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1.
Medicine (Baltimore) ; 98(36): e16780, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490365

RESUMO

To investigate the influence of uterine artery ligation before placental delivery during cesarean section on postpartum hemorrhage (PPH) and related complications in patients with placenta previa accreta.A retrospective study was conducted of data from 78 patients with pernicious placenta previa, treated at Fujian Provincial Maternal and Child Health Hospital (Fuzhou, China) between January 2014 and June 2018. Twenty-nine patients underwent uterine arterial ligation before placental delivery (UALBPD), and the other 49 patients in the control group did not undergo peri-paracentesis before the delivery of the placenta. The statistical analysis and data management were performed with SPSS 19.0.The intraoperative and postoperative complications after uterine artery ligation were compared between the 2 groups: in the UALBPD group, no woman (0.0%) underwent a subtotal cesarean hysterectomy, whereas four (8.2%) did so in the control group (P = .24). The mean number of packed red blood cell (RBC) units transfused was 3.7 ±â€Š1.2 in the UALBPD group and 5.7 ±â€Š3.4 units in the control group (P = .0002). The estimated blood loss was 734.2 ±â€Š317.5 mL in the UALBPD group and 1101.6 ±â€Š442.7 mL in the control group (P < .0001). Nine (31.0%) women in the UALBPD group underwent transfusion compared with 38 (77.6%) in the control group (P = .003). The reduction in hemoglobin was 2.63 ±â€Š1.85 g/L in the UALBPD group and 5.41 ±â€Š2.38 g/L in the control group (P < .0001). The reduction in hematocrit was 2.96 ±â€Š4.07 in the UALBPD group and 6.77 ±â€Š8.74 (%) in the control group (P = .009).Bilateral uterine artery ligation before the delivery of the placenta in women with placenta accreta can effectively reduce the amount of intraoperative blood loss, the incidence of PPH, and the risk of complications, such as hysterectomy.


Assuntos
Cesárea/métodos , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/prevenção & controle , Artéria Uterina/cirurgia , Adulto , Transfusão de Sangue/estatística & dados numéricos , Feminino , Hemoglobinas/análise , Humanos , Gravidez , Estudos Retrospectivos , Adulto Jovem
2.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(4): 492-500, 2019 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-31484611

RESUMO

To compare the accuracy of SHA.LIN,S.T.O.N.E.nephrolithometry scoring system,and Clinical Research Office of the Endourological Society(CROES)nephrolithometry nomogram in predicting percutaneous nephrolithotomy(PCNL)outcomes including stone free rate(SFR)and perioperative status. Methods The clinical data of 90 patients with nephrolithiasis undergoing PCNL in department of urology,China-Japan Friendship Hospital from January 2015 to March 2018 were retrospectively analyzed.The general data,stone characteristics,operation approaches,and perioperative variables were recorded.SHA.LIN,S.T.O.N.E.score,and CROES nomogram were assigned according to the computed tomography(CT)findings before surgery.Stone free status was evaluated by kidney-ureter-bladder one month after PCNL.The relationships of SHA.LIN score,S.T.O.N.E.score,and CROES score with SFR,postoperative complications,operation time(OT),length of hospital stay(LOS),estimated blood loss(EBL),and decrease of hemoglobin was evaluated.Receiver operating characteristic(ROC)curves were used to analyze the predictive accuracy. Results The SFR was 72.2%(65/90)and postoperative complications occurred in 33 cases(36.7%).The mean OT was(103.1±39.6)min,the mean EBL was(46.1±53.0)ml,the mean LOS was(15.3±5.2)d,the mean postoperative LOS was(8.5±3.4)d,and the mean decrease of hemoglobin was(16.1±10.2)g/L.Stone-free patients had significantly lower SHA.LIN score(8.23 vs. 10.36,P=0.000)and S.T.O.N.E.score(7.05 vs.8.16,P=0.000)and significantly higher CROES score(188.50 vs. 143.89,P=0.000)compared to patients with residual fragments.All these scores were not significantly associated with complications(P>0.05).On the other hand,all these scores were significantly correlated with OT,EBL,and decrease of hemoglobin(SHA.LIN:POT=0.006,PEBL=0.028,Pdecrease of hemoglobin=0.014;S.T.O.N.E.:POT=0.012,PEBL=0.047,Pdecrease of hemoglobin=0.011;and CROES:POT=0.040,PEBL=0.045,Pdecrease of hemoglobin=0.013).SHA.LIN(P=0.001)and S.T.O.N.E.(P=0.005)scores were associated with LOS.Logistic regression analysis revealed that SHA.LIN(OR=2.491),S.T.O.N.E.(OR=3.030),and CROES(OR=0.973)scores were significantly associated with stone-free status.ROC curves in predicting SFR showed that there was significant difference in the areas under the curves(AUC)for the SHA.LIN vs. S.T.O.N.E.score [0.808(95% CI=0.711-0.905)vs. 0.748(95% CI=0.632-0.864),P=0.047].AUC for the CROES score [0.770(95% CI=0.664-0.877)] showed no significantly different for the SHA.LIN score or the S.T.O.N.E.score(P>0.05). Conclusions All these three scoring systems have good predictive accuracy for SFR.SHA.LIN is more precise than S.T.O.N.E.in predicting SFR.However,they can not predict postoperative complications.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea , Nomogramas , China , Hemoglobinas/análise , Humanos , Tempo de Internação , Duração da Cirurgia , Complicações Pós-Operatórias , Prognóstico , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
3.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(4): 541-547, 2019 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-31484619

RESUMO

Perioperative restrictive red blood cell(RBC)transfusion strategy,in which a trigger of hemoglobin(Hb)<7 g/dl is used,is of great benefits to save blood storage and reduce transfusion-related adverse events including infections,immunologic risks,and circulatory overload.Human body can display a series of compensatory mechanisms to acute anemia,including increased cardiac output,favored oxyhemoglobin dissociation,and lung vascular dilation.Therefore,moderate Hb decrease does not necessarily lead to hypoxemia.Patients undergoing hip surgery or suffering from septic shock and/or upper gastrointestinal bleeding can benefit from restrictive RBC transfusion;however,restrictive transfusion may be associated with adverse outcomes in patients with coronary heart disease or undergoing cardiac surgery.Restrictive RBC transfusion strategies have been included in described in many different guidelines.Most of them recommended Hb<7 g/dl to be a trigger for allogeneic RBC transfusion.For patients with an Hb of 7-10 g/dl,the application of restrictive RBC transfusion should be based on the expected blood loss,compensatory ability,and metabolic rate.


Assuntos
Transfusão de Eritrócitos , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Hemoglobinas/análise , Humanos , Assistência Perioperatória
4.
Bone Joint J ; 101-B(9): 1122-1128, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474150

RESUMO

AIMS: Low haemoglobin (Hb) at admission has been identified as a risk factor for mortality for elderly patients with hip fractures in some studies. However, this remains controversial. This study aims to analyze the association between Hb level at admission and mortality in elderly patients with hip fracture undergoing surgery. PATIENTS AND METHODS: All consecutive patients (prospective database) admitted with hip fracture operated in a tertiary hospital between 2012 and 2016 were analyzed. We collected patient characteristics, time to surgery, duration and type of surgery, comorbidities, Hb at admission, nadir of Hb after surgery, the use and amount of red blood cells (RBCs) transfusion products, postoperative complications, and death. The main outcome measures were mortality at 30 days, 90 days, 180 days, and one year after surgery. RESULTS: We included 829 patients; the mean age was 81 years (sd 11). Mortality at 30 days, 90 days, 180 days, and one year was 5.7%, 12.3%, 18.1%, and 23.5%, respectively. The highest mortality was observed in patients aged over 80 years (162/557, 29%) and in male patients (85/267, 32%). Survival at 90 days, 180 days, and one year after surgery was significantly lower in patients with a Hb level below 120 g/l at admission. In multivariate analysis, Hb level below 120 g/l at admission was found to be an independent factor associated with mortality (adjusted hazard ratio (aHR) 1.68 (95% confidence interval (CI) 1.22 to 2.31); p = 0.001), along with age (aHR 1.06 (95% CI 1.04 to 1.06); p < 0.001), male sex (aHR 2.19 (95% CI 1.61 to 2.96); p < 0.001), and need for RBC transfusions (aHR 1.10 (95% CI 1.02 to 1.19); p = 0.01). CONCLUSION: Our results suggest that low Hb at admission along with age and RBC transfusions is significantly associated with short- and long-term mortality after hip fracture surgery, independently of comorbidity confounders. Further studies should be performed to understand how preoperative Hb could be taken into account in perioperative management. Cite this article: Bone Joint J 2019;101-B:1122-1128.


Assuntos
Anemia/sangue , Anemia/mortalidade , Hemoglobinas/análise , Fraturas do Quadril/mortalidade , Fraturas por Osteoporose/mortalidade , Idoso , Idoso de 80 Anos ou mais , Anemia/complicações , Anemia/terapia , Comorbidade , Transfusão de Eritrócitos/mortalidade , Feminino , Fraturas do Quadril/complicações , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Masculino , Fraturas por Osteoporose/complicações , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de Risco
7.
N Engl J Med ; 381(5): 407-419, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31365799

RESUMO

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


Assuntos
Anemia/terapia , Transfusão de Sangue , Hemoglobinas/análise , Tempo para o Tratamento , Anemia/complicações , Anemia/mortalidade , Transfusão de Sangue/economia , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Seguimentos , Custos de Cuidados de Saúde , Humanos , Lactente , Tempo de Internação/economia , Malária/complicações , Malaui/epidemiologia , Masculino , Readmissão do Paciente/estatística & dados numéricos , Reação Transfusional/epidemiologia , Uganda/epidemiologia
9.
N Engl J Med ; 381(5): 420-431, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31365800

RESUMO

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


Assuntos
Anemia/terapia , Transfusão de Sangue , Hemoglobinas/análise , Anemia/complicações , Anemia/mortalidade , Transfusão de Sangue/economia , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Febre/complicações , Seguimentos , Custos de Cuidados de Saúde , Humanos , Lactente , Tempo de Internação/economia , Malária/complicações , Malaui/epidemiologia , Masculino , Readmissão do Paciente/estatística & dados numéricos , Reação Transfusional/epidemiologia , Uganda/epidemiologia
10.
Am Surg ; 85(7): 708-711, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405412

RESUMO

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


Assuntos
Anemia/sangue , Anemia/mortalidade , Hemoglobinas/análise , Alta do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Feminino , Humanos , Modelos Logísticos , Masculino , Estudos Retrospectivos
11.
Medicine (Baltimore) ; 98(34): e16713, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441844

RESUMO

To evaluate the nutritional status of children with chronic kidney disease (CKD) before dialysis via a series of indexes, and investigate the prognostic impact of nutritional status in these patients assessed by the Prognostic Nutritional Index (PNI).Fifty-four children with CKD before dialysis were enrolled in this study. The nutritional status was evaluated by different indexes, including dietary intake, anthropometry data and biochemical parameters. Additionally, PNI is calculated as 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (/mm). Glomerular filtration rate (GFR) of patients with different PNI scores was followed up.Thirty-four patients (63.0%) experienced unreasonable dietary intake, and the patients with CKD stage 4 were characterized by lower energy intake. The height was the most affected anthropometry parameter. Additionally, 46 patients (85.2%) suffered from anemia. The serum albumin of 42 patients (77.8%) was <35 g/L, while 34 cases (63.0%) had increased cholesterol and triglyceride. According to the PNI scores, the patients were divided into 3 groups: high-PNI (PNI ≥ 38), middle-PNI (35 ≤ PNI < 38), and low-PNI (PNI < 35). Of the 54 patients, the PNI was <35 in 29 (53.7%) and ≥38 in 13 (24.1%). The patients with CKD stage 4 were belonged to the low-PNI group. At follow-up, GFR decreased significantly in patients with low-PNI scores compared with the high-PNI group (P < .05).Malnutrition, as a common complication of CKD, has a prognostic impact in children with CKD before dialysis, as assessed by the PNI score.


Assuntos
Avaliação Nutricional , Estado Nutricional/fisiologia , Insuficiência Renal Crônica/fisiopatologia , Pesos e Medidas Corporais , Criança , Ingestão de Energia , Feminino , Taxa de Filtração Glomerular , Hemoglobinas/análise , Humanos , Estimativa de Kaplan-Meier , Lipídeos/sangue , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise
12.
Medicine (Baltimore) ; 98(34): e16793, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441851

RESUMO

Osteoporosis is a chronic, progressive disease in which early diagnosis is very important. The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have been reported as new predictors in inflammatory and immune diseases including osteoporosis. No studies have reported the relationship between monocyte-to-lymphocyte ratio (MLR) and osteoporosis patients.To investigated the ability of MLR to predict osteoporosis.Three hundred sixteen osteoporosis patients and 111 healthy control subjects were enrolled. Patients' laboratory and clinical characteristics were recorded. MLR, NLR, and PLR levels were calculated. The differences were compared and the diagnostic values of MLR were analyzed.There were 76 male and 105 female patients included, with a mean age of 56.57 ±â€Š9.95 years. The levels of MLR, NLR, and PLR in osteoporosis patients were all higher than those in healthy control subjects. The area under the curve of MLR was higher than those of NLR and PLR. Multivariate linear regression analysis showed that T-score was affected by age and MLR. MLR was positively correlated with C-reactive protein, erythrocyte sedimentation rate, red blood cell distribution width, age, sex, and inversely with hemoglobin. MLR and PLR levels were significantly higher in osteoporosis patients than in osteopenia patients (P < .05).The present study shows that MLR had a higher diagnostic value for osteoporosis. MLR may be a reliable, inexpensive, and novel potential predictor of osteoporosis.


Assuntos
Linfócitos/metabolismo , Monócitos/metabolismo , Osteoporose/sangue , Adulto , Fatores Etários , Idoso , Plaquetas/metabolismo , Sedimentação Sanguínea , Proteína C-Reativa/biossíntese , Estudos Transversais , Feminino , Hemoglobinas/análise , Humanos , Mediadores da Inflamação/metabolismo , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
13.
Life Sci ; 234: 116787, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31445028

RESUMO

Iron deficiency anemia (IDA) is a major worldwide public health problem. This is due to its prevalence among infants, children, adolescents, pregnant and reproductive age women. Ferrous sulfate (FeSO4) is the first line therapy for iron IDA. Unfortunately, it is reported that FeSO4 suffers from low absorption rate in the body and itself exhibits severe side effects. Herein, iron oxide magnetic nanoparticles-loaded liposomes (LMNPs) are prepared, characterized and evaluated as a treatment regimen for IDA in Wistar rats (as an animal model). Iron oxide magnetic nanoparticles (MNPs) are prepared and loaded into liposomes using the thin film hydration method. The size of the prepared formulations is in the range 10-100 nm, thus it can avoid the reticular endothelial system (RES), and increased their blood circulation time. For in vivo assessment, thirty-five Wistar rats are divided into 5 groups (n = 7): negative control group, positive control group, and three groups treated with different iron formulations (FeSO4, MNPs and LMNPs). Anemia is induced in the anemic groups by the bleeding method and then treatment started with different iron compounds administrated orally for 13 days. Hematological parameters are followed up during the treatment period. Results indicate that, in the LMNPs group, the hematological parameters turn to normal values and the histopathological structures of the liver, spleen and kidney remain normal. This proves that liposome increases the bioavailability of MNPs. In conclusion, LMNPs demonstrate superiority as a therapeutic regimen for the treatment of IDA among the tested iron formulations.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Compostos Ferrosos/administração & dosagem , Hematínicos/administração & dosagem , Lipossomos/química , Nanopartículas de Magnetita/química , Anemia Ferropriva/sangue , Animais , Disponibilidade Biológica , Feminino , Compostos Ferrosos/farmacocinética , Compostos Ferrosos/uso terapêutico , Hematínicos/farmacocinética , Hematínicos/uso terapêutico , Hemoglobinas/análise , Lipossomos/ultraestrutura , Nanopartículas de Magnetita/ultraestrutura , Ratos Wistar
14.
Pan Afr Med J ; 33: 48, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31448011

RESUMO

Introduction: diagnostic methods and management of iron deficiency and iron deficiency anemia in clinical practice in Algeria is poorly known. Methods: we conducted a cross-sectional survey among doctors in different specialties treating patients with iron deficiency anemia in 2016. Results: data analysis was based on 349 questionnaires which were validated (anesthesia/resuscitation: 39; obstetrics and gynaecology: 111; oncology/Hematology: 71; hepato-gastroenterology: 64; cardiology: 36; internal medicine: 28). All specialties combined, 73% (254/349) of physicians thought that at least 30% of their patients had iron deficiency anemia; 65% of physicians (226/349) thought that at least 30% of their patients had iron deficiency. Iron deficiency was investigated systematically by 57% (63/111) of physicians of the group obstetrics and gynaecology, but only by 11% (26/238) of the remaining doctors; indeed, 82% (195/238) of physicians investigated it only in patients with anemia. The assessment of iron deficiency showed that the hemoglobin (Hb) was almost always determined (89%; 310/349) while laboratory tests to explore iron metabolism were inadequate: 70% (244/349) of physicians performed serum ferritin test and only 37% (128/349) performed transferrin saturation. Patients with iron deficiency (with or without anemia) received oral iron therapy (prescribed by 92% (322/349) of physicians) and iron injections therapy depending on Hb level (prescribed by 36% (127/349) of physicians). Conclusion: this survey shows that iron deficiency is evaluated only in patients with anemia. In particular, laboratory tests to measure iron deficiency are insufficiently prescribed.


Assuntos
Anemia Ferropriva/diagnóstico , Ferro/deficiência , Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Argélia , Anemia/diagnóstico , Anemia/terapia , Anemia Ferropriva/terapia , Estudos Transversais , Feminino , Ferritinas/sangue , Pesquisas sobre Serviços de Saúde , Hemoglobinas/análise , Humanos , Ferro/administração & dosagem , Masculino , Pessoa de Meia-Idade , Adulto Jovem
15.
Exp Parasitol ; 205: 107735, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31381870

RESUMO

Two experiments were performed to determine whether oral administration of copper oxide capsules controlled helminthic infections in Lacaune sheep without acute collateral effects on animal health. In experiment 1, 48 multiparous lactating sheep (60.1 ±â€¯8.5 kg) were stratified according to initial number of eggs (Haemonchus contortus) per gram of feces (EPG) and were assigned randomly to 1 of two treatments (24 sheep/treatment): no oral administration (control) or oral administration of two copper capsules (treated; approximately 58 mg copper/kg body weight). Blood and fecal samples were collected on days 0, 15 and 45. Animals treated with copper capsules showed lower of EPG, eosinophils, acetylcholinesterase (AChE) in whole blood, and lower butyrylcholinesterase (BChE) activity in serum. Treated sheep had higher erythrocyte numbers, hemoglobin concentrations, hematocrit, and lymphocyte numbers. In experiment 2, 12 male lambs negative for helminths and coccidia were assigned randomly to one of two treatments (six lambs/treatment): control or treated (one copper capsule; approximately 58 mg copper/kg body weight); the experiment was designed to determine whether the results of experiment 1 were due to treatment or parasitism. Blood samples were collected on days 0, 5, 10 and 15 and fecal samples were collected on days 0, 7 and 15. Treated animals showed greater concentrations of lymphocytes; however, treatment had no effect on other hemogram variables, AChE and BChE activities, or levels of alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, creatinine, urea, albumin, total protein, and reactive oxygen species. These data suggest that copper capsules in dairy sheep efficiently controlled H. contortus infections. Treatment was not harmful to lambs during the first 15 days, i.e. there were no signs of acute toxicity.


Assuntos
Cobre/administração & dosagem , Hemoncose/veterinária , Helmintíase Animal/tratamento farmacológico , Lactação , Doenças dos Ovinos/tratamento farmacológico , Acetilcolinesterase/sangue , Administração Oral , Animais , Butirilcolinesterase/sangue , Cápsulas , Cobre/uso terapêutico , Indústria de Laticínios , Resíduos de Drogas , Eosinófilos/efeitos dos fármacos , Contagem de Eritrócitos/veterinária , Fezes/parasitologia , Feminino , Hemoncose/tratamento farmacológico , Hemoncose/prevenção & controle , Helmintíase Animal/sangue , Helmintíase Animal/prevenção & controle , Hematócrito/veterinária , Hemoglobinas/análise , Contagem de Linfócitos/veterinária , Masculino , Leite/química , Contagem de Ovos de Parasitas/veterinária , Paridade , Distribuição Aleatória , Ovinos , Doenças dos Ovinos/sangue , Doenças dos Ovinos/parasitologia , Doenças dos Ovinos/prevenção & controle
16.
Niger J Clin Pract ; 22(8): 1078-1082, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417050

RESUMO

Background: One of the major causes of anemia, defined as the reduction in the level of hemoglobin or red blood cells (RBCs) in the blood, in children in sub-Saharan Africa is malaria. Anemia is diagnosed by using either the hematocrit method or by measuring the hemoglobin concentration. Aims: To evaluate the relationship and agreement between hemoglobin and three-fold conversion of hematocrit results of participants in a clinical trial. Materials and Methods: This is a cross-sectional study that obtained data from a multi-center clinical trial that took place from 2007 to 2008 in public health facilities in Calabar, Nigeria. The hemoglobin and hematocrit results of 494 children who had ≥2000 parasite density recruited were pooled to evaluate the relationship and agreement between the two methods. The difference between the measures against the mean of the two measures was plotted according to the theory of Bland and Altman. Results: The mean age of the children was 34 months, with approximately equal number of boys and girls. The measured hemoglobin was lower than the calculated hemoglobin in 84.5% of the children. The result showed that lower the hemoglobin concentration, the higher the chances that the three-fold hematocrit conversion overestimates hemoglobin levels in the participants. Conclusions: The three-fold hematocrit conversion of hemoglobin estimation is a less reliable method than the measured hemoglobin in anemic children in the study setting.


Assuntos
Anemia/diagnóstico , Doenças Endêmicas , Hematócrito , Hemoglobinas/análise , Malária/complicações , Anemia/complicações , Anemia/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Malária/sangue , Malária/diagnóstico , Malária/epidemiologia , Masculino , Nigéria/epidemiologia , Valor Preditivo dos Testes , Sensibilidade e Especificidade
17.
Ecotoxicol Environ Saf ; 182: 109311, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31272021

RESUMO

Effects of sub-lethal concentrations (0 (control), 0.009, 0.014, and 0.023 ppm) of the organophosphate insecticide "malathion" to rainbow trout (Oncorhynchus mykiss) after the determination of LC50-96 h value (0.093 ppm) were evaluated. Changes in biomarkers of neurotoxicity (acetylcholinesterase (AChE) activity), genotoxicity (DNA damage), and hematological parameters (red (RBC) and white (WBC) blood cell count, hemoglobin (Hb), hematocrit (Hct), mean cell hemoglobin (MCH), mean cell volume (MCV), and mean cell hemoglobin concentration (MCHC)) were assessed for a 15-day exposure. A significant time- and dose-dependent reduction in AChE activities of gill, muscle, brain, and liver tissues was found. However, the AChE activity was less affected by malathion concentration than by exposure time. DNA damage of erythrocytes at different malathion concentrations increased by increasing the experimental time up to the fourth day. A decrease in the count of WBC, RBC, and Hct and an increase in the number of MCH and MCV were observed by increasing malathion exposure dose and time (p < 0.05). An increase in the malathion concentration and exposure time significantly resulted in a decrease in Hb and an increase in MCHC. A significant improvement in AChE activity; DNA damage; and RBC, Hb, Hct, MCV, and MCH indices was detected during a 30-day recovery period, but the WBC count changed insignificantly. The recovery pattern based on 100% water exchange with clean water could be a successful strategy to improve the biomarker responses of rainbow trout habituating in contaminated aquatic environments.


Assuntos
Acetilcolinesterase/metabolismo , Malation/toxicidade , Oncorhynchus mykiss/fisiologia , Poluentes Químicos da Água/toxicidade , Animais , Dano ao DNA , Índices de Eritrócitos , Eritrócitos/efeitos dos fármacos , Hematócrito , Hemoglobinas/análise , Dose Letal Mediana , Contagem de Leucócitos
18.
Exp Parasitol ; 204: 107726, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31299264

RESUMO

The aims of this study were to evaluate if the use of copper oxide wire particles, isolated or in association with closantel, in lambs infected with Haemonchus contortus enhances the anthelmintic efficacy of closantel, as well as to evaluate the effects of treatment in hepatic energy metabolism, inflammatory markers and hematological and biochemical tests. The lambs were randomly divided into five groups (6 animals each), as follows: uninfected animals (Control); animals infected with H. contortus (HC); infected and treated with closantel (HC + CL); infected and treated with copper oxide wire particles (HC + Cu); and infected and treated with closantel plus copper oxide wire particles (HC + CL + Cu). The animals of infected groups were infected orally with H. contortus (5,000 L3 -larvae) and on day 14 post infection (p.i) the treatments were initiated. The egg per gram of feces (EPG), butyrylcholinesterase (BuChE), myeloperoxidase (MPO), adenylate kinase (AK) and pyruvate kinase (PK) activities and hematological and biochemical tests were evaluated. Treatments with copper oxide (isolated and associated) were able to reduce the EPG count on days 28, 35, 42 and 49 p.i when compared to HC group, while closantel was able to reduce EPG only from day 35 p.i. Moreover, treatment with closantel (isolated or associated) was able to prevent the inhibition of hepatic AK and PK activities caused by H. contortus infection, which may contribute to efficient intracellular energetic communication in order to maintain the balance between cellular ATP consumption and production. Butyrylcholinesterase and MPO activities were higher in infected lambs compared to uninfected, while treated groups showed lower enzymatic activity compared to the group HC. The use of all therapeutic protocols was able to reduce the EPG count. Based on these evidences, the use of copper oxide plus closantel may be considered an alternative to treat lambs infected by H. contortus.


Assuntos
Anti-Helmínticos/administração & dosagem , Cobre/administração & dosagem , Hemoncose/veterinária , Inflamação/veterinária , Salicilanilidas/administração & dosagem , Doenças dos Ovinos/tratamento farmacológico , Abomaso/metabolismo , Adenilato Quinase/metabolismo , Administração Oral , Animais , Anti-Helmínticos/farmacologia , Anti-Helmínticos/uso terapêutico , Análise Química do Sangue/veterinária , Butirilcolinesterase/sangue , Cápsulas , Metabolismo Energético/efeitos dos fármacos , Contagem de Eritrócitos/veterinária , Fezes/parasitologia , Hemoncose/complicações , Hemoncose/tratamento farmacológico , Hemoncose/metabolismo , Hematócrito/veterinária , Hemoglobinas/análise , Inflamação/tratamento farmacológico , Inflamação/prevenção & controle , Fígado/efeitos dos fármacos , Fígado/enzimologia , Fígado/metabolismo , Masculino , Contagem de Ovos de Parasitas/veterinária , Peroxidase/sangue , Piruvato Quinase/metabolismo , Distribuição Aleatória , Salicilanilidas/farmacologia , Salicilanilidas/uso terapêutico , Ovinos , Doenças dos Ovinos/metabolismo , Doenças dos Ovinos/prevenção & controle
19.
N Engl J Med ; 381(11): 1001-1010, 2019 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-31340089

RESUMO

BACKGROUND: Roxadustat (FG-4592) is an oral inhibitor of hypoxia-inducible factor (HIF) prolyl hydroxylase that stimulates erythropoiesis and regulates iron metabolism. In phase 2 studies involving patients with chronic kidney disease, roxadustat increased levels of endogenous erythropoietin to within or near the physiologic range, along with increasing hemoglobin levels and improving iron homeostasis. Additional data are needed regarding the efficacy and safety of roxadustat for the treatment of anemia in patients with chronic kidney disease who are not undergoing dialysis. METHODS: In this phase 3 trial conducted at 29 sites in China, we randomly assigned 154 patients with chronic kidney disease in a 2:1 ratio to receive roxadustat or placebo three times a week for 8 weeks in a double-blind manner. All the patients had a hemoglobin level of 7.0 to 10.0 g per deciliter at baseline. The randomized phase of the trial was followed by an 18-week open-label period in which all the patients received roxadustat; parenteral iron was withheld. The primary end point was the mean change from baseline in the hemoglobin level, averaged over weeks 7 through 9. RESULTS: During the primary-analysis period, the mean (±SD) change from baseline in the hemoglobin level was an increase of 1.9±1.2 g per deciliter in the roxadustat group and a decrease of 0.4±0.8 g per deciliter in the placebo group (P<0.001). The mean reduction from baseline in the hepcidin level (associated with greater iron availability) was 56.14±63.40 ng per milliliter in the roxadustat group and 15.10±48.06 ng per milliliter in the placebo group. The reduction from baseline in the total cholesterol level was 40.6 mg per deciliter in the roxadustat group and 7.7 mg per deciliter in the placebo group. Hyperkalemia and metabolic acidosis occurred more frequently in the roxadustat group than in the placebo group. The efficacy of roxadustat in hemoglobin correction and maintenance was maintained during the 18-week open-label period. CONCLUSIONS: In Chinese patients with chronic kidney disease who were not undergoing dialysis, those in the roxadustat group had a higher mean hemoglobin level than those in the placebo group after 8 weeks. During the 18-week open-label phase of the trial, roxadustat was associated with continued efficacy. (Funded by FibroGen and FibroGen [China] Medical Technology Development; ClinicalTrials.gov number, NCT02652819.).


Assuntos
Anemia/tratamento farmacológico , Glicina/análogos & derivados , Hemoglobinas/análise , Prolina Dioxigenases do Fator Induzível por Hipóxia/antagonistas & inibidores , Isoquinolinas/uso terapêutico , Insuficiência Renal Crônica/complicações , Acidose/induzido quimicamente , Adulto , Idoso , Anemia/etiologia , Colesterol/sangue , Método Duplo-Cego , Feminino , Glicina/efeitos adversos , Glicina/uso terapêutico , Hematínicos/efeitos adversos , Hematínicos/uso terapêutico , Humanos , Hiperpotassemia/induzido quimicamente , Isoquinolinas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/sangue
20.
N Engl J Med ; 381(11): 1011-1022, 2019 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-31340116

RESUMO

BACKGROUND: Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor that stimulates erythropoiesis and regulates iron metabolism. Additional data are needed regarding the effectiveness and safety of roxadustat as compared with standard therapy (epoetin alfa) for the treatment of anemia in patients undergoing dialysis. METHODS: In a trial conducted in China, we randomly assigned (in a 2:1 ratio) patients who had been undergoing dialysis and erythropoiesis-stimulating agent therapy with epoetin alfa for at least 6 weeks to receive roxadustat or epoetin alfa three times per week for 26 weeks. Parenteral iron was withheld except as rescue therapy. The primary end point was the mean change in hemoglobin level from baseline to the average level during weeks 23 through 27. Noninferiority of roxadustat would be established if the lower boundary of the two-sided 95% confidence interval for the difference between the values in the roxadustat group and epoetin alfa group was greater than or equal to -1.0 g per deciliter. Patients in each group had doses adjusted to reach a hemoglobin level of 10.0 to 12.0 g per deciliter. Safety was assessed by analysis of adverse events and clinical laboratory values. RESULTS: A total of 305 patients underwent randomization (204 in the roxadustat group and 101 in the epoetin alfa group), and 256 patients (162 and 94, respectively) completed the 26-week treatment period. The mean baseline hemoglobin level was 10.4 g per deciliter. Roxadustat led to a numerically greater mean (±SD) change in hemoglobin level from baseline to weeks 23 through 27 (0.7±1.1 g per deciliter) than epoetin alfa (0.5±1.0 g per deciliter) and was statistically noninferior (difference, 0.2±1.2 g per deciliter; 95% confidence interval [CI], -0.02 to 0.5). As compared with epoetin alfa, roxadustat increased the transferrin level (difference, 0.43 g per liter; 95% CI, 0.32 to 0.53), maintained the serum iron level (difference, 25 µg per deciliter; 95% CI, 17 to 33), and attenuated decreases in the transferrin saturation (difference, 4.2 percentage points; 95% CI, 1.5 to 6.9). At week 27, the decrease in total cholesterol was greater with roxadustat than with epoetin alfa (difference, -22 mg per deciliter; 95% CI, -29 to -16), as was the decrease in low-density lipoprotein cholesterol (difference, -18 mg per deciliter; 95% CI, -23 to -13). Roxadustat was associated with a mean reduction in hepcidin of 30.2 ng per milliliter (95% CI, -64.8 to -13.6), as compared with 2.3 ng per milliliter (95% CI, -51.6 to 6.2) in the epoetin alfa group. Hyperkalemia and upper respiratory infection occurred at a higher frequency in the roxadustat group, and hypertension occurred at a higher frequency in the epoetin alfa group. CONCLUSIONS: Oral roxadustat was noninferior to parenteral epoetin alfa as therapy for anemia in Chinese patients undergoing dialysis. (Funded by FibroGen and FibroGen [China] Medical Technology Development; ClinicalTrials.gov number, NCT02652806.).


Assuntos
Anemia/tratamento farmacológico , Epoetina alfa/uso terapêutico , Glicina/análogos & derivados , Hematínicos/uso terapêutico , Hemoglobinas/análise , Prolina Dioxigenases do Fator Induzível por Hipóxia/antagonistas & inibidores , Isoquinolinas/uso terapêutico , Insuficiência Renal Crônica/complicações , Adulto , Idoso , Análise de Variância , Anemia/etiologia , Colesterol/sangue , Método Duplo-Cego , Epoetina alfa/efeitos adversos , Feminino , Glicina/efeitos adversos , Glicina/uso terapêutico , Hematínicos/efeitos adversos , Humanos , Hiperpotassemia/induzido quimicamente , Hipertensão/induzido quimicamente , Isoquinolinas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Diálise Renal , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/terapia
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