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Background: Blood donation is associated with a loss of hemoglobin (Hb)-bound iron. Hb levels recover relatively fast by using stored iron. However, it takes more time to replenish iron stores, potentially resulting in iron deficiency. Study design: Hb and ferritin levels were measured in 5056 new, first-time, and repeat whole blood donors. We investigated whether increasing numbers of donations are associated with lower ferritin levels. Furthermore, we tested whether low ferritin levels are associated with low-Hb deferral at the subsequent donation attempt by performing logistic regression adjusted for age and stratified by sex. Results: Whereas mean Hb levels are relatively stable, ferritin levels significantly decrease with increasing numbers of donations and were approximately 50% lower for donors with >50 donations compared with those with 2–10 donations. Despite the poor correlation of ferritin and Hb levels, cross-sectional, iron-deficient donors (ferritin

IntroductionOur aim is to identify the presence of serologically active clinically quiescent (SACQ) episodes in pediatric systemic lupus erythematosus (SLE) patients. We aim to identify serologic biomarkers associated with SACQ episodes and discuss risks and benefits of escalating treatments.Material and methodsWe evaluated 25 pediatric SLE patients, 13 of whom experienced SACQ epis­odes. Serologically active clinically quiescent was defined as two consecutive clinic visits without any clinical symptoms or clinical examination findings of a lupus flare with a clinical Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score of zero, but either elevated anti-ds-DNA antibodies or low complement (C3 and/or C4) levels.ResultsAmong the 13 patients who experienced a SACQ episode, there were a total of 24 episodes, with each patient experiencing 1–4 SACQ episodes. Erythrocyte sedimentation rate (ESR) was the most commonly elevated laboratory marker in a SACQ episode, followed by low hemoglobin levels, and then elevated anti-dsDNA antibodies. Of the 17 episodes treated during a SACQ episode, 15 (88%) did not progress to a clinical flare within six months, while two did. Furthermore, of the 7 patients who were not treated during their SACQ episode, 2 (29%) continued to be SACQ without flare, whereas 5 led to a clinical flare within six months.ConclusionsSerologically active clinically quiescent episodes were identified in pediatric SLE patients, suggesting that the presence of SACQ is not limited to adults with SLE. Serologic markers such as increased ESR, hemoglobin, and elevated anti-dsDNA antibodies are preliminarily associated with pediatric SACQ episodes. Treating these SACQ episodes in pediatric SLE patients was less likely to lead to a clinical flare within six months when compared to not treating (p < 0.05). More research with a larger sample size is needed to define SACQ episodes, determine the prevalence in pediatric SLE patients, and establish SACQ treatment guidelines.

Objetivo: Evaluar el estado nutricional de estudiantes universitarios con proponer las recomendaciones adecuadas de alimentación. Materiales y Métodos: Los alumnos participantes fueron evaluados mediante un estudio transversal, se diseñaron y aplicaron encuestas con la finalidad de obtener información relacionados con hábitos alimenticios y sintomatología; la evaluación antropométrica y la toma de muestras sanguíneas para la realización de hemograma se realizaron bajo la normatividad ética estandarizada. Para el análisis estadístico de los datos se aplicó un modelo de regresión logística multifactorial utilizando para ello el programa EPI INFOTM. Adicionalmente, se realizó una revisión de la literatura en base de datos en relación a los nutrientes adecuados y recomendados para prevenir la COVID-19. Resultados : Se evaluó un grupo de 42 estudiantes universitarios (n=42) cuya edad oscila entre 18 y 22 años de edad. Más del 95% de los jóvenes declararon consumir carbohidratos como su mayor fuente de alimento; por otro lado, el 76% mostraron un IMC dentro de los parámetros normales (19-24.9 Kg/m2). Se estimaron recuentos bajos de hemoglobina con una prevalencia del 11.90% entre el grupo participante. Conclusiones: La alimentación sigue siendo la clave para la salud y el bienestar del ser humano. Para mejorar el sistema inmunitario se recomienda el consumo de alimentos naturales, en lugar de alimentos con alto contenido de azucares, harinas y grasas. Dentro de los alimentos con mayor potencial para la prevención de la COVID-19 se encuentran los frutos secos, los huevos, el pescado, los vegetales de hoja verde y los granos enteros. El consumo de fitoquímicos y nutracéuticos puede prevenir e incluso tratar la infección por SARS- CoV-2.

Background: B2-microglobulin (B2M) is recognized as a surrogate marker of middle-molecule uraemic toxins and is a key component in the genesis of dialysis-associated amyloidosis. Objectives: To investigate the relation between hidden cardiac dysfunction in one side and B2M levels, conventional risk factors low hemoglobin levels, and aging on the other side. Subjects and methods: This was a case control study conducted on 50 patients aged 20-60 years with ESRD on regular HD and 50 apparently healthy individuals at El- Mokattam Insurance Hospital from September 2019 till March 2020. Results: There were statistically significant differences between groups regarding B2M, EF, LVMI, intraventricular septal thickness and LVEDD. There were no statistically significant differences between groups. Patient’s B2- microglobulin in Group (A) ranged between 76.00-109.70 with mean±S.D. 94.162±9.735, while in Group (B) ranged between 0.78-3.29 with mean±S.D. 1.956±0.704. There were statistically significant differences between groups. Patient’s LVMI in Group (A) ranged between 111.87-131.59 with mean±S.D. 123.41±5.675, while in Group (B) ranged between 82.02-104.84 with mean±S.D. 91.63±7.236. There were statistically significant differences between groups. Patient’s LVEDD in Group (A) ranged between 5.94-7.56 with mean±S.D. 6.79±0.505, while in Group (B) ranged between 3.27-5.25 with mean±S.D. 4.25±0.571. There were statistically significant differences between groups. Patient’s LVESD in Group (A) ranged between 4.80-5.73 with mean±S.D. 5.34±0.250, while in Group (B) ranged between 2.87-3.65 with mean±S.D. 3.27±0.243. There were no statistically significant differences between groups. Conclusion: Plasma B2M level was significantly and directly correlated with some cardiac performance factors such as LVMI, LVEDD, and LVESD. It was also significantly and inversely associated with GFR, albumin and Hb.

Background A low hemoglobin level, commonly referred to as anemia, is frequently encountered in the acute care setting among patients with different comorbidities. It is essential that clinicians understand the pathophysiology of anemia to develop a practical differential diagnosis of the cause of the low hemoglobin level. A systematic approach should be used when determining the diagnosis to provide the correct treatment for the patient. Objective This article highlights the equal importance of the patient's history and laboratory values in arriving at the correct diagnosis of low hemoglobin level. The approach to diagnosis is described along with an algorithm to enable the clinician to quickly and effectively diagnose their patients. Discussion The differential diagnosis of low hemoglobin level is extensive, and some may be overlooked if an organized approach is not taken. For unstable patients, the diagnosis is usually clearer to the clinician. However, for a stable patient, the diagnosis may be difficult to obtain owing to the many causes of low hemoglobin level. The algorithm allows for easier navigation of the diagnostic process.

Background: Leukemia is frequently associated with fundoscopic abnormalities. However, no organized effort has been made for analyzing leukemic retinopathy in our country. This study was done to observe the demographic profile and correlation between fundoscopic findings of retinal exudates and hematological parameters in leukemic patients. Materials and Methods: The study was a hospital-based descriptive cross-sectional study among 50 leukemic patients in Medicine and Oncology departments of Bangladesh Medical College and Hospital (BMCH) from May, 2020 to October, 2020. Fundoscopic examination was done which was reviewed by an ophthalmologist. Collected data was analyzed statistically by using SPSS-17 (Chicago, Illinois). Results: Among 50 leukemic patients’, the fundal lesion was detected in 32 patients (64%), retinal exudates are rare. Only 3 patients (6%) had exudates while others (29 patients, 58%) have retinal hemorrhages. Exudates did not show any statistically significant relationship with types of leukemia (p value = 0.53). There was no statistically significant association between fundal exudates and high white cell count (p = 0.56) or low hemoglobin level (p = 0.11) or low platelet level (p = 0.11). Conclusion: This study has identified retinopathy occurring frequently in leukemic patients. Therefore, an adequate attention should be paid at fundoscopic evaluation while treating leukemic patients.

Pendahuluan: Nilai Annual Parasite Incidence (API) malaria tahun 2014 di Puskesmas Hanura, Kabupaten Pesawaran adalah sebesar 48,75‰ yang tergolong dalam endemisitas tinggi sedangkan API malaria di Puskesmas Rajabasa Indah, Kota Bandar Lampung adalah sebesar 0,00‰ yang tergolong dalam non-endemis. Malaria pada ibu hamil secara langsung dapat menyebabkan anemia materna karena penghancuran eritrosit yang mengandung parasit dan yang tidak mengandung parasit, reduced survival time, dan diseritropoiesis. Prevalensi tertinggi anemia materna di Sumatra adalah Provinsi Lampung, yaitu sebanyak 25,9%. Tujuan penelitian: tujuan penelitian ini adalah untuk mengetahui perbandingan rerata kadar hemoglobin ibu hamil di daerah endemis dan non-endemis malaria tahun 2016. Metode penelitian: Metode yang digunakan adalah komparatif dengan pendekatan cross-sectional yang melibatkan 104 ibu hamil di wilayah Puskesmas Hanura dan Rajabasa Indah tahun 2016. Penelitian ini menggunakan data primer dengan mengambil darah tepi ibu hamil. Hasil penelitian: terdapat ibu hamil dengan kadar hemoglobin di bawah normal lebih banyak terjadi di daerah endemis malaria sebanyak 67,3% ibu dibandingkan di daerah non-endemis malaria dengan persentase 34,6% ibu. Hasil penelitian dengan tes Mann-Whitney menunjukkan terdapat perbedaan rerata kadar hemoglobin ibu hamil (p=0,014) yang tinggal di daerah endemis dan non-endemis malaria. Kesimpulan: Terdapat perbedaan rerata kadar hemoglobin ibu hamil di daerah endemis dan non-endemis malaria Provinsi Lampung.

BACKGROUND: To prevent (negative consequences of) temporary deferral due to low hemoglobin, the Dutch national blood service Sanquin introduced a ferritin monitoring policy in 2017. Ferritin is measured after the donation (as opposed to before donation for hemoglobin), and low ferritin levels lead to deferral of 6 (ferritin 15-30 ng/mL) or 12 months (ferritin STUDY DESIGN AND METHODS: We included all Dutch whole blood donors who made a donation (attempt) between 13 November and 31 December 2017. At that point, the ferritin monitoring policy was randomly implemented in 8 of 29 regional clusters of collection centers. We extracted information from Sanquin's donor database about donors' deferrals, subsequent donation attempts, and donation cessation (up to 31 December 2019). Donors deferred for low ferritin were compared to those deferred for low hemoglobin or other reasons, as well as to donors who were not deferred.RESULTS: A total of 55 644 donors were included (11% deferred). For donor behavior, we found that donors deferred for low ferritin less often unsubscribed and switched to other donation types, yet also made fewer donations in the follow-up period. For availability, we found they were less often deferred, yet they were unavailable to donate for a longer period.CONCLUSION: Results suggest that the implementation of a ferritin monitoring policy may lead to a decrease in donor availability and reduced donations. However, the policy is successful in retaining more donors and reducing low hemoglobin deferrals.

According to WHO, the prevalence of anemia is highest in South Asia, and India has the maximum prevalence of anemia among the South Asian countries. Anemia is major concern in developing countries like India. Thus, the present study explored the dietary factors influencing hemoglobin levels among college students. Adopting stratified and simple random sampling technique, this study is showed at 3 Arts and Science Colleges situated in North Chennai. This study is directed among 1000 students in the age group of 19 to 22 years. Interview schedule was used for collection of the details regarding the background information and eating habits of the participants. Biochemical tests are the most objective and sensitive measures of nutritional status. In the present study, hemoglobin is evaluated using Drabkin Method. The attained particulars are oblique and arrived into Microsoft excel. The oblique raw data are exposed to numerical study utilizing Statistical Package for Social Science (SPSS) version 20.0. Hemoglobin levels of the participants were correlated with dietary habits. The prevalence of anemia was more among 19 years (73.4%), followed by 65% in 20 years, 54.6% in 21 years and 46% in 22 years. Hostel dwellers were more prone to anemia than the students resided with the parents, friends and relatives. Students residing at hostel tend to have a poor eating habit leading to low hemoglobin levels. Vegetarians are more prone to anemia when compared to mixed diet consumers and ova- vegetarians.

Background: Open heart surgery is usually performed by connecting the heart to a cardiopulmonary bypass (CPB) machine. The use of the CPB machine may decrease the hemoglobin level and a very low hemoglobin levelcould cause seriouscomplications.This study aimed to explore the decrease in hemoglobin level after open heart surgery. Methods: A cross-sectional retrospective descriptive study was conducted on medical records of patients underwent coronary artery bypass graft (CABG) surgery and heart valve surgery in a tertiary hospital in Indonesia in 2018. The total sampling method was deployed to all medical records of patients underwent CABG surgery (n=25) and patients underwent heart valve surgery (n=3). Results: The decrease in hemoglobin level among young-adult female patients after heart valve surgery was 6.8 g/dl. The average decrease in mid-adult male and female patients after CABG surgery were 6 g/dl and 5.8 g/dl, respectively, and, after the heart valve surgery, the levels were 8.5 g/dl and 5.4 g/dl, respectively. The average decrease in Hb level among late-adult male and female patients after CABG surgery was 6.1 g/dl and 5.4 g/dl, respectively. Conclusion: Hemoglobin level decreases after an open heart surgery. Therefore, observation on the hemoglobin level to prevent complications and to facilitate early treatment is necessary.

Se'i/nu is one of the traditions of the local community on the island of Timor. The research objective was to prove the relationship between the roasting tradition (se'i/nu) with the hemoglobin level and the process of uterine involution in postpartum women. The research design was analytical with an observational approach. The sample consisted of 42 respondents obtained through total sampling. The independent variable was the roasting tradition (se’i/nu) and the dependent variables were hemoglobin level and maternal uterine involution. The method used to measure the roasting tradition (se’i/nu) was an observation sheet. To measure the hemoglobin level, we used a laboratory check and to measure uterine involution, we conducted a physical examination and used an observation sheet. The results showed that the largest percentage of hemoglobin levels in postpartum mothers was among those that did the roasting tradition (se'i/nu) with an abnormal hemoglobin level of 66.66% (22 people). The puerperal women who did the tradition of roasting (se'i/nu) obtained high uterine fundus and the abnormal mothers made up the largest percentage of 69.70% (23 people). There was a correlation between the roasting tradition (se'i/nu) and maternal hemoglobin level (p=0.025) and there was also a correlation between the roasting tradition (se'i/ nu) with the process of maternal uterine involution (0.00). The conclusion is that there is a prolonged uterine involution process and that the low hemoglobin levels in the puerperium may be due to exposure to chemical susceptibility as a result of inhaling polluted air due to the se'i/nu process.

BACKGROUND Depression is the most common extrahepatic neuropsychiatric manifestation in chronic hepatitis C (CHCV) and is due to direct neuropathogenic mechanisms. Our aim is to evaluate the effect of viral clearance by directly acting antivirals (DAAs) on depression in CHCV patients. METHODS One hundred fifty chronic HCV patients eligible for DAAs were assessed for depression using the Beck depression inventory (BDI) scale at baseline, 1 and 3 months after end of treatment (EOT). BDI ≥10 reliable in detecting depression in CHCV. RESULTS All included patients received Sofosbuvir/Dacltasvir ± Ribavirin for 12 weeks and all achieved sustained virological response (SVR). Baseline BDI of all included patients was 10 ± 5 then decreased to 5.3 ± 5 and 3.5 ± 4.5 at 1 and 3 months after EOT (P = 0.001), respectively. After EOT, 20 patients (13.3%) had BDI >10 which were 11.35 ± 6.5 and 13.3 ± 3.2 at 1 and 3 months (SVR), respectively. A comparison between patients with high and low BDI after EOT showed that patients with persistent high score were older (60.6 ± 9.5vs 52.2 ± 10.6, P = 0.001) and included higher percentage of females (50% vs 22.3%, P = 0.01). Also high BDI patients had higher baseline FIB4 (3 ± 1.6 vs 2 ± 1.3, P = 0.006) and included more patients with significant fibrosis (40% vs 17.7%, P = 0.05), as well as lower baseline hemoglobin (13.6 ± 1.5 vs 14.4 ± 1.65, P = 0.04). CONCLUSION Depression associated with CHCV improves after successful treatment with DAAs; however, it may persist in elderly females with significant fibrosis and low hemoglobin.

BACKGROUND Studies in adults showed a relationship between low hemoglobin (Hb) and acute kidney injury (AKI). We performed this study to evaluate this association in newborns. METHODS We evaluated 1891 newborns from the Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN) database. We evaluated the associations for the entire cohort and 3 gestational age (GA) groups

The study of the movement of donation in enterprises with harmful working conditions in Tyumen. The influence of professional factors on red blood parameters (hemoglobin concentration, number of red blood cells, ESR, hematocrit, color index) of donors with regard to gender and age was studied. According to the results of a survey of 4,267 blood donors in 2013–2016, there was an increase in the number of withdrawals from donations, due to changes in red blood indicators, in workers at enterprises with harmful working conditions. The examined men and women, whose work is associated with harmful occupational factors, showed a significant decrease in the concentration of hemoglobin and the number of red blood cells. Objective hematological observations along with subjective assessments of the donors ‘own health showed the development of anemic syndrome — one of the main syndromes of lead professional pathology. It is necessary to continue searching for factors that cause an increase in the percentage of donor withdrawal due to low hemoglobin concentrations. Among the promising measures for maintaining and developing donation in enterprises with harmful working conditions, specific plans for improving health should be developed, including specific tools and conditions for improving the blood system.Funding. The study had no funding.Conflict of interests. The authors declare no conflict of interests.

Aim: In this study, we aimed to retrospectively review the clinical characteristics of patients who were operated on for ectopic pregnancy rupture (EPG) in our hospital and hospitalized in the postoperative intensive care unit (ICU) and evaluate the possible relations between the patient laboratory data and ICU length of stay. Materials and Methods: The study included 56 female patients whose medical records were available and who were hospitalized in the ICU between 1.1.2017 and 1.1.2019. We retrospectively recorded the patients’ demographic and clinical characteristics and laboratory data, amount of blood and blood products received, and number of days spent in the ICU. Results: The mean patient age was 30.21±5.26 years and the mean ICU length of stay was 1.87±1.20 days. The patients were given an average of 1.78±1.76 units of erythrocyte suspension (EU), 1.19±1.55 U fresh frozen plasma (FFP), and 0.03±0.26 U platelet suspension (PS). It was found that between the ICU length of stay and the hematocrit and platelet values, hemoglobin values, ES and FFP use, and PS use there was a weak negative (r=-0.388, p=0.003; r=-0.380, p=0.004), moderate negative (r=-0.436, p=0.001), moderate positive (r= 0.469, p

Introduction: Anemia and Ascaris infection are important indicators to reflect the health status of students. In this study, by investigating the current situation of low hemoglobin and positive rate of Ascaris eggs of primary and secondary school students in Hohhot, the health status of local primary and secondary school students is actually reflected. Objectives: To understand the prevalence of Low Hemoglobin and Ascaris infection among primary and secondary school students in Hohhot in 2015 and to give some suggestions on the health status of primary and secondary school students in Hohhot. Study Design: This project uses a cross-sectional study to investigate the distribution of disease and health status of primary and middle school students in Hohhot at a specific time, and to provide a clue to the cause of the hypothesis test. Methods: A stratified cluster random sampling method was used to select 4 districts, 4 counties and 1 flag in Hohhot, a total of 36 primary and secondary schools for sample survey. Cyanine HiCN and smear method is to detect hemoglobin and ascaris eggs positive. Results: In 2015, the positive rate of low hemoglobin in primary and secondary school students was 21.45% in urban and rural areas, 33.17% in urban and rural areas, 43.69% in rural areas, 13.59% in ascaris eggs, 10.69% in urban and rural areas, 7.81% in rural areas. There are geographical differences and gender differences between cities, urban-rural junctions and rural areas (p < 0.05). Conclusion: The prevalence of low hemoglobin in primary and secondary school students in Hohhot is high in rural areas. The detection rate of ascaris egg positive rate in the city is high. Monitoring, publicity and education should continue to be strengthened.

Background: Due to frequent hospitalizations, complex dialysis procedures and immune compromising effects of end stage renal disease (ESRD), patients on dialysis are more prone to healthcare associated infections (HCAIs). Objective: To study the impact of HCAIs on survival and treatment outcomes among ESRD patients on renal replacement therapy (RRT). Methodology: A multicenter, retrospective study was conducted from June to December 2019 at two public hospitals of Malaysia. ESRD patients with minimum of 6 months on RRT were included, while pregnant patients and patients Results: A total of 670 records were examined, of which 400 patients were included as per the inclusion criteria. The mean survival time of patients without HCAIs [22.7 (95%CI:22.1–23.2)] was higher than the patients with HCAIs [19.9 (95%CI:18.8–20.9)]. Poor survival was seen in patients with >2 comorbidities, >60 years of age, low hemoglobin concentration and high C-reactive protein levels. The most frequent treatment outcome was cured [113 (64.9%)], followed by death [37 (21.3%)] and treatment failure [17 (9.8%)]. Advancing age, and low hemoglobin concentration were independent risk factors associated with death, while recurrent HCAIs, use of central venous catheters, and low serum sodium levels were risk factors for treatment failure. Conclusion: The high burden of HCAIs is a profound challenge faced by patients on RRT, which not only effects the treatment outcomes but also contributes substantially to the poor survival among these patients.

ObjectiveThis study aimed to determine the rate and risk factors of allogeneic red blood cell transfusions (ABT) after hemiarthroplasty (HA) in elderly patients with femoral neck fracture (FNF).MethodsThe subjects of the study were elderly patients (≥65 years old) who were admitted to the geriatric trauma orthopedics ward of Beijing Jishuitan Hospital between March 2018 and June 2019 for HA treatment due to an FNF. The perioperative data were collected retrospectively, and univariate and multivariate stepwise logistic regression analyses were performed to determine the post-operative ABT rate and its risk factors.ResultsThere were 445 patients in the study, of whom 177 (39.8%) received ABT after surgery. Multivariate stepwise logistic regression analysis showed that preoperative low hemoglobin (Hb), high intraoperative blood loss (IBL), advanced age, and a low body mass index (BMI) are independent risk factors of ABT after HA in elderly FNF patients.ConclusionABT after HA is a common phenomenon in elderly patients with FNF. Their post-operative ABT needs are related to preoperative low Hb, high IBL, advanced age, and low BMI. Therefore, ABT can be reduced by taking these factors into account. When the same patient had three risk factors (preoperative low hemoglobin, advanced age, and low BMI), the risk of ABT was very high (78.3%). Also, when patients have two risk factors of preoperative low hemoglobin and low BMI, the risk of ABT was also high (80.0%).

Patients with unstable hemoglobin (Hb), caused by a qualitative abnormality in α- and β-globin genes, are often asymptomatic or mildly symptomatic. It is often difficult to diagnose unstable Hb patients with only mild hemolysis or low oxygen saturation. We herein report a case of a family with an unstable Hb, specifically, Hb Sydney (HBB: c.203T>C), an abnormal β-globin chain. A 5-year-old boy was referred to our hospital for low percutaneous oxygen saturation (SpO2) in the setting of bronchitis. During hospitalization, low SpO2 persisted despite the improvement in respiratory distress symptoms. As he had mild hemolysis and splenomegaly, his disease was diagnosed to carry Hb Sydney based on gene analysis. His mother and brother also carried Hb Sydney. In this case, bronchial asthma had been treated, but unstable Hb was not assessed. Low SpO2 may be tolerated and overlooked in cases of asthma and it took time to diagnose this patient. The present case suggests that unstable Hb should be considered in patients with bronchial asthma and prolonged low SpO2.

Background Acute ischemic stroke patients are a group at high risk for pressure sores. It is important to identify risk factors for pressure sores in acute ischemic stroke patients in order to facilitate early adoption of appropriate preventive and treatment measures. Methods Data were derived from the China National Stroke Registry. Acute ischemic stroke patients aged >18 years who presented at the hospital within 14 days after the onset of symptoms were eligible for this study. Comprehensive baseline data were collected. The definition of pressure sores was based on assessment at discharge of whether the patient had pressure sores at any time during hospitalization. Results 12,415 patients with a mean age of 67 years and a mean length of hospitalization of 14 days were included in the study. Among these patients, 97 (0.8%) had pressure sores during hospitalization. In the multivariate analysis of risk factors for pressure sores, age (each increment of 5 years), being unmarried, NIHSS at admission (each increment of 3 points), mRS at admission (3-5 points), diabetes mellitus, hemoglobin at admission (each incremental reduction of 10 units), and history of peripheral vascular disease all were significantly correlated with the occurrence of pressure sores among acute ischemic stroke patients during hospitalization. Conclusions Old age, severe neurological disability, being unmarried, low hemoglobin, and history of diabetes mellitus and peripheral vascular disease were risk factors for pressure sores in acute ischemic stroke patients.

BACKGROUND The number of red blood cell units transfused per capita in China is lower than in western countries and the reason(s) for the difference is unknown. STUDY DESIGN AND METHODS We randomly chose 5050 transfused patients from five Chinese hospitals. We compared transfused cases to nontransfused controls matched for the same underlying diagnosis. We assessed the pretransfusion hemoglobin (Hb) trigger and other clinical characteristics associated with transfusion. After stratifying by underlying disease, we compared pretransfusion Hb level in Chinese hospitals to 12 US hospitals. RESULTS In 5050 patients who received transfusion, the pretransfusion Hb levels were lower in medical (6.3 g/dL) compared to surgical patients receiving transfusion postoperatively (8.1 g/dL). In patients with nonsurgical diagnoses, the pretransfusion Hb was much lower than that in the United States; the difference in mean Hb level varied by underlying diagnosis from 0.4 to 1.8 g/dL. In case-control analysis of cases (n = 1356) compared to controls (n = 1201), the pretransfusion Hb showed the strongest association with transfusion. Compared to 10 g/dL, the odds ratio (95% confidence interval) for pretransfusion Hb of 7 to 7.9 g/dL was 37.7 (24.8-57.4). CONCLUSION Transfusion triggers in five Chinese hospitals appear comparable to those in the United States for surgical patients; however, medical patients have lower pretransfusion Hb levels (approx. 6 g/dL). Of the factors assessed, the pretransfusion Hb was most strongly associated with transfusion. The clinical impact of lower transfusion thresholds used in China is unknown.

To evaluate the clinical impact of preoperative glycemic status upon oncological and functional outcomes after radical prostatectomy in patients with localized prostate cancer, we analyzed the data of 2664 subjects who underwent radical prostatectomy with preoperative measurement of hemoglobin A1c within 6 months before surgery. The possible association between high hemoglobin A1c (≥ 6.5 ng/dL) and oncological/functional outcomes was evaluated. Among all subjects, 449 (16.9%) were categorized as the high hemoglobin A1c group and 2215 (83.1%) as the low hemoglobin A1c group. High hemoglobin A1c was associated with worse pathological outcomes including extra-capsular extension (HR 1.277, 95% CI 1.000–1.630, p = 0.050) and positive surgical margin (HR 1.302, 95% CI 1.012–1.674, p = 0.040) in multi-variate regression tests. Kaplan–Meier analysis showed statistically shorter biochemical recurrence-free survival in the high hemoglobin A1c group (p p = 0.024). Moreover, the high hemoglobin A1c group showed a significantly longer incontinence-free survival than the low hemoglobin A1c group (p = 0.001), and high preoperative hemoglobin A1c was also an independent predictor for longer incontinence-free survival in multivariate Cox analyses (HR 0.929, 95% CI 0.879–0.981, p = 0.008). The high preoperative hemoglobin A1c level was independently associated with worse oncological outcomes and also with inferior recovery of urinary continence after radical prostatectomy.

Few studies assess the malnutrition risk of older Mexican adults because most studies do not assess nutritional status. This study proposes a modified version of the Mini Nutritional Assessment (MNA) to assess the risk of malnutrition among older Mexicans adults in the Mexican Health and Aging Study (MHAS). Data comes from the 2012, 2015, and 2018 waves of the MHAS, a nationally representative study of Mexicans aged 50 and older. The sample included 13,338 participants and a subsample of 1911 with biomarker values. ROC analysis was used to calculate the cut point for malnutrition risk. This cut point was compared to the definition of malnutrition from the ESPEN criteria, BMI, low hemoglobin, or low cholesterol. Logistic regression was used to assess predictors of malnutrition risk. A score of 10 was the optimal cut point for malnutrition risk in the modified MNA. This cut point had high concordance to identify malnutrition risk compared to the ESPEN criteria (97.7%) and had moderate concordance compared to BMI only (78.6%), and the biomarkers of low hemoglobin (56.1%) and low cholesterol (54.1%). Women, those older than 70, those with Seguro Popular health insurance, and those with fair/poor health were more likely to be malnourished. The modified MNA is an important tool to assess malnutrition risk in future studies using MHAS data.

Background Revision knee arthroplasty (RKA) is associated with low hemoglobin (Hb) levels after surgery, which results mostly from perioperative blood loss. Periprosthetic joint infection (PJI) is one of the common reasons for RKA. This study aimed to determine whether low Hb levels affect the healing process of PJI. Methodology This retrospective study included 69 patients who underwent two-stage revision for PJI between 2013 and 2016. Patients were divided into two groups according to the latest Hb levels (Hb < 10 and Hb > 10 g/dL) during hospitalization for the first-stage revision surgery. Laboratory parameters of infection were measured during the cement spacer retention period: C-reactive protein (CRP), sedimentation rate (SEDIM), and white blood cell (WBC) count. Treatment was evaluated in two periods: cement spacer retention period (between the first surgery and second surgery) and the first normal CRP period (between the first surgery with the first normal CRP level during the cement spacer retention period). Infection parameters in the two time periods and reoperation with cement spacer were compared between the groups. Results The mean patient age was 67.3 ± 7.94 (50-87) years, and the female-to-male ratio was 4:1. No difference was found in the postoperative first control CRP, SEDIM, and WBC between the groups (p = 0.953, p = 0.3341, and p = 0.444, respectively). CRP-SEDIM control curves were observed in parallel, and no significant difference was found. The cement spacer retention period was 60.3 ± 24.8 (17-123) days, and the first normal CRP period was 87.3 ± 28.4 (14-161) days; no statistical difference was found between the groups (p = 0.727, p = 0.754). Conclusions In RKA, as low Hb level was not a negative factor of infection, blood transfusion should be avoided as it has many complications.

Background: A simple classification for the relevance of lesions (P0, P1, and P2; no bleeding potential, less likely to bleed, and more likely to bleed, respectively) based on capsule endoscopy (CE) findings has been used. This study aimed at investigating rebleeding rates and predictive factors of P0 and P1 lesions after obtaining negative findings in both, CE and computed tomography (CT), for patients with obscure gastrointestinal bleeding (OGIB). Methods: Among 193 patients resulted in negative CE findings defined as P0 or P1 lesions, 84 patients with negative results on CT images were enrolled in this study. The rebleeding rates and predictive factors were assessed in the P0 and P1 groups. Results: Overall rebleeding rate in patients with negative CT and CE was 17.9%; 18.4% in the P0 group; 17.4% in the P1 group within a median follow-up duration of 18.5 months. In the P0 and P1 groups, the cumulative rebleeding rates were 9.2%, 25.4%, and 25.4%, and 6.9%, 11.8%, and 18.6% at 12, 24, and 60 months, respectively (p = 0.97). There were no independent rebleeding associated factors in the P0 group, whereas Charlson comorbidity index (CCI) (hazard ratio (HR) = 2.019, 95% confidence interval (CI): 1.158–3.519, p = 0.013), and initial low hemoglobin (Hb) level (p = 0.037) were independent predictive factors responsible for rebleeding in the P1 group. Conclusions: Despite having negative findings on CT and CE, patients with OGIB have a significant potential rebleeding risk. Although there was no significant difference in rebleeding rates between the P0 and P1 groups on CE, the P1 group, with CCI or low initial Hb level, should be cautiously observed after the first bleeding episode.

Background Anemia is common in patients with severe chronic liver disease, but its role in HBV-related decompensated cirrhosis (DeCi) is still unclear. We therefore aimed to assess the impact of anemia on prognosis in HBV-DeCi patients. Methods One hundred thirty-three patients diagnosed with HBV-DeCi were retrospectively collected. Results A total of 113 (85.0%) patients suffered from anemia in our cohort. The low hemoglobin (Hb) level group exhibited a significantly increased 28-day mortality rate compared with the high Hb group. Hb level was a predictor of 28-day mortality in HBV-DeCi patients. Conclusions Reduced Hb levels were associated with unfavorable prognosis in HBV-DeCi patients, and more attention should be paid to anemia in routine clinical assessments of liver cirrhosis.

In developing countries, anemia is a major public health problem; anemia affects 24.8% of the global population, corresponding to 1.62 billion people. As anemia is defined as a low hemoglobin level in the blood, it is important to measure exact hemoglobin content in grams per deciliter of the blood. Recent advances in mobile health (mHealth) technologies for blood hemoglobin levels are promising, but often rely on additional complex components to the smartphone and require blood sampling. As a result, noninvasive quantification of hemoglobin content in the blood is still limited. We have recently developed intravital mHealth spectroscopy to extract spectrally encoded microvascular and blood information from peripheral tissue. Spectral learning virtually transforms the built-in camera of a smartphone into a hyperspectral imager for spectroscopic analyses. Owing to the easy accessibility and relatively uniform microvasculature, the inner eyelid is used as a sensing site. Spectroscopic analyses of spectra acquired from the inner eyelid further result in key parameters about the blood and the microvasculature that are used for predicting blood hemoglobin levels in a noninvasive and real-time manner. Our clinical study conducted in sub-Saharan Africa supports reliable performance of blood hemoglobin quantification and anemia prediction. As our mHealth technology requires no additional attachment (our data-centric approach minimizes hardware complexity), the key features include mobility, simplicity, and affordability for rapid and scalable adaptation. Successful implementation with local governments and community healthcare workers can potentially provide unreached and underserved remote populations with accessible and affordable healthcare services in low-resource settings.

Background: The aim of this study was to determine the predictive risk factors for development of severe bronchiolitis in patients with acute bronchiolitis with no previous chronic disease. Methods: Four hundred forty children aged 1-24 months hospitalized with acute bronchiolitis, were examined between February 2018 and February 2019 in this prospective study. Results: Eighty-five cases were regarded as severe bronchiolitis and 355 as mild-moderate bronchiolitis. Statistically significant differences were observed between the severe and mild-moderate bronchiolitis groups in terms of weight-for-age z-scores, history of bronchiolitis, hemoglobin levels, and time elapsed between onset of symptoms and admission. Weight-for-age z-scores, the mean time interval between onset of symptoms and admission, and mean hemoglobin values were lower in the severe bronchiolitis group while the mean number of bronchiolitis attacks was higher than in the mild-moderate bronchiolitis group. Logistic regression analysis determined that a low weight-for-age z-score increased the risk of severe bronchiolitis development 0.56-fold (CI: 0.409 – 0.760), a short duration between the onset of symptoms and admission increased the risk 0.62-fold (CI: 0.519 – 0.735), a frequent history of bronchiolitis increased the risk 1.81-fold (CI: 1.135 – 2.968) and low hemoglobin levels increased the risk 0.72-fold (CI: 0.537 – 0.969). Conclusion: Low weight-for-age z-scores, a short duration between the onset of symptoms and admission, a high number of previous attacks, and low hemoglobin levels were identified as independent parameters of severe bronchiolitis development. Key words: Bronchiolitis, Infant, Risk factors, Severity degree

Objective Studies of patients with iron deficiency anemia (IDA) have shown a relationship between high glycated hemoglobin (HbA1c) and low hemoglobin (Hb) concentration. The present study was conducted to determine the influence of IDA on HbA1c in non-diabetic women. Methods Fifty-nine Saudi women (20 to 50 years old) were enrolled and categorized into groups according to their circulating hemoglobin concentration: Non-IDA (Hb ≥7.45 mmol/L; n = 38) and IDA (Hb ≤7.44 mmol/L; n = 21). The IDA group was further subdivided according to the severity of the IDA, as follows: mild (Hb 6.83 to 7.44 mmol/L; n = 9) and moderate–severe (Hb Results HbA1c did not significantly differ between the groups, but the absolute HbA1c level was significantly lower in the mild and moderate–severe anemia groups than the non-anemic group, and was positively associated with Hb, ferritin, and RBC count. In addition, the HbA1c level was inversely associated with the Hb concentration. Conclusions HbA1c is significantly associated with parameters related to IDA in non-diabetic Saudi women. Therefore, assessment of IDA-related parameters is recommended prior to making a diagnosis of diabetes.

The risk factors for the survival of elderly patients with oral squamous cell carcinoma (OSCC) are multifarious. Here, we developed a novel clinical signature to serve as an indicator of prognosis in these patients. Clinicopathological data were collected for 554 patients aged ≥ 60 years who were treated for primary OSCC. Overall survival (OS), disease-specific survival, and disease-free survival were the primary outcomes. Multivariate cox regression analysis showed that high N stage, low hemoglobin level, low body mass index (BMI), and high neutrophil-to-lymphocyte ratio (NLR) showed a poor survival (P

Background Worldwide, pressure ulcers (PUs) have been implicated in costing billions annually, with 60,000 deaths out of 2.5 million hospitalized patients resulting from complications related to PU. The prevention of PU reduces the incidence of other illnesses, decreases the financial costs, and improves the quality of life for patients. We aimed to identify the most influential factors that increased the risk of developing PUs among hospitalized patients at a university hospital according to the Waterlow scale. Methods Data were collected retrospectively from patients who developed PUs between January 2016 and December 2018 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, and were evaluated using the Waterlow PU risk assessment tool. The analysis was performed using the Statistical Package for Social Science (SPSS), version 23.0 (IBM, Armonk, NY). Results A total of 272 cases were included in this study. The highest number of cases (n = 83, 30.5%) belonged to the age group of 50 to 64 years. The majority of patients had stage 2 PUs (165, 60.7%). The most frequent location of PU was the "back" (97, 35.7%). A history of undergoing major surgery was significantly associated with a higher stage of PU (p = 0.040). The mean Waterlow PU score for all cases was 27.19 ± 13.143. There was a moderate positive correlation between the neurological deficit score and the Waterlow PU score (correlation coefficient: 0.447, p < 0.001). Multinomial logistic regression analysis revealed that increasing age is a significant predictive factor for developing higher stages of PUs (p = 0.046). Conclusion Major surgery, neurological deficit, low hemoglobin level, and increasing age were strong predictors for developing higher stages of PU. Therefore, healthcare contributors should consider these risks when applying a comprehensive PU management plan.

Anemia, defined as a low hemoglobin concentration, has a large impact on the health of the world’s population. We describe the use of a ubiquitous device, the smartphone, to predict hemoglobin concentration and screen for anemia. This was a prospective convenience sample study conducted in Emergency Department (ED) patients of an academic teaching hospital. In an algorithm derivation phase, images of both conjunctiva were obtained from 142 patients in Phase 1 using a smartphone. A region of interest targeting the palpebral conjunctiva was selected from each image. Image-based parameters were extracted and used in stepwise regression analyses to develop a prediction model of estimated hemoglobin (HBc). In Phase 2, a validation model was constructed using data from 202 new ED patients. The final model based on all 344 patients was tested for accuracy in anemia and transfusion thresholds. Hemoglobin concentration ranged from 4.7 to 19.6 g/dL (mean 12.5). In Phase 1, there was a significant association between HBc and laboratory-predicted hemoglobin (HBl) slope = 1.07 (CI = 0.98–1.15), p

Severe imported pediatric malaria is of concern in non-endemic settings. We aimed to determine the features of pediatric severe cases in order to design a model able to stratify patients at presentation.We conducted a retrospective cross-sectional study including all imported P. falciparum malaria infection in patients ≤14 years of age, treated from January 2008 to February 2019 in two tertiary hospitals: Brescia, Italy and Barcelona, Spain. Severe malaria was defined according to World Health Organization criteria. Mortality rate, pediatric intensive care unit (PICU) stay and blood transfusion were analysed as adverse outcomes.Out of 139 children included, 30.9% were severe malaria. Twenty-seven (19.4%) were admitted to PICU, and transfusion was required in 14 cases (10.1%). Predictors for severe malaria were: young age, low hemoglobin, high white blood cells (WBC) and high C-reactive protein. Platelet130,000/μl correlated with severe malaria (without statistical significance). A model that includes age, WBC and C-reactive protein shows a high specificity to classify patients without severe malaria (92.3%) with 70% PPV and 75% NPV.A score based on patient's age, WBC and C-reactive protein easily available at emergency room can help to identify children with higher risk of adverse outcomes.

The prevalence of dementia is around 5% worldwide in people above 65 years, which increases with aging. Alzheimer's disease is the most common cause of dementia in the elderly. On the other hand, anemia is considered one of the most prevalent comorbidities in the elderly with a prevalence of 11% in those above the age of 65. It is crucial that we find the association between anemia and dementia, as this linkage can prove beneficial. Many currently conducted studies support the idea that anemia is a significant risk factor for dementia. However, some studies still consider anemia and dementia as just an aging process, nothing more. In our study, we found that there are a lot of theories, such as low brain hemoglobin associated with low oxygen levels, which leads to neuron damage. One article mentioned that it is dependent on the level of hemoglobin as an effect with mild to moderate anemia, but apparent with severe forms of it. Researchers are expected to further explore and identify the exact relationship between anemia and dementia. We used the PubMed database as the principal source for data search and extracted articles exploring the relationship and role of anemia in decreasing the cognitive brain functions in the elderly. We reviewed 35 different articles, including clinical trials, review papers, randomized controlled trials (RCTs), and original research published between 2010 and 2020 to find commonly accepted pathophysiology that highlights how anemia causes a decrease in cognitive brain functions.