Targeting patient blood management's first pillar: A multicentric retrospective study on preoperative anemia

ABSTRACT Introduction: Anemia is a common issue in surgical patients and has been associated with worse clinical outcomes, such as a higher probability of transfusions and longer hospital stay. Therefore, Patient Blood Management programs are actively aiming to achieve early identification and treatment of anemia, previous to the surgery. Methods and materials: In this study, preoperative hemoglobin within the Blood Order Schedule (BOS) at 16 blood centers in several Brazilian regions were retrospectively evaluated. Data regarding hemoglobin, age, gender and Brazilian regions were further analyzed. Results: From the 20,201 BOSs evaluated, the mean age was 55.65 ± 23.52 years old, with an overall prevalence of preoperative anemia of 60.9%. Women had a lower mean preoperative hemoglobin (11.74 ± 2.84 for women and 12.27 ± 3.06 for men) and higher prevalence of anemia than men (66% of females and 52.2% of males). The individuals over 65 years old and under 18 were the most affected by preoperative anemia. All regions had a high prevalence of preoperative anemia, without any direct association with the Human Development Index. Conclusion: In summary, upon evaluating the BOS, our study showed a high prevalence of preoperative anemia in all Brazilian regions, regardless of the gender and age group, but that women and individuals less than 18 or over 65 years old have an even higher prevalence of preoperative anemia. This information can identify the institutions in which preoperative anemia is a critical issue and in which new strategies, such as preoperative screening clinics, might be helpful.

A Case Report of Fanconi Anemia: A Literature Review and Dental Perspective of Rare Disease

Introduction: Fanconi Anaemia (FA) is a very rare genetic disease characterised by genetic alterations, which causes con- genital abnormalities in individuals. This clinical case report of Fanconi anaemia, will review classical signs of the disease in detail. The various aspects of this rare condition are examined, with an emphasis on oral manifestations and their impact on af- fected patients overall health. Since this group is more likely to acquire cancers, paediatric dentists must be aware of common oral symptoms and possibly malignant lesions in order to make an early diagnosis and provide thorough care and maintenance of oral health to those who are affected. Case Presentation: A four-year-old female patient was brought by her parents to the Department of Pediatric and Preventive Dentistry, Yenepoya Dental college, with a chief complaint of pain in the upper back tooth region. The child had already been diagnosed with FA. Conclusion: Patients with FA are more prone to get infections, so proper precautions should be taken to avoid any situation that might put them at risk of infection or bleeding. Patients should be motivated to have regular follow-ups and encourage them to maintain good periodontal health, to help prevent the incidence of caries and to monitor their overall oral wellbeing.

Serum Ferritin as an Indicator of Neonatal Anaemia

Introduction:Haemoglobin levels are usually used to diagnose neonatal anaemia. By the time haemoglobin levels drop, body iron is depleted. Serum ferritinis the standard measure for assessment of iron levels in neonates and detects iron deficiency earlier than haemoglobin levels. Aims:To determine the prevalence of low haemoglobin and ferritin levels amongst term and preterm newborn babies. To determine the value of serum ferritin in the diagnosis of low iron stores amongst term and preterm newborns. Methodology:This was a cross sectional descriptive study carried out at the Neonatal Intensive Care Unit of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria between June and December 2014. The study included 140 newborns of all birth weights delivered at the UNTH. These were categorized into preterm (gestational age <37 completed weeks) and term (gestational age ≥37 completed weeks. Babies with C-reactive protein levels > 10mg/dl, who were intra-uterine growth restricted, and whose mothers had conditions associated with low iron stores were excluded from the study. Anthropometric measurements were done for all subjects. Haemoglobin estimation and ferritin assay were carried out and the prevalence of neonatal anaemia was determined using each of these. Results:The range of haemoglobin concentration in the study population was 12.22g/gl –22.80g/dl. The mean serum haemoglobin concentrations were 15.69mg/dl ± 1.58 and 16.45 ± 1.92 in the preterm and term babies respectively (t = 2.557, P= .0116). The prevalence of low haemoglobin concentrations amongst both preterm and term babies was zero= .024). The range of serum ferritin level in the studypopulation was 20.6μg/l -296μg/l. The mean serum ferritin levels were 63.13μg/l ± 23.93 and 133.67μg/l ± 50.14 in the preterm and term babies respectively (t = 10.623, P< .001). The prevalence of low serum ferritin in the study population was 22.14%, but was higher in preterm than term babies 35.7% vs 8.6%: (OR –5.926, 95% C.I OR = 2.248 –15.619)(P<.001).Conclusion:Serum ferritin assay is more useful than haemoglobin as an indicator of anaemia during the neonatal period.

Short Term Outcome of Percutaneous Coronary Intervention in Anaemic Patients Presenting with Coronary Artery Diseases

Background: Percutaneous coronary intervention (PCI) has been an effective and widely used treatment for patients with coronary artery disease (CAD). The presence of anaemia in critically ill patients undergoing surgical procedures has been associated with worse clinical outcomes. Hence, the current study was conducted to assess short term outcome of percutaneous coronary interventions in anaemic patients presenting with coronary artery diseases. Methods: This prospective observational study enrolled 200 patients who underwent PCI. Patients were classified into 2 groups: anaemic patients and non-anaemic patients. The anaemic patients were furtherly be classified according to severity of anaemia into 3 grades mild anaemia, moderate anaemia, and severe anaemia. All cases were subjected to complete history taking, clinical examination and baseline laboratory tests: including CBC, serum urea and creatinine, cardiac enzymes include serum troponin, CK-MB and standard 12-lead ECG. Results: The mean Heart Rate was statistically significantly higher in the anaemic group as compared with the non-anaemic group. The mean Ejection Fraction was statistically significantly lower in the anaemic group as compared with the non-anaemic group. The percentage of LM affection in the anaemic group was statistically significantly higher as compared with the non-anaemic group. The incidence of arrythmia in the anaemic group was statistically significantly higher as compared with the non-anaemic group. Severe anaemic and low EF% patients were associated with higher incidence of stroke and MI. Conclusions: Patients with baseline anaemia before PCI have a higher incidence of PCI associated complications. Therefore, anaemia could be a predictor of PCI related complications.

Pre-and post-donation ferritin level of blood donors attending University of Calabar Teaching Hospital, Donor Clinic in Southern Nigeria

While trying to save the patient via blood transfusion, the safety of the blood donor is paramount. This study evaluated the pre-and post-donation ferritin and packed cell volume (PCV) of donors attending University of Calabar Teaching Hospital.Method: The study adopted descriptive longitudinal approach. A total of 18 donors with age range of 18 ­48years were enrolled and followed up for 30 days post-donation. The serum ferritin was analyzed using ELISA method while the PCV was analyzed using the microhematocrit method. Difference between means was performed using repeated measure ANOVA while post hoc was done using Bonferroni adjustment. Prediction of return to baseline values were performed using logistic regression. Alpha value was placed at 0.05 There was a decline in ferritin and packed cell volume from pre-to post-donation. The decline in ferritin was imminent until day 14 when recovery was initiated. Significant difference was observed between the pre-donation ferritin and the rest of the days except day 30. There was also a decline in PCV from pre-donation all through with recovery noticeable after day 7. The PCV of the pre-donation was only comparable to the day 30 post-donation. Approximately 5.6% (n=1) of the subjects was iron deficient pre-donation.Approximately 25% (n=4) of the subject have returned to baseline PCV while 0% of the subjects have returned to baseline ferritin at day 30 post-donation.Conclusion: For the safety of the donor, donation interval should be widened, and iron supplement followed up

Prevalence and factors associated with the severity of anaemia among patients on chronic haemodialysis in Lagos, Nigeria

Anaemia is a global public health problem with high mortality and morbidity. It is also a common consequence of chronic kidney disease (CKD). There is a paucity of data on the actual burden of anaemia among patients on chronic haemodialysis (CHD) in Lagos, Nigeria. Objectives: To determine the prevalence and factors associated with the severity of anaemia among Nigerian patients undergoing chronic haemodialysis. Methods: This was a retrospective analysis of adult patients with end-stage renal disease (ESRD) on maintenance haemodialysis at the Lagos State University Teaching Hospital, Ikeja, Lagos. The data extracted from the clinical case files included the bio-demographic and clinical parameters, including the treatment modalities. Results: A total of 92 patients comprising 69 (75%) males and 23 (25.0%) females with the overall mean age of 48.2±14.0 years were included. Hypertension was the commonest aetiology of CKD and the average duration of haemodialysis was 16.6 months. The commonest access route for haemodialysis was a central line while 96.7% and 81.5% received erythropoietin and intravenous iron sucrose respectively. Seventy-three (79.3%) patients have had intra-dialysis blood transfusions in the past. Mild, moderate, and severe anaemia were recorded in 17%, 67%, and 16% respectively. The use of erythropoietin, iron sucrose, and increased frequency of blood transfusions correlated with the severity of anaemia. Conclusion: Anaemia is highly prevalent among patients with CKD on chronic haemodialysis. Increased frequency of blood transfusions, inadequate utilization of erythropoietin, and iron sucrose administration are associated with anaemia severity.

Effectiveness of Structured Teaching Program on Knowledge of Anaemic Adolescent Girls, Uttarakhand

@#Introduction: Anaemia in India is still a point of concern when it comes to adolescent girls. Adolescent girls are more prone to develop anaemia if they lack knowledge on how to manage the menace of anaemia in adolescence. The study was conducted to identify the prevalence of anaemia in adolescent girls and assess the effectiveness of teaching program on knowledge regarding prevention of anaemia in adolescent girls. Methods: The study was conducted in two phases. First phase adopted exploratory survey design and second phase involved one group pre-test post-test design. The sample consisted of 400 adolescent girls (13 – 15) years studying in rural schools of Haldwani block, Uttarakhand. Results: The study results revealed that about 90 (22.5%) adolescent girls were anaemic. Maximum 64 (71%) adolescent girls had average knowledge regarding anaemia and its prevention. There was 11% enhancement in the level of knowledge of anaemic adolescent girls post administration of teaching program and was significant at 0.05 level. Conclusion: The present study found that there was significant enhancement in the level of knowledge of adolescent girls in the post-test. Thus, it emphasizes the need to educate the adolescent girls regarding dietary choices they make so that it may help in reducing prevalence of anaemia in later ages of life in young girls of India.

The Prevalence of Anaemia and Its Associated Risk Factors in Children Admitted To General Paediatric Ward At Hospital Universiti Sains Malaysia, Kelantan

@#Introduction: Anaemia is a common medical condition among children worldwide, yet a commonly overlooked health problem if not life-threatening. This study aimed to determine the prevalence of anaemia in hospitalized children and identify its associated risk factors. Methods: A retrospective study was conducted from January to December 2021 on 792 patients aged 6 months to less than 12 years old with acute illnesses, who were admitted to the general paediatric ward in Hospital Universiti Sains Malaysia. We analysed socioeconomic and demographic data, and risk factors associated with anaemia. Result: The overall prevalence of anaemia among children aged 6 months to less than 12 years old was 16.4%. The age group of 6 to 59 months has a significant association with anaemia with 3.73 odds compared to the age group of 5 to 11 years (Adj OR 3.73, 95% CI 2.53-5.49). Birth weight of more than 2.5kg has a significant association with anaemia with 1.80 odds compared to weight less than 2.5kg (Adj OR 1.79, 95% CI 1.12-2.88). Conclusion: The prevalence of anaemia in the studied population was considered as a mild public health problem according to WHO severity classification. Children aged 6 to 59 months and those with birth weight more than or equivalent to 2.5kg were more likely to be anaemic. Early iron supplementation should be taken into consideration to reduce anaemia in this population.

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

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

Effects of lactoprotein iron chelates on iron deficiency anaemia in rats / 预防医学

Objective@#To investigate the effects of lactoprotein iron chelates on rats with iron deficiency anaemia (IDA), so as to provide insights into developing and utilizing novel iron supplements.@*Methods@#Seventy weaning female SPF-graded rats of the SD strain were randomly divided into the control group (A), model group (B), ferrous sulfate group (C), lactoferrin group (D), lactoferrin iron chelate group (E), Casein oligopeptide iron chelate group (F) and whey protein oligopeptide iron chelate group (G), with 10 rats in each group. The rats in group A were fed with normal diet, and the others were fed with poor iron diet for IDA modeling. The corresponding interventions were given by intragastric administration once a day. The iron ion concentrations of group C, E, F and G were 2.0 mg/kg, and the protein and oligopeptide concentrations of group D, E, F and G were 2 000 mg/kg. Body weight and hemoglobin of rats were measured weekly during 21-day intervention. At the end, peripheral blood samples were collected, and blood routine, iron metabolism and liver function indicators were determined. @*Results@#After the intervention, among blood routine indicators, the rats in group C, E, F and G showed elevated hemoglobin, red blood cell, mean corpuscular volume and hematocrit, and decreased free protoporphyrin and mean corpuscular hemoglobin concentration when compared with the rats in group B (all P<0.05); among iron metabolism indicators, the rats in group C, E and G showed elevated serum ferritin, the rats in group C, E, F and G showed elevated serum iron, the rats in group C, D, E, F and G showed decreased unsaturated iron binding capacity and total iron binding capacity when compared with the rats in group B (all P<0.05); among liver function indicators, the rats in group E and G showed decreased alanine transaminase when compared with the rats in group B (both P<0.05). @*Conclusions@#Lactoprotein alone could not completely improve IDA in rats compared with traditional iron supplement (ferrous sulfate). Lactoprotein iron chelate, especially whey protein oligopeptide iron chelate, could significantly improve IDA, iron reserve and liver function damage in rats.

Study of Safety and Effect of T-AYU-HM Premium in Sickle Cell Anemia Patient: A Case Study

Sickle cell anaemia is a type of haemoglobin disorder causing morbidity and mortality in many countries. The disease is incurable and therefore requires symptomatic management to improve quality of life. Because the alternative system of medicine can play a significant role in the management of quality of life in sickle cell anaemia, lot many combinations and formulations are attempted across many countries. Unfortunately, very few have reached a preclinical and clinical research level. In the current case study, T-AYU-HM Premium was evaluated as per the standard parameters, and a clinical evaluation considering its effect and safety was performed in this case report of a 24-year-old male with a history of sickle cell disease in hereditary. History was 8 times blood transfusion and 7 times hospitalization in past two year. He was infected with covid-19 and hospitalized, recovered with T-AYU-HM Premium only. Next month because of joint pain, fever, and weakness he visited the daycare clinic. On complete physical and laboratory examination he was started on T-AYU-HM Premium 300mg two tablets twice a day. During 6 months of treatment, he had complained of pain only thrice for which analgesics were prescribed, and no blood transfusion was required. During this 6 month period, there is a remarkable improvement in his haemoglobin, red blood corpuscles, white blood cells, and platelets. There were no untoward complaints from him suggesting that T-AYU-HM Premium exhibited its potential in sustaining the cellular integrity and thereby preventing the lysis of red blood corpuscles. The improvement in laboratory parameters, clinical parameters and established studies indicated that T-AYU-HM Premium is safe and exhibit an observational effect on red blood corpuscles of sickle cell anaemia patient.

A simulation study to compare physiological responses to hypoxia and exercise between anaemic subjects and healthy controls

Objectives: Military flying is a complex task and requires high level of physical fitness of aviators. Various aviation stressors such as acceleratory force, hypoxia, cold weather conditions and decompression sickness place enormous stress on human physiological systems of the aviators. Individuals with Hb <13 g/dL (males) are being placed in the lower medical category which makes them unfit to fly. The present study was undertaken to assess the implication of low haemoglobin (Hb) on exercise capacity and hypoxia tolerance. Materials and Methods: Twenty-five individuals with anaemia and 15 healthy controls participated in the study. The participants were subjected to normobaric hypoxia (NH) equivalent to an altitude of 15,000 feet. Different physiological parameters such as heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), respiratory rate (fR) and arterial oxygen saturation (SpO2) were measured during NH. Participants also performed maximal aerobic capacity (V?O2 max) and maximal anaerobic capacity test in bicycle ergometer. Results: HR, SBP, DBP and fR in anaemic subjects were higher than healthy controls during NH, whereas SpO2 in anaemic subjects was lower as compared to healthy controls. Anaemic individuals had a lower VO2 max than their healthy counterparts. Critical power and anaerobic work capacity were lower in anaemic subjects than healthy controls. Conclusion: There is a deterioration in exercise capacity and hypoxia tolerance in individuals with low Hb levels. Adequate precaution should be exercised for permitting military aviators to fly with low Hb level.

Hemoglobin S identification in blood donors: A cross section of prevalence

ABSTRACT Introduction: In Brazil, the sickle cell trait (SCT) has an average prevalence of 4% in the general population and 6-10% among Afro-descendants. Although SCT is highly prevalent, a large segment of the population ignores their status. The Therapeutic Guidelines prohibit the transfusion of SCT red blood cells into patients with hemoglobin disorders or severe acidosis and newborns. Methods: This was a cross-sectional study with data from 37,310 blood donation candidates. The study included only eligible first-time donors qualified to be tested for the presence of hemoglobin S (HbS) at the Fundação Hemominas Juiz de Fora, Brazil. The variables studied were gender, skin color, age, type of donation, place of birth, blood type, result of the solubility test for hemoglobin S (HbST) and hemoglobin electrophoresis (HbEF). Statistical analysis was performed using the Q square test and the Kappa index of agreement for comparing biochemical methods. This project was approved by the National Research Ethics Committee. Results: The analysis of first-time donor data showed that 7166 were considered eligible. A total of 127 of the 7166 donors were carriers of SCT (1.77%). Among the blood donors, 73.23% were from the local area. The HbST and HbEF were found to be 100% in concordance. Sensitivity was not tested in the present study. Conclusions: The HbST is highly specific for identifying the HbS, but sensitivity was not tested in this study. The screening of blood donors for abnormal hemoglobins is useful, helping to detect and counsel heterozygous people. The study seeks to identify the prevalence of SCT in a region of Brazil.

Burden of sickle cell disease in tribal students in Maa-Baadi institutions in southern Rajasthan - A pilot study

Background & objectives: Sickle cell disease (SCD), an inherited disorder of erythrocytes, is highly prevalent in the tribal population of India. The tribal population of India is approximately 100 million and it is necessary to identify the magnitude of this problem. Furthermore, the prevalence of the disease is unknown among the five million tribal people of southern provinces of Rajasthan. In this study, we intended to determine the prevalence and characteristics of sickle cell disorder among the tribal inhabitants of southern Rajasthan. Methods: This cross-sectional study was conducted among the tribal students of the Maa-Baadis and hostels situated in the five tribal sub-plan districts of Rajasthan. Maa-Baadi centres are located in every village, whereas for every four to five villages, one hostel is allocated to accommodate the tribal students. The screening for SCD was done by solubility test and electrophoresis was used for confirmation. Results: A total of 36,752 tribal students were screened from 1,006 Maa-Baadi centres and 243 hostels. The prevalence of SCD among the tribal students was 5.8 per cent. The prevalence of heterozygous and homozygous conditions was 5.61 and 0.17 per cent, respectively. Among the five sub-plan districts, the highest prevalence was observed in Sirohi district (10.5%) followed by Banswara (7.42%), Udaipur (6.53%), Pratapgarh (5.51%) and Dungarpur (1.89%). Among the four major tribes belonging to these districts, the highest prevalence was recorded in Garasia tribes (13.81%). The history of leg ulcers and the mean pulse rate were significantly high in SCD individuals. Interpretation & conclusions: SCD is a significant problem among the tribes of southern Rajasthan, with the highest prevalence among the Garasia tribe. The present study recommends that a structured screening programme targeting the entire tribal population with appropriate counselling as well as providing treatment through the existing health system is the need of the hour.

Pattern and Severity of Anaemia in Predialysis Chronic Kidney Disease Patients in Bangladesh: A Tertiary Care Hospital Study

Background: Anemia is a common complication in chronic kidney disease (CKD), and is associated with a reduced quality of life, and increased morbidity and mortality. The mechanisms involved in ananaemiassociated with CKD are diverse and complex. They include a decrease in endogenous erythropoietin (EPO) production, absolute and/or functional iron deficiency, and inflammation with increased hepcidin levels, among others. Objective: The objective of our study was to investigate the prevalence and severity of anaemia in pre-dialysis patients, and chronic kidney disease patients in Bangladesh.Material & Methods:This was a case-control prospective study conducted with over 300 Bangladeshi non-patients as the control group A and 87 with different stages of chronic kidney disease (CKD) patients as the case group B in the department of Nephrology BSMMU from April’2004 to June 2006. The normal people who had no history of diabetes mellitus, hypertension, or CKD and were not on any medication were controlled and different stages of the CKD patients who had no history of blood transfusion, erythropoietin and parental iron infusion were cases.Results:Out of 300 normal populations male was 158(52.7%) and the female was 142(47.3%) and the mean haemoglobin level of the male was 13.94 g/dl and the female was 12.29 g/dl. Among males 24(15.2%) and females 55(38.7%) were anaemic and the overall prevalence of anaemia was noted at 26.3%. Of the total anaemic people, 25% was microcytic anemia. Out of 87 CKD patients, 56 (64%) were male and 31 (36%) were female. The overall prevalence of anaemia in CKD patients was 95.4%. The haemoglobin level was <11g/dl in 57.14% patients with CCr 30-59 ml/min/1.73m2 which increases to 87.5 % in patients with CCr 15-29 ml/min/1.73m2, which also increases to 94.2 % in patients with CCr<15 ml/min/1.73m2. Mean haemoglobin was observed at 8.6 g/dl, 9.54 g/dl and 11.25 g/dl in stage V, stage IV and stage III CKD patients respectively. Anaemia appeared at 43.53 ml/min/1.73 m2 of CCR.Conclusions:The results demonstrate that patient with reduced renal function is more likely to have anaemia and the prevalence and severity of anaemia increase with declining kidney function. CCr and TSAT is the important predictor of anaemia. In a significant number of the CKD, patient anaemia was associated with iron deficiency.

A Prospective and Retrospective Study of Bone Marrow in Patients with Pancytopenia– A Study of 150 Cases

BACKGROUND : The bone marrow is widely distributed organ and is the principle site for blood cells forma?on. The broad spectrum of disorders affects the marrow primarily or secondarily with presenta?on of peripheral pancytopenia. Hence, bone marrow examina?on is extremely helpful in evalua?on of pancytopenia. This study emphasizes the different causes of pancytopenia and bone marrow morphology in cases of pancytopenia. MATERIALS & METHODS: The present study is a retrospec?ve and prospec?ve study done in the department of Pathology, for a period of two years. All the relevant history, clinical details, radiological details, and biochemistry parameters were considered. RESULTS: Out of 150 cases,96 were males and 54 were females. Majority of the pa?ents were in the age group of 41-60 years (54%) amongst whom Megaloblas?c anaemia was the most important cause of pancytopenia. CONCLUSION: Bone marrow aspira?on is rela?vely a very safe invasive procedure and primarily permits cytological assessment since the underlying pathology determines the management and prognosis of the pa?ents.

Dietary diversity as a sustainable approach towards micronutrient Deficiencies in India

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

Impact of hydroxyurea on hospital stay & analgesic utilization in sickle cell anaemia with vaso-occlusive crises

Background & objectives: Hydroxyurea (HU) has been useful in preventing sickle cell vaso-occlusive crises (VOC). A few studies also suggest utility of HU, during acute VOC. Sickle cell anaemia (SCA) is of high prevalence in western districts of Odisha State, India, and VOC is a common presentation, despite being mostly of Arab-Indian haplotype. This study was undertaken to evaluate the impact of HU on hospital stay and analgesic utilization in acute painful VOC of SCA. Methods: Homozygous sickle cell disease (HbSS) patients were categorized as cases who were receiving low-dose HU (10 mg/kg/day) and patients who were not on HU were considered as control. Days of hospital stay, analgesic utilization and visual analogue scale (VAS) score in patients were compared with that of control. Analgesics used to control pain were tramadol hydrochloride, ketorolac and diclofenac. Results: A total of 359 homozygous sickle cell disease (SCD) patients with VOC were studied (187 patients and 172 controls). The patient group had lesser mean days of hospital stay (1.4 days less than controls, P<0.001) and required lesser days of analgesic utilization than controls (1.18 days less than controls, P<0.001). Significant differences were observed between patients and controls concerning VAS score and amount of tramadol hydrochloride, ketorolac and diclofenac utilization (P<0.05). Interpretation & conclusions: In this study, HU was found to have beneficial effects in acute VOC of homozygous SCD, which includes shortening the duration of hospital stay and reducing the net amount of analgesic utilization during hospitalization

A case of Osler-Weber-Rendu syndrome associated with portal hypertension

Osler-Weber-Rendu syndrome is a rare autosomal dominant vascular disorder, characterised by multiple telangiectasesof the skin and mucous membranes with recurrent nasal and gastrointestinal bleedings and arteriovenous malformations of various organ systems. It is also called as hereditary hemorrhagic telangiectasia (HHT). The occurrence of telangiectases in the stomach and small bowel can result in chronic bleeding and anaemia. We report a rare case of 39 year old female with Osler Weber Rendu syndrome associated with portal hypertension. She had recurrent nasal and gastrointestinal bleeding, and presented with complaints of progressive dyspnea NYHA class III. On further evaluation she was found to have portal hypertension, which is a rare association.

Effectiveness Of Homoeopathic Medicines In Increasing Haemoglobin Level In Pregnant Anaemic Women

Background:Anaemia is prevalent in society as leading disorder is for dissertationwhich starts usually since birth and it is seen at any age during life time irrespective of sex, area, community or life style. It seems to be difficult to treat or prevent the occurrences by the government because it is multi facet illness, in the sense that there are several types of anaemia and with different causative factors, the line of treatment varies with each and every group of patient with same causative factor or similar symptoms totality. Aim:To evaluate the efficacy of Homoeopathic medicines and Homoeopathic Approach in Increasing Haemoglobin Level in Pregnant Anaemic Women. Material And Methods:Number of cases:60, Duration of study: 24 months. Result:Laboratory Findings: Haemoglobin levels before and after the treatment, Case record form is especially modified to take the historyof Anaemia, Inclusion criteria: Only pregnant anaemic women of child bearing age are included in the study.Conclusion:As per the totality of case the most similar remedy were chosen to satisfy Susceptibility. And the Indicated Constitutional Dynamic Medicine was administered to establish a state of Health and in few cases, Biochemic Medicines were also been prescribed, depending on the deficiency of concerned salts.