Improvement In Hemoglobin Levels Research Articles

Momelotinib - a promising advancement in the management of myelofibrosis in adults with anemia.

Myelofibrosis (MF) is a rare BCR-ABL negative myeloproliferative neoplasm characterized by clonal proliferation of stem cells, with mutations in JAK2, CALR, or MPL genes. MF presents in primary and secondary forms, with common symptoms including splenomegaly, anemia, and thrombocytopenia. Diagnostic criteria involve bone marrow examination and mutation studies. Current treatments are limited, with allogeneic stem cell transplant as the only curative option. Recent FDA approval of Momelotinib (MMB) offers new promise for MF patients with anemia. MMB, a JAK1/2 and ACVR1 inhibitor, effectively reduces spleen size, improves hemoglobin levels, and decreases transfusion dependency. The MOMENTUM trial compared MMB to danazol in JAK inhibitor-treated MF patients with anemia, showing MMB's superior symptom relief and transfusion independence rates. Additionally, the SIMPLIFY-1 and SIMPLIFY-2 trials evaluated MMB in JAK inhibitor-naïve and experienced patients, respectively, confirming MMB's non-inferiority to ruxolitinib in spleen volume reduction and highlighting its benefits in transfusion requirements. MMB's unique dual inhibition mechanism addresses anemia by suppressing hepcidin production, thus enhancing erythropoiesis. These trials collectively suggest MMB as an effective treatment for MF, improving quality of life and offering a survival advantage for patients with anemia. Despite challenges, such as trial design limitations and adverse events, MMB represents a significant advancement in MF management, providing a new therapeutic option for a previously underserved patient population.

High Doses of Dexamethasone Improved Hemoglobin Levels Lowered by Corona Virus in COVID-19 Infected Patients

Corona virus an infectious disease caused by SARS–CoV-2 virus that lower hemoglobin level leading to worsening of the conditions. The respiratory symptoms are treated by steroids and patients are rapidly recovered. Objective: To study the effect of high and low doses of dexamethasone on hemoglobin level in COVID-19 infected patients. Methods: This experimental study was carried out in Rawal Institute of Health Sciences, Islamabad and Pakistan Institute of Medical Sciences, Islamabad between May 2021 to Sep 2021 on 100 adult male and female of COVID-19 patients having blood hemoglobin level < 10 g/dl. For different doses of dexamethasone patients were divided into two groups of 50 patients in each group. Blood samples were taken on day 01 and day 15 for hemoglobin analysis. Mean and standard deviation of both groups was calculated and p-value of < 0.05 was considered significant. Results: At the time of admission 74% of the patients had a cough, 89% of the patients presented with fever, 98% had increased heart rate whereas 100% of the patients presented with the complaint of fatigue. Mean Hemoglobin (Hb) levels of both groups were compared on day 01 and day 15 respectively. The comparison of Hb levels showed a significant difference on day 15, there was a marked increase in Hb levels in the group which was taking 12mg/day of dexamethasone as compared to the group which was taking 6mg/day of dexamethasone (P-value <0.05). Conclusions: Administration of high doses of Dexamethasone caused a pronounced increase in hemoglobin levels in COVID-19 patients

#535 Roxadustat as a treatment of anemia after kidney transplantation

Abstract Background and Aims Roxadustat is a recently approved hypoxia-inducible factor prolyl hydroxylase inhibitor that has demonstrated favourable safety and efficacy in the treatment of renal anaemia. The goal of this study is to analyse the effect of roxadustat on the level of hemoglobin in a group of patient with chronic kidney disease with or without kidney transplantation. Method This is a monocentric study conducted on the patients of Transplant-nephrology department and/or Transplant-nephrology out-patient clinic of University Hospital Martin, Slovakia who have been treated with roxadusat since August 1st, 2022. Results 33 patients were included in the study. The average follow up of treatment with roxadustat was 4.2 months. The following parameters were recorded at the baseline: age, gender, estimated glomerular filtration rate—eGFR (CKD-EPI), treatment with iron and level of iron in serum, level of C-reactive protein, level of hemoglobin, starting dose of Roxadustat. We discovered a significant improvement in the levels of hemoglobin after one month of roxadustat treatment (P < 0.0001) and another significant improvement in follow-up (P ‚0,0373). There was no significant difference in eGFR, CRP or iron levels during follow up, so hemoglobin levels were not affected by inflammation or kidney function. In the next step the group of patients was divided based on history of kidney transplantation. Again, we confirmed significant improvement in hemoglobin levels in kidney transplantation group in first month of treatment (P < 0.0001) as well as in follow up (P < 0.0001). There was a significant improvement in hemoglobin levels in the first month of roxadustat treatment in the group of patients who did not undergo kidney transplantation (P = 0.0261). However, there was no significant difference between hemoglobin levels in month 1 and follow up in this group. Conclusion Roxadustat—as a new treatment option of anaemia for patients with chronic kidney diseases. Our first analysis confirmed that roxadustat is very effective not only in patients with CKD, but also in patients with anaemia after kidney transplantation.

A preliminary study of roxadustat in the treatment of aplastic anemia patients with inadequate erythroid responses.

Some aplastic anemia(AA) patients only have partial hematological responses after immunosuppressive therapy. Failure to achieve complete normalization of blood counts, particularly hemoglobin, will reduce their quality of life. This open-label pilot study was conducted to evaluate the efficacy and safety of roxadustat in this setting. A total of 14 patients with AA who had inadequate erythroid response after immunosuppressive therapy were included in the study. The primary efficacy endpoint was hemoglobin response at week 8 after roxadustat treatment. The median duration of roxadustat therapy was 14 (4-30) weeks, with 12 patients receiving roxadustat for ≥ 8 weeks. At week 8, nine patients (9/14, 64.3%) had their hemoglobin rising for at least 15g/L, with two patients (2/14, 14.3%) achieving normal hemoglobin levels. By the last follow-up, hemoglobin responses were observed in 10 patients (10/14, 71.4%), with 4 patients(4/14, 28.6%) having normal hemoglobin levels. Roxadustat was tapered or discontinued in four responded patients; one relapsed after 12 weeks of tapering, and three maintained their response. Four patients (4/14, 28.6%) experienced mild adverse effects during therapy. Roxadustat is safe and well tolerated by patients with AA. Treatment with the hypoxia-inducible factor prolyl hydroxylase inhibitor improves hemoglobin levels in AA patients with inadequate erythroid responses.

A heterotopic pregnancy at 12 weeks’ pregnancy

Heterotopic pregnancy (HP) represents a rare and complex condition where simultaneous pregnancies occur at different implantation sites, with only one located within the uterine cavity. Typically diagnosed in the first trimester, HP presents diagnostic challenges due to its rarity and varying clinical presentations. Here, we present a unique case of HP diagnosed at Bengkalis Hospital involving a 42-year-old multipara at 12 weeks of gestation. The patient's presentation included regular uterine contractions and upper abdominal pain, with a positive Plano test upon admission. Despite experiencing vaginal bleeding two days prior and an initial refusal of care, further examination revealed a 2.13 cm gestational sac in the intrauterine cavity, consistent with the gestational age. Additionally, free intra-abdominal fluid was observed in the Douglas cavity. Haematological examination indicated a low haemoglobin level of 7.2 g/dl and elevated leukocytes at 16,000. An emergency laparotomy revealed a ruptured right ovarian tube containing a gestational sac, which was managed with hemostasis and a subsequent salpingectomy. The left ovarian tube underwent a tubectomy as a preventive measure. The patient received multiple blood transfusions, leading to an improvement in haemoglobin levels to 10.2 g/dl postoperatively. Following a two-day hospitalisation, the patient was discharged in good general condition. HP cases often necessitate laparotomies for tubal pregnancies, and ultrasound plays a crucial role in diagnosis, especially given its prevalence of 1 in 7000 due to assisted reproduction. Treatment typically involves laparoscopic or laparotomic intervention, highlighting the multidisciplinary approach required for managing this rare condition.

Comparative evaluation of different oral iron salts in the management of iron deficiency anemia.

Anemia affects one-fourth of the world's population and is caused mostly by iron deficiency. Iron supplementation is the most essential strategy for preventing iron deficiency anemia. Conventional oral iron salts have many drawbacks such as poor absorption & bioavailability, and poor tolerability resulting in poor clinical outcomes. To compare the effectiveness and safety of ferrous ascorbate, ferrous fumarate, ferrous bis-glycinate, and Sucrosomial iron in the management of iron deficiency anemia. The study is a retrospective observational clinical study comprising 260 subjects with hemoglobin between 7-10g/dl. The patients were divided into four groups I, II, III, and IV, and received ferrous fumarate, ferrous ascorbate, ferrous bis-glycinate, and Sucrosomial iron respectively. Hematological profile and iron store indices were measured at baseline and month 3. One-way ANOVA followed by Tukey multiple comparison test was used to assess statistical significance (P < 0.05) using GraphPad Prism V.9.3.1 software. The observational study showed that hemoglobin levels were significantly increased in the ferrous ascorbate group (11.86 ± 0.09; P < 0.0001), ferrous fumarate group (11.72 ± 0.08; P < 0.0001), ferrous bis-glycinate group (11.69 ± 0.11; P = 0.0003) and Sucrosomial iron group (12.20 ± 0.1; P < 0.0001) compared to the baseline. The Sucrosomial iron-supplemented group showed significantly higher improvement in hemoglobin levels and serum ferritin levels compared to conventional oral iron salts (P < 0.05) with a better safety profile. The Sucrosomial iron showed significantly higher improvement in hemoglobin levels and higher improvement in iron store indices parameters along with a good tolerability profile compared to other conventional oral iron salts.

Clinical and Demographic Characteristics of Pyruvate Kinase Deficiency Patients: A Comprehensive Case Series Analysis.

Introduction Pyruvate kinase deficiency (PKD) is a rare autosomal recessive disorder characterized by mutations in the PKLR gene, causing impaired glycolysis in red blood cells and leading to diverse clinical manifestations. The prevalence of PKD in Saudi Arabia remains understudied, particularly in the context of consanguinity and non-specialized medical facilities. Methods We conducted a retrospective analysis of seven PKD patients of Arab ethnicity, focusing on demographics, medical history, clinical features, laboratory results, treatments, and outcomes. Results Our patient cohort comprised five males and two females, aged 10 to 38 years, of Arab ethnicity. Consanguinity was prevalent, and hereditary connections were identified in five patients. PKD exhibited varying clinical presentations, with early-onset symptoms including neonatal jaundice and symptomatic anemia. One patient experienced severe hepatic disease progression leading to multiorgan failure. Blood transfusions were universally required, indicating the severity of the disorder. Anemia severity varied among patients, with diverse hematological irregularities. Splenectomy was performed for most patients, improving hemoglobin levels and transfusion needs in some cases. Iron chelation was administered, although iron overload persisted. Thrombocytosis and venous thromboembolism were observed post splenectomy. Jaundice and gallstones were common, leading to cholecystectomy. Laboratory findings remained consistent, with heightened reticulocyte counts and altered enzyme levels. Discussion PKD is a rare disorder characterized by diverse clinical manifestations. Prevalence estimation is complex due to various factors, and its diagnosis is challenged by clinical similarities with other disorders. Our cohort exhibited a spectrum of complications, highlighting the necessity for tailored interventions. Iron overload remained a concern, necessitating continuous monitoring. Although endocrine disorders and osteoporosis were absent in our cohort, vigilance is essential due to the disease's progressive nature. Genetic factors were prominent, supporting the genetic basis of PKD. Splenectomy improved anemia but had a limited impact on gallstones. Iron overload management and bone health remain crucial considerations. Conclusion This study offers comprehensive insights into the clinical and demographic characteristics of PKD patients, illustrating the complex nature of the disorder. The findings underscore the need for personalized management strategies and vigilant monitoring to address the diverse clinical manifestations and challenges associated with PKD.

Assessing the Clinical Outcomes of Voxelotor Treatment in Patients with Sickle Cell Disease

The results of Voxelotor treatment in Sickle Cell Disease, as assessed through clinical outcomes, demonstrated its efficacy in reducing hemolysis and improving hemoglobin levels. This effect can be attributed to Voxelotor's inhibition of HbS polymerization, thereby restoring the deformability and compliance of sickle RBCs. Our mathematical model provided mechanistic insights into how altered rheological properties of sickle RBCs impact their flow dynamics in microcirculation. Specifically, we observed that Voxelotor-induced improvements in RBC deformability and compliance lead to enhanced plasma film height in capillaries, promoting smoother blood flow and reducing the risk of vaso-occlusive events. We established a direct relationship between the molecular mechanism of Voxelotor action and its clinical outcomes. The mathematical model served as a bridge, elucidating how Voxelotor-induced changes in sickle RBC mechanics translate to improved microcirculatory flow and reduced vaso-occlusion. This holistic understanding not only validates the therapeutic efficacy of Voxelotor but also underscores the importance of considering biomechanical factors in evaluating treatment outcomes in SCD. Furthermore, this study highlighted the relevance of microfluidics based diagnostic tools in assessing the efficacy of Voxelotor treatment. By leveraging insights from our mathematical model, microfluidics devices can be designed to mimic physiological conditions and effectively evaluate the deformability of sickle RBCs before and after treatment. This integrated approach not only facilitates the development of personalized therapeutic interventions but also accelerates the translation of novel treatments, such as Voxelotor, from preclinical studies to clinical practice for the management of Sickle Cell Disease. Int. J. Appl. Sci. Biotechnol. Vol 12(1): 46-53.

First-in-Human Phase 1 Study Evaluating the Safety, Pharmacokinetics, and Pharmacodynamics of DISC-0974, an Anti-Hemojuvelin Antibody, in Healthy Participants.

Pathologic elevations in hepcidin, a key regulator of iron homeostasis, contribute to anemia of inflammation in chronic disease. DISC-0974 is a monoclonal antibody that binds to hemojuvelin and blocks bone morphogenetic protein signaling, thereby suppressing hepcidin production. Reduction of systemic hepcidin levels is predicted to increase iron absorption and mobilize stored iron into circulation, where it may be utilized by red blood cell (RBC) precursors in the bone marrow to improve hemoglobin levels and to potentially alleviate anemia of inflammation. We conducted a first-in-human, double-blind, placebo-controlled, single-ascending dose study to evaluate safety, pharmacokinetics, and pharmacodynamics of DISC-0974 in healthy participants. Overall, 42 participants were enrolled and received a single dose of placebo or DISC-0974 at escalating dose levels (7-56mg), administered intravenously (IV) or subcutaneously (SC). DISC-0974 was well tolerated, with a safety profile comparable to that of placebo. Pharmacokinetic data was dose and route related, with a terminal half-life of approximately 7 days. The bioavailability of SC dosing was ∼50%. Pharmacodynamic data showed dose-dependent decreases in serum hepcidin, with reductions of nearly 75% relative to baseline at the highest dose level tested, and corresponding increases in serum iron in response to DISC-0974 administration. Dose-dependent changes in serum ferritin and hematology parameters were also observed, indicating mobilization of iron stores and downstream effects of enhanced hemoglobinization and production of RBCs. Altogether, these data are consistent with the mechanism of action of DISC-0974 and support the selection of a biologically active dose range for evaluation in clinical trials for individuals with anemia of inflammation.

Oral Iptacopan Monotherapy in Paroxysmal Nocturnal Hemoglobinuria

BackgroundPersistent hemolytic anemia and a lack of oral treatments are challenges for patients with paroxysmal nocturnal hemoglobinuria who have received anti-C5 therapy or have not received complement inhibitors. Iptacopan, a first-in-class oral factor B inhibitor, has been shown to improve hemoglobin levels in these patients.MethodsIn two phase 3 trials, we assessed iptacopan monotherapy over a 24-week period in patients with hemoglobin levels of less than 10 g per deciliter. In the first, anti-C5–treated patients were randomly assigned to switch to iptacopan or to continue anti-C5 therapy. In the second, single-group trial, patients who had not received complement inhibitors and who had lactate dehydrogenase (LDH) levels more than 1.5 times the upper limit of the normal range received iptacopan. The two primary end points in the first trial were an increase in the hemoglobin level of at least 2 g per deciliter from baseline and a hemoglobin level of at least 12 g per deciliter, each without red-cell transfusion; the primary end point for the second trial was an increase in hemoglobin level of at least 2 g per deciliter from baseline without red-cell transfusion.ResultsIn the first trial, 51 of the 60 patients who received iptacopan had an increase in the hemoglobin level of at least 2 g per deciliter from baseline, and 42 had a hemoglobin level of at least 12 g per deciliter, each without transfusion; none of the 35 anti-C5–treated patients attained the end-point levels. In the second trial, 31 of 33 patients had an increase in the hemoglobin level of at least 2 g per deciliter from baseline without red-cell transfusion. In the first trial, 59 of the 62 patients who received iptacopan and 14 of the 35 anti-C5–treated patients did not require or receive transfusion; in the second trial, no patients required or received transfusion. Treatment with iptacopan increased hemoglobin levels, reduced fatigue, reduced reticulocyte and bilirubin levels, and resulted in mean LDH levels that were less than 1.5 times the upper limit of the normal range. Headache was the most frequent adverse event with iptacopan.ConclusionsIptacopan treatment improved hematologic and clinical outcomes in anti-C5–treated patients with persistent anemia — in whom iptacopan showed superiority to anti-C5 therapy — and in patients who had not received complement inhibitors. (Funded by Novartis; APPLY-PNH ClinicalTrials.gov number, NCT04558918; APPOINT-PNH ClinicalTrials.gov number, NCT04820530.)

Improvement of Hemoglobin Levels in Pregnant Women with Anemia Through Dragon Fruit Consumption

Anemia frequently manifests in pregnant women as a consequence of alterations in the cardiovascular system, leading to hemodilution and a subsequent decline in blood oxygen levels. The augmented iron demands during pregnancy arise from the needs of the fetus and placenta, coupled with physiological shifts like heightened blood volume and red blood cell count. This elevation in levels may contribute to diminished hemoglobin and hematocrit levels, consequently escalating the prevalence of anemia and iron deficiency during pregnancy. A viable solution for averting anemia in pregnant women involves the consumption of fruits rich in iron and vitamin C, such as dragon fruit, crucial for hemoglobin synthesis. The research method employed in this study followed a quantitative approach, specifically utilizing quasi-experimental research with a pretest-post-test design, including a control group. The study population comprised all pregnant women attending TPMB N Depok, West Java, during October-December 2023. Inclusion criteria involved pregnant women aged 16-34 weeks who visited TPMB N and exhibited signs of anemia. The study sample consisted of pregnant women willing to consume 200 cc of dragon fruit juice daily for a duration of 14 days. Bivariate data analysis was conducted using the Mann-Whitney Test. The intervention implemented involved administering dragon fruit juice, prepared by blending 200g of dragon fruit with 200cc of water and adding 3 tablespoons of sugar. The findings reveal a statistically significant difference in Hb levels among pregnant women before and after the consumption of dragon fruit juice, with a P value of 0.001.

Comparative evaluation of anti-anemic effect of Sucrosomial iron in experimental model of iron deficiency anemia in Wistar rats

Abstract Anemia is a grave public health issue that affects 25% of the global population. Conventional iron formulations used in treatment have drawbacks such as poor bioavailability and gastric intolerability. The current study aimed to evaluate the anti-anemic effects of different iron salts in Wistar rats with iron deficiency anemia (IDA). IDA was induced by the validated pre-clinical model by retro-orbital bloodletting (1 ml) for 21 days along with an iron-deficient diet in Wistar rats. The rats (n=48) were assigned into 8 groups: Control group, IDA rats, IDA rats receiving either vehicle or different iron salts (ferrous sulfate, ferrous ascorbate, ferrous fumarate, and Sucrosomial iron) for 21 days at a dose of 30 mg/kg p.o. Hematological parameters and iron store indices were assessed at each visit. Anemia induction markedly reduced hemoglobin levels in all IDA groups on day 21. In contrast, iron supplements showed significant improvement in hematological profile after 21 days of treatment. Interestingly, the Sucrosomial iron-supplemented group (group 8) showed significantly higher improvement in hemoglobin levels and hematocrit than did conventional iron supplements such as ferrous sulfate (group 5), ferrous ascorbate (group 6) and ferrous fumarate (group 7) (p &lt;0.05 for each group, respectively). Sucrosomial iron also showed slightly better improvement in iron store indices (serum iron &amp; ferritin levels, total iron binding capacity and transferrin saturation [%]) when compared with other iron supplements (non-significant difference). Authors concluded that Sucrosomial iron has a significant potential to improve IDA in Wistar rats compared to conventional iron salts. Sucrosomial iron can be useful for the management of IDA either prophylactically or therapeutically.

To Evaluate the Efficacy and Safety of Mifepristone in Reducing the Size & Symptoms of Uterine Leiomyoma/Fibroids.

Uterine leiomyomas, or fibroids, are prevalent benign gynecological tumors affecting many women during their reproductive years. While surgical excision has long been the gold standard for fibroid treatment, the pharmacological management, including progesterone receptor modulators like mifepristone (RU 486), has garnered attention due to the reduced surgical approaches. However, there is a notable paucity of research on the effectiveness of mifepristone, on the same. This study seeks to evaluate the safety and efficacy of mifepristone in reducing uterine leiomyoma size and alleviating associated symptoms. Conducted prospectively, the study enrolled 20 pre-menopausal women, aged 18years or older, from Nanavati Max Super Speciality Hospital Mumbai, Maharashtra, India. Participants were selected based on specific inclusion criteria, including the presence of at least one uterine myoma with a minimum diameter of 2.5cm as confirmed by ultrasound. Participants had an average age of 39.75years and an average BMI of 27.58kg/m2. The study found that mifepristone significantly reduced uterine volume by 75%, with hemoglobin levels substantially improving from 9 gm/dL initially to 12.51 gm/dL after six months. Pain intensity, assessed using the Visual Analog Scale (VAS) score, gradually decreased from baseline to three-month, with all 20 patients reporting the complete absence of pelvic pain by six months. This prospective study highlights mifepristone's promise as a non-surgical approach to effectively reduce uterine fibroid volume, improve hemoglobin levels, and mitigate uterine blood loss in patients.

Mean Rise in Hemoglobin After Intravenous Iron Therapy in Children with Iron Deficiency Anemia

Introduction: Iron deficiency anemia (IDA) is a significant public health issue in Pakistan, affecting up to 63% of children, as revealed by the Pakistan National Nutritional Survey 2018. While oral iron remains the primary choice, challenges in compliance have led to the consideration of intravenous (IV) iron therapy, particularly iron sucrose. The study discusses the safety and efficacy of IV iron therapy in Pakistani children and aims to broaden our understanding of treating IDA in resource-constrained regions. Aims &amp; Objectives: To determine the average hemoglobin (Hb) increase in iron-deficient-anemic children aged 01 to 12 years after treatment with intravenous iron sucrose. Place and Duration of Study: A quasi-experimental study was undertaken at Fauji Foundation Hospital in Rawalpindi, spanning from September 2021 to September 2022. Material &amp; Methods: The study focused on a cohort of pediatric patients aged between 1 and 12 years, all of whom were diagnosed with iron deficiency anemia and had previously encountered ineffective outcomes with oral iron therapy. In this investigation, the patients received treatment involving intravenous iron sucrose. Subsequently, their progress was diligently monitored after a period of 8 weeks. Improvement in hemoglobin level was assessed at the end of treatment to evaluate its efficacy.Data processing and statistical analysis were carried out using SPSS version 23,p-value of &lt;0.05 indicated statistical significance. Results: Out of 150 study cases, 96 (64.0 %) were male, while 54 (36.0 %) were female. The mean age of our study cases was 05 ± 2.3 years of these 150 study cases, 74 (49.3 %) belonged to rural areas, and 76 (50.7 %) belonged to urban areas. Poor socioeconomic status was noted in 97 (64.7 %), and 53 (35.3%) were middle-income. A family history of iron deficiency anaemia was recorded in 16 (10.7%). Iron deficiency due to dietary iron insufficiency was reported in 67 (44.7%), Total Parentral Nutrition (TPN) dependencywas seen in 61 (40.7%) and 22 (14.7%) had chronic gastritis. The mean baseline (pretreatment) haemoglobin level was 7.71 ± 0.63 g/dl, while the mean post-treatment haemoglobin level was 10.68 ± 0.60 g / dl (p = 0.001). Conclusion: After intravenous iron sucrose, we noted a significant rise in paediatric patients' hemoglobin levels, emphasizing its effectiveness and safety. Statistically, we found correlations with age, family history, and causes. Healthcare practitioners should consider injectable iron treatments for better results and reduced health issues in this group.

Pemberian Buah Kurma Meningkatkan Kadar Hemoglobin pada Ibu Hamil

Anaemia, a common condition during pregnancy, has been found to be associated with various factors such as physiological changes occurring during pregnancy, gestational fetal age and medical history of the pregnant woman. The current study was conducted to investigate the potential impact of consuming dates on the elevation of haemoglobin levels in pregnant women undergoing treatment at the Barokah Pajang Clinic. Employing an experimental design with pretest and posttest measurements using a control group, the study followed a quantitative approach. The sample collection method used was non-probability sampling, specifically sequential sample collection. The collected data was analyzed using the independent sample t-test, which revealed that pregnant women with anaemia who consumed dates experienced a statistically significant increase in haemoglobin levels at the Barokah Pajang Clinic. The findings suggest that taking iron supplements and consuming seven dates on an empty stomach for a week can help improve haemoglobin levels among pregnant women with anaemia. The P-value of 0.049 indicates the statistical significance of the results. This study highlights the potential benefits of a dietary intervention for pregnant women with anaemia, and it is recommended that they follow this regimen to ensure healthy pregnancies.

P548 Ustekinumab shows favourable safety profile and drug persistence rates in patients with Crohn’s Disease – results from a tertiary IBD centre

Abstract Background Patients with Crohn’s disease (CD) often require multiple biological therapies due to loss of response. Anti-TNF drugs are generally used as first-line biologic followed by a switch of class when patients lose response. Ustekinumab (UST), an IL12/23p40 antagonist is used in CD, often after anti-TNF failure. The aim of the study was to report on outcomes of UST therapy with a median follow-up period of nearly 24 months. Methods All CD patients who commenced UST therapy were identified from EMR at two tertiary referral centers between January 2017 and December 2021. All relevant demographic and clinical data were collected. Data on clinical response (defined as a downgrade in disease activity based on clinician assessment &amp; biochemical parameters), steroid-free duration, and long-term response to UST at 52 and 104 weeks were recorded. The response was assessed clinically and supported by biomarkers, cross-sectional imaging, endoscopic data, and sustained maintenance of UST. Statistical analysis was carried out using the IBM® SPSS® Statistics software package Version: 28.0.0.0. Results A total of 249 CD patients (M=133 (53%); median age 41 years) were included, with a median follow-up period of nearly 24 months (5-79 months). 94 (38%) patients had stricturing (B2), penetrating (B3) and perianal phenotype at baseline and 104 (42%) had undergone previous resection/s. 207 (83%) had documented moderate to severe disease activity and 211 (85%) patients were exposed to at least one biologic prior to treatment with UST. 66 (27%) patients were on concomitant thiopurines at the start of treatment. 224 (90%) patients in our cohort showed clinical response to UST and all remained on treatment at the end of follow-up period. The distribution of patients as per disease activity at baseline, 52 and 104 weeks is illustrated in Figure 1. An improvement in haemoglobin levels was observed post-therapy with UST, which was statistically significant at 104 weeks (p&amp;lt;0.001), with corresponding significant reduction in faecal calprotectin levels (median reduction: 506 mcg/g to 335 mcg at 104w; p&amp;lt;0.001). Only 10 (4%) patients had side-effects which were directly attributed to UST therapy. Conclusion UST is an effective therapeutic option in CD for both bio-naïve and previous biologic failure patients. Although our cohort had a large proportion of patients with complicated and refractory disease, clinical response was observed, regardless of their previous exposure status to biologics, and disease phenotype. UST appears to be well tolerated with a reasonable safety profile. UST has good drug-persistence rates making it economically feasible in the long term. Clinicians could safely continue UST for longer durations to manage CD.

The Effects of Ying Yang Bao on Nutritional Status of Children Aged 6-60 Months in Underdeveloped Rural Areas of China.

The Ying Yang Bao (YYB) intervention, a national policy in China, has been implemented for over two decades. Most previous studies have focused only on the short-term effects of YYB, while the long-term effects remain unexplored. This study was designed to evaluate the long-term effects of YYB in children aged 6-60 months. A sample of 4666 children was divided into intervention and control groups. Information on basic characteristics, physical examination, YYB consumption, etc., was obtained annually from 2018 to 2021. T-tests or chi-square tests were used to compare differences between the groups for continuous or categorical variables. Children in the intervention group showed greater incremental improvements in hemoglobin levels and physical development (p < 0.05). Prevalence of anemia, underweight, and stunting were lower in the intervention group than in the control group (all p < 0.05). Two-level regression models were constructed to assess the long-term effects of YYB. YYB reduced the risk of anemia and wasting by 37% (OR: 0.63, 95% CI: 0.52-0.75) and 49% (OR: 0.51, 95% CI: 0.39-0.67), respectively. This study indicates that YYB could significantly improve the nutritional status of children aged 6-60 months in underdeveloped rural areas of China.

Mechanism of Action and Validation of the Traditional Medicinal use of Grewia Tenax Fruits in Sudan to Encounter Iron Deficiency Anemia

Introduction: In Sudan, Grewia tenax fruits, are known commonly as Goddaim. The fruit’s pericarp is used traditionally for a long time as a juice or a porridge to treat iron deficiency anemia (IDA). Traditional Goddaim users have a very strong belief in its effectiveness. However, the pattern of hemoglobin improvement follows an initial fast increase followed by a decline upon continuing its use. Some previous studies have attributed its effect to high iron content, while the iron quantity was too small. This work attempts to find an explanation for its mechanism of action by screening the fruit extract and its respective fractions for secondary metabolites, minerals, vitamins, and fibre. Methods: Entailed three methodologies: Chemical analysis to identify quantified minerals, ascorbic acid and non-digestible fibers, Phytochemical Analysis to separate and identify secondary metabolites using high-performance liquid chromatography coupled to tandem mass spectrometry (HPLC-MS-MS technique), and estimation of radical scavenging activities of crude fruit extract and its respective chloroform and ethyl acetate fractions by inhibition of the 2,2-diphenylpicrylhydrazyl (DPPH). Results: Ascorbic acid and indigestible fibres were revealed in the aqueous extract. Secondary metabolites were flavonoids (e.g., quercetin, kaempferol), organic acids (e.g., ferulic acid, chlorogenic acid), β-carboline alkaloids (e.g., 3-hydroxy-tetrahydroharman) identified in the chloroform, and ethyl acetate fractions. The in vitro antioxidant activity of G. tenax fruit extract was confirmed spectrophotometrically. Conclusion: It can be concluded that the initial enhancement of iron absorption through ascorbic acid and fibres, followed by iron uptake inhibition, could be explained by iron chelation by the chelators in the fruits. This paradoxical effect may qualify G. tenax fruits as a safety gauge for improving haemoglobin levels without compromising iron excess once iron stores are filled by keeping the oxidative stress in check. This may present G. tenax fruits as a good and safe remedy that optimizes the treatment of IDA.

Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia: Long-term results of endoscopic treatment.

Background and study aims This longitudinal prospective study evaluated the long-term outcome of endoscopic treatment of gastrointestinal bleeding in hereditary hemorrhagic telangiectases (HHT), its safety and outcome predictors. Patients and methods Consecutive patients with HHT and either anemia disproportionate to epistaxis or overt gastrointestinal bleeding received endoscopic treatment of gastrointestinal telangiectases with argon plasma coagulation (APC). Hemoglobin levels and transfusion requirements were evaluated before and after treatment. Treatment effectiveness was classified as: 1) complete: hemoglobin level during the follow-up ≥9 g/dL; 2) complete with recurrence: hemoglobin ≥9 g/dL for at least 12 months with subsequent drop to <9 g/dL; or 3) absent: no improvement of hemoglobin level. Adverse events (AEs) were classified as mild, moderate, severe or fatal. Correlations were searched between treatment outcome and demographic/genetic characteristics, number, size and site of telangiectases, and hepatic arterio-venous malformations grade. Results Forty-seven patients with HHT were enrolled. At median follow-up of 134 months (range 20-243 months), 41 of 47 patients showed treatment response (complete or with recurrence) after one (14/47) or more (27/47) endoscopic treatments. Median hemoglobin levels were 7.0 g/dL and 11.9 g/dL at baseline and at the end of follow-up, respectively. Transfusion requirement decreased from 22.8 to 7.3 red cell unit/year. A higher baseline number of telangiectases was associated with a lower chance of response ( P =0.008). Only one severe AE (0.4%, jejunal perforation) was recorded. Conclusions Endoscopic treatment of gastrointestinal teleangiectases for gastrointestinal bleeding in patients with HHT is effective in the long term and safe.

Real-World Patient Characteristics, Treatment Patterns, and Outcomes in Patients with Lower-Risk Myelodysplastic Syndromes Who Have Been Treated with Luspatercept

Background: Myelodysplastic syndromes (MDS) are a group of rare, clonal bone marrow malignancies characterized by ineffective erythropoiesis. Erythropoiesis-stimulating agents (ESAs) are a treatment option for anemia in patients with lower-risk MDS (LR-MDS); however as only one in three patients respond to ESAs, there is a need for additional treatment options. In April 2020, luspatercept was approved for the treatment of anemia in adult patients with LR-MDS who failed to respond to ESAs. The aim of this study was to investigate real-world treatment patterns and early clinical outcomes in adult patients in the United States with LR-MDS receiving luspatercept. Methods: This was a retrospective observational cohort study of adult patients (aged ≥ 18 years at initial MDS diagnosis) with an International Prognostic Scoring System/Revised IPSS (IPSS-R/IPSS) classification of Very Low-, Low-, or Intermediate-risk MDS on or before the initial MDS diagnosis date +30 days, who were actively treated with a therapy of interest (including ESAs, hypomethylating agents [HMAs], erythroid maturation agents [EMAs], iron chelation therapy [ICT], white blood cells [WBCs], growth factors, chemotherapy, immunomodulating drugs [IMiDs], and platelet growth factors), and who received at least one dose of luspatercept between initial MDS diagnosis and November 1, 2022 in the COTA Vantage database which contains longitudinal, HIPAA-compliant data pertaining to the diagnosis, clinical management, and outcomes of patients with cancer from a mix of academic and community settings. The index date was the date of luspatercept initiation. Patients were required to have at least 2 months of medical data post-index unless they died during this period. All analyses were descriptive. Results: A total of 86 patients who were treated with luspatercept (median age 78.0 years, 79.1% White, 52.3% male, 80.2% ECOG 0-1) were included. Median baseline hemoglobin level was 7.8 g/dL (range: 5.3-11.4 g/dL). Median time from MDS diagnosis to luspatercept initiation was 35.4 months and the median follow-up time was 13.4 months. The majority of patients (89.5%) were previously treated with ESAs for a median duration of 9.0 months. The two most used ESAs were darbepoetin alfa (54.5%) and epoetin alfa (44.2%). In addition, 40.7% of patients had previously received a non-ESA treatment, most commonly azacitidine (62.9%) or lenalidomide (31.4%). The median duration of treatment (DoT) with luspatercept was 9.9 months. Around a quarter of patients who received luspatercept (25.6%, n = 22) received a further treatment, such as an ESA or an HMA for a median of 2.8 months. Overall, 51/76 (67.1%) patients with a baseline hemoglobin test who received luspatercept had an increase in hemoglobin of ≥1 g/dL compared with baseline (i.e. the closest hemoglobin test within 6 months prior to index date). Of these, 56.9% maintained the ≥1 g/dL hemoglobin level for ≥8 weeks and 45.1% maintained it for ≥16 weeks. Further, 44/76 (57.9%) patients with a baseline hemoglobin test who received luspatercept had an increase in hemoglobin ≥1.5 g/dL compared with baseline. Of these, 50.0% maintained the ≥1.5 g/dL hemoglobin level for ≥8 weeks and 25.0% maintained it for ≥16 weeks. Conclusion: This real-world study described treatment patterns and outcomes in patients with LR-MDS receiving luspatercept. An improvement in hemoglobin levels was observed in more than half of patients. In a quarter of patients who had a ≥1.5 g/dL increase compared to baseline, these improvements were maintained for ≥16 weeks. As this was a relatively small and descriptive study, future analyses are required to further elucidate these findings.