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Anemia in the aged is a frequent but still under-estimated problem in geriatric patients. However, in recent years increasing research on anemia in the aged has improved awareness and interest in this clinically relevant problem. Guidelines for diagnostic and therapeutic steps are now required to improve the treatment of anemic aged patients. For encouraging the development of diagnostic and therapeutic recommendations, the “working group anemia” of the German Geriatric Society (DGG) has issued a position paper on anemia in the aged, based on the current literature. The statements are (1) that anemia has to be considered a highly prevalent but not a physiologic finding in aged persons; (2) that reference values for hemoglobin concentration are independent of age, indicating that WHO reference values for anemia definition are valid for aged persons; (3) that anemia in the aged is associated with functional and cognitive impairment based on comprehensive geriatric assessment (CGA), requiring diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) in children is a rare but devastating condition. Once a critical amount of nephron mass has been lost, progression of CKD is irreversible and results in end-stage renal disease (ESRD) and need of renal replacement therapy. The time course of childhood CKD is highly variable. While in children suffering from congenital anomalies of the kidneys and the urinary tract, progression of CKD in general is slow, in children with acquired glomerulopathies, disease progression can be accelerated resulting in ESRD within months. However, irrespective of the underlying kidney disease, hypertension and proteinuria are independent risk factors for progression. Thus, in order to prevent progression, the primary objective of treatment should always aim for efficient control of blood pressure and reduction of urinary protein excretion. Blockade of the renin-angiotensin-aldosterone system preserves kidney function not only by lowering blood pressure, but also by reducing proteinuria and exerting additional anti-proteinuric, anti-fibrotic, and anti-inflammatory effects. Besides, intensified blood pressure control, aiming for a target blood pressure below the 50th percentile, may exert additive renoprotective effects. Additionally, other modifiable risk factors, such as anemia, metabolic acidosis, dyslipidemia, and altered bone-mineral homeostasis may also contribute to CKD progression. In conclusion, beyond strict blood pressure control and reduction of urinary protein excretion, identification and treatment of both, renal disease-related and conventional risk factors are mandatory in children with CKD in order to prevent deterioration of kidney function. [ABSTRACT FROM AUTHOR]

In this paper we attempt to answer the following question: "Is it possible to obtain reliable estimates for the prevalence of anemia rates in children under five years in the districts of Peru?" Specifically, the objective of the present paper is to understand to which extent employing the basic and the spatial Fay–Herriot models can compensate for inadequate sample size in most of the sampled districts, and whether the way of choosing the spatial neighbors has an impact on the resulting inference. Furthermore, we explore the question of how to choose an optimal way to define the neighbors. As such, our research focuses on studying the prediction accuracy of the aforementioned models, and on the sensitivity of the results to the definition of "neighbor". We use the data from the Demographic and Family Health Survey of the year 2019, and the National Census carried out in 2017. [ABSTRACT FROM AUTHOR]

Intravenous iron administration has emerged as a crucial intervention for managing patients with cardiorenal syndrome (CRS) and iron deficiency, with or without the presence of anemia. Multiple studies have demonstrated the benefits of intravenous iron supplementation in improving anemia, symptoms, and functional capacity in patients with HF and iron deficiency. Furthermore, iron supplementation has been associated with a reduction in hospitalizations for HF exacerbation and the improvement of patients' quality of life and clinical outcomes. In addition to its effects on HF management, emerging evidence suggests a potential positive impact on kidney function in patients with CRS. Studies have shown an increase in estimated glomerular filtration rate and improvements in renal function markers in patients receiving intravenous iron therapy, highlighting the potential of this intervention in patients with CRS. This paper reviews the existing literature on the impact of intravenous iron therapy in these patient populations and explores its effects on various clinical outcomes. Future research endeavors are eagerly awaited to further improve our understanding of its clinical implications and optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To characterize pregnant women admitted to Irene Neto Maternity Hospital, Lubango city, Huíla province, and their pregnancy outcomes. Methods: We conducted a descriptive cross-sectional facility-based survey between October 2016 and September 2017, involving 500 pregnant women, followed from admission in labor until the end of delivery. Mean (SD) was computed for quantitative variables, while relative and absolute frequencies were determined for categorical variables. Additionally, confidence intervals were estimated. Results: Among pregnant women 18.3% were adolescents (≤ 19 years) and 14.5% had advanced maternal age (≥ 35 years). Illiteracy was reported by 8.2%. One in three (33.6%) had a short stature (< 1.55 m). Malaria was the most frequent infection during pregnancy (16.3%). Upon admission, 18.1% were anemic (Hb < 11 g/dl) and 36.0% had hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg), contrasting with the few cases reported of chronic hypertension and pregnancy-induced hypertension. There were 15 twin pregnancies. Cesarean section was performed in 25.2% of the women, although there was no medical indication for 23.0% of women having cesareans. Two maternal deaths occurred in our sample. Among live births from singleton pregnancies (97.1%), birth asphyxia (Apgar < 7 at 5 min) was observed in 22.7% and 10.3% had low birth weight (< 2.5 kg). Conclusions: There are very few studies reporting pregnancy outcomes in Angola. This analysis presents data from Huíla province, the second most populous province. We identified characteristics for higher risk of adverse pregnancy outcomes: adolescence, illiteracy, and short stature. Among newborn outcomes, birth asphyxia and low birth weight demand special attention. Further research is needed to explore the non-medical indications for cesarean section and to better understand the twinning rate in Lubango. Significance: The significance of this paper is that it is one of the very few reports contributing for the knowledge of detailed maternal, obstetric and newborn outcomes in Angolan women. Although our study only addresses the outcomes descriptively, it can be used as a first step in monitoring and improving outcomes of Angolan women. Maternal and child health is a key issue to address sustainable development in Angola. [ABSTRACT FROM AUTHOR]

Infertility is a common issue that threatens couples worldwide. Infertility can result from the male or female partner alone, or both partners. It can be due to multiple factors related to the patient's overall health or lifestyle. Causes related to patient health can be systemic or related to gonadal dysfunction. One of the systematic causes can be hematological. The two most common hemoglobinopathies that are thought to cause infertility, especially male infertility, are sickle cell disease (SCD) and thalassemia major (TM). These two hemoglobinopathies cause male infertility through pathophysiological alterations. Specifically, they alter the oxygen carrying ability of red blood cells (RBCs), causing tissue hypoxia that affects the normal physiological process of spermatogenesis, eventually inducing infertility. Semen analyses and other systemic blood testing can be used to investigate male infertility. Both hemoglobinopathies can be helped by blood transfusions, which can then alleviate male infertility. This paper aims to explore the relationship between hemoglobinopathies (SCD and TM) and their role in contributing to male infertility, in addition to the role of blood transfusions in addressing male infertility by correcting the root cause. [ABSTRACT FROM AUTHOR]

Iron deficiency anemia (IDA) is one of the most common nutritional problems in patients with obesity and after bariatric surgery. While it can be reduced with diet and oral supplementation, a subset of patients is refractory to these measures. Several factors have been implicated including high hepcidin levels reducing the release of absorbed iron into the circulation. We found 6 papers studying hepcidin levels before and after bariatric surgery. Patients with obesity have higher hepcidin and other inflammatory markers. Five out of six studies reported significant falls in hepcidin levels after bariatric surgery. This was accompanied by an improvement in the RBC morphology indices in restrictive surgeries. However, the fall in hepcidin is not uniform and may be a contributing factor for refractory IDA. [ABSTRACT FROM AUTHOR]

Chronic anemia is an independent risk factor for mortality in patients with heart failure (HF). Restoring physiological hemoglobin (Hb) levels is essential to increase oxygen transport capacity to tissues and improve cell metabolism as well as physical and cardiac performance. Nutritional deficits and iron deficiency are the major causes of chronic anemia, but other etiologies include chronic kidney disease, inflammatory processes, and unexplained anemia. Hormonal therapy, including erythropoietin (EPO) and anabolic treatment in chronic anemia HF patients, may contribute to improving Hb levels and clinical outcomes. Although preliminary studies showed a beneficial effect of EPO therapy on cardiac efficiency and in HF, more recent studies have not confirmed this positive impact of EPO, alluding to its side effect profile. Physical exercise significantly increases Hb levels and the response of anemia to treatment. In malnourished patients and chronic inflammatory processes, low levels of anabolic hormones, such as testosterone and insulin-like growth factor-1, contribute to the development of chronic anemia. This paper aims to review the effect of nutrition, EPO, anabolic hormones, standard HF treatments, and exercise as regulatory mechanisms of chronic anemia and their cardiovascular consequences in patients with HF. [ABSTRACT FROM AUTHOR]

Iron deficiency is the most common nutritional disorder detrimental to the behavior, cognitive performance, immune system, and physical growth of infants and preschool- and school-age children. Iron deficiency anemia (IDA) increases children's susceptibility to some metals, including the highly toxic lead (Pb), but the character of this relationship is still disputed. Thus, this study aimed to review and meta-analyze the association between the IDA and blood lead levels (BLL) among children, based on papers indexed by international scientific databases and published up to September 2021. A search was performed of the literature in several databases including the ISI Web of Science, PubMed, and Scopus. The final papers were assessed concerning their quality based on the Newcastle–Ottawa Scale (NOS) for cross-sectional studies. Moreover, analyses were performed using R statistical software with the "meta" package. Of the 1528 articles found, only 12 studies met the inclusion criteria and were considered in the meta-analysis. Significantly higher BLL in IDA children (SMD = 2.40; CI 95%, 0.93–3.87 µg/L; p = 0.0014) was seen when compared to non-IDA children. Moreover, the pooled OR is equal to 2.75 (CI 95%, 1.10–6.85 µg/L; p = 0.0303) suggesting a higher risk of IDA development among children with BLL > 10 µg/dL. Thus, we recommend systematic monitoring of Fe and Pb levels among children, especially in countries with limited sources of nutritious food. Since only a few studies were available for this meta-analysis, further studies are necessary to examine the association between IDA and BLL in detail. [ABSTRACT FROM AUTHOR]

Background: Anemia during pregnancy is an important global health concern, affecting 40% of women worldwide, and iron deficiency shares a significant proportion of the burden. From conception to birth, pregnancy is a period when women undergo metabolic and physiological changes. The nutritional needs are higher during pregnancy; thus, adequate nutrition is essential to maintain fetal growth and development. However, adverse effects due to deficiency in nutrition during pregnancy can result in maternal, fetal and neonatal complications. Despite the multifactorial etiology of anemia, iron deficiency is assumed as the primary cause of anemia during pregnancy and hence, mitigation strategy pivots around it for anemia management. Therefore, excluding other contributors, a single-micronutrient approach with iron supplements remains a myopic approach and this can exacerbate iron deficiency anemia. Micronutrient deficiencies are of particular concern as they may pose a silent threat to the survival and well-being of reproductive-age women and their infants. Aim: Micronutrients, especially trace minerals, play a myriad of roles in pregnancy, and the lack of each one causes adverse complications to both the mother and the fetus. In this review paper, we attempt to piece together available information regarding the adverse effects of abnormal trace mineral levels along with iron deficiency on the mother and the fetus. Method: A non-systematic literature search in PubMed, Google Scholar, and the Cochrane databases, for publications on minerals and vitamins during pregnancy and the possible influence of supplements on pregnancy outcomes. Conclusion: Micronutrient deficiency exacerbates the pregnancy-induced anemia and other adverse birth outcomes. Micronutrient supplementation during pregnancy can combat anemia as well as reduce a number of adverse pregnancy outcomes in a comprehensive manner. [ABSTRACT FROM AUTHOR]

The study of canine haemoglobin (Hb) components can help to forecast Hb changes during many pathological and physiological processes such as responsive anaemia. The aims of our study were to show canine Hb electrophoretic pattern on cellulose acetate and identify Hb types similar to the human Hb pattern. Blood samples from 78 different canine breeds were randomly collected in tubes containing anticoagulant EDTA. Animals were brought to the Small Animal Teaching Centre for a check-up and vaccination. All blood samples underwent electrophoresis on cellulose acetate paper strips to determine Hb types. Haematocrit and Hb were measured simultaneously. The Hb electrophoresis results showed that Hb A was assigned to most of Hb components on cellulose acetate paper. Also, in some blood samples, Hb A was detected at the cathode end of cellulose acetate paper similar to human Hb A, by densitometer. Small amounts of Hb F were detected in some dogs which was not significant. According to our study, Hb A composes most of the total Hb percent in canine blood. Two types of Hb, A and F, were detected in a few animals, but the majority did not possess Hb F. It seems that Hb F is not significant in these animals. We concluded that one or two Hb types could be seen in dogs. There is no difference in electrophoretic pattern between male and female dogs. [ABSTRACT FROM AUTHOR]

Anemia is the blood disorder which develops in the condition of lack of healthy red blood cells or hemoglobin. According to the World Health Organization (WHO) nearly quarter of the human population suffers from anemia moreover, invasive detection of anemia is tedious and expensive. Initial screening for noninvasive detection of anemia is done by examining the color of eye conjunctiva and after that by accommodating the outcomes with an intrusive blood test. This paper aims to resolve this issues along with providing an optimal and fast solution for detecting the anemia using noninvasive methods. This process includes capturing the image of eyes and then manually extracting the eye conjunctiva and obtaining the region of interest (ROI). Once ROI is extracted, these images are processed to obtain the mean intensity values of red and green components of image pixels corresponding to ROI. Then a tuned machine learning algorithm is used to predict whether the patient is anemic or not. The model employed is run over 99 test subjects using k-Fold cross-validation and had achieved an accuracy of 93 percent. This study aims to develop an automated and cost-effective noninvasive technique. [ABSTRACT FROM AUTHOR]

Purpose of the Review: In this review paper, we examine the latest evidence regarding the use of iron supplementation, erythropoiesis-stimulating agents (ESAs), and blood transfusions as therapeutic targets for anemia to mitigate morbidity and mortality in patients with cardiovascular disease. Recent Findings: Intravenous ferric carboxymaltose (FC) injections in heart failure (HF) have resulted in improved self-reported patient symptoms; higher exercise capacity, as measured by 6-min walk test distance in anemic patients; and lower re-hospitalization rates in iron deficient patients. Darbepoetin alfa has shown evidence of improved Kansas City Cardiomyopathy Questionnaire scores. No mortality benefits have been noted thus far with FC injections or darbepoetin in HF, with an increase in adverse events with darbepoetin. Aggressive transfusions (Hg < 10 g/dL) are not associated with improved outcomes in cardiovascular disease. Summary: Quality of life metrics, rather than mortality, appear to improve with IV FC and ESA use in HF. More studies are required to see if these treatments have a role in coronary artery disease. Current evidence suggests that anemia is a marker of underlying disease severity, with a limited role in disease modification. Further studies are required to solidify our understanding of this topic. [ABSTRACT FROM AUTHOR]

Objectives: With a fourth of all under-five children affected, stunting remains one of the biggest health challenges worldwide. Even though the main underlying factors are known, the exact pathways to stunting varying in affected regions, and interventions thus need to be tailored to the local contexts. This study aimed assessing and comparing factors associated with stunting in two understudied sub-Saharan urban contexts with some of the highest stunting prevalence globally: Bangui, Central African Republic (~ 36%) and Antananarivo, Madagascar (42%). Methods: We performed a case–control study on 175 + 194 stunted and 237 + 230 non-stunted control children aged 2–5 years and matched for age, gender and district of residency. Factors associated with stunting were identified using a standardized, paper questionnaire delivered by trained interviewers. Statistical analysis was done using logistic regression modelling. Results: In both sites, formal maternal education lowered the risk of being stunted and restricted access to soap, suffering of anaemia and low birth weight were associated with higher risk of stunting. Short maternal stature, household head different from parents, diarrhoea and coughing were associated with an increased risk and continuing breastfeeding was associated with a lower risk of stunting in Antananarivo. Previous severe undernutrition and dermatitis/ fungal skin infections were associated with higher and changes in diet during pregnancy with lower risk of stunting in Bangui. Conclusions: Our results suggest maternal education, antenatal care, iron supplementation and simple WASH interventions such as using soap and infection control as general and breastfeeding (Antananarivo) or better nutrition (Bangui) as area-specified interventions. [ABSTRACT FROM AUTHOR]

Background: The ongoing Boko Haram insurgency in northeastern Nigeria has depleted the country's capability to deliver quality healthcare to her citizenry. The ailing health sector is overwhelmed with a rising incidence and prevalence of infectious and non-communicable diseases. Aim: The aim of this paper was to determine the trend of kidney disease, end-stage renal disease (ESRD), anaemia, malnutrition and human immunodeficiency virus (HIV) in northeastern Nigeria. Materials and methods: Data covering different periods between 1999 and 2017 were obtained from the University of Maiduguri Teaching Hospital (UMTH), Maiduguri in northeastern Nigeria. This hospital is the largest tertiary healthcare facility in the region. The data were demographic in nature, i.e. sex, age or simply the registered cases. A quadratic model of time-series analysis was used to create the various trends of the respective diseases with the aid of Minitab software (version 18.0). t-Tests and analysis of variance (ANOVA) were also performed, with a p-value of less than or equal to 0.05 being considered significant. Results: About three out of every five patients treated for kidney disease were male, while three out of every five patients treated for HIV were female. Patients between the ages of 31 and 50 years were at the greatest risk of developing kidney disease. The mean distribution of disease incidence was the same for both sexes for kidney disease, anaemia, malnutrition and HIV. The mean distribution disease incidence was different between age groups for kidney disease but the same for anaemia. The incidence of anaemia and malnutrition reported was almost the same for both sexes. Children under the age of 10 years old were at the most risk of anaemia, with the distribution decreasing with increasing age. The trend analysis of the incidence of kidney disease, ESRD, anaemia and malnutrition showed that these ailments were on the increase, while the number of patients that were on antiretroviral therapy (ART) was on the decline in northeastern Nigeria. Conclusion: These increasing trends are evidences of the effect of Boko Haram on the public health of the people of northeastern Nigeria and will continue to be a public health concern for the region and the country as a whole. [ABSTRACT FROM AUTHOR]

Data provenance focuses on the source of the data and on the identification of data sources and their transformations undergone over time. This paper proposes a generic method for collecting provenance data, and is a follow-up of a study carried out by the same authors in a Brazilian hemotherapy center. This method is based on the W3C's Provenance Data Model (PROV-DM), and proposes a way to capture, store and analyze anemia-index provenance data by applying a scientific workflow, together with the management of provenance of knowledge. This is an exploratory, practical and deductive study carried out with real data from 197,551 candidates for blood donors, extracted from reports ranging from 2000 to 2018 provided by a Brazilian hemotherapy center. People identified with high anemia rates were quantified and tagged as not-suitable for blood donations. The inadequate candidates were quantified with the highest rate of anemia, and out of 1011 male candidates and 4039 female candidates, women had the highest levels of inadequate blood donations. At the end of this study, it can be concluded that the generic method for collecting data provenance proposed here can be applied in several areas of knowledge. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis is a major public health problem caused by Mycobacterium tuberculosis, occurring predominantly in population with low socioeconomic status. It is the second most common cause of death from infectious diseases. Tuberculosis becomes a double burden among anemic patients. Anemia increases an individual's susceptibility to infectious diseases including tuberculosis by reducing the immunity level. Therefore, the purpose of this study was to determine whether anemia is a risk factor for tuberculosis. Method: Relevant published articles were searched in electronic databases like PubMed, Google Scholar, EMBASE, and Cochrane Library using the following MeSH terms: risk factor, predictors, tuberculosis, TB, Anaemia, Anemia, hemoglobin, Hgb, and Hb. Articles written in the English, observational studies conducted on the incidence/prevalence of tuberculosis among anemic patients, or papers examined anemia as risk factors for tuberculosis were included. From those studies meeting eligibility criteria, the first author's name, publication year, study area, sample size and age of participants, study design, and effect measure of anemia for tuberculosis were extracted. The data were entered using Microsoft Excel and exported to Stata version 11 for analysis. The random-effects model was applied to estimate the pooled OR and HR, and 95% CI. The sources of heterogeneity were tested by Cochrane I-squared statistics. The publication bias was assessed using Egger's test statistics. Results: A total of 17 articles with a 215,294 study participants were included in the analysis. The odd of tuberculosis among anemic patients was 3.56 (95% CI 2.53–5.01) times higher than non-anemic patients. The cohort studies showed that the HR of tuberculosis was 2.01 (95% CI 1.70–2.37) times higher among anemic patients than non-anemic patients. The hazard of tuberculosis also increased with anemia severity (HR 1.37 (95% CI 0.92–2.05), 2.08 (95% CI 1.14–3.79), and 2.66 (95% CI 1.71–4.13) for mild, moderate, and severe anemia, respectively). Conclusion: According to the current systematic review and meta-analysis, we can conclude that anemia was a risk factor for tuberculosis. Therefore, anemia screening, early diagnose, and treatment should be provoked in the community to reduce the burden of tuberculosis. [ABSTRACT FROM AUTHOR]

Ratio-based prevalence and absolute headcounts are the two most commonly accepted metrics to measure the burden of various socioeconomic phenomenon. However, ratio-based prevalence, calculated as the number of cases with certain conditions relative to the total population, is by far the most widely used to rank burden and consequently for targeting, across different populations, often defined in terms of geographical areas. In this regard, targeting areas exclusively based on prevalence-based metric poses certain fundamental difficulties with some serious policy implications. Drawing the data from the National Family Health Survey 2015–2016, and Census 2011, this paper takes four indicators of child undernutrition in India as an example to examine two contextual questions: first, does the choice of metric matter for targeting areas for reducing child undernutrition in India? and second; which metric should be used to facilitate comparisons and targeting across variable populations? Our findings suggest a moderate correlation between prevalence estimates and absolute headcounts implying that choice of metric does matter when targeting child undernutrition. Huge variations were observed between prevalence-based and absolute count-based ranking of the districts. In fact, in various cases, districts with the highest absolute number of undernourished children were ranked as relatively lower-burden districts based on prevalence. A simple comparison between the two approaches—when applied to targeting undernourished children in India—indicates that prevalence-based prioritization may miss high-burden areas where substantially higher number of undernourished children are concentrated. For developing populous countries like India, which is already grappling with high levels of maternal and child malnutrition and poor health infrastructure along with intrinsic socioeconomic inequalities, it is critical to adopt an appropriate metric for effective targeting and prioritization. [ABSTRACT FROM AUTHOR]

Anemia management with erythropoiesis stimulating agents is a challenging task in hemodialysis patients since their response to treatment varies highly. In general, it is difficult to achieve and maintain the predefined hemoglobin (Hgb) target levels in clinical practice. The aim of this study is to develop a fully personalizable controller scheme to stabilize Hgb levels within a narrow target window while keeping drug doses low to mitigate side effects. First in-silico results of this framework are presented in this paper. Based on a model of erythropoiesis we formulate a non-linear model predictive control (NMPC) algorithm for the individualized optimization of epoetin alfa (EPO) doses. Previous to this work, model parameters were estimated for individual patients using clinical data. The optimal control problem is formulated for a continuous drug administration. This is currently a hypothetical form of drug administration for EPO as it would require a programmable EPO pump similar to insulin pumps used to treat patients with diabetes mellitus. In each step of the NMPC method the open-loop problem is solved with a projected quasi-Newton method. The controller is successfully tested in-silico on several patient parameter sets. An appropriate control is feasible in the tested patients under the assumption that the controlled quantity is measured regularly and that continuous EPO administration is adjusted on a daily, weekly or monthly basis. Further, the controller satisfactorily handles the following challenging problems in simulations: bleedings, missed administrations and dosing errors. [ABSTRACT FROM AUTHOR]

Nephropathic cystinosis (NC) is a rare autosomal recessive lysosomal storage disease characterized by defective lysosomal efflux of cystine due to variations in the CTNS gene encoding the lysosomal cystine transporter, cystinosin. This leads to pathological crystal accumulation in almost all tissues and organs in the body, affecting their functions. NC primarily affects the kidneys followed by a cascade of extrarenal organ involvement later in life. There are few reports of hematological complications as anemia or cytopenias; nevertheless, most of the reported data have been derived from case reports or small case series. Anemia/cytopenias in NC can be multifactorial in origin. Early identification and timely management of these alterations are critical to better growth, improved outcome, and quality of life of NC patients. Early diagnosis of NC, early initiation of both supportive and definitive cystine-depleting treatment, and adherence to therapy remain the mainstay for disease control and prevention of progression of some extrarenal complications. We hereby review hematological findings in NC, discuss the underlying contributing factors, suggest work-up, and highlight treatment options for hematological complications in NC patients. Given the multisystem nature of NC, we recommend integrated NC care approach with involvement of hematologist into its multidisciplinary team. [ABSTRACT FROM AUTHOR]

Background: Anemia of inflammation (AI) is common in critically ill patients. Although this syndrome negatively impacts the outcome of critical illness, understanding of its pathophysiology is limited. Also, new therapies that increase iron availability for erythropoiesis during AI are upcoming. A model of AI induced by bacterial infections that are relevant for the critically ill is currently not available. This paper describes the development of an animal model for AI that is relevant for critical care research. Results: In experiments with rats, the rats were inoculated either repeatedly or with a slow release of Streptococcus pneumoniae or Pseudomonas aeruginosa. Rats became ill, but their hemoglobin levels remained stable. The use of a higher dose of bacteria resulted in a lethal model. Then, we turned to a model with longer disease duration, using pigs that were supported by mechanical ventilation after inoculation with P. aeruginosa. The pigs became septic 12 to 24 h after inoculation, with a statistically significant decrease in mean arterial pressure and base excess, while heart rate tended to increase. Pigs needed resuscitation and vasopressor therapy to maintain a mean arterial pressure > 60 mmHg. After 72 h, the pigs developed anemia (baseline 9.9 g/dl vs. 72 h, 7.6 g/dl, p = 0.01), characterized by statistically significant decreased iron levels, decreased transferrin saturation, and increased ferritin. Hepcidin levels tended to increase and transferrin levels tended to decrease. Conclusions: Using pathogens commonly involved in pulmonary sepsis, AI could not be induced in rats. Conversely, in pigs, P. aeruginosa induced pulmonary sepsis with concomitant AI. This AI model can be applied to study the pathophysiology of AI in the critically ill and to investigate the effectivity and toxicity of new therapies that aim to increase iron availability. [ABSTRACT FROM AUTHOR]

Objectives Since the 1990s, programs for the control of micronutrient deficiencies became a public health priority for many governments, including the countries partnering the project "Sustainable Micronutrient Interventions to Control Deficiencies and Improve Nutritional Status and General Health in Asia" (SMILING): Cambodia, Indonesia, Laos-PDR, Thailand and Vietnam. The aim of this study was to map which micronutrient deficiencies have been addressed and which interventions were in place in the SMILING countries. Methods The mapping covered the period up to 2012. Updated information from relevant surveys after 2012 is included in this paper after the completion of the SMILING project. The mapping of micronutrient status was limited to either national or at least large-scale surveys. Information on nutrition interventions obtained through a systematic mapping of national programs combined with a snowball collection from various sources. Results Among the five SMILING countries, Thailand differed historically by an early implementation of a nationwide community-based nutrition program, contributing to reductions in undernutrition and micronutrient deficiencies. For Cambodia, Indonesia, Laos PDR, and Vietnam, some national programs addressing micronutrients have been implemented following adjusted international recommendations. National surveys on micronutrient status were scattered and inconsistent across the countries in design and frequency. Conclusion for practice In conclusion, some micronutrient deficiencies were addressed in national interventions but the evidence of effects was generally lacking because of limited nationally representative data collected. Improvement of intervention programs to efficiently reduce or eliminate micronutrient deficiencies requires more systematic monitoring and evaluation of effects of interventions in order to identify best practices. [ABSTRACT FROM AUTHOR]

In this paper we describe health and morbidity characteristics of Bedouin women in southern Israel, based on papers published over the past 20 years. This is a unique population whose customs, tradition, singular circumstances as a population 'in transit', and underprivileged socio-economic status are reflected in mental illness, pregnancy course, perinatal morbidity and mortality rates, and acute and chronic disease. Recognition of these characteristics can help the medical team treat various health problems in this population as well as other populations with similar characteristics. [ABSTRACT FROM AUTHOR]

The digital revolution in healthcare, amplified by the COVID-19 pandemic and artificial intelligence (AI) advances, has led to a surge in the development of digital technologies. However, integrating digital health solutions, especially AI-based ones, in rare diseases like Waldenström macroglobulinemia (WM) remains challenging due to limited data, among other factors. CURATE.AI, a clinical decision support system, offers an alternative to big data approaches by calibrating individual treatment profiles based on that individual's data alone. We present a case study from the PRECISE CURATE.AI trial with a WM patient, where, over two years, CURATE.AI provided dynamic Ibrutinib dose recommendations to clinicians (users) aimed at achieving optimal IgM levels. An 80-year-old male with newly diagnosed WM requiring treatment due to anemia was recruited to the trial for CURATE.AI-based dosing of the Bruton tyrosine kinase inhibitor Ibrutinib. The primary and secondary outcome measures were focused on scientific and logistical feasibility. Preliminary results underscore the platform's potential in enhancing user and patient engagement, in addition to clinical efficacy. Based on a two-year-long patient enrollment into the CURATE.AI-augmented treatment, this study showcases how AI-enabled tools can support the management of rare diseases, emphasizing the integration of AI to enhance personalized therapy. [ABSTRACT FROM AUTHOR]

The study was based to find out the effect of iron deficiency anemia on glutathione concentration, and the level of peroxynitrite was taken as an indication of the change in oxidative stress levels for patients with iron deficiency anemia. Sixty-one random samples were collected from a specialized laboratory in the city of Mosul, and the samples were from women whose ages ranged from 17 to 50 years. The samples were divided into three groups, the first group included severe anemia, and the second group had a blood test result within the average limits, and the third group was the control group for women without anima. When a comparison was made between the three groups, a significant decrease in the concentration of glutathione was found, followed by a rise in the level of peroxynitrite in the first and the second group when compared with the third group in which the concentration of peroxynitrite decreased and glutathione increased. The study also included conducting biochemical tests that included zinc, copper and iron. The results showed a decrease in zinc in the first and second group compared to the third group, while copper decreased in the first group compared with the second and third. Iron decreased in the first and second groups only. [ABSTRACT FROM AUTHOR]

Objective: This study was designed to develop and validate a robust predictive model for one-year mortality in elderly coronary heart disease (CHD) patients with anemia using machine learning methods. Methods: Demographics, tests, comorbidities, and drugs were collected for a cohort of 974 elderly patients with CHD. A prospective analysis was performed to evaluate predictive performances of the developed models. External validation of models was performed in a series of 112 elderly CHD patients with anemia. Results: The overall one-year mortality was 43.6%. Risk factors included heart rate, chronic heart failure, tachycardia and β receptor blockers. Protective factors included hemoglobin, albumin, high density lipoprotein cholesterol, estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF), aspirin, clopidogrel, calcium channel blockers, angiotensin converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), and statins. Compared with other algorithms, an ensemble machine learning model performed the best with area under the curve (95% confidence interval) being 0.828 (0.805–0.870) and Brier score being 0.170. Calibration and density curves further confirmed favorable predicted probability and discriminative ability of an ensemble machine learning model. External validation of Ensemble Model also exhibited good performance with area under the curve (95% confidence interval) being 0.825 (0.734–0.916) and Brier score being 0.185. Patients in the high-risk group had more than six-fold probability of one-year mortality compared with those in the low-risk group (P < 0.001). Shaley Additive exPlanation identified the top five risk factors that associated with one-year mortality were hemoglobin, albumin, eGFR, LVEF, and ACEIs/ARBs. Conclusions: This model identifies key risk factors and protective factors, providing valuable insights for improving risk assessment, informing clinical decision-making and performing targeted interventions. It outperforms other algorithms with predictive performance and provides significant opportunities for personalized risk mitigation strategies, with clinical implications for improving patient care. [ABSTRACT FROM AUTHOR]

Purpose: Fanconi anemia is a rare inherited genetic disorder that is characterized by all three defective blood cell lines such as reduced red blood cells, platelets, and white blood cells. This makes the individual susceptible to spontaneous oral bleeding and prone to oral infections including periodontal diseases. Method: Dental management of individuals with Fanconi anemia can be a difficult task as these individuals have a tendency for uncontrolled hemorrhage and infections after any simple dental procedure. This case report highlights the oral manifestations and management of the same in such individuals taking into consideration the complications in such rare diseases. Result: In this case report, the individuals' oral manifestations and spontaneous oral bleeding were successfully managed by preventive single-donor platelet transfusion, factor VII transfusion, and local tranexamic acid usage during the dental interventions along with parental counseling. Conclusion: Fanconi anemia being a rare inherited disorder is often difficult to manage due to a lack of knowledge and awareness among the dental clinicians. This case report attempts in highlighting the same and spreading awareness among the clinicians. [ABSTRACT FROM AUTHOR]

Globally one-third of global population are victims of anemia, significantly impacting maternal and infant health and linked to poor cognition, productivity, and mortality risks. We used randomly selected 4040 lactating mothers' record from nationally representative survey. Descriptive statistics were weighted, and the standard hemoglobin cutoff point (below 12 g/dl) was used. Bivariable and multivariable multilevel binary logistic regression model considering the individual and community-level factors associated with anemia was employed. Crude and adjusted odds ratios with a 95% confidence interval were reported. In Ethiopia, 32.3% (95% CI 30.9–33.7%) of lactating women were anemic, with 23.4% having mild, 7.3% moderate, and 1.2% severe anemia. Pastoral regions (Afar, Somalia, and Oromia region) had higher burden of anemia than the others. The advanced age of the mother above 45 years (AOR = 1.43 (1.11–1.82), unemployment (AOR = 1.19; 95% CI 1.08–1.32), household wealth index (AOR = 0.56; 95% CI 0.50–0.63), extended family size (AOR = 1.20; 95% CI 1.04–1.46), and not using family planning (AOR = 1.70; 95% CI 1.49–1.93) were significant factors associated with anemia. Anemia is a moderate public health problem and associated with location and other factors to be addressed via effective interventions. [ABSTRACT FROM AUTHOR]

This study on severe malarial anemia (SMA: Hb < 6.0 g/dL), a leading global cause of childhood morbidity and mortality, compares the entire expressed whole blood host transcriptome between Kenyan children (3-48 mos.) with non-SMA (Hb ≥ 6.0 g/dL, n = 39) and SMA (n = 18). Differential expression analyses reveal 1403 up-regulated and 279 down-regulated transcripts in SMA, signifying impairments in host inflammasome activation, cell death, and innate immune and cellular stress responses. Immune cell profiling shows decreased memory responses, antigen presentation, and immediate pathogen clearance, suggesting an immature/improperly regulated immune response in SMA. Module repertoire analysis of blood-specific gene signatures identifies up-regulation of erythroid genes, enhanced neutrophil activation, and impaired inflammatory responses in SMA. Enrichment analyses converge on disruptions in cellular homeostasis and regulatory pathways for the ubiquitin-proteasome system, autophagy, and heme metabolism. Pathway analyses highlight activation in response to hypoxic conditions [Hypoxia Inducible Factor (HIF)−1 target and Reactive Oxygen Species (ROS) signaling] as a central theme in SMA. These signaling pathways are also top-ranking in protein abundance measures and a Ugandan SMA cohort with available transcriptomic data. Targeted RNA-Seq validation shows strong concordance with our entire expressed transcriptome data. These findings identify key molecular themes in SMA pathogenesis, offering potential targets for new malaria therapies. Here, the authors analyze the blood transcriptome of Kenyan children with severe malarial anemia and observe impaired immune responses and molecular activation of hypoxia and reactive oxygen species networks, providing insight into disease pathogenesis. [ABSTRACT FROM AUTHOR]

It has recently been recognized that many patients with congestive heart failure (CHF) are anemic. The anemia is very often associated with chronic kidney disease (CKD). The more severe the anemia the more severe the CHF, with higher mortality, morbidity, and hospitalization rate. The only way to prove that the anemia is itself a causative factor in the progression of both the CKD and the CHF is to correct it. In this paper we review the results of published papers and some preliminary reports about correction of this anemia in CHF. These studies frequently showed that erythropoietic stimulating agents (ESA) with oral or IV iron often resulted in improvement in left ventricular systolic and diastolic function, dilation, and hypertrophy, stabilization or improvement in renal function, reduced hospitalizations, diuretic dose, mitral regurgitation, pulmonary artery pressure, plasma volume, heart rate, serum brain natriuretic peptide levels, and the inflammatory markers C reactive protein and Interleukin 6, and an improvement in New York Heart Association class, exercise capacity, oxygen utilization during exercise, sleep apnea, caloric intake, depression, and quality of life. The activity of endothelial progenitor cells was also increased. Iron deficiency may also play an important role in the anemia, because significant improvement of cardiac, renal, and functional status in these anemic CKD–CHF has been seen after treatment with IV iron alone. Clearly more work is needed to clarify the relationship between anemia, CKD and CHF. [ABSTRACT FROM AUTHOR]

Objective: To estimate a dose-conversion ratio (DCR) between epoetin alfa (EPO) and darbepoetin alfa (DARB) and compare the costs of both drugs at the estimated DCRs using average wholesale prices (AWPs). Methods: A search of PUBMED, CANCERLIT and references for papers and abstracts reporting on clinical trials of DARB or EPO for chemotherapy-related anaemia (CRA) identified 56 publications. A meta-analysis was conducted on the 12 eligible papers to estimate a DCR at which the two drugs were equally effective as measured by the area under the curve of haemoglobin (Hb) change (Hb AUC) at weeks 4 and 13. The DCR is based on the ratio of the coefficients of DARB and EPO doses in a regression of Hb AUC on those two variables, baseline Hb, Hb change calculation method, tumour type, and dosing frequency. Studies were frequency-weighted by the number of subjects. DCRs with confidence intervals (CIs) were calculated using a Monte-Carlo approach. Results from the regression were used to calculate DCRs for different dosing regimen comparisons – EPO three times weekly (TIW) versus DARB once weekly (QW), EPO TIW versus DARB once every 2 weeks (Q2W), EPO QW versus DARB QW, and EPO QW versus DARB Q2W. Relative cost effectiveness (RCE) was assessed by comparing drug costs at the estimated DCRs at $US 2003 AWPs [RCE = DCR · ($/U EPO)/($/μg DARB)]. Results: The regression results suggest an EPO QW : DARB QW DCR of 187 (95% CI 183, 191). Depending on the assumed starting dose, the DCR ranges from 126 to 137 for EPO TIW : DARB QW; from 128 to 139 for EPO TIW : DARB Q2W; and equals 191 for EPO QW : DARB Q2W. RCE was 2.0 for the main regression. Conclusion: The DCR of 330 : 1 estimated for the 2004 Hospital Outpatient Prospective Payment System by the Centers for Medicare and Medicaid Services is greater than the DCRs estimated based on Hb AUC. The DCR estimated in the primary regression suggests that based on AWPs, EPO is 2.0 times more cost effective than DARB. [ABSTRACT FROM AUTHOR]

While the crucial role of haemoglobin in aerobic exercise has been well accepted, there is still a great deal of controversy about the optimal haematological parameters in the athletic population. The initial part of this review will examine the question of anaemia in athletes. The most common finding in athletes is a dilutional pseudoanaemia that is caused by a plasma volume expansion, rather than an actual blood loss. It is not a pathological state and normalises with training cessation in 3 to 5 days. This entity should be distinguished from conditions associated with lowered blood counts, such as intravascular haemolysis or iron deficiency anaemia. The evaluation of true anaemia states in the athlete must take into account not only blood losses secondary to exercise, such as foot strike haemolysis or iron losses through sweat, but non-athletic causes as well. Depending on the age and sex of the athlete, consideration must be given to evaluation of the gastrointestinal or genitourinary systems for blood loss. Finally, a comprehensive nutritional history must be taken, as athletes, especially women, are frequently not consuming adequate dietary iron. The second section of the paper will deal with the very contentious issue of sickle cell trait. While there have been studies demonstrating an increased risk of sudden death in people with sickle cell trait, it is still quite rare and should not be used as a restriction to activity. Further, studies have demonstrated that patients with sickle cell trait have an exercise capacity that is probably normal or near normal. However, in the cases of sudden death, it has been secondary to rhabdomyolysis occurring among sickle cell trait athletes performing at intense exertion under hot conditions, soon after arriving at altitude. The recommendations are that athletes with sickle cell trait adhere to compliance with the general guidelines for fluid replacement and acclimatisation to hot conditions and altitude. The final section of the paper examines the issue of haematological manipulation for the purposes of ergogenic improvement. Although experiments with blood doping revealed improvements in running time to exhaustion and maximal oxygen uptake, the introduction of recombinant erythropoietin has rendered blood doping little more than a historical footnote. However, the improvements in performance are not without risk, and the use of exogenous erythropoietin has the potential for increased viscosity of the blood and thrombosis with potentially fatal results. Until a definitive test is developed for detection of exogenous erythropoietin, it will continue to be a part of elite athletics. [ABSTRACT FROM AUTHOR]

The high burden of anaemia during pregnancy underscores the urgent need to gain a comprehensive understanding of the factors contributing to its widespread occurrence. Our study assessed the prevalence and the trends of moderate-to-severe anaemia (MSA) in late pregnancy (28 to 36 weeks) and then investigated the key determinants driving this prevalence among women in Lagos, Nigeria. We conducted a secondary data analysis involving 1216 women enrolled in the Predict-PPH study between January and March 2023. We employed a multivariate binary logistic regression model with a backward stepwise selection approach to identify significant predictors of MSA. The study revealed a 14.5% prevalence of MSA during pregnancy. Independent predictors of MSA included having given birth to two or more children (adjusted odds ratio = 1.46, 95% confidence interval: 1.03–2.07), having a maternal body mass index (BMI) of 28 kg/m2 or higher (adjusted odds ratio = 1.84, 95% confidence interval: 1.29–2.61), having less than tertiary education (adjusted odds ratio = 1.51, 95% confidence interval: 1.08–2.11), and being unemployed (adjusted odds ratio = 1.97, 95% confidence interval: 1.19–3.26). It is crucial for pregnant women, particularly those with higher parities and elevated BMI, to be monitored regularly for anaemia and its consequences during their antenatal care. Additionally, addressing the link between low education, unemployment, and anaemia necessitates comprehensive strategies that empower women in terms of education and economic status to enhance the overall well-being of individuals and communities, ultimately reducing the prevalence of anaemia and associated health issues in pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: Intraoperative cell salvage is central to Patient Blood Management including for lower segment caesarean section. Prior to April 2020, we initiated intraoperative cell salvage during caesarean section based on risk assessment for hemorrhage and patient factors. As the pandemic broadened, we mandated intraoperative cell salvage to prevent peri-partum anemia and potentially reduce blood product usage. We examined the association of routine intraoperative cell salvage on maternal outcomes. Methods: We conducted a single-center non-overlapping before-after study of obstetric patients undergoing lower segment caesarean section in the 2 months prior to a change in practice ('usual care = selective intraoperative cell salvage', n = 203) and the 2 months following ('mandated intraoperative cell salvage', n = 228). Recovered blood was processed when a minimal autologous reinfusion volume of 100 ml was expected. Post-operative iron infusion and length of stay were modelled using logistic or linear regression, using inverse probability weighting to account for confounding. Results: More emergency lower-segment caesarean sections occurred in the Usual Care group. Compared to the Usual Care group, post-operative hemoglobin was higher and anemia cases fewer in the Mandated intraoperative cell salvage group. Rates of post-partum iron infusion were significantly lower in the Mandated intraoperative cell salvage group (OR = 0.31, 95% CI = 0.12 to 0.80, P = 0.016). No difference was found for length of stay. Conclusion: Routine cell salvage provision during lower segment caesarean section was associated with a significant reduction in post-partum iron infusions, increased post-operative hemoglobin and reduced anemia prevalence. [ABSTRACT FROM AUTHOR]

The primary triggers that stimulate the body to generate platelet antibodies via immune mechanisms encompass events such as pregnancy, transplantation, and blood transfusion. Interestingly, our findings revealed that a subset of male patients with hepatocellular carcinoma (HCC), despite having no history of transplantation or blood transfusion, has shown positive results in platelet antibody screenings. This hints at the possibility that certain factors, potentially related to the tumor itself or its treatment, may affect antibody production. To delve the causes we initiated this study. We employed a case–control study approach to analyze potential influential factors leading to the positive results via univariate and multivariate regression analysis. We utilized Kendall’s tau-b correlation to examine the relationship between the strength of platelet antibodies and peripheral blood cytopenia. Antitumor medication emerged as an independent risk factor for positive results in HCC patients, and the strength of platelet antibodies positively correlated with the severity of anemia and thrombocytopenia. Without history of blood transfusion, transplantation, pregnancy, those HCC patients underwent recent tumor medication therapy are experiencing peripheral erythrocytopenia or thrombocytopenia, for them platelet antibody screenings holds potential clinical value for prevention and treatment of complications like drug-immune-related anemia and/or bleeding. [ABSTRACT FROM AUTHOR]

In developing countries, one-quarter of young women have suffered from anemia. However, the available studies in Ethiopia have been usually used the traditional stastical methods. Therefore, this study aimed to employ multiple machine learning algorithms to identify the most effective model for the prediction of anemia among youth girls in Ethiopia. A total of 5642 weighted samples of young girls from the 2016 Ethiopian Demographic and Health Survey dataset were utilized. The data underwent preprocessing, with 80% of the observations used for training the model and 20% for testing. Eight machine learning algorithms were employed to build and compare models. The model performance was assessed using evaluation metrics in Python software. Various data balancing techniques were applied, and the Boruta algorithm was used to select the most relevant features. Besides, association rule mining was conducted using the Apriori algorithm in R software. The random forest classifier with an AUC value of 82% outperformed in predicting anemia among all the tested classifiers. Region, poor wealth index, no formal education, unimproved toilet facility, rural residence, not used contraceptive method, religion, age, no media exposure, occupation, and having more than 5 family size were the top attributes to predict anemia. Association rule mining was identified the top seven best rules that most frequently associated with anemia. The random forest classifier is the best for predicting anemia. Therefore, making it potentially valuable as decision-support tools for the relevant stakeholders and giving emphasis for the identified predictors could be an important intervention to halt anemia among youth girls. [ABSTRACT FROM AUTHOR]

Introduction: Anemia and malnutrition are recognized indicators of suboptimal physical condition in chronic inflammatory diseases. This study aimed to examine the association between anemia, low body mass index (BMI), and clinical outcomes in axial spondyloarthritis (axSpA). Method: This cross-sectional analysis utilized data from the multicenter ChinaSpA cohort. A total of 4146 participants with axSpA were categorized into four groups based on BMI and hemoglobin levels: those with both anemia and low BMI, those with anemia only, those with low BMI only, and those with neither condition. Logistic regression analyses were performed to analyze the association between anemia, low BMI, inflammation status, functional impairment, and disease activity. Results: Anemia was present in 13.94%, low BMI in 11.99%, and both conditions in 2.15% of axSpA participants. Those with both anemia and low BMI showed significantly higher levels of inflammation (hypersensitive C-reactive protein [hsCRP] 30.60 mg/L vs. 8.44 mg/L), functional impairment (Bath Ankylosing Spondylitis Functional Index [BASFI] 3.80 vs. 2.10), and disease activity (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] 4.52 ± 2.04 vs. 3.67 ± 2.21; Ankylosing Spondylitis Disease Activity Score calculated with C-reactive protein [ASDAS_CRP] 3.51 ± 1.10 vs. 2.62 ± 1.21) compared to those without these conditions. After adjusting for sex and age, significant associations were observed between elevated hsCRP levels and the presence of low BMI (odds ratio [OR] 1.44, 95% CI 1.17–1.78), anemia (OR 1.91, 95% CI 1.56–2.32), and their concurrent presence (OR 3.59, 95% CI 2.22–5.80). Similarly, increased BASFI was significantly associated with low BMI (OR 1.57, 95% CI 1.25–1.97), anemia (OR 1.47, 95% CI 1.19–1.80), and their combination (OR 3.11, 95% CI 2.02–4.78). Conclusion: All-cause anemia and low BMI are prevalent complications in patients with axSpA, exhibiting a significant correlation with elevated inflammation status and functional impairment. The simultaneous occurrence of anemia and low BMI particularly exacerbates clinical outcomes, emphasizing the critical role of comprehensive nutritional assessment and management in the therapeutic strategy for axSpA. [ABSTRACT FROM AUTHOR]

Antihypertensive medications have been associated with a reduction in hemoglobin (Hb) levels, leading to clinically significant anemia. We aimed to provide valuable insights into the impact of angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) on hematological parameters by measuring the levels of erythropoietin (EPO), ferritin, and complete blood count (CBC) in individuals with type 2 diabetes mellitus (T2DM), particularly considering the duration of the antihypertensives use. In addition to comparing their effects on blood pressure, glycemic status, and renal function, a retrospective cohort study was conducted at the consultation unit of Alsalam Teaching Hospital, Mosul, Nineveh Province, between October 2022 and February 2023. A total of 160 participants were enrolled after being fully examined by the consultants to detect their eligibility for inclusion in the study and to rule out any abnormality. They consisted of 40 healthy controls, 30 T2DM patients (T2DM group), 30 T2DM patients with newly diagnosed hypertension (HT) (T2DM+HT group), 30 type 2 diabetic-hypertensives on ARBs (T2DM+HT+ARBs group), and 30 type 2 diabetic-hypertensives on CCBs (T2DM+HT+CCBs group). Five milliliters of blood was drawn from a vein and divided into two parts. Two milliliters was transferred into an anticoagulant tube for the measurement of HbA1c and complete blood picture. Serum was obtained from the remaining blood and used for assessment of ferritin, EPO, FSG, creatinine, urea, and uric acid. Significantly reduced FSG and HbA1c levels were observed in T2DM+HT+CCBs and T2DM+HT+ARBs groups vs T2DM+HT group (p < 0.05). The T2DM+HT+CCBs group had statistically higher urea levels than the T2DM group (p < 0.05). Both CCBs and ARBs use resulted in reduced creatinine clearance (CrCl). T2DM+HT+CCBs group exhibited slightly higher uric acid levels compared to controls (p < 0.05). Prolonged use of CCBs and ARBs led to disturbances in hematological parameters, with CCBs users showing the lowest levels of hemoglobin (Hb), RBCs, and hematocrit (Hct) among the groups. ARBs users displayed the lowest values of EPO and ferritin compared to other patient groups, along with reduced levels of Hb, RBCs, and Hct, albeit slightly higher than CCBs users. Our study highlights the importance of a balanced approach in prescribing ARBs and CCBs to patients with T2DM, given their potential to induce blood abnormalities, particularly with prolonged usage. [ABSTRACT FROM AUTHOR]

The discovery of the role of autophagy, particularly the selective form like ferritinophagy, in promoting cells to undergo ferroptosis has inspired us to investigate functional connections between diseases and cell death. Ferroptosis is a novel model of procedural cell death characterized by the accumulation of iron-dependent reactive oxygen species (ROS), mitochondrial dysfunction, and neuroinflammatory response. Based on ferroptosis, the study of ferritinophagy is particularly important. In recent years, extensive research has elucidated the role of ferroptosis and ferritinophagy in neurological diseases and anemia, suggesting their potential as therapeutic targets. Besides, the global emergence and rapid transmission of COVID-19, which is caused by SARS-CoV-2, represents a considerable risk to public health worldwide. The potential involvement of ferroptosis in the pathophysiology of brain injury associated with COVID-19 is still unclear. This review summarizes the pathophysiological changes of ferroptosis and ferritinophagy in neurological diseases, anemia, and COVID-19, and hypothesizes that ferritinophagy may be a potential mechanism of ferroptosis. Advancements in these fields will enhance our comprehension of methods to prevent and address neurological disorders, anemia, and COVID-19. [ABSTRACT FROM AUTHOR]

Purpose: African Animal Trypanosomosis (AAT) caused by Trypanosoma congolense is a parasitic disease affecting the livestock industry in sub-Saharan Africa and usually results in severe anemia, organ damage, and ultimately the death of the infected host. The present study was designed to investigate the possible chemotherapeutic effect of eugenol on T. congolense infections and its inhibitory effect on the trans-sialidase (TconTS) gene expression. Methods: Animals were infected with T. congolense and treated with 15 and 30 mg/kg body weight (BW) of eugenol for ten (10) days. Results: The eugenol (15 mg/kg BW) significantly (P < 0.05) reduced the T. congolense proliferation, increased animal survival, and reduced serum urea level. However, both dosages of eugenol significantly (P < 0.05) ameliorated T. congolense-induced anemia, renal hypertrophy, splenomegaly, and reduced total damage score in the liver and kidney of infected animals. In addition, the compound significantly (P < 0.05) downregulated the expression levels of TconTS1, TconTS2, TconTS3, and TconTS4 but the effect was more pronounced (sevenfold reduction) on TconTS1. Conclusions: The oral administration of eugenol suppressed T. congolense proliferation and prevented some major pathologies associated with trypanosomiasis infection. The reversal of renal hypertrophy and splenomegaly by the compound in addition to the reduction in the expression level of the TconTS gene variants could explain the observed anemia ameliorative potential of the compound. [ABSTRACT FROM AUTHOR]

Introduction: Owing to evolution of parasite strains that are resistant to existing antimalarial drugs, research for novel antimalarial medicines is progressing on numerous fronts. Purpose: Herein, we evaluated the in vivo anti-Plasmodium berghei activity of β-ionone including its ameliorative potential towards P. berghei-associated anaemia and oxidative organ damage. Methods: Mice were infected with chloroquine-sensitive strain of P. berghei and then treated with β-ionone at doses of 10 and 20 mg/kg body weight (BW) for seven days. The parasitemia, packed cell volume and redox sensitive biomarkers in the liver, brain and spleen were estimated. Results: Our result showed that β-ionone, in a dose-dependent fashion, significantly (p < 0.05) repressed the multiplication of P. berghei. More so, the compound, at doses of 10 and 20 mg/kg BW, significantly (p < 0.05) mitigated anaemia and organ damage induced by P. berghei. Conclusion: Overall, the findings demonstrated that β-ionone has antiplasmodial actions and plays a mitigative role against P. berghei-induced anaemia and oxidative organ damage. [ABSTRACT FROM AUTHOR]

The European Medicines Agency (EMA), under a strictly regulated pathway, has approved several biosimilar products since 2005, including biosimilar versions of the erythropoiesis-stimulating agent (ESA) epoetin alfa since 2007. Subsequent to these approvals, the use of biosimilar epoetin alfa in the management of renal anemia has grown steadily throughout Europe. With the enactment of the US Biologics Price Competition and Innovation Act of 2009, a US Food and Drug Administration regulatory approval process for biosimilars was legalized. Thus, biosimilar erythropoietin products are expected to be available for prescription in the USA by mid-decade, presumably at a price that is competitive with the originator brand-name reference products. In this paper, we describe the status of originator and biosimilar ESAs, review the clinical development and regulatory approval of biosimilar erythropoietins in Europe, and summarize relevant efficacy and safety information of biosimilar erythropoietins in relation to their reference products to provide a background for US nephrologists as they appraise biosimilar erythropoietins as treatment options for renal anemia. Key lessons learned from Europe are that (a) EMA-approved biosimilar erythropoietins have comparable efficacy and safety profiles to their reference product erythropoietin; (b) pharmacovigilance preapproval and postapproval are critical, especially with regard to immunogenicity and vascular thromboembolic events; (c) strict preapproval and postapproval requirements must guide the regulatory pathway for biosimilars; and (d) high-quality manufacturing and production processes must be established to ensure quality biosimilar products. The availability of biosimilar erythropoietins in the USA will provide nephrologists with alternative effective, and potentially more affordable, treatment options for patients with renal anemia. [ABSTRACT FROM AUTHOR]

This paper addresses how indicators of early life nutrition and development and later life nutrition vary in aging populations in the U.S., England, Mexico, China, Taiwan, Indonesia, and the Tsimane of Bolivia. These populations span a wide range of current life expectancy and infant mortality when they were young. The indicators of nutritional problems are related to both current life expectancy and to levels of past infant mortality. The indicators of past and present nutrition are also related to a set of risk factors for chronic disease including the ratio of Total Cholesterol to High Density Lipoprotein Cholesterol, level of glycosylated hemoglobin, pulse pressure, and C-reactive protein. Results indicate that current obesity is associated with significantly higher levels of most risk factors in most settings. On the other hand, stunting in childhood is not related consistently to any of the indicators of current risk. Social and demographic differences in risk vary across settings. Future increases in obesity around the world are likely to be related to increasing risk for the chronic conditions of old age. [ABSTRACT FROM AUTHOR]

Background/Objectives:Anemia is a significant public health concern, especially among women and young children. An improved understanding of the complex etiology of anemia is crucial for developing appropriate prevention strategies. This paper examines the determinants of anemia in a large sample of Vietnamese women of reproductive age (WRA).Methods:We included baseline data from 4986 WRA participating in a randomized controlled trial (PRECONCEPT). Hemoglobin (Hb) concentrations were measured with Hemocue. Plasma ferritin (Fe), retinol binding protein (RBP) and markers of inflammation were assessed using the ELISA technique. We used multivariate logistic regression to describe associations with anemia and structural equation modeling (SEM) to characterize direct and indirect pathways influencing Hb concentrations.Results:Prevalence of anemia, iron deficiency (Fe <12 μg/l), insufficient iron stores (Fe<30 μg/l) and iron deficiency anemia was 19.7, 3.5, 14.4 and 1.9%, respectively. Ferritin concentration (0.29 per log-mg/dl), being an ethnic minority (−0.24 compared with Kinh), number of children (−0.17) and socioeconomic status (0.09) were directly associated with Hb concentration (P<0.05). Similarly, RBP was directly (0.27 per mg/dl) associated with Hb and also indirectly (0.09 mg/dl) with ferritin. Hookworm infection was indirectly associated with Hb (−0.11) through RBP and ferritin.Conclusion:These findings illustrate the complex etiology of anemia and provide a useful framework for designing, targeting and evaluating appropriate strategies for the prevention and control of anemia. Contrary to expectations, iron deficiency accounted for a very small proportion of anemia in Northern Vietnam. [ABSTRACT FROM AUTHOR]

Iron metabolism has been found to be closely related to gestational diabetes mellitus (GDM). Excessive ferritin levels were shown to be related to an increased risk of GDM because of iron overload which may lead to insulin resistance and β-cell injury by enhancing oxidative stress and inflammatory responses. On the contrary, insufficient ferritin levels can cause a number of obstetric complications, such as high incidence rates of anaemia and gestational hypertension. Therefore, high or low ferritin levels may have adverse effects on the mother and the foetus, putting clinicians in a dilemma when giving pregnant women iron supplements. This also explains why there have been more conflicting findings in the studies on dietary or oral iron supplementation during pregnancy. Hence, there is an urgent need for more evidence and strategies for appropriate recommendations for ferritin levels and iron supplementation during pregnancy to prevent iron insufficiency without causing iron overload and increasing the risk of GDM. Therefore, we gave an updated review on the association of GDM with ferritin metabolism, ferritin levels and iron supplementation based on the summary of the latest research. [ABSTRACT FROM AUTHOR]

Optical resonators are particularly suitable for anaemia state detection due to small sample size, real-time detection and low power consumption. However, the quality factor and sensitivity of resonant cavity sensors are mutually constrained, so the single objective optimization algorithms proposed so far can only achieve a single optimization of sensitivity or quality factor, which limits chip performance. This article presents a multi-objective optimization design of the runway ring resonant cavity sensor based on the BP-NSGA II algorithm, which has achieved good performance improvement. The simultaneous incorporation of quality factor and sensitivity provides access to key structural design parameters to overcome the limitations of sensitivity and quality factor constraints on each other, thereby improving sensor performance. The results show that the optimized structure has a sensitivity of 439 nm/RIU, a quality factor of 938, a relative error of 1.37% and 3.9% for the sensitivity and quality factor, respectively, a linearity of 0.00004636% for the sensitivity, and a training time of 3 min. The method has the advantages of small errors and short learning time. A new optimization method is provided for the design of the resonant cavity of a runway ring. [ABSTRACT FROM AUTHOR]

Background: Inflammatory myofibroblastic tumor (IMT) is a rare stromal tumor, often found in children and young adults, and most commonly occurs in the lungs. Surgical resection is considered the standard treatment for localized IMT, although only limited data exist. Gastric IMT in adults is extremely rare, and there are no established guidelines for its treatment. Case presentation: A 69-year-old male presented with persistent fatigue and weakness. Laboratory examination revealed severe anemia and inflammation. Upper gastrointestinal endoscopy at admission revealed a 40-mm type I softish tumor in the lesser curvature of the gastric body, without apparent hemorrhage. Repeated biopsies, including partial resection with snare, failed to give a definitive diagnosis. Computed tomography (CT) revealed a massive lesion at the gastric body, protruding into the gastric lumen, which was consistent with the gastric tumor. After admission, the patient developed anemia refractory to frequent blood transfusions despite the absence of apparent gastrointestinal bleeding. In addition, the patient had recurrent fevers of 38 °C or higher, and persistent high inflammatory levels. Fluorodeoxyglucose-positron emission tomography (FDG-PET) CT 1 month after the first visit exhibited an increased FDG uptake in the gastric tumor. In addition, this CT scan revealed a rapid increase in tumor size to 75 mm. It was suspected that the undiagnosed gastric tumor caused these serious clinical symptoms, and he underwent distal gastrectomy and cholecystectomy. The gross image of the tumor showed an 80-mm cauliflower-like shape with a gelatinous texture. The histopathological diagnosis was IMT. The postoperative course was uneventful, and the patient's symptoms subsided drastically, improving both anemia and systemic inflammation. The patient has shown no recurrence or relapse of the symptoms over one and a half years. Conclusions: In this case, the tumor resection finally enabled the diagnosis of IMT and resolved the clinical symptoms. Despite its predominantly benign morphological nature, some cases of IMT present clinically adverse courses. Surgical treatment may lead to its final diagnosis and improvement of clinical symptoms. [ABSTRACT FROM AUTHOR]