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1.
Impact of blood lead level on haemoglobin and intelligence among school children living near lead based industries.
Maheswari, BU, Vijayaraghavan, R, Venkatesh, T
Pakistan journal of pharmaceutical sciences. 2018;(3):807-812
Abstract
Blood lead level and its impact on haemoglobin and intelligence among school children near lead based industries, and to supplement them with a nutritious food for its effect, were studied. Blood was withdrawn from 120 children (9-12 years) and lead was estimated by Lead Care Analyzer Kit and haemoglobin by auto analyser. Culture Fair Non-verbal Test was used to assess the Intelligence Quotient. After pre-test, the experimental group (n = 60) were given nutritional supplementation for 3 months and education on hygiene measures, while the control group (n = 60) did not receive them. Food supplementation and education significantly decreased the lead level in the experimental group (8.8±0.5 to 6.9±0.4, μg/dL, mean ± SE) but not in the control group. The intelligence score improved in the experimental group but not in the control group. A negative correlation was observed between the lead level and intelligence. No improvement was observed in the haemoglobin. This study shows that the blood lead level in children near lead based industries is high and is negatively correlated with intelligence. Supplementation of nutritious food and education on hygiene measures have decreased the lead level and increased the intelligence score.
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2.
Anemia and acute coronary syndrome: current perspectives.
Stucchi, M, Cantoni, S, Piccinelli, E, Savonitto, S, Morici, N
Vascular health and risk management. 2018;:109-118
Abstract
Reference hemoglobin (Hb) values for the definition of anemia are still largely based on the 1968 WHO Scientific Group report, which established a cutoff value of <13 g/dL for adult men and <12 g/dL for adult nonpregnant women. Subsequent studies identified different normal values according to race and age. Estimated prevalence of anemia on admission in the setting of an acute coronary syndrome (ACS) is between 10% and 43% of the patients depending upon the specific population under investigation. Furthermore, up to 57% of ACS patients may develop hospital-acquired anemia (HAA). Both anemia on admission and HAA are associated with worse short- and long-term mortality, even if different mechanisms contribute to their prognostic impact. Baseline anemia can usually be traced back to preexisting disease that should be specifically investigated and corrected whenever possible. HAA is associated with clinical characteristics, medical therapy and interventional procedures, all eliciting cardiovascular adaptive response that can potentially worsen myocardial ischemia. The intrinsic fragility of anemic patients may limit aggressive medical and interventional therapy due to an increased risk of bleeding, and could independently contribute to worse outcome. However, primary angioplasty for ST elevation ACS should not be delayed because of preexisting (and often not diagnosed) anemia; delaying revascularization to allow fast-track anemia diagnosis is usually feasible and justified in non-ST-elevation ACS. Besides identification and treatment of the underlying causes of anemia, the only readily available means to reverse anemia is red blood cell transfusion. The adequate transfusion threshold is still being debated, although solid evidence suggests reserving red blood cell transfusions for patients with Hb level <8 g/dL and considering it in selected cases with Hb levels of between 8 and 10 g/dL. No evidence supports the use of iron supplements and erythropoiesis-stimulating agents in the setting of ACS.
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Investigations on the role of hemoglobin in sulfide metabolism by intact human red blood cells.
Bianco, CL, Savitsky, A, Feelisch, M, Cortese-Krott, MM
Biochemical pharmacology. 2018;:163-173
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Abstract
In addition to their role as oxygen transporters, red blood cells (RBCs) contribute to cardiovascular homeostasis by regulating nitric oxide (NO) metabolism via interaction of hemoglobin (Hb) with nitrite and NO itself. RBCs were proposed to also participate in sulfide metabolism. Although Hb is known to react with sulfide, sulfide metabolism by intact RBCs has not been characterized so far. Therefore we explored the role of Hb in sulfide metabolism in intact human RBCs. We find that upon exposure of washed RBCs to sulfide, no changes in oxy/deoxyhemoglobin (oxy/deoxyHb) are observed by UV-vis and EPR spectroscopy. However, sulfide reacts with methemoglobin (metHb), forming a methemoglobin-sulfide (metHb-SH) complex. Moreover, while metHb-SH is stable in cell-free systems even in the presence of biologically relevant thiols, it gradually decomposes to produce oxyHb, inorganic polysulfides and thiosulfate in intact cells, as detected by EPR and mass spectrometry. Taken together, our results demonstrate that under physiological conditions RBCs are able to metabolize sulfide via intermediate formation of a metHb-SH complex, which subsequently decomposes to oxyHb. We speculate that decomposition of metHb-SH is preceded by an inner-sphere electron transfer, forming reduced Hb (which binds oxygen to form oxyHb) and thiyl radical (a process we here define as "reductive sulfhydration"), which upon release, gives rise to the oxidized products, thiosulfate and polysulfides. Thus, not only is metHb an efficient scavenger and regulator of sulfide in blood, intracellular sulfide itself may play a role in keeping Hb in the reduced oxygen-binding form and, therefore, be involved in RBC physiology and function.
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The clinical utility of new reticulocyte and erythrocyte parameters on the Sysmex XN 9000 for iron deficiency in pregnant patients.
Levy, S, Schapkaitz, E
International journal of laboratory hematology. 2018;(6):683-690
Abstract
INTRODUCTION Iron deficiency (ID) is a major cause of morbidity in pregnancy. Antenatal clinics use a hemoglobin to screen for ID, which delays the diagnosis of subclinical ID. The aim of this study was to investigate the clinical utility of the percentage of microcytic red cells (%Micro-R), percentage of hypochromic red cells (%Hypo-He), and reticulocyte hemoglobin content (Ret-He) on the Sysmex hematology analyzer in pregnant patients. METHODS For this study, 102 nonanemic patients in the first trimester of pregnancy presenting for the first time to antenatal clinic were screened for ID. There were 50 (49.02%) patients with ID as defined according to iron studies. The independent t test and receiver operating characteristic (ROC) analysis were applied. RESULTS There was a significant difference in the Ret-He, %Micro-R, and %Hypo-He between the ID and non-ID groups (P < 0.001). The area under curve (AUC) for the Ret-He (0.81, 95% CI 0.71-0.88) indicates that the Ret-He at a cutoff <31.2 pg is the best discriminator of ID (P < 0.0001). The AUC of %Hypo-He (0.78, 95% CI 0.69-0.86) was not superior to the mean cell hemoglobin (0.78, 95% CI 0.69-0.86). The %Micro-R (0.79, 95% CI 0.70-0.87) showed improved diagnostic accuracy compared to mean cell volume (0.75, 95% CI 0.65-0.83). CONCLUSION The new reticulocyte and erythrocyte parameters are reliable tests for the diagnosis of subclinical ID in pregnant patients. Further studies, however, are required to confirm the diagnostic utility of the erythrocyte parameters in pregnant patients. These tests will benefit the management of pregnant patients attending antenatal clinic.
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Anemia and coronary artery disease: pathophysiology, prognosis, and treatment.
Rymer, JA, Rao, SV
Coronary artery disease. 2018;(2):161-167
Abstract
The mechanisms, pathophysiology, and treatment of anemia in coronary artery disease (CAD) are complex. The hemodynamic changes found in the acute anemic state may contribute to progressive arterial wall and left ventricular hypertrophy if the anemic state persists chronically. We will examine the evidence for anemia as an independent risk factor for CAD events and cardiovascular mortality after percutaneous coronary intervention. We will also investigate the thresholds for appropriate blood transfusion in patients with CAD, as well as the cardiovascular outcomes associated with the utilization of a liberal versus conservative blood transfusion strategy. Although there is evidence supporting the use of intravenous iron replacement in patients with congestive heart failure, we will demonstrate the lack of evidence for iron replacement in patients with CAD. Finally, we will examine the evidence for increased cardiovascular mortality and venous thromboembolic events with the use of erythropoietin-stimulating agents in patients with CAD.
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6.
Intravenous iron isomaltoside improves hemoglobin concentration and iron stores in female iron-deficient blood donors: a randomized double-blind placebo-controlled clinical trial.
Gybel-Brask, M, Seeberg, J, Thomsen, LL, Johansson, PI
Transfusion. 2018;(4):974-981
Abstract
BACKGROUND This trial evaluated the efficacy and safety of intravenous (IV) iron isomaltoside (Monofer) in comparison with placebo in first-time female blood donors. STUDY DESIGN AND METHODS The trial was a prospective, double blind, placebo-controlled, randomized, comparative, single-center trial of 85 first-time female blood donors. The subjects were randomly assigned 1:1 to either 1000 mg IV iron isomaltoside infusion or placebo. The primary endpoint of the trial was change in hemoglobin (Hb) from baseline to right before the third blood donation. RESULTS The increase in Hb was significantly higher for iron isomaltoside compared with placebo right before both the second blood donation (p = 0.0327) and the third blood donation (primary endpoint, p < 0.0001). Improvements in other iron-related variables (plasma iron, plasma ferritin, transferrin saturation, and reticulocyte count) in favor of iron isomaltoside were also observed. The trial was not powered on patient-reported outcomes. However, improvements in iron stores and Hb levels after iron isomaltoside administration were supported by the fact that several of the fatigue symptoms scores showed numerical differences in favor of iron isomaltoside. There were no differences in side effects between the groups. CONCLUSION In iron-deficient female blood donors a single IV iron isomaltoside administration resulted in an improvement in Hb concentration and iron stores and demonstrated a favorable safety profile comparable to placebo.
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Hemoglobin level and XRCC1 polymorphisms to select patients with locally advanced rectal cancer candidate for neoadjuvant chemoradiotherapy with concurrent capecitabine and a platinum salt.
Formica, V, Benassi, M, Del Vecchio Blanco, G, Doldo, E, Martano, L, Portarena, I, Nardecchia, A, Lucchetti, J, Morelli, C, Giudice, E, et al
Medical oncology (Northwood, London, England). 2018;(6):83
Abstract
A platinum salt (oxaliplatin or cisplatin) is widely used to enhance chemoradation (CRT) response. The potential of cisplatin in neoadjuvant CRT for locally advanced rectal cancer (LARC) has not been fully investigated. Consecutive patients with histologically confirmed LARC were treated with standard pelvic radiotherapy and concurrent cisplatin plus capecitabine (CisCape CRT). Surgery and eight cycles of adjuvant FOLFOX4 were offered to all patients after CRT. Common biochemical variables and key germline genetic polymorphisms were analyzed as predictors of pathological complete response (pCR). Fifty-one patients were enrolled. pCR (regression AJCC grade 0) was documented in 7 patients (14%), nearly complete response (AJCC grade 1) in 10 pts. There was a strong association between disease-free survival and AJCC grade (p 0.0047). Grade 3-4 toxicities (mainly diarrhea) was observed in 41% of patients. Among all analyzed variables, baseline hemoglobin (Hb) was significantly associated with AJCC grade 0-1 response (p 0.027). As for the pharmacogenetic analysis, XRCC1 rs25487 polymorphism was significantly associated with AJCC grade 0-1, Odds Ratio 25.8, p 0.049. AJCC grade 0-1 response rate for patients with high Hb and/or XRCC1 rs25487 G/G genotype was as high as 57%. Baseline Hb and XRCC1 polymorphisms are valuable selection criteria for the CisCape CRT regimen, given its otherwise meaningful toxicity.
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Effects of iron supplementation and nutrition education on haemoglobin, ferritin and oxidative stress in iron-deficient female adolescents in Palestine: randomized control trial.
Jalambo, M, Karim, N, Naser, I, Sharif, R
Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit. 2018;(6):560-568
Abstract
BACKGROUND Iron deficiency and iron-deficiency anaemia are associated with oxidative stress, but their role is largely unclear. Information is scarce on the effects of iron supplementation on biomarkers of oxidative stress in humans. AIMS This study evaluated the effectiveness of iron supplementation and nutrition education on improving the levels of haemoglobin and ferritin, and decreasing oxidative stress among iron-deficient female adolescents in Gaza, Palestine. METHODS A total 131 iron-deficient female adolescents were recruited and allocated randomly into 3 different groups. The iron supplementation group (A) received 200 mg of ferrous fumarate weekly during the 3-month intervention, the iron supplementation with nutrition education group (B) received iron supplements with nutrition education sessions, and the control group (C) did not receive any intervention. The levels of haemoglobin, ferritin and malonyl dialdehyde were measured at baseline, after 3 months (at which point the intervention was stopped), and then 3 months later. Trial registration number: ACTRN12618000960257. RESULTS Haemoglobin levels increased significantly after supplementation in both groups A and B. At the follow-up stage (3 months after stopping the intervention), iron and haemoglobin levels in group B continued to increase and malonyl dialdehyde decreased. In Group A, haemoglobin, ferritin and malonyl dialdehyde levels decreased after 3 months of stopping the intervention. No changes were seen in Group C. CONCLUSIONS A nutrition programme should be adopted and integrated into comprehensive intervention programmes to target iron-deficiency anaemia among female adolescents in Palestine.
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Reference Values of Reticulocyte Hemoglobin Content in Healthy Adolescents.
Ibáñez-Alcalde, MM, Vázquez-López, MÁ, Ruíz-Sánchez, AM, Lendínez-Molinos, FJ, Galera-Martínez, R, Bonillo-Perales, A, Parrón-Carreño, T
Journal of pediatric hematology/oncology. 2018;(4):298-303
Abstract
Assessing iron status in a pediatric population is not easy, as it is based on parameters that undergo physiological variations in childhood and adolescence. Analysis of the reticulocyte hemoglobin content (CHr) to screen for iron deficiency may increase the accuracy of diagnosis, but, to date, reference values in healthy adolescents have not been adequately determined. A cross-sectional study was conducted on a population-based representative sample in the city of Almería (Spain), with 253 healthy non-iron-deficient (ID) subjects, aged 12 to 16 years. The mean CHr value was 31.6±1.3 pg. The CHr 2.5 percentile was 28.7 pg. There were no significant differences as regards age or sex. In the multivariate linear regression analysis, sex did not influence the variability of CHr, but it was related to age. CHr was influenced by hemoglobin and the Mentzer index, as well as by functional iron indicators such as erythrocyte protoporphyrin and serum transferrin receptor. These independent variables predicted two thirds of the variability in healthy adolescents (R=0.55). This study provides CHr reference ranges in healthy adolescents for use in clinical practice for the early detection of ID states. In populations with similar sociodemographic characteristics, values above the 2.5 percentile rule out ID, as values under the 2.5 percentile could be suggestive of functional ID.
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Haemoglobin glycation index and risk for diabetes-related complications in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial.
van Steen, SC, Woodward, M, Chalmers, J, Li, Q, Marre, M, Cooper, ME, Hamet, P, Mancia, G, Colagiuri, S, Williams, B, et al
Diabetologia. 2018;(4):780-789
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AIMS/HYPOTHESIS Previous studies have suggested that the haemoglobin glycation index (HGI) can be used as a predictor of diabetes-related complications in individuals with type 1 and type 2 diabetes. We investigated whether HGI was a predictor of adverse outcomes of intensive glucose lowering and of diabetes-related complications in general, using data from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. METHODS We studied participants in the ADVANCE trial with data available for baseline HbA1c and fasting plasma glucose (FPG) (n = 11,083). HGI is the difference between observed HbA1c and HbA1c predicted from a simple linear regression of HbA1c on FPG. Using Cox regression, we investigated the association between HGI, both categorised and continuous, and adverse outcomes, considering treatment allocation (intensive or standard glucose control) and compared prediction of HGI and HbA1c. RESULTS Intensive glucose control lowered mortality risk in individuals with high HGI only (HR 0.74 [95% CI 0.61, 0.91]; p = 0.003), while there was no difference in the effect of intensive treatment on mortality in those with high HbA1c. Irrespective of treatment allocation, every SD increase in HGI was associated with a significant risk increase of 14-17% for macrovascular and microvascular disease and mortality. However, when adjusted for identical covariates, HbA1c was a stronger predictor of these outcomes than HGI. CONCLUSIONS/INTERPRETATION HGI predicts risk for complications in ADVANCE participants, irrespective of treatment allocation, but no better than HbA1c. Individuals with high HGI have a lower risk for mortality when on intensive treatment. Given the discordant results and uncertain relevance beyond HbA1c, clinical use of HGI in type 2 diabetes cannot currently be recommended.