ABSTRACT
La importancia de la investigación científica referida a la definición de la anemia por deficiencia de hierro en altitud, se relaciona con los hallazgos de los estudios realizados y que permiten avanzar al conocimiento científico, en poblaciones vulnerables, siendo que están dirigidos a mejorar la salud pública e influir en políticas de salud. Se presenta el análisis y reflexión de una innovadora modalidad para nuestro medio de altitud, basada en la suplementación con hierro y folatos para definir anemia en la población estudiada, situación que difiere de investigaciones previas sobre el tema en nuestro contexto de altitud. Estos estudios han tenido un escrutinio intenso de parte de los revisores que han valorado las publicaciones sobre anemia ferropénica a gran altitud. La claridad de los diseños de ensayos clínicos formales y controlados aleatorizados, pertinentes en tiempo y necesarios por su importancia fueron realizados, en regiones de altitud de Bolivia. La falta de reconocimiento por terceros de este nivel de evidencia logrado, equivaldría a sustituirlos por estudios de ensayos no formales y no controlados, es decir seguir aplicando diseños de tipo observacional, con contrastación teórica y lógica que solo incrementan el estado de incertidumbre sobre el tema en Bolivia. El sumario presentado de la historia sobre la anemia ferropénica en regiones de altitud en Bolivia nos permite reflexiones importantes, a saber: 1. Es importante resaltar, como claro ejemplo, que la observación simple puede llevar a la incertidumbre y lo costoso de sus consecuencias futuras por la persistencia de la anemia ferropénica en poblaciones de altitud, más aún si se mantiene el posible manejo de prueba y error en resultados difundidos. 2. Se demuestra la necesidad de los controles en la investigación científica, y finalmente 3. Los ensayos clínicos controlados aleatorizados son la mejor fuente de evidencia confiable.
The importance of scientific research related to the definition of iron deficiency anemia at altitude is related to the findings of the studies carried out and that allow advancing scientific knowledge, in vulnerable populations, being that they are aimed at improving public health and influence health policies. The analysis and reflection of an innovative modality for our altitude environment is presented, based on supplementation with iron and folates to define anemia in the studied population, a situation that differs from previous research on the subject in our altitude context. These studies have received intense scrutiny from reviewers who have evaluated the publications on high altitude iron deficiency anemia. The clarity of the designs of formal and randomized controlled clinical trials, pertinent in time and necessary due to their importance, were carried out in highland regions of Bolivia. The lack of recognition by third parties of this level of evidence achieved, would be equivalent to replacing them with studies of non-formal and uncontrolled trials, that is, to continue applying observational designs, with theoretical and logical contrast that only increase the state of uncertainty on the subject in Bolivia. The summary presented of the history of iron deficiency anemia in high-altitude regions of Bolivia allows us important reflections, namely: 1. It is important to highlight, as a clear example, that simple observation can lead to uncertainty and the cost of its future consequences due to the persistence of iron deficiency anemia in high altitude populations, even more so if the possible trial and error management is maintained in disseminated results. 2. The need for controls in scientific research is demonstrated, and finally 3. Randomized controlled clinical trials are the best source of reliable evidence.
Subject(s)
Anemia, Iron-Deficiency , Altitude , AnemiaABSTRACT
Introduction@#Methotrexate is being given by dermatologists in only extreme cases of skin disorders such as in severe Psoriasis Vulgaris. Strict precautionary measures are done to avoid its well-known adverse effects. An early but less common sign of its toxicity are painful erosions on plaques. Methotrexate is an effective but potentially toxic treatment for different severe dermatologic disorders such as in severe Psoriasis Vulgaris. Meticulous and complete history-taking, physical examination and laboratory work-up to come up with a correct diagnosis as well as, knowledge of indications for treatment, proper dosing, folate supplementa-tion, monitoring, proper referral and early detection of its toxicity are important in order to avoid cutaneous and systemic adverse effects including death. @*Case Report@#A case of a 57-year old male with a 2-day history of painful erosions on plaques on both upper and lower extremities after eleven days of taking Methotrexate 2.5mg/tablet one tablet three times a day without folate supplementation. He was then being treated by a general physician as a case of Psoriasis Vulgaris. He was subsequently admitted under the Internal Medicine service due to epigastric pain, nausea, anorexia, generalized body weakness and passage of black tarry stools. He was referred to the Department of Dermatology for the painful erosions on plaques. He expired two days after admission due to Acute Respiratory Failure. Post-mortem Skin punch biopsy was done and revealed chronic eczematous dermatitis consistent with Lichen Simplex Chronicus with superimposed drug induced hypersensitivity reaction.
Subject(s)
NeurodermatitisABSTRACT
Objectives: To assess impact of daily and intermittent iron-folate (IFA) supplementation on physical work capacity of underprivileged schoolgirls in Vadodara. Design: Randomized controlled trial. Setting: Municipal Primary schools. Participants: Schoolgirls (n=163) in the age group of 9-13 years. Intervention: Three randomly selected schools were given IFA tablets (100 mg elemental iron + 0.5 mg folic acid) either once weekly or twice weekly or daily for one year. The fourth was the control school. Outcome Measures: Hemoglobin, modified Harvard's Step test for physical work capacity. Results: All three IFA supplemented groups showed significant improvement in number of steps climbed and recovery time compared to controls; with impact being relatively better in girls with higher Hb gain (>1 g/dL) vs. lower Hb gain. Similarly, higher the frequency of dosing better was the impact- it being the best in daily IFA group. Twice weekly IFA was as good as daily IFA under conditions of good compliance. Conclusion: Twice weekly IFA supplementation is comparable to daily IFA in terms of beneficial effects on physical work capacity in young girls.
Subject(s)
Adolescent , Child , Drug Administration Schedule , Female , Folic Acid/administration & dosage , Hemoglobins/analysis , Humans , Iron/administration & dosage , Longitudinal Studies , Motor Activity/drug effects , Socioeconomic Factors , Students , WorkABSTRACT
Folic acid antagonists, which include such common drugs as trimethoprim, triamterene, carbamazepine, phenytoin, phenobarbital and primidone, may increase the risk not only of neural-tube defects but also of cardiovascular defect, oral clefts, and urinary tract defects. Folate supplementation before conception and during the first trimester reduces the risk of having infants with neural-tube defects and has the potential to reduce the risk of having infants with other congenital malformations and Down’s syndrome. Long-term use of multivitamins containing folic acid may reduce risks for hypertension, colon cancer, and breast cancer. The fortification of enriched grain products with folic acid also reduces the number of middle-aged and older adults with hyperhomocyteinemia, which is known to be a risk factor for deep-vein thrombosis, myocardial infarction, dementia and Alzheimer’s disease, congestive heart failure, and osteoporotic fracture. Therefore, folate supplementation has the potential to reduce the risk of a wide variety of conditions and diseases. For example, treatment with folate and mecobalamin (B12) reduced risk of hip fracture successfully in elderly patients with hemiplegia following stroke in a Japanese population. However, compared with specifically supplemented/fortified foods, consumption of naturally-occurring levels of folate in non-supplemented/fortified foods has been shown to be relatively ineffective at increasing folate status. Therefore, advice to consume folate-rich foods as a means of optimizing folate status may be misleading. Rather, increased folate intake with supplements is highly recommended.<br>
ABSTRACT
Lactating women have an increased need of folate in the breastfeeding period and, as a consequence, may be in risk of folate deficiency. Folate content of breast milk, furthermore, is important for infants to support exponential growth. However, little is known about the folate content of breast milk from Korean lactating women and their folate nutritional status. In this study, therefore, we investigated the folate status of Korean lactating women and the folate content of their breast milk during extended lactation. A total of 10 subjects who delivered full-term infants participated this study voluntarily. Dietary folate intakes were measured and blood and breast milk were collected at 1, 2, 3, and 6 months postpartum. The women who did not take folic acid supplements failed to meet the recommended intake (RI) of folate for lactating women during all the study periods but those who did met the RI. The unsupplemented women showed lower plasma folate concentrations compared to the supplemented women and all the women were in suboptimal folate status determined by plasma folate concentration throughout the study periods. But the supplemented women showed lower prevalence of suboptimal folate status only at 3 or 6 months postpartum. Plasma folate concentrations of both groups decreased with the progression of lactation. Erythrocyte folate concentrations were not different between the two groups, however, that of the unsupplemented reduced further as time progressed. Plasma homocysteine levels were not different between the two groups. Concentrations of erythrocyte folate and plasma homocysteine were not changed throughout the study periods. Folate contents of their breast milk through the study periods were not different between the two groups and it decreased as lactation progressed in both groups. The results of this study suggest that the folate nutritional status of Korean lactating women might be deteriorated with the progression of lactation without folic acid supplements.