Incidence of cutaneous vasoactivity in patients with anemia and pulmonary hypoxia

Renal function as risk factor for diabetic foot ulcers: A meta-analysis

The meta-analysis aimed to assess renal function (RF) as a risk factor for diabetic foot ulcers (DFUs). Using dichotomous or contentious random or fixed effect models, the outcomes of this meta-analysis were examined, and the odds Ratio (OR) and the mean difference (MD) with 95% confidence intervals (CIs) were computed. 16 examinations from 2004 to 2023 were enrolled for the present meta-analysis, including 808 914 individuals with diabetes mellitus (DM). DFU had significantly higher chronic renal failure (OR, 3.17; 95% CI, 1.97-5.09, p < 0.001), higher serum Creatinine (MD, 29.30; 95% CI, 9.68-48.92, p = 0.003), and a low estimated glomerular filtration rate (MD, -15.31; 95% CI, -19.36 to -11.26, p < 0.001) compared to non-DFU patients with DM. The examined data revealed that DFU had significantly higher chronic renal failure, higher serum Creatinine, and a low estimated glomerular filtration rate compared to non-DFU patients with DM. Yet, attention should be paid to its values since some comparisons had a low number of selected studies.

Vascular endothelial damage in COPD: current functional assessment methods and future perspectives

Introduction: Cardiovascular disease is a major cause of death in chronic obstructive pulmonary disease (COPD), but the relationship between these two entities is not fully understood; smoking, inflammation, arterial stiffness and endothelial dysfunction are significant determinants. Endothelial dysfunction is not only associated with cardiovascular disease, but also with COPD severity.Areas covered: Several functional methods have been developed to evaluate endothelial function in healthy and diseased individuals; from the invasive angiography of epicardial coronary arteries and Venous-Occlusion-Plethysmography, to more modern, noninvasive approaches such as Flow-Mediated-Dilatation, Peripheral-Arterial-Tonometry and Near-Infrared-Spectroscopy, all these methods have boosted clinical research in this field. In this context, this narrative review, which included articles published in PubMed and Scopus up to 25-November-2020, summarizes available functional methods for endothelial damage assessment in COPD and discusses existing evidence on their associations with comorbidities and outcomes in this population.Expert opinion: Accumulated evidence suggests that endothelial dysfunction occurs in early stages of CΟPD and worsens with pulmonary obstruction severity and during acute exacerbations. Novel methods evaluating endothelial function offer a detailed, real-time assessment of different parameters related to vascular function and should be increasingly used to shed more light on the role of endothelial damage on cardiovascular and COPD progression.

Is there an association between anemia and diabetic foot ulcers? A systematic review and meta-analysis

Anemia was found to be prevalent in patients with diabetes mellitus. Higher rates of anemia were reported in patients having diabetic foot ulcers (DFU). With the presence of an altered microcirculation, the potential negative effects of anemia might impede ulcer healing leading to higher rates of amputation and mortality. Medline, Embase, Scopus, CINAHL, Cochrane Library, and Google Scholar, were searched for from inception to locate relevant papers reporting any association between anemia and diabetic foot ulcers. The meta-analysis included 15 studies with 2895 patients. The weighted prevalence anemia rates of the total, mild-to-moderate DFU, and severe DFU groups were as follows: 69.7%, 49.5%, and 73%, respectively. For the hemoglobin level outcome, the same samples yielded the following pooled means: 11.00 ± 1.13, 12.08 ± 0.8, and 10.57 ± 0.68 g/dl. Individual studies showed association between low levels of hemoglobin and higher rates of non-healing ulcer, amputation, and mortality. This review demonstrated (a) a clear association between the presence of anemia and diabetic foot ulcers, (b) a clear association between the severity of anemia and the severity of DFUs, and (c) that anemia could be a predictor of amputation and mortality. Whether anemia is a predictor of adverse outcomes or an independent risk factor is to be further investigated.

Anemia in diabetes: marker or mediator of microvascular disease?

Anemia is a common finding in patients with diabetes due to the high burden of chronic kidney disease in this population. Anemia is more prevalent and is found earlier in patients with diabetes than in those with kidney disease from other causes. The increased risk of anemia in diabetes probably reflects changes in the renal tubulointerstitium associated with diabetic kidney disease, which disrupt the delicate interaction between interstitial fibroblasts, capillaries and tubular cells required for normal hemopoietic function. In particular, the uncoupling of the hemoglobin concentration from renal erythropoietin synthesis seems to be the key factor underlying the development of anemia. Systemic inflammation, functional hematinic deficiencies, erythropoietin resistance and reduced red cell survival also drive anemia in the setting of impaired renal compensation. Although anemia can be considered a marker of kidney damage, reduced hemoglobin levels independently identify diabetic patients with an increased risk of microvascular complications, cardiovascular disease and mortality. Nevertheless, a direct role in the development or progression of diabetic complications remains to be clearly established and the clinical utility of correcting anemia in diabetic patients has yet to be demonstrated in randomized controlled trials. Correction of anemia certainly improves performance and quality of life in diabetic patients. In the absence of additional data, treatment should be considered palliative, and any functional benefits must be matched against costs to the patient and the health system.

Divergent trophoblast invasion and apoptosis in placental bed spiral arteries from pregnancies complicated by maternal anemia and early-onset preeclampsia/intrauterine growth restriction

OBJECTIVE

Impaired trophoblast invasion into spiral arteries is associated with early-onset intrauterine growth restriction and preeclampsia. We compared trophoblast invasion into spiral arteries in pregnancies with maternal anemia or early-onset preeclampsia/intrauterine growth restriction and related these findings to trophoblast apoptosis.

STUDY DESIGN

Full-thickness uterine wall samples were obtained from women with early-onset preeclampsia/intrauterine growth restriction (n = 6), normal pregnancies (n = 5), and chronic anemia (n = 8). Trophoblast invasion into the walls of spiral arteries was quantified by morphometric analysis of paraffin sections stained with anticytokeratin 18, antiactin, and anticytokeratin 18 neoepitope (M30) antibodies.

RESULTS

Trophoblast invasion into spiral arteries was increased in anemic pregnancies (mean [SD]: 206 [46] cell profiles/mm2) and severely impaired in preeclamptic/intrauterine growth restriction pregnancies (17 [6]), compared with normal subjects (149 [52]). Spiral artery lumen area was increased in anemia (0.07 [0.03] mm2) versus normal pregnancies (0.09 [0.04] mm2) and reduced in preeclampsia/intrauterine growth restriction (0.04 [0.02] mm2). Trophoblast apoptosis was similar in anemic (4.2% [3.4%]) and normal (5.0% [1.9%]) pregnancies but increased in preeclampsia/intrauterine growth restriction (12% [5.6%]).

CONCLUSION

Trophoblast invasion into the placental bed in early-onset preeclampsia/intrauterine growth restriction is limited by increased apoptosis, resulting in narrower spiral arteries, which is in contrast to findings in anemia.