Retrospective audit compares screening and treatment of pregnancy-related anaemia in regional New South Wales with Australian guidelines.

BACKGROUND: Anaemia during pregnancy is common worldwide. In Australia, approximately 17% of non-pregnant women of reproductive age have anaemia, increasing to a rate of 25% in pregnant women. This study sought to determine the rate of screening for anaemia in pregnancy in regional New South Wales, and to determine whether screening and treatment protocols followed the recommended guidelines. METHODS: This retrospective study reviewed antenatal and postnatal (48 h) data of women (n = 150) who had a live birth at Bathurst Hospital between 01/01/2020 and 30/04/2020. Demographic data, risk factors for anaemia in pregnancy, antenatal bloods, treatments provided in trimesters one (T1), two (T2) and three (T3), and postpartum complications were recorded. These were compared to the Australian Red Cross Guidelines (ARCG) using descriptive statistics. RESULTS: Of the women with screening data available (n = 103), they were mostly aged 20-35yrs (79.6%), 23.3% were obese, 97.1% were iron deficient, 17% were anaemic and only a few (5.3%) completed the full pregnancy screening as recommended by the ARCG while a majority completed only partial screenings specifically Hb levels in T1 (56.7%), T2 (44.7%) and T3 (36.6%). Compliance to oral iron was largely undocumented, but constipation was a common side effect among the women. IV iron was administered in 14.0% of women, approximately 1.75x higher than the recommended rate. CONCLUSIONS: This study provided useful information about compliance to screening and treatment guidelines for anaemia in pregnancy. We identified the need for improved documentation and communication between various health providers to ensure adequate antenatal care to prevent maternal complications during pregnancy. This will improve patient care and encourage further developments in maternal care, bridging the rural health gap.

Glycoprotein VI is not a Functional Platelet Receptor for Fibrin Formed in Plasma or Blood.

Glycoprotein VI (GPVI), a platelet collagen receptor, is crucial in mediating atherothrombosis. Besides collagen, injured plaques expose tissue factor (TF) that triggers fibrin formation. Previous studies reported that GPVI also is a platelet receptor for fibrinogen and fibrin. We studied the effect of anti-GPVI antibodies and inhibitors of GPVI signaling kinases (Syk and Btk) on platelet adhesion and aggregate formation onto immobilized fibrinogen and different types of fibrin under arterial flow conditions. Fibrin was prepared from isolated fibrinogen ("pure fibrin"), recombinant fibrinogen ("recombinant fibrin"), or generated more physiologically from endogenous fibrinogen in plasma ("plasma fibrin") or by exposing TF-coated surfaces to flowing blood ("blood fibrin"). Inhibition of GPVI and Syk did not inhibit platelet adhesion and aggregate formation onto fibrinogen. In contrast anti-GPVI antibodies, inhibitors of Syk and Btk and the anti-GPIb antibody 6B4 inhibited platelet aggregate formation onto pure and recombinant fibrin. However, inhibition of GPVI and GPVI signaling did not significantly reduce platelet coverage of plasma fibrin and blood fibrin. Plasma fibrin contained many proteins incorporated during clot formation. Advanced optical imaging revealed plasma fibrin as a spongiform cushion with thicker, knotty, and long fibers and little activation of adhering platelets. Albumin intercalated in plasma fibrin fibers left only little space for platelet attachment. Pure fibrin was different showing a dense mesh of thin fibers with strongly activated platelets. We conclude that fibrin formed in plasma and blood contains plasma proteins shielding GPVI-activating epitopes. Our findings do not support a role of GPVI for platelet activation by physiologic fibrin.

Disordered eating attitudes correlate with body dissatisfaction among Kuwaiti male college students.

BACKGROUND: The prevalence of disordered eating attitudes and body dissatisfaction based on muscularity and body fat was investigated among male college students in Kuwait with a range of body mass index values including underweight, normal weight, overweight, and obese participants. METHODS: Data were collected, using the Eating Attitudes Test (EAT-26) and the Bodybuilder Image Grid (BIG), from 400 male undergraduate students (84.8% Kuwaiti nationals) recruited from both public and private universities in Kuwait. An anonymous, self-administered questionnaire was used to determine the prevalence of symptomatology indicative of anorexia nervosa and bulimia nervosa and to examine the associations between body dissatisfaction and muscularity and body fat. RESULTS: Most participants were dissatisfied with their current muscle mass and body fat (67.3 and 69%, respectively). Logistic regression analyses produced odds ratios (ORs) demonstrating that students dissatisfied with their muscularity and body fat and those who indicated a desire to decrease both muscularity and body fat had significantly higher odds of being at risk of disordered eating attitudes (OR = 2.241, 95% CI [1.17, 3.6], p = .032, and OR = 1.898, 95% CI [1.214, 2.967], p = .005, respectively). Obese participants also had higher odds of exhibiting disordered eating attitudes (OR = 2.06, 95% CI [1.17, 3.60], p = .011). CONCLUSION: The high proportion of disordered eating attitudes among Kuwaiti college men was associated with high levels of body image dissatisfaction in relation to both body fat and muscularity. High levels of eating disorder symptoms were also linked to obesity.

Distorted weight perception correlates with disordered eating attitudes in Kuwaiti college women.

OBJECTIVE: We investigated the presence of disordered eating attitudes and weight perception among young women at body mass index (BMI) values that correspond to underweight, normal weight, overweight, and obese weight status. METHOD: Data were collected from 1,147 female undergraduate students (89% Kuwaiti nationals) recruited from Kuwait University through employment of the eating attitude test (EAT-26) together with an anonymous, self-administered questionnaire to determine the prevalence of symptomatology indicative of anorexia nervosa and bulimia nervosa. RESULTS: The mean EAT-26 scores differed significantly between the weight categories. More students with overweight and obesity scored above the established EAT-26 cut off value indicating at risk of disordered eating compared to students who were at a normal weight or underweight (52.1% vs. 38.8%, respectively, X2 (1) =16.1, p < .001). Logistic regression analyses showed significantly higher odds ratios (ORs) for the groups with overweight and obesity for dieting and bulimic behaviors, while women at normal and underweight had higher ORs for restrictive oral control behaviors associated with anorexia nervosa. Distorted weight perception was found in all weight categories. DISCUSSION: The high proportion of disordered eating attitudes among Kuwaiti college women could not be attributed to obesity alone as the type of disordered eating behavior varied more by weight perception than by weight status. The high levels of eating disorder related symptoms could be due to a combination of the social influences, diet, and lifestyle of college students. Such factors need to be considered by healthcare professionals as early as possible with more focused programs towards promotion of healthy weight for college students.

Dimeric Glycoprotein VI Binds to Collagen but Not to Fibrin.

Platelet glycoprotein VI (GPVI) acts as a decisive collagen receptor in atherothrombosis. Besides collagen, injured atherosclerotic plaques expose tissue factor (TF) that triggers fibrin formation. Two recent studies reported that platelet GPVI also functions as fibrin receptor, which would importantly widen the mode of action of GPVI-targeted antithrombotic drugs. We studied the binding of two GPVI fusion proteins to fibrin under static and arterial flow conditions. Fibrin was prepared from purified fibrinogen or generated more physiologically from endogenous fibrinogen by coagulating plasma with thrombin. Fibrin formation was also triggered by exposing TF-coated surfaces or human atherosclerotic plaque slices to arterially flowing blood. By binding studies and advanced optical imaging, we found that recombinant dimeric GPVI-Fc fusion proteins with Fc from either IgG1 (GPVI-Fc1) or IgG2 (GPVI-Fc2) bound to collagen fibres, but neither to fibrin prepared from purified fibrinogen obtained from three suppliers, nor to physiological fibrin formed by thrombin in plasma or triggered by exposing TF or atherosclerotic plaque slices to arterially flowing blood. Our findings do not support a role of dimeric platelet GPVI as receptor for fibrin. This is important for the understanding of plaque-triggered platelet thrombus formation and is clinically relevant for future GPVI-targeting therapies with recombinant GPVI-Fc and anti-GPVI antibodies.