Association of hemoglobin level and packed cell volume with gestational diabetes mellitus

Background: Gestational diabetes mellitus (GDM) is a type of insulin resistance that develops in the second trimester of pregnancy. This type of diabetes ends after delivery. GDM poses serious health hazards to both the mother and the baby. Pathology behind this carbohydrate intolerance is insulin resistance. The previous studies have pointed out that this insulin resistance is due to oxidative stress caused by free radicals. Free radicals can be generated by iron. Since pregnancy is a condition where iron requirement rises, universal iron supplementation is given. According to the previous studies, excess iron can cause free-radical mediated injury leading on to diabetes. Supplementation of a prooxidant irrespective of body iron stores may be more harmful than beneficial. Hemoglobin and PCV are two hematological parameters that reflect body iron stores. Aims and Objectives: The aim of the study was to compare hemoglobin and PCV values in pregnant woman with and without GDM. Materials and Methods: A case–control study was done in the obstetric department of a tertiary care center in south India from August 2010 to December 2010.The study included 85 cases and 85 controls. Cases were pregnant women at 24–28 weeks of gestation with gestational diabetes who attended the obstetric OPD during the study period. GDM was diagnosed as per ADA guidelines. Controls were pregnant women at 24–28 weeks gestation without GDM as per ADA guidelines. Data for the study were collected using a preformed tested questionnaire. All subjects were provided with iron supplementation according to the national programme. Estimation of hemoglobin and PCV was done with 2 ml of blood sample obtained by venepuncture using an automated analyzer. The association of elevated hemoglobin and PCV with the risk of developing GDM was tested using Chi-square analysis. P ? 0.05 was taken as statistically significant. Results: Hemoglobin in cases and controls showed a significant difference by Chi-square analysis (P = 0.004). PCV in cases was significantly higher than in controls by Chi-square analysis (P = 0.003). Conclusion: The study found a statistically significant association between higher maternal hemoglobin level and PCV with GDM.

A Community-Based Trial on The Comparison of Efficacy, Safety and Cost Effectiveness of Ferrous Sulphate and Ferrous Ascorbate for Anaemia in Pregnancy In Madhya Pradesh, India

Background: Anaemia has significant impact on health of the fetus as well as that of mother. Increased need of iron during pregnancy especially after 2nd trimester makes iron supplementation mandatory. Ferrous ascorbate is known to exist intact inside the gastrointestinal tract due to the stable chelation of iron with ascorbate. This compound does not dissociate due to any of the food inhibitors. The aim is to study the effec-tiveness of Ferrous Ascorbate and Ferrous sulphate in terms of compliance and cost effectiveness of manage-ment of anaemia in pregnancy. Methodology: Study design: Quasi Experimental study, Study area: District Vidisha, Study participants: Preg-nant women of first trimester registered during the study period in the selected Anganwadis/ Gram Arogya Kendra (GAK), Sample size: 240 antenatal mothers. Results: Baseline mean haemoglobin was 11.31±1.05 gm/dl. The mean increase in Ferrous Sulphate was 0.55 gm/dl, and in Ferrous ascorbate was 1.27 gm/dl. Ferrous Sulphate was less compliant than Ferrous ascorbate, and has higher efficacy and lesser side effects. Only Rs. 10.2 additional cost per antenatal mothers for increase of ≥1gm% in Hb will be borne by government if Ferrous Sulphate is replaced by Ferrous Ascorbate. Conclusions: Study results show statistically significant difference in rise of haemoglobin amongst the ante-natal mothers consuming Ferrous ascorbate over Ferrous Sulphate

The efficacy and safety of intravenous sucrose iron therapy for recurrent iron deficiency anemia / 中华血液学杂志

Objective: To evaluate the efficacy and safety of intravenous iron supplementation in patients with recurrent iron deficiency anemia (IDA) . Methods: This retrospective analysis of 90 patients with recurrent IDA from May 2012 to December 2021 was conducted, comparing the efficacy and safety of the intravenous iron therapy group and the oral iron therapy group. Results: Among the 90 patients with recurrent IDA, 20 were males and 70 were females, with a median age of 40 (range: 14-85) years. A total of 60 patients received intravenous iron supplementation and 30 received oral iron supplementation. The hematologic response rates in the intravenous iron group were significantly higher than those in the oral iron group at 4 and 8 weeks after treatment [80.0% (48/60) vs 3.3% (1/30) and 96.7% (58/60) vs 46.7% (14/30), all P<0.001, respectively]. The median increase in hemoglobin levels was also significantly higher in the intravenous iron group than in the oral iron group [38 (4, 66) g/L vs 7 (1, 22) g/L at week 4 and 44.5 (18, 80) g/L vs 19 (3, 53) g/L at week 8, all P<0.001]. The intravenous iron group had a significantly higher proportion of patients who achieved normal hemoglobin levels than the oral iron group (55.0% vs 0 and 90% vs 43.3%, all P<0.001, respectively). Iron metabolism indicators were tested before and after 8 weeks of treatment in 26 and 7 patients in the intravenous and oral iron groups, respectively. The median increase in serum ferritin (SF) levels in the intravenous iron group 8 weeks after treatment was 113.7 (49.7, 413.5) μg/L, and 54% (14/26) of these patients had SF levels of ≥100 μg/L, which was significantly higher than the median increase in SF levels in the oral iron group [14.0 (5.8, 84.2) μg/L, t=4.760, P<0.001] and the proportion of patients with SF levels of ≥100 μg/L (P=0.013). The incidence of adverse reactions was 3.3% (2/60) in the intravenous iron group, which was significantly lower than that in the oral iron group [20.0% (6/30), P=0.015]. Conclusion: Intravenous iron supplementation is more effective for hematologic response, faster hemoglobin increase, and higher iron storage replenishment rates compared with oral iron supplementation in patients with recurrent IDA, and it is well tolerated by patients.

Prophylactic Oral Iron Therapy During Pregnancy

Background: Anemia is one of the most common medical disorder during pregnancy and one of the important cause of maternal death in the third world countries. A sufficient supply of iron is also required for the proper development of the fetus and newborn baby. During pregnancy, iron deficiency and iron deficiency anemia (IDA) increase the risk of preterm birth and low birth weight. Iron is essential for the development of the fetal brain and the newborn’s cognitive abilities. Pregnant women receive oral iron prophylaxis have better iron status and are less likely to develop IDA. The aim of the study was to evaluate the effects of prophylactic oral iron therapy in pregnant women in terms of rise of haemoglobin level.Material & Methods:The present study was conducted at the department of obstetrics and gynecology, US-Bangla Medical College & Hospital, Dhaka, Bangladesh, from January 2020 to June 2021 with a sample size of 100 pregnant women. All the participants were non-anemic at the time of inclusion, and a proper follow-up was done. All the women were supplied with 60 mg dose of elemental iron prophylactic. During follow up haemoglobin level was measured and serum ferritin levelwas measured when anemia was found. The collected data were analyzed by using the Statistical Package for Social Science (SPSS-24) for windows version 10.0.Results:During the first follow-up, 89% were found non-anemic, 9% were mildly anemic and 2% were moderately anemic. S ferritin levels of the 11 anemic participants showed that 36.30% had <15 ng/mL ferritin levels, and 63.64% had 15-150 ng/mL ferritin levels. During the second follow-up, 86% were non-anemic, 1% was severely anemic, 4% were moderately anemic and 9% were mildly anemic. S. ferritin level test showed that among the 14 anemic women, 35.72% had <15 ng/mL, 57.14% had 15-150 ng/mL, and 7.14% had >150 ng/mL serum ferritin levels. During third follow up at 34-36 weeks, 81% were non-anemic, 1% were moderately anemic, 8% had mild anemia. S. ferritin levels of 9anamic women showed that 3 women (33.33%)had <15 ng/mL and 6 women (66.67 %) had between 15-150 ng/mL.Conclusions:Pregnancy produces relatively high iron demand. Iron requirements cannot be met merely through dietary iron intake. Even prophylacyic 60 mg elemental iron giving may not be sufficient to prevent maternal anemia. Regular follow up and monitoring is essential during whole pregnancy for better management of the patients.

Efficacy of intermittent iron supplementation in children with mild iron-deficiency anemia / 中国当代儿科杂志

OBJECTIVES@#To study the efficacy of intermittent iron supplementation in children with mild iron-deficiency anemia.@*METHODS@#A total of 147 children with mild iron-deficiency anemia were enrolled in this prospective study. They were divided into an intermittent iron supplementation group (n=83) and a conventional iron supplementation group (n=64). The levels of hemoglobin were measured before treatment and after 1 and 3 months of treatment. The treat response rate and the incidence rate of adverse drug reactions were compared between the two groups.@*RESULTS@#Both groups had a significant increase in the level of hemoglobin after iron supplementation (P<0.05). After 1 month of treatment, the conventional iron supplementation group had a significantly higher treatment response rate than the intermittent iron supplementation group (61% vs 42%, P<0.05). After 3 months of treatment, there was no significant difference in the treatment response between the two groups (86% vs 78%, P>0.05). The incidence rate of adverse drug reactions in the conventional iron supplementation group was significantly higher than that in the intermittent iron supplementation group (25% vs 8%, P<0.05).@*CONCLUSIONS@#For children with mild iron-deficiency anemia, although intermittent iron supplementation is inferior to conventional iron supplementation in the short-term efficacy, there is no significant difference in the long-term efficacy between the two methods, and compared with conventional iron supplementation, intermittent iron supplementation can reduce the incidence of adverse drug reactions, alleviate family financial burdens, and improve treatment compliance of children, thus holding promise for clinical application.

Prevalence of anaemia among females in reproductive age group attending a health center in the urban area of Kancheepuram district: a cross sectional study

Background: Anaemia, which is defined as a low oxygen carrying capacity of blood, is a major public health problem. It is a condition in which there is a decrease in the total number of red blood cells in the blood, either due to decreased production or increased destruction or both. Anaemia, one of the most prevailing nutritional disorders, has a worldwide prevalence of approximately 52%. The burden of anaemia is high especially among females of reproductive age group where India ranks the top. The study is aimed to establish the prevalence of anaemia among female patients of reproductive age group (15-49 years).Methods: A cross sectional study was conducted among 254 females of reproductive age group, attending Anakaputhur, an urban field practice area of Sree Balaji Medical College. Convenient sampling method was used. Data was collected by discussion using a pretested semi-structured questionnare and haemoglobin estimation was done by venous sampling method.Results: The mean age of the study participants were 34.6±12.4 years with 9.05% uneducated and 8.6% graduate females. 26% gave history of symptoms of anaemia and prevalence of anaemia was reported to be 42.12% with 24.4%, 12.2% and 5.5% of mild, moderate and severe anaemia, respectively.Conclusions: Prevention and its treatment in women is much essential at this point, hence programmes and policies should be implemented based on the needs of the community, and health education should be imparted with respect to measures that can prevent and help in early diagnosis of anaemia.

A study on prevalence of anemia in pregnancy in South India

Background: Anemia in pregnancy is a major health problem worldwide, especially in developing countries like India. Maternal and fetal outcomes are poor in pregnant patients with anemia. The most important cause of anemia is iron deficiency anemia which can be prevented by early oral iron supplementation.Methods: This cross-sectional study was conducted in the department of obstetrics and gynecology of our tertiary care teaching institution for a period of one year. 1290 pregnant women coming to the antenatal OPD were screened for anemia and 490 women. Patients who were not anemic were excluded. 800 patients were enrolled in the study. Each patient was interviewed using a structured interview schedule and the data obtained was analyzed.Results: The percentage of anemia in pregnant women was 62% in our study of which 40% were mildly anemic, 55% were moderately anemic and 5% were severely anemic. Maximum number of anemic women -mild, moderate and severe was seen in the age group 20-24 years. Mild and severe anemia was seen more in the secondary educated women. Maximum percentage of anemia was seen in the lower socio-economic status followed by middle and was lowest in the higher socio-economic status group. Prevalence of anemia was almost equal in primigravida and multigravidas (around 50%) but 80% of severely anemic patients were multigravida. Almost 68% took iron and folic acid tablets regularly.Conclusions: Treating anemia in pregnant women will go a long way in improving maternal and fetal outcome. Hence a future healthy younger generation can be produced. Iron tablets can be distributed at school to young girls to prevent anemia in future women.

Anemia no diabetes mellitus gestacional: implicações na instabilidade genômica / Anemia in gestational diabetes mellitus: implications for genomic instability

Introdução: Evidências têm mostrado uma associação entre anemia e Diabetes Mellitus. Contudo, a relação entre anemia e Diabetes Mellitus Gestacional (DMG) ainda não está bem estabelecida, bem como sua repercussão na instabilidade genômica. Portanto, objetivou-se verificar a associação entre anemia e instabilidade genômica em mulheres com DMG atendidas em um hospital universitário. Métodos: Estudo transversal com mulheres apresentando diagnóstico de DMG que realizaram pré-natal no Hospital Universitário de Santa Maria (RS). Informações referentes ao DMG, anemia e suplementação de ferro foram obtidas nos prontuários. A instabilidade genômica foi avaliada pelo ensaio de citoma em micronúcleos em células bucais (BMCyt). Resultados: Das 44 gestantes avaliadas, 28,6% apresentaram anemia e 79,5% foram suplementadas com ferro. Das gestantes que realizaram suplementação, 75,0% não apresentaram anemia gestacional. Níveis de hemoglobina não se associaram com a instabilidade genomica (p > 0,05), mas foi observada uma associação entre brotos nucleares e os níveis de glicemia (r = 0,977; p = 0,003). Conclusão: Não foi verificado associação entre anemia e instabilidade genômica em mulheres com DMG.(AU)

Introduction: There is evidence of an association between anemia and diabetes mellitus. However, the relationship between anemia and gestational diabetes mellitus (GDM) remains to be established, as well as its impact on genomic instability. Therefore, we aimed to examine the association between anemia and genomic instability in women with GDM treated at a university hospital. Methods: A cross-sectional study of women with a diagnosis of GDM who received prenatal care at the University Hospital of Santa Maria, southern Brazil. Data on GDM, anemia, and iron supplementation were obtained from medical records. Genomic instability was assessed by the buccal micronucleus cytome (BMCyt) assay. Results: Of 44 pregnant women evaluated, 28.6% had anemia and 79.5% received iron supplementation; of the latter, 75.0% did not have gestational anemia. Hemoglobin levels were not associated with genomic instability (p > 0.05), but an association was found between nuclear buds and blood glucose levels (r = 0.977; p = 0.003). Conclusion: There was no association between anemia and genomic instability in women with GDM.(AU)

Differences in iron intake during pregnancy influence in trainability response of male rat offspring / Diferenças na ingestão de ferro durante a gravidez influenciam na resposta à treinabilidade da prole de ratos machos

ABSTRACT Objective: To evaluate if different concentrations of iron in diets during pregnancy would interfere in the aerobic and anaerobic performance of the offspring, observed during 8-week swimming training and measured by lactate minimum test. Methods: Pregnant rats were divided into four groups with different dietary iron concentrations: standard (40mg/kg), supplementation (100mg/kg), restriction since weaning, and restriction only during pregnancy (4mg/kg). After birth, the offspring were assigned to their respective groups (Standard Offspring, Supplementation Offspring, Restriction Offspring or Restriction Offspring 2). The lactate minimum test was performed at three time points: before starting exercise training, after 4 weeks and after 8 weeks of exercise training. Results: The Restriction Offspring Group had a significant reduction in the concentration of lactate minimum and in swimming time to exhaustion, after 4 and 8 weeks of training as compared to before training. Therefore, the results showed the Restriction Offspring Group was not able to maintain regularity during training in lactate minimum tests. Conclusion: Our results suggested the Restriction Offspring Group showed a marked decrease in its performance parameters, which may have occurred due to iron restriction.

RESUMO Objetivo: Avaliar parâmetros aeróbios e anaeróbios da prole de ratas alimentadas com diferentes dietas de ferro durante a prenhez, por meio do teste de lactato mínimo. Métodos: As ratas prenhes foram divididas em quatro grupos com diferentes concentrações de ferro na dieta: padrão (40mg/kg), suplementação (100mg/kg), restrição desde o desmame e restrição apenas durante a gravidez (4mg/kg). Após o nascimento, os filhotes foram designados para seus respectivos grupos (Prole Padrão, Prole Suplementação, Prole Restrição ou Prole Restrição 2). O teste de lactato mínimo foi realizado em três momentos: antes de iniciar o treinamento físico, após 4 semanas e após 8 semanas de treinamento físico. Resultados: O Grupo Prole Restrição apresentou redução significativa na concentração do lactato mínimo e no tempo de natação até a exaustão, após 4 e 8 semanas de treinamento em relação ao período antes do início do treinamento. Assim, o Grupo Prole Restrição não foi capaz de manter regularidade durante o treinamento nos testes de lactato mínimo. Conclusão: Os resultados sugerem que o Grupo Prole Restrição apresentou diminuição acentuada nos parâmetros de desempenho, o que pode ter ocorrido devido à restrição de ferro.

Intussusception: Single Center Experience of 10 Years

Objective: To analyze the association between the clinical presentation, clinical course,management and outcome in intussusception with emphasis on safety of saline hydrostaticreduction. Methods: This retrospective study included 375 patients of intussusceptiondiagnosed between March 2007 to February 2017. Symptoms at presentation, mode ofreduction of intussusception and associated complications were recorded. Results: 336(89.6%) patients were aged below 3 years. Classical triad of abdominal pain, vomiting andred stools was present in 111 (29.6%) patients. While 64 (17.1 %) patients had spontaneousresolution, hydrostatic reduction and surgery cured 283 (75.5 %) and 28 (7.4 %) patients,respectively; overall recurrence rate was 13.1%. Among the patients who underwentoperative reduction, blood in stools was present in 15 (53.6%) patients. Conclusion:Hydrostatic reduction of intussusception is effective irrespective of duration of symptoms andnumber of recurrences

Effect of directly observed oral iron supplementation during pregnancy on iron status in a rural population in Haryana: A randomized controlled trial

Background: In India, more than half of the pregnant women suffer from anemia. Low compliance to iron supplementation is one of the important reasons. Objectives: The objective of the study is to estimate the reduction in the prevalence of anemia, improvement in iron status, and to compare the compliance to oral iron supplementation during pregnancy between directly observed iron-folic acid (IFA) supplementation group and control group. Methods: This was a community-based open labeled parallel block-randomized controlled trial including 400 pregnant women in a rural setting of north India. In the intervention group, the first dose of IFA every week was supervised by ASHA and women were instructed to take the remaining tablets during the week as per the prescription. In control group, IFA tablets were supplemented without direct supervision. Results: After 100 days of IFA supplementation, the reduction in anemia in the intervention group was 6% higher as compared to control group (P = 0.219). The increase in the mean hemoglobin level over and above control group was 0.52 g/dl in intervention group (P < 0.001). However, the mean increase in serum ferritin level in the intervention group was similar to the control group. The mean percentage compliance in the intervention group was almost 9% higher than that of control group (P = 0.001). Conclusion: Directly supervised oral iron (IFA) supplementation improves compliance to oral iron (IFA) supplementation and also improves hemoglobin status among pregnant women. However, the mean increase in serum ferritin and reduction in the prevalence of anemia in the intervention group were not higher than the control group.

Iron supplementation for lambs experimentally infected by Haemonchus contortus: response to anemia and iron store in the bone marrow / Suplementação com ferro em cordeiros infectados experimentalmente por Haemonchus contortus: resposta a anemia e as reservas de ferro na medula óssea

To evaluate the effect of supplementation of iron dextran on blood variables and iron metabolism in lambs experimentally infected by Haemonchus contortus, four experimental groups were used: uninfected and non-supplemented animals (GI); infected animals supplemented with iron (GII); uninfected animals supplemented with iron (GIII); and infected non-supplemented animals (GIV). Groups II and IV received 10,000 larvae (L3) of Haemonchus contortus, and groups II and III received three doses of iron dextran (20mg/kg) intramuscularly with seven days of interval. Blood and faeces samples were collected on days 10 (D10), 17 (D17), 24 (D24), and 31 (D31), in order to determine red blood cell counts, iron metabolism, and EPG. Infected animals developed anemia from D24 and anemia was more severe on D31. Animals from GII had higher hematocrit and hemoglobin concentration compared to animals of GIV on D31. Iron stores in the bone marrow were higher in GII and GIII compared to GI and GIV. The GIV showed lower seric levels of iron on D24 compared to the other groups. The iron supplementation reduces the severity of the anemia caused by infection with Haemonchus contortus in lambs, improving erythropoietic response after blood loss.(AU)

Para avaliar o efeito da suplementação de ferro dextrano sobre variáveis sanguíneas e metabolismo do ferro em cordeiros experimentalmente infectados por Haemonchus contortus, foram utilizados quatro grupos experimentais: animais não infectados e não suplementados (GI); animais infectados e suplementados com ferro (GII); animais não infectados e suplementados com ferro (GIII); e animais não suplementados infectados (GIV). Os grupos II e IV receberam 10.000 larvas (L3) de Haemonchus contortus, e os grupos II e III receberam três doses de ferro dextrano (20mg/kg) por via intramuscular com sete dias de intervalo. As amostras de sangue e fezes foram coletadas nos dias 10 (D10), 17 (D17), 24 (D24) e 31 (D31), para determinar o eritrograma, o metabolismo do ferro e a quantidade de ovos por gramas de fezes (OPG). Os cordeiros infectados desenvolveram anemia no D24, sendo esta mais severa no dia 31. Os cordeiros do GII apresentaram maior hematócrito e concentração de hemoglobina em comparação com animais dd GIV no D31. Os estoques de ferro na medula óssea foram maiores no GII e GIII em comparação com o GI e GIV. O GIV mostrou menores níveis séricos de ferro no D24 em comparação com os outros grupos. A suplementação de ferro reduz a gravidade da anemia causada por infecção por Haemonchus contortus em cordeiros, melhorando a resposta eritropoietica após a perda de sangue.(AU)

Parâmetros hematológicos e bioquímicos de bezerros neonatos da raça Holandesa tratados com ferro suplementar / Hematological and biochemical parameters of neonatal Holstein calves supplemented with iron

A deficiência de ferro em bezerros neonatos está associada ao desenvolvimento de anemia, que favorece o aparecimento de outras enfermidades como pneumonia e diarreia. Avaliou-se o efeito da suplementação de ferro sobre o eritrograma, teores séricos de ferro, ceruloplasmina e transferrina, bem como o potencial para toxicidade do protocolo utilizado por meio da avaliação dos teores de ureia, creatinina e enzimas hepáticas. Para tal avaliação foram utilizados 40 bezerros neonatos da raça Holandesa, alocados em cinco grupos experimentais com oito animais em cada grupo, que foram submetidos aos seguintes protocolos: administração intramuscular de 5mL de solução fisiológica estéril no 5º dia de idade (grupo controle G1), e administração intramuscular de 5mL de ferro dextrano 10% nos seguintes momentos: no 5º dia de idade (G2); no 5o e no 20º dias de idade (G3); no 5o e no 30º dias de idade (G4) e no 5o, 20o e 45º dias de idade (G5). Foram coletadas amostras de sangue até 8 horas após o nascimento e aos 5, 10, 20, 30, 60 e 90 dias de idade para realização do eritrograma, avaliação dos teores séricos de ferro, ceruloplasmina, transferrina, ureia, creatinina, bilirrubina total e direta, e das atividades das enzimas aspartato aminotransferase (AST), fosfatase alcalina (ALP) e gamaglutamiltransferase (GGT). Os animais que receberam ferro suplementar apresentaram menor oscilação nos parâmetros eritrocitários, embora os animais do grupo controle não tenham desenvolvido anemia. Notou-se também aumento, embora não significativo, nos teores séricos de ferro e das proteínas de fase aguda ceruloplasmina e transferrina, cuja atividade está relacionada ao metabolismo desse mineral. Os teores séricos de ureia, creatinina, bilirrubina total e direta e as atividades das enzimas GGT, AST e ALP não foram influenciados pelos protocolos de administração de ferro suplementar. Os protocolos de tratamento empregados não ocasionaram hepatoxidade ou nefrotoxidade aos animais. Concluiu-se que a suplementação com ferro dextrano por via parenteral em bezerros que recebem outras dietas que não apenas leite não traz benefícios que justifiquem sua indicação, embora sejam necessários mais estudos que avaliem a influência da suplementação com ferro sobre o tempo necessário para a recuperação, custos com o tratamento e impacto sobre a vida produtiva dos animais na idade adulta.(AU)

Iron deficiency in newborn calves is associated with the development of anemia, which favors the development of other infirmities such as pneumonia and diarrhea. The present study evaluated the effect of iron supplementation on erythrogram, serum levels of iron, ceruloplasmin and tranferrin, as well as potential toxicity of the protocol used by means of evaluation of urea, creatinine and hepatic enzyme activities. 40 newborn Holstein calves were allocated into 5 experimental groups comprising 8 calves each, which were subjected to the following treatment protocols: intramuscular administration of 5mL of sterile saline on the 5th day of age (control group G1), intramuscular administration of 5mL of 10% dextran iron in the following moments: on the 5th day of age (G2); on the 5th and in the 20th day of age (G3); on the 5th and 30th day of age (G4); on the 5th, 20th and 45th days of age (G5). Blood samples were taken until 8 hours after birth and with 5, 10, 20, 30, 60, and 90 days of age, and subjected to hemogram, evaluation of serum levels of iron, ceruloplasmin, transferrin, urea, creatinine, total and direct bilirrubin, and serum activities of aspartate aminotransferase (AST), alcaline phosphatase (ALP), and gamma-glutamyltransferase (GGT). Calves that received iron supplementation at any time presented less variation in the erythrocyte parameters, although calves in the control group did not develop anemia. Serum concentration of iron and acute phase protein ceruloplasmin and transferrin, which activities are related to iron metabolism, also increased, although not significantly. Serum levels of urea, creatinine, bilirubins and activities of AST, ALP, and GGT were not influenced by the administration protocols used in this experiment. The results of the experiment led to the conclusion that the supplementation with parenteral dextran iron in calves that receive diets other than exclusive milk does not bring sufficient advantages to be indicated, although more studies are necessary to evaluate the influence of iron supplementation on the outcome of infections in newborn calves, especially its influence on cost of treatment, time necessary for discharge and impact on its productive life.(AU)

Eficácia do programa nacional de suplementação de ferro no controle de anemia em lactentes assistidos em centros de educaçao infantil / Efficacy of the national program of Iron supplementation in the anaemia control in infants assisted by child education centers

INTRODUÇÃO: a deficiência de ferro ocorre em proporção endêmica entre a população infantil e constitui um dos fatores causais do inadequado desenvolvimento cognitivo, social, motor e de redução da capacidade de aprendizado, colocando os lactentes como grupo prioritário para programas de intervenção nutricional visando o controle da deficiência de ferro. Assim, em 2005 o Ministério da Saúde implantou o Programa Nacional de Suplemento de Ferro (PNSF) disponível para o universo de crianças de 6-24 meses atendidas em Unidades Básicas de Saúde. OBJETIVO: verificar a prevalência de anemia e a eficácia da suplementação profilática com o sulfato ferroso fornecido pelo Programa Nacional de Suplementação de Ferro (PNSF) do Ministério da Saúde do Brasil. MÉTODO: trata-se de estudo prospectivo de intervenção, que foi desenvolvido no município de Guarujá-SP no universo de crianças de 6-24 meses frequentadoras de creches públicas cujos responsáveis autorizaram sua participação. O suplemento de ferro foi oferecido de acordo com as normas do PNSF e o diagnóstico de anemia foi realizado antes e seis meses após o período de intervenção. Como critério de anemia utilizou-se os padrões da Organização Mundial da Saúde que define anemia moderada para valores de hemoglobina (Hb) entre 11,0 e 9,5gHb/dL e anemia grave para valores inferiores a 9,5gHb/dL. RESULTADOS: do total das 136 crianças menores de 2 anos, 81% participou do estudo. Não foi encontrada diferença estatisticamente significativa entre a concentração média de Hb antes e após o período de intervenção (p = 0,684). A média inicial de Hb foi 11,6g/dL(D.p. = 1,82) e a final 11,5 g/dL (d.p.1,31). Embora apenas 11 dos 49 anêmicos atingissem os valores normais, 33 deles apresentaram um aumento na concentração de Hb. CONCLUSÃO: houve um aumento na concentração de hemoglobina entre as crianças com anemia grave. Não houve mudança na situação das crianças com anemia moderada. A suplementação com sulfato ferroso ...

INTRODUCTION: iron deficiency occurs in endemic proportion among children and is one of the causal factors of inappropriate cognitive, social, motor and reduced learning ability, putting infants as a priority group for nutritional intervention programs aiming to control iron deficiency. Thus, in 2005 the Ministry of Health established the National Program of Iron Supplementation (PNSF) available for the universe of children of 6-24 months old attended in Basic Health Units. OBJECTIVE: to estimate the prevalence of anaemia and analyse the efficacy of profilatic supplementation with ferrous sufate. METHODS: a prospective follow-up study intervention that was developed in the city of Guarujá - SP, Brazil in the universe of children between 6-24 months old attended in the Public Basic Health Units whose parents authorized their participation. The supplement was offered in accordance with the standards of PNSF and diagnosis of anaemia was performed before and 6 months after the intervention period. As a criterion for anaemia was used the standards of the World Health Organization that defines moderate anaemia to haemoglobin (Hb) between 11.0 and 9,5gHb/dL and severe anaemia to below 9,5gHb/dL. RESULTS: a total of 136 children under two years, (81% of total) participated in the study. No statistically significant difference was found between the mean Hb concentration before and after the intervention period (p=0.684). The initial mean Hb was 11,6g/dL (SD=1.82) and the final 11.5g/dL (SD=1.31). Although only 11 of the 49 anemic reached normal values, 33 of them showed an increase in Hb concentration. CONCLUSION: there was an increase in Hb concentration among children with severe anaemia. There was no change in the situation of children with moderate anaemia. Supplementation with ferrous sulphate...

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. .

Anemia, insuficiência cardíaca e manejo clínico baseado em evidências / Anemia, heart failure and evidence-based clinical management

A anemia é uma comorbidade prevalente e marcadora de pior prognóstico em pacientes com insuficiência cardíaca (IC). Sua relevância clínica, bem como a fisiopatologia e abordagem terapêutica nesses pacientes são temas de destaque na literatura especializada. Nessa revisão são descritos os conceitos atuais sobre a fisiopatologia da anemia na IC, os critérios diagnósticos e as indicações da suplementação de ferro, ao mesmo tempo em que são analisados criticamente os principais estudos que ofereceram evidências sobre os benefícios dessa suplementação. São abordados os quatro componentes principais da anemia: doença crônica, dilucional, "renal" e disabsortiva. Nos pacientes com IC, os critérios para o diagnóstico são os mesmos utilizados na população geral: níveis de ferritina sérica inferiores a 30 mcg/L em pacientes não nefropatas e menores que 100 mcg/L ou ferritina sérica entre 100-299 mcg/L com saturação de transferrina menor que 20% em pacientes com doença renal crônica. Finalmente, são discutidas as possibilidades terapêuticas da anemia nessa população específica de pacientes.

Anemia is a prevalent comorbidity and marker of a poorer prognosis in patients with heart failure (HF). Its clinical relevance, as well as its pathophysiology and the clinical management of these patients are important subjects in the specialized literature. In the present review, we describe the current concepts on the pathophysiology of anemia in HF, its diagnostic criteria, and the recommendations for iron supplementation. Also, we make a critical analysis of the major studies showing evidences on the benefits of this supplementation. The four main components of anemia are addressed: chronic disease, dilutional, "renal" and malabsorption. In patients with HF, the diagnostic criteria are the same as those used in the general population: serum ferritin levels lower than 30 mcg/L in patients without kidney diseases and lower than 100 mcg/L or serum ferritin levels between 100-299 mcg/L with transferring saturation lower than 20% in patients with chronic kidney diseases. Finally, the therapeutic possibilities for anemia in this specific patient population are discussed.

Prevalencia y etiología de la anemia en Panamá

Desde 1998, el Ministerio de Salud de Panamá desarrolla un programa nacional de suplementación con hierro de forma preventiva en grupos de riesgo. El objetivo del estudio fue determinar las prevalencia total de anemia y de anemia ferropriva en una muestra representativa nacional de lactantes, preescolares, escolares y embarazadas, pertenecientes a distritos prioritarios y escolares de distritos prioritarios y no prioritarios. Se determinaron Hb, VCM, zinc-protoporfirina, ferritina sérica, proteína C reactiva (PCR) y solubilidad de hemoglobina. La Anemia ferropriva se definió como anemia con dos o más indicadores de nutrición de hierro alterados. Dado que un alto porcentaje de los sujetos presentó una PCR elevada, se utilizó un punto de corte para la ferritina de 50 ug/l. La prevalencia de anemia fue 66% en niños de 9 a 15 meses de edad, 41.8% en niños de 16 a 59 meses, 6.3% en escolares y 23.4% en embarazadas, mientras la prevalencia de anemia ferropriva fue 48.8%, 20.3%, 2.5% y 9.4%, respectivamente en embarazadas. La portación de drepanocitosis fue <2.5%. Conclusión: La anemia ferropriva tiene una alta prevalencia y es la principal causa de anemia en lactantes y preescolares. En embarazadas y escolares los procesos infecciosos constituirían la principal etiología de la anemia. La baja prevalencia de anemia ferropriva en escolares y embarazada es atribuible a la efectividad de la suplementación con hierro. Se requiere de la mejoría de la efectividad del programa nacional de suplementación y medidas destinadas a disminuir la incidencia de infecciones para reducir la prevalencia global de anemia en la población panameña.

From 1998, the Ministry of Health of Panama has a national program of prophylactic iron supplementation of risk groups. The objective of the study was to determine the prevalence anemia and of iron deficiency anemia (IDA) in a national representative sample of infants, preschool children and pregnant women from high-priority districts and scholar children from high-priority and not high-priority districts. Hb, MCV, zinc-protoporphyrin, serum ferritin, C reactive protein (CRP) and hemoglobin solubility were measured. IDA was defined as anemia plus two or more abnormal iron nutrition status. Since most of the subjects presented a high CRP, a 50 ug/l cutoff was used for serum ferritin. The prevalence of anemia was 66% in children from 9 to 15 months of age, 41.8% in children of 16 to 59 months, 6.3% in school children and 23.4% in pregnant women, whereas IDA prevalence was 48.8%, 20.3%, 2.5% and 9.4%, respectively. Sickle-cell trait was found in <2.5 % of the subjects. Conclusion, IDA was highly prevalent and the main cause of anemia in infants and preschool children. Infectious processes would constitute the main etiology of anemia in school children and pregnant women. The low prevalence of IDA in scholars and pregnant women is attributable to the effectiveness of the iron supplementation. The improvement of the effectiveness of the national iron supplementation program together with measures to diminish the incidence of infections are required to reduce the prevalence of anemia in the Panamanian population.

Protective effects of lycopene on oxidative stress, proliferation and autophagy in iron supplementation rats

Lycopene is common in diet and known for its antioxidant activities. However, the impact of lycopene on iron metabolism is poorly investigated. In this study, we hypothesize that lycopene can prevent iron-mediated oxidative stress, proliferation and autophagy in liver and use a rat model of nutritional iron supplementation to confirm its intervention in these defence mechanisms. We found that iron supplementation induced cell proliferation predominantly in non parenchymal cells compared with hepatocytes, but not apoptosis. In addition, iron was accumulated within the hepatic lysosomes where it triggered autophagy as evidenced by the formation of autophagic vesicles detected by LC3-B staining. Iron supplementation also induced morphologic alterations of the mitochondrial membranes probably due to increased lipid peroxidation as indicated by elevated iron and malondialdehyde concentrations in serum and tissues. Lycopene reduced iron-catalyzed lipid peroxidation by decreasing the malondialdehyde level in the liver and colon and enhancing the total superoxide dismutase activities in serum and tissues. The result suggest that lycopene prevents iron-induced oxidative stress, proliferation and autophagy at both biochemical and histological levels due to its potent free radical scavenging and antioxidant properties.

Suplementação de ferro e sua associação com a incidência de diabetes mellitus gestacional / Iron supplementation and its association with the incidence of gestational diabetes mellitus

Iron requirements are significantly increased during pregnancy, which makes the daily dietary reference intake difficult to achieve through diet. Because iron deficiency may cause iron-deficiency anemia, which increases perinatal mortality, iron supplementation has been broadly adopted as a standard procedure during pregnancy. However, caution should be exercised as recent evidence suggests that iron excess may hamper fetus development and increase the risk for gestational diabetes mellitus (GDM). Literature is still scarce and it is inconclusive on this matter as the risks and benefits of prophylactic iron supplementation during pregnancy are still a source of controversy. However, it is imperative that a greater attention be given to the iron circulating levels individually. This practice would provide a better evaluation of the necessity and dosage determination of iron supplementation during pregnancy, being, therefore, potentially less likely to trigger the excess of iron-induced deleterious effects.

La demanda nutricional de hierro aumenta significativamente durante el embarazo siendo difícil alcanzar las dosis diarias recomendadas solamente a través de la alimentación. Dado que la deficiencia de hierro puede causar anemia y aumento de la mortalidad perinatal, la suplementación con hierro ha sido ampliamente utilizada como procedimiento estándar en las mujeres embarazadas. Sin embargo esta práctica debe usarse con cautela porque evidencias recientes sugieren efectos adversos de los niveles altos de hierro, que pueden perjudicar el desarrollo fetal y aumentar el riesgo de la diabetes mellitus gestacional (DMG). Aún no existe acuerdo, en la literatura, sobre la mejor manera de abordar el problema. Los riesgos y beneficios de la suplementación con hierro todavía son materia de debate. Sin embargo, es necesario que se preste más atención, de forma individual, a los niveles de hierro circulante Esta práctica permitiría una mejor evaluación de la necesidad de suplementación con hierro y de la determinación de la dosis a ser administrada, siendo de esta manera menos factible que se desencadenen los efectos deletéreos causados por el exceso de hierro.

A demanda nutricional de ferro aumenta significativamente durante a gestação, sendo difícil alcançar a ingestão diária recomendada apenas via alimentação. Como a deficiência de ferro pode ocasionar anemia ferropriva, aumentando a mortalidade perinatal, sua suplementação tem sido amplamente utilizada como procedimento padrão em gestantes. No entanto, tal prática deve ser vista com cautela, pois novas evidências sugerem efeitos adversos dos altos níveis férricos, que podem comprometer o desenvolvimento fetal e aumentar o risco para o diabetes mellitus gestacional (DMG). A literatura não é conclusiva sobre a melhor abordagem ao problema. Os riscos e benefícios da suplementação profilática de ferro ainda são motivo de controvérsia. Entretanto, é imperativo que maior atenção seja dada aos níveis circulantes de ferro de forma individualizada. Essa prática permitiria melhor avaliação da necessidade e da determinação da dosagem da suplementação de ferro durante a gestação, sendo então potencialmente menos passível de desencadear os efeitos deletérios induzidos pelo excesso de ferro.

Effect of Prenatal Zinc Supplementation on Birthweight.

Although iron and zinc deficiencies are known to occur together and also appear to be high in Ghana, a few supplementation studies addressed this concurrently in pregnancy. In a double-blind, randomized controlled trial, 600 pregnant women in Ghana were randomly assigned to receive either a combined supplement of 40 mg of zinc as zinc gluconate and 40 mg of iron as ferrous sulphate or 40 mg of elemental iron as ferrous sulphate. Overall, there was no detectable difference in the mean birthweight between the study groups, although the effect of iron-zinc supplementation on the mean birthweight was masked by a strong interaction between the type of supplement and the iron status of participants [F (1,179)=5.614, p=0.019]. Prenatal iron-zinc supplementation was effective in increasing the mean birthweight among anaemic and iron-deficient women but not among women with elevated iron stores in early pregnancy.