Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes?

Introduction and objective: Anemia is a common comorbidity in patients with acute coronary syndromes (ACS), and is associated with higher risk for both bleeding and ischemic complications. We aimed to assess the predictive ability of bleeding risk scores (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines [CRUSADE], Mehran and Acute Coronary Treatment and Intervention Outcomes Network [ACTION]) in ACS patients with anemia. Methods: All consecutive ACS patients were prospectively included. The primary outcome was in-hospital major bleeding according to the CRUSADE, Mehran and ACTION definitions. Anemia was defined as hemoglobin <130 g/l in men and <120 g/l in women. The predictive ability of the bleeding risk scores was assessed by binary logistic regression, calculating receiver operating characteristic (ROC) curves and their corresponding area under the curve (AUC). Results: We included 2255 patients, mean age 62.4 years. Anemia was present in 550 patients (24.4%). Patients with anemia had a significantly higher prevalence of comorbidities. The three bleeding risk scores adequately predicted major bleeding in the whole cohort. No significant differences were observed regarding the predictive ability of each of the scores in patients with and without anemia (CRUSADE: AUC 0.73 without anemia vs. 0.74 with anemia, p=0.913; ACTION: AUC 0.68 without anemia vs. 0.73 with anemia, p=0.353; Mehran: AUC 0.69 without anemia vs. 0.61 with anemia, p=0.210). Only the Mehran score showed significantly lower predictive ability in patients with hemoglobin <11 g/dl (AUC 0.51, p=0.044). Conclusions: Anemia was a common comorbidity in patients with ACS from our series. Currently available bleeding risk scores showed an adequate predictive ability in patients with mild anemia

Assessing pollution trends in the Guadalquivir River estuary using N-way analysis

Human activities have contributed to a deployment of environmental quality. In the last decades the problem of water preservation has gained increasing attention, and new policies have been developed for water resources remediation. Statistical techniques for data treatment are based on the organization of data in a bi-dimensional array; thus, some shades on the trend of the distribution tend to be ignored. Multiway techniques, where data are gathered in n directions, allow the analysis of the results through different directions at the same time. In particular, for 3MPCA a principal components analysis is conducted using three modes and a “core” matrix that allows assessing their interactions. The Guadalquivir River estuary has been used as a model system for the application of 3MPCA in the study of long term evolution of pollutants. Nutrients and heavy metals ultra-traces level have been used to characterize the estuary. The 3MPCA was used to assess the relationships within chemical variables, sampling stations and sampling campaigns

Liquid phase micro-extraction: Towards the green methodology for ultratrace metals determination in aquatic ecosystems

Heavy metals are normally found, in natural waters, in very low concentrations. Some of them are essential for life in low level; however, in higher level they are toxic. Therefore, analyzing their bio-available fraction is of main interest. Standard methodology is based in the collection of a number of samples from a water body. Collected samples must be stored, pre-treated and then analyzed. Pre-treatment usually involves pre-concentrating the metal, with the corresponding risk of contamination or loss of analyte. This way, punctual information is obtained from every sampling campaign. As an alternative, passive sampling techniques allow the continuous and coupled sampling-pre-treatment for heavy metals analysis, giving a better approach in the characterization of the studied water body. Liquid phase micro-extraction (LPME) is a green analytical alternative for liquid-liquid extraction that promotes a reduction of sample volume, solvent needed and waste generation. Using these systems, polypropylene hollow fibers (HF) with pores in their walls can be used. A few micro-liters of organic solvent are supported in the pores. The sample is placed in the outer part of the fiber and a receiving phase is placed in its inner part, allowing continuous liquid extraction of the metal from the sample. Several fibers with different physical features have been employed to analyzed total concentration and bio-availability of some heavy metals (Ag, Ni, Cu) in natural water samples. Thanks to fibers configuration, devices for passive sampling based in HF-LPME could be designed. Advantages of this methodology over existing ones are supported because the receiving phase is liquid. As a consequence, retained metals do not need to be eluted from the acceptor prior to instrumental analysis

Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes?

Introduction and objective: Anemia is a common comorbidity in patients with acute coronary syndromes (ACS), and is associated with higher risk for both bleeding and ischemic complications. We aimed to assess the predictive ability of bleeding risk scores (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines [CRUSADE], Mehran and Acute Coronary Treatment and Intervention Outcomes Network [ACTION]) in ACS patients with anemia. Methods: All consecutive ACS patients were prospectively included. The primary outcome was in-hospital major bleeding according to the CRUSADE, Mehran and ACTION definitions. Anemia was defined as hemoglobin <130 g/l in men and <120 g/l in women. The predictive ability of the bleeding risk scores was assessed by binary logistic regression, calculating receiver operating characteristic (ROC) curves and their corresponding area under the curve (AUC). Results: We included 2255 patients, mean age 62.4 years. Anemia was present in 550 patients (24.4%). Patients with anemia had a significantly higher prevalence of comorbidities. The three bleeding risk scores adequately predicted major bleeding in the whole cohort. No significant differences were observed regarding the predictive ability of each of the scores in patients with and without anemia (CRUSADE: AUC 0.73 without anemia vs. 0.74 with anemia, p=0.913; ACTION: AUC 0.68 without anemia vs. 0.73 with anemia, p=0.353; Mehran: AUC 0.69 without anemia vs. 0.61 with anemia, p=0.210). Only the Mehran score showed significantly lower predictive ability in patients with hemoglobin <11 g/dl (AUC 0.51, p=0.044). Conclusions: Anemia was a common comorbidity in patients with ACS from our series. Currently available bleeding risk scores showed an adequate predictive ability in patients with mild anemia

Changes in the Lower Drava River Water Quality Parameters Over 24 Years

The goal of this study was to analyse 13 physico-chemical and microbiological parameters of the Drava River water at three sampling sites in the lower Drava region (eastern Croatia) over two distinct periods: the pre-war period between 1985 and 1992 and the post-war period between 1993 and 2008. Over both periods, most parameters kept within the tolerable water quality limits, while NO3-N, NH4-N and BOD5 were higher. The lower Drava showed slight organic pollution with high concentrations of dissolved oxygen. High levels of total coliforms and heterotrophic bacteria in the post-war period were only found downstream of the town of Osijek. Upstream of Osijek, the river showed a tendency for improvement.prostornih i vremenskih promjena tijekom perioda od 24 godine. Analizirali smo 13 fi zikalno-kemijskih i mikrobioloških parametara vode rijeke Drave na tri mjerne postaje smještene na području donjeg toka Drave (istočna Hrvatska) tijekom dvaju različitih razdoblja: 1985.-1992. (period prije rata) i 1993.-2008. (period poslije rata). Iako su vrijednosti većine podataka prikupljenih tijekom dvaju promatranih razdoblja oscilirale, vrijednosti su im se još uvijek nalazile u granicama za I. i II. vrstu voda. Vrijednosti nekih fi zikalno-kemijskih varijabla, kao što su NO3-N, NH4-N i BPK5 još su uvijek iznad granice za II. vrstu. Rezultati ovog istraživanja pokazali su blago organsko onečišćenje vode rijeke Drave s visokim koncentracijama otopljenog kisika. Povećanje broja ukupnih koliformnih i heterotrofnih bakterija u poslijeratnom razdoblju veliki je problem u području nizvodno od Osijeka pri čemu njihov broj katkad dostiže i vrijednosti za V. skupinu površinskih voda. Rezultati analize kvalitete vode rijeke Drave u dva različita razdoblja na dva mjerna mjesta uzvodno od Osijeka upućuju na tendenciju poboljšanja, iako neki od promatranih parametara pokazuju vrijednosti više od onih za II. skupinu riječnih voda. Različitosti, odnosno sličnosti među mjernim postajama istražene su metodom klasterske analize