Fatores associados à deficiência de vitamina D em mulheres gestantes e lactantes / Factores asociados a la deficiencia de vitamina D en mujeres embarazadas y lactantes / Factors associated with vitamin d deficiency in pregnant and lactatingwomen

Introdução: A deficiência de vitamina D durante a gestação e a lactação pode repercutir negativamente no desenvolvimento fetal e infantil, devido seu papel fundamental nos sistemas imunológico, cardíaco, ósseo, muscular e neural. Objetivo: Realizar uma revisão de literatura para integrar estudos que evidenciam a deficiência de vitamina D em gestantes e lactantes, e os fatores de risco associados a essa carência. Metodologia: Foi realizado um levantamento bibliográfico entre agosto e outubro de 2021, com atualização entre outubro e novembro de 2022 através de pesquisas às bases Pubmed e Scielo, bem como às listas de referências dos artigos selecionados. Foram empregados os descritores consumo alimentar, vitamina D, deficiência de vitamina D, gestantes e lactantes, usando-se o operador booleano AND para a associação entre eles. Como critérios de inclusão foram adotados o tipo de estudo (epidemiológicos, ensaios clínicos e revisões integrativa e sistemática), o idioma (espanhol, inglês e português) e o período de publicação (2010 a 2022). Resultados: Evidenciou-se que existem vários fatores de riscos para a inadequação do status de vitamina D em gestantes e lactantes como a baixa exposição da pele à luz solar e fatores relacionados (uso excessivo de protetor solar, menor tempo de atividades ao ar livre, clima, religião e hábitos culturais, maior escolaridade);a pigmentação mais escura da pele; o baixo consumo alimentar de vitamina D e variáveis associadas; a menor idade materna; o primeiro trimestre gestacional; a primiparidade e o excesso de tecido adiposo. Conclusões: Em gestantes e lactantes, a carência de vitamina D associa-se a distintos fatores, com destaque principalmente para a baixa exposição à luz solar, a pigmentação mais escura da pele e o excesso de tecido adiposo, sendo de extrema importância que sejam abordados com cautela, visando ações voltadas a variáveis modificáveis, de modo a auxiliar na redução da hipovitaminose D nestes grupos (AU).

Introduction: Vitamin D deficiency during pregnancy and breastfeeding can have a negative impact on fetal and infant development due to its fundamental role in the immune, cardiac, bone, muscular and neural systems. Objective: To conduct a literature review to integrate studies which show the Vitamin D deficiency in pregnant andlactating women, and the risk factors associated with this deficiency. Methodology: A bibliographic survey was carried out between August and October 2021, with an update between October and November 2022 through searches in the Pubmed and Scielo databases, as well as the reference lists of the selected articles. The descriptors food consumption, vitamin D, vitamin D deficiency, pregnant and lactating women were used, using the Boolean operator AND for the association between them. The type of study (epidemiological, clinical trials and integrative and systematic reviews), language (Spanish, English and Portuguese) and publication period (2010 to 2022) was adopted as inclusion criteria.Results:It was shown that there are several risk factors for inadequate vitamin D status in pregnant and lactating women, such as low skin exposure to sunlight and related factors (excessive use of sunscreen, less time spent outdoors, climate, religion and cultural habits, higher education); darker skin pigmentation; low dietary intake of vitamin D and associated variables; the lowest maternal age; the first gestational trimester; primiparity and excess adipose tissue.Conclusions: Vitamin D deficiency in pregnant and lactating women is associated with different factors, witha main emphasis on low exposure to sunlight, darker skin pigmentation and excess adipose tissue. Furthermore, it is extremely important that these factors are approached with caution, implementing actions aimed at modifiable variables in order to help reduce hypovitaminosis D in these groups (AU).

Introducción: La deficiencia de vitamina D durante el embarazo y la lactancia puede tener un impacto negativo en el desarrollo fetal e infantil, por su papel fundamental en los sistemas inmunológico, cardíaco, óseo, muscular y neural. Objetivo: Realizar una revisión bibliográfica para integrar estudios que evidencien la deficiencia de vitamina D en mujeres embarazadas y lactantes, y los factores de riesgo asociados. Metodología:Se realizó un levantamiento bibliográfico entre agosto y octubre de 2021, con actualizaciones entre octubre y noviembre de 2022 mediante búsquedas en las bases de datos Pubmed y Scielo, así como en las listas de referencias de los artículos seleccionados. Se utilizaron los descriptores consumo de alimentos, vitamina D, deficiencia de vitamina D, gestantes y lactantes, utilizándose el operador booleano AND para la asociación entre ellos. Se adoptaron como criterios de inclusión el tipo de estudio (epidemiológicos, clínicos, revisiones integradoras y sistemáticas), idioma (español, inglés y portugués) y período de publicación (2010 a 2022).Resultados: Existen varios factores de riesgo para un estado inadecuado de vitamina D en mujeres embarazadas y lactantes, como la baja exposición de la piel a la luz solar y factores relacionados (uso excesivo de protector solar, menor tiempo al aire libre, clima, religión y hábitos culturales, educación más alta); pigmentación de la piel más oscura; baja ingesta dietética de vitamina D y variables asociadas; la edad materna más baja; el primer trimestre gestacional; Primiparidad y exceso de tejido adiposo. Conclusiones:En mujeres embarazadas y lactantes, el déficit de vitamina D se asocia a diferentes factores, especialmente la baja exposición solar, la pigmentación de la piel más oscura y el exceso de tejido adiposo, y es de suma importancia abordarlos con precaución, apuntando a acciones dirigidas a variables modificables, con el fin de ayudar a reducir la hipovitaminosis D en estos grupos (AU).

Iron deficiency and child psychomotor development in a rural region of Chota, Peru, 2022 / Deficiencia de hierro y desarrollo psicomotor infantil en una zona rural de Chota, Perú 2022 / Deficiência de ferro e desenvolvimento psicomotor infantil em uma área rural de Chota, Peru 2022

Introduction: Iron deficiency and psychomotor developmental delay are two public health problems that cause high childhood morbidity and mortality worldwide, which can be related to social, economic, cultural and health factors that affect the environment where children and their family live. Objective: To determine the relationship between iron deficiency anemia and psychomotor development in children aged 2 to 4 years treated at the Cuyumalca Clinic, Chota. Materials and methods: Relational, cross-sectional study conducted on 48 children, who underwent hemoglobin testing through a portable hemoglobinometer and were subjected to the Psychomotor Development Test. Results: 31.2% of the children displayed some type of anemia, with the most common being moderate anemia (17.7%). On average, 10.9% showed some type of psychomotor developmental delay, including coordination (6.3%), language (8.4%), motor skills (16.7%), and overall development (12.5%). 4.2% of the children who had minor to moderate anemia showed developmental delay risks in the three assessed areas as well as in their overall development. Conclusion: There is no statistically significant relationship between iron deficiency anemia and several domains of psychomotor development, including coordination, language, motor skills as well as overall development.

Introducción: La deficiencia de hierro y las alteraciones en el desarrollo psicomotor son dos problemas de salud pública que causan una alta morbimortalidad infantil alrededor del mundo. Los estudios apuntan a que esto se relaciona con los factores sociales, económicos, culturales y sanitarios en los que el niño y su familia vive. Objetivo: Determinar la relación entre anemia ferropénica y desarrollo psicomotor en niños de 2 a 4 años atendidos en el Puesto de Salud de Cuyumalca, Chota. Materiales y métodos: Estudio relacional, transversal, desarrollado con 48 niños a quienes se les realizó un dosaje de hemoglobina con hemoglobinómetro portátil y se les aplicó el Test de Desarrollo Psicomotor. Resultados: El 31,2% de niños presentaron algún tipo de anemia, siendo la anemia moderada la más frecuente (16,7%); en promedio 10,9% evidenciaron alguna alteración en el desarrollo psicomotor en coordinación (6,3%), lenguaje (8,4%), motricidad (16,7%) y desarrollo global (12,5%). El 4,2% de niños con riesgo para el desarrollo presentaron anemia leve o moderada en las tres áreas evaluadas, al igual que en el desarrollo global. Conclusión: No existe relación estadística significativa entre anemia ferropénica y desarrollo psicomotor para las áreas de coordinación, lenguaje y motricidad; además del desarrollo global.

Introdução: A deficiência de ferro e as alterações no desenvolvimento psicomotor são dois problemas de saúde pública que causam elevada morbidade e mortalidade infantil em todo o mundo. Estudos sugerem que isso está relacionado aos fatores sociais, econômicos, culturais e de saúde em que vivem a criança e sua família. Objetivo: Determinar a relação entre anemia ferropriva e desenvolvimento psicomotor em crianças de 2 a 4 anos atendidas no Posto de Saúde Cuyumalca, Chota. Materiais e métodos: Estudo relacional, transversal, desenvolvido com 48 crianças que realizaram dosagem de hemoglobina com hemoglobinômetro portátil e foi aplicado o Teste de Desenvolvimento Psicomotor. Resultados: 31,2% das crianças apresentaram algum tipo de anemia, sendo a anemia moderada a mais frequente (16,7%); em média, 10,9% apresentaram alguma alteração no desenvolvimento psicomotor na coordenação (6,3%), linguagem (8,4%), motricidade (16,7%) e desenvolvimento global (12,5%). 4,2% das crianças em risco de desenvolvimento apresentaram anemia leve ou moderada nas três áreas avaliadas, bem como no desenvolvimento global. Conclusão: Não há relação estatística significativa entre anemia ferropriva e desenvolvimento psicomotor para as áreas de coordenação, linguagem e motricidade; bem como o desenvolvimento global.

Determinants of poor sleep quality in adults during the coronavirus disease pandemic: COVID-Inconfidentes, a population-based study

ABSTRACT BACKGROUND: The coronavirus disease (COVID-19) pandemic has adversely affected the health of the global population, with sleep quality being one of the affected parameters. OBJECTIVES: To evaluate sleep quality and its associated factors in adults during the COVID-19 pandemic in Brazil. DESIGN AND SETTING: A population-based cross-sectional serological survey of 1,762 adults in the Iron Quadrangle region of Brazil. METHODS: The Pittsburgh Sleep Quality Index was used to assess sleep quality. Sociodemographic variables, health conditions, health-related behaviors, anxiety, vitamin D levels, weight gain/loss, and pandemic characteristics were assessed using a structured questionnaire. Univariate and multivariate analyses using Poisson regression with robust variance were performed to identify factors associated with sleep quality. RESULTS: More than half of the participants reported poor sleep quality (52.5%). Multivariate analysis revealed that the factors associated with poor sleep quality included living alone (prevalence ratio [PR] = 1.34; 95% confidence interval [CI]: 1.04-1.73), anxiety disorder (PR = 1.32; 95% CI: 1.08-1.62), 5.0% weight loss (PR = 1.21; 95% CI: 1.02-1.44), 5.0% weight gain (PR = 1.27; 95% CI: 1.03-1.55), vitamin D deficiency (PR = 1.16; 95% CI: 1.01-1.35), and COVID-19 symptoms (PR = 1.29; 95% CI: 1.10-1.52). CONCLUSIONS: Our study revealed that more than half of the participants experienced poor sleep quality during the COVID-19 pandemic. Factors associated with poor sleep quality included vitamin D deficiency and weight changes related to the pandemic.

Budget Impact Analysis of Ferric Derisomaltose for the Treatment of Iron-Deficiency in Malaysia

@#Introduction: Untreated iron deficiency (ID) can lead to severe anaemia, requiring blood transfusion, or increased mortality risk. Globally intravenous (IV) iron is increasingly recognised as a recommended option for patients. This study aims to evaluate the budget impact associated with introducing a new intravenous (IV) iron, ferric derisomaltose (Monofer® [IIM]) as one of the treatment options for the management of ID in the Ministry of Health Malaysia (MOHM) setting. Methods: A 5-year budget impact model was developed from 2020 to 2024 for patients with ID that require a high iron dose (≥500 mg), using the perspective of MOHM. The model was built with four external medical specialists, each with experience and deep knowledge of ID management, to support estimations on the future development of iron use in Malaysia. Results: Compared to the current market mix with the existing IV iron products (i.e., iron sucrose and iron dextran), a cost-saving of MYR 53,910 could be achieved with the introduction of IIM in 2020. The uptake of IIM into MOHM over five years is estimated to lead to an overall budget saving of MYR 11,837,524 over a 5-year time horizon. Conclusion: The use of IIM in place of the current IV iron products in MOHM resulted in a significant cost saving by reducing the number of visits required to achieve the targeted iron dose and the shorter IV infusion time with IIM.

Factores nutricionales y alimentarios asociados al desarrollo y comportamiento del Espectro Autista: Un resumen de la evidencia

La incidencia de individuos con Trastorno Espectro Autista (TEA) va en aumento. Por lo tanto, es importante la detección oportuna de la condición y conocer los factores de riesgo asociado a nutrición, en especial porque se trata de una población nutricionalmente vulnerable. Desde la última década, las investigaciones han aportado evidencia sobre los mecanismos que subyacen al TEA. Se ha comprobado la coexistencia de diversas complicaciones asociadas al TEA, tales como: trastornos metabólicos, deficiencias nutricionales y condiciones asociadas a la microbiota y funcionalidad gastrointestinal, que podrían estar relacionadas con la etiología o comportamiento en este grupo en particular. Es de suma importancia realizar un resumen de la evidencia con la finalidad de entregar información relacionada a los factores alimentarios y nutricionales asociados a modificación de comportamiento en TEA y desarrollo del mismo, para llevar a cabo una evaluación e intervención oportuna e individualizada, con un enfoque multidimensional, sistémico, multi e interdisciplinario.

The incidence of individuals with autism spectrum disorder (ASD) is increasing. Early detection of the condition and recognizing risk factors associated with nutrition is essential, mainly because this population is nutritionally vulnerable. In the last decade, research has provided evidence on the mechanisms underlying ASD. The coexistence of various complications associated with ASD, such as metabolic disorders, nutritional deficiencies, and conditions associated with the microbiota and its gastrointestinal functionality, have been proven to be related to the etiology of behavior in this particular group. Therefore, it is of utmost importance to summarize the evidence to provide information related to dietary and nutritional factors associated with behavior modification in ASD and to carry out a timely and individualized assessment and intervention, with a multidimensional, systemic, multi and interdisciplinary approach.

Dermatological manifestations relating to nutritional deficiencies after bariatric surgery: case report and integrative literature review

ABSTRACT BACKGROUND: The number of bariatric surgeries performed worldwide is growing. Among the main short, medium or long-term complications after surgery are nutritional deficiencies. Many of these, such as those of Zn, Cu and vitamins A, B1, B3, B6 and B12, are manifested by dermatological lesions before potentially fatal systemic disorders occur. OBJECTIVE: To identify the main dermatological manifestations associated with nutritional deficiencies after bariatric surgery, and the associated variables. DESIGN AND SETTING: Integrative literature review carried out at a public university in Brazil. METHODS: This was a case report and a review of health research portals and databases of national and international biomedical journals, without publication date limitation. The descriptors used for searches followed the ideal methodology for each database/search portal: "bariatric surgery", "skin", "skin disease", "skin manifestation", "deficiency disease" and "malnutrition". RESULTS: A total of 59 articles were selected, among which 23 were review articles or articles that addressed specific dermatological manifestations. The other 36 articles described 41 cases, which were organized into a table with the clinical variables. CONCLUSIONS: Although nutritional deficiencies are expected as complications after bariatric surgery, few articles relating them to their dermatological manifestations were found. It is important to recognize skin changes caused by nutritional deficiencies in patients treated via bariatric surgery, as these may occur before systemic complications appear and are easier to diagnose when the patient does not have any systemic symptoms yet. However, there is generally a delay between the appearance of skin lesions and making the diagnosis of nutritional deficiency.

Systemic immune inflammation index in patients with recurrent aphthous stomatitis / Índice de inflamação imune sistêmica em pacientes com estomatite aftosa recorrente

Abstract Objectives: Recurrent Aphthous Stomatitis (RAS) a chronic idiopathic oral mucosal disease. But yet the etiology and pathogenesis of RAS are not exactly known, it is thought that inflammation play an important role in the pathogenesis. The aim of this study is to demonstrate the role of systemic inflammation among the possible etiological factors of RAS and to find the possible diagnostic correlation between Systemic Immune Inflammation Index (SII). Methods: Patients who were consulted the otolaryngology outpatient clinic and diagnosed with RAS between 2019-2021 were retrospectively analyzed. Neutrophil/Lymphocyte Ratio (NLR), Platelet/Lymphocyte Ratio (PLR) and SII values were calculated based on the results of complete blood count. Demographic and hematological parameters between control and RAS groups were compared. The statistical significance level was considered as <0.05. Results: There was no statistically significant difference between the control and RAS groups in terms of sex and age distributions (p = 0.566 and p = 0.173, respectively). SII, NLR and PLR values were significantly higher in the RAS group compared to the controls (p < 0.001, p < 0.001 and p = 0.001, respectively). A very strong correlation between SII and NLR, moderately strong correlation between SII and PLR and moderate correlation between NLR and PLR values were detected (respectively ρ: 0.813, 0.719, 0.532; p-values <0.001). Conclusion: SII, NLR and PLR has significantly higher levels in the RAS group compared to the control group, that it supports the role of systemic inflammation in the etiopathogenesis of RAS. In addition, the results show that SII is a valuable marker for inflammation. Level of evidence: 4. HIGHLIGHTS RAS is a chronic, idiopathic, ulcerative oral mucosal disease. SII is a new and inexpensive biomarker that can easily be calculated using the platelet, neutrophil, and lymphocyte count. SII may be a valuable marker to demonstrate the role of systemic inflammation in RAS etiopathogenesis. Vascular, thrombotic, and inflammatory processes are thought to have a role in RAS activation.

Resumo Objetivo: A estomatite aftosa recorrente (EAR) é uma doença crônica idiopática da mucosa oral. Embora sua etiologia e patogênese não sejam totalmente conhecidas, acredita-se que a inflamação possa desempenhar um papel importante. O objetivo deste estudo é demonstrar o papel da inflamação sistêmica entre os possíveis fatores etiológicos da estomatite aftosa recorrente e encontrar uma possível correlação diagnóstica com o índice de inflamação imunológica sistêmica, SII. Método: Foram analisados retrospectivamente pacientes avaliados no ambulatório de otorrinolaringologia e diagnosticados com estomatite aftosa recorrente entre 2019-2021. A relação neutrófilos/linfócitos, a relação plaquetas/linfócitos e os valores de SII foram calculados com base nos resultados do hemograma completo. Parâmetros demográficos e hematológicos dos grupos controle e de pacientes foram comparados. O nível de significância estatística foi considerado como <0,05. Resultados: Não houve diferença estatisticamente significante entre os grupos controle e com estomatite aftosa recorrente quanto à distribuição por sexo e idade (p = 0,566 e p = 0,173, respectivamente). Os valores de SII, a relação neutrófilos/linfócitos e a relação plaquetas/linfócitos foram significantemente maiores no grupo de pacientes em relação aos controles (p <0,001, p <0,001 e p = 0,001, respectivamente). Foi detectada uma correlação muito forte entre SII e relação neutrófilos/linfócitos, uma correlação moderadamente forte entre SII e relação plaquetas/linfócitos e uma correlação moderada entre valores da relação neutrófilos/linfócitos e relação plaquetas /linfócitos (ρ: 0,813, 0,719, 0,532 respectivamente; p-valores <0,001). Conclusão: SII, relação neutrófilos/linfócitos e relação plaquetas/linfócitos apresentam níveis significantemente maiores no grupo com estomatite aftosa recorrente quando comparados ao grupo controle, o que corrobora o papel da inflamação sistêmica na sua etiopatogênese. Além disso, os resultados mostram que o SII é um marcador inflamatório valioso. Nível de evidência: 4. HIGHLIGHTS A estomatite aftosa recorrente é uma doença ulcerativa crônica idiopática da mucosa oral. O SII (do inglês Systemic Immune Inflammation Index) é um biomarcador novo e de baixo custo que pode ser facilmente calculado que usa a contagem de plaquetas, neutrófilos e linfócitos. O SII pode ser um marcador valioso para demonstrar o papel da inflamação sistêmica na etiopatogênese da estomatite aftosa recorrente. Acredita-se que processos vasculares, trombóticos e inflamatórios tenham um papel na ativação da estomatite aftosa recorrente.

Anemia en la enfermedad inflamatoria intestinal: un objetivo subestimado / Anemia in inflammatory bowel disease

Anemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD). Although there are several causes of anemia in IBD, the two most frequent etiologies are iron deficiency anemia and anemia of chronic disease. Despite the high prevalence of anemia in IBD and its significant impact on patient's quality of life, this complication is still underdiagnosed and undertreated by providers. Active screening for anemia, structured assessment, comprehensive management, and multidisciplinary collaboration are needed in IBD patients. The cornerstone of anemia management depends on the underlying etiology along with normalization of inflammatory activity. Although, oral iron is effective for the treatment of mild iron deficiency-related anemia, intravenous iron formulations have a good safety profile and can be used as first-line therapy in patients with active IBD, severe anemia and previous intolerance prior to oral iron. After proper treatment of anemia, careful monitoring is necessary to prevent its recurrence. Herein, we discuss the etiology, screening, diagnosis, therapy selection, and follow-up for anemia in IBD.

Beneficios del uso del hierro parenteral como alternativa eficaz en el manejo de la anemia gestacional en Colombia / Benefits of the Use of Parenteral Iron as an Efficient Alternative in the Management of Gestational Anemia in Colombia / Benefícios do uso de ferro parenteral como alternativa eficaz no manejo da anemia gestacional na Colômbia

Introducción. La Organización Mundial de la Salud (OMS) estima que más del 40% de las mujeres embarazadas a nivel mundial tienen anemia, y la mitad de estas padecen deficiencia de hierro. La prevalencia en América Latina es del 40% y en Colombia del 44.7%. Fisiológicamente en el embarazo se produce una mal llamada "anemia dilucional", existen condiciones en la embarazada que la predisponen a tener una anemia patológica. Esta última es causada principalmente por un déficit de hierro, de allí la importancia de diagnosticar a tiempo esta entidad e iniciar el manejo. La administración de hierro es la base del tratamiento de la anemia por deficiencia de hierro. Puede ser administrado por vía oral, la cual es la preferida en la mayoría de las pacientes; sin embargo, cuando este no es posible administrarlo, es esencial recurrir al hierro parenteral. No obstante, el hierro parenteral es poco usado como primera línea en el manejo de la anemia gestacional. El presente artículo tiene como objetivo realizar una revisión que permita identificar la terapia con hierro parenteral como una alternativa eficaz de manejo para la anemia gestacional, teniendo en cuenta las características farmacológicas, la administración y el uso entre las diferentes moléculas disponibles en Colombia. Metodología. Corresponde a un estudio de revisión de literatura en bases de datos y bibliotecas electrónicas, los criterios que se tuvieron en cuenta fueron textos publicados entre 1996 y 2020, en español e inglés. Se obtuvo un resultado de 95 artículos, de los cuales se seleccionaron 49. Las palabras clave para su búsqueda fueron fisiología, hierro parenteral, anemia gestacional, déficit de hierro, complicaciones del embarazo, compuestos de hierro, farmacocinética, diagnóstico y tratamiento. División de temas tratados. Fisiología; ayudas diagnósticas; características farmacológicas del hierro parenteral; ventajas, indicaciones y contraindicaciones del hierro parenteral; efectos secundarios y forma de aplicación. Conclusiones. El hierro parenteral es un tratamiento seguro y eficaz para manejar la anemia en el embarazo, se debe tener en cuenta las indicaciones y la farmacología de las moléculas para elegir la más adecuada. Además, repone más rápidamente las reservas de hierro y los niveles de hemoglobina.

Introduction. The World Health Organization (WHO) estimates that more than 40% of pregnant women worldwide have anemia, and that half of them suffer from iron deficiency. The prevalence of this in Latin America is 40%, and in Colombia, 44.7%. Physiologically, a problem called "dilutional anemia" occurs during pregnancy. There are conditions in pregnant women that predispose them to suffering from pathological anemia. The latter is mainly caused by iron deficiency, hence the importance of diagnosing this entity on time and starting treatment. Iron administration is the basis of treatment of anemia caused by iron deficiency. It can be administered orally, which is the preferred option in the majority of patients. However, when this is not possible, parenteral iron must be used. However, parenteral iron is rarely used as the first line of treatment of gestational anemia. The objective of this article is to carry out a review that allows for the identification of therapy with parenteral iron as an efficient alternative for the treatment for gestational anemia, considering the pharmacological characteristics, administration, and use among the different molecules available in Colombia. Methodology. We carried out a search in databases and electronic libraries. The criteria considered were texts published between 1996 and 2020 in Spanish and English. 95 articles were obtained, of which 49 were selected. The keywords for their search were physiology, parenteral iron, gestational anemia, iron deficit, pregnancy complications, iron compounds, pharmacokinetics, diagnosis, and treatment. Division of Covered Topics. Physiology; diagnostic aids; pharmacological characteristics of parenteral iron; advantages, indications, and contraindications of parenteral iron; secondary effects and application method. Conclusions. Parenteral iron is a safe and efficient treatment to handle anemia during pregnancy. The indications and pharmacology of the molecules must be considered to choose the most appropriate option. In addition, it replaces iron reserves and hemoglobin levels more quickly.

Introdução. A Organização Mundial de Saúde (OMS) estima que mais de 40% das mulheres grávidas em todo o mundo são anêmicas, e metade delas sofre de deficiência de ferro. A prevalência na América Latina é de 40% e na Colômbia de 44.7%. Fisiologicamente na gravidez ocorre a chamada "anemia dilucional", e existem condições na gestante que a predispõem a ter uma anemia patológica. Esta última é causada principalmente por deficiência de ferro, daí a importância de diagnosticar esta entidade a tempo e iniciar o manejo. A administração de ferro é a base do tratamento da anemia por deficiência de ferro. Pode ser administrado por via oral, o que é preferido pela maioria das pacientes; porém, quando não for possível administrá-lo dessa forma, é imprescindível recorrer ao ferro parenteral. No entanto, o ferro parenteral é raramente usado como primeira linha no manejo da anemia gestacional. O objetivo deste artigo é realizar uma revisão que permita identificar a terapia com ferro parenteral como uma alternativa eficaz de tratamento da anemia gestacional, levando em consideração as características farmacológicas, administração e uso entre as diferentes moléculas disponíveis na Colômbia. Metodologia. Foi realizada uma busca em bases de dados e bibliotecas eletrônicas, os critérios levados em consideração foram textos publicados entre 1996 e 2020, em espanhol e inglês. Foi obtido um total de 95 artigos, dos quais 49 foram selecionados. As palavras-chave para a busca foram fisiologia, ferro parenteral, anemia gestacional, deficiência de ferro, complicações na gravidez, compostos de ferro, farmacocinética, diagnóstico e tratamento. Divisão dos temas abordados. Fisiologia; auxiliares de diagnóstico; características farmacológicas do ferro parenteral; vantagens, indicações e contraindicações do ferro parenteral; efeitos colaterais e método de aplicação. Conclusões. O ferro parenteral é um tratamento seguro e eficaz para o manejo da anemia na gravidez, as indicações e farmacologia das moléculas devem ser levadas em consideração a fim de escolher a mais adequada. Além disso, reabastece mais rapidamente as reservas de ferro e os níveis de hemoglobina.

Dietary diversity as a sustainable approach towards micronutrient Deficiencies in India

The silent epidemic of micronutrient deficiencies (MNDs) continues to be a major public health challenge in the developing world, including India. The prevalence of iron, iodine, zinc, vitamin A and folate deficiencies is alarmingly high worldwide. India is additionally facing a high prevalence of vitamin D and B12 deficiencies. To combat the hidden epidemic of MNDs, various governments around the world have mostly relied on supplementation or fortification-based interventions. India launched salt iodization programme in 1962 and vitamin A and iron-folate supplementation programmes in 1970. Yet, even after decades of these programmes, MNDs are still widespread in the country. Due to slow progress in alleviating the burden of most MNDs, the Government of India aims to scale up fortification-based intervention programmes. However, there are safety and effectiveness concerns with such approaches. Hence, overdependence on supplementation and fortification alone may be counterproductive. Instead, food based dietary diversification approach can be the way forward. In this article, we list the common MNDs in India, evaluate major policy interventions, discuss concerns pertaining to fortification and suggest the need for a concurrent food-based approach, in particular dietary diversification, as a long-term and sustainable strategy to address population-based MNDs.

Antibody deficiencies with normal IgG in adults with Non-cystic fibrosis bronchiectasis or recurrent pneumonia: Cross-sectional study / Deficiencias Predominantemente de Anticuerpos con niveles normales de IgG en adultos con bronquiectasias no fibrosis quística o neumonía recurrente en Colombia

Abstract Background: Inborn errors of immunity, mainly Predominantly Antibody deficiencies with normal IgG levels are unrecognized in adults with lung diseases such as bronchiectasis or recurrent pneumonia. Objective: To determine IgM, IgA, IgG2 subclass deficiencies, and Specific antibody deficiency (anti-pneumococcal polysaccharide antibodies) in adults with non-cystic fibrosis bronchiectasis or recurrent pneumonia. Methods: Cross-sectional study. Consecutive patients with non-cystic fibrosis bronchiectasis or recurrent pneumonia were recruited in Cali, Colombia. IgG, IgA, IgM, and IgE, IgG2subclass and IgG anti-pneumococcal serum levels were measured. Results: Among the 110 participants enrolled, Antibody deficiencies with normal serum IgG levels were found in 11(10%) cases. IgA deficiency (3 cases), IgM deficiency (2 cases) and IgG2 deficiency (2 cases) were the most frequent primary immunodeficiencies. In addition, IgG2+IgA deficiency, Ataxia-telangiectasia, Hyper-IgE syndrome and Specific Antibody Deficiency(anti-polysaccharides) were found in one case each. Conclusions: Predominantly antibody deficiencies with normal IgG levels are an important etiology of non-cystic fibrosis bronchiectasis and recurrent pneumonia in adults.

Resumen Antecedentes: Los Errores Innatos de la Inmunidad principalmente las Deficiencias Predominantemente de anticuerpos con niveles normales de IgG no se conocen en adultos con enfermedades pulmonares como las bronquiectasias o la neumonía recurrente. Objetivo: Determinar las deficiencias de IgM, IgA y de subclase de IgG2 y la Deficiencia Específica de Anticuerpos (anticuerpos antineumocócicos de polisacáridos) en adultos con Bronquiectasias no Fibrosis Quística (BQnoFQ) o neumonía recurrente. Métodos: Estudio observacional prospectivo. Se reclutaron 110 pacientes consecutivos con BQnoFQ o neumonía recurrente en Cali, Colombia. Se midieron los niveles séricos de IgG, IgA, IgM e IgE, subclase IgG2 y anticuerpos anti-neumococo. Resultados: Se encontraron deficiencias de anticuerpos con niveles normales de IgG en el 10% de los sujetos; Cuatro casos con IgG2 baja, incluido 1 caso de deficiencia de IgG2 + IgA, 1 caso de ataxia-telangiectasia, 3 deficiencias de IgA (IgAD), 2 deficiencias selectiva de IgM (IgMD), 1 síndrome de Hiper-IgE (HIES-AR) y 1 deficiencia específica de anticuerpos. Ocho pacientes fueron diagnosticados con enfermedades relacionadas con la hipogammaglobulinemia IgG. Conclusiones: Las deficiencias predominantemente de anticuerpos con niveles normales de IgG son una etiología importante de BQnoFQ y neumonía recurrente en adultos. Los sujetos con bronquiectasias o neumonía recurrente requieren una evaluación exhaustiva de la respuesta inmune humoral y clínica.

Vitamin D status in Mexican children 1 to 11 years of age: an update from the Ensanut 2018-19 / Estado de vitamina D en niños mexicanos de 1 a 11 años de edad: una actualización de la Ensanut 2018-19

Abstract Objective: To evaluate vitamin D status and deficiency in Mexican children and related factors, with updated data from a representative national survey. Materials and methods: Data and serum samples of child participants were collected in the Ensanut 2018-19. The measurement 25-(OH)-D was obtained through chemiluminescence. Height and weight, as well as dietary information, were measured using a semi-quan- titative food frequency questionnaire and sociodemographic information. Results: Data of 4 691 children aged 1-11 years were analyzed. Vitamin D deficiency (25-OH-D70% of vitamin D intake. Conclusions: Vitamin D deficiency is important in Mexican children. Actions and programs to fight this deficiency are required.

Resumen Objetivo: Evaluar el estado y la deficiencia de vitamina D en niños mexicanos, así como los factores relacionados, con datos actualizados de una encuesta nacional representativa. Material y métodos: Los datos y muestras de suero de niños participantes se recolectaron en la Ensanut 2018-19. La medición de 25- (OH)- D se realizó mediante quimiolu- miniscencia. Se obtuvo estatura, peso e información dietética a través de un cuestionario semicuantitativo de frecuencia alimentaria e información sociodemográfica. Resultados: Se analizaron datos de 4 691 niños entre 1 y 11 años. Se observó deficiencia de vitamina D (25-OH-D 70% de la ingesta. Conclusiones: La deficiencia de vitamina D es considerable en los niños mexicanos. Se requieren acciones y programas para combatirla.

Research on chronic disease prevention and control strategies at home and abroad / 公共卫生与预防医学

Objective To describe the development status of the prevention and control of chronic non-communicable diseases (hereinafter referred to as "chronic diseases") at home and abroad, and to explore coping strategies suitable for the prevention and control of chronic diseases in China. Methods Through literature review relevant data on chronic diseases as well as the prevention and control strategies and measures were collected. A comprehensive analysis on the data was conducted. Results The epidemic trend of chronic diseases is relatively serious both in China and in the world. To cope with the rapid development and epidemic of chronic diseases, China and many other countries have implemented relevant policies to curb the growth and development of chronic diseases and have achieved different results to a certain extent. Conclusion Chronic diseases have become the main cause of death and health threats in human society. The implementation and practice of chronic disease prevention and control strategies should be strengthened, in combination with successful experience at home and abroad, to rapidly develop the strategies for the prevention and control of chronic diseases in line with national conditions in China.

Cobalt deficiency in cattle and its impact on production / Deficiência de cobalto em bovinos e seu impacto na produção

Two outbreaks of cobalt deficiency in beef cattle were diagnosed in Midwestern Brazil. We discuss the clinical, epidemiological, pathological features, therapeutic measures, and impact aspects of the production system associated with these outbreaks occurring outbreaks in two farms of extensive cattle raising-system in the state of Mato Grosso do Sul. Seven affected cattle were euthanized and necropsied. Tissues for histopathology and microelements dosage were secured. At Farm A, 3100 cattle of all ages got sick, and 396 died; at Farm B, 148 were affected, and 110 died. In both farms, cattle were fed the same mineral supplement. The main clinical signs were weight loss and weakness, even though a good supply of forage was available in the paddocks. Many cattle stop grazing and chew at tree barks, wood chips from fence posts, and bones. In addition to the deaths, there was a compromised growth, and the reproductive rates fell sharply. The necropsied cattle were thin, with rough hair coat and pale mucous membranes. The liver was diffusely orange and showed a lobular pattern. The bone marrow was gelatinous and diffusely yellow. Histological changes included hemosiderosis in the liver and spleen, hepatocellular vacuolar degeneration, and myeloid and erythroid hypoplasia of the bone marrow. In the white matter of four cattle's brains, the myelin sheath was markedly distended (spongy degeneration). Proliferative parasitic abomasitis was observed in three cattle. The presumptive diagnosis was based on the association of the clinical picture, the necropsy findings, and the ruling out of other possible causes. The diagnosis was confirmed by the favorable response to treatment with cobalt and vitamin B12 orally and by mineral supplementation.(AU)

Dois surtos de deficiência de cobalto em bovinos de corte foram diagnosticados. Os aspectos clínicos, epidemiológicos, anatomopatológicos, terapêuticos e impactos no sistema de produção são descritos e discutidos. Os surtos ocorreram em duas fazendas de criação extensiva estado de Mato Grosso do Sul, Centro-Oeste brasileiro. Sete bovinos afetados foram eutanasiados e necropsiados. Na necropsia foram colhidas amostras para exames histopatológicos e dosagem de microelementos. Na Fazenda A, 3100 bovinos de todas as idades adoeceram e 396 morreram e na Fazenda B, 148 bovinos adoeceram e 110 morreram. Ambas as fazendas utilizavam o mesmo suplemento mineral. Os principais sinais clínicos observados foram emagrecimento e fraqueza, apesar da boa oferta de forragem nos piquetes, muitos bovinos deixaram de pastejar e comiam cascas de árvores, madeira das porteiras e ossos. Além das mortes, tiveram crescimento comprometido e os índices reprodutivos tiveram queda acentuada. Os bovinos necropsiados estavam magros, com os pelos arrepiados e mucosas pálidas. O fígado estava difusamente alaranjado e com evidenciação do padrão lobular. A medula óssea estava de consistência gelatinosa e difusamente amarelada. Alterações histológicas incluíam degeneração vacuolar hemossiderose que era moderada no fígado e marcada no baço. Hipoplasia mieloide e eritoide era vista na medula óssea. Na substância branca do encéfalo de quatro bovinos, a bainha de mielina estava marcadamente distendida (degeneração esponjosa). Abomasite parasitária proliferativa foi observada em três bovinos. O diagnóstico presuntivo baseou-se na associação do quadro clínico, nos achados de necropsia e na eliminação de outras possíveis causas. O diagnóstico foi confirmado pela resposta favorável ao tratamento com cobalto e vitamina B12 por via oral, e a suplementação mineral.(AU)

Morbidity profile of children from birth to 18 years of age referred for intervention to the district early intervention centre in a District Hospital, Andhra Pradesh

Background: The 揅hild Health Screening and Early Intervention Services� program aims at early detection and management of the four dimensions prevalent in children-defects at birth, diseases in children, deficiency conditions, and developmental delays, including disabilities. Objective: The objective of the study was to assess the morbidity profile of children from birth to 18 years of age screened in the district early intervention center (DEIC). Methods: A record-based descriptive study was done in the DEIC in Chittoor, Andhra Pradesh. The data were retrieved for 1-year from April 2017 to March 2018 into the excel sheet, and the combined master sheet was prepared for analysis. The analysis was done with SPSS 21.0 Version. Results: A total of 10571 children were screened and referred to the DEIC during the period. Out of them, 5679 (53.7%) were male and 4892 (46.3%) were female. Among all the four types of morbidities screened, majority 4847 (45.9%) were having the childhood diseases, 4177 (39.5%) had developmental delays including disabilities, 1067 (10.1%) had different deficiencies, and 361 (3.4%) had birth defects. Among the adolescent health issues, 119 (1.1%) were screened and sent for the early intervention to the district hospital. Conclusions: A huge number of children were screened and referred to the DEIC every year for intervention. The health sector has to focus more on the resources like workforce, training of peripheral health workers at regular intervals about the different morbidities screened, that would help in identifying the morbidities at the earliest possible time and receive the intervention at the best center.

Two Cases of Night Sweat Due to eiefuwa Successfully Treated with Kampo Medicine / 日本東洋医学雑誌

We present two cases of night sweats due to eiefuwa (deficiencies of nutrients and defenses) that were suc­cessfully treated with Kampo medicine. Case 1 was that of a 64-­year-­old man with perspiration during sleep and slight fever, and Case 2 was that of a 78­-year-­old man with perspiration during sleep and common cold­-like symptoms. Case 1 was administered with saikokeishito, and his symptoms quickly disappeared. Case 2 was administered with common cold drugs and saikokeishito initially, but the treatment was ineffective. Therefore, keishito was administered, and the patient's symptoms disappeared within 2 days. Sweating and common cold-­like symptoms were successfully treated with Kampo medicine for the diagnosis of eiefuwa. Further, we discuss the various descriptions of eiefuwa in the literature.

Estomatitis aftosa recurrente y deficiencias nutricionales: Reporte de tres casos y revisión de literatura / Recurrent Aphthous Stomatitis and Nutritional Deficiencies: Report of Three Cases with Literature Review

RESUMEN Introducción: La estomatitis aftosa recurrente (EAR) es la enfermedad ulcerativa más común que afecta la mucosa oral no queratinizada. La etiología aún se desconoce, pero se han propuesto varios factores locales y sistémicos como agentes causales. Descripción del caso: se informa tres pacientes con presencia de EAR asociada a deficiencias nutricionales, debidas a dietas de restricción alimentaria. El primer caso, una mujer de 19 años con deficiencia de hierro, refirió tomar té verde a diario y consumir poca cantidad de carbohidratos, grasas y carne. El segundo caso, un hombre de 32 años con deficiencia de hierro y vitamina B12 asociada a dieta tipo vegana, aunque a veces si consumía carne. El tercer caso, hombre de 50 años, vegano y exfumador desde hace un año, presentó deficiencia de hierro, vitamina B12 y ácido fólico. En los tres casos un detallado interrogatorio, examen clínico y análisis sanguíneo completo, permitió establecer un adecuado diagnóstico, manejo odontológico y derivación con un nutricionista, con el fin de tratar la patología de base y no sólo brindarles un tratamiento sintomático de las lesiones. Discusión: Ante un cuadro de EAR es recomendable realizar un análisis que incluya hemograma, ácido fólico, hierro y vitamina B12, para descartar posibles causas sistémicas y eventualmente tratarlas. El manejo clínico tiene como objetivo mejorar la función del paciente y la calidad de vida mediante terapias tópicas y sistémicas; sin embargo, es fundamental identificar y controlar los factores causales que contribuyen; así como, la exclusión o tratamiento de la enfermedad sistémica subyacente.

ABSTRACT Introduction: Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease that affects the non-keratinized oral mucosa. The etiology is still unknown, but several local and systemic factors have been proposed as causal agents. Case description: three patients are reported with RAS associated with nutritional deficiencies, due to dietary restriction diets. The first case, a 19-year- old woman with iron deficiency, reported taking green tea daily and consuming a small amount of carbohydrates, fats and meat. The second case, a 32-year-old man with iron deficiency and vitamin B12 associated with vegan diet, although sometimes if he consumed meat. The third case, man of 50 years, vegan and ex-smoker for a year, presented deficiency of iron, vitamin B12 and folic acid. In all three cases a detailed questioning, clinical examination and complete blood analysis allowed to establish an adequate diagnosis, dental management and referral with a nutritionist, in order to treat the underlying pathology and not only provide a symptomatic treatment of the injuries. Discussion: In the setting of RAS, it is advisable to perform an analysis that includes a blood count, folic acid, iron and vitamin B12, to rule out possible systemic causes and eventually treat them. Clinical management aims to improve patient function and quality of life through topical and systemic therapies; however, it is essential to identify and control the causal factors that contribute; as well as, the exclusion or treatment of the underlying systemic disease.

Prevalence of nutritional deficiencies among school going adolescents of Vadodara, Gujarat, India: a cross sectional study

Background: Adolescent constitutes over 23% of the population in India. Critical development occurs during adolescence period. Growth spurt and increase in physical activity during adolescent period increases the nutrition and health needs of the adolescent. Objective was to study prevalence of nutritional deficiencies among school going adolescents of Vadodara city, Gujarat.Methods: The study was carried during period from September 2018 to August 2019. After taking the permission of principals of 3 schools and consent of the parents of adolescents, 511 adolescents from 3 schools of Vadodara city were examined for signs of various nutritional deficiencies. The data was collected by predesign, pretested proforma and analyzed using SPSS 17.0 (Trial Version).Results: Out of total 511 adolescents 253(49.5%) were female. Mean age of the study adolescents was 15.6±1.81 years. Maximum numbers of the adolescents were in the age group of 10-14 years (60.3%). Mean age of female and male adolescents was 15.2±1.71 years and 15.6±2.01 years respectively. The study revealed that vitamin A deficiency was present in 38(7.4%) adolescents. Vitamin B complex deficiency signs were seen in 112(21.9%) adolescents. Vitamin C deficiency signs were seen in 43(8.4%) adolescents. Protein Energy Malnutrition was observed in 52(10.1%) adolescents. Essential fatty acid deficiency was observed in 56(10.9%) adolescents.Conclusions: High prevalence of nutritional deficiencies among these adolescents needs great attention and health education.

Impact of Dietary Pattern on Nutritional Status of Pregnant Women in Low and High Strata between the Age Group of 30-39 Years in Mumbai

Background: Maternal Nutrition plays an important role in shaping the mother’s and fetal health. Therefore intake of high salt, high fat, high sugar in the diet might lead to over nutrition among pregnant women due to varied food choices of the since most of the subjects consumed outside food, Sugar Sweetened Beverages such as (Cola, Pepsi, Thumps Up, Soda, Sherbet etc), Processed Food such as(Ready to eat food, Mayonnaise, Cheese spread etc) which consist of increase amount of preservative which might affect the mother and foetal’s health. Since there was increase intake of above food groups and decrease intake of macro and micronutrients in the diet through food group such as Fruits, Nuts and Oilseed, Green Leafy Vegetables etc. Therefore there might be increased risk of Over nutrition among women which might lead to GDM (Gestational Diabetes Mellitus), IUGR(Intra Uterine Growth Retardation), Low Birth weight etc.Aim: To study the impact of dietary pattern on Nutritional of pregnant women in Low and High Strata. Method: A purposive random sampling was done among pregnant women because only 2ndtrimester pregnant women were selected for the study. The 50 subjects were divided into LSES (Lower Socioeconomic Strata) &HSES (Higher Socioeconomic Strata) on the basis of Kuppuswamy Index. The dietary pattern of the subjects was assessed through FFQ (Food Frequency Questionnaire) & 3 Day Diet Recall. Result: There was increase consumptionof High Fat, High Salt, High Sugar in the diet through consumption if food group such as Outside Food, Processed Food, Sugar Sweetened Beverages etc and in comparison the consumption of Macro and Micronutrient rich food group was lower which included Fruits, Green Leafy Vegetables, Nuts and oilseed etc. In Lower Strata the consumption of above food group was low because they were financially not stable therefore they were given additional services where the company paid their ration balance so that they could consume selective food group which were costing comparatively more. Since the RDA(Recommended Dietary Allowances) requirements were not met therefore the women were prescribed Iron, Calcium and Folic Acid supplements in the diet to decrease the risk ofMaternal and fetal complication such as GDM(Gestational Diabetes Mellitus), NTD(Neural Tube Defect), IUGR(Intra Uterine Growth Retardation) etc.Conclusion: Therefore to decrease the risk of Maternal and Fetal Complications intake of Macro and Micro nutritions in the diet is imperative and it is important to organize Nutrition Intervention programmes and counsel the pregnant women about Maternal Nutrition and how decrease intake of Nutrients in the diet might lead to Maternal Under nutrition and over nutrition and its related risk