Elevated Hepcidin Is Part of a Complex Relation That Links Mortality with Iron Homeostasis and Anemia in Men and Women with HIV Infection.

BACKGROUND: Early and chronic inflammation is a hallmark of HIV infection, and inflammation is known to increase hepcidin expression. Consequently, hepcidin may be a key determinant of the iron homeostasis and anemia associated with poorer HIV prognoses. OBJECTIVE: The objective of this study was to understand how hepcidin is related to anemia, iron homeostasis, and inflammation at HIV diagnosis and to investigate associations between hepcidin and all-cause mortality in HIV infection. METHODS: In a retrospective cohort, baseline plasma hepcidin was measured by competitive enzyme immunoassay within 3 mo of HIV diagnosis in 196 antiretroviral-naive Gambians. Iron homeostasis [hemoglobin, plasma transferrin, ferritin, iron, soluble transferrin receptor (sTfR)] and inflammation [α1-antichymotrypsin (ACT)] from the same plasma sample were available, as were absolute CD4 cell counts, age, gender, body mass index (BMI), and HIV type. RESULTS: Anemia was common across the spectrum of immunosuppression [CD4 cell counts (prevalence of anemia): >500 cells/μL (68%), 200-500 cells/μL (73%), and <200 cells/μL (89%); P = 0.032] and in men (81%) and women (76%). Increasing hepcidin was associated with iron homeostasis biomarkers (higher ferritin and lower transferrin, hemoglobin, and sTfR), inflammation (higher ACT), and key health indicators (lower CD4 or BMI, advancing age, and male gender; P < 0.001 except for hemoglobin, P = 0.021). Elevated hepcidin was associated with greater all-cause mortality in a dose-dependent manner [intermediate vs. lowest tertile: unadjusted HR (95% CI), 1.95 (1.22, 3.10); upper vs. lowest tertile: 3.02 (1.91, 4.78)]. Principal components analysis identified 2 patterns composed of hepcidin-ferritin-transferrin, with or without ACT, and iron-sTfR-hemoglobin that may distinguish inflammation and erythropoiesis iron functions. CONCLUSIONS: Elevated hepcidin is independently associated with greater mortality in men and women with HIV infection, and hepcidin is also part of a complex relation linking iron homeostasis, anemia, and HIV. Understanding the mechanisms and role of hepcidin modulation may further guide evidence-based interventions needed to counter detrimental iron homeostasis and anemia in HIV infection

Causes of Road Accidents against the Background of the Theory of Causation

The problem of finding out the exact causes of road accidents is one of the most controversial problems being under discussion in the field of road safety. There are no satisfactory definitions of the basic notions relevant to the causes of accidents and the accident itself and it is why investigation of the mechanism of a road accident and its causes is faced with difficulties. This results in an imperfect statistical classification of road accidents, and classification is the basis of research into any quantitative phenomena and a component of the statistical method. The question to be answered is which definition of the cause of a road accident should be accepted as a tool for selecting the causes for statistical purposes. After a rough analysis of practical application of numerous conceptions of causation used in various fields founded on the theory of casual nexus it can be noted that „the theory of equivalent causes" applied by criminal law may also serve to work out methods of preventing accidents. On the grounds of the assumptions of that theory and an analysis of the views up to now of the adaptation of the theory for preventive purposes it seems useful to assume that „equivalent conditions" existing before an accident, which could be eliminated or whose influence could be limited, are the cause of the accident. If in the statistics of road accidents several causes of an accident are given according to the suggested criterion, the field of observation is much larger and the accuracy of selecting causes is increased and consequently the statistical observation for basic research purposes is of greater value.Digitalizacja i deponowanie archiwalnych zeszytów RPEiS sfinansowane przez MNiSW w ramach realizacji umowy nr 541/P-DUN/201

The role of selected risk factors in the aetiology and the course of Alzheimer’s disease

Alzheimer’s disease (AD) is the most common form of dementia among elderly. It is a progressive, neurodegenerative disease. Morbidity of AD rises with age. Aetiology of AD is multifactorial and it compounds of genetics and environmental factors including general lifestyles, diet, physical activity smoking and alcohol abuse. It is believed that a diet similar in composition to the Mediterranean diet has a protective effect and promotes a long life in health. Hyperhomocysteinemia and a diet deficient in B12 is indirectly associated with AD. On the other hand, supplementation of vitamins C, E and folate in diet can be protective from AD. Both, obesity and undernutrition, can increase the risk of development of AD. The importance of correlation between vascular disease of the brain and dementia is undeniable. It is supported by the fact that appropriate diet, proper nutritional status, absence of diabetes, avoiding smoking and attention to physical activity play an important role not only in preventing cardiovascular diseases, but also the AD. Epidemiological studies suggest that the incidence of AD will continue to rise along with aging population, which will increase the amount of disable people due to AD impacting medical, cultural and economic aspects of the society. Therefore the role of individual factors should have been investigated still and prophylactic activities must have been introduced in the early age.Choroba Alzheimera (Alzheimer’s disease, AD) stanowi jedną z najczęstszych przyczyn otępienia w wieku starszym. Ma charakter postępujący i prowadzi do stopniowej degeneracji mózgu. Zapadalność na AD wzrasta wraz z wiekiem. Etiologia choroby jest wieloczynnikowa. Składają się na nią interakcje pomiędzy czynnikami genetycznymi a środowiskowymi, w tym m.in. stylem życia, dietą, aktywnością fizyczną i nałogami. Uważa się, że sposób odżywiania zbliżony w składzie do diety śródziemnomorskiej ma ochronne działanie i sprzyja długotrwałemu życiu w zdrowiu. Podwyższone stężenie homocysteiny oraz obniżone stężenie witaminy B12 może pośrednio wpływać na rozwój AD. Natomiast zwiększone spożycie kwasu foliowego, witaminy C i E może działać ochronnie. Niekorzystny wpływ na rozwój AD odnotowano zarówno w przypadku zbyt dużej masy ciała, jak i w przebiegu niedożywienia. Podkreśla się również związek pomiędzy naczyniopochodnym uszkodzeniem mózgu a rozwojem otępienia. Przemawia za tym fakt, że odpowiednia dieta, prawidłowy stan odżywienia, brak cukrzycy, unikanie palenia papierosów oraz zwrócenie uwagi na aktywność fizyczną odgrywają istotną rolę w zapobieganiu nie tylko chorobom układu sercowo-naczyniowego, ale także AD. Dane epidemiologiczne dowodzą, iż wraz ze starzeniem się społeczeństwa częstość występowania AD będzie wzrastać, tym samym zwiększy się liczba osób niezdolnych do samodzielnego funkcjonowania. Następstwem tego będzie wzrost obciążeń medycznych, kulturowych i ekonomicznych całego społeczeństwa. Dlatego znaczenie poszczególnych czynników ryzyka AD powinno być nadal zgłębiane, a skuteczna profilaktyka wprowadzana już we wczesnym okresie życia