Antianemic Drugs Research Articles

A Study of Drug Uses Evaluation of Anti Anemic Drugs in Pregnancy Patients at a Tertiary Care Teaching Hospital

Background: Anemia is a common condition among pregnant women and can have adverse effects on both maternal and fetal health. The use of antianemic drugs in pregnancy is essential to manage and treat anemia, but their efficacy and safety remain a topic of significant interest and concern. Objective: To study the drug use evaluation of anti anemic drugs in pregnancy patients in hospital. Cases were collected from OBG ward Methodology: A prospective observational study was conducted for three months from December 2023 to February 2024 in Navodaya medical college, hospital & research centre with a sample size of 100. Data were collected from OBG ward. Result: Among the 100 cases collected, most of the anemic patients were in the age group of (18-25) years. Most common anti anemic drugs prescribed in anemic patients are Ferrous ascorbate and Folic acid. Conclusion: in evaluation of antianemic drug use in pregnancy is essential for ensuring the effective management of maternal anemia while minimizing risks to the fetus. By assessing prescribing practices, safety considerations, and adherence to clinical guidelines, healthcare providers can enhance the quality of care provided to pregnant women and contribute to better maternal and child health outcomes

ANALYSIS OF DRUG UTILIZATION PATTERN IN CHRONIC KIDNEY DISEASE PATIENTS IN A TERTIARY CARE HOSPITAL, SOUTH INDIA

Objective: The objective of the study is to assess the drug utilization pattern of various drugs prescribed in chronic kidney disease (CKD) patients in a tertiary care hospital. Methods: As a cross-sectional study 200 prescriptions were randomly selected from both the nephrology outpatient department and the inpatient ward. Patient demographics details, CKD staging, classes of drugs prescribed, and number of drugs prescribed were noted and data were analyzed with the World Health Organization core prescribing indicators. Results: Incidence of CKD is more common in the age group of 40–50 years (45%) with male predominance (70%). Hypertension, diabetes, and anemia are the common comorbid conditions seen with CKD. Anti-hypertensives, anti-anemic drugs, calcium supplements, and anti-diabetic drugs are the commonly prescribed drugs in CKD. Number of prescription contains that generic names are near optimal and drugs from the National List of Essential Medicine are optimal. Majority of the prescriptions contain on average 5 drugs. Conclusion: Diabetes and high blood pressure are the two most common causes of CKD with male dominance. Since polypharmacy is common in CKD patients , they should be monitored for drug – drug interaction and adverse drug reactions.

Anemia in patients receiving anticancer treatments: focus on novel therapeutic approaches.

Anemia is common in cancer patients and impacts on quality of life and prognosis. It is typically multifactorial, often involving different pathophysiological mechanisms, making treatment a difficult task. In patients undergoing active anticancer treatments like chemotherapy, decreased red blood cell (RBC) production due to myelosuppression generally predominates, but absolute or functional iron deficiency frequently coexists. Current treatments for chemotherapy-related anemia include blood transfusions, erythropoiesis-stimulating agents, and iron supplementation. Each option has limitations, and there is an urgent need for novel approaches. After decades of relative immobilism, several promising anti-anemic drugs are now entering the clinical scenario. Emerging novel classes of anti-anemic drugs recently introduced or in development for other types of anemia include activin receptor ligand traps, hypoxia-inducible factor-prolyl hydroxylase inhibitors, and hepcidin antagonists. Here, we discuss their possible role in the treatment of anemia observed in patients receiving anticancer therapies.

Pre-clinical protective potentials of Carica papaya constituents in experimentally induced anemia.

Anemia is a pathological condition characterized by reduced oxygen bioavailability and/or changes in hematological parameters. This study investigated the anti-anemic activities of Carica papaya (CP) phytoconstituents in aluminium-chloride-induced anemic rats. Twenty-seven rats were randomized into nine groups of three rats as follows; group 1 was the normal (non-induced) group, 2-9 were anemic rats administered 1 mL distilled water, standard drug (3 mg/kg body weight (bw) ferrous sulphate), 100, 300 and 500 mg/kg bw of crude methanolic extract of CP (CMECP) of the leaf and 100, 300 and 500 mg/kg bw of CMECP of the seed respectively in the first stage of the study. In the second stage, thirty-three rats were randomized into eleven groups of three rats as follows; group 1 was the normal group, 2-11 were anemic rats treated with 1 mL distilled water, standard drug, 75 mg/kg bw, 150 mg/kg of alkaloid fraction of CP seed, 75 mg/kg bw, 150 mg/kg bw of flavonoid fraction of CP seed, 75 mg/kg bw and 150 mg/kg of alkaloid fraction of CP leaf, 75 mg/kg bw and 150 mg/kg bw of flavonoid fraction of CP leaf respectively. Treatment of anemic rats with CP extracts and fractions of the seed and leaf significantly reversed the hematological parameters and body weight of anemic rats in a dose independent fashion. The CMECP leaf at 100 and 500 mg/kg gave PCV of 42.50±0.50 and 47.00±0.50, while the seed gave 49.50±0.50 and 42.50±0.50 respectively after 2 weeks of treatment. However, the alkaloid and flavonoid fraction of CP presented better anti-anemic properties probably due to constituents' synergism. This study concluded that CP possesses phytoconstituents which potentiates it as a safe anti-anemic drug candidate.

Use of antianemics in prenatal care: A population cohort from a capital city in the North region of Brazil

Anemia during pregnancy is a significant risk factor for adverse maternal and fetal outcomes, including preterm birth, low birth weight, and maternal mortality. In Brazil, anemia prevention and treatment programs are available, but regional variations in prevalence and factors associated with antianemic drug use remain understudied. The objective was to identify the prevalence of gestational anemia and the factors associated with the use of antianemic drugs during pregnancy in a cross-sectional population-based study carried out in Rio Branco, AC. To do so, we planned a cross-sectional, population-based study with a total of 1190 postpartum women who gave birth between April 6 and July 10, 2015, were interviewed about demographic, socioeconomic, reproductive, and prenatal care factors. The prevalence of anemia during pregnancy was found to be 13.8 %, with 93.2 % of women using antianemic drugs, such as ferrous sulfate and folic acid. Factors positively associated with antianemic drug use were higher education (elementary school II RCajust = 2.46; 95 %, CI: 1.01–6.13; high school RCajust = 2.61; 95 %, CI: 1.11–6.12), primiparity (ACadjust = 1.69; 95 %, CI: 0.98–3.74), 6 to 8 prenatal consultations (ACjust = 2.16; 95, CI%: 1.15–4.05), and planned pregnancy (ARjust = 1.94; 95 %, CI: 1.05–3.74). Food security during pregnancy was inversely associated. These findings suggest that while anemia prevention and treatment programs exist, more targeted strategies are needed, particularly for women with lower socioeconomic status, to improve maternal and fetal health outcomes.

Investigation on photo-isomeric impurity of Roxadustat: Structure conformation, physicochemical characterization, interconversion feasibility and in vitro toxicological evaluation

This research article describes the comprehensive characterization and toxicological activities of a photo-isomeric impurity (PI) of an antianemic drug Roxadustat (ROX). The PI, which has the same molecular mass as that of the drug, possesses strikingly distinct structural features compared to the drug. A detailed investigation on structural as well as toxicological aspects of this impurity is warranted due to likelihood of formation of this impurity because of routine light exposure of the API, and due to alerts concerning to its carcinogenicity, mutagenicity, and teratogenicity based on in silico assessments reported in the literature. The molecular structure of the PI was confirmed by single crystal XRD providing the first evidence for the unambiguous structure determination. Complete physicochemical characterization of the impurity was carried out using powder X-ray diffraction, Fourier Transform Infrared Spectroscopy, Differential Scanning Calorimetry, and Thermogravimetric Analysis establishing phase identification and phase purity of the impurity. The feasibility of interconversion of API (ROX) to the impurity PI and vice versa was evaluated using the RP-HPLC and Triple Quadrupole LC-MS techniques for both the solution state as well as solid state. The in vitro toxicological activity of the PI was assessed through cytotoxicity assays, DNA fragmentation assays, morphological analysis, and COMET assay. These structural, synthetic and toxicological studies contribute to the overall understanding of drug stability, safety, and pharmaceutical formulation development of ROX.

An investigation on availability and efficacy of anti-anemic drugs for pigs in the Ukrainian pharmaceuticals

Antianemic drugs are used to prevent anemia, majorly iron deficiency anemia. Drugs with such pharmacological action are especially relevant for piglets, as animals of this species at this age are particularly sensitive to iron deficiency. The present investigation aimed at studying the pharmaceutical market of antianemic drugs registered in Ukraine during 2017-2022. It should be noted that if the drug is registered, it has been checked for safety according to the food industry standards of Ukraine. In 2017, the national market of veterinary iron-containing drugs was represented by 13 drugs from the group QB03A “Antianemic drugs. Drugs of iron”, according to the АТС-vet classification. The range of these drugs by 38 % was provided by pharmaceutical products of Ukrainian manufacturers: "O.L.KAR-AgroZooVet-Service", "Pharmaton", "Brovapharma", "Experimental production of the Institute of Epizootology", "Biopharm", and "Vetsintez". Imported products (62 %) were represented by Pharmacosmos, Merial, Koofavet , "Vugen B&G" , "Biovet Pulawy", "Interchem Verken De Adelaar", and "Bioveta". In general, the modern pharmaceutical market of veterinary drugs in Ukraine during 2017–2022 was sufficiently provided with antianemic drugs for pigs and mostly imported drugs. The percentage of antianemic drugs of Ukrainian production prevailed in 2020, however the imported drugs of this pharmacological group's was higher in 2022. It can be concluded that the drugs of non-Ukrainian production predominated among antianemic drugs in Ukraine during 2017-2022. Based on the obtained results, we can state that in Ukraine there is a need for the development and/or production of domestic anti-anemic drugs. They must be effective and ensure a reduction in the dependence of the national pharmaceutical market of drugs of this group on foreign manufacturers.

Real-World Treatment Patterns, Outcomes and Disease Burden of Japanese Patients with High-Risk Myelodysplastic Syndrome: A Claims Database Study

Introduction Inherent complex pathophysiology of myelodysplastic syndrome (MDS) along with its higher occurrences in elderly population often limits available treatment options. In Japan, azacitidine (AZA) is the only first-line (1L) treatment, which is not cytarabine-based, available for patients (pts) with high-risk MDS (HR-MDS) ineligible for hematopoietic stem cell transplantation (HSCT). Prior autoimmune diseases have been associated with susceptibility of MDS. However, durability of AZA treatment and data on MDS-specific comorbidities, especially immune-driven events are currently lacking in Japanese pts. This study aimed to answer clinical questions on AZA real-world treatment outcomes in Japan, the epidemiology of autoimmune diseases in this specific pt cohort, as well as treatment cost. Methods This was a retrospective, longitudinal study utilizing hospital-based administrative claims for MDS patients in the Medical Data Vision (MDV) database in Japan. Data on pt demographics, clinical characteristics, treatments, procedures and hospitalization records were collected. Adult pts with first a confirmed MDS diagnosis either as an inpatient or twice in outpatient setting during the identification period (1October 2008 - 30 September 2017), who had a bone marrow biopsy in ±3 months from index date and at least 1 MDS-related treatment post-index date, were included in this real-world study. Pts with confirmed acute myeloid leukemia (AML) diagnosis or who had any history of HSCT, graft-versus-host-disease or transplant-related disorder/complications were excluded. As IPSS/R scoring is unavailable in MDV, pts were classified as HR-MDS if they had either AZA treatment or HSCT within 6 months post-index date, or pancytopenia diagnosis within 6 months post-index date and initiated AZA within 12 months. Results Of 6204 pts who met the eligibility criteria (main cohort), 2138 pts were assigned as HR-MDS. The median age of pts in the main cohort was 74.0 years (range: 18.0 - 100.0 years, ≥60 years old: 87.8%) vs 73.0 years (range: 20.0 - 95.0 years; ≥60 years old: 88.6%) in the HR-MDS cohort. Mean Charlson Comorbidity Index was 1.7 (± 1.66) and 1.6 (± 1.47) for the main cohort and HR-MDS cohort respectively. The proportion of transfusion-dependent pts in the main cohort was 9.4% vs 7.1% of patients in the HR-MDS cohort. Among 2138 pts with HR-MDS, 251 pts reported having concomitant autoimmune disease with rheumatoid arthritis (32.3%), glomerulonephritis (26.7%) and seronegative arthritis (23.1%) being the most common. More pts in the main cohort (53.2%) compared to pts with HR-MDS (38.9%) received anti-anemic drugs, G-CSF and iron chelators as supportive therapy at 1L. Compared to 39.5% pts in main cohort, 88.3% pts with HR-MDS received antineoplastic agents at 1L therapy. In HR-MDS cohort, 2078 pts received AZA in different cycles (1-3 cycles: 40.5%, 4-6 cycles: 21.1%, 7-9 cycles: 11.5%, >9 cycles: 26.9%) but only 121 pts received intensive chemotherapy (1 cycle: 90.1%, 2 cycles: 9.1%, >2 cycles: 0.8%). Median duration of MDS-specific treatment for patients with HR-MDS was 9.8 months. Significantly higher median OS (P<0.001) was achieved in pts with HR-MDS who received more cycles of AZA (Fig. 1: 1-3 cycles: 14.6 months, 4-6 cycles: 21.4 months, 7-9 cycles: 22.8 months, >9 cycles 40.8 months). After controlling for death as a competing risk, the cumulative incidence function (CIF) of HSCT and AML transformation was not affected by the number of cycles of AZA received. Although more cycles of AZA treatment increased the total treatment cost, median cost per pt per month was inversely affected with the lowest cost for pts receiving >9 cycles (Fig. 2). Conclusion Our findings based on the real-world data analysis in Japanese pts follow the similar trend of elderly pts with HR-MDS mostly receiving AZA as 1L treatment. Despite higher median OS being associated with higher number of AZA cycles, only ~27% pts with HR-MDS received >9 cycles of AZA. Autoimmune disease was reported by 11.7% of pts with HR-MDS. Although treatment cost increased with number of cycles of AZA received, median cost per pt per month was lowest in patients receiving >9 cycles. The cost per pt per month for other MDS-related treatment as well as costs for blood transfusions and infection related treatments were lower as increasing cycles of AZA were given which contributed to lower cost per pt per month. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Haemopoietic Actions of Justicia secunda Leaf Extracts in Mice

Objective: To evaluate the haemopoietic effects of Justicia secunda leaf ethanol, n-hexane, ethyl acetate, and n-butanol extracts in mice and compare these effects with the effects of standard antianaemic agents.Methods: Sixteen groups of mice, six in each group, were used for the study. Anemia was induced in Groups 1 to 12 using 20 mg/kg i.p. phenylhydrazine (PHZ) daily for 2 days, followed by either ethanol, n-hexane, ethyl acetate or n-butanol extracts for 6 days. Groups 13 and 14 were induced for anemia and then received 200 mg/kg ferrous sulphate and vitamin B12 for 6 days. Group 15 (positive control) received 20 mg/kg PHZ i.p. only, while group 16 (negative control) was untreated. Blood was collected from the retro-orbital plexuses of the mice into EDTA-containing bottles on the 7th day and analyzed for hemoglobin (Hb) level, packed cell volume, mean cell hemoglobin concentration, and mean cell volume. Red blood cell, white blood cell, and platelet counts were also measured.Results: The ethanol leaf extract of J. secunda significantly increased the hematological parameters of mice compared to the positive and negative controls (p &lt; 0.05). However, the n-hexane, ethyl acetate, and n- butanol extracts showed greater hemopoietic effects (p &lt; 0.001) than the ethanol extract and standard antianemic drugs. The extract of J. secunda leaf tended to stimulate erythropoiesis comparable to the standard antianemic drugs, especially the n-hexane.Conclusion: Justicia secunda leaf extracts exert hemopoietic actions in mice, while the n-hexane extract shows greater haemopoietic activities than ferrous sulphate and vitamin B12.

Detection of erythropoiesis stimulating agent Luspatercept after administration to healthy volunteers for antidoping purposes.

Luspatercept (Reblozyl®) is a newly approved anti-anemic drug prohibited by the World Anti-Doping Agency. It promotes erythropoiesis by limiting apoptosis of immature erythroblasts and the risk of misuse by athletes for doping is high. Proposed detection methods have been published recently but only evaluated in vitro. The objective of this study was to perform the first administration of luspatercept in healthy volunteers for antidoping purpose and to evaluate the detectability in serum, dried capillary blood spots (DBS, collected using TASSO M20 device), and urine. Indirect detection was also evaluated by analyzing hematological parameters for the Athlete Biological Passport. Four volunteers (two males, two females) received one subtherapeutic dose of luspatercept (0.25 mg/kg) followed 3 weeks after by a second dose. Samples were collected from before administration until 7 weeks after the second dose. After immunopurification, electrophoretic separation SDS-/SAR-/IEF- polyacrylamide gel electrophoresis (PAGE), and immunodetection, luspatercept was detected at high levels in serum until the end of the collection, sign of a very slow elimination and similarly detected unchanged at lower levels in urine from 2 days after the first administration until 7 weeks postadministration. DBS showed also the same long window of detection. Luspatercept effects were however of limited amplitude on hematological markers, and only two subjects presented atypical points outside the physiological limits during the study. The direct detection method was very efficient, and change of electrophoretic method and detection antibody can be used for confirmation of suspicious samples.

Anemia in nursing homes, proton pump inhibitors and prescribing cascade of antianemic drugs.

Some medications can cause anemia through their effect on gastrointestinal function, such as proton pump inhibitors and H2-antagonists, and on the risk of bleeding, such as anticoagulants and antiplatelet agents. The main aim of this study is to evaluate how anemia is related with the most commonly used drugs in a large sample of NH residents. This retrospective cross-sectional multicenter study was conducted in a sample of Italian long-term care NHs distributed throughout the country. In all, 2602 NH residents recruited from 27 Italian long-term NHs (mean age ± SD: 88.4 ± 8.5) and 441 (16.9%) had a diagnosis of anemia. The unadjusted model showed a significant relation with PPI (OR 1.71, 95% CI 1.39-2.11, p < 0.0001). This relation was maintained in the model adjusted for age, sex, CKD, atrophic gastritis, peptic ulcer and rheumatic disease (OR 1.61, 95% CI 1.31-1.99, p < 0.0001). PPI users were also at higher risk of being treated with antianemicdrugs-iron supplements, folate, vitamin B12 and erythropoietin (OR 2.03, 95% CI 1.67-2.48, p < 0.0001)-even if they did not have anemia (OR 1.94, 95% CI 1.55-2.42, p < 0.0001). Proton pump inhibitors are associated with anemia in NH residents. PPIs are also related with an increased probability of receiving drugs to treat anemia, such as iron supplements, folate or cyanocobalamin and erythropoietin, as the effect of a prescribing cascade. Optimization of PPI prescription is needed to avoid adverse events and promote rational drug prescription.

Dynamics of Morphological Indicators of Blood of Piglets under the Influence of Iron Clathrochelate Complex and Cyanocobalamin

Iron deficiency anemia is one of the most common non-contagious diseases of piglets. Veterinary antianemic drugs have several drawbacks, so finding new medicines is an important current task for scientists. Therefore, the present study investigated the antianemic effect of iron (IV) clathrochelate in the organism of piglets. The subsequent studies included the exploration of its antianemic actions, particularly in combination with cyanocobalamin when this combination was administered to sows for prophylaxis in piglets. The experiment was carried out on 30 suckling piglets during the period of their detention with sows. According to the method of analogue groups, two groups of control (I) and experimental (II, each containing 15 animals) were formed and they were studied for 30 days. The piglets from five sows (three from each) were selected for the experimental group. During the pregnancy of these sows, 10 ml of 10% solution of iron (IV) IV clathrochelate and solution of cyanocobalamin were injected intramuscularly twice 7 and 14 days before their expected farrowing. For prevention of iron deficiency anemia, the traditional solution of iron dextran was administered once intramuscularly to piglets of the control group. The investigative material included the blood samples of piglets considering the dynamics of probable changes in the number of erythrocytes, hemoglobin content and hematocrit, and other morphological indicators and blood indices of piglets. The dynamics of changes in erythrocyte count, hemoglobin content, hematocrit, leukocytes and platelets, indices of blood almost did not differ from the dynamics of these values when using only 10% solution of iron (IV) clathrochelate for pregnant sows. The proposed scheme for the prophylaxis of iron deficiency anemia in piglets, involving simultaneous intramuscular injections of IV clathrochelate and cyanocobalamin to pregnant sows, is somewhat inferior to the previous preventive measures, which included only the intramuscular injections of iron (IV) IV clathrochelate, but it can be recommended as highly effective.

Supply of iron in piglets with colostrum/milk of sows using iron (IV) clatrochelate

Many works of both Ukrainian scientists and foreign are devoted to the study of the prevention of iron deficiency anemia in piglets as one of the most common non-communicable diseases of pigs. However, the development of new effective antianemic drugs is still relevant today. We have previously proposed a scheme for the prevention of iron deficiency anemia, based on intramuscular parallel administration of solutions of iron (IV) clatrochelate and cyanocobalaminе to pregnant sows 14 and 7 days before the expected farrowing. This scheme was effective in the absence of stillbirth and clinical signs of anemia in piglets. The aim of our next study was to investigate the content of iron in the milk of sows using iron (IV) clatrochelate during pregnancy. To achieve this goal, 2 groups of sows (hybrids of Landrace and Great White breeds) were formed during their pregnancy and kept with suckling piglets - control and experimental, 5 animals in each. Sows in the experimental group were injected twice (14 and 7 days before expected farrowing) with 10 ml of 10% iron (IV) clatrochelate solution and cyanocobalaminе solution (at the dose recommended by official instructions) twice during pregnancy. Sows of the control group were injected with isotonic sodium chloride solution in conventional doses. During the experiment, the sows of the experimental group during pregnancy (after drug administration) and during the feeding of piglets did not differ in behavior and general condition from the sows of the control group. The study of the dynamics of hemoglobin and morphological parameters of the blood of sows in the control and experimental groups did not reveal significant differences. The content of iron in colostrum / milk of sows of the experimental group during the first seven days after administration was significantly higher compared to the control: 1 day 1.5 times, 4 days 2.1 times and 7 days 2.8 times. Therefore, the proposed scheme for the prevention of iron deficiency anemia in piglets is highly efficientand based on the intake of iron with colostrum/milk of sows. Key words: anemia, injection, macrobicyclic complex, prophylaxis, pigs, cyanocobalaminе.

Efficacy of Butanolic Fraction of Cocos Nucifera&amp;#39;s Root Aqueous Extract on Induced Anemia Treatment

Cocos nucifera was a coastal plant whose roots were used in pharmacopoeia to treat anemia in Benin. The aqueous extract from its roots stimulated the synthesis of hemoglobin. The aim of this work was to test in vivo the efficacy of the butanolic fraction of the extract in the treatment of anemia. Methods: Wistar rats were anemic with phenylhydrazine for two days. From D2 to D15, some were treated by gavage with the butanolic fraction of the aqueous extract of Cocos nucifera roots at the dose of 40 mg or 60 mg / kg of body weight / day, others were treated with vitafer (an anti-anemic drug) or with distilled water. The rats blood were collected on days D0, D2, D7, D10 and D15 for the complete blood count and the osmotic resistance of the red blood cells. Results: On D2, phenylhydrazine significantly lowered the hemoglobin level and the number of red blood cells, which were respectively corrected on D10 and D15 by the fraction of extract with release of hypochromic macrocytes. However, the effect was slower than that of the crude extract, was not specific to erythropoiesis because it also stimulated thrombopoiesis and was not dose-dependent. Conclusion: The butanolic fraction of the aqueous extract of Cocos nucifera roots corrected anemia by stimulation of hematopoiesis. The observed biological activity would probably be linked to anthocyanins which are mainly isolated by butanol. These results contribute to a better knowledge of bioactive compounds of our antianemic plants.

Polypharmacy in elderly patients with falls

Background: Falls in elderly–a multifactorial syndrome. One of the modifiable factors is polypharmacy. STOPP/START criteria are used for correction of polypharmacy in geriatrics.Aim: Assessment of the prevalence of polypharmacy, analysis and correction of pharmacotherapy using STOPP/START criteria in patients with falls.Materials and methods: The study included 655 patients hospitalized in the geriatric department over 60 years of age, who were divided into two groups. Group 1 (n=332, 50.7%)–patients with 1 or more falls, group 2 (n=323,49.3%)–patients without falls. The analysis of the received therapy before hospitalization was performed. After that, based on the indications, contraindications and STOPP/START criteria, drug therapy was corrected in patients with falls.Results: Patients of group 1 took 4.5±2.18 drugs, group 2–4.3±2.6. Polypharmacy was diagnosed in 150 (45.2%) patients with falls and in 122 (37.8%) patients without falls. Patients with falls were more likely to receive sleeping pills, NSAIDs. Univariate analysis showed that falls were associated with NSAIDs (OR 2.15, 95% CI 1.38–3.35, p=0.001) and sleeping pills (OR 2.03, 95% CI 1.02–4.02, p=0.047). An audit and correction of therapy was performed: in 108 (32.5%) patients the number of prescribed drugs was reduced. Patients with falls were prescribed statins, antidementia drugs, anticonvulsants and antidepressants as components of therapy for chronic pain syndrome, chondroitin sulfate and glucosamine sulfate for the treatment of osteoarthritis, calcium and antiresorbtive therapy, antianemic drugs, vitamin D. Antiplatelet agents, digoxin, sleeping pills and NSAIDs were less frequently prescribed. STOPP/START criteria and their frequency in patients with falls were analyzed. 141 cases of potentially non-recommended but prescribed medications were identified. STOPP criteria were for the administration of NSAIDs (n=53, 37.6%) and acetylsalicylic acid (n=62, 44%). There were 458 cases of potentially recommended but not prescribed medications. The most common START criteria were not for the administration of vitamin D and statins.Conclusion. Half of elderly patients with falls have polypharmacy. These patients are more likely to take sleeping pills and NSAIDs. STOPP criteria most often concerned the appointment of NSAIDs and acetylsalicylic acid, and the START criteria revealed the absence of the appointment of vitamin D and statins.

ПОЛИПРАГМАЗИЯ У ПОЖИЛЫХ ПАЦИЕНТОВ С СИНДРОМОМ ПАДЕНИЙ

Background : Falls in elderly–a multifactorial syndrome. One of the modifiable factors is polypharmacy. STOPP/START criteria are used for correction of polypharmacy in geriatrics. Aim : Assessment of the prevalence of polypharmacy, analysis and correction of pharmacotherapy using STOPP/START criteria in patients with falls. Materials and methods : The study included 655 patients hospitalized in the geriatric department over 60 years of age, who were divided into two groups. Group 1 (n=332, 50.7%)–patients with 1 or more falls, group 2 (n=323,49.3%)–patients without falls. The analysis of the received therapy before hospitalization was performed. After that, based on the indications, contraindications and STOPP/START criteria, drug therapy was corrected in patients with falls. Results : Patients of group 1 took 4.5±2.18 drugs, group 2–4.3±2.6. Polypharmacy was diagnosed in 150 (45.2%) patients with falls and in 122 (37.8%) patients without falls. Patients with falls were more likely to receive sleeping pills, NSAIDs. Univariate analysis showed that falls were associated with NSAIDs (OR 2.15, 95% CI 1.38–3.35, p=0.001) and sleeping pills (OR 2.03, 95% CI 1.02–4.02, p=0.047). An audit and correction of therapy was performed: in 108 (32.5%) patients the number of prescribed drugs was reduced. Patients with falls were prescribed statins, antidementia drugs, anticonvulsants and antidepressants as components of therapy for chronic pain syndrome, chondroitin sulfate and glucosamine sulfate for the treatment of osteoarthritis, calcium and antiresorbtive therapy, antianemic drugs, vitamin D. Antiplatelet agents, digoxin, sleeping pills and NSAIDs were less frequently prescribed. STOPP/START criteria and their frequency in patients with falls were analyzed. 141 cases of potentially non-recommended but prescribed medications were identified. STOPP criteria were for the administration of NSAIDs (n=53, 37.6%) and acetylsalicylic acid (n=62, 44%). There were 458 cases of potentially recommended but not prescribed medications. The most common START criteria were not for the administration of vitamin D and statins. Conclusion . Half of elderly patients with falls have polypharmacy. These patients are more likely to take sleeping pills and NSAIDs. STOPP criteria most often concerned the appointment of NSAIDs and acetylsalicylic acid, and the START criteria revealed the absence of the appointment of vitamin D and statins.

Anemia: A Connection Between Heart Failure and Kidney Failure

Erythropoiesis-stimulating agents (ESAs) have improved the quality of life and reduced the need for transfusions in patients with chronic kidney disease. However, randomized trials showed no benefit but possible safety issues following high doses of ESAs given to reach normal hemoglobin levels. Iron therapy is used together with ESA; when given proactively, it may reduce the risk of mortality and cardiovascular events in hemodialysis patients. Recent trials also showed benefits of intravenous iron therapy in patients with heart failure. New drugs for correcting anemia may retain the present efficacy of ESAs as antianemic drugs and reduce cardiovascular risks.

Anemia in older adults as a geriatric syndrome: A review.

Anemia, a frequently occurring condition in older patients, has no standard definition; however, in most studies, it is defined as hemoglobin level <12 and <13 g/dL in women and men, respectively. Approximately 10% of older adults living in the community have anemia. The prevalence of anemia is significantly correlated with advanced age and male sex. Anemia is associated with falls, frailty and other negative outcomes, including early mortality. However, there remains little consensus regarding whether anemia treatment favorably affects these adverse outcomes. Therefore, this article reviews the prevalence of anemia, and provides updates on its common causes and treatments in older adults. While excluding well-established hematopoietic diseases, the etiology of anemia in older adults has been grouped into four categories: (i) nutritional deficiency; (ii) inflammation; (iii) clonal hematopoiesis; and (iv) "unexplained anemia," when there is no clear mechanism to account for the anemia. Recently, clonal leukocytes were detected in a considerable number of older individuals. The number of somatic mutations in blood leukocytes increases with age; however, single mutations of DNMT3A, TET2 and ASXL1 are not correlated with the presence of unexplained anemia in older adults. With an increased understanding of anemia etiology and the availability of innovative anti-anemic drugs, future studies that evaluate the causes and benefits of treatment are required. Geriatr Gerontol Int 2021; 21: 549-554.

Efficacy of Butanolic Fraction of Cocos Nucifera&amp;#39;s Root Aqueous Extract on Induced Anemia Treatment

Cocos nucifera was a coastal plant whose roots were used in pharmacopoeia to treat anemia in Benin. The aqueous extract from its roots stimulated the synthesis of hemoglobin. The aim of this work was to test in vivo the efficacy of the butanolic fraction of the extract in the treatment of anemia. Methods: Wistar rats were anemic with phenylhydrazine for two days. From D2 to D15, some were treated by gavage with the butanolic fraction of the aqueous extract of Cocos nucifera roots at the dose of 40 mg or 60 mg/kg of body weight/day, others were treated with vitafer (an anti-anemic drug) or with distilled water. The rats blood were collected on days D0, D2, D7, D10 and D15 for the complete blood count and the osmotic resistance of the red blood cells. Results: On D2, phenylhydrazine significantly lowered the hemoglobin level and the number of red blood cells, which were respectively corrected on D10 and D15 by the fraction of extract with release of hypochromic macrocytes. However, the effect was slower than that of the crude extract, was not specific to erythropoiesis because it also stimulated thrombopoiesis and was not dose-dependent. Conclusion: The butanolic fraction of the aqueous extract of Cocos nucifera roots corrected anemia by stimulation of hematopoiesis. The observed biological activity would probably be linked to anthocyanins which are mainly isolated by butanol. These results contribute to a better knowledge of bioactive compounds of our antianemic plants.

Use of preventive drugs during the last year of life in older adults with cancer or chronic progressive diseases.

To evaluate the prescription of preventive medications with questionable usefulness in community dwelling elderly adults with cancer or chronic progressive diseases during the last year of life. Through the utilization of the healthcare databases of the Lombardy region, Italy, we identified two retrospective cohorts of patients aged 65 years or more, who died in 2018 and had a diagnosis of either a solid cancer (N=19 367) or a chronic progressive disease (N=27 819). We estimated prescription of eight major classes of preventive drugs 1 year and 1 month before death; continuation or initiation of preventive drug use during the last month of life was also investigated. Over the last year of life, in both oncologic and non-oncologic patients, we observed a modest decrease in the prescription of blood glucose-lowering drugs, anti-hypertensives, lipid-modifying agents, and bisphosphonates, and a slight increase in the prescription of vitamins, minerals, antianemic drugs, and antithrombotic agents (among oncologic patients only). One month before death, the prescription of preventive drugs was still common, particularly for anti-hypertensives, antithrombotics, and antianemics, with more than 60% of patients continuing to be prescribed most preventive drugs and an over 10% starting a therapy with an antithrombotic, an antianemic, or a vitamin or mineral supplement. These findings support the need for an appropriate drug review and improvement in the quality of drug prescription for vulnerable populations at the end-of-life.