Hemoglobin Status Research Articles

323. CLINICAL CHARACTERISTICS OF HIATAL HERNIA WITH ANEMIA AND SIGNIFICANCE OF SURGICAL REPAIR

Abstract Most patients with hiatal hernia (HH) are asymptomatic. However, HH may provoke severe gastroesophageal reflex, anorexia, and anemia. Therefore, therapeutic indication and approach are controversial especially for elderly and frail patients. So, we investigated clinical features of HH with anemia and treatment outcome of surgical repair. From Jan. 2010 to Sep. 2021, 97 patients diagnosed HH by upper gastrointestinal scope and/or computed tomography and were taken blood test at the same time. Patients with malignant disease and after gastrectomy were excluded in this research. We examined the correlation between anemia and clinical characteristics (symptoms, physical and morphological factors) retrospectively. Similarly, hemoglobin(HGB) status after surgical repair were investigated. HGB of 21 cases (21.6%) represented less than 10 g/dl at the time of diagnosis. Elderly (p = 0.0007), disorders of the spine (kyphosis and scoliosis) (p = 0.006), typeIV hiatal hernia (p = 0.02), GERD (Grade ≥ A) (p = 0.07) were correlated with anemic cases of HH, which were consistent with clinical characteristic of giant hiatal hernia (GHH). In GHH (47 cases) with more than 30% stomach bulges into mediastinum, HGB of 17 cases (36%) represented less than 8 g/dl, and 9 cases (19%) were required blood transfusion. Six cases (13%) of GHH underwent surgical repair, and no exacerbation of anemia was observed after surgery. Elderly, kyphosis/scoliosis, and GHH were represented as the features of HH with anemia. Severe anemia is common symptom in GHH cases, and surgical repair might improve anemia in operable cases.

Injectable Iron and Blood Transfusion for Correction of Anemia in Pregnancy in a Peripheral Tertiary Hospital in Bangladesh: A Quasi-Experimental Study

Background: Anemia in pregnancy is one of the most commonly encountered medical disorders.Objective: To compare the effects of injectable iron and blood transfusion for correction of anemia in pregnancy.Methods: This quasi-experimental study was conducted in the Obstetrics & Gynaecology outpatient department (OPD) of Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh, between April and December of 2020on 100 expecting mothers through interviews, investigation of hemoglobin (Hb) level at 16 weeks, 24-28 weeks and 36 weeks. The injectable iron and blood transfusion were the experiments given to the pregnant women around 24-28 weeks.The effect of the experiment along with other factors were assessed over the change of Hb level from 24-28 weeks to 36 weeks.Results: Only iron injection singly significantly improved Hb level (1.4 mg/ dl, p<0.001) though it improved a little in combination with blood transfusion (0.472 mg/ dl, p=0.15) too, but blood alone was associated with decreased Hb level (-0.414 mg/dl, p=0.07). Other factors were not related to the change.Conclusion: Iron injection improves hemoglobin status and should be given to all anemic women irrespective of presence or absence or other risk factors.International Journal of Human and Health Sciences Vol. 06 No. 04 Oct’22 Page: 372-376

Cohort profile: maternal antecedents of adiposity and studying the transgenerational role of hyperglycaemia and insulin (MAASTHI)

PurposeThe Maternal Antecedents of Adiposity and Studying the transgenerational role of Hyperglycaemia and Insulin cohort in Bengaluru, South India, aims to understand the transgenerational role of increased circulating glucose levels...

Evaluation of a Text Messaging Intervention to Promote Preconception Micronutrient Supplement Use: Feasibility Study Nested in the Healthy Life Trajectories Initiative Study in South Africa.

BackgroundSocial messaging strategies such as SMS text messaging and radio are promising avenues for health promotion and behavior change in low- to middle-income settings. However, evidence of their acceptability, feasibility, and impact in the context of young women’s health and micronutrient deficiencies is lacking.ObjectiveThis study aimed to evaluate the feasibility of an automated 2-way text messaging intervention nested in an ongoing preconception health trial, the Healthy Life Trajectories Initiative (HeLTI; HeLTI Bukhali) in Soweto, South Africa. Second, we aimed to evaluate the acceptability of a health promotion radio serial, which aired concurrently in the region.MethodsIn this feasibility study, 120 participants enrolled in HeLTI Bukhali between November 2020 and February 2021 received the 6-month 2-way text messaging intervention. Quantitative and qualitative data on intervention acceptability, usability, interaction, perceived benefit, and fidelity were collected during 5 focus group discussions (FGDs) and from study data logs. During the FGDs, data were collected on the acceptability of the radio serial. Following the text messaging intervention, capillary hemoglobin levels were assessed, and a participant questionnaire provided information on adherence and attitudes toward supplements. The text messaging control group comprised the first 120 women recruited from November 2019 to February 2020, who received the Bukhali intervention but not the text messages. Statistical significance testing and a linear mixed model were used for indicative effect comparisons between the text message–receiving and control groups.ResultsThe text messaging intervention was found to be acceptable and to have perceived benefits, including being reminded to take supplements, gaining knowledge, and feeling supported by the study team. The use of the 2-way text messaging reply function was limited, with only a 10.8% (13/120) response rate by week 24. Barriers to replying included a lack of interest or phone credit and technical issues. Regarding the indicative effect, participants receiving the text messages had higher self-reported adherence at follow-up than the text messaging control group (42/63, 67% vs 33/85, 39% taking supplements every time; P=.02), and altitude-adjusted hemoglobin increased more between baseline and follow-up in the SMS text message–receiving group than in the text messaging control group (1.03, 95% CI 0.49-1.57; P<.001). The radio serial content was acceptable, although few participants reported exposure before the FGD.ConclusionsWomen reported that the text messaging intervention was useful and described the benefits of receiving the messages. Examination of hemoglobin status indicated a promising beneficial effect of text messaging support on adherence to micronutrient supplementation, requiring further exploration through randomized controlled studies. Health promotion through radio and text messages were both found to be acceptable, although more research into the radio serial reach among young women is needed.Trial RegistrationPan African Clinical Trials Registry (PACTR) PACTR201903750173871; https://tinyurl.com/4x6n32ff

Low-Level Environmental Mercury Exposure and Thyroid Cancer Risk Among Residents Living Near National Industrial Complexes in South Korea: A Population-Based Cohort Study.

Background: Previous studies suggested that mercury may be linked to thyroid cancer due to its bioaccumulation in the thyroid gland, but no studies have evaluated the association between mercury exposure and thyroid cancer risk. We examined the relationship between mercury exposure and thyroid cancer risk, with the potential modification of hematological parameters. Methods: We performed a secondary analysis of a prospective cohort study among residents living near industrial complexes in South Korea (recruited from 2003 to 2011). Incident thyroid cancer cases (C73, ICD-10 code) were identified from the National Cancer Registry and Statistics Korea. Urinary mercury concentrations were measured using thermal decomposition amalgamation atomic absorption spectrometry (TDA-AAS). Cox proportional hazards regression models (adjusted for age, sex, educational level, smoking status, and employment) were used to estimate the hazard ratio (HR) and confidence interval [CI] between mercury exposure and the incidence of thyroid cancer. Results: We documented 69 cases of thyroid cancer in a total of 5213 participants during follow-up (median 8.7 years). The geometric mean of urinary mercury concentration was 1.8 μg/L for thyroid cancer cases and 1.2 μg/L for noncases (p for difference = 0.001). After adjusting for potential confounders, those in the highest tertile of urinary mercury levels had a twofold higher risk of thyroid cancer (HR = 1.97 [CI 1.03 - 3.80] in the highest tertile vs. the lowest tertile, p for trend = 0.043). This association was stronger for those with lower mean corpuscular volume and mean corpuscular hemoglobin status. Conclusions: Urinary mercury concentration was positively associated with the risk of thyroid cancer among residents living near national industrial complexes, and this association was influenced by red blood cell indices status. These results provide some evidence suggesting the adverse effects of environmental metal pollution in the development of thyroid cancer.

Study of correlation of neonatal low birth weight and maternal anemia in first, second and third trimester of pregnancy

In Indian antenatal scenario , anemia in pregnant women is one of the commonest pathology routinely encountered. the most common cause of anemia during pregnancy is Iron deficiency anemia. Objective: To identify and analyze the real impact of Anemia during pregnancy individual all three trimesters of pregnancy in Indian pregnant women and its real effect on fetal weight. Materials and Methods: Retrospective evaluation of about 400 pregnant women who came for delivery during the study period February 2022 to May 2022 in Dhiraj hospital, Pipariya was done. The status and level of hemoglobin of these pregnant women during all three trimesters of pregnancy was done by proper detailed record of laboratory investigations and record of neonatal birth weight was done. Results: Among 400 Pregnant patients who had been delivered at Dheeraj Hospital , more than 72 % mothers were anemic in any of the three trimester of pregnancy. The rate of low birth weight baby was higher in these anemic mother than nonanemic mother in any of the three trimester. Conclusions: Considering the relationship between maternal anemia and LBW in the third trimester of pregnancy, anemia in third trimester can be used as a preventable factor for infant LBW.

Prevalence and risk factors of malaria and anaemia and the impact of preventive methods among pregnant women: A case study at the Akatsi South District in Ghana.

AimThis study aimed to ascertain the prevalence and risk factors of malaria and anaemia as well as the impact of preventive methods among pregnant women at the Akatsi South District Hospital of Ghana.Subjects and methodsA hospital based cross-sectional study using simple random sampling technique was conducted among 200 pregnant women receiving antenatal care and laboratory services at the Akatsi District Hospital from May 2016 to July 2016. A semi-structured questionnaire was administered to obtain participants’ malaria preventive methods in addition to demographic and gestational details. Participants’ hemoglobin and malaria status were assessed using one milliliter (1 ml) whole blood collected from each participant following standard procedures. Factors that produced a p-value of ≤0.2 from the univariate model were included in the final model. Association between potential covariates and the outcomes was assessed using multivariate logistic regression. The Clopper-Pearson test statistic was used to determine the 95% confidence intervals of the outcome variables of interest. We also estimated the population attributable fraction (PAF) of anaemia due to malaria by substituting the adjusted relative risk estimates (RRi) (using the adjrr command in STATA) of anaemia due to malaria into the category-specific attributable formula. P-values of <0.05 were considered statistically significant.ResultsPrevalence of anaemia in pregnancy (AiP), malaria in pregnancy (MiP) and AiP/MiP comorbidity was 63.5% (95% CI:56.4–70.2), 11.0% (96% CI:7.0–16.2) and 10.5% (95% CI:6.6–15.6) respectively. Prevalence rates of AiP (66.7%) and MiP (18.5%) predominated among pregnant women aged < 20 years. PAF of AiP due to MiP was 34.5% (95% CI:23.8–43.6). High use of IPTp-SP, 64.0% (95% CI:56.9–70.6) and LLIN, 90.0% (95% CI:85.0–93.8) was observed in this study. Only 42.0% (95% CI:35.1–49.2) used repellent. Not being on the IPTp-SP program posed a 11.70 times risk of MiP (95% CI:2.32–58.96; p = 0.003) compared to pregnant women on the IPTp-SP program. Similarly, not sleeping under LLIN posed an 8.07 times risk of MiP (95% CI:1.98–32.2; p = 0.004) compared to pregnant women who slept under LLIN. Meanwhile, being positive for MiP posed a 12.10 times risk (95% CI:1.35–85.06; p = 0.025) of AiP compared to those negative for malaria whereas failure to attend ANC as scheduled posed 6.34 times risk (95% CI:1.81–22.19; p = 0.004) of AiP among the pregnant women studied.ConclusionThe prevalence of MiP and AiP among pregnant women in the Akatsi South District remains a great concern. High utilization of IPTp-SP and LLIN was observed with a resultant positive effect on malaria prevalence among pregnant women. Improved access to IPTp-SP and LLIN is hence encouraged to help further diminish the risk of malaria infection amongst pregnant women in the District.

Anthropometrics, Hemoglobin Status and Dietary Micronutrient Intake among Tanzanian and Mozambican Pigeon Pea Farmers.

Inadequate consumption of micronutrient-dense and protein-rich foods such as vegetables, legumes and meat is an important contributing cause for anemia and deficiencies of vitamin A and iron in rural communities of Tanzania and Mozambique. A cross-sectional study was conducted to assess the nutritional status (anthropometrics and hemoglobin) and diets in particular micronutrient intake of female and male pigeon pea farmers from Lindi, Tanzania, and Gurué, the Zambézia province of Mozambique. A total of 1526 farmers (669 from Tanzania, 857 from Mozambique) were studied, of whom 16% were overweight and 35% were anemic. The highest prevalence of overweight and anemia, at 35% and 48%, was observed in Tanzanian and Mozambican women, respectively. Overall, only a small proportion of women and men reached the recommended daily dietary intake of vitamin A (10%), iron (51%) and zinc (44%). Multiple regression models revealed that dark green leafy vegetables (DGLVs) highly predicted vitamin A intake, whereas legumes in Tanzania and starchy plants in Mozambique were actually the dominant sources of vitamin A. Cereals covered over half of the iron and the zinc intake in both countries. An increased consumption of micronutrient-rich DGLVs and legumes, while reducing the high amounts of refined maize or polished rice, is suggested to counteract the high prevalence of anemia and overweight among smallholder farmers in East and South Eastern Africa.

Nutritional Education to the Nutritional Maternal Knowledge and Iron Intake among Toddlers with Anemia

BACKGROUND: In general, maternal knowledge about nutrition and health affects food habits, influencing the child’s nutritional or iron intake. One effort to improve children’s iron status is by providing maternal nutrition education. AIM: The purpose of this study was to analyze the effect of a nutrition education intervention on maternal knowledge and toddlers’ iron intake to prevent anemia among children under five. Paired t-test was used to analyze differences in knowledge, nutrient intake, consumption of iron sources, and hemoglobin (Hb) status of children before and after nutrition education interventions. METHODS: This study was a Quasi Experiment with a one-group pre-posttest design. The subjects of this study were 40 toddlers consisting of two groups, namely, 20 toddlers in the intervention group and 20 toddlers in the control group. Mother’s knowledge about anemia, while nutrient intake, food sources containing iron were analyzed using Paired T-test. RESULTS: The results of this study indicated a significant effect of a nutrition education intervention on improvement of maternal knowledge (p = 0.000), energy intake (p = 0.001), carbohydrates (p = 0.038), fat (0.047), iron (0.031), and consumption of iron food sources including chicken (p = 0.000) and fish (p = 0.005). However, no significant effect was identified on the Hb level of toddlers (p = 0.66). CONCLUSION: Nutrition education intervention significantly affected the mother’s knowledge and toddlers’ iron intake but did not affect the Hb levels of toddlers.

Comparative evaluation of serum high-density lipoprotein and low-density lipoprotein levels and glycated hemoglobin levels and periodontal status in type 2 diabetic patients: A pilot project.

High levels of cholesterol in the body can be alarming and point toward a possible cardiac or diabetic problem. Current evidence reveals that the harmful low-density lipoproteins (LDL) cholesterol tend to increase in poorly controlled diabetes, whereas the useful high-density lipoprotein (HDL) cholesterol, known for its protective anti-inflammatory and antioxidant activities, is decreased. With a positive evidence of periodontal disease being implicated in diabetes, it was decided to investigate whether there was any association between serum HDL, LDL, glycated hemoglobin (HbA1c) and periodontal status with Type II diabetes mellitus patients. A total of 500 nonsmoking patients (males and females) aged between 35 and 55 years with Type 2 diabetes mellitus and no other systemic disease were selected from the diabetic center, Diacon hospital, Bengaluru, Karnataka, India. Periodontal examination consisted of the clinical parameters, namely, attachment loss, gingival index (GI) and plaque index based on which the patients were divided into periodontally healthy and diseased groups. Blood samples were collected from each patient to evaluate the serum levels of HDL, LDL and HbA1c. No significant differences were observed between the HDL, LDL and HbA1c levels in both the periodontal groups (P > 0.05). Linear regression analysis showed significant positive correlations of clinical attachment level with LDL and negative correlation with HbA1c, whereas GI has a positive correlation with LDL and negatively with HDL and Hba1c levels (P < 0.05). Varied associations were found between dyslipidemia, glycemic control and periodontal inflammation. Further longitudinal as well as interventional studies may be beneficial to ascertain the causal relationship between cholesterol levels, periodontal status and diabetes mellitus.

STUDY ON COOKING PRACTICES INFLUENCING DIETARY IRON BIOAVAILABILITY IN CAUSING IRON DEFICIENCY ANEMIA IN PREGNANT WOMEN

Background: Common south Indian cooking practices including precooking processes and cooking method has a variable effect on dietary Iron bioavailability (1) by altering the level of promoters and inhibitors of dietary Iron absorption. Limited studies are there to describe the association between common cooking practices inuencing dietary Iron bioavailability and Iron deciency anemia(IDA). To study the association between cookingObjective: practices inuencing dietary Iron bioavailability and IDA in antenatal women. Cross sectional study was conducted onDesign: 150 Primi pregnant women who were recruited consecutively based on the haemoglobin status. Interviewer administered pretested questionnaire was used to collect data about their pre-cooking and cooking practices. Comparison was made between the anemic (Hb&lt;10gm/dl), latent anemic (Hb10-10.9gm/dl) and non-anemic (&gt;11gm/dl) pregnant women and their cooking practices. Using Fischer exact and Chi-square test method, association between cooking practices andResults: anemia was made out. Precooking method was found to be signicant with the p value of 0.000. DietaryConclusions: modication by adapting appropriate Cooking practices is essential to improve the dietary Iron bioavailability. Enhancing dietary iron bioavailability through optimum cooking practices would be an alternative approach to prevent IDA (2).

Comparison Study of Bacterial Profile, Wound Healing, and Cost Effectiveness in Pressure Injury Patients Using Treatment Honey Dressing and Hydrogel

Background : Pressure injury is a localized soft tissue injury caused by prolonged pressure over bony prominence. Most published papers used Manuka honey as dressing, while this product is expensive. As this reason, this study will use local product honey called Nusantara honey, to prove the use of local honey has better healing process, bacterial profile, and cost effectiveness, compared to the standard dressing, hydrogel.Method : This is a one-month experimental study conducted in patients with pressure injury that referred to our division. Parameter of the bacterial profile was taken from deep-tissue specimen. The healing process was examined with Pressure Ulcer Scale for Healing (PUSH) Tool. Cost was accumulated after all the treatment. Data was analysed with t-Test or Mann Whitney (if the distribution is not normal), with statistical significance was define as p&lt;0.05..Result : Of 26 wounds, 12 were randomized to hydrogel and 14 to honey dressing. Characteristics were determined by sex, age, body mass index, level of consciousness, mobilization status, immobilization etiology, comorbidities, grade and location of ulcer, hemoglobin, leukocytes, and albumin level. There was clinically significant wound size reduction in honey dressing according to PUSH Tool (p=0.118). The bacterial profile and reduction were similar. Honey dressing appeared to be more cost effective in terms of dressing cost (p&lt;0.001) and lower total cost.Conclusion: The local honey dressing has better wound healing outcome, although it is not statistically significant. Its capability of decreasing pathogens is similar with hydrogel, with lower cost, particularly the dressing cost. This local honey dressing could be a good choice as wound dressing in areas where the modern dressings are not available.

The Relationship between Intakes of Iron, Folic Acid, Vitamin C, Age at Menarche, Hemoglobin Status and Physical Activity with Menstrual Cycles in Female Students at Smait Al-Ichwan Cikarang Utara-Indonesia

Background: Adolescence is the period of transition from children becoming adults that is marked by the occurrence of puberty, namely menstruation. At that time there was a change in the reproductive system that allows the occurrence of disturbances, one of which is menstrual cycle disorders. Aim: Based on data from RISKESDAS (basic health survei) (2013), it shows that the percentage of menstrual cycle irregularities at the age of 10-29 years is 16.4% (RISKESDAS (basic health survei). Irregular menstrual cycles in adolescent girls aged 15-19 years are 11.7% and as many as 14.9% women who live in urban areas in Indonesia. Methods: Samples were taken by using purposive sampling technique; it is obtained a sample of 35 students from grade 11 and 12 aged 16-18 years at SMAIT-Al-Ichwan Cikarang Utara. Data on the age at menarche and menstrual cycle with the method of interview used a questionnaire, food intake was obtained from 2x24 hours food recall form that is not in a row and hemoglobin status used Easy Touch Blood Hb tool conducted by nurses. Physical activity data was obtained by filling out a form and the results were calculated by using the PAR/PAL method. Statistical analysis used a chi-square test and used a fisher exact test value. Results: The results of the reserach showed that there is no significant relationship between the intake of iron, folic acid, vitamin C and physical activity on menstrual cycle (p &gt; 0.05). Conclusion: This conclusion constitues there is a significant relationship between hemoglobin status on menstrual cycle (p = 0.005).

Clinical Predictors of a Positive Ct Angiogram Study Used for the Evaluation of Acute Gastrointestinal Hemorrhage.

Acute gastrointestinal (GI) bleeding is one of the leading causes of emergency department visits and hospital admissions. CT angiography (CTA) has had an expanding role in the evaluation of acute GI bleeding because it is rapidly performed, widely available, reasonably sensitive and provides precise localization when positive. We attempted to identify patient and clinical characteristics that predict CTA results in order to help guide the utilization of this modality in patients with acute GI bleeding. In this retrospective study, we analyzed all CTAs performed for the evaluation of GI bleeding in the Duke University healthcare system between October 2019 and March 2020.We captured patient characteristics including age, sex, vital signs, hemoglobin, platelets, PT/INR, and anticoagulation status. Study indications were grouped by suspected source of bleeding: upper GI bleeding (hematemesis or coffee-ground emesis) vs small bowel bleeding (melena or "dark stools") vs lower GI bleeding (hematochezia or bright red blood per rectum (BRBPR)). Chi-square, Wilcoxon, t test, and multivariate logistic regression were used to describe and assess the relationship between patient characteristics and study outcomes (Table 1). Table 1 Univariate analysis of patient characteristics by CT angiography outcome Patient Characteristics by Positive CT for GI Bleed No (N = 274) Yes (N = 43) Total (N = 317) p value Gender 0.451 Female 138 (50.4%) 19 (44.2%) 157 (49.5%) Male 136 (49.6%) 24 (55.8%) 160 (50.5%) Age, median (Q1,Q3) 65 (51,75) 70 (62,80) 66 (52, 76) < 0.012 Heart rate, median (Q1,Q3) 86 (74,100) 89 (72,98) 86(74, 99) 0.782 MAP, mean (SD) 87.32 (15.52) 81.72 (16.53) 86.56 0.033 Shock index,median (Q1,Q3) 0.70(0.58, 0.85) 0.78(0.55, 1.00) 0.71 (0.58, 0.85) 0.352 Hemoglobin 0.332 N 273 43 316 Median (Q1, Q3) 8.50(6.90, 11.00) 7.70 (6.50, 11.30) 8.45 (6.90, 11.00) Baseline hemoglobin 0.202 N 258 39 297 Median (Q1, Q3) 11.20 (9.40, 13.00) 12.00 (9.40, 14.00) 11.20 (9.40, 13.00) Hemoglobin drop from baseline 0.062 N 258 39 297 Median (Q1, Q3) 2.10 (0.60, 3.70) 2.70 (1.20, 4.80) 2.20 (0.70, 3.80) Platelets, median (Q1, Q3) 219.5 (141, 301) 183 (139, 246) 217 (139, 282) 0.102 INR 0.272 N 263 42 305 Median (Q1, Q3) 1.10 (1.00, 1.30) 1.20 (1.00, 1.30) 1.10 (1.00, 1.30) Anticoagulation 0.131 No 155 (56.6%) 19 (44.2%) 174 (54.9%) Yes 119 (43.4%) 24 (55.8%) 143 (45.1%) Upper GI bleeding 0.401 No 251 (91.6%) 41 (95.3%) 292 (92.1%) Yes 23 (8.4%) 2 (4.7%) 25 (7.9%) Small Bowel bleeding 0.761 No 216 (78.8%) 33 (76.7%) 249 (78.5%) Yes 58 (21.2%) 10 (23.3%) 68 (21.5%) Lower GI bleeding 0.091 No 134 (48.9%) 15 (34.9%) 149 (47.0%) Yes 140 (51.1%) 28 (65.1%) 168 (53.0%) 1Chi-Square 2Wilcoxon 3Equal Variance T-Test RESULTS: A total of 317 patients underwent CTA between October 2019 and March 2020. Forty-three patients (13.6%) had a CTA positive for active bleeding. Multivariable logistic regression showed that after controlling for age, mean arterial pressure (MAP) and indication, only a hemoglobin drop from baseline was significantly associated with a positive CTA. For each 1g / dL drop in hemoglobin from the patient's baseline, the odds of a positive CT increased by 1.17 (OR 1.17 95% CI 1.00 - 1.36, p = 0.04). Age (OR 1.02 95% CI 0.99 - 1.04, p = 0.06) and hematochezia / BRBPR (OR 2.09 95% CI 0.94-4.64, p = 0.07) approached statistical significance. In patients who present to the hospital with GI bleeding, CTA can be a helpful triage tool that is most helpful in older patients with suspected lower GI bleeding with a drop in hemoglobin from baseline. Other clinical factors including MAP and the use of anticoagulants were not predictive of a positive CTA.

An observational study examining utilization of prehabilitation and its association with postoperative cardiac rehabilitation participation and risk factors following coronary artery bypass grafting

BackgroundGrowing evidence supports the use of prehabilitation before coronary artery bypass grafting (CABG) to improve surgical outcomes, but its feasibility and impact on risk factor management in real-world clinical settings remain unknown. This observational study examined prehabilitation utilization and its association with postoperative cardiac rehabilitation (CR) participation and cardiovascular risk profile. MethodsAs standard care in a large Canadian city, eligible patients were referred to prehabilitation upon entering the elective CABG waitlist then were re-referred to CR following surgery. Prehabilitation consisted of medically supervised exercise training and multidisciplinary support with health behavior change until the scheduled surgery. An assessment of cardiorespiratory fitness, blood pressure, body habitus, psychological distress, lipids, glycated hemoglobin, and smoking status was completed during a prehabilitation intake visit then was repeated after surgery prior to starting CR. ResultsAmong 97 prehabilitation referrals over a 20-month period, only 49% attended an intake visit. Most patients who enrolled (n = 39) also completed (n = 37) prehabilitation. Completion of prehabilitation was significantly associated with higher CR referral (OR = 6.92, 95% CI 1.50–32.00), enrollment (OR = 14.08, 95% CI 5.09–38.94) and attendance [t(62) = 4.48, p < .001], and with improvements in cardiorespiratory fitness, body mass index, and symptoms of depression and anxiety (p < .004). ConclusionsPrehabilitation may improve CR participation and risk factors among individuals undergoing elective CABG, but more work is needed to disseminate this service to eligible patients.

MO431: Estimation of the Risk of Progression and Renal Substitution Treatment in Patients With Chronic Kidney Disease Using an Artificial Intelligence Model

Abstract BACKGROUND AND AIMS The use of tools that allow to estimate the probability of progression of chronic kidney disease (CKD) to advanced stages, has not yet gained a notable space in our clinical practice. The aim of this study was to develop and validate a model to predict disease progression, and the need for renal replacement therapy, based on machine learning, for patients with CKD grades 3 to 5. This is the first model of its kind to be implemented in Colombia. METHOD This is an observational retrospective closed cohort study. We included patients with CKD from a primary care program and followed them for 5 years. Demographic, clinical and laboratory predictors were included. The outcomes were CKD stage progression, &amp;gt;25% reduction in baseline glomerular filtration rate (eGFR) and the need for renal replacement therapy (RRT), dialysis, or kidney transplantation. We designed two prediction models, one time-independent, based on logistic regression, neural networks and random forest; and a second model, a survival analysis (time to event), by Cox regression, random forest and gradient boosting. Finally, we conducted an internal validation with bootstrapping for the first model, and external validation for the second model in a second real cohort. As a result, we designed a risk calculator. RESULTS Time-independent model included 2619 patients, 62.7% female, 92.6% with hypertension, 23.5% diabetics, with a baseline eGFR 51.06 mL/min/1.73m2 (40–61.9). An estimated performance for predicting RRT risk of F1: 0.61 and Kappa: 0.60 (113 events) was detected; stage progression of F1: 0.4 and Kappa: 0.25; reduction in eGFR F1: 0.29 and Kappa: 0.21. For this first model, the most relevant predictors were: initial eGFR, hemoglobin, sex, central region, total cholesterol and socioeconomic status. The second, a 5-year Time-to-Event prediction model, included data from 1803 patients, had good accuracy with a C-Index assessed performance for RRT risk of 0.96, grade progression of 0.71 and eGFR reduction of 0.69 respectively. The most relevant predictors were initial eGFR, mean heart rate, hemoglobin, hospitalizations, sex, hypertension, diabetes, total cholesterol and central region. The validation cohort, with 658 patients with CKD, 63.9% male, 39% diabetics, with a mean eGFR of 34.9 mL/min/1.73m2, showed good accuracy with a C-Index for RRT risk of 0.935, grade progression of 0.69 and eGFR reduction of 0.0.62 respectively. CONCLUSION Our study demonstrated the utility of novel tools to predict renal outcomes in a CKD population in Colombia. This is the first study conducted with our local population. The resulted risk calculator is intended to be part of the electronic medical history in our hospitals.

The Dietary Pattern and Hemoglobin Status of School-Age Children in Odeda Local Government Area of Ogun State in Nigeria

Iron deficiency is the most common case of micronutrient deficiency in the world and widely known to cause anemia. School-age children are at high risk of micronutrient deficiency due to increased energy expenditure, combined with decreased meal frequency and insufficient maternal attention as well as parasitic infections. This study assessed the dietary pattern and hemoglobin status of school-age children in Odeda Local Government area of Ogun State in Nigeria. Two-hundred-and-twenty-seven (227) children from two schools were recruited for the study. Data on the socio-demographic characteristics of the respondents and consumption pattern were obtained through a semi-structured questionnaire. Anthropometric measurements (height and weight) of the children were determined using standard anthropometric procedures, while anthropometric indices were measured against WHO growth standard. Blood samples of the subjects were collected and analysed for haematological variables (haemoglobin, serum transferrin, and serum ferritin). Data were analyzed using frequency count, percentage, and mean. Research results have revealed that regular consumption of fruits is generally low (6.8%) among respondents. Most of the respondents (61.0%) consume green leafy vegetables on a regular basis, while 54.3% and 46.3% consume meat and fish more than 4 times per week, respectively. The anthropometric measurement of the subjects at baseline shows that 17.2% are severely stunted (HAZ-3SD), 19.5% are moderately stunted (-3SD&lt;HAZ&lt;-1SD), and 39.4% are mildly stunted (‐2 SD &lt; HAZ &lt;‐1 SD). The BAZ status record that 14.1% are underweight (BAZ&lt;-2SD), 1.4% are overweight (2 SD &gt; BAZ &gt;1 SD), and 0.8% are identified with obesity (BAZ &gt;2 SD). Biochemical status shows that 54.9% are anemic, while all (100.0%) of the children have adequate ferritin and transferrin status. This study has acknowledged that school-age children in Odeda local government face serious prevalence of anemia associated with causes beyond the lack of iron-rich food sources.

Phytate-iron molar ratio and bioavailability of iron in Bangladesh.

OBJECTIVEPhytate, an important component of plant origin foods, works as a chelator for mineral nutrients such as iron. Estimating the phytate‐iron molar ratio is a traditional method to assess the bioavailability of dietary iron, and a ratio >1 is suggestive of poor absorption of iron through the intestinal mucosa. In Bangladesh, the ratio is considerably higher; nonetheless, the haemoglobin and ferritin status are satisfactory. Hence, we appraised phytate‐iron molar ratios and concomitant haemoglobin and ferritin status.METHODSDietary intake of iron and phytate was estimated in non‐pregnant non‐lactating women and school‐age children from a nationally representative survey. The phytate‐iron molar ratios were estimated. Linear regressions on haemoglobin for the phytate‐iron molar ratios and on molar ratios predicting inflammation‐adjusted ferritin were performed.RESULTSThe median ratios were 6.12 in women and 5.47 in children, with corresponding haemoglobin concentrations of 12.6 and 12.5 g/dl. Hypothetical lowering of the ratios by ~50% revealed a nominal increment of haemoglobin and ferritin.CONCLUSIONThe standard cut‐off phytate‐iron molar ratio of >1 is inconsistent with the iron and haemoglobin status of the Bangladeshi population. One plausible explanation for the inconsistency is a non‐dietary environmental factor—groundwater iron. Isotope studies incorporating the iron from dietary and the drinking groundwater sources are needed to establish a ratio which might better explain iron bioavailability.

Health Status of Young Girls in Selected Area of Bangladesh

Background:Adolescence, a period of transition between childhood and adulthood, occupies a crucial position in the life of human beings. Hence, it is essential to improve health status through interventions. Objective:To assess and compare nutritional status of adolescent school girls in nutritional intervention and non-intervention area. Methods: A cross-sectional analytic study was conducted at Laxmipur sadar upazila as nutrition intervention area &amp; neighboring Chatkhil upazila as non–nutrition intervention area. A total of 367 adolescent girls of age 10-19 years were selected purposively of them 177 and 190 were selected from intervention and non-intervention area respectively. Anthropometric data of the study subjects were collected by using standard techniques. Body mass index (BMI) and anemia were classified according to WHO cut off levels. Results:Study reveals that hemoglobin status was 72.3% normal, 20.3% mild anemia and 7.3% moderate anemia in intervention area and 51.6% normal, 43.7% mild anemia and 4.7% moderate anemia in non-intervention area. Significant difference was found both BMI and hemoglobin status among intervention and non-intervention area. Significant difference was found between intervention and non-intervention area of different illness, typhoid and jaundice. Conclusion:This study concludes that health status was better in intervention area than non-intervention area so community-based intervention is effective for better health status of young girls.

Impact of Tobacco, Marijuana and Alcohol Use on Overall Survival in Recurrent Metastatic Head and Neck Cancer Patients Treated with Immune Checkpoint Inhibitors

<h3>Purpose/Objective(s)</h3> Tobacco, marijuana, and alcohol use have all been associated with immune suppressive effect. This study assess the impact of smoking status, marijuana use and alcohol consumption on overall survival (OS) in patients (pts) with recurrent-metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) treated with immune checkpoint inhibitors (ICI). <h3>Materials/Methods</h3> Between January 15^th 2016 and April 9^th 2020, 201 pts with R/M HNSCC were treated with ICI. Data on smoking status, marijuana use and alcohol consumption were collected through retrospective chart review. We had p16 status, hemoglobin, albumin, lactate dehydrogenase (LDH), neutrophil, lymphocyte and platelet count recorded initially at the time of starting ICI. OS was defined from the start of ICI to death. Progression Free Survival (PFS) was defined from the start of ICI to disease progression (PD) or death. <h3>Results</h3> 201 pts were analyzed, sex: 154 male (77%), 47 female (23%). Median age 61 (IQR: 55-68). ICI drug: pembrolizumab 100 (50%), nivolumab 91 (45%), ipilimumab+nivolumab 10 (5%). Line of therapy: first: 98 (49%), second and beyond: 103 (51%). Tumor site: oropharynx 84 (42%), oral cavity 45 (22%), others 72 (36%). p16 status: negative 132 (66%), positive 69 (34%). Smoking status: former 111 (55%), never 54 (27%), current 36 (18%), median pack-year 18 (IQR: 0-37). Alcohol use: yes 110 (55%), no 91 (54%). Marijuana use: yes 47 (23%), no 154 (77%). Laboratory values: median neutrophil count: 4.58 (IQR: 3.43-6.47), median lymphocyte count: 0.69 (IQR: 0.47-1.08), median platelet count: 229 (IQR: 187-300), hemoglobin: normal/low 101/100 (50%/50%), albumin: normal/low 156/45 (78%/22%), LDH: normal/high 124/77 (62%/38%). Overall response rate: 36 (18%). Median OS: 12 months (CI: 9.4-14.8), median PFS: 4 months (CI: 3.5-5.7). Tobacco: former [HR 0.92 (0.62-1.36), <i>p=0.3</i>], current [HR 0.66 (0.39-1.14), <i>p=0.3</i>]. Marijuana: yes [HR 0.66 (0.43-1.01), <i>p=0.054</i>]. Alcohol: yes [HR 0.91 (0.65-1.28), <i>p=0.6</i>]. The variables associated with OS were high neutrophil count [HR 1.28 (1.08 – 1.51), <i>p=0.004</i>], high lymphocyte count [HR 0.75 (0.60 – 0.95), <i>p=0.015</i>], albumin (low) [HR 2.06 (1.37 – 3.10), <i>p<0.001</i>], hemoglobin (low) [HR 1.64 (1.14 – 2.35), <i>p=0.007</i>], LDH (high) [HR 1.78 (1.23 – 2.56), <i>p=0.002</i>] and p16 status (positive) [HR 0.58 (0.39-0.87), <i>p=0.009</i>]. <h3>Conclusion</h3> In our single institutional cohort, smoking status, marijuana use and alcohol consumption did not appear to have a significant impact on OS in patients with R/M HNSCC treated with ICI. As we previously reported, the pre-treatment patient characteristics associated with OS include neutrophil count, lymphocyte count, hemoglobin, albumin, LDH and p16 status.