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1.
Splanchnic-Cerebral Oxygenation Ratio Decreases during Enteral Feedings in Anemic Preterm Infants: Observations under Near-Infrared Spectroscopy.
Braski, K, Weaver-Lewis, K, Loertscher, M, Ding, Q, Sheng, X, Baserga, M
Neonatology. 2018;(1):75-80
Abstract
BACKGROUND Anemia is common in premature infants. Due to risks with red blood cell transfusions, many anemic infants are not transfused. The implications of this pathophysiologic status, especially at times of increased metabolic demand (enteral feedings), is not well understood. Near-infrared spectroscopy (NIRS) allows for the noninvasive determination of regional oxygen saturations (rSO2) in tissues such as the brain and mesentery, giving insight into their oxygen sufficiency. OBJECTIVE We tested the hypothesis that during enteral feedings very low birth weight (VLBW) infants with a hematocrit ≤28% will experience a decrease in splanchnic rSO2 and splanchnic-cerebral oxygenation ratio (SCOR). METHODS This prospective, observational, 2-centered study included VLBW infants receiving full enteral feedings with a hematocrit ≤28%. Cerebral and splanchnic rSO2 were monitored via NIRS for 24 h. Average values were calculated for periods immediately preceding, during, and after each feeding. SCOR was calculated from these values (rSO2 splanchnic/rSO2 cerebral), and data were analyzed using a linear mixed effect model. RESULTS Fifty neonates with a median gestational age of 28 weeks (range 23-32), a birth weight of 1,118 ± 284 g (mean ± SD), and a hematocrit of 26 ± 2% (mean ± SD) were studied. During feedings, SCOR decreased significantly from baseline (0.72 ± 0.17 to 0.69 ± 0.17, p = 0.043). With feedings, there was a trend of decreased splanchnic rSO2 (47 ± 11 to 45 ± 10, p = 0.057) and no change in cerebral rSO2 (66 ± 8 to 66 ± 7, p = 0.597). CONCLUSIONS VLBW infants with a hematocrit ≤28% had a decrease in SCOR and a trend towards decreased splanchnic rSO2 with enteral feedings.
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Factors associated with ultrasound-guided water enema reduction for pediatric intussusception in resource-limited setting: potential predictive role of thrombocytosis and anemia.
Lim, RZM, Lee, T, Ng, JYZ, Quek, KF, Abdul Wahab, N, Amansah, SL, Vellusamy, VMAM, Ngim, CF
Journal of pediatric surgery. 2018;(11):2312-2317
Abstract
BACKGROUND/PURPOSE Although ultrasound-guided hydrostatic reduction (USGHR) is increasingly used in managing pediatric intussusception, there is limited literature concerning its use in Malaysia. We aim to examine the experience and factors associated with the effectiveness of USGHR using water. METHODS This is a single-center retrospective observational study in a Malaysian tertiary referral center. Children with intussusception admitted between year 2012 and 2016 were included and medical records reviewed. Factors associated with success or failure of USGHR were identified using multivariable logistic regression. RESULTS Of the 172 cases included, 151 cases (87.8%) underwent USGHR, of whom 129 cases were successfully reduced (success rate of 85.4%). One perforation (0.7%) was reported. Age more than 3years old (aOR=7.16; 95% CI=1.07-47.94; p=0.042), anemia (aOR=10.12; 95% CI=1.12-91.35; p=0.039), thrombocytosis (aOR=11.21; 95% CI=2.06-64.33; p=0.005) and ultrasound findings of free fluid (aOR=9.39; 95% CI=1.62-54.38; p=0.012) and left-sided intussusception (aOR=8.18;95% CI=1.22-54.90, p=0.031) were independently associated with USGHR irreducibility. Symptom duration, blood in stool, vomiting and other clinical presentations, however, showed no association. CONCLUSIONS USGHR with water is effective in the non-operative management of pediatric intussusception. Prolonged symptom duration need not necessarily preclude USGHR. The findings of anemia and thrombocytosis as independent predictors of USGHR irreducibility deserve further study. TYPE OF STUDY Treatment study LEVEL OF EVIDENCE III.
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Impact of preoperative anemia on outcomes in patients undergoing curative resection for gastric cancer: a single-institution retrospective analysis of 2163 Chinese patients.
Liu, X, Qiu, H, Huang, Y, Xu, D, Li, W, Li, Y, Chen, Y, Zhou, Z, Sun, X
Cancer medicine. 2018;(2):360-369
Abstract
We sought to evaluate whether preoperative anemia was an important determinant of survival in gastric cancer (GC). A single institution cohort of 2163 GC patients who underwent curative resection were retrospectively analyzed. Anemia was defined as a preoperative hemoglobin level <120 g/L in males and <110 g/L in females. Overall survival (OS) was analyzed using the Kaplan-Meier method, and a multivariate Cox proportional hazards model was performed to identify the independent prognostic factor. Anemic patients had a poorer OS compared with nonanemic patients after resection for tumor-nodes-metastasis (TNM) stage III tumors (5-year OS rate: 32.2% vs. 45.7%, P < 0.001) but not stage I (P = 0.480) or stage II (P = 0.917) tumors. Multivariate analysis revealed that preoperative anemia was an independent prognostic factor in TNM stage III (hazard ratio [HR], 1.771; 95% CI, 1.040-3.015; P = 0.035). In a stage-stratified analysis, preoperative anemia was still independently associated with OS in TNM stages IIIa through IIIc (P < 0.001, P = 0.075, and P = 0.012, respectively), though the association was only marginal in stage IIIb. Of note, preoperative mild anemia had a similar prognostic value in TNM stage III GC. Furthermore, preoperative anemia was significantly associated with more perioperative transfusions, postoperative complications and several nutritional-based indices, including the prognostic nutritional index (PNI), preoperative weight loss and performance status (all P < 0.05). Preoperative anemia, even mild anemia, was an important predictor of postoperative survival for TNM stage III GC.
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4.
Prolyl Hydroxylase Inhibitors: A Breakthrough in the Therapy of Anemia Associated with Chronic Diseases.
Joharapurkar, AA, Pandya, VB, Patel, VJ, Desai, RC, Jain, MR
Journal of medicinal chemistry. 2018;(16):6964-6982
Abstract
Chronic kidney disease, cancer, chronic inflammatory disorders, nutritional, and genetic deficiency can cause anemia. Hypoxia causes induction of hypoxia-inducible factor (HIF), which stimulates erythropoietin (EPO) synthesis. Prolyl hydroxylase domain (PHD) enzyme inhibition can stabilize hypoxia-inducible factor (HIF). HIF stabilization also decreases hepcidin, a hormone of hepatic origin, which regulates iron homeostasis. PHD inhibitors represent a novel pharmacological treatment of anemia associated with chronic diseases. Many orally active PHD inhibitors like roxadustat, molidustat, vadadustat, and desidustat are in late phase clinical trials. This review discusses the role of PHD inhibitors in the treatment of anemia associated with chronic diseases.
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Causes of microcytic anaemia and evaluation of conventional laboratory parameters in the differentiation of erythrocytic microcytosis in blood donors candidates.
Carlos, AM, Souza, BMB, Souza, RAV, Resende, GAD, Pereira, GA, Moraes-Souza, H
Hematology (Amsterdam, Netherlands). 2018;(9):705-711
Abstract
CONTEXT AND OBJECTIVE Microcytic anaemia results from defective synthesis of haemoglobin in the erythroid precursors, causing a reduction in its mean corpuscular volume (MCV). The most common causes of microcytosis, without the increase in HbA2 levels, are iron deficiency anaemia (IDA) and α-thalassemia. The aim of this study was to identify the causes of microcytic anaemia and evaluate the haematological parameters from blood donors deemed ineligible (due to the low haematocrit level) that would differentiate the IDA and α-thal, whether isolated or in association. METHODS Genomic DNA was submitted to the polymerase chain reaction multiplex for the diagnosis of the most common allele deletions of α-thal and erythrogram and in order to verify haematological parameters. Iron deficiency (ID) was determined through the measurement of serum ferritin. RESULTS Of the 204 samples, 82 (40.2%) were identified with ID, 24 (17.8%) with α-thal and 10 (4.9%) with ID associated with α-thal. In the α-thal with ID group haemoglobin (Hb), MCV, mean corpuscular Hb concentration (MCHC) and mean corpuscular Hb (MCH) values were significantly lower compared to the isolated α-thal. In the group with ID Hb, MCV, MCHC and MCH values were significantly lower compared to those with isolated α-thal. The α-thal with ID group, showed Hb, MCV, MCHC and MCH significantly reduced when compared to those with IDA. CONCLUSIONS This study showed that the values of haematological parameters, especially haematocrit, Hb, MCV, MCH, MCHC and red blood cell distribution width (RDW), are lower in patients with IDA, especially when associated with α-thal and therefore it may be useful to discriminate between the different types of microcytic anaemia.
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Anemia and hypoalbuminemia as risk factors for left ventricular diastolic dysfunction in children with chronic kidney disease on peritoneal dialysis.
García-Bello, JA, Ortiz-Flores, J, Torres de la Riva, FE, Mendoza-Moreno, GK, Gómez-Tenorio, C
Nefrologia. 2018;(4):414-419
Abstract
INTRODUCTION Left ventricular diastolic dysfunction (LVDD) is an independent predictor of mortality in Chronic Kidney Disease (CKD). The increase in the E/e' ratio is an indicator of LVDD. The association between cardiovascular risk factors (CVRFs) and E/e' in children with automated peritoneal dialysis (APD) has not been widely studied. OBJECTIVE To measure the association between CVRFs and E/e' in children with CKD on APD. METHODS Cross-sectional, prolective, observational, analytical study of children aged 6-16 years on APD. We recorded age, gender, time since onset, time on dialysis, and measured weight, height, blood pressure, hemoglobin, albumin, calcium, phosphorus, parathyroid hormone, and C-reactive protein. E/e' ratio was measured and considered to have increased when it was higher than 15. RESULTS Twenty-nine children were studied, (19 females). Age was 14.0±2.5 years, and 16.9±11.2 months with substitutive therapy. One patient had reduced left ventricular ejection fraction, and 21 (72.4%) had increased E/e'. E/e' correlated significantly with hemoglobin (r=-0.53, P=.003). Hemoglobin and albumin were significantly lower (9.72±1.9 vs. 12.2±1.8; P=.004 and 3.6±0.5 vs. 4.0±0.3; P=.035) and the proportion of patients with anemia and hypoalbuminemia was significantly higher (85.7% vs. 37.5%; P=.019 and 61.9% vs. 12.5%; P=.035) in patients with increased E/e'. Hemoglobin was the only independent predictor of E/e' (β=-0.66; P=.020) and patients with anemia were 10 times more likely to have increased E/e' (95% CI 1.5-65.6, P=.016). CONCLUSIONS 75% of the children had increased E/e'. Anemia and hypoalbuminemia were significantly related with an increased E/e'.
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Effect of Zinc Acetate Dihydrate (NobelzinR) Treatment on Anemia and Taste Disorders in Patients with Chronic Kidney Disease with Hypozincemia.
Sato, D, Gohda, T, Kihara, M, Kanaguchi, Y, Kobayashi, T, Mano, S, Sasaki, Y, Nohara, N, Murakoshi, M, Nakata, J, et al
Acta medica Okayama. 2018;(5):535-538
Abstract
Some patients with chronic kidney disease (CKD) receiving hemodialysis develop erythropoietin-resistant anemia, possibly due to zinc deficiency. The frequency of zinc deficiency in CKD (stages 1-5 and 5D) and CKD improvement via zinc supplementation are not completely verified. Here 500 CKD patients (Stage 1/2, n=100; Stage 3, n=100; Stage 4, n=100, Stage n=5, 100; Stage 5D, n=100) will be recruited to determine the frequency of serum zinc deficiency at each CKD stage. Patients with serum zinc concentrations <80 μg/dL will be treated with zinc acetate dihydrate (NobelzinR) to evaluate its effects on hypozincemia, taste disturbances, and anemia.
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Review of the nutrition situation in the Eastern Mediterranean Region.
Nasreddine, L, Ayoub, JJ, Al Jawaldeh, A
Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit. 2018;(1):77-91
Abstract
This situation analysis for the World Health Organization Eastern Mediterranean Region focuses on specific nutrition indicators, namely low birth weight, exclusive breastfeeding, under- and overnutrition (anthropometric indicators) and anaemia. The regional average prevalence of low birth weight and exclusive breastfeeding was estimated at 19.31% and 29.3%, respectively. Stunting, wasting and underweight had an average prevalence of 28%, 8.69% and 18%, respectively. Afghanistan, Djibouti, Pakistan, Sudan and Yemen had the highest burden of stunting (> 30%). Prevalence of anaemia ranged from 7.4% to 88% in children aged < 5 years and from 19.9% to 63% in women of childbearing age. Of concern is the increasing trend in overweight and obesity among adults and children. Average prevalence of overweight and obesity was 27% and 24% in adults and 16.5% and 4.8% in school-aged children, respectively. The highest levels of obesity were reported from Bahrain, Kuwait, Qatar and the United Arab Emirates. This review highlights the double burden of malnutrition in countries of the Region and calls for the prioritization of policies aimed at improving the population's nutritional status.
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[Anemia in patients with acute coronary syndrome in the Vichy Hospital center].
Ntima, G, Bepouka, B, Tixier, V, Ferrier, N, Marcaggi, X
Annales de cardiologie et d'angeiologie. 2018;(5):321-326
Abstract
INTRODUCTION Objectives were to determine the clinical, epidemiological and biological profile of the patients suffering from acute coronary syndrome and presenting the anaemia, the determinants of variation of the haemoglobin rate, and to estimate the impact of the anaemia on the prognosis of these patients. PATIENTS AND METHODS Retrospective and observational study conducted in the cardiology department of Vichy Hospital in France. All patients with acute coronary syndrome admitted from 31 of October 2015 to 30 of April 2016 were selected. The patients were followed for 1 month. The anaemia was defined by: less than 13g/dL in man and less than 12g/L in woman (WHO definition). Biological markers were taken at the admission. Factors associated to the haemoglobin rate were analysed by multivariate linear regression and those associated to the mortality within 30 days were analysed by logistic regression. RESULTS Among 251 included patients, there were 180 males and 71 females with the average age of 67 years. 94 patients had ST elevation myocardial infarction (STEMI), 116 had Non ST myocardial infarction (NSTEMI) and 41 had unstable angina. Haemoglobin value was known in 238 patient's, among whom 44.1% were anaemic (105/238). The anaemia was more frequent in women. The tobacco was less frequent; High blood pressure, renal failure, malnutrition, subclinical atherosclerosis, lower limb arteritis and the inflammatory syndrome were more frequent in patients with anaemia. They presented more complications. The age (P=0,003), the pulsed pressure (P=0,007), LVEF (P=0,005), the albumin (P=0,010), Creatine kinase (CK) level (P=0,048) and of CRP (P=0,011), were linear factors of variations of the haemoglobin rate (R2=0,955). Ten patients died during the follow-up. The multivariate analysis revealed the anaemia as independently associated with the mortality in 30 days (Odds Ratio 3,69; P=0,02). CONCLUSION Anaemia is frequent in patients with an ACS, and it is associated with a particular clinical and biological profile. The patients with anaemia have a mortality rate in 30 days higher than the patients without anaemia.
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Intravenous iron and erythropoiesis-stimulating agents in haemodialysis: A systematic review and meta-analysis.
Roger, SD, Tio, M, Park, HC, Choong, HL, Goh, B, Cushway, TR, Stevens, V, Macdougall, IC
Nephrology (Carlton, Vic.). 2017;(12):969-976
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Abstract
AIM: Higher dosages of erythropoiesis-stimulating agents (ESAs) have been associated with adverse effects. Intravenous iron is used to optimize ESA response and reduces ESA doses in haemodialysis patients; this meta-analysis evaluates the magnitude of this effect. METHODS A literature search was performed using MEDLINE, Embase and the Cochrane Collaboration Central Register of Clinical Trials from inception until December 2014, to identify randomized controlled trials of intravenous iron and ESA, in patients undergoing haemodialysis for end-stage kidney disease. Dosing of IV iron in concordance with the Kidney Disease Improving Global Outcomes guidelines was considered optimal iron therapy. RESULTS Of the 28 randomized controlled trials identified, seven met the criteria for inclusion in the meta-analysis. Results of random-effects meta-analysis show a statistically significant weighted mean (95% CI) difference of -1733 [-3073, -392] units/week in ESA dose for optimal iron versus suboptimal iron. The weighted average change in ESA dose was a reduction of 23% (range -7% to -55%) attributable to appropriate dosing of intravenous iron. A comparison of intravenous iron versus oral iron/no iron (five trials) showed a greater reduction in ESA dose, although this did not reach statistical significance (weighted mean difference, 95% CI: -2,433 [-5183, 318] units/week). The weighted average change in ESA dose across the five trials was a reduction of 31% (range -8% to -55%). CONCLUSION Significant reductions in ESA dosing may be achieved with optimal intravenous iron usage in the haemodialysis population, and suboptimal iron use may require higher ESA dosing to manage anaemia.