Individualized red-cell transfusion strategy for non-cardiac surgery in adults: a randomized controlled trial / 中华医学杂志(英文版)

BACKGROUND@#Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion.@*METHODS@#Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test).@*RESULTS@#We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies.@*CONCLUSION@#The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT01597232.

Risk factors associated with different types of Henoch-Schönlein purpura in Tibetan patients at high altitude / 北京大学学报(医学版)

OBJECTIVE@#To investigate the risk factors of different types of Henoch-Schönlein purpura (HSP) in Tibetan patients at high altitude, as to provide reference for correctly identifying high-risk patients.@*METHODS@#A retrospective study was used to analyze the 304 HSP patients admitted to Tibet Autonomous Region People's Hospital from April 2014 to March 2022. The gender, age, allergic history, family history, clinical type, laboratory indexes (hemoglobin, platelet count, eosinophil, C-reactive protein (CRP), albumin, immunoglobulin G, immunoglobulin A, complement C3 and C4) were analyzed retrospectively. Univariate and multivariate Logistic regression analysis to screen for risk factors affecting different types of HSP.@*RESULTS@#Renal HSP patients showed higher IgA [(9.2±1.7) g/L vs. (6.4±2.4) g/L, P=0.015], lower complement C3 [(203.3±21.6) mg/dL vs. (301.1±19.5) mg/dL, P=0.043], and complement C4 [(33.5±2.3) mg/dL vs. (53.0±7.2) mg/dL, P=0.032]. The patients with abdominal HSP showed lower levels of hemoglobin [(119.6±19.6) g/L vs. (146.6±47.3) g/L, P=0.038] and plasma albumin [24.8 (22.1, 33.9) g/L vs. 32.6 (24.6, 35.1) g/L, P=0.045]. The patients with articular HSP exhibited higher CRP [13.5 (0.2, 20.6) g/L vs. 7.5 (0.1, 15.2) g/L, P=0.036] and erythrocyte sedimentation rate (ESR) [24 (5, 40) mm/h vs. 15 (4, 30) mm/h, P=0.049]. Elevated IgA and decreased complement C4 were risk factors for renal HSP, anemia and decreased plasma albumin were risk factors for abdominal HSP, and elevated CRP was a risk factor for articular HSP.@*CONCLUSION@#The clinical characteristics of different types of HSP in plateau areas were different. Patients with high IgA, low complement C4, anemia, hypoalbuminemia, and significantly elevated CRP should be highly vigilant. Early and effective intervention can improve the clinical efficacy, avoid severe development, and improve the prognosis.

Anemia in pregnant women residing at different geographical altitudes in Arequipa, Peru / Anemia en gestantes residentes en diferentes altitudes geográficas de Arequipa, Perú

Purpose: To identify the frequency of anemia in pregnant women at different geographical altitudes in the Arequipa region of Peru. Methods: A quantitative, descriptive, and retrospective study was carried out. The study population consisted of 35,725 pregnant women living in the Arequipa Region at different altitudes. Data on age, gestational age, weight, height, province of residence, altitude, hemoglobin were collected. Results: Using World Health Organization altitude adjusted hemoglobin values, anemia prevalence in pregnant women between 2018-2019 was 13.7 percent in the Arequipa Region, while using unadjusted hemoglobin, the overall prevalence was 4.1 percent. When analyzed by altitudes, the frequency of anemia was 9.77 percent below 1 000 m 13.1 percent between 1 000-1 999 m, 13.1 percent between 2.000-2.999 m, 31.5 percent between 3.000-3.999 and 47.1 percent between 4.000-4.999. Nevertheless, when using unadjusted hemoglobin values rates were 6.67 percent for the 1.000-1.999 range, 2.39 percent for ranges between 2.000-2.999 m and 3.000-3.999 m, and 5.19 percent for altitudes above 4.000 m. Conclusions: There is a directly proportional correlation in the prevalence of anemia in pregnant women and higher altitude (p<0.01) as well as levels of anemia during the last trimester of pregnancy. Adjusting the hemoglobin values by altitude results in triple the prevalence of anemia. A throughout revision of the suitability of current guidelines to diagnose and prevent anemia at high altitude is recommended (AU)

Objetivo: Identificar la frecuencia de anemia en gestantes de diferentes altitudes geográficas en la región Arequipa, Perú. Métodos: Se realizó un estudio cuantitativo, descriptivo y retrospectivo. La población de estudio estuvo constituida por 35 725 gestantes residentes en la Región Arequipa a diferentes altitudes. Se recogieron datos de edad, edad gestacional, peso, talla, provincia de residencia, altitud, hemoglobina. Resultados: Utilizando los valores de hemoglobina ajustados por altitud de la Organización Mundial de la Salud, la prevalencia de anemia en gestantes entre 2018-2019 fue de 13,7 por ciento en la Región Arequipa, mientras que utilizando la hemoglobina no ajustada, la prevalencia global fue de 4,1 por ciento. Al analizar por altitudes, la frecuencia de anemia fue de 9,77 por ciento por debajo de 1 000 m 13,1 por ciento entre 1 000-1 999 m, 13,1 por ciento entre 2 000-2 999 m, 31,5 por ciento entre 3 000-3 999 y 47,1 por ciento entre 4 000-4 999. Sin embargo, cuando se utilizaron valores de hemoglobina no ajustados, las tasas fueron del 6,67 por ciento para el intervalo de 1 000-1 999, del 2,39 por ciento para los intervalos entre 2 000-2 999 m y 3 000-3 999 m, y del 5,19 por ciento para altitudes superiores a 4 000 m. Conclusiones: Existe una correlación directamente proporcional en la prevalencia de anemia en embarazadas y mayor altitud (p<0,01), así como niveles de anemia durante el último trimestre del embarazo. Ajustando los valores de hemoglobina por la altitud se triplica la prevalencia de anemia. Se recomienda una revisión en profundidad de la idoneidad de las directrices actuales para diagnosticar y prevenir la anemia a gran altitud(AU)

Monitoring physiological and biochemical indices in the systematic training of sprinters / Monitoramento de índices fisiológicos e bioquímicos no treino sistemático de velocistas / Monitoreo de los índices fisiológicos y bioquímicos en el entrenamiento sistemático de velocistas

ABSTRACT Introduction This paper studies physiological and biochemical indicators in the systematic training of sprinters. This paper analyzes the data measured during the athletes' training process and studies the detailed data of their physical functions. Objective This study aimed to find a link between exercise data and biochemical indicator data in sprinter athletes. By analyzing the data from this article, the researchers were able to find the optimal training program for the athletes. Methods High-intensity aerobic training tests were performed with statistical analysis of various physiological and biochemical indicators. Results Hemoglobin data were shown to be highly sensitive to intensity. The researchers found that long-term high-load training in athletes can lead to physical fatigue. This fatigue production is positively correlated with the intensity of the training load. Conclusion There is a strong positive correlation between biochemical and physiological indicators on performance levels in sprinter athletes. Evidence Level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução Este artigo estuda o monitoramento de indicadores fisiológicos e bioquímicos no treino sistemático de velocistas. Este documento analisa os dados medidos durante o processo de treino das atletas e estuda os dados detalhados de suas funções físicas. Objetivo O objetivo deste estudo foi encontrar uma ligação entre os dados de exercício e os dados de indicadores bioquímicos nas atletas velocistas. Ao analisar as informações deste artigo, os pesquisadores conseguiram encontrar um programa de treino ideal para as atletas. Métodos Foram empegadas experiências de treino aeróbico de alta intensidade, com análise estatística de vários indicadores fisiológicos e bioquímicos. Resultados Os dados de hemoglobina mostraram-se altamente sensíveis à intensidade. Os pesquisadores descobriram que o treino a longo prazo de alta carga em atletas pode acarretar numa fadiga física. Essa produção de fadiga está positivamente correlacionada com a intensidade da carga de treino. Conclusão Há uma forte correlação positiva entre indicadores bioquímicos e fisiológicos nos níveis de desempenho em atletas velocistas. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción Este trabajo estudia el seguimiento de los indicadores fisiológicos y bioquímicos en el entrenamiento sistemático de los velocistas. Este artículo analiza los datos medidos durante el proceso de entrenamiento de los atletas y estudia los datos detallados de sus funciones físicas. Objetivo El objetivo de este estudio fue encontrar una relación entre los datos del ejercicio y los datos de los indicadores bioquímicos en los atletas velocistas. Al analizar las informaciones de este artículo, los investigadores pudieron encontrar un programa de entrenamiento óptimo para los atletas. Métodos Se realizaron pruebas de entrenamiento aeróbico de alta intensidad con análisis estadístico de varios indicadores fisiológicos y bioquímicos. Resultados Los datos de la hemoglobina se mostraron muy sensibles a la intensidad. Los investigadores descubrieron que el entrenamiento de alta carga a largo plazo en los atletas puede conducir a la fatiga física. Esta producción de fatiga está positivamente correlacionada con la intensidad de la carga de entrenamiento. Conclusión Existe una fuerte correlación positiva entre los indicadores bioquímicos y fisiológicos en los niveles de rendimiento de los atletas velocistas. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

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.

Association of liver damage with coronary artery lesion and no response to intravenous immunoglobulin in the acute stage of Kawasaki disease / 中国当代儿科杂志

OBJECTIVES@#To summarize the clinical features of liver damage in children in the acute stage of Kawasaki disease (KD), and to investigate the clinical value of liver damage in predicting coronary artery lesion and no response to intravenous immunoglobulin (IVIG) in children with KD.@*METHODS@#The medical data were collected from 925 children who were diagnosed with KD for the first time in Beijing Children's Hospital from January 1, 2016 to December 31, 2017. According to the presence or absence of abnormal alanine aminotransferase (ALT) level on admission, the children were divided into a liver damage group (n=284) and a non-liver damage group (n=641). A logistic regression analysis was used to investigate the clinical value of the indicators including liver damage in predicting coronary artery lesion and no response to IVIG in children with KD.@*RESULTS@#Compared with the non-liver damage group, the liver damage group had a significantly earlier admission time and significantly higher serum levels of inflammatory indicators (P<0.05). The liver damage group had a significantly higher incidence rate of coronary artery lesion on admission than the non-liver damage group (P=0.034). After initial IVIG therapy, the liver damage group had a significantly higher proportion of children with no response to IVIG than the non-liver damage group (P<0.001). In children with KD, coronary artery lesion was associated with the reduction in the hemoglobin level and the increases in platelet count, C-reactive protein, and ALT (P<0.05), and no response to IVIG was associated with limb changes, the reduction in the hemoglobin level, the increases in platelet count, C-reactive protein, and ALT, and coronary artery lesion (P<0.05).@*CONCLUSIONS@#Compared with those without liver damage, the children in the early stage of KD with liver damage tend to develop clinical symptoms early and have higher levels of inflammatory indicators, and they are more likely to have coronary artery lesion and show no response to IVIG treatment.

The Efficacy of Rh Phenotype Matched Blood Transfusion / 中国实验血液学杂志

OBJECTIVE@#To analyze and evaluate the efficacy of Rh phenotype matched blood transfusion.@*METHODS@#The increasing of hemoglobin (Hb) and hemolysis tests in the patients treated by Rh matched red blood cells or not, as well as the first time unmatched transfusions and the unmatched transfusions happened again after a period (≥10 d) were retrospectively analyzed.@*RESULTS@#A total of 674 times transfusions in 120 patients were evaluated. The increasing of Hb in each unit was higher in the patients treated by Rh matched blood transfusion (vs unmatched) [(33.397±1.475) g/U vs (29.951±1.304) g/U, P=0.033], while the increasing of Hb at first time unmatched transfusion and the second time unmatched transfusion was not statistically different[ (28.942±2.083) g/U vs (30.686±1.737) g/U, P=0.589]. The level of lactate dehydrogenase were related to erythrocyte washing, irradiation, period of validity and the second time unmatched transtusion (all P<0.05); the levels of total bilirubin (TBil), direct bilirubin (DBil) and indirect bilirubin (IBil) between the first time unmatched transfusion and the second time unmatched transfusion were statistically different (all P<0.05).@*CONCLUSION@#For the patients need multiple blood transfusions, Rh phenotype matched blood transfusion can reduce the exposure to Rh allogenic antigens, improve the efficacy and ensure the safety of blood transfusion.

Influence of hemoglobin level(Hb) on survival and prognosis of elderly hip fracture at admission / 中国骨伤

OBJECTIVE@#To analyze the relationship between hemoglobin(Hb) level on admission and survival prognosis of patients with hip fracture.@*METHODS@#From February 2016 to October 2018, 249 elderly patients with hip fracture were surgically treated including 62 males and 187 females;the age ranged from 60 to 91(73.67±10.52) years;the time from injury to operation was (6.79±2.27) d. The clinical and laboratory examination results were collected. The Hb level at admission and the mortality at 30, 90, 180 and 360 days after operation were observed. According to the Hb level at admission, the patients were divided into Hb<120 g/L and Hb≥120 g/L groups. The survival conditions of the two groups at 30, 90, 180 and 360 days after operation were compared and analyzed. Logistic regression was used to analyze the effect of Hb level on death 30, 90, 180 and 360 days after operation.@*RESULTS@#The mortality rates at 30, 90, 180 and 360 days after operation were 5.22%, 9.24%, 16.87% and 20.48% respectively. The level of Hb at admission was a risk factor for prognosis and death 30, 90, 180 and 360 days after operation(P<0.05). The OR(95% CI) were 2.431(1.475-4.006), 2.625(1.468-4.695), 2.276(1.320-3.925) and 2.082(1.221-3.551) respectively.@*CONCLUSION@#The level of Hb at admission can affect the survival and prognosis of elderly patients with hip fracture. We should further study how to manage the level of Hb before operation.

LA ADAPTACIÓN DE LA HEMOGLOBINA Y LOS GLOBULOS BLANCOS EN CASOS SEVEROS DE SARS-COV-2 / THE ADAPTATION OF HEMOGLOBIN AND WHITE BLOOD CELLS IN SEVERE CASES OF SARS-COV-2

Dado que el SARS-CoV-2 causa alteraciones en los parámetros hematológicos, muchos estudios se han concentrado en esta área y los han correlacionado con la gravedad de la enfermedad. Se revisó en un estudio retrospectivo de casos graves de COVID-19, en el cual se contabilizaron y documentaron los datos de hemoglobina (Hb) y glóbulos blancos (WBC) de pacientes reclutados en el período de marzo a julio de 2021. Retrospectivamente, los datos extraídos fueron sobre el nivel de Hb y los recuentos de glóbulos blancos de los informes de laboratorio tanto al ingreso como cuando alta de los pacientes. Se calcularon las frecuencias de anemia o eritrocitopenia (Hb <12 g/dL) y leucocitosis (WBC >11×103/µL) en la población estudiada. De 3637 casos de SARS-COV-2, 250 pacientes con condiciones graves de COVID-19 según la definición de la OMS, ingresaron en la UCI o fallecieron, De 250, 80 (32%) ingresaron a UCI, y el resto 170 casos (68%) fallecieron. Mientras que la edad media de los pacientes fue de 55,46±17,49 años, los pacientes con la condición grave tuvieron significativamente mayor edad que aquellos con la condición leve-moderada (edad media de 50,68 frente a 68,59; P: <0,01). El número medio de glóbulos blancos (WBC) fue de 8,88±7,29 x109/L en todos los pacientes con SARS-COV-2, que es significativamente mayor en los casos graves en comparación con aquellos con enfermedad leve-moderada (10,56 frente a 8,95; P: <0,01). El nivel de Hb (<12 g/dL) fue más bajo en el COVID-19 grave que en otros grupos; sin embargo, no fue estadísticamente significativo. El aumento del número de glóbulos blancos y la disminución de la Hb durante la hospitalización de pacientes con SARS-COV-2, puede predecir un mal resultado. Llegamos a la conclusión de que no sólo el número medio de glóbulos blancos era significativamente mayor en los casos severos también la leucocitosis fue un hallazgo común; lo que indica que un mayor número de glóbulos blancos probablemente puede predecir un mal resultado. Asimismo, el nivel de La Hb fue mayor en el grupo leve-moderado; sin embargo, no fue estadísticamente significativo.

SARS-CoV-2 cause alterations in the hematological parameters and many studies have concentrated on this area and correlated these with severity of disease. A retrospective study of severe cases of COVID-19 were reviewed. The data of hemoglobin (Hb) and white blood cells (WBCs) were accounted and documented. Patients recruited at period from March to July, 2021. Retrospectively, data extracted on the Hb level and WBC counts from Lab reports both at admission and when patients discharge. The frequencies of anemia or erythrocytopenia (Hb <12 g/dL) and leukocytosis (WBC >11×103/µL) was calculated in the studied population. Of 3637 SARS-COV-2 cases, 250 patients with severe conditions of COVID-19 as de ne by WHO, which were either admitted to ICU or died. Of 250, 80(32%) were entered to ICU, and the rest 170 cases (68%) who died. While the mean age of the patients was 55.46±17.49 years, patients with the severe condition were signi cantly older than those with the mildmoderate condition (mean age of 50.68 vs. 68.59; P: <0.01). The mean number of white blood cells (WBC) was 8.88±7.29 x109/L in all SARS-COV-2 patients, which is signi cantly higher in the severe cases compared to those with the mild-moderate disease (10.56 vs. 8.95; P: <0.01). The Hb level (<12 g/ dL) was lower in the severe COVID-19 than other groups; however, it was not statistically signi cant. Increased number of WBCs and dropped Hb level during hospitalization of SARS-COV-2 patients may predict a poor outcome. We concluded that not only the mean number of WBCs was signi cantly higher in the severe cases also leukocytosis was a common nding; indicating that an increased number of WBCs may probably predict a poor outcome. Also, the level of Hb was higher in the mild-moderate group; however, it was not statistically signi cant.

Association of cigarette and water-pipe smoking with increased visceral adiposity, glycemic intolerance and hematological derangement in Iraqi healthy smokers

Abstract The present study aims to investigate the impacts of cigarette smoking (CS) and water-pipe smoking (WPS) on the visceral adiposity index (VAI), hematological characteristics, and glycemic tolerance in Iraqi healthy smokers. A total of 528 healthy males from different locations of Baghdad city were allocated to three groups; nonsmokers (176), cigarette smokers (178), and WP smokers (174). Baseline characteristics, anthropometric and hematological markers and were reported. Glycemic control was evaluated using the glucose tolerance test. The evidence of elevated VAI, disrupted hematological markers, and impaired glucose tolerance was significantly (P<0.001) different compared with non-smokers and related to the duration of smoking. The impacts of WPS seem to be significantly greater than CS in certain parameters (hemoglobin, hematocrit, methemoglobin, and 2-hour glucose tolerance values). In conclusion, CS and WPS negatively impacted body fat distribution, glucose tolerance, and hematological markers. There is a positive association between the rate of smoking and obesity, glycemic intolerance in both groups

Relación entre el consumo materno de carne vacuna durante el embarazo y los niveles de ferritina en el cordón umbilical / Relationship between maternal beef consumption during pregnancy and umbilical cord ferritin concentration / Relação entre o consumo materno de carne bovina durante a gravidez e os níveis de ferritina no cordão umbilical

Antecedentes: la nutrición durante el embarazo impacta en la salud del recién nacido, con efectos a nivel epigenético determinando consecuencias neurológicas a largo plazo. Las necesidades de hierro durante el embarazo se estiman en 27 mg/día. El hierro hemo que se absorbe mejor se encuentra en la carne. La determinación de ferritina en sangre de cordón umbilical permite evaluar los depósitos de hierro alcanzados durante la etapa fetal. Sus niveles se asociaron con efectos a largo plazo sobre el desarrollo infantil. Objetivos: el objetivo de este estudio de carácter exploratorio es determinar la relación entre el consumo de carnes rojas durante el tercer trimestre de gestación y el nivel de ferritina en el cordón umbilical. Métodos: se realizó un estudio observacional descriptivo con datos recolectados prospectivamente durante un año en el Departamento de Neonatología del Centro Hospitalario Pereira Rossell (CHPR) en Montevideo, Uruguay. Un total de 188 pacientes cumplieron los criterios de inclusión. Se extrajo sangre del cordón umbilical después de un pinzamiento estricto del cordón pasado un minuto de vida. La ferritina se midió utilizando el método de quimioinmunofluorescencia. Se aplicó una encuesta nutricional materna (cualitativo-cuantitativa) que midió la frecuencia de consumo de alimentos con fuente de hierro y las cantidades aproximadas consumidas durante el último trimestre del embarazo. Esta encuesta se centró en el consumo materno de carne vacuna como principal fuente de hierro hemínico en Uruguay. Se analizó la relación entre estas variables. Resultados: el déficit latente de hierro (ferritina en el cordón umbilical <100 ng/ml) se asoció con un menor consumo de carne vacuna durante el embarazo. Valor p de Fisher: 0,0133, OR: 3,71, IC del 95% (1,25-11,05). Conclusiones: este estudio considera adecuada la evidencia que relaciona que los niveles bajos de consumo total de hierro y de carne vacuna durante el tercer trimestre de gestación determinarán un mayor riesgo de déficit latente de hierro y de ferritina medido en el cordón umbilical. Los niveles descendidos de ferritina en cordón umbilical se asocian con un mayor riesgo de efectos adversos a largo plazo sobre la mielinización y el desarrollo neurocognitivo.

Background: nutrition during pregnancy impacts the foetus and the newborn health, it has consequences at the epigenetic level and determines long-term neurological consequences. Iron requirements during pregnancy are estimated at 27 mg/day. Iron is blood absorption from is most efficient from beef. Umbilical cord blood ferritin levels can be used to assess iron deposits reached during the foetal stage. Ferritin levels are linked to the child's long-term development. Objective: this exploratory study's objective is to determine the relationship between beef consumption during the first quarter of pregnancy and ferritin levels in the umbilical cord. Methods: we carried out a descriptive, observational study with prospectively collected data for one-year at the Neonatology Department of the Pereira Rossell Hospital Center (CHPR) in Montevideo, Uruguay. A total of 188 patients met the inclusion criteria. We extracted umbilical cord blood after a strict cord clamping after one minute of life. Ferritin was measured using the chemoimmunofluorescence method. We carried out a maternal nutritional survey using a qualitative-quantitative method and measured the frequency and approximate quantity of iron source food consumption during the last quarter of pregnancy. This survey was focused on maternal beef consumption as the major heme iron source in Uruguay. We analyzed the relationship between these variables. Results: latent iron deficiency (ferritin in the umbilical cord <100 ng / ml) was associated with lower beef consumption during pregnancy. Fisher p-value: 0.0133, OR: 3.71, 95% CI (1.25 - 11.05). Conclusions: this study agrees with the evidence that shows that low levels of total iron and beef consumption during pregnancy determine an increased risk of latent iron deficiency and lower levels of ferritin in newborns, and therefore, greater risk of long-term adverse effects on myelination and neurocognitive development.

Contexto: a nutrição durante a gravidez tem impacto sobre a saúde do recém-nascido, com efeitos no nível epigenético, determinando consequências neurológicas a longo prazo. As necessidades de ferro durante a gravidez são estimadas em 27 mg / dia. O ferro heme de melhor absorção e aquele encontrado na carne vacuna. A determinação da ferritina no sangue do cordão umbilical permite avaliar os depósitos de ferro atingidos na fase fetal. Seus níveis foram associados a efeitos de longo prazo no desenvolvimento das crianças. Objetivos: o objetivo deste estudo exploratório é determinar a relação entre o consumo de carne vermelha durante o terceiro trimestre de gestação e o nível de ferritina no cordão umbilical. Métodos: foi realizado um estudo observacional descritivo com dados coletados prospectivamente durante um ano no Departamento de Neonatologia do Centro Hospitalar Pereira Rossell (CHPR) em Montevidéu, Uruguai. Um total de 188 pacientes cumpriram os critérios de inclusão. O sangue do cordão umbilical foi coletado após clampeamento estrito do cordão após um minuto de vida da criança. A ferritina foi medida pelo método de quimioimunofluorescência. Aplicamos um inquérito nutricional materno (qualitativo-quantitativo) que mediu a frequência de consumo de alimentos com fonte de ferro e as quantidades aproximadas consumidas durante o último trimestre da gravidez. Esta pesquisa enfocou o consumo materno de carne bovina como principal fonte de ferro heme no Uruguai. A relação entre essas variáveis foi analisada. Resultados: a deficiência latente de ferro (ferritina no cordão umbilical <100 mg / ml) foi associada ao menor consumo de carne bovina durante a gestação. Valor de p de Fisher: 0,0133, OR: 3,71, IC 95% (1,25-11,05). Conclusões: este estudo concorda com as evidências que relacionam que os baixos níveis de ferro total e consumo de carne bovina durante o terceiro trimestre de gestação determinam um maior risco de déficit de ferro latente e ferritina mensurado no cordão umbilical. A redução dos níveis de ferritina no cordão umbilical está associada a um risco aumentado de efeitos adversos de longo prazo na mielinização e no desenvolvimento neurocognitivo.

Improvement of cardiovascular function health level by regular sports / Melhoria do nível de saúde da função cardiovascular por meio de esportes regulares / Mejora del nivel de salud de la función cardiovascular mediante deportes regulares

ABSTRACT Introduction Regular physical activity helps improve cardiovascular and cerebrovascular skills. How to evaluate the nervous tension of the cardiovascular and cerebrovascular vessels through sports is a hot topic. Objective The paper discusses the influence of regular participation in sports on people's cardiovascular function and blood-related indicators. Methods We select 30 healthy older adults who regularly participate in sports, record their ECG changes, blood pressure, heart rate and other related cardiovascular function indicators, and analyze the blood function of the elderly. Detection of blood cell count (RBC), red blood cell volume (MCV) and hemoglobin (Hb), serum creatinine (Cr), blood glucose (BGS), triglycerides (TG), cholesterol (TC), low-density lipoprotein (LDL) and high-Density lipoprotein (HDL) is measured. Results Older adults who persist in exercise for a long time have better indicators than those who do not exercise. Conclusions Appropriate aerobic exercise can reduce the stiffness of blood vessels in the elderly. Exercise can help the elderly increase heart rate variability and improve the heart's autonomic nerve function's blood indicators, and body mass. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução A atividade física regular ajuda a melhorar as habilidades cardiovasculares e cerebrovasculares. Como avaliar a tensão nervosa dos vasos cardiovasculares e cerebrovasculares por meio de esportes é um assunto quente. Objetivo o artigo discute a influência da participação regular em esportes sobre a função cardiovascular das pessoas e indicadores relacionados ao sangue. Métodos Selecionamos 30 idosos saudáveis que participam regularmente de esportes, registramos suas alterações no ECG, pressão arterial, frequência cardíaca e outros indicadores relacionados à função cardiovascular e analisamos a função sanguínea dos idosos. Detecção de contagem de células sanguíneas (RBC), volume de glóbulos vermelhos (MCV) e hemoglobina (Hb), creatinina sérica (Cr), glicose no sangue (BGS), triglicerídeos (TG), colesterol (TC), lipoproteína de baixa densidade (LDL ) e a lipoproteína de alta densidade (HDL) é medida. Resultados Idosos que persistem por muito tempo nos exercícios têm melhores indicadores do que aqueles que não praticam. Conclusão O exercício aeróbio adequado pode reduzir a rigidez dos vasos sanguíneos em idosos. O exercício pode ajudar os idosos a aumentar a variabilidade da frequência cardíaca e melhorar os indicadores sanguíneos da função nervosa autonômica do coração e a massa corporal. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción La actividad física regular ayuda a mejorar las habilidades cardiovasculares y cerebrovasculares. Cómo evaluar la tensión nerviosa de los vasos cardiovasculares y cerebrovasculares a través del deporte es un tema candente. Objetivo El artículo analiza la influencia de la participación regular en deportes sobre la función cardiovascular de las personas y los indicadores relacionados con la sangre. Métodos Seleccionamos a 30 adultos mayores sanos que participan regularmente en deportes, registramos sus cambios en el ECG, presión arterial, frecuencia cardíaca y otros indicadores relacionados con la función cardiovascular, y analizamos la función sanguínea de los ancianos. Detección del recuento de glóbulos rojos (RBC), volumen de glóbulos rojos (MCV) y hemoglobina (Hb), creatinina sérica (Cr), glucosa en sangre (BGS), triglicéridos (TG), colesterol (TC), lipoproteínas de baja densidad (LDL) ) y se mide la lipoproteína de alta densidad (HDL). Resultados Los adultos mayores que persisten en el ejercicio durante mucho tiempo tienen mejores indicadores que los que no lo hacen. Conclusión El ejercicio aeróbico adecuado puede reducir la rigidez de los vasos sanguíneos en los ancianos. El ejercicio puede ayudar a los ancianos a aumentar la variabilidad de la frecuencia cardíaca y mejorar los indicadores sanguíneos y la masa corporal de la función nerviosa autónoma del corazón. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Relationship between maternal hemoglobin and birthweight in Antioquia, Colombia / Relación de la hemoglobina materna y el peso al nacer en Antioquia-Colombia

Abstract Objectives: to determine the relationship between maternal hemoglobin (HbM) per gestational trimester and birthweight (BW). Methods: this was an analytical, cross-sectional observational study that included the prenatal records of494 pregnant women who delivered live newborns in the Department of Antioquia. The maternal health data collected included HbM and BW, and gynecological and obstetric, anthropometric, and maternal health-related data. The Mann-Whitney U test was applied, supplemented by effect size (ES) to compare the study groups. Results: HbMin the third trimester was significantly associated with BW (p=0.029).It showed a significant effect size on BW as follows: first trimester: ES=0.44 (CI95%= 0.183-0.697); second trimester: ES=0.49 (CI95%= 0.187-0.79); and third trimester: ES=0.43 (CI95% = 0.202-0.658). Maternal anemia was 4.2%>, 11.2%, and 21.4%> in the first, second, and third trimester, respectively. Conclusions: as it is an inexpensive indicator and easy to determine, the timely monitoring and assessment of HbM is required owing to its importance in maternal and neonatal health, quality of life, and human capital development.

Resumen Objetivos: determinar la relación entre hemoglobina materna (HbM) por trimestre de gestación y peso al nacer (PN). Métodos: estudio observacional analítico, transversal, en 494 historias prenatales de gestantes con recién nacido vivo del departamento de Antioquia. Se tomaron datos de HbMy PN, ginecobstétricos, antropométricos y de salud materna. Para comparar los grupos de estudio, se aplicó la prueba U-Mann Whitney, complementada con el tamaño de efecto (ES). Resultados: la HbM de tercer trimestre se asoció significativamente con el PN (p=0,029); la HbM mostró un tamaño de efecto importante sobre el PN, así: primer trimestre: ES=0,44 (IC95%= 0,183 a 0,697); segundo trimestre: ES=0,49 (IC95%= 0,187 a 0,79); tercer trimestre: ES=0,43 (IC95%o= 0,202 a 0,658). La anemia materna fue 4,2°%, 11,2%o y 21,4°% en el primero, segundo y tercer trimestre, respectivamente. Conclusiones: Se necesita seguimiento y evaluación oportuna de la HbM, indicador de bajo costo y fácil determinación, por su importancia en la salud materna y neonatal, en la calidad de vida y desarrollo del capital humano.

Head-to-head comparison of the test performance of self-administered qualitative vs. laboratory-based quantitative fecal immunochemical tests in detecting colorectal neoplasm / 中华医学杂志(英文版)

BACKGROUND@#Fecal immunochemical tests (FITs) are the most widely used non-invasive tests in colorectal cancer (CRC) screening. However, evidence about the direct comparison of the test performance of the self-administered qualitative a laboratory-based quantitative FITs in a CRC screening setting is sparse.@*METHODS@#Based on a CRC screening trial (TARGET-C), we included 3144 pre-colonoscopy fecal samples, including 24 CRCs, 230 advanced adenomas, 622 non-advanced adenomas, and 2268 participants without significant findings at colonoscopy. Three self-administered qualitative FITs (Pupu tube) with positivity thresholds of 8.0, 14.4, or 20.8 μg hemoglobin (Hb)/g preset by the manufacturer and one laboratory-based quantitative FIT (OC-Sensor) with a positivity threshold of 20 μg Hb/g recommended by the manufacturer were tested by trained staff in the central laboratory. The diagnostic performance of the FITs for detecting colorectal neoplasms was compared in the different scenarios using the preset and adjusted thresholds (for the quantitative FIT).@*RESULTS@#At the thresholds preset by the manufacturers, apart from the qualitative FIT-3, significantly higher sensitivities for detecting advanced adenoma were observed for the qualitative FIT-1 (33.9% [95% CI: 28.7-39.4%]) and qualitative FIT-2 (22.2% [95% CI: 17.7-27.2%]) compared to the quantitative FIT (11.7% [95% CI: 8.4-15.8%]), while at a cost of significantly lower specificities. However, such difference was not observed for detecting CRC. For scenarios of adjusting the positivity thresholds of the quantitative FIT to yield comparable specificity or comparable positivity rate to the three qualitative FITs accordingly, there were no significant differences in terms of sensitivity, specificity, positive/negative predictive values and positive/negative likelihood ratios for detecting CRC or advanced adenoma between the two types of FITs, which was further evidenced in ROC analysis.@*CONCLUSIONS@#Although the self-administered qualitative and the laboratory-based quantitative FITs had varied test performance at the positivity thresholds preset by the manufacturer, such heterogeneity could be overcome by adjusting thresholds to yield comparable specificities or positivity rates. Future CRC screening programs should select appropriate types of FITs and define the thresholds based on the targeted specificities and manageable positivity rates.

Utilidad clínica del equivalente de hemoglobina reticulocitaria en niños en hemodiálisis / Clinical usefulness of the reticulocyte hemoglobin equivalent in children on hemodialysis

Introducción. La anemia por deficiencia de hierro en hemodiálisis es frecuente. Para su detección se utiliza la ferritina sérica y la saturación de transferrina (ST). El equivalente de hemoglobina reticulocitaria (RET-He) es un análisis que no se modifica en estados inflamatorios y refleja directamente el hierro disponible en médula ósea.Objetivo. Explorar la capacidad diagnóstica de deficiencia absoluta de hierro del RET-He y evaluar su correlación con marcadores tradicionales de ferropenia.Población y métodos. Estudio retrospectivo que comparó RET-He con ferritina y ST en niños en hemodiálisis atendidos en el Hospital Garrahan entre julio de 2016 y julio de 2019. Resultados. En 164 observaciones realizadas en 40 niños, se encontró correlación positiva débil entre hemoglobina y RET-He (r 0,35, p < 0,001), positiva significativa entre ST y RET-He (r 0,52, p < 0,001), negativa baja entre hemoglobina y ferritina (r -0,19, p 0,02) y ausencia de correlación entre hemoglobina y ST (r 0,05, p 0,5). El 50 % presentaba anemia; la ferropénica fue por marcadores tradicionales en el 13 % y por RET-He en el 44 %. El RET-He mostró sensibilidad del 90,9 % (IC 95: 57,1-99,5 %), especificidad del 74,5 % (IC 95: 66,7-81 %), valor predictivo negativo del 99,1 % (IC 95: 94,5-99,9 %) y positivo del 20,4 % (IC 95: 10,7-34,7 %) para detectar anemia ferropénica con valor de corte de 29 picogramos.Conclusiones. Pese a su capacidad limitada, el RET-He como biomarcador de deficiencia de hierro aumenta la detección de anemia ferropénica en niños en hemodiálisis

Introduction. Iron-deficiency anemia is common in hemodialysis patients. Serum ferritin and transferrin saturation (TS) are used for its detection. The reticulocyte hemoglobin equivalent (RET-He) is a marker that is not altered by inflammatory conditions and directly reflects iron availability in the bone marrow.Objective. To explore the diagnostic capability of RET-He to detect absolute iron deficiency and assess its correlation with traditional markers of iron deficiency.Population and methods. Retrospective study comparing RET-He with ferritin and TS in children on hemodialysis seen at Hospital Garrahan between July 2016 and July 2019.Results. In 164 observations carried out in 40 children, a weak positive correlation was found between hemoglobin and RET-He (r = 0.35, p < 0.001), a significant positive correlation between TS and RET-He (r = 0.52, p < 0.001), a low negative correlation between hemoglobin and ferritin (r = -0.19, p = 0.02), and a lack of correlation between hemoglobin and TS (r = 0.05, p = 0.5). Anemia was observed in 50 %; iron-deficiency anemia was detected by traditional markers in 13 % and by RET-He in 44 %. RET-He showed a sensitivity of 90.9 % (95 % CI: 57.1-99.5 %), a specificity of 74.5 % (95 % CI: 66.7-81 %), a negative predictive value of 99.1 % (95 % CI: 94.5-99.9 %), and a positive predictive value of 20.4 % (95 % CI: 10.7-34.7 %) to detect iron-deficiency anemia with a cut-off value of 29 pg.Conclusions. Despite its limited capability, the use of RET-He as a biomarker of iron deficiency increases the detection of iron-deficiency anemia in children on hemodialysis.

Associação de índices hematológicos com fatores de risco, gravidade e complexidade da lesão no infarto agudo do miocárdio / Association of hematological índices with risk factors, severity and complexity of lesion in the acute myocardium infarction

Objetivo: Avaliar a associação entre os índices hematológicos e os fatores de risco, a complexidade e a gravidade do infarto em relação aos desfechos cardiovasculares. Métodos: Trata-se de uma coorte prospectiva, aninhada ao Catarina Heart Study e realizada em um hospital público da Grande Florianópolis. Resultados: Entre 2016 e 2019, foram analisados 580 participantes. Os indivíduos diabéticos apresentaram valores de hemoglobina de 13,0g/dL (12,0 a 14,1g/dL), inferior aos não diabéticos, com valores de 14,0g/dL (12,7 a 15,0g/dL; p<0,001). Indivíduos dislipidêmicos apresentavam valores de hemoglobina e segmentados, respectivamente, de 13,3g/dL (12,1 a 14,4g/dL) e 6.910mm³ (5.990 a 7.807mm³), inferiores aos sem dislipidemia, que possuíam, respectivamente, 14,0g/dL (12,8 a 15,0g/dL; p<0,001) e 7.205mm³ (6.300 a 8.030mm³; p=0,038). A contagem de plaquetas foi maior nos que possuíam dislipidemia, 224.000mm³ (178.000 a 273.500mm³), quando comparados aos que não possuíam, 210.000mm³ (173.000 a 255.000mm³; p=0,029). Houve correlação entre o SYNTAX e a contagem de leucócitos (r=0,143; p=0,001) e segmentados (r=0,222; p<0,001). Houve correlação negativa entre a fração de ejeção ventricular e a contagem de leucócitos (r=-0,173; p<0,001) e dos segmentados (r=-0,255; p<0,001). Indivíduos reinternados em 30 dias apresentaram valores de segmentados de 7.440mm³ (6.590 a 8.360mm³), maior em relação aos não reinternados, com 7.100mm³ (6.100 a 8.022mm³), sendo p=0,05. Os participantes que morreram por qualquer causa possuíam hemoglobina de 12,0g/dL (11,4 a 13,7g/dL), inferior aos indivíduos que permaneceram vivos em 30 dias, cujos valores foram de 13,7g/dL (12,5 a 14,9g/dL), sendo p=0,021. Conclusão: A contagem maior de plaquetas está associada à dislipidemia. Valores de hemoglobina baixas estão associados a um pior prognóstico em 30 dias e aos fatores de risco cardiovasculares, como diabetes mellitus e dislipidemia. A contagem maior de leucócitos está associada à reinternação em 30 dias e correlacionada à gravidade e à complexidade da lesão do infarto.

Objective: To evaluate the association of hematological indices with risk factors, complexity, and severity of the acute myocardial infarction regarding cardiovascular outcomes. Methods: This is a prospective cohort, nested to Catarina Heart Study, performed in a public hospital of Florianópolis. Results: Between 2016 and 2019, 580 participants were analyzed. Diabetic individuals had hemoglobin levels of 13.0g/dL (12.0 to 14.1g/dL), lower than those in non-diabetic individuals, with values of 14.0g/dL (12.7 to 15.0g/dL; p<0.001). Individuals with dyslipidemia had hemoglobin and segmented leukocytes of, respectively, 13.3g/dL (12.1 to 14.4g/dL) and 6,910mm³ (5,990 to 7,807mm³), lower than in non-dyslipidemic individuals, who had, respectively, 14.0g/dL (12.8 to 15.0g/dL; p<0.001) and 7,205mm³ (6,300 to 8,030mm³; p=0.038). Platelet count was higher in those who had dyslipidemia, 224,000mm³ (178,000 to 273,500mm³), when compared to non-dyslipidemic, 210,000mm³ (173,000 to 255,000mm³; p=0.029). There was a correlation between Syntax and leukocyte count (r=0.143, p=0.001) and segmented (r=0.222; p<0.001). There was a negative correlation between ventricular ejection fraction and leukocytes count (r=-0.173; p<0.001) and segmented (r=-0.255; p<0.001). Individuals readmitted in 30 days had segmented values of 7,440mm³ (6,590 to 8,360mm³), higher compared to non-readmitted, with 7,100mm³ (6,100 to 8,022mm³), p=0,05. Individuals who died of any cause had hemoglobin of 12.0g/dL (11.4 to 13.7g/dL), lower than those that remained alive in 30 days, with values of 13.7g/dL (12.5 to 14.9g/dL), p=0.021. Conclusion: Higher platelet count is associated with dyslipidemia. Low hemoglobin values are associated with worse outcomes in 30 days and with cardiovascular risk factors, such as diabetes mellitus and dyslipidemia. Higher leukocyte count is associated with readmission in 30 days and is also correlated to the severity and complexity of acute myorcardial infarction.

Noninvasive hemoglobin monitoring in clinical trials: a systematic review and meta-analysis / Monitorização não invasiva da hemoglobina em ensaios clínicos: uma revisão sistemática e metanálise

Abstract Background and objectives: The measurement of hemoglobin concentration (Hb) by co-oximetry is an innovative technique that offers efficiency and agility in the processing of information regarding the measurement of Hb obtained through continuous, non-invasive and rapid monitoring. Because of this attribute, it avoids unnecessary exposures of the patient to invasive procedures by allowing a reduction in the number of blood samples for evaluation and other unnecessary therapies. It also helps to make decisions about the need for transfusion and how to handle it. The objective of this study is to compare the performance offered to obtain Hb values between the Masimo Corporation (Irvine, CA, USA) instrument and the standard gold tool (laboratory examination). Contents: The study corresponds to a systematic review followed by meta-analysis, which included fully registered full-text clinical trials published from 1990 to 2018. PubMed, Cochrane, Medline, Embase and Web of Science databases were investigated. The mean overall difference found between the non-invasive and invasive methods of hemoglobin monitoring was 0.23 (95% CI -0.16, 0.62), that is, it did not present statistical significance (p = 0.250). The results of the analysis of heterogeneity within and between the studies indicated high levels of inconsistency (Q = 461.63, p < 0.0001, I2 = 98%), method for Hb values. Conclusions: Although the mean difference between noninvasive measurements of Hb and the gold standard method is small, the co-oximeter can be used as a non-invasive "trend" monitor in detecting unexpected responses at Hb levels.

Resumo Justificativa: A medida da concentração de hemoglobina (Hb)por co-oximetria é uma técnica inovadora que oferece eficiência e agilidade no processamento das informações referentes à medida da concentração de hemoglobina obtida por meio de monitorização contínua, não-invasiva e rápida. Por conta desse atributo, evita exposições desnecessárias do paciente a procedimentos invasivos ao possibilitar redução da quantidade de amostras sanguíneas para avaliação e de outras terapêuticas desnecessárias. Além disso, auxilia a tomada de decisões quanto à necessidade de transfusão e quanto ao manejo da mesma. Objetivo: Comparar o desempenho oferecido para a obtenção dos valores de concentração de hemoglobina entre medida não invasiva da Hb e a ferramenta padrão ouro (exame laboratorial). Conteúdo: O estudo corresponde a uma revisão sistemática seguida de metanálise que incluiu ensaios clínicos devidamente registrados com texto completo, publicados a partir de 1990 até 2018. Foram investigadas as bases de dados PubMed, Cochrane, Medline, Embase e Web Of Science. A diferença média global encontrada entre os métodos não invasivo e invasivo de monitorização da hemoglobina foi de 0,23 (95% IC -0,16; 0,62), ou seja, não apresentou significância estatística (p = 0,250). Os resultados da análise de heterogeneidade dentro e entre os estudos, apontou níveis elevados de inconsistência (Q = 461,63, p< 0,0001, I2 = 98%). Conclusão: Embora a diferença média entre as medidas não invasivas da Hb e o método padrão ouro sejam pequenas, o co-oxímetro pode ser utilizado como um monitor não invasivo de "tendência" na detecção de alterações inesperadas nos níveis de Hb.

Avaliação da prevalência de anemia pós-parto e fatores associados em uma maternidade terciária do estado do Piauí / Prevalence of postpartum anemia and associated factors in a tertiary maternity hospital of the state of Piaui

Este trabalho avaliou a prevalência de anemia puerperal por meio das dosagens de hemoglobina (Hb) e hematócrito (Ht) numa maternidade pública terciária do estado do Piauí e os fatores de risco associados à presença de anemia. No total, 198 puérperas internadas na maternidade foram submetidas a entrevista e análise do prontuário e do cartão pré-natal. Foram feitas coletas de amostra de sangue venoso periférico antes do parto, 24 horas após o parto vaginal e 48 horas após o parto cesariano. A prevalência de anemia pós-parto encontrada na maternidade estudada foi de 27,27%. A presença de anemia pré-parto e gemelaridade e o ganho de peso foram os fatores de risco significativamente associados à anemia pós-parto.(AU)

This study evaluated the prevalence of puerperal anemia using hemoglobin (Hb) and hematocrit (Ht) measurements in a public tertiary maternity hospital in the state of Piauí and the risk factors associated with the presence of anemia. In total, 198 puerperal women admitted to the maternity hospital were interviewed, analyzed the medical record and the prenatal card. A peripheral venous blood sample was collected before delivery, 24 hours after vaginal delivery and 48 hours after cesarean delivery. The prevalence of postpartum anemia found in the maternity studied was 27.27%. The presence of pre-delivery anemia, twinning and weight gain were the risk factors significantly associated with postpartum anemia.(AU)

Avaliação da qualidade de vida de pacientes com Doença Falciforme / Evaluation of the quality of life of patients with Sickle Cell Disease

INTRODUÇÃO: A doença falciforme (DF) compreende um grupo de anemias hemolíticas hereditárias cuja principal característica é a presença do gene da hemoglobina S (Hb S) que pode combinar-se com outras anormalidades sanguíneas hereditárias. O quadro clínico varia desde quase assintomático até formas graves. A Hidroxiuréia (HU) é a terapia de maior sucesso. É uma doença crônica, cuja prevalência e morbidade são altas no Brasil, dessa forma a qualidade de vida (QV) surge como um importante desafio para os pacientes, familiares e profissionais de saúde. OBJETIVOS: Avaliar a QV de pacientes portadores de DF, suas características sociodemográficas e clínicas. MÉTODOS: Os dados foram coletados através do questionário de QV abreviado (WHOQOL-Bref), questionário sociodemográfico e prontuário clínico. RESULTADOS: foram entrevistados 39 pacientes, entre 18 e 54 anos, tratados na Fundação Hemominas em Divinópolis - MG. A maioria dos pacientes eram homens (56%), homozigotos para a Hb S (80%), solteiros (67%), segundo grau completo (31%) e não usuários de HU (61%). Dentre os pacientes avaliados 53,8% considerou ter boa QV (escore médio 74,2 ±20,3). O escore relacionado à QV geral foi de 71,5. Os domínios físico e meio ambiente obtiveram os menores escores médio (61,5 e 59,0, respectivamente). Não foram encontradas diferenças significativas entre os que utilizavam ou não HU. CONCLUSÕES: Os pacientes com DF apresentaram boa QV, sendo mais comprometida pelos aspectos relacionados ao domínio meio ambiente, (como recursos financeiros) e físico (como dor e desconforto) que se correlacionam com as características clínicas e sociais relacionadas a DF.

Introduction: sickle cell disease (SCD) comprises a group of hereditary hemolytic anemias whose main characteristic is the presence of the hemoglobin S (Hb S) gene that can be combined with other hereditary blood abnormalities. The clinical picture ranges from almost asymptomatic to severe forms. Hydroxyurea (HU) is the most successful therapy. It is a chronic disease whose prevalence and morbidity are high in Brazil, thus quality of life (QoL) emerges as an important challenge for patients, family members and health professionals. Objectives: This study aimed to evaluate the QoL of patients with SCD, their sociodemographic and clinical characteristics. Methods: Data were collected through the abbreviated QoL questionnaire (WHOQOL-Bref), sociodemographic questionnaire and clinical chart. Results: It has interviewed at the Hemominas Foundation in Divinópolis - MG, 39 patients aged 18-54. Most of the patients were male (56%), homozygous for Hb S (80%), unmarried (67%), completed high school (31%) and non HU users (61%). Among the patients evaluated, 53.8% considered having a good QoL (mean score 74.2 ± 20.3). The overall QoL score was 71.5. The physical and environmental domains had the lowest mean scores (61.5 and 59.0, respectively). No significant differences were found among those using or not using HU. Conclusions: Patients with SCD presented good QoL, being more affected by aspects related to the environmental domain (such as financial resources) and physical (such as pain and discomfort) those correlate with clinical and social characteristics related to SCD.

The effects of favipiravir on hematological parameters of covid-19 patients

SUMMARY INTRODUCTION This study aims to evaluate changes in hematological parameters after the follow-up of patients who received treatment with favipiravir due to COVID-19 infections. METHODS Sixty-two cases receiving favipiravir treatment for at least five days due to COVID-19 infection were evaluated retrospectively. Parameters including age, gender, nasopharyngeal swab positivity, and chronic diseases were analyzed. Hematologic parameters were analyzed before and after the treatment. RESULTS The mean age of the patients receiving treatment with favipiravir was 63.7±12.3 years. Nasopharyngeal swab positivity was detected in 67.7%. The most common comorbid conditions detected in patients were hypertension in 25 cases (40.3%) and diabetes in 16 cases (25.8%). In the statistical analysis of the hematological parameters before and after treatment with favipiravir, WBC, PT-PTT-INR levels were found to be unaffected; the mean RBC was found to have decreased from 4.33 ± 0.58 M/uL to 4.16 ± 0.54 M/uL (p:0.003); the median hemoglobin level was found to have decreased from 12.3 g/dl to 11.9 g/dl (p:0.041); the hematocrit level decreased from 38.1% ± 4.8 to 36.9% ± 4.2 (p:0.026); the median neutrophil count decreased from 4.57 K/uL to 3.85 K/uL (p:0.001); the mean lymphocyte count increased from 1.22 ± 0.53 K/uL to 1.84 ± 1.19 K/uL (p:0.000); and the mean platelet count increased from 244.1 ± 85.1 K/uL to 281.9 ± 103.3 K/uL (p:0.005). CONCLUSION We concluded that the pathological effect of treatment with favipiravir on the hematologic system was the suppression in the erythrocyte series, and there were no adverse effects in other hematologic parameters.

RESUMO INTRODUÇÃO Este estudo tem como objetivo avaliar as alterações nos parâmetros hematológicos após o acompanhamento de pacientes que receberam tratamento com favipiravir devido à infecção por Covid-19. MÉTODOS Sessenta e dois casos em tratamento com favipiravir por pelo menos cinco dias devido à infecção por Covid-19 foram avaliados retrospectivamente. Parâmetros como idade, sexo, positividade do swab nasofaríngeo e doenças crônicas foram analisados. Os parâmetros hematológicos foram analisados antes e após o tratamento. RESULTADOS A idade média dos pacientes que receberam tratamento com favipiravir foi de 63,7±12,3 anos. A positividade do swab nasofaríngeo foi detectada em 67,7%. As condições comórbidas mais comuns detectadas nos pacientes foram hipertensão em 25 casos (40,3%) e diabetes em 16 casos (25,8%). Na análise estatística dos parâmetros hematológicos antes e após o tratamento com favipiravir, os níveis de leucócitos, PT-PTT-INR não foram afetados. Verificou-se que o RBC médio diminuiu de 4,33±0,58 M/uL para 4,16±0,54 M/uL (p=0,003); o nível médio de hemoglobina foi reduzido de 12,3 g/dl para 11,9 g/dl (p=0,041); o nível de hematócrito diminuiu de 38,1%±4,8 para 36,9%±4,2 (p=0,026); a contagem mediana de neutrófilos diminuiu de 4,57 K/uL para 3,85 K/uL (p=0,001); a contagem média de linfócitos aumentou de 1,22±0,53 K/uL para 1,84±1,19 K/uL (p=0,000); a contagem média de plaquetas aumentou de 244,1±85,1 K/uL para 281,9±103,3 K/uL (p=0,005). CONCLUSÃO Concluiu-se que o efeito patológico do tratamento com favipiravir no sistema hematológico foi a supressão na série eritrocitária e que não houve efeitos adversos em outros parâmetros hematológicos.