Frailty as a predictor of clinical problems and events that require elderly patients with heart failure to use health resources.

BACKGROUND: The clinical management of elderly patients with heart failure (HF) is not firmly established. Decision-making should be individualized depending on the biological deterioration of each patient, from aggressive management to a palliative approach. Frailty can serve as the basis for this comprehensive individualized management. Our objective was to evaluate the importance of the main clinical problems, as well as the events that required the use of health resources, based the degree of frailty, in elderly patients with HF. METHODS AND RESULTS: Retrospective observational cohort study. Frailty was defined according to the deficit accumulation construct. A total of 546 patients hospitalized for acute HF were included. The median age (Q1-Q3) was 82 (78-86) years. A total of 454 patients (83%) showed some degree of frailty: 221 (48.7%) mild, 207 (45.6%) moderate and 26 (5.7%) advanced. There was a significant tendency towards polypharmacy from no to severe frailty. Hospital events were recorded for 4 (1-6) patients with mild frailty, 4 (2-6) patients with moderate frailty and 2 ((1-4) patients with advanced frailty (p = 0.045). A total of 204 patients (37.4%) died during follow-up. The median time to death was 11.4 (4-16.8), 6.7 (3.3-11.6), 6.5 (3.4-12.2) and 4.1 (0.8-7.7) months for patients with no, mild, moderate, or advanced frailty, respectively (p = 0.006). CONCLUSIONS: Frailty due to deficit accumulation is a good predictor of clinical problems and events that require the use of health resources; therefore, it can serve as a basis for the management of HF in the elderly.

Determinación y especiación de selenio de leche humana y en fórmulas comerciales: importancia en la nutrición del lactante / Selenium measurement and speciation in human milk and comercial formulae; importance in the nutrition of the infant

Se determina el contenido de selenio en leche humana y en fórmulas lácteas comerciales utilizando una metodología adecuada (espectrometría de masas con fuente de plasma “ICP-MS” al que se incorpora una celda de colisión para eliminar las interferencias poliatómicas “ICP-(ORC)MS”). Se comprueba que el selenio disminuye con el tiempo transcurrido desde el parto en la leche humana de madres con gestación inferior a 37 semanas y que es insuficiente para cubrir los requerimientos de este oligoelemento. Como la biodisponibilidad del selenio varía en relación a las moléculas a las que su une (especies), se utiliza una técnica híbrida (acoplamiento de una columna de cromatolografía de alta resolución “SEC” al espectrómetro de masas con fuente de plasma y celda de colisión “SEC-ICP-(ORC) MS” para conocer las especies existentes en leche humana y en fórmulas lácteas comerciales. Con esta técnica se comprueba que las distintas especies en la leche humana, no varían de forma significativa ni en relación al tiempo transcurrido desde el parto ni en relación a la duración de la gestación. Sin embargo, se encontraron diferencias significativas entre la especiación de selenio en leche de madres con parto pretérmino (antes de las 37 semanas de gestación) y en fórmulas lácteas comerciales para el recién nacido prematuro. Por último se postula la necesidad de verificar la biodisponiblidad de las diferentes especies de selenio, para así, proponer la más adecuada en la suplementación de fórmulas lácteas comerciales (AU)

The selenium content in human milk and in comercial formulae is measured using an appropriate methodology (mass spectrometry with plasma source, “ICP-MC”) to which a colision cell is added in order to eliminate polyatomic interferences “ICP-(ORC)MS”). It was verified that selenium decrease according to the time from delivery in the human milk of the mother with a pregnancy of less than 37 weeks and Is insufficient to cover the requirements of this oligoelement. As the bioavailability of selenium varies in relationship to the molecules to which it is bond (species),, a hybrid technique (high resolution chromatography column coupling “SEC” to the mass spectrometer with plasma source and collision cell “SEC-ICP-(ORC)MS”) to know the species existing in the human milk and in commercial lactic acid formulae. It ahs been verified with this technique that there is no significant variation regarding the time from delivery or the relationship to the duration of the pregnancy in the different species of human milk. However, significant differences were found between the selenium speciation in the milk of mothers having preterm delivery (before 37 weeks of pregnancy) and in commercial lactic acid formulae for the premature newborn. Finally, the need to verify the bioavailability of the different selenium species has been postulated in order to propose the most adequate in the commercial lactic acid formulae supplementation (AU)

Total selenium and selenomethionine in pharmaceutical yeast tablets: assessment of the state of the art of measurement capabilities through international intercomparison CCQM-P86.

Results of an international intercomparison study (CCQM-P86) to assess the analytical capabilities of national metrology institutes (NMIs) and selected expert laboratories worldwide to accurately quantitate the mass fraction of selenomethionine (SeMet) and total Se in pharmaceutical tablets of selenised-yeast supplements (produced by Pharma Nord, Denmark) are presented. The study, jointly coordinated by LGC Ltd., UK, and the Institute for National Measurement Standards, National Research Council of Canada (NRCC), was conducted under the auspices of the Comité Consultatif pour la Quantité de Matière (CCQM) Inorganic Analysis Working Group and involved 15 laboratories (from 12 countries), of which ten were NMIs. Apart from a protocol for determination of moisture content and the provision of the certified reference material (CRM) SELM-1 to be used as the quality control sample, no sample preparation/extraction method was prescribed. A variety of approaches was thus used, including single-step and multiple-step enzymatic hydrolysis, enzymatic probe sonication and hydrolysis with methanesulfonic acid for SeMet, as well as microwave-assisted acid digestion and enzymatic probe sonication for total Se. For total Se, detection techniques included inductively coupled plasma (ICP) mass spectrometry (MS) with external calibration, standard additions or isotope dilution MS (IDMS), inductively coupled plasma optical emission spectrometry , flame atomic absorption spectrometry and instrumental neutron activation analysis. For determination of SeMet in the tablets, five NMIs and three academic/institute laboratories (of a total of five) relied upon measurements using IDMS. For species-specific IDMS measurements, an isotopically enriched standard of SeMet (76Se-enriched SeMet) was made available. A novel aspect of this study relies on the approach used to distinguish any errors which arise during analysis of a SeMet calibration solution from those which occur during analysis of the matrix. To help those participants undertaking SeMet analysis to do this, a blind sample in the form of a standard solution of natural abundance SeMet in 0.1 M HCl (with an expected value of 956 mg kg(-1) SeMet) was provided. Both high-performance liquid chromatography (HPLC)-ICP-MS or gas chromatography (GC)-ICP-MS and GC-MS techniques were used for quantitation of SeMet. Several advances in analytical methods for determination of SeMet were identified, including the combined use of double IDMS with HPLC-ICP-MS following extraction with methanesulfonic acid and simplified two-step enzymatic hydrolysis with protease/lipase/driselase followed by HPLC-ICP-IDMS, both using a species-specific IDMS approach. Overall, satisfactory agreement amongst participants was achieved; results averaged 337.6 mg kg(-1) (n = 13, with a standard deviation of 9.7 mg kg(-1)) and 561.5 mg kg(-1) (n = 11, with a standard deviation of 44.3 mg kg(-1)) with median values of 337.6 and 575.0 mg kg(-1) for total Se and SeMet, respectively. Recovery of SeMet from SELM-1 averaged 95.0% (n = 9). The ability of NMIs and expert laboratories worldwide to deliver accurate results for total Se and SeMet in such materials (selensied-yeast tablets containing approximately 300 mg kg(-1) Se) with 10% expanded uncertainty was demonstrated. The problems addressed in achieving accurate quantitation of SeMet in this product are representative of those encountered with a wide range of organometallic species in a number of common matrices.

Use of enriched 74Se and 77Se in combination with isotope pattern deconvolution to differentiate and determine endogenous and supplemented selenium in lactating rats.

A quantitative methodology has been developed to differentiate between endogenous and supplemented selenium in lactating rats using two enriched selenium isotopes. Lactating rats were fed for 2 weeks with formula milk containing one enriched Se isotope, (77)Se, as the metabolic tracer. The isotopic composition of selenium in serum and urine samples was then measured by collision cell ICP-MS after the addition of a solution containing another enriched isotope, (74)Se, as quantitation tracer, before analysis. Isotope pattern deconvolution allowed the transformation of measured Se isotopic abundances into concentrations of natural abundance (endogenous) selenium and enriched (77)Se (supplemented) present in the samples. The proposed methodology was validated using serum and urine reference materials spiked with both (77)Se and (74)Se. The obtained results are discussed in terms of selenium exchange and half-life in lactating rats (11-12 days) and selenium levels in serum in comparison with non-supplemented rats and control rats after maternal feeding.

Hipertensión arterial refractaria verdadera. Estudio de prevalencia en una consulta hospitalaria / True refractory hypertension. Study of prevalence at a tertiary care clinic

Introducción. La hipertensión arterial refractaria (HTA-R) puede definirse como la falta de control de las cifras de presión arterial por debajo de 140/90 mmHg a pesar de tratamiento con una combinación adecuada de tres fármacos, siendo uno de ellos un diurético. La prevalencia de HTA-R entre los hipertensos españoles no es bien conocida. El objetivo sería estimar la prevalencia real de HTA-R en una consulta hospitalaria. Material y métodos. A partir de una población inicial de 281 pacientes remitidos por HTA resistente al tratamiento se seleccionó a aquellos individuos que cumplían criterios de HTA-R tras la primera evaluación. Se realizó un estudio exhaustivo de dichos pacientes para confirmar el diagnóstico de HTA-R, buscando causas de HTA secundaria y otros factores contribuyentes a la falta de respuesta al tratamiento. Resultados. Se seleccionó al subgrupo poblacional que cumplía criterios de HTA-R: 42 pacientes de 60 ± 9 años de edad media (27 mujeres y 15 hombres). Tras un seguimiento medio de 3,3 ± 0,5 años, el 73,8 % de los individuos presentaba HTA secundaria, siendo el síndrome de apnea obstructiva del sueño la causa más frecuente. Se obtuvo un control adecuado de la presión arterial en la mayoría de los casos (61,9 %). Sólo en el 4,8 % del subgrupo de 42 pacientes existía HTA-R verdadera, al presentar HTA esencial y mantener cifras elevadas de presión arterial, a pesar del estricto seguimiento y tratamiento. Discusión. La prevalencia real de HTA-R es muy baja, siendo necesario realizar un estudio exhaustivo de los pacientes. En la gran mayoría de los casos se encuentran causas secundarias de HTA y factores contribuyentes a la aparente refractariedad al tratamiento

Introduction. Refractory hypertension is defined as the failure to reach goal blood pressure (¾ 140/90 mmHg) in patients who are adhering to full doses of an appropriate three-drug regimen that includes a diuretic. Its prevalence among spanish patients is not well documented. The objective was to determine the true prevalence of refractory hypertension in adult patients from a university hospital hypertension clinic. Material and methods. Patients who fulfilled criteria for refractory hypertension were selected from an initial sample of 281 individuals with suspected resistant hypertension. An exhaustive study was performed on these patients in order to confirm refractory hypertension and to search for causes of secondary hypertension and contributing factors to poor response to treatment. Results. Forty two patients were selected (average age: 60 ± 9 years, 27 women, 15 men). After 3.3 ± 0.5 years of monitoring, 73.8 % of the individuals were diagnosed with secondary hypertension (sleep apnoea as the most frequent cause). Recommended treatment goals were achieved in most patients (61.9 %). Only 4.8 % of the selected patients suffered from true refractory hypertension, as they had essential hypertension and maintained high blood pressure in spite of strict treatment and monitoring. Discussion. Real prevalence of refractory hypertension is very low. An exhaustive study is needed in order to diagnose it. Causes of secondary hypertension and other contributing factors to poor response to treatment can be found in most casesIntroduction. Refractory hypertension is defined as the failure to reach goal blood pressure (¾ 140/90 mmHg) in patients who are adhering to full doses of an appropriate three-drug regimen that includes a diuretic. Its prevalence among spanish patients is not well documented. The objective was to determine the true prevalence of refractory hypertension in adult patients from a university hospital hypertension clinic. Material and methods. Patients who fulfilled criteria for refractory hypertension were selected from an initial sample of 281 individuals with suspected resistant hypertension. An exhaustive study was performed on these patients in order to confirm refractory hypertension and to search for causes of secondary hypertension and contributing factors to poor response to treatment. Results. Forty two patients were selected (average age: 60 ± 9 years, 27 women, 15 men). After 3.3 ± 0.5 years of monitoring, 73.8 % of the individuals were diagnosed with secondary hypertension (sleep apnoea as the most frequent cause). Recommended treatment goals were achieved in most patients (61.9 %). Only 4.8 % of the selected patients suffered from true refractory hypertension, as they had essential hypertension and maintained high blood pressure in spite of strict treatment and monitoring. Discussion. Real prevalence of refractory hypertension is very low. An exhaustive study is needed in order to diagnose it. Causes of secondary hypertension and other contributing factors to poor response to treatment can be found in most cases

Static headspace versus head space solid-phase microextraction (HS-SPME) for the determination of volatile organochlorine compounds in landfill leachates by gas chromatography.

The determination of five volatile organochlorine compounds, VOX (chloroform, 1,1,1-trichloroethane, carbon tetrachloride, trichloroethene and tetrachloroethene) in raw landfill leachates and biologically cleansed leachates by GC-MS is investigated. Two extraction and preconcentration procedures were evaluated for recovery of such analies from the samples, including static headspace (HS) and solid phase microextraction by sampling the headspace above the sample (HS-SPME). Optimisation of operating parameters for the best performance of both, sampling and preconcentration techniques was described. Detection limits, time of analysis, precision and linear ranges of both introduction techniques have been established. Application of proposed methods to the determination of the five VOX under study in the above referred samples revealed the absence of such analytes in both leachates. Then both methods were applied to the determination to the five organochlorine compounds under study on spiked leachates samples. While HS-GC-MS offered better analytical precision than HS-SPME-GC-MS, this last technique gave a faster analytical response because no dilution must be done for a reliable VOX determination in landfill leachates. In any case, both sample introduction techniques tested provides excellent recoveries and good analytical precision (ranged from 1 to 3%).

Urinary selenium speciation by high-performance liquid chromatography-inductively coupled plasma mass spectrometry: advantages of detection with a double-focusing mass analyser with a hydride generation interface.

A detailed comparison of the performance of inductively coupled plasma mass spectrometry (ICP-MS), with quadrupole and double-focusing instruments for the speciation of selenium in urine has been carried out. Selenium sensitivity about 23-59 times higher with double-focusing ICP-MS detection was observed, but limits of detection were only 1-8.7 times better because of background noise. Selenium species separation has been carried out by both reversed-phase and vesicle-mediated high-performance liquid chromatography (HPLC), coupled on-line with the detector via conventional nebulization and via on-line focused microwave digestion-hydride generation. A remarkable improvement in sensitivity (28-110 times better for (77)Se depending on the chromatographic system) and elimination of interference problems from the urinary matrix or the components of the mobile phases were achieved when an on-line microwave digestion-hydride generation interface was used, but the background noise was much higher than with conventional nebulization. Therefore, the limits of detection were not as low as expected from such improvement in the sensitivity. More selenocompounds can be separated, and a slight improvement in the sensitivity and limits of detection was obtained when the vesicle-mediated HPLC system was used as compared with reverse-phase chromatography. However, the use of several complementary chromatographic systems, such as reverse-phase HPLC, is recommended to bring some light on the selenocompounds present in basal human urine. Comparative data of rat urine speciation are also given.