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Pang FS, Liaw EYF, De S. Comprehensive management of Jehovah's Witness in pregnancy. Postgrad Med J 2023; 99:1068-1075. [PMID: 37334974 DOI: 10.1093/postmj/qgad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/16/2023] [Accepted: 05/13/2023] [Indexed: 06/21/2023]
Abstract
Jehovah's Witness (JW) is a denomination of Christianity which has many-fold higher morbidity and mortality compared to the general population as they refuse blood transfusion. Information is scanty regarding guidelines on the optimal approach to pregnant ladies of JW faith. In this review we have attempted to analyse the ways and techniques available which can be used to reduce the morbidity and mortality of these women. In antenatal care, haematological status can be optimised to reduce modifiable risk factors, namely anaemia by parenteral iron therapy from the second trimester onwards especially in patients who do not respond to oral iron therapy. In severe cases, erythropoietin serves as an effective alternative to blood transfusion. During the intrapartum period, using antifibrinolytics, cell salvage, bloodless surgical techniques, and uterine cooling for patients undergoing caesarean delivery have been proven effective. To conclude, complications of pregnant JW patients may be reduced if they comply with the preventives and targeted monitoring during the various phases of pregnancy. Further studies are warranted as this population exists as a minor group but is growing worldwide. KEY MESSAGES CURRENT RESEARCH QUESTIONS
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Affiliation(s)
- Fei San Pang
- Department of Obstetrics and Gynaecology, Manipal University College, 75150 Melaka, Malaysia
| | - Elvin Yee Fan Liaw
- Department of Obstetrics and Gynaecology, Manipal University College, 75150 Melaka, Malaysia
| | - Somsubhra De
- Department of Obstetrics and Gynaecology, Manipal University College, 75150 Melaka, Malaysia
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102
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Ji J, Wan Z, Ruan J, Yang Y, Hu Q, Chen Z, Yang C, Chen M, Han B. Eltrombopag with or without Tacrolimus for relapsed/refractory acquired aplastic anaemia: a prospective randomized trial. Blood Cancer J 2023; 13:146. [PMID: 37726286 PMCID: PMC10509202 DOI: 10.1038/s41408-023-00921-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023] Open
Abstract
This trial compared eltrombopag (EPAG)+tacrolimus and EPAG monotherapy in patients with refractory/relapsed acquired aplastic anaemia (AA). Patients with refractory/relapsed AA were randomly assigned to receive either EPAG+tacrolimus or EPAG monotherapy at a ratio of 2:1. Patient response, safety, clonal evolution and survival were compared. In total, 114 patients were included in the analysis, with 76 patients receiving EPAG+tacrolimus and 38 receiving EPAG only. With a median follow-up of 18 (6-24) months, the overall response rate (ORR) for patients treated with EPAG+tacrolimus and EPAG alone was 38.2% vs. 31.6% (P = 0.490) at the 3rd month, 61.8% vs. 39.5% (P = 0.024) at the 6th month, 64.5% vs. 47.1% (P = 0.097) at the 12th month, and 60.5% vs. 34.2% (P = 0.008) at the last follow-up. The rate of each adverse event, overall survival curves (P = 0.635) and clonal evolution rate (P = 1.000) were comparable between the groups. A post hoc subgroup analysis showed that EPAG+tacrolimus could have advantage over EPAG monotherapy in terms of the ORR at the 6th month (P = 0.030)/last follow-up (P = 0.013) and the cumulative relapse-free survival (RFS) curves (P = 0.048) in patients <60 years old.
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Affiliation(s)
- Jiang Ji
- Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ziqi Wan
- Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Ruan
- Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Yang
- Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinglin Hu
- Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zesong Chen
- Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Yang
- Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Miao Chen
- Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Bing Han
- Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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103
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Jaleel A, Arlappa N, Ramakrishna KS, Sunu PV, Jayalakshmi G, Neeraja G, Narasimhulu D, Kumar TS, Kumar SB. Examining the Triple Burden of Malnutrition: Insights from a Community-Based Comprehensive Nutrition Survey among Indigenous Tribal Children (0-19 Years) in the Western Ghats Hills of India. Nutrients 2023; 15:3995. [PMID: 37764778 PMCID: PMC10537611 DOI: 10.3390/nu15183995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
This article presents findings from a community-based cross-sectional study conducted in Attappadi, Kerala, India, aimed at assessing the prevalence of the triple burden of malnutrition among indigenous children aged 0-19 years. Historically, the indigenous population in Attappadi has faced significant developmental challenges, including high rates of malnutrition, infant mortality, and neonatal mortality. This study revealed alarming rates of undernutrition among children aged 0-59 months, with 40.9% experiencing stunting, 27.4% wasting, and 48.3% being underweight. Adolescent girls also suffered from undernutrition, with 21% classified as underweight and 43.3% experiencing stunting. Surprisingly, overweight or obesity was identified as a nutritional problem, affecting 1.4% of children aged 0-59 months, 4.2% of children aged 5-9 years, and 10.5% of adolescent girls. Additionally, a distressing proportion of young children aged 12-59 months (91.2%) were anaemic, with 50% diagnosed specifically with iron deficiency anaemia (IDA). Nearly all adolescent girls (96.6%) were reportedly suffering from anaemia. Deficiencies in vitamin B12, vitamin D, folate, and vitamin-A were prevalent among 35%, 20%, 16%, and 12% of children aged 12-59 months, respectively. The study underscores the urgent need for comprehensive interventions to address this triple burden of malnutrition. Recommendations include promoting culturally appropriate local food-based solutions, establishing participatory and community-led systems for health and nutrition information dissemination, and strengthening the nutrition surveillance system through village-level health and nutrition workers. By adopting a holistic approach, these interventions can help improve the nutritional status and well-being of the indigenous tribal children in Attappadi.
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Affiliation(s)
- Abdul Jaleel
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - N. Arlappa
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - K. Sree Ramakrishna
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - P. V. Sunu
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - G. Jayalakshmi
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - G. Neeraja
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - D. Narasimhulu
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - T. Santhosh Kumar
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - Senthil B. Kumar
- Department of Epidemiology Statistics, ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai 600031, India;
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104
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Bae CO, Kwon SS, Kim S. Investigation of blood group genotype prevalence in Korean population using large genomic databases. Sci Rep 2023; 13:15326. [PMID: 37714914 PMCID: PMC10504236 DOI: 10.1038/s41598-023-42473-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
Blood group antigens, which are prominently expressed in red blood cells, are important in transfusion medicine. The advent of high-throughput genome sequencing technology has facilitated the prediction of blood group antigen phenotypes based on genomic data. In this study, we analyzed data from a large Korean population to provide an updated prevalence of blood group antigen phenotypes, including rare ones. A robust dataset comprising 72,291 single nucleotide polymorphism arrays, 5318 whole-exome sequences, and 4793 whole-genome sequences was extracted from the Korean Genome and Epidemiology Study, Genome Aggregation Database, and Korean Variant Archive and then analyzed. The phenotype prevalence of clinically significant blood group antigens, including MNSs, RHCE, Kidd, Duffy, and Diego, was predicted through genotype analysis and corroborated the existing literature. We identified individuals with rare phenotypes, including 369 (0.51%) with Fy(a-b+), 188 (0.26%) with Di(a+b-), and 16 (0.02%) with Jr(a-). Furthermore, we calculated the frequencies of individuals with extremely rare phenotypes, such as p (0.000004%), Kell-null (0.000310%), and Jk(a-b-) (0.000438%), based on allele frequency predictions. These findings offer valuable insights into the distribution of blood group antigens in the Korean population and have significant implications for enhancing the safety and efficiency of blood transfusion.
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Affiliation(s)
- Cheol O Bae
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul, 03722, South Korea
| | - Soon Sung Kwon
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul, 03722, South Korea.
| | - Sinyoung Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul, 03722, South Korea
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105
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Woldehawaryat EG, Geremew AB, Asmamaw DB. Uptake of human papillomavirus vaccination and its associated factors among adolescents in Gambella town, Southwest, Ethiopia: a community-based cross-sectional study. BMJ Open 2023; 13:e068441. [PMID: 37669848 PMCID: PMC10481830 DOI: 10.1136/bmjopen-2022-068441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 07/26/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE To assess the uptake of human papillomavirus (HPV) vaccination and its associated factors among adolescents in Gambella town, Southwest Ethiopia. DESIGN A community-based cross-sectional study. SETTING Gambella town, Southwest Ethiopia. PARTICIPANTS A total of 882 adolescents were included between May and July 2022. OUTCOME Uptake of HPV vaccination. METHODS A cluster sampling technique was used to select study participants. An interviewer-administered and pretested questionnaire was used to collect the data. The collected data were entered into Epi-data V.4.6 and exported to STATA V.16 for cleaning, coding and analysis. A binary logistic regression model was used to test the association between independent and dependent variables. Variables with a p<0.05 in the multivariable logistic regression were considered statistically significant factors for the uptake of HPV vaccination. RESULTS A total of 825 adolescents participated in this study. Among participants, 48% (95% CI 44.6% to 51.4%) have been vaccinated for HPV. Ever heard of the HPV vaccine (AOR 2.5, 95% CI 1.23 to 5.08), good knowledge of HPV infection (AOR 3.62, 95% CI 2.17 to 6.02), good knowledge of the HPV vaccine (AOR 5.54, 95% CI 3.28 to 9.36) and attitude towards the HPV vaccine (AOR 2.74, 95% CI 1.88 to 3.98) were significantly associated HPV vaccination. CONCLUSION In the current study, the uptake of HPV vaccination was found to be low. The finding highlights the importance of promoting community health education about HPV infection and vaccines and providing behaviour change education, which plays a substantial role in promoting the uptake of HPV vaccination.
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Affiliation(s)
| | - Alehegn Bishaw Geremew
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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106
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O'Loughlin E, Chih H, Sivalingam P, Symons J, Godsall G, MacLean B, Richards T. IRON NOF trial: IV iron for anaemic patients with femoral fracture. BJA Open 2023; 7:100222. [PMID: 37638076 PMCID: PMC10457485 DOI: 10.1016/j.bjao.2023.100222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023]
Abstract
Background Preoperative anaemia is associated with increased use of blood transfusions, a greater risk of postoperative complications, and patient morbidity. The IRON NOF trial aimed to investigate whether the administration of i.v. iron in anaemic patients during hip fracture surgery reduced the need for blood transfusion and improved patient outcomes. Methods This phase III double-blind, randomised, placebo-controlled trial included patients >60 yr old with preoperative anaemia undergoing surgery for femoral neck or subtrochanteric fracture across seven Australian Hospitals. Patients were randomly allocated on a 1:1 basis to receive either i.v. iron carboxymaltose 1000 mg or placebo (saline) at operation. The primary endpoint was blood transfusion use, with secondary endpoints of haemoglobin concentration at 6 weeks, length of hospital stay, rehabilitation duration to discharge, and 6-month mortality. Subgroup analysis compared outcomes in patients <80 yr old and patients >80 yr old. All analyses were performed by intention-to-treat. This trial was terminated early because of jurisdictional changes of more restrictive transfusion practices and changes in consent requirements. Results Participants (n=143) were recruited between February 2013 and May 2017. There was no difference observed in the incidence of blood transfusion between the treatment group (18/70) (26%) compared with the placebo group (27/73) (37%) (odds ratio for transfusion if receiving placebo: 1.70; 95% confidence interval [CI] 0.83-3.47; P=0.15) and there was no overall difference in the median number of blood units transfused between groups (odds ratio 1.52; 95% CI 0.77-3.00; P=0.22). Patients receiving i.v. iron had a higher haemoglobin 6 weeks after intervention compared with the placebo group (Hb 116 g L-1vs 108 g L-1; P=0.01). No difference was observed in length of hospital stay, rehabilitation duration to discharge, or 6-month mortality. However, in younger patients without major bleeding, the use of placebo compared with i.v. iron was associated with an increased number of units of blood transfused (placebo transfusion incidence rate ratio 3.88; 95% CI 1.16-13.0; P=0.03). Conclusions In anaemic patients undergoing surgery for hip fracture, i.v. iron did not reduce the overall proportion of patients receiving blood transfusion. The use of i.v. iron may reduce the amount of blood transfused in younger patients. The use of i.v. iron is associated with increased haemoglobin concentrations 6 weeks after the operation. Clinical trial registration ACTRN12612000448842.
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Affiliation(s)
- Edmond O'Loughlin
- Department of Anaesthesia, Pain and Perioperative Medicine, Fiona Stanley and Fremantle Hospital Group, Perth, Western Australia, Australia
| | - HuiJun Chih
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Perth, Western Australia, Australia
| | - Pal Sivalingam
- Department of Anaesthetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Joel Symons
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Guy Godsall
- Department of Anaesthesia, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Beth MacLean
- Division of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - Toby Richards
- Division of Surgery, The University of Western Australia, Perth, Western Australia, Australia
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107
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Chu Z, Cushway T, Wong M, Lim KX, Peh WM, Ng CT, Lim WY, Ong SGK, Tey TT, Foo FJ, Koh FH. Incidence and predictors of hypophosphataemia after ferric carboxymaltose use-A 3-year experience from a single institution in Singapore. Br J Haematol 2023; 202:1199-1204. [PMID: 37455143 DOI: 10.1111/bjh.18979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Ferric carboxymaltose (FCM) administration helps reduce transfusion requirements in the perioperative situation, which improves patient outcomes and reduces healthcare costs. However, there is increasing evidence of hypophosphataemia after FCM use. We aim to determine the incidence of hypophosphataemia after FCM administration and elucidate potential biochemical factors associated with the development of subsequent hypophosphataemia. A retrospective review of anonymised data of all FCM administrations in a single institution was conducted from August 2018 to August 2021. Each unique FCM dose administered was examined to assess its effect on Hb and serum phosphate levels within the subsequent 28 days from each FCM administration. Phosphate levels were repeatedly measured within the 28-day interval and the lowest phosphate level within that period was determined. Patients' serum phosphate levels within 28 days of FCM administration were compared against normal serum phosphate levels within 2 weeks before FCM administration. The odds ratios of various pre-FCM serum markers were calculated to elucidate potential biochemical predictors of post-FCM hypophosphataemia. In 3 years, a total of 1296 doses of FCM were administered to 1069 patients. The mean improvement in Hb was 2.45 g/dL (SD = 1.94) within 28 days of FCM administration, with the mean time taken to peak Hb levels being 6.3 days (SD = 8.63), which is earlier than expected, but was observed in this study and hence reported. The incidence of hypophosphataemia <0.8 mmol/L was 22.7% (n = 186), and <0.4 mmol/L was 1.6% (n = 9). This figure is lower than the numbers reported in previously published meta-analyses given that routine checks of serum phosphate levels were not conducted initially and hence could possibly be higher. The odds of developing hypophosphataemia (<0.8 mmol/L) were 27.7 (CI: 17.3-44.2, p < 0.0001) if baseline serum phosphate was less than 1 mmol/L. The odds of developing hypophosphataemia (<0.8 mmol/L) were 1.3 (CI: 1.08-1.59, p < 0.01) if the change in Hb levels observed after FCM administration were more than 4 g/dL. Hypophosphataemia after FCM administration is significant and FCM should be used by clinicians with caution.
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Affiliation(s)
- Zachary Chu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tim Cushway
- The Integrative Medical Centre by The Iron Suites, Singapore, Singapore
| | - Marc Wong
- Department of Internal Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Kai-Xiong Lim
- Department of Internal Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Wee-Ming Peh
- Department of Internal Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Choong-Tatt Ng
- Department of Internal Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Wan-Yen Lim
- Department of Anaesthesiology, Sengkang General Hospital, Singapore, Singapore
| | - Sharon G K Ong
- Department of Anaesthesiology, Sengkang General Hospital, Singapore, Singapore
| | - Tze-Tong Tey
- Department of Gastroenterology, Sengkang General Hospital, Singapore, Singapore
| | - Fung-Joon Foo
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Frederick H Koh
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
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108
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Meybohm P, Schmitt E, Choorapoikayil S, Hof L, Old O, Müller MM, Geisen C, Seifried E, Baumhove O, de Leeuw van Weenen S, Bayer A, Friederich P, Bräutigam B, Friedrich J, Gruenewald M, Elke G, Molter GP, Narita D, Raadts A, Haas C, Schwendner K, Steinbicker AU, Jenke DJ, Thoma J, Weber V, Velten M, Wittmann M, Weigt H, Lange B, Herrmann E, Zacharowski K. German Patient Blood Management Network: effectiveness and safety analysis in 1.2 million patients. Br J Anaesth 2023; 131:472-481. [PMID: 37380568 DOI: 10.1016/j.bja.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/04/2023] [Accepted: 05/01/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Patient Blood Management (PBM) is a patient-centred, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood whilst promoting patient safety and empowerment. The effectiveness and safety of PBM over a longer period have not yet been investigated. METHODS We performed a prospectively designed, multicentre follow-up study with non-inferiority design. Data were retrospectively extracted case-based from electronic hospital information systems. All in-hospital patients (≥18 yr) undergoing surgery and discharged between January 1, 2010 and December 31, 2019 were included in the analysis. The PBM programme focused on three domains: preoperative optimisation of haemoglobin concentrations, blood-sparing techniques, and guideline adherence/standardisation of allogeneic blood product transfusions. The outcomes were utilisation of blood products, composite endpoint of in-hospital mortality and postoperative complications (myocardial infarction/ischaemic stroke/acute renal failure with renal replacement therapy/sepsis/pneumonia), anaemia rate at admission and discharge, and hospital length of stay. RESULTS A total of 1 201 817 (pre-PBM: n=441 082 vs PBM: n=760 735) patients from 14 (five university/nine non-university) hospitals were analysed. Implementation of PBM resulted in a substantial reduction of red blood cell utilisation. The mean number of red blood cell units transfused per 1000 patients was 547 in the PBM cohort vs 635 in the pre-PBM cohort (relative reduction of 13.9%). The red blood cell transfusion rate was significantly lower (P<0.001) with odds ratio 0.86 (0.85-0.87). The composite endpoint was 5.8% in the PBM vs 5.6% in the pre-PBM cohort. The non-inferiority aim (safety of PBM) was achieved (P<0.001). CONCLUSIONS Analysis of >1 million surgical patients showed that the non-inferiority condition (safety of Patient Blood Management) was fulfilled, and PBM was superior with respect to red blood cell transfusion. CLINICAL TRIAL REGISTRATION NCT02147795.
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Affiliation(s)
- Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany; University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany.
| | - Elke Schmitt
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany; Institute of Biostatistics and Mathematical Modelling, Department of Medicine, Goethe University, Frankfurt, Germany
| | - Suma Choorapoikayil
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Lotta Hof
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Oliver Old
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Markus M Müller
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Transfusion Service Baden-Wuerttemberg-Hessen, Kassel, Germany; Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Transfusion Service Baden-Wuerttemberg-Hessen, Frankfurt, Germany
| | - Christof Geisen
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Transfusion Service Baden-Wuerttemberg-Hessen, Frankfurt, Germany
| | - Erhard Seifried
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Transfusion Service Baden-Wuerttemberg-Hessen, Frankfurt, Germany
| | - Olaf Baumhove
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Klinikum Westmuensterland, Bocholt, Germany
| | - Samuel de Leeuw van Weenen
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Klinikum Westmuensterland, Bocholt, Germany
| | - Alexandra Bayer
- Department of Anaesthesiology and Intensive Care Medicine, Agatharied Hospital, Hausham, Germany
| | - Patrick Friederich
- Department of Anaesthesiology, Operative Intensive Care Medicine and Pain Therapy, Muenchen Klinik, Bogenhausen, Munich, Germany
| | - Brigitte Bräutigam
- Central Controlling, Department of Finance, Muenchen Klinik, Bogenhausen, Munich, Germany
| | - Jens Friedrich
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Leverkusen, Leverkusen, Germany
| | - Matthias Gruenewald
- Department of Anaesthesiology and Operative Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gunnar Elke
- Department of Anaesthesiology and Operative Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gerd P Molter
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Leverkusen, Leverkusen, Germany
| | - Diana Narita
- Institute for Laboratory Diagnostics and Transfusion Medicine, Donauisar Klinikum, Deggendorf/Dingolfing/Landau, Germany
| | - Ansgar Raadts
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany
| | - Christoph Haas
- Executive Department for Structure, Process and Quality Management, University Hospital Jena, Jena, Germany
| | - Klaus Schwendner
- Department of Anaesthesiology and Operative Intensive Care Medicine, Diakonie Hospital Martha-Maria, Nuremberg, Germany
| | - Andrea U Steinbicker
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Dana J Jenke
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Josef Thoma
- Department of Anaesthesiology and Operative Intensive Care Medicine, Ortenau Klinikum, Offenburg-Kehl, Germany
| | - Viola Weber
- Department of Anaesthesiology and Operative Intensive Care Medicine, Ortenau Klinikum, Offenburg-Kehl, Germany
| | - Markus Velten
- Department of Anaesthesiology and Operative Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Maria Wittmann
- Department of Anaesthesiology and Operative Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Henry Weigt
- Department of Anaesthesiology, SLK-Kliniken, Heilbronn, Germany
| | - Björn Lange
- Department of Anaesthesiology, SLK-Kliniken, Heilbronn, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, Department of Medicine, Goethe University, Frankfurt, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
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Sandin L, von Below A, Waller M, Björkelund C, Blomstrand A, Runevad R, Hange D. Trends in haemoglobin levels from 1968 to 2017 and association with hormonal contraceptives: observations from the population study of women in Gothenburg, Sweden. Scand J Prim Health Care 2023; 41:214-223. [PMID: 37354123 PMCID: PMC10478586 DOI: 10.1080/02813432.2023.2222767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 06/04/2023] [Indexed: 06/26/2023] Open
Abstract
AIM To investigate trends in the haemoglobin (Hb) level in middle-aged Swedish women from 1968 to 2017 and to examine the potential association between Hb and the use of hormonal contraceptives (HCs). DESIGN A prospective observational population study of representative 38- and 50-year-old women of Gothenburg, Sweden. SETTING The population study of women in Gothenburg started in 1968-1969 and has continued since then with new examinations every 12 years, including both follow-ups and new recruited cohorts. The study consists of both physical examinations and questionnaires. SUBJECTS Two thousand four hundred eighty-eight women aged 38 and 50 participated in the study from 1968 to 2017. STATISTICAL METHODS Linear regression model analyses were used to analyse linear and non-linear trends in the level of Hb. Linear and logistic regression models were used to analyse possible associations between HC and Hb and possible associations between the use of HC and anaemia, respectively. MAIN OUTCOME MEASURES AND COVARIATES Hb was measured in g/L. HC included any ongoing use of HC therapy. Covariates were smoking, body mass index (BMI), alcohol consumption and education. RESULTS A non-linear U-shaped trend in mean Hb was seen in the two age groups, 38- and 50-years old. After adjusting for covariates, a significantly higher mean Hb was seen in the 2016-2017 examination compared to 1980-1981, 1992-1993 and 2004-2005. In 38-year-olds, using HC was associated with a reduced risk of anaemia (OR 0.35, 95% CI 0.13-0.75). In both age groups, the use of HC was significantly associated with having a higher Hb. CONCLUSIONS Mean levels of Hb in middle-aged women of the general population seem to be increasing again after lower levels in the 1980s and 1990s. The use of HC was associated with having a higher Hb and a lower risk of anaemia in 38-year-old women.
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Affiliation(s)
- Linda Sandin
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Amanda von Below
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Maria Waller
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Cecilia Björkelund
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Ann Blomstrand
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Rebecca Runevad
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Dominique Hange
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
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110
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Moxon R, Dutton Worsfold R, Davis J, Adams W, England GCW. Luteal phase decrease in packed cell volume in healthy non-pregnant and pregnant bitches. Vet Med Sci 2023; 9:1989-1997. [PMID: 37466012 PMCID: PMC10508517 DOI: 10.1002/vms3.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 02/14/2023] [Accepted: 06/03/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES To establish packed cell volume (PCV) ranges for non-pregnant, pregnant and post-partum bitches from day 10 of proestrus, investigating any relationship with parity and litter size. METHODS This prospective cohort study used 37 healthy breeding bitches to examine PCV counts from routine blood samples collected every 4 weeks, from day 10 of proestrus, as part of routine PCV monitoring. RESULTS For pregnant (n = 19) and non-pregnant (n = 18) bitches, PCV decreased until week 8 (corresponding to 8.5 ± 1.1 days before whelping for pregnant bitches) and recovered by 16-20 weeks after the initial sample; bitches that whelped average and large litters showed greater declines. PCV began to recover sooner for bitches that had previously whelped one or two litters compared to bitches that had previously whelped three or more litters. There was a significant three-way interaction between time after the onset of proestrus, litter size and the number of previous litters which demonstrated that the large decrease in PCV for bitches that had previously whelped three or more litters only occurred in bitches that were expecting an average or large sized litter. CLINICAL SIGNIFICANCE Chronological variation in PCV for pregnant and non-pregnant bitches was established during the reproductive cycle. There was no evidence to suggest that routine PCV measurement for normal, healthy bitches would be beneficial. However, knowledge from this study may be useful when deciding whether to prospectively monitor a bitch where there is a history of previous pregnancy-related anaemia, when performing a caesarean section due to the anticipated blood loss during surgery, or when examining blood profiles for post-litter bitches.
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Affiliation(s)
- Rachel Moxon
- Guide Dogs National CentreLeamington SpaUK
- School of Veterinary Medicine and ScienceUniversity of NottinghamSutton BoningtonUK
| | | | | | | | - Gary C. W. England
- School of Veterinary Medicine and ScienceUniversity of NottinghamSutton BoningtonUK
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111
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Motsepe TA, Machete TA, Ziqubu N. Adult intussusception in the era of HIV/AIDS: A case report. S Afr J Infect Dis 2023; 38:534. [PMID: 37670935 PMCID: PMC10476221 DOI: 10.4102/sajid.v38i1.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/20/2023] [Indexed: 09/07/2023] Open
Abstract
The high incidence of HIV infection in South Africa has been associated with a proportional increase in AIDS-defining cancers, including non-Hodgkin's lymphomas (NHL). Intussusception is a rare presentation of NHL, accounting for 1% - 5% of all cases of small bowel obstruction. Contribution To our knowledge, this is the first reported case of B-cell NHL presenting with intussusceptions and small bowel obstruction in South Africa.
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Affiliation(s)
- Tshepang A Motsepe
- Department of General Surgery, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Thekganang A Machete
- Department of General Surgery, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Noluthando Ziqubu
- Department of Nursing Sciences, Dr. George Mukhari Academic Hospital, Pretoria, South Africa
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112
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Cai Z, Li L, Feng J, Raat H, Wu Y, Zhou H, Rozelle S. Dietary Diversity and Its Contribution to the Magnitude of Anaemia among Pregnant Women: Evidence from Rural Areas of Western China. Nutrients 2023; 15:3714. [PMID: 37686751 PMCID: PMC10490469 DOI: 10.3390/nu15173714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Prenatal anaemia causes serious consequences for both mother and foetus, and dietary factors are suggested to be associated with anaemia. However, research in pregnant women living in rural areas is limited. We aim to assess the contribution of dietary diversity to the magnitude of prenatal anaemia in rural China and identify the interactions between dietary diversity and several sociodemographic and maternal characteristics in relation to anaemia. METHODS A multi-stage random cluster sampling method was used to select pregnant women in rural western China. The Woman's Dietary Diversity Score was created to measure dietary diversity, which was recoded into terciles. Multinomial logistic regression models were used to assess the associations between dietary diversity score terciles and the magnitude of prenatal anaemia. Multiplicative interactions were tested by adding the product term of dietary diversity and several sociodemographic and maternal characteristics into the regression models. RESULTS Out of 969 participants, 54.3% were measured as anaemic, with 28.6% mildly anaemic and 25.7% moderately to severely anaemic. There was an absence of agreement between self-reported and measured anaemia status (κ = 0.28, 95% CI [0.22-0.34]). Participants in the highest dietary diversity score tercile had lower odds of being moderately to severely anaemic after adjusting for potential confounders (RRR = 0.65, 95% CI [0.44, 0.98]). In participants with moderate to severe anaemia, significant interactions were found between dietary diversity score terciles, age, and parity (p for interaction < 0.05). CONCLUSIONS The prevalence of prenatal anaemia in rural China remains high, and pregnant women living in these areas are insufficiently aware of their anaemia status. Improving dietary diversity is needed to manage prenatal anaemia in rural areas.
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Affiliation(s)
- Zhengjie Cai
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 South Renmin Road 3 Section, Chengdu 610041, China; (Z.C.); (L.L.)
| | - Linhua Li
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 South Renmin Road 3 Section, Chengdu 610041, China; (Z.C.); (L.L.)
| | - Jieyuan Feng
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA 94305, USA; (J.F.); (S.R.)
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Yuju Wu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 South Renmin Road 3 Section, Chengdu 610041, China; (Z.C.); (L.L.)
| | - Huan Zhou
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 South Renmin Road 3 Section, Chengdu 610041, China; (Z.C.); (L.L.)
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA 94305, USA; (J.F.); (S.R.)
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Ali Z, Ismail M, Rehman IU, Rani GF, Ali M, Khan MTM. Long-term clinical efficacy and safety of thalidomide in patients with transfusion-dependent β-thalassemia: results from Thal-Thalido study. Sci Rep 2023; 13:13592. [PMID: 37604857 PMCID: PMC10442319 DOI: 10.1038/s41598-023-40849-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023] Open
Abstract
Regular blood transfusion is the mainstay of treatment in transfusion-dependent β-thalassemia (TDT); however, transfusions culminate in an array of serious complications. Therefore, a single-arm, non-randomized clinical trial was conducted in hydroxyurea refractory TDT patients to explore the long-term safety and efficacy of thalidomide. The primary outcomes for efficacy were rise in hemoglobin (Hb) level and changes in transfusion frequency. Whereas, several clinical and laboratory parameters were assessed for safety of thalidomide. Secondary outcomes included changes in serum ferritin, serum lactate dehydrogenase (LDH), serum uric acid, red blood cell indices, and size of liver and spleen. A total of 532 patients were followed for a period of 30 months. Significant increase in mean Hb level was identified at 6 months (1.4 g/dL, p ≤ 0.001) and 30 months (2 g/dL, p ≤ 0.001) in comparison with baseline. A total of 408 (76.7%) patients responded to thalidomide therapy (excellent responders 25.8%, good responders 31%, and partial responders 19.9%) and attained transfusion independence within 6 months of therapy. A significant decline in mean ferritin, LDH level, liver size, and spleen size was observed. No unfavorable effects were observed on kidney and liver functions. Mild adverse events were reported in 48 (9%) patients and serious adverse events, including cerebral vascular accident and portal vein thrombosis were reported in two patients each. This study concludes that thalidomide is an effective and well-tolerated drug that can improve Hb levels and reduce transfusion burden in hydroxyurea refractory TDT patients.Trial registration: This trial is registered at http://www.clinicaltrial.gov as # NCT03651102.
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Affiliation(s)
- Zahid Ali
- Department of Pharmacy, University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Mohammad Ismail
- Department of Pharmacy, University of Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacology, Northwest School of Medicine, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Gulab Fatima Rani
- Department of Pathology, Institute of Pathology and Diagnostic Medicine, Khyber Medical University Peshawar, Peshawar, Pakistan
| | - Muhammad Ali
- Department of Hematology, Pak International Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Tariq Masood Khan
- Department of Hematology, Pak International Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan.
- Blood Disease Clinic, Peshawar, Khyber Pakhtunkhwa, Pakistan.
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114
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Wu PC, Lee YQ, Möller M, Storry JR, Olsson ML. Elucidation of the low-expressing erythroid CR1 phenotype by bioinformatic mining of the GATA1-driven blood-group regulome. Nat Commun 2023; 14:5001. [PMID: 37591894 PMCID: PMC10435571 DOI: 10.1038/s41467-023-40708-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/08/2023] [Indexed: 08/19/2023] Open
Abstract
Genetic determinants underlying most human blood groups are now clarified but variation in expression levels remains largely unexplored. By developing a bioinformatics pipeline analyzing GATA1/Chromatin immunoprecipitation followed by sequencing (ChIP-seq) datasets, we identify 193 potential regulatory sites in 33 blood-group genes. As proof-of-concept, we aimed to delineate the low-expressing complement receptor 1 (CR1) Helgeson phenotype on erythrocytes, which is correlated with several diseases and protects against severe malaria. We demonstrate that two candidate CR1 enhancer motifs in intron 4 bind GATA1 and drive transcription. Both are functionally abolished by naturally-occurring SNVs. Erythrocyte CR1-mRNA and CR1 levels correlate dose-dependently with genotype of one SNV (rs11117991) in two healthy donor cohorts. Haplotype analysis of rs11117991 with previously proposed markers for Helgeson shows high linkage disequilibrium in Europeans but explains the poor prediction reported for Africans. These data resolve the longstanding debate on the genetic basis of inherited low CR1 and form a systematic starting point to investigate the blood group regulome.
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Affiliation(s)
- Ping Chun Wu
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Yan Quan Lee
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Mattias Möller
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Department of Clinical Genetics and Pathology, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Jill R Storry
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Martin L Olsson
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, Lund, Sweden.
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115
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Güven AT, Demiroğlu YZ, Koçer NE. Systemic Bacillus Calmette-Guérin (BCG) Infection and Accompanying Warm Autoimmune Haemolytic Anaemia Following Intravesical BCG Immunotherapy. Eur J Case Rep Intern Med 2023; 10:004009. [PMID: 37680784 PMCID: PMC10482133 DOI: 10.12890/2023_004009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 09/09/2023] Open
Abstract
Intravesical bacillus Calmette-Guérin (BCG) is used for urothelial carcinoma. Systemic side effects are rare and commonly include organ involvement but rarely include bone marrow. We describe a patient who had received intravesical BCG and presented shortly afterwards with constitutional symptoms. Initial work-up revealed pancytopenia and immune haemolysis. He was presumptively diagnosed with systemic BCG infection and secondary warm autoimmune haemolytic anaemia. Isoniazid, rifampin and ethambutol was started. The bone marrow biopsy revealed granulomas. Within 6 weeks of treatment, the patient's clinic and laboratory results were dramatically improved. A high level of suspicion is crucial for diagnosis and treatment. LEARNING POINTS Systemic bacillus Calmette-Guérin (BCG) infection following intravesical BCG instillation is a rare but serious consequence. A high level of suspicion and scrutiny of history is of paramount importance for diagnosis.Autoimmune haemolytic anaemia secondary to systemic BCG infection is even rarer.Autoimmune haemolytic anaemia resolution was in parallel with improvement in systemic BCG infection.
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Affiliation(s)
- Alper Tuna Güven
- Department of Internal Medicine, Division of General Internal Medicine, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Yusuf Ziya Demiroğlu
- Department of Infectious Diseases, Başkent University Adana Hospitals, Ankara, Turkey
| | - Nazım Emrah Koçer
- Department of Pathology, Başkent University Adana Hospitals, Ankara, Turkey
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116
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Singh SK, Chauhan A, Sharma SK, Puri P, Pedgaonkar S, Dwivedi LK, Taillie LS. Cultural and Contextual Drivers of Triple Burden of Malnutrition among Children in India. Nutrients 2023; 15:3478. [PMID: 37571415 PMCID: PMC10420920 DOI: 10.3390/nu15153478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
This study examines malnutrition's triple burden, including anaemia, overweight, and stunting, among children aged 6-59 months. Using data from the National Family Health Survey-5 (2019-2021), the study identifies risk factors and assesses their contribution at different levels to existing malnutrition burden. A random intercept multilevel logistic regression model and spatial analysis are employed to identify child, maternal, and household level risk factors for stunting, overweight, and anaemia. The study finds that 34% of children were stunted, 4% were overweight, and 66% were anaemic. Stunting and anaemia prevalence were higher in central and eastern regions, while overweight was more prevalent in the north-eastern and northern regions. At the macro-level, the coexistence of stunting, overweight, and anaemia circumstantiates the triple burden of childhood malnutrition with substantial spatial variation (Moran's I: stunting-0.53, overweight-0.41, and anaemia-0.53). Multilevel analysis reveals that child, maternal, and household variables play a substantial role in determining malnutrition burden in India. The nutritional health is significantly influenced by a wide range of determinants, necessitating multilevel treatments targeting households to address this diverse group of coexisting factors. Given the intra-country spatial heterogeneity, the treatment also needs to be tailor-made for various disaggregated levels.
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Affiliation(s)
- Shri Kant Singh
- International Institute for Population Sciences, Mumbai 400088, India; (S.P.); (L.K.D.)
| | - Alka Chauhan
- International Food Policy Research Institute (IFPRI), Delhi 110012, India;
| | - Santosh Kumar Sharma
- The George Institute for Global Health, New Delhi 110025, India; (S.K.S.); (P.P.)
| | - Parul Puri
- The George Institute for Global Health, New Delhi 110025, India; (S.K.S.); (P.P.)
| | - Sarang Pedgaonkar
- International Institute for Population Sciences, Mumbai 400088, India; (S.P.); (L.K.D.)
| | - Laxmi Kant Dwivedi
- International Institute for Population Sciences, Mumbai 400088, India; (S.P.); (L.K.D.)
| | - Lindsey Smith Taillie
- Carolina Population Center, Department of Nutrition, University of North Carolina, Chapel Hill, NC 27516, USA;
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117
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Morocho-Alburqueque N, Quincho-Lopez A, Nesemann JM, Cañari-Casaño JL, Elorreaga OA, Muñoz M, Talero S, Harding-Esch EM, Saboyá-Díaz MI, Honorio-Morales HA, Durand S, Carey-Angeles CA, Klausner JD, Keenan JD, Lescano AG. Prevalence of and factors associated with childhood anaemia in remote villages of the Peruvian Amazon: a cross-sectional study and geospatial analysis. Trans R Soc Trop Med Hyg 2023; 117:598-605. [PMID: 37039044 PMCID: PMC10398418 DOI: 10.1093/trstmh/trad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/28/2023] [Accepted: 03/23/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Anaemia is a public health problem in Peru. In the Loreto region of the Amazon, ≥50% of children may be anaemic, although insufficient information exists for rural villages. METHODS To generate more data about childhood anaemia in the Peruvian Amazon, haemoglobin was measured as part of a trachoma survey in 21 randomly selected villages. All children 1-9 y of age from 30 randomly selected households per village were recruited. Anaemia was classified according to the World Health Organization guidelines and a socio-economic status (SES) index was created for each household using principal component analysis. Spatial autocorrelation was determined using Moran's I and Ripley's K function. RESULTS Of 678 children with complete haemoglobin data, 25.4% (95% confidence interval [CI] 21.2 to 30.1) had mild-or-worse anaemia and 22.1% (95% CI 15.6 to 30.3) had moderate-or-worse anaemia. Mild-or-worse anaemia was more common among children whose primary source of drinking water was surface water (prevalence ratio [PR] 1.26 [95% CI 1.14 to 1.40], p<0.001) and who were in the lowest SES tercile (PR 1.16 [95% CI 1.02 to 1.32], p=0.021). Moderate-or-worse anaemia was more common among boys (PR 1.32 [95% CI 1.09 to 1.60], p=0.005). No evidence of geospatial clustering was found. CONCLUSIONS Remote villages of the Amazon would benefit from interventions for childhood anaemia and the poorest households would have the most to gain. Integrating anaemia screening into neglected tropical diseases surveys is an opportunity to use public health resources more efficiently.
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Affiliation(s)
| | - Alvaro Quincho-Lopez
- Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Peru
| | - John M Nesemann
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, USA
| | - Jorge L Cañari-Casaño
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Oliver A Elorreaga
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- GMINIS Research Group, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Marleny Muñoz
- Área de Epidemiología, Red de Salud Alto Amazonas, Yurimaguas, Peru
| | - Sandra Talero
- Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Martha Idalí Saboyá-Díaz
- Pan American Health Organization, Department of Communicable Diseases and Environmental Determinants of Health, Washington, DC, USA
| | | | - Salomón Durand
- Área de Epidemiología, Dirección Regional de Salud Loreto, Iquitos, Peru
| | | | - Jeffrey D Klausner
- Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jeremy D Keenan
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, USA
| | - Andres G Lescano
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Collier T, Shakur-Still H, Roberts I, Balogun E, Olayemi O, Bello FA, Chaudhri R, Muganyizi P. Tranexamic acid for the prevention of postpartum bleeding in women with anaemia: Statistical analysis plan for the WOMAN-2 trial: an international, randomised, placebo-controlled trial. Gates Open Res 2023; 7:69. [PMID: 37664793 PMCID: PMC10471795 DOI: 10.12688/gatesopenres.14529.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Background: Postpartum haemorrhage (PPH) is responsible for over 50,000 maternal deaths every year. Most of these deaths are in low- and middle-income countries. Tranexamic acid (TXA) reduces bleeding by inhibiting the enzymatic breakdown of fibrin blood clots. TXA decreases surgical bleeding and reduces deaths from bleeding after traumatic injury. When given within three hours of birth, TXA reduces deaths from bleeding in women with PPH. However, for many women, treatment of PPH is too late to prevent death. World-wide, over one-third of pregnant women are anaemic and many are severely anaemic. These women have an increased risk of PPH and are more likely to die if PPH occurs. There is an urgent need to identify ways to prevent severe postpartum bleeding in anaemic women. The WOMAN-2 trial will quantify the effects of TXA on postpartum bleeding in women with anaemia. Results: This statistical analysis plan (version 1.0; dated 22 February 2023) has been written based on information in the WOMAN-2 Trial protocol version 2.0, dated 30 June 2022. The primary outcome of the WOMAN-2 trial is the proportion of women with a clinical diagnosis of primary PPH. Secondary outcomes are maternal blood loss and its consequences (estimated blood loss, haemoglobin, haemodynamic instability, blood transfusion, signs of shock, use of interventions to control bleeding); maternal health and wellbeing (fatigue, headache, dizziness, palpitations, breathlessness, exercise tolerance, ability to care for her baby, health related quality of life, breastfeeding); and other health outcomes (deaths, vascular occlusive events, organ dysfunction, sepsis, side effects, time spent in higher level facility, length of hospital stay, and status of the baby). Conclusions: WOMAN-2 will provide reliable evidence about the effects of TXA in women with anaemia. Registration: WOMAN-2 was prospectively registered at the International Standard Randomised Controlled Trials registry ( ISRCTN62396133) on 07/12/2017 and ClinicalTrials.gov on 23/03/2018 ( NCT03475342).
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Affiliation(s)
- Tim Collier
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Haleema Shakur-Still
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Ian Roberts
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Eni Balogun
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Oladapo Olayemi
- College of Medicine, University of Ibadan, Ibadan, 200212, Nigeria
| | | | - Rizwana Chaudhri
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Projestine Muganyizi
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - WOMAN-2 Trial Collaborators
- CTU Global Health Trials Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- College of Medicine, University of Ibadan, Ibadan, 200212, Nigeria
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Léger M, Auchabie J, Ferrandière M, Parot-Schinkel E, Campfort M, Rineau E, Lasocki S. Erythropoietin to treat anaemia in critical care patients: a multicentre feasibility study. Anaesthesia 2023; 78:979-987. [PMID: 37184109 DOI: 10.1111/anae.16038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/16/2023]
Abstract
Anaemia is common and associated with poor outcomes during and after critical illness. The use of erythropoietin to treat such anaemia is controversial with older studies showing mixed results. In this study, we aimed to evaluate the feasibility of performing a large multicentre randomised controlled trial of erythropoietin in this setting. We randomly allocated patients staying in the ICU for ≥ 72 h with haemoglobin ≤ 120 g.l-1 to either a weekly injection of erythropoietin (40,000 iu, maximum of five injections) or placebo (saline). The primary endpoint was feasibility (as measured by recruitment, randomisation and follow-up rates, and protocol compliance). Secondary endpoints included biological efficacy and clinical outcomes. Forty-two participants were recruited and randomly allocated, all participants received the allocated intervention, but one withdrew their consent and refused the use of their data, leaving 20 in the erythropoietin group and 21 in placebo group. Follow-up was completed for all patients who survived. The overall recruitment rate was 73.7% with 8.4 participants recruited on average per month. The last haemoglobin measured before hospital discharge (or death) was similar between the groups with a mean (SD) haemoglobin of 107 (21) vs. 95 (25) g.l-1 , mean difference (95%CI) 11 (-4-26), g.l-1 , p = 0.154. A large, multicentre randomised controlled trial of erythropoietin to treat anaemia in ICU patients is feasible and necessary to determine effects of erythropoietin on mortality in ICU anaemic patients.
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Affiliation(s)
- M Léger
- Department of Anaesthesiology and Critical Care, Angers University, CHU Angers, Angers, France
| | - J Auchabie
- Réanimation polyvalente, CH de Cholet, Cholet, France
| | - M Ferrandière
- Department of Anaesthesiology and Critical Care, CHRU Tours, Tours, France
| | - E Parot-Schinkel
- Department of Biostatistics and Methodology, CHU Angers, Angers, France
| | - M Campfort
- Department of Anaesthesiology and Critical Care, Angers University, CHU Angers, Angers, France
| | - E Rineau
- Department of Anaesthesiology and Critical Care, Angers University, CHU Angers, Angers, France
| | - S Lasocki
- Department of Anaesthesiology and Critical Care, Angers University, CHU Angers, Angers, France
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120
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Mukhtar G, Shovlin CL. Unsupervised machine learning algorithms identify expected haemorrhage relationships but define unexplained coagulation profiles mapping to thrombotic phenotypes in hereditary haemorrhagic telangiectasia. EJHaem 2023; 4:602-611. [PMID: 37601877 PMCID: PMC10435691 DOI: 10.1002/jha2.746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 08/22/2023]
Abstract
Hereditary haemorrhagic telangiectasia (HHT) can result in challenging anaemia and thrombosis phenotypes. Clinical presentations of HHT vary for relatives with identical casual mutations, suggesting other factors may modify severity. To examine objectively, we developed unsupervised machine learning algorithms to test whether haematological data at presentation could be categorised into sub-groupings and fitted to known biological factors. With ethical approval, we examined 10 complete blood count (CBC) variables, four iron index variables, four coagulation variables and eight iron/coagulation indices combined from 336 genotyped HHT patients (40% male, 60% female, 86.5% not using iron supplementation) at a single centre. T-SNE unsupervised, dimension reduction, machine learning algorithms assigned each high-dimensional datapoint to a location in a two-dimensional plane. k-Means clustering algorithms grouped into profiles, enabling visualisation and inter-profile comparisons of patients' clinical and genetic features. The unsupervised machine learning algorithms using t-SNE and k-Means identified two distinct CBC profiles, two iron profiles, four clotting profiles and three combined profiles. Validating the methodology, profiles for CBC or iron indices fitted expected patterns for haemorrhage. Distinct coagulation profiles displayed no association with age, sex, C-reactive protein, pulmonary arteriovenous malformations (AVMs), ENG/ACVRL1 genotype or epistaxis severity. The most distinct profiles were from t-SNE/k-Means analyses of combined iron-coagulation indices and mapped to three risk states - for venous thromboembolism in HHT; for ischaemic stroke attributed to paradoxical emboli through pulmonary AVMs in HHT; and for cerebral abscess attributed to odontogenic bacteremias in immunocompetent HHT patients with right-to-left shunting through pulmonary AVMs. In conclusion, unsupervised machine learning algorithms categorise HHT haematological indices into distinct, clinically relevant profiles which are independent of age, sex or HHT genotype. Further evaluation may inform prophylaxis and management for HHT patients' haemorrhagic and thrombotic phenotypes.
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Affiliation(s)
- Ghazel Mukhtar
- National Heart and Lung InstituteImperial College LondonLondonUK
- Imperial College School of MedicineLondonUK
| | - Claire L. Shovlin
- National Heart and Lung InstituteImperial College LondonLondonUK
- Specialist MedicineImperial College Healthcare NHS TrustLondonUK
- NIHR Imperial Biomedical Research CentreLondonUK
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121
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Patel S, Yang K, Malik R, Sanchez-Melendez S, Nambudiri VE. Impact of deficiency anaemia comorbidity in generalized pustular psoriasis hospitalizations. Exp Dermatol 2023; 32:1314-1316. [PMID: 36808654 DOI: 10.1111/exd.14771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/02/2023] [Accepted: 02/11/2023] [Indexed: 02/20/2023]
Affiliation(s)
- Shrey Patel
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin Yang
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rhea Malik
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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122
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Singh AK, McCausland FR, Claggett BL, Wanner C, Wiecek A, Atkins MB, Carroll K, Perkovic V, McMurray JJV, Wittes J, Snapinn S, Blackorby A, Meadowcroft A, Barker T, DiMino T, Mallett S, Cobitz AR, Solomon SD. Analysis of on-treatment cancer safety events with daprodustat versus conventional erythropoiesis-stimulating agents-post hoc analyses of the ASCEND-ND and ASCEND-D trials. Nephrol Dial Transplant 2023; 38:1890-1897. [PMID: 36565721 PMCID: PMC10387380 DOI: 10.1093/ndt/gfac342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The prespecified on-treatment analysis of ASCEND-ND (NCT02876835) raised concerns about a higher relative risk of cancer-related adverse events (AEs) with daprodustat vs darbepoetin in patients with anaemia of CKD. This concern was not observed in dialysis patients in ASCEND-D (NCT02879305). METHODS ASCEND-ND randomized 3872 patients to daprodustat or darbepoetin. ASCEND-D randomized 2964 patients to daprodustat or conventional erythropoiesis-stimulating agents (ESAs). In both studies ESA comparators used different dosing intervals (3/week, 1/week, every 2 or every 4 weeks). The prespecified on-treatment approach examined relative risks for cancer AEs up to the last dose date + 1 day. In these analyses, owing to different dosing intervals between arms, Cox models were used to estimate the daprodustat effect by various follow-up periods (censoring at last dose date, last dose date + dosing intervals, or end of study). RESULTS In ASCEND-ND, the safety of daprodustat vs darbepoetin on cancer-related AEs depended on the duration of follow-up after last dose date: hazard ratio (HR) 1.04 [95% confidence interval (CI) 0.77, 1.40] at end of study [HR 1.12 (95% CI 0.81, 1.56) for last dose date + dosing interval; HR 1.50 (95% CI 1.04, 2.15) for last dose date + 1 day]. In ASCEND-D, no excess risk of cancer-related AEs was observed with any model examined. CONCLUSIONS Prespecified on-treatment analyses for cancer-related AEs appeared to result in biased risk estimates in ASCEND-ND by preferentially under-counting events from patients assigned to darbepoetin. Analyses accounting for longer darbepoetin dosing intervals, or extending follow-up, resulted in attenuation of effect estimates towards neutrality, similar to ASCEND-D, where ESA comparator dosing intervals are closer to daprodustat. TRIAL REGISTRATION The ASCEND-ND trial is registered with ClinicalTrials.gov (NCT02876835); the ASCEND-D trial is registered with ClinicalTrials.gov (NCT02879305).
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Affiliation(s)
- Ajay K Singh
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Finnian R McCausland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Brian L Claggett
- Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Michael B Atkins
- Georgetown-Lombardi Comprehensive Cancer Center, Washington DC, USA
| | | | - Vlado Perkovic
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, Glasgow, University of Glasgow, UK
| | | | | | | | | | | | | | | | | | - Scott D Solomon
- Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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123
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Hassan S, Mumford L, Robinson S, Foukanelli D, Torpey N, Ploeg RJ, Mamode N, Murphy MF, Brown C, Roberts DJ, Regan F, Willicombe M. Blood transfusions post kidney transplantation are associated with inferior allograft and patient survival-it is time for rigorous patient blood management. Front Nephrol 2023; 3:1236520. [PMID: 37675353 PMCID: PMC10479650 DOI: 10.3389/fneph.2023.1236520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/03/2023] [Indexed: 09/08/2023]
Abstract
Background Patient Blood Management (PBM), endorsed by the World Health Organisation is an evidence-based, multi-disciplinary approach to minimise inappropriate blood product transfusions. Kidney transplantation presents a particular challenge to PBM, as comprehensive evidence of the risk of transfusion is lacking. The aim of this study is to investigate the prevalence of post-transplant blood transfusions across multiple centres, to analyse risk factors for transfusion and to compare transplant outcomes by transfusion status. Methods This analysis was co-ordinated via the UK Transplant Registry within NHS Blood and Transplant (NHSBT), and was performed across 4 centres. Patients who had received a kidney transplant over a 1-year period, had their transfusion status identified and linked to data held within the national registry. Results Of 720 patients, 221(30.7%) were transfused, with 214(29.7%) receiving a red blood cell (RBC) transfusion. The proportion of patients transfused at each centre ranged from 20% to 35%, with a median time to transfusion of 4 (IQR:0-12) days post-transplant. On multivariate analysis, age [OR: 1.02(1.01-1.03), p=0.001], gender [OR: 2.11(1.50-2.98), p<0.0001], ethnicity [OR: 1.28(1.28-2.60), p=0.0008], and dialysis dependence pre-transplant [OR: 1.67(1.08-2.68), p=0.02], were associated with transfusion. A risk-adjusted Cox proportional hazards model showed transfusion was associated with inferior 1-year patient survival [HR 7.94(2.08-30.27), p=0.002] and allograft survival [HR: 3.33(1.65-6.71), p=0.0008], and inferior allograft function. Conclusion RBC transfusions are common and are independently associated with inferior transplant outcomes. We urge that further research is needed to understand the mechanisms behind the outcomes, to support the urgent development of transplant-specific anaemia guidelines.
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Affiliation(s)
- Sevda Hassan
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
- Imperial College Renal and Transplant Centre, Imperial College Healthcare National Health Service (NHS) Trust, Hammersmith Hospital, London, United Kingdom
| | - Lisa Mumford
- Statistics and Clinical Studies, National Health Service (NHS) Blood and Transplant, Bristol, United Kingdom
| | - Susan Robinson
- Department of Haematology, Guys, Evelina and St Thomas National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Dora Foukanelli
- Department of Haematology, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Nick Torpey
- Department of Clinical Nephrology and Transplantation, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
| | - Rutger J. Ploeg
- Department of Surgery, Nuffield Department of Surgical Science, University of Oxford, Oxford, United Kingdom
| | - Nizam Mamode
- Department of Transplantation, Guys, Evelina and St Thomas National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Michael F. Murphy
- National Health Service (NHS) Blood and Transplant, and Nuffield Department of Clinical and Laboratory Sciences, University of Oxford, Oxford, United Kingdom
| | - Colin Brown
- Haematology, National Health Service (NHS) Blood and Transplant, London, United Kingdom
| | - David J. Roberts
- Haematology, National Health Service (NHS) Blood and Transplant, London, United Kingdom
| | - Fiona Regan
- Haematology, National Health Service (NHS) Blood and Transplant, London, United Kingdom
| | - Michelle Willicombe
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
- Imperial College Renal and Transplant Centre, Imperial College Healthcare National Health Service (NHS) Trust, Hammersmith Hospital, London, United Kingdom
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124
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de Almeida JG, Gudgin E, Besser M, Dunn WG, Cooper J, Haferlach T, Vassiliou GS, Gerstung M. Computational analysis of peripheral blood smears detects disease-associated cytomorphologies. Nat Commun 2023; 14:4378. [PMID: 37474506 PMCID: PMC10359268 DOI: 10.1038/s41467-023-39676-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/22/2023] [Indexed: 07/22/2023] Open
Abstract
Many hematological diseases are characterized by altered abundance and morphology of blood cells and their progenitors. Myelodysplastic syndromes (MDS), for example, are a group of blood cancers characterised by cytopenias, dysplasia of hematopoietic cells and blast expansion. Examination of peripheral blood slides (PBS) in MDS often reveals changes such as abnormal granulocyte lobulation or granularity and altered red blood cell (RBC) morphology; however, some of these features are shared with conditions such as haematinic deficiency anemias. Definitive diagnosis of MDS requires expert cytomorphology analysis of bone marrow smears and complementary information such as blood counts, karyotype and molecular genetics testing. Here, we present Haemorasis, a computational method that detects and characterizes white blood cells (WBC) and RBC in PBS. Applied to over 300 individuals with different conditions (SF3B1-mutant and SF3B1-wildtype MDS, megaloblastic anemia, and iron deficiency anemia), Haemorasis detected over half a million WBC and millions of RBC and characterized their morphology. These large sets of cell morphologies can be used in diagnosis and disease subtyping, while identifying novel associations between computational morphotypes and disease. We find that hypolobulated neutrophils and large RBC are characteristic of SF3B1-mutant MDS. Additionally, while prevalent in both iron deficiency and megaloblastic anemia, hyperlobulated neutrophils are larger in the latter. By integrating cytomorphological features using machine learning, Haemorasis was able to distinguish SF3B1-mutant MDS from other MDS using cytomorphology and blood counts alone, with high predictive performance. We validate our findings externally, showing that they generalize to other centers and scanners. Collectively, our work reveals the potential for the large-scale incorporation of automated cytomorphology into routine diagnostic workflows.
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Affiliation(s)
- José Guilherme de Almeida
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
- Champalimaud Foundation-Centre for the Unknown, Lisbon, Portugal
| | - Emma Gudgin
- Department of Haematology, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Martin Besser
- Department of Haematology, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - William G Dunn
- Department of Haematology, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Jonathan Cooper
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | | | - George S Vassiliou
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK.
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK.
- Department of Haematology, University of Cambridge, Cambridge, UK.
| | - Moritz Gerstung
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK.
- Division of AI in Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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125
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Simman R, Oostra D, Sullivan P, Wilson M, Khatib J, Jackson SE. Wounds resulting from non-malignant haematological disease: a case series. J Wound Care 2023; 32:S6-S18. [PMID: 37405961 DOI: 10.12968/jowc.2023.32.sup7.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
A proactive and systemic approach is imperative to preventing wounds due to disorders of non-malignant haematologic disease. Here, the authors provide several examples of patients with either a known history or acute diagnosis of a coagulation disorder with the aim of reviewing potential cutaneous injuries as well as diagnosis and treatment. A description of the wound and treatment course along with recommendations where appropriate are presented. The article serves as a general review for health professionals who may encounter patients with this disorder and who are involved in treatment decisions. After reviewing the article, the practitioner will be able to identify cutaneous injuries that may be secondary to an underlying haematological disorder, review the diagnosis and treatment recommended, and understand the need for a multidisciplinary approach to patient care.
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Affiliation(s)
- Richard Simman
- University of Toledo, College of Medicine and Life Science, Department of Surgery, Toledo, Ohio, US
- Jobst Vascular Institute, ProMedica Health Network, Toledo, Ohio, US
| | - Drew Oostra
- Jobst Vascular Institute, ProMedica Health Network, Toledo, Ohio, US
- University of Toledo, College of Medicine and Life Sciences, Department of Hematology and Oncology, Toledo, Ohio, US
| | - Patrick Sullivan
- Jobst Vascular Institute, ProMedica Health Network, Toledo, Ohio, US
| | - Michael Wilson
- Department of Pharmacology and Toxicology, Boonshoft School of Medicine, Wright State University, Dayton Ohio, US
| | - Jude Khatib
- Department of Pharmacology and Toxicology, Boonshoft School of Medicine, Wright State University, Dayton Ohio, US
| | - Sarah E Jackson
- University of Toledo, College of Medicine and Life Science, Department of Internal Medicine, Toledo, Ohio, US
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Elkin M, Amichay-Menashe N, Segev G, Kelmer E, Adlersberg D, Aroch I, Klainbart S. Retrospective study of canine blood xenotransfusion compared with type-matched feline blood allotransfusion to cats: indications, effectiveness, limitations and adverse effects. J Feline Med Surg 2023; 25:1098612X231183930. [PMID: 37466270 DOI: 10.1177/1098612x231183930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVES Xenotransfusion is the transfusion of blood from one species to another. With varying availability of allogenic feline blood (AFB) and in emergency conditions, circumstances occur when canine blood is transfused to cats. This study aimed to characterise the indications, effectiveness, limitations, and acute and late transfusion-related adverse effects of canine blood xenotransfusion compared with matched AFB to anaemic cats, and their survival and longer-term outcome. METHODS This retrospective study (2013-2020) examined cats receiving canine blood xenotransfusions or AFB. RESULTS The study included 311 cats (xenotransfusion [X-group], n = 105; allotransfusion [A-group], n = 206). Xenotransfusion was more frequent among cats sustaining haemorrhage than in those with haemolysis (P <0.01) or hypoproliferative anaemia (P <0.001). Financial constraints were the most common reason to elect xenotransfusion (49%). The post-transfusion mean packed cell volume was higher (P <0.001) in the X-group (22%) compared with the A-group (18%), and also higher (P <0.001) at 48-96 h post-transfusion (23% vs 18%, respectively). Transfusion-related adverse effects (TRAEs) were more frequent (P = 0.001) in the X-group (37.1%) compared with the A-group (19.4%), as were delayed haemolytic transfusion reactions (85% vs 42.5%, respectively; P <0.001). Acute transfusion reactions (ATRs) were more frequent (P <0.001) in the A-group (60%) compared with the X-group (20%). TRAEs were unassociated with survival to discharge. The survival to discharge rate of the X-group (55%) was lower (P = 0.007) than in the A-group (73%), while post-discharge survival rates to 30 days of cats surviving to discharge were 90% and 88%, respectively (P = 0.85). CONCLUSIONS AND RELEVANCE Canine blood xenotransfusions to cats might save lives in emergency conditions when AFB is unavailable or blood typing is infeasible. The survival to discharge rate of the X-group was lower than that of the A-group. The longer-term survival rate of cats administered xenotransfusions and surviving to discharge from the hospital was good.
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Affiliation(s)
- Maria Elkin
- Department of Small Animals Emergency and Critical Care, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Israel
| | - Noa Amichay-Menashe
- Department of Small Animals Emergency and Critical Care, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Israel
| | - Gilad Segev
- Department of Small Animal Internal Medicine, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Israel
| | - Efrat Kelmer
- Department of Small Animals Emergency and Critical Care, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Israel
| | - Dana Adlersberg
- Department of Small Animals Emergency and Critical Care, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Israel
| | - Itamar Aroch
- Department of Small Animal Internal Medicine, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Israel
| | - Sigal Klainbart
- Department of Small Animals Emergency and Critical Care, The Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Israel
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Sahiledengle B, Mwanri L, Petrucka P, Agho KE. Coexistence of Anaemia and Stunting among Children Aged 6-59 Months in Ethiopia: Findings from the Nationally Representative Cross-Sectional Study. Int J Environ Res Public Health 2023; 20:6251. [PMID: 37444099 PMCID: PMC10341109 DOI: 10.3390/ijerph20136251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION Stunting and anaemia, two severe public health problems, affect a significant number of children under the age of five. To date, the burden of and predictive factors for coexisting forms of stunting and anaemia in childhood have not been well documented in Ethiopia, where both the conditions are endemic. The primary aims of the present study were to: (i) determine the prevalence of co-morbid anaemia and stunting (CAS); (ii) and identify factors associated with these co-morbid conditions among children aged 6-59 months in Ethiopia. METHODS The study was based on data from the Ethiopian Demographic and Health Survey (EDHS 2005-2016). The EDHS was a cross-sectional study that used a two-stage stratified cluster sampling technique to select households. A total weighted sample of 21,172 children aged 6-59 months was included in the current study (EDHS-2005 (n = 3898), EDHS-2011 (n = 8943), and EDHS-2016 (n = 8332)). Children with height-for-age z-scores (HAZ) less than -2 SD were classified as stunted. Anaemia status was measured by haemoglobin level with readings below 11.0 g/deciliter (g/dL) categorized as anaemic. A multilevel mixed-effects logistic regression model was used to identify the factors associated with CAS. The findings from the models were reported as adjusted odds ratios (AOR) with 95% confidence intervals (CIs). RESULTS Almost half of the children were males (51.1%) and the majority were from rural areas (89.2%). The prevalence of CAS was 24.4% [95% CI: (23.8-24.9)]. Multivariate analyses revealed that children aged 12-23 months, 24-35 months, and 36-59 months, and children perceived by their mothers to be smaller than normal at birth had higher odds of CAS. The odds of CAS were significantly higher among children born to anaemic mothers [AOR: 1.25, 95% CI: (1.11-1.41)], mothers with very short stature [AOR: 2.04, 95% CI: (1.44-2.91)], children from households which practiced open defecation [AOR: 1.57, 95% CI: (1.27-1.92)], children born to mothers without education [AOR: 3.66, 95% CI: (1.85-7.22)], and those who reside in rural areas [AOR: 1.41, 95% CI: (1.10, 1.82)]. Male children had 19% lower odds of having CAS compared to female children [AOR: 0.81, 95% CI: (0.73-0.91)]. Children born to mothers who had normal body mass index (BMI) [AOR: 0.82, 95%CI: (0.73-0.92)] reported lower odds of CAS. CONCLUSIONS One in four preschool-age children in Ethiopia had co-morbid anaemia and stunting, which is a significant public health problem. Future interventions to reduce CAS in Ethiopia should target those children perceived to be small at birth, anaemic mothers, and mothers with short stature.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba P.O. Box 302, Ethiopia
| | - Lillian Mwanri
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide Campus, Adelaide 5000, Australia
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith 2751, Australia
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Almendros A, Choi YR, Bęczkowski PM, Baiker K, Barrs VR, Beatty JA. Babesia gibsoni Infection in a Cat with Immune-Mediated Haemolytic Anaemia and Thrombocytopenia. Animals (Basel) 2023; 13:2128. [PMID: 37443927 DOI: 10.3390/ani13132128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Tick-borne haemoparasite Babesia gibsoni has been detected rarely in cats, in surveys of apparently healthy animals. In stored blood from a 6-year-old male-neutered domestic shorthair cat in Hong Kong, B. gibsoni DNA was detected retrospectively using PCR for Babesia spp. 18S rRNA and mitochondrial cytochrome B genes, followed by sequencing and basic local alignment search tool (BLAST) analysis. The cat presented with severe haemolytic anaemia and thrombocytopenia. The cat responded to supportive care and glucocorticoids and was clinically normal despite persistent subclinical thrombocytopenia until six months after presentation, when it succumbed to a fatal haemorrhagic episode. Necropsy revealed severe intestinal and pulmonary haemorrhage and hypocellular bone marrow with megakaryocytosis but no other causes of immune-mediated thrombocytopenia (IMTP) or immune-mediated haemolytic anaemia (IMHA). Blood stored on days 158 and 180 tested PCR negative for Babesia spp. This report demonstrates that geographic range of B. gibsoni detection in cats includes Hong Kong. The exclusion of other causes suggests that B. gibsoni might have potentially played a role in triggering immune-mediated disease in this case.
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Affiliation(s)
- Angel Almendros
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine, City University of Hong Kong, Hong Kong SAR, China
| | - Y R Choi
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine, City University of Hong Kong, Hong Kong SAR, China
| | - Paweł M Bęczkowski
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine, City University of Hong Kong, Hong Kong SAR, China
| | - Kerstin Baiker
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine, City University of Hong Kong, Hong Kong SAR, China
| | - Vanessa R Barrs
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine, City University of Hong Kong, Hong Kong SAR, China
| | - Julia A Beatty
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine, City University of Hong Kong, Hong Kong SAR, China
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Zavaleta-Cortijo C, Cade J, Ford J, Greenwood DC, Carcamo C, Silvera-Ccallo R, Fernandez-Neyra C, Lancha-Rucoba G, Pizango-Tangoa M, Pizango-Inuma R, Chanchari-Huiñapi J, Velez-Quevedo J, Inuma-Tangoa N, Antazu T, Miranda-Cuadros M, Aparco JP, Aro-Guardia P, Verastegui M, Morales-Ancajima V, Bressan T, Miranda JJ. Does food biodiversity protect against malnutrition and favour the resilience to climate change-related events in Amazon Indigenous communities? A protocol for a mixed methods study. Wellcome Open Res 2023; 7:246. [PMID: 38463717 PMCID: PMC10924752 DOI: 10.12688/wellcomeopenres.18235.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 03/12/2024] Open
Abstract
Background : Undernutrition is projected to be a major consequence of climate change. Biodiversity could enhance climate change resilience by improving nutritional outcomes and providing healthy food resources during and/or after climate-related events. For Indigenous populations who currently base their diet on local biodiversity, rapid climate changes may affect their ability to produce, access or gather food and consequently impact their nutritional status. There is a knowledge gap regarding whether nutritional status among Indigenous populations is better among those who consume a diet with greater biodiversity than those who have a diet with low biodiversity. Objective : This study aims to investigate the role of food biodiversity (FBD) in nutritional resilience to extreme flooding events of Shawi Amazon Indigenous adults living in Peruvian communities that have experienced extreme floods in the past five years. Methods : This study will use a mixed-method sequential explanatory design. The quantitative component includes a cross-sectional survey to assess the association between food biodiversity (FBD) and the prevalence of anaemia in adults aged 15 to 60 years old (n=365). Anaemia will be evaluated using blood hemoglobin and serum ferritin. FBD will be measured with a food frequency questionnaire and a 24-hour dietary recall. Soil-transmitted helminth infections, malaria, and inflammatory biomarkers will also be evaluated. The qualitative component will include a community-based participatory approach to investigate the role of FBD in the responses to extreme floods. Male (n=14) and female (n=14) participants, previously identified in the quantitative phase with high and low levels of FBD, will be invited to participate in a Photovoice activity and semi-structured interviews. A analytical framework for climate change resilience will be used to integrate the data. Discussion : Findings will be integrated to identify nutritional resilience indicators that can inform adaptative interventions to changing climatic conditions in the Amazon and that respect Indigenous worldviews.
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Affiliation(s)
- Carol Zavaleta-Cortijo
- Unidad de Ciudadanía Intercultural y Salud Indígena, Facultad de Salud Pública y Administración,, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, 15102, Peru
| | - Janet Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS 2 9JT, UK
| | - James Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, LS 2 9JT, UK
| | | | - Cesar Carcamo
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, 15102, Peru
| | - Rosa Silvera-Ccallo
- Unidad de Ciudadanía Intercultural y Salud Indígena, Facultad de Salud Pública y Administración,, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, 15102, Peru
| | | | | | | | | | | | - Jorge Velez-Quevedo
- Taller Verde, Caserio San Luis s/n , Carretera Munichis, San Rafael, Yurimaguas, Peru
| | - Nerita Inuma-Tangoa
- Comunidad de Palmiche, Pueblo Indígena Shawi, cuenca del río Sillay, Loreto, Peru
| | - Teresita Antazu
- Programa Mujer, Asociación Interétnica de Desarrollo de la Selva Peruana (AIDESEP), La Victoria, Lima, 15034, Peru
| | - Marianella Miranda-Cuadros
- Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud, Jesús María, Lima, 15072, Peru
| | - Juan Pablo Aparco
- Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud, Jesús María, Lima, 15072, Peru
| | - Pedro Aro-Guardia
- Centro de Hemoterapia y Banco de Sangre, Hospital Nacional Cayetano Heredia, San Martín de Porres, Lima, 15102, Peru
| | - Manuela Verastegui
- Infectious Diseases Research Laboratory of the LID, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, 15102, Peru
| | - Valeria Morales-Ancajima
- Unidad de Ciudadanía Intercultural y Salud Indígena, Facultad de Salud Pública y Administración,, Universidad Peruana Cayetano Heredia, San Martín de Porres, Lima, 15102, Peru
| | - Tiana Bressan
- Department of Engineering, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - J. Jaime Miranda
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Miraflores, Lima, 15074, Peru
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Ștefan M, Tomescu D, Predoi C, Goicea R, Perescu M, Popescu M, Dorobanțu D, Droc G, Andrei Ș, Știru O, Bubenek Turconi ȘI, Filipescu D. Less (Transfusion) Is More-Enhancing Recovery through Implementation of Patient Blood Management in Cardiac Surgery: A Retrospective, Single-Centre Study of 1174 Patients. J Cardiovasc Dev Dis 2023; 10:266. [PMID: 37504522 PMCID: PMC10380242 DOI: 10.3390/jcdd10070266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction: The implementation of Patient Blood Management (PBM) in cardiac surgery has been shown to be effective in reducing blood transfusions and associated complications, as well as improving patient outcomes. Despite the potential benefits of PBM in cardiac surgery, there are several barriers to its successful implementation. Objectives: The main objectives of this study were to ascertain the impact of the national Romanian PBM recommendations on allogeneic blood product transfusion in cardiac surgery and identify predictors of perioperative packed red blood cell transfusion. Methods: As part of the Romanian national pilot programme of PBM, we performed a single-centre, retrospective study in a tertiary centre of cardiovascular surgery, including patients from two time periods, before and after the implementation of the national recommendations. Using coarsened exact matching, from a total of 1174 patients, 157 patients from the before group were matched to 169 patients in the after group. Finally, we built a multivariate regression model from the entire cohort to analyse independent predictors of PRBC transfusion in the perioperative period. Results: Although there was a trend towards a lower proportion of patients requiring PRBC transfusion in the "after" group compared to the "before" group (44.9%vs. 50.3%), it was not statistically significant. There was a significant difference between the "after" group and the "before" group in terms of fresh-frozen plasma (FFP) transfusion rates, with a lower percentage of patients requiring FFP transfusion in the "after" group compared to "before" (14.2%, vs. 22.9%, p = 0.04). This difference was also seen in the total perioperative FFP transfusion (mean transfusion 0.7 units in the "before" group, SD 1.73 vs. 0.38 units in the "after" group, SD 1.05, p = 0.04). In the multivariate regression analysis, age > 64 years (OR 1.652, 95% CI 1.17-2.331, p = 0.004), female sex (OR 2.404, 95% CI 1.655-3.492, p < 0.001), surgery time (OR 1.295, 95% CI 1.126-1.488, p < 0.001), Hb < 13 g/dl (OR 3.611, 95% CI 2.528-5.158, p < 0.001), re-exploration for bleeding (OR 3.988, 95% CI 1.248-12.738, p = 0.020), viscoelastic test use (OR 2.18, 95% CI 1.34-3.544, p < 0.001), FFP transfusion (OR 4.023, 95% CI 2.426-6.671, p < 0.001), and use of a standardized pretransfusion checklist (OR 8.875, 95% CI 5.496-14.332, p < 0.001) remained significantly associated with PRBC transfusion. The use of a preoperative standardized haemostasis questionnaire was independently associated with a decreased risk of perioperative PRBC transfusion (0.565, 95% CI 0.371-0.861, p = 0.008). Conclusions: Implementation of national PBM recommendations led to a reduction in FFP transfusion in a cardiac surgery centre. The use of a preoperative standardized haemostasis questionnaire is an independent predictor of a lower risk for PRBC transfusion in this setting.
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Affiliation(s)
- Mihai Ștefan
- 2nd Department of Anaesthesiology and Intensive Care, "Prof Dr CC Iliescu" Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Dana Tomescu
- Discipline of Anaesthesiology and Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 419291 Bucharest, Romania
- 3rd Department of Anaesthesiology and Intensive Care, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Cornelia Predoi
- 2nd Department of Anaesthesiology and Intensive Care, "Prof Dr CC Iliescu" Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
- Discipline of Anaesthesiology and Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 419291 Bucharest, Romania
| | - Raluca Goicea
- 2nd Department of Anaesthesiology and Intensive Care, "Prof Dr CC Iliescu" Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
- Discipline of Anaesthesiology and Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 419291 Bucharest, Romania
| | - Mihai Perescu
- 2nd Department of Anaesthesiology and Intensive Care, "Prof Dr CC Iliescu" Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Mihai Popescu
- Discipline of Anaesthesiology and Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 419291 Bucharest, Romania
- 3rd Department of Anaesthesiology and Intensive Care, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Dan Dorobanțu
- Children's Health and Exercise Research Center, University of Exeter, Exeter EX4 4QJ, UK
- Faculty of Health Sciences, University of Bristol, Bristol BS8 1TH, UK
- Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol BS2 8ED, UK
| | - Gabriela Droc
- Discipline of Anaesthesiology and Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 419291 Bucharest, Romania
- 1st Department of Anaesthesiology and Intensive Care, Fundeni Clinical Institute, 022322 Bucharest, Romania
| | - Ștefan Andrei
- 1st Department of Anaesthesiology and Intensive Care, Fundeni Clinical Institute, 022322 Bucharest, Romania
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France
| | - Ovidiu Știru
- Department of Cardiovascular Surgery, "Prof Dr CC Iliescu" Emergency Institute for Cardiovascular Diseases, 419291 Bucharest, Romania
- Discipline of Cardiovascular Surgery, "Carol Davila" University of Medicine and Pharmacy, 419291 Bucharest, Romania
| | - Șerban-Ion Bubenek Turconi
- Discipline of Anaesthesiology and Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 419291 Bucharest, Romania
- 1st Department of Anaesthesiology and Intensive Care, "Prof Dr CC Iliescu" Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Daniela Filipescu
- 2nd Department of Anaesthesiology and Intensive Care, "Prof Dr CC Iliescu" Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
- Discipline of Anaesthesiology and Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 419291 Bucharest, Romania
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Mohammad Z, Ananthaneni A, Fontenot A, Ramadas P, Nour Salloum M. Unusual case of pernicious anaemia masquerading as thrombotic thrombocytopenic purpura in the setting of multiple normal vitamin B12 deficiency parameters: preventing anchoring and overdiagnosis. Fam Pract 2023:7192930. [PMID: 37294666 DOI: 10.1093/fampra/cmad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Pseudo-thrombotic microangiopathy (pseudo- thrombotic microangiopathy (TMA)) is a rare presentation of B12 deficiency. Overlapping features like elevated LDH/total bilirubin with low haemoglobin/haptoglobin/platelets could deceivingly suggest thrombotic thrombocytopenic purpura (TTP) resulting in avoidable procedures/treatments. CASE PRESENTATION A 36-year-old female with hypothyroidism initially presented to clinic with fatigue, palpitations, lightheadedness, and dyspnoea over a 3-month duration and was found to have a haemoglobin of 5.7 g/dL. She received two packed red blood cell units in the emergency room and subsequently discharged with outpatient follow-up and empiric oral iron. During her follow-up visit, she was found to have easy bruisability, gum bleeding, and generalized weakness from hemolytic anaemia (mean corpuscular volume (MCV) 90 fL, haptoglobin <8 mg/dL, LDH >4,000 U/L and schistocytosis on CBC) and thrombocytopenia of 52 K/uL. Due to PLASMIC score of 6 and suspicion for TTP, she was transferred to our facility and tr eated with three cycles of plasma exchange and prednisone but were discontinued when ADAMTS13 levels returned normal. While the patient had normal B12 levels, further testing revealed positive intrinsic factor antibodies (IF-Ab) and an elevated MMA level of 1.56 umol/L. Replacement with cobalamin led to normalization of labs and symptoms. CONCLUSIONS Timely diagnosis of pseudo-TMA was exceptionally challenging due to several overlapping features with TTP including normal B12 and normal MCV. B12 levels may falsely appear normal in pernicious anemia due to IF-Ab interference with chemiluminescent immunoassay. Schistocytes lower the MCV in automated cell counters. Lower reticulocyte index (<2%), presence of immature/large platelets and teardrop cells, elevated MMA and a higher LDH (>2500) are indicative of B12 deficiency.
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Affiliation(s)
- Zoya Mohammad
- Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Anil Ananthaneni
- Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Andee Fontenot
- Department of Internal Medicine, Medical Student, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Poornima Ramadas
- Division of Haematology & Oncology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Mohammad Nour Salloum
- Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, LA, USA
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132
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Joshi D, Akram M, Das K, Kala M. A Cross-Sectional Study of the Haematological Profile of Patients With Chronic Liver Disease (CLD). Cureus 2023; 15:e40003. [PMID: 37416021 PMCID: PMC10322163 DOI: 10.7759/cureus.40003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 07/08/2023] Open
Abstract
The liver keeps haematological parameters normal and preserves haemostasis by storing iron, vitamin B-12, and, folic acid, necessary for healthy haematopoiesis. Anaemia of various aetiologies affects approximately 75% of chronic liver disease (CLD) patients, specifically caused by iron deficiency, hypersplenism, chronic diseases, autoimmune haemolysis, folic acid deficiency, aplasticity, and as a side effect of antiviral drugs. This study sought to observe the derangements in haematological parameters in patients with CLD, analyse the spectrum of anaemia in patients with CLD, and predict CLD outcomes utilizing Child-Pugh Score. This cross-sectional observational research was carried out in the Department of General Medicine, Himalayan Institute of Medical Sciences (HIMS), Dehradun, India over the course of a year. The patients with CLD who were admitted to the ward participated in the study. Most patient's blood pictures reported normocytic normochromic with thrombocytopenia (TCP) (28.7%), macrocytic hypochromic with TCP (26%), microcytic hypochromic with TCP (13.3%) and macrocytic normochromic with TCP (9.3%). The incidence of anaemia was 85.3%: mild in 12.7% patients, moderate in 55.3% patients, and severe in 17.3% patients. Interestingly, this study also builds upon others suggesting that 85.9% of CLD patients have Class C Child-Pugh Score.
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Affiliation(s)
- Deepika Joshi
- Internal Medicine, Swami Rama Himalayan University, Dehradun, IND
| | - Mohamad Akram
- Internal Medicine, Swami Rama Himalayan University, Dehradun, IND
| | - Kunal Das
- Pediatrics, Swami Rama Himalayan University, Dehradun, IND
| | - Mansi Kala
- Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University (SRHU), Dehradun, IND
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Turner JK, Sakulpolwat S, Sukdanon S, Lertwanakarn T, Waiyamitra P, Piewbang C, Pierezan F, Techangamsuwan S, Soto E, Surachetpong W. Tilapia lake virus (TiLV) causes severe anaemia and systemic disease in tilapia. J Fish Dis 2023; 46:643-651. [PMID: 36848441 DOI: 10.1111/jfd.13775] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 05/07/2023]
Abstract
Tilapia lake virus disease (TiLVD) is an emerging disease in tilapia that is associated with mass mortality affecting global tilapia aquaculture. In this study, red hybrid tilapias (Oreochromis spp.) were experimentally infected by intracoelomic injection with Tilapia lake virus (TiLV) to gain a better understanding of the clinicopathological changes during infection. Pale bodies and gill were observed in infected fish after 7 days of post-challenge (dpc) associated with severe anaemia. Further haematological analysis in TiLV-infected fish revealed decreased levels of haemoglobin and haematocrit at 3 dpc. Common pathological findings included pale and friable liver, pale intestine with catarrhal content, and dark and shrunken spleen in TiLV-infected fish at 7 dpc and 14 dpc. Histologically, reduced numbers of red blood cells and accumulation of melano-macrophage centre in the spleen were found in infected fish at 3 dpc, and severe lesions were more commonly observed at 7 and 14 dpc. Lymphocyte infiltration, syncytial cell formation and multifocal necrotic hepatitis were the prominent pathological findings in the liver of infected fish. The severity of pathological changes was associated with TiLV-infection with higher viral loads and with the expression pattern of pro-inflammatory cytokines and antiviral genes, including interferon regulatory factor 1 (irf1), interleukin (il-8), radical s-adenosyl methionine domain containing 2 (rsad2) and mx. Our study provides a comprehensive analysis of the haematological profile and pathological changes in tilapia during TiLV infection. Overall, lesions present in various organs, together with alteration of host immune response in TiLV-infected fish, indicate the systemic infection of this virus. The knowledge gained from this study improves our understanding of how TiLV causes pathological and haematological changes in tilapia.
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Affiliation(s)
- Jessica Kaye Turner
- Department of Veterinary Microbiology and Immunology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Sasakorn Sakulpolwat
- Department of Veterinary Microbiology and Immunology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Suchanuch Sukdanon
- Department of Veterinary Microbiology and Immunology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Tuchakorn Lertwanakarn
- Department of Physiology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Pitchaporn Waiyamitra
- Department of Veterinary Microbiology and Immunology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Chutchai Piewbang
- Animal Virome and Diagnostic Development Research Unit, Department of Pathology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Felipe Pierezan
- Department of Pathology, Veterinary Clinics and Surgery, School of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Somporn Techangamsuwan
- Animal Virome and Diagnostic Development Research Unit, Department of Pathology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Esteban Soto
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Win Surachetpong
- Department of Veterinary Microbiology and Immunology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
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Mishina S, Waratani M, Onozawa S, Okumura H, Ito Y, Yasuda Y. A retrospective database analysis of erythropoiesis-stimulating agent treatment patterns and associated healthcare resource use in patients with non-dialysis-dependent chronic kidney disease-related anaemia in Japan. Nephrology (Carlton) 2023. [PMID: 37161826 DOI: 10.1111/nep.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 03/17/2023] [Accepted: 04/23/2023] [Indexed: 05/11/2023]
Abstract
AIM This study was conducted to evaluate clinical characteristics, treatment patterns, and healthcare resource use (HCRU) for patients in Japan with non-dialysis-dependent chronic kidney disease (CKD) and anaemia. METHODS This retrospective, longitudinal, epidemiological database extraction study used the JMDC Claims Database, comprising ~9.4 million unique beneficiaries. The observation period for anaemia and erythropoiesis-stimulating agent (ESA)/iron treatment was 1 January 2015 to 31 December 2018, and for HCRU and costs was 1 April 2016 to 31 March 2018. The non-dialysis-dependent CKD anaemia population, and the ESA treatment, iron treatment, and no-treatment cohorts were evaluated. Patient characteristics, treatment patterns, and outcomes were summarised descriptively. RESULTS The non-dialysis-dependent CKD anaemia population included 5908 patients (7.9%), with 464 patients in the ESA treatment cohort, 809 patients (13.7%) in the iron treatment cohort (13.7%), and 4405 (74.6%) patients in the no-treatment cohort. The prevalence of patients prescribed an antihypertensive, antidiabetic, and/or antihyperlipidaemic medication generally increased with increasing baseline CKD stage. Proportions of no treatment for anaemia decreased while ESA treatment increased with increasing CKD stage; ESA treatment increased with decreasing baseline haemoglobin levels. Patients in the ESA treatment cohort generally had more frequent events associated with HCRU and higher costs from HCRU-associated activities (e.g., inpatient and outpatient care, pharmacy). CONCLUSION As CKD severity increased, anaemia management changed from iron use or no treatment to ESA use; however, anaemia may be undertreated across all CKD stages. ESA-treated patients incurred greater HCRU-associated costs relative to other patients with non-dialysis-dependent CKD anaemia in Japan.
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Aswal R, Ahmad S, Kala M. Haematological factors and anaemia in acute malaria: A prospective hospital-based cross-sectional observational study. Trop Doct 2023:494755221148226. [PMID: 37157838 DOI: 10.1177/00494755221148226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This prospective, observational, cross-sectional study was undertaken to estimate the burden of anaemia in malaria and to evaluate the contribution of haematogenic factors and haemolysis in its pathogenesis. Haematogenic factors (vitamin B12, folic acid, lactate dehydrogenase, ferritin, total iron binding capacity, direct Coombs test) were estimated in patients with malaria at the time of admission. They were categorized as anaemics or non-anaemics and their complications and outcomes were recorded. P. vivax (97/112) and P. falciparum (13/112) mono-infections dominated; anaemia was seen in 63.3%. Patients with and without anaemia were comparable in terms of haemolysis and the haematogenic factors evaluated. Bleeding events, acute kidney injury and acute liver injury were comparable; however, the need for mechanical ventilation and transfusion of blood products was significantly higher amongst the anaemics. We concluded that haemolysis and presumably transient bone marrow suppression contribute to anaemia in malaria. Pre-existing nutritional deficiencies do not, however, predispose to severe malaria.
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Affiliation(s)
- Richa Aswal
- Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Sohaib Ahmad
- Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Mansi Kala
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Abad-Motos A, Ripollés-Melchor J, Jericó C, Bisbe E, Basora M, Colomina MJ, Becerra-Bolaños Á, Bermúdez-López M, Massa-Gómez C, Albaladejo-Magdalena J, Solar-Herrera A, Pérez-Chrzanowska H, Yárnoz C, Fedriani-de-Matos JJ, Blanco-Del-Val B, Fabián-González D, Bellver J, Redondo-Enríquez JM, Serrat-Puyol J, Abad-Gurumeta A, Zorrilla-Vaca A, Aldecoa C, García-Erce JA. Identification of the haemoglobin level associated with a lower risk of complications after total hip and knee arthroplasty. Acta Anaesthesiol Scand 2023; 67:629-639. [PMID: 36795045 DOI: 10.1111/aas.14217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/16/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Preoperative anaemia is associated with poor outcomes in surgical patients, but the preoperative haemoglobin cut-off that determines lower morbidity in total knee arthroplasty (TKA) and total hip arthroplasty (THA) is not well established. METHODS Planned secondary analysis of data collected during a multicentre cohort study of patients undergoing THA and TKA in 131 Spanish hospitals during a single 2-month recruitment period. Anaemia was defined as haemoglobin <12 g dl-1 for females and < 13 g dl-1 for males. The primary outcome was the number of patients with 30-day in-hospital postoperative complications according to European Perioperative Clinical Outcome definitions and specific surgical TKA and THA complications. Secondary outcomes included the number of patients with 30-day moderate-to-severe complications, red blood cell transfusion, mortality, and length of hospital stay. Binary logistic regression models were constructed to assess association between preoperative Hb concentrations and postoperative complications, and variables significantly associated with the outcome were included in the multivariate model. The study sample was divided into 11 groups based on preoperative Hb values in an effort to identify the threshold at which increased postoperative complications occurred. RESULTS A total of 6099 patients were included in the analysis (3818 THA and 2281 TKA), of whom 8.8% were anaemic. Patients with preoperative anaemia were more likely to suffer overall complications (111/539, 20.6% vs. 563/5560, 10.1%, p < .001) and moderate-to-severe complications (67/539, 12.4% vs. 284/5560, 5.1%, p < .001). Multivariable analysis showed preoperative haemoglobin ≥14 g dl-1 was associated with fewer postoperative complications. CONCLUSION Preoperative haemoglobin ≥14 g dl-1 is associated with a lower risk of postoperative complications in patients undergoing primary TKA and THA.
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Affiliation(s)
- Ane Abad-Motos
- Department of Anaesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
- Department of Anaesthesiology, Hospital Universitario Donostia, San Sebastián, Spain
- Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
| | - Javier Ripollés-Melchor
- Department of Anaesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
- Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spanish Society of Anesthesiology and Critical Care (SEDAR), Madrid, Spain
| | - Carlos Jericó
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Barcelona, Spain
| | - Elvira Bisbe
- Department of Anaesthesiology, Parc de Salut Mar, Barcelona, Spain
| | | | - Maria J Colomina
- Department of Anaesthesiology, Hospital Universitario de Bellvitge, Barcelona, Spain
- Universidad de Barcelona, Barcelona, Spain
| | - Ángel Becerra-Bolaños
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - María Bermúdez-López
- Department of Anaesthesiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Cristina Massa-Gómez
- Department of Anaesthesiology, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain
| | | | - Ana Solar-Herrera
- Department of Anaesthesiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Hanna Pérez-Chrzanowska
- Department of Anaesthesiology, Hospital Cantoblanco, Hospital Universitario La Paz, Madrid, Spain
| | - Carlos Yárnoz
- Department of Anaesthesiology, Hospital Universitario Donostia, San Sebastián, Spain
| | | | | | - David Fabián-González
- Department of Anaesthesiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Jorge Bellver
- Department of Anaesthesiology, Hospital Universitario Dr Peset, Valencia, Spain
| | | | | | - Alfredo Abad-Gurumeta
- Department of Anaesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
- Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
| | | | - César Aldecoa
- Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
- Department of Anaesthesiology, Hospital Universitario Rio Hortega, Valladolid, Spain
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Mary Nnagha E, Kayode Ademola M, Ann Izevbizua E, Uwishema O, Nazir A, Wellington J. Tackling sickle cell crisis in Nigeria: the need for newer therapeutic solutions in sickle cell crisis management - short communication. Ann Med Surg (Lond) 2023; 85:2282-2286. [PMID: 37228913 PMCID: PMC10205306 DOI: 10.1097/ms9.0000000000000696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/06/2023] [Indexed: 05/27/2023] Open
Abstract
Sickle cell disease (SCD) is a group of inherited haematological disorders, which affects the shape of the oxygen-carrying haemoglobin component of erythrocytes, giving it an abnormal sickle-shaped appearance. This disease is one of the most common haematological disorders in Nigeria and is generally characterized by anaemia, painful crises, and multi-organ dysfunction. Recurrent episodes of painful crises account for most of the morbidities and mortalities observed in SCD, particularly sickle cell anaemia. This has been a critical concern in the field of haematology and molecular genetics as several therapeutic solutions have been explored over the past few years to treat symptoms of this disease and alleviate painful crises. However, most of these treatment options are not readily available and affordable to affected patients in lower socioeconomic settings in Nigeria, causing a wider range of complications and end-stage organ failure. To address this issue, this article explores an overview of SCD, management alternatives and the need for newer therapeutic solutions to cover the gaps or inadequacies of effective sickle cell crisis management.
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Affiliation(s)
- Ekene Mary Nnagha
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
- College of Medical Sciences, University of Calabar, Calabar
| | - Matthew Kayode Ademola
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
- Obafemi Awolowo University Teaching Hospital, Ile-Ife
| | - Eghosa Ann Izevbizua
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
- Benjamin S. Carson College of Health and Medical Sciences, Babcock University, Ilishan-Remo, Nigeria
| | - Olivier Uwishema
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
- Clinton Global Initiative University, New York, New York, USA
- Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Abubakar Nazir
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Jack Wellington
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
- Faculty of Medicine, Cardiff University School of Medicine, Cardiff University, Cardiff, UK
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Roy A, Rodge G, Goenka MK. Spur Cell Anaemia in Cirrhosis: A Narrative Review. J Clin Exp Hepatol 2023; 13:500-508. [PMID: 37250881 PMCID: PMC10213867 DOI: 10.1016/j.jceh.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
The presence of anaemia has been linked to increased complications and a worse prognosis in cirrhosis. Spur cell anaemia (SCA) is a specific form of haemolytic anaemia reported in patients with advanced cirrhosis. The literature on the entity has not been systematically reviewed, despite the classical association and frequent association with worse outcomes. We undertook a narrative review of available literature on SCA which yielded only 4 were original studies, one case series and the rest of the literature as case reports and clinical images. SCA is usually defined by the presence of spur cell rate of ≥5%, although there remains a lack of consensus in the definition. SCA has been classically associated with alcohol-related cirrhosis but can be seen across the spectrum of cirrhosis and acute to chronic liver failure. Patients with SCA tend to have evidence of higher grades of liver dysfunction, abnormal lipid profiles, worse prognostic scores and a high mortality. Experimental therapies including corticosteroids, pentoxifylline, flunarizine and plasmapheresis has been tried with variable effect, but liver transplantation remains the management of choice. We propose a stepwise approach to diagnosis and re-enforce the need for further prospective research, especially in subgroups of advanced cirrhosis like acute to chronic liver failure.
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Affiliation(s)
- Akash Roy
- Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
| | - Gajanan Rodge
- Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
| | - Mahesh K. Goenka
- Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
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Crooks CJ, West J, Morling JR, Simmonds M, Juurlink I, Briggs S, Cruickshank S, Hammond-Pears S, Shaw D, Card TR, Fogarty AW. Anaemia of acute inflammation: a higher acute systemic inflammatory response is associated with a larger decrease in blood haemoglobin levels in patients with COVID-19 infection. Clin Med (Lond) 2023; 23:201-205. [PMID: 38614771 DOI: 10.7861/clinmed.2022-0436] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
AIMS The study tests the hypothesis that a higher acute systemic inflammatory response was associated with a larger decrease in blood hemoglobin levels in patients with Coronavirus 2019 (COVID-19) infection. METHODS All patients with either suspected or confirmed COVID-19 infection admitted to a busy UK hospital from February 2020 to December 2021 provided data for analysis. The exposure of interest was maximal serum C-reactive protein (CRP) level after COVID-19 during the same admission. RESULTS A maximal serum CRP >175mg/L was associated with a decrease in blood haemoglobin (-5.0 g/L, 95% confidence interval: -5.9 to -4.2) after adjustment for covariates, including the number of times blood was drawn for analysis. Clinically, for a 55-year-old male patient with a maximum haemoglobin of 150 g/L who was admitted for a 28-day admission, a peak CRP >175 mg/L would be associated with an 11 g/L decrease in blood haemoglobin, compared with only 6 g/L if the maximal CRP was <4 mg/L. CONCLUSIONS A higher acute systemic inflammatory response is associated with larger decreases in blood haemoglobin levels in patients with COVID-19. This represents an example of anaemia of acute inflammation, and a potential mechanism by which severe disease can increase morbidity and mortality.
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Affiliation(s)
| | - Joe West
- University of Nottingham, Nottingham, UK
| | | | - Mark Simmonds
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Irene Juurlink
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Steve Briggs
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Azinge IE, Ogunyemi A, Ogamba CF, Jimoh RO. Prevalence of anemia and associated factors among adults in a select population in Lagos, Southwest Nigeria. J Public Health Afr 2023; 14:2224. [PMID: 37347070 PMCID: PMC10280247 DOI: 10.4081/jphia.2023.2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/08/2022] [Indexed: 06/23/2023] Open
Abstract
Background Anemia is a public health problem affecting people in both the developed and developing world and has serious consequences on health. Objective This study determines the prevalence of anemia amongst people of different socioeconomic levels, associated factors, and the prevalence of anemia in populations other than children or pregnant women. Methods This is a descriptive cross-sectional study using a pretested interviewer-administered questionnaire to collect data from 387 residents. A multi-stage random sampling technique was used. Analysis of blood samples using the HemoCue301 system and data analysis using SPSS 20. Chi-square test and binary logistic regression were used to test association and determine predictors of anemia respectively, with P<0.05 considered statistically significant. Results The mean age of respondents was 35±11.8 years, with 28.9% of respondents being anemic. Female respondents (52.7%) were more than male respondents (47.3%). Female respondents (39.2%) had a higher prevalence of anemia than male respondents (17.5%). There was a significant association between sex, level of education, and anemia status. Being female, having no formal education, or only having a primary school level of education were significant predictors of anemia [odds ratio (OR)=2.55; 95% confidence interval (CI)=1.54, 4.23; P=0.00; OR=12.57; 95%CI=2.39, 66.27; P=0.00; and OR=2.54; 95%CI=1.16, 5.58; P=0.02 respectively]. Conclusion There was a higher prevalence of anemia among women, younger people, and those with no or only primary levels of formal education. Awareness programs targeted at women and people with lower levels of education are necessary to reduce the overall prevalence of anemia in this region.
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Affiliation(s)
- Ifeoma Elaine Azinge
- Department of Community Health and Primary Care, College of Medicine, University of Lagos
| | - Adedoyin Ogunyemi
- Department of Community Health and Primary Care, College of Medicine, University of Lagos
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Christian AK, Atiglo DY, Okyere MA, Obeng-Dwamena A, Marquis GS, Jones AD. Women's empowerment, children's nutritional status, and the mediating role of household headship structure: Evidence from sub-Saharan Africa. Matern Child Nutr 2023:e13520. [PMID: 37092343 DOI: 10.1111/mcn.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/23/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023]
Abstract
We aimed to examine the association between women's empowerment and childhood nutritional status while accounting for the mediating role of household headship structure. Cross-country, cross-sectional quantitative data from the most recent Demographic and Health Surveys (2015-2018) were used. Women's empowerment was measured as a composite index of participation in household decision-making, attitude towards domestic violence, and asset ownership. Childhood nutrition status was measure as anaemia (haemoglobin concentration < 110g/L), stunting (height-for-age z-scorescore <-2) and the co-occurrence of anaemia and stunting. Applying the Lewbel two-stage least squares, women's migration status was used as an instrumental variable. We used data on 25,665 woman-child dyads from eight sub-Saharan African countries: Burundi (2016), Ethiopia (2016), Guinea (2018), Malawi (2016), Mali (2018), Zimbabwe (2015), Uganda (2016), and Tanzania (2015). The women were in their reproductive ages (15-49 years) and children were under 5 years old. The findings showed that an increase in women's empowerment index reduces children's likelihood of being anaemic and having a co-occurrence of anaemia and stunting [coeff (SE), -0.114 (0.025) and -0.072 (0.032), respectively]. Specifically, an increase in asset ownership or decision-making dimensions of empowerment significantly reduces the likelihood of anaemia and the co-occurrence of anaemia and stunting among children. Children of empowered women from male-headed households were more likely to be anaemic and be concurrently anaemic and stunted compared to their counterparts whose mothers were from female-headed households. Interventions designed to improve childhood nutrition through women's empowerment approaches need to consider asset ownership and instrumental agency of women while acknowledging the mediating effect of household headship typology.
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Affiliation(s)
- Aaron K Christian
- Regional Institute for Population Studies (RIPS), University of Ghana, Accra, Ghana
| | - D Yaw Atiglo
- Regional Institute for Population Studies (RIPS), University of Ghana, Accra, Ghana
| | - Michael A Okyere
- School of Management, Collaborative Innovation Center for Energy Economics and Energy Policy, China Institute for Studies in Energy Policy, Xiamen University, Xiamen, China
| | - Akua Obeng-Dwamena
- Regional Institute for Population Studies (RIPS), University of Ghana, Accra, Ghana
| | - Grace S Marquis
- School of Human Nutrition, McGill University, Ste Anne de Bellevue, Quebec, Canada
| | - Andrew D Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Kalezi ZE, Kisenge R, Naburi H, Simbila AN, Mkony M, Leyna G. Prevalence of anaemia and associated factors among preterm infants at six weeks chronological age at Muhimbili National Hospital, Dar es Salaam, Tanzania: a cross-sectional study. Pan Afr Med J 2023; 44:193. [PMID: 37484596 PMCID: PMC10362685 DOI: 10.11604/pamj.2023.44.193.31190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/15/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction preterm infants are vulnerable to several medical complications including anaemia, a significant public health problem with consequences on neurodevelopment. This study looked at the magnitude of anaemia and its associated factors among preterm infants at 6 weeks chronological age in a paediatric clinic of Muhimbili National Hospital (MNH). Methods this was a hospital based cross-sectional study conducted among preterm infants at 6 weeks chronological age attending follow-up clinic at MNH from October 2019 to March 2020. Parental interviews, medical records reviews and haemoglobin assessment was done during the clinic visits. Logistic regression was used to determine the association between studied factors and anaemia. Results the proportion of preterm infants with anaemia at 6 weeks chronological age was 38.4% (142/370) with 74% of these infants having moderate anaemia. Morphological types of anaemia were normocytic (56.3%) and microcytic anaemia (4.9%). Two-thirds of preterm infants (62%) were on haematinics supplementation. Moderate preterm born at gestation age 32 to <34 weeks (OR=2.21, 95% CI 1.15-4.25, p=0.017), two or less phlebotomies (OR=2.3; 95% CI 1.23-4.30; P=0.010) and more than two phlebotomies (OR=7.2, 95% CI 3.62-14.16, p≤0.001) were significantly associated with anaemia. Conclusion the proportion of preterm infants with anaemia at 6 weeks chronological age is high despite two-thirds being on haematinics supplementation. Moderate preterm and multiple phlebotomies significantly contributed to the occurrence of anaemia. Screening preterm infants for anaemia, appropriate management, and close follow-up are recommended to reduce its burden.
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Affiliation(s)
- Zawadi Edward Kalezi
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rodrick Kisenge
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Helga Naburi
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alphonce Nsabi Simbila
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Martha Mkony
- Department of Paediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Mejía-Rodríguez F, Kim-Herrera EY, Quezada-Sánchez AD, Venosa López M, Pacheco-Miranda S, Shamah-Levy T, Bonvecchio Arenas A, García Guerra A, De la Cruz-Góngora V. Anaemia in adolescent women: A priority for the nutrition agenda in Mexico. A comparison of data from the ENSANUT 2012 and 2018-2019 surveys. NUTR BULL 2023; 48:203-215. [PMID: 37070325 DOI: 10.1111/nbu.12614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2023]
Abstract
The risk of anaemia in adolescence increases due to accelerated growth. This study aims to: (1) estimate the prevalence of anaemia in 2012 and 2018-2019 (Encuesta Nacional de Salud y Nutricion - ENSANUT [n = 5841 in 2012 and n = 2380 in 2018-2019]) in non-pregnant, Mexican adolescent women aged 12-19 years, and the changes in prevalence over this period according to sociodemographic, health and nutrition characteristics; (2) estimate the associations between anaemia and sociodemographic, health and nutrition characteristics in each year and overall, in non-pregnant Mexican adolescent women. Anaemia was defined as capillary haemoglobin <12 g/dL. The distribution of characteristics and their changes between 2012 and 2018-2019 were described. The covariate-adjusted prevalence of anaemia in 2012 and 2018-2019 and the changes over that period were estimated from a multiple log-binomial regression model and the factors associated with anaemia were assessed in each survey year and in both years combined. The prevalence of anaemia was 7.7% in 2012 and 13.1% in 2018-2019 (69% increase, Prevalence Ratio: PR = 1.69; 95%CI: 1.35, 2.13). The covariate-adjusted prevalence of anaemia increased from 6.9% to 10.5% in the overall population (PR = 1.53, 95%CI: 1.19, 1.96), and increased considerably in the age group 12-14 years (PR = 1.94, 95%CI: 1.36, 2.75), and in the northern region (PR = 3.68, 95%CI: 2.55, 5.32). Those receiving iron supplements or school breakfasts did not register a significant increase. A higher household wellbeing status and older age were associated with a lower prevalence of anaemia. Anaemia in non-pregnant adolescent women continues to be a public health problem. To improve the development and health of adolescent women in Mexico and to pave the way to a healthy pregnancy for the next generation, the causes of anaemia should be identified.
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Affiliation(s)
- Fabiola Mejía-Rodríguez
- Instituto Nacional de Salud Pública, Centro de Investigación en Nutrición y Salud, Av. Universidad 655. Sta. Ma. Ahuacatitlán, Cuernavaca, Morelos, Mexico
| | - Edith Y Kim-Herrera
- Instituto Nacional de Salud Pública, Centro de Investigación en Nutrición y Salud, Av. Universidad 655. Sta. Ma. Ahuacatitlán, Cuernavaca, Morelos, Mexico
| | - Amado D Quezada-Sánchez
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública-México, Av. Universidad 655. Sta. Ma. Ahuacatitlán, Cuernavaca, Morelos, Mexico
| | - Mónica Venosa López
- Instituto Nacional de Salud Pública, Centro de Investigación en Nutrición y Salud, Av. Universidad 655. Sta. Ma. Ahuacatitlán, Cuernavaca, Morelos, Mexico
| | - Selene Pacheco-Miranda
- Instituto Nacional de Salud Pública, Centro de Investigación en Nutrición y Salud, Av. Universidad 655. Sta. Ma. Ahuacatitlán, Cuernavaca, Morelos, Mexico
| | - Teresa Shamah-Levy
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública-México, Av. Universidad 655. Sta. Ma. Ahuacatitlán, Cuernavaca, Morelos, Mexico
| | - Anabelle Bonvecchio Arenas
- Instituto Nacional de Salud Pública, Centro de Investigación en Nutrición y Salud, Av. Universidad 655. Sta. Ma. Ahuacatitlán, Cuernavaca, Morelos, Mexico
| | - Armando García Guerra
- Instituto Nacional de Salud Pública, Centro de Investigación en Nutrición y Salud, Av. Universidad 655. Sta. Ma. Ahuacatitlán, Cuernavaca, Morelos, Mexico
| | - Vanessa De la Cruz-Góngora
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública-México, Av. Universidad 655. Sta. Ma. Ahuacatitlán, Cuernavaca, Morelos, Mexico
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Boonrusmee S, Kasemsripitak S, Navykarn T, Jaruratanasirikul S. Association between anaemia and vitamin D insufficiency among 6- to 12-month-old infants: implications for clinical practice. Fam Pract 2023:7103538. [PMID: 37014969 DOI: 10.1093/fampra/cmad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Anaemia and vitamin D insufficiency (VDI) are among the most common nutritional problems. Anaemia screening is routinely performed; however, screening for VDI is not usually recommended. OBJECTIVES To study the association between anaemia and VDI and identify the risk factors for VDI. METHODS We conducted a cross-sectional study of 120 infants aged 6-12 months attending a well-child clinic at Songklanagarind Hospital between December 2020 and November 2021. Sociodemographic data and 24-h food records were also collected. Blood samples were obtained for complete blood count and 25-hydroxyvitamin D [25(OH)D] levels. Logistic regression analysis was used to determine risk factors for VDI. RESULTS The mean 25(OH)D level was 22.2 ± 8.9 ng/mL in anaemic infants and 27.2 ± 9.6 ng/mL in non-anaemic infants (P value 0.01). The median (IQR) Hb level was 11.1 g/dL (10.3, 11.4) in the VDI group and 11.4 g/dL (11, 12.1) in the non-VDI group (P value 0.002). The proportion of breastfed infants was higher in infants with anaemia (80%) (P < 0.001) and VDI (85.3%) (P < 0.001). Sunlight exposure <15 min/day (odds ratio [OR] 3.84; 95% confidence interval [CI]: 1.23-12.00; P = 0.020) was a risk factor, and vitamin D intake (OR 0.37; 95% CI: 0.20-0.74; P = 0.004) was a protective factor for VDI. CONCLUSION Infants with anaemia, short duration of sunlight exposure, breastfeeding, low vitamin D intake, and low iron intake were more likely to be vitamin D insufficient. However, after adjustment in the multivariate analyses, only sunlight exposure and vitamin D intake were significantly associated with vitamin D insufficiency.
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Affiliation(s)
- Sasivara Boonrusmee
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Staporn Kasemsripitak
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Thitiporn Navykarn
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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145
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Karyadi E, Reddy JC, Dearden KA, Purwanti T, Mardewi, Asri E, Roquero LB, Juguan JA, Sapitula‐Evidente A, Anand B, Warvadekar K, Bhardwaj A, Alam MK, Das S, Nair GK, Srivastava A, Raut MK. Antenatal care is associated with adherence to iron supplementation among pregnant women in selected low-middle-income-countries of Asia, Africa, and Latin America & the Caribbean regions: Insights from Demographic and Health Surveys. Matern Child Nutr 2023; 19:e13477. [PMID: 36705031 PMCID: PMC10019046 DOI: 10.1111/mcn.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/02/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023]
Abstract
Anaemia is a global public health problem affecting 800 million women and children globally. Anaemia is associated with perinatal mortality, child morbidity and mortality, mental development, immune competence, susceptibility to lead poisoning and performance at work. The objective of this article is to identify whether antenatal care-seeking was associated with the uptake of iron supplementation among pregnant women, adjusting for a range of covariates. This article used data from the cross-sectional recent Demographic and Health Surveys (DHS) of 12 countries in Asia, Africa and Latin America & the Caribbean regions. The individual-level data from 273,144 women of reproductive age (15-49 years) were analysed from multi-country DHS. Multiple Logistic regression analyses were conducted using Predictive Analytics Software for Windows (PASW), Release 18.0. Receiving at least four antenatal care visits was significantly associated with the consumption of 90 or more iron-containing supplements in 12 low and middle income countries across three regions after adjusting for different household and respondent characteristics, while mass media exposure was found to be a significant predictor in India and Indonesia. Antenatal care seems to be the most important predictor of adherence to iron intake in the selected countries across Africa, Asia, Latin America and Caribbean regions.
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Affiliation(s)
- Elvina Karyadi
- Former Country Director, Nutrition InternationalIndonesia Country OfficeJakartaIndonesia
| | - J. C. Reddy
- Senior Program Officer, Research and Evaluation, Nutrition InternationalAsia Regional OfficeNew DelhiIndia
| | - Kirk A. Dearden
- Senior Technical Advisor for Nutrition and WASHIMA World Health/Corus InternationalWashingtonDistrict ColumbiaUSA
| | - Tutut Purwanti
- Former Maternal and Child Nutrition Advisor, Nutrition InternationalIndonesia Country OfficeJakartaIndonesia
| | - Mardewi
- Former Program Coordinator ‐ Maternal and Child Health, Nutrition InternationalIndonesia Country OfficeJakartaIndonesia
| | - Eriana Asri
- Former Adolescent Nutrition Advisor, Nutrition InternationalIndonesia Country OfficeJakartaIndonesia
| | - Loreto B. Roquero
- Former Country DirectorNutrition International, Philippines Country OfficeManilaPhilippines
| | - Jocelyn A. Juguan
- Country Program Coordinator, Nutrition InternationalPhilippines Country OfficeManilaPhilippines
| | | | - Binu Anand
- Technical Assistance to Nutrition, Nutrition InternationalAsia Regional OfficeNew DelhiIndia
| | - Kirti Warvadekar
- Regional Program Officer, Research and Evaluation, Asia, Nutrition InternationalAsia Regional OfficeNew DelhiIndia
| | - Anjali Bhardwaj
- Regional Technical Advisor, Adolescent and Women's Health and Nutrition, Nutrition InternationalAsia Regional OfficeNew DelhiIndia
| | - Md. K. Alam
- Project DirectorSave the ChildrenDhakaBangladesh
| | - Susmita Das
- Deputy Regional Director, Nutrition InternationalAsia Regional OfficeNew DelhiIndiaIndia
| | - Gopa K. Nair
- Chief Executive OfficerLeo and Mia FoundationLondonUK
| | | | - Manoj K. Raut
- Asia Regional Technical Advisor, Research and Evaluation, Global Technical ServicesNutrition InternationalNew DelhiIndia
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146
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Benediktsson SB, Karason S, Sigurdsson MI. Haemoglobin levels and outcomes of subgroups of patients with pre-operative anaemia based on red cell size: A retrospective cohort study. Acta Anaesthesiol Scand 2023; 67:422-431. [PMID: 36635957 DOI: 10.1111/aas.14198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND Pre-operative anaemia is common and associated with adverse outcomes. We hypothesised that pre-operative anaemia would be evident more than 1 month pre-operatively, and that peri-operative changes in haemoglobin and post-operative outcomes differed between red cell size-based subsets of anaemia. METHODS A retrospective single-centre cohort study, including all patients 18 years and older undergoing their first surgery at Landspitali between January 2006 and December 2018 with available measurement of haemoglobin (Hb) within 30 days preceding surgery. Clinical data were compared between patients with subgroups of anaemia classified by mean corpuscular volume (MCV) into microcytic (MCV < 80 fl), normocytic (MCV 80-100 fl), and macrocytic (MCV > 100 fl) anaemia. The development of haemoglobin measurements from a nationwide database was plotted from 1 year pre-operatively to 2 years post-operatively. RESULTS Of 40,979 patients, 10,505 (25.6%) had pre-operative anaemia, of which 1089 (10.4%) had microcytic anaemia, 9243 (88.0%) had normocytic anaemia, and 173 (1.6%) had macrocytic anaemia. Patients within all subgroups of pre-operative anaemia had a higher degree of comorbidity and frailty burden and a low haemoglobin evident for more than 100 days pre-operatively and similar changes post-operatively. Post-operative prolonged recovery of haemoglobin was slower for macrocytic anaemia than other types of anaemia. All groups of patients with anaemia had a higher incidence of 30-day mortality, acute kidney injury, and rate of readmission compared with patients without anaemia. CONCLUSIONS Pre-operative anaemia is evident long prior to the procedure and its association with worse outcomes is similar regardless of red cell size.
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Affiliation(s)
| | - Sigurbergur Karason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Division of Anaesthesia and Intensive Care Medicine, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Martin I Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Division of Anaesthesia and Intensive Care Medicine, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
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147
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Kooshki A, Akbarzadeh R, Amin B, Tofighiyan T, Foroumandi E. Synbiotic supplement for treatment of iron deficiency anaemia in haemodialysis patients: A randomized controlled trial. Nephrology (Carlton) 2023; 28:234-239. [PMID: 36745046 DOI: 10.1111/nep.14149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/21/2023] [Accepted: 02/01/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is evidence that probiotics can increase the availability of iron. The aim of current study was to determine the effects of synbiotic supplementation on the haematological parameters and anaemia in haemodialysis patients. METHODS This study was a randomized, double-blind, placebo-controlled trial. Fifty patients were randomly selected from the haemodialysis section of Vaseii Hospital, Sabzevar, Iran. Subjects in the symbiotic and control groups received 2 capsules of synbiotic supplement or placebo, respectively, once a day for 8 weeks. Blood samples were divided into two test tubes in equal volumes. Blood haemoglobin, haematocrit, transferrin saturation, red blood cells (RBCs), and total iron binding capacity (TIBC) were measured with auto-analyser. Ferritin was determined using Sandwich enzyme-linked immunosorbent assay (ELISA). RESULTS Twenty tree patients in each group completed the study. Significant results were recorded in synbiotic groups regarding the concentration of blood haemoglobin, haematocrit, transferrin saturation, the number of RBCs, and serum ferritin compare to placebo group (P < .05). At the end of week 8, TIBC significantly decreased in synbiotic than placebo group (P < .05). CONCLUSION Synbiotic supplementation could be a safe and promising candidate in improving anaemia in CKD patients.
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Affiliation(s)
- Akram Kooshki
- Non-Communicable Disease Research Center, Department of Nutrition & Biochemistry, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Roya Akbarzadeh
- Department of Anesthesia & Operating Room, School of Paramedic, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Bahareh Amin
- Cellular and Molecular Research Center, Department of Physiology and Pharmacology, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Tahereh Tofighiyan
- Department of Nursing, School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Elaheh Foroumandi
- Non-Communicable Disease Research Center, Department of Nutrition & Biochemistry, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
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148
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Czempik PF, Wiórek A. Iron deficiency in sepsis patients managed with divided doses of iron dextran: a prospective cohort study. Sci Rep 2023; 13:5264. [PMID: 37002279 PMCID: PMC10066317 DOI: 10.1038/s41598-023-32002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Iron deficiency (ID) impairs hemoglobin (Hb) synthesis and immune function, both crucial for sepsis patients. We assessed the impact of iron dextran on reticulocyte (Ret) Hb equivalent (Ret-He) and Ret subpopulations in iron-deficient sepsis patients. In this prospective clinical study we enrolled patients with sepsis or septic shock with procalcitonin concentration > 0.5 ng/mL, diagnosed with ID based on Ret-He. Study subjects received divided doses of iron dextran until normalization of Ret-He. The study population included 35 subjects. The median Ret-He increase after 2 doses of iron dextran was 3.0 (IQR 1.9-6.1) pg (p < 0.01) with median time to normalization 4 (IQR 3-5) days. Although no change in Ret percentage [Me 1.5 (IQR 1.1-2.1) vs. Me 1.4 (IQR 1.1-2.4) %, p = 0.39] and number [Me 0.05 (IQR 0.04-0.07) vs. Me 0.05 (IQR 0.03-0.06) 106/µL, p = 0.88] was noted, Ret subpopulations changed significantly (p for all < 0.01). Divided doses of iron dextran relatively quickly normalize Ret-He in iron-deficient sepsis patients. Changes in Ret subpopulations suggest increased erythropoietic activity. Further research is needed to explore the role of intravenous iron in this clinical setting.
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Affiliation(s)
- Piotr F Czempik
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, 40-752, Katowice, Poland.
- Transfusion Committee, University Clinical Center of Medical University of Silesia in Katowice, Katowice, Poland.
| | - Agnieszka Wiórek
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, 40-752, Katowice, Poland
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149
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Partap U, Tadesse AW, Shinde S, Sherfi H, Mank I, Mwanyika-Sando M, Sharma D, Baernighausen T, Drysdale R, Worku A, Tinkasimile A, Fawzi WW. Burden and determinants of anaemia among in-school young adolescents in Ethiopia, Sudan and Tanzania. Matern Child Nutr 2023:e13439. [PMID: 36994612 DOI: 10.1111/mcn.13439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/23/2022] [Accepted: 09/22/2022] [Indexed: 03/31/2023]
Abstract
Anaemia among adolescents is a global health problem. However, evidence regarding its burden and risk factors, particularly for younger adolescents and in sub-Saharan Africa (SSA), remains scarce. We aimed to assess the prevalence and potential determinants of anaemia among urban and semi-urban in-school young adolescents in Ethiopia, Sudan and Tanzania. We conducted a school-based survey among 3558 adolescents aged 10-14 years. A capillary blood sample was used to assess haemoglobin concentration. We assessed anaemia prevalence and examined associations between measures at the individual, household and school levels and anaemia using Poisson regression models adjusted for school and country-level clustering. The prevalence of anaemia was 32.0% overall, and 10.8% in Ethiopia, 25.0% in Sudan and 58.3% in Tanzania. Being a boy [adjusted risk ratio (RR): 1.11, 95% confidence interval (CI): 1.08-1.15, p < 0.001], poorer diet quality (RR: 1.12, 95% CI: 1.02-1.23 p = 0.015), no school handwashing stations (RR: 1.26, 95% CI: 1.20-1.32, p < 0.001) and food insecurity (RR for moderate/severe anaemia: 1.06, 95% CI: 1.02-1.10, p = 0.002) were associated with increased anaemia risk. Younger age (RR: 0.91, 95% CI: 0.86-0.96, p < 0.001) and increasing height-for-age z-score (RR: 0.93, 95% CI: 0.91-0.95, p < 0.001) were associated with decreased anaemia risk. Associations were consistent for moderate or severe anaemia. There was no evidence of effect modification by sex. This study highlights anaemia as a public health problem and identified nutritional, dietary and hygiene measures as key risk factors of anaemia among young adolescents in SSA. School-based interventions addressing these factors could reduce the burden of anaemia in adolescence.
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Affiliation(s)
- Uttara Partap
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amare W Tadesse
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Sachin Shinde
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Center for Inquiry into Mental Health, Pune, India
| | - Huda Sherfi
- School of Health Sciences, Ahfad University for Women, Omdurman, Sudan
| | - Isabel Mank
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- German Institute for Development Evaluation (Deval), Bonn, Germany
| | | | | | - Till Baernighausen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Roisin Drysdale
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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150
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Woźniak M, Borkowska A, Jastrzębska M, Sochal M, Małecka-Wojciesko E, Talar-Wojnarowska R. Clinical and Laboratory Characteristics of Anaemia in Hospitalized Patients with Inflammatory Bowel Disease. J Clin Med 2023; 12:jcm12072447. [PMID: 37048531 PMCID: PMC10095056 DOI: 10.3390/jcm12072447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 04/14/2023] Open
Abstract
Anaemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD). Due to its multifactorial etiopathogenesis, the differential diagnosis and treatment of anaemia in IBD is a significant clinical problem. The main aim of our study was to assess the usefulness of laboratory parameters, including hepcidin, in differential diagnoses of anaemia in hospitalized IBD patients. This study also estimated the impact of anaemia on the length of hospitalization and its relationship with clinical data of analyzed patients. The study included 118 adult patients diagnosed with IBD-55 with ulcerative colitis (UC) and 63 with Crohn's disease (CD). Anaemia was significantly more frequent in patients with CD-42 (66.7%)-compared to 31 (56.4%) patients with UC (p = 0.033). The prevalence of anaemia increased significantly with the severity of IBD and the extent of inflammatory changes in the endoscopic examination. Hospitalization time was significantly longer in patients with anaemia, especially in the group with UC. Ferritin concentrations < 30 ng/mL were found only in 15 (20.55%) IBD patients (9 with UC and 6 with CD), and ferritin < 100 ng/mL was observed in 22 (30.14%) patients, equally frequent with UC and CD (p > 0.05). Significantly higher concentrations of transferrin were observed in patients with anaemia in the course of UC compared to CD (2.58 ± 0.90 g/L vs. 2.15 ± 0.82 g/L; p = 0.037). On the other hand, saturation of transferrin < 16% was equally common in UC and CD patients. In our study, hepcidin levels in anaemic UC patients were significantly lower compared to UC without anaemia (p = 0.042), with no similar differences in CD independently of anaemia presence (p = 0.565). To conclude, we observed a high incidence of anaemia in patients with IBD and its significant impact on the length of hospitalization in UC. Routinely determined single laboratory parameters are not sufficient for the differential diagnosis of anaemia, and a complex laboratory assessment, including of hepcidin levels, is necessary for the full picture of anaemia in the course of IBD.
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Affiliation(s)
- Małgorzata Woźniak
- Department of Digestive Tract Diseases, Medical University of Lodz, 90-419 Lodz, Poland
| | - Anna Borkowska
- Department of Internal Diseases and Diabetology, Medical University of Lodz, 90-419 Lodz, Poland
| | - Marta Jastrzębska
- Department of Gastroenterology, Health Care Center, 26-200 Konskie, Poland
| | - Marcin Sochal
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 90-419 Lodz, Poland
| | - Ewa Małecka-Wojciesko
- Department of Digestive Tract Diseases, Medical University of Lodz, 90-419 Lodz, Poland
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