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1.
Am Fam Physician ; 104(3): 271-276, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34523897

RESUMO

Splenomegaly can be due to several mechanisms but is almost always a sign of a systemic condition. Patient habits, travel, and medical conditions can increase risk of splenomegaly and suggest etiology. Symptoms can suggest infectious, malignant, hepatic, or hematologic causes. Physical examination will typically reveal splenomegaly, but abdominal ultrasonography is recommended for confirmation. Physical examination should also assess for signs of systemic illness, liver disease, and anemia or other hematologic issues. The most common causes of splenomegaly in the United States are liver disease, malignancy, and infection. Except for apparent causes such as infectious mononucleosis, basic laboratory analysis and ultrasonography are the first-line steps in determining etiology. Malaria and schistosomiasis are common in tropical regions, where as many as 80% of people may have splenomegaly. Management of splenomegaly involves treating the underlying disease process. Splenectomies and spleen reduction therapies are sometimes performed. Any patient with limited splenic function requires increased vaccination and prophylactic antibiotics for procedures involving the respiratory tract. Acute infections, anemia, and splenic rupture are the most common complications of splenomegaly, and people with splenomegaly should refrain from participating in contact sports to decrease risk of rupture.


Assuntos
Esplenomegalia/diagnóstico , Esplenomegalia/terapia , Anemia/etiologia , Anemia/fisiopatologia , Gerenciamento Clínico , Humanos , Ruptura Esplênica/complicações , Ruptura Esplênica/cirurgia , Esplenomegalia/fisiopatologia , Ultrassonografia/métodos
2.
Br J Nurs ; 30(15): S32-S38, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34379458

RESUMO

Anaemia is a common and multifactorial blood disorder in elderly individuals. This condition may be a significant barrier to pressure ulcers healing as it is associated with a decreased level of oxygen being supplied to body tissues. Some nutritional deficiencies such as iron, vitamin B12 and folate may also cause anaemia and have a negative impact on pressure ulcer healing. An increased iron demand in hard-to-heal pressure ulcers is a significant factor associated with the risk of anaemia of chronic disease in elderly patients. Anaemia screening and correction may need to be considered as well as iron supplementation if required in pressure ulcer prevention and management.


Assuntos
Anemia , Lesão por Pressão , Cicatrização , Idoso , Anemia/fisiopatologia , Humanos , Lesão por Pressão/prevenção & controle , Cicatrização/fisiologia
3.
Nutrients ; 13(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34371908

RESUMO

Anemia has been acknowledged as worldwide problem, including in Indonesia. This cross-sectional study aims to explore dietary determinants as risk factors for anemia in children aged 6-36 months living in a poor urban area of Jakarta. The study was done in Kampung Melayu sub-district in Jakarta, Indonesia. Data was collected within two weeks in September-October 2020. A structured questionnaire for a 24-h recall and a semi-quantitative Food Frequency Questionnaire (FFQ) were used to collect the dietary intake data, and venous blood was withdrawn to determine the hemoglobin levels. Bivariate chi-square and multiple logistic regression tests were executed to explore the dietary determinant factors for anemia. We recruited 180 subjects. The average hemoglobin concentration was 11.4 ± 1.7 mg/dL; the anemia prevalence was 29.4%. The following variables were significantly associated with higher risk of anemia: no cow's milk formula consumption, inadequate intake of fats, protein, calcium, vitamin D, iron, zinc, vitamin A, vitamin C, vitamin B6, and vitamin B12. Only cow's milk formula consumption and zinc intake were revealed as the determinant factors of anemia. In conclusion, the prevalence of anemia was 29.4% among children aged 6-36 months old. Anemia was significantly associated with two dietary determinants as risk factors that are cow's milk formula consumption and zinc intake.


Assuntos
Anemia/epidemiologia , Dieta/efeitos adversos , Fenômenos Fisiológicos da Nutrição do Lactente , Estado Nutricional , Fatores Etários , Anemia/sangue , Anemia/diagnóstico , Anemia/fisiopatologia , Biomarcadores/sangue , Alimentação Artificial , Pré-Escolar , Estudos Transversais , Inquéritos sobre Dietas , Feminino , Hemoglobinas/metabolismo , Humanos , Indonésia/epidemiologia , Lactente , Fórmulas Infantis/efeitos adversos , Masculino , Prevalência , Medição de Risco , Fatores de Risco , Saúde da População Urbana , Zinco/sangue , Zinco/deficiência
4.
Transfusion ; 61(6): 1908-1915, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33938570

RESUMO

BACKGROUND: The anti-M antibody can lead to hemolytic disease of the fetus and newborn (HDFN) and adverse fetal outcomes, especially in the Asian population. However, fetal erythropoiesis resulting from M alloimmunization needs further investigation. STUDY DESIGN AND METHODS: We analyzed erythropoiesis in eight fetuses with M alloimmunization and compared them with the fetuses affected by anti-D. They were matched as pairs according to the gestational age of diagnosis and the hematocrit before treatment. Paired t-tests or paired Wilcoxon rank-sum tests were conducted to compare the difference in the cord blood indexes. Pearson correlation analysis was used to evaluate the correlativity between hematocrit and the reticulocyte percentage in the two groups. RESULTS: The fetuses in the MN group had lower reticulocyte count and percentage than those in the RhD group (p < .05). All of the fetal reticulocyte production indexes (RPIs) in the MN group were less than 2, indicating an inadequate hemopoietic response to anemia, while the majority of the RPIs in the RhD group (85.7%) were significantly higher (p = .003), with 6 cases greater than 2.5. Hematocrit was negatively correlated with reticulocyte percentage (y = 54.7-171.7x, r2  = 0.825, p = .005) in the RhD group, while no significant correlation was found in the MN group. No difference in the number of IUT, interval, or the fetal outcome was found between the two groups. CONCLUSION: Fetal reticulocytopenia provided direct evidence of an inadequate hemopoietic response in HDFN due to anti-M, leading to hyporegenerative anemia. Once the IgG component of anti-M is detected, close monitoring should be considered.


Assuntos
Anemia/imunologia , Eritroblastose Fetal/imunologia , Feto/imunologia , Imunoglobulina M/imunologia , Isoanticorpos/imunologia , Adulto , Anemia/etiologia , Anemia/fisiopatologia , Anemia/terapia , Transfusão de Sangue Intrauterina , Eritroblastose Fetal/fisiopatologia , Eritroblastose Fetal/terapia , Eritropoese , Feminino , Feto/fisiopatologia , Humanos , Recém-Nascido , Masculino , Gravidez , Reticulocitose , Imunoglobulina rho(D)/imunologia , Resultado do Tratamento , Adulto Jovem
5.
PLoS One ; 16(4): e0249789, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33852614

RESUMO

BACKGROUND: Anemia is one of the world's leading cause of disability and the most serious global public health issues. This systematic review and meta-analysis was conducted very carefully in order to give up the pooled compliance of Iron and Folic-Acid Supplementation in Sub-Saharan Africa. METHODS: To conduct this brief systematic review and meta-analysis, a related literature search was done from different sources, PubMed Medline and Google Scholar Journals. Then IFA Supplementation related searching engine was used to make the work more meaningful and intensive. Moreover, we used modified Newcastle-Ottawa quality assessment scale for cross sectional studies to assess the quality of the study in terms of their inclusion. Then, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to carry out the work in a carful manner. Finally, the pooled effect size was computed using the review manager and Compressive Meta-analysis software. RESULTS: Twenty-three studies, which encompassed 24272 pregnant women, were chosen for the analysis. From those an overall prevalence of compliance with Iron and Folic Acid Supplementation (IFAS) in pregnancy in SSA was 39.2%. However, the result from meta-analysis showed that women who were counseled on IFAS in their courses of pregnancy were 1.96 times more likely to adhere to IFAS compared to those who were not counseled [OR:1.96, 95% CI (1.76-,5.93)]. Moreover, it showed that women who had knowledge of IFAS were 2.71 times more likely to have compliance with IFAS as compared to those who had no knowledge of IFAS [OR:2.71, 95% CI (1.33,5.54)]. Also it revealed that those women who had knowledge of anemia were 5.42 times more likely to have compliance with IFAS as compared with those who had no knowledge of anemia [OR5.42, 95% CI (1.52, 19.43)]. Furthermore, women who had received fourth visit for ANC were 1.54 times more likely to have compliance with IFAS as compared to those who had not received for ANC [OR 1.54, 95% CI (0.66, 3.58.43)]. CONCLUSIONS: Our finding from this systematic review and meta-analysis shows the low case in prevalence of compliance to IFAS among pregnant women in SSA. Predictors for this includes: knowledge about anemia, knowledge about IFAS, counseling on IFAS and receiving fourth antenatal care visit were statistically correlated positively with compliance to IFAS. This demands careful appraisal of effect of prevention work for functioning policy, programs and plan nutrition intrusions for refining maternal dietary intake in gestation. Also dietary education intrusion requires to be planned to satisfy the needs of pregnant women. So we hope that the result of this study might be essential as a bridging stone for policy makers of Africa; exclusively for maternal and child health care. Finally, we recommended further studies to be conducted in the area of the study for more intensive and detailed suggestions.


Assuntos
Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Ferro/administração & dosagem , Adesão à Medicação , Estado Nutricional/fisiologia , Gestantes/psicologia , África ao Sul do Saara , Anemia/fisiopatologia , Anemia/prevenção & controle , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Gravidez , Gestantes/educação , Cuidado Pré-Natal
6.
J Pediatr Hematol Oncol ; 43(4): e486-e493, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33625076

RESUMO

Diastolic dysfunction is a known cause of mortality in adults with sickle cell disease (SCD). Left atrial function (LAf) and strain (LAS) are novel echocardiographic parameters to assess early diastolic dysfunction, which have not been assessed in pediatric SCD. Through a retrospective single-center study, we describe echocardiographic parameters of diastology in children with SCD and evaluate their relationship with clinical variables including anemia and blood pressure. Baseline clinical data, 24-hour ambulatory blood pressure monitoring data and echocardiography results were collected. LAf and LAS were measured using volumetric data and speckle-tracking echocardiography, respectively. Sixty-seven children with SCD (13.5±7 y, 47% male, 7% hypertensive) with a mean hemoglobin of 8.8±1.3 g/dL, LAf of 61±8% (n=53) and LAS of 46.3±7.4% (n=28) were included. LAS was significantly associated with hemoglobin (ρ=0.43, P=0.022) but not with maximal left atrial (LA) volume (ρ=-0.05, P=0.79) or any blood pressure parameters. On multivariate analysis, LAS decreased by 3.2% (1.3, 5.1) and LA volume increased by 1.6 mL/m2 (3.1, 0.08) for every 1 g/dL decrease in hemoglobin. Thus, severity of baseline anemia in pediatric SCD correlates with diastolic function as measured by LAS, independent of LA dilation.


Assuntos
Anemia Falciforme/fisiopatologia , Anemia/fisiopatologia , Pressão Sanguínea , Diástole , Adolescente , Anemia/complicações , Anemia Falciforme/complicações , Criança , Pré-Escolar , Feminino , Coração/fisiopatologia , Humanos , Masculino
7.
Arthritis Rheumatol ; 73(2): 276-285, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32892503

RESUMO

OBJECTIVE: Deficiency of adenosine deaminase 2 (DADA2) is a potentially fatal monogenic syndrome characterized by variable manifestations of systemic vasculitis, bone marrow failure, and immunodeficiency. Most cases are diagnosed by pediatric care providers, given the typical early age of disease onset. This study was undertaken to describe the clinical phenotypes and treatment response both in adults and in children with DADA2 in India. METHODS: A retrospective analysis of pediatric and adult patients with DADA2 diagnosed at various rheumatology centers across India was conducted. Clinical characteristics, diagnostic findings, and treatment responses were analyzed in all subjects. RESULTS: In total, 33 cases of DADA2 were confirmed in this cohort between April 2017 and March 2020. Unlike previous studies, nearly one-half of the confirmed cases presented during adulthood. All symptomatic patients exhibited features of vasculitis, whereas constitutional symptoms and anemia were more common in pediatric patients. Cutaneous and neurologic involvement were common, and 18 subjects had experienced at least one stroke. In addition, the clinical spectrum of DADA2 was expanded by recognition of novel features in these patients, including pancreatic infarction, focal myocarditis, and diffuse alveolar hemorrhage. Treatment with tumor necrosis factor inhibitors (TNFi) was initiated in 25 patients. All of the identified disease manifestations showed marked improvement after initiation of TNFi, and disease remission was achieved in 19 patients. Two cases were complicated by tuberculosis infection, and 2 deaths were reported. CONCLUSION: This report presents the first case series of patients with DADA2 from India, diagnosed by adult and pediatric care providers. The findings raise awareness of this syndrome, particularly with regard to its presentation in adults.


Assuntos
Agamaglobulinemia/fisiopatologia , Gastroenteropatias/fisiopatologia , Doenças Hematológicas/fisiopatologia , Nefropatias/fisiopatologia , Doenças do Sistema Nervoso/fisiopatologia , Imunodeficiência Combinada Severa/fisiopatologia , Adenosina Desaminase/genética , Adenosina Desaminase/metabolismo , Adolescente , Adulto , Agamaglobulinemia/diagnóstico , Agamaglobulinemia/tratamento farmacológico , Agamaglobulinemia/genética , Idade de Início , Anemia/fisiopatologia , Criança , Pré-Escolar , Diagnóstico Tardio , Feminino , Glucocorticoides/uso terapêutico , Hemorragia/fisiopatologia , Humanos , Índia , Lactente , Infarto/fisiopatologia , Peptídeos e Proteínas de Sinalização Intercelular/genética , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Leucopenia/fisiopatologia , Pneumopatias/fisiopatologia , Masculino , Miocardite/fisiopatologia , Pancreatopatias/fisiopatologia , Estudos Retrospectivos , Imunodeficiência Combinada Severa/diagnóstico , Imunodeficiência Combinada Severa/tratamento farmacológico , Imunodeficiência Combinada Severa/genética , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Vasculite/fisiopatologia , Adulto Jovem
8.
Biomed Res Int ; 2020: 8824291, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33294455

RESUMO

Background: Anemia is a major public health problem in both developed and developing countries especially among pregnant women. Nearly half of pregnant women in Ethiopia have anemia which has both health and economic impacts. Therefore, this study is aimed at identifying nutritional-related predictors of anemia among pregnant women attending antenatal care in Central Ethiopia, 2019. Methods: An unmatched case-control study was conducted at public hospitals in Central Ethiopia from February to April 2019. The consecutive sampling technique was used to select study participants. Data were collected by a structured questionnaire, and the collected data were entered into Epi Info version 7 and SPSS version 23 for analysis. Binary and multiple logistic regression analyses were computed to identify predictors of anemia. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value < 0.05 was used to determine the presence of an association. Result: A total of 426 pregnant women (142 cases and 284 controls) had participated in this study. Taking tea/coffee immediately after food (AOR = 2.35, 95% CI: 1.39-3.99), mid-upper arm circumference (MUAC) of mothers of <23 centimeters (AOR = 3.83, 95% CI: 2.26-6.49), the presence of forbidden food during pregnancy (AOR = 2.21, 95% CI: 1.24-3.88), not taking additional food (AOR = 1.99, 95% CI: 1.17-3.40), unable to take fruit (AOR = 4.05, 95% CI: 1.3-15.47), loss of appetite (AOR = 2.28, 95% CI: 1.28-4.09), low dietary diversity score (DDS) (AOR = 3.29, 95% CI: 1.83-5.90), and medium DDS (AOR = 2.88, 95% CI: 1.46-5.70) were found to be determinants of anemia. Conclusions: Taking tea or coffee immediately after food, MUAC of mothers, the presence of forbidden food, not taking additional food, frequency of taking fruit, and dietary diversity were predictors of anemia among pregnant women. Therefore, interventions targeted at prevention of anemia among pregnant mothers should emphatically consider those identified determinants. This finding also highlights the need for strong nutritional counseling to prevent anemia among pregnant mothers during antenatal care follow-ups along with other interventions.


Assuntos
Anemia/fisiopatologia , Fenômenos Fisiológicos da Nutrição , Cuidado Pré-Natal , Adulto , Estudos de Casos e Controles , Etiópia , Comportamento Alimentar , Feminino , Seguimentos , Hospitais Públicos , Humanos , Análise Multivariada , Gravidez
9.
PLoS One ; 15(11): e0240694, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33147287

RESUMO

BACKGROUND: Severe anaemia is a common clinical problem among young children in sub-Saharan Africa. However, the effect of severe anaemia on neurodevelopment of these children is not well described. Therefore, we assessed the neurodevelopmental performance of preschool children diagnosed with severe anaemia in Northern Uganda. METHODS: We conducted a prospective cohort study among children < 5 years of age 14 days post discharge after an episode of severe anaemia (Hb < 5.0 g/dl; n = 171; mean Hb = 3.9g/dl) at Lira Regional Referral Hospital, Uganda. Neurodevelopmental outcomes (cognitive, language and motor) were assessed using Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III). Age-adjusted z-scores for each domain were calculated using scores from healthy community control children (n = 88) recruited from the same environment for each age category. Multiple linear regression was used to compare z-scores in the cognitive, language and motor scales between the two groups after adjusting for weight-for-age z-score, socioeconomic status, mother's education, and father's employment on all the scales. RESULTS: The prevalence of neurodevelopmental impairment was 2.3% (95% CI: 0.8-6.1) for cognition, 1.7% (95%: 0.6-5.3) for language and 3.5% (95% CI: 1.6-7.6) for motor scales and 4.6% (95% CI: 2.3-9.1) for deficits in ≥1 area of neurodevelopment. Significant differences were observed between the two groups with the SA group performing worse on cognition [adjusted mean score, (Standard error, SE), P-value] [-0.20, (0.01) vs. 0.00, (0.01), P = 0.02]; language [-0.25, (0.01) vs. 0.00, (0.01), P< 0.001]; and motor [-0.17, (0.01) vs. 0.00, (0.01), P = 0.05] scales. CONCLUSION: In children < 5 years of age, severe anaemia was associated with neurocognitive (cognition, language and motor) deficits in the immediate period post treatment. Further research is needed to identify risk factors and determine the long-term effects of poor neurodevelopment in young children with severe anaemia.


Assuntos
Anemia/fisiopatologia , Cognição/fisiologia , Desenvolvimento da Linguagem , Destreza Motora/fisiologia , Transtornos do Neurodesenvolvimento/fisiopatologia , Anemia/epidemiologia , Anemia/terapia , Pré-Escolar , Comorbidade , Feminino , Hospitais , Humanos , Lactente , Recém-Nascido , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/epidemiologia , Alta do Paciente/estatística & dados numéricos , Prevalência , Estudos Prospectivos , Encaminhamento e Consulta , Índice de Gravidade de Doença , Uganda/epidemiologia
10.
PLoS One ; 15(11): e0241975, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33206682

RESUMO

BACKGROUND: Even though anemia was highly targeted in different global strategies, many pregnant and/or lactating women and children were suffering from it and its complications. Besides this, prior trend analysis has not been conducted among pregnant and/or lactating women in Ethiopia. Therefore, this study aimed to assess the trend and determinants of anemia change among pregnant and/or lactating women in Ethiopia. METHODS: The study utilized two consecutive Ethiopia Demographic and Health Survey (EDHS) datasets. A total of 6,106 and 5,641 pregnant and/or lactating women in 2011 and 2016 survey respectively were included in the analysis. The data were analyzed by using Stata version 14.0. Logit based decomposition analysis was done to identify contributing factors for anemia change and statistical significance was determined by using P-value. RESULTS: The trend of anemia was increased from 19% in 2011 to 29% in 2016 EDHS. The analysis revealed that, 8% of the overall change in anemia was because of the change in women's composition. Changes in the composition of pregnant and/or lactating women according to region, economic status and tobacco and/or cigarette use were the major sources of the change. Greater than 90% of the increase in anemia was due to differences in the coefficient. Mostly, the change in behaviors of the Amhara population, those who had a history of terminated pregnancy and use tobacco and/or cigarette were the sources of the change. CONCLUSIONS: Anemia among pregnant and/or lactating women was increased against government interventions over the last half-decade in Ethiopia. Programmatic interventions targeting Somali and Dire Dawa regions are still needed to decrease anemia.


Assuntos
Anemia/fisiopatologia , Lactação/fisiologia , Adolescente , Adulto , Etiópia , Feminino , Inquéritos Epidemiológicos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Gravidez , Inquéritos e Questionários , Adulto Jovem
11.
PLoS One ; 15(10): e0241003, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33095810

RESUMO

BACKGROUND: The composite Model for End-Stage Liver Disease Excluding International Normalized Ratio Score (MELD-XI) is a novel tool to evaluate cardio-renal and cardio-hepatic interactions in patients with advanced heart failure (HF). However, its prognostic ability remains unclear in elderly HF patients. METHODS AND RESULTS: From July 2014 to July 2018, patients hospitalized for HF were prospectively recruited at 16 centers. Clinical features, laboratory findings, and echocardiography results were assessed prior to discharge. Cardiovascular (CV) death and HF re-hospitalization were recorded. Of the 676 patients enrolled, 264 (39.1%) experienced CV events throughout a 1-year median follow-up period. Patients with high MELD-XI were predominantly male and had a higher prevalence of NYHA III/IV, history of HF admission, hyperuricemia, ventricular tachycardia, anemia, and ischemic heart disease. In Kaplan-Meyer analysis, patients with higher MELD-XI (≥11) scores showed a worse prognosis than did those with lower (<11) scores (log-rank p≤0.001). Multivariate Cox proportional hazards testing revealed MELD-XI as an independent predictor of CV events (HR: 1.033, 95% CI: 1.006-1.061, p = 0.015) after adjusting for age, gender, body mass index, NYHA III/IV, prior HF hospitalization, systolic blood pressure, ischemic etiology, ventricular tachycardia, anemia, BNP, and left ventricular ejection fraction. CONCLUSIONS: Cardio-renal and cardio-hepatic interactions predicted CV events in aged HF patients.


Assuntos
Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Fígado/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Anemia/epidemiologia , Anemia/fisiopatologia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Comorbidade , Eletrocardiografia , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Peptídeo Natriurético Encefálico/sangue , Prognóstico , Estudos Retrospectivos , Função Ventricular Esquerda
12.
Expert Rev Hematol ; 13(11): 1175-1188, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33028115

RESUMO

INTRODUCTION: Anemia has and will continue to be a central theme in medicine particularly as clinicians are treating a burgeoning population of complex multi-organ system processes. As a result of multiple randomized controlled trials (RCTs), meta-analyses, and societal recommendations overly restrictive paradigms and under-administration of erythropoiesis stimulating agents (ESAs) have likely been followed by clinicians among all specialties. AREAS COVERED: A review of anemia in the context of chronic kidney disease, hematologic malignancies, and cancer is presented with focus on the establishment of ESAs as integral in the treatment of anemia. Multiple RCTs and meta-analyses studying the use of ESAs are presented with focus upon their application to clinical practice. A 'compendium' is proffered describing the evolution, establishment, and implications of ESA administration initially among those with CKD with rapid subsequent application to the Hematology-Oncology population of patients. Literature search methodologies have included MEDLINE (1985-2020), PubMed (1996-2020), Cochrane Central Trials (1985-2020), EMBASE (2000-2020), and ClinicalTrials.gov (2000-2020). EXPERT OPINION: Upon evaluation of risks and benefits of ESAs focused opinion and commentary is made supporting more liberal use of these agents and strongly suggesting that the current underlying treatment 'pendulum' has perhaps shifted too far to the 'under-treatment' side in many cases.


Assuntos
Anemia/terapia , Neoplasias/complicações , Insuficiência Renal Crônica/complicações , Anemia/tratamento farmacológico , Anemia/etiologia , Anemia/fisiopatologia , Transfusão de Sangue , COVID-19/epidemiologia , Terapia Combinada , Epoetina alfa/efeitos adversos , Epoetina alfa/uso terapêutico , Eritropoetina/fisiologia , Eritropoetina/uso terapêutico , Prova Pericial , Previsões , Fidelidade a Diretrizes , Hematínicos/administração & dosagem , Hematínicos/uso terapêutico , Neoplasias Hematológicas/complicações , Hematopoese , Humanos , Ferro/uso terapêutico , Medicina , Metanálise como Assunto , Estudos Multicêntricos como Assunto , Isquemia Miocárdica/complicações , Estudos Observacionais como Assunto , Pandemias , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Ensaios Clínicos Controlados Aleatórios como Assunto , Receptores da Eritropoetina/efeitos dos fármacos , Diálise Renal , Insuficiência Renal Crônica/terapia , SARS-CoV-2 , Tromboembolia Venosa/induzido quimicamente
13.
Sci Rep ; 10(1): 16514, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33020528

RESUMO

Proprotein convertase subtilisin/kexin type 9 (PCSK9) deficiency leads to lower cholesterol and is associated with reduced vascular complications in the general population. Cholesterol lowering may also have beneficial effects in sickle cell disease (SCD). The objective of this study was to determine effects of PCSK9 deficiency in a mouse model of SCD. Bone marrow transplantation (BMT) was performed from donor SCD mice to wild-type, PCSK9-deficient, and LDLR-deficient recipients to generate SCD controls (Pcsk9+/+, SCDbmt) with preserved PCSK9 status, SCD mice with deficiency of PCSK9 (Pcsk9-/-, SCDbmt), and SCD mice with deficiency of LDLR (Ldlr-/-, SCDbmt). Although cholesterol levels were lower in Pcsk9-/-, SCDbmt mice compared to Pcsk9+/+, SCDbmt mice, anemia was more severe in Pcsk9-/-, SCDbmt mice. Increased reticulocytosis, enhanced ex vivo erythrocyte sickling, and increased erythrocyte phosphatidylserine exposure was also observed. Livers, spleens, and kidneys contained increased iron in Pcsk9-/-, SCDbmt mice compared to Pcsk9+/+, SCDbmt mice consistent with greater hemolysis. SCD mice with deficiency of LDLR (Ldlr-/-, SCDbmt mice) had similar anemia as Ldlr+/+, SCDbmt mice despite higher serum cholesterol. In conclusion, deficiency of PCSK9 is associated with worsened anemia in SCD mice due to increased hemolysis. These findings may have implications for lipid-lowering strategies in patients with SCD, as well as for potential novel modifiers of anemia severity.


Assuntos
Anemia Falciforme/fisiopatologia , Anemia/metabolismo , Pró-Proteína Convertase 9/metabolismo , Anemia/fisiopatologia , Anemia Falciforme/metabolismo , Animais , Transplante de Medula Óssea/métodos , Colesterol/metabolismo , LDL-Colesterol/sangue , Modelos Animais de Doenças , Fígado/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Pró-Proteína Convertase 9/genética , Pró-Proteína Convertase 9/fisiologia , Pró-Proteína Convertases/metabolismo , Receptores de LDL/metabolismo , Receptores de LDL/fisiologia , Serina Endopeptidases/metabolismo , Subtilisinas/metabolismo
14.
Transfus Apher Sci ; 59(5): 102949, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32994126

RESUMO

Maternal alloantibody-mediated hemolytic disease of the fetus and newborn (HDFN) ranges from no or mild symptoms to severe hydrops and intrauterine fetal demise. Hemolytic anti-D-mediated HDFN proceeds via a long-known mechanism, to which three other pathways to fetal/neonatal anemia may be added: (0) Fetal erythrocyte destruction can proceed by extravascular phagocytosis. (1) An apoptotic pathway has been described for anti-Kell, and anti-Ge3. (2) Erythropoietic suppression may arise from altered or deformed erythroblast architecture in anti-M-mediated disease. (3) Clonal escape from erythropoietic suppression is hypothesized to arise from maternal anti-Jra immune pressure, albeit this requires further elucidation. Alloantibody-mediated anemic disease of the fetus and newborn (ADFN) is a designation we favor for cases when hemolysis or hyperbilirubinemia are not the dominant features, such as those provoked by anti-Kell, anti-Ge3, anti-M, and anti-Jra.


Assuntos
Anemia/genética , Eritroblastose Fetal/imunologia , Hemólise/imunologia , Sistema do Grupo Sanguíneo de Kell/imunologia , Anemia/fisiopatologia , Feminino , Feto , Humanos , Recém-Nascido
15.
Placenta ; 101: 132-138, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32979717

RESUMO

INTRODUCTION: Past studies have shown that maternal anemia is associated with a heavy placenta or a higher placental weight/birthweight (PW/BW) ratio. Although these findings suggest a non-linear relationship between maternal hemoglobin concentration and PW/BW ratio, this relationship has not been closely examined. METHODS: We evaluated 83,354 singletons and their mothers in a nation-wide birth cohort study, the Japan Environment and Children's Study (JECS). The associations between maternal hemoglobin concentration and placental weight, birthweight, and PW/BW ratio were assessed. RESULTS: Mean placental weight was significantly higher in women with moderate or severe anemia (576 [183] g), but not in women with elevated hemoglobin levels (564 [117] g), compared with in women with normal hemoglobin levels (560 [115] g). In contrast, mean PW/BW ratio was significantly higher in women with moderate or severe anemia (0.190 [0.049]) or elevated hemoglobin levels (0.189 [0.033]) than in women with normal hemoglobin levels (0.185 [0.033]). In a regression analysis with cubic spline, a U-shaped relationship was found between maternal hemoglobin concentration and PW/BW ratio. DISCUSSION: We demonstrated non-linear and concentration-dependent relationships between maternal hemoglobin concentration and placental weight, birthweight, and PW/BW ratio. Although the mechanisms underlying these associations are not fully understood, we suggest that low or elevated hemoglobin concentration may lead to placental compensatory hypertrophy and fetal growth restriction. Prevention and proper management of anemia before and during pregnancy are important for a well-functioning placenta and favorable fetal growth.


Assuntos
Anemia/fisiopatologia , Peso ao Nascer , Hemoglobinas/metabolismo , Placentação , Complicações Hematológicas na Gravidez/fisiopatologia , Adulto , Anemia/sangue , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , Tamanho do Órgão , Gravidez , Complicações Hematológicas na Gravidez/sangue
16.
Rev. patol. respir ; 23(3): 95-98, jul.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-198472

RESUMO

La anemia más frecuente en los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) es la de trastornos crónicos, cuya prevalencia oscila entre el 5 y el 33% de los casos. Su presencia tiene un impacto pronóstico, ya que puede empeorar el grado de disnea y la tolerancia al ejercicio en estos enfermos. Debido a que en la EPOC hay un estado de inflamación crónica, el diagnóstico de anemia y deficiencia de hierro en presencia de esta enfermedad es complejo. En cuanto al tratamiento, no existen actualmente estudios con evidencia suficiente para realizar indicaciones al respecto. No obstante, dado que el mecanismo fisiopatológico es similar, las recomendaciones pueden ser similares a las que se establecen para la insuficiencia cardiaca


The most frequent anemia in patients with chronic obstructive pulmonary disease (COPD) is that of chronic disorders, whose prevalence ranges from 5% to 33% of cases. Its presence has a prognostic impact, since it can worsen the degree of dyspnea and exercise tolerance in these patients. Because there is a state of chronic inflammation in COPD, the diagnosis of anemia and iron deficiency in the presence of this disease is complex. Regarding treatment, there are currently no studies with sufficient evidence to make indications in this regard. However, since the pathophysiological mechanism is similar, the recommendations may be similar to those established for heart failure


Assuntos
Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Anemia/fisiopatologia , Deficiência de Ferro , Anemia/diagnóstico , Anemia/terapia , Prognóstico , Deficiência de Ferro/diagnóstico , Deficiência de Ferro/terapia , Comorbidade , Insuficiência Cardíaca/fisiopatologia
17.
High Blood Press Cardiovasc Prev ; 27(5): 399-408, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32770527

RESUMO

INTRODUCTION: The association of patients with heart failure (HF) and preserved ejection fraction (HFpEF) and with type 2 diabetes mellitus (T2DM) is strong and related additionally to blood pressure (BP). AIMS: To analyze distinctive clinical profiles among patients with HFpEF both with and without T2DM. METHODS: The study was based on a Spanish National Registry (multicenter and prospective) of patients with HF (DICUMAP), that enrolled outpatients with HF who underwent an ambulatory BP monitoring (ABPM) and then were followed-up for 1 year. We categorized patients according to the presence/absence of T2DM then building different clusters based on K-medoids algorithm. RESULTS: 103 patients were included. T2DM was present in 44.7%. The patients with T2DM were grouped into two clusters and those without T2DM into three. All patients with T2DM had kidney disease and anemia. Among them, cluster 2 had higher systolic blood pressure and pulse pressure (PP) with a bad outcome (p = 0.03) regarding HF mortality and readmissions, influenced by eGFR (HR 0.93, 95% CI 0.97-0.87, p = 0.04), and hemoglobin (HR 0.65, 95% CI 0.71-0.63, p = 0.03). Among those without T2DM, cluster 3 had a pathological ABPM pattern with the highest PP, cluster 4 was slightly similar to cluster 2, and cluster 5 expressed a more benign pattern without differences on both, HF mortality and readmissions. CONCLUSIONS: Patients with HFpEF and T2DM expressed two different profiles depending on neurohormonal activation and arterial stiffness with prognostic implications. Patients without T2DM showed three profiles depending on ABPM pattern, kidney disease and PP without prognostic repercussion.


Assuntos
Pressão Sanguínea , Diabetes Mellitus Tipo 2/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Volume Sistólico , Função Ventricular Esquerda , Idoso , Idoso de 80 Anos ou mais , Anemia/mortalidade , Anemia/fisiopatologia , Monitorização Ambulatorial da Pressão Arterial , Análise por Conglomerados , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Diabetes Mellitus Tipo 2/terapia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Humanos , Nefropatias/mortalidade , Nefropatias/fisiopatologia , Masculino , Readmissão do Paciente , Prognóstico , Sistema de Registros , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo
18.
J Pharm Pharm Sci ; 23: 278-288, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32762831

RESUMO

Anemia is a common complication of chronic kidney disease (CKD), and its prevalence has shown a tendency to increase in many countries. Anemia is associated with incident heart failure and increases mortality in CKD patients, garnering public attention. Here, we reviewed recent studies about CKD with anemia, and tried to summarize the risks and causes and new progress in the treatment of renal anemia. Among the risks and causes, calcium and phosphorus metabolism disorders should be pointed out along with common causes such as iron and erythropoietin deficiencies, hypoxia, inflammation and uremic toxins, and so on. The new anti-anemia treatments mainly include hematopoietic materials supplementation, erythropoietin-stimulating agents, calcium and phosphorus regulators and hypoxia-inducible factor prolyl hydroxylase inhibitors.


Assuntos
Anemia/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Anemia/etiologia , Anemia/fisiopatologia , Cálcio/metabolismo , Humanos , Fósforo/metabolismo , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco
19.
Clin Exp Nephrol ; 24(12): 1162-1176, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32779058

RESUMO

BACKGROUND: ESRD (End-stage renal disease) treatment is a comprehensive medical process and requires numerous serological biochemical tests (SBTs) in diagnosis. To reduce these invasive, expensive, cumbersome, and time-consuming SBTs, there is a need to develop an alternative serological biochemical composition evaluation method. Bioelectrical impedance analysis (BIA) is affected by body's chemical and physical components, which might be correlated with serological biochemical composition and can be potentially used to evaluate biochemical composition in hemodialysis patient treatments. In this work, the relationship of classic and specific bioelectrical impedance vector analysis (BIVA) with major serological biochemical indexes in maintenance hemodialysis (MHD) patients was examined. METHODS: Bioelectrical and biochemical datasets were measured from 280 women and 408 men and formed 3872 effective biochemical-bioelectrical records in total. Statistical analysis was performed. RESULTS: The results show that BIVA vectors have strong relationship with phosphorus, hemoglobin, and PTH in both male and female groups. Strong correlation was also observed between Ca, albumin, CHOL, LDLC, and BIVA vectors in the male group. In the female group, a significant correlation was observed between classic BIVA values and NT-proBNP. SVM models are effective for classifying biochemical indexes. CONCLUSIONS: The obtained correlations and SVM classification models imply that BIVA can be used as a preliminary tool to evaluate and classify the degree of anemia, malnutrition, fluid overload, and mineral and bone disorder (MBD) in MHD patients by reducing the number of SBTs.


Assuntos
Anemia/diagnóstico , Composição Corporal , Distúrbio Mineral e Ósseo na Doença Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Desnutrição/diagnóstico , Estado Nutricional , Diálise Renal , Adulto , Idoso , Anemia/sangue , Anemia/fisiopatologia , Biomarcadores/sangue , Distúrbio Mineral e Ósseo na Doença Renal Crônica/sangue , Distúrbio Mineral e Ósseo na Doença Renal Crônica/fisiopatologia , Estudos Transversais , Impedância Elétrica , Feminino , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Masculino , Desnutrição/sangue , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Adulto Jovem
20.
PLoS One ; 15(8): e0237600, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813750

RESUMO

BACKGROUND: Preeclampsia and eclampsia are common complications of pregnancy globally, including sub-Saharan African (SSA) countries. Although it has a high burden on maternal and neonatal mortality and morbidity, evidence on the risk of the problem is limited. Therefore, the aim of this review was to examine the factors associated with preeclampsia and eclampsia among mothers in SSA countries. METHODS: We searched article from SSA countries using electronic database MEDLINE, EMBASE, PubMed, CINAHL published in English from January 2000 to May 2020. Two reviewers independently screened, extracted and assessed the quality of the articles. Both random and fixed effect model were used for analysis. Heterogeneity of the studies and publication bias were checked. STATA 16 used for analysis. RESULTS: Fifty-one studies met the inclusion criteria and included in this review. The following factors were identified through meta-analysis: being primiparous (OR: 2.52; 95% CI:1.19, 3.86), previous history of maternal preeclampsia/eclampsia (OR:5.6; 95% CI:1.82, 9.28), family history of preeclampsia/eclampsia (OR:1.68; 95% CI:1.26, 2.11), high maternal body mass index (OR: 1.69; 95% CI:1.17, 2.21), chronic hypertension (OR: 2.52; 95% CI:1.29, 3.74), anaemia during pregnancy (OR: 3.22; 95% CI:2.70, 3.75) and lack of antenatal care visits (OR: 2.71; 95% CI:1.45, 3.96). There was inconclusive evidence for a relationship with a number of other factors, such as nutrition and related factors, antenatal care visits, birth spacing, and other factors due to few studies found in our review. CONCLUSIONS: The risk of preeclampsia and eclampsia is worse among women who have a history of preeclampsia/eclampsia (either themselves or family members), primiparous, obesity and overweight, living with chronic disease, having anaemia during pregnancy and absence from ANC visits. Therefore, investment must be made in women's health needs to reduce the problem and health service providers need to give due attention to high-risk women.


Assuntos
Anemia/fisiopatologia , Eclampsia/epidemiologia , Hipertensão/fisiopatologia , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Pré-Eclâmpsia/epidemiologia , África ao Sul do Saara/epidemiologia , Feminino , Humanos , Incidência , Gravidez , Fatores de Risco
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