Síndrome de Plummer-Vinson / Plummer-Vinson syndrome

Introducción: El síndrome de Plummer-Vinson es una entidad rara caracterizada por la tríada anemia ferropénica, disfagia y membrana esofágica. Descrito en la segunda década del siglo pasado, en la actualidad la mayoría de los datos que se obtienen provienen de presentaciones de casos o pequeñas series de estudios prospectivos. Objetivo: Hacer la revisión de la bibliografía disponible a propósito de un caso portador de síndrome de Plummer-Vinson. Caso clínico: Paciente femenina de 35 años de edad con anemia desde la adolescencia remitida por presentar disfagia de 8 años de evolución. Se realizaron complementarios de laboratorio donde se constata anemia ferropénica y estudio contrastado del tracto digestivo superior que reveló imagen sugestiva de membrana en esófago cervical. Conclusiones: A pesar de su baja frecuencia en la actualidad debemos mantenernos alertas ante la aparición de síntomas sugestivos del síndrome de Plummer-Vinson fundamentalmente en mujeres con cuadros de anemia(AU)

Introduction: Plummer-Vinson syndrome is a rare entity characterized by the triad of iron deficiency anemia, dysphagia and esophageal membrane. Described in the second decade of the last century, today most of the data obtained comes from case presentations or small series of prospective studies. Objective: To review the available bibliography regarding a case with Plummer-Vinson syndrome. Clinical case: 35-year-old female patient with anemia since adolescence, referred to surgery clinic for presenting dysphagia of 8 years of evolution. Additional laboratory tests were carried out where iron deficiency anemia was found. A contrasted study of the upper digestive tract revealed a suggestive image of a membrane in the cervical esophagus. Conclusions: Despite its low frequency we must be alert to the appearance of symptoms suggestive of Plummer-Vinson syndrome, mainly in women with anemia. Its association with esophageal cancer indicates this(AU)

Recomendação e uso de sulfato ferroso em crianças de 12 e 24 meses de idade: avaliação da coorte de nascimentos de Pelotas, RS, de 2015 / Recommendation and use of ferrous sulphate in 12- and 24-month-old children: evaluation in the 2015 Pelotas Birth Cohort

RESUMO: Objetivo: Verificar a prevalência e os fatores associados à recomendação de uso de ferro a crianças aos 12 e aos 24 meses de idade. Metodologia: Todas as crianças nascidas nas maternidades de Pelotas em 2015 foram elegíveis para a coorte. Os desfechos foram a recomendação de uso de sulfato ferroso por profissional de saúde e a respectiva utilização. Resultados: A coorte acompanhou 4.275 crianças. Aproximadamente 65% receberam recomendação de suplementação de ferro até 12 meses. Destas, 68,8% fizeram a utilização recomendada. Dos 12 aos 24 meses, 39,4% das crianças receberam recomendação de suplementação de ferro e 26,2% fizeram o uso recomendado. Aos 12 meses, após ajuste, permaneceram associadas com recomendação de uso de ferro: maior escolaridade, maior renda, menor paridade e baixo peso ao nascer. Aos 24 meses, após ajuste, observou-se maior recomendação às mães com menor paridade e às crianças com baixo peso ao nascer. Conclusão: Houve baixa recomendação e baixa utilização de ferro. Esses achados são preocupantes diante da alta prevalência de anemia em crianças na faixa etária estudada. A baixa recomendação de profilaxia de ferro a crianças até 24 meses de idade, assim como a baixa utilização entre aquelas que receberam a orientação de uso refletem a necessidade de ações coordenadas entre profissionais de saúde e de ampliação do conhecimento entre as mães para possibilitar maior alcance dessa importante política pública.

ABSTRACT: Aim: To verify the prevalence of recommendation of iron supplementation among children aged 12 and 24 months. Methodology: All children born in the maternities of Pelotas/RS in 2015 were eligible for the Cohort. The outcomes were the recommendation of ferrous sulphate by health professionals and its use. Results: The cohort followed up 4,275 children. Approximately 64.0% of them were recommended to receive iron supplementation until 12 months of age. Among these, 68.8% used iron. From 12 to 24 months, 39.4% of the children received a prescription of iron supplementation, and among them, 26.2% actually used it. At 12 months, after adjusted analysis, higher maternal education, higher family income, lower parity, and low birth weight remained associated with the outcome. At 24 months, after adjusted analysis, we observed a higher recommendation of iron supplementation among mother with lower parity and for children with low birth weight. Conclusion: There was a low frequency of recommendation and low rate of use of iron among children. These findings are highly relevant given the high prevalence of anemia observed in children this year. The low recommendation of iron use among children up to 24 months of age, and the low use among those who are recommended to use it reflect the need for coordinated actions among health professionals and the expansion of knowledge among mothers to enable a wider reach of this important public policy.

La visión de médicos pediatras de atención primaria de la salud sobre la anemia infantil y el suplemento con hierro / The perspective of primary health care pediatricians regarding childhood anemia and iron supplementation

Introducción. La anemia ferropénica es más frecuente en los países de bajos y medianos ingresos. La evidencia sugiere que el impacto del suplemento con sulfato ferroso en la población infantil es bajo. Nuestro objetivo fue analizar la visión de los pediatras en torno a la problemática de la anemia y al suplemento con hierro. Población y métodos. Estudio cualitativo, exploratorio. Se realizaron entrevistas semiestructuradas a los pediatras del primer nivel de atención de Rosario. Se incluyeron tres ejes de indagación: "relevancia del problema", "práctica clínica" y "representaciones sobre el suplemento con hierro". El análisis consistió en sistematizar la información obtenida mediante la transcripción de entrevistas grabadas y anotaciones. Resultados. Se realizaron 32 entrevistas. Todos los entrevistados pensaban que la anemia era un problema relevante. Actualmente, se la asocia con una alimentación de mala calidad. Los hallazgos llevan a considerar que la práctica pediátrica sigue las normativas nacionales. Hay acuerdo en que la baja adherencia es un obstáculo para el manejo clínico de la anemia ferropénica. Los pediatras expresaron ideas potencialmente beneficiosas para el contexto local, que incluían la organización de talleres sobre anemia y la distribución gratuita de preparados con hierro de mejor sabor. Conclusiones. La anemia por déficit de hierro se consideró un problema grave. En atención primaria, las intervenciones destacadas fueron la organización de talleres y el acceso a preparados con hierro de sabor más agradable.

Introduction. Iron deficiency anemia is common in low- and middle-income countries. According to the evidence, the impact of ferrous sulfate supplementation in the pediatric population is low. Our objective was to analyze the perspective of pediatricians regarding anemia and iron supplementation. Population and methods. Qualitative, exploratory study. Semi-structured interviews were conducted with primary health care pediatricians from Rosario. Three core inquiry concepts were included: importance of this problem, clinical practice, and representations about iron supplementation. The analysis consisted in the systematization of the information collected by transcribing the recorded interviews and notes. Results. A total of 32 interviews were conducted. All interviewees considered anemia was a relevant problem. At present, anemia is associated with a poor-quality diet. Based on the findings, pediatric practice follows national standards. There is consensus that low adherence is a barrier for the clinical management of iron deficiency anemia. Pediatricians described concepts that are potentially beneficial for the local setting, including workshops on anemia and free provision of more flavorful iron supplements. Conclusions. Iron deficiency anemia was considered a severe problem. In the primary health care setting, outstanding interventions included workshops and access to more flavorful iron supplements.

Iniquidade na suplementação de sulfato ferroso entre gestantes no sul do Brasil / Inequality in iron sulfate supplementation among pregnant women in Southern Brazil

RESUMO: Introdução: O uso de sulfato ferroso é recomendado a todas as gestantes a partir da vigésima semana de gestação até o terceiro mês após o parto. Objetivo: Avaliar a cobertura de sulfato ferroso entre as gestantes e diferenciais de acordo com variáveis demográficas e socioeconômicas. Metodologia: Estudo transversal de base populacional com mulheres que tiveram filhos em Rio Grande, Rio Grande do Sul, no período de 01 de janeiro a 31 de dezembro de 2013. A cobertura de sulfato ferroso foi avaliada de acordo com idade e escolaridade materna, renda familiar e tipo de assistência médica no pré-natal. A análise estatística incluiu teste do χ2 de Pearson e regressão de Poisson. Resultados: Foram entrevistadas 2.685 puérperas (97% das mulheres elegíveis). A cobertura de sulfato ferroso foi de 63%. As maiores diferenças relativas foram entre os grupos extremos de escolaridade materna (50%) e em relação ao tipo de assistência médica no pré-natal (72%). Mulheres com idade entre 13 e 19 anos mostraram-se significativamente associadas ao uso do suplemento (RP = 1,16; IC95% 1,08 - 1,25) quando comparadas às mulheres com idade ≥ 30 anos. Quem utilizou o serviço público no pré-natal esteve mais fortemente associado ao desfecho quando comparado com quem utilizou o sistema privado (RP = 1,61; IC95% 1,49 - 1,74). Conclusão: São incomuns situações no setor de saúde em que os grupos menos favorecidos são privilegiados. Esses achados são raros e indicam a presença de iniquidade de forma contrária ao esperado. O suplemento deve considerar todas as mulheres, em especial as mais velhas, com maior escolaridade e de melhor nível socioeconômico.

ABSTRACT: Introduction: The use of ferrous sulfate is recommended for all pregnant women from the 20th week of gestation to the 3rd month after delivery. Objective: To evaluate the coverage of ferrous sulfate among pregnant women and differentials according to demographic and socioeconomic variables. Method: A cross-sectional population-based study with women who had children in Rio Grande, Rio Grande do Sul, Brazil, from January 1st to December 31st, 2013. Ferrous sulfate coverage was assessed according to maternal age, schooling, family income, and type of prenatal care. Statistical analysis included Pearson's χ2 test and Poisson regression. Results: 2,685 postpartum women (97% of the total) were interviewed and the ferrous sulfate coverage was 63%. The largest relative differences were between the extreme maternal schooling groups (50%) and the type of medical care in prenatal care (72%). Women aged between 13 and 19 years were significantly associated with the use of supplement (RP = 1.16; 95%CI 1.08 - 1.25) when compared to women aged ≥ 30 years. Those who used the public service in prenatal care were more strongly associated with the outcome when compared to those who used the private system (PR = 1.61; 95%CI 1.49 - 1.74). Conclusion: Considering that there are unusual situations in the health sector in which disadvantaged groups are privileged, these findings are rare and indicate the presence of inequality in a way that is opposite to what was expected. The supplement should consider all women, especially older women, with higher education and better socioeconomic status.

Uso de medicamentos no primeiro trimestre de gravidez: avaliação da segurança dos medicamentos e uso de ácido fólico e sulfato ferroso / Medication use during the first trimester of pregnancy: drug safety and adoption of folic acid and ferrous sulphate

OBJETIVO: Identificar o perfil de uso de medicamentos no primeiro trimestre de gravidez com ênfase na avaliação da segurança e na adoção do ácido fólico e do sulfato ferroso por gestantes em uma Unidade Básica de Saúde da região Sul do Brasil. MÉTODOS: Trata-se de estudo transversal aninhado a uma coorte de gestantes. Os medicamentos foram classificados segundo a Anatomical Therapeutic Chemical (ATC), e a segurança avaliada segundo a Food and Drug Administration (FDA) e a Agência Nacional de Vigilância Sanitária (ANVISA). Foi investigado o uso/prescrição de sulfato ferroso e ácido fólico segundo o protocolo do Ministério da Saúde. RESULTADOS: Foram incluídas 212 gestantes. Dessas, 46,7% estavam em uso de medicamentos no momento do diagnóstico da gravidez e 97,6% utilizaram medicamentos no primeiro trimestre gestacional. O percentual mais elevado de automedicação ocorreu antes do início do pré-natal (64,9%). Observou-se maior exposição a medicamentos de risco D e X, segundo a classificação do FDA, antes do início do pré-natal (23,0%). Entre as gestantes, 32,5% não seguiam o protocolo de uso de ácido fólico e sulfato ferroso do Ministério da Saúde. No total, 67,9% das gestantes tiveram exposição inadequada aos medicamentos. Houve diferença entre as proporções de medicamentos utilizados segundo a ATC, e os principais grupos anatômicos identificados foram os dos medicamentos que atuam no sangue e órgãos hematopoiéticos e anti-infecciosos de uso sistêmico. Na época do diagnóstico da gravidez, observou-se expressivo uso de medicamentos que atuam no sistema geniturinário e hormônios sexuais (16,2%), como anticoncepcionais orais, o que provavelmente está relacionado ao percentual ...

PURPOSE: To identify the profile of use of medication during the first trimester of pregnancy with emphasis on safety assessment and on the adoption of folic acid and ferrous sulfate by pregnant women attended at a Basic Health Unit in Brazil. METHODS: This was a cross-sectional study nested in a cohort of pregnant women. Medications were classified according to the Anatomical Therapeutic Chemical (ATC), and their safety was evaluated according to the Food and Drug Administration (FDA) and the Brazilian Health Surveillance Agency (ANVISA). The adoption of ferrous sulfate and folic acid was investigated according to the protocol set forth by the Brazilian Ministry of Health. RESULTS: The survey included 212 pregnant women, 46.7% of whom were taking medications at the time of pregnancy diagnosis, and 97.6% used medication during the first trimester after diagnosis. The highest percentage of self-medication occurred before the beginning of prenatal care (64.9%). According to the FDA criteria, there was a high level of exposure to D and X risk drugs before the beginning of prenatal care (23.0%), which was also observed for drugs not recommended by ANVISA (36.5%). Of the surveyed sample, 32.5% did not follow the protocol of the Brazilian Ministry of Health. In all, 67.9% of pregnant women had inadequate drug exposure. There was a difference between the proportions of drugs used according to the ATC, and the main anatomical groups identified were the drugs that act on blood and blood-forming organs, and anti-infective medications for systemic use. When pregnancy was diagnosed, the use of a large number of medications that act on the genitourinary system and sex hormones (16.2%) was identified, such as oral contraceptives, a fact probably related to the percentage of unplanned pregnancies (67.0%), on the same occasion 4 pregnant women used folic acid and 3 used ferrous sulphate. CONCLUSION: The present results show that a large number ...

Dietary germanium biotite supplementation enhances the induction of antibody responses to foot-and-mouth disease virus vaccine in pigs

We evaluated the potential ability of germanium biotite (GB) to stimulate the production of antibodies specific for foot-and-mouth disease virus (FMDV). To this aim, we measured the total FMDV-specific antibody responses and IgM production after vaccination against FMD both experimentally and in the field. GB supplementation with FMDV vaccination stimulated the production of anti-FMDV antibodies, and effectively increased IFN-gamma and TNF-alpha levels. These results suggest that GB may be a novel alternative feed supplement that can serve as a boosting agent and an immunostimulator for increasing the efficacy of FMDV vaccination in pigs.

Eficacia del hierro aminoquelado en comparación con el sulfato ferroso como fortificante de un complemento alimentario en preescolares con deficiencia de hierro, Medellín, 2011 / Effectiveness of iron amino acid chelate versus ferrous sulfate as part of a food complement in preschool children with iron deficiency, Medellín, 2011

Introducción. La disminución de los depósitos de hierro constituye el primer eslabón de la cadena conducente a la deficiencia de hierro, la carencia nutricional más prevalente y principal causa de anemia en todo el mundo, situación que puede prevenirse mediante la fortificación de alimentos. Objetivo. Comparar la eficacia del hierro aminoquelado con el sulfato ferroso como fortificante de un complemento alimentario en preescolares con deficiencia de hierro. Materiales y métodos. Se llevó a cabo un ensayo clínico triple ciego con distribución aleatoria de grupos. Se analizaron 56 preescolares con deficiencia de hierro (ferritina menor de 24 ng/ml) a los que se les dio diariamente 13 g de leche con 12,5 mg de hierro,. Después de dos meses se midieron los niveles de hemoglobina, hematocrito y ferritina sérica. Resultados. En el grupo con sulfato ferroso la concentración de ferritina sérica aumentó de 18,8 a 24,1 ng/ml, mientras que dicha variación fue de 18,4 a 29,7 ng/ml con el hierro aminoquelado, en ambos casos con diferencias significativas. El nivel de ferritina final difirió según el grupo de estudio, siendo mayor en el grupo con hierro aminoquelado (p=0,022). La hemoglobina y el hematocrito no variaron después de la intervención. Las reacciones adversas en el grupo con sulfato ferroso fueron de 35,7 %, en contraste con el 42,9 % en el grupo con hierro aminoquelado; cinco niños presentaron infección de las vías respiratorias, sin diferencias estadísticas. Conclusiones. Los dos compuestos aumentan los niveles de ferritina, siendo mayor el aumento entre quienes toman leche con hierro aminoquelado. No fue diferente la incidencia de reacciones adversas o de infecciones entre los grupos.

Introduction: Iron depleted deposits are the first link in the chain of events leading to iron deficiency which is the most prevalent nutritional shortage and main cause of anemia worldwide. This situation can be prevented through food fortification. Objective: To compare the efficacy of amino acid chelate iron with ferrous sulfate as fortifier of a dietary complement in preschoolers with iron deficiency. Materials and methods: This study was a blinded clinical trial with randomized groups. We analyzed 56 preschoolers with iron deficiency (ferritin < 24 ng/ml) that received 13 g of milk with 12.5 mg of iron, either amino acid chelate or in the ferrous sulfate form. After two months, hemoglobin, hematocrit and serum ferritin concentrations were measured. Results: In the ferrous sulfate group, ferritin concentration increased from 18.8 ng/ml to 24.1 ng/ml, while the variation was of 18.4 ng/ml to 29.7 ng/ml in the amino acid chelate group, with statistically differences in both cases. Serum ferritin was different between groups, being higher in iron amino acid chelate group (p=0.022). Hemoglobin and hematocrit levels did not change after the intervention. Adverse reactions in the ferrous sulfate group were 35.7%, compared with 42.9% in the iron amino acid chelate group; 5 children had respiratory tract infection, without statistical differences. Conclusions: Both compounds increased serum ferritin concentration, with a higher increase in those who were given milk with iron amino acid chelate. There were no differences in the adverse reactions and infections incidences between the groups.

Iron supplementation among pregnant women: results from a population-based survey study / Suplementacao com sulfato ferroso entre gestantes: resultados de estudo transversal de base populacional

Objectives: To measure the prevalence and risk factors associated with iron supplementation among pregnant women in the municipality of Rio Grande, Southern Brazil. Methods: All mothers living in this municipality who had children in 2007 were surveyed for demographic, socioeconomic and health care received during pregnancy and childbirth. The statistical analysis consisted of Poisson regression with robust adjustment of variance, and the measure of effect was prevalence ratio (PR). Results: Among the 2,557 mothers interviewed (99% of total), 59% were supplemented with iron during pregnancy period. After adjusting for various confounding factors, a higher PR to iron supplementation was observed among teenagers, women with black skin color, primigravidae, who had six or more antenatal visits, who performed prenatal care in public sector and received vitamin during pregnancy. Conclusion: There is a clear need to increase the iron supplementation coverage of all pregnant women, especially among those currently considered with low gestational risk. .

Objetivos: Medir a prevalência e identificar fatores associados à suplementação com sulfato ferroso entre gestantes residentes no município de Rio Grande, RS. Métodos: Mães residentes neste município que tiveram filho em 2007 foram investigadas quanto a características demográficas, nível socioeconômico e assistência recebida durante a gestação e o parto. Na análise estatística, foi utilizada regressão de Poisson com ajuste robusto da variância, e a medida de efeito foi razão de prevalências (RP). Resultados: Dentre as 2.557 mães entrevistadas (99% do total), 59% foram suplementadas com sulfato ferroso durante a gestação. Após análise ajustando para diversos fatores de confusão, mostraram maior RP à suplementação com sulfato ferroso as gestantes adolescentes, de cor da pele preta, primigestas, que realizaram seis ou mais consultas de pré-natal, que fizeram essas consultas na rede pública e que receberam complexo vitamínico durante a gestação. Conclusão: Há evidente necessidade de aumentar a cobertura da suplementação com sulfato ferroso entre todas as gestantes, sobretudo entre aquelas tidas, em geral, como de menor risco gestacional. .

Coverage and adequacy of ferrous sulfate supplementation in the prevention of anemia among children treated at health centers of Florianopolis, Santa Catarina / Cobertura y adecuacion de la suplementacion con sulfato ferroso en la prevencion de anemia entre ninos atendidos en centros de salud informatizados de Florianopolis, Santa Catarina (Brasil) / Cobertura e adequacao da suplementacao com sulfato ferroso na prevencao de anemia em criancas atendidas em centros de saude de Florianopolis, Santa Catarina

OBJECTIVE To evaluate the National Program of Iron Supplementation (PNSF) coverage, the compliance with the directions for of using of this supplementation and the association with sociodemographic factors in children aged six to 18 months old and registered in 35 public health centers of Florinópolis (Southern Brazil). METHODS Cross-sectional study using secondary data obtained from the health information system of the Health Department of Florianópolis, Santa Catarina, Brazil (Infosaúde). Data on ferrous sulfate supplementation and sociodemographic variables were obtained of all children registered in PNSF in Florianópolis in 2010. STATA 11.0 software was used in the analyses. RESULTS The PNSF covered 6.3% (95%CI 5.9-6.7) of the children; the compliance with the directions regarding age at the onset of supplementation and its frequency was adequate only in 2.4% of the cases (95%CI 1.5-3.7). There was no association with the child's gender, maternal education level and ethnicity or the distance from home to the health center. CONCLUSIONS This study showed low coverage and inadequate compliance with the PNSF directions. Measures to improve this strategy are urgent. .

OBJETIVO Evaluar la cobertura del Programa Nacional de Suplementación de Ferro (PNSF), el cumplimiento de la normativa de utilización de la suplementación y la asociación con factores sociodemográficos en niños de 6 a 18 meses atendidos en 35 centros de salud informatizados de Florianópolis, Santa Catarina (Brasil). MÉTODOS Estudio transversal con datos secundarios obtenidos del sistema de informaciones en salud de la Secretaría Municipal de Salud de Florianópolis (Infosaúde). Se obtuvieron informaciones sociodemográficas y sobre la suplementación con sulfato ferroso de todos los niños registrados en el PNSF en Florianópolis, en 2010. Se utilizó el software STATA 11.0 en los análisis. RESULTADOS La cobertura del PNSF en niños fue igual a 6,3% (IC95% 5,9-6,7), entre los que la normativa de la edad de inicio y la periodicidad de la suplementación se cumplió en solamente un 2,4% (IC95% 1,5-3,7) de los casos. No hubo asociación con el sexo del niño, la escolaridad y el color de la piel materna, tampoco con la distancia del domicilio al centro de salud. CONCLUSIONES El estudio mostró cobertura baja e inadecuación en el cumplimiento de las normativas del PNSF, siendo urgente la adopción de medidas que mejoren esa estrategia. .

OBJETIVO Avaliar a cobertura do Programa Nacional de Suplementação de Ferro (PNSF), o cumprimento da normativa de utilização da suplementação e a associação com fatores sociodemográficos em crianças de seis a 18 meses de idade, atendidas em 35 centros de saúde de Florianópolis, Santa Catarina. MÉTODOS Estudo transversal com dados secundários obtidos do sistema de informações em saúde da Secretaria Municipal de Saúde de Florianópolis (Infosaúde). Obtiveram-se informações sociodemográficas e sobre a suplementação com sulfato ferroso de todas as crianças cadastradas no PNSF em Florianópolis em 2010. Utilizou-se o software STATA 11.0 nas análises. RESULTADOS A cobertura do PNSF em crianças foi igual a 6,3% (IC95% 5,9-6,7), entre as quais a normativa da idade de início e a periodicidade da suplementação foi cumprida apenas em 2,4% (IC95% 1,5-3,7) dos casos. Não houve associação com o sexo da criança, a escolaridade e a cor da pele materna, nem com a distância do domicílio ao centro de saúde. CONCLUSÕES O estudo mostrou cobertura baixa e inadequação no cumprimento das normativas do PNSF, sendo urgente a adoção de medidas que melhorem essa estratégia. .

A problemática da adesão na prevenção da anemia ferropriva e suplementação com sais de ferro no município de Viçosa (MG) / Problems of adherence to the program of prevention of iron deficiency anemia and supplementation with iron salts in the city of Viçosa, Minas Gerais, Brazil

Foi analisada a apreensão das mães/responsáveis por lactentes suplementados com sulfato ferroso, sobre a anemia e suas consequências, por grau de adesão à suplementação. Pesquisa populacional, prospectiva e quanti-qualitativa. Selecionou-se crianças não anêmicas e que não estivessem recebendo suplementação. As mães/responsáveis foram orientadas a administrarem a suplementação profilática de ferro por seis meses e a adesão foi avaliada após o período. Dentre as 133 crianças elegíveis inicialmente para a pesquisa, foi possível reavaliar 90 pares crianças/responsáveis e realizaram-se entrevistas semiestruturadas com os responsáveis. Das crianças avaliadas, 56,7% apresentaram alta adesão e 43,3% baixa, sendo que 23,3% destas tinham interrompido a suplementação, sendo os motivos mais frequentes a ausência de orientação e apoio do serviço de saúde. Dentre as mães/responsáveis, um baixo percentual reconheceu o sulfato ferroso como forma de prevenção da anemia, e ambos os grupos demonstraram pouco conhecimento acerca da anemia, suas formas de prevenção e consequências à saúde da criança. Há necessidade de mais informação através de atividades de promoção e educação em saúde incluindo estratégias participativas, acompanhamento dos profissionais de saúde e avaliação da percepção dos indivíduos envolvidos na suplementação.

The scope of this article is to analyze the understanding of mothers and persons responsible for infants taking ferrous sulfate supplement about anemia and its consequences, assessed by the level of adherence to supplementation. A prospective, qualitative and quantitative population study was conducted with non-anemic children not taking supplements to receive prophylactic supplementation with ferrous sulfate for six months. After six months, there was adherence to supplementation. Among the 133 children initially eligible for the study, 97 returned for the second evaluation. Of these, 4 had anemia during the follow-up and began treatment and 3 others were brought in by individuals who were unable to provide information on use of the supplement. High adherence was showed by 56.7% of children and low adherence by 43.3%, while 23.3% had interrupted supplementation due to the lack of guidance and support of the health service. Mothers and persons responsible of the two groups (high and low adherence) manifested little knowledge about anemia, its prevention and health consequences for the child. More information regarding iron deficiency anemia, routine follow-up by professionals and evaluation of the perception of individuals involved with iron supplementation is necessary.

Iron Plays a Certain Role in Patterned Hair Loss

Role of iron in hair loss is not clear yet. The purpose of this study was to evaluate the relationship between iron and hair loss. Retrospective chart review was conducted on patients with female pattern hair loss (FPHL) and male pattern hair loss (MPHL). All patients underwent screening including serum ferritin, iron, and total iron binding capacity (TIBC), CBC, ESR and thyroid function test. For normal healthy controls, age-sex matched subjects who had visited the hospital for a check-up with no serious disease were selected. A total 210 patients with FPHL (n = 113) and MPHL (n = 97) with 210 healthy controls were analyzed. Serum ferritin concentration (FC) was lower in patients with FPHL (49.27 +/- 55.8 microg/L), compared with normal healthy women (77.89 +/- 48.32 microg/L) (P < 0.001). Premenopausal FPHL patients turned out to show much lower serum ferritin than age/sex-matched controls (P < 0.001). Among MPHL patients, 22.7% of them showed serum FC lower than 70 microg/L, while no one had serum FC lower 70 microg/L in healthy age matched males. These results suggest that iron may play a certain role especially in premenopausal FPHL. The initial screening of iron status could be of help for hair loss patients.

Implantação e impacto do Programa Nacional de Suplementação de Ferro no município de Viçosa - MG / Implementation and impact of the National Iron Supplementation Program in the city of Viçosa, State of Minas Gerais

Objetivou-se avaliar a implantação do Programa Nacional de Suplementação de Ferro no município de Viçosa/MG e seu impacto em lactentes não anêmicos de 6 a 18 meses de idade, atendidos pelas Equipes de Saúde da Família. Realizou-se entrevistas aos profissionais de nível superior e às mães/responsáveis pelas crianças. As crianças não anêmicas e que não recebiam suplementação anteriormente (n=133) foram suplementadas com xarope de sulfato ferroso por seis meses. Realizou-se dosagem de hemoglobina, avaliação antropométrica e de condições socioeconômicas, antes e após os seis meses. Classificou-se como alta adesão as crianças que ingeriram 75 por cento ou mais da dose prescrita e como baixa adesão as demais, de acordo com o referido pelas mães. Sobre a implantação do PNSF no município, observou-se que o sistema de distribuição nem sempre foi acessível ao grupo prioritário e houve ausência de capacitação e motivação da maioria dos Agentes Comunitários de Saúde; sobre o grupo prioritário observou-se ausência de divulgação para promoção do PNSF, além de sensibilização e educação somente de parte das mães; quanto ao suplemento as crianças tiveram baixa adesão e a dosagem não foi efetiva na prevenção da anemia. Portanto, a implantação do PNSF no município revelou entraves operacionais importantes.

The scope of this work was to evaluate the implementation of the National Iron Supplementation Program (NISP) in Viçosa in the State of Minas Gerais and its impact on 6- to 18-month-old non-anemic infants assisted by the Family Health Teams. Interviews were conducted with the professionals and with the children's mothers/guardians. The non-anemic children who didn't receive the earlier supplementation (n=133) were given ferrous sulphate syrup for six months. Hemoglobin dosage, anthropometric evaluation and a socioeconomic survey were conducted before and after the six-month period. Children who ingested 75 percent or more of the prescribed dosage were classified as high adhesion, while the others were classified as low adhesion, according to the mothers' testimonials. With respect to the implementation in the city, the distribution system was not always available to the priority group and there was a lack of training and motivation on the part of most Community Health Agents. The lack of promotion of NISP among the priority group was detected, apart from a mothers' awareness drive. Regarding diet supplementation, children showed low adhesion and the dosage wasn't effective in preventing anemia. Therefore, important operational barriers to implementation were observed.

Prevalência de anemia em pré-escolares e resposta ao tratamento com suplementação de ferro / Prevalence of anemia among preschoolers and response to iron supplementation

OBJETIVOS: Avaliar a prevalência de anemia entre os pré-escolares da rede pública de Ilhabela (SP) e a resposta ao tratamento instituído. MÉTODOS: Estudo com 667 pré-escolares, entre 2007 e 2008. As crianças foram avaliadas na escola quanto ao peso, estatura e concentração de hemoglobina. As anêmicas foram tratadas com sulfato ferroso por 12 semanas, com uma consulta intermediária e outra ao final. RESULTADOS: A prevalência de anemia foi de 25,6 por cento (170 crianças). A concentração de hemoglobina mais baixa foi de 9,5 g/dL. A maior prevalência de anemia (36 por cento) ocorreu em crianças de 60 a 65 meses de idade. A mediana da concentração de hemoglobina evoluiu de 10,5 g/dL para 11,8 g/dL ao final do tratamento, recuperando 76 por cento das crianças. CONCLUSÃO: A identificação de crianças anêmicas nas escolas, o pronto tratamento da anemia e o acompanhamento durante o tratamento mostrou ser estratégia eficaz no combate a esse importante problema de saúde pública.

OBJECTIVES: To assess the prevalence of anemia among children attending public preschools in Ilhabela, state of São Paulo, Brazil, and their response to a treatment regimen. METHODS: Between 2007 and 2008, the weight, height, and hemoglobin levels of 667 children were measured in the school setting. Anemic children were prescribed a 12-week course of ferrous sulfate, and follow-up assessment visits were scheduled for halfway through this course and the end of treatment. RESULTS: The prevalence of anemia was 25.6 percent (N = 170). The lowest hemoglobin level measured was 9.5 g/dL. Anemia was most prevalent (36 percent) in children between the ages of 60 and 65 months. Median hemoglobin levels rose to 11.8 g/dL from 10.5 g/dL after treatment; 76 percent of children recovered from anemia. CONCLUSION: Screening for anemia in the school setting and prompt therapy, including mid-treatment follow-up, proved to be an effective strategy for facing this major public health issue.

Effectiveness of two programs of intermittent ferrous supplementation for treating iron-deficiency anemia in infants: randomized clinical trial / Efetividade de dois programas de suplementação intermitente de ferro no tratamento de anemia ferropriva em lactentes: ensaio clínico aleatório

CONTEXT AND OBJECTIVE: Low compliance among mothers regarding the treatment of anemic children using daily doses of ferrous sulfate administered at home has been reported. This study aimed to establish the effectiveness of weekly doses administered by mothers at home compared with weekly supplements administered directly by healthcare professionals, to reduce the prevalence of anemia. DESIGN AND SETTING: This was a randomized clinical trial at a public healthcare clinic in São José do Rio Preto, Brazil. METHODS: This iron supplementation study was carried out using two intervention groups. The sample population was 130 infants, randomly allocated to two groups of 65 children. All of them received 12 weekly doses of 25 mg of elemental iron, administered either in the public healthcare clinic or at their homes. RESULTS: Treatment compliance was shown in both groups. The prevalence of anemia among all of the children was 75 percent at the beginning of supplementation and 46.3 percent at the end of the period (P < 0.0005), corresponding to a reduction in the number of anemic children of 38.3 percent. The average increases in hemoglobin concentration levels were 0.75 g/dl and 0.65 g/dl, respectively for home interventions and healthcare clinic administration (P < 0.00005). CONCLUSION: Weekly supplementation of 25 mg of iron was proven to be efficient in reducing anemia, using interventions both at home and in healthcare clinics. Compliance among the mothers was achieved because weekly supplementation was easy to administer and had few side effects. The results showed that the treatment presented low cost and fast benefits.

CONTEXTO E OBJETIVOS: Considerando que a literatura mostra baixa adesão de mães de crianças anêmicas ao tratamento medicamentoso com sulfato ferroso administrado no domicílio em doses diárias, o presente trabalho teve a finalidade de comparar a efetividade da suplementação semanal, realizada por profissionais de Unidade Básica de Saúde (UBS) ou no domicílio, pelas mães. TIPO DE ESTUDO E LOCAL: Estudo clínico aleatório, realizado em UBS de São José do Rio Preto, São Paulo. MÉTODOS: O estudo foi realizado com dois grupos de intervenção. A população deste estudo submetida à suplementação teve como amostra inicial 130 lactentes alocados aleatoriamente em dois grupos de 65 crianças. Para todas as crianças, a suplementação foi de 25 mg de ferro elementar, uma vez por semana, durante 12 semanas consecutivas, administrada em uma UBS do município ou no domicílio das crianças. RESULTADOS: O estudo mostrou adesão das mães ao tratamento das crianças em ambos os grupos estudados. A prevalência de anemia foi de 75 por cento antes do início da suplementação e de 46,3 por cento, após o término da suplementação para todas as crianças do estudo (P < 0,0005). A taxa de redução do número de crianças anêmicas foi de aproximadamente 38,3 por cento. O aumento médio da concentração de hemoglobina foi de 0,75 g/dl e de 0.65 g/dl, respectivamente, para o grupo de intervenção domiciliar e o suplementado na UBS (P < 0,00005 para o aumento em ambos). CONCLUSÕES: A suplementação intermitente de 25 mg de ferro na administração domiciliar ou em UBS mostra-se igualmente eficaz na redução da prevalência de anemia. A adesão das mães provavelmente deve-se à facilidade de suplementação apenas uma vez por semana e à baixa ocorrência de efeitos colaterais. Os resultados mostram um tratamento com baixo custo e rápido benefício.

Iron deficiency anemia in an urban slum.

OBJECTIVE: Of this pilot study was to assess the iron status and dietary intake of 1-3 year-old apparently healthy toddlers of the lower socio-economic class, and the effect of eight weeks intervention with liquid oral iron in an urban slum in Pune, India. METHODS: 50 toddlers (M= 25, F= 25) with mean age of 2.4 years (SD 0.82) were evaluated. Anthropometry, Food Frequency Questionnaire, a hemogram and ferritin were measured. Twenty mg of elemental iron was given to all toddlers. After 8 weeks clinical examination, anthropometry, hemoglobin (HGB) and Ferritin were measured. RESULTS: Prevalence of anemia was 66% (HGB <11 gm %) and ferritin (iron stores) were low (< 12 microgm/L) in 45 (90%). After therapy prevalence of anemia was 30%. There was a significant difference in the HGB and ferritin levels of children after eight weeks of therapy (p<0.001). CONCLUSION: The prevalence of anemia decreased from 66 to 30% after treatment with liquid iron. We propose that all concerned in the care of toddlers should join the fight against anemia and prescribe iron to all toddlers when they are seen for minor ailments.

Prophylaxis for iron deficiency anemia using ferrous sulfate among infants followed up at a primary healthcare unit in the municipality of Embu-SP (2003/2004) / Profilaxia da anemia carencial com sulfato ferroso em lactentes acompanhados em Unidade Básica de Saúde no município de Embu (SP) (2003/2004)

CONTEXT AND OBJECTIVE: Iron deficiency anemia is an important public health problem in Brazil. In the municipality of Embu, a population study in 1996 found anemia prevalence of 68.5 percent among children aged one to two years. From these data, prescription of prophylactic ferrous sulfate was instituted in 1998 for children under two years old followed up within the children's healthcare program. After five years of intervention, the prevalence of anemia and associated factors were investigated among children aged 12 to 18 months to whom guidance for prophylactic ferrous sulfate use had been given. DESIGN AND SETTING: Cross-sectional study covering October 2003 to June 2004 at a primary healthcare unit in Embu. METHODS: A randomized sample of children aged 12 to 18 months to whom guidance for prophylactic ferrous sulfate use had been given was obtained. Hemoglobin was measured in capillary blood, using HemoCue® apparatus. Hemoglobin < 11 g/100 dl was taken to indicate anemia. RESULTS: The sample comprised 118 children and anemia was found in 41.5 percent. There was no statistically significant association between anemia presence and the variables of sex, birth weight, neonatal intercurrences, chronic diseases, breastfeeding or iron supplementation use. There was a statistically significant association (p = 0.03) between anemia presence and per capita income, such that the higher the income was, the lower the prevalence of anemia was. CONCLUSION: The prophylaxis program against iron deficiency anemia did not achieve the expected results. New strategies must be considered in the light of the magnitude of the problem.

CONTEXTO E OBJETIVO: A anemia ferropriva é um importante problema de saúde pública no Brasil. No município de Embu, estudo populacional realizado em 1996 verificou prevalência de anemia de 68,5 por cento em crianças de um a dois anos. A partir desses resultados, o uso de sulfato ferroso profilático foi introduzido em 1998 no Programa de Saúde da Criança para as crianças a partir do desmame até os dois anos de idade. Após cinco anos de intervenção, avaliou-se a prevalência de anemia e os fatores associados, em crianças de 12 a 18 meses de idade que receberam orientação para uso profilático de sulfato ferroso. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico realizado no período de 10/2003 a 06/2004 em Unidade Básica de Saúde, Embu. MÉTODO: Amostra aleatória de crianças entre 12 a 18 meses que receberam orientação do uso de ferro profilático. Mensuração de hemoglobina em sangue capilar através do aparelho portátil HemoCue®. Hemoglobina < 11 g/100 dl foi considerada anemia. RESULTADOS: A amostra foi composta por 118 crianças. A prevalência de anemia foi de 41,5 por cento. Não foi observada associação estatisticamente significativa entre a anemia e as variáveis: sexo, peso ao nascer, intercorrências neonatais, doenças crônicas, internação anterior, aleitamento materno, uso de suplementação de ferro, estado nutricional. Verificou-se associação estatisticamente significante (p = 0,03) entre a presença de anemia e renda per capita, em que a maior renda associou-se a menor prevalência de anemia. CONCLUSÃO: O programa de profilaxia da anemia ferropriva não alcançou os resultados esperados. Novas estratégias devem ser consideradas frente à magnitude do problema.

A randomised double-blind study comparing sodium feredetate with ferrous fumarate in anaemia in pregnancy.

Iron deficiency anaemia is a major health problem in India especially in women of reproductive age group. The World Health Organisation recommends that the haemoglobin concentration should not fall below 11.0 g/dl at any time during pregnancy. The aim of study was to compare the efficacy and safety of two doses of sodium feredetate with ferrous fumarate in improving haemoglobin profile in pregnant anaemic women. Pregnant women with gestation period between 12 and 26 weeks having serum haemoglobin < 10 g/dl, serum ferritin levels less than 12 microg/l were included in the study. Patients were divided into 3 groups and drugs administered accordingly. A total of 48 patients were available for analysis which included 37 patients who had completed all the visits up to 75 days follow-up and 11 patients who were treatment failures. In group A combination of sodium feredetate (containing 33 mg of elemental iron) along with vitamin B12 (15 microg) and folic acid (1.5 mg) was administered twice a day. In group B combination of sodium feredetate (containing 66 mg of elemental iron) along with vitamin B12 (15 microg) and folic acid (1.5 mg) was administered twice a day. In group C combination of ferrous fumarate (containing 100 mg of elemental iron) along with vitamin B12 (15 microg) and folic acid (1.5 mg) was administered twice a day. Patients were evaluated for Hb, RBC count, MCV, MCH and MCHC at day 0, 30, 45, 60 and 75. Serum ferritin, serum iron, TIBC and transferrin saturation were assessed at recruitment and end study. Mean rise of haemoglobin at the completion of study, over that of basal values was 1.79 g/dl (0.71 to 2.87, 95% CI, p < 0.05) in group A, 1.84 g/dl (0.82 to 2.86, 95% CI, p < 0.05) in group B and 1.63 g/dl (0.38 to 2.88, 95% CI, p < 0.05) in group C. Safety assessment was done by doing liver and kidney function test at the time of recruitment and end study. Low doses of sodium feredetate (33 mg and 66 mg of elemental iron given twice daily) produce comparable results as higher dose of ferrous fumarate (100 mg elemental iron given twice daily). As there were no adverse effects reported with sodium feredetate, it can be concluded from this study that this new formulation appears to be effective in improving haemoglobin profile in pregnant anaemic women and is tolerated well.