Effect of Diet Counseling on Nutritional Status of Chronic Respiratory Diseases Patients Enrolled in the Pulmonary Rehabilitation Program in a Teaching Hospital: A Pre-Post Intervention Study.

We conducted the study to assess the effect of patient-tailored diet counseling on the nutritional status of chronic respiratory disease (CRD) patients under the pulmonary rehabilitation program from June 2021-May 2022. These patients completed 2 months of patient-tailored diet counseling sessions under the pulmonary rehabilitation program, which consisted of 4-5 interactive diet counseling sessions fortnightly. The pre- and postassessment was done using standardized outcomes: Malnutrition Universal Screening Tool (MUST), body mass index (BMI), and ideal body weight. The study enrolled 110 CRD patients. There was a statistically significant improvement in pre- and postassessment in MUST score, appetite, and unintentional weight loss (P < 0.001). Most of the patient's BMI normalized. In prenutritional assessment, most of the patients were malnourished and in postassessment, the number of malnourished and anemic patients was reduced. This study concludes that nutritional counseling effectively improves nutritional status and anemia.

Pyogenic granuloma in the jejunum successfully removed by single-balloon enteroscopy

Pyogenic granuloma is a non-infectious and non-granulomatous lesion. Its location in the small bowel is very rare. We present a 46 year-old woman with a chronic liver disorder that had a severe chronic anemia with occult blood losses. Upper endoscopy and colonoscopy were normal. A small bowel capsule endoscopy showed a pyogenic granuloma in jejunum that was resected endoscopically with single balloon enteroscopy with no major complications. The patient recovered from anemia and six months latter capsule endoscopy did not show lesions (AU)

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Clinical, hematological, total plasma protein and fibrinogen parameters of magellanic penguins (Spheniscus magellanicus) pre- and post-rehabilitation / Parâmetros clínicos, hematológicos, de proteína plasmática total e fibrinogênio em pinguins-de-magalhães (Spheniscus magellanicus) pré e pós-reabilitação

Magellanic penguins (Spheniscus magellanicus) usually arrive in poor body conditions at Brazilian beaches during the winter. Hematology provides valuable information about clinical and immunity status of the animals. The aims of this study were to determine the hematologic, total plasma protein (TPP) and fibrinogen profiles of young and adult magellanic penguins in PROAMAR and CETAS-SC, relating these results with the state of health and survival possibility of the animals. In Paraná 14 animals were evaluated in pre and eight in post-rehabilitation and 29 animals were evaluated in Santa Catarina after rehabilitation. Before rehabilitation, all animals showed weakness. In hematological exams of these animals, we found that anemia was present in 83% of the penguins that died and 50% of those which survived. The heterophils/lymphocytes (H/L) ratio was 3.87±0.57 in animals that died, significantly higher than the average of 2.20±0.30 for animals that survived. These two parameters are useful to assess the survival possibility of animals to rehabilitation. The body condition score was positively correlated with hematocrit and TPP, and negatively correlated with H/L ratio. After rehabilitation, the values were similar to other animals of the family Spheniscidae, with averages ranging from 1.64 to 1.90x106 erythrocytes/µL; 43.38 to 48.80% of hematocrit; 12.45 to 13.52g/dL of hemoglobin; 8,684 to 14,011 leukocytes/µL; 4,767 to 8,041 heterophils/µL; 3,215 to 4,951 lymphocytes/µL; 95 to 655 eosinophils/µl; 179.8 to 277.9 monocytes/µL; 141 to 184.9 basophils/µL; and 1.26 to 1.74 of H/L ratio. These parameters can therefore be used as reference values and release parameters for young and adult Magellanic penguins in captivity on the rehabilitation centers.(AU)

Pinguins-de-magalhães (Spheniscus magellanicus) geralmente chegam debilitados às praias do Brasil durante o inverno. A hematologia fornece informações valiosas sobre estado clínico e imunidade dos animais. Os objetivos do presente estudo foram determinar o perfil hematológico, de proteína plasmática total (PPT) e fibrinogênio de pinguins-de-magalhães jovens e adultos no PROAMAR e no CETAS-SC, relacionando esses resultados com o estado de saúde e possibilidade de sobrevivência dos animais. Foram avaliados no Paraná 14 animais na pré e oito na pós-reabilitação e 29 animais em Santa Catarina após a reabilitação. Antes da reabilitação, todos os animais apresentavam debilidade. Nos exames hematológicos desses animais, observou-se que a anemia estava presente em 83% dos pinguins que foram a óbito e em 50% dos que sobreviveram. A relação heterófilos/linfócitos (H/L) foi de 3,87±0,57 nos animais que foram a óbito, significativamente maior que a média de 2,20±0,30 dos animais que sobreviveram. Esses dois parâmetros são úteis na avaliação da possibilidade de sobrevivência dos animais à reabilitação. O escore corporal apresentou correlação positiva com hematócrito e PPT, e correlação negativa com relação H/L. Após a reabilitação os valores foram semelhantes aos de outros animais da família Spheniscidae, com médias variando de 1,64 a 1,90 x106 eritrócitos/µL; 43,38 a 48,80% de hematócrito; 12,45 a 13,52g/dL de hemoglobina; 8.684 a 14.011 leucócitos/µL; 4.767 a 8.041 heterófilos/µL; 3.215 a 4.951 linfócitos/µL; 95 a 655 eosinófilos/µL; 179,8 a 277,9 monócitos/µL; 141 a 184,9 basófilos/µL; e 1,26 a 1,74 de relação H/L. Esses parâmetros, portanto, podem ser utilizados como valores de referência e parâmetros para soltura para pinguins-de-magalhães jovens e adultos em cativeiro nos centros de reabilitação.(AU)

Does the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis.

BACKGROUND: In hemodialysis (HD) patients, anemia relates to three main factors: insufficient production of erythropoietin; impaired management of iron; and decreased lifespan of red blood cells (RBCs). The third factor can relate to structural deterioration of RBCs due to extrinsic (extracorporeal circuit; biochemical activation and/or mechanical stress during dialysis) and intrinsic (uremic milieu; biochemical interference of the RBC membrane constituents with toxins) mechanisms. Herein, we evaluate information accessed with advanced imaging techniques at the cellular level. METHODS: Atomic force and scanning electron microscopes were employed to survey intact RBCs (iRBCs) of seven HD patients in comparison to seven healthy donors. The extrinsic factor was investigated by contrasting pre- and post-HD samples. The intrinsic environment was investigated by comparing the microscopy data with the clinical ones. RESULTS: The iRBC membranes of the enrolled HD patients were overpopulated with orifice-like (high incidence; typical size within 100-1,000 nm) and crevice-like (low incidence; typical size within 500-4,000 nm) defects that exhibited a statistically significant (P < 0.05) relative increase (+55% and +350%, respectively) in respect to healthy donors. The relative variation of the orifice and crevice indices (mean population of orifices and crevices per top membrane surface) between pre- and post-HD was not statistically significant (-3.3% and +4.5%, respectively). The orifice index correlates with the concentrations of urea, calcium, and phosphorus, but not, however, with that of creatinine. CONCLUSION: Extracorporeal circulation is not detrimental to the structural integrity of RBC membranes. Uremic milieu is a candidate cause of RBC membrane deterioration, which possibly worsens anemia.

Disappearance of association in diabetic patients on hemodialysis between anemia and mortality risk: the Japan dialysis outcomes and practice pattern study.

We previously demonstrated that anemia was not associated with mortality in hemodialysis patients with cardiovascular disease (CVD). Since diabetes mellitus (DM) accelerates CVD, the influence of DM on the relationship between anemia and mortality was examined using the data obtained from 1,385 DM patients and 2,583 non-DM hemodialysis patients recruited into the Dialysis Outcomes Practice Pattern Study in Japan (J-DOPPS). When all patients were stratified into four groups on their hematocrit levels, mortality rate was significantly and steadily lower in the subgroups with the higher levels of hematocrit by the Kaplan-Meier method (p = 0.0003 by log-rank test). When DM and non-DM patients were analyzed separately, a significant association of lower hematocrit levels with higher mortality disappeared in DM patients (p = 0.6280), in contrast with its retention in non-DM counterparts (p < 0.0001). Multivariable-adjusted Cox proportional hazards models demonstrated a significant association between hematocrit with all-cause mortality in non-DM patients after adjustment for age, gender, BMI, hemodialysis duration, SBP, DBP, albumin, total cholesterol, calcium, phosphorus, and intact PTH (p = 0.046), whereas this association disappeared in DM patients in the same model (p = 0.583). In conclusion, these results suggested that the association between anemia and higher mortality disappeared in DM hemodialysis patients, in contrast with non-DM counterparts.

Intoxicação experimental por Indigofera suffruticosa em caprinos e ovinos / Experimental poisoning by Indigofera suffruticosa in goats and sheep

Indigofera suffruticosa é uma planta invasora, ção. Em um caprino e um ovino foram realizados os testes que causa anemia hemolítica com hemoglobinúria em bo-de fragilidade osmótica, determinação de hemoglobina e vinos e, experimentalmente, anemia sem hemoglobinúria metemoglobina e pesquisa de corpúsculos de Heinz. Foi em cobaios. O objetivo deste trabalho foi determinar a comprovado que em caprinos e ovinos, I. suffruticosa cautoxicidade de I. suffruticosa para caprinos e ovinos. Par-sa anemia hemolítica sem hemoglobinúria com formação tes aéreas da planta foram administradas a seis caprinos de corpúsculos de Heinz. Os animais recuperaram-se da e quatro ovinos em doses diárias de 10, 20 e 40g por kg anemia, total ou parcialmente, mesmo com a continuidade de peso vivo, durante períodos de 2 a 24 dias. Foram ava-da administração da planta. Oito a 12 horas após a coleliados os parâmetros hematológicos (hematócrito, níveis ta observa-se pigmento azulado na urina. Sugere-se que o de hemoglobina e contagem de hemácias) e foi coletada pigmento seja anilina ou algum metabolito dessa substânurina para urinálise e observação de variações na coloracia e que a anilina seja o princípio ativo responsável pela hemólise causada por I. suffruticosa.

Indigofera suffruticosa is a weed, which causes hemolytic anemia and hemoglobinuriain cattle and, experimentally, anemia without hemoglobinuria in guinea pigs. With the objective to determinate the toxicity of I. suffruticosa to sheep and goats aerial parts of the plant were administrated to six goats and four sheep at daily doses of 10, 20 and 40g of fresh plant per kg body weight, during two to 24 days. Blood samples were collected daily for the determination of packed cell volume, hemoglobin concentrations, and red blood cells count. Urine was also collected daily for urine examination and observation of color changes. Osmotic fragility and blood concentrations of hemoglobin and methemoglobin were determined in one goat and one sheep. Anemia due to extravascular hemolysis, without hemoglobinuria, was observed in the experimental sheep and goats. Heinz bodies were observed in brilliant cresyl blue stained blood smears. There was total or partial recovery of the anemia in spite of the continued plant administration. Eight to 12 hours after collection a bluish pigment was observed in the urine. It is suggested that aniline is thetoxic compound of I. suffruticosa responsible for the hemolysis.

The economic impact of pre-dialysis epoetin alpha on health care and work loss costs in chronic kidney disease: an employer's perspective.

The objective of the study was to quantify the direct and indirect incremental costs of epoetin alpha (EPO) therapy for anemia in pre-dialysis chronic kidney disease (CKD). Using employer claims data from January 1998 to January 2005, direct (medical and pharmacy) and indirect (sick leave and disability) costs were compared between CKD-anemic patients treated with EPO before dialysis (n = 199) and those not treated with an erythropoiesis-stimulating therapy (EST) (n = 196). Among the results, incremental direct and indirect cost savings for EPO-treated patients were $1443 and $328 per member per month (PMPM) (p < 0.001), respectively, compared to non-EST-treated patients with anemia. After multivariate adjustments, direct and indirect costs remained significantly lower by $852 and $308 PMPM (p < 0.001), respectively, for the EPO-treated group. Direct costs during the first 6 months of dialysis also were significantly lower for the EPO-treated group (who received EPO before dialysis), by $1515 PMPM (p = 0.0267, in multivariate regression). In conclusion, anemic CKD patients treated with EPO before dialysis had significantly lower direct and indirect costs compared to non-EST-treated patients.

Endurance exercise and the production of growth hormone and haematopoietic factors in patients with anaemia.

BACKGROUND: Physical activity has been shown to stimulate haematopoiesis in patients with anaemia due to chronic renal failure or haematological malignancies. OBJECTIVE: To evaluate the effect of moderate exercise on the production of haematopoietically active factors. METHODS: Ten patients (four men and six women, mean (SD) age 51 (10) years) with a haemoglobin concentration under 130 g/l (men) or 120 g/l (women) carried out five three minute exercise bouts at an intensity of 80% of the maximal heart rate, corresponding to a lactate concentration of 3 (0.5) mmol/l. Patients rested for three minutes between bouts. The concentrations of interleukin 6, stem cell factor, granulocyte-monocyte colony stimulating factor, granulocyte colony stimulating factor, erythropoietin, and growth hormone (GH) were evaluated before and in the eight hours after exercise. RESULTS: GH had risen significantly 15 minutes after exercise (1.1 (1.3) v 2.7 (2.8) ng/ml; p<0.05). No change in the concentration of the other cytokines and growth factors was observed in the eight hours after exercise. CONCLUSIONS: In patients with anaemia, submaximal exercise does not affect the concentration of haematopoietically active cytokines. However, it leads to an increased concentration of GH. This may be responsible for the improved haematopoiesis observed after an exercise programme in patients with chronic diseases.

Renal rehabilitation: keys to success. Case study of the anemic patient.

Rehabilitation of dialysis patients was an original goal of the Medicare End-stage Renal Disease (ESRD) program. Since this program's inception, advances in technology (e.g., better dialysis equipment) and pharmacology (e.g., maintenance of an optimum hematocrit with Epoetin alfa) have greatly improved the care of patients with ESRD and increased the potential for successful rehabilitation. Recognizing the importance of rehabilitation, many health providers and patients have focused attention on developing innovative programs that can help improve outcomes. A key component of successful programs is the formation of a multidisciplinary team that actively plans, directs, and participates in the rehabilitation effort. This article provides case study overviews from three dialysis centers, including key steps that can ensure a continual focus on rehabilitation.

The effects of recombinant human erythropoietin on functional health and well-being in chronic dialysis patients.

As a component of the open-label, multicenter National Cooperative Recombinant Human Erythropoietin (Epo) Study, the health-related quality-of-life effects of Epo therapy were assessed in 484 dialysis patients who had not previously been treated with Epo therapy (New-to-Epo) and 520 dialysis patients who were already receiving Epo therapy at the time of study enrollment (Old-to-Epo). Using scales from the Medical Outcomes Study 36-item Short Form Health Survey (SF-36), health-related quality of life was assessed on study enrollment (baseline) and at an average of 99 days follow-up. At baseline, SF-36 scores for Old- and New-to-Epo patients were well below those observed in the general population, reflecting substantial impairments in functional status and well-being among patients with chronic renal failure. Significant improvements from baseline to follow-up were observed among New-to-Epo patients in vitality, physical functioning, social functioning, mental health, looking after the home, social life, hobbies, and satisfaction with sexual activity (P < 0.05 for each). The mean improvements in hematocrit values among New-to-Epo and Old-to Epo patients were 4.6 and 0.3, respectively. At the time of follow-up, SF-36 scores for New-to-Epo patients were comparable with those observed among Old-to-Epo patients, whose scores did not change significantly from baseline to follow-up. Analysis of the relationship between Epo therapy, hematocrit values, and health-related quality of life suggest that some of the beneficial quality-of-life effects of Epo are mediated through a change in hematocrit level.

Erythropoietin and cytokine levels in the anemia of severe alcoholic liver disease.

PURPOSE: The anemia of chronic disease is mediated by the cytokines that modulate the immune response, such as tumor necrosis factor (TNF) and gamma-interferon (gamma-IFN), and is associated with a blunted serum erythropoietin (sEPO) response to anemia. Previous reports suggest that patients with liver disease (LD) also exhibit a blunted sEPO response to anemia, and that patients with alcoholic LD had altered cytokines, including elevated TNF levels. To investigate the pathogenesis of anemia in alcoholic LD, sEPO, TNF, and gamma-IFN levels were determined in patients who had participated in a Department of Veterans Affairs Cooperative study of alcoholic LD. METHODS: sEPO, serum TNF-alpha, and serum gamma-IFN levels were evaluated in 40 patients with severe biopsy-proven alcoholic LD whose serum had been stored during the Department of Veterans Affairs Cooperative Study 275, and in 18 patients with iron deficiency (controls). RESULTS: Mean hemoglobin (Hgb) was 11.2 +/- 0.3 g/dl for LD patients versus 11.4 +/- 0.4 g/dl for controls (p = 0.84). sEPO levels measured by ELISA were 29.6 +/- 4.1 units/liter in LD patients versus 25.4 +/- 5.4 units/liter in controls (p = 0.64). In both sets of patients, sEPO and Hgb were inversely related; the slopes of the two regression lines did not differ significantly (p = 0.92). TNF was detected in 3 of 40 LD patients and in 0 of 18 iron-deficient patients. Detection of TNF did not correlate with sEPO or Hgb, but did correlate strongly with severe caloric malnutrition (marasmus) and mortality at 6 months (p = 0.049 and 0.04, respectively). gamma-IFN was not detected. CONCLUSIONS: These findings indicate that the sEPO response is preserved in patients with severe alcoholic LD, and suggest that anemia in LD arises from different mechanisms than does the anemia of chronic disease. TNF production in severe alcoholic LD is strongly correlated with caloric malnutrition and mortality.

[A study of anemia and life activity in the elderly].

One hundred senior citizens aged 80 years and over in homes for the aged were evaluated for the incidence of anemia (hemoglobin under 11.0 g/dl), Hb concentration, serum iron, and total iron binding capacity (TIBC). The subjects were classified into different groups according to age distribution (80-84, 85-89, over 90), as well as sex and life activity levels. In the 80-84 year age group, the Hb concentration was 0.5 g/dl higher than that in the other age groups. The Hb values of the male subjects were 1 g/dl higher than the corresponding values for female subjects. Subjects classified as bedridden had Hb values 1.2 g/dl lower than those in the groups that had higher activity levels (p < 0.001). The incidence of anemia was independent of sex and age differences; however, differences in activity levels were significant (p < 0.001). There are 53 patients with some diseases, urinary tract infections, bed sores (over 3 cm diameter), chronic bronchitis, progressive cancers and chronic rheumatoid arthritis, which may be origins of anemia. Seventy six percent of bedridden patients have one or two of the above diseases and 30% of non-bedridden patients have these diseases. The difference was statistically significant (p < 0.001). In the bedridden group, the differences of the mean Hb levels and the rates of anemia in patients with and without disease were not statistically significant (p > 0.1 in both factors). These facts indicate that the bedridden elderly have a high risk of anemia which is independent of some infectious and malignant diseases.