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The prevalence of heart failure (HF) is continuously rising in both the industrialized and non-industrialized nations. Despite current therapeutic advances, prognosis of HF patients remains poor. Presently, therapeutic pharmacological and device strategies for HF with reduced ejection fraction (HFrEF) are mostly palliative and do not induce regeneration of lost myocardial tissue. Stem cell therapy has demonstrated promising results in clinical studies by promoting myocardial restoration in HFrEF subjects. Despite decades of investigation, many challenges remain unanswered to the widespread clinical application of stem cell therapy for HFrEF. This review will describe the foundational work already accomplished in cardiac stem cell therapy, advantages and limitations of the various candidates for tissue restoration, their presumed mechanisms of action, the role of scaffolding materials as well as the challenges that exist for widespread clinical application.

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Antithyroid medications can cause antineutrophil cytoplasmic antibody (ANCA) vasculitis. However, no literature in English describes the coexistence of granulomatosis with polyangiitis (GPA) and untreated Graves' disease. We present a 19-year-old female with thyroid storm and additional complaints of cough, hemoptysis, nasal discharges, polyarthralgia, and skin lesions. Imaging showed peri-hilar cavities and acute-on-chronic sinusitis. Elevated cytoplasmic pattern antineutrophil cytoplasmic antibody (C-ANCA) and anti-proteinase-3 antibody levels plus histopathology of the nasal and skin biopsies suggested GPA. Propranolol, methimazole, and potassium-iodide resolved the thyroid storm. Induction therapy (steroids, rituximab) for GPA provided relief of chronic symptoms stressing the importance of early recognition and swift initiation of treatment Categories: Endocrinology/Diabetes/Metabolism, Allergy/Immunology, Rheumatology

Introduction: Iron deficiency (ID) is a common comorbidity in chronic heart failure patients that can be routinely diagnosed by serum laboratorial tests showing reduced ferritin and/or transferrin saturation (TSAT) levels. However, it is not clear the impact on survival of different biochemical tests widely used for ID diagnosis. Hypothesis: We hypothesized that different laboratorial tests for ID diagnosis also implies in different prognostic values in heart failure patients. Methods: We performed a cohort study with 108 chronic and stable heart failure patients, attended in an outpatient clinic. The mean age was 59 ± 14 years, 53% were male, 31% had Chagas Disease, and 35% were NYHA functional class III/IV. The mean follow-up time was 712 ± 277 days, and the primary endponint investigated was all-cause death. We analysed biochemical levels of ferritin, serum iron, and latent iron binding capacity, which were used to estimate TSAT. Cut-off values for serum ferritin was <100 ng/dL and TSAT <20%. Combined values of ferritin and TSAT determined three metabolic states: iron depleted stores (ferritin <100 ng/dL with TSAT >20%), functional iron deficiency (TSAT <20% ferritin >100 ng/dL), and absolute iron deficiency (ferritin <100 ng/dL to TSAT <20%). Results: During the study, 31 (28.7%) deaths were reported. A univariate analysis showed a higher mortality rate in patients with serum sodium <130 mmol/L (P < .001), advanced NYHA functional class (III/IV) (P < .05), systolic blood pressure <90 mmHg (P < .01), and creatinine clearance <60 mL/min (P < .01). In the univariate analysis for ID assessments, only TSAT <20% was associated with poor survival (P < .01). On metabolic iron states investigation, functional (P < .05) and absolute iron deficiency (P < .01) were associated with worse prognosis. In a multivariate model TSAT <20% (HR 2.15 -P < .005) and functional iron deficiency (TSAT <20% with ferritin >100 ng/dL) (P < .005; HR 1.81) remained independent prognostic factors. Iron depleted stores, diagnosed solely by ferritin <100 ng/dL, had no correlation with survival. Conclusions: Iron deficiency, diagnosed when TSAT parameter <20%, identified heart failure patients with higher mortality, independent of ferritin values.