tenían HH, la etiología metabólica fue la más común (59,32 %). Los pacientes con HH tuvieron niveles más elevados de ferritina y Fe sérico, mientras que en el grupo sin HH se presentaron mayores elevaciones en la saturación de transferrina, transfe-rrina y transaminasas. En pacientes con sobrecarga de Fe, la mutación más frecuentemente encontrada fue la homocigota H63D (36,67 %). Finalmente, 93,94 % de los pacientes con HH recibieron tratamiento con flebotomías, mientras que los cambios en el estilo de vida fueron indicados en el 55,93 % de los pacientes sin HH. Conclusiones. La hiperferritinemia es una presentación clínica frecuente y es importante hacer un abordaje sistemático para identificar sus causas. Aunque la HH es una causa importante de elevación persistente de ferritina, en el enfoque de los pacientes con esta condición, se deben descartar etiologías más frecuentes como la hiperferritinemia de etiología metabólica.

Introduction. The aim of this investigation was to compare the biochemical and clinical profile of patients with secondary hyperferritinemia caused by hereditary hemochromatosis (HH), versus those with hyperferritinemia due to suspected causes of iron (Fe) overload other than HH. Methodology. A total of 92 patients (61 men and 31 women) referred after the detection of ferritin values >300 µg/L in men and >200 µg/L in women were studied. General demographic data, comorbidities, referral reasons for hyperferritinemia studies, clinical manifestations, family history of HH, and treatment received were analyzed in all patients. The results of laboratory tests, medical imaging, histopatho-logical findings, and genetic studies were described based on availability. Results. Of all patients, 96.74% were evaluated as outpatients, 86,96% from the municipality of Medellin in Antioquia, Colombia. The average age of the participants was 52 years, the main reason for being referred for studies was the elevation of serum Fe markers, the most frequent cause of hyperferritinemia in the population studied were conditions other than HH (64.13%), and among those who did not have HH, the metabolic etiology was the most common cause (60%). Patients with HH had higher levels of ferritin and serum Fe, while in the group without HH there were greater elevations of transferrin saturation, transferrin and transaminases. In patients with iron overload, the most frequently found mutation was the homozygous H63D (36.67%). Finally, 93.94% of the patients with HH received phlebotomy treatment, while changes in lifestyle were indicated in 55.93% of patients without HH. Conclusions. Hyperferritinemia is a frequent clinical presentation and it is important to make a systematic approach to identify its causes. Although HH is an important cause of persistent ferritin elevation, in the approach to patients with this condition, more frequent etiologies such as hyperfe-rritinemia of metabolic etiology should be ruled out.

Hemocromatosis: actualización clínica y diagnóstica / Hemochromatosis: clinical and diagnostic update

La hemocromatosis es un desorden en el cual la sobrecarga progresiva de hierro puede llevar a complicaciones sistémicas con gran morbimortalidad. Es una entidad clinicopatológica, con múltiples genes comprometidos y una fisiopatología común, con una expresión clínica y fenotípica variable, que depende de múltiples factores, tanto individuales como ambientales. Para su diagnóstico y seguimiento adecuado es necesario tener en cuenta elementos clínicos, bioquímicos y moleculares. En esta revisión, se presentan las generalidades de la hemocromatosis, además de sus mecanismos fisiopatológicos y moleculares, teniendo en cuenta su valor para el diagnóstico de la enfermedad. Adicionalmente, se describe la clasificación y un algoritmo diagnóstico propuestos recientemente por grupos de trabajo de expertos, así como las opciones de manejo y seguimiento de los pacientes con hemocromatosis

Hemochromatosis is a disorder in which progressive iron overload may lead to systemic complications with potential morbidity and mortality. It is a clinicopathologic entity that involves multiple genes and common pathophysiology, and has a variable clinical and phenotypic expression that depends on several individual and environmental factors. To make the diagnosis and perform a proper follow-up, clinical, biochemical, and molecular elements must be considered. This review aims to present the general characteristics of hemochromatosis, its molecular and pathophysiologic mechanisms, and their significance in the diagnosis of this disorder. In addition, a new classification and a proposed diagnostic algorithm by an expert working group are described, as well as management and follow-up options for patients with hemochromatosis

Cenário das políticas públicas para hemocromatose hereditária no Brasil / Public policy scenario for hereditary hemochromatosis in Brazil

Resumo Hemocromatose hereditária (HH) é a doença genética mais comum em descendentes de europeus e sua epidemiologia em nosso país é incerta. Considerando o cenário das políticas públicas em HH no mundo contemporâneo, este artigo propõe uma reflexão sobre o tema, com objetivo de fazer uma revisão bibliográfica narrativa sobre a abordagem adotada para essa doença em países desenvolvidos e a nível nacional. Além disso, discute sobre o custo-benefício da incorporação do índice de saturação da transferrina (ST) e ferritina sérica (FS) no nosso sistema de saúde, com a finalidade de identificar a HH antes que surjam suas complicações, bem como seu rastreio em campanhas nacionais de prevenção. O valor gasto para o screening da HH com dosagem de ST e FS pelo Sistema Único de Saúde (SUS) é muito menor do que os custos gerados quando o dano por excesso de ferro já está estabelecido. Nos casos suspeitos de HH, deveria ser viabilizada pelo SUS a pesquisa da mutação genética para o gene HFE, que atualmente só está disponível de forma privada. Com essas medidas, modifica-se a história natural da doença, reduzindo a morbimortalidade dos portadores e custos ao sistema público de saúde.

Abstract Hereditary hemochromatosis (HH) is the most common genetic disease among European descendants and its epidemiology in Brazil is unclear. Considering the contemporary public policy scenario aimed at HH, this narrative bibliographic review reflects on the approach adopted for this disease at the national level in developed countries. It also discusses the cost-effectiveness of incorporating transferrin saturation (TS) and serum ferritin (SF) indexes in the Brazilian healthcare system for early HH identification, as well as its screening in national prevention campaigns. The amount spent on ST- and FS-based HH screening by the Brazilian National Health System (SUS) is much lower than the costs generated by the already established iron overload. In suspected cases, genetic mutation research of the HFE gene, which is currently only performed privately, should be made available by the SUS. These measures can modify the natural history, reducing HH morbidity and mortality and its costs to the public health system.

Hyperferritinemic sepsis secondary to invasive Toxoplasma gondii in a child with untreated HIV / Sepsis hiperferritinémica secundaria a Toxoplasma gondii invasiva en un paciente pediátrico con virus de inmunodeficiencia humana sin tratamiento

Abstract Background: Untreated human immunodeficiency virus (HIV)-immunosuppressed pediatric patients show high morbidity and mortality from opportunistic infections. Limited cases of hyperferritinemic sepsis have been described in patients with toxoplasmosis. Case report: We describe the case of a 13-year-old female patient with a history of untreated HIV who presented with hyperferritinemic sepsis secondary to Toxoplasma gondii infection and Pneumocystis jirovecci pneumonia. She received ventilatory support, inotropic drugs, treatment for opportunistic germs, and high-dose corticosteroids, but with unfavorable evolution. Conclusions: The global approach to sepsis with elevated ferritin guides to using of therapies aimed at neutralizing the severe inflammatory response. A timely diagnosis would allow prompt treatment and minimize complications.

Resumen Introducción: Los pacientes pediátricos inmunodeprimidos por el virus de la inmunodeficiencia humana (VIH) sin tratamiento presentan una elevada morbilidad y mortalidad por infecciones oportunistas. Se han descrito limitados casos de sepsis hiperferritinémica en pacientes con toxoplasmosis. Caso clínico: Se describe el caso de una paciente de 13 años con antecedente de VIH sin tratamiento que presentó sepsis hiperferritinémica secundaria a una infección por Toxoplasma gondii y neumonía por Pneumocystis jirovecci. Recibió soporte ventilatorio, uso de inotrópicos, tratamiento para gérmenes oportunistas y corticoides en altas dosis, pero su evolución fue desfavorable. Conclusiones: El abordaje global de la sepsis con ferritina elevada orienta a utilizar terapias dirigidas a neutralizar la respuesta inflamatoria severa, por lo que un diagnóstico oportuno permitiría iniciar el tratamiento prontamente y minimizar las complicaciones.

Hierro: desde la homeostasis a la muerte por ferroptosis / Iron: from normal homeostasis to death by ferroptosis

Resumen El hierro (Fe) es un elemento vital para casi todos los organismos debido a su facilidad para donar y aceptar electrones. Es cofactor de muchas proteínas y enzimas necesarias para la adecuada utilización del oxígeno y la generación de energía. Su desregulación se relaciona a procesos de estrés oxidativo y muerte celular mediada por Fe(II) denominada ferroptosis. Las células de mamíferos utilizan múltiples mecanismos para garantizar la adquisición del hierro como nutriente esencial, que se encuentra oxidado [Fe(III)], y que debe ser reducido a Fe(II) para su adecuada utilización intracelular. Cada etapa de transferencia del hierro a través de las membranas biológicas exige una reconversión de su estado de oxidado a reducido y viceversa, dependiendo del paso metabólico implicado. La distorsión de dichos procesos se asocia con varias enfermedades: desde la deficiencia de hierro debida a defectos en la adquisición o distribución del metal, que causa anemia, a la sobrecarga de hierro que resulta de una absorción excesiva de hierro o en una utilización defectuosa, que causa una sobreoferta de Fe(II) en los tejidos y que lleva a un daño oxidativo y a la muerte celular. Existen múltiples mecanismos regulatorios que en conjunto aseguran el equilibrio en la homeostasis del hierro. Esta actualización describe los avances recientes en las vías reguladoras del hierro, así como en los mecanismos subyacentes al tráfico de dicho elemento desde su absorción, principalmente biodistribución y su uso intracelular, quizás el área más importante donde se define su adecuada utilización o la muerte celular por ferroptosis.

Abstract Iron (Fe) is a vital element for almost all organisms due to its ability to donate and accept electrons with relative ease. It serves as a cofactor for many proteins and enzymes necessary for the proper use of oxygen and energy generation, and its deregulation is related to the processes of oxidative stress and iron-mediated cell death called ferroptosis. Mammalian cells use multiple mechanisms to ensure the acquisition of iron as an essential nutrient, which is normally oxidised in the form of Fe(III) and must be reduced to Fe(II) for adequate intracellular use. Each stage of iron transfer across biological membranes requires a reconversion of its state from oxidised to reduced and vice versa, depending on the metabolic step involved. Distortion of these processes is associated with various diseases, such as iron deficiency due to defects in the acquisition or distribution of the metal that causes anemia, as well as iron overload from excessive iron absorption or defective use, which results in an oversupply of Fe(II) in tissues leading to oxidative damage and cell death. There are multiple regulatory mechanisms that together ensure the balance in iron homeostasis. This update describes the recent advances in the iron regulatory pathways, as well as in the mechanisms underlying iron trafficking from its absorption, mainly biodistribution and its intracellular use, perhaps the most important area where its adequate utilisation or cell death by ferroptosis is defined.

Resumo O ferro (Fe) é um elemento vital para quase todos os organismos devido à sua capacidade de doar e aceitar elétrons com relativa facilidade. O ferro serve como cofator para muitas proteínas e enzimas necessárias para o uso adequado do oxigênio e geração de energia, e a sua desregulação está relacionada a processos de estresse oxidativo e morte celular mediada por Fe(II) denominado ferroptose. As células de mamíferos utilizam múltiplos mecanismos para garantir a aquisição de ferro como nutriente essencial, que normalmente é oxidado na forma de Fe(III) e deve ser reduzido a Fe(II) para o uso intracelular adequado. Cada estágio de transferência de Fe através das membranas biológicas requer uma reconversão de seu estado de oxidado para reduzido e vice-versa, dependendo da etapa metabólica envolvida. A distorção desses processos está associada a várias doenças: desde a deficiência de ferro devido a defeitos na aquisição ou distribuição do metal que causa a anemia, até a sobrecarga de ferro resultante da absorção excessiva de ferro ou utilização defeituosa, que causa um excesso de oferta de Fe(II) nos tecidos levando ao dano oxidativo e morte celular. Existem múltiplos mecanismos regulatórios que juntos garantem o equilíbrio na homeostase do ferro. Esta atualização descreve os avanços recentes nas vias reguladoras do ferro, bem como nos mecanismos subjacentes ao tráfico deste elemento desde a sua absorção, principalmente biodistribuição e seu uso intracelular, talvez a área mais importante onde sua utilização adequada ou morte celular por ferroptose é definido.

Iron Salts, High Levels of Hemoglobin and Ferritin in Pregnancy, and Development of Gestational Diabetes: A Systematic Review / Sais de ferro, níveis elevados de hemoglobina e ferritina na gravidez e o desenvolvimento de diabetes gestacional: Uma revisão sistemática

Abstract Objective The aim of this study was to systematically review literature on the use of iron supplements (not including iron derived from diet), increased levels of hemoglobin and/or ferritin, and the risk of developing gestational diabetes mellitus (GDM). Data source The following databases were searched, from the study's inception to April 2021: PUBMED, Cochrane, Web of Science, Scopus, Embase, Cinahl and Lilacs. Selection of studies A total of 6,956 titles and abstracts were reviewed, 9 of which met the final inclusion criteria, with 7,560 women in total. Data collection Data extraction was performed by two independent reviewers and disagreements were resolved by a third researcher. Data synthesis Methodological quality in controlled trials were assessed according to the Cochrane Collaboration tools (ROB-2 and ROBINS-1) and for the observational studies, the National Institutes of Health's (NIH) quality assessment tool was used. Among the 5 observational studies, women with a higher hemoglobin or ferritin level were more likely to develop GDM when compared with those with lower levels of these parameters. Among the 3 randomized clinical trials, none found a significant difference in the incidence of GDM among women in the intervention and control groups. However, we identified many risks of bias and great methodological differences among them. Conclusion Based on the studies included in this review, and due to the important methodological problems pointed out, more studies of good methodological quality are needed to better establish the association between iron supplementation and GDM.

Resumo Objetivo O objetivo deste estudo foi revisar sistematicamente a literatura sobre o uso de suplementos de ferro (não incluindo o ferro derivado da dieta), aumento dos níveis de hemoglobina e/ou ferritina e o risco de desenvolver diabetes mellitus gestacional (DMG). Fontes dos dados as bases de dados PUBMED, Cochrane, Web of Science, Scopus, Embase, Cinahl e Lilacs foram pesquisadas até abril de 2021. Seleção dos estudos Foram revisados 6.956 títulos e resumos, dos quais 9 preencheram os critérios finais de inclusão, totalizando 7.560 mulheres. Coleta de dados A extração de dados foi realizada por dois revisores independentes e as divergências foram resolvidas por um terceiro revisor. Síntese dos dados A qualidade metodológica dos ensaios controlados foi avaliada de acordo com as ferramentas da Colaboração Cochrane (ROB-2 e ROBINS-1) e para os estudos observacionais, foi utilizada a ferramenta de avaliação de qualidade do National Institutes of Health (NIH). Entre os 5 estudos observacionais, as mulheres com maiores níveis de hemoglobina ou ferritina apresentaram maior probabilidade de desenvolver DMG quando comparadas àquelas com níveis mais baixos nesses parâmetros. Entre os 3 ensaios clínicos randomizados, nenhum deles encontrou diferença significativa na incidência de DMG entre as mulheres dos grupos de intervenção e controle. No entanto, identificamos muitos riscos de viés e enormes diferenças metodológicas entre eles. Conclusão Com base nos estudos incluídos nesta revisão e devido aos importantes problemas metodológicos apontados, são necessários mais estudos de boa qualidade metodológica para melhor estabelecer a associação entre suplementação de ferro e DMG.

Eventos trombóticos y marcadores inflamatorios en pacientes con neumonía grave por síndrome respiratorio agudo severo coronavirus-2 (SARS-CoV-2) / Thrombotic events and inflammatory markers in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) / Eventos trombóticos e marcadores inflamatórios em pacientes com pneumonia grave devido à síndrome respiratória aguda grave coronavirus-2 (SARS-CoV-2)

Resumen: Introducción: La neumonía por SARS-CoV-2 se asocia a secreción importante de citoquinas y aglomeramiento de células inmunológicas, que activan las células endoteliales condicionando coagulopatía, afectando al pulmón en una fase temprana, con un fenotipo clínico del síndrome de dificultad respiratoria aguda (SDRA), que posteriormente progresa a respuesta inflamatoria sistémica desregulada por marcadores inflamatorios que causan mayor lesión endotelial generando trombosis. Muchos pacientes presentan niveles elevados de dímero D (DD), así como de proteína-C-reactiva (PCR), interleucina-6 (IL-6) y ferritina, supeditando la formación de coágulos, con la interrupción de la circulación (arterial o venosa) a cualquier nivel del sistema circulatorio. Objetivos: Determinar si existe relación entre los niveles elevados de marcadores inflamatorios y eventos trombóticos en pacientes con neumonía por SARS-CoV-2 con ventilación mecánica invasiva (VMI). Material y métodos: Realizamos estudio de una cohorte, observacional, retrospectivo y longitudinal, en pacientes que ingresaron a la Unidad de Terapia Respiratoria del Centro Médico ABC, de abril a julio de 2020, con diagnóstico de neumonía por SARS-CoV-2 con VMI. Utilizamos el programa STATA para el análisis estadístico. Efectuamos un análisis lineal de medidas repetitivas por regresión logística para evaluar el comportamiento cronológico de las variables inflamatorias. Posteriormente, ajustamos los marcadores inflamatorios con variables demográficas, para la obtención de certeza diagnóstica y predicción de riesgo de eventos trombóticos. Resultados: Analizamos un total de 100 pacientes, predominando el sexo masculino en 78%. El 18% presentó trombosis. Inicialmente, los marcadores inflamatorios estadísticamente significativos fueron DD (p = 0.010) con niveles de 1375.5 ng/mL (967-2651) y ferritina (p = 0.030) con niveles 1391.5 ng/mL (622-1779). Con el ajuste de variables inflamatorias por edad, género, índice de masa corporal (IMC) y escalas de gravedad, las variables estadísticamente significativas fueron DD (p = 0.001) y ferritina (p = 0.004), obteniendo certeza diagnóstica de 80.57% para predecir el riesgo de eventos trombóticos. Conclusión: El control estricto de los parámetros de laboratorio y un alto índice de sospecha son vitales para formular un enfoque de tratamiento personalizado para los pacientes, y también pueden ayudar a clasificar a los pacientes con alto riesgo de presentar eventos trombóticos. Nuestro modelo enfatiza que hay que tener precaución con niveles elevados de DD y ferritina.

Abstract: Introduction: SARS-CoV-2 pneumonia is associated with an important secretion of cytokines and agglomeration of immune cells, which activate endothelial cells conditioning coagulopathy, affecting the lung at an early stage, with a clinical phenotype of Acute Respiratory Distress Syndrome (ARDS), which later progresses to a systemic inflammatory response deregulated by inflammatory markers that cause greater endothelial injury generating thrombosis. Many patients present high levels of D-dimer (DD), as well as C-reactive protein (CRP), interleukin-6 (IL-6) and ferritin, subordinating the formation of clots, with the interruption of circulation (arterial or venous) at any level of the circulatory system. Objectives: To determine if there is a relationship between elevated levels of inflammatory markers and thrombotic events in patients with SARS-CoV-2 pneumonia with invasive mechanical ventilation (IMV). Material and methods: We conducted an observational, retrospective and longitudinal cohort study in patients admitted to the Respiratory Therapy Unit of the ABC Medical Center, from April to July 2020, with a diagnosis of SARS-CoV-2 pneumonia with IMV. We use the STATA program for statistical analysis. We performed a linear analysis of repetitive measures by logistic regression to evaluate the chronological behavior of the inflammatory variables. Subsequently, we adjusted the inflammatory markers with demographic variables, to obtain diagnostic certainty and prediction of risk of thrombotic events. Results: We analyzed a total of 100 patients, the male sex prevailing in 78%. 18% had thrombosis. Initially the statistically significant inflammatory markers were DD (p = 0.010) with levels of 1375.5 ng/mL (967-2651) and ferritin (p = 0.030) with levels 1391.5 ng/mL (622-1779). With the adjustment of inflammatory variables by age, gender, Body Mass Index (BMI) and severity scales, the statistically significant variables were DD (p = 0.001) and ferritin (p = 0.004), obtaining a diagnostic certainty of 80.57% to predict risk of thrombotic events. Conclusion: Tight control of laboratory parameters and a high index of suspicion are vital to formulating a personalized treatment approach for patients, and can also help classify patients at high risk for thrombotic events. Our model emphasizes that caution must be exercised with elevated levels of DD and ferritin.

Resumo: Introdução: A pneumonia por SARS-CoV-2 está associada à secreção significativa de citocinas e aglomeração de células imunes, que ativam as células endoteliais, causando coagulopatia, afetando o pulmão em estágio inicial, com um fenótipo clínico de Síndrome do Desconforto Respiratório Agudo (SDRA), que posteriormente progride para uma resposta inflamatória sistêmica desregulada por marcadores inflamatórios que causam maior lesão endotelial gerando trombose. Muitos pacientes apresentam níveis elevados de D-dímero (DD), bem como de proteína C-reativa (PCR), Interleucina-6 (IL-6) e ferritina, causando formação de coágulos, com interrupção da circulação (arterial ou venosa) em qualquer nível do sistema circulatório. Objetivos: Determinar se existe uma relação entre níveis elevados de marcadores inflamatórios e eventos trombóticos em pacientes com pneumonia por SARS-CoV-2 com ventilação mecânica invasiva (VMI). Material e métodos: Foi realizado um estudo de coorte observacional, retrospectivo e longitudinal em pacientes internados na Unidade de Terapia Respiratória do Centro Médico ABC, de abril a julho de 2020, com diagnóstico de pneumonia por SARS-CoV-2 com VMI. Usamos o programa STATA para análise estatística. Realizamos uma análise linear de medidas repetitivas por regressão logística para avaliar o comportamento cronológico das variáveis inflamatórias. Posteriormente, ajustamos os marcadores inflamatórios com variáveis demográficas, para obter certeza diagnóstica e predizer o risco de eventos trombóticos. Resultados: Analisamos um total de 100 pacientes, com predominância do sexo masculino em 78%. 18% apresentaram trombose. Inicialmente, os marcadores inflamatórios estatisticamente significativos foram DD (p = 0.010) com níveis de 1375.5 ng/mL (967-2651) e ferritina (p = 0.030) com níveis de 1391.5 ng/mL (622-1779). Com o ajuste das variáveis inflamatórias por idade, sexo, índice de massa corporal (IMC) e escalas de gravidade, as variáveis estatisticamente significativas foram DD (p = 0.001) e ferritina (p = 0.004), obtendo-se certeza diagnóstica de 80.57% para predizer o risco de eventos trombóticos. Conclusão: O controle estrito dos parâmetros laboratoriais e um alto índice de suspeita são vitais na formulação de uma abordagem de tratamento personalizado para os pacientes, e também podem ajudar a classificar os pacientes com alto risco de apresentar eventos trombóticos. Nosso modelo enfatiza que deve-se ter cautela com níveis elevados de DD e ferritina.

Validación de un método analítico para cuantificación de ferritina en líquido cefalorraquídeo / Validation of an analytical method for the quantification of ferritin in cerebrospinal fluid

Resumen La ferritina es una proteína de gran tamaño que se encuentra fisiológicamente en el líquido cefalorraquídeo (LCR) en concentraciones de 2-10 ng/mL. Su elevación puede utilizarse como biomarcador en distintas condiciones patológicas. El procedimiento de validación tradicional para la medición en LCR no puede ser utilizado debido a la ausencia de controles y calibradores comerciales para esta matriz. El objetivo de este trabajo fue llevar a cabo una validación analítica de ferritina en LCR. Se realizaron ensayos de estimación de precisión y veracidad mediante el protocolo EP15-A3, linealidad por el protocolo EP6-A (ambos de la guía de la CLSI), recuperación, estabilidad, contaminación por arrastre, interferencia por hemólisis y bilirrubina y límite de detección (LoD). La ferritina en LCR en el autoanalizador DxI 800 de Beckman Coulter tuvo una performance intra e interensayo <3,7%, el ensayo denota linealidad en el intervalo de 2,1-547 ng/mL; se estableció estabilidad por un período de 5 días y la recuperación resultó ser aceptable. No se evidenció efecto de contaminación por arrastre ni interferencia por hemólisis hasta un rango entre 300-500 mg/dL de hemoglobina, ni interferencia por bilirrubina hasta una concentración de 16,0 mg/dL de bilirrubina total. El LoD fue de 0,4 ng/mL. Por medio de los ensayos realizados se logró validar la ferritina en LCR a partir de la utilización de pools de muestras, lo que pudo garantizar la confiabilidad y exactitud del método analítico.

Abstract Ferritin is a large protein physiologically present in the cerebrospinal fluid (CSF) in concentrations of 2-10 ng/mL. Its elevation can be used as a biomarker in several pathological conditions. The traditional validation procedure for measurement in CSF cannot be used due to the absence of commercial controls and calibrators for this matrix. The objective of the present study was to perform CSF ferritin analytical validation. Assays such as precision and accuracy estimation through the EP15-A3 protocol, linearity according to the EP6-A protocol (both from the CLSI guidelines), recovery, stability, carry-over, hemolysis and bilirubin interference and limit of detection (LoD) were conducted. Serum samples with different concentrations of ferritin were added to aliquots of a normal CSF pool. CSF ferritin in the Beckman Coulter DxI 800 had a <3.7% intra and inter-assay performance, the assay shows linearity in the 2.1 -547 ng/mL interval, stability was established for a 5-day period and the recovery was acceptable. There was neither carry-over effect or hemolysis interference up to a range of 300-500 mg/dL of hemoglobin, nor interference by bilirubin up to 16.0 mg/dL of total bilirubin. The LoD was 0.4 ng/mL. By means of the performed assays, CSF ferritin was validated by using sample pools, thereby ensuring the reliability and accuracy of the analytical method.

Resumo A ferritina é uma grande proteína fisiologicamente encontrada no líquido cefalorraquidiano (LCR) em concentrações de 2 a 10 ng/mL. Sua elevação pode ser usada como biomarcador em diferentes condições patológicas. O procedimento de validação tradicional para medição no LCR não pode ser usado devido à ausência de controles e calibradores comerciais para esta matriz. O objetivo deste estudo foi realizar uma validação analítica da ferritina no LCR. Foram realizados estudos de precisão e veracidade utilizando o protocolo EP15-A3, linearidade pelo protocolo EP6-A (ambos das diretrizes do CLSI), recuperação, estabilidade, contaminação transportada, interferência de hemólise e bilirrubina e limite de detecção (LoD). A ferritina no LCR no DxI 800 da Beckman Coulter teve um desempenho intra e inter-ensaio <3,7%, o ensaio denota linearidade na faixa de 2,1-547 ng/mL, a estabilidade foi estabelecida em um período de 5 dias e a recuperação foi considerado aceitável. Nenhum efeito de transporte ou interferência por hemólise foi evidenciado até um intervalo entre 300-500 mg/dL de hemoglobina, nem interferência pela bilirrubina até uma concentração de 16,0 mg/dL de bilirrubina total. O LoD foi de 0,4 ng/mL. Através dos testes realizados, a ferritina no LCR foi validada, com base no uso de pool de amostras, o que poderia garantir a confiabilidade e a acurácia do método analítico.

Relação entre os níveis de ferritina e o prognóstico da COVID-19 / Relationship between ferritin levels and the prognosis of COVID-19

O elevado nível de ferritina sérica tem sido associado à COVID-19 grave devido à sua estimulação por citocinas relacionadas com o processo inflamatório. Embora este aumento seja esperado, esta revisão propõe analisar o quão elevado o nível de ferritina pode estar relacionado com esta severidade. Nesta linha de pensamento, a hiperferritinemia na COVID-19 poderia ser um importante fator de previsão e outra forma de compreender as complicações da COVID-19 - coagulopatia, síndrome do desconforto respiratório agudo (SDRA). Além disso, esta correlação tem sido vista como uma possível quinta síndrome entre as outras "síndromes hiperferritinêmicas", todas caracterizadas por ferritina sérica elevada; esta é uma comparação e análise pertinente em termos de tratamentos. [au]

The high level of serum ferritin has been associated with severe COVID-19 due to its stimulation by cytokines related to the inflammatory process. Although this increase is expected, this review proposes to analyze how high ferritin can be related to this severeness. According to this premise, the hyperferritinemia on COVID-19 could be an important factor of prediction and another way to understand the complications of COVID-19 -coagulopathy, acute respiratory distress syndrome (ARDS). Furthermore, this correlation has been seen as a possible fifth syndrome among the other "hyperferritinemic syndromes", which are all characterized by high serum ferritin; this is an pertinent comparison and analyzation in terms of treatments. [au]

Interleucina-6 versus Ferritina, Dímero-D en el síndrome de liberación de citocinas, en pacientes críticos Covid-19

Introducción: La inexistencia de una definición clara del síndrome de liberación de citocinas (SLC), permitió a este estudio, analizar la utilidad de la interleucina-6 (IL-6), ferritina y dímero-D (DD) con otras variables y su evolución clínica. Métodos: Se realizó un estudio prospectivo, observacional y analítico, desde octubre del 2020 hasta julio 2021, en 125 pacientes de la Unidad de Terapia Intensiva (UTI) del Hospital Obrero Nro. 2 de la Caja Nacional de Salud, Cochabamba-Bolivia; se solicitaron los tres marcadores y otros exámenes, para determinar correlaciones, sobrevida y relación con el SLC. Resultados: La media de ferritina fue 1193,7±814,8 ng/ml, del dímero-D 1427±1005 ng/ml y de la IL-6 58,5±34,1 pg/mL; no se constató asociación estadística entre estos marcadores, si un Rho de Spearman de 0,5 entre la ferritina y DD (p<0,05) en pacientes que fallecieron, además de asociaciones entre sexo masculino y ferritina; entre el DD y disnea; y la IL-6 con traqueostomía. La sobrevida fue 9 días IC 95% (8,02-9,98) con valores similares del DD y ferritina, tanto con los niveles normales y elevados. Los valores del área bajo la curva (ABC) no mostraron predicción en la mortalidad, si una tasa del 70%. La sobrevida en los que no padecieron un síndrome de distrés respiratorio agudo (SDRA) fue mejor, con ocho días (p=0,011). Discusión: No es posible relacionar al SLC con la IL-6, DD y ferritina, menos definirla con fiebre, leucocitosis, fallo renal, traqueostomía, por los valores heterogéneos de la IL-6 en relación con el COVID-19 y otras patologías inflamatorias; aún queda en duda la postura de una enfermedad hipoinflamatoria más que una hipercitocinemia.

Introduction: The lack of a clear definition of cytokine release syndrome (CRS) allowed this study to analyze the utility of interleukin-6 (IL-6), ferritin, and D-dimer (DD) with other variables and their clinical evolution. Methods: A prospective, observational, and analytical study was conducted from October 2020 to July 2021 in 125 patients in the intensive care unit (ICU) of Hospital Obrero Nro. 2 of the Caja Nacional de Salud in Cochabamba, Bolivia. The three markers and other exams were requested to determine correlations, survival, and relationship with CRS. Results: The mean ferritin was 1193.7±814.8 ng/ml, D-dimer 1427±1005 ng/ml, and IL-6 58.5±34.1 pg/mL. No statistical association was found between these markers, but a Spearman's Rho of 0.5 between ferritin and DD (p<0.05) was found in patients who died. In addition, there were associations between male gender and ferritin, DD and dyspnea, and IL-6 and tracheostomy. Survival was 9 days 95% CI (8.02-9.98) with similar values of DD and ferritin for both normal and elevated levels. The values of the area under the curve (AUC) did not show prediction of mortality, but a rate of 70%. Survival was better in those who did not suffer from acute respiratory distress syndrome (ARDS), with eight days (p=0.011). Conclusions: It is not possible to relate CRS to IL-6, DD, and ferritin, or to define it with fever, leukocytosis, renal failure, tracheostomy, due to the heterogeneous values of IL-6 in relation to COVID-19 and other inflammatory pathologies. The position of a hypoinflammatory disease rather than a hypercytokinemia remains in doubt.

Evolución clínica de pacientes internados con cáncer e infección por COVID-19 / Clinical outcomes in cancer patients hospitalized with COVID-19

Resumen Los pacientes con cáncer y COVID-19 tienen más complicaciones que la población general. Comunicamos una cohorte de 74 pacientes con cáncer y COVID-19 internados en una institución on cológica. El 87.8% tenía diagnóstico de tumores sólidos y 12.2% oncohematológicos. Entre los tumores sólidos, el 61.5% presentó enfermedad metastásica. El 78.3% (N = 58) tenía infiltrados pulmonares al diagnóstico de COVID-19. La infección fue intrahospitalaria en 20 pacientes. Habían recibido tratamiento antineoplásico den tro de los 30 días anteriores al diagnóstico 39 pacientes (52.7%); uno se encontraba recibiendo radioterapia. Veinticuatro pacientes (32.4%) se derivaron a terapia intensiva (UTI) y 18 (75%) de ellos requirieron asistencia respiratoria mecánica (ARM). La mortalidad general durante la internación fue 32.4% (N = 24). La mortalidad en UTI fue 62.5% (N = 15). La mortalidad en ARM fue 72.2% (N = 13). La edad, recuento de neutrófilos, índice neutrófilo/linfocito, dímero D, ferritina, tabaquismo y haber adquirido la infección durante la internación resultaron estadísticamente significativos en el análisis univariado para mortalidad. No hallamos diferencias en mortalidad por estadio de enfermedad, en los pacientes con tumores sólidos, ni por haber recibido tratamiento antineoplá sico dentro de los 30 días del diagnóstico de COVID-19. En el análisis multivariado con el modelo de regresión logística, solo la edad y el tabaquismo fueron predictores de mortalidad. Los odds ratios (IC 95) ajustados para la edad ≥65 años y el tabaquismo fueron 8.87 (1.35-58.02) y 8.64 (1.32-56.64), respectivamente. Este trabajo puede resultar de utilidad para instituciones polivalentes que asistan pacientes oncológicos durante la pandemia.

Abstract Cancer patients are exposed to more complications from COVID-19 than non-cancer patients. We report a cohort of 74 cancer patients (87.8% with solid neoplasia and 12.2% with hematological diseases) with COVID-19 infection admitted to a tertiary medical cancer center in Argentina. Pulmonary infiltrates were diagnosed at admission in 78.3% (N = 58) of the cases. COVID-19 infection was hospital-acquired in 20 (27.0%) patients. Thirty-nine patients (52.7%) received anticancer therapy within the 30 days prior to COVID-19 diagnosis; one was on radiation therapy. Twenty-four (32.4%) patients were admitted in the intensive care unit (ICU) and 18 (75.0%) required mechanical ventilation. All cause in-hospital mortality was 32.4% (N = 24) and ICU mortality was 62.5% (N = 15). Mortality under me chanical ventilation was 72.2% (N = 13). In the univariate analysis age, neutrophil count, neutrophil/lymphocyte index, D-dimer, ferritin, smoking, and nosocomial acquired infection were associated with in-hospital mortality. There were no statistically significant differences in mortality related to disease stage for solid tumors, neither cancer treatment within 30 days of COVID-19 diagnosis. Age and smoking were associated with mortality in the multivariate analysis. The adjusted odds ratios (95 CI) for age ≥ 65 years and smoking were 8.87 (1.35-58.02) and 8.64 (1.32 - 56.64), respectively. Our experience can be useful for other institutions that assist cancer patients during the pandemic.

Factores asociados con inadecuados depósitos de hierro en mujeres en primer trimestre de gestación

RESUMEN Introducción: niveles bajos de ferritina sérica en la gestación se asocian con inadecuados depósitos de hierro, lo cual puede producir anemia, y aumentar el riesgo de mortalidad materna, parto prematuro y deficiencias a largo plazo en el desarrollo cognitivo del neonato. Objetivo: determinar la relación entre factores demográficos, económicos, familiares y de seguridad alimentaria con los inadecuados depósitos de hierro en mujeres en primer trimestre de gestación. Métodos: estudio descriptivo transversal, con 664 mujeres en primer trimestre de gestación. Depósitos de hierro inadecuados se definieron como una concentración de ferritina sérica <30 μg/L. Se estimó la prueba chi cuadrado, se calcularon odds ratio crudas y ajustadas mediante regresión logística binaria. Resultados: La proporción de mujeres con depósitos de hierro inadecuados fue de 32%, promedio geométrico de ferritina de 39,2 μg/L (rango 38,4 - 40,0 μg/L) Las gestantes que no deseaban el embarazo, tuvieron 1,1 veces más posibilidad de tener inadecuados depósitos de hierro comparado con las que si lo deseaban (OR= 2,10 IC95% 1,18-3,74). La inseguridad alimentaria incrementó en un 47% la probabilidad de tener inadecuados depósitos de hierro (OR= 1,47 IC95% 1,02-2,13). El apoyo familiar redujo en un 61% la probabilidad de inadecuados depósitos de hierro (OR= 0,39 IC95% 0,19-0,78). Conclusión: Una de cada tres mujeres presentó inadecuados niveles séricos de ferritina, lo cual se asoció principalmente con factores socioeconómicos y familiares, esto sugiere la necesidad de considerar otros aspectos no clínicos en las intervenciones que se hacen antes del embarazo para mejorar las reservas de hierro.

ABSTRACT Introduction: Low levels of serum ferritin in pregnancy are associated with inadequate iron stores, which can cause anemia and increase the risk of maternal mortality, premature delivery, and long-term deficiencies in the cognitive development of the newborn. Objective: To determine the relationship between demographic, economic, family and food security factors with inadequate iron stores in women in the first trimester of pregnancy. Methods: Descriptive cross-sectional study with 664 women in the first trimester of pregnancy. Inadequate iron stores were defined as a serum ferritin concentration <30 μg / L. The chi-square test was estimated, crude and adjusted odds ratios were calculated using binary logistic regression. Results: The proportion of women with inadequate iron stores was 32%, geometric average of ferritin 39.2 μg/L (rank 38.4 - 40.0 μg/L). Pregnant women who did not want a pregnancy were 1.1 times more likely to have inadequate iron stores compared to those who did (OR= 2.10; 95% CI 1.18-3.74). Food insecurity increased the probability of having inadequate iron stores by 47% (OR= 1.47; 95% CI: 1.02-2.13). Family support reduced the probability of inadequate iron stores by 61% (OR= 0.39; 95% CI 0.19-0.78). Conclusion: One in three women presented inadequate levels of serum ferritin, which was mainly associated with socioeconomic and family factors, this suggests the need to consider other non-clinical aspects in the interventions carried out before pregnancy to improve iron stores.

Prevalencia de anemia en niños de 1 a 4 años de edad en Asunción y Central, Paraguay 2017

RESUMEN Introducción: Los niños constituyen el grupo más afectado por la anemia. En Paraguay no existen datos actualizados sobre prevalencia de anemia en menores de 5 años. Objetivos: Determinar la prevalencia de anemia en niños previamente sanos de 1 a 4 años que acuden a consultorios de servicios de salud y guarderías de Asunción y Central de Paraguay, durante el año 2017. Materiales y Métodos: Estudio prospectivo, de corte transverso, observacional, descriptivo. Muestreo aleatorio, estratificado. Nivel de confianza: 95% Error de muestra: 5%. Variables: edad, sexo, hemoglobina, índices hematimétricos, ferritina, Proteína C reactiva (PCR), albúmina, zPeso/Edad, zPeso/Talla, zTalla/Edad, peso al nacer. Fueron analizadas medidas paramétricas y no paramétricas, χ2. La anemia se definió por criterios OMS para el grupo de 1 a 5 años de edad: Hemoglobina Hb<11 g/dL y Volumen Corpuscular Medio VCM< 72 fL Se utilizó el Programa Anthro v 3.2.2 y SPSS 16.0. Aprobado por Comité de Ética del Instituto de Medicina Tropical, se obtuvo consentimiento informado. Nivel de significancia<0,05. Resultados: Fueron reclutados 806 pacientes. Se determinó Hb, VCM y ferritina en 706 pacientes.327 (46,3%) fueron varones. El promedio de Hb fue 11,9±1,03 g/dL. Volumen corpuscular medio promedio 71,2±26 fL. Se encontraron 83/706 pacientes con anemia (11,8%), 44/83 (53%) fueron microcíticas (VMC<72 fL). PCR negativa 640/706 (90,7%) pacientes. El promedio de albuminemia fue 4,5±0,2 g/dL. El promedio de z Peso/Edad fue 0,29±1,33, z Peso/Talla -0,38±1,52 y el z Talla/Edad fue 0,92±1,64. Ferritina < 12µg/L fue del 17,6 %. No se encontró relación entre el peso al nacer y la anemia [p=0,11. RR: 1,45 (0,6- 2,3)]. La prevalencia de anemia en el grupo de 12 a 23 meses fue del 39 % vs el 6,9 % en preescolares (χ2 p<0,05). Conclusiones: La prevalencia de anemia en lactantes de Asunción y Central constituye un problema de salud pública.

ABSTRACT Introduction: Children are the group most affected by anemia. In Paraguay there are no updated data on the prevalence of anemia in children under 5 years of age. Objectives: To determine the prevalence of anemia in previously healthy children aged 1 to 4 years who presented to health services clinics and nurseries in Asunción and the Central Department, Paraguay, during the year 2017. Materials and Methods: This was a prospective, cross-sectional, observational descriptive study. We used random, stratified sampling. Confidence level: 95% Sample error: 5%. Variables: age, sex, hemoglobin, hematometric indices, ferritin, C-reactive protein (CRP), albumin, z Weight / Age, z Weight / Height, z Height / Age, birth weight. Parametric and non-parametric measures, χ2, were analyzed. Anemia was defined by WHO criteria for the 1 to 5 year-old group: Hemoglobin Hb <11 g / dL and Mean Corpuscular Volume MCV <72 fL The Anthro Program v 3.2.2 and SPSS 16.0 were used. The study was approved by the Ethics Committee of the Institute of Tropical Medicine, and informed consent was obtained. Significance level <0.05. Results: 806 patients were recruited. Hgb, MCV and ferritin were determined in 706 patients. 327 (46.3%) were male. The mean Hgb was 11.9 ± 1.03 g / dL. Mean corpuscular volume 71.2 ± 26 fL. 83/706 patients with anemia (11.8%) were found, 44/83 (53%) were microcytic (MCV <72 fL). Negative CRP 640/706 (90.7%) patients. Average albuminemia was 4.5 ± 0.2 g / dL. The mean of z Weight / Age was 0.29 ± 1.33, z Weight / Height -0.38 ± 1.52 and the z Height / Age was 0.92 ± 1.64. Ferritin <12µg / L was 17.6%. No relationship was found between birth weight and anemia [p = 0.11. RR: 1.45 (0.6-2.3)]. The prevalence of anemia in the 12 to 23 month group was 39% vs 6.9% in preschool children (χ2 p <0.05). Conclusions: The prevalence of anemia in infants from Asunción and the Central Department constitutes a public health problem.

La prevalencia de la deficiencia de hierro se mantuvo estable y la anemia aumentó durante 12 años (2006-2018) en mujeres mexicanas de 20 a 49 años / Prevalence of iron deficiency was stable and anemia increased during 12 years (2006-2018) in Mexican women 20-49 years of age

Resumen Objetivo: Comparar la proporción de mujeres de 20 a 49 años con anemia por deficiencia de hierro (ADH), con deficiencia de hierro (DH) con deficiencia de hierro sin anemia (DHSA) y anemia no DH (ANDH) durante 2006, 2012 y 2018, y sus asociaciones con características sociodemográficas y estado nutricional. Material y métodos: Las Encuestas Nacionales de Salud y Nutrición de 2006, 2012 y 2018-19 usan métodos comparables para medir anemia (hemoglobina capilar) y deficiencia de hierro (DH, ferritina sérica). Ambas mediciones combinadas se compararon por año de encuesta y variables de control mediante regresión multinomial. Resultados: En 2006 la prevalencia global de anemia fue de 14.9% y DH de 29.0%, la de ADH de 8.35%, la de DHSA 20.5%, y ANDH 6.6%; en 2012 la prevalencia global de anemia fue de 13.3%, la de DH 29.6%, de ADH 8.6%, DHSA 21.0% y ANDH 4.7%; en 2018 prevalencia global de anemia fue de 21.4%, de DH 25.7%, ADH 10.5%, 15.2% y ANDH 10.9%. Conclusiones: La presencia global de anemia aumentó 6.5 pp entre 2006 y 2018; la de DHSA disminuyó; ADH no tuvo cambios significativos y el aumento mayor fue de ANDH.

Abstract Objective: To compare the prevalence of women 20-49 years of age with iron deficiency anemia (IDA), iron deficiency with no anemia (IDNA), and non-ID anemia (NIDA) in comparison during 2006, 2012 and 2018, and their association with sociodemographic characteristics and nutritional status. Materials and methods: Ensanut 2006, 2012 and 2018-19 are comparable for measurements of anemia (hemoglobin) and Iron deficiency (ID, by ferritin). Both measurements combined were compared with year of surveys and other dependent variables using a multinomial regression. Results: In 2006, the total prevalence of anemia was 14.9% and ID 29.0%, the prevalence of IDA was 8.35%, of IDNA 20.5%, and NIDA 6.6%; in 2012, the total prevalence of anemia was 13.3%, ID was 9.6%, IDA 8.6%, IDNA 21.0% y NIDA 4.7%; in 2018 total prevalence of anemia was 21.4%, of ID 25.7%, IDA 10.5%, IDNA 15.2% and NIDA 10.9%. Conclusions: The total prevalence of anemia increased 6.5 pp between 2006 and 2018, IDNA reduced, IDA had no significant changes, the mayor increase (4.3 pp) occurred in NIDA.

Increased levels of ferritin on admission predicts intensive care unit mortality in patients with COVID-19

Background: The aim of this study was to evaluate hyperferritinemia could be a predicting factor of mortality in hospitalized patients with coronavirus disease-2019 (COVID-19).MethodsA total of 100 hospitalized patients with COVID-19 in intensive care unit (ICU) were enrolled and classified into moderate (n=17), severe (n=40) and critical groups (n=43). Clinical information and laboratory results were collected and the concentrations of ferritin were compared among different groups. The association between ferritin and mortality was evaluated by logistic regression analysis. Moreover, the efficiency of the predicting value was assessed using receiver operating characteristic (ROC) curve.ResultsThe amount of ferritin was significantly higher in critical group compared with moderate and severe groups. The median of ferritin concentration was about three times higher in death group than survival group (1722.25μg/L vs. 501.90μg/L, p<0.01). The concentration of ferritin was positively correlated with other inflammatory cytokines, such as interleukin (IL)-8, IL-10, C-reactive protein (CRP) and tumor necrosis factor (TNF)-α. Logistic regression analysis demonstrated that ferritin was an independent predictor of in-hospital mortality. Especially, high-ferritin group was associated with higher incidence of mortality, with adjusted odds ratio of 104.97 [95% confidence interval (CI) 2.63–4185.89; p=0.013]. Moreover, ferritin had an advantage of discriminative capacity with the area under ROC (AUC) of 0.822 (95% CI 0.737–0.907) higher than procalcitonin and CRP.ConclusionThe ferritin measured at admission may serve as an independent factor for predicting in-hospital mortality in patients with COVID-19 in ICU. (AU)

Antecedentes: El objetivo de este estudio fue evaluar si la hiperferritinemia podría ser un factor predictivo de la mortalidad en pacientes hospitalizados con enfermedad por coronavirus de 2019 (COVID-19).MétodosSe incluyó un total de 100 pacientes hospitalizados con COVID-19 en la unidad de cuidados intensivos (UCI), clasificándose como grupos moderado (n=17), grave (n=40) y crítico (n=43). Se recopiló la información clínica y de laboratorio, comparándose los niveles de ferritina entre los diferentes grupos. Se evaluó la asociación entre ferritina y mortalidad mediante un análisis de regresión logística. Además, se evaluó la eficacia del valor predictivo utilizando la curva ROC (receiver operating characteristic).ResultadosLa cantidad de ferritina fue significativamente superior en el grupo de pacientes críticos en comparación con el grupo de pacientes graves. La media de concentración de ferritina fue cerca de 3 veces superior en el grupo de muerte que en el grupo de supervivientes (1.722,25μg/L vs. 501,90μg/L, p<0,01). La concentración de ferritina guardó una correlación positiva con otras citoquinas inflamatorias tales como interleucina (IL)-8, IL-10, proteína C reactiva (PRC) y factor de necrosis tumoral (TNF)-α. El análisis de regresión logística demostró que la ferritina era un factor predictivo independiente de la mortalidad intrahospitalaria. En especial, el grupo de ferritina alta estuvo asociado a una mayor incidencia de la mortalidad, con un valor de odds ratio ajustado de 104,97 [intervalo de confianza (IC) del 95% 2,63-4.185,89; p=0,013]. Además, el valor de ferritina tuvo una ventaja de capacidad discriminativa en el área bajo la curva ROC (AUC) de 0,822 (IC 95% 0,737-0,907] superior al de procalcitonina y PRC.ConclusiónEl valor de ferritina medido durante el ingreso puede servir de factor independiente para prevenir la mortalidad intrahospitalaria en los pacientes de COVID-19 en la UCI. (AU)

[Increased levels of ferritin on admission predicts intensive care unit mortality in patients with COVID-19]. / El incremento de ferritina sérica durante el ingreso predice la mortalidad de los pacientes de COVID-19 en Cuidados Intensivos.

BACKGROUND: The aim of this study was to evaluate hyperferritinemia could be a predicting factor of mortality in hospitalized patients with coronavirus disease-2019 (COVID-19). METHODS: A total of 100 hospitalized patients with COVID-19 in intensive care unit (ICU) were enrolled and classified into moderate (n=17), severe (n=40) and critical groups (n=43). Clinical information and laboratory results were collected and the concentrations of ferritin were compared among different groups. The association between ferritin and mortality was evaluated by logistic regression analysis. Moreover, the efficiency of the predicting value was assessed using receiver operating characteristic (ROC) curve. RESULTS: The amount of ferritin was significantly higher in critical group compared with moderate and severe groups. The median of ferritin concentration was about three times higher in death group than survival group (1722.25µg/L vs. 501.90µg/L, p<0.01). The concentration of ferritin was positively correlated with other inflammatory cytokines, such as interleukin (IL)-8, IL-10, C-reactive protein (CRP) and tumor necrosis factor (TNF)-α. Logistic regression analysis demonstrated that ferritin was an independent predictor of in-hospital mortality. Especially, high-ferritin group was associated with higher incidence of mortality, with adjusted odds ratio of 104.97 [95% confidence interval (CI) 2.63-4185.89; p=0.013]. Moreover, ferritin had an advantage of discriminative capacity with the area under ROC (AUC) of 0.822 (95% CI 0.737-0.907) higher than procalcitonin and CRP. CONCLUSION: The ferritin measured at admission may serve as an independent factor for predicting in-hospital mortality in patients with COVID-19 in ICU.

Vitamin D and iron deficiencies in children and adolescents with cerebral palsy. / Deficiencia de vitamina D y de hierro en niños y adolescentes con parálisis cerebral.

INTRODUCTION: Children and adolescents with cerebral palsy (CP) are at a greater risk of malnutrition and micronutrient deficiencies. Two deficiencies that we can study and treat are vitaminD (VD) and iron deficiencies; however, no studies have described these deficiencies in Chile. OBJECTIVE: To describe the status of VD and iron in patients with CP and evaluate the relationship with certain factors associated with deficiencies of these micronutrients. PATIENTS AND METHOD: We performed a descriptive, cross-sectional study including 69 patients aged between 2 and 21years, from two public hospitals. Data were obtained on demographic variables, motor function, use of feeding tube, and pharmacological treatment. We performed a nutritional assessment according to patterns of CP and determined 25-hydroxyvitaminD (25[OH]D) ferritin, and albumin levels. RESULTS: Patients' mean age was 11.1±4.9years; 43 (62.3%) were male; and 56 (81.2%) had moderate-to-severe CP. Thirty-five (50.7%) used a nasogastric tube and/or gastrostomy; 15.4% were underweight and 73.8% were eutrophic, all with normal height. Twenty (29%) and 4 patients (6.2%) received VD and iron supplementation, respectively. Albuminaemia was normal in all patients. Mean 25(OH)D level was 24.3±8.8ng/mL; 33 patients (47.8%) had insufficiency and 21 (30.4%) deficiency; 36 patients (52.2%) had low ferritin levels. There was no association between 25(OH)D level and the other variables studied. Low ferritin levels were found to be associated with older age (P=.03), being male (P=.006), and feeding tube use (P=.006). CONCLUSIONS: The patients studied mainly had moderate-to-severe CP, with a high frequency of suboptimal VD values and low plasma ferritin; few patients received VD and/or iron supplementation. We suggest monitoring 25(OH)D and ferritin levels due to the high rate of deficiency of these nutrients; public hospitals should be equipped with drugs to treat these deficiencies.