Anaemia In Population Research Articles

Dependency on host vitamin B12 has shaped Mycobacterium tuberculosis Complex evolution

Human and animal tuberculosis is caused by the Mycobacterium tuberculosis Complex (MTBC), which has evolved a genomic decay of cobalamin (vitamin B12) biosynthetic genes. Accordingly, and in sharp contrast to environmental, opportunistic and ancestor mycobacteria; we demonstrate that M. tuberculosis (Mtb), M. africanum, and animal-adapted lineages, lack endogenous production of cobalamin, yet they retain the capacity for exogenous uptake. A B12 anemic model in immunocompromised and immunocompetent mice, demonstrates improved survival, and lower bacteria in organs, in B12 anemic animals infected with Mtb relative to non-anemic controls. Conversely, no differences were observed between mice groups infected with M. canettii, an ancestor mycobacterium which retains cobalamin biosynthesis. Interrogation of the B12 transcriptome in three MTBC strains defined L-methionine synthesis by metE and metH genes as a key phenotype. Expression of metE is repressed by a cobalamin riboswitch, while MetH requires the cobalamin cofactor. Thus, deletion of metE predominantly attenuates Mtb in anemic mice; although inactivation of metH exclusively causes attenuation in non-anemic controls. Here, we show how sub-physiological levels of B12 in the host antagonizes Mtb virulence, and describe a yet unknown mechanism of host-pathogen cross-talk with implications for B12 anemic populations.

Prevalence and risk factors of anemia in the mother–child population from a region of the Colombian Caribbean

BackgroundDespite Colombia's robust well-child visits program, Colombian children and mothers still suffer from anemia, especially in populations of lower socioeconomic status. In this study, we aimed to quantify the prevalence and risk factors among mothers and their children attending their well-child visits in Apartadó, a municipality in the Urabá region of the Colombian Caribbean.MethodsThere were 100 mother–child pairs enrolled in this secondary data-analysis study from a health facility in the municipality of Apartadó, Urabá, Colombia, during well-child visits. Self-reported data included child illnesses in the past two weeks (diarrheal, fever, or respiratory symptoms), child feeding practices (breastfeeding, complementary feeding), child vaccinations, and demographic characteristics (mother’s and child’s age, mother’s education, marital status, race, and child sex) and socioeconomic status. Mother and child anthropometry data were collected via standardized weight and height measurements. Mother or child anemia status was collected via a blood test. Chi-squared tests and multivariable logistic regression were used to assess associations between risk factors and anemia.ResultThe anemia prevalence in children (74%) and mothers (47%) was higher than the Colombian national prevalence. Reported child comorbidities in the preceding two weeks were not significantly associated with child anemia and included respiratory illnesses (60%), fever (46%), and diarrhea (30%). Stunting (8%) was not significantly associated with anemia. Wasting (0%) was not observed in this study. Reported child breastfeeding and complementary feeding were also not significantly associated with child anemia. In adjusted models, the child's significant risk factors for anemia included the mother's "Mestiza" race (OR: 4.681; 95% CI: 1.258, 17.421) versus the Afro-Colombian race. Older children (25–60 months) were less likely to develop anemia than younger (6–24 months) children (OR: 0.073; 95% CI: 0.015, 0.360).ConclusionsThe finding of high anemia prevalence in this study advances our understanding of child and maternal anemia in populations of low socioeconomic status where health care is regularly accessed through well-child programs.

TT@MHA: A machine learning-based webpage tool for discriminating thalassemia trait from microcytic hypochromic anemia patients

BackgroundIron deficiency anemia (IDA) and thalassemia trait (TT) are the most common causes of microcytic hypochromic anemia (MHA) and are endemic in lower resource settings and rural areas with poor medical infrastructure. Accurate discrimination between IDA and TT is an essential issue for MHA patients. Although various discriminant formulas have been reported, distinguishing between IDA and TT is still a challenging problem due to the diversity of anemic populations. MethodsWe retrospectively collected laboratory data from 798 MHA patients. High proportions of α-TT (43.33 %) and TT concomitant with IDA (TT&IDA) patients (14.04 %) were found among TT patients. Five machine learning (ML) approaches, including Liner SVC (L-SVC), support vector machine learning (SVM), Extreme gradient boosting (XGB), Logistic Regression (LR), and Random Forest (RF), were applied to develop a discriminant model. Performance was assessed and compared with six existing discriminant formulas. ResultsThe RF model was chosen as the discriminant algorithm, namely TT@MHA. TT@MHA was tested in an interlaboratory cohort with a sensitivity, specificity, accuracy, and AUC of 91.91 %, 91.00 %, 91.53 %, and 0.942, respectively. A webpage tool of TT@MHA (https://dxonline.deepwise.com/prediction/index.html?baseUrl=%2Fapi%2F&id=26408&topicName=undefined&from=share&platformType=wisdom) was developed to facilitate the healthcare providers in rural areas. ConclusionThe ML-based TT@MHA algorithm, with high sensitivity and specificity, could help discriminate TT patients from MHA patients, especially in populations with high proportions of α-TT patients and TT&IDA patients. Moreover, a user-friendly webpage tool for TT@MHA could facilitate healthcare providers in rural areas where advanced technologies are not accessible.

Hemoglobin Change after Red Blood Cell Transfusion for Postpartum Anemia: Secondary Analysis of a Randomized, Controlled Trial.

We aimed to describe hemoglobin (Hb) change after transfusion in the nonacute postpartum anemic population in order to provide clinicians with appropriate expectations regarding Hb rise posttransfusion. We performed a secondary analysis of a randomized controlled trial comparing initial transfusion with 1 unit of packed red blood cells (pRBCs) to 2 units pRBCs for postpartum women requiring nonacute transfusion (n = 66). Inclusion criteria were: age 18 years and older, Hb level either <7 g/dL or >7 g/dL with signs or symptoms of anemia, and > 6 hours postpartum without contraindication to transfusion. Hb assessment was performed 4 to 6 hours after initial transfusion. Hb change (ΔHb) was calculated as posttransfusion Hb minus randomization Hb. Our primary goal was to describe mean ΔHb per pRBC transfused at the 4- to 6-hour posttransfusion blood count. We also compared ΔHb per pRBC transfused by number of units transfused, body mass index (BMI), and symptoms (dizziness and/or fatigue) at time of posttransfusion assessment. Participants were mean age 29, mean BMI of 27, and over 70% self-identified as black, 12% identified as white, and 9% as Asian race. Mean Hb prior to transfusion was 6.9 ± 0.6 g/dL. Mean ΔHb per pRBC transfused was 0.9 ± 0.4g/dL. There was no difference in ΔHb per pRBC by BMI category (normal weight < 25 kg/m2: 1.1 ± 0.2 g/dL; overweight 25-29.9 kg/m2: 0.9 ± 0.5 g/dL; obese ≥ 30 kg/m2: 0.9 ± 0.5 g/dL; p = 0.12). Finally, there was also no significant difference in ΔHb per pRBC by whether or not symptoms of anemia persisted after initial transfusion (1.0 ± 0.7 vs. 0.9 ± 0.4 g/dL, p = 0.39). Our data supports the classically accepted rise in Hb after pRBC of approximately 1 g/dL, regardless of BMI category or anemia symptomatology. The study population includes patients at highest risk of postpartum anemia. The results of our study provide important information for clinicians caring for postpartum patients with nonacute anemia. · Postpartum anemia is a significant public health issue.. · Providers use hemoglobin change to assess response to blood transfusion.. · The established 1 g/dL change in Hb after transfusion is based on historic surgical populations.. · Our data suggests the 1 g/dL Hb change is applicable to postpartum patients..

New logarithm-based discrimination formula for differentiating thalassemia trait from iron deficiency anemia in pregnancy

BackgroundThalassemia trait (TT) and iron deficiency anemia (IDA) are the most common conditions of microcytic hypochromic anemia (MHA) in pregnant women. Accurate discrimination between TT and IDA is an important issue, and better methods are urgently needed. Although considerable RBC formulas and indices have been developed since 1973, distinguishing between IDA and TT is still a challenging problem due to the diversity of various anemic populations. To address this problem, we assessed the diagnostic function of 43 different differential formulas in patients with microcytic anemia by using accuracy measures and recommending a new log-based differential formula.MethodsThe data of 430 pregnant women (229 with TT and 201 with IDA) were enrolled, and 44 formula performances were evaluated with receiver operating characteristic (ROC) analysis.ResultsThe newly introduced logarithm-based formula XS-1 performs better than the general discriminant index with sensitivity and specificity of 82.10 and 89.05, which are better than other formulas. In the pregnant population, the Shine and Lal and Roth..SVM. formulas have shown excellent performance, while other formulas showed poorer discriminative abilities in our study than in the original authors.ConclusionThe logarithm-based formula XS-1 can be used to screen thalassemia and iron deficiency anemia during the first trimester. Considering the particularity of pregnancy, medical personnel in different regions should choose a screening formula similar to that of the local region and population when identifying thalassemia in pregnancy. Any formula should be independently verified locally before use. For the convenience of the health care team and experimental scientists, a web-based tool has been established at http://yyy.yiyiy.top/XS-1/ by which users can easily get their desired screening test result without going through the underlying mathematical and computational details.

Challenges and opportunities in shared care for international patients treated with cellular therapy for nonmalignant disease

As cellular therapies gradually become the mainstay of treatment for several nonmalignant diseases, there appears to be varied accessibility to these therapies globally. Despite considerable burden of nonmalignant conditions, such as sickle cell disease, thalassemia, and aplastic anemia in populations of low-middle-income countries, the utilization of cellular therapies remain sparse because of lack of resources. Globally, the frequency of hematopoietic stem cell transplant (HSCT) has increased disproportionately in countries with higher gross national income (GNI) per capita, governmental healthcare expenditures, and a high human development index. This leads to a large subset of international patients seeking care in the United States. This review summarizes the unique set of challenges that often arise when offering sophisticated therapies such as HSCT to international patients constituting of cross-cultural, logistical, financial, and medical challenges and the opportunities that are available to bridge the gap.

A study on prevalence of newly diagnosed anemia and its clinical profile in male patients in a tertiary care hospital

Background: In India, most of the studies on anemia are confined to cohort of female and children leading to inadequate data on anemia among male population in spite of many negative effects of anemia on health in male. Aims and Objectives: This study was aimed to estimate the prevalence of anemia and its clinical profile. Materials and Methods: In this cross-sectional study, 286 male subjects aged between 15 and 75 years old were included in the study. Grading of anemia among the study participants was graded as mild, moderate, and severe as per the World Health Organization criteria. Data were analyzed in different subgroups. Results: The overall prevalence of anemia in male was 26.7%. The anemia was mostly found in age group of 50–65% (64.6%, 95% confidence interval [CI]: 59.1–70.1%) and anemia was more common among rural dwellers (72.04%, 95% CI: 66.8–77.2%) than urban dwellers (27.98%, 95% CI: 22.7–33.1%). Conclusion: Anemia has negative effects in male health such as decreased physical capacity, fertility, and economy in the family. This study will guide policymakers to take appropriate measures in male anemic population.

A smartphone-integrated low-cost, reagent-free, non-destructive dried blood spot-based paper sensor for hematocrit measurement.

The blood hematocrit (Hct) level provides vital information about a person's health. Traditional Hct measurement equipment relies heavily on infrastructure and skilled manpower, limiting its broad implementation in resource-limited contexts. Therefore, we developed a simple, reagent-free, non-destructive, smartphone-integrated paper-based device for Hct measurement by analyzing blood-spreading area on a paper substrate. Blood spreading area was found to be dependent on the Hct value, paper properties, and assay duration. This device was calibrated using a custom-made Python algorithm with 10 μl of blood, which produced a sensitivity of -1.90 ± 0.03 mm2/Hct (%) with a LOD as low as 2.17% Hct. The device linear range (8.8 to 58% Hct) is wide enough to cover the clinically relevant range of blood Hct (%). Furthermore, this Python algorithm was coupled with a user-friendly and clinically beneficial Android application (app) to establish an automated tool for quantitative estimation. Comparing the app performance with the result obtained from the gold standard hematology analyzer using blood from 87 subjects reveals a strong correlation (r = 0.99), an average bias of 0.15 with limits of agreement of -2.5 to 2.79 at 95% CI. The device exhibits an accuracy of 96.85% and acceptable reproducibility, with CV ranging from 0.8 to 7.5%. An integrated detection cum readout guiding pattern may allow this device to be suitable for simultaneous quantitative and qualitative estimation and to be employed in both developed and resource-limited clinical settings for Hct measurement in routine checkups and regular monitoring during critical care, as well as in the initial screening of large anemic populations.

Association of hemoglobin levels with clinical outcomes in acute coronary syndromes in Koreans.

Anemia is a well-known risk factor for cardiovascular disease. However, there are limited data on whether anemia on admission is a long-term prognostic factor in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention. We sought to evaluate the prevalence and prognostic consequences of anemia in patients with ACS treated with percutaneous coronary intervention in Korea. We retrospectively enrolled 1930 consecutive patients. Among the anemic population (hemoglobin [Hb] < 13 g/dL in men, and < 12 g/dL in women), we classified patients with Hb ≥ 7 g/dL, <10 d/dL as moderate anemia, other cases classified as mild anemia. Among patients with normal hemoglobin levels, we classified those with Hb > 16.5 g/dL in men, and > 16.0 g/dL in women, as having high hemoglobin. We examined the relationship between anemia with all-cause mortality and secondary outcomes - including cardiovascular mortality, myocardial infarction, stroke, and repeat revascularization. We classified 3.3%, 21.5%, and 5.3% of patients as moderate anemia, mild anemia, and high hemoglobin, respectively. During a median follow-up of 67.2 (interquartile range; 46.8-88.5) months, 74 (3.8%) patients died. Compared with patients with normal hemoglobin, we detected a significantly increased risk for all-cause mortality in patients with anemia (adjusted hazard ratios for moderate and mild anemia, respectively: 8.26 [95% confidence interval: 3.98-17.15], P < .001 and 2.60 [1.54-4.40], P < .001). Among patients with ACS, anemia is prevalent and is strongly associated with increased mortality and cardiovascular events. Clinical trials will prospectively evaluate the efficacy of treatment for anemia on the outcomes of patients with ACS.

Ferritin and its association with anaemia in a healthy adult population in Kenya.

BackgroundIron deficiency is the commonest cause of anaemia worldwide. Serum ferritin is the most sensitive non-invasive indicator of iron stores but its utility is compromised in inflammatory states as it is an acute phase reactant. This study sought to estimate the burden of iron deficiency in a healthy adult population residing in Kenya and to determine the association between various ferritin cut-offs and anaemia in a population known to have chronic low-grade inflammation.MethodsHealthy adults aged 18–65 years were recruited from urban towns in 4 counties in Kenya at average altitudes of 1683-2099m above sea level as part of a global study conducted by the International Federation of Clinical Chemistry (IFCC) to determine reference intervals (RIs) for common laboratory tests. We analyzed complete blood count (CBC), C-reactive protein, iron, transferrin, transferrin saturation and ferritin data.ResultsWe obtained data from 528 participants. There were 254 (48.1%) males and 274 females (51.9%). Based on a ferritin cut-off of 15 μg/L and Hb cut-offs of 14.5 g/dL and 12 g/dL, the prevalence of iron deficiency anaemia was 0.8% and 7.3% in males and females respectively. The odds of having anaemia was highest if one had a ferritin value less than 15 μg/L with a sensitivity of 28.6% and specificity of 98.4% in males, and sensitivity of 83.3% and specificity of 78.0% in females.ConclusionOnly the ferritin cut-off of 15 ug/L had an association with anaemia where it can be used for ruling out iron deficiency as the cause. Sex specific ferritin cut-offs for diagnosing iron deficiency in adults in sub-Saharan Africa need to be derived by comparing ferritin levels to stainable iron in bone marrow aspirates and trephines in order to ensure that we are using appropriate clinical decision limits.

Anemia Etiology and the Response to a Gluten-Free Diet in Untreated Patients With Celiac Disease: A 2-Year Follow-Up.

Anemia and micronutrient deficiencies are common in newly diagnosed patients with celiac disease (CeD). We aim to determine the prevalence and etiology of anemia in a cohort of patients with CeD in the United States and examine the effect of a gluten-free diet (GFD) on the laboratory parameters related to anemia in CeD. We analyzed a prospectively collected cohort of adults with biopsy-proven CeD followed in a specialized CeD center between January 2000 and June 2016. We used the level of hemoglobin (Hb) and micronutrients suggested by the World Health Organization to establish the diagnosis of anemia or deficiencies. Demographic data and laboratory parameters related to anemia and micronutrients were recorded at the time of diagnosis and on a GFD. A celiac expert nutritionist or gastroenterologist evaluated all patients. In 572 patients with laboratory evaluation before starting a GFD, approximately 25% presented with anemia at the time of diagnosis of CeD. Iron deficiency was present in 50.8% of the cohort and in 78.8% of the patients with anemia. Within the anemic population, 84.4% of female patients as compared with 58.3% of male patients ( P = 0.02) showed iron deficiency. Folate deficiency (23.2%), vitamin B12 deficiency (11%), and anemia of chronic diseases (7.8%) were also part of both sexes' anemia etiology. Of the initially anemic patients, 81% and 89% normalized their Hb levels within 1 year and 2 years of beginning a GFD, respectively. All patients received appropriate supplementation when needed. Approximately 25% of individuals have anemia at CeD diagnosis. The anemia etiology included iron deficiency, vitamin deficiencies, and anemia of chronic diseases. Most of the patients will normalize their Hb levels and the anemia laboratory parameters 1 year after starting a strict GFD.

A Smartphone-Based Biosensor for Non-Invasive Monitoring of Total Hemoglobin Concentration in Humans with High Accuracy.

In this paper, we propose a smartphone-based biosensor for detecting human total hemoglobin concentration in vivo with high accuracy. Compared to the existing biosensors used to measure hemoglobin concentration, the smartphone-based sensor utilizes the camera, memory, and computing power of the phone. Thus, the cost is largely reduced. Compared to existing smartphone-based sensors, we developed a highly integrated multi-wavelength LED module and a specially designed phone fixture to reduce spatial errors and motion artifacts, respectively. In addition, we embedded a new algorithm into our smartphone-based sensor to improve the measurement accuracy; an L*a*b* color space transformation and the “a” parameter were used to perform the final quantification. We collected 24 blood samples from normal and anemic populations. The adjusted R2 of the prediction results obtained from the multiple linear regression method reached 0.880, and the RMSE reached 9.04, which met the accuracy requirements of non-invasive detection of hemoglobin concentration.

Epidemiology of malaria and anemia in high and low malaria-endemic North-Eastern districts of India.

Anemia and malaria are the two major public health problems that lead to substantial morbidity and mortality. Malaria infection destroys erythrocytes, resulting in low hemoglobin (Hb) levels known as anemia. Here we report the determinants of anemia in high and low malaria-endemic areas that would help understand which parasite densities, age, and gender-associated low Hb levels. Therefore, a cross-sectional mass survey (n = 8,233) was conducted to screen anemia and malaria in high and low malaria-endemic districts (HMED and LMED) of North-East India. Axillary body temperature was measured using a digital thermometer. The prevalence of anemia was found to be 55.3% (4,547/8,233), of which 45.1% had mild (2,049/4,547), 52.1% moderate (2,367/4,547) and 2.9% had severe anemia (131/4,547). Among anemic, 70.8% (3,219/4,547) resided in LMED and the rest in HMED. The median age of the anemic population was 12 years (IQR: 7–30). Overall, malaria positivity was 8.9% (734/8,233), of which HMED shared 79.6% (584/734) and LMED 20.4% (150/734) malaria burden. The village-wise malaria frequency was concordant to asymptomatic malaria (10–20%), which showed that apparently all of the malaria cases were asymptomatic in HMED. LMED population had significantly lower Hb than HMED [standardized beta (β) = −0.067, p < 0.0001] and low-density Plasmodium infections had higher Hb levels than high-density infections (β = 0.113; p = 0.031). Women of reproductive age had higher odds for malaria (OR: 1.42; 95% CI: 1.00–2.05; p = 0.04). Females (β = −0.193; p < 0.0001) and febrile individuals (β = −0.029; p = 0.008) have shown lower Hb levels, but malaria positivity did not show any effect on Hb. Young children and women of reproductive age are prone to anemia and malaria. Although there was no relation between malaria with the occurrence of anemia, we found low-density Plasmodium infections, female gender, and LMED were potential determinants of Hb.

Prevalence of Celiac Disease in Adult Patients with Iron Deficiency Anemia

Background and Aim: Celiac disease is a gastrointestinal condition that is chronic and mediated by an immunological reaction to gluten present in different grains such as wheat, barley, and rye. Studies document that the incidence of celiac disease within the Pakistani population to be 29.3% and is highly prevalent among the younger age groups. Iron deficiency anemia is a major cause of anemia around the world, especially in developing countries such as Pakistan. Anemia has been acknowledged to be one of the major manifestations of celiac disease worldwide. This study will aim to assess the incidence and burden of celiac disease among the known anemic adult population of due to iron deficiency in tertiary care hospitals of Khyber Pakhtoonkhaw. Methodology: A cross-section study was conducted in the department of Gastroenterology Bacha Khan Medical Complex, Swabi and Northwest General Hospital &amp; Research Centre Hayatabad, Peshawar during the period of six months from May 2021 to October 2021. Participants were recruited after assessment of criteria. All recruited participants were anemic and underwent extensive serological assessment for screening of celiac disease. For confirmation of celiac disease duodenal biopsies were performed at five different levels. Results: 5.4% of the participants (n= 108) were found to have positive results for screening of IgA tTG. 38% of these participants (n= 41) showed IgA tTG ranging between 20 – 79 who were found negative for IgA EMA. These participants were kept on a gluten-free diet for the following 6 months and were scheduled on a recall assessment after 6 months and then 1 year of diet. On follow up duodenal biopsies were performed for these participants and the outcomes were classified as Marsh 0. These participants comprising 38% of IgA tTG screening were discarded from the possible suspect of celiac disease.The remaining 62% (n= 67) population of positive IgA tTG screening test, comprising 3.35% of the entire recruited population had values for IgA tTG of greater than 100 and showed positive results in serology reports of IgA EMA. All 67 participants who tested positive underwent duodenal endoscopy on five sites for a definite diagnosis of celiac disease and were found to be celiac disease positive Conclusion: The study concludes that the prevalence of the celiac disease among the anemic population is high, and anemia can be considered an extra gastric manifestation of celiac disease. Majority of identified participants were female and shows a predilection for female susceptibility. Keywords: Iron deficiency, Celiac disease, Prevalence, Correlation.

RBC Indices and Morphological Pattern of Anemia in Geriatric Population: A Cross-sectional Study in Eastern India

Background: Geriatric anemia is one of the neglected and undiagnosed health problems throughout the world leading to increased morbidity and mortality among this vulnerable age group. Anemia in elderly is often an indicator of an underlying co-morbid condition. Morphological pattern of anemia may reflect the underlying etiology and thus directs the appropriate way to management of the condition. Aims: To evaluate the severity and morphological pattern of anemia in geriatric age groups. Materials and Methods: Elderly individuals aged 60 years or older of either sex with Hb level &lt;12 gm/dl in women and &lt;13 gm/dl in males were included in this study as geriatric anemic population. Blood samples were analyzed for Hb, hematocrit (Hct), Mean corpuscular volume (MCV), Mean corpuscular haemoglobin (MCH), Mean corpuscular haemoglobin concentration (MCHC) and Red cell distribution width (RDW-CV). Anemia was graded as mild, moderate and severe according to WHO criteria. Morphological classification was done based on RBC indices and peripheral blood smear examination. Statistical analysis was done using SPSS software. Results: Total 277 geriatric anemic subjects were included in this study. Female to male ratio was 1.9:1. Most of the participants (60.29%) were in the age group of 60-69 years. Majority had mild anemia (48.02%). Normocytic-normochromic was the most predominant morphological subtype (74.73%). Mean Hb, MCH and MCHC were found to be significantly lower in geriatric females compared to males (P &lt; 0.05). Conclusion: Normocytic-normochromic anemia of mild degree was the most common type of anemia among geriatric population. Evaluation of morphological pattern of anemia may help in appropriate management of underlying condition.

Evaluating Deficiency of Vitamin B12 and Risk Factors in Healthy Infants

Background: The deficiency of vitamin b12 is highly extensive within the developed countries and is often found to remain undiagnosed within these populations. the main feature within infants suffering from vitamin b12 deficiency is altered neurological development and generalized growth. Effects of vitamin b12 deficiency on the brain can be prevented. To avoid these morbidities and mortality associated with vitamin b12 deficiency it is pivotal for clinicians to understand what other risk factors are associated with a deficiency within the infant population of developing countries. Materials and methods: This cross-sectional study was conducted on 82 healthy infants for the assessment of Vitamin B12 at Pediatric Department of LGH, Lahore from March 2021 to August 2021. Participants were selected who were healthy. After recruitment, participants underwent hematological and biochemical indices analysis. Hemoglobin, serum vitamin b12, homocysteine and methylmalonic acid were different parameters measured. Maternal vitamin b12 deficiency was investigated along with risk factor vitamin b12 deficiency in healthy infants. Results: A total of 82 recruited participants were selected after screening and meeting the recruitment criteria. After assessment of hematological data, anemia was diagnosed in 67.82% of infants (n=56). The breakdown of the anemic population showed that the male population was predominant with 58.2% affected males and 41.8% affected females. Decreased levels of plasma vitamin b12 concentration were documented in 22% of the population with a total number of 18 participants (male: 11, female: 7). Increased levels of homocysteinemia were documented in 49.1% of infants with n=40. Increased levels of methylmalonic acid were appreciated in all infants. As defined by previous criteria, the diagnosis of vitamin b12 deficiency was appreciated in 30 infants with a percentage of 38%. Furthermore, an assessment of folate deficiency showed that 8 out of 82 participants had concurrent folate deficiency in red cells with a percentile prevalence of 9.7%. maternal vitamin b12 deficiency was considered as risk factor for infant vitamin b12 deficiency Conclusion: The prevalence of vitamin b12 deficiency in healthy infants is significantly high in developing and underdeveloped countries. Vitamin b12 deficiency cooccurs with anemia and other variation of biological markers. The study concluded that among the various risk factors that may predispose an infant to vitamin b12 deficiency, maternal b12 deficiency remains the highest appreciated risk factor. Keywords: Vitamin B12, Risk Factors, Vitamin B12 deficiency, Maternal B12

Anaemia Is Associated with an Increased Risk of Fractures, a Systematic Review, and Meta-Analysis

Background: Anaemia and osteoporotic fractures are both major health problems among older adults worldwide. Objectives: Previous studies suggest that anaemia may be associated with elevated fracture risk among older adults; however, the exact relationship between them is unknown. We aimed to investigate the association between anaemia and fracture risk. Methods: A comprehensive literature search was performed in four medical databases. We included articles that were published from inception to February 18, 2021. Odds ratios (ORs), hazard ratios (HRs) with 95% confidence intervals (CIs), and original raw incidences from studies comparing fracture rates in anaemic versus non-anaemic patients were extracted and pooled with the random-effects model. I2 test was used to assess heterogeneity. Risk of bias assessment was performed using the Quality of Prognostic Studies tool. PROSPERO: CRD42021241109. Results: A total of 13 studies were identified; 8 of them were included in the quantitative synthesis. Anaemia was found to be a risk factor for fracture compared to non-anaemia. Anaemia increased hip fracture risk in both older men (HR = 1.71; CI: 1.46–2.00, p< 0.001, I2 = 83.2%) and women (HR = 1.31; CI: 1.13–1.52, p< 0.001), but the fracture risk was more increased among men. There was also an increased chance of hip fracture in the presence of anaemia in populations, including both older men and women (OR = 1.64; CI: 1.35–2.01, p< 0.001, I2 = 61.1%). Anaemia was also associated with increased vertebral (HR = 1.21; CI: 1.04–1.40, p = 0.012) and all-type (HR = 1.49; CI: 1.19–1.86, p< 0.001) fracture risk in older men. Conclusion: Our results suggest that there is a significant relationship between anaemia and fracture risk in older adults. This association is stronger among older men than women and differs in the different types of fractures.

A Mathematical Model for Blood Flow Accounting for the Hematological Disorders

Abstract This paper considers a mathematical model that accounts for the hematological disorders of blood in its flow in human arteries. Blood is described as a Newtonian fluid but with its viscosity as a function of the hematocrit, plasma viscosity, and shape factor of the red blood cells. The artery is modeled as a flexible circular pipe with the blood flow as oscillatory. This model is solved using HAM (Homotopy Analysis Method), an approximate analytical method, and we computed expressions for wall shear stress (WSS) and volumetric flow rate. With the help of publicly available data, blood flow in the human femoral artery for male and female populations aged 19 to 60 and above years is simulated for healthy, anemia, and polycythemia cases. The model projected a significant difference in the mean volumetric flow rates in the conditions mentioned above. Results also indicated that the mean WSS of healthy and anemic populations are not significantly different. However, a significant difference in the mean has been observed in healthy and polycythemic conditions. Furthermore, a 33.3% decrease in hematocrit value from that in the normal range (taken as 0.45) of a healthy population has increased the flow rate by 33.5%. For a value 33.3% above 0.45, there is a decrease of 42.7% in the flow rate.

Non-invasive hemoglobin measurement devices require refinement to match diagnostic performance with their high level of usability and acceptability.

Anemia remains an important global health problem. Inexpensive, accurate, and noninvasive solutions are needed to monitor and evaluate anemia in resource-limited settings. We evaluated the performance of multiple point-of-care hemoglobin devices, including a novel noninvasive smartphone application tested on Apple® and Android® cell phones, Masimo Pronto®, and HemoCue® Hb-301 and Hb-801, against a gold-standard hematology analyzer (reference hemoglobin) using venous blood. We examined correlations between hemoglobin devices and reference hemoglobin, device accuracy (average bias, Bland-Altman plots, clinical performance) and classification bias (sensitivity, specificity) among 299 refugees (10mo-65y) in Atlanta, GA. Semi-structured interviews (n = 19) with participants and staff assessed usability and acceptability. Mean reference hemoglobin was 13.7 g/dL (SD:1.8) with 12.5% anemia. Noninvasive hemoglobin devices were not well correlated with reference hemoglobin (Apple® R2 = 0.08, Android® R2 = 0.11, Masimo Pronto® R2 = 0.29), but stronger correlations were reported with HemoCue® Hb-301 (R2 = 0.87) and Hb-801 (R2 = 0.88). Bias (SD) varied across each device: Apple®: -1.6 g/dL (2.0), Android®: -0.7 g/dL (2.0), Masimo Pronto®: -0.4 g/dL (1.6), HemoCue® Hb-301: +0.4 g/dL (0.7) and HemoCue® Hb-801: +0.2 g/dL (0.6). Clinically acceptable performance (within ± 1 g/dL of reference hemoglobin) was higher for the invasive devices (HemoCue® Hb-301: 90.3%; HemoCue® Hb-801: 93.4%) compared to noninvasive devices (Apple®: 31.5%; Android®: 34.6%; Masimo Pronto®: 49.5%). Sensitivity and specificity were 63.9% and 48.2% for Apple®, 36.1% and 67.6% for Android®, 45.7% and 85.3% for Masimo Pronto®, 54.3% and 97.6% for HemoCue® Hb-301, and 66.7% and 97.6% for HemoCue® Hb-801. Noninvasive devices were considered easy to use and were the preferred method by participants. Among the only studies to compare multiple point-of-care approaches to hemoglobin testing, the diagnostic ability of HemoCue® was comparable to reference hemoglobin, while noninvasive devices had high user acceptability but considerable biases. Improvements in noninvasive device performance and further testing in anemic populations are recommended before broader use.

Effects of Supplementation With Iron Syrup or Iron-Containing Multiple Micronutrient Powders on Neural Indices of Cognitive Functioning in Bangladeshi Children

ObjectivesMicronutrients, especially iron, play a critical role in the developing infant brain. Yet, the causal effects of iron supplementation on neurocognitive functioning in a low-income anemic population of children have not been examined. This study sought to evaluate the effects of supplementation with iron syrup and iron-containing multiple micronutrient powders (MNPs) in Bangladeshi children on habituation to familiar sounds, a marker for healthy memory development, using auditory event-related brain potentials (ERPs). MethodsThis study was nested within the Benefits and Risks of Iron Supplementation in Children (BRISC) trial, a double blinded double dummy randomized controlled trial (RCT). At 8 months of age, 3300 children were randomized to receive 3 months of 1) iron syrup + placebo MNPs, or 2) MNPs (containing iron, retinol, zinc, and Vitamin C) + placebo iron syrup, or 3) placebo iron syrup and placebo MNPs. ERPs in response to an auditory roving oddball paradigm were measured in a random subset of 441 children at 3 months post-intervention (11 months of age) and 595 children after a further 9 months follow-up (20 months of age). ERP measures indexing aspects of habituation included the [deviant minus standard] difference waveform amplitude, N2 waveform amplitude, and the difference in deviant-evoked ERP amplitudes between the first and second half of the paradigm. Intention-to-treat analyses on ERP outcomes using linear models were used at 11 and 20 months of age separately. ResultsBaseline characteristics were balanced between treatment groups. Overall prevalence of anemia was 43.7% and iron deficiency was 28.4%. Intention-to-treat analyses indicated no significant treatment effects of iron or MNPs on the difference waveform amplitude at 11 months of age [mean difference (MD, 95% CI) iron vs placebo 0.24 (–1.03, 1.51); MNP vs placebo 0.59 (–0.70, 1.88)] and 20 months of age [(MD, 95% CI) iron vs placebo 0.50 (–0.62, 1.63); MNP vs placebo 0.24 (–0.89, 1.38)]. There were no differences by treatment arm for the other ERP measures. ConclusionsResults from a rigorous prospectively powered sub-study of an RCT in an iron deficient population indicated no significant effects of supplementation with iron or MNPs on neural indices of habituation. Funding SourcesNHMRC and The University of Melbourne.