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1.
Isr Med Assoc J ; 21(8): 546-551, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474018

RESUMO

BACKGROUND: The Bedouins living in southern Israel are a Muslim-Arab population that is transitioning from a nomadic lifestyle to life in permanent settlements. The population has unique characteristics that could affect hemoglobin A1c (HbA1c) measurements. The objective of this study was to describe the socio-demographic and unique morbidity characteristics of this community and their effect on HbA1c measurements. Consanguinity, especially among cousins in the Bedouin population, results in a high prevalence of autosomal recessive genetic diseases such as thalassemia (underestimate of HbA1c), hemoglobinopathies (underestimate and overestimate), Gilbert's disease, and glucose-6-phosphate dehydrogenase deficiency, an X-linked disorder, which can cause hyperbilirubinemia with an overestimate of HbA1c. Furthermore, nutritional deficiencies, autosomal recessive diseases, high birth rates, parasitic infections, and poverty can all cause high rates of anemia (iron and vitamin B12 deficiencies) that can raise HbA1c levels. Congenital dyserythropoietic anemia is found among Bedouin tribes in the Negev region and can lead to an underestimation of HbA1c levels. Pregnancy can also affect HbA1c levels. Medical teams working in the Bedouin community and in other Muslim populations with similar morbidity characteristics throughout the world should identify patients with medical conditions that can affect HbA1c measurements and be aware of possible measurement alternatives such as fructosamine and glycated albumin.


Assuntos
Anemia/etnologia , Hemoglobina A Glicada/análise , Hemoglobinopatias/etnologia , Desnutrição/etnologia , Complicações na Gravidez/etnologia , Anemia/sangue , Anemia/complicações , Árabes , Feminino , Hemoglobinopatias/sangue , Hemoglobinopatias/complicações , Humanos , Islamismo , Israel/etnologia , Masculino , Desnutrição/sangue , Desnutrição/complicações , Gravidez , Complicações na Gravidez/sangue , Reprodutibilidade dos Testes , Fatores Socioeconômicos
2.
Rev. méd. panacea ; 8(2): 69-72, mayo-ago. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1015988

RESUMO

Objetivo: Determinar el uso de los micronutrientes y grado de anemia en niños menores de 3 años atendidos en un Centro de Salud de Ica 2017. Materiales y métodos: El estudio fue cuantitativo, de tipo descriptivo, y transversal, la muestra estuvo conformada por 40 niños menores de tres años con sus respectivas madres, la técnica que se utilizó fue la observación y el análisis documental. Resultados: En relación a los datos generales de la madre, el 47.5% (19) tienen 19 a 34 años, el 50% (20) tienen instrucción superior, el 40% (16) son solteras y el 57.5% (23) trabaja fuera de casa; sobre los datos del niño, el 55% (22) tienen de 6 a 12 meses, el 72.5% (29) recibió solo lactancia materna hasta los seis meses y el 100% (40) inició la alimentación complementaria a los 6 meses. El uso de micronutrientes es adecuado en el 82.5% (33) de las madres y es inadecuado en el 17.5% (07). Según valores de hemoglobina, el 62.5% (25) de los niños no presentan anemia, el 37.5% (15) presentan anemia leve, no encontrando niños con anemia moderada ni anemia severa. Conclusiones: El uso de micronutrientes que administran las madres a sus niños es adecuado y los niños no presentan anemia en su mayoría, existiendo porcentajes menores de niños con anemia leve por lo que se sugiere que se continúe con el abastecimiento continuo de los micronutrientes realizando campañas educativas a fin de comprometer a las madres en la administración correcta de los micronutrientes en sus menores hijos aprovechando los momentos de contacto con las madres para la educación respectiva en las sala de espera, durante sus controles de inmunizaciones, controles CRED, y realizar un monitoreo periódico del control de hemoglobina. (AU)


Objective: To determine the use of micronutrients and the degree of anemia in children under 3 years of age served in an Ica Health Center 2017. Materials and methods: The study was quantitative, descriptive, and cross-sectional, the sample consisted of 40 children under three years with their respective mothers, the technique used was observation and documentary analysis. Results: In relation to the general data of the mother, 47.5% (19) are 19 to 34 years old, 50% (20) have higher education, 40% (16) are single and 57.5% (23) work ; On the data of the child, 55% (22) have from 6 to 12 months, 72.5% (29) received only breastfeeding until six months and 100% (40) started complementary feeding at 6 months. The use of micronutrients is adequate in 82.5% (33) of mothers and is inadequate in 17.5% (07). According to hemoglobin values, 62.5% (25) of the children do not have anemia, 37.5% (15) have mild anemia, and there are no children with moderate anemia or severe anemia. Conclusions: The use of micronutrients administered by mothers to their children is mostly adequate and children do not have anemia in their majority. There are smaller percentages of children with mild anemia, so it is suggested that continuous supply of the micronutrients conducting educational campaigns in order to engage mothers in the correct administration of micronutrients in their younger children, taking advantage of the moments of contact with mothers for the respective education in the waiting room, during their immunization controls, CRED controls, and perform periodic monitoring of hemoglobin control. (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Micronutrientes/uso terapêutico , Anemia , Análise Quantitativa , Epidemiologia Descritiva , Estudos Transversais
3.
N Engl J Med ; 381(5): 407-419, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31365799

RESUMO

BACKGROUND: The World Health Organization recommends not performing transfusions in African children hospitalized for uncomplicated severe anemia (hemoglobin level of 4 to 6 g per deciliter and no signs of clinical severity). However, high mortality and readmission rates suggest that less restrictive transfusion strategies might improve outcomes. METHODS: In this factorial, open-label, randomized, controlled trial, we assigned Ugandan and Malawian children 2 months to 12 years of age with uncomplicated severe anemia to immediate transfusion with 20 ml or 30 ml of whole-blood equivalent per kilogram of body weight, as determined in a second simultaneous randomization, or no immediate transfusion (control group), in which transfusion with 20 ml of whole-blood equivalent per kilogram was triggered by new signs of clinical severity or a drop in hemoglobin to below 4 g per deciliter. The primary outcome was 28-day mortality. Three other randomizations investigated transfusion volume, postdischarge supplementation with micronutrients, and postdischarge prophylaxis with trimethoprim-sulfamethoxazole. RESULTS: A total of 1565 children (median age, 26 months) underwent randomization, with 778 assigned to the immediate-transfusion group and 787 to the control group; 984 children (62.9%) had malaria. The children were followed for 180 days, and 71 (4.5%) were lost to follow-up. During the primary hospitalization, transfusion was performed in all the children in the immediate-transfusion group and in 386 (49.0%) in the control group (median time to transfusion, 1.3 hours vs. 24.9 hours after randomization). The mean (±SD) total blood volume transfused per child was 314±228 ml in the immediate-transfusion group and 142±224 ml in the control group. Death had occurred by 28 days in 7 children (0.9%) in the immediate-transfusion group and in 13 (1.7%) in the control group (hazard ratio, 0.54; 95% confidence interval [CI], 0.22 to 1.36; P = 0.19) and by 180 days in 35 (4.5%) and 47 (6.0%), respectively (hazard ratio, 0.75; 95% CI, 0.48 to 1.15), without evidence of interaction with other randomizations (P>0.20) or evidence of between-group differences in readmissions, serious adverse events, or hemoglobin recovery at 180 days. The mean length of hospital stay was 0.9 days longer in the control group. CONCLUSIONS: There was no evidence of differences in clinical outcomes over 6 months between the children who received immediate transfusion and those who did not. The triggered-transfusion strategy in the control group resulted in lower blood use; however, the length of hospital stay was longer, and this strategy required clinical and hemoglobin monitoring. (Funded by the Medical Research Council and Department for International Development; TRACT Current Controlled Trials number, ISRCTN84086586.).


Assuntos
Anemia/terapia , Transfusão de Sangue , Hemoglobinas/análise , Tempo para o Tratamento , Anemia/complicações , Anemia/mortalidade , Transfusão de Sangue/economia , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Seguimentos , Custos de Cuidados de Saúde , Humanos , Lactente , Tempo de Internação/economia , Malária/complicações , Malaui/epidemiologia , Masculino , Readmissão do Paciente/estatística & dados numéricos , Reação Transfusional/epidemiologia , Uganda/epidemiologia
4.
N Engl J Med ; 381(5): 420-431, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31365800

RESUMO

BACKGROUND: Severe anemia (hemoglobin level, <6 g per deciliter) is a leading cause of hospital admission and death in children in sub-Saharan Africa. The World Health Organization recommends transfusion of 20 ml of whole-blood equivalent per kilogram of body weight for anemia, regardless of hemoglobin level. METHODS: In this factorial, open-label trial, we randomly assigned Ugandan and Malawian children 2 months to 12 years of age with a hemoglobin level of less than 6 g per deciliter and severity features (e.g., respiratory distress or reduced consciousness) to receive immediate blood transfusion with 20 ml per kilogram or 30 ml per kilogram. Three other randomized analyses investigated immediate as compared with no immediate transfusion, the administration of postdischarge micronutrients, and postdischarge prophylaxis with trimethoprim-sulfamethoxazole. The primary outcome was 28-day mortality. RESULTS: A total of 3196 eligible children (median age, 37 months; 2050 [64.1%] with malaria) were assigned to receive a transfusion of 30 ml per kilogram (1598 children) or 20 ml per kilogram (1598 children) and were followed for 180 days. A total of 1592 children (99.6%) in the higher-volume group and 1596 (99.9%) in the lower-volume group started transfusion (median, 1.2 hours after randomization). The mean (±SD) volume of total blood transfused per child was 475±385 ml and 353±348 ml, respectively; 197 children (12.3%) and 300 children (18.8%) in the respective groups received additional transfusions. Overall, 55 children (3.4%) in the higher-volume group and 72 (4.5%) in the lower-volume group died before 28 days (hazard ratio, 0.76; 95% confidence interval [CI], 0.54 to 1.08; P = 0.12 by log-rank test). This finding masked significant heterogeneity in 28-day mortality according to the presence or absence of fever (>37.5°C) at screening (P=0.001 after Sidak correction). Among the 1943 children (60.8%) without fever, mortality was lower with a transfusion volume of 30 ml per kilogram than with a volume of 20 ml per kilogram (hazard ratio, 0.43; 95% CI, 0.27 to 0.69). Among the 1253 children (39.2%) with fever, mortality was higher with 30 ml per kilogram than with 20 ml per kilogram (hazard ratio, 1.91; 95% CI, 1.04 to 3.49). There was no evidence of differences between the randomized groups in readmissions, serious adverse events, or hemoglobin recovery at 180 days. CONCLUSIONS: Overall mortality did not differ between the two transfusion strategies. (Funded by the Medical Research Council and Department for International Development, United Kingdom; TRACT Current Controlled Trials number, ISRCTN84086586.).


Assuntos
Anemia/terapia , Transfusão de Sangue , Hemoglobinas/análise , Anemia/complicações , Anemia/mortalidade , Transfusão de Sangue/economia , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Febre/complicações , Seguimentos , Custos de Cuidados de Saúde , Humanos , Lactente , Tempo de Internação/economia , Malária/complicações , Malaui/epidemiologia , Masculino , Readmissão do Paciente/estatística & dados numéricos , Reação Transfusional/epidemiologia , Uganda/epidemiologia
5.
Am Surg ; 85(7): 708-711, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405412

RESUMO

Few studies have evaluated outcomes in geriatric trauma patients discharged with anemia. Our hypothesis was that anemia at discharge was not associated with six-month mortality. A 22-month retrospective study of trauma patients ≥ 65 years was conducted from 2015 to 2016. The end point was six-month mortality. The degree of anemia at admission (admission hemoglobin [AHb]) and discharge (discharge hemoglobin [DHb]) was categorized as follows based on hemoglobin (Hb) (g/dL): I (>10), II (>9 and ≤10), III (>8 and ≤9), and IV (≤8). Univariate analysis and multivariate analysis were performed to determine the association of AHb and DHb with the end point. Nine hundred forty-nine patients were analyzed (median age, 82 years). Six-month mortality was 11 per cent. Mortality was associated with AHb by univariate analysis (I: 10% [84/831]; II: 13% [9/67]; III: 22% [7/32]; and IV: 26% [5/19]) (P = 0.003). DHb was not associated with mortality (I: 11% [65/613]; II: 12% [21/183]; III: 10% [12/116]; and IV: 18% [7/39]) (P = 0.37). Logistic regression found that AHb category IV, age, and chronic kidney disease were independently associated with the end point. In geriatric patients, the severity of anemia at admission and not at discharge predicted six-month mortality. Discharging patients with an Hb of ≤8 g/dL was not adversely associated with mortality.


Assuntos
Anemia/sangue , Anemia/mortalidade , Hemoglobinas/análise , Alta do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Feminino , Humanos , Modelos Logísticos , Masculino , Estudos Retrospectivos
6.
Pan Afr Med J ; 33: 31, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31384346

RESUMO

Tuberculosis (TB) is endemic in the Central African Republic (CAR) with an incidence rate of 391 per 100,000 population in 2015. This study aims to analyze current epidemiological and clinical features of TB at the Hôpital de l'Amitié in the Central African Republic. We conducted an analytic retrospective study of patients hospitalized in the Department of Medicine at the Hôpital de l'Amitié from 15 April 2010 to 14 October 2011. Data were collected using a questionnaire and then analyzed with Epi info software 3.5.3. Chi-square test was used to compare proportions, using a threshold significance level of 5%. The study included 220 patients, of whom 128 were women (58.18%). The average age of patients was 35.69± 10.65 years. In 42.70% of cases, patients had no professional activity. Prevalence of tuberculosis in hospital was 10.99%. On average, 12 cases of TB were recorded each month. Most common clinical signs included: chronic cough (71.81%), fever (96.82%), alteration of the general state (91.36%) and pulmonary condensation syndrome (63.64%). The diseases most commonly associated with tuberculosis were HIV/AIDS (73.36%), malaria (48.63%) and anemia (31.81%). The mean time between symptom onset and diagnosis was 37.65 days. Mortality rate was 18.63%. TB/HIV co-infection and neuromeningeal TB were associated with a high mortality rate (p < 0.05). Tuberculosis is a common disease in Bangui and it is often associated with HIV infection. Prognosis is poor in the case of neuromeningeal involvement. Prevention and routine monitoring in HIV infected patients may contribute to reduce the extent and severity of TB.


Assuntos
Infecções por HIV/epidemiologia , Hospitalização , Tuberculose Meníngea/epidemiologia , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Anemia/epidemiologia , República Centro-Africana/epidemiologia , Coinfecção , Feminino , Humanos , Malária/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Tuberculose/diagnóstico , Tuberculose/mortalidade , Tuberculose Meníngea/mortalidade , Adulto Jovem
7.
Pan Afr Med J ; 33: 34, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384349

RESUMO

Introduction: A cross-sectional study was conducted between the months of April to October 2015, to determine the effects of intestinal parasitic infections (IPIs) on nutritional status of school age children in Owerri and Orlu geographical zones, in Imo State, Nigeria. Methods: Faecal samples were examined using Kato Katz method and formol-ether concentration techniques, while blood samples were examined using cyamethahaemoglobin method. Anthropometric indices were used as indicators of nutritional status, children whose Height-for-Age, Weight-for-Age and Weight-for-Height were <-2 standard deviation (SD) were classified as stunted, wasted, and underweight respectively. Results: Total prevalence rate of 16.6% was recorded in the study areas with Ascaris lumbricoides (4.0%), Trichuris trichiura (0.6%), Hookworm (1.0%) Taenia sp (0.3%), Entaomeba histolytica (5.3%), Entamoeba coli (2.7%) and Giardia lambia (2.7) Majority (73.4%) of the children had light intensity. Anthropometric study results showed that 79(31.3%) of the children were malnourished. The prevalence of stunting, under-weight and wasting were higher in uninfected (86.1%, 90.0% and 10%) respectively than in infected children (13.9%, 10.0% and 0.0%) respectively, although not significant at p = 0.857, 0.587 and 0.368 respectively. Prevalence of anaemia was 17.4%, anaemia was insignificantly (p = 0.09) higher in infected (21.1%) than in uninfected (16.5%) children. Children that had co-infection recorded higher prevalence (2.2%) of severe anaemia. There was an association (p = 0.002) between anaemia and intensity of helminth infection. Malnutrition was insignificantly (p = 0.319) higher in children with heavy (100.0%) and moderate (75.0%) intensity of helminth infection than children that had light intensity (41.7%) of helminth infection. Conclusion: When compared with previous study, there were decline in the prevalence of intestinal parasitic infections and anaemia among school age children. Low intensity parasitemia with intestinal parasites had no significant effect on the malnutrition and haemoglobin profile of the children in the study areas. Therefore, improved sanitation and more deworming efforts should be intensified to ensure further decline in prevalence of intestinal parasitic infections.


Assuntos
Anemia/epidemiologia , Transtornos da Nutrição Infantil/epidemiologia , Enteropatias Parasitárias/epidemiologia , Estado Nutricional , Adolescente , Anemia/parasitologia , Criança , Transtornos da Nutrição Infantil/parasitologia , Pré-Escolar , Estudos Transversais , Fezes/parasitologia , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/parasitologia , Humanos , Enteropatias Parasitárias/complicações , Enteropatias Parasitárias/parasitologia , Nigéria/epidemiologia , Prevalência , Magreza/epidemiologia , Magreza/parasitologia , Síndrome de Emaciação/epidemiologia , Síndrome de Emaciação/parasitologia
8.
West Afr J Med ; 36(2): 133-137, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385599

RESUMO

BACKGROUND: Anaemia is a common disorder occurring in about 33% of the global population. It is an important cardiovascular risk factor and a key indicator of some chronic complications of Diabetes Mellitus (DM). This study aimed to determine the burden of anaemia and its correlation with some clinical and biochemical parameters among patients with DM attending a tertiary health facility in Zaria, Northwestern Nigeria. SUBJECTS, MATERIALS AND METHODS: This was a case-control study in which 168 participants were enrolled (84 DM patients, 84 controls). It was conducted in the Endocrinology and Metabolic clinics of Ahmadu Bello University Teaching Hospital, Zaria. Consenting DM patients were enrolled consecutively and subsequently, sex- and age-matched with non-diabetic controls. Data on age, gender and Haemoglobin (Hb) concentrations were collated for all study participants. Additional data on type of DM, duration of DM once diagnosis, treatment, type of treatment, history of hypertension, chronic kidney disease, peripheral neuropathy, and Fasting Blood Sugar (FBS) were collated for all cases. Data were collated and analyzed using SPSS version 21. Level of significance was set at <0.05. Ethical approval for the study was obtained from the Institutional Health Research Ethics Committee and informed consent was obtained from the all the participants. RESULTS: Females constituted 39/84(46.4%) of each arm of the study. The mean ± SD of age for both cases and controls was 53.7 ± 8.9 years. The mean ± SD duration of DM, treatment for DM and FBS were 8.4 ± 5.7 years, 5.0 ± 3.6 years and 6.1 ± 2.5mmol/L respectively. Cases had significantly lower Hb concentration compared to controls (12.1±2.2g/dl vs. 13.1 ± 1.4g/dl, t= -3.446, p = 0.001). Overall prevalence of anaemia among cases and controls was 36/84(42.9%) vs. 26/84(31.0%) Z = 1.6, p = 0.110. Among cases, haemoglobin concentration had very weak, inverse and non-statistically significant relationships with age, duration of DM diagnosis, duration of therapy and FBS levels. There was a significant relationship between anaemia on one hand and type of DM and treatment on the other. The odds of DM patients with history of CKD or uncontrolled FBS having anaemia were OR= 0.600 (95% CI 0.196, 1.836) and OR=1.755 (95% CI 0.737, 4.181) respectively. CONCLUSION: The burden of anaemia amongst patients with DM is high in Zaria, Northwestern Nigeria, and it is associated with poor glycaemic control. Hence, the need to include haematological assessment as part of routine care of patients with DM.


Assuntos
Anemia/epidemiologia , Glicemia/análise , Diabetes Mellitus Tipo 2/epidemiologia , Hemoglobina A Glicada/análise , Adulto , Idoso , Estudos de Casos e Controles , Diabetes Mellitus/epidemiologia , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Doenças do Sistema Nervoso Periférico/epidemiologia , Prevalência , Insuficiência Renal Crônica/epidemiologia
10.
Anaesthesia ; 74(9): 1204, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31386182
11.
Egypt J Immunol ; 26(1): 141-150, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31333004

RESUMO

The most common types of anemia in rheumatoid arthritis (RA) are iron deficiency anemia (IDA) and anemia of chronic disease (ACD).The differentiation between both is important and challenging. Our objective is to select the most accurate method that differentiates IDA from ACD in RA patients. This case control study was carried out on 80 RA patients. 40 RA patients with anemia and 40 RA patients without anemia, complete blood count, assessment of disease activity using DAS 28 score, serum iron, transferrin level, transferrin saturation (TSAT), serum ferritin, log ferritin and transferrin /log ferritin were tested, anemic patients were divided into 2 subgroups according to TSAT: group Ia (with low TSAT) and group Ib (with normal TSAT). There was a statistically significant difference between anemic and non-anemic RA patients as regard serum iron level and transferrin saturation. Among the anemic group 67.5% had low TSAT (IDA) and 32.5% had normal TSAT (ACD). In these 2 subgroups there was no significant differences as regard DAS28 score, blood indices, serum ferritin and transferrin /log ferritin) and there was a positive correlation between TSAT and ferritin and log ferritin and a significant negative correlation between TSAT and transferrin/log ferritin. In conclusions, Iron deficiency anemia is prevalent in RA patients. A combination of serum ferritin and TSAT is simple and accurate parameter to differentiate both. Log ferritin and transferrin /log ferritin may be promising new parameters in diagnosis of IDA in general population but their use in inflammatory diseases like RA still has a limitation.


Assuntos
Anemia Ferropriva/diagnóstico , Artrite Reumatoide/complicações , Ferritinas/sangue , Transferrina/análise , Anemia/diagnóstico , Estudos de Casos e Controles , Doença Crônica , Diagnóstico Diferencial , Humanos , Ferro
12.
Gan To Kagaku Ryoho ; 46(7): 1183-1186, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31296827

RESUMO

The present study reports the case of a 49-year-old woman who was diagnosed with cancer of the left breast at the age of 43 years.Following chemotherapy, the patient had undergone partial mastectomy and axillary lymphadenectomy.Postoperatively, she underwent radiotherapy and hormone therapy.Five years and 4 months after the operation, the patient developed pain in the cervical vertebrae and was diagnosed with spinal metastasis.During the period, she began experiencing fatigue and hematological investigations indicated anemia, as well as thrombocytopenia, jaundice, and schistocytes.The patient was referred to our facility for further examination and treatment.On investigation, she was diagnosed with cancer-related thrombotic microangiopathy(TMA).The patient was advised to undergo chemotherapy due to which symptoms of TMA were relieved.She continued to receive chemotherapy for the following 3 years and 2 months until her death.


Assuntos
Anemia , Neoplasias da Mama , Microangiopatias Trombóticas , Neoplasias da Mama/complicações , Dor do Câncer , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Microangiopatias Trombóticas/etiologia
13.
Parasit Vectors ; 12(1): 301, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31262362

RESUMO

BACKGROUND: Biological rhythms allow organisms to compartmentalise and coordinate behaviours, physiologies, and cellular processes with the predictable daily rhythms of their environment. There is increasing recognition that the biological rhythms of mosquitoes that vector parasites are important for global health. For example, whether perturbations in blood foraging rhythms as a consequence of vector control measures can undermine disease control. To address this, we explore the impacts of altered timing of blood-feeding on mosquito life history traits and malaria transmission. METHODS: We present three experiments in which Anopheles stephensi mosquitoes were fed in the morning or evening on blood that had different qualities, including: (i) chemical-induced or (ii) Plasmodium chabaudi infection-induced anaemia; (iii) Plasmodium berghei infection but no anaemia; or (iv) stemming from hosts at different times of day. We then compared whether time-of-day variation in blood meal characteristics influences mosquito fitness proxies relating to survival and reproduction, and malaria transmission proxies. RESULTS: Mosquito lifespan is not influenced by the time-of-day they received a blood meal, but several reproductive metrics are affected, depending on other blood characteristics. Overall, our data suggest that receiving a blood meal in the morning makes mosquitoes more likely to lay eggs, lay slightly sooner and have a larger clutch size. In keeping with previous work, P. berghei infection reduces mosquito lifespan and the likelihood of laying eggs, but time-of-day of blood-feeding does not impact upon these metrics nor on transmission of this parasite. CONCLUSION: The time-of-day of blood-feeding does not appear to have major consequences for mosquito fitness or transmission of asynchronous malaria species. If our results from a laboratory colony of mosquitoes living in benign conditions hold for wild mosquitoes, it suggests that mosquitoes have sufficient flexibility in their physiology to cope with changes in biting time induced by evading insecticide-treated bed nets. Future work should consider the impact of multiple feeding cycles and the abiotic stresses imposed by the need to forage for blood during times of day when hosts are not protected by bed nets.


Assuntos
Anopheles/parasitologia , Ritmo Circadiano , Comportamento Alimentar , Malária/transmissão , Mosquitos Vetores/parasitologia , Plasmodium berghei/fisiologia , Anemia , Animais , Anopheles/fisiologia , Feminino , Fertilidade , Humanos , Longevidade , Malária/parasitologia , Masculino , Camundongos , Mosquitos Vetores/fisiologia , Reprodução
14.
BJOG ; 126 Suppl 4: 34-42, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31257668

RESUMO

OBJECTIVES: A diagnosis of hypertensive disorders during pregnancy (HDPs) or gestational diabetes mellitus (GDM) is highly predictive of women at increased risk of developing chronic hypertension, Type 2 diabetes, and cardiovascular disease. This study investigates perceptions of women and healthcare providers in rural India regarding these long-term risks. DESIGN: Qualitative study using modified grounded theory. SETTING: Two states in rural India: Haryana and Andhra Pradesh. POPULATION: Pregnant and postpartum women, community health workers (CHWs), primary care physicians, obstetricians, laboratory technicians, and healthcare officials. METHODS: In-depth interviews and focus group discussions explored: (1) priorities for high-risk pregnant women; (2) detection and management of HDPs and GDM; (3) postpartum management, and (4) knowledge of long-term sequelae of high-risk conditions. A thematic analysis was undertaken. RESULTS: Seven focus group discussions and 11 in-depth interviews (n = 71 participants) were performed. The key priority area for high-risk pregnant women was anaemia. Blood pressure measurement was routinely embedded in antenatal care; however, postpartum follow up and knowledge of the long-term complications were limited. GDM was not considered a common problem, although significant variations and challenges to GDM screening were identified. Knowledge of the long-term sequelae of GDM with regard to an increased risk of Type 2 diabetes and cardiovascular disease among doctors was minimal. CONCLUSIONS: There is a need for improved education, standardisation of testing and postpartum follow up of HDPs and GDM in rural Indian settings. FUNDING: SN is supported by an MRC Clinical Research Training Fellowship (MR/R017182/1). The George Institute for Global Health Global Women's Health programme provided financial support for the research assistant and fieldwork costs in India. TWEETABLE ABSTRACT: Improved education and postpartum care of women with hypertension and diabetes in pregnancy in rural India are needed to prevent long-term risks.


Assuntos
Atitude do Pessoal de Saúde , Diabetes Gestacional/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pré-Eclâmpsia/psicologia , Adulto , Idoso , Anemia/psicologia , Feminino , Grupos Focais , Teoria Fundamentada , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Cuidado Pós-Natal , Gravidez , Pesquisa Qualitativa , População Rural/estatística & dados numéricos , Saúde da Mulher
15.
Medicine (Baltimore) ; 98(29): e16544, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335736

RESUMO

To investigate the status of percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI) and analyze the reasons for not receiving PCI.A cohort of 387 consecutive hospitalized AMI patients aged ≥80 years were recruited from 2005 to 2014. Their clinical data were collected and analyzed.Among 387 elderly patients with AMI (190 men and 197 women, mean age 84.1 ±â€Š3.9 years), there were 171 patients with ST-elevation myocardial infarction (STEMI) and 216 patients with non-ST-elevation myocardial infarction (NSTEMI). The emergency and elective PCI treatment rate was 40.6% and 12.1%, respectively, in patients with STEMI; and 1% and 18%, respectively, in patients with NSTEMI. PCI treatment rate of elderly AMI patients enrolled after 2009 showed no significant difference compared to that before 2009 (P > .05). The in-hospital mortality decreased significantly in PCI treatment group. After adjustment for age, sex, and other factors, PCI treatment was identified as the independent protective factors for in-hospital mortality (odds ratio = 0.323, 95% confidence interval 0.147-0.710, P = .005). The main influence factors for not receiving PCI treatment were hemorrhage, severe renal dysfunction, infection, or severe anemia-associated complications, whereas delayed treatment was the important reason for patients not undergoing emergency PCI.PCI treatment is the independent protective factor for in-hospital mortality of elderly patients with AMI. Due to various complications, PCI treatment rate is still low in elderly patients with AMI and has not been improved recently. Paying attention to performing PCI treatment for elderly patients with AMI has positive significance.


Assuntos
Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Idoso de 80 Anos ou mais , Anemia/complicações , China , Procedimentos Cirúrgicos Eletivos , Serviço Hospitalar de Emergência , Feminino , Hemorragia/complicações , Mortalidade Hospitalar , Humanos , Infecção/complicações , Nefropatias/complicações , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Centros de Atenção Terciária , Tempo para o Tratamento
16.
Khirurgiia (Mosk) ; (5): 25-30, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169815

RESUMO

AIM: To justify the concept of systemic membrane-destabilizing distress syndrome in surgery via analysis of phospholipid bilayer of cell membranes of various organs in urgent surgical abdominal diseases. MATERIAL AND METHODS: Experimental research on dogs (n=90) included modeling of peritonitis, pancreatitis, intestinal obstruction, obstructive jaundice, and post-hemorrhagic anemia. Clinical and laboratory studies were performed in patients (n=119) with acute peritonitis, severe pancreatitis, intestinal obstruction, post-hemorrhagic anemia, acute cholecystitis, gastrointestinal bleeding, benign mechanical jaundice. Lipid profile in tissues and blood cells was determined by extraction, fractionation and densitometry. Moreover, we assessed intensity of lipid peroxidation and phospholipase activity, endogenous intoxication, functional state of organs and blood cells. RESULTS: It was revealed that all above-mentioned acute abdominal diseases are followed by significant changes of lipid bilayer and dysfunction of tissues in target organs, blood cells and other organs (liver, kidney, colon and small intestine, heart, lungs, spleen, brain). Changes of phospholipid bilayer are correlated with severity and course of the disease. These data were used to determine a new complex in surgery - systemic membrane-destabilizing distress syndrome. Its concept, pathogenesis, and diagnosis are presented. It was analyzed its role in development and progression of dysregulation pathology and thanatogenesis. Evidence of its importance in the pathogenesis of surgical aggression was obtained.


Assuntos
Anemia/fisiopatologia , Membrana Celular/fisiologia , Doenças do Sistema Digestório/fisiopatologia , Hemorragia/fisiopatologia , Icterícia Obstrutiva/fisiopatologia , Estresse Fisiológico/fisiologia , Anemia/complicações , Animais , Doenças do Sistema Digestório/complicações , Modelos Animais de Doenças , Cães , Hemorragia/complicações , Humanos , Icterícia Obstrutiva/complicações , Lipídeos de Membrana/fisiologia , Fosfolipídeos/fisiologia , Síndrome
17.
Horiz. méd. (Impresa) ; 19(2): 6-11, Jun. 2019. tab
Artigo em Espanhol | LILACS, LIPECS | ID: biblio-1006793

RESUMO

Objetivo: Determinar la frecuencia de anemia en gestantes y su relación con el estado nutricional pregestacional. Materiales y métodos: Estudio descriptivo, observacional, transversal y retrospectivo, realizado en el Servicio de Obstetricia y Nutrición del Centro de Salud del distrito de Santiago de Surco entre el 1 de julio de 2015 y el 31 julio de 2016.Se revisaron 455 historias clínicas materno-perinatales (HCMP) del servicio de Obstetricia del Centro de Salud de Surco de las que se seleccionaron 93 que cumplian los criterios de inclusión. Se utilizó estadística descriptiva.Resultados: El 11,8 % de gestantes presentaron anemia. La hemoglobina promedio en las gestantes fue 12,2 ± 1,06 g/dl. El 58,5 % tenía índice de masa corporal (IMC) pregestacional normal y también una mayor frecuencia de anemia (10,7 %). Se observó que los casos de anemia son más frecuentes en los dos primeros trimestres, con un promedio de 4,8 %, y disminuyen en el tercer trimestre (2,2 %). Conclusiones: La mayor frecuencia de anemia en mujeres embarazadas se presentó en el grupo con IMC pregestacional normal. Los niveles de hemoglobina disminuyen de acuerdo a la edad de la madre y aumentan conforme a la edad gestacional.


Objective: To determine the frequency of anemia in pregnant women and its relationship with the pregestational nutritional status.Materials and methods: A descriptive, observational, cross-sectional and retrospective study was carried out in the Obstetrics and Nutrition Department of the Centro de Salud de Surco between July 1, 2015 and July 31, 2016. Four hundred fifty-five (455) maternal perinatal medical records (HCMP) from the Obstetrics Department of the Centro de Salud de Surco were reviewed, out of which 93 met the inclusion criteria and were selected. Descriptive statistics was used.Results:Eleven point eight percent (11.8 %) of the pregnant women presented anemia. The average hemoglobin level in the aforementioned women was 12.2 ± 1.06 g/dl. Fifty-eight point five percent (58.5 %) had a normal pregestational body mass index (BMI) and the highest frequency of anemia (10.7 %). It was observed that cases of anemia were more frequent in the first two quarters of pregnancy, reaching on average 4.8 %, and decreased in the third quarter (2.2 %).Conclusions: The highest frequency of anemia in pregnant women occurred in the normal pregestational BMI group. Hemoglobin levels decrease according to the age of the mother and increase according to the gestational age.


Assuntos
Gravidez , Anemia , Cuidado Pré-Natal , Deficiência de Ferro , Estado Nutricional
18.
Klin Lab Diagn ; 64(5): 277-283, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31185150

RESUMO

Evaluation of anemic syndrome (AS) was performed in 79 patients with advanced stages of Hodgkin's lymphoma (LH) at various stages of chemotherapy (CT) according to the EACOPP-14 scheme. Against the background of the treatment, the number of erythrocytes and, accordingly, the HCT indices decreased with each subsequent cycle of chemotherapy (CTC) and reached the maximum reduction to 5, 6 th CCT. Absolute iron deficiency (IDA), which was combined with a low level of EPO and an inadequate degree of anemia, was found in a few LH patients (5 people, 6.3%). Functional iron deficiency (FDZH) was diagnosed in 9 patients (11.4%), had the same morphological signs as IDA. Namely, microcytosis, erythrocyte hypochromia and low hemoglobin content in reticulocytes (RET-HE). In contrast to IDA, patients with FDZh concentration of FR, GP-25 and IL-6 were high. Despite the fairly large reserves of iron, the level of rRTF testified to the "iron hunger" of the erythrocariocytes of the bone marrow, its index exceeded the upper limit of the norm, while RET-HE was low. In 34 (43%) patients, LH revealed a deficiency of endogenous erythropoietin (EPO), which was observed not only in patients with AHZ, but also in patients with IDA. Lower levels of EPO were detected in patients with leukopenia and very low erythropoietic activity of the bone marrow.


Assuntos
Anemia Ferropriva/diagnóstico , Anemia/diagnóstico , Doença de Hodgkin/complicações , Anemia/complicações , Anemia Ferropriva/complicações , Eritropoetina/sangue , Doença de Hodgkin/tratamento farmacológico , Humanos , Reticulócitos/química
19.
BMC Public Health ; 19(1): 735, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196013

RESUMO

BACKGROUND: Anemia is associated with impaired quality of life (QoL). We examined the relationship between anemia and QoL in the Korean population using the EuroQol five-dimensional (EQ-5D) questionnaire. METHODS: Data of 30,526 subjects were included from the Korean National Health and Nutrition Examination Survey (2008-2016). The QoL was assessed using three-levels of the EQ-5D questionnaire (G1, G2, and G3). Analysis of variance was used to compare the prevalence of anemia according to the three levels of health status in each of the five dimensions of EQ-5D. Multiple linear regression analysis was used to evaluate the association between hemoglobin level and QoL, and multivariable logistic regression analysis was used to evaluate the odds ratios (ORs) and 95% confidence intervals (CIs) for low levels of each of the five dimensions of EQ-5D. RESULTS: As the level of EQ-5D was worse (from G1 to G3), the prevalence of anemia increased (p for trend < 0.001). Hemoglobin level and EQ-5D showed positive association after adjusting for all covariates such as age, sex, smoking, alcohol drinking, exercise, education, income, marital status, urban living, diabetes mellitus, hypertension, hypercholesterolemia, chronic kidney disease, total calorie intake, and protein intake. Subjects with anemia had increased ORs for low levels (G2 + G3) of each dimension of EQ-5D compared to subjects without anemia. ORs and 95% CIs for mobility, self-care, and usual activities were 1.208(1.078, 1.353), 1.161(0.98, 1.376), and 1.331(1.173, 1.51), respectively, after adjusting for all covariates. Pain/discomfort and anxiety/depression were not associated with increased ORs for low levels of EQ-5D. CONCLUSIONS: In South Korea, low QoL was associated with anemia, particularly in the mobility, self-care, and usual activities dimensions of EQ-5D.


Assuntos
Anemia/epidemiologia , Qualidade de Vida , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , República da Coreia/epidemiologia , Inquéritos e Questionários
20.
Br J Anaesth ; 123(2): 161-169, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31227271

RESUMO

BACKGROUND: Preoperative anaemia is associated with elevated risks of postoperative complications. This association may be explained by confounding related to poor cardiopulmonary fitness. We conducted a pre-specified substudy of the Measurement of Exercise Tolerance before Surgery (METS) study to examine the associations of preoperative haemoglobin concentration with preoperative cardiopulmonary exercise testing performance (peak oxygen consumption, anaerobic threshold) and postoperative complications. METHODS: The substudy included a nested cross-sectional analysis and nested cohort analysis. In the cross-sectional study (1279 participants), multivariate linear regression modelling was used to determine the adjusted association of haemoglobin concentration with peak oxygen consumption and anaerobic threshold. In the nested cohort study (1256 participants), multivariable logistic regression modelling was used to determine the adjusted association of haemoglobin concentration, peak oxygen consumption, and anaerobic threshold with the primary endpoint (composite outcome of death, cardiovascular complications, acute kidney injury, or surgical site infection) and secondary endpoint (moderate or severe complications). RESULTS: Haemoglobin concentration explained 3.8% of the variation in peak oxygen consumption and anaerobic threshold (P<0.001). Although not associated with the primary endpoint, haemoglobin concentration was associated with moderate or severe complications after adjustment for peak oxygen consumption (odds ratio=0.86 per 10 g L-1 increase; 95% confidence interval, 0.77-0.96) or anaerobic threshold (odds ratio=0.86; 95% confidence interval, 0.77-0.97). Lower peak oxygen consumption was associated with moderate or severe complications without effect modification by haemoglobin concentration (P=0.12). CONCLUSION: Haemoglobin concentration explains a small proportion of variation in exercise capacity. Both anaemia and poor functional capacity are associated with postoperative complications and may therefore be modifiable targets for preoperative optimisation.


Assuntos
Anemia , Tolerância ao Exercício , Estudos de Coortes , Estudos Transversais , Teste de Esforço , Hemoglobinas , Humanos , Consumo de Oxigênio
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