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1.
Orv Hetil ; 161(37): 1569-1573, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32894736

RESUMO

Worldwide, the prevalence of anemia is high, and iron deficiency anemia is the fifth most common disorder according to the study called "Global burden of disease". It can be attributed to a number of factors, complex pathomechanisms, and etiology is highly variable in terms of age, gender, and geographical distribution. The prevalence of anemia increases with age. Demographic change and the aging of the population are now faster than in previous decades, posing major challenges to societies and health systems. The mean prevalence of anemia in the elderly is 17%, but significantly higher among nursing-home (47%) and hospitalized elderly (40%). The cause is usually multifactorial and often, due to comorbidities, several mechanisms are involved at the same time. The prevalence of preoperative anemia was higher (35%) than the prevalence of anemia in the general population, and evidence showed an unfavorable effect on postoperative morbidity and mortality. Timely identification and correction is a multidisciplinary task and a shared responsibility for both Patient Blood Management program and improving the patients' life expectancy. Orv Hetil. 2020; 161(37): 1569-1573.


Assuntos
Anemia Ferropriva , Anemia , Idoso , Anemia/epidemiologia , Anemia Ferropriva/epidemiologia , Comorbidade , Humanos , Morbidade , Prevalência
2.
Niger J Clin Pract ; 23(7): 889-896, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620715

RESUMO

Anemia in pregnancy is a public health problem in Nigeria and it is more than likely that iron deficiency is the major cause. This study aimed to review relevant publications in order to summarize the prevalence of iron deficiency anemia, risk factors associated with iron deficiency, anemia in pregnancy as well as factors associated with compliance to routine iron therapy. MEDLINE Entrez PubMed search was performed in August 2017 and studies that investigated iron deficiency anemia in pregnancy in Nigeria from 1968 to 2017 were sought. Search keywords included "iron deficiency anemia, pregnancy, Nigeria." Only studies that provided information on the prevalence of iron deficiency anemia, risk factors associated with iron deficiency anemia and risk factors associated with compliance to routine iron therapy in pregnancy in Nigeria were eligible and were selected. Inclusion criteria were original scientific investigations, not reviews, studies conducted in Nigeria between 1968 and 2017 and studies written in the English language. A total of six relevant studies that fulfilled the study inclusion criteria were identified out of 36 studies found. All the studies reported a high prevalence of iron deficiency anemia among pregnant women and risk factors associated with iron deficiency anemia in pregnancy include multiparity, third trimester of pregnancy, and low socioeconomic status. Risk factors associated with noncompliance to routine iron therapy include poor utilization of antenatal services, low educational attainment, distance to a health facility, single or teenage pregnancy, increasing age of the pregnant women, and living in the rural areas. The prevalence of iron deficiency anemia among pregnant women was reported to be high. Awareness creation and education on the importance of family planning and proper utilization of antenatal care services should be encouraged. There should be economic empowerment of women, provision of health facilities to areas where they are absent to encourage early booking and utilization of antenatal care services.


Assuntos
Anemia Ferropriva/epidemiologia , Complicações Hematológicas na Gravidez/epidemiologia , Adolescente , Adulto , Anemia/epidemiologia , Feminino , Humanos , Nigéria/epidemiologia , Paridade , Gravidez , Cuidado Pré-Natal , Prevalência , Fatores de Risco
3.
Niger J Clin Pract ; 23(7): 928-933, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620721

RESUMO

Background: Short inter-pregnancy interval (IPI) is a potential risk factor for adverse pregnancy outcomes. Previous reports from sub-Sahara Africa documented increasing incidence of short IPI but evidence is lacking in its effect on pregnancy outcome. Aim: The study aimed to determine the effect of short IPI on pregnancy outcome in Nigeria. Subjects and Methods: It was a prospective cohort study of 271 pregnant women receiving antenatal care in a tertiary hospital in Nigeria. For every eligible woman with short IPI (<18 months) recruited; a suitable control with IPI ≥18 months was selected. Statistical analysis was both inferential and descriptive using the statistical package for social sciences version 24 (SPSS Inc. Chicago, Illinois, USA) for windows. A P value of less than 0.05 was considered statistically significant. Results: Incidence of maternal anemia was higher in women with short IPI than control (RR: 2.091; 95% CI: 1.4433.031; P < 0.001). Other maternal and perinatal outcome measures including premature rupture of membranes, preterm labor/delivery, pregnancy induced hypertension, third trimester bleeding, postpartum hemorrhage, and inadequate gestational weight gain did not show any significant association with short IPI (P > 0.05). Conclusion: Short IPI is associated with anemia in pregnancy in Nigeria. Public health campaigns for improvement in uptake of family planning services and breastfeeding may help reduce the incidence of short IPI and anemia in low income countries.


Assuntos
Intervalo entre Nascimentos , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Anemia/epidemiologia , Estudos de Coortes , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Incidência , Recém-Nascido , Nigéria/epidemiologia , Trabalho de Parto Prematuro/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Pobreza , Gravidez , Estudos Prospectivos
4.
BMJ ; 370: m2397, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32699176

RESUMO

OBJECTIVE: To assess the effects of food supplementation on improving working memory and additional measures including cerebral blood flow in children at risk of undernutrition. DESIGN: Randomized controlled trial. SETTING: 10 villages in Guinea-Bissau. PARTICIPANTS: 1059 children aged 15 months to 7 years; children younger than 4 were the primary population. INTERVENTIONS: Supervised isocaloric servings (≈1300 kJ, five mornings each week, 23 weeks) of a new food supplement (NEWSUP, high in plant polyphenols and omega 3 fatty acids, within a wide variety and high fortification of micronutrients, and a high protein content), or a fortified blended food (FBF) used in nutrition programs, or a control meal (traditional rice breakfast). MAIN OUTCOME MEASUREMENTS: The primary outcome was working memory, a core executive function predicting long term academic achievement. Additional outcomes were hemoglobin concentration, growth, body composition, and index of cerebral blood flow (CBFi). In addition to an intention-to-treat analysis, a predefined per protocol analysis was conducted in children who consumed at least 75% of the supplement (820/925, 89%). The primary outcome was assessed by a multivariable Poisson model; other outcomes were assessed by multivariable linear mixed models. RESULTS: Among children younger than 4, randomization to NEWSUP increased working memory compared with the control meal (rate ratio 1.20, 95% confidence interval 1.02 to 1.41, P=0.03), with a larger effect in the per protocol population (1.25, 1.06 to 1.47, P=0.009). NEWSUP also increased hemoglobin concentration among children with anemia (adjusted mean difference 0.65 g/dL, 95% confidence interval 0.23 to 1.07, P=0.003) compared with the control meal, decreased body mass index z score gain (-0.23, -0.43 to -0.02, P=0.03), and increased lean tissue accretion (2.98 cm2, 0.04 to 5.92, P=0.046) with less fat (-5.82 cm2, -11.28 to -0.36, P=0.04) compared with FBF. Additionally, NEWSUP increased CBFi compared with the control meal and FBF in both age groups combined (1.14 mm2/s×10-8, 0.10 to 2.23, P=0.04 for both comparisons). Among children aged 4 and older, NEWSUP had no significant effect on working memory or anemia, but increased lean tissue compared with FBF (4.31 cm2, 0.34 to 8.28, P=0.03). CONCLUSIONS: Childhood undernutrition is associated with long term impairment in cognition. Contrary to current understanding, supplementary feeding for 23 weeks could improve executive function, brain health, and nutritional status in vulnerable young children living in low income countries. Further research is needed to optimize nutritional prescriptions for regenerative improvements in cognitive function, and to test effectiveness in other vulnerable groups. TRIAL REGISTRATION: ClinicalTrials.gov NCT03017209.


Assuntos
Anemia/dietoterapia , Disfunção Cognitiva/dietoterapia , Suplementos Nutricionais/efeitos adversos , Desnutrição/dietoterapia , Estado Nutricional/fisiologia , Sucesso Acadêmico , Anemia/epidemiologia , Estudos de Casos e Controles , Circulação Cerebrovascular/fisiologia , Criança , Pré-Escolar , Cognição/fisiologia , Disfunção Cognitiva/fisiopatologia , Suplementos Nutricionais/estatística & dados numéricos , Feminino , Alimentos Fortificados/provisão & distribução , Guiné-Bissau/epidemiologia , Humanos , Lactente , Análise de Intenção de Tratamento/métodos , Masculino , Desnutrição/epidemiologia , Desnutrição/prevenção & controle , Micronutrientes/provisão & distribução , Medição de Risco
5.
Lancet Child Adolesc Health ; 4(7): 515-525, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32562633

RESUMO

BACKGROUND: Anaemia is a serious public health concern in India. However, national estimates for its prevalence are not available for the 5-14 years age group, nor are estimates available for the types of anaemia among children and adolescents (1-19 years). We aimed to assess the prevalence of anaemia among children and adolescents in India and to categorise types of anaemia on the basis of micronutrient deficiencies. METHODS: We assessed the prevalence of anaemia among children (1-4 years and 5-9 years) and adolescents (10-19 years) using nationally representative data from the Comprehensive National Nutrition Survey. Anaemia was classified on the basis of age and sex-specific WHO cutoffs and serum ferritin, soluble transferrin receptor, folate, cyanocobalamin, and C-reactive protein concentrations as iron deficiency anaemia, folate or vitamin B12 deficiency anaemia, dimorphic anaemia (iron deficiency anaemia and folate or vitamin B12 deficiency anaemia), anaemia of other causes (anaemia not classified as iron deficiency anaemia and folate or vitamin B12 deficiency anaemia), and anaemia of inflammation. FINDINGS: We included 26 765 children (11 624 aged 1-4 years and 15 141 aged 5-9 years) and 14 669 adolescents. In the weighted sample, anaemia prevalence was 40·5% (4553 of 11 233) among 1-4 year-olds, 23·4% (3439 of 14 664) among 5-9 year-olds, and 28·4% (4064 of 14 300) among adolescents. Among 2862 children aged 1-4 years, iron deficiency anaemia (1045 [36·5%]) was the most prevalent type, followed by anaemia of other causes (702 [24·5%]), folate or vitamin B12 deficiency anaemia (542 [18·9%]), dimorphic anaemia (387 [13·5%]), and anaemia of inflammation (186 [6·5%]). Among 2261 children aged 5-9 years, anaemia of other causes was the most common (986 [43·6%]), followed by folate or vitamin B12 deficiency anaemia (558 [24·6%]), iron deficiency anaemia (353 [15·6%]), dimorphic anaemia (242 [10·7%]), and anaemia of inflammation (122 [5·4%]). 861 (31·4%) of 2740 adolescents had anaemia of other causes, 703 (25·6%) had folate or vitamin B12 deficiency anaemia, 584 (21·3%) had iron deficiency anaemia, 498 (18·2%) and dimorphic anaemia, and 94 (3·4%) had anaemia of inflammation. INTERPRETATION: Iron deficiency anaemia is the most common form of anaemia among younger children and anaemia of other causes among 5-9-year-old children and adolescents. Folate or vitamin B12 deficiency anaemia accounts for more than a third of anaemia prevalence. Anaemia prevention efforts should focus on strengthening the existing iron and folate supplementation programmes and prevention of folate or vitamin B12 deficiency anaemia. FUNDING: The Mittal Foundation.


Assuntos
Anemia/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Deficiência de Ácido Fólico/epidemiologia , Inquéritos Epidemiológicos , Humanos , Índia/epidemiologia , Lactente , Masculino , Prevalência , Deficiência de Vitamina B 12/epidemiologia , Adulto Jovem
6.
PLoS One ; 15(6): e0234541, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584835

RESUMO

Erythropoisis stimulating agent (ESA) use was addressed in Food and Drug Administration (FDA) Oncology Drug Advisory Committee (ODAC) meetings between 2004 and 2008. FDA safety-focused regulatory actions occurred in 2007 and 2008. In 2007, black box warnings advised of early death and venous thromboembolism (VTE) risks with ESAs in oncology. In 2010, a Risk Evaluation Strategies (REMS) was initiated, with cancer patient consent that mortality and VTE risks were noted with ESAs. We report warnings and REMS impacts on ESA utilization among Veterans Administration (VA) cancer patients with chemotherapy-induced anemia (CIA). Data were from Veterans Affairs database (2003-2012). Epoetin and darbepoetin use were primary outcomes. Segmented linear regression was used to estimate changes in ESA use levels and trends, clinical appropriateness, and adverse events (VTEs) among chemotherapy-treated cancer patients. To estimate changes in level of drug prescription rate after policy actions, model-specific indicator variables as covariates based on specific actions were included. ESA use fell by 95% and 90% from 2005, for epoetin and darbepoetin, from 22% and 11%, respectively, to 1% and 1%, respectively, among cancer patients with CIA, respectively (p<0.01). Following REMS in 2010, mean hematocrit levels at ESA initiation decreased from 30% to 21% (p<0.01). Black box warnings preceded decreased ESA use among VA cancer patients with CIA. REMS was followed by reduced hematocrit levels at ESA initiation. Our findings contrast with privately- insured and Medicaid insured cancer patient data on chemotherapy-induced anemia where ESA use decreased to 3% to 7% by 2010-2012. By 2012, the era of ESA administration to VA to cancer patients had ended but the warnings remain relevant and significant. In 2019, oncology/hematology national guidelines (ASCO/ASH) recommend that cancer patients with chemotherapy-induced anemia should receive ESAs or red blood cell transfusions after risk-benefit evaluation.


Assuntos
Anemia/epidemiologia , Antineoplásicos/efeitos adversos , Hematínicos/efeitos adversos , Neoplasias/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia/induzido quimicamente , Anemia/patologia , Anemia/prevenção & controle , Antineoplásicos/uso terapêutico , Rotulagem de Medicamentos , Feminino , Hematínicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/patologia , Estados Unidos/epidemiologia , United States Department of Veterans Affairs , Tromboembolia Venosa , Adulto Jovem
8.
Geriatr Gerontol Int ; 20(7): 720-726, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32515163

RESUMO

AIM: The incidence of anemia increases with aging, and it is considered to affect mortality through complex pathophysiological outcomes. Although it has been suggested that self-rated health may also contribute to the prognosis of anemia in older people, the relationship between anemia and self-rated health is not well understood. This study thus examined the actual status of anemia in older community-dwelling Japanese people and clarified the relationship between anemia and self-rated health. METHODS: We conducted medical interviews, physical measurements and blood testing in 2083 people aged 69-91 years who participated in the long-term observational Septuagenarians, Octogenarians, Nonagenarians, Investigation with Centenarians (SONIC) study. Subjects were divided into two groups according to whether they had anemia. Logistic regression analyses were used to assess the relationship between anemia and self-rated health after adjusting for possible confounding factors. RESULTS: The prevalence of anemia was 22.3% in all participants, 7.2% in men and 11.6% in women aged 69-71 years, 27.4% in men and 26.3% in women aged 79-81 years, and 55.8% in men and 44.9% in women aged 89-91 years. Multivariate analysis revealed a correlation between the presence of anemia and poor self-rated health in all (odds ratio 0.67, 95% confidence interval 0.48-0.93) and aged 69-71 years (odds ratio 0.47, 95% confidence interval 0.25-0.86). CONCLUSIONS: Anemia was associated with self-rated health in older Japanese people, suggesting that careful management of anemia may contribute to health and longevity. Geriatr Gerontol Int 2020; ••: ••-••.


Assuntos
Anemia/epidemiologia , Autoavaliação Diagnóstica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vida Independente , Japão/epidemiologia , Masculino
9.
BMC Infect Dis ; 20(1): 379, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460777

RESUMO

BACKGROUND: Intestinal parasitic infections (IPIs) and anaemia are major health problems. This study assessed the prevalence of intestinal parasitic infections, anaemia and associated factors among pre-school children in rural areas of the Tigray region, northern Ethiopia. METHODS: A community based cross-sectional study was conducted among 610 pre-school children in rural communities of Northern Ethiopia from June 2017 to August 2017. Stool specimens were examined for the presence of trophozoites, cysts, oocysts, and ova using direct, formal-ethyl acetate concentration, Kato-Katz, and Ziehl-Neelsen techniques. Haemoglobin was measured using a HemoCue spectrometer. RESULTS: Among the 610 participating pre-school children in the study, the prevalence of IPIs and anaemia were 58% (95% conference interval (CI): 54.1-61.9%) and 21.6% (95% CI: 18.5-25.1%), respectively. Single, double, and triple parasitic infections were seen in 249 (41, 95% CI: 37-45%), 83 (14, 95% CI: 11-17%), and 22 (3.6, 95% CI: 2.4-5.4%) children, respectively. Of the seven intestinal parasitic organisms recorded from the participants, Entamoeba histolytica/dispar was the most prevalent 220 (36.1%) followed by Giardia lamblia 128 (20.1%), and Hymenolepis nana 102 (16.7%). Mixed infections were common among G. lamblia, E. histolytica/dispar and Cryptosporidium spp. oocyst. Intestinal parasitic infection prevalence increased from 47% in children aged 6-11 months to 66% in those aged 48-59 months; the prevalence ratio (PR) associated with a one-year increase in age was 1.08 (95% CI: 1.02-1.14, p = 0.009). Age-adjusted prevalence was higher in children who had been dewormed (PR = 1.2; 95% CI: 1.00-1.4, p = 0.045), and lower in households having two or more children aged under five (PR = 0.76, 95% CI: 0.61-0.95, p = 0.015). Anaemia rose from 28% in children aged 6-11 months to 43% in those aged 12-23 months, then fell continuously with age, reaching 7% in those aged 48-59 months. Age adjusted, anaemia was more prevalent in households using proper disposal of solid waste (PR = 1.5, 95% CI: 0.1-2.10, p = 0.009) while eating raw meat (PR = 0.49, 95% CI: 0.45-0.54, p = 0.000), any maternal education (PR = 0.64 95% CI: 0.52-0.79, p = 0.000), and household water treatment (PR = 0.75, 95% CI: 0.56-1.0, p = 0.044) were associated with lower prevalence of anaemia. CONCLUSIONS: More than half of the children were infected with intestinal parasites, while anaemia prevalence was concentrated in the 12-23 month age group. This study has identified a number of potentially modifiable risk factors to address the significant prevalence of IPIs and anaemia in these children. Improvements in sanitation, clean water, hand hygiene, maternal education could address both short and long-term consequences of these conditions in this vulnerable population.


Assuntos
Anemia/epidemiologia , Enteropatias Parasitárias/epidemiologia , Anemia/parasitologia , Animais , Criança , Pré-Escolar , Estudos Transversais , Cryptosporidium/genética , Cryptosporidium/isolamento & purificação , Entamoeba histolytica/genética , Entamoeba histolytica/isolamento & purificação , Etiópia/epidemiologia , Fezes/parasitologia , Feminino , Giardia lamblia/genética , Giardia lamblia/isolamento & purificação , Higiene das Mãos , Humanos , Hymenolepis nana/genética , Hymenolepis nana/isolamento & purificação , Lactente , Enteropatias Parasitárias/parasitologia , Intestinos/parasitologia , Masculino , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricos , Saneamento
10.
PLoS One ; 15(5): e0232838, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32384106

RESUMO

BACKGROUND: In South Africa, 30.9% of children under five years with Severe Acute Malnutrition (SAM) died in 2018. We aimed to identify factors associated with mortality among children under five years hospitalized with SAM in Limpopo province, South Africa. METHODS: We conducted a cross-sectional study including children under five years admitted with SAM from 2014 to 2018 in public hospitals of Limpopo province. We extracted socio-demographic and clinical data from hospital records. We used logistic regression to identify factors associated with mortality. FINDINGS: We included 956 children, 50.2% (480/956) male and 49.8% (476/956) female. The median age was 13 months (inter quartile range: 9-19 months). The overall SAM mortality over the study period was 25.9% (248/956). The most common complications were diarrhea, 63.8% (610/956), and lower respiratory tract infections (LRTIs), 42.4% (405/956). Factors associated with mortality included herbal medication use (adjusted Odds Ratio (aOR): 2.2, 95% Confidence Interval (CI): 1.4-3.5, p = 0.001), poor appetite (aOR: 2.7, 95% CI: 1.4-5.2, p = 0.003), Mid-upper circumference (MUAC) <11.5 cm (aOR: 3.0, 95% CI: 1.9-4.7, p<0.001), lower respiratory tract infections (LRTIs) (aOR: 1.6, 95% CI: 1.2-2.0, p<0.001), anemia (aOR: 2.5, 95% CI: 1.1-5.3, p = 0.021), hypoglycemia (aOR: 12.4, 95% CI: 7.1-21.8, p<0.001) and human immunodeficiency virus (HIV) infection (aOR: 2.3, 95% CI: 1.6-3.3, p<0.001). INTERPRETATION: Herbal medication use, poor appetite, LRTIs, anemia, hypoglycemia, and HIV infection were associated with mortality among children with SAM. These factors should guide management of children with SAM.


Assuntos
Transtornos da Nutrição Infantil/mortalidade , Criança Hospitalizada/estatística & dados numéricos , Mortalidade Hospitalar , Transtornos da Nutrição do Lactente/mortalidade , Desnutrição Aguda Grave/mortalidade , Adulto , Anemia/epidemiologia , Cuidadores/estatística & dados numéricos , Criança , Transtornos da Nutrição Infantil/terapia , Pré-Escolar , Comorbidade , Estudos Transversais , Diarreia Infantil/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Hipoglicemia/epidemiologia , Lactente , Transtornos da Nutrição do Lactente/terapia , Modelos Logísticos , Malária/epidemiologia , Masculino , Preparações de Plantas , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , África do Sul/epidemiologia
11.
Am J Trop Med Hyg ; 103(1): 485-493, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32372751

RESUMO

Tropical splenomegaly is often associated with malaria and schistosomiasis. In 2014 and 2015, 145 Congolese refugees in western Uganda diagnosed with splenomegaly during predeparture medical examinations underwent enhanced screening for various etiologies. After anecdotal reports of unresolved splenomegaly and complications after U.S. arrival, patients were reassessed to describe long-term clinical progression after arrival in the United States. Post-arrival medical information was obtained through medical chart abstraction in collaboration with state health partners in nine participating states. We evaluated observed splenomegaly duration and associated clinical sequelae between 130 case patients from eastern Congo and 102 controls through adjusted hierarchical Poisson models, accounting for familial clustering. Of the 130 case patients, 95 (73.1%) had detectable splenomegaly after arrival. Of the 85 patients with records beyond 6 months, 45 (52.9%) had persistent splenomegaly, with a median persistence of 14.7 months (range 6.0-27.9 months). Of the 112 patients with available results, 65 (58.0%) patients had evidence of malaria infection, and the mean splenomegaly duration did not differ by Plasmodium species. Refugees with splenomegaly on arrival were 43% more likely to have anemia (adjusted relative risk [aRR]: 1.43, 95% CI: 1.04-1.97). Those with persistent splenomegaly were 60% more likely (adjusted relative risk [aRR]: 1.60, 95% CI: 1.15-2.23) to have a hematologic abnormality, particularly thrombocytopenia (aRR: 5.53, 95% CI: 1.73-17.62), and elevated alkaline phosphatase (aRR: 1.57, 95% CI: 1.03-2.40). Many patients experienced persistent splenomegaly, contradicting literature describing resolution after treatment and removal from an endemic setting. Other possible etiologies should be investigated and effective treatment, beyond treatment for malaria and schistosomiasis, explored.


Assuntos
Anemia/epidemiologia , Eosinofilia/epidemiologia , Malária/epidemiologia , Refugiados , Esquistossomose/epidemiologia , Esplenomegalia/epidemiologia , Trombocitopenia/epidemiologia , Adolescente , Adulto , Fosfatase Alcalina/sangue , Anemia/sangue , Anti-Helmínticos/uso terapêutico , Antimaláricos/uso terapêutico , Combinação Arteméter e Lumefantrina/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , República Democrática do Congo/etnologia , Progressão da Doença , Eosinofilia/sangue , Feminino , Hepatite A/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Imunoglobulina M , Lactente , Malária/complicações , Malária/diagnóstico , Malária/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Praziquantel/uso terapêutico , Esquistossomose/complicações , Esquistossomose/tratamento farmacológico , Esplenomegalia/sangue , Esplenomegalia/etiologia , Trombocitopenia/sangue , Estados Unidos/epidemiologia , Adulto Jovem
12.
J Clin Psychiatry ; 81(2)2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32237297

RESUMO

Many observational studies have found an association between antidepressant drug prescription during pregnancy and neurodevelopmental disorders such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and intellectual disability. The results of such studies cannot be considered conclusive because of the possible presence of inadequately measured, unmeasured, and unknown confounds. In this context, maternal anemia before or at but not after 30 weeks of gestation was recently associated with an increased risk of all 3 of these neurodevelopmental disorders. Additionally, meta-analysis has shown that maternal anemia during pregnancy is associated with other adverse gestational outcomes, as well. Given that anemia is common during pregnancy, and that iron deficiency during pregnancy can compromise neurodevelopment in the offspring, it is clear that maternal anemia during pregnancy should be included as a confound that is adjusted for in analyses in studies of psychotropic drugs in pregnancy. However, many studies that significantly associated gestational exposure to antidepressants with adverse pregnancy outcomes did not adjust for maternal anemia during pregnancy. This issue is not merely academic because studies with such "significant" findings discourage depressed pregnant women from accepting antidepressants; therefore, women and their unborn children may risk experiencing the known harms associated with untreated depression during pregnancy. Additionally, such "significant" findings may provoke unjustified guilt in women who do use antidepressants during pregnancy, especially if the pregnancy is associated with an adverse outcome. Whereas this is not an endorsement of the unquestioning use of antidepressants during pregnancy, it does imply that those who argue against medication use during pregnancy should re-examine the science on which their views are based.


Assuntos
Anemia/complicações , Antidepressivos/efeitos adversos , Transtorno Depressivo/tratamento farmacológico , Transtornos do Neurodesenvolvimento/etiologia , Complicações Hematológicas na Gravidez/sangue , Efeitos Tardios da Exposição Pré-Natal/etiologia , Adolescente , Adulto , Anemia/epidemiologia , Criança , Transtorno Depressivo/epidemiologia , Feminino , Idade Gestacional , Humanos , Masculino , Transtornos do Neurodesenvolvimento/induzido quimicamente , Transtornos do Neurodesenvolvimento/epidemiologia , Gravidez , Complicações Hematológicas na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adulto Jovem
13.
Medicine (Baltimore) ; 99(15): e19726, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282730

RESUMO

This study aimed to discuss the risk factors of perioperative blood transfusion after the application of proximal femoral nail antirotation (PFNA) in the treatment of elderly patients with femoral intertrochanteric fracture (FIF). Moreover, this study also aimed to analyze the causes of perioperative blood transfusion and provide guidance for clinical treatment.Records of elderly patients with FIF who were treated with PFNA in our hospital from September 2014 to May 2017 were reviewed. They were divided into transfused and nontransfused groups. The Student t test, Chi-squared test, and Fisher exact test were used in univariate analysis of 11 variables. Multivariate logistic regression analysis was performed to analyze the possible risk factors associated with postoperative blood transfusion after the application of PFNA in elderly patients with FIF. Correlations were sought using the Spearman rank correlation analysis.The univariate analysis showed that age, sex, type of fracture, admission hemoglobin (Hb), admission albumin, and intraoperative blood loss were significantly associated with perioperative blood transfusion (P = .000, .019, .000, .000, .000, and .007, respectively). The multivariate logistic regression analysis demonstrated that age (P = .019, odds ratio [OR] = 1.062), type of fracture (P = .001, OR = 4.486), and admission Hb (P = .000, OR = 0.883) were independent risk factors of postoperative blood transfusion. We found a significant positive correlation between perioperative blood transfusion and age (r = 0.264, P = .000) and type of fracture (r = 0.409, P = .000), but a negative correlation between perioperative blood transfusion and admission Hb (r = -0.641, P = .000).The main factors affecting perioperative blood transfusion are age, fracture type, and admission Hb. These results indicate that, in high-risk patients who are older in age, more unstable fractures, and lower admission Hb, monitoring Hb concentrations during the perioperative period is important to correct severe anemia in a timely manner and avoid exacerbating existing underlying diseases and inducing severe complications.


Assuntos
Transfusão de Sangue/métodos , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Quadril/cirurgia , Período Perioperatório/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Albuminas/análise , Anemia/epidemiologia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Pinos Ortopédicos/efeitos adversos , Feminino , Fêmur/patologia , Fêmur/cirurgia , Hemoglobinas/análise , Humanos , Masculino , Admissão do Paciente , Período Perioperatório/estatística & dados numéricos , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco
14.
PLoS One ; 15(4): e0231519, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32324775

RESUMO

BACKGROUND: Poor diet is a risk factor for anemia, overweight, and obesity among adolescent girls. However, comprehensive assessment on dietary quality and habits in this population is limited. We assessed the association of meal patterning, dietary quality, and dietary diversity with both anemia and overweight-obesity. METHODS: We conducted a cross-sectional survey in 335 school-going adolescent girls aged 12-19 years from three districts in West Java using multi-stage cluster sampling. Meal patterning, Dietary Quality Index for Adolescents (DQI-A), and Dietary Diversity Score (DDS) were determined using 2-day 24-h recall. RESULTS: Of the girls, 45% were anemic and 17% overweight or obese. Eating occasions of 3-4 times (AOR 2.68, 95% CI 1.21-5.98) and >4 times (AOR 2.43, 95% CI 1.01-5.83) were associated with greater odds of developing anemia compared to eating occasions of <3 times. Adolescent girls who skipped dinner had greater odds of being overweight or obese (AOR 2.13, 95% CI 1.10-4.10) and were less likely to be anemic (AOR 0.56, 95%CI 0.33-0.95) compared to those who did not skip dinner. Difference in energy intake was found between girls who had dinner and skipped dinner (p = 0.05). Mean total DQI-A score was 44.4% ± 7.71% and DDS was 4.0 out of 9.0. DQI-A score was significantly higher in non-anemic compared to anemic girls. Moreover, each unit increment of 1% of total DQI-A score was associated with a 3.967 g/dL increases of hemoglobin after adjustment for confounders. We found differences in total DQI-A score between normal-weight and overweight or obese girls. DDS score was not significantly different between groups, although lower meat, chicken, and fish consumption were correlated with anemia (p<0.01). CONCLUSIONS: Overall, the girls had poor dietary quality and diversity. The findings therefore indicated the importance of improving dietary quality and diversity in a regular meal pattern, especially meal frequency and meal skipping, to reduce the risk of anemia and overweight-obesity among adolescent girls.


Assuntos
Anemia/epidemiologia , Dieta , Comportamento Alimentar , Refeições , Sobrepeso/epidemiologia , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Indonésia/epidemiologia , Adulto Jovem
15.
PLoS Med ; 17(3): e1003060, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32231367

RESUMO

BACKGROUND: More than 700,000 ethnic Rohingya have crossed the border from Rakhine State, Myanmar to Cox's Bazar District, Bangladesh, following escalated violence by Myanmar security forces. The majority of these displaced Rohingya settled in informal sites on previously forested land, in areas without basic infrastructure or access to services. METHODS AND FINDINGS: Three cross-sectional population-representative cluster surveys were conducted, including all informal settlements of Rohingya refugees in the Ukhia and Teknaf Upazilas of Cox's Bazar District. The first survey was conducted during the acute phase of the humanitarian response (October-November 2017), and the second and third surveys were conducted 6 (April-May 2018) and 12 (October-November 2018) months later. Anthropometric indices (weight, height, mid-upper arm circumference [MUAC], oedema) and haemoglobin (Hb) were measured in children aged 6-59 months following standard procedures. Final samples for survey rounds 1, 2, and 3 (R1, R2, and R3) included 1,113, 628, and 683 children, respectively, of which approximately half were male (50.7%-53.5% per round) and a third were 6-23 months of age (32.4%-33.3% per round). Prevalence of global acute malnutrition (GAM) as assessed by weight for height in R2 (12.1%, 95% CI: 9.6-15.1) and R3 (11.0%, 95% CI: 8.4-14.2) represent a significant decline from the observed prevalence in R1 (19.4%, 95% CI: 16.8-22.3) (p < 0.001 for both comparisons). Overall, the prevalence of anaemia significantly declined (p < 0.001) between the first 2 rounds (47.9%, 95% CI: 44.1-51.7 and 32.3%, 95% CI: 27.8-37.1, respectively); prevalence increased significantly (p = 0.04) to 39.8% (95% CI, 34.1-45.4) during R3 but remained below R1 levels. Reported receipt of both fortified blended foods (12.8%) and micronutrient powders (10.3%) were low during R1 but increased significantly (p < 0.001 for both) within the first 6 months to 49.8% and 29.9%, respectively. Although findings demonstrate improvement in anthropometric indicators during a period in which nutrition programme coverage increased, causation cannot be determined from the cross-sectional design. CONCLUSIONS: These data document significant improvements in both acute and micronutrient malnutrition among Rohingya children in makeshift settlements. These declines coincide with a scaleup of services aimed at prevention and treatment of malnutrition. Ongoing activities to improve access to nutritional services may facilitate further reductions in malnutrition levels to sustained below-crisis levels.


Assuntos
Anemia/epidemiologia , Desnutrição/epidemiologia , Refugiados/estatística & dados numéricos , Anemia/etiologia , Bangladesh/epidemiologia , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Desnutrição/etiologia , Mianmar/etnologia , Prevalência
16.
PLoS One ; 15(4): e0229959, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32243480

RESUMO

Sickle cell disease (SCD) is characterized by deoxygenation-induced polymerization of hemoglobin in red blood cells, leading to hemolytic anemia, vaso-occlusion, and the development of multiple clinical complications. To characterize the clinical burden associated with differences in hemoglobin concentration and hemolysis measures, a systematic literature review of MEDLINE, EMBASE, and related meta-analyses was undertaken. For quantitative analyses related to hemoglobin concentration, pooled results were analyzed using random effects models to control for within-and between-study variability. To derive risk ratios associated with hemoglobin concentration change, we combined ratios of means from select studies, which reported hazard and odds ratios in meta-analyses for hemoglobin concentration-related outcomes and changes between groups. Forty-one studies were identified for inclusion based on relating hemoglobin concentration to clinical outcomes. Meta-analyses demonstrated that mean hemoglobin concentration was significantly lower in patients with cerebrovascular disease (0.4 g/dL), increased transcranial Doppler velocity in cerebral arteries (0.6 g/dL), albuminuria (0.6 g/dL), elevated estimated pulmonary artery systolic pressure (0.9 g/dL), and in patients that subsequently died (0.6 g/dL). In a risk reduction meta-analysis, modeled increased hemoglobin concentrations of 1 g/dL or greater resulted in decreased risk of negative clinical outcomes of 41% to 64%. In conclusion, chronic anemia is associated with worse clinical outcomes in individuals with SCD and even modest increases in hemoglobin concentration may be beneficial in this patient population. This systematic review has been registered on Prospero (Registration number CRD42018096860; https://www.crd.york.ac.uk/prospero/).


Assuntos
Anemia Falciforme/sangue , Transtornos Cerebrovasculares/sangue , Hemoglobinas/metabolismo , Nefropatias/sangue , Anemia/sangue , Anemia/epidemiologia , Anemia/patologia , Anemia Falciforme/mortalidade , Anemia Falciforme/patologia , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/patologia , Hemoglobina Falciforme/genética , Hemoglobina Falciforme/metabolismo , Hemólise , Humanos , Nefropatias/epidemiologia , Nefropatias/patologia , Razão de Chances , Ultrassonografia Doppler Transcraniana
17.
PLoS One ; 15(4): e0230980, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32240223

RESUMO

OBJECTIVES: Anemia is highly prevalent in chronic kidney disease patients; however, its identification and management have been reported to be suboptimal. In this study we aimed to describe the prevalence, severity, risk factors, and treatment of anemia in different nephrology centers, among chronic kidney disease patients who were not given renal replacement therapy. MATERIALS AND METHODS: We performed a multicenter cross-sectional study in three different nephrology clinics. Adult (>18 years of age) chronic kidney disease patients with an estimated glomerular filtration rate (eGFR) below 60 ml/min, and who were not started dialysis were recruited. Demographic, clinical and laboratory data regarding anemia and its management were collected using a standard data form. Anemia was defined as a hemoglobin level below 12g/dL and severe anemia as a hemoglobin level below 10g/dl. RESULTS: A total of 1066 patients were enrolled in the study. Anemia and severe anemia were present in 55.9% and 14.9% of the patients, respectively. The mean hemoglobin level for the whole cohort was 11.8±1.8 g/dL. Univariate analyses revealed that the mean hemoglobin level was significantly different among the centers. Moreover, the frequency of the presence of anemia stratified by severity was also significantly different among the centers. According to binary logistic regression analysis, gender, levels of eGFR and iron, ferritin ≥ 100 ng/mL, and the nephrology center were independent determinants of severe anemia. CONCLUSIONS: We found a high prevalence of anemia among chronic kidney disease patients who were not on renal replacement therapy. Each center should determine the treatment strategy according to the patient's characteristics. According to our results, the center-specific management of anemia seems to be important.


Assuntos
Anemia/epidemiologia , Anemia/etiologia , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/complicações , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Ferritinas/metabolismo , Taxa de Filtração Glomerular/fisiologia , Hemoglobinas/metabolismo , Humanos , Ferro/metabolismo , Falência Renal Crônica/complicações , Falência Renal Crônica/metabolismo , Masculino , Pessoa de Meia-Idade , Nefrologia/métodos , Prevalência , Insuficiência Renal Crônica/metabolismo , Fatores de Risco
18.
BMC Public Health ; 20(1): 422, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228513

RESUMO

BACKGROUND: Valid measurement of hemoglobin is important for tracking and targeting interventions. This study compares hemoglobin distributions between surveys matched by country and time from The Demographic and Health Survey (DHS) Program and the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. METHODS: Four pairs of nationally representative surveys measuring hemoglobin using HemoCue® with capillary (DHS) or venous (BRINDA) blood were matched by country and time. Data included 17,719 children (6-59 months) and 21,594 non-pregnant women (15-49 y). Across paired surveys, we compared distributional statistics and anemia prevalence. RESULTS: Surveys from three of the four countries showed substantial differences in anemia estimates (9 to 31 percentage point differences) which were consistently lower in BRINDA compared to DHS (2 to 31 points for children, 1 to 16 points for women). CONCLUSION: We identify substantial differences in anemia estimates from surveys of similar populations. Further work is needed to identify the cause of these differences to improve the robustness of anemia estimates for comparing populations and tracking improvements over time.


Assuntos
Anemia/epidemiologia , Saúde Global/estatística & dados numéricos , Hemoglobinas/análise , Saúde da População/estatística & dados numéricos , Adolescente , Adulto , Anemia/sangue , Biomarcadores/sangue , Pré-Escolar , Demografia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
19.
Zhonghua Er Ke Za Zhi ; 58(3): 201-205, 2020 Mar 02.
Artigo em Chinês | MEDLINE | ID: mdl-32135591

RESUMO

Objective: To explore the predictive values of routine blood test results for iron deficiency (ID) screening in children. Methods: Routine blood test results and serum ferritin (SF) levels from 1 443 healthy children (862 boys, 581 girls) aged 6 months to 18 years, who were seen for well-child visits between June 2017 and May 2019 in Children's Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. ID was defined as SF<20 µg/L, iron deficiency anemia (IDA) as ID with anemia (hemoglobin(Hb)<110 g/L at 6 months-5 years of age, Hb<120 g/L at 6-18 years of age), non-anemia ID as ID without anemia, non-ID anemia as SF≥20 µg/L with anemia, and healthy control subjects as those with SF≥20 µg/L but without anemia. The blood test results including Hb, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), and the percentage of low hemoglobin density (LHD) of healthy control, non-anemia ID, non-ID anemia, and IDA groups were compared by analysis of variance (ANOVA) or non-parametric test, quantitative data were described as x±s or M(interquartile range), and receiver operating characteristic curve (ROC) analysis was applied to assess predictive values of routine blood test results and LHD for detecting IDA and ID. Results: Among 1 443 children with median age of 2.1(3.3) years, 1 061 children were in healthy control group, 292 in non-anemia ID group, 43 in non-ID anemia group and 47 in IDA group. The prevalence of ID was much higher than that of anemia (23.5% (339/1 443) vs. 6.2% (90/1 443) , χ(2)=169.76, P<0.01). Compared with control group, non-anemia ID group showed higher LHD (0.088 (0.093) vs.0.073 (0.068), P<0.01) and RDW (0.131±0.013 vs. 0.126±0.008, P<0.01), lower MCV ((80±4) vs. (83±4) fl, P<0.01) and MCHC values ((326±9) vs. (329±8) g/L, P<0.01). IDA group showed higher LHD (0.322(0.544)) and RDW (0.151±0.018), lower MCV ((73±6) fl) and MCHC values((309±14) g/L) than non-anemia ID group (all P<0.01). The area under curve (AUC) values of MCHC, LHD, RDW and MCV for detecting ID were 0.63 (95%CI: 0.60-0.67), 0.63 (95%CI:0.60-0.67), 0.67 (95%CI: 0.63-0.70) and 0.73 (95%CI: 0.69-0.76) respectively. With cutoff limits (MCV<80.2 fl, RDW>0.131 or MCHC<322 g/L), MCV, RDW and MCHC showed higher sensitivity for screening ID than hemoglobin (0.540, 0.469 and 0.336 vs. 0.139, χ(2)=121.70, 87.47, 35.56, all P<0.01). Conclusion: MCV, RDW and MCHC can be used to screen ID in primary health care settings.


Assuntos
Anemia Ferropriva/diagnóstico , Anemia/diagnóstico , Adolescente , Anemia/epidemiologia , Anemia Ferropriva/sangue , Anemia Ferropriva/epidemiologia , Criança , Pré-Escolar , China/epidemiologia , Índices de Eritrócitos , Eritrócitos/química , Feminino , Hemoglobinas/química , Humanos , Lactente , Ferro/sangue , Ferro/deficiência , Masculino , Estudos Retrospectivos
20.
Rev Assoc Med Bras (1992) ; 66(1): 55-60, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32130382

RESUMO

OBJECTIVE: It has been observed that celiac disease (CD) is not restricted to a single type characterized by diarrhea but also has atypical, asymptomatic (silent), and latent forms. The prevalence of this autoimmune disease, which affects approximately 1% of the world, is estimated to be around 3%, including atypical and asymptomatic cases. In our study, we aimed to evaluate adult celiac patients. METHODS: Between December 2008-2015, patients diagnosed with CD over the age of 18 years old were included in the study. Patients' symptoms at admission, frequency and type of anemia, transaminase levels, and celiac antibody positivity, and autoimmune diseases diagnosed at follow up were evaluated retrospectively. RESULTS: Of 195 patients, 151 (77.4%) were female. The mean age of the patients was 35.73 ± 12.19 years (range, 18-71 years). A hundred patients (51.3%) had gastrointestinal symptoms. At the time of admission, 118 patients (60.5%) had anemia, and 52 (26.7%) had hypertransaminasemia. During the mean follow-up period of 58 months (36-120 months), 84 (43.1%) of the patients presented at least one autoimmune disease, and this rate was 96.6% in individuals diagnosed above the age of 50 years. CONCLUSION: In adult CD, resistant anemia, dyspepsia, and hypertransaminasemia are very common findings at the time of diagnosis, and the association with other autoimmune diseases, especially Hashimoto's thyroiditis, is high.


Assuntos
Anemia/epidemiologia , Doenças Autoimunes/epidemiologia , Doença Celíaca/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Anemia/complicações , Doenças Autoimunes/complicações , Doença Celíaca/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Estatísticas não Paramétricas , Centros de Atenção Terciária/estatística & dados numéricos , Doenças da Glândula Tireoide/complicações , Doenças da Glândula Tireoide/epidemiologia , Transaminases/sangue , Turquia/epidemiologia , Adulto Jovem
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