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Skeletal remains of an adult (estimated age at death ≈ 27-30 years) Prehispanic male with fusion in the sacroiliac joints showed a heterotopic ossification consisting of a flat, 10 × 5 cm bone formation covering the posterior aspect of the right sacroiliac joint. The bones were recovered from a burial cave containing remains of 4 individuals, located on the side of a ravine, in Buenavista del Norte (NW corner of Tenerife, Canary Islands), at ≈ 450 m altitude. This individual was probably affected by ankylosing spondylitis (AS) that led to bony fusion of the pelvic bones with the sacrum, but several unusual features prompted us to compare the pelvis with those belonging to two modern individuals affected by AS (20th century) housed at the Department of Anatomy of the school of medicine (University of La Laguna, Tenerife). The Prehispanic individual possibly suffered a pelvic fracture that caused a hematoma which underwent ossification. Some features (periosteal reaction, formation of new foramina) may also suggest a superimposed infection. The fracture altered the pelvic structure, severely narrowing the right sciatic notch, possibly causing neural and/or vascular compromise of the lower limbs. Living in a steep mountainous environment, this individual (possibly a goatherder) probably suffered a fall, that caused the fracture complicated by a severe bleeding and pelvic deformation.
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BACKGROUND: The long-term survival of patients hospitalized with COVID-19 and the factors associated with poorer survival months after infection are not well understood. The aims of the present study were to analyze the overall mortality 10 months after admission. METHODS: 762 patients with COVID-19 disease were included. Patients underwent a complete clinical evaluation, routine laboratory analysis and chest X-ray. Data collected included demographic and clinical data, such as vascular risk factors, tobacco or alcohol use, comorbidity, and institutionalization. RESULTS: Ten-month mortality was 25.6%: 108 deaths occurred in-hospital, while 87 patients died after discharge. In-hospital mortality was independently related to NT-proBNP values > 503.5 pg/mL [OR = 4.67 (2.38-9.20)], urea > 37 mg/dL [3.21 (1.86-7.31)] and age older than 71 years [OR = 1.93 (1.05-3.54)]. NT-proBNP values > 503.5 pg/mL [OR = 5.00 (3.06-8.19)], urea > 37 mg/dL [3.51 (1.97-6.27)], cognitive impairment [OR = 1.96 (1.30-2.95), cancer [OR = 2.23 (1.36-3.68), and leukocytes > 6330/mm3 [OR = 1.64 (1.08-2.50)], were independently associated with long-term mortality. CONCLUSIONS: the risk of death remains high even months after COVID-19 infection. Overall mortality of COVID-19 patients during 10 months after hospital discharge is nearly as high as that observed during hospital admission. Comorbidities such as cancer or cognitive impairment, organ dysfunction and inflammatory reaction are independent prognostic markers of long-term mortality.
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Maspalomas is one of the most important archaeological sites in Gran Canaria, Canary Islands. The necropolis is one of the few funerary sites on the island where several the skeletons were found in anatomical position. The burials correspond to graves and cists dated between the 12th and 15th century CE. These graves and cists are clustered together in different formations across the necropolis, giving rise to a complex composition that denotes the existence of possible interpersonal relationships of the people buried there. A total of 135 calcanei and 118 tali were analysed to find non-metric traits and to test whether the clustered burials share a non-metric trait relationship. Trait combinations were formed using talus and calcaneus non-metric traits separately. The results of this study suggest that the individuals of Maspalomas showed a very high prevalence of lateral and medial talar facets, attributed to prolonged squatting position and/or walking on uneven ground. The calcaneal facet pattern (that may be aetiologically genetic) is more closely related to that observed among North-Africans or Indians than to Western Europeans. Calcaneal facet type Ib, and other genetically-determined traits, such as the extra facet extension of Posterior Facet, or the medial root of the inferior extensor retinaculum trait, either as single traits or as the combination of both traits, were significantly associated with individuals buried in different geographical areas of the necropolis defined by differences in burial structures, a finding that may suggest that genetically-linked individuals were buried in a separate area of the necropolis. The use of trait combination analysis in this study shows that the method can be applied to identify relationships among genetically or professionally related individuals that were subjected to a different burial procedure by their contemporaries.
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Antropología Física , Calcáneo , Humanos , España/epidemiología , Masculino , Femenino , Calcáneo/patología , Calcáneo/anatomía & histología , Adulto , Entierro/historia , Astrágalo/patología , Astrágalo/anatomía & histología , Historia Medieval , Persona de Mediana Edad , Adulto JovenRESUMEN
The usefulness of anatomical variation is determined by the knowledge of why nonmetric traits appear. Clear descriptions of the traits are a necessary task, due to the risk of confusing anatomical variants and evidence of trauma. Numerous interpretations of the appearance of calcaneal anatomical variants add to the need of an anatomical atlas of calcaneal nonmetric traits. We have analyzed a total of 886 calcanei; 559 belong to different modern and pre-Hispanic samples, and 327 bones were studied from a reference collection from Athens. In this study, we present the anatomical variations that exist on the calcaneus bone, some of which have rarely been mentioned in previous research. The standardization of methods proposed may be useful to experts working in human anatomy, physical anthropology as well as comparative morphology, due to usefulness of this information during surgery, and bioanthropology to observe and study the lifestyle of past populations.
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Variación Anatómica , Calcáneo , Calcáneo/anatomía & histología , Humanos , Masculino , FemeninoRESUMEN
Severe alcoholic hepatitis is the most lethal complication in alcohol dependent patients. The concurrence of infections in these patients is very frequent. Both produce a systemic inflammatory response syndrome (SIRS), secondary to intense release of inflammatory cytokines, which can complicate the diagnosis. In our study, Interleukin (IL)-6 and IL-10 levels are higher in patients with SIRS (p<0.001 and p = 0.033, respectively). IL-4, IL-6, Interferon-gamma (IFNγ), Tumor necrosis factor alpha (TNFα) and IL-17 levels correlate with liver function, as estimated by MELD-Na (p = 0.018, p = 0.008, p = 0.009, p = 0.016 and p = 0.006, respectively). Malondialdehyde (MDA), a product of lipid peroxidation and marker of cell damage, also correlates with liver function (p = 0.002), but not with SIRS or infections. Only elevated IL-6 correlates independently with the presence of infections (RR=1.023 IC 95% 1.000-1.047), so it may be useful for the correct diagnosis in these patients. Values greater than 30 pg/mL have a sensitivity: 86.7% and specificity: 94.7% for the diagnosis of infections.
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Hepatitis Alcohólica , Humanos , Hepatitis Alcohólica/complicaciones , Hepatitis Alcohólica/diagnóstico , Interleucina-6 , Citocinas , Factor de Necrosis Tumoral alfa , Estrés Oxidativo , Síndrome de Respuesta Inflamatoria Sistémica/diagnósticoRESUMEN
Skeletal remains of two prehispanic male adult individuals (antiquity ≈ 550 BP) recovered from a burial cave located in Montaña Blanca (Las Cañadas del Teide) at an altitude of 2450 m above sea level, in the highlands of Tenerife (Canary Islands) showed some unusual features. Femora and tibiae of both individuals showed increased bone density, with irregular thickening of the midshaft diaphyses. One individual showed a cystic lesion in the distal third of the left femoral diaphysis, surrounded by a subtle sclerotic reaction of the spongiosa and a thin cortex that was partially fractured. Periosteal thickening was present, but not around the cystic lesion. A thoracic vertebra with rachischisis was also recovered. The bone density of vertebrae and iliac bones were normal, and one recovered jaw was also normal. The tibiae of one individual showed an abnormal location of the foramen nutritium. Hypoplasia of the lesser trochanter and an abnormally thin left femoral neck were also observed. It is possible that both individuals were affected by diaphyseal dysplasia (possibly Camurati Engelmann or Ribbing disease). One of them also showed a lesion compatible with a unicameral bone cyst. The alternative possibility of a Klippel-Trenaunay-Weber disease, with a bone aneurysmal cyst, also exists.
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Quistes Óseos , Síndrome de Camurati-Engelmann , Adulto , Humanos , Masculino , España , Entierro , CanadáRESUMEN
In recent years, the terms sarcopenia, sarcopenic obesity, and osteosarcopenic obesity (OSO) were coined to define a situation in elderly people strongly associated with frailty and increased mortality. Possibly, a complex interplay of several hormones and cytokines are involved in its development. Ongoing research detected that OSO may occur at any age and in several conditions. The prevalence of OSO in alcoholism was poorly analyzed. The aim of this study was to analyze the prevalence of OSO in alcoholism and its relationship with proinflammatory cytokines and/or common complications of alcoholism, such as cirrhosis, cancer, or vascular disease. We included 115 patients with alcoholic use disorder. Body composition analysis was performed by double X-ray absorptiometry. Handgrip strength was recorded using a dynamometer. We assessed liver function according to Child's classification, and determined serum levels of proinflammatory cytokines (TNF-α, IL-6, IL-8), routine laboratory variables, and vitamin D. People with alcoholic use disorder showed a high prevalence of OSO, especially regarding OSO obesity (60%), OSO osteopenia (55.65%), and OSO lean mass (60.17%). OSO handgrip was closely, independently, related to the presence of vascular calcification (χ2 = 17.00; p < 0.001). OSO handgrip was related to several proinflammatory cytokines and vitamin D. Vitamin D deficiency kept a close correlation with OSO handgrip (rho = -0.54, p < 0.001). Therefore, among people with alcohol use disorder, OSO prevalence was high. OSO handgrip is related to serum proinflammatory cytokine levels supporting the possible pathogenetic role of these cytokines on OSO development. Vitamin D deficiency is related to OSO handgrip suggesting its pathogenetic involvement in sarcopenia in patients with alcohol use disorder. The close association between OSO handgrip and vascular calcification is clinically relevant and suggests that OSO handgrip may constitute a prognostic tool in these patients.
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Alcoholismo , Sarcopenia , Calcificación Vascular , Deficiencia de Vitamina D , Niño , Humanos , Anciano , Sarcopenia/complicaciones , Sarcopenia/epidemiología , Alcoholismo/complicaciones , Fuerza de la Mano , Obesidad/complicaciones , Obesidad/epidemiología , Factores de Riesgo , Vitamina D , Inflamación/complicaciones , Vitaminas , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/epidemiología , Citocinas , Calcificación Vascular/complicacionesRESUMEN
Several recent studies have pointed out the relationship of platelet size with increased mortality or adverse clinical course. Most studies show that increased mean platelet volume (MPV) may be associated with a deleterious outcome in different settings such as sepsis or neoplasia, whereas other researchers have found the opposite. In inflammatory conditions there is an altered secretion of several cytokines, some of them exerting a marked influence on platelet biogenesis and/or on platelet activation and aggregation. Alcohol use disorder is a chronic situation characterized by a protracted low-grade inflammation. In this study we analyze the relationship between proinflammatory cytokines and MPV and their relationships with mortality in patients with alcohol abuse. We determined serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8 and routine laboratory variables among 184 patients with alcohol use disorder admitted to our hospital and followed-up for a median of 42 months. We found that MPV was inversely related to TNF-α (ρ=-0.34), and directly to IL-8 (ρ=0.32, p<0.001 in both cases) and to IL-6 (ρ=0.15; p = 0.046). Reduced MPV was related both with short-term (<6 months) and long-term mortality. Conclusion: These results suggest that inflammatory cytokines are strongly related to MPV. A low MPV is associated with a poor prognosis among patients with alcohol use disorder.
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Alcoholismo , Volúmen Plaquetario Medio , Humanos , Pronóstico , Interleucina-8 , Estudios RetrospectivosRESUMEN
Objective: Heavy alcohol consumption causes several organic complications, including vessel wall calcification. Vascular damage may be involved in the development of brain atrophy and cognitive impairment. Recently, sclerostin (whose levels may be altered in alcoholics) has emerged as a major vascular risk factor. The objective of the present study is to analyze the prevalence of vascular calcifications in alcoholics, and the relationships of these lesions with brain atrophy, as well as the role of sclerostin on these alterations. Patients and methods: A total of 299 heavy drinkers and 32 controls were included. Patients underwent cranial computed tomography, and several indices related to brain atrophy were calculated. In addition, patients and controls underwent plain radiography and were evaluated for the presence or absence of vascular calcium deposits, cardiovascular risk factors, liver function, alcohol intake, serum sclerostin, and routine laboratory variables. Results: A total of 145 (48.47%) patients showed vascular calcium deposits, a proportion significantly higher than that observed in controls (χ2 = 16.31; p < 0.001). Vascular calcium deposits were associated with age (t = 6.57; p < 0.001), hypertension (t = 5.49; p < 0.001), daily ethanol ingestion (Z = 2.18; p = 0.029), duration of alcohol consumption (Z = 3.03; p = 0.002), obesity (χ2 = 4.65; p = 0.031), total cholesterol (Z = 2.04; p = 0.041), triglycerides (Z = 2.05; p = 0.04), and sclerostin levels (Z = 2.64; p = 0.008). Calcium deposits were significantly related to Bifrontal index (Z = 2.20; p = 0.028) and Evans index (Z = 2.25; p = 0.025). Serum sclerostin levels were related to subcortical brain atrophy, assessed by cella media index (Z = 2.43; p = 0.015) and Huckmann index (ρ = 0.204; p = 0.024). Logistic regression analyses disclosed that sclerostin was the only variable independently related to brain atrophy assessed by altered cella media index. Sclerostin was also related to the presence of vascular calcifications, although this relationship was displaced by age if this variable was also included. Conclusion: Prevalence of vascular calcification in alcoholics is very high. Vascular calcium deposits are related to brain atrophy. Serum sclerostin is strongly related to brain shrinkage and also shows a significant relationship with vascular calcifications, only displaced by advanced age.
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Myostatin acts as a negative regulator of muscle growth. Its effect on fat mass is subject to debate. Among alcoholics, there is a high prevalence of muscle atrophy, and increased fat deposition has been also described in these patients. Myostatin could be involved in these alterations, but its relationships with body composition have been scarcely studied in alcoholic patients. To analyze the behavior of myostatin among alcoholics and its relationship with alcohol intake, liver function, and body composition. We investigated serum myostatin in 59 male patients and 18 controls. Patients were all heavy drinkers admitted with organic complications related to excessive ethanol ingestion. Densitometry analysis was used to assess body composition in 46 patients. Handgrip was assessed in 51 patients. Patients showed lower myostatin values than controls (Z = 3.80; p < 0.001). There was a significant relationship between myostatin and fat at the right leg (ρ = 0.32; p = 0.028), left leg (ρ = 0.32; p = 0.028), trunk (ρ = 0.31, p = 0.038), total fat proport ion (ρ = 0.33, p = 0.026), and gynecoid fat distribution (ρ = 0.40, p = 0.006) but not with lean mass (total lean ρ = 0.07; p = 0.63; trunk lean ρ = 0.03; p = 0.85; lower limbs ρ = 0.08; p = 0.58; upper limbs ρ = 0.04 p = 0.82; android ρ = 0.02; p = 0.88, or gynoid lean mass ρ = 0.20; p = 0.19). In total, 80.43% of patients showed at least one criterion of osteosarcopenic adiposity (OSA). Myostatin was related to OSA obesity. We also observed higher myostatin values among patients with body mass index > 30 kg/m2. Serum myostatin was lower among excessive drinkers, and it was related to increased fat deposition among these patients but not to lean mass, handgrip, or bone mineral density.
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Alcoholismo , Miostatina , Humanos , Masculino , Alcoholismo/complicaciones , Composición Corporal/fisiología , Fuerza de la Mano , Miostatina/sangre , ObesidadRESUMEN
We describe diffuse microporotic lesions observed in most of the scattered skeletal remains belonging to a ≈ 6 months-old female (genetic sexing) prehispanic (antiquity ≈ 600 years BP) individual recovered from a small recess of a basaltic burial cave in the highlands (2300 m above sea level) of Tenerife. Although sphenoid wings were lacking, microporotic lesions were present in several bones, especially in the hard palate, basilar part of the occipital bone, outer aspect of the maxilla, and proximal half of the right humerus, accompanied by a subtle periosteal reaction. Although non-specific, bone lesions may be compatible with scurvy, possibly in the context of malnutrition, that probably also affected the mother, given the young age of the infant and her dependence on maternal feeding. Pathophysiological connections among iron deficiency, vitamin C deficiency and vitamin D deficiency are discussed. Both observational reports on paleopathological cases of diffuse microporotic lesions as well as experimental studies devoted to discern the relative and combined effects of hypoxia-mediated bone marrow expansion, protein-calorie malnutrition, ascorbate, vitamin D or iron deficiency on such lesions are needed.
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Escorbuto , Humanos , Lactante , Femenino , Escorbuto/patología , Huesos , Ácido Ascórbico , Vitamina D , VitaminasRESUMEN
α-Klotho (Klotho) is an antiaging hormone with anti-inflammatory and antioxidative properties. Some studies suggest that Klotho increases in response to enhanced oxidative damage and inflammation. Alcoholism is a proinflammatory condition. The aim of this study was to analyze the relationship between Klotho and the serum levels of the inflammatory markers in alcoholic liver disease and to assess its prognostic value. We included 184 alcoholics and 35 age- and sex-matched controls. We determined the serum levels of Klotho, the tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, and malondialdehyde (MDA), and routine laboratory variables. Patients were followed-up with during 16 ± 18 months; 67 patients died. Klotho levels were higher among cirrhotics (with KW = 37.00 and p < 0.001) and were related to the Child−Pugh score (with KW = 15.96 and p < 0.001) and to the TNF-α (ρ = 0.28; p < 0.001) and MDA (ρ = 0.21; p = 0.006). The child's groups were associated with mortality, both in the univariate (with the log-rank = 13.56, p = 0.001, Breslow = 12.33, and p = 0.002) and multivariate (with ß = 0.43, p = 0.02, and OR = 1.53 (1.07−2.15)) analyses, also introducing Klotho and the TNF-α as dichotomic variables. However, the independent prognostic value of the Child's groups was displaced by Klotho when only cirrhotics were considered; Klotho, over the median (574.4 pg/mL), was associated with higher mortality (with p = 0.04 and OR = 2.68 (1.06−6.84)). We conclude that Klotho is increased in liver cirrhosis. It is directly related to TNF-α, MDA, and to mortality in cirrhotics.
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Alcoholismo , Proteínas Klotho/sangre , Humanos , Inflamación , Interleucina-6 , Cirrosis Hepática , Factor de Necrosis Tumoral alfaRESUMEN
BACKGROUND: Sclerostin was initially described as an inhibitor of the Wnt-ß catenin bone-forming pathway, but it also exerts important effects on intermediate metabolism and body composition. Osteosarcopenia and altered body fat distribution are common findings in excessive drinkers. The role of sclerostin in these patients is uncertain. We aim to analyze the behavior of sclerostin in excessive drinkers and its relationships with body composition (fat mass, lean mass, bone mass), handgrip strength, body mass index (BMI), liver function and ethanol intake. METHODS: 107 male active heavy drinkers and 26 age-matched controls were included. Serum sclerostin was determined by ELISA. Body composition analysis was performed by double X-ray absorptiometry. Handgrip strength was recorded using a dynamometer. Liver function was assessed according to Child's classification. RESULTS: Sclerostin was higher among Child's C patients, keeping a relationship with deranged liver function. Obesity, defined according to BMI, and body fat were strongly related to sclerostin, being independent of serum creatinine and of liver function. The relationship of sclerostin with total hip bone mineral density was displaced by BMI. CONCLUSION: Deranged liver function is associated with higher sclerostin levels in alcoholics. Raised sclerostin levels are related to fat deposition and increased BMI.
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Proteínas Adaptadoras Transductoras de Señales , Fuerza de la Mano , Absorciometría de Fotón , Composición Corporal , Densidad Ósea , Niño , Humanos , Hígado , MasculinoRESUMEN
BACKGROUND: Brain-derived neurotrophic factor (BDNF) is involved in neurogenesis and in the protection against oxidative damage and neuronal apoptosis. After exercise, there is an increased expression of this myokine, especially in skeletal muscle and brain. Low BDNF levels have been described in neurodegenerative diseases. Alcoholics show both muscle atrophy and brain atrophy. Thus, this study was performed in order to analyze serum BDNF levels among alcoholics and their associations with brain atrophy and muscle strength. METHODS: Serum BDNF values were determined to 82 male alcoholics and 27 age-matched controls, and compared with handgrip strength, with the presence of brain atrophy, assessed by computed tomography, and with the intensity of alcoholism and liver function derangement. RESULTS: BDNF levels and handgrip strength were significantly lower among patients. Handgrip strength was correlated with BDNF values, both in the whole population and in alcoholics, especially in patients over 59 years of age. BDNF was poorly related to liver dysfunction but showed no relationship with brain atrophy or age. CONCLUSION: Chronic alcoholics show decreased BDNF serum levels that are related to muscle function impairment rather than to age, brain atrophy, liver dysfunction, or the amount of ethanol consumed.
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Alcoholismo/sangre , Factor Neurotrófico Derivado del Encéfalo/sangre , Encéfalo/diagnóstico por imagen , Anciano , Atrofia/sangre , Atrofia/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To define SEM characteristics that may aid identification of sialoliths. MATERIALS: Two sialoliths from modern patients affected by sialadenitis. METHODS: Samples were coated with silver and subjected to scanning electron microscopy using an energy-dispersive X-ray spectroscopy detector. Samples were then sectioned to permit study of the internal structure. RESULTS: Sialoliths show an external smooth surface with no distinctive features. Internal structures consist of a distinctive aggregate of coarse granules of different sizes surrounded by a lamellar coat. Elemental composition consists of carbon, phosphate, calcium and oxygen, with traces of magnesium. The proportion of these elements differs between the core and the surface. CONCLUSION: Although elemental composition is not specific, SEM analyses of sialoliths greatly differ from those of sesamoid bones, gallstones and nephroliths. Therefore, SEM analysis constitutes a useful tool for the precise identification of small calcified structures recovered during archaeological excavations. SIGNIFICANCE: Precise identification of calcified structures may provide information about nutritional and/or pathological aspects of past individuals. LIMITATIONS: Sialoliths are less common than other types of calcifications, and only two cases were analyzed in this study. FUTURE PROSPECTS: SEM technology should be applied to identify the etiology of all minute calcified remains recovered during archaeological excavations of burial sites.
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Microscopía Electrónica de Rastreo , Cálculos de las Glándulas Salivales/diagnóstico por imagen , Arqueología , Diagnóstico Diferencial , Humanos , Paleopatología , Cálculos de las Glándulas Salivales/etiología , Glándulas Salivales/diagnóstico por imagen , Sialadenitis/complicacionesRESUMEN
BACKGROUND AND AIMS: Cancer risk is increased in alcoholics. Heavy ethanol consumption is also associated with other potentially lethal conditions such as cirrhosis, diabetes, hypertension, dyslipidemia or malnutrition, that increase mortality. The aim of the present study is to analyze the impact on mortality of new cancer development in a cohort of heavy alcoholics. METHODS: Three hundred and thirty nine heavy alcoholics (about 200 g ethanol/daily during more than 15 years), initially admitted for organic problems to our service (reference hospital) were prospectively followed up for a maximum period of 120 months (median = 26, interquartile range = 12-60 months), either as outpatients or during successive admissions. Clinical and laboratory evaluation including incidence of new cancer and drinking habits were recorded at each appointment, as well as mortality. RESULTS: During the study period 57 patients developed cancer and 151 died. Only 75 did not relapse in alcohol drinking. Mortality was related to deranged liver function, relapse of alcohol drinking, and malnutrition, whereas age, the development of new cancer, or the presence of diabetes, dyslipidemia or hypertension did not influence on mortality, especially in cirrhotics and among those who did not quit drinking. Cancer was related to mortality only among non-cirrhotics, together with ethanol abstention and age. CONCLUSIONS: Heavy drinking is associated with high mortality among alcoholic patients admitted to the hospital. If a patient is already cirrhotic or if there is drinking relapse, the development of a new cancer, the concurrent presence of diabetes, hypertension, dyslipidemia, or advanced age have no impact on survival. Mortality is only related to deranged liver function, relapse of alcohol drinking, and malnutrition.
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Alcohólicos , Alcoholismo , Neoplasias , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Alcoholismo/epidemiología , Humanos , Incidencia , Neoplasias/epidemiologíaRESUMEN
INTRODUCTION: In chronic hepatitis C virus (HCV) infection there is increased iron absorption leading to iron overload, a fact that may promote ferritin synthesis. Theoretically, increased ferritin should promote ongoing liver fibrosis but disparate results have been described. OBJECTIVE: We analyze the behavior of iron metabolism- related variables, comparing them with fibrosis and inflammatory activity in liver biopsy in HCV infected patients. PATIENTS AND METHODS: We analyzed among 90 HCV patients subjected to liver biopsy prior to antiviral treatment the relationships of serum levels of iron, ferritin, transferrin, transferrin saturation index (TSI) and total iron binding capacity (TIBC) with liver fibrosis and histological severity, assessed by Metavir-f, Metavir-a and Knodell indices, as well as with liver function, and also compared the aforementioned iron metabolism- related variables with 34 controls. RESULTS: Patients showed higher values of sideremia (Tâ¯=â¯2.04; pâ¯=â¯0.044) and transferrin (Tâ¯=â¯2.29; pâ¯=â¯0.004) compared with controls; but not ferritin, that was significantly higher among the 33 patients who also consumed alcohol (Zâ¯=â¯2.05; pâ¯=â¯0.041). Most patients showed a well preserved liver function (86 cases, Child A). Patients with Child B or C showed higher ferritin levels (Zâ¯=â¯2.68; pâ¯=â¯0.007) and TSI (Zâ¯=â¯2.41; pâ¯=â¯0.016), but lower transferrin and TIBC (Zâ¯=â¯3.25; pâ¯=â¯0.001) than Child A patients. Transferrin and TIBC were directly related to albumin (ρâ¯=â¯0.24; pâ¯=â¯0.026), whereas bilirubin showed direct relationships with iron (ρâ¯=â¯0.25; pâ¯=â¯0.016), TSI (ρâ¯=â¯0.39; pâ¯<â¯0.001) and ferritin (ρâ¯=â¯0.36; pâ¯<â¯0.001). Both ferritin (ρâ¯=â¯-0.22; pâ¯=â¯0.04) and TSI (ρâ¯=â¯-0.25; pâ¯=â¯0.016) were related to platelet count. No relationships were observed between iron variables and Knodell index, but serum iron, serum transferrin, and TSI were directly related to Metavir-f score (ρâ¯=â¯0.28; pâ¯=â¯0.009, ρâ¯=â¯0.22; pâ¯=â¯0.044, and ρâ¯=â¯0.22; pâ¯=â¯0.044, in this order). CONCLUSION: Alterations of iron related variables are relatively subtle in our series of 90 well compensated HCV patients. Serum ferritin was not related to liver fibrosis and increases only when alcoholism co-exists with HCV infection.
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Ethanol increases iron absorption. Therefore, increased amount of iron reaches the liver, and exerts pro-oxidant effects and stimulates ferritin synthesis and hepatic stellate cell activation, promoting fibrosis and inflammation. These mechanisms would theoretically support a role of ferritin as a marker of the transition to liver cirrhosis, and, consequently, as a prognostic factor, but there is controversy regarding its behavior in alcoholics. We analyzed among 238 severe alcoholics the prognostic value of iron, ferritin, transferrin, transferrin saturation index (TSI) and total iron binding capacity (TIBC), and the relationships of these variables with liver function, proinflammatory markers (C-reactive protein (CRP), interleukin (IL)-6, IL-8, and tumor necrosis factor α), and the presence of cirrhosis. Patients showed higher serum ferritin (Z = 2.50, p = 0.031) but lower transferrin (t(264) = 4.81, p < 0.001), TIBC (t(262) = 4.44, p < 0.001), and iron (Z = 3.19, p = 0.001) values compared with 32 age- and sex-matched controls. Ferritin was related to inflammatory cytokines such as IL-8 (ρ = 0.18, p = 0.012) and to IL-6 (ρ = 0.16, p = 0.016), but not to liver function. On the contrary, cirrhotics showed lower transferrin (t(234) = 4.77, p < 0.001) and TIBC (t(232) = 4.67, p < 0.001), but higher TSI (Z = 3.35, p < 0.001) than non-cirrhotics. Transferrin, TSI, and TIBC were related to liver function impairment (marked differences among the Child's groups regarding transferrin (KW (2) = 22.83, p < 0.001), TSI (KW (2) = 15.81, p < 0.001), and TIBC (KW (2) = 21.38, p < 0.001) but only weakly to inflammation (inverse relationships between IL-6 and total iron (ρ = - 0.16, p = 0.017), TIBC (ρ = - 0.20, p = 0.002), and transferrin (ρ = - 0.20, p = 0.003). In accordance, albumin, IL-6, alcohol quitting, and TSI, in this order, were independently related to mortality, but not ferritin or iron.
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Ferritinas/sangre , Hierro/sangre , Hepatopatías Alcohólicas/sangre , Transferrina/metabolismo , Femenino , Humanos , Hepatopatías Alcohólicas/diagnóstico , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: To analyze the prognostic value of lean mass measured by DEXA and to compare it with lean muscle mass assessed by anthropometrics, calf circumference, subjective assessment and with physical muscle function tests in elderly hospitalized patients. METHODS: We study 187 hospitalized patients aged ≥65 years. We assessed nutrition by anthropometrics, mid arm muscle area, triceps skinfold and calf circumference, by subjective nutritional assessment and by DEXA, lean and fat mass and bone mineral density (BMD); muscle function by handgrip strength, gait speed, standing balance and stand-up test; disability and activities of daily living and the clinical frailty score; and comorbidity by Charlson index. Outcomes were assessed by mortality at 100 days and long-term follow up. RESULTS: Male sex showed higher comorbidity and mortality although females were older, with decreased muscle mass and function, disabled and frailer. Long term mortality was also related to decreased lean mass evaluated by subjective assessment, midarm anthropometry, calf circumference and DEXA (appendicular lean and fat mass and BMD); muscle function impairment assessed by gait speed, standing balance and stand-up test; frailty; disability and comorbidity. Variables with long term independent predictive value were comorbidity, inability to perform any of the muscle function tests: gait speed, standing balance and stand-up; subjective nutritional score, appendicular lean mass under the 10th percentile and male sex. CONCLUSIONS: Females are older and frailer but with lower comorbidity; they showed a better survival. The best predictive mortality factor was comorbidity, but DEXA appendicular lean mass under the 10th percentile showed an independent and high predictive value on mortality.
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Anciano Frágil , Evaluación Geriátrica , Hospitalización , Desnutrición/diagnóstico , Absorciometría de Fotón , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Femenino , Humanos , Masculino , Desnutrición/complicaciones , Desnutrición/mortalidad , Desnutrición/fisiopatología , Músculo Esquelético/diagnóstico por imagen , Evaluación Nutricional , Valor Predictivo de las Pruebas , Pronóstico , Factores de Riesgo , Factores Sexuales , EspañaRESUMEN
BACKGROUND: In neurodegenerative disorders or in normal aging humans a relationship between muscle mass and/or performance and brain volume was observed, that is not dependent on age or other confounding factors. The aim of the present study is to analyse the relationship between lean mass and handgrip strength in alcoholics, who frequently show brain and muscle atrophy. METHODS: It was included 101 male patients aged 58.35 ± 11.59 years, and 44 controls, all of them workers of our hospital, drinkers of less than 20 g ethanol/day, of similar age. Patients and controls underwent dominant handgrip assessment with a Collins' dynamometer, whole body composition analysis by densitometry, and brain computed tomography (CT) examination, with further calculation of several indices indicative of brain atrophy. MAIN RESULTS: 1) Brain atrophy is a very common finding among alcoholics, both among cirrhotics and non-cirrhotics. 2) Alcoholics show a marked reduction in handgrip strength, and also in lean mass, especially at the arms and legs -but not in the trunk, even if patients with ascites were excluded.3) There is a relationship between reduced lean mass and brain atrophy, and a close correlation between handgrip strength and brain atrophy, that is independent of age and liver function. 4) Total fat amount is not different among alcoholics and controls, but there are marked differences in fat distribution: alcoholics show less fat in arms, but more fat in trunk, so that if we calculate the peripheral fat/trunk fat index, marked differences were observed among alcoholics and controls. Neither total fat nor fat distribution were related to brain atrophy. CONCLUSION: among alcoholics, as in other neurodegenerative conditions, there is a relationship between reduced lean mass and brain atrophy, and a close correlation between handgrip strength and brain atrophy, that is independent of age, duration of ethanol consumption and liver function.