Clinical, radiographic and histological evaluation of primary teeth pulpotomy using mta and ferric sulfate

Abstract The aim of this study was to evaluate the clinical, radiographic and histological outcomes of the dentin-pulp complex from primary molars after pulpotomy with mineral trioxide aggregate (MTA) and 15.5% ferric sulfate (FS). Thirty-one primary molars were randomly allocated into MTA or FS groups. Clinical and radiographic evaluations were recorded at 3-, 6-, 12- and 18-month follow-up. Teeth at the regular exfoliation period were extracted and processed for histological analysis. Clinical and radiographic data were tested by statistical analysis (p≤0.01). Histological outcomes were analyzed descriptively. All of the treated teeth presented clinical success over the experimental periods. Both groups exhibited 100% of radiographic success at 3, 6 and 12 months. At the 18-month follow-up, one tooth from FS group presented inter-radicular radiolucency (p>0.01). Histologically, the treated teeth presented pulp vitality and absence of inflammatory infiltrate into the connective tissue. Only MTA group showed hard tissue barrier surrounded by odontoblasts over the pulp stumps. Both MTA and 15.5% FS are effective for pulpotomies of primary teeth. Although MTA is considered the first-choice material, FS may be a suitable alternative when treatment cost is an issue.

Resumo O objetivo deste estudo foi avaliar os resultados clínicos, radiográficos e histológicos do complexo dentino-pulpar de molares decíduos após pulpotomia com agregado trióxido mineral (MTA) e sulfato férrico (SF) 15,5%. Trinta e um molares decíduos foram alocados aleatoriamente nos grupos MTA ou SF. As avaliações clínicas e radiográficas foram realizadas aos 3, 6, 12 e 18 meses de acompanhamento. Os dentes no período regular de esfoliação foram extraídos e processados ​​para análise histológica. Os dados clínicos e radiográficos foram analisados estatisticamente (p≤0,01). O resultados histológicos foram analisados ​​descritivamente. Todos os dentes tratados apresentaram sucesso clínico ao longo dos períodos experimentais. Ambos os grupos exibiram 100% de sucesso radiográfico aos 3, 6 e 12 meses. Aos 18 meses de acompanhamento, um dente do grupo SF apresentou radiolucidez interradicular (p>0,01). Histologicamente, os dentes tratados apresentaram vitalidade pulpar e ausência de infiltrado inflamatório no tecido conjuntivo. Somente o grupo MTA mostrou barreira de tecido duro rodeada por odontoblastos sobre os cotos pulpares. MTA e SF 15,5% são eficazes para pulpotomias de dentes decíduos. Embora o MTA seja considerado o material de primeira escolha, o SF pode ser uma alternativa adequada quando o custo do tratamento é um problema.

TREATMENT OF ANEMIA AND IMPROVEMENT OF QUALITY OF LIFE AMONG PATIENTS WITH CROHN'S DISEASE: experience using ferric carboxymaltose

Objectives - Anemia is the most common hematological alteration in patients with Crohn's disease, and is frequently related to intestinal inflammatory activity. Its cause is multifactorial and mostly associated with absolute iron deficiency (iron deficiency anemia) and/or functional iron deficiency (inflammation anemia or anemia of chronic disease). It may also be identified through other causes, such as folic acid or vitamin B12 deficiency and secondary to adverse effects from medications (salicylic derivatives and immunosuppressive drugs). In the present study, patients with active Crohn's disease and anemia were evaluated and treated with intravenous ferric carboxymaltose. We discuss the therapeutic schemes (doses), safety, results and improvement of quality of life. Methods - In the present prospective study, 10 consecutive patients with Crohn's disease, with moderate to severe activity, with anemia (Hb: 6.7 to 10 g/dL), who were attended between March 2014 and March 2015, were evaluated. Six (60%) were men and four were women, all with moderate or severe anemia (hemoglobin <10 g/dL). They were treated with a maximum of three intravenous infusions of 1000 mg of ferric carboxymaltose, of at least 15 minutes in duration. It was also sought to correlate the inflammatory Crohn's disease activity degree (measured using the Crohn's Disease Activity Index, CDAI) and C-reactive protein level with the severity of anemia. The primary outcome was an increase in Hb of ≥2 g/dL and the secondary outcome was the normalization of anemia (Hb ≥12 g/dL for women and ≥13 g/dL for men) and the improvement in quality of life seen 12 weeks after the last application of carboxymaltose. Results - Among the 10 patients studied, parenteral iron supplementation was administered in three cases during hospitalization and the others received this on an outpatient basis. The total iron dose ranged from 1,000 to 2,000 mg, with an average of 1,650 mg. Crohn's disease activity measured using CDAI and C-reactive protein correlated with the intensity of anemia. An increase of 2 g/dL occurred in eight (80%) patients after 12 weeks and normalization of anemia was found in seven (70%) patients. Improvements in quality-of-life scores were found for all (100%) patients after 12 weeks. Carboxymaltose was well tolerated. Three patients presented adverse reactions (two with nausea and one with headache) of mild intensity. Conclusions - Anemia is a frequent complication for Crohn's disease patients. Intravenous iron therapy has been recommended for Crohn's disease patients, because for these patients, oral iron absorption is very limited. This is because of the inflammatory state and "blocking" of iron entry into enterocytes through hepcidin action on ferroportin, along with the elevated rates of gastrointestinal adverse events that compromise adherence to treatment and possibly aggravate the intestinal inflammatory state. The degree of Crohn's disease activity, as measured using CDAI and C-reactive protein, correlates with the severity of anemia. Carboxymaltose is a safe drug, which can be administrated in high doses (up to 1,000 mg per application per week) and corrects anemia and iron stocks over a short period of time, with consequent improvement in quality of life.

Objetivos - Anemia é a alteração hematológica mais comum em portadores de doença de Crohn, estando frequentemente relacionada à atividade inflamatória intestinal. Sua causa é multifatorial, está associada na maioria das vezes com deficiência absoluta de ferro (anemia ferropriva) e/ou deficiência funcional de ferro (anemia da inflamação ou anemia de doença crônica), podendo também ser identificada outras causas como deficiência de ácido fólico ou vitamina B12 e secundária a efeitos adversos de medicamentos (derivados salicílicos e imunossupressores). Neste trabalho, avaliamos portadores de doença de Crohn em atividade com anemia que foram tratados com carboximaltose férrica endovenosa, e discutimos os esquemas terapêuticos (doses), a segurança e os resultados, assim como a melhora da qualidade de vida. Métodos - Neste estudo prospectivo, avaliamos 10 consecutivos pacientes portadores de doença de Crohn de moderada a grave atividade com anemia (Hb: 6,7 a 10 g/dL) que foram atendidos no período de março de 2014 a março de 2015. Eram seis (60%) do sexo masculino e quatro do sexo feminino, todos com anemia moderada ou grave (hemoglobina <10g/dL), tratados com no máximo três infusões de 1000 mg de carboximaltose férrica por via endovenosa em, pelo menos, 15 minutos. Procurou-se também correlacionar o grau de atividade inflamatória da doença de Crohn (mensuração realizada com o IADC-índice de atividade da doença de Crohn) e dosagem da proteína C reativa com a gravidade da anemia. O desfecho primário foi aumento da Hb de ≥2 g/dL e desfecho secundário a normalização da anemia (Hb ≥12 g/dL para mulheres e ≥13 g/dL para homens) e melhora na qualidade de vida após 12 semanas da aplicação da última dose de carboximaltose férrica. Resultados - Dos 10 pacientes estudados, em 3 a suplementação parenteral de ferro foi realizada durante internação hospitalar, o restante em regime ambulatorial. A dose total de ferro administrada variou de 1.000 a 2.000 mg, sendo a média de 1.650 mg. A atividade da doença de Crohn mensurada pelo IADC e pelo PCR se correlacionou com a intensidade da anemia. O aumento de 2 g/dL ocorreu em oito (80%) pacientes após 12 semanas e a normalização da anemia foi observada em sete (70%). Melhora do escore de qualidade de vida foi observada em todos (100%) após 12 semanas. A carboximaltose férrica foi bem tolerada, três pacientes apresentaram reações adversas (2 - náusea e 1 - cefaléia) de leve intensidade. Conclusões - Anemia é uma complicação frequente em portadores de doença de Crohn. A terapia com ferro por via endovenosa tem sido a recomendada em portadores de doença de Crohn, pois nestes pacientes a absorção do ferro oral é bastante limitada devido ao estado inflamatório e "bloqueio" da entrada de ferro nos enterócitos por ação da hepcidina sobre a ferroportina, além das elevadas taxas de eventos adversos gastrointestinais que comprometem a adesão ao tratamento e podem agravar o estado inflamatório intestinal. O grau de atividade da doença de Crohn mensurado pelo IADC e PCR se correlaciona com a severidade da anemia. A carboximaltose férrica é uma droga segura, pode ser administrada em altas doses (até 1.000 mg por aplicação por semana), corrige a anemia e os estoques de ferro em curto espaço de tempo, com consequente melhora da qualidade de vida.

Evaluation of clinical and laboratory variables associated with anemia in pediatric patients on hemodialysis / Avaliação de variáveis clínicas e laboratoriais associadas à anemia em pacientes pediátricos em hemodiálise

OBJECTIVE: To identify the occurrence of anemia in pediatric patients on hemodialysis and the association between hemoglobin levels and anemia in CKD-related variables. METHODS: This was a retrospective study. Patients aged up to 18 years with chronic kidney disease undergoing hemodialysis at this service between January of 2009 and December of 2010 were selected. Clinical and laboratory data were obtained from medical records. Statistical analysis was performed with chi-squared test, Student's t-test and general estimating equations (GEE) using SPSS 20.0, assuming a significance level of 5%. RESULTS: A total of 357 medical records depicting the monthly evolution of 29 patients were analyzed. The most common etiology for chronic kidney disease was malformations of the genitourinary tract (28%). Hemoglobin showed a mean (standard deviation) value of 9.20 (1.8) g/dL, with the occurrence of anemia in 65.3% of cases. Anemia was associated with hospitalization; antibiotic use; transfusion; use of intravenous iron hydroxide; low values of creatinine, hematocrit, and albumin; and high values of ferritin, aluminum, and equilibrated Kt/V (p < 0.05). The odds ratio for anemia with the use of intravenous iron hydroxide was 0.36 (95% CI: 0.25 to 0.89), i.e., a 2.78-fold higher chance of developing anemia without the use of this medication. CONCLUSIONS: Anemia predominated in children and adolescents with chronic kidney disease; intravenous iron hydroxide use was a protective factor. .

OBJETIVO: Identificar a ocorrência de anemia entre pacientes pediátricos em hemodiálise e a associação entre os valores de hemoglobina e variáveis relacionadas à anemia na DRC. MÉTODOS: Estudo retrospectivo. Selecionados pacientes até 18 anos com doença renal crônica em hemodiálise no serviço entre janeiro de 2009 e dezembro de 2010. Verificados prontuários para coleta de dados clínicos e laboratoriais. Análise estatística com testes de qui-quadrado, t de Student e General Estimating Equations (GEE) em programa Statistical Package for the Social Sciences 20.0, assumindo-se nível de significância de 5%. RESULTADOS: Analisadas 357 fichas de evolução médica mensal de 29 pacientes. A etiologia mais frequente para a doença renal crônica foram as malformações do trato genito-urinário (28%). Hemoglobina apresentou valor médio (desvio padrão) de 9,20 (1,8) g/dL, com ocorrência de anemia em 65,3% das consultas. Anemia associou-se a internação, uso de antibiótico, transfusão, uso de hidróxido de ferro endovenoso, valores baixos de creatinina, hematócrito e albumina e valores altos de ferritina, alumínio e Kt/V equilibrado (p < 0,05). A odds ratio para anemia com uso de hidróxido de ferro endovenoso foi 0,36 (95% IC 0,25-0,89), ou seja, uma chance 2,78 vezes maior de desenvolver anemia sem o uso dessa medicação. CONCLUSÕES: A anemia predominou em crianças e adolescentes com doença renal crônica, tendo como fator protetor o uso de hidróxido de ferro endovenoso. .

Efficacy of Ferric Carboxymaltose in Anaemia of Malignancy - A Pilot Study.

Anaemia is an important problem in malignancy. It may be due to chronic causes like malnutrition, marrow infiltration, associated renal or endocrine disorders and it may be complicated with blood loss. Measures like blood transfusion, erythropoietin injections often pose a logistical problem. Parenteral iron injections have proved to be useful in fighting anaemia in some chronic conditions e.g. patients on hemodialysis. Aims and Objectives: Primarily to see the observable change in hemoglobin (Hb) level with ferric carboxymaltose (FCM) in treating patients of malignancy on anti-cancer treatment. Materials and Methods: Twenty seven patients were enrolled for this study who were suffering from various malignancies. The baseline Hb level was estimated and FCM injection was administered as per the schedule of 500 mg intravenously (IV) weekly once. The overall results of increase in Hb level was noted during the middle of the treatment (chemotherapy or radiotherapy) and later 3-4 weeks after treatment completion. The results were analysed using SPSS and the mean values of initial Hb and after treatment were analysed. Level of significance (p value) was noted using t test. Results: In 27 patients the mean initial Hb level was 8.09 g/dl before treatment which increased to 10.28 g/dl after FCM treatment (p <0.0001). Conclusion: Treatment with FCM definitely led to a significant increase in Hb level in patients of malignancy undergoing treatment. However, further detailed study is needed to establish its definite role in improving the body iron parameters.

Comparison of Oral and Intravenous Iron for Treatment of Iron Deficiency Anaemia in Pregnancy.

Oral iron supplementation is standard obstetrical practice. But programmes of anaemia prophylaxis based on oral iron supplementation still remain a failure. Whether or not there is need for parenteral iron may be debated. Parenteral iron is indicated when oral iron supplementation is not possible or fails. Intravenous iron could be a good alternative in pregnant women to ensure compliance. Many workers have shown that parenteral iron therapy supplies enough iron for erythropoiesis. Therefore, In the present review, we assessed oral iron supplementation with intravenous (IV) iron sucrose in the management of iron deficiency anaemia in pregnancy. Intravenous iron sucrose appears a good alternative to oral iron in patients who are either intolerant to oral iron or are non compliant and may also reduce the incidence of blood transfusion and its associated risks.

Study of EDTA intake of children for potential use of FeNaEDTA for breakfast cereal fortification

EDTA is used as disodium salt or disodiumcalcium in foods, to prevent lipid oxidation or as color and flavor stabilizer. In some countries, FeNaEDTA is also used as a source of iron for fortification. However, EDTA has an Acceptable Daily Intake (ADI) of 2.5 mg / kg/day. The aim of this study was to estimate the intake of EDTA in children of school age and the potential use of Fe- NaEDTA as iron source for breakfast cereal fortification. A qualitative-quantitative food frequency questionnaire was conducted on 225 schoolchildren of both sexes, aged between 4 and 13, from school canteens, public and private schools, from the city of Santa Fe (Argentina). Only those foods which EDTA addition is allowed in Argentina: packaged ice cream, soda, soft drinks and powdered soft drinks (upper limit of Na2EDTA o Na2CaEDTA: 35 mg/kg) and dressings and margarines (upper limit of Na2CaEDTA: 75 mg/kg) were considered. EDTA Average Daily Consumption (ADC) was 0.06 mg/kg/day with a median of 0.011 mg/kg/day, representing 2.4% of the ADI. In the hypothetical case that FeNaEDTA would be used as iron source for breakfast cereal fortification at level of 11 mg Fe%, the potential EDTA ADC would be 0.46 ± 0.32 mg/kg/day, representing 18.4% of the ADI (2.5 mg/kg/day). Results indicate that children from Santa Fe city have an EDTA ADC currently well below the maximum ADI of EDTA, which would remain low even if FeNaEDTA is used for breakfast cereal fortification.

Estudio de la ingesta de EDTA en niños para la utilización potencial de FeNaEDTA en la fortificación de cereales para desayuno. El EDTA es utilizado en alimentos como sal disódica o disódica-cálcica, para prevenir la oxidación lipídica o como estabilizante del color y sabor. En algunos países, FeNaEDTA es también usado como una fuente de hierro para la fortificación de alimentos. Sin embargo, posee una Ingesta Diaria Admisible (IDA) de 2,5 mg/kg/día. El objetivo de este estudio fue estimar la ingesta de EDTA en niños y el potencial uso de FeNaEDTA como fuente de fortificación de hierro en cereales para desayuno (CPD). Se realizó un cuestionario de frecuencia alimentaria cuali-cuantitativo a niños de ambos sexos, en edades comprendidas entre 4 y 13 años, que asistían a comedores escolares, escuelas públicas y privadas de la Ciudad de Santa Fe, Argentina. Solo se evaluaron aquellos alimentos en los que se halla permitido el agregado de EDTA en Argentina: helados envasados, gaseosas, bebidas sin alcohol y jugos en polvo, aderezos y margarina. La Ingesta Diaria Promedio (IDP) de EDTA fue de 0,06 mg/Kg/día con una mediana de 0,011 mg/kg/día, lo que representa el 2,4% de la IDA. En el hipotético caso de que FeNaEDTA fuera usado como fuente de hierro para fortificación de CPD en un nivel de 11 mg Fe%, la potencial IDP de EDTA sería de 0,46 ± 0,32 mg/kg/día, lo que representa un 18,4 % de la IDA. Los resultados indican que la IDP de EDTA está muy por debajo de la IDA máxima, la cual seguiría siendo baja incluso si el FeNaEDTA se utilizara como fortificante de hierro en CPD.

Disponibilidad potencial in vitro de hierro y zinc en una dieta infantil con pan fortificado con distintas fuentes de hierro o con agregado de promotores de la absorción / Iron and zinc in vitro potential availability in an infant diet with fortified bread with different iron sources or with the adition of different iron absorption promoters

Los alimentos complementarios más utilizados son las dietas caseras. En el presente trabajo se evaluó la disponibilidad de hierro y zinc en una dieta infantil de consumo habitual conteniendo pan fortificado con diferentes fuentes de hierro: sulfato ferroso, bisglicinato ferroso, NaFeEDTA. También se utilizó pan sin fortificar con agregado de ácido ascórbico, citrato de sodio o Na2EDTA como promotores de la absorción, combinada con diversas bebidas. La dieta (papa, zapallo, sémola, pan y manzana) se combinó con agua, leche, té, bebida cola y bebida artificial a base de naranja. La dializabilidad (D) mineral, como indicador de la disponibilidad potencial fue determinada utilizando un método in vitro. El análisis estadístico se realizó utilizando ANOVA, con test de Tukey a posteriori. No hubo diferencias significativas en la DFe entre las dietas del pan fortificado con sulfato o bisglicinato; con el NaFeEDTA aumentó significativamente (p<0,05). El aumento de la DFe fue mayor en las dietas que tenían panes con promotores que en las que tenían panes fortificados. La bebida a base de naranja aumentó la DFe, mientras que el té y la leche la disminuyeron significativamente (p<0,05). La DZn aumentó en forma significativa cuando el pan estaba fortificado con sulfato o NaFeEDTA, pero no cuando se fortificó con bisglicinato. El agregado de té o leche disminuyó la DZn mientras que la bebida a base de naranja la aumentó significativamente (p<0,05). En relación a los promotores, las mayores DFe y DZn se observaron en las dietas con el pan sin fortificar, con agregado de Na2EDTA.

Home-made diets are the most frequently used complementary foods. In the present work we evaluated iron and zinc availability in a usually consumed infant diet containing either iron-fortified bread with different iron sources: ferrous sulfate, ferrous bisglycinate, NaFeEDTA. We also used non-fortified bread with absorption promoters: ascorbic acid, sodium citrate, Na2EDTA, combined with different beverages. The diet (potato, pumpkin, grits, bread, and apple) was combined with water, milk, tea, a soft drink and an orange-based artificial drink. Mineral dialyzability (D) as an indicator of potential availability was determined using an in vitro method. Statistical analysis was performed by ANOVA, and a posteriori Tukey test. There were no significant differences in FeD between diets with ferrous sulfate or ferrous bisglycinate fortified bread; in NaFeEDTA fortified bread it increased significantly (p<0.05). Iron D increase was greater in diets with bread containing absorption promoters than in those with fortified bread. The orange-based artificial drink increased FeD, while tea and milk decreased it significantly (p<0.05). Zinc D increased significantly when the bread was fortified either with ferrous sulfate or NaFeEDTA, but remained unchanged in diets with ferrous bisglycinate fortified bread. The addition of tea or milk decreased ZnD while the orange-based artificial drink increased it significantly (p<0.05). Regarding absorption promoters, the greater values both in FeD and ZnD were observed in diets with iron nonfortified bread containing Na2EDTA.

Postoperative High-Dose Intravenous Iron Sucrose with Low Dose Erythropoietin Therapy after Total Hip Replacement

Erythropoietin combined with parenteral iron sucrose therapy is an alternative to blood transfusion in anemic patients. It was shown to be effective in surgical patients in several previous studies when used in conjunction with other methods. However, there are no guidelines about safety limits in dosage amounts or intervals. In this study, we report a case of significant postoperative hemorrhage managed with high dose parenteral iron sucrose, low dose erythropoietin, vitamin B12, vitamin C, and folic acid. An 80-year-old female patient presented for severe anemia after a total hip arthroplasty and refused an allogenic blood transfusion as treatment. The preoperative hemoglobin of 12.2 g/dL decreased to 5.3 g/dL postoperatively. She received the aforementioned combination of iron sucrose, erythropoietin, and vitamins. A total of 1,500 mg of intravenous iron sucrose was given postoperatively for 6 consecutive days. Erythropoietin was also administered at 2,000 IU every other day for a total of 12,000 IU. The patient was discharged in good condition on the twelfth postoperative day with a hemoglobin of 8.5 g/dL. Her hemoglobin was at 11.2 g/dL on the twentieth postoperative day.

Granular parakeratosis presenting with facial keratotic papules.

A 27-year-old female presented with pruritic keratotic papules over the left side of the face since one month. The lesions developed a few days after working in a hot humid environment and were preceded by severe uncontrollable pruritus for which she had repeatedly wiped the area with handkerchiefs and towels. A biopsy from one of the keratotic papules revealed granular parakeratosis with a markedly thick stratum corneum that had parakeratosis and also housed keratohyaline granules. Similar changes were seen in keratotic plugs of dilated follicular infundibula.

A randomised double-blind study comparing sodium feredetate with ferrous fumarate in anaemia in pregnancy.

Iron deficiency anaemia is a major health problem in India especially in women of reproductive age group. The World Health Organisation recommends that the haemoglobin concentration should not fall below 11.0 g/dl at any time during pregnancy. The aim of study was to compare the efficacy and safety of two doses of sodium feredetate with ferrous fumarate in improving haemoglobin profile in pregnant anaemic women. Pregnant women with gestation period between 12 and 26 weeks having serum haemoglobin < 10 g/dl, serum ferritin levels less than 12 microg/l were included in the study. Patients were divided into 3 groups and drugs administered accordingly. A total of 48 patients were available for analysis which included 37 patients who had completed all the visits up to 75 days follow-up and 11 patients who were treatment failures. In group A combination of sodium feredetate (containing 33 mg of elemental iron) along with vitamin B12 (15 microg) and folic acid (1.5 mg) was administered twice a day. In group B combination of sodium feredetate (containing 66 mg of elemental iron) along with vitamin B12 (15 microg) and folic acid (1.5 mg) was administered twice a day. In group C combination of ferrous fumarate (containing 100 mg of elemental iron) along with vitamin B12 (15 microg) and folic acid (1.5 mg) was administered twice a day. Patients were evaluated for Hb, RBC count, MCV, MCH and MCHC at day 0, 30, 45, 60 and 75. Serum ferritin, serum iron, TIBC and transferrin saturation were assessed at recruitment and end study. Mean rise of haemoglobin at the completion of study, over that of basal values was 1.79 g/dl (0.71 to 2.87, 95% CI, p < 0.05) in group A, 1.84 g/dl (0.82 to 2.86, 95% CI, p < 0.05) in group B and 1.63 g/dl (0.38 to 2.88, 95% CI, p < 0.05) in group C. Safety assessment was done by doing liver and kidney function test at the time of recruitment and end study. Low doses of sodium feredetate (33 mg and 66 mg of elemental iron given twice daily) produce comparable results as higher dose of ferrous fumarate (100 mg elemental iron given twice daily). As there were no adverse effects reported with sodium feredetate, it can be concluded from this study that this new formulation appears to be effective in improving haemoglobin profile in pregnant anaemic women and is tolerated well.

[ effect of intravenous Iron therapy on haemoglobin level and optimization of erythropoietin therapy in haemodialysis patients]

Decrease in production of erythropoietin has been noted as one of the main factors causing anemia in ESRD patients, and administration of recombinant human erythropoietin [rhEPO] has been used to correct the anemia. Iron deficiency, including functional iron deficiency, limits the efficacy of rhEPO therapy in ESRD patients. This study examined the effects of maintenance intravenous iron sucrose [Venofer] on haemoglobin level and, optimization of erythropoietin therapy. Forty eight haemodialysis patients with haemoglobin level<9 gr/dl who were dialyzed three times weekly went under the study. Two thousands units of rhEPO were given subcutaneously at the end of each dialysis for seven weeks. At the end of the seventh week, those with haemoglobin level<9 gr/dl and with ferritin level <200 ng/dl [29 patients] were chosen for intravenous administration of 100 mg Venfor during the next five consecutive haemodialysis while maintaining the rhEPO dose at 2000 units with each dialysis. A week after the last dose of Venofer, haemoglobin and serum ferritin were determined. Average haemoglobin level among the patients before administration of rhEPO was 7.5 gr/dl. After seven weeks of subcutaneous rhEPO at 2000 units with each haemodialysis, the average haemoglobin level raised to 8.5 gr/dl. The effect of maintenance IV Venofer was an increase in average haemoglobin level to 10.4 gr/dl. The same effect was seen on the ferritin level. The ferritin level of 131 ng/dl increased to 237 ng/dl a week after last dose of IV venofer. Intravenous [IV] iron improves haemoglobin response and, thus, optimizes rhEPO therapy

O uso intravenoso de sacarato de hidróxido de ferro III em pacientes com anemia ferropriva / Evaluation of the efficacy of intravenous iron III-hydroxide saccharate for treating adult patients with iron deficiency anemia

OBJETIVO: Avaliar a eficácia do uso intravenoso de sacarato de hidróxido de ferro III no tratamento de pacientes adultos com anemia ferropriva que não obtiveram resposta satisfatória à terapia com ferro oral. MÉTODOS: No período de janeiro de 2003 a janeiro de 2004, estudamos 25 pacientes com anemia ferropriva que apresentaram intolerância e/ou resposta inadequada ao tratamento com ferro por via oral e/ou valor de hemoglobina < 7 g/dl. Os principais exames laboratoriais realizados foram: hemograma completo, contagem de reticulócitos, ferro sérico, capacidade total de ligação de ferro e ferritina sérica. Os pacientes receberam uma dose semanal de 200 mg de sacarato de hidróxido de ferro III diluído em 250 ml de soro fisiológico 0,9 por cento administrado por via intravenosa em 30 minutos. O tratamento foi realizado até a obtenção dos valores de hemoglobina =12 g/dl para mulheres e =13 g/dl para homens, ou até a administração da dose total de ferro parenteral recomendada para cada paciente. RESULTADOS: A idade mediana dos 25 pacientes estudados foi de 45 anos, variando entre 31 e 70 anos; 19 (76 por cento) eram do sexo feminino. A causa mais comum de anemia ferropriva no sexo feminino foi sangramento uterino anormal observado em 13/19 pacientes (68 por cento) e, no sexo masculino, gastrectomia parcial observada em 4/6 (67 por cento). Dezessete (68 por cento) pacientes foram incluídos neste estudo por falta de resposta à terapia com ferro oral, 6/25 (24 por cento) por intolerância ao ferro oral e 2/25 (8 por cento) por hemoglobina < 7 g/dL. Correção da anemia foi obtida em 12/19 (63 por cento) dos pacientes do sexo feminino e em 5/6 (83 por cento) dos pacientes do sexo masculino. Os valores médios da hemoglobina e da ferritina eram de 8,09 g/dl e 4,20 ng/ml (pré-tratamento) e 12,42 g/dl e 87,78 ng/ml (pós-tratamento) (p<0,001), respectivamente. O aumento médio de hemoglobina foi de 3,74 g/dl, variando entre 1,30 g/dl e 7,60 g/dl. Nenhum paciente recebeu transfusão de sangue durante ou após o tratamento com ferro intravenoso. CONCLUSÃO: O uso intravenoso de sacarato de hidróxido de ferro III é uma opção eficaz e segura no tratamento de pacientes adultos com anemia ferropriva que não obtiveram resposta satisfatória com a utilização do ferro oral. Esta opção terapêutica deve ser levada em consideração sobretudo nos pacientes com intensa anemia a fim de se obter rápido aumento dos valores da hemoglobina e se evitar transfusão de sangue.

Evaluation of efficacy and safety of iron polymaltose complex and folic acid (Mumfer) vs iron formulation (ferrous fumarate) in female patients with anaemia.

Treatment of iron deficiency anaemia with conventional oral preparations is handicapped by unpredictable haematological response in addition to potential for irritating gastrointestinal adverse events. Iron polymaltose complex (IPC), a novel oral iron formulation with better absorbability, predictable haematinic response and less side effects was compared with oral ferrous fumarate in 100 female patients with documented iron deficiency anaemia. Clinical parameters (pallor, weakness) as well as biochemical parameters (Hb, serum iron, total iron binding capacity) show favourable changes with IPC; the physician and patient assessment also favour IPC over ferrous fumarate.

Seguridad y tolerancia del sacarato férrico, administrado por infusión endovenosa continua, en una población mexicana con anemia / Safety and tolerance of iron saccharate, administered by intravenous route, in a Mexican population with iron deficiency anemia

El propósito de este estudio fue conocer la seguridad y tolerancia del sacarato férrico, administrado por vía endovenosa en una población mexicana. De marzo a noviembre de 1994 se atendieron 32 pacientes con anemia ferropriva que aceptaron ser incluidos en el estudio. El sacarato se aplicó, mediante un catéter endovenoso, diluido en 250 ml de solución salina, en el curso de seis horas, y en dosis no mayor de 1,000 mg cada vez. Se observaron molestias en 16 pacientes. Las más frecuentes fueron dolor abdominal, hipotesión y urticaria, sin ameritar que la administración se suspendiera. La frecuencia e intensidad de las reacciones fue mayor cuando la dosis de sacarato superó los 550 mg. La corrección de la enemia, en todos los casos, se alcanzó en tres semanas. El estudio muestra que el sacarato férrico puede usarse con seguridad y sin datos importantes de intolerancia, a dosis inferiores a 550 mg, con la ventaja de obtener recuperación de la anemia, por lo menos en la mitad del tiempo que con el hierro dextrán, actualmente el preparado más usado por vía endovenosa