ABSTRACT
Daily administration of oral iron is considered the current treatment standard for treating iron deficiency anemia due to availability and reduced cost compared to intravenous iron therapy. But adverse effects like epigastric pain, heartburn, and constipation reduce compliance to daily oral iron. There is scanty evidence regarding compliance and efficacy with alternate-day iron therapy. As per our knowledge, this is the first systematic review to compare daily with alternate-day oral iron therapy. Six electronic databases including PubMed and EMBASE were searched for randomized controlled trials, quasi-experimental studies published between January 2000 to March 2023 that compared daily with alternate day iron therapy in individuals diagnosed with iron deficiency anemia. The primary outcome analyzed was a change in hemoglobin. The other hematological parameters were assessed as secondary outcomes. Risk of bias was assessed regarding randomization process, deviation from intended intervention, missing outcome data, measurement of the outcome, and selection of the reported result. Out of the 9 full-text articles, 2 were not included as one was an ongoing trial and the second one had a different study design. The reviewed trials involved 594 participants, and the study participants ranged from 19 to 200. The mean age of the participants in the reported trials was 21 ± 2 to 49 ± 16 years. There is no significant increase in hemoglobin level and also the iron indices namely ferritin, hepcidin, total iron binding capacity, and reticulocyte count between daily and alternate-day dosing of iron. However, the frequency of adverse effects especially nausea, metallic taste, and altered bowel habits are reduced with alternate-day dosing. Oral iron given daily or on alternate days did not have a significant difference in the hemoglobin levels though iron absorption may be affected in the initial few days.Trial registration: The review protocol was registered with PROSPERO (Prospero2023CRD42023393095).
ABSTRACT
BACKGROUND/AIMS: Physical exhaustion is not always peripheral, and it is the brain that causes the sensation of fatigue either due to decrease of metabolic resources or due to central activation process that regulates attention and performance. This study was undertaken to observe the variations in event-related potentials (ERPs) and cognitive performance after an exhausting physical exercise. METHODS: A total of 60 healthy young adult subjects were included in the study. The study was conducted in 2 phases with at least a week gap between the phases. The participants answered a Multidimensional Fatigue Inventory (MFI-20) questionnaire before and after trials in each phase to measure the induced physical exhaustion. In phase I (control trial), the ERP data were processed using P300, Standard auditory "oddball paradigm," on computerized evoked potential recorder (RMS EMG MK-2) using 10/20 system to know the engagement of attention after which participants were given to perform cognitive tasks such as "Stroop Test, Trial Making Test and Mini Mental State Examination." In Phase II (exercise trial), the participants were instructed to cycle as hard as they could, till they could not continue anymore, which was followed by recording of P300-evoked potentials and performance of cognitive tasks as in Phase I. Paired t test was used to compare between any dependent variables. RESULTS: Fatigue-related subjective measures (MFI-20) showed that both mental and physical exhaustion were significantly greater in the exercise-involved cognitive trial than in the control trial. Lower P300 latencies reflect faster reaction time; however, their response accuracies were poorer resulting in poorer cognitive performances. Participants subjected to control trial performed better in terms of higher percentage accuracy but with slow reaction time. CONCLUSION: The participants experienced more fatigue physically and mentally during the exercise that involved cognitive tasks. An apparent decrease in attention based on decreased percentage accuracy of response was evident, implying that fatigue, performance, and attention are interdependent.
