Role of heme oxygenase-1 in human placenta on iron supply to fetus.

INTRODUCTION: To date, details on how iron is supplied from the mother to the fetus through the placenta have remained unclear. Recently, increasing evidence has shown that heme oxygenase (HO)-1, which is an inducible isoform of the rate-limiting enzyme in the heme degradation pathway, may be involved in the effective reutilization of iron. In this study, we examined the distribution and gene expression of HO-1 in the villous tissue of human placenta at various periods of pregnancy. METHODS: Using the placenta of 38 samples for which consent was obtained, chronological changes in the localization of HO-1 protein were examined by histological examination. RT-PCR was also performed to examine the expression of HO-1, transferrin receptor-1, and ferroportin 1. Ferric iron in the tissues was analyzed by Prussian blue staining. RESULTS: Immunohistochemical studies showed that HO-1 protein was exclusively expressed in trophoblastic cells throughout gestation. In the miscarriage placenta in the first trimester, ho-1 mRNA levels were significantly higher than normal. Placenta with fetal death (miscarriage) in the first and second trimester indicate significantly higher ratio of ho-1 gene for iron production to the fpn-1 gene for iron excretion than normal. These suggest that the role of HO-1 with various physiological functions is changing throughout pregnancy. DISCUSSION: These findings suggest that HO-1 in placenta plays an important role in iron supplying system in the second trimester to support fetal development.

Recycling of iron and titanium resources from early tailings: From fundamental work to industrial application.

The comprehensive recovery of iron and titanium resources from early tailings were systematically attempted from fundamental work to industrial application. Geochemical characterization of the tailings was first conducted, followed by the iron recovery and titanium recovery. Iron recovery was mainly achieved through a series of magnetic separation, and titanium recovery was on the combination of magnetic pre-concentration and flotation separation. Special for titanium recovery, different pretreatment methods including ultrasonic cleaning and attrition-scrubbing were studied to reduce the influence of serious surface pollution of early tailings on ilmenite floatability, and attrition-scrubbing proved to be the best one. Associated mechanisms of flocculants influence on ilmenite floatability and the attrition-scrubbing effects were explored using micro-flotation and XPS tests. After a series of fundamental studies, the industrial production of iron and ilmenite concentrate went into operation and the industrial debugging results were roughly satisfactory. At last, a brief economic analysis was given for the present work.

The safety and efficacy of ferumoxytol in the treatment of iron deficiency: a systematic review and meta-analysis.

INTRODUCTION: Ferumoxytol is an intravenous (IV) iron formulation for treatment of iron deficiency (ID) that faced post-marketing reports of serious adverse events (SAEs). OBJECTIVES: To determine the safety and efficacy of ferumoxytol compared to other iron formulations and placebo. METHODS: We searched the Cochrane Library, Medline, and EMBASE from inception until February 2018 as well as trial registries and reference lists of relevant articles for randomized or quasi-randomized controlled trials. RESULTS: The review included nine studies with 5691 participants. Studies were at low risk of bias. When comparing ferumoxytol to other IV iron formulations, there is moderate quality evidence (QE) of little to no difference in treatment emergent adverse events (TEAEs) (risk ratio [RR] 0.88, 95% confidence interval [CI] 0.80-0.97), treatment related adverse events (TRAEs) (RR 0.73, 95% CI 0.61-0.88), SAEs (RR 1.13, 95% CI 0.77-1.67), hypotension or hypersensitivity reactions (RR 0.58, 95% CI 0.31-1.09), or composite cardiovascular outcomes (RR 0.56, 95% CI 0.24-1.29), low QE of little to no difference in related SAEs (RR 0.55, 95% CI 0.05-6.16), and high QE of little to no difference in the number of patients with an increase in hemoglobin by at least 1 g/dL (RR 1.04, 95% CI 0.96-1.12). Ferumoxytol had less TEAEs compared to oral iron (RR 0.78, 95% CI 0.61-0.98), but more compared to placebo (RR 1.62, 95% CI 1.01-2.61). DISCUSSION: Ferumoxytol is as efficacious and safe as alternative IV iron formulations with no clear safety concerns.

Assessment of adherence to iron supplementation among pregnant women in the Yaounde gynaeco-obstetric and paediatric hospital.

INTRODUCTION: Anemia is a global problem affecting 41.8% of pregnant women. Iron deficiency is the leading cause during pregnancy. Its prevalence among Cameroonian pregnant women was estimated at 50.9% in 2004. Few studies have evaluated women's adherence to iron supplementation prescribed during pregnancy. We carried this study in order to evaluate the rate of adherence to iron supplementation and its determinants during pregnancy. METHODS: The study was cross-sectional descriptive, on postpartum women at the Gynaeco-Obstetric and Pediatric Hospital of Yaoundé during three months. Adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). The total score was classified as low, moderate and high adherence. RESULTS: For a total of 304 recruited women, 16.4% were highly compliant, 27.6% moderately compliant, while 56% were low compliant with iron supplementation during pregnancy. The reasons for non-adherence were side effects (19.7%), forgetting (70.1%) and inaccessibility of iron supplements (20.1%). Up to 85 (or 28%) women found it boring to take medication daily. Women with no side effects were about thrice most likely to adhere to the iron supplementation than those with side effects: OR = 3.73 [2.43-5.71]; P = 0.04. Women aged 25 years and above were more likely to be non-compliant to iron supplementation than those youngers: OR = 0.40 [0.31-0.88]; P = 0.02. CONCLUSION: To improve adherence to antenatal iron supplementation, it is important to increase communication for behavior change and counseling before or during antenatal care. Forgetting being the main reason for non-adherence, women should keep their iron in a place of easy access.

Identifying bottlenecks in the iron and folic acid supply chain in Bihar, India: a mixed-methods study.

BACKGROUND: Maternal anaemia prevalence in Bihar, India remains high despite government mandated iron supplementation targeting pregnant women. Inadequate supply has been identified as a potential barrier to iron and folic acid (IFA) receipt. Our study objective was to examine the government health system's IFA supply and distribution system and identify bottlenecks contributing to insufficient IFA supply. METHODS: Primary data collection was conducted in November 2011 and July 2012 across 8 districts in Bihar, India. A cross-sectional, observational, mixed methods approach was utilized. Auxiliary Nurse Midwives were surveyed on current IFA supply and practices. In-depth interviews (n = 59) were conducted with health workers at state, district, block, health sub-centre, and village levels. RESULTS: Overall, 44% of Auxiliary Nurse Midwives were out of IFA stock. Stock levels and supply chain practices varied greatly across districts. Qualitative data revealed specific bottlenecks impacting IFA forecasting, procurement, storage, disposal, lack of personnel, and few training opportunities for key players in the supply chain. CONCLUSIONS: Inadequate IFA supply is a major constraint to the IFA supplementation program, the extent of which varies widely across districts. Improvements at all levels of infrastructure, practices, and effective monitoring will be critical to strengthen the IFA supply chain in Bihar.

Oclusión de arteria ciliorretiniana en la hemocromatosis / Cilioretinal artery occlusion in hemochromatosis

CASO CLÍNICO: Se presenta el caso de una mujer de 31 años con pérdida brusca de visión de un ojo debido a una oclusión de arteria ciliorretiniana. En la exploración presentaba hepatomegalia y en la analítica los niveles séricos de hierro, saturación de transferrina y ferritina estaban elevados. Los perfiles de autoinmunidad y de hipercoagulabilidad fueron normales. El estudio doppler-ultrasónico de los troncos supraaórticos fue anodino, pero la ecografía cardíaca evidenció una miocardiopatía con calcificación subendocárdica. El estudio genético para la hemocromatosis fue positivo. DISCUSIÓN: La calcificación subendocárdica secundaria a hemocromatosis puede ser la causa de la oclusión embólica de la arteria ciliorretiniana. El cuadro embólico ocular fue la forma de presentación de la hemocromatosis en nuestra paciente

CLINICAL CASE: We report a case of a 31 year-old woman with a sudden visual loss due to a cilioretinal artery occlusion. The physical examinination showed hepatomegaly. Serum iron and ferritin and transferrin saturation were unusually high. The doppler scan of carotid arteries showed no relevant signs of atheromatous disease. Dilated cardiomiopaty was revealed in the B-scan with subendocardial calcium deposits. Genetic tests were positive for hemochromatosis. DISCUSSION: Subendocardial calcification due to hemochromatosis could be the embolic source in our patient. This embolic ocular disease is the first presentation of hemochromatosis in this patient

Zinc y desnutrición / Zinc and undernutrition

Son cuatro los nutrientes en que su deficiencia es importante en niños: hierro, yodo, vitamina A y zinc. Más o menos se calcula que hay 2 billones de personas en el mundo con algún grado de déficit de zinc. Los pacientes que están en riesgo de presentar deficiencias de zinc son los recién nacidos con bajo peso al nacimiento, bien sea prematuros, desnutridos in útero o hijos de madres desnutridas, en los cuales sus depósitos están reducidos. A diferencia de otros oligoelementos o micronutrientes, determinar el estado de déficit no es fácil. Los niveles séricos de zinc, están influenciados por factores no dietarios como infección, estrés o actividad física extenuante; al igual que por el ciclo circadiano.

Four nutrient deficiency that is important in children, iron, iodine, vitamin A and zinc. More or less it is estimated that 2 billion people in the world with some degree of zinc deficiency. Patients who are at risk for zinc deficiency are infants with low birth weight, either premature or malnourished in utero, undernourished mothers, in which their deposits are reduced. Unlike other trace elements or micronutrients, determine the deficit is not easy. Serum levels of zinc are not influenced by dietary factors such as infection, stress or strenuous physical activity, as well as by the circadian cycle.

Lessons learned from implementation of a demonstration program to reduce the burden of anemia and hookworm in women in Yen Bai Province, Viet Nam.

BACKGROUND: Iron deficiency, anemia and hookworm disease are important public health problems for women of reproductive age living in developing countries and affect the health of newborns and infants. Iron supplementation and deworming treatment are effective in addressing these problems in both pregnant and non-pregnant women. Daily iron supplementation and deworming after the first trimester is recommended for pregnant women although these programs usually do not operate efficiently or effectively. Weekly iron-folic acid supplementation and regular deworming for non-pregnant women may be a viable approach for improving iron status and preventing anemia during the reproductive years. Addressing these diseases at a population level before women become pregnant could significantly improve women's health before and during pregnancy, as well as their infants' growth and development. METHODS AND RESULTS: This paper describes the major processes undertaken in a demonstration intervention of preventive weekly iron-folic acid supplementation with regular deworming for all 52,000 women aged 15-45 years in two districts of Yen Bai province, in northern Viet Nam. The intervention strategy included extensive consultation with community leaders and village, commune, district and provincial health staff, and training for village health workers. Distribution of the drugs was integrated with the existing health service infrastructure and the village health workers were the direct point of contact with women. Iron-folic acid tablets and deworming treatment were provided free of charge from May 2006. An independent Vietnamese NGO was commissioned to evaluate compliance and identify potential problems. The program resulted in effective distribution of iron-folic acid tablets and deworming treatment to all villages in the target districts, with full or partial compliance of 85%. CONCLUSION: Training for health staff, the strong commitment of all partners and the use of appropriate educational materials led to broad support for weekly iron-folic acid supplementation and high participation in the regular deworming days. In March 2008 the program was expanded to all districts in the province, a target population of approximately 250,000 WRA, and management was handed over to provincial authorities.