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2.
Blood Cells Mol Dis ; 85: 102462, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32623341

RESUMO

Dizygotic twin males, born at 34 weeks gestation, had prolonged jaundice, microcytic, hypochromic anemia, FABarts hemoglobin, elevated end-tidal CO, and blood films consistent with hereditary pyropoikilocytosis. DNA sequencing revealed both had a heterozygous alpha spectrin (SPTA1) mutation (c.460_462dup) inherited from their asymptomatic mother, plus a 3-base pair duplication in alpha globin (HBA2) (c.364_366dupGTG) inherited from their asymptomatic father.


Assuntos
Anemia Hemolítica/complicações , Anemia Hipocrômica/complicações , Eliptocitose Hereditária/complicações , Icterícia/complicações , Anemia Hemolítica/sangue , Anemia Hemolítica/genética , Anemia Hipocrômica/sangue , Anemia Hipocrômica/genética , Eliptocitose Hereditária/sangue , Eliptocitose Hereditária/genética , Humanos , Recém-Nascido , Icterícia/sangue , Icterícia/genética , Masculino , Mutação Puntual , Espectrina/genética , Gêmeos Dizigóticos/genética
4.
Clin Dermatol ; 37(5): 516-519, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31896406

RESUMO

Greenish staining of human skin may result from a gamut of causes, such as chlorosis, exogenous copper, resolving ecchymosis, drugs, green textile dyes, green tattoos, apocrine and eccrine chromhidrosis, hyper biliverdinemia, chloromas, use of green dyes during tube feeding in patient with multiorgan failure, Pseudomonas infections, and Wells' syndrome in its second stage. Physicians may rarely encounter patients with green skin, hair, nails, or mucosae.


Assuntos
Anemia Hipocrômica/complicações , Doenças da Unha/etiologia , Transtornos da Pigmentação/etiologia , Cor , Cobre/efeitos adversos , Doenças do Cabelo/etiologia , Humanos , Hepatopatias/complicações , Mucosa , Sarcoma Mieloide/complicações
5.
Rev. bras. cir. plást ; 33(4): 511-517, out.-dez. 2018. tab
Artigo em Inglês, Português | LILACS | ID: biblio-980147

RESUMO

Introdução: A lipoaspiração é o sendo segundo procedimento mais realizado no Brasil. Com os avanços da técnica, melhores equipamentos e aumento da segurança no ambiente cirúrgico, passaram-se a ser lipoaspiradas grandes áreas. Contudo, existe uma preocupação com a segurança do paciente. Comitês de segurança têm feito recomendações sobre a infiltração, anestesia, seleção do paciente, volume aspirado, entre outros. A Sociedade Brasileira de Cirurgia Plástica e o Conselho Federal de Medicina também determinaram parâmetros de volumes de segurança do aspirado e superfície corporal aspirada. Ainda assim, a literatura de apoio para as recomendações é escassa. O objetivo é avaliar as alterações dos níveis de hemoglobina, ferro sérico e proteínas totais no pré e pós-operatório mediato (7-10 dias), assim como seus reflexos nos pacientes. Métodos: Realizamos um estudo prospectivo, com pacientes submetidos à lipoaspiração isolada e associada à dermolipectomia abdominal, por indicações estéticas. Avaliamos 30 pacientes, sendo coletados dados demográficos, peso, Índice de Massa Corporal, níveis de hemoglobina, ferro sérico e proteínas totais, no pré-operatório, e entre 7 a 10 dias de pós-operatório. Resultados: A queda da hemoglobina foi entre 2-6g/dl, com média de 3,1g/dl aos 7-10 dia de PO. Tivemos como valor mínimo de hemoglobina 7,8g/dl no pós-operatório com 7-10 dias, enquanto o ferro sérico apresentou redução média de 44,87g/dl. Conclusão: A redução no nível da hemoblogina foi responsável pela sintomatolgia clinica apresentada. A reposição de ferro se mostrou necessária no pós-operatório imediato.


Introduction: Liposuction is the second commonest procedure performed in Brazil. The scope for liposuction has broadened with advances in the technique, with better equipment, and increased safety in the surgical environment. However, there are concerns about patient safety. Safety committees have made recommendations on various aspects of the procedure including infiltration, anesthesia, patient selection, and aspirated volume. The Brazilian Society of Plastic Surgery and the Federal Council of Medicine have also determined the parameters for aspiration safety volumes, and for the aspiration of body surface. However, supporting literature for the recommendations is scarce. The objective is to evaluate changes in hemoglobin, serum iron, and total protein levels in the peri-operative days (between 7 and 10 days), in addition to its impact in patients. Methods: We performed a prospective study, with patients submitted to either liposuction alone, or in conjunction with abdominal dermolipectomy for esthetic indications. We evaluated 30 patients, collecting their demographic data, weight, body mass index, hemoglobin, serum iron, and total protein levels in both, the pre-operative period, and between 7 and 10 post-operative days. Results: The fall in hemoglobin levels were between 2 and 6 g /dL, with an average of 3.1 g /dL between 7 and 10 post-operative days . A minimum hemoglobin value of 7.8 g/dL was noted between 7 and 10 days after surgery, while the mean reduction of serum iron was found to be 44.87 g/dL. Conclusion: The reduction in hemoglobin levels was responsible for the clinical symptoms. Iron supplementation was required in the immediate post-operative period.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Operatórios/métodos , Lipectomia/métodos , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Hipotensão Ortostática/complicações , Anemia Hipocrômica/complicações , Complicações Pós-Operatórias , Segurança do Paciente
6.
Rev. méd. hondur ; 85(3/4): 108-111, jul.-dic. 2017. ilus
Artigo em Espanhol | LILACS | ID: biblio-970302

RESUMO

Antecedentes: A pesar de los grandes avances en la medicina contemporánea; la Tuberculosis continúa siendo un reto diagnóstico, en especial al presentarse con características clínicas poco usuales. Caso clínico: Paciente masculino de 48 años, agri-cultor, de escasos recursos económicos, sin comorbilidades previas, el cual presenta sintomatología constitucional, pérdida de peso, iebre y dolor lumbar irradiado a ambos lancos de la región abdominal, de características poco especíicas, de un mes de evolución; acompañado de disuria y oliguria, y niega síntomas respiratorios. Al examen físico luce crónicamente enfermo, en mal estado nutricio-nal, sin deterioro de la conciencia, no se evidencia adenopatías cervicales ni inguinales; sin presencia de signos pulmonares, con leve dolor con la puño percusión renal bilateral, en el área genital, se identiica una masa de borde regular, móvil sobre el polo superior del testículo derecho. En el examen hematológico con presencia de Bicitopenia anemia microcitica hipocromica y trombocitopenia leve, en gases arteriales acidosis metabólica con Anión Gap elevado, además con hiperazoemia e hiperkalemia en la bioquímica sanguínea refractaria al tratamiento, razón por la cual fue sometido a Hemodiálisis aguda. Al evaluar radiografía de tórax se observa patrón micro-nodular difuso, no se realiza baciloscopias por falta de expectoración ni por lavado gástrico, en el ultrasonido renal y de vías urinarias se visualizó nefromegalia y la presencia de masa heterogénea de aspecto granulomatoso en testículo derecho; por lo que se solicitó tomografía toracoabdominal, en donde se observa patrón micronodular múltiple a nivel pulmonar, con afectación renal, ganglionar y testicular, se solicita BAAR de sedimento urinario seriado con resultados positivos, y la tinción Ziehl Neelsen en orina con resultado positivo; con ello se inicia terapia antiimica. Discusión: La Tuberculosis renal no tiene un cuadro clínico clásico; generalmente se presenta con manifestaciones atípicas; como en nuestro caso con sintomatología urinaria, hiperazoemia que culmino en terapia de restitución renal de emergencia, con posterior recuperación de la función renal.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose Miliar/diagnóstico , Tuberculose Renal/diagnóstico , Anemia Hipocrômica/complicações
7.
Sleep Med ; 16(5): 589-92, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25900141

RESUMO

OBJECTIVE: Almost one-third of pregnant women develop symptoms of restless legs syndrome (RLS), which could have a negative impact on quality of life and the course of pregnancy and/or labor. The aim of our study was to determine possible risk factors for developing RLS in pregnant women. METHODS: A total of 300 random women in the third trimester of gravidity filled out a simple questionnaire based on the official diagnostic criteria for RLS. Respondents positive for RLS were interviewed to further characterize their symptoms. The parameters of iron metabolism were examined based on blood samples. All data were statistically analyzed. RESULTS: We detected significantly lower hemoglobin levels with signs of hypochromic anemia typical of iron deficiency in RLS-positive respondents, although oral iron supplementation was significantly higher in this group. The overall severity of symptoms correlated inversely with hemoglobin level. CONCLUSION: According to our results, it appears that serum iron level disturbances play a crucial role in the pathophysiology of secondary RLS in pregnant women.


Assuntos
Anemia Ferropriva/complicações , Complicações na Gravidez/etiologia , Síndrome das Pernas Inquietas/etiologia , Adolescente , Adulto , Anemia Hipocrômica/complicações , Feminino , Hemoglobinas/análise , Humanos , Ferro/sangue , Deficiências de Ferro , Gravidez , Síndrome das Pernas Inquietas/complicações , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
8.
Ophthalmologe ; 112(4): 368-72, 2015 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-25619165

RESUMO

A 51-year-old diabetic and overweight male presented to our eye clinic with right-sided impairment of visual acuity and scotoma. A thorough work-up had been carried out at our institute 9 months prior to this event due to left-sided nonarteriitic anterior ischemic optic neuropathy (NAION). Despite the similarity of visual symptoms in the currently and previously affected eyes microcystic anemia (Hb 81 g/dl) associated with severe hemorrhoidal bleeding was diagnosed. The patient underwent surgical hemorrhoidectomy and received two red blood cell concentrates. Therefore, this article reports on an extraordinarily rare case of shock-induced anterior ischemic optic neuropathy (SIAION) caused by hemorrhoidal bleeding.


Assuntos
Anemia Hipocrômica/complicações , Anemia Hipocrômica/etiologia , Hemorragia Ocular/complicações , Neuropatia Óptica Isquêmica/diagnóstico , Escotoma/diagnóstico , Choque Hemorrágico/complicações , Diabetes Mellitus Tipo 2/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Neuropatia Óptica Isquêmica/etiologia , Escotoma/etiologia , Acuidade Visual
9.
J Obstet Gynaecol Res ; 41(6): 967-70, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25510540

RESUMO

α°-thalassemia is a well-known cause of hydrops fetalis in South-East Asia and can be detected in utero. We report a very rare case of thyrotoxic cardiomyopathy associated with hyperplacentosis secondary to α°-thalassemia-associated hydrops fetalis. A 22-year-old primigravida with microcytic anemia presented at 27 weeks' gestation with pre-eclampsia, hyperthyroidism and cardiac failure. Serum ß-human chorionic gonadotrophin was markedly elevated and abdominal ultrasound revealed severe hydropic features and enlarged placenta. Serum ß-human chorionic gonadotrophin, cardiac function and thyroid function tests normalized after she delivered a macerated stillbirth. Histopathology of the placenta showed hyperplacentosis. Blood DNA analysis revealed that both patient and husband have the α°-thalassemia trait. This case illustrates a very atypical presentation of α°-thalassemia-associated hydrops fetalis and the importance of early prenatal diagnosis of α-thalassemia in women of relevant ethnic origin with microcytic anemia so that appropriate genetic counseling can be provided to reduce maternal morbidity and the incidence of hydrops fetalis.


Assuntos
Cardiomiopatias/complicações , Hidropisia Fetal/etiologia , Complicações na Gravidez/fisiopatologia , Tireotoxicose/complicações , Talassemia alfa/genética , Adulto , Anemia Hipocrômica/complicações , Anemia Hipocrômica/fisiopatologia , Cardiomiopatias/fisiopatologia , Feminino , Aconselhamento Genético , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Heterozigoto , Humanos , Hidropisia Fetal/diagnóstico por imagem , Hipertireoidismo/complicações , Hipertireoidismo/fisiopatologia , Malásia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Natimorto , Tireotoxicose/fisiopatologia , Ultrassonografia Pré-Natal , Adulto Jovem , Talassemia alfa/embriologia , Talassemia alfa/fisiopatologia
10.
J Stroke Cerebrovasc Dis ; 23(7): 1985-7, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24794947

RESUMO

We report a case of cerebral venous thrombosis (CVT) associated with a giant adenomyosis. At admission, the patient demonstrated generalized seizures and consciousness disturbance. Brain fluid-attenuated inversion recovery magnetic resonance imaging revealed a localized, high-intensity region in the left frontal lobe. Subsequent brain angiography showed that right internal carotid angiograms display abrupt termination of the anterior half of the superior sagittal sinus and a filling defect in the lateral part of the left transverse sinus. The patient complicated with iron deficiency anemia (IDA) and adenomyosis with higher levels of serum carbohydrate antigen 125 (CA125) and d-dimer. After 1 year from onset, intermittent severe menalgia and headache persisted, and blood examination revealed abnormal values; the patient was receiving oral medications. Finally, adenomyosis resection was performed with a favorable outcome, and no recurrence was observed during the 2-year follow-up period. We conclude that IDA and increased CA125 levels may have promoted hypercoagulability and CVT. This report emphasizes the possible relationship between CVT and adenomyosis.


Assuntos
Adenomiose/complicações , Trombose dos Seios Intracranianos/etiologia , Adenomiose/cirurgia , Anemia Hipocrômica/complicações , Anemia Hipocrômica/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Convulsões/etiologia , Trombose dos Seios Intracranianos/tratamento farmacológico , Resultado do Tratamento , Trombose Venosa/tratamento farmacológico , Trombose Venosa/etiologia
11.
G Ital Cardiol (Rome) ; 15(4): 240-3, 2014 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-24873813

RESUMO

Systemic thrombolysis is a well known treatment for massive pulmonary embolism (PE) but it remains often underutilized in clinical practice because of the risk of major bleeding, especially intracranial hemorrhage. Recently, the use of safe-dose recombinant tissue-type plasminogen activator (rTPA) has been proposed for the treatment of moderate PE demonstrating to be safe and more effective than standard anticoagulation. We report the case of an 83-year-old male patient affected by massive PE associated with high bleeding risk, and treated with half-dose of rTPA that resulted in rapid clinical improvement. This clinical experience led us to focus on the role of reduced doses of rTPA to decrease bleeding risk in patients with PE. We conclude that the new concept of "safe-dose thrombolysis" with rTPA may be considered a reasonable and interesting option in high-bleeding risk patients with massive PE.


Assuntos
Fibrinolíticos/administração & dosagem , Transtornos Hemorrágicos/induzido quimicamente , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Idoso de 80 Anos ou mais , Anemia Hipocrômica/complicações , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Bloqueio de Ramo/complicações , Complicações do Diabetes/tratamento farmacológico , Relação Dose-Resposta a Droga , Enoxaparina/administração & dosagem , Enoxaparina/efeitos adversos , Enoxaparina/uso terapêutico , Fibrinolíticos/efeitos adversos , Fibrinolíticos/uso terapêutico , Transtornos Hemorrágicos/etiologia , Transtornos Hemorrágicos/prevenção & controle , Heparina/administração & dosagem , Heparina/efeitos adversos , Heparina/uso terapêutico , Humanos , Hipertensão/complicações , Achados Incidentais , Infusões Intravenosas , Injeções Intravenosas , Nefropatias/complicações , Masculino , Obesidade/complicações , Guias de Prática Clínica como Assunto , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Radiografia , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Fatores de Risco , Neoplasias Gástricas/complicações , Neoplasias Gástricas/diagnóstico por imagem , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Ativador de Plasminogênio Tecidual/uso terapêutico , Ultrassonografia
12.
Am J Cardiol ; 113(9): 1481-6, 2014 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-24630790

RESUMO

Bleeding complications after percutaneous coronary intervention (PCI) have been associated with higher short and long-term mortality. Bivalirudin has been shown to reduce bleeding complications in patients who underwent PCI; however, the impact of anemia on bleeding complications and long-term mortality has not been studied. A total of 11,991 patients who underwent PCI over a period of 8 years with bivalirudin as the primary antithrombotic agent were included. Anemia was defined according to the World Health Organization definition. Bleeding complications were prospectively collected. Survival analysis was performed using multivariable Cox proportional hazards models. Of the 11,991 patients, 4,815 patients (40%) had baseline anemia. Major bleeding occurred in 3.3% of patients with anemia compared with 0.7% of patients without anemia (p <0.001) driven largely by transfusion events. In the overall study population, major bleeding was a significant predictor of mortality (hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.04 to 1.8, p = 0.027) at a mean follow-up of 2.6 years (interquartile range 1.4 to 3.5). In patients with anemia, major bleeding remained an independent predictor of mortality (HR 1.5, 95% CI 1.1 to 2.0, p = 0.008); however, in patients without anemia, it did not (HR 1.25, 95% CI 0.52 to 3.03, p = 0.62). In patients who underwent PCI with bivalirudin therapy, major bleeding is associated with early and long-term mortality, which is more pronounced in patients with baseline anemia.


Assuntos
Anemia Hipocrômica/complicações , Antitrombinas/uso terapêutico , Hemorragia/complicações , Fragmentos de Peptídeos/uso terapêutico , Intervenção Coronária Percutânea/mortalidade , Idoso , Feminino , Hirudinas , Humanos , Masculino , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Proteínas Recombinantes/uso terapêutico
13.
Indian J Pathol Microbiol ; 56(2): 109-13, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24056645

RESUMO

BACKGROUND: Hemoglobinopathies are the most common inherited red cell disorders worldwide. Identification of these disorders is immensely important epidemiologically and for improved management protocols. AIM AND OBJECTIVES: Our aim was to determine the prevalence of hemoglobinopathies in patients with microcytic hypochromic anemia and to assess the suitability of using high performance liquid chromatography (HPLC) routinely for screening antenatal cases and patients with anemia. MATERIALS AND METHODS: A total of 4335 cases received from Mar 2007 to Nov 2011 were studied for various hemoglobinopathies and variants on BIO RAD 'VARIANT' analyzer. RESULTS: Of the 4335 cases studied, 2119 were antenatal cases, 1710 patients with other disorders and 506 family studies. Of these, 688 cases displayed abnormal hemoglobin fractions on HPLC of which 140 were antenatal women. There were 455 cases of ß thalassemia trait, 24 ß thalassemia major, 20 thalassemia inter-media, 54 sickle cell trait, fivesickle cell disease, 21 double heterozygous ß thalassemia-sickle cell trait, nineand 4 Hb D- Punjab heterozygous and homozygous respectively, three Hb D ß Thalassemia trait, 20 and 37 Hb E homozygous and heterozygous respectively, three Hb E ß Thalassemia trait and four cases of Hb Q India. Twenty nine adults had isolated HbF elevation. CONCLUSION: Our study found a high prevalence (15.8%) of hemoglobinopathies amongst microcytic hypochromic anemia and antenatal cases. An accurate diagnosis helps in preventing unnecessary iron loading. Screening all antenatal cases with anemia helps in timely antenatal counseling, thus preventing the psychological trauma of bearing a transfusion dependent child for life.


Assuntos
Anemia Hipocrômica/diagnóstico , Anemia Hipocrômica/patologia , Cromatografia Líquida de Alta Pressão/métodos , Técnicas de Laboratório Clínico/métodos , Talassemia beta/diagnóstico , Talassemia beta/patologia , Adolescente , Adulto , Anemia Hipocrômica/complicações , Anemia Hipocrômica/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Gravidez , Adulto Jovem , Talassemia beta/complicações , Talassemia beta/epidemiologia
14.
J Cancer Res Ther ; 9(4): 739-40, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24518732

RESUMO

Squamous cell carcinoma of the small intestine is very rare. Only four cases have been reported so far. We report a case of primary squamous cell carcinoma arising in the small intestine and unusually causing strangulation of sigmoid colon in a 59-year-old female, the first case in India.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Neoplasias Intestinais/diagnóstico , Neoplasias Intestinais/patologia , Anemia Hipocrômica/complicações , Colo Sigmoide/patologia , Feminino , Humanos , Intestino Delgado/patologia , Pessoa de Meia-Idade
15.
Mali Med ; 27(1): 71-2, 2012.
Artigo em Francês | MEDLINE | ID: mdl-22766185

RESUMO

Pernicious anemia appears classically by macrocytosis. We report a case of a late discovered Biermer disease, on a 42-year-old young black woman. The reason was an unusual aspect of this disease in a context of betathalassemia. The patient presented chronic anemia which evolved during about ten year. Biology showed a normocytosis and signs of hemolysis according to beta-thalassemia. This was confirmed by an electrophoresis showing 9.1 % of fraction F some haemoglobin. Since this date, the patient was treated by folic acid alone with periodic transfusions of red blood cell. She presented eight years after the beginning of her disease, neurological deterioration. Diagnosis of pernicious anemia was finally established up on histological gastritis, low level of the blood rate of vitamin B12, macrocytosis, and presence of intrinsic anti-factor and parietal anti-cells antibodies.


Assuntos
Anemia Perniciosa/diagnóstico , Talassemia beta/complicações , Adulto , Anemia Hipocrômica/complicações , Anemia Perniciosa/sangue , Anemia Perniciosa/complicações , Anemia Perniciosa/tratamento farmacológico , Anemia Perniciosa/imunologia , Anemia Perniciosa/terapia , Autoanticorpos/sangue , Autoanticorpos/imunologia , Autoantígenos/imunologia , Terapia Combinada , Diagnóstico Tardio , Progressão da Doença , Transfusão de Eritrócitos , Feminino , Hemoglobina Fetal/análise , Ácido Fólico/uso terapêutico , Humanos , Fator Intrínseco/imunologia , Deficiências de Ferro , Parestesia/etiologia , Células Parietais Gástricas/imunologia , Vitamina B 12/sangue
16.
Acta Obstet Gynecol Scand ; 91(9): 1061-8, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22676243

RESUMO

OBJECTIVE: To identify factors associated with perinatal mortality in northeastern Tanzania. DESIGN: Prospective cohort study. SETTING: Northeastern Tanzania. Population. 872 mothers and their newborns. METHODS: Pregnant women were screened for factors possibly associated with perinatal mortality, including preeclampsia, small-for-gestational age, preterm delivery, anemia, and health-seeking behavior. Fetal growth was monitored using ultrasound. Finally, the specific causes of the perinatal deaths were evaluated. MAIN OUTCOME MEASURE: Perinatal mortality. RESULTS: Forty-six deaths occurred. Key factors associated with perinatal mortality were preterm delivery (adjusted odds ratio (OR) 14.47, 95% confidence interval (CI) 3.23-64.86, p < 0.001), small-for-gestational age (adjusted OR 3.54, 95%CI 1.18-10.61, p = 0.02), and maternal anemia (adjusted OR 10.34, 95%CI 1.89-56.52, p = 0.007). Adherence to the antenatal care program (adjusted OR 0.027, 95%CI 0.003-0.26, p = 0.002) protected against perinatal mortality. The cause of death in 43% of cases was attributed to complications related to labor and specifically to intrapartum asphyxia (30%) and neonatal infection (13%). Among the remaining deaths, 27% (7/26) were attributed to preeclampsia and 23% (6/26) to small-for-gestational age. Of these, 54% (14/26) were preterm. CONCLUSIONS: Preeclampsia, small-for-gestational age and preterm delivery were key risk factors and causes of perinatal mortality in this area of Tanzania. Maternal anemia was also strongly associated with perinatal mortality. Furthermore, asphyxia accounted for a large proportion of the perinatal deaths. Interventions should target the prevention and handling of these conditions in order to reduce perinatal mortality.


Assuntos
Asfixia Neonatal/mortalidade , Recém-Nascido Pequeno para a Idade Gestacional , Mortalidade Perinatal , Nascimento Prematuro/mortalidade , Adulto , Anemia Hipocrômica/complicações , Causas de Morte , Feminino , Humanos , Recém-Nascido , Complicações do Trabalho de Parto/mortalidade , Pré-Eclâmpsia , Gravidez , Estudos Prospectivos , Fatores de Risco , Tanzânia/epidemiologia
17.
Hemoglobin ; 36(2): 139-43, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22401170

RESUMO

The major defect in α-thalassemia (α-thal) is a single or double gene deletion. The aim of this study was to evaluate the α-thal mutations in two provinces of Southern Iran, Fars & Kohkeloye and Bouyer Ahmad. A total of 2000 subjects with microcytic hypochromic anemia was selected as a study group; finally, 1177 subjects were found to be α-thal mutation carriers by gap-polymerase chain reaction (gap-PCR) protocols and were confirmed by multiplex PCR and reverse hybridization test strips. A total of 1195 mutated α-globin alleles was identified in these patients that includes at least 10 different gene mutations. The most common mutation found was -α(3.7) (rightward deletion) (71.7%) and α(-5 nt) (IVS-I, -TGAGG) and the polyadenylation signal site (poly A1; AATAAA>AATAAG) were the second and third most common mutations (7.0 and 4.2%, respectively). In countries like Iran, with a high prevalence of thalassemia, identifying different mutations is helpful in carrier screening, genetic counseling and prenatal diagnosis of at-risk couples for the prevention of the birth of babies affected by severe thalassemic anomalies.


Assuntos
Anemia Hipocrômica/genética , Mutação , Deleção de Sequência , alfa-Globinas/genética , Talassemia alfa/genética , Adolescente , Adulto , Alelos , Anemia Hipocrômica/complicações , Anemia Hipocrômica/epidemiologia , Análise Mutacional de DNA , Feminino , Frequência do Gene , Aconselhamento Genético , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Reação em Cadeia da Polimerase Multiplex , Exames Pré-Nupciais , Prevalência , Talassemia alfa/complicações , Talassemia alfa/epidemiologia
18.
Rinsho Shinkeigaku ; 52(3): 147-51, 2012.
Artigo em Japonês | MEDLINE | ID: mdl-22453037

RESUMO

A 53-year-old woman was admitted to our hospital with headache and convulsion. Advanced anemia with a Hb level of 3.5 g/dl had been detected about a month earlier, and it had been treated by iron administration to achieve a Hb level of 8.9 g/dl. The patient developed status epilepticus on admission. The blood pressure was elevated, and brain diffusion weighted imaging and fluid attenuated inversion recovery imaging revealed high intensity areas in the bilateral posterior and parietal lobes, right frontal lobe, and right basal ganglia. The cerebrospinal fluid protein was elevated. The convulsions settled after continuous infusion of thiamylal under mechanical ventilation. Subsequently, the patient became conscious, and the brain MRI abnormalities gradually disappeared. While a number of factors such as hypertension, medication and others have been reported as causes of posterior reversible encephalopathy syndrome (PRES), comparatively rapid anemia correction could also possibly precipitate PRES as like as this case. Thus anemia correction needs to be undertaken carefully.


Assuntos
Anemia Hipocrômica/tratamento farmacológico , Síndrome da Leucoencefalopatia Posterior/etiologia , Anemia Hipocrômica/complicações , Feminino , Humanos , Ferro/uso terapêutico , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Síndrome da Leucoencefalopatia Posterior/diagnóstico
20.
Matern Child Nutr ; 8(3): 287-98, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22236211

RESUMO

Prenatal iron supplementation may improve pregnancy outcomes and decrease the risk of child mortality. However, little is known about the importance of post-natal maternal iron status for child health and survival, particularly in the context of HIV infection. We examined the association of maternal anaemia and hypochromic microcytosis, an erythrocyte morphology consistent with iron deficiency, with child health and survival in the first two to five years of life. Repeated measures of maternal anaemia and hypochromic microcytosis from 840 HIV-positive women enrolled in a clinical trial of vitamin supplementation were prospectively related to child mortality, HIV infection and CD4 T-cell count. Median duration of follow-up for the endpoints of child mortality, HIV infection and CD4 cell count was 58, 17 and 23 months, respectively. Maternal anaemia and hypochromic microcytosis were associated with greater risk of child mortality [hazard ratio (HR) for severe anaemia = 2.58, 95% confidence interval (CI): 1.66-4.01, P trend < 0.0001; HR for severe hypochromic microcytosis = 2.36, 95% CI: 1.27-4.38, P trend = 0.001]. Maternal anaemia was not significantly associated with greater risk of child HIV infection (HR for severe anaemia = 1.46, 95% CI: 0.91, 2.33, P trend = 0.08) but predicted lower CD4 T-cell counts among HIV-uninfected children (difference in CD4 T-cell count/µL for severe anaemia: -93, 95% CI: -204-17, P trend = 0.02). The potential child health risks associated with maternal anaemia and iron deficiency may not be limited to the prenatal period. Efforts to reduce maternal anaemia and iron deficiency during pregnancy may need to be expanded to include the post-partum period.


Assuntos
Anemia Ferropriva/epidemiologia , Mortalidade da Criança , Proteção da Criança/estatística & dados numéricos , Infecções por HIV/epidemiologia , Deficiências de Ferro , Adulto , Anemia Hipocrômica/complicações , Anemia Hipocrômica/epidemiologia , Anemia Ferropriva/complicações , Pré-Escolar , Comorbidade , Suplementos Nutricionais , Feminino , Infecções por HIV/complicações , Infecções por HIV/transmissão , Humanos , Ferro da Dieta/administração & dosagem , Gravidez , Complicações Hematológicas na Gravidez/epidemiologia , Fenômenos Fisiológicos da Nutrição Pré-Natal/fisiologia , Fatores de Risco
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