No abstract

Iron is an essential micronutrient, as it is required for adequate erythropoietic function, oxidative metabolism and cellular immune responses. Although the absorption of dietary iron (1-2 mg/d) is regulated tightly, it is just balanced with losses. Therefore, internal turnover of iron is essential to meet the requirements for erythropoiesis (20-30 mg/d). Increased iron requirements, limited external supply, and increased blood loss may lead to iron deficiency (ID) and iron-deficiency anemia. Hepcidin, which is made primarily in hepatocytes in response to liver iron levels, inflammation, hypoxia and anemia, is the main iron regulatory hormone. Once secreted into the circulation, hepcidin binds ferroportin on enterocytes and macrophages, which triggers its internalization and lysosomal degradation. Thus, in chronic inflammation, the excess of hepcidin decreases iron absorption and prevents iron recycling, which results in hypoferremia and iron-restricted erythropoiesis, despite normal iron stores (functional ID), and anemia of chronic disease (ACD), which can evolve to ACD plus true ID (ACD + ID). In contrast, low hepcidin expression may lead to iron overload, and vice versa. Laboratory tests provide evidence of iron depletion in the body, or reflect iron-deficient red cell production. The appropriate combination of these laboratory tests help to establish a correct diagnosis of ID status and anemia.

Context-Systemic hypertension is prevalent among patients with obstructive sleep apnea (OSA). Short-term studies indicate that continuous positive airway pressure (CPAP) therapy reduces blood pressure in patients with hypertension and OSA.Objective-To determine whether CPAP therapy is associated with a lower risk of incident hypertension.Design, Setting, and Participants-A prospective cohort study of 1889 participants without hypertension who were referred to a sleep center in Zaragoza, Spain, for nocturnal polysomnography between January 1, 1994, and December 31, 2000. Incident hypertension was documented at annual follow-up visits up to January 1, 2011. Multivariable models adjusted for Corresponding Author: José M. Marin, MD, Respiratory Department, Hospital Universitario Miguel Servet, Avda Isabel la Católica, 1-3, 50006 Zaragoza, Spain (jmmarint@unizar.es).. Author Contribution: Dr Marin had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Conclusion-Compared with participants without OSA, the presence of OSA was associated with increased adjusted risk of incident hypertension; however, treatment with CPAP therapy was associated with a lower risk of hypertension. HHS Public AccessOBSTRUCTIVE SLEEP APNEA (OSA), a prevalent condition that is estimated to affect 17% of US adults, is associated with an increased risk for cardiovascular diseases and overall mortality. [1][2][3][4][5] Although treatment of OSA with continuous positive airway pressure (CPAP) therapy is associated with decreased overall cardiovascular risk, its efficacy in preventing new-onset hypertension is unknown. 2Several cross-sectional studies link OSA to arterial hypertension, a major risk factor for fatal and nonfatal cardiovascular events. [6][7][8][9][10] However, the association between OSA and increased rate of incident hypertension has not been observed consistently in prospective studies. 11,12 A relatively short follow-up period (<5 years) and a limited inclusion of patients with severe OSA hinder conclusions regarding the association of OSA with incident hypertension. 11,12 Further more, the contribution of change in body weight over time, a well-established risk factor for both hypertension and OSA, to the development of newonset hyper-tension has not been investigated in patients with OSA. 13 Treatment of OSA eliminates repetitive episodes of hypoxia associated with transient cessation of breathing and stabilizes cardiovascular function. 14 Short-term studies indicate that CPAP use is associated with a reduction in blood pressure in patients with hypertension and OSA. 15 Whether long-term CPAP therapy prevents or reduces the rate of new-onset hypertension in patients with OSA has not been investigated. We hypothesized that OSA is an independent risk factor for the development of new-onset hypertension and that longterm CPAP therapy reduces this risk regardless of change in body weight over time. Clinical DataDemographic, anthropomet...

Several major orthopaedic surgical procedures may result in significant blood loss and the need for allogeneic blood transfusion (ABT). However, overall concerns about adverse effects of ABT have prompted the review of transfusion practice and the search for transfusion alternatives to decrease or avoid the use of ABT. These strategies include the correction of perioperative anaemia, pharmacological and non-pharmacologic measures to reduce blood loss, preoperative autologous blood donation and perioperative red blood cell salvage. We have reviewed the efficacy and safety of these strategies and where appropriate offer evidence-based recommendations on their use in orthopaedic surgery. We also reviewed the European regulations on ABT alternatives. Pharmacological alternatives need to be used with a total adherence to European regulations in their legal and off-label use. The administration and use of pharmacological agents to stimulate erythropoiesis or reduce blood loss needs to be within the context of attempting to use allogenic blood in a rational manner. As for autologous blood, European Directives cover preoperative autologous blood donation, but not its clinical use, and perioperative red blood cell salvage devices, but not the product yielded by them. Therefore, the development of quality standards and good practice guidelines for perioperative red blood cell salvage, as well as its inclusion in the haemovigilance programme, is urgently needed. Finally, it is noteworthy that some recommendations given for ABT alternatives are not supported by a high level of evidence and that the goal of performing major orthopaedic surgical procedures without the use of ABT may be better accomplished by combining several of these techniques within a defined algorithm.

Medication adherence and persistence during a 2-year period for 3 well-known protective cardiovascular medications were not different in patients with severe OSA, whether or not they were treated with CPAP.