Comorbid Anemia Research Articles

Anaemia and glucose-6-phosphate dehydrogenase deficiency in pregnant women in Ghana

Background/Aims Glucose-6-phosphate dehydrogenase deficiency worsens the risk of anaemia and complicates gestation and birth if poorly managed. This study investigated the prevalence and factors associated with anaemia and this deficiency in pregnant women. Methods This cross-sectional study was conducted among 369 pregnant women at the Cape Coast Metropolitan Hospital, Ghana. Multiple logistic regression was used to investigate the relationship between anaemia and various sociodemographic variables. Results The prevalence of anaemia was 41.2% at 13 weeks' and 66.7% at 36 weeks' gestation. Overall, 29.8% of participants were glucose-6-phosphate dehydrogenase deficient. Age (P=0.024)and marital status (P=0.009) were significantly associated with anaemia at 13 weeks. Gravidity (P=0.014) and employment status (P=0.001) were significantly associated with anaemia at 36 weeks. Conclusions There was a high prevalence of co-morbid anaemia and glucose-6-phosphate dehydrogenase deficiency at 13 and 36 weeks' gestation. Future studies should consider genetic and dietary factors that may contribute to gestational anaemia. Implications for practice Clinicians and midwives should be aware of the factors that can affect anaemia and glucose-6-phosphate dehydrogenase deficiency, particularly in areas where deficiency is prevalent. Early detection could allow individualised treatment.

Inflammatory indexes and anemia in chronic kidney disease: correlation and survival analysis of the National Health and Nutrition Examination Survey 2005–2018

Background There is currently no research on the correlation between novel inflammatory indexes systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the risk of anemia in chronic kidney disease (CKD) population, as well as survival analysis in CKD with anemia. Methods This investigation encompassed 4444 adult subjects out of the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. The study utilized multi-variable logistic regression to assess the relationship between SII, NLR, PLR, and anemia risk occurrence in CKD population. Survival differences in CKD patients with anemia, based on varying levels of SII, NLR, and PLR were evaluated employing Kaplan–Meier and Cox proportional hazards models. Results The adjusted logistic regression model demonstrates that SII, NLR, and PLR are associated with the risk of anemia occurrence in CKD population. Kaplan–Meier’s analysis reveals significant differences in survival rates among CKD patients with anemia stratified by NLR levels. The adjusted Cox proportional hazards model shows that the higher NLR group has a 30% elevated risk of all-cause mortality contrasted with lower group (hazard ratio, HR: 1.30, confidence interval (CI) [1.01, 1.66], p value <.04). Restricted cubic spline (RCS) demonstrates no nonlinear relationship between NLR and all-cause mortality. Lastly, sub-cohort analysis indicates that in populations with diabetes, hypertension, and hyperuricemia, NLR levels have a greater impact on all-cause mortality. Conclusions Controlling inflammation may reduce the occurrence of anemia in CKD populations, with NLR serving to be a potential prognostic indicator for survival results within CKD patients suffering from co-morbid anemia.

ERYTHROPOIETIN SYNTESIS IN PATIENTS WITH CHRONIC HEART FAILURE DEPENDING ON COMORBID PATHOLOGY

Introduction. Decreased production of erythropoietin by the kidneys plays crucial role in the development of anemia in patients with chronic heart failure, especially on the background of comorbid diabetes mellitus type 2. In diabetic patients due to early damage of the kidney vessels and following erythropoietin deficiency anemia develops much earlier than clinically significant decrease of glomerular filtration rate.&#x0D; The aim of the study was to find out possible dependence of changes in the erythropoietinsynthesizing function of the kidneys on the degree of severity of anemic hypoxia in elderly and senile patients with chronic heart failure, including those with comorbid type 2 diabetes mellitus.&#x0D; Materials and methods. 120 patients with chronic heart failure of ischemic origin, type 2 diabetes mellitus and mild and moderate anemia were examined. Control group comprised 12 people with chronic heart failure without comorbid pathology. The examined groups were comparable in terms of gender and age, differing in the presence of comorbid diabetes mellitus and degree of severity of anemic syndrome. The level of erythropoietin in blood serum was determined by standard enzymelinked immunosorbent assay.&#x0D; Results. Type 2 diabetes mellitus in patients with chronic heart failure results in a significant decrease in erythropoietin production by 25 % compared to the control group (p&lt;0,05). Comorbid to heart failure anemia leads to an increase in the level of erythropoietin by 74,4 % (р&lt;0,05), and in the case of chronic heart failure and type 2 diabetes mellitus on the background of concomitant anemia – only by 39,5 % (р&lt;0,05). As the severity of anemia in patients with chronic heart failure without diabetes progresses, the severity of the compensatory response of the kidneys to chronic anemic hypoxia is significantly higher than in patients with heart failure and comorbid type 2 diabetes.&#x0D; Conclusions. Diabetic nephropathy in patients with chronic heart failure and comorbid anemia leads to a significant deterioration of the erythropoietin-synthesizing function of the kidneys, complicating the course of both main and comorbid diseases.

Comorbid normochromic and normocytic anemia in coronary artery disease: retrospective study

The study's objective was to ascertain the prevalence and defining characteristics of anemia in coronary artery disease patients. Retrospectively, 534 patients with comorbid anemia and coronary artery disease were examined. All patients were determined to have ongoing coronary supply route infection. The normal time of examined patients was 76.2 ± 5.11. Males with hemoglobin levels below 13.5 mg/dL and females with hemoglobin levels below 11.5 mg/dL were diagnosed with comorbid anemia. The patients were randomized by sex, age, and type of coronary corridor infection. Among all analyzed patients with coronary vein sickness frailty is viewed as in almost 75% of cases, which matches with the writing information. In individuals after 50 pallor is more normal in men than in ladies, while in youthful and moderately aged patients weak condition is more run of the mill in females. Just in under 90 case reports the determination of frailty was kept in the last clinical analysis during patients' release from the emergency clinic, in one more case low hemoglobin level was not thought about by doctors. Roughly only 35% of all instances of serious paleness were not analyzed in a medical clinic and no fitting rectification of hemoglobin level was performed. The rate of sickliness doesn't rely upon the type of constant coronary vein infection. In many patients with coronary course sickness comorbid sickliness is of normochromic and normocytic character. Alongside movement of the seriousness of the comorbid paleness, a genuinely critical increment of the hospitalization time frame is noticed. In patients with coronary corridor sickness and comorbid pallor, the recurrence of hospitalizations each year is additionally expanded alongside iron deficiency level of seriousness. In conclusion, constant types of coronary corridor sickness in old and feeble patients in 69.89% of cases are confounded by comorbid paleness of various levels of seriousness. In more established patients with coronary course sickness, the weak disorder is most frequently brought about by respiratory illnesses, stomach ulcers, and duodenal ulcers, diseases of various limitations. In many patients with coronary conduit sickness comorbid sickliness is of normochromic and normocytic character.

Coexistence of Anaemia and Stunting among Children Aged 6–59 Months in Ethiopia: Findings from the Nationally Representative Cross-Sectional Study

Introduction: Stunting and anaemia, two severe public health problems, affect a significant number of children under the age of five. To date, the burden of and predictive factors for coexisting forms of stunting and anaemia in childhood have not been well documented in Ethiopia, where both the conditions are endemic. The primary aims of the present study were to: (i) determine the prevalence of co-morbid anaemia and stunting (CAS); (ii) and identify factors associated with these co-morbid conditions among children aged 6–59 months in Ethiopia. Methods: The study was based on data from the Ethiopian Demographic and Health Survey (EDHS 2005–2016). The EDHS was a cross-sectional study that used a two-stage stratified cluster sampling technique to select households. A total weighted sample of 21,172 children aged 6–59 months was included in the current study (EDHS-2005 (n = 3898), EDHS-2011 (n = 8943), and EDHS-2016 (n = 8332)). Children with height-for-age z-scores (HAZ) less than −2 SD were classified as stunted. Anaemia status was measured by haemoglobin level with readings below 11.0 g/deciliter (g/dL) categorized as anaemic. A multilevel mixed-effects logistic regression model was used to identify the factors associated with CAS. The findings from the models were reported as adjusted odds ratios (AOR) with 95% confidence intervals (CIs). Results: Almost half of the children were males (51.1%) and the majority were from rural areas (89.2%). The prevalence of CAS was 24.4% [95% CI: (23.8–24.9)]. Multivariate analyses revealed that children aged 12–23 months, 24–35 months, and 36–59 months, and children perceived by their mothers to be smaller than normal at birth had higher odds of CAS. The odds of CAS were significantly higher among children born to anaemic mothers [AOR: 1.25, 95% CI: (1.11–1.41)], mothers with very short stature [AOR: 2.04, 95% CI: (1.44–2.91)], children from households which practiced open defecation [AOR: 1.57, 95% CI: (1.27–1.92)], children born to mothers without education [AOR: 3.66, 95% CI: (1.85–7.22)], and those who reside in rural areas [AOR: 1.41, 95% CI: (1.10, 1.82)]. Male children had 19% lower odds of having CAS compared to female children [AOR: 0.81, 95% CI: (0.73–0.91)]. Children born to mothers who had normal body mass index (BMI) [AOR: 0.82, 95%CI: (0.73–0.92)] reported lower odds of CAS. Conclusions: One in four preschool-age children in Ethiopia had co-morbid anaemia and stunting, which is a significant public health problem. Future interventions to reduce CAS in Ethiopia should target those children perceived to be small at birth, anaemic mothers, and mothers with short stature.

Abstract #1505817: Outcomes of Diabetic Complications in Patients with Comorbid Anemia: A National Inpatient Sample Analysis (2016-2020)

Abstract #1505817: Outcomes of Diabetic Complications in Patients with Comorbid Anemia: A National Inpatient Sample Analysis (2016-2020)

THE FEATURES OF LIMITED PROTEOLYSIS IN PLACENTAL FIBRINOID IN COMBINATION WITH INFLAMMATION AND IRON DEFICIENCY ANEMIA OF PREGNANT WOMEN.

The aim: To establish the features of limited proteolysis in fibrinoid of the chorionic and basal plates of the placenta in acute and chronic chorioamnionitis, as well as basal deciduitis on the background of iron deficiency anemia in pregnant women. Materials and methods: The histochemical procedure was performed using the ninhydrin-Schiff response to free amino groups of proteins by the method of A. Yasuma and T. Ichikava, and Bonheg bromophenol blue. Results: With iron deficiency anemia of pregnant women, the relative units of optical density in the chorionic plate were 0.312±0.0026, and with basal one - 0.310±0.0024 (with indicators of physiological pregnancy 0.285±0.0024 and 0.289±0.002.1). In the observations of acute chorioamnionitis, the quantitative indicators were 0.311±0.0024, chronic one - 0.311±0.0024, and with inflammation on the background of anemia of pregnant women - 0.315±0.0031 and 0.339±0.0036, respectively. With acute basal deciduitis - 0.316±0.0027, chronic one - 0.326±0.0034, and with inflammation of the basal plate of the placenta on the background of anemia of pregnant women - 0.320±0.0031 and 0.341±0.0038, respectively. Conclusions: With anemia of pregnant women, the processes of limited proteolysis are intensified in accordance with the indicators of optical density of histochemical staining in the fibrinoid of the chorionic and basal plates of the placenta compared with physiological pregnancy. In case of acute and chronic forms of chorioamnionitis and basal deciduitis, quantitative indicators of optic density of histochemical staining increase compared with physiological preg¬nancy. Comorbid anemia of pregnant women activates the processes of limited proteolysis only in the chronic form of chorioamnionitis and basal deciduitis.

Structure of Anemic Syndrome in Patients with Chronic Forms of Coronary Artery Disease

The purpose of the study was to determine the incidence and characteristic features of anemia in elderly and senile patients with chronic forms of coronary artery disease. Materials and methods. 1,993 case reports of patients with chronic forms of coronary artery disease with comorbid anemia were analyzed retrospectively. All patients were diagnosed with chronic coronary artery disease (stable angina pectoris of II-III functional classes, diffuse or focal (post-infarction) cardiosclerosis). Average age of investigated patients was 79.5 ± 5.24. Comorbid anemia was diagnosed in case of hemoglobin level below 130 G/l in males and 120 G/l in females. The patients were randomized by gender, age and form of coronary artery disease. Results and discussion. Among all examined patients with coronary artery disease anemia is found in nearly 70% of cases, which coincides with the literature data. In people after 60 anemia is more common in men than in women, while in young and middle-aged patients anemic syndrome is more typical in females. Only in less than hundred case reports the diagnosis of anemia was recorded in the final clinical diagnosis during patients’ discharge from the hospital, in another cases low hemoglobin level was not taken into consideration by physicians. Approximately only one-third of all cases of severe anemia was not diagnosed in a hospital and no appropriate correction of hemoglobin level was performed. Incidence of anemia does not depend on the form of the chronic coronary artery disease (stable angina pectoris or cardiosclerosis). In most patients with coronary artery disease comorbid anemia is of normochromic and normocytic character. Along with progression of the severity of the comorbid anemia, statistically significant increase of the hospitalization period is observed. In patients with coronary artery disease and comorbid anemia the frequency of hospitalizations per year is also increased along with anemia degree of severity progressing. Conclusion. Chronic forms of coronary artery disease in elderly and senile patients in 69.89% of cases are complicated by comorbid anemia of different degrees of severity. In older patients with coronary artery disease, anemic syndrome is most often caused by respiratory diseases, stomach ulcer and duodenal ulcer, cancer of different localization. In most patients with coronary artery disease comorbid anemia is of normochromic and normocytic character. Comorbid anemia in patients with coronary artery disease contributes to the prolongation of the patients’ in-hospital treatment and increasing of the frequency of hospitalizations due to the main disease throughout the year

Anemia in Patients with Ulcerative Colitis in Remission: A Cross-Sectional Study from Pakistan

Background and Aim: Anemia is an extra intestinal manifestation of inflammatory bowel disease that frequently causes complications. In inflammatory bowel disease (IBD) such as ulcerative colitis and Crohn’s disease, anemia is mostly caused by iron deficiency which impacts the patient's quality of life [1, 2]. The present study aimed to assess the anemia in ulcerative colitis patients in remission. Methodology: A cross-sectional study was conducted on 82 ulcerative colitis patients at the Department of Medicine and Gastroenterology, Jinnah hospital, Lahore from February 2021 to January 2022. All the patients were assessed for anemia based on Mayo clinical score &lt;3 for at least three months. Hemogram tests such as CBC, vitamin B12 serum levels, ferritin, folic acid levels, concentration of C - reactive protein (CRP), and transferrin were performed for the initial screening. Further, patients were evaluated for the determination of different causes of anemia. Patients were categorized into mild, moderate, and severe anemia cases. Oral iron, intravenous iron, and blood transfusion were given to mild, moderate, and severe anemia patients respectively. SPSS version 25 was used for data analysis. Results: Of the total 82 ulcerative colitis patients, there were 48 (58.5%) male and 34 (41.5%) females. The prevalence of anemia in ulcerative colitis patients and control was 51.2% (n=42) and 11.9% (n=5) respectively. The hemoglobin mean values in UC patients and control was 11.95 g/dL and 13.21 g/dL respectively. Out of 42 ulcerative colitis patients, the prevalence of mild, moderate, and severe anemia was 52.4% (n=22), 35.7% (n=15), and 11.9% (n=5) respectively. Iron deficiency was the prevalent etiology of anemia found in 22 (52.4%) patients followed by chronic anemia disease with iron deficiency found in 8 (21.9%). Hemoglobin level has no association with ferritin level. Hemoglobin level has no association with ferritin level. The hemoglobin level was increased with oral iron and intravenous iron by 1.6 g/dL and 2.3 g/dL respectively. Conclusion: The present study concluded that prevalence of anemia was higher in ulcerative colitis patients. The most common etiology of anemia was iron deficiency in both groups. Increased CRP and moderate activity associated to anemia disease was significantly related with comorbid anemia. Oral iron and intravenous iron could increase hemoglobin levels in ulcerative colitis associated anemia patients. Keywords: Anemia, Ulcerative Colitis, Iron deficiency

A national analysis on complications and readmissions for adult cerebral palsy patients undergoing primary spinal fusion surgery.

Retrospective National Database Study. Surgical intervention with spinal fusion is often indicated in cerebral palsy (CP) patients with progressive scoliosis. The purpose of this study was to utilize the National Readmission Database to determine the national estimates of complication rates, 90-day readmission rates, and costs associated with spinal fusion in adult patients with CP. The 2012-2015 NRD databases were queried for all adult (age ≥ 19years) patients diagnosed with CP (ICD-9: 333.71, 343.0-4, and 343.8-9) undergoing spinal fusion (ICD-9: 81.00-08). 1166 adult patients with CP (42.7% female) underwent spinal fusion surgery between 2012 and 2015. 153 (13.1%) were readmitted within 90days following the primary surgery, with a mean 33.8 ± 26.5days. Mean hospital charge of the primary admission was $141,416 ± $157,359 and $167,081 ± $145,416 for the non-readmitted and readmitted patients, respectively (p = 0.06). The mean 90-day readmission charge was $72,479 ± $104,100. Most common complications with the primary admission included UTIs (no readmission vs. readmission: 7.6% vs. 4.8%; p = 0.18), respiratory (6.9% vs. 5.6%; p = 0.62), implant (3.8% vs. 6.0%; p = 0.21), and paralytic ileus (3.6% vs. 3.2%; p = 0.858). Multivariate analyses demonstrated the following as independent predictors for 90-day readmission: comorbid anemia (OR: 2.8; 95% CI: 1.6-4.9; p < 0.001), coagulopathy (2.9, 1.1-8.0, 0.037), perioperative blood transfusion (2.0, 1.1-3.8, 0.026), wound complication (6.4, 1.3-31.6, 0.023), and transfer to short-term hospital versus routine disposition (4.9, 1.0-23.3, 0.045). Quality improvement efforts should be aimed at reducing rates of infection related complications as this was the most common reason for short-term complications and unplanned readmission following surgery.

Abstract 11811: Impact of Anemia on the Outcomes of Hospitalizations for Atrial Fibrillation: Analysis of National Inpatient Sample

Introduction: Anemia is a known adverse prognostic factor among patients with cardiovascular diseases. We sought to determine the impact of anemia on hospitalizations for atrial fibrillation (AF). Methods: Data were extracted from the National Inpatient Sample (NIS) 2016 - 2018 Database. The NIS was searched for hospitalizations for adult patients with AF as principal discharge diagnosis with and without anemia as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis were used accordingly to adjust for confounders. STATA software was used for analysis. Results: Of the 1,236,549 patients admitted for AF, 196,430 (15.9%) had anemia. The mean age of patients with anemia was 74 years (95% CI 73.8 - 74.1) vs. 70 years (95% CI 70.2 - 70.3) at the time of admission for AF (p&lt;0.001). There were 56.6% females in the Anemia group vs. 50.3% in the other group (p&lt;0.001). The adjusted odds ratio (aOR) for inpatient mortality for AF with anemia compared to AF without anemia was 1.53 (95% CI 1.388 - 1.686, p&lt;0.001). Patients with anemia averaged 1.23 days longer length of stay (95% CI 1.182 - 1.287, p&lt;0.001) and 14112 USD higher mean hospitalization charge (95% CI 13179 - 15046, p&lt;0.001). Comorbid anemia in AF patients was associated with higher risks of cardiac arrest (aOR 1.61; 95% CI 1.38 - 1.87, p&lt;0.001) and cardiogenic shock (aOR 1.84; 95% CI 1.61 - 2.10, p&lt;0.001) and a lower likelihood of cardioversion (aOR 0.73; 95% CI 0.71 - 0.76, p&lt;0.001). Detailed outcomes are listed in Table 1. Conclusions: Comorbid anemia leads to worse outcomes in patients with AF. Early detection and treatment of anemia in at-risk patients may improve clinical outcomes in AF.

Erytrocytes deformability in patients with coronary artery disease and anemia

Background and Aims: Rheological disorders in patients with coronary artery disease (CAD) are of great importance as they lead to the disease progression. They are mainly conditioned by changes of the erythrocyte membrane as red blood cells compose up to 45% of the cells in the bloodstream. Aim of the investigation – to detect possible changes of the erythrocyte deformability index (EDI) in patients with CAD and comorbid anemia.

Predictors of outcomes in hospitalized patients undergoing pacemaker insertion: Analysis from the national inpatient database (2016-2017).

Pacemaker implantation in the U.S. is rising due to an aging population. The aim of this analysis was to identify risk factors associated with increased mortality and complications in hospitalized patients requiring pacemaker implantation. We performed a retrospective analysis using the National Inpatient Sample database, identifying hospitalized patients who underwent pacemaker implantation using International Classification of Disease, Tenth Revision, Clinical Modification codes. Independent predictors of inpatient mortality were identified using multivariate logistic regression analysis. There were 242,980 hospitalizations with pacemaker implantation during 2016 and 2017. The most frequently encountered indications for hospitalizations involving pacemaker insertion included sick sinus syndrome (SSS) (27.60%), complete atrioventricular (AV) block (21.57%), and second-degree AV block (7.83%). Chronic liver disease was associated with the highest adjusted odds of inpatient mortality (aOR=5.76, 95% CI: 4.46 to 7.44, p<.001). Comorbid anemia had the highest statistically significant adjusted odds ratio (aOR) for predictors of post-procedural cardiac complications (aOR=3.17, 95% CI: 2.81 to 3.58, p<.001). Mortality in hospitalized patients needing pacemaker implantation was 1.05%. About 3.36% of hospitalizations developed post procedural circulatory complications (PPCC), 2.45% developed sepsis, and 1.84% developed mechanical complications of cardiac electronic devices. We identified several predictors of inpatient mortality in hospitalized patients undergoing pacemaker implantation, including chronic liver disease, protein-calorie malnutrition, chronic heart failure, anemia, and history of malignancy. Anemia, chronic liver disease, and congestive heart failure were independent predictors of adverse outcomes in such patients.

Co-morbid anaemia and stunting among children 2–5 years old in southern Ethiopia: a community-based cross-sectional study

BackgroundIn Ethiopia, 38% of children less than 5 years of age are stunted and 57% are anaemic. Both have a negative impact later in life on physical growth and cognitive...

Anemia of cardiorenal syndrome

Cardiorenal syndrome includes a spectrum of disorders of the kidneys and heart in which loss of function in one organ contributes to reduced function in the other organ. Cardiorenal syndrome is frequently complicated by comorbid anemia, which leads to reciprocal and progressive cardiac and renal deterioration. The triad of heart failure, chronic kidney disease (CKD), and anemia is termed cardiorenal anemia syndrome (CRAS). There are currently no evidence-based recommendations for managing patients with CRAS; however, the treatment of these patients is multifactorial. Not only must the anemia be controlled, but heart failure and kidney injury must be addressed, in addition to other comorbidities. Intravenous iron and erythropoiesis-stimulating agents are the mainstays of treatment for anemia of CKD, addressing both iron and erythropoiesis deficiencies. Since erythropoiesis-stimulating agent therapy can be associated with adverse outcomes at higher doses in patients with CKD and is not used in routine practice in patients with heart failure, treatment options for managing anemia in patients with CRAS are limited. Several new therapies, particularly the hypoxia-inducible factor-prolyl hydroxylase inhibitors, are currently under clinical development. The hypoxia-inducible factor-prolyl hydroxylase inhibitors have shown promising results for treating anemia of CKD in clinical trials and may confer benefits in patients with CRAS, potentially addressing some of the limitations of erythropoiesis-stimulating agents. Updated clinical practice guidelines for the screening and management of anemia in cardiorenal syndrome, in light of potential new therapies and clinical evidence, would improve the clinical outcomes of patients with this complex syndrome.

Comorbid patterns of anaemia and diarrhoea among children aged under 5 years in Ghana: a multivariate complex sample logistic regression analysis and spatial mapping visualisation.

BackgroundAnaemia and diarrhoea are known independent causes of under-five morbidity and mortality. This study sought to investigate predictors of comorbid patterns of anaemia and diarrhoea using the 2014 Ghana Demographic and Health Survey (GDHS).MethodsThe study employed analysis of secondary data from the 2014 GDHS. We performed a multivariate complex sample logistic regression and spatial analysis.ResultsThe weighted prevalence of comorbid anaemia and diarrhoea was 9.28% with the highest burden (16.45%) found in the Upper West region. Independent predictors (risk factors) of comorbid patterns of anaemia and diarrhoea were children aged 6–23 mo (OR=2.17, 95% CI 1.42 to 3.33), male gender (OR=1.50, 95% C1 1.04 to 2.16), history of fever (OR=4.37, 95% CI 2.94 to 6.50) and living in a household with two children aged <5 y (OR=1.80, 95% CI 1.14 to 2.84). Protective factors were having a father with secondary or higher education (OR=0.57, 95% CI 0.33 to 0.97), living in a household with ≥6 members (OR=0.46, 95% CI 0.28 to 0.75) and living in a richer household (OR=0.38, 95% CI 0.16 to 0.89). Surface maps revealed inter-regional and subregional variations.ConclusionThe study shows that the independent predictors of comorbid patterns of anaemia and diarrhoea among children aged <5 y in Ghana are age, gender, history of fever, the number of children aged <5 y in the household, parental education, household size and household wealth. The study identified zones to be targeted for cost-effective policy interventions.

Socio-demographic patterning of the individual-level double burden of malnutrition in a rural population in South India: a cross-sectional study

BackgroundThe double burden of malnutrition is the co-occurrence of undernutrition (e.g. underweight, stunting, and micronutrient deficiencies) and over-nutrition (e.g. obesity, type 2 diabetes, and cardiovascular disease) at the population, household, or individual level. The objectives of this study were to determine the extent and determinants of individual-level co-morbid anemia and overweight and co-morbid anemia and diabetes in a population in rural Tamil Nadu, South India.MethodsWe undertook a cross-sectional study of adults (n = 753) in a rural region of Tamil Nadu, South India. A survey assessed socio-demographic factors, physical activity levels, and dietary intake. Clinical measurements included body-mass index, an oral glucose tolerance test, and blood hemoglobin assessments. Multivariable logistic regression analyses were used to determine associations between risk factors and two co-morbid double burden pairings: (1) anemia and overweight, and (2) anemia and diabetes.ResultsPrevalence of co-morbid anemia and overweight was 23.1% among women and 13.1% among men. Prevalence of co-morbid anemia and diabetes was 6.2% among women and 6.3% among men. The following variables were associated with co-morbid anemia and overweight in multivariable models [odds ratio (95% confidence interval)]: female sex [2.3 (1.4, 3.85)], high caste [3.2 (1.34, 7.49)], wealth index [1.1 (1.00, 1.12)], rurality (0.7 [0.56, 0.85]), tobacco consumption [0.6 (0.32, 0.96)], livestock ownership [0.5 (0.29, 0.89)], and energy-adjusted meat intake [1.8 (0.61, 0.94)]. The following variables were associated with co-morbid anemia and diabetes in multivariable models: age [1.1 (1.05, 1.11)], rurality [0.8 (0.57, 0.98)], and family history of diabetes [4.9 (1.86, 12.70).ConclusionThis study determined the prevalence and factors associated with individual-level double burden of malnutrition. Women in rural regions of India may be particularly vulnerable to individual-level double burden of malnutrition and should be a target population for any nutrition interventions to address simultaneous over- and undernutrition.

Trends in Emergency Department Visits among Adolescents with Abnormal Uterine Bleeding.

To explore trends over time in the utilization of the Emergency Department (ED) for adolescents with abnormal uterine bleeding (AUB). Retrospective cross-sectional study. Nationwide Emergency Department Sample database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, Rockville, MD). Subset of adolescents aged 10-19years from overall cohort of women aged 10-49years. All ED visits from 2010-2014 for which International Classification of Diseases, ninth revision codes for AUB were listed as the principal diagnosis were compared. Health insurance coverage, demographic factors, hospital characteristics, comorbid anemia, and comorbid bleeding disorders were explored. Number of visits, ED disposition, blood transfusions, and billing for pelvic ultrasound. There were an estimated 262,939 ED visits nationally for women aged 10-49years for AUB in 2014. Of these, 12.7% (33,511/262,939) were from adolescents aged 10-19years. The number of adolescent visits with an AUB diagnosis declined by 11% from 2010-2014 (37,642 vs 33,511; P=.026), while visits by patients aged 20-49 did not change significantly (215,309 vs 229,428; P=.19). The number of adolescent visits for which Medicaid was the primary payer increased slightly, from 17,283 to 18,785, from 2010 to 2014 (P=.152), while the number using self-pay decreased from 8769 (23.4%) in 2010 to 5146 (15.4%) in 2014 (P<.0001). ED visits among adolescents with AUB decreased from 2010 to 2014. There was a sharp reduction in the number of visits funded by self-pay and a slight increase in visits funded by Medicaid.

Experience in treatment of comorbid pathologies in calves in the neonatal period

The article describes an integrated approach in the treatment of hypotrophic calves with transindromal comorbid anemia. The clinical status of the calves was established and the therapeutic effect of the combined use of Carnitine chloride, Actovegin and Taurine on the metabolic status of calves with comorbid diseases in the neonatal period, restoration of hematopoiesis, energy status and reduction of imbalance of immunological parameters was studied. As a result, a decrease in the sensitivity of young animals to adverse environmental factors was found.

THE INCIDENCE AND CHARACTERISTIC FEATURES OF ANEMIA IN OLDER PATIENTS WITH CORONARY ARTERY DISEASE

INTRODUCTION: Previous studies have shown that the presence of anemia is associated with increased short- and long-term outcomes in patients with cardio-vascular diseases, especially coronary artery disease. Decreased hemoglobin level is associated with increased mortality, increased frequency of hospitalization due to different reasons, decreased quality of life and worsening of the clinical course of the main and comorbid diseases. Knowledge about the origin of the patient’s anemia should result in its treatment and possible prevention of the rapid progression of the main cardio-vascular disease, particularly in elderly patients.OBJECTIVES: determination of the incidence and characteristic features of anemia in elderly and senile patients with chronic forms of coronary artery disease.METHODS: 1993 case reports of patients with chronic forms of coronary artery disease with comorbid anemia were analyzed retrospectively.RESULTS: Among all examined patients with coronary artery disease, anemia is found in nearly 70% of cases. In people after the age of 60, anemia is more common in men than in women. Only in less than a hundred case reports, the diagnosis of anemia was recorded in the final clinical diagnosis during patients’ discharge from the hospital. The incidence of anemia does not depend on the form of the chronic CAD (stable angina pectoris or cardiosclerosis). In most patients with CAD, comorbid anemia is of a normochromic and normocytic character. Along with the progression of the severity of the comorbid anemia, a statistically significant increase of the hospitalization period is observed. In patients with CAD and comorbid anemia the frequency of hospitalizations per year is also increased.CONCLUSIONS: Chronic forms of coronary artery disease in elderly and senile patients in 69,89% of cases are complicated by comorbid anemia of different degrees of severity. In older patients with CAD, anemic syndrome is most often caused by respiratory diseases, stomach and duodenal ulcers, and cancer of various localizations. In most patients with CAD, comorbid anemia is of a normochromic and normocytic character. Concomitant anemia in patients with CAD contributes to the prolongation of the patients’ in-hospital treatment and increases the frequency of hospitalizations due to the main disease throughout the year.