Efectividad de la administración de hierro en forma semanal y diaria para la prevención de anemia por deficiencia de hierro en lactantes / Effectiveness of weekly and daily iron administration for the prevention of iron deficiency anemia in infants

Introducción. La deficiencia de hierro (DH) es la carencia nutricional más prevalente y la principal causa de anemia en lactantes. Existe consenso en la suplementación diaria con hierro como estrategia de prevención; también se demostró que la suplementación semanal es eficaz, pero la evidencia en lactantes es escasa. El objetivo fue comparar la efectividad de la administración diaria de hierro frente a la semanal para la prevención de la anemia por DH del lactante. Población y métodos. Ensayo clínico controlado y aleatorizado. Lactantes atendidos en un centro de salud público, sin anemia a los 3 meses de edad, aleatorizados en tres grupos: suplementación diaria (1 mg/kg/día), semanal (4 mg/kg/semana) o sin suplementación (grupo control con lactancia materna exclusiva [LME]). Se evaluó anemia y DH a los 3 y 6 meses. Se registró grado de adherencia y efectos adversos. Los datos se analizaron con el software R versión 4.0.3. Resultados. Participaron 227 lactantes. A los 6 meses el grupo de lactantes con LME sin suplementación (control) presentó prevalencias de DH y anemia por DH (ADH) mayores que los grupos intervenidos (diario y semanal). DH: 40,5 % vs. 13,5 % y 16,7 % (p = 0,002); ADH: 33,3 % vs. 7,8 % y 10 % (p < 0,001). No hubo diferencias entre los grupos diario y semanal. Tampoco hubo diferencias en el porcentaje de alta adherencia a la suplementación (50,6 % diaria vs. 57,1 % semanal), ni en los efectos adversos. Conclusiones. No se hallaron diferencias significativas en la efectividad entre la administración diaria y semanal para la prevención de ADH del lactante.

Introduction. Iron deficiency (ID) is the most prevalent nutritional deficiency and the main cause of anemia in infants. There is consensus on daily iron supplementation as a preventive strategy; and weekly iron supplementation has also been shown to be effective, but evidence in infants is scarce. The objective of this study was to compare the effectiveness of daily versus weekly iron administration for the prevention of ID anemia (IDA) in infants. Population and methods. Randomized, controlled clinical trial. Infants seen at a public health center, without anemia at 3 months of age, were randomized into 3 groups: daily supplementation (1 mg/kg/ day), weekly supplementation (4 mg/kg/week), or no supplementation (control group with exclusive breastfeeding [EB]). Anemia and ID were assessed at 3 and 6 months old. Adherence and adverse events were recorded. Data were analyzed using the R software, version 4.0.3. Results. A total of 227 infants participated. At 6 months, the group of infants with EB without supplementation(control) had a higher prevalence of ID and IDA than the intervention groups (daily and weekly). ID: 40.5% versus 13.5% and 16.7% (p = 0.002); IDA: 33.3% versus 7.8% and 10% (p < 0.001). There were no differences between the daily and weekly supplementation groups. There were also no differences in the percentage of high adherence to supplementation (50.6% daily versus 57.1% weekly) or adverse events. Conclusions. No significant differences in effectiveness were observed between daily and weekly administration for the prevention of infant IDA.

Comparative study on efficacy, tolerability, and cost of different iron supplements among antenatal women with iron-deficiency anemia

Background: Anemia is one of the most common medical complications encountered during pregnancy. India is among the countries with maximum prevalence of anemia in the world. The commonly used treatment for iron-deficiency anemia is oral iron preparations such as ferrous sulfate, ferrous gluconate, ferrous ascorbate, ferrous fumarate, and parenteral iron sucrose. Aims and Objectives: The aims of this study were to assess the mean change in the hemoglobin levels from baseline up to 60th day of treatment with different iron supplements and to assess its cost effectiveness ratio. Materials and Methods: This was a prospective interventional clinical end point study conducted at Sri Venkateshwaraa Medical College Hospital and Research Center, Puducherry, India, from December 2019 to December 2020, among 84 antenatal women (>14 weeks) with iron-deficiency anemia. After getting ethics committee approval, the participants who fulfilled the inclusion and exclusion criteria were randomized to respective treatment groups. Group 1 (n = 21) received ferrous sulfate 200 mg, Group 2 (n = 21) received ferrous ascorbate 200 mg, Group 3 (n = 21) received ferrous fumarate 200 mg twice daily for a period of 60 days, and Group 4 (n = 21) received Iron sucrose 200 mg, based on iron requirement in divided doses and administered once in 2 weeks for a period of 60 days. Hemoglobin (Hb), RBC count, mean corpuscular volume, mea n corpuscular Hb (MCH), MCHC, WBC, platelet count, and cost of the treatment were assessed before and at the end of 60 days. Data were analyzed using GraphPad Prism software version 7.0 using Student “t”-test and one-way ANOVA. Results: We observed a significant (P < 0.001) rise in the mean Hb level from 10.4 ± 0.4, 10.4 ± 0.5, 10.4 ± 0.5 and 8.5 ± 0.3 to 11.2 ± 0.6 (P = 0.0001), 11.1 ± 0.6 (P = 0.0001), 11.3 ± 0.8(P = 0.0001), and 10.9 ± 0.6 (P = 0.0001) in Group 1, 2, 3, and 4, respectively. The average cost effectiveness ratio, with respect to Groups 1, 2, 3, and 4 was Rs. 675, Rs. 1782.9, Rs. 1110.7, and Rs. 786.7 per increase in Hb%, respectively. Conclusion: The outcome of this study proved the effective role of various oral ferrous iron preparations and all of them were found to be equally efficacious in improving the Hb concentration. However, the injectable iron sucrose showed a significant improvement in mean hemoglobin percentage compared to the various oral preparations. However, on analyzing the cost-effectiveness ratio, it was found out that the cost incurred per increase in Hb% was less in ferrous sulfate group, followed by iron sucrose, ferrous fumarate, and ferrous ascorbate. The results of this study can be helpful in pharmacoeconomical decision making while selecting a cost effective iron supplement for treating iron-deficiency anemia.

Avaliação da pentoxifilina e do sulfato ferroso no tratamento da úlcera varicosa dos membros inferiores / Evaluation of pentoxifylline and ferrous sulfate for treatment of lower limb venous ulcers

Resumo Contexto A úlcera varicosa (UV) é o estágio mais avançado da doença venosa crônica (DVC) dos membros inferiores (MMII), frequentemente associada a episódios de hemorragia que podem provocar anemia crônica (AC) e retardar a sua cicatrização. Não há, na literatura, trabalhos que avaliem a prevalência da AC nos portadores de UV dos MMII, e poucos trabalhos analisam o uso da pentoxifilina no tratamento das UV dos MMII. Objetivos Avaliar a prevalência da AC nos pacientes portadores de UV de MMII e a resposta terapêutica ao sulfato ferroso (SF) e a associação da pentoxifilina com SF no tratamento adjuvante das UV dos MMII. Métodos Foram avaliados 67 pacientes portadores de UV de MMII atendidos no ambulatório de Cirurgia Vascular do Hospital das Clínicas, Recife, PE. Após as avaliações clínica e laboratorial iniciais, os pacientes diagnosticados com AC foram randomizados em dois grupos: o grupo controle, que recebeu SF (900 mg/dia via oral), e o grupo de estudo, tratado com SF (900 mg/dia via oral) e pentoxifilina (1.200 mg/dia). Todos foram reavaliados após 90 dias. Resultados Entre os pacientes avaliados, 27 (40%) apresentavam AC. Após o tratamento, foram observados aumento dos níveis de hemoglobina e de hematócrito e melhora das taxas da cinética do ferro, assim como a diminuição da profundidade e da área das UV em ambos os grupos, sem diferença estatística. Conclusões Foi encontrada alta prevalência de anemia na população estudada. A associação do SF com a pentoxifilina não se mostrou mais eficaz do que o emprego isolado do SF no tratamento adjuvante da UV dos MMII.

Abstract Background Venous ulcers (VU) are the most advanced stage of chronic venous disease (CVD) of the lower limbs. They are frequently associated with episodes of hemorrhage that can provoke chronic anemia (CA), delaying healing. There are no studies in the literature analyzing the prevalence of CA among patients with VU of the lower limbs and few studies have analyzed use of pentoxifylline to treat VU of the lower limbs. Objectives To evaluate the prevalence of CA in patients with lower limb VU and responses to treatment with ferrous sulfate (SF) compared with a combination of SF plus pentoxifylline as adjuvant treatment for VU of the lower limbs. Methods A total of 67 patients with lower limb VU were recruited from a Lymphedema and Angiodysplasia Clinic at the Hospital das Clínicas, Recife, PE, Brazil. After initial clinical and laboratory assessments, patients diagnosed with CA were randomized into one of two groups: a control group, given SF (900 mg/day oral route), or a study group, treated with SF (900 mg/day oral route) and pentoxifylline (1,200 mg/day). All were reassessed after 90 days. Results Twenty-seven patients (40%) had CA. After treatment, increases were observed in hemoglobin and hematocrit levels, iron kinetics had improved, and both depth and area of VU had reduced in both groups, without statistically significant differences. Conclusions A high prevalence of anemia was detected in the study population. The combination of SF and pentoxifylline was not more effective than SF alone for adjuvant treatment of VU of the lower limbs.

Screening of medium constituents for clavulanic acid production by Streptomyces clavuligerus

ABSTRACT Clavulanic acid is a β-lactam compound with potent inhibitory activity against β-lactamases. Studies have shown that certain amino acids play essential roles in CA biosynthesis. However, quantitative evaluations of the effects of these amino acids are still needed in order to improve CA production. Here, we report a study of the nutritional requirements of Streptomyces clavuligerus for CA production. Firstly, the influence of the primary nitrogen source and the salts composition was investigated. Subsequently, soybean protein isolate was supplemented with arginine (0.0-3.20 g L-1), threonine (0.0-1.44 g L-1), ornithine (0.0-4.08 g L-1), and glutamate (0.0-8.16 g L-1), according to a two-level central composite rotatable design. A medium containing ferrous sulfate yielded CA production of 437 mg L-1, while a formulation without this salt produced only 41 mg L-1 of CA. This substantial difference suggested that Fe2+ is important for CA biosynthesis. The experimental design showed that glutamate and ornithine negatively influenced CA production while arginine and threonine had no influence. The soybean protein isolate provided sufficient C5 precursor for CA biosynthesis, so that supplementation was unnecessary. Screening of medium components, together with experimental design tools, could be a valuable way of enhancing CA titers and reducing the process costs.

Generación de radicales libres por efecto de vitamina C sobre un jarabe antianémico de sulfato ferroso / Generation of free radicals by the effect of vitamin C on a ferrous sulfate antianemic syrup

Objetivo: Determinar el efecto que ejerce la vitamina C sobre el sulfato ferroso, principio activo de un jarabe antianémico. Materiales y métodos: La reacción que se produce entre el sulfato ferroso de un jarabe antianémico y la vitamina C se determinó al aplicar la técnica de descomposición de la desoxirribosa, que evalúa la formación de malondialdehído por acción de radicales libres. Resultados: En un medio de ensayo constituido por tampón fosfato 50 mM (pH 7,4), el jarabe antianémico de sulfato ferroso a una concentración 1,080 mM reaccionó con la vitamina C en concentraciones comprendidas entre 5,0 x 10-6 mM y 0,5 mM, generando radicales libres que disminuyen cuando se utiliza una concentración de vitamina C de 5,0 x 10-2 mM mientras que a una concentración 0,5 mM, se eleva. Cuando se usa sulfato ferroso en condiciones similares se aprecia un incremento de la generación de radicales libres que alcanza un valor máximo a una concentración de vitamina C de 5,0 x 10-6 mM que se mantiene invariable a concentraciones de dos órdenes de magnitud mayor y, ulteriormente, decrece a concentraciones más elevadas. La vitamina C a una concentración 1,0 mM reacciona con el sulfato ferroso utilizado en concentraciones comprendidas entre 0,270 y 2,160 mM describiendo una curva de tipo hiperbólica. En cambio, el jarabe de sulfato ferroso, utilizado en las mismas concentraciones, mostró un elevado incremento a bajas concentraciones de tipo no lineal pero que tuvo una respuesta lineal a partir de la concentración 0,540 mM del jarabe, respuesta que fue mayor a la alcanzada por el sulfato ferroso disuelto en agua destilada. Conclusiones: La vitamina C reacciona con el jarabe de sulfato ferroso y genera radicales libres, esta respuesta depende de las concentraciones relativas de sulfato ferroso, vitamina C y de los excipientes del jarabe.

Objective: To determine the effect of vitamin C on ferrous sulfate, the active ingredient of an antianemic syrup. Materials and methods: The reaction between the ferrous sulfate contained in an antianemic syrup and vitamin C was determined using the decomposition technique of deoxyribose, which evaluates the formation of malondialdehyde by the action of free radicals. Results: In an assay medium consisting of 50 mM phosphate buffer (pH 7.4), the ferrous sulfate antianemic syrup at a concentration of 1.080 mM reacted with vitamin C at concentrations between 5.0 x 10-6 mM and 0.5 mM, generating levels of free radicals that decrease when vitamin C is used at a concentration of 5.0 x 10-2 mM, and increase at a concentration of 0.5 mM. When ferrous sulfate is used under similar conditions, an increase in the generation of free radicals is observed, which reaches a maximum value with vitamin C at a concentration of 5.0 x 10-6 mM, remains unchanged at concentrations of two orders of magnitude higher, and subsequently decreases at higher concentrations. Vitamin C at a concentration of 1.0 mM reacts with ferrous sulfate used at concentrations between 0.270 and 2.160 mM, describing a hyperbolic curve. In contrast, ferrous sulfate syrup used at the same concentrations showed a high increase at low non-linear concentrations, but a linear response from the 0.540 mM concentration of the syrup, a response that was higher than that reached by the ferrous sulfate dissolved in distilled water. Conclusions: Vitamin C reacts with ferrous sulfate syrup generating free radicals. This response depends on the relative concentrations of ferrous sulfate, vitamin C and syrup excipients.

Suplementação de sulfato ferroso na gestação e anemia gestacional: uma revisão de literatura / Ferrous sulfate supplementation in pregnancy and gestational anemia: a systematic review

Este estudo objetivou realizar uma revisão da literatura sobre a influência da suplementação de ferro na prevenção da anemia ferropriva na gestação e seus efeitos associados na saúde do binômio mãe e feto. Para tanto, foram consultadas as bases de dados PUBMED, MEDLINE, SCIELO com os descritores "anemia", "pregnancy" e "ferrous sulfate", e selecionados os estudos que avaliavam os benefícios, malefícios e/ou a necessidade da suplementação ferrosa durante a gestação. Dos duzentos e um (201) artigos selecionados, onze (11) se enquadravam nos critérios. Dentre esses, quatro (04) abordaram apenas aspectos positivos, quatro (04) somente a perspectiva negativa e três (03) apresentaram ambos os lados. Ademais, oito (08) artigos fizeram ressalvas que contrapõem o atual modelo de uso rotineiro no Brasil, evidenciando que a suplementação individual de ferro seja preferida à rotineira. Isso porque, embora a anemia seja apontada como geradora de abortos espontâneos, restrição de crescimento intrauterino, parto pré-termo, pré-eclâmpsia, dentre outros, a suplementação também pode gerar efeitos negativos, os quais são resultantes tanto da hemoconcentração ­ em função do aumento expressivo dos níveis de hemoglobina ­ quanto dos efeitos colaterais da suplementação, como náuseas, vômitos, dor abdominal e constipação. Ainda, não houveram diferenças nos valores de hemoglobina e de prevalência de anemia significantes nos estudos avaliados, nem desfechos clinicamente relevantes em gestantes não anêmicas que receberam profilaxia com sulfato ferroso. Desse modo, o uso individualizado de acordo com cada paciente é mais plausível, pois a forma rotineira negligencia aspectos individuais, como a melhor frequência de uso, a demanda e os efeitos colaterais.

This study aimed to realize a literature review about the influence of iron supplementation on the prevention of iron deficiency anemia in pregnancy and its associated effects on the health of the mother and fetus binomial. Therefore, were consulted the databases PUBMED, MEDLINE and SCIELO with the descriptors "anemia", "pregnancy" and "ferrous sulfate", selecting the studies that evaluated the benefits, harms and/or the necessity of ferrous supplementation during pregnancy. Of the two hundred and one (201) selected articles, eleven (11) fit the criteria. Among these, four (04) addressed only positive aspects, four (04) only negative perspective and three (03) presented both sides. In addition, eight (08) articles made caveats that counterpose the current model of routine use in Brazil, evidencing that individual iron supplementation is preferred to routine. This because, although anemia is pointed as generating spontaneous abortions, intrauterine growth restriction, preterm delivery, preeclampsia, among others, supplementation can also generate negative effects, both of which result from hemoconcentration ­as a function of increased hemoglobin levels- as well as the side effects of supplementation, such as nausea, vomiting, abdominal pain and constipation. Furthermore, there were no significant differences in hemoglobin values and prevalence of anemia in the studies evaluated nor clinically relevant outcomes in non-anemic pregnant women who received prophylaxis with ferrous sulfate yet. In this way, the individualized use according to each patient is more plausible, since the routine way neglects individual aspects, such as the best frequency of use, the demand and the side effects.

The maturation state of the auditory nerve and brainstem in rats exposed to lead acetate and supplemented with ferrous sulfate / Estado de maturação do nervo auditivo e tronco encefálico em ratos expostos a acetato de chumbo e suplementados com sulfato ferroso

Abstract Introduction The literature has reported the association between lead and auditory effects, based on clinical and experimental studies. However, there is no consensus regarding the effects of lead in the auditory system, or its correlation with the concentration of the metal in the blood. Objective To investigate the maturation state of the auditory system, specifically the auditory nerve and brainstem, in rats exposed to lead acetate and supplemented with ferrous sulfate. Methods 30 weanling male rats (Rattus norvegicus, Wistar) were distributed into six groups of five animals each and exposed to one of two concentrations of lead acetate (100 or 400 mg/L) and supplemented with ferrous sulfate (20 mg/kg). The maturation state of the auditory nerve and brainstem was analyzed using Brainstem Auditory Evoked Potential before and after lead exposure. The concentration of lead in blood and brainstem was analyzed using Inductively Coupled Plasma-Mass Spectrometry. Results We verified that the concentration of Pb in blood and in brainstem presented a high correlation (r = 0.951; p < 0.0001). Both concentrations of lead acetate affected the maturation state of the auditory system, being the maturation slower in the regions corresponding to portion of the auditory nerve (wave I) and cochlear nuclei (wave II). The ferrous sulfate supplementation reduced significantly the concentration of lead in blood and brainstem for the group exposed to the lowest concentration of lead (100 mg/L), but not for the group exposed to the higher concentration (400 mg/L). Conclusion This study indicate that the lead acetate can have deleterious effects on the maturation of the auditory nerve and brainstem (cochlear nucleus region), as detected by the Brainstem Auditory Evoked Potentials, and the ferrous sulphate can partially amend this effect.

Resumo Introdução A literatura relatou a associação entre o chumbo e os efeitos auditivos, com base em estudos clínicos e experimentais. No entanto, não há consenso em relação aos efeitos do chumbo no sistema auditivo, ou sua correlação com a concentração do metal no sangue. Objetivo Investigar o estado de maturação do sistema auditivo, especificamente do nervo auditivo e do tronco encefálico, em ratos expostos ao acetato de chumbo e suplementados com sulfato ferroso. Método 30 ratos machos desmamados (Rattus norvegicus, Wistar) foram distribuídos em seis grupos de cinco animais e expostos a uma de duas concentrações de acetato de chumbo (100 ou 400 mg/L) e suplementados com sulfato ferroso (20 mg/kg). O estado de maturação do nervo auditivo e do tronco encefálico foi analisado pelo Potencial Evocado Auditivo do Tronco Encefálico antes e após a exposição ao chumbo. A concentração de chumbo no sangue e tronco encefálico foi analisada utilizando-se Espectrometria de Massa com Plasma Indutivamente Acoplado. Resultados Verificamos que as concentrações de Pb no sangue e no tronco encefálico apresentaram alta correlação (r = 0,951, p < 0,0001). Ambas as concentrações de acetato de chumbo afetaram o estado de maturação do sistema auditivo, a maturação foi mais lenta nas regiões correspondentes à porção do nervo auditivo (onda I) e dos núcleos cocleares (onda II). A suplementação com sulfato ferroso reduziu significativamente a concentração de chumbo no sangue e no tronco encefálico no grupo exposto à menor concentração de chumbo (100 mg/L), mas não para o grupo exposto à maior concentração (400 mg/L). Conclusão Esse estudo indica que o acetato de chumbo pode ter efeitos deletérios na maturação do nervo auditivo e do tronco encefálico (região do núcleo coclear), como detectado pelos potenciais evocados auditivos do tronco encefálico, e que o sulfato ferroso pode diminuir parcialmente esse efeito.

Comparison of the efficacy of iron amino acid chelate and ferrous sulfate in the treatment of iron deficiency anemia among pregnant women seen at the out-patient department of a tertiary medical center on 2016-2017 / Philippine Journal of Obstetrics and Gynecology

Background@#Anemia is a major global problem that affects women and prevalent during pregnancy. Effective management is needed to prevent adverse maternal and pregnancy outcomes. Ferrous iron salts are the preparation of choice and recommended for both prevention and treatment of iron deficiency anemia (IDA). However, most commonly available iron supplement are poorly absorbed, with gastrointestinal disturbances as side effect.@*Objective@#To compare the efficacy of iron amino acid chelate and ferrous sulfate in the treatment of IDA among pregnant women seen at the out-patient department of a tertiary medical center.@*Methodology@#This study is a single blind randomized clinical trial which included women 18 to 40 years old, with singleton pregnancies diagnosed with IDA without any co-existing fetal and maternal complications seen at the OutPatient Department. Forty eight eligible participants were randomized, with 24 women allocated on each treatment arm who took their assigned treatment twice a day for 90 days. Hemoglobin, hematocrit, MCHC, MCV, RDW & serum ferritin levels were taken at baseline and monitored on days 30, 60 and 90 from initiation of treatment. Mean blood parameters between two treatment arms were compared on days 30, 60 and 90 post-treatment as well as the mean difference of blood parameters on days post-treatment from the baseline using T-test. Chi-square was used to compare adverse effects between two treatment arms.@*Results@#No statistically significant differences in the mean blood parameters on days 30 and 60 of treatment between Iron amino acid chelate and Ferrous sulfate. It was only on day 90 from initiation of treatment when there were a significantly higher hematocrit and MCHC and lower RDW in Iron amino acid chelate compared to Ferrous sulfate group. All of the CBC parameters on days 30, 60, and 90 post-treatment when compared to baseline level were significantly increased for both treatment arms. However, day 90 level of serum ferritin in the Iron amino acid chelate group significantly increased unlike those in ferrous sulfate group.@*Conclusion@#Iron amino acid chelate is comparable to Ferrous sulfate in the treatment of IDA among pregnant women. Iron amino acid chelate was found to be superior to Ferrous sulfate in achieving optimum treatment response even at a lower dose with lesser adverse effects. Hence, better oral iron treatment tolerability, thereby, compliance to long-term therapy can be expected resulting to successful treatment outcome.

Iniquidade na suplementação de sulfato ferroso entre gestantes no sul do Brasil / Inequality in iron sulfate supplementation among pregnant women in Southern Brazil

RESUMO: Introdução: O uso de sulfato ferroso é recomendado a todas as gestantes a partir da vigésima semana de gestação até o terceiro mês após o parto. Objetivo: Avaliar a cobertura de sulfato ferroso entre as gestantes e diferenciais de acordo com variáveis demográficas e socioeconômicas. Metodologia: Estudo transversal de base populacional com mulheres que tiveram filhos em Rio Grande, Rio Grande do Sul, no período de 01 de janeiro a 31 de dezembro de 2013. A cobertura de sulfato ferroso foi avaliada de acordo com idade e escolaridade materna, renda familiar e tipo de assistência médica no pré-natal. A análise estatística incluiu teste do χ2 de Pearson e regressão de Poisson. Resultados: Foram entrevistadas 2.685 puérperas (97% das mulheres elegíveis). A cobertura de sulfato ferroso foi de 63%. As maiores diferenças relativas foram entre os grupos extremos de escolaridade materna (50%) e em relação ao tipo de assistência médica no pré-natal (72%). Mulheres com idade entre 13 e 19 anos mostraram-se significativamente associadas ao uso do suplemento (RP = 1,16; IC95% 1,08 - 1,25) quando comparadas às mulheres com idade ≥ 30 anos. Quem utilizou o serviço público no pré-natal esteve mais fortemente associado ao desfecho quando comparado com quem utilizou o sistema privado (RP = 1,61; IC95% 1,49 - 1,74). Conclusão: São incomuns situações no setor de saúde em que os grupos menos favorecidos são privilegiados. Esses achados são raros e indicam a presença de iniquidade de forma contrária ao esperado. O suplemento deve considerar todas as mulheres, em especial as mais velhas, com maior escolaridade e de melhor nível socioeconômico.

ABSTRACT: Introduction: The use of ferrous sulfate is recommended for all pregnant women from the 20th week of gestation to the 3rd month after delivery. Objective: To evaluate the coverage of ferrous sulfate among pregnant women and differentials according to demographic and socioeconomic variables. Method: A cross-sectional population-based study with women who had children in Rio Grande, Rio Grande do Sul, Brazil, from January 1st to December 31st, 2013. Ferrous sulfate coverage was assessed according to maternal age, schooling, family income, and type of prenatal care. Statistical analysis included Pearson's χ2 test and Poisson regression. Results: 2,685 postpartum women (97% of the total) were interviewed and the ferrous sulfate coverage was 63%. The largest relative differences were between the extreme maternal schooling groups (50%) and the type of medical care in prenatal care (72%). Women aged between 13 and 19 years were significantly associated with the use of supplement (RP = 1.16; 95%CI 1.08 - 1.25) when compared to women aged ≥ 30 years. Those who used the public service in prenatal care were more strongly associated with the outcome when compared to those who used the private system (PR = 1.61; 95%CI 1.49 - 1.74). Conclusion: Considering that there are unusual situations in the health sector in which disadvantaged groups are privileged, these findings are rare and indicate the presence of inequality in a way that is opposite to what was expected. The supplement should consider all women, especially older women, with higher education and better socioeconomic status.

Prevenção da anemia ferropriva em crianças: foco na adesão ao uso do sulfato ferroso / Prevention of iron deficiency anemia in children: focus on adherence to the use of ferrous sulfate

O estudo teve por objetivos caracterizar as crianças na faixa etária entre seis meses e 11 meses e 29 dias em seguimento em unidades de saúde da família, de acordo com dados de nascimento, maternos, alimentação e socioeconômicos; descrever aspectos sobre a prevenção da anemia ferropriva, com destaque para o uso preventivo do sulfato ferroso na perspectiva do cuidador principal da criança; e identificar elementos facilitadores e dificultadores da prevenção da anemia ferropriva na infância. Estudo descritivo e exploratório, desenvolvido em duas fases, sendo a primeira etapa com coleta de dados secundários de 183 prontuários, caracterizando o perfil das crianças de seis meses a 11 meses e 29 dias de idade em seguimento na estratégia saúde da família. Na segunda etapa, foram realizadas 12 entrevistas com o cuidador principal da criança, para apreender suas noções acerca da prevenção da anemia ferropriva e o uso do sulfato ferroso em crianças. Os resultados apontam informações sobre aleitamento materno, introdução da alimentação complementar, conhecimento sobre alimentos e formas de prevenção da anemia ferropriva, identificadas como elementos facilitadores para a prevenção dessa enfermidade. Por outro lado, o pouco reconhecimento sobre a enfermidade e seus malefícios à saúde da criança, o baixo número de crianças com prescrição do sulfato ferroso e a interrupção do uso do sulfato ferroso foram considerados como elementos que dificultam a prevenção da anemia ferropriva. O estudo conclui que o incentivo e apoio ao aleitamento materno exclusivo, o monitoramento do desmame precoce, a introdução de alimentos saudáveis, as informações sobre a anemia ferropriva e o uso cotidiano do sulfato ferroso em crianças devem ser mais bem trabalhados com as famílias e equipes de saúde da família, tendo em vista a promoção de práticas alimentares saudáveis e das práticas educativas em saúde. A presente investigação traz contribuições para expandir a prevenção de agravos e promoção da saúde infantil, particularmente com vistas ao manejo e diminuição da prevalência da anemia ferropriva em crianças

The objective of the study was to characterize children in the age group between six months and 11 months and 29 days in follow-up in family health units, according to birth, maternal, feeding and socioeconomic data; To describe aspects about the prevention of iron deficiency anemia, especially the preventive use of ferrous sulfate from the perspective of the child's primary caregiver; And to identify elements that facilitate and impede the prevention of iron deficiency anemia in childhood. A descriptive and exploratory study was carried out in two phases, the first stage with secondary data collection of 183 charts, characterizing the profile of children from six months to 11 months and 29 days of age in a follow-up in the family health strategy. In the second stage, 12 interviews were carried out with the child's primary caregiver to learn their notions about the prevention of iron deficiency anemia and the use of ferrous sulfate in children. The results point to information about breastfeeding, introduction of complementary feeding, knowledge about food and ways of preventing iron deficiency anemia, identified as facilitating factors for the prevention of this disease. On the other hand, the lack of recognition of the disease and its harmful effects on the health of the child, the low number of children with iron sulfate prescription and the interruption of the use of ferrous sulfate were considered as elements that make it difficult to prevent iron deficiency anemia. The study concludes that encouraging and supporting exclusive breastfeeding, monitoring early weaning, introducing healthy foods, reporting on iron deficiency anemia, and daily use of ferrous sulfate in children should be better handled with families and family health teams; the promotion of healthy eating practices and educational practices in health. The present research brings contributions to expand the prevention of injuries and promotion of child health, particularly with a view to the management and reduction of the prevalence of iron deficiency anemia in children

Prevenção da anemia ferropriva em crianças: foco na adesão ao uso do sulfato ferroso / Prevention of iron deficiency anemia in children: focus on adherence to the use of ferrous sulfate

O estudo teve por objetivos caracterizar as crianças na faixa etária entre seis meses e 11 meses e 29 dias em seguimento em unidades de saúde da família, de acordo com dados de nascimento, maternos, alimentação e socioeconômicos; descrever aspectos sobre a prevenção da anemia ferropriva, com destaque para o uso preventivo do sulfato ferroso na perspectiva do cuidador principal da criança; e identificar elementos facilitadores e dificultadores da prevenção da anemia ferropriva na infância. Estudo descritivo e exploratório, desenvolvido em duas fases, sendo a primeira etapa com coleta de dados secundários de 183 prontuários, caracterizando o perfil das crianças de seis meses a 11 meses e 29 dias de idade em seguimento na estratégia saúde da família. Na segunda etapa, foram realizadas 12 entrevistas com o cuidador principal da criança, para apreender suas noções acerca da prevenção da anemia ferropriva e o uso do sulfato ferroso em crianças. Os resultados apontam informações sobre aleitamento materno, introdução da alimentação complementar, conhecimento sobre alimentos e formas de prevenção da anemia ferropriva, identificadas como elementos facilitadores para a prevenção dessa enfermidade. Por outro lado, o pouco reconhecimento sobre a enfermidade e seus malefícios à saúde da criança, o baixo número de crianças com prescrição do sulfato ferroso e a interrupção do uso do sulfato ferroso foram considerados como elementos que dificultam a prevenção da anemia ferropriva. O estudo conclui que o incentivo e apoio ao aleitamento materno exclusivo, o monitoramento do desmame precoce, a introdução de alimentos saudáveis, as informações sobre a anemia ferropriva e o uso cotidiano do sulfato ferroso em crianças devem ser mais bem trabalhados com as famílias e equipes de saúde da família, tendo em vista a promoção de práticas alimentares saudáveis e das práticas educativas em saúde. A presente investigação traz contribuições para expandir a prevenção de agravos e promoção da saúde infantil, particularmente com vistas ao manejo e diminuição da prevalência da anemia ferropriva em crianças

The objective of the study was to characterize children in the age group between six months and 11 months and 29 days in follow-up in family health units, according to birth, maternal, feeding and socioeconomic data; To describe aspects about the prevention of iron deficiency anemia, especially the preventive use of ferrous sulfate from the perspective of the child's primary caregiver; And to identify elements that facilitate and impede the prevention of iron deficiency anemia in childhood. A descriptive and exploratory study was carried out in two phases, the first stage with secondary data collection of 183 charts, characterizing the profile of children from six months to 11 months and 29 days of age in a follow-up in the family health strategy. In the second stage, 12 interviews were carried out with the child's primary caregiver to learn their notions about the prevention of iron deficiency anemia and the use of ferrous sulfate in children. The results point to information about breastfeeding, introduction of complementary feeding, knowledge about food and ways of preventing iron deficiency anemia, identified as facilitating factors for the prevention of this disease. On the other hand, the lack of recognition of the disease and its harmful effects on the health of the child, the low number of children with iron sulfate prescription and the interruption of the use of ferrous sulfate were considered as elements that make it difficult to prevent iron deficiency anemia. The study concludes that encouraging and supporting exclusive breastfeeding, monitoring early weaning, introducing healthy foods, reporting on iron deficiency anemia, and daily use of ferrous sulfate in children should be better handled with families and family health teams; the promotion of healthy eating practices and educational practices in health. The present research brings contributions to expand the prevention of injuries and promotion of child health, particularly with a view to the management and reduction of the prevalence of iron deficiency anemia in children

Factors associated with non-adherence to prescribed iron supplement use: a study with pregnant women in the city of Rio de Janeiro / Fatores associados a não adesão à prescrição de uso de suplemento de ferro: estudo com gestantes do município do Rio de Janeiro

Abstract Objectives: to identify factors associated with non-use of iron supplements (IS) by pregnant women attending National Health System (SUS) prenatal care in the Municipality of Rio de Janeiro. Methods: a cross-sectional study was conducted in 2007/2008 with a representative sample of pregnant women using SUS hospitals and basic care in the Municipality of Rio de Janeiro. The group that had gestational age of ≥ 20 weeks at the time of the interview and who had been prescribed IS (n=1407) was subjected to a Poisson multiple regression model to estimate the association between use and independent variables. Results: of the 1407 pregnant women, 65% reported use of IS. Younger age, black skin/race, larger number of births, not having received guidance on use of IS, not having tried to obtain IS at the SUS (with a stronger association between pregnant women with lower levels of education and lower household assets indicator - HAI) and not having been able to obtain them at the SUS (amongpregnant women with lower HAI) were significantly associated with non-use. Conclusions: the guidance of health professionals regarding use of IS and their regular availability may increase adherence to prescription among pregnant women and prevent iron deficiency anemia.

Resumo Objetivos: identificar fatores associados ao não uso de suplemento de ferro (SF) por gestantes usuárias da atenção pré-natal do Sistema Único de Saúde (SUS) no Município do Rio de Janeiro. Métodos: foi conduzido um estudo seccional em 2007/2008 com amostra representativa de gestantes usuárias de unidades básicas e hospitais do SUS no Município do Rio de Janeiro. Com o grupo que tinha idade gestacional ≥20 semanas na entrevista e que recebeu prescrição para o uso do SF (n=1407), realizou-se um modelo de regressão de Poisson múltiplo para estimar a associação entre o uso e variáveis independentes. Resultados: entre as 1407 gestantes, 65% referiram o uso do SF. Idade mais jovem, raça/cor preta, maior número de partos, não ter recebido orientação para o uso do SF, não ter tentado obter SF no SUS (com maior força de associação entre as gestantes de menor escolaridade e menor indicador de bens - IB) e não ter conseguido obtê-lo no SUS (entre gestantes com menor IB) associaram-se significativamente ao seu não uso. Conclusões: as orientações dos profissionais de saúde para o uso do SF e sua disponibilidade regular podem aumentar a adesão à prescrição entre as gestantes e prevenir a anemia por deficiência de ferro.

Comparación del potencial oxidativo de Acidithiobacillus ferrooxidans, en un proceso de biodesulfurización de carbón / Comparison of the oxidative potential of Acidithiobacillus ferrooxidans, in biodesulphurization process of coal

En este estudio se comparó la actividad oxidativa de dos cepas de Acidithiobacillus ferrooxidans en un proceso de desulfurización, empleando un carbón sub-bituminoso alto en azufre (2.30% de azufre total, con 1.06% pirítico, 1.10% orgánico y 0.14% de sulfatos), proveniente de la mina "La Guacamaya" ubicada en Puerto Libertador -Córdoba, Colombia. Se realizaron ensayos a nivel de erlenmeyer, la concentración de hierro total en la solución fue de 200 mg/L y 1200 mg/L respectivamente, empleando sulfato ferroso. El proceso fue monitoreado mediante mediciones periódicas de los principales factores físico-químicos implicados (pH, potencial de óxido-reducción (Eh), hierro en solución y concentración celular). Según los resultados obtenidos, la mayor eficiencia del proceso se logró, al trabajar con microorganismos compatibles con Acidithiobacillus ferrooxidans y una concentración de sulfato ferroso inicial de 1200 mg/L, el cual obtuvo la mayor tasa de oxidación de pirita (Py oxidada) (68%), así como, mejores condiciones en el medio lixiviante (pH: 1,47; Eh: 625 mV; 6.3×10(8) células/mL) en comparación con el cultivo axénico a las mismas condiciones (Py oxidada: 52%, pH: 1,63, Eh: 580 mV, 5.1×10(8) células/mL), después de 12 días de experimentación.

This study aimed comparing the oxidative activity of two strains of Acidithiobacillus ferrooxidans in a desulphurization process, using a sub-bituminous coal with a high sulfur content (2.30% total sulfur: 1.06% as pyritic, 1.10% as organic and 0.14% from sulfates) from "La Guacamaya" mine, located in Puerto Libertador - Cordoba, Colombia. Several assays were performed in Erlenmeyer flasks, the total iron concentration used in solution were 200 mg/L and 1200 mg/L respectively, using ferrous sulfate. The process was monitored by periodically measuring the main physicochemical factors involved (pH, Eh, cell population and iron in solution). According to the results obtained, the highest efficiency of the process was achieved by working with microorganisms compatible with Acidithiobacillus ferrooxidans and initial concentration of 1200 mg/l of ferrous sulfate, which had higher pyrite oxidation rates (Py oxidized) up to 68% and the best experimental conditions in the leaching medium (pH: 1,47; Eh: 625 mV; 6.3×108 cells/mL), in comparison with the axenic culture on the same conditions (Py oxidized: 52%; pH: 1,63; Eh: 580 mV; 5.1×108cells/mL), after 12 days of experimentation.

Evaluation of efficacy, safety and cost of oral and parenteral iron preparations in patients with iron deficiency anemia.

Objective: To compare the efficacy and safety of different oral and parenteral iron preparations in patients with anemia. Methods: An observational, prospective study in patients of anemia in pregnancy and chronic kidney disease (CKD) receiving iron sucrose, oral ferrous ascorbate and ferrous sulfate were included. Demographic details, clinical history, baseline hemoglobin, anemia indices data were recorded in a case record form. The patients were followed up monthly for 12 weeks and observed for clinical and haematological improvement and adverse drug reactions (ADRs). The data was analyzed using paired t-test, unpaired t-test and Fisher`s exact test. Results: Out of 232 patients, 84 received iron sucrose, 62 ferrous ascorbate and 86 ferrous sulfate. Oral and parenteral iron preparations significantly (P<0.0001) improved mean hemoglobin, anemia indices and serum ferritin at the end of study. However, mean increase in hemoglobin and anemia indices were significant (P<0.0001) with iron sucrose (4.42 ± 0.17gms/dL) as compared to ferrous ascorbate (3.45 ± 0.1) and sulfate (3.3 ± 0.4). Increase in serum ferritin was more and rapid (at 4 weeks) with iron sucrose as compared to ferrous ascorbate in CKD patients. Surprisingly, ADRs were more in patients treated with oral ferrous sulfate (86%) and ascorbate (71%) compared to iron sucrose (63%). Conclusion: Parenteral iron sucrose improves hemoglobin. anemia indices and replenish iron stores rapidly and is well tolerated than oral iron preparations.

Uso de medicamentos no primeiro trimestre de gravidez: avaliação da segurança dos medicamentos e uso de ácido fólico e sulfato ferroso / Medication use during the first trimester of pregnancy: drug safety and adoption of folic acid and ferrous sulphate

OBJETIVO: Identificar o perfil de uso de medicamentos no primeiro trimestre de gravidez com ênfase na avaliação da segurança e na adoção do ácido fólico e do sulfato ferroso por gestantes em uma Unidade Básica de Saúde da região Sul do Brasil. MÉTODOS: Trata-se de estudo transversal aninhado a uma coorte de gestantes. Os medicamentos foram classificados segundo a Anatomical Therapeutic Chemical (ATC), e a segurança avaliada segundo a Food and Drug Administration (FDA) e a Agência Nacional de Vigilância Sanitária (ANVISA). Foi investigado o uso/prescrição de sulfato ferroso e ácido fólico segundo o protocolo do Ministério da Saúde. RESULTADOS: Foram incluídas 212 gestantes. Dessas, 46,7% estavam em uso de medicamentos no momento do diagnóstico da gravidez e 97,6% utilizaram medicamentos no primeiro trimestre gestacional. O percentual mais elevado de automedicação ocorreu antes do início do pré-natal (64,9%). Observou-se maior exposição a medicamentos de risco D e X, segundo a classificação do FDA, antes do início do pré-natal (23,0%). Entre as gestantes, 32,5% não seguiam o protocolo de uso de ácido fólico e sulfato ferroso do Ministério da Saúde. No total, 67,9% das gestantes tiveram exposição inadequada aos medicamentos. Houve diferença entre as proporções de medicamentos utilizados segundo a ATC, e os principais grupos anatômicos identificados foram os dos medicamentos que atuam no sangue e órgãos hematopoiéticos e anti-infecciosos de uso sistêmico. Na época do diagnóstico da gravidez, observou-se expressivo uso de medicamentos que atuam no sistema geniturinário e hormônios sexuais (16,2%), como anticoncepcionais orais, o que provavelmente está relacionado ao percentual ...

PURPOSE: To identify the profile of use of medication during the first trimester of pregnancy with emphasis on safety assessment and on the adoption of folic acid and ferrous sulfate by pregnant women attended at a Basic Health Unit in Brazil. METHODS: This was a cross-sectional study nested in a cohort of pregnant women. Medications were classified according to the Anatomical Therapeutic Chemical (ATC), and their safety was evaluated according to the Food and Drug Administration (FDA) and the Brazilian Health Surveillance Agency (ANVISA). The adoption of ferrous sulfate and folic acid was investigated according to the protocol set forth by the Brazilian Ministry of Health. RESULTS: The survey included 212 pregnant women, 46.7% of whom were taking medications at the time of pregnancy diagnosis, and 97.6% used medication during the first trimester after diagnosis. The highest percentage of self-medication occurred before the beginning of prenatal care (64.9%). According to the FDA criteria, there was a high level of exposure to D and X risk drugs before the beginning of prenatal care (23.0%), which was also observed for drugs not recommended by ANVISA (36.5%). Of the surveyed sample, 32.5% did not follow the protocol of the Brazilian Ministry of Health. In all, 67.9% of pregnant women had inadequate drug exposure. There was a difference between the proportions of drugs used according to the ATC, and the main anatomical groups identified were the drugs that act on blood and blood-forming organs, and anti-infective medications for systemic use. When pregnancy was diagnosed, the use of a large number of medications that act on the genitourinary system and sex hormones (16.2%) was identified, such as oral contraceptives, a fact probably related to the percentage of unplanned pregnancies (67.0%), on the same occasion 4 pregnant women used folic acid and 3 used ferrous sulphate. CONCLUSION: The present results show that a large number ...

Iron supplementation among pregnant women: results from a population-based survey study / Suplementacao com sulfato ferroso entre gestantes: resultados de estudo transversal de base populacional

Objectives: To measure the prevalence and risk factors associated with iron supplementation among pregnant women in the municipality of Rio Grande, Southern Brazil. Methods: All mothers living in this municipality who had children in 2007 were surveyed for demographic, socioeconomic and health care received during pregnancy and childbirth. The statistical analysis consisted of Poisson regression with robust adjustment of variance, and the measure of effect was prevalence ratio (PR). Results: Among the 2,557 mothers interviewed (99% of total), 59% were supplemented with iron during pregnancy period. After adjusting for various confounding factors, a higher PR to iron supplementation was observed among teenagers, women with black skin color, primigravidae, who had six or more antenatal visits, who performed prenatal care in public sector and received vitamin during pregnancy. Conclusion: There is a clear need to increase the iron supplementation coverage of all pregnant women, especially among those currently considered with low gestational risk. .

Objetivos: Medir a prevalência e identificar fatores associados à suplementação com sulfato ferroso entre gestantes residentes no município de Rio Grande, RS. Métodos: Mães residentes neste município que tiveram filho em 2007 foram investigadas quanto a características demográficas, nível socioeconômico e assistência recebida durante a gestação e o parto. Na análise estatística, foi utilizada regressão de Poisson com ajuste robusto da variância, e a medida de efeito foi razão de prevalências (RP). Resultados: Dentre as 2.557 mães entrevistadas (99% do total), 59% foram suplementadas com sulfato ferroso durante a gestação. Após análise ajustando para diversos fatores de confusão, mostraram maior RP à suplementação com sulfato ferroso as gestantes adolescentes, de cor da pele preta, primigestas, que realizaram seis ou mais consultas de pré-natal, que fizeram essas consultas na rede pública e que receberam complexo vitamínico durante a gestação. Conclusão: Há evidente necessidade de aumentar a cobertura da suplementação com sulfato ferroso entre todas as gestantes, sobretudo entre aquelas tidas, em geral, como de menor risco gestacional. .

Eficacia del hierro aminoquelado en comparación con el sulfato ferroso como fortificante de un complemento alimentario en preescolares con deficiencia de hierro, Medellín, 2011 / Effectiveness of iron amino acid chelate versus ferrous sulfate as part of a food complement in preschool children with iron deficiency, Medellín, 2011

Introducción. La disminución de los depósitos de hierro constituye el primer eslabón de la cadena conducente a la deficiencia de hierro, la carencia nutricional más prevalente y principal causa de anemia en todo el mundo, situación que puede prevenirse mediante la fortificación de alimentos. Objetivo. Comparar la eficacia del hierro aminoquelado con el sulfato ferroso como fortificante de un complemento alimentario en preescolares con deficiencia de hierro. Materiales y métodos. Se llevó a cabo un ensayo clínico triple ciego con distribución aleatoria de grupos. Se analizaron 56 preescolares con deficiencia de hierro (ferritina menor de 24 ng/ml) a los que se les dio diariamente 13 g de leche con 12,5 mg de hierro,. Después de dos meses se midieron los niveles de hemoglobina, hematocrito y ferritina sérica. Resultados. En el grupo con sulfato ferroso la concentración de ferritina sérica aumentó de 18,8 a 24,1 ng/ml, mientras que dicha variación fue de 18,4 a 29,7 ng/ml con el hierro aminoquelado, en ambos casos con diferencias significativas. El nivel de ferritina final difirió según el grupo de estudio, siendo mayor en el grupo con hierro aminoquelado (p=0,022). La hemoglobina y el hematocrito no variaron después de la intervención. Las reacciones adversas en el grupo con sulfato ferroso fueron de 35,7 %, en contraste con el 42,9 % en el grupo con hierro aminoquelado; cinco niños presentaron infección de las vías respiratorias, sin diferencias estadísticas. Conclusiones. Los dos compuestos aumentan los niveles de ferritina, siendo mayor el aumento entre quienes toman leche con hierro aminoquelado. No fue diferente la incidencia de reacciones adversas o de infecciones entre los grupos.

Introduction: Iron depleted deposits are the first link in the chain of events leading to iron deficiency which is the most prevalent nutritional shortage and main cause of anemia worldwide. This situation can be prevented through food fortification. Objective: To compare the efficacy of amino acid chelate iron with ferrous sulfate as fortifier of a dietary complement in preschoolers with iron deficiency. Materials and methods: This study was a blinded clinical trial with randomized groups. We analyzed 56 preschoolers with iron deficiency (ferritin < 24 ng/ml) that received 13 g of milk with 12.5 mg of iron, either amino acid chelate or in the ferrous sulfate form. After two months, hemoglobin, hematocrit and serum ferritin concentrations were measured. Results: In the ferrous sulfate group, ferritin concentration increased from 18.8 ng/ml to 24.1 ng/ml, while the variation was of 18.4 ng/ml to 29.7 ng/ml in the amino acid chelate group, with statistically differences in both cases. Serum ferritin was different between groups, being higher in iron amino acid chelate group (p=0.022). Hemoglobin and hematocrit levels did not change after the intervention. Adverse reactions in the ferrous sulfate group were 35.7%, compared with 42.9% in the iron amino acid chelate group; 5 children had respiratory tract infection, without statistical differences. Conclusions: Both compounds increased serum ferritin concentration, with a higher increase in those who were given milk with iron amino acid chelate. There were no differences in the adverse reactions and infections incidences between the groups.

Estudio prospectivo y randomizado de suplementación de hierro temprana versus tardía en niños con peso al nacer menor de 1.301 g / Prospective randomized study of early versus late enteral iron supplementation in children who weighed < 1, 301 grams at birth

Objetivo: Determinar si la suplementación temprana de hierro disminuye la necesidad, el número y volúmen de glóbulos rojos transfundidos, en relación a la suplementación tardía de hierro en niños con peso de nacimiento menor a 1.301 g. Pacientes y Método: Recién nacidos de muy bajo peso (RNMPN) fueron randomi-zados a recibir suplementación temprana de hierro de 3 mg/kg/día, tan pronto estaban tolerando alimentación enteral de 100 ml/kg/día, o a los 61 días de vida como suplementación tardía. Se midió niveles de hemoglobina al inicio de la suplementación temprana de hierro y a los 2 meses de vida. La transfusión de glóbulos rojos fue restringida de acuerdo a las guías de transfusión y no se administró eritropoyetina. Resultados: No hay diferencias en el número de transfusiones de glóbulos rojos entre los grupos y en relación a las morbilidades asociadas con la prematuridad no habría diferencias significativas. Conclusiones: La suplementación temprana de hierro cuando el niño este tolerando 100 ml/kg/día de leche, no disminuiría la incidencia de las transfusiones de glóbulos rojos en relación al inicio tardío de hierro a los 61 días de vida y probablemente sea segura en los niños menores de 1.301 g.

Objective: Determine whether early iron supplementation would decrease the need, the number and volume of transfused red blood cells in relation to late iron supplementation in children with birth weight less than 1,301 g. Patients and Methods: Very low birth weight (VLBW) infants were randomly assigned to receive early iron supplementation of 3 mg/kg/day as soon as they could tolerate enteral feeding of 100 ml/kg/day, or at 61 days of life as late supplementation. Hemoglobin levels were measured at the beginning of early iron supplementation and at 2 months of age. The red blood cell transfusion was performed according to transfusion guidelines and erythropoietin was not administered. Results: No differences were observed regarding the number of red cell transfusions between the groups. Morbidities associated with prematurity presented no significant differences. Conclusions: Early iron supplementation to a child that is tolerating 100 mL/kg/day of milk, does not decrease the incidence of red blood cell transfusions compared to late start iron at 61 days of life, and it is probably safe in infants with birth weight < 1,301 g.

Impact of oral iron therapy on quality of life in patients with heart failure.

Background: To assess the effect of oral iron supplementation on quality of life (QOL) in anemic patients with heart failure (HF) and to compare QOL with HF patients without iron treatment. Methods: Sixty anemic patients (Hb 8-11g/dl) with HF (NYHA-class II and III) with LVEF<40% were divided in to 2 groups of 30 each. Group I- received ferrous sulfate 100mg bid x 90 days + standard treatment for HF. Group II- anemic patients received standard treatment for HF only. Primary end point- QOL was measured by MLWHF questionnaire. Secondary end points are Borg scale for dyspnoea and fatigue and exercise tolerance/ capacity in the form of 6 min. walk distance, haematological parameters, efficacy and safety assessment. Results: There was significant improvement in QOL in iron treated patients as compared to group II (control). Exercise tolerance /capacity, Borg scale for fatigue and dyspnoea showed improvement in patients received iron for 90 days. Haematological parameters were improved gradually with less incidence of fatigue and pallor. Orally administered ferrous sulfate was well tolerated with mild side effects. Conclusions: Oral iron supplementation in anemic patients with heart failure improves quality of life/ physical functioning in these patients.

A utilidade dos índices eritrocitários e da ferritina sérica na indicação de ferroterapia na predição da eficácia terapêutica do ferro oral durante a gravidez: a inadequação do conceito Gaussiano da normalidade para o manejo dos casos de anemia ferropriva materna / The utility of erythrocyte indices and serum ferritin to prescribe iron-therapy and to predict the therapeutic efficacy of oral iron during pregnancy: the inappropriateness of the normal Gaussian-concept to manage maternal iron-deficiency anaemia cas

Objetivo: estimar a acurácia dos índices eritrocitários (eritrometria, concentração de hemoglobina-Hb, hematócrito-HTC, volume corpuscular médio-VCM, hemoglobina corpuscular média-HCM, concentração de hemoglobina corpuscular média-CHCM,red blood cell distribution width-RDW, contagem de reticulócitos) e da ferritina sérica (FS) para o diagnóstico de deficiência de ferro em gestantes.Métodos: a tese compreendeu três estudos. O primeiro, com dadosde linha de base de 347 gestantesnão suplementadas com ferrode um ensaio clínico ocorrido entre maio de 2000 e junho de 2001, calculoucurvas de distribuição...

Objective: to estimate the accuracy of the erythrocyte indices (red blood cell count, haemoglobin concentration-Hb, haematocrit-HTC, mean corpuscular volume-MCV, mean corpuscular haemoglobin-MCH, mean corpuscular haemoglobin concentration-MCHC, red blood cell distribution width-RDW, reticulocyte count) and the serum ferritin (SF) for iron deficiency diagnosis in pregnant women. Methods: the thesis comprised three studies. The first study evaluated the baseline data from 347 pregnant women before the iron supplementation of a clinical trial performed between May 2000 and June 2001, and determined the distribution curves of the erythrocyte indices and their accuracy parameters versus SF 12 ng/mL. The second study examined longitudinal data from the 140 women enrolled for the preceding trial to receive 60 mg of oral iron (weekly, twice a week or daily) and each treatment group was subdivided into strata with and without iron deficiency (SF 12 ng/mL) to compare the therapeutic responses (means of differences-MD between pre and post-treatment Hb) in absolute values (g/dL) and in Z-scores (standard deviation-SD). The original trial of this thesis was carried out between August 2011 and October 2012 and had a phase III validation design with 144 anemic pregnant women (Hb 11 g/dL) treated with 80 mg of elemental iron daily during 28 to 90 days, to calculate the accuracy parameters of erythrocyte indices and SF pre-treatment versus the gold-standard responsiveness to therapeutic test with oral iron, which was measured by the differences between the Hb Z-scores before-and-after the trial. Results: the mean value of red blood cell count (3.7 1012 cells/L), HTC (32.9 por cento) and Hb (10.8 g/dL) were below their reference cutoff points. The curves of morphological indices were not adjusted to the Normal distribution with the following mean values: MCV...