Anemia In People Research Articles

Contribution of ARV Treatment in the Correction of Anemia in People Living with HIV during the First Semester in the Hematology Department of Conakry University Hospital

Contribution of ARV Treatment in the Correction of Anemia in People Living with HIV during the First Semester in the Hematology Department of Conakry University Hospital

Reactive oxygen species, glutathione, and vitamin E concentrations in dogs with hemolytic or nonhemolytic anemia.

BackgroundRed blood cells (RBC) are uniquely susceptible to oxidative injury. Oxidative stress is both a cause for, and effect, of anemia in people but this has been minimally documented in dogs.ObjectiveTo describe direct and indirect markers of oxidative stress in anemic dogs.HypothesisAnemic dogs will have oxidative stress when compared to healthy dogs.AnimalsForty‐seven dogs with anemia (10 with hemolytic anemia) and 70 healthy control dogs.MethodsProspective, cross‐sectional study. Anemic dogs were identified from the patient population, and medical records were reviewed to classify the anemia as hemolytic or nonhemolytic. Flow cytometry was used to detect reactive oxygen species (ROS) in erythrocyte isolates. Reduced glutathione (GSH) concentrations were measured in both plasma and hemolysate samples, and vitamin E was measured in serum.ResultsAnemic dogs (both hemolytic and nonhemolytic) had significantly lower median RBC hemolysate GSH concentrations (3.1 μM [0.4‐30.8]) when compared to healthy dogs (7.0 μM [0.5‐29.7]; P = .03). Dogs with hemolytic anemia had significantly higher median plasma GSH (7.6 μM [0.4‐17.8]) when compared to dogs with nonhemolytic anemia (1.6 μM [0.01‐7.1]; P = .04) and healthy dogs (2.8 μM [0.1‐29.9]; P < .0001). Reactive oxygen species were detectable in all samples, but there was no difference in ROS or vitamin E between groups.Conclusions and Clinical ImportanceOxidative stress is present in anemic dogs. Derangements in biomarkers of oxidative stress are different in dogs with hemolytic anemia and nonhemolytic anemia.

Application of corn zein as an anchoring molecule in a carbon nanotube enhanced electrochemical sensor for the detection of gliadin

This research focused on the fabrication of an electrochemical sensor capable of detecting the protein ‘gliadin’, which is responsible for serious autoimmune disorder causing chronic diarrhea, fatigue, weight loss and anemia in people having celiac disease. The fabrication process involves the replacement of toxic synthetic chemicals that are used for anchoring of the capture antibody in the working electrode, by the natural polymer zein coupled with several nanoparticles including, carbon nanotubes, graphene oxide and Laponite®. Novel biodegradable coatings made from zein nanocomposites: zein-graphene oxide (Z-GO), zein-Laponite® (Z-LAP) and zein-multiwalled carbon nanotubes (Z-CNT) using drop casting nanocomposite technique were tested for fabricating the electrochemical sensors using cyclic voltammetry (CV), square wave voltammetry (SWV) and electrochemical impedance spectroscopy (EIS). Pristine zein coated electrode did not generate any oxidation/reduction peaks in the cyclic voltammograms and showed high degree of impedance in the EIS curves. While addition of the three nanoparticles (CNT, LAP, GO) considerably improved the electrical signal, Z-CNT gave the highest and strongest signals compared to other nanomaterials. The active tip of the electrochemical sensor was functionalized through a sequence of layer by layer deposition of Z-CNT nanocomposite, and other linker molecules, where Z-CNT acts as a natural linker molecule with large number of functional groups that offers immobilization of capture antibody and target and ensures high performance. Both CV curves and SWV curves indicated successful sequential immobilization of gliadin antibody onto the Z-CNT coated electrode. The Z-CNT biosensor was successfully able to give CV signals for gliadin allergens for as low as 0.5 ppm, and was highly selective for gliadin, when tested against other food toxins like acrylamide and formamide, and the Z-CNT nanocomposite remained stable over a 30-day period.

Interventions for treating iron deficiency anaemia in inflammatory bowel disease: a network meta-analysis

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective will be to evaluate the efficacy and harms of the interventions for the treatment of iron deficiency anaemia in people with inflammatory bowel disease and rank the treatments in order of effectiveness in a network meta‐analysis.

PDG1 RECOMBINANT HUMAN ERYTHROPOIETIN VERSUS PLACEBO OR NO TREATMENT IN PATIENTS WITH ANEMIA OF CHRONIC KIDNEY DISEASE: META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Chronic kidney disease (CKD) is associated with anemia due to decrease erythropoietin production by kidney. Several erythropoiesis-stimulating agents (ESAs) are available for treating anemia in people with CKD. The aim of this study was to evaluate the relative efficacy of recombinant human erythropoietin (rHuEPO) and safety by meta-analysis. We searched the MEDLINE database (up to March 2019) using search terms relevant to this review for. Randomized controlled trials (RCTs) and quasi-RCTs, that included a comparison of rHuEPO with placebo or no treatment in adults with CKD, and that reported prespecified patient-relevant outcomes. Only published data were used. Quality assessment was performed by two assessors independently. were expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). Ten studies (13 reports) with a total of 1080 participants (499 pre-dialysis patients, and 581 patients on hemodialysis) reported in published papers, were included in this meta-analysis. rHuEPO therapy produced a marked improvement in hemoglobin (MD 1.69 g/dL, 95% CI 1.57 to 1.82; p < 0.00001) and hematocrit (MD 9.21%, 95% CI 7.97% to 10.45%; p < 0.00001) levels as well as prevented blood transfusions (RR 0.13, 95% CI 0.06 to 0.27; p < 0.00001) compared to placebo. The risk of increase in or introduction of antihypertensive treatment was 2.64 times higher in rHuEPO-treated group than in control group in population of patients on hemodialysis (RR 2.46, 95% CI 1.24 to 4.90; p = 0.01) however it was less certain for pre-dialysis patients (RR 1.38, 95% CI 0.94 to 2.01; p = 0.10). No significant increase in other adverse events was identified. The rHuEPO therapy allows to correct the symptoms attributable to anemia of CKD, avoid blood transfusions, and significantly improve the overall quality of life.

Strong association of anemia in people with diabetic foot ulcers (DFUs): Study from a specialist foot care center.

Background & Objective:Anemia is common finding in people with diabetes and diabetic foot ulcers. Therefore, our objective was to observe and compare the association of anemia in people with diabetic foot ulcers (DFUs) with age and sex matched people without DFUs.Method:This prospective case control study was undertaken at a multidisciplinary diabetic foot clinic of Baqai Institute of Diabetology and Endocrinology (BIDE) between October 2014 and October 2015. Participants were categorized into two groups; Case group (people with DFUs) and Control group (people without DFUs). Baseline demographic characteristics, biochemical and hematological parameters were recorded. University of Texas (UT) classification system was used to grade and stage DFU in case group. Subjects with other apparent causes of anaemia were excluded. Age and sex matched controls were taken from diabetic clinic presented during same time period. Data was analyzed by using statistical package for social science (SPSS) version 20.Results:Total of 161 participants in case group were compared with similar number of age and sex matched participants of control group. Most of the participants were males 119(73.9%). Age and sex matched case and control groups were comparable except for duration of diabetes, BMI and HDL levels. Overall, 85.67% case group (males 64.56%); females 21.11%) and 35.3% control group (males 22.9%; females12.4%) have anemia. Mean Hb level was 10.49g/dl in case group and 13.39g/dl in control group. Significant differences were also noted in other blood parameters.Conclusion:Our study concludes that anaemia is strongly associated with DFU disease. Anaemia should be considered and treated as co-morbidity while managing patients with foot ulcers.

Intestinal protozoa parasites association with anemia in people from Brazilian western Amazon communities

Introduction: Nowadays intestinal parasitic infection remains an important public health trouble in Latin and South America, emphasizing the Amazon region. Furthermore, intestinal parasites have been considered important factors in etiology of nutritional anemia and malnutrition. Objective: This study aimed to evaluate the intestinal parasitic infection and its possible association with anemia in people from Amazon communities. Methods: The study was a research in documentary records, descriptive, retrospective and cross-sectional, with confirmed cases of parasites infection found in State Hospital of Cacoal-Rondônia, Brazilian Western Amazon. The parameters evaluated were gender, age, race, parasites, hematocrit and hemoglobin. Results: Females where slight higher for the number of cases of parasites occurrence (51%) compared to males (49%) and children had higher parasitic index (43%) followed by adults (37%), teenagers (11%) and seniors (9%). With regards to race, pardos (brown skin color) group was the most affected by the parasites with 69% of cases, followed by caucasians (17%), indians (11%) and blacks (3%). The major parasites diagnosed were Endolimax nana (55%), Giardia lamblia (28%), Entamoeba coli (14%) and Iodamoeba bütschlii (3%). In relation to the association of intestinal parasites and anemia, children had a 60% anemia increase when compared to adults (p &lt;0.05) and the indians increased by 100% anemia when paired against caucasians (p &lt;0.05).Conclusion: Thus, it is suggested that attention should be given to the increase in protozoa parasitic infection prevalence in Amazonian communities and expedite the emergency of improvements in political and sanitation programs of water treatment and waste and sewer management.

Anemia in people on second line antiretroviral treatment in Lilongwe, Malawi: a cross-sectional study

BackgroundAnemia is common among people living with HIV infection and is frequently associated with poor quality of life and poor prognosis. It has been well described in antiretroviral naïve individuals and those on non-nucleoside reverse transcriptase inhibitor-based first line antiretroviral therapy (ART) regimens. However there is limited information on anemia for ART experienced individuals on protease inhibitor-based second line ART regimens in resource limited settings. Our objective was to describe the prevalence and risk factors of anemia in this ART experienced population in Malawi.MethodsWe conducted a cross-sectional study using routine facility data at two HIV clinics in Lilongwe, Malawi. The analysis included individuals receiving protease inhibitor-based second line ART. Clinical and laboratory data were collected at routine clinic visits. We used descriptive statistics, two-sample t-tests and multivariate logistic regression for data analysis.ResultsThree hundred seventy-seven records were included in this analysis (37% male, median age 41 years, median CD4 count 415 cells/μL). The prevalence of anemia was 125/377 (33.2%) − mild, moderate and severe anemia was 17.5%, 13.8%, and 1.9% respectively. Female participants had a higher prevalence than male participants (43.6% vs. 15.7%, p < 0.001). In multivariate logistic regression, female sex (adjusted odds ratio (aOR) 5.3; 95% CI 2.9–9.5) and a CD4 count <200 cell/ul (aOR 3.1; 95%CI 1.6–6.0) were associated with increased risk of having anemia while a BMI ≥30 kg/m2 (aOR 0.8; 95% CI 0.6–1.0) and being on ART for more than 10 years (aOR 0.4; 95% CI 0.2–0.9) were associated with reduced risk of anemia. Being on a zidovudine- containing ART regimen was not associated with anemia.ConclusionAnemia is common in people on second line ART in Lilongwe, Malawi. Screening for anemia in this population would be a useful strategy; especially for female patients, those who are underweight and have a low CD4 cell counts.

Anemia in people on second line antiretroviral treatment in Lilongwe, Malawi: a cross-sectional study

Anemia in people on second line antiretroviral treatment in Lilongwe, Malawi: a cross-sectional study

The Relation between Diabetes Type II and Anemia

Background: Anemia is defined as a decrease in the hemoglobin concentration of blood, which accordingly decreases the oxygen-carrying capacity of red blood cells such that they are unable to meet the body’s physiological requirements. Numerous reports have specified that anemia customarily occurs in patients with diabetes with renal insufficiency whereas limited studies have described the occurrence of anemia in people with diabetes prior to indication of renal impairment. Other studies have similarly recognized anemia as a risk factor for the need for renal replacement treatment in diabetes. Understanding the pathogenesis of anemia allied with diabetes can lead to the development of interventions to optimize results in these patients. Purpose: The purpose of this study was consequently to determine the pervasiveness of anemia among patients with type 2 diabetes. Materials and Methods: A total of 50 (25 with type 2 diabetes and 25 controls) participants were enlisted for the current study. Participants’ blood samples were analyzed for fasting blood glucose, full blood count and renal function tests among others. The pervasiveness of anemia was then determined statistically. Results: A high incidence of anemia was perceived in the cases. Of the patients with diabetes, 85 % had a hemoglobin concentration that was significantly less (males 10.88±1.78 and females 10.32±1.52) compared to that of controls (males 14.16±1.82 and females 12.49±1.11). A significantly increased fasting blood glucose, urea, sodium, potassium, and calcium ions were observed in the cases (8.02±1.28, 5.21±2.01, 141.08±7.01, 4.84±0.49 and 1.51±0.28 respectively) as compared to the controls (4.57±0.52, 3.61±2.09, 134.86±6.75, 4.38±0.61 and 1.31±0.31 respectively). Finally, a significant association between hemoglobin concentration and fasting blood glucose was also observed in the cases. Conclusions: The findings suggest that a high incidence of anemia is likely to occur in patients with poorly controlled diabetes and in patients with diabetes and renal insufficiency.

Prevalence, genetic variants and clinical implications of G-6-PD deficiency in Burkina Faso: a systematic review

BackgroundIt is now well-known that some antimalarials such as primaquine may induce severe hemolytic anemia in people with G-6-PD deficiency. Antimalarial drug prescriptions must, therefore take into account the patient’s G-6-PD status in malaria endemic areas such as Burkina Faso, where the prevalence of this genetic abnormality is relatively high. Although great clinical heterogeneity is observed depending on the molecular nature of the deficiency and the residual enzyme activity in the red blood cell, there is very poor data on the prevalence of G-6-PD deficiency and the distribution of involved genetic variants in Burkina Faso. In this systematic review, we present a synthesis of the various studies carried out on the G-6-PD deficiency in Burkina Faso in order to determine its prevalence, probable distribution of the genetic variants involved and their clinical implications for a national systematic screening policy among the groups most vulnerable to malaria.MethodsA systematic review was carried out to analyze available published data on the prevalence, phenotypes and mutations responsible for G-6-PD deficiency in Burkina Faso. The key words used were “G-6-PD deficiency AND Burkina Faso” or “Déficit en G-6-PD AND Burkina Faso” in French. To identify the relevant articles, two independent reviewers reviewed the titles, abstracts and the full text of the selected papers.ResultsAn average prevalence of 16.6% (183/1100; CI 95%: 0.145–0.190) and 6.5% (69/1066; CI 95%: 0.051–0.081) of G-6-PD deficiency was found respectively in men and women in this systematic review. Although the predominance (99.8% of G-6-PD deficient cases) of 202A/376G G-6-PD A- variant, the Santamaria and Betica Selma variants were identified in Burkina Faso. Independently of the method used, the enzymatic deficiency was significantly higher in males (2.5–20.5%) compared to females (3.3–12.3%).ConclusionThis systematic review suggests that despite the ubiquity of the 202A/376G G-6-PD A- variant in Burkina Faso, it will be necessary to consider the Santamaria and Betica Selma variants although their frequencies remain to be specified. A systematic screening of the G-6-PD deficiency is also needed to prevent the occurrence of iatrogenic hemolytic accidents.

Concurrent Plasmodium infection, anemia and their correlates among newly diagnosed people living with HIV/AIDS in Northern Ethiopia

The magnitude of concurrent malaria infection and the impact it has on hematological abnormalities, such as anemia in people living with HIV/AIDS, is not well studied in Ethiopian set up. In this cross sectional study, therefore, we assessed the prevalence of concurrent malaria infection and anemia among highly active anti-retroviral therapy (HAART) naive people living with HIV/AIDS between October, 2012 to May, 2013 in Northern Ethiopia. After obtaining consent, socio demographic, clinical, immunological and behavioural data was obtained. The overall prevalence of concomitant malaria infection was 17.4%. Rural residents and low to middle income class clients were more frequently co-infected with malaria (p<0.0001). Utilization of insecticide treated nets (p=0.0002) and co-trimoxazole intake (p=0.006) were protective factors against Plasmodium infection. The overall prevalence of anemia was also high (43%), being significantly higher (91.3%) in malaria positive people living with HIV/AIDS compared to malaria free HIV patients (32.8%) (p<0.0001). Female gender (p=0.011), history of opportunistic infections (P=0.0027) and late HIV stages (III and IV) (p=0.0001) were also significantly associated with anemia in HIV patients. In conclusion, concurrent malaria represents a common condition and there was a significant difference in the odds of anemia between malaria positive and negative people living with HIV/AIDS in Northern Ethiopia indicating a need for routine screening of people living with HIV/AIDS living in malaria endemic-areas and close monitoring of co-infected patients. Indeed utilization of ITNs, malaria prophylaxis and early HIV diagnosis are highly encouraged in people living with HIV/AIDS.

A case-control study of prevalence of anemia among patients with type 2 diabetes.

BackgroundAnemia is defined as a reduction in the hemoglobin concentration of blood, which consequently reduces the oxygen-carrying capacity of red blood cells such that they are unable to meet the body’s physiological needs. Several reports have indicated that anemia mostly occurs in patients with diabetes with renal insufficiency while limited studies have reported the incidence of anemia in people with diabetes prior to evidence of renal impairment. Other studies have also identified anemia as a risk factor for the need for renal replacement therapy in diabetes. Understanding the pathogenesis of anemia associated with diabetes may lead to the development of interventions to optimize outcomes in these patients. The aim of this study was therefore to determine the prevalence of anemia among patients with type 2 diabetes.MethodsA total of 100 (50 with type 2 diabetes and 50 controls) participants were recruited for our study. Participants’ blood samples were analyzed for fasting blood glucose, full blood count and renal function tests among others. The prevalence of anemia was then determined statistically.ResultsA high incidence of anemia was observed in the cases. Of the patients with diabetes, 84.8 % had a hemoglobin concentration that was significantly less (males 11.16±1.83 and females 10.41±1.49) than the controls (males 14.25±1.78 and females 12.53±1.14). Renal insufficiency determined by serum creatinine level of >1.5 mg/dL, estimated glomerular filtration rate <60 ml/minute/1.73 m2, and erythropoietin levels was also observed to be high in the cases (54.0 %; with mean creatinine concentration of 3.43±1.73 and erythropoietin 6.35±1.28 mIU/mL). A significantly increased fasting blood glucose, urea, sodium, potassium, and calcium ions were observed in the cases (7.99±1.30, 5.19±1.99, 140.90±6.98, 4.86±0.53 and 1.47±0.31 respectively) as compared to the controls (4.66±0.54, 3.56±2.11, 135.51±6.84, 4.40±0.58 and 1.28±0.26 respectively). Finally, a significant association between hemoglobin concentration and fasting blood glucose was also observed in the cases.ConclusionsThe findings suggest that a high incidence of anemia is likely to occur in patients with poorly controlled diabetes and in patients with diabetes and renal insufficiency.

Anaemia and Pro-inflammatory Cytokines in Human Immunodeficiency Virus Infection

Anaemia is often seen in HIV infected individuals and cytokines imbalance have been reported to cause haematopoietic stem cells suppression in the bone marrow. This case control study was carried out to determine any possible correlation between haemoglobin and pro-inflammatory cytokines in the development of anaemia in people living with HIV. 54 HIV infected and 34 apparently healthy HIV uninfected individuals were enrolled in this study. Full blood count and levels of three pro-inflammatory cytokines [(IL- α (interleukin-1 alpha), TNF-α (tumour necrosis factor- alpha) and IFN- γ (interferon- gamma)] were determined using MindrayBC- 6800 automated Haematology analyser and Enzyme linked Immunosorbent Assay (ELISA) kits (Aviva system Biology, San Diego, CA, USA) respectively. The results obtained showed that prevalence of anaemia was 40.7% in HIV infected subjects, with higher prevalence in females (54.5%) than in males (19.0%). The difference in the mean concentrations of haemoglobin, red blood cell, packed cell volume, IL- α and TNF-α was statistically significant (p 0.05) when compared to the control group. Though, there was a higher level of IFN- γ in HIV infected group than in the control group. There were weak correlations between haematological parameters and pro-inflammatory cytokines in the HIV positive group. HIV subjects were later divided into treatment groups: those on highly active antiretroviral therapy (HAART) - Zidovudine- Lamuvidine- Nevirapine (ZLN) combination, Tenofovir-Lamuvidine- Efavirenz (TLE) combination and those that are not on HAART- treatment naive patients (TNP). There were statistically significant differences in the mean concentrations of red blood cell and white blood cell across the TLE and TNP groups (p<0.05). There were positive correlations between IFN-γ and HB in TLE group but negative correlations in other two groups. Also, there were positive correlations between IFN-γ and WBC in ZLN group but negative correlations in other two groups. This study suggests that the dysregulated pro-inflammatory cytokine levels caused by HIV itself played a role in causing anaemia in HIV infections.

Early versus delayed erythropoietin for the anaemia of end-stage kidney disease.

Anaemia is a common complication in people with chronic kidney disease (CKD) and mainly develops as a consequence of relative erythropoietin (EPO) deficiency. Anaemia develops early in the course of disease and peaks among people with end-stage kidney disease (ESKD). Many types of EPO - also called erythropoiesis-stimulating agents (ESAs) - are used to treat anaemia in people with ESKD.ESAs have changed treatment of severe anaemia among people with CKD by relieving symptoms and avoiding complications associated with blood transfusion. However, no benefits have been found in relation to mortality rates and non-cardiac fatal events, except quality of life. Moreover, a relationship between ESA use and increased cardiovascular morbidity and mortality in patients with CKD has been reported in studies with fully correcting anaemia comparing with partial anaemia correction. Until 2012, guidelines recommended commencing ESA treatment when haemoglobin was less than 11 g/dL; the current recommendation is EPO commencement when haemoglobin is between 9 and 10 g/dL. However, advantages in commencing therapy when haemoglobin levels are greater than 10 g/dL but less than 11 g/dL remain unknown, especially among older people whose life expectancy is limited, but in whom EPO therapy may improve quality of life. To assess the clinical benefits and harms of early versus delayed EPO for anaemia in patients with ESKD undergoing haemodialysis or peritoneal dialysis We searched the Cochrane Kidney and Transplant Specialised Register to 8 July 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. We planned to include randomised controlled trials (RCTs) and quasi-RCTs evaluating at the clinical benefits and harms of early versus delayed EPO for anaemia in patients with ESKD undergoing haemodialysis or peritoneal dialysis. Studies comparing EPO with another EPO, placebo or no treatment were eligible for inclusion. It was planned that two authors would independently extract data from included studies and assess risk of bias using the Cochrane risk of bias tool. For dichotomous outcomes (all-cause mortality, cardiovascular mortality, overall myocardial infarction, overall stroke, vascular access thrombosis, adverse effects of treatment, transfusion), we planned to use the risk ratio (RR) with 95% confidence intervals (CI). We planned to calculate the mean difference (MD) and CI 95% for continuous data (haemoglobin level) and the standardised mean difference (SMD) with CI 95% for quality of life if different scales had been used. Literature searches yielded 1910 records, of these 1534 were screened after duplicates removed, of which 1376 were excluded following title and abstract assessment. We assessed 158 full text records and identified 18 studies (66 records) that were potentially eligible for inclusion. However, none matched our inclusion criteria and were excluded. We found no evidence to assess the benefits and harms of early versus delayed EPO for the anaemia of ESKD.

Germinação de sementes de tomateiro tratadas com fontes de ferro e zinco para biofortificação agronômica

O tomateiro é uma cultura muito exigente em nutrientes e possui destaque econômico em todo o mundo. No Brasil, alguns tipos de solos são deficitários em micronutrientes. Além do mais, pessoas de várias regiões do mundo têm sofrido devido aos elevados índices de desnutrição e anemia promovidos pela deficiência de ferro e zinco. Portanto, o objetivo do presente trabalho foi avaliar a germinação de sementes e desenvolvimento de plântulas de tomate submetidas às fontes de ferro e zinco, utilizando técnicas de biofortificação agronômica. O experimento foi realizado na Universidade do Estado da Bahia (UNEB), em Juazeiro-BA. O delineamento utilizado foi inteiramente casualizado, constituído de 9 tratamentos e 4 repetições de 25 sementes. Para o tratamento de sementes considerou-se uma produção média de 90 ton ha-1 e um espaçamento de 1,2 x 0,8 m entre plantas. Utilizaram-se como fonte dos nutrientes Sulfato de Ferro e o Sulfato de Zinco. Os tratamentos foram constituídos de 0, 5, 10, 15 e 20% de Zn e 0, 5, 10, 15 e 20% de Fe extraídos pela cultura até a colheita. As características avaliadas foram porcentagem e cinética de germinação, além da coleta de cinco plântulas para determinação do comprimento da parte aérea e raiz, massa fresca e seca da plântula. Os resultados apontam que o incremento de dosagens de Fe e Zn nas sementes não se mostrou positivo, reduzindo a germinação e não proporcionando um desenvolvimento de plântulas.

HIV symptom burden and anemia among HIV-positive individuals: cross-sectional results of a community-based positive living with HIV (POLH) study in Nepal.

BackgroundPrevious research has reported high rates of anemia in people living with HIV/AIDS (PLWHA) in hospital or tertiary care settings. The objective of this community-based study was to measure the prevalence of anemia and describe the risk factors, with a specific emphasis on HIV symptom burden, in PLWHA in the Kathmandu Valley, Nepal.MethodsWe conducted a cross-sectional survey of 319 PLWHA residing in the Kathmandu Valley, Nepal. We recruited participants from five non-governmental organizations in the Kathmandu Valley. Descriptive statistics and multivariable logistic regression analyses were used.ResultsOur study found a 55.8% prevalence of anemia in PLWHA in the Kathmandu Valley. The prevalence of anemia among the participants with first, second, third, and fourth quartiles of HIV symptom burden was 44.8%, 49.3%, 60.3%, and 69.6%, respectively. Compared to the participants with lowest level of HIV symptom burden, the participants with highest level of HIV symptom burden were more likely to have anemia (adjusted odds ratio = 2.14; 95% confidence interval = 1.07 to 4.30).ConclusionDue to a high prevalence of anemia in a community-based sample of PLWHA, HIV patients should be counseled on their risk of developing anemia and encouraged to seek timely care for HIV symptoms.

Erythropoiesis-stimulating agents for anaemia in adults with chronic kidney disease: a network meta-analysis.

Several erythropoiesis-stimulating agents (ESAs) are available for treating anaemia in people with chronic kidney disease (CKD). Their relative efficacy (preventing blood transfusions and reducing fatigue and breathlessness) and safety (mortality and cardiovascular events) are unclear due to the limited power of head-to-head studies. To compare the efficacy and safety of ESAs (epoetin alfa, epoetin beta, darbepoetin alfa, or methoxy polyethylene glycol-epoetin beta, and biosimilar ESAs, against each other, placebo, or no treatment) to treat anaemia in adults with CKD. We searched the Cochrane Renal Group's Specialised Register to 11 February 2014 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Randomised controlled trials (RCTs) that included a comparison of an ESA (epoetin alfa, epoetin beta, darbepoetin alfa, methoxy polyethylene glycol-epoetin beta, or biosimilar ESA) with another ESA, placebo or no treatment in adults with CKD and that reported prespecified patient-relevant outcomes were considered for inclusion. Two independent authors screened the search results and extracted data. Data synthesis was performed by random-effects pairwise meta-analysis and network meta-analysis. We assessed for heterogeneity and inconsistency within meta-analyses using standard techniques and planned subgroup and meta-regression to explore for sources of heterogeneity or inconsistency. We assessed our confidence in treatment estimates for the primary outcomes within network meta-analysis (preventing blood transfusions and all-cause mortality) according to adapted GRADE methodology as very low, low, moderate, or high. We identified 56 eligible studies involving 15,596 adults with CKD. Risks of bias in the included studies was generally high or unclear for more than half of studies in all of the risk of bias domains we assessed; no study was low risk for allocation concealment, blinding of outcome assessment and attrition from follow-up. In network analyses, there was moderate to low confidence that epoetin alfa (OR 0.18, 95% CI 0.05 to 0.59), epoetin beta (OR 0.09, 95% CI 0.02 to 0.38), darbepoetin alfa (OR 0.17, 95% CI 0.05 to 0.57), and methoxy polyethylene glycol-epoetin beta (OR 0.15, 95% CI 0.03 to 0.70) prevented blood transfusions compared to placebo. In very low quality evidence, biosimilar ESA therapy was possibly no better than placebo for preventing blood transfusions (OR 0.27, 95% CI 0.05 to 1.47) with considerable imprecision in estimated effects. We could not discern whether all ESAs were similar or different in their effects on preventing blood transfusions and our confidence in the comparative effectiveness of different ESAs was generally very low. Similarly, the comparative effects of ESAs compared with another ESA, placebo or no treatment on all-cause mortality were imprecise.All proprietary ESAs increased the odds of hypertension compared to placebo (epoetin alfa OR 2.31, 95% CI 1.27 to 4.23; epoetin beta OR 2.57, 95% CI 1.23 to 5.39; darbepoetin alfa OR 1.83, 95% CI 1.05 to 3.21; methoxy polyethylene glycol-epoetin beta OR 1.96, 95% CI 0.98 to 3.92), while the effect of biosimilar ESAs on developing hypertension was less certain (OR 1.18, 95% CI 0.47 to 2.99). Our confidence in the comparative effects of ESAs on hypertension was low due to considerable imprecision in treatment estimates. The comparative effects of all ESAs on cardiovascular mortality, myocardial infarction (MI), stroke, and vascular access thrombosis were uncertain and network analyses for major cardiovascular events, end-stage kidney disease (ESKD), fatigue and breathlessness were not possible. Effects of ESAs on fatigue were described heterogeneously in the available studies in ways that were not useable for analyses. In the CKD setting, there is currently insufficient evidence to suggest the superiority of any ESA formulation based on available safety and efficacy data. Directly comparative data for the effectiveness of different ESA formulations based on patient-centred outcomes (such as quality of life, fatigue, and functional status) are sparse and poorly reported and current research studies are unable to inform care. All proprietary ESAs (epoetin alfa, epoetin beta, darbepoetin alfa, and methoxy polyethylene glycol-epoetin beta) prevent blood transfusions but information for biosimilar ESAs is less conclusive. Comparative treatment effects of different ESA formulations on other patient-important outcomes such as survival, MI, stroke, breathlessness and fatigue are very uncertain.For consumers, clinicians and funders, considerations such as drug cost and availability and preferences for dosing frequency might be considered as the basis for individualising anaemia care due to lack of data for comparative differences in clinical benefits and harms.

Nonregenerative anemia: mechanisms of decreased or ineffective erythropoiesis.

In veterinary medicine, anemia without an appropriate compensatory hematopoietic response is termed nonregenerative. Nonregenerative anemia is a common clinical entity, occurring as a result of diminished or ineffective erythropoiesis in association with many types of pathology. This article reviews nonregenerative anemia in domestic animals, emphasizing mechanisms of disease, and also covers other conditions associated with nonregenerative anemia in people. Many aspects of nonregenerative anemia in animals are worthy of further investigation, from molecular mechanisms of disease to epidemiologic impacts.

Darbepoetin for the anaemia of chronic kidney disease

Erythropoiesis-stimulating agents are used to treat anaemia in people with chronic kidney disease (CKD). Several agents are available including epoetin alfa or beta as well as agents with a longer duration of action, darbepoetin alfa and methoxy polyethylene glycol-epoetin beta. To assess the benefits and harms of darbepoetin alfa to treat anaemia in adults and children with CKD (stages 3 to 5, 5D, and kidney transplant recipients). We searched the Cochrane Renal Group's Specialised Register (to 13 January 2014) through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE. We included randomised controlled trials of any darbepoetin alfa treatment of at least three months duration in adults or children with CKD (any stage). Data were extracted by two independent investigators. Patient-centred outcomes (need for blood transfusion, iron therapy, progression of kidney disease, total and cardiovascular mortality, cardiovascular events, cancer, hypertension, seizures, and health-related quality of life) and other outcomes (haemoglobin levels) were assessed using random effects meta-analysis. We calculated risk ratios for dichotomous outcomes and mean differences for continuous outcomes, both with 95% confidence intervals. We identified 32 studies comprising 9414 participants; 21 studies in 8328 participants could be included in our meta-analyses. One study (4038 participants) compared darbepoetin alfa to placebo, 16 studies (2955 participants) compared darbepoetin alfa to epoetin alfa or beta, four studies (1198 participants) compared darbepoetin alfa to methoxy polyethylene glycol-epoetin beta, three studies (420 participants) compared more frequent with less frequent darbepoetin alfa administration and four studies (303 participants) compared intravenous with subcutaneous darbepoetin alfa administration.In a single large study, darbepoetin alfa reduced the need for blood transfusion and iron therapy compared with placebo in adults with CKD stage 3 to 5, but had little or no effect on survival, increased risks of hypertension, and had uncertain effects on quality of life. Data comparing darbepoetin alfa with epoetin alfa or beta or methoxy polyethylene glycol-epoetin beta were sparse and inconclusive. Comparisons of differing dosing schedules and routes of administration were compared in small numbers of participants and studies. Evidence for treatment effects of darbepoetin alfa were particularly limited for children with CKD, adults with CKD stage 5D, and recipients of a kidney transplant.Studies included in this review were generally at high or unclear risk of bias for all items (random sequence generation, allocation concealment, incomplete outcome data, blinding of participants and personnel, blinding of outcome assessment, selective outcome reporting, intention to treat analysis and other sources of bias). One large study comparing darbepoetin alfa with placebo was at low risk of bias for most items assessed. Data suggest that darbepoetin alfa effectively reduces need for blood transfusions in adults with CKD stage 3 to 5, but has little or no effect on mortality or quality of life. The effects of darbepoetin alfa in adults with CKD stage 5D and kidney transplant recipients and children with CKD remain uncertain as do the relative benefits and harms of darbepoetin alfa compared with other ESAs (epoetin alfa or beta and methoxy polyethylene glycol-epoetin beta).