Double-blind randomized controlled trial of rolls fortified with microencapsulated iron / Estudo duplo-cego randomizado controlado com pães fortificados com ferro microencapsulado

OBJECTIVE: To evaluate the impact of the fortification of rolls with microencapsulated iron sulfate with sodium alginate on the hemoglobin levels in preschoolers as compared to controls. METHODS: Double-blind randomized controlled trial comprised of children aged 2 to 6 years with initial hemoglobin exceeding 9 g/dL from four not-for-profit daycares randomly selected in the city of São Paulo - Brazil. Children of 2 daycares (n = 88) received rolls with fortified wheat flour as the exposed group (EC) and children of 2 daycares (n = 85) received rolls without fortification as the control group (CG) over a 24-week period. Rolls with 4 mg iron each were offered once a day, five days a week. Hemoglobin concentrations were determined in capillary blood by HemoCue® at three moments of trial: baseline (Ml), after 12 and 24 weeks of intervention (M2, M3). RESULTS: Hemoglobin concentration presented significant increase up to M3 in EG (11.7-12.5-12.6 g/dL) and in CG (11.1-12.4-12.3 g/dL) with higher elevations in children initially with anemia. There was significant reduction in the occurrence of anemia from 22 percent to 9 percent in EG and from 47 percent to 8.2 percent in CG at M3. CONCLUSION: Rolls fortified with microencapsulated iron sulfate were well tolerated, increased hemoglobin levels and reduced the occurrence of anemia, but with no difference compared to the control group.

OBJETIVO: A deficiência de ferro é a carência nutricional mais frequente no Brasil, tendo como principal etiologia a baixa ingestão do mineral. A fortificação alimentar é medida sustentável e de melhor custo-benefício para a prevenção e controle. O objetivo foi avaliar o impacto da fortificação de pães com sulfato ferroso microencapsulado com alginato de sódio sobre os níveis de hemoglobina em pré-escolares, comparados com controles. MÉTODOS: Estudo duplo-cego randomizado controlado incluindo crianças de 2 a 6 anos com hemoglobina inicial maior que 9 g/dL procedentes de 4 creches filantrópicas selecionadas aleatoriamente, São Paulo - Brasil. Crianças de 2 creches (n = 88) receberam pães com farinha de trigo fortificada, constituindo o grupo exposto (EC), e de outras 2 creches (n = 85) receberam pães não fortificados, compondo o grupo-controle (CG), durante 24 semanas. Pães contendo 4 mg de ferro foram oferecidos uma vez ao dia, cinco dias por semana. As concentrações de hemoglobina foram determinadas no sangue capilar por HemoCue® em três momentos do estudo: momento inicial (M1), após 12 e 24 semanas da intervenção (M2, M3). RESULTADOS: A concentração de hemoglobina apresentou aumento significativo até M3 no EG (11,7-12,5-12,6 g/dL) e no CG (11,1-12,4-12,3 g/dL) com maiores elevações nas crianças inicialmente anêmicas. Houve redução significativa na ocorrência de anemia de 22 por cento a 9 por cento no EG e de 47 por cento a 8,2 por cento no CG em M3. CONCLUSÃO: Os pães fortificados com sulfato ferroso microencapsulado foram bem tolerados, elevando os níveis de hemoglobina e reduzindo a ocorrência de anemia, porém sem diferenças em relação ao grupo-controle.

Evaluation of laboratory markers of progression of HIV disease to death / Avaliação de marcadores laboratoriais de progressão da doença HIV para óbito

INTRODUCTION: One of the important current problems in HIV/AIDS infection is the establishment of epidemiological and laboratorial prognostic parameters during patient follow-up. This study aimed at analyzing the evolution of laboratory tests: CD4 lymphocyte count, viral load, hemoglobin (Hb), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and the epidemiological variables sex and age as prognostic factors for survival in progression to death among AIDS patients. METHODS: A retrospective study was conducted using analysis of medical records, and prospective 24-month follow-up of patients with HIV/ AIDS attended at the President Vargas Hospital Outpatient Clinic, a reference center in HIV/ AIDS attendance in the State of Maranhão, Brazil. The study analyzed patients aged 10 to 60 years old, who manifested AIDS and who were not using antiretroviral therapy or had used it for less than 5 years. The Chi-square test was used for statistical analysis. RESULTS: The sample included 100 patients - 57 were current outpatients, and 43 had died. The variables viral load (p=0.726), ALT (p=0.314), sex (p=0.687), and age (p=0.742) were analyzed, and no evidence of association between them and worst prognosis was observed. CONCLUSIONS: A significant relation was verified between low Hb levels (p=0.000) and CD4 (p=0.000) and shorter survival.

INTRODUÇÃO: Uma das importantes dificuldades atuais na infecção HIV/AIDS é estabelecer parâmetros epidemiológicos e laboratoriais prognósticos no seguimento dos pacientes. Esse trabalho objetivou analisar a evolução dos exames laboratoriais: contagem de linfócitos CD4, carga viral, dosagem de hemoglobina (Hb), de aspartato aminotransferase (AST), de alanino aminotransferase (ALT) e as variáveis epidemiológicas: sexo e idade, como fatores prognósticos de sobrevida na evolução para o óbito em pacientes com AIDS. MÉTODOS: Foi realizado um estudo retrospectivo a partir da análise de prontuários e um prospectivo por seguimento de pacientes portadores de HIV/AIDS, no Serviço Ambulatorial da referência assistencial em HIV/AIDS, no Estado do Maranhão, durante 24 meses. Os pacientes analisados tinham faixa etária compreendida entre 10 e 60 anos, apresentavam quadro clínico manifesto e não faziam uso de antirretroviral ou ainda o faziam há menos de 5 anos. Para análise estatística, foi adotado o teste qui-quadrado. RESULTADOS: A amostra compreendeu 100 pacientes, dos quais 57 se encontravam em tratamento ambulatorial e 43 já tinham ido a óbito. Variáveis como carga viral (p= 0,726), ALT (p=0,314), sexo (p=0,687) e faixa etária (p=0,742) foram analisadas e nenhuma evidência de associação entre elas com o pior prognóstico foi verificada. CONCLUSÕES: Constatou-se uma significante relação entre baixos níveis de Hb (p=0,000) e de CD4 (p=0,000) com menor sobrevida.

[Semiological profile of gout in patients with AA, AS and AC hemoglobins]

To search a possible difference in gout and in the risk factors for gout expression according to the hemoglobin in patients seen at the lome teaching hospital rheumatology clinic [Togo]. Medical records of patients seen during 17 years were studied. The patients affected by the gout and answering New York criteria have been included. All patients object of the comparison, benefitted from a hemoglobin electrophoresis and the search of possible risk factors for gout. Among the 14902 patients seen over a 17 year period, 214 had gout [210 males, 4 famales]. These 214 patients were carriers of an A A hemoglobin [147 cases], of an AS hemoglobin [41 cases], or of an AC [hemoglobin [26 cases]. The alcoholism, the obesity, and the arterial hypertension were the main risk factors associated with gout in 207 patients [97%]. Semiological and risk factors comparison according to the type of hemoglobin didn't show statistically significant difference. it results from this study that the AS hemoglobin and AC hemoglobin don't exercise any influence on the gout Semiological expression. Thus, the presence of one of these hemoglobins in gout patient must exercise no influence in the diagnostic gait and in the etiological investigation

Characterization and oxygen binding properties of des-Arg human hemoglobin

The role of chloride in the stabilization of the deoxy conformation of hemoglobin (Hb), the low oxygen affinity state, has been studied in order to identify the nature of this binding. Previous studies have shown that arginines 141α could be involved in the binding of this ion to the protein. Thus, des-Arg Hb, human hemoglobin modified by removal of the α-chain C-terminal residue Arg141α, is a possible model for studies of these interactions. The loss of Arg141α and all the salt bridges in which it participates is associated with subtle structural perturbations of the α-chains, which include an increase in the conformational flexibility and further shift to the oxy state, increasing oxygen affinity. Thus, this Hb has been the target of many studies of structural and functional behavior along with medical applications. In the present study, we describe the biochemical characterization of des-Arg Hb by electrophoresis, high-performance liquid chromatography and mass spectroscopy. The effects of chloride binding on the oxygen affinity and on the cooperativity to des-Arg Hb and to native human hemoglobin, HbA, were measured and compared. We confirm that des-Arg Hb presents high oxygen affinity and low cooperativity in the presence of bound chloride and show that the binding of chloride to des-Arg does not change its functional characteristics as observed with HbA. These results indicate that Arg141α may be involved in the chloride effect on Hb oxygenation. Moreover, they show that these residues contribute to lower Hb oxygen affinity to a level compatible with its biological function.

Fluorescence studies on the binding of reduced nicotinamide adenine dinucleotide phosphate to human hemoglobin A and its variant hemoglobin providence

The affinity constants for the binding of NADPH to human hemoglobin A were directly determined by fluorescence analyssis since nucleotide fluorescence is quenched on binding to the protein. The binding constants 6.1 x 10**5, 5.02 x 10**5 and 1.2 x 10**5 were found for deosyhemoglobin at pH 6.5, 7.0,respectively. Oxyhemoglobin does not bind NADPH significantly. These results are consistent with those found in oxygen-hemoglobin equilibrium experiments. The human hemoglobin variant, Providence-Asp, which has a marked decrease in 2,3 DPG affinity was also investigated. NADPH does not bind to the variant suggesting that the Lys B 82 residues is of fundamental importance to nucleotide binding and showing that the binding site is the same as that of 2,3 DPG or other organic polyphosphate, aloosteric modulators of hemoglobins. Experiments of inositol hexaphosphate (IHP)-NADPH site competition corroborate these results

Kinetic study of hemoglobin Porto Alegre [ß9(A6)SER-CYS] polymerization by inter-tetramer disulfide bond formation

The polymerization of hemoglobin Porto Alegre (HbPA) by inter-tetramer disulfide bond formation at pH 7.6 follows kinetics second order in Hb concnetration. The initial stage of the polymerization was associated with the formation of an HbPAS-S-S-HbPA octamer and a rate constant of 9 x 10***-2M***-1min***-1 was found at 13-C. A later stage of the polymerization wa associated with HbPA-S-S-HbPA-S-S-HbPA dodecamer formation and the rate constant calculated by an approximate treatment was found to be 2.8M***-1 at 13-C. The polymerization by intertetramer disulfide bond formation of HbPA in a 1:1 mixture with HbA follows second orfer kinetics and is monophasic. the lower rate constant found for the HbPA-S-S-HbA octamer (3.9 x 10***-2 M***-1min***-1 at 13-C) is attributed to the formation of S-S bond involving the thiols of the ß9 cysteine from HbPA and the ß93 cysteine from HbA. The 25.6 e.u. more positive "apparent" entropy of activation found for the dodecamer, when comapred to that of the HbPA-S-S-HbPA octamer, is interpreted as due to dehydration of electrically charged groups. The 15.6 e.u. more positive "apparent" entropy of activation of the HbPAS-S-HbA octamer when compared to that of the HbPA-S-S-HbPA octamer is also interpreted as due to dehydration

Modificaçöes da afinidade da hemoglobina do sangue venoso pelo oxigênio e da fosfatemia no curso da circulaçäo extracorpórea / Changes of affinity of hemoglobin, in venous blood due to oxigen and phosphatenia during extracorporeal circulation

As alteraçöes da afinidade da hemoglobina (Hb) pelo oxigênio (O2) e o comportamento da fosfatemia induzidos pela circulaçäo extracorpórea (CEC) foram avaliados em crianças, no curso da correçäo para cardiopatias congênitas e reumáticas. A afinidade do sangue pelo O2 foi estimada pela determinaçäo do PO250 (pressäo parcial de O2 que satura o sangue 50%) do sangue venoso, calculado a partir da equaçäo de Lichtman, e obtidas seriadamente antes, durante e após a CEC. Paralelamente, a fosfatemia foi determinada. Foram observadas diminuiçäo significativa do nível da PO250 até 24ª hora de pós operatório e queda progressiva da fosfatemia durante a CEC com elevaçäo gradativa posterior, permanecendo significativa até o nível da 12ª hora de pós operatório. Os autores discutem os diversos fatores envolvidos no desvio da curva de dissociaçäo da oxihemoglobina, destacando-se a hipotermia na CEC, o uso do sangue citratado do perfusato e a diminuiçäo da fosfatemia. É enfatizado novamente que se devem evitar os fatores que desviem a curva de dissociaçäo da oxihemoglobina para a esquerda, por seus efeitos adversos na oxigenaçäo tissular. O uso do fósforo no perfusato ainda é prematuro inferir por este trabalho