Hierro en falla cardiaca/Iron in heart failure

¿Es la corrección de deficiencia de hierro algo nuevo en el manejo de la insuficiencia cardiaca? Is Correction of Iron Deficiency a New Addition to the Treatment of the Heart Failure? Silverberg DS, Wexler D, Schwartz D Int J Mol Sci. 2015 Jun 18;16(6):14056-74. doi: 10.3390/ijms160614056. Abstract Anemia is present in about 40% of heart failure (HF) patients. Iron deficiency (ID) is present in about 60% of the patients with anemia (about 24% of all HF patients) and in about 40% of patients without anemia (about 24% of all HF patients). Thus ID is present in about half the patients with HF. The ID in HF is associated with reduced iron stores in the bone marrow and the heart. ID is an independent risk factor for severity and worsening of the HF. Correction of ID with intravenous (IV) iron usually corrects both the anemia and the ID. Currently used IV iron preparations are very safe and effective in treating the ID in HF whereas little information is available on the effectiveness of oral iron. In HF IV iron correction of ID is associated with improvement in functional status, exercise capacity, quality of life and, in some studies, improvement in rate of hospitalization for HF, cardiac structure and function, and renal function. Large long-term adequately-controlled intervention studies are needed to clarify the effect of IV iron in HF. Several heart associations suggest that ID should be routinely sought for in all HF patients and corrected if present. In this paper we present our approach to diagnosis and treatment of iron deficiency in heart failure. KEYWORDS: anemia; erythropoietin; heart failure; intravenous iron; iron; iron deficiency; renal failure PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Hemoglobina, transfusión y cirugía cardiaca/Hemoglobin, transfusion and cardiac surgery

Optimización de la hemoglobina y estrategias de transfusión en pacientes programados para cirugía cardiaca Hemoglobin optimization and transfusion strategies in patients undergoing cardiac surgery. Najafi M, Faraoni D. World J Cardiol. 2015 Jul 26;7(7):377-82. doi: 10.4330/wjc.v7.i7.377. Abstract Although red blood cells (RBCs) transfusion is sometimes associated with adverse reactions, anemia could also lead to increased morbidity and mortality in high-risk patients. For these reasons, the definition of perioperative strategies that aims to detect and treat preoperative anemia, prevent excessive blood loss, and define "optimal" transfusion algorithms is crucial. Although the treatment with preoperative iron and erythropoietin has been recommended in some specific conditions, several controversies exist regarding the benefit-to-risk balance associated with these treatments. Further studies are needed to better define the indications, dosage, and route of administration for preoperative iron with or without erythropoietin supplementation. Although restrictive transfusion strategies in patients undergoing cardiac surgery have been shown to effectively reduce the incidence and the amount of RBCs transfusion without increase in side effects, some high-risk patients (e.g., symptomatic acute coronary syndrome) could benefit from higher hemoglobin concentrations. Despite all efforts made last decade, a significant amount of work remains to be done to improve hemoglobin optimization and transfusion strategies in patients undergoing cardiac surgery. KEYWORDS: Anemia; Blood transfusion; Cardiac surgery; Risk factor; Transfusion threshold PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Eritrocitos suicida/Suicidal erythrocyte

Disparadores, inhibidores, mecanismos, y la importancia de la eriptosis: la muerte de eritrocitos suicida. Triggers, inhibitors, mechanisms, and significance of eryptosis: the suicidal erythrocyte death. Lang E, Lang F. Department of Physiology, University of Tübingen, Gmelinstrasse 5, 72076 Tübingen, Germany. Biomed Res Int. 2015;2015:513518. doi: 10.1155/2015/513518. Epub 2015 Mar 4 Abstract Suicidal erythrocyte death or eryptosis is characterized by erythrocyte shrinkage, cell membrane blebbing, and cell membrane scrambling with phosphatidylserine translocation to the erythrocyte surface. Triggers of eryptosis include Ca(2+) entry, ceramide formation, stimulation of caspases, calpain activation, energy depletion, oxidative stress, and dysregulation of several kinases. Eryptosis is triggered by a wide variety of xenobiotics. It is inhibited by several xenobiotics and endogenous molecules including NO and erythropoietin. The susceptibility of erythrocytes to eryptosis increases with erythrocyte age. Phosphatidylserine exposing erythrocytes adhere to the vascular wall by binding to endothelial CXC-Motiv-Chemokin-16/Scavenger-receptor for phosphatidylserine and oxidized low density lipoprotein (CXCL16). Phosphatidylserine exposing erythrocytes are further engulfed by phagocytosing cells and are thus rapidly cleared from circulating blood. Eryptosis eliminates infected or defective erythrocytes thus counteracting parasitemia in malaria and preventing detrimental hemolysis of defective cells. Excessive eryptosis, however, may lead to anemia and may interfere with microcirculation. Enhanced eryptosis contributes to the pathophysiology of several clinical disorders including metabolic syndrome and diabetes, malignancy, cardiac and renal insufficiency, hemolytic uremic syndrome, sepsis, mycoplasma infection, malaria, iron deficiency, sickle cell anemia, thalassemia, glucose 6-phosphate dehydrogenase deficiency, and Wilson's disease. Facilitating or inhibiting eryptosis may be a therapeutic option in those disorders. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Niño con Intestino Corto, como abordarlo

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 16 Septiembre 2015 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Niño con Intestino Corto, como abordarlo” por el “Dr. Jose Luis Martínez Orozco”, Gastroenterologo Pediatra de la Cd. de Fresno Ca. La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador http://connectpro60196372.adobeconnect.com/intestino_corto/
2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia
6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.

Henrys



--

Dr. Enrique Mendoza López
Webmaster: CONAPEME

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Av La Clinica 2520-310 col Sertoma
Monterrey N.L. CP 64718
Tel (81) 83482940, (81) 83485701
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Eritropoyetina/Erythropoietin

Células renales produciendo eritropoyetina en salud y enfermedad Renal erythropoietin-producing cells in health and disease. Souma T, Suzuki N, Yamamoto M. Front Physiol. 2015 Jun 3;6:167. doi: 10.3389/fphys.2015.00167. eCollection 2015. Abstract Erythropoietin (Epo) is an indispensable erythropoietic hormone primarily produced from renal Epo-producing cells (REPs). Epo production in REPs is tightly regulated in a hypoxia-inducible manner to maintain tissue oxygen homeostasis. Insufficient Epo production by REPs causes renal anemia and anemia associated with chronic disorders. Recent studies have broadened our understanding of REPs from prototypic hypoxia-responsive cells to dynamic fibrogenic cells. In chronic kidney disease, REPs are the major source of scar-forming myofibroblasts and actively produce fibrogenic molecules, including inflammatory cytokines. Notably, myofibroblast-transformed REPs (MF-REPs) recover their original physiological properties after resolution of the disease insults, suggesting that renal anemia and fibrosis could be reversible to some extent. Therefore, understanding the plasticity of REPs will lead to the development of novel targeted therapeutics for both renal fibrosis and anemia. This review summarizes the regulatory mechanisms how hypoxia-inducible Epo gene expression is attained in health and disease conditions. KEYWORDS: erythropoietin; fibrosis; hypoxia; plasticity; renal Epo-producing cell (REP) PDF  Eficacia y seguridad de eritropoyetina para prevenir falla renal aguda en pacientes críticos o en cuidado postoperatorio Efficacy and Safety of Erythropoietin to Prevent Acute Kidney Injury in Patients With Critical Illness or Perioperative Care: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Zhao C, Lin Z, Luo Q, Xia X, Yu X, Huang F. J Cardiovasc Pharmacol. 2015 Jun;65(6):593-600. doi: 10.1097/FJC.0000000000000229. Abstract OBJECTIVE: The aim was to investigate the efficacy and safety of erythropoietin (EPO) to prevent acute kidney injury (AKI) in patients with critical illness or perioperative care. METHODS: Randomized controlled trials comparing EPO with placebo for AKI prevention in adult patients with critical illness or perioperative care were searched in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, and Clinical Trials.gov until October 2014. The outcomes of interest included the incidence of AKI, dialysis requirement, mortality, and adverse event. Fixed effect model was used to calculate the pooled risk ratio (RR) and 95% confidence interval (CI) for eligible studies. RESULTS: Ten randomized controlled trials involving 2759 participants were identified and included in the analysis. Compared with placebo, EPO administration did not reduce the incidence of AKI (RR, 0.97; 95% CI, 0.79-1.19; P = 0.782), dialysis requirement (RR, 0.72; 95% CI, 0.31-1.70; P = 0.457), or mortality (RR, 0.96; 95% CI, 0.78-1.18; P = 0.705). Moreover, EPO had no effect on the risk of adverse events, but estimations of RR were difficult due to their relatively infrequent occurrence. CONCLUSIONS: This meta-analysis suggests that prophylactic administration of EPO in patients with critical illness or perioperative care does not prevent AKI, dialysis requirement, or mortality. PDF Eritropoyetina mejora la evolución a largo plazo de pacientes con accidente vascular isquémico Erythropoietin improves long-term neurological outcome in acute ischemic stroke patients: a randomized, prospective, placebo-controlled clinical trial. Tsai TH, Lu CH, Wallace CG, Chang WN, Chen SF, Huang CR, Tsai NW, Lan MY, Sung PH, Liu CF, Yip HK. Crit Care. 2015 Feb 25;19:49. doi: 10.1186/s13054-015-0761-8. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015