High cobalamin levels as a five-year risk predictor for developing hematological cancer.

BACKGROUND: A high cobalamin level has been related to non-malignant diseases (mainly liver diseases, alcoholism, and renal diseases) and cancer (hematological malignancies and solid cancers such as liver and stomach cancer). However, a previous high level of cobalamin and the implications in the possible development of cancer is still unclear. The main aim of this study was to describe if a previous high cobalamin level is a determinant in the future development of cancer in five years of follow-up. The secondary objective was to determine any differences between cancer groups. METHODS: A retrospective study was performed. Two databases were employed. The first one included all patients who had a determination of cobalamin in a routine blood test during the year 2010 (a total of 44,166 patients). The second one showed every patient who was admitted to the reference hospital, Hospital Clinico Universitario de Valladolid, during the following five years. Finally, a number of 6710 patients was included. Both databases belong to the medical records of the Hospital Data Surveillance System and are completely validated. Multivariate logistic regression analyses were employed to evaluate the association between cobalamin levels and the appearance of cancer (total and in each subgroup). All analyses were performed using IBM SPSS 24 software (IBM Corp., Armonk, NY, USA). RESULTS: The sample studied showed a clear association between the risk of hematological cancer and a previous high Cbl level. This relationship was higher among patients with the highest levels (over 779 pmol/L), showing almost two times more risk for development of hematological malignance within 5 years in the multivariate analysis (OR: 1.975, 95% CI: 1.056-3.697, P=0.033). Hematological malignancies were mostly diagnosed within the first three years (86.6%), showing a similar percentage in those three years. There was no association between this previous level and the development of any other type of cancer. CONCLUSIONS: Our study shows that a high cobalamin plasma level (hypervitaminosis) is associated with the development of hematologic cancer within five years after the measurement. The clinical implication of these findings, together with the clinical suspicion, reinforces the necessity of carrying out specific screening hematological tests in patients with not justified elevated plasma cobalamin levels. New prospective and multicenter studies are necessary to validate these results.

A Non-Stressful Temperature Rise and Greater Food Availability Could Increase Tolerance to Calcium Limitation of Daphnia cf. pulex (Sensu Hebert, 1995) Populations in Cold Soft-Water Lakes.

Calcium (Ca) is an important driver of community structure in freshwaters. We examined the combined effects of increased temperatures and variations in food quantity on the tolerance to low Ca of Daphnia pulex. The aim was to predict the impact of climate warming on this keystone zooplanktonic species in cold-climate lakes. We conducted a factorial life-history experiment in a clone of North American Daphnia cf. pulex to analyse the interaction effects of a temperature increase (17.5 °C−21 °C) within their physiological preferred range and expected by climate warming over the next few decades and a narrow Ca gradient (0.25−1.74 mg Ca L−1) under stressful vs. abundant food conditions. We found a striking positive synergistic effect of Ca and temperature on D. pulex reproduction at high food conditions. Although the increase in temperature to 21 °C greatly reduced survival, high energy allocation to reproduction at high food levels allowed the population to succeed in poor Ca (<0.25 mg Ca L−1). Results suggest that climate warming and higher food availability will make the populations of many cold and Ca-limited lakes more tolerant to low Ca levels with higher growth population rates, thereby altering zooplanktonic community structures and inducing potential cascading effects on the food web.

Assessing the toxic effects of magnetic particles used for lake restoration on phytoplankton: A community-based approach.

Inactivation by adding different phosphorus (P) adsorbents is one of the most frequently used methods for combating inland water eutrophication. The aim of this work was to assess the toxic effects of novel P adsorbents (magnetic particles, MPs) on the phytoplankton community. An outdoor microcosm experiment, containing lake water and surface sediment from a hypertrophic Mediterranean lake, was carried out following a factorial design (n = 5) with three different treatments: control (C), where no MPs were added; Treatment-Water (T-W) and Treatment-Sediment (T-S). In T-W and T-S treatments, MPs were added on the surface water layer and on the sediment, respectively, to obtain a final concentration of 1.4 g MP L-1. This concentration was based on both the sedimentary mobile P concentration of the study site and the maximum P adsorption capacity of the MPs, obtained from the literature. After 24 h of contact time, the MPs were removed using a magnetic rake. Physicochemical measurements and biological samples were taken after 24 h of exposure to the MPs and at different time points after such exposure (day 2, 7, 21, 35 and 70). Changes in phytoplankton community such as abundance (biovolume and Chla), species composition and taxonomic groups were assessed, as well as changes in the Shannon-Wiener diversity index. Additionally, the eutrophic metric Algae Group Index (AGI), one of the metrics proposed in the Water Framework Directive, was also calculated. Our results indicate that there is no strong evidence to infer that MPs caused an effect on the phytoplankton community, since no significant differences (GLM test; p > 0.05) were found between controls and treatments in any of the studied variables (phytoplankton taxonomic groups, AGI, Chla concentration, biovolume, diversity and community responses). Accordingly, MPs did not cause any toxic effects on the phytoplankton community of the lake, encouraging the use of MPs in a future whole-lake restoration strategy. However, if the final goal of the restoration plan is to combat nuisance cyanobacteria blooms, higher initial MPs doses or repeated MPs applications are required to achieve a reduction in P concentrations below biological thresholds in order to prevent algal blooms.

Fluctuating neurological symptoms: should I call the neurologist or the hematologist?

Objectives: The objective of this study was to highlight the role of the clinical laboratory and the relevance of reporting the case immediately to the unit of hematology for the diagnosis and early administration of treatment in the presence of such an urgent hematologic disease as thrombotic thrombocytopenic purpura (TTP). Case presentation: An elderly patient was referred to the emergency department of our hospital by his general practitioner for speech difficulty, facial asymmetry and weakness in the upper limb. Stroke code was activated. However, laboratory findings (anemia, thrombocytopenia, elevated creatinine, total bilirubin and LDH, negative direct Coombs test) and presence of schistocytes in the peripheral blood smear test were consistent with a completely different diagnosis: TTP thrombotic microangiopathy. Conclusions: The first diagnostic approach of left hemispheric stroke was not confirmed in the laboratory, with findings of nonautoimmune hemolytic anemia, thrombocytopenia without apparent cause and presence of schistocytes. We should not forget that the clinical manifestations of this condition are widely variable and may include multiorganic dysfunction. Although confirmation of diagnosis is based on ADAMTS-13, its associated high mortalitiy requires immediate treatment on mere suspicion.

Clínica neurológica fluctuante: ¿Llamo al neurólogo o al hematólogo?

Objetivos: Resaltar el papel del laboratorio clínico y la pronta comunicación con el servicio de Hematología en el diagnóstico y la rapidez en la instauración del tratamiento de una patología hematológica tan urgente como la Púrpura Trombótica Trombocitopénica (PTT). Caso clínico: Varón de edad avanzada derivado a Urgencias hospitalarias por su médico de Atención Primaria por trastorno de emisión del lenguaje, asimetría facial y disminución de fuerza en extremidad superior, por lo que se activa el código ictus. Sin embargo, los hallazgos de laboratorio (anemia y trombocitopenia, creatinina, bilirrubina total y LDH elevadas, test de Coombs directo negativo) y presencia de esquistocitos en el frotis de sangre periférica, acaban derivando en un diagnóstico completamente diferente: microangiopatía trombótica tipo PTT. Conclusiones: La primera orientación diagnóstica de ictus hemisférico izquierdo fue rechazada ante los signos de anemia hemolítica no autoinmune, trombocitopenia sin causa aparente y presencia de esquistocitos. No debemos olvidar que esta patología puede cursar con afectación multiorgánica y características clínicas muy variables. Aunque su diagnóstico definitivo se basa en la determinación de actividad de ADAMTS-13, debido a la elevada mortalidad es necesario instaurar tratamiento de forma inmediata tras su sospecha.

Long-term ecological changes in Mediterranean mountain lakes linked to recent climate change and Saharan dust deposition revealed by diatom analyses.

Anthropogenic climate change and the recent increase of Saharan dust deposition has had substantial effects on Mediterranean alpine regions. We examined changes in diatom assemblage composition over the past ~180 years from high-resolution, dated sediment cores retrieved from six remote lakes in the Sierra Nevada Mountains of Southern Spain. In all lakes, changes in diatom composition began over a century ago, but were more pronounced after ~1970 CE, concurrent with trends in rising regional air temperature, declining precipitation, and increased Saharan dust deposition. Temperature was identified as the main predictor of diatom assemblage changes, whereas both Saharan dust deposition drivers, the Sahel precipitation index and the winter North Atlantic Oscillation, were secondary explanatory variables. Diatom compositional shifts are indicative of lake alkalinization (linked to heightened evapoconcentration and an increase in calcium-rich Saharan dust input) and reduced lake water turbulence (linked to lower water levels and reduced inflows to the lakes). Moreover, decreases in epiphytic diatom species were indicative of increasing aridity and the drying of catchment meadows. Our results support the conclusions of previous chlorophyll-a and cladoceran-based paleolimnological analyses of these same dated sedimentary records which show a regional-scale response to climate change and Saharan dust deposition in Sierra Nevada lakes and their catchments during the 20th century. However, diatom assemblages seem to respond to different atmospheric and climate-related effects than cladoceran assemblages and chlorophyll-a concentrations. The recent impact of climate change and atmospheric Saharan deposition on lake biota assemblages and water chemistry, as well as catchment water availability, will have important implications for the valuable ecosystem services that the Sierra Nevada provides.

Climate change and Saharan dust drive recent cladoceran and primary production changes in remote alpine lakes of Sierra Nevada, Spain.

Recent anthropogenic climate change and the exponential increase over the past few decades of Saharan dust deposition, containing ecologically important inputs of phosphorus (P) and calcium (Ca), are potentially affecting remote aquatic ecosystems. In this study, we examine changes in cladoceran assemblage composition and chlorophyll-a concentrations over the past ~150 years from high-resolution, well-dated sediment cores retrieved from six remote high mountain lakes in the Sierra Nevada Mountains of Southern Spain, a region affected by Saharan dust deposition. In each lake, marked shifts in cladoceran assemblages and chlorophyll-a concentrations in recent decades indicate a regional-scale response to climate and Saharan dust deposition. Chlorophyll-a concentrations have increased since the 1970s, consistent with a response to rising air temperatures and the intensification of atmospheric deposition of Saharan P. Similar shifts in cladoceran taxa across lakes began over a century ago, but have intensified over the past ~50 years, concurrent with trends in regional air temperature, precipitation, and increased Saharan dust deposition. An abrupt increase in the relative abundance of the benthic cladoceran Alona quadrangularis at the expense of Chydorus sphaericus, and a significant increase in Daphnia pulex gr. was a common trend in these softwater lakes. Differences in the magnitude and timing of these changes are likely due to catchment and lake-specific differences. In contrast with other alpine lakes that are often affected by acid deposition, atmospheric Ca deposition appears to be a significant explanatory factor, among others, for the changes in the lake biota of Sierra Nevada that has not been previously considered. The effects observed in Sierra Nevada are likely occurring in other Mediterranean lake districts, especially in softwater, oligotrophic lakes. The predicted increases in global temperature and Saharan dust deposition in the future will further impact the ecological condition of these ecosystems.

Caracterización de adultos mayores con cáncer de cabeza y cuello / Head and Neck Cancer Characterization in Elderly Patients

Introducción: los carcinomas de cabeza y cuello constituyen el 7% de todas las neoplasias y la cuarta causa de muerte por cáncer en el varón; son heterogéneos, varían histológicamente y tienen una etiología y una epidemiología distintas; aparecen en diferentes formas clínicas y con progresión variable, son diversos también los enfoques terapéuticos y pronósticos. Objetivo: caracterizar el comportamiento clínico-epidemiológico y terapéutico de los carcinomas de cabeza y cuello en adultos mayores en la provincia Holguín. Métodos: se realizó una investigación descriptiva, longitudinal retrospectiva en 407 adultos mayores con diagnóstico de cáncer de cabeza y cuello en Holguín entre enero 2005- diciembre 2010. Se confeccionó una base de datos, se organizó y procesó la información por medio de estadísticos descriptivos. Resultados: predominó la enfermedad en la sexta década de la vida (42,76%) y el sexo masculino (72,00%). Los municipios más afectados fueron Holguín (28,00%) y Mayarí (11,80%). Predominaron los hábitos tóxicos, principalmente, el tabaquismo (64,62%). El mayor porcentaje se diagnosticó en los estadios IV (41,52%) y III (25,06%). El carcinoma epidermoide bien diferenciado prevaleció (39,56%). La cavidad bucal (33,91%) y la laringe (29,00%) fueron los sitios más afectados con metástasis en el 69,77% de los pacientes. Las modalidades terapéuticas más empleadas fueron las oncoespecíficas combinadas (50,85%). Conclusiones: predominó un diagnóstico tardío de los tumores de cabeza y cuello en las edades geriátricas; la pobre calidad de vida y escasas posibilidades terapéuticas y de supervivencia.

Introduction: head and neck carcinomas (HNC) constitute 7% of all neoplasias and fourth fatal cause for cancer in males. They are diverse considering its epidemiologic and etiological aspects, heterogeneous and histologically varied. It appears with different clinical presentations and progress, and several therapeutic management and prognosis. Objective: to describe the head and neck cancer clinical-epidemiological behavior as well as therapeutic behavior in elderly people of Holguin. Methods: a descriptive observational study in 407 with head and neck Cancer elderly people, registered in Holguin Health Administration Oncology Report from January 2005 to December 2010 was carried out. Microsoft Excel program and statistical methods to study some variables and to obtain absolute number and percentage were used. Results: there was a highest incidence of this disease in 42.76% of six-year-old patients and those of male sex (72.00%). Holguin (28.00%) and Mayari (11.80%) represented the most affected cities. The majority of patients had toxic habits: smoking (64.62%). The highest percentage of patients was in IV (41.52%) and III (25.06%) stages. The epidermoid carcinoma prevailed. The oral cavity (33.91%) and larynx (29.00%) were the most affected anatomic localization, with metastasis in 69.77% of patients. Combined therapies were the most applied ones in 50.85% of these patients. Conclusions: diagnosis of head and neck tumors in geriatric ages was late; bad quality of life and lowest therapeutic and survival possibilities was observed.

Caracterización de adultos mayores con cáncer de cabeza y cuello / Head and Neck Cancer Characterization in Elderly Patients

Introducción : Los carcinomas de cabeza y cuello constituyen el 7 por ciento de todas las neoplasias y la cuarta causa de muerte por cáncer en el varón ; son heterogéneos, varían histológicamente y tienen una etiología y una epidemiología distintas, aparece en diferentes formas clínicas y con progresión variable, son diversos también los enfoques terapéuticos y pronósticos .Objetivo: caracterizar el comportamiento clínico - epidemiológico y terapéutico de los carcinomas de cabeza y cuello en adultos mayores en la provincia Holguín. Métodos : se realizó una investigación descriptiva, longitudinal retrospectiva en 407 adultos mayores con diagnóstico de cáncer de cabeza y cuello en Holguín entre enero 2005 -diciembre 2010. Se confeccionó una base de datos, se organizó y procesó la información por medio de estadísticos descriptivos. Resultados: predominó la enfermedad en la sexta década de la vida 42,76 por ciento y el sexo masculino 72 por ciento. Los municipios más afectados fueron Holguín 28 por ciento y Mayarí 11,80 por ciento. Predominaron los hábitos tóxicos, principalmente, el tabaquismo 64,62 por ciento. El mayor porcentaje se diagnosticó en los estadios IV 41,5 2 por ciento y III 25,06 por ciento. El carcinoma epidermoide bien diferenciado prevaleció 39,56 por ciento. La cavidad bucal 33,91 por ciento y la laringe 29,00 por ciento fueron los sitios más afectados con metástasis en el 69,77 por ciento de los pacientes. Las modalidades terapéuticas más empleadas fueron las oncoespecíficas combinadas 50,85 por ciento. Conclusiones: predominó un diagnóstico tardío de los tumores de cabeza y cuello en las edades geriátricas; la pobre calidad de vida y escasas posibilidades terapéuticas y de supervivencia(AU)...

Introduction : Head and neck carcinomas HNC constitute, 7 percent, of all neoplasias and fourth fatal cause for cancer in males. They are diverse considering its epidemiologic and etiological aspects, heterogeneous and histologically varied. It appears with different clinical presentations and progress and several therapeutic management and prognosis. Objective: to describe the head and neck cancer clinical-epidemiological behav ior as well astherapeutic behavior in elderly people of Holguin. Methods: a descriptive observational study in 40, with head and neck Cancer elderly people, registered in Holguin Health Administration Oncology Report from January 2005, to December ,2010, was carried out. Microsoft Excel program and statistical methods to study some variables and to obtain absolu te number and percentage were used. Results: there was a highest incidence of this disease in 42.76 percent of six-year old patientsand those of male sex ,72. 00 percent, Holguin, 28 00 percent, and Mayari 11. 80 percent, represented the most affected cities. The majority of patients had toxic habits: smoking ,64. 62 percent:. The highest percentage of patients was in IV 41. 52 percent and III 25.06 percent, stages. The epidermoidcarcinoma prevailed. The oral cavity 33.91 percent and larynx 29.00 percent, were the most affected anatomic localization, with metastasis in 69.77 percent, of patients. Combined therapies were the most applied ones in 50.85 percent of these patients. Conclusions: diagnosis of head and neck tumors in geriatric ages was late; bad quality of life and lowest therapeutic and survival possibilities was observed(AU)...