Red cell distribution width is associated with cardiovascular risk in adults / A medida da amplitude da distribuição do tamanho dos eritrócitos está associada ao risco cardiovascular em adultos

Abstract Red cell distribution width (RDW) is a measure of erythrocyte size variability. Recent studies have shown that RDW is a predictive, and prognostic marker of mortality and cardiovascular (CVD) events in the general population and in CVD patients. This study aimed to investigate the association between RDW and CVD risk in a large sample of adults. A subsample of CVD free participants of the ELSA-Brasil cohort were included (n=4,481). In the cross-sectional approach, multiple regression analysis was used to investigate the association between RDW and the Framingham Risk Score (FRS). Linear mixed effect model evaluated whether baseline RDW predicted changes in CVD risk after about four-year follow up. Cross-sectional analysis showed that RDW was independently associated with FRS, participants in the fourth-quartile of RDW distribution had a 29% higher FRS than those in the first-quartile RDW (p<0.001). A longitudinal analysis revealed that RDW remained associated with increased FRS. In this large cohort of adult Brazilians, RDW was independently associated with increased CVD risk, as measured by the FRS, both at baseline and after four-year follow-up. However, RDW did not predict change in CVD risk in this short-term follow up.

Resumo Estudos recentes têm mostrado que o RDW (do inglês Red Cell Distribution Width) é um marcador preditivo e prognóstico de mortalidade e eventos cardiovasculares (DCV) na população geral e em pacientes com DCV. Este estudo teve como objetivo investigar a associação entre RDW e risco de DCV em uma grande amostra de adultos. Foram incluídas uma subamostra de participantes sem DCV da coorte ELSA-Brasil (n=4.481). Na abordagem transversal, a análise de regressão múltipla foi usada para investigar a associação entre o RDW e o Escore de Risco de Framingham (ERF). O modelo linear de efeito misto foi usado para avaliar se o RDW basal previa mudanças no risco de DCV após cerca de quatro anos de acompanhamento. A análise transversal mostrou que o RDW foi independentemente associado ao ERF, os participantes no quarto quartil da distribuição do RDW tiveram um ERF 29% maior do que aqueles no primeiro quartil RDW (p<0,001). Na análise longitudinal, o RDW permaneceu associado ao aumento do ERF. Nesta grande coorte de adultos brasileiros, o RDW foi independentemente associado ao aumento do risco de DCV, medido pelo ERF, tanto no início quanto após quatro anos de acompanhamento. No entanto, RDW não previu mudança no risco de DCV neste seguimento de curto prazo.

Biometria corporal e parâmetros hematológicos de Trachemys scripta elegans e Trachemys dorbignyi (Testudines: Emydidae) criadas em cativeiro em Petrolina, Pernambuco / Body biometry and hematological parameters of Trachemys scripta elegans and Trachemys dorbignyi (Testudines: Emydidae) reared in captivity in Petrolina/PE, Brazil

Este estudo objetivou avaliar a biometria corporal e o perfil hematológico de Trachemys scripta elegans (N=28) e de Trachemys dorbignyi (N=22) criadas em cativeiro na região do submédio do Vale do São Francisco, semiárido nordestino brasileiro, visando estabelecer valores sanguíneos básicos de saúde e gerar dados úteis na fisiologia comparativa de Testudines. Após 120 dias de adaptação e jejum de 24 horas, 2,5 mL de sangue foram coletados do seio occipital dorsal e depositados em tubo com heparina sódica para a avaliação, na sequência, dos níveis hematologicos. A contagem total de eritrócitos (CTE) e global de leucócitos (CGL) foi realizada em câmara de Neubauer; a dosagem de hemoglobina (HGB) pelo método da método da cianometahemoglobina e o hematócrito (HCT) através da técnica do microhematócrito. A partir da CTE estabeleceram-se matematicamente os índices hematimétricos. A biometria corporal também foi avaliada: a) massa corporal (MC, g); b) dimensões máximas da carapaça [comprimento (CMC, cm) e largura (LMC, cm)];c) dimensões máximas do plastrão [comprimento (CMP, cm) e largura (LMP, cm)]; d) comprimento total da cauda (CTC, cm); e) comprimento linear da base da cauda ao orifício cloacal (CprC, cm); f) comprimento linear do orifício cloacal a extremidade da cauda(CpoC, cm). T. scripta elegans apresentaram valores maiores (P < 0,05) para a biometria corporal, enquanto que o CTC e CprC foram maiores (P<0,05) em T dorbignyi. Os níveis hematológicos não diferiram (P>0,05) entre as espécies. Os resultados demostram que a maior parte da variação observada entre T. scripta elegans e T. dorbignyi é explicada pelas variáveis biométricas e que algumas correlações hematológicas caracterizam diferenças interespecíficas. Conclui-se que os resultados lançam luz sobre valores de referência para estas espécies mantidas em cativeiro na região do semiárido e servem como um modelo para a fisiologia comparativa intra e interespécies.(AU)

This study aimed to evaluate the body biometry and hematological profile of Trachemys scripta elegans (N=28) and Trachemys dorbignyi (N=22) reared in captivity in the Brazilian submedium northeastern semi-arid region in the Valley of the São Francisco river. It aimed to establish basic health blood values and generate useful data on the comparative physiology of Testudines. After 120-day adaptation and 24-hour fasting, 2.5mL of blood were collected from the dorsal occipital sinus and deposited into a tube with sodium heparin for evaluation, following, of hematological levels. The red blood cell count (RBC) and GLC was conducted in a Neubauer chamber, the hemoglobin level (HGB) was supplied by the cyanmethemoglobin method and the hematocrit (HCT) was obtained by the microhematocrit technique. Based on the RBC, the hematimetric were mathematically established. Body biometry were also evaluated: a) body mass (BM, g); b) maximum dimensions of the carapace [length (MLC, cm) and width (MWC, cm)]; c) maximum dimensions of plastron [length (MLP, cm) and width (MWP, cm)]; d) total length of tail (TLT, cm); e) linear length from the base of the tail to the cloacal orifice (LPrC, cm); f) linear length from the cloacal orifice to the extremity of the tail (LPoC, cm). T. scripta elegans showed higher values (P<0.05) for biometrics, while TLT and LPrC were higher (P<0.05) in T. dorbignyi. The hematological values did not differ (P>0.05) among species. The results show that most of the variation found between T. scripta elegans and T. dorbignyi is explained by the biometric variables and that some hematologic correlations characterize interspecies differences. It was conclude that the results shed light on benchmarks for these species kept in captivity in the northeastern semi-arid region and serve as a model for intra and interspecies comparative physiology.(AU)

Optimizing preoperative haemoglobin in major orthopaedic surgery using intravenous iron with or without erythropoietin. An epidemiologic study.

AIM: To evaluate the effectiveness of intravenous iron treatment, with or without associated erythropoietin (rHuEPO), measured as haemoglobin (Hb) increase. The relationships between the Hb increase and parameters used to evaluate anaemia were analysed. MATERIAL AND METHOD: Retrospective observational study carried out in two third-level hospitals between January 2005 and December 2009. The study included patients with iron deficiency anaemia scheduled for elective orthopaedic surgery and treated with intravenous iron sucrose alone or associated with rHuEPO. Treatment efficacy was analysed based on the Hb increase from baseline to just before surgery. RESULTS: A total of 412 patients who received a median of 800mg of iron sucrose were included; 125 of them (30.4%) additionally received 2.4 vials of rHuEPO. The Hb increase was 0.8 (1.1) g/dL in patients treated with intravenous iron and 1.5 (1.3) g/dL in those additionally given rHuEPO(P<.01). The percentage of hypochromic red blood cells (r=0.52) and soluble transferrin receptor (r=0.59) value were significantly correlated to the Hb increase in patients receiving iron. CONCLUSIONS: In patients with iron deficiency anaemia, the effectiveness of iron sucrose treatment to optimize Hb before surgery was moderate; adjuvant administration of erythropoietin improved the results. Determination of functional iron status parameters may improve the treatment effectiveness.

[Red cell distribution width and mortality following hospital discharge in patients over 70 years of age]. / Ancho de distribución eritrocitario como predictor de mortalidad tras el alta hospitalaria en mayores de 70 años.

BACKGROUND AND OBJECTIVE: To examine whether red cell distribution width (RDW) performs as a mortality predictor after hospital discharge in patients over 70 years of age and if its prognostic power is superior to other laboratory parameters. PATIENTS AND METHODS: Longitudinal and prospective study of 426 patients admitted to the Internal Medicine Department who survived hospitalization. Sociodemographic and comorbidity factors, functional and cognitive status as well as disease parameters causing admission (diagnosis, analytical parameters, length of stay) were collected. Patients were followed for one year by telephone interview and data were collected regarding vital status and, if appropriate, death date. RDW effect on mortality was assessed using logistic regression and prognostic capability by the area under the ROC curve. RESULTS: Each percentage point rise in RDW was associated with increased mortality at one year with an odds ratio of 1.19 (95% confidence interval [95% CI] 1.08 to 1.31). Mortality in each tertile of RDW was 15.6% in the lowest, 21.5% in the middle and 30.5% in the highest. A clinical model supplemented with RDW improved mortality predictive ability assessed by ROC curve. Net reclassification improvement of the prediction rule was 1.71% (95% CI 0.07 to 3.35) p=0.04. CONCLUSION: This study provides new evidence of the RDW association with mortality in a cohort of elderly patients who survived hospitalization. RDW was the only laboratory parameter that improved the one-year prognostic mortality ability.