Objetivo: describir la calidad de vida relacionada con la salud de los adultos mayores residentes en centros de protección social en Cartagena (Colombia). Materiales y métodos: estudio descriptivo. La población fueron 187 adultos mayores residentes en centros de protección social en Cartagena. Se aplicó el Test de Valoración Mental (Pfeiffer), una encuesta sociodemográfica y el “Índice multicultural de calidad de vida”. Se mantuvo la confidencialidad de la información, el anonimato de los participantes y se diligenció el consentimiento informado. Resultados: el promedio de edad fue de 75 años (95 %), predominó el estado civil soltero (57,6 %), nivel educativo primaria (45,5 %), recibir medicamentos (80,3 %), realizar actividades físicas (54,5 %) y no realizar actividades productivas (37,9 %). La autopercepción de la calidad de vida relacionada con salud tiende a valores que pueden considerarse como buenos (7,6 %). Conclusiones: las dimensiones que presentaron puntajes más altos fueron la plenitud espiritual y el autocuidado, y con menor puntaje el bienestar físico y el apoyo comunitario. Esta información será útil para proponer políticas de salud y prácticas de cuidado para esta población.
3203 Ferritin trends are used as surrogates for change in total body iron in patients with transfusional iron overload who are on chelation therapy. They are often used to infer patient adherence with prescribed therapy and for recommending changes. Population studies of ferritin show a 70% correlation with liver iron. The aim of this study was to determine whether the trends in ferritin adequately reflect the change in liver iron concentration (LIC) in individual patients. We retrospectively evaluated ferritin and LIC for 10 years in 40 patients with transfusion dependent anemia (23 with transfusion dependent thalassemia, 12 with sickle cell anemia, 2 with congenital dyserythropoetic anemia, 2 with Diamond Blackfan Anemia and one with sideroblastic anemia). Ferritin levels are evaluated every three weeks at each transfusion and liver iron concentration (LIC) by MRI at approximately annual intervals. The LIC values in mg/g dry weight (dw) are derived by MRI. The trends for both LIC and ferritin were evaluated at each period between the sequential MRIs. We used the average of all ferritins in a four month window centered on the date of the MRI for comparison to the LIC. The overall correlation between ferritin and LIC was similar to other published results (r2=0.69). When ferritin and LIC were plotted against time for each patient, the ferritin trend clearly predicted the LIC trend during certain periods of time (Example figure 1 segment A) and did not during other periods (Figure 1 segment B). The trend in ferritin correctly predicted the trend in LIC all of the time in 55% of patients (22/40). In 45 % of the patients (18/40) the ferritin trend did not correlate with the LIC in over half of the observational periods. In 37.5 % (15/40) of patients during at least one observation period the direction of change was dramatically different. Of these, the direction of change was opposite in 12.5% (5/40). In 22.5 % (9/40) the changes were disproportionate. Six of these patients showed a period during which there was a slight decrease in ferritin but a significant decrease in LIC. In two there was a significant increase in LIC with only a minimal rise in ferritin. In one, with a significant increase in ferritin the LIC increased minimally. While the ferritin was decreasing the LIC and ferritin trends correlated much better than when the ferritin was increasing. This implies that when ferritin levels increase it is a particularly poor tool for assessing change in iron overload. It is clear from this analysis that over certain periods of time, even up to four years, the trends in ferritin can be opposite in direction to the change in total body iron, as derived from LIC. This could lead to inappropriate changes in therapy and incorrect assumptions by health care providers about patient adherence. It is accepted that poor compliance with chelation therapy is the greatest barrier to effective management of iron overload. If only ferritin is used to assess changes in total body iron, patients could be discouraged by their apparent poor response to therapy even though their LIC may actually be decreasing. Serial assessment of total body iron burden by direct measurement of LIC is essential for proper management of patients with transfusional iron overload. Disclosures: Berdoukas: ApoPharma Inc.: Consultancy. Carson:ApoPharma Inc.: Honoraria; Novartis Inc: Speakers Bureau. Wood:Novartis: Research Funding; Ferrokin Biosciences: Consultancy; Cooleys Anemia Foundation: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Coates:Novartis Inc: Speakers Bureau.
3206 Introduction: Pituitary iron toxicity remains a critical problem in thalassemia and other transfusional iron overload syndromes because gonadotropic iron deposition occurs early and remains clinically silent until puberty. While MRI screening of heart and liver iron have improved overall survival in these disorders, the heart develops iron overload only after prolonged, unprotected exposure to transfusional iron. We previously demonstrated that overt, clinical hypogonadism is common (83%) in patients having detectable cardiac iron, and is independently associated with pituitary iron deposition and gland shrinkage. The US29T study was an investigator-initiated, industry-sponsored prospective observational trial examining trends in pituitary iron (by MRI R2) and pituitary volume over two years in children and young adults receiving deferasirox monotherapy for iron overload. We hypothesized that deferasiroxtherapy would prevent pituitary iron accumulation and gland shrinkage over the study interval. Methods: 31 chronically-transfused subjects with thalassemia major (N=28) and Blackfan-Diamond (N=3) syndrome, ages 2–25 years participated in this study. MRI assessment of pituitary R2 and volume was performed at baseline, 1 year, and 2 years; technical details are in (1) and (2). Iron chelation was prescribed by the patient's referring hematologist based upon the patients LIC, cardiac R2*, and pancreas R2* according to local clinical practice; prescribing physicians were screened to the pituitary results. Hypogonadismwas defined clinically based upon inadequate progression of secondary sex characteristics during puberty, primary or secondary amenorrhea in women, or low testosterone in men. All MRI measurements were transformed to Z-scores using age and sex matched norms from 100 nonthalassemic subjects (1). Analysis of variance was used with DunnettÕspost hoc correction. Results: 26 patients completed two years. Reasons for discontinuation were a change to combination deferoxamine/deferasirox therapy (N=2), bone-marrow transplantation (N=1), loss to follow up (N=1), and inability to complete the baseline MRI examination. In the remaining patients, 10 were prepubertal, 12 had achieved normal puberty, and 4 were hypogonadalat baseline. Figure 1 summarizes the change in pituitary R2 Z-score and volumes over the study interval. Pituitary R2 Z-score was elevated at baseline (2.9 ±0.6) but remained stable over two years. Changes in pituitary R2 correlated with mean cardiac and pancreatic R2* but not LIC. Anterior and total pituitary volume were decreased at baseline (mean Z-score −1.1 and −1.4, respectively) but normalized over time; both Year 1 and Year 2 volumes were significantly improved (p<0.03) from baseline. Changes were most strongly correlated with average LIC; 24 out of 26 subjects increased their volume Z-scores over two years. The single patient whose anterior pituitary shrank significantly (DZ = −0.8) during the study interval was openly noncompliant. Her liver iron rose from 10.4 mg/g to 21.4 mg/g, her cardiac R2* increased from 81 to 142 and her pituitary R2 Z-score climbed from 5.4 to 10.3 over two years. Although she had normal initiation of puberty at study entry, she developed pubertal arrest and has not begun her periods by the age of 16. The endocrine status of all of the other subjects in the study was clinically stable. Discussion: The most striking finding was the systematic restoration of pituitary volume toward the normal range, despite no net change in pituitary R2. We postulate that suppression of oxidative stress from labile plasma iron may represent the mechanism of improvement. Stabilization of pituitary R2 is also encouraging. Based upon the baseline cross-sectional relationship of R2 and age, one would have predicted a 0.4 increase in the average R2 Z-score over two years instead of the 0.1 decline observed. Deferasirox monotherapy, in clinical practice, appears to protect the pituitary gland for iron accumulation, shrinkage and dysfunction. Disclosures: Wood: Ferrokin Biosciences: Consultancy; Shire: Consultancy; Apotex: Consultancy, Honoraria; Novartis: Honoraria, Research Funding. Paley:Novartis Pharmaceuticals: Employment. Berdoukas:Apopharma: Consultancy. Coates:Novartis: Speakers Bureau; Apopharma: Consultancy.
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