Study of anti-diabetic, beta-carotene-bleaching inhibiting and iron chelating properties of Carissa opaca root extracts

Abstract Degenerative diseases diabetes and oxidative stress constitute a major health concern worldwide. Medicinal plants are expected to provide effective and affordable remedies. The present research explored antidiabetic and antioxidant potential of extracts of Carissa opaca roots. Methanolic extract (ME) was prepared through maceration. Its fractions were obtained, sequentially, in hexane, chloroform, ethyl acetate and n-butanol. An aqueous decoction (AD) of the finely ground roots was obtained by boiling in distilled water. The leftover biomass with methanol was boiled in water to obtain biomass aqueous decoction (BAD). The extracts and fractions showed considerable porcine pancreatic α-amylase inhibitory activity with IC50 in the range of 5.38-7.12 mg/mL while acarbose had 0.31 mg/mL. The iron chelating activity in terms of EC50 was 0.2939, 0.3429, 0.1876, and 0.1099 mg/mL for AD, BAD, ME, and EDTA, respectively. The EC50 of beta-carotene bleaching activity for AD, BAD, ME, and standard BHA were 4.10, 4.71, 3.48, and 2.79 mg/mL, respectively. The total phenolic content (TPC) and total flavonoid content (TFC) of AD and BAD were also considerable. In general, ethyl acetate fraction proved to be the most potent. Thus, the C. opaca roots had excellent antioxidant activity while having moderate α-amylase inhibitory potentia

Elevated Iron Chelating Activity of Ilex paraguariensis Leaf Infusion: in vitro and in vivo Pilot Studies

Abstract This study presents an Ilex paraguariensis leaf infusion with important potential as natural iron-chelating. The impact of infusion time and the water volume to obtain an Ilex paraguariensis leaf infusion with high phenolic content and iron chelating activity, such as the stability of these proprieties in the storage time and temperature (immediately and after 24 h at 8 and 25 (C) were assessed. The acute consumption effect of this infusion to reduce iron absorption in vivo was also evaluated. A preliminary crossover trial with volunteers that ingested a meal containing non-haem iron (11.4 mg) with the treatments: Ilex paraguariensis leaf infusion with the highest phenolic content and iron chelating activity (200 mL) or control (200 mL water). Blood samples were withdrawn before and 1, 2, 3 and 4 h after the meal for serum iron measurement. The highest phenolic content (18.1 mg/mL) and iron chelating activity ((100%) were observed for 10 min infusion time using 30 g leaves/300 mL water. Storage at 8 or 25 (C for 24 h decreased total phenolics and di-caffeoylquinic acids by 23.5% and 25.5%, respectively (p< 0.05), without affecting the iron-chelating activity due to a saturating chelating effect at 3.34 mg/mL phenolic content. Inhibition of the iron absorption in vivo by infusion was 78% considering the iron recovery at peak maximum. The in vitro and preliminary in vivo results showed a functional property of the Ilex paraguariensis leaf infusion that may be useful for adjuvant management of iron overload diseases.

Treatment of iron overload syndrome: a general review

SUMMARY INTRODUCTION Iron overload is a broad syndrome with a large spectrum of causative etiologies that lead to iron deposition. When iron exceeds defenses, it causes oxidative damage and tissular disfunction. Treatment may prevent organ dysfunction, leading to greater life expectancy. METHODS Literature from the last five years was reviewed through the use of the PubMed database in search of treatment strategies. DISCUSSION Different pharmacological and non-pharmacological strategies are available for the treatment of iron overload and must be used according to etiology and patient compliance. Therapeutic phlebotomy is the basis for the treatment of hereditary hemochromatosis. Transfusional overload patients and those who cannot tolerate phlebotomy need iron chelators. CONCLUSION Advances in the understanding of iron overload have lead to great advances in therapies and new pharmacological targets. Research has lead to better compliance with the use of oral chelators and less toxic drugs.

RESUMO INTRODUÇÃO A síndrome de sobrecarga de ferro engloba um grande espectro de etiologias que levam a um aumento da quantidade de ferro nos tecidos. Esse ferro excede a capacidade de proteção dos tecidos, levando a dano oxidativo e lesão tissular. Tratamento pode prevenir esse dano, levando à melhor sobrevida. METODOLOGIA A literatura dos últimos cinco anos foi revisada por meio de pesquisa na base de dados PubMed buscando identificar estratégias de tratamento. DISCUSSÃO Medidas farmacológicas e não farmacológicas estão disponíveis para o tratamento da síndrome de sobrecarga de ferro e devem ser utilizadas de acordo com a etiologia e a aceitação do paciente. A flebotomia terapêutica é base do tratamento dos pacientes com hemocromatose hereditária. Pacientes com sobrecarga transfusional ou aqueles que não toleram flebotomias devem utilizar quelantes de ferro. CONSIDERAÇÕES FINAIS Avanços no entendimento da síndrome de sobrecarga de ferro têm levado a grandes progressos na terapêutica, com promessas de abordagem de novos alvos farmacológicos. A evolução da pesquisa tem possibilitado melhor aderência com o uso de quelantes orais e com possibilidade de drogas menos tóxicas.

Chelating effects of siderophore in reducing organ dysfunction caused by iron overload in ICR Mice

Background and Objectives@#Iron is an essential element that plays a vital role in a wide variety of cellular processes. But when present in excess concentration in organs, it may increase the risk for liver disease, heart failure, and diabetes. Recently, siderophores, which are iron-chelating agents produced by microorganisms, have attracted tremendous attention because of their strong binding and high selectivity to the ferric form of iron. Thus, the use of siderophore in sequestering excess iron in the body as a form of therapy is very attractive. This study determined the effects of commercially available siderophore in sequestering excess iron in organs such as liver, heart, and pancreas under excess iron conditions. @*Methodology@#First, iron-overload was induced by injecting iron dextran (20 mg) into male ICR mice for three consecutive days. The effects of iron to the liver, heart, and pancreas and the possible sequestration by siderophore were determined by scoring histological sections. The liver iron concentration was also assessed by atomic absorption spectroscopy (AAS).@*Results and Conclusion@#The study showed that iron-overloaded mice exhibited skin hyperpigmentation and hemosiderosis in liver, heart, and pancreas. Significant changes in the liver include hepatomegaly and development of tumor. Iron-overloaded mice had 2,935% increase in liver iron content compared to the salinetreated mice. However, when iron-overloaded mice were treated with either 100 µg or 200 µg siderophore, there was a 77% and 84% decrease in liver iron content, respectively. Moreover, the treatment of ironoverloaded mice with siderophore prevented the development of hemosiderosis, tumor, and structural changes in the tissues studied. The results showed that siderophore can effectively reduce excess iron and organ damage in iron-overloaded mice and can be potentially employed in chelation therapy of iron-overload diseases. Further studies on the possible mechanisms of siderophore aside from decreasing iron excess and lowering organ dysfunction are recommended.

Biomarcadores da função renal: do que dispomos atualmente? / Biomarkers of renal function: what is currently available?

A avaliação da função renal é de extrema importância na prática clínica, tanto para o diagnóstico quanto para e prognóstico e monitoração das doenças renais. Neste contexto, aparticipação do laboratório é de grande importância, uma vez que a maior parte das doenças renais só se manifesta clinicamente quando mais de 50% a 75% da função renal estácomprometida. O desenvolvimento de novos biomarcadores para diagnóstico precoce, estratificação de risco, prognóstico de lesão renal tem sido um dos principais alvos das pesquisas envolvendo o sistema renal. Dessa forma, diversos novos biomarcadores, tais como lipocalina associada à gelatinase de neutrófilos (NGAL), cistatina C, molécula-1 de lesão renal (KIM-1), interleucina-18 (IL-18), enzimas urinárias tubulares e proteínas de baixo peso molecular, dentre outros, têm sido propostos para diagnosticar /monitorar as doenças renais agudas e crônicas. Este estudo visa discutir aspectos associados aos principais biomarcadores utilizados na rotina laboratorial para diagnóstico, prognóstico e acompanhamento do paciente com disfunção renal, bem como apresentar novos marcadores que se destacam na literatura recente e que podem ser promissores na prática clínica

The assessment of renal function is very important in clinical practice, both for diagnosis and for prognosis and monitoring of renal diseases. In this context, the role of the laboratory is of great importance, since most of the kidney disease manifests itself clinically only when more than 50 to 75% of kidney function is compromised. The development of new biomarkers for early diagnosis, risk stratification, prognosis of renal injury has been a major focus of research involving the renal system. Thus, several new biomarkers, such as neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), interleukin-18 (IL18) and low-molecular weight proteins and enzymes, and others, have been proposed to diagnose/monitoring acute and chronic renal diseases. The aim of this study is to discuss aspects related to the main biomarkers used in routine laboratory tests for diagnosis, prognosis and monitoring of patients with renal dysfunction, as well as provide new markers that stand out in the recent literature, and that may be promising in clinical practice

Deferasirox-induced urticarial vasculitis in a patient with myelodysplastic syndrome

Abstract Deferasirox is an iron chelator agent used in the treatment of diseases with iron overload, such as thalassemia and myelodysplastic syndrome. Although the majority of adverse reactions of deferasirox involve gastrointestinal symptoms and increase in serum creatinine and transaminases, skin rashes, such as maculopapular and urticarial eruptions, have also been reported. This study reports a case of myelodysplastic syndrome with urticarial vasculitis due to deferasirox therapy. Drug eruption was been confirmed by means of a challenge test, together with histopathological and clinical findings. To the best of our knowledge, we report the first case of deferasirox-induced urticarial vasculitis. Physicians should be aware of the possibility of urticarial vasculitis on deferasirox therapy and the fact that the discontinuation of the drug generally results in improvement.

Protective effects of deferasirox and N-acetyl-L-cysteine on iron overload-injured bone marrow

Using an iron overload mouse model, we explored the protective effect of deferasirox (DFX) and N-acetyl-L-cysteine (NAC) on injured bone marrow hematopoietic stem/progenitor cells (HSPC) induced by iron overload. Mice were intraperitoneally injected with 25 mg iron dextran every 3 days for 4 weeks to establish an iron overload (Fe) model. DFX or NAC were co-administered with iron dextran in two groups of mice (Fe+DFX and Fe+NAC), and the function of HSPCs was then examined. Iron overload markedly decreased the number of murine HSPCs in bone marrow. Subsequent colony-forming cell assays showed that iron overload also decreased the colony forming capacity of HSPCs, the effect of which could be reversed by DFX and NAC. The bone marrow hematopoiesis damage caused by iron overload could be alleviated by DFX and NAC.

Diferentes fontes de ferro na prevenção da anemia ferropriva e no desempenho de leitões lactentes / Different sources of iron for the prevention of iron deficiency anemia and performance of suckling piglets

Com o objetivo de avaliar o uso de diferentes fontes de ferro na prevenção da anemia ferropriva e no desempenho em leitões lactentes, dividiram-se 202 leitões em cinco tratamentos: FD - aplicação intramuscular de 200mg de ferro dextrano no terceiro dia de idade; T24 - terra à vontade fornecida aos leitões a cada 24 horas do terceiro ao 19º dia; T48 - terra à vontade fornecida aos leitões a cada 24 horas do terceiro ao 10º dia e do 11º ao 19º dia, com intervalo de 48 horas; T72 - terra à vontade fornecida aos leitões a cada 24 horas do terceiro ao 10º dia e do 11º ao 19º dia, com intervalo de 72 horas; SA - suplemento alimentar ultraprecoce rico em ferro quelatado em pó (SAUP) fornecido do terceiro ao 11º dia, com intervalo de 48 horas. O ferro dextrano aplicado no terceiro dia de vida e a suplementação com terra e SAUP foram eficientes para garantir o desempenho de leitões no período de aleitamento e não influenciaram no consumo de ração nem na taxa de viabilidade. As diferentes fontes de ferro estudadas não influenciaram o leucograma e foram eficientes na prevenção da anemia ferropriva e no desempenho dos leitões lactentes. Com relação às concentrações de hemoglobina e hematócrito, os animais suplementados com ferro dextrano apresentaram valores superiores quando comparados aos que recebem terra e SAUP.(AU)

In order to evaluate the use of different sources of iron to prevent iron deficiency anemia and to appraise the performance of suckling piglets, we sorted 202 piglets in five treatments. ID - intramuscular injection of 200mg of iron dextran on the third day of age; T24 - free daily access to land provided to piglets every 24 hours from the third to the nineteenth day; T48 - free daily access to land provided to piglets every 24 hours from the third to the tenth day and from day 11 to day 19 with an interval of 48 hours; T72 - free daily access to land provided to piglets every 24 hours from the third to the tenth day and from day 11 to day 19 with an interval of 72 hours; FS - Food supplement rich in iron-chelating powder (SAUP) available from the third to the eleventh day with an interval of 48 hours. The iron dextran applied on the third day of life as well as the supplementation with land and SAUP were effective to ensure the performance of piglets during the lactation period and did not affect feed intake or the viability rate. The different sources of iron studied did not influence the WBC (White Blood Cell) and succeded in preventing iron deficiency anemia and performance of suckling piglets. Regarding the concentrations of hemoglobin and hematocrit, the animals supplemented with iron dextran showed higher values when compared to those who receive land and SAUP.(AU)

Efficacy and safety of deferasirox in aplastic anemia patients with iron overload: a single arm, multi-center,prospective study in China / 中华血液学杂志

<p><b>OBJECTIVE</b>To explore the efficacy and safety of deferasirox in aplastic anemia (AA)patients with iron overload.</p><p><b>METHODS</b>A single arm, multi- center, prospective, open- label study was conducted to evaluate absolute change in serum ferritin (SF)from baseline to 12 months of deferasirox administration, initially at a dose of 20 mg·kg(-1)·d(-1), and the safety in 64 AA patients with iron overload.</p><p><b>RESULTS</b>All patients started their deferasirox treatment with a daily dose of 20 mg · kg(-1) ·d(-1). The mean actual dose was (18.6±3.60) mg · kg(-1)·d(-1). The median SF decreased from 4 924 (2 718- 6 765)μg/L at baseline (n=64) to 3 036 (1 474- 5 551)μg/L at 12 months (n=23) with the percentage change from baseline as 38%. A median SF decrease of 651 (126-2 125)μg/L was observed at the end of study in 23 patients who completed 12 months' treatment, the median SF level decreased by 1 167(580-4 806)μg/L [5 271(3 420-8 278)μg/L at baseline; 3 036(1 474-5 551)μg/L after 12 months' treatment; the percentage change from baseline as 42% ] after 12 months of deferasirox treatment. The most common adverse events (AEs) were increased serum creatinine levels (40.98%), gastrointestinal discomfort (40.98%), elevated liver transaminase (ALT: 21.31%; AST: 13.11%)and proteinuria (24.59%). The increased serum creatinine levels were reversible and non-progressive. Of 38 patients with concomitant cyclosporine use, 12(31.8%)patients had two consecutive values >ULN, 10(26.3%)patients had two consecutive values >1.33 baseline values, but only 1(2.6%)patient's serum creatinine increased more than 1.33 baseline values and exceeded ULN. For both AST and ALT, no patients experienced two post- baseline values >5 ×ULN or >10 × ULN during the whole study. In AA patients with low baseline PLT count (less than 50 × 10(9)/L), there was no decrease for median PLT level during 12 months' treatment period.</p><p><b>CONCLUSIONS</b>AA patients with iron overload could achieve satisfactory efficacy of iron chelation by deferasirox treatment. The drug was well tolerated with a clinically manageable safety profile and no major adverse events.</p>

Use of deferasirox, an iron chelator, to overcome imatinib resistance of chronic myeloid leukemia cells

BACKGROUND/AIMS: The treatment of chronic myeloid leukemia (CML) has achieved impressive success since the development of the Bcr-Abl tyrosine kinase inhibitor, imatinib mesylate. Nevertheless, resistance to imatinib has been observed, and a substantial number of patients need alternative treatment strategies. METHODS: We have evaluated the effects of deferasirox, an orally active iron chelator, and imatinib on K562 and KU812 human CML cell lines. Imatinib-resistant CML cell lines were created by exposing cells to gradually increasing concentrations of imatinib. RESULTS: Co-treatment of cells with deferasirox and imatinib induced a synergistic dose-dependent inhibition of proliferation of both CML cell lines. Cell cycle analysis showed an accumulation of cells in the subG1 phase. Western blot analysis of apoptotic proteins showed that co-treatment with deferasirox and imatinib induced an increased expression of apoptotic proteins. These tendencies were clearly identified in imatinib-resistant CML cell lines. The results also showed that co-treatment with deferasirox and imatinib reduced the expression of BcrAbl, phosphorylated Bcr-Abl, nuclear factor-kappaB (NF-kappaB) and beta-catenin. CONCLUSIONS: We observed synergistic effects of deferasirox and imatinib on both imatinib-resistant and imatinib-sensitive cell lines. These effects were due to induction of apoptosis and cell cycle arrest by down-regulated expression of NF-kappaB and beta-catenin levels. Based on these results, we suggest that a combination treatment of deferasirox and imatinib could be considered as an alternative treatment option for imatinib-resistant CML.

Modulatory effect of iron chelators on adenosine deaminase activity and gene expression in Trichomonas vaginalis

Trichomonas vaginalis is a flagellate protozoan that parasitises the urogenital human tract and causes trichomoniasis. During the infection, the acquisition of nutrients, such as iron and purine and pyrimidine nucleosides, is essential for the survival of the parasite. The enzymes for purinergic signalling, including adenosine deaminase (ADA), which degrades adenosine to inosine, have been characterised in T. vaginalis. In the evaluation of the ADA profile in different T. vaginalisisolates treated with different iron sources or with limited iron availability, a decrease in activity and an increase in ADA gene expression after iron limitation by 2,2-bipyridyl and ferrozine chelators were observed. This supported the hypothesis that iron can modulate the activity of the enzymes involved in purinergic signalling. Under bovine serum limitation conditions, no significant differences were observed. The results obtained in this study allow for the assessment of important aspects of ADA and contribute to a better understanding of the purinergic system in T. vaginalis and the role of iron in establishing infection and parasite survival.

In vitro antioxidant capacity and free radical scavenging evaluation of active metabolite constituents of Newbouldia laevis ethanolic leaf extract

BACKGROUND: The aim of the present study was to evaluate the in vitro antioxidant and free radical scavenging capacity of bioactive metabolites present in Newbouldia laevis leaf extract. RESULTS: Chromatographic and spectrophotometric methods were used in the study and modified where necessary in the study. Bioactivity of the extract was determined at 10 µg/ml, 50 µg/ml, 100 µg/ml, 200 µg/ml and 400 µg/ml concentrations expressed in % inhibition. The yield of the ethanolic leaf extract of N.laevis was 30.3 g (9.93%). Evaluation of bioactive metabolic constituents gave high levels of ascorbic acid (515.53 ± 12 IU/100 g [25.7 mg/100 g]), vitamin E (26.46 ± 1.08 IU/100 g), saponins (6.2 ± 0.10), alkaloids (2.20 ± 0.03), cardiac glycosides(1.48 ± 0.22), amino acids and steroids (8.01 ± 0.04) measured in mg/100 g dry weight; moderate levels of vitamin A (188.28 ± 6.19 IU/100 g), tannins (0.09 ± 0.30), terpenoids (3.42 ± 0.67); low level of flavonoids (1.01 ± 0.34 mg/100 g) and absence of cyanogenic glycosides, carboxylic acids and aldehydes/ketones. The extracts percentage inhibition of DPPH, hydroxyl radical (OH.), superoxide anion (O2 .-), iron chelating, nitric oxide radical (NO), peroxynitrite (ONOO-), singlet oxygen (1O2), hypochlorous acid (HOCl), lipid peroxidation (LPO) and FRAP showed a concentration-dependent antioxidant activity with no significant difference with the controls. Though, IC50 of the extract showed significant difference only in singlet oxygen (1O2) and iron chelating activity when compared with the controls. CONCLUSIONS: The extract is a potential source of antioxidants/free radical scavengers having important metabolites which maybe linked to its ethno-medicinal use.

Factors associated with satisfaction at work in Psychosocial Care Centers / Fatores associados à satisfação no trabalho em Centros de Atenção Psicossocial / Factores asociados a la satisfacción en el trabajo en Centros de Atención Psicosocial

OBJECTIVES: to analyze the prevalence of satisfaction at work and identify associated factors in Psychosocial Care Centers. METHOD: cross-sectional study involving 546 workers from 40 Psychosocial Care Centers in the South of Brazil. The satisfaction was identified based on the Assessment Scale of Satisfaction in the Mental Health Team and a logistic regression model was used for the adjusted data analysis. RESULTS: the prevalence of satisfaction at work corresponded to 66.4%. Factors directly associated with satisfaction: higher-level function (except physicians and psychologists), work time of six months or less, making a larger number of home visits, good supervision by the team, possibility to make collective choices and take courses. CONCLUSIONS: the satisfaction is associated with the work organization and conditions and demonstrates the need to invest in team supervisions, in process that democratize the services and in the workers' training. .

OBJETIVOS: analisar a prevalência de satisfação no trabalho e identificar fatores associados em Centros de Atenção Psicossocial. MÉTODO: estudo transversal com 546 trabalhadores de 40 Centros de Atenção Psicossocial, da Região Sul do Brasil. A satisfação foi identificada a partir da Escala de Avaliação da Satisfação da Equipe de Saúde Mental e a análise ajustada dos dados, realizada por modelo de regressão logística. RESULTADOS: prevalência de satisfação no trabalho de 66,4%. Fatores diretamente associados à satisfação: função de nível superior (excetuando médicos e psicólogos), tempo de trabalho menor ou igual a seis meses, realização de maior número de visitas domiciliares, boa supervisão pela equipe, possibilidade de fazer escolhas coletivas e cursos. CONCLUSÕES: a satisfação está associada à organização e às condições do trabalho e demonstra necessidade de se investir em supervisão pelas equipes, em processos que democratizem os serviços e, também, na formação de seus trabalhadores. .

OBJETIVOS: analizar la prevalencia de satisfacción en el trabajo e identificar factores asociados en Centros de Atención Psicosocial. MÉTODO: estudio trasversal con 546 trabajadores de 40 Centros de Atención Psicosocial de la región Sur de Brasil. La satisfacción fue identificada a partir de la Escala de Evaluación de la Satisfacción del Equipo de Salud Mental y el análisis ajustado de los datos efectuado mediante un modelo de regresión logística. RESULTADOS: prevalencia de satisfacción en el trabajo de 66,4%. Factores directamente asociados a la satisfacción: función de nivel superior (excepto médicos y psicólogos), tiempo de trabajo menor o igual a seis meses, efectuar mayor número de visitas a domicilio, boa supervisión por el equipo, posibilidad de hacer opciones colectivas y cursos. CONCLUSIONES: la satisfacción está asociada a la organización y a las condiciones del trabajo y demuestra la necesidad de invertir en supervisión por los equipos, en procesos que democraticen los servicios y también en la formación de sus trabajadores. .

Antioxidant potential and oxidative DNA damage preventive activity of unexplored endemic species of Curcuma.

Free radical scavenging activity, ferrous ion chelating capacity, reducing power and genoprotective effect of the aqueous leaf extracts of four unexplored endemic Curcuma spp. (C. vamana, C. neilgherrensis, C. mutabilis, C. haritha) were found to be dose-dependent and were highest in C. vamana. DNA protection property of the extracts was evaluated against H2O2/UV-induced oxidative damage. DNA-methyl green displacement assay showed that these extracts were free of DNA intercalating compounds. Further, hemolysis assay also showed that the extracts were non-toxic to human erythrocytes. The results highlight C. vamana as a promising source for herbal preparations possessing high antioxidant potential and genoprotective activity.

Serum zinc level in children with beta-thalassemia major on iron chelator

Zinc as a second trace element of human body plays an important role in numerous functions Thalassemic patients are at risk of zinc deficiency due to various causes including the use of iron chelating agents oral or injectable. In this study we aim to measure the serum zinc level in beta-thalassemic patients on oral versus injectable iron chelator. A hospital based case control study conducted in the Center of Hereditary Blood Disorders in Al-Zahra Teaching Hospital for the period between 1st of December 2011 to 31th of Augest 2012. Seventy children with beta-thalassemia major were studied, patients were divided into two groups: 37 patients were treated by deferoxamine constituent of group A and 33 were those on deferasiroxe therapy constituent group B. Control group consisted of 35 healthy children. Serum zinc was measured by atomic absorption spectrophotometery. Patients aged between 5-11 years, boys were 34 and girls 36. The mean age of patients was 7.5 years. The mean serum zinc level in group A [patients on deferoxamine] 59.3784 +/- 28.44913 microg/dl was significantly lower than that of group B [patients on deferasiroxe] 105.5667 +/- 30.25488 microg/dl and control group 96.8974 +/- 24.98083 microg/dl respectively. Hypozincemia found in 70.7%, 20% and 17.9% in group A, B and control group respectively. There was a significant difference between patients of both groups and control [p<0.05], while high significant difference between patients of different iron chelators [p<0.001]. Hypozincemia is common in thalassemic patients. The low level of serum zinc mainly found in those with injectable iron chelator. Routine follow up of serum zinc level and other possible causes of hypozenicemia should be studied before giving zinc to these patients

Liver and heart iron deposition status in patients with β thalassemia major: a multicenter study / 中华儿科杂志

<p><b>OBJECTIVE</b>To observe the status of iron deposition in patient with β thalassemia major, and to formulate appropriate treatment strategies.</p><p><b>METHOD</b>The data of status of transfusion and chelation in 135 patients aged from 6 years and 4 months to 17 years and 11 months with β thalassemia major were collected and analyzed. Serum ferritin levels were determined and cardiac and hepatic iron deposition was determined using MRI T2(*) technology.</p><p><b>RESULT</b>Of the 135 cases studied, 66 were male, and 69 were female, their average age was 12.1 years. Serum ferritin (SF) was determined for 111 cases, it varied from 1 086.8 µg/L to 15 011.5 µg/L. Among them, 16 cases had SF level <2 000 µg/L (14.5%) , in 41 cases SF were between 2 000 and 4 000 µg/L (36.0%) ;in 54 cases SF >4 000 µg/L (48.7%) . Liver MRI T2(*) results showed that in only 8 cases (5.9%) iron content in the liver was in normal range, 19 cases (14.9%) showed mild liver iron deposition;34 (25.2%) moderate and 74 (54.8%, the youngest one was only 6 years and 4 months of age) had severe iron deposition respectively. Cardiac MRI T2(*) showed that in 89 cases (65.9%) iron content in the heart was in normal range;19 cases (14.1%) had mild cardiac iron deposition and 27 (20.0%) presented severe iron deposition (the youngest one was only 9 years and 3 months of age) . SF level was obviously related to liver and cardiac iron deposition (MRI T2(*)) r and P value were -0.284, 0.003 and -0.374, 0.000 respectively. In 108 cases regular transfusion and chelation were delayed due to financial problem. The late and insufficient dosage administered and irregular chelation caused the higher SF level and the severe iron deposition.</p><p><b>CONCLUSION</b>The survival status of β thalassemia major in China is worrisome. Majority of them had not received regular transfusion and chelation. Liver and cardiac iron deposition occur early and had a high incidence.</p>

Diagnostic and Therapeutic Approach for Acute Paraquat Intoxication

Paraquat (PQ) has known negative human health effects, but continues to be commonly used worldwide as a herbicide. Our clinical data shows that the main prognostic factor is the time required to achieve a negative urine dithionite test. Patient survival is a 100% when the area affected by ground glass opacity is <20% of the total lung volume on high-resolution computed tomography imaging 7 days post-PQ ingestion. The incidence of acute kidney injury is approximately 50%. The average serum creatinine level reaches its peak around 5 days post-ingestion, and usually normalizes within 3 weeks. We obtain two connecting lines from the highest PQ level for the survivors and the lowest PQ level among the non-survivors at a given time. Patients with a PQ level between these two lines are considered treatable. The following treatment modalities are recommended to preserve kidney function: 1) extracorporeal elimination, 2) intravenous antioxidant administration, 3) diuresis with a fluid, and 4) cytotoxic drugs. In conclusion, this review provides a general overview on the diagnostic procedure and treatment modality of acute PQ intoxication, while focusing on our clinical experience.

Recent advances in treatment of aplastic anemia

Recent advances in the treatment of aplastic anemia (AA) made most of patients to expect to achieve a long-term survival. Allogeneic stem cell transplantation (SCT) from HLA-matched sibling donor (MSD-SCT) is a preferred first-line treatment option for younger patients with severe or very severe AA, whereas immunosuppressive treatment (IST) is an alternative option for others. Horse anti-thymocyte globuline (ATG) with cyclosporin A (CsA) had been a standard IST regimen with acceptable response rate. Recently, horse ATG had been not available and replaced with rabbit ATG in most countries. Subsequently, recent comparative studies showed that the outcomes of patients who received rabbit ATG/CsA were similar or inferior compared to those who received horse ATG/CsA. Therefore, further studies to improve the outcomes of IST, including additional eltrombopag, are necessary. On the other hand, the upper age limit of patients who are able to receive MSD-SCT as first-line treatment is a current issue because of favorable outcomes of MSD-SCT of older patients using fludarabine-based conditioning. In addition, further studies to improve the outcomes of patients who receive allogeneic SCT from alternative donors are needed. In this review, current issues and the newly emerging trends that may improve their outcomes in near futures will be discussed focusing the management of patients with AA.

Intervenção nutricional alternativa no controle da anemia em crianças e mães / Alternative nutritional intervention for the anemia control in children and mothers

As anemias carenciais constituem um dos maiores problemas de saúde pública no mundo, afetandocerca de 2 bilhões de pessoas, sendo a maioria, mulheres e crianças. Diante disso, o presente estudoobjetivou avaliar a eficácia de uma intervenção alternativa no controle da anemia, com a adição deferro suplementar em refeição habitual, de crianças com idade entre 2 e 4 anos e suas respectivasmães, atendidas pelo programa Estratégia Saúde da Família (ESF), no município de Diamantina – MG.Este estudo foi cego e a amostra foi constituída por 125 famílias voluntárias do Programa (ESF), sendo formados dois grupos: Grupo Intervenção (GI) e Grupo Controle (GC), este diferenciado por adicionar solução não contendo ferro na refeição. O diagnóstico de anemia foi feito pela medida daconcentração de hemoglobina e após três meses de intervenção foi feita a dosagem de hemoglobina para diagnóstico da anemia. Verificou-se pelos calendários que a solução de suplemento de ferro/placebo ficou restrita às crianças de 2 a 4 anos. Verificaram-se prevalências iguais de anemia nas mães dos GI (32%) e GC (34%), enquanto entre as crianças do GI nenhuma foi diagnosticada como anêmica contra 29% de ocorrência da anemia entre aquelas do GC. A suplementação com ferro no controle daanemia foi comprovada no caso das crianças que ingeriram o suplemento. A prevalência de anemia similar nos GI e GC entre a população de mães é justificada pela ausência de utilização do suplemento, refletindo as dificuldades inerentes à forma de intervenção aplicada.

Nutritional anemia is one of the biggest problems of the world’s public health. It affect near to 2 billion of people, being women and children more affected. The aim of this study was to evaluate the efficacy of an alternative nutritional intervention in anemia control. It was done by adding supplementary iron,ferrous bisglycinate, on children habitual meals, aged between 2 and 4 years, as well as on their mothers. This was a longitudinal placebo-blind comparative study and the sample was 125 mothers and 125 children from 125 volunteer families assisted the Family Health Strategy (ESF) in Diamantinacity – MG. They were separated in four groups of mothers and children: 2 Intervention (GI) and 2 Control Groups (GC). The GC received a placebo supplementation. Anemia diagnostic was taken by measuring hemoglobin concentration after three months of intervention on all groups. It was observed that the solution of iron supplement or placebo were restricted only to children between 2 and 4 years. Regard to mothers, there was no difference on anemia prevalence between GC (34%) compared to GI (32%) (p>0,05). Among children, there was no anemia on GI and 29% of occurrence on GC (p<0,05), sochildren who received iron supplementation were protected against anemia. Similar anemia prevalence on both mother groups is explained by high absence on supplement use for them.

Evaluación de efectividad y seguridad de deferasirox en Hemosiderosis Transfusional / Evaluation of effectiveness and safety of deferasirox in Hemosiderosis Transfusional

Antecedentes: Descripción de la condición de salud de interés (indicación): El cuerpo humano no posee un mecanismo activo para la excreción de hierro, y sus niveles son controlados principalmente por su absorción en el intestino delgado. Fisiológicamente, la cantidad de hierro absorbido (1-2mg/dia) se pierde mediante exudados de la mucosa intestinal y piel, así como pequeñas cantidades a través de la orina y bilis. Los pacientes que cursan con anemias crónicas y que son dependientes de transfusiones sanguíneas, reciben un exceso de hierro con cada transfusión (cada unidad de glóbulos rojos contiene aproximadamente 250mg de hierro); este hierro es acumulado de forma gradual en diferentes tejidos, tales como corazón e hígado. Descripción de la tecnología: El deferasirox es un medicamento quelante, trifdentado que se une especialmente al hierro; es empleado en el tratamiento de la sobrecarga crónica de este metal en el organismo. Está disponible en comprimidos para administración por vía oral. Cuenta con registro sanitario en Colombia. Evaluación de efectividad y seguridad: En pacientes con diagnóstico de hemosiderosis transfusional ¿cuál es la efectividad y seguridad de deferasirox comparado con deferoxamina, en la reducción de depósitos de hierro hepático o cardíaco, niveles de ferritina sérica y mortalidad? La pregunta de investigación fue validada teniendo en cuenta las siguientes fuentes de información: registro sanitario INVIMA, Acuerdo 029 de 2011, guías de práctica clínica, revisiones sistemáticas y narrativas de la literatura, estudios de prevalencia/incidencia y carga de enfermedad, libros de texto, consulta con expertos temáticos, sociedades científicas y otros actores clave. Población: pacientes con diagnóstico de hemosiderosis transfusional. Tecnología de interés: Deferasirox. Conclusiones: Efectividad: Deferasirox es una alternativa terapéutica de administración oral, efectiva para el tratamiento de la hemosiderosis transfusional. No existen diferencias significativas en mortalidad entre deferasirox y deferoxamina. La efectividad de deferasirox puede ser similar a deferoxamina dependiendo de la dosis y proporción comparada; sin embargo, la satisfacción de los pacientes es mayor en el grupo de pacientes previamente tratados con deferoxamina, que recibieron posteriormente deferasirox, lo que puede llevar a una mejor adherencia al tratamiento. Seguridad: los eventos adversos más frecuentes se encuentran relacionados con síntomas gastrointestinales, sin diferencias estadísticamente significativas entre ambos agentes. Sin embargo, se demuestra una mayor probabilidad de presentar aumento en los niveles de creatinina sérica con deferasirox en comparación con deferoxamina.