Deficiency Anemia Research Articles

To Investigate The Prevalence And Incidence Of Anaemia And Its Comorbidities In The Gandhinagar Population

Background: Anaemia is a major public health issue that affects 2 billion people worldwide, affecting people of all ages and genders. According to the WHO, iron deficiency anaemia is the leading cause of anaemia, accounting for 50% of all cases.
 Methodology: An observational study was carried out at Gandhinagar, Gujarat from November 2015 to March 2016. A complete blood count (CBC) report of patients were collected directly from patient’s laboratory report and entered in structured case report form. The Questionnaire, to obtain information regarding life style, food habits, socioeconomic status and medical history was filled by the patients.
 Results: A total of 521 patient’s data were collected in which 146 (48.66%) males and 154 (51.33%) females were suffering from anaemia. In anaemic patients 131 (43.66%) patient were microcytic anaemic, 125 (41.66%) were normocytic and 44 (14.66%) patient were macrocytic anaemic. Out of 300 anaemic patients, 231 (76.15%) were in age group of 16-50 years. Majority of patients seems to be suffering from the nutritional anaemia due to poor consumption of diet. Majority of anaemic patients belonged to upper-middle class and upper-lower class family. There were no significant differences of the smoking, tobacco, alcohol consumption with anaemia.
 Conclusion: According to our data, poor dietary habits seem to be major cause for anaemia. Lack of awareness about the disease worsens the problem. Awareness programs at community levels by health agencies can significantly help in reducing the burden of the diseases.

Effectiveness of video assisted teaching programme regarding knowledge on nutritional anemia and its prevention among adolescent girls in selected girls high school at vellore

Effectiveness of video assisted teaching programme regarding knowledge on nutritional anemia and its prevention among adolescent girls in selected girls high school at vellore

Prevalence of Anemia and Associated Nutritional Factors

Nutritional anemia is one of the most common types of anemia worldwide and is considered a major public health problem especially in developing countries. Therefore, this study was conducted to determine the prevalence and risk factors of anemia among university students in the Kurdistan region. A cross-sectional study of 151 healthy university’s students aged between 18 and 28 years was performed between November and February 2019-2020. Blood was collected to measure hemoglobin, and a questionnaire was designed to determine participants’ nutrition habits. A Pearson’s chi-square test was used to reveal anemia risk factors. The anemia prevalence was 17.9%. The factors associated with an elevated anemia risk were inadequate vegetables and red meat intakes, in addition to drinking tea after meals. This study revealed that a considered part of university students have anemia that might become worse by malnutrition. Our results suggest that anemia can be prevented by encouraging the consumption of rich dietary iron, folic acid, and B12 sources and by raising awareness of the food and drinks which facilitate or hinder the bioavailability of these nutrients.

The Relationship between the Nutritional Status of Pregnant Women and Anemia at the Nursing Health Center in Blangkejeren City, Gayo Lues Regency, Aceh Province in 2022

For mothers, pregnancy is an important period in their life. During pregnancy, the mother must prepare herself to welcome the birth of her baby. A healthy mother can give birth to a healthy and physically perfect baby with sufficient body weight. Maternal nutritional status in pregnancy affects nutritional status. At the Puskesmas where the study was conducted, out of 14 pregnant women, 8 pregnant women experienced CED, as can be seen from the results of LILA measurements <23.5 cm. The purpose of this study was to determine the relationship between the nutritional status of pregnant women and the incidence of anemia at the Nursing Health Center in Blangkejeren City, Gayo Lues District, Aceh Province in 2022. The research design used was an analytical survey. The population in this study were all Trimester II and III pregnant women who came for treatment at the Nursing Center in September 2022. The sampling technique was a total population of 37 people. The research data was taken using a measuring tape and Hb Sahli. The results of this study, the nutritional status of pregnant women who were not normal were 21 respondents (56.8%), not anemic as many as 1 respondent (4.8%), anemia as many as 20 respondents (54.1%) and normal as many as 16 respondents (43.2%).), 10 respondents (27.%) were not anemic, 6 respondents (16.2%) had anemia. The results of the statistical assessment obtained a value of P = 0.000 <0.05, from the results of this study it was obtained Results There is a relationship between the nutritional status of pregnant women and anemia. In conclusion, there are many pregnant women with poor nutritional status and anemia. It is recommended that pregnant women increase their nutritional intake and consume Fe tablets, and have their pregnancy checked 4 times during pregnancy. Advice to health workers to provide counseling to pregnant women during examinations

Prevalence and clinic hematological profile of vitamin B12 deficiency associated megaloblastic anemia in children of Jammu region - A hospital based observational study

: Vitamin B12 deficiency (VBD) Megaloblastic Anemia (MA) is a relatively common disease encountered by pediatricians in Jammu region of north India, yet the data on prevalence of VBD in this age group remains scarce. Hence this study was conducted to study the prevalence and clinic hematological profile of VBD associated MA in children between 6 months to 18 years of age. To estimate the prevalence and clinico hematological profile of vitamin B12 deficiency associated MA in children between 6 months to 18 years, who were admitted in SMGS Hospital, Government Medical College Jammu. A Retrospective cross sectional study was conducted in children between 6 months to 18 years, who were admitted in SMGS Hospital, Government Medical College Jammu with diagnosis of Nutritional Anemia from April 2020 - March 2021.Case records of patients were reviewed for vitamin B12 deficiency as a cause of MA who were included in study. Vitamin B12 deficiency was diagnosed by measuring B12 levels in blood and by bone marrow examination if required. Clinic hematological profile of the participants was observed by reviewing their records for age, sex, socioeconomic status, food habits, presenting complaints, clinical signs and symptoms, peripheral smear findings and need for transfusion. All descriptive data collected was represented by tables and evaluated for statistical outcomes. The prevalence of vit. B12 deficiency associated MA in our study is 16.66 %. Among them 60% were females and 40% males. Age wise distribution was 6months -1 year 20 %, 1-5 years 22%, 6-10years 16% and 11-18 years was 42%. Vitamin B12 deficiency was more prevalent in lower socioeconomic group 80% and in those who were vegetarians 60%. Anorexia, generalised weakness, pallor was observed in 100% subjects. Neurologic involvement in the form of irritability, tremors was present in 30%. Icterus was seen in 10% while hepatomegaly and splenomegaly was present in 20 % and 22% respectively. Edema was seen in 2% of the subjects. Hyperpigmentation of knuckles was observed in 86% of the patients. Macrocytic anemia (MCV >100 ug/L) was observed in 100%. Bicytopenia was seen in 80% while Pancytopenia was present in 20%. Among 150 cases of Megaloblastic Anemia 80% of the patients were diagnosed by Vitamin B12 essay, 20% were diagnosed by Bone marrow examination. Blood transfusion secondary to severe anemia was required in about 10%. Vitamin B12 deficiency is not that uncommon in our population with prevalence of 16.66% in hospitalized children. However true prevalence can only be estimated by population based surveys in pediatric age group. The most common presenting complaint in Megaloblastic Anemia is anorexia, generalised weakness, irritability manifesting clinically as pallor, hyperpigmentation of knuckles and hematologically as macrocytic anemia with 80% bicytopenia and 20% pancytopenia. Thus vitamin B12 addition in anaemia control and prophylaxis programmes may be considered.

Abstract 9784: All-Cause Mortality and Cardiovascular Events in Cancer Patients Undergoing Hematopoietic Stem Cell Transplantation (Kurume-CREO Study)

Backgrounds: Recent advances in chemotherapy and supportive therapy have resulted in improved clinical outcomes in cancer patients undergoing hematopoietic stem-cell transplantation (HSCT). However, there is limited evidence regarding prognosis, cardiovascular (CV) events and their predictors in patients undergoing HSCT. Therefore, we investigated the predictors for all-cause death and CV events in cancer patients undergoing HSCT. Methods: We enrolled 490 patients with hematological malignancies (n=399) and breast cancer (n= 91) in a prospective observational cohort study (Kurume-CREO study) in Kurume University from October 2016 to February 2021. Patients were followed up every 6 months after enrollment until August 2021. Outcomes were all-cause death, CV death and non-fatal CV events, the last defined as ≧ Grade 2 cardiac or vascular events based on CTCAE (Common Terminology Criteria for Adverse Events) v4.0-JCOG version. Results: The mean age ± standard deviation of all study subjects was 63.7 ± 13.4 years old. Among them, 107 all-cause deaths (21.8%), 84 CV events (17.1%, 3 CV deaths) were observed during the follow-up period (median:713.5 days). In this study, 60 patients (all were patients with hematological malignancies) received HSCT. The 3-year survival rate was 63.6% (Figure 1A) and the 3-year CV event-free rate was 70.7% (Figure 1B) in 60 patients with HSCT. Age- and sex-adjusted Cox proportional hazards analysis showed that hypoalbuminemia (p=0.02), anemia (p=0.03), low platelet count (p=0.0009) and history of depression (p=0.01) were associated with all-cause mortality and non-fatal CV events were associated with receiving a second HSCT (p=0.006). Conclusions: Nutritional status and anemia were associated with all-cause mortality and second HSCT was a risk factor for future CV events in patients undergoing HSCT. Thus, oncologists should carefully monitor cancer patients, particularly after second HSCT, and consult with cardiologists.

Literasi Gizi Remaja Melalui Permainan Edukasi Goaksi (Go Aksi Bergizi)

Nutritional problems in adolescents are increasingly complex, one of which is nutritional anemia and skipping breakfast. It happens because of limited knowledge about balanced nutrition in adolescents. With the increasing nutritional problems of adolescents, the Community Service (PKM) team collaborates with partners, namely students of SMAN 1 Perhentian Raja, Kampar to carry out adolescents' nutrition literacy through the educational game GOAKSI (Go Aksi Bergizi). This activity effort to convey adolescent nutritional literacy through counseling the contents of my plate in meeting nutrition needs. The PKM was attended by 28 student 11th graders. All students were able to understand well the concept of balanced nutrition through the contents of my plate by an increase in the average value of knowledge from 5.4 to 8.0 (pre-test and post-test results) of 2.6 points. It is hoped that PKM activities can be carried out continuously with different topics, so that the formation of knowledge and positive attitudes of adolescents in fulfilling balanced nutrition and good food habits in overcoming adolescent nutritional problems.

Prevalence of iron deficiency anemia in pregnancy and its therapeutic response to treatment: a retrospective audit in a tertiary hospital

Background: Iron deficiency anemia is the commonest type of nutritional anemia seen during pregnancy. Despite implementing oral iron prophylaxis in pregnancy, IDA in pregnant women constitute a major health problem. The present study aims to look at the prevalence of IDA in a pregnant population in Seremban, Malaysia and their response to treatment.Methods: This is a retrospective study looking into the prevalence of iron deficiency anaemia among pregnant women who delivered between October 2019 to March 2020 in a state hospital in Seremban, Malaysia and their response to treatment. Main outcome measures were the prevalence of iron deficiency anaemia, associated demographic and clinical factors and response to iron therapy. Results: About 920 patients’ records were included for analysis. The prevalence of anaemia in this cohort was 42.8% (N=394). The prevalence of iron deficiency anemia (IDA) was 31.5% (N=124) among the anemic patients or 13.5% of the studied population. The mean hemoglobin level for this group was 10.0±0.74 g/dl (6.8-10.9 g/dl) and majority had mild anemia (91.9%, N=114). 68.5% IDA patients were successfully treated by 36 weeks pregnancy. Of the remaining 39 patients who were still anemic, 37 (94.9%) had mild anemia with mean hemoglobin level of 10.3g/dl (SD 0.48, range 9.0-10.9 g/dl). Conclusion: Current treatment strategy is inadequate to achieve the set national target. There is a role for an early recourse to parenteral iron therapy to improve treatment outcome.

ASSESSMENT OF IMMATURE RETICULOCYTE FRACTION (IRF) WITH ABSOLUTE RETICULOCYTE COUNT (ARC) AS A RESPONSE MARKER IN ANTEPARTUM PATIENTS WITH NUTRITIONAL ANEMIA

Background: Peripheral blood reticulocyte count is an important index in the diagnosis, classication, and monitoring of anemic patients. After initiation of therapy, reticulocytosis develops within 3 to 7 days th th 1 and peaks (8–10%) between the 8 and 10 day . The IRF (Immature Reticulocyte Fraction) increases several days before reticulocyte count and is thus an early indicator of response to therapy. Aim: To study the response of therapy using IRF on day rd th th th 3 - 4 and day7 - 8 in antenatal patients with nutritional anemia. To correlate ARC (Absolute Reticulocyte Count) with IRF after therapy in antenatal patients with nutritional anemia. Study design: Prospective, analytical observational study. Materials and Methods: A total of 63 pregnant women with nutritional anemia were enrolled. Baseline samples for RBC indices, ARC and IRF were taken and treated with parental iron and Vit B12 injection accordingly. Baseline, 3rd - 4th and 7th – 8th day of therapy, values of hematological parameters along with ARC and IRF for predicting the response were determined. Results: The rise in mean ARC and IRF from baseline to day3/4 and day7/8 is signicantly higher in responders. There was a signicant positive correlation between IRF and ARC at baseline, day3/4 and day7/8. Conclusion: IRF and ARC increase in nutritional anemia in subjects, as early as 3-4 days post-therapy, however ARC on day 3-4 is an accurate prediction of response to therapy as evaluated on day 7-day 8 in the present study

Hospital Admissions Secondary to Diseases of the Blood, Blood-Forming Organs, and Immune System in England and Wales.

Background Non-malignant hematologic and immune disorders-related hospitalization trends are unstudied despite their importance from a public health standpoint. Therefore, this study aimed to define the hospitalization trends of the International Statistical Classification of Diseases-10 (ICD-10) categorydiseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (B&ID). Methods We conducted an ecologic study to analyze hospital admission data obtained from England's Hospital Episode Statistics database and Wales' Patient Episode Database. Hospital admissions data for non-malignant hematologic disorders and immune disorders were extracted for the period from April 1999 to March 2019. We used the Poisson model to assess trends in hospital admissions. Results The total annual B&ID-related hospital admission (RHA) rate for all categories increased by 137.9% between 1999 and 2019 (p<0.01). Females accounted for 54% of all B&ID-RHA. Around 37% of B&ID-RHA were seen in the age group of 15-59 years and 29% in the age group of 75 years and above. The most common causes of B&ID-RHA were aplastic and other anemias and other bone marrow failure syndromes, ICD-10 category (33%) and nutritional anemias category (28%). Certain disorders involving the immune mechanism category accounted for the least number of B&ID-RHA (8.4%). The highest increase in B&ID-RHA was seen in the nutritional anemias category (3.86 fold), followed by certain disorders involving the immune mechanism (1.28 fold). Iron deficiency anemia accounted for 95.1% of all hospitalizations secondary to nutritional anemias. Around half of all, hemolytic anemia categoryhospitalizations were secondary to the sickle cell anemia subcategory. Conclusions Hospital admissions trends in non-malignant hematologic and immune disorders changed dynamically among age groups and gender in England and Wales over the last two decades. Understanding these changes has important implications for public health planning.

INCREASING TRENDS AND UNFAVORABLE OUTCOMES OF ACUTE KIDNEY INJURY AMONG PATIENTS WITH PULMONARY HYPERTENSION: A NATIONWIDE ANALYSIS

SESSION TITLE: PAH with ComplicationsSESSION TYPE: Rapid Fire Original InvPRESENTED ON: 10/17/2022 12:15 pm - 1:15 pmPURPOSE: Cardiorenal syndrome is an established risk factor for acute kidney injury (AKI). No contemporary data is available for assessing pulmonary hypertension as an independent risk factor for AKI. We aimed to identify the burden, trends, and outcomes of AKI in pulmonary hypertension hospitalized patients.METHOD: Using National Inpatient Sample (2016-2019, ICD10 codes), we identified hospitalizations with pulmonary heart disease and diseases of pulmonary circulation (PHDPC, 18-90 years) and divided them into AKI and non-AKI. Odds and yearly trend of AKI in PHDPC, demographics, comorbidities, and outcomes for hospitalization between 2 cohorts were analyzed.RESULTS: PHDPC (6,000,000) hospitalizations had 28.3% AKI. Odds of AKI for PDHPC were significantly higher on univariate (OR 2.46, 95CI 2.44-2.48) and multivariate (OR 1.15, 95CI 1.14-1.16) analysis. AKI increased from 23% in 2016 to 27.2% in 2019 in PDHPC (ptrend<0.001). AKI patients were significantly older (mean, 71.3 vs 68.1 years), had higher proportion of males (47.7 vs 42.5%), blacks (20.8 vs 18.4%), Medicare-enrollees (75.1 vs 69.6%), large, urban-teaching, Midwest and West region hospitalizations, non-electively admissions than non-AKI. AKI cohort had significantly higher hyperlipidemia, obesity, prior CABG/MI/PCI, CHF, arrhythmia, valvular disease, PVD, complicated hypertension, neurological disorders, complicated diabetes, hypothyroidism, renal failure, liver disease, peptic ulcer disease, lymphoma, coagulopathy, weight loss, fluid/electrolyte disorders, blood loss anemia, deficiency anemia, and alcohol abuse. All-cause mortality (10.2 vs 3.3%), LOS (mean, 9.2 vs 5.8 days), adjusted charges (median, 64158 vs 41910 USD) were significantly higher in AKI than non-AKI. Univariate (OR 3.38, 95CI 3.32-3.45) and multivariate (OR 2.53, 95CI 2.48-2.58) analysis revealed significantly higher odds of mortality in AKI than in non-AKI in PDHPC (ptrend<0.001).CONCLUSIONS: Nearly one-fourth PDHPC present with concurrent AKI and worsening renal function.CLINICAL IMPLICATIONS: Increased risk of AKI in PDHPC, with poor outcomes, warrants extra vigilant care for patients having concomitant risk factors for AKI.DISCLOSURES: No relevant relationships by Thomas Alukalno disclosure on file for Shilp Arora;no disclosure on file for Behnam Bozorgnia;No relevant relationships by Rupak DesaiNo relevant relationships by Sohiel DeshpandeNo relevant relationships by Akhil JainNo relevant relationships by VIRALKUMAR PATEL SESSION TITLE: PAH with Complications SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Cardiorenal syndrome is an established risk factor for acute kidney injury (AKI). No contemporary data is available for assessing pulmonary hypertension as an independent risk factor for AKI. We aimed to identify the burden, trends, and outcomes of AKI in pulmonary hypertension hospitalized patients. METHOD: Using National Inpatient Sample (2016-2019, ICD10 codes), we identified hospitalizations with pulmonary heart disease and diseases of pulmonary circulation (PHDPC, 18-90 years) and divided them into AKI and non-AKI. Odds and yearly trend of AKI in PHDPC, demographics, comorbidities, and outcomes for hospitalization between 2 cohorts were analyzed. RESULTS: PHDPC (6,000,000) hospitalizations had 28.3% AKI. Odds of AKI for PDHPC were significantly higher on univariate (OR 2.46, 95CI 2.44-2.48) and multivariate (OR 1.15, 95CI 1.14-1.16) analysis. AKI increased from 23% in 2016 to 27.2% in 2019 in PDHPC (ptrend<0.001). AKI patients were significantly older (mean, 71.3 vs 68.1 years), had higher proportion of males (47.7 vs 42.5%), blacks (20.8 vs 18.4%), Medicare-enrollees (75.1 vs 69.6%), large, urban-teaching, Midwest and West region hospitalizations, non-electively admissions than non-AKI. AKI cohort had significantly higher hyperlipidemia, obesity, prior CABG/MI/PCI, CHF, arrhythmia, valvular disease, PVD, complicated hypertension, neurological disorders, complicated diabetes, hypothyroidism, renal failure, liver disease, peptic ulcer disease, lymphoma, coagulopathy, weight loss, fluid/electrolyte disorders, blood loss anemia, deficiency anemia, and alcohol abuse. All-cause mortality (10.2 vs 3.3%), LOS (mean, 9.2 vs 5.8 days), adjusted charges (median, 64158 vs 41910 USD) were significantly higher in AKI than non-AKI. Univariate (OR 3.38, 95CI 3.32-3.45) and multivariate (OR 2.53, 95CI 2.48-2.58) analysis revealed significantly higher odds of mortality in AKI than in non-AKI in PDHPC (ptrend<0.001). CONCLUSIONS: Nearly one-fourth PDHPC present with concurrent AKI and worsening renal function. CLINICAL IMPLICATIONS: Increased risk of AKI in PDHPC, with poor outcomes, warrants extra vigilant care for patients having concomitant risk factors for AKI. DISCLOSURES: No relevant relationships by Thomas Alukal no disclosure on file for Shilp Arora; no disclosure on file for Behnam Bozorgnia; No relevant relationships by Rupak Desai No relevant relationships by Sohiel Deshpande No relevant relationships by Akhil Jain No relevant relationships by VIRALKUMAR PATEL

REMDESIVIR PLUS DEXAMETHASONE VS TOCILIZUMAB OR BARICITINIB SUPPLEMENTATION INITIATED INSIDE 48 HOURS OF INDEX COVID-19 HOSPITALIZATION IN ICU PATIENTS

REMDESIVIR PLUS DEXAMETHASONE VS TOCILIZUMAB OR BARICITINIB SUPPLEMENTATION INITIATED INSIDE 48 HOURS OF INDEX COVID-19 HOSPITALIZATION IN ICU PATIENTS

PREVALENCE AND PREDICTORS OF MAJOR ADVERSE CARDIAC AND CEREBROVASCULAR EVENTS IN GERIATRIC HOSPITALIZATIONS WITH OSA: A NATIONAL INPATIENT SAMPLE ANALYSIS

PREVALENCE AND PREDICTORS OF MAJOR ADVERSE CARDIAC AND CEREBROVASCULAR EVENTS IN GERIATRIC HOSPITALIZATIONS WITH OSA: A NATIONAL INPATIENT SAMPLE ANALYSIS

Direct-acting antiviral retreatment patterns for hepatitis C.

BACKGROUND: Despite the strong efficacy of direct-acting antivirals (DAAs) against the hepatitis C virus, many patients require a second regimen of DAA treatment. However, limited research exists to characterize rates of retreatment across different DAA agents or potential factors that may increase retreatment risk. OBJECTIVE: To characterize patterns and predictors of DAA retreatment among a large, generalizable, commercially insured US population of patients. METHODS: Using the IBM MarketScan Commercial Claims and Encounters data source, this retrospective cohort study examined retreatment patterns among patients receiving DAAs between 2013 and 2019. Descriptive statistics were used to compare patient characteristics predictive of retreatment risk and to examine rates of retreatment in patients initiating different DAA treatments. RESULTS: Among 31,553 DAA users, a total of 1,017 (3.2%) required DAA retreatment. Among the 1,017 patients re-treated, 44 (4.3%) received a third treatment regimen and 2 patients received a fourth treatment regimen. The average total cost for a retreatment regimen was $109,683, with patient out-of-pocket costs totaling $1,287 Patients requiring retreatment had higher rates of hypertension (32.0% vs 26.7%; P < 0.001), diabetes (16.9% vs 11.9%; P < 0.001), coagulopathy (9.9% vs 4.5%; P < 0.001), deficiency anemia (11.1% vs 7.4%; P < 0.001), alcohol abuse (3.3% vs 2.3%; P = 0.038), prior liver transplantation (3.4% vs 2.3%; P = 0.024), and hepatocellular carcinoma (6.1% vs 1.9%; P < 0.001) compared with patients not requiring retreatment. CONCLUSIONS: Although uncommon, some patients receiving DAAs require a second regimen of DAA treatment at substantial cost to both health plans and patients. These patients tend to have more comorbidities and markers of hepatic disease severity. Patients with high retreatment risk may benefit from careful monitoring for occurrences of retreatment.

Diagnosis, Treatment and Prevention of Nutritional Anemia in Children: Recommendations of the Joint Committee of Pediatric Hematology-Oncology Chapter and Pediatric and Adolescent Nutrition Society of the Indian Academy of Pediatrics

Anemia in children is a significant public health problem in our country. Comprehensive National Nutrition Survey 2016-18 provides evidence that more than 50% of childhood anemia is due to an underlying nutritional deficiency. The National Family Health Survey-5 has reported an increase in the prevalence of anemia in the under-five age group from 59% to 67.1% over the last 5 years. Clearly, the existing public health programs to decrease the prevalence of anemia have not shown the desired results. Hence, there is a need to develop nationally acceptable guidelines for the diagnosis, treatment and prevention of nutritional anemia. To review the available literature and collate evidence-based observations to formulate guidelines for diagnosis, treatment and prevention of nutritional anemia in children. These guidelines have been developed by the experts from the Pediatric Hematology-Oncology Chapter and the Pediatric and Adolescent Nutrition (PAN) Society of the Indian Academy of Pediatrics (IAP). Key areas were identified as: epidemiology, nomenclature and definitions, etiology and diagnosis of iron deficiency anemia (IDA), treatment of IDA, etiology and diagnosis of vitamin B12 and/or folic acid deficiency, treatment of vitamin B12 and/or folic acid deficiency anemia and prevention of nutritional anemia. Each of these key areas were reviewed by at least 2 to 3 experts. Four virtual meetings were held in November, 2021 and all the key issues were deliberated upon. Based on review and inputs received during meetings, draft recommendations were prepared. After this, a writing group was constituted which prepared the draft guidelines. The draft was circulated and approved by all the expert group members. We recommend use of World Health Organization (WHO) cut-off hemoglobin levels to define anemia in children and adolescents. Most cases suspected to have IDA can be started on treatment based on a compatible history, physical examination and hemogram report. Serum ferritin assay is recommended for the confirmation of the diagnosis of IDA. Most cases of IDA can be managed with oral iron therapy using 2-3 mg/kg elemental iron daily. The presence of macro-ovalocytes and hypersegmented neutrophils, along with an elevated mean corpuscular volume (MCV), should raise the suspicion of underlying vitamin B12 (cobalamin) or folic acid deficiency. Estimation of serum vitamin B12 and folate level are advisable in children with macrocytic anemia prior to starting treatment. When serum vitamin B12 and folate levels are unavailable, patients should be treated using both drugs. Vitamin B12 should preferably be started 10-14 days ahead of oral folic acid to avoid precipitating neurological symptoms. Children with macrocytic anemia in whom a quick response to treatment is required, such as those with pancytopenia, severe anemia, developmental delay and infantile tremor syndrome, should be managed using parenteral vitamin B12. Children with vitamin B12 deficiency having mild or moderate anemia may be managed using oral vitamin B12 preparations. After completing therapy for nutritional anemia, all infants and children should be advised to continue prophylactic iron-folic acid (IFA) supplementation as prescribed under Anemia Mukt Bharat guidelines. For prevention of anemia, in addition to age-appropriate IFA prophylaxis, routine screening of infants for anemia at 9 months during immunization visit is recommended.

Nutrition Counseling for Pregnant Women and Making Healthy Drinks from BIT (Beta Vulgaris L.) to Prevent and Overcome Iron Nutrient Anemia

Anemia is often caused by a lack of iron in food; parasites in the body consume substances that inhibit the absorption of iron before, during, and after eating, such as the tannins found in tea. The goal of this study is to improve mothers' understanding of pregnant women about iron nutritional anemia and understanding of making healthy drinks from beetroot (Beta vulgaris L.) and nutritional sources that contain lots of iron and factors that inhibit and facilitate the absorption of iron in the body. The method used involved pretest treatment and posttest. Results and discussion focused on increasing the knowledge of pregnant women about iron nutritional anemia and how to prevent and overcome the occurrence of iron nutritional anemia through the consumption of various sources of iron nutrition. There has been a change in understanding of the pharmacist's role as a caregiver; this can be seen in question no 1. There has been a change in understanding of how to get medicine at a pharmacy (Dagusibu); this can be seen in question no 2. There has been a change in understanding of getting drug information; this can be seen from the correct answer to question no. 3.

Systematic review and meta-analysis of intravenous iron-carbohydrate complexes in HFrEF patients with iron deficiency.

Iron deficiency (ID) is a common co-morbidity in patients with heart failure (HF). The present meta-analysis evaluates the effect of intravenous (IV) iron-carbohydrate complex supplementation in patients with HF with reduced ejection fraction (HFrEF) and ID/iron deficiency anaemia (IDA). Randomized controlled trials (RCTs) comparing IV iron-carbohydrate complexes with placebo/standard of care in patients with HFrEF with ID/IDA were identified using Embase (from 1957) and PubMed (from 1989) databases through 25 May 2021. Twelve RCTs including 2381 patients were included in this analysis. The majority (90.8%) of patients receiving IV iron-carbohydrate therapy were administered ferric carboxymaltose (FCM); 7.5% received iron sucrose and 1.6% received iron isomaltoside. IV iron-carbohydrate therapy significantly reduced hospitalization for worsening HF [0.53 (0.42-0.65); P<0.0001] and first hospitalization for worsening HF or death [0.75 (0.59-0.95); P=0.016], but did not significantly impact all-cause mortality, compared with control. IV iron-carbohydrate therapy significantly improved functional and exercise capacity compared with the control. There was no significant difference in outcome between IV iron-carbohydrate formulations when similar endpoints were measured. No significant difference in adverse events (AE) was observed between the treatment groups. IV iron-carbohydrate therapy resulted in improvements in a range of clinical outcomes and increased functional and exercise capacity, whereas AEs were not significantly different between IV iron-carbohydrate and placebo/standard of care arms. These findings align with the European Society of Cardiology's 2021 HF guidelines, which recommend the consideration of FCM in symptomatic patients with a left ventricular ejection fraction < 45% and ID.

Clinical Pattern and Malnutrition among Children with Congenital Heart Disease at Tertiary Care Hospital

Background and Aim: Congenital heart disease is defined as the heart or intra-thoracic great vessel structural abnormalities present since birth with significantly functional irrespective of their detection age. It is the most prominent congenital anomaly and cause of morbidity and mortality among the pediatric age group population. The present study aimed to investigate the clinical pattern and malnutrition among children with congenital heart disease. Methodology: This descriptive cross-sectional study was carried out on 132 congenital heart disease patients in the Department of Pediatric, Imran Idrees Teaching Hospital Sialkot from January 2021 to December 2021. Children with clinical basis of cyanosis, feeding refusal, decreased activity, cough, hurried breathing, fever, and excessive sweating were enrolled. Acquired heart diseases and post-operative cardiac cases were excluded. Eligible children were assessed for sociodemographic details, physical examination, nutritional status, history, and types of congenital heart diseases. SPSS version 25 was used for data analysis. Results: Of the total 132 CHD children, there were 92 (69.7%) male and 40 (30.3%) females. The prevalence of acyanotic heart diseases, cyanotic heart diseases, complex CHD, and valvular diseases were 98 (74.2%), 22 (16.7%), 10 (7.6%), and 2 (1.5%) respectively. Age-wise distribution of all the children were as follows: 38 (28.8%) &lt; 1 month, 62 (47%) 1 month-1 year, 20 (15.2%) 1-5 years, and 12 (9.1%) 5-10 years. Based on presented symptoms, the incidence of breathlessness, fever, cough, and other symptoms were 68 (51.5%), 58 (43.9%), 54 (40.9%), and 49 (37.1%) respectively. The incidence of protein-energy malnutrition and normal cases were 72 (54.5%) and 60 (45.5%) respectively. Anemia was the most prevalent risk factor CHD in 52 (39.4%) cases followed by pneumonia 41 (31.1%). Conclusion: The present study concluded that acyanotic heart diseases were the most commonly found in children followed by cyanotic, complex, and valvular diseases. Infancy and childhood age are more susceptible to congenital heart diseases. Breathlessness and fever were the most common symptoms. Nutritional anemia followed by pneumonia and failure to thrive were the major risk factors for congenital heart diseases among children. Keywords: Congenital heart diseases, Clinical pattern, Malnutrition

Effect of Mobile Phone Call Reminders With Standard Therapy Versus Standard Therapy Alone on Compliance With Iron Supplementation in Antenatal Women With Iron Deficiency Anemia: A Randomized Controlled Trial.

IntroductionIn spite of the implementation of the National nutritional anemia prophylaxis program in India, the prevalence of anemia during pregnancy is 50 in 100 women. One main cause for the high frequency of anemia among antenatal women in India is a lack of iron consumption. Few studies are available in the literature where efforts have been made to improve compliance with iron therapy. In the same line of thinking, it was decided in the present study to use mobile phone calls as a reminder for iron tablets.MethodThe present study is a randomized controlled open-label trial. Antenatal women with gestational age between 13-28 weeks of pregnancy diagnosed with iron deficiency anemia (Hb - 8 to 11 gm/dl) having mobile phones were included in the study. Recruited women were randomized into two groups of study groups receiving standard therapy with the addition of fortnightly mobile phone call reminders and a control group receiving standard therapy alone.ResultsCompliance with iron supplementation was observed higher in the study group as compared to the control group (range of 48% to 93%). There was a mean hemoglobin rise in both the groups at the time of delivery compared with the hemoglobin at the time of recruitment (Study group- 9.74 to 10.69, Control group- 9.48 to 10.06). There was a statistically higher (0.00001) increase in the mean hemoglobin concentration in the study group (0.96 gm/dl) as compared to the control group (0.59 gm/dl). The reasons for poor compliance were boredom with taking daily oral iron therapy (66.66%), constipation (3.7%), forgetfulness (14.81%), and heartburn (14.81%). There was no statistical difference in the reason for poor compliance with iron supplementation in both groups.ConclusionThe present study concludes that mobile phone call reminders along with standard therapy with iron supplementation improve compliance with iron supplementation and lead to a greater rise in hemoglobin in antenatal women with iron deficiency anemia.

Effects of nutrition counselling on iron deficiency anemia in pregnancy

Anemia is a significant public health concern in pregnant women and women of reproductive age globally. The prevalence of anemia in Thailand was approximately 36.7%. Common causes of anemia were iron deficiency anemia (IDA) and beta-thalassemia trait (BTT). World Health Organization (WHO) recommends that dietary adjustments focusing on iron-rich foods foster the improvement of IDA and IDA with BTT. This study aimed to evaluate the effect of nutrition counselling in pregnant women with IDA on anemia parameters and dietary intake records. Retrospective data were obtained from the Division of Nutrition and Antenatal Care (ANC) Clinic at Bamrasnaradura Infectious Diseases Institute (BIDI) in Nonthaburi, Thailand. Nutrition Care Process Model was used in nutrition service at BIDI. During the second trimester, nutrition counselling was provided at the ANC Clinic by a dietitian routinely based on WHO guidelines for nutritional anemia. The anemia parameters and dietary intake records were recorded during ANC visits at the second and third trimesters. A paired t-test was used to evaluate differences within each group. Collected data from 61 pregnant women with anemia were analyzed (IDA: 55; BTT: 6). In the third trimester, the changes in hematocrit levels were significantly high in both IDA (p ≤ 0.001) and BTT groups (p = 0.016). In addition, the improvement in daily energy consumption and iron-rich foods was significantly observed in both groups (p ≤ 0.001). In conclusion, the delivery of nutrition counselling focusing on iron-rich foods significantly enhanced IDA parameters and eating behaviours, including increased hematocrit levels, and improved daily energy intake and iron-rich foods intake among pregnant women with anemia.