Lower Hemoglobin Levels Research Articles

Predictive utility of the Rockall scoring system in patients suffering from acute nonvariceal upper gastrointestinal hemorrhage.

Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) represents a significant clinical challenge due to its unpredictability and potentially severe outcomes. The Rockall risk score has emerged as a critical tool for prognostic assessment in patients with ANVUGIB, aiding in the prediction of rebleeding and mortality. However, its applicability and accuracy in the Chinese population remain understudied. To assess the prognostic value of the Rockall risk score in a Chinese cohort of patients with ANVUGIB. A retrospective analysis of 168 ANVUGIB patients' medical records was conducted. The study employed statistical tests, including the t-test, χ 2 test, spearman correlation, and receiver operating characteristic (ROC) analysis, to assess the relationship between the Rockall score and clinical outcomes, specifically focusing on rebleeding events within 3 months post-assessment. Significant associations were found between the Rockall score and various clinical outcomes. High Rockall scores were significantly associated with rebleeding events (r = 0.735, R 2 = 0.541, P < 0.001) and strongly positively correlated with adverse outcomes. Low hemoglobin levels (t = 2.843, P = 0.005), high international normalized ratio (t = 3.710, P < 0.001), active bleeding during endoscopy (χ 2 = 7.950, P = 0.005), large ulcer size (t = 6.348, P < 0.001), and requiring blood transfusion (χ 2 = 6.381, P = 0.012) were all significantly associated with rebleeding events. Furthermore, differences in treatment and management strategies were identified between patients with and without rebleeding events. ROC analysis indicated the excellent discriminative power (sensitivity: 0.914; specificity: 0.816; area under the curve: 0.933; Youden index: 0.730) of the Rockall score in predicting rebleeding events within 3 months. This study provides valuable insights into the prognostic value of the Rockall risk score for ANVUGIB in the Chinese population. The results underscore the potential of the Rockall score as an effective tool for risk stratification and prognostication, with implications for guiding risk-appropriate management strategies and optimizing care for patients with ANVUGIB.

Association of serum iron profile in female patients with melasma

Background: Melasma, an acquired pigmentary disorder, presents as symmetric, hyperpigmented macules and patches, primarily on the face. Its prevalence ranges from 1.5% to 33.3% and affects women more than men, impacting self-image and quality of life. Genetic predisposition, sun exposure, and hormonal factors significantly increase tyrosinase activity. The study aims to find an association between serum iron profile and melasma among female patients. Methods: This hospital-based cross-sectional study occurred in the Department of Dermatology and Venereology at Dhaka Medical College Hospital, enrolling 100 women from July 2022 to June 2023. Participants were divided into groups: Group A (patients with melasma) and Group B (healthy respondents without melasma). Results: The study compared two groups, finding no significant differences in age, marital status, occupation, or income. Group A had a higher percentage of patients with a family history of melasma (70% vs 28%) and significantly lower levels of hemoglobin, serum ferritin, iron, and transferrin saturation, but higher TIBC levels compared to Group B. Melasma was mainly central facial and symmetrical. Group A had a higher frequency of low haemoglobin, ferritin, iron, and transferrin saturation. The mMASI scores showed a negative correlation with hemoglobin, iron, ferritin, and transferrin saturation, and a positive correlation with TIBC, indicating more severe melasma with poorer iron profiles. Conclusions: There was a significant inverse correlation between low body iron stores and the severity of melasma, indicating that iron deficiency may contribute to or aggravate melasma in females. Therefore, the findings suggest that iron supplementation could improve treatment outcomes for melasma.

The use of reduced DOAC doses in atrial fibrillation patients does not always lead to good anticoagulation levels and avoid adverse events

BackgroundThe MAS study (Blood Advances 2024) showed that a high proportion of Italian AF patients treated with direct oral anticoagulants (DOACs) receive reduced doses. This sub-analysis of MAS data aimed to analyze the effects of reduced (appropriate or not)- or standard-dose use on DOAC activity assessed at baseline and the occurrence of thrombotic or bleeding complications during follow-up. MethodsThe MAS study design, the methods for DOAC measurement, the results, and the adverse events during follow-up, are described in detail elsewhere. ResultsSeven hundred AF patients (42 % of the total 1657) received a reduced dose (considered inappropriate in 140 [20 %]). They were older, more frequently women, with lower body mass index (BMI), hemoglobin levels, and creatinine clearance. They more often had cerebral or cardiovascular diseases, were taking more medications, with higher scores for thrombotic or bleeding risk. Despite the use of low doses, 133 (19.0 %) patients had high standardized C-trough DOAC levels and experienced a high proportion of bleeding events (8.3 % per year). Conversely, some patients (4.7 %) had very low levels, resulting in a high incidence of thrombotic events (6.7 % per year). No difference was detected if the reduced dose was appropriate or not. ConclusionThe unpredictable, highly variable inter-individual anticoagulant effect of DOACs may lead to either too low or too high anticoagulant levels, increasing the risk of thrombotic or bleeding events. This is particularly relevant for patients with high-risk conditions, such as those chosen for reduced-dose treatment. Further studies are needed to investigate this important clinical issue.

Acute limb ischemia and its predictive factors after revascularization: A single-center retrospective study from a resource-limited setting

Background: Patients with acute limb ischemia (ALI) are being treated using both open and endovascular procedures, with technological developments making treatments simpler and safer. However, the most significant improvements in outcomes for these patients will come from timely diagnosis, followed by quick and standardized therapy to reduce the likelihood of limb loss and subsequent sequels. The study sought to explore the clinical presentation and treatment outcome of open surgical revascularization for ALI in a resource-limited setting. Method: Between June 2019 and December 2022, a retrospective study including all patients presenting with ALI and treated with urgent revascularization at Al-Thora General Hospital, Sana’a, Yemen, was performed. All patients were classified using Rutherford’s ALI categorization. Demographic parameters, clinical data, treatment details, and outcomes were obtained from patient medical profiles. The main outcome was organ/patient survival and amputation 30 days following surgery. Secondary outcomes included factors associated with amputation. Result: Overall, 91 ALI patients were treated with urgent open revascularization during the study period. The mean age of patients was 55.9 ± 11.5 years, and most cases (61.5%) were male patients. The duration of symptoms was longer than 36 h in 29 cases (31.9%). Comorbidities such as ischemic heart disease, hypertension, diabetes mellitus, hyperlipidemia, cerebrovascular disease, congestive heart failure, renal impairment, atrial fibrillation, and history of malignancy were present in 61 (67.0%), 76 (83.5%), 56 (61.5%), 49 (53.8%), 11 (12.1%), 21 (23.1%), 25 (27.5%), 47 (51.6%), and 8 (8.8%) cases, respectively. Sensory impairment was seen in 30 (33.0%) cases. Thrombosis etiology was the most common ALI causes (80.2%). In laboratory results, high C-reactive protein (CRP) levels, low hemoglobin levels (anemia), and low albumin levels were present in 15 (16.5%), 15 (16.5%), and 8 (8.8%), respectively. Most ALI (85.7%) were occurred in lower extremity. Additionally, 61 (67.0%) cases were in the Rutherford IIb stages. All cases were undergoing open surgical revascularization and fasciotomy was made in 6 (6.6%) cases. The amputation-free survival rate was 76.9% at 30 days follow-up. The 30-day outcome was amputation in 21 (23.1%) cases and death in one case. In univariate analysis, current smoking, history of diabetes, hemodialysis, history of malignancy, atrial fibrillation, sensory impairment, prolonged symptoms duration (&gt;36 h), elevated CRP (&gt;5 mg/L), advanced ALI stage (Rutherford’s class IIb), fasciotomy, and thrombosis etiology were associated with revascularization failure and amputation and were statistically significant (all p-values &lt; 0.05). Conclusion: In this study, despite no endovascular treatment offered, the application of the standard treatment—open surgical revascularization—in patients with ALI represents the key to success for limb salvage with acceptable amputation rates even in a resource-limited setting. Additionally, independent risk factors for amputation were current smoking, history of diabetes, hemodialysis, history of malignancy, atrial fibrillation, sensory impairment, prolonged symptoms duration (&gt;36 h), elevated CRP (&gt;5 mg/L), advanced ALI stage, fasciotomy, and thrombosis etiology. Advanced tailoring revascularization strategy and timing for the proper patient and comorbidities treatment could potentially improve amputation-free survival in ALI patients. Future studies should incorporate both limb severity and anatomic staging to best guide clinical decision-making in ALI.

Low hemoglobin causes hematoma expansion and poor intracerebral hemorrhage outcomes.

Although lower hemoglobin levels associate with worse intracerebral hemorrhage (ICH) outcomes, causal drivers for this relationship remain unclear. We investigated the hypothesis that lower hemoglobin relates to increased hematoma expansion (HE) risk and poor outcomes using human observational data and assessed causal relationships using a translational murine model of anemia and ICH. ICH patients with baseline hemoglobin measurements and serial CT neuroimaging enrolled between 2010-2016 to a multicenter, prospective observational cohort study were studied. Patients with systemic evidence of coagulopathy were excluded. Separate regression models assessed relationships of baseline hemoglobin with HE (≥33% and/or ≥6mL growth) and poor long-term neurological outcomes (modified Rankin Scale 4-6) after adjusting for relevant covariates. Using a murine collagenase ICH model with serial neuroimaging in anemic vs. non-anemic C57/BL6 mice, intergroup differences in ICH lesion volume, ICH volume changes, and early mortality were assessed. Among 1190 ICH patients analyzed, lower baseline hemoglobin levels associated with increased odds of HE (adjusted OR per -1g/dL hemoglobin decrement: 1.10 [1.02-1.19]) and poor 3-month clinical outcomes (adjusted OR per -1g/dL hemoglobin decrement: 1.11 [1.03-1.21]). Similar relationships were seen with poor 6 and 12-month outcomes. In our animal model, anemic mice had significantly greater ICH lesion expansion, final lesion volumes, and greater mortality, as compared to non-anemic mice. These results, in a human cohort and a mouse model, provide novel evidence suggesting that anemia has causal roles in HE and poor ICH outcomes. Additional studies are required to clarify whether correcting anemia can improve these outcomes.

Iron status and anemia as predictors for acute bronchiolitis severity

BackgroundThe aim of this study was to determine the effect of iron deficiency anemia (IDA) on the severity of symptoms in infants hospitalized for acute bronchiolitis.MethodsThis is a case–control study, which was carried out on 80 infants from November 2022 to April 2023. The study involved 60 infants ranging in age from 2 months to 2 years, who were admitted to the Pediatric Pulmonology Unit and met the diagnostic criteria for acute bronchiolitis. Furthermore, a control group of 20 apparently healthy infants was incorporated into the study.ResultsThis study showed that patients with moderate and severe bronchiolitis exhibited notably reduced levels of hemoglobin, HCT, MCV, MCH, and MCHC. Concerning the iron status, a substantial decrease in serum iron and increase in TIBC in the severe group (P = 0.012, 0.001, respectively). No substantial correlation was detected between the severity of acute bronchiolitis and serum ferritin levels. Hemoglobin and serum iron were found to be independent predictors of the severity of acute bronchiolitis.ConclusionsInfants suffering from IDA exhibit increased vulnerability to acute bronchiolitis. The low levels of hemoglobin and serum iron may function as prognostic indicators for the severity of the condition in infants with acute bronchiolitis.

Establishment of a predictive model for blood transfusion after femoral head replacement in elderly patients.

The study aimed to establish a nomogram predictive model for blood transfusion after artificial femoral head replacement surgery in elderly patients with intertrochanteric fractures. Two hundred five elderly patients (55 males, 150 females; mean age: 82.1±6.6 years; range, 63 to 103 years) with intertrochanteric femoral fractures who underwent artificial femoral head replacement surgery between January 2015 and May 2023 were retrospectively analyzed. The patients were randomly divided into two groups: the training group (n=143) and the validation group (n=62). Within the training group, patients were further categorized into the nontransfused (n=86) and transfused (n=57) groups. Perioperative data were collected for logistic regression analysis to identify risk factors for postoperative blood transfusion. A nomogram model was developed to predict the need for blood transfusion, with assessments including the C-index, receiver operating characteristic curve, decision curve analysis, and clinical impact curve. Logistic regression analysis showed that low preoperative hemoglobin levels, high intraoperative bleeding volume, high drainage volume, the use of wire reinforcement, and history of cerebral infarction were the independent risk factors for transfusion after femoral head replacement. Both decision curve analysis and clinical impact curves indicated that the prediction model could be used as a good prediction tool for blood transfusion after artificial femoral head replacement for intertrochanteric femoral fractures in the elderly. A nomogram prediction model that effectively assesses the risk of blood transfusion in elderly patients undergoing femoral head replacement for intertrochanteric femoral fractures was established in this study. This model demonstrated high predictive accuracy and consistency, providing a valuable tool for clinicians to identify high-risk patients and implement early interventions to reduce the need for postoperative blood transfusions.

Magnetic Resonance Evaluation of Tissue Iron Deposition and Cardiac Function in Adult Regularly Transfused Thalassemia Intermedia Compared with Thalassemia Major Patients.

Objectives: This multicenter, retrospective, population-based, matched-cohort study compared clinical characteristics and magnetic resonance imaging (MRI) findings, including hepatic, pancreatic, and cardiac iron levels and cardiac function, between 135 adult regularly transfused thalassemia intermedia (TI) patients (44.73 ± 12.16 years, 77 females) and 135 age- and sex-matched thalassemia major (TM) patients (43.35 ± 9.83 years, 77 females), enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. Methods: The MRI protocol included the quantification of hepatic, pancreatic, and cardiac iron levels (R2* technique), the assessment of biventricular function parameters (cine images), and the detection of replacement myocardial fibrosis (late gadolinium enhancement technique). Results: Age, sex, frequency of splenectomy and chelation, and serum ferritin levels were not significantly different (p > 0.05) between the two groups, but TI patients started regular transfusions significantly later (p < 0.0001) and showed significantly lower pre-transfusion hemoglobin levels (p = 0.005). No difference was found in hepatic iron levels (p = 0.853). TI patients exhibited significantly lower pancreatic R2* values (p < 0.0001), also correcting for the duration of regular transfusions, and significantly lower cardiac R2* values (p < 0.0001). In the receiver operating characteristic analysis, pancreatic iron was the strongest discriminator between the two diseases. Left and right ventricular end-diastolic volume indexes were significantly higher in TI than in TM patients (p = 0.003 and p = 0.046, respectively), but the correction for the duration of regular transfusions removed the disease-specific differences (p > 0.05). Left ventricular (LV) mass index was significantly higher in TI (p = 0.049), while no difference (p > 0.05) was found in biventricular ejection fractions and replacement myocardial fibrosis. Conclusions: TI patients showed lower pancreatic and cardiac iron burden and more pronounced LV hypertrophy. These differences could not be explained by the different duration of the transfusional regimen.

Causes of pre and post-donation deferrals among blood donors, at Kwale Satellite Blood Transfusion Center, Kwale County, Kenya, 2018–2022

BackgroundBoth pre-donation and post-donation deferrals pose challenges to blood safety and availability. This study delved into the deferral rates before donations and their underlying reasons, as, transfusion transmissible infections (TTIs) leading to post-donation deferrals among potential blood donors at the Kwale Satellite Blood Transfusion Centre (KSBTC) in Kenya.MethodsWe performed a retrospective electronic record review of pre- and post-donation deferrals among blood donors at KSBTC, 2018–2022. The pre-donations deferral rate and reasons for deferral were analyzed. Accepted donations were analyzed to determine the prevalence of HIV, hepatitis B (HBV), hepatitis C (HCV), and syphilis. Descriptive statistics were calculated and both crude odds ratio (COR) and adjusted odds ratio (AOR), and their 95% confidence intervals (CI) were calculated. Variables with p < 0.05 were considered statistically significant.ResultsA review was conducted on 12,633 blood donation records. Among these, individuals 2,729/12,633 (21.60%) were deferred from donating with the primary reason being low hemoglobin levels, constituting 51.86% of deferrals. Around 773/9,904 (7.80%) of blood units, were discarded due to at least one TTI. Among these, HBV accounted for 4.73%, HIV for 2.01%, HCV for 1.21%, and Syphilis for 0.59% of cases. The adjusted odds ratio for male donors were, (aOR = 1.3, 95% CI 1.01–1.57), donors with none or primary education level (aOR = 1.4 95% CI 1.11–1.68), first-timer donors (aOR = 1.2, 95% CI 1.01–1.44), and static strategy for blood collection (aOR = 1.4, 95%CI 1.12–1.63) were independently potentially associated with testing positive for at least one TTI.ConclusionThe study indicates that TTIs continue to pose a risk to the safety of Kenya’s bloodstock, with a notable prevalence of HBV infections. Male donors, individuals with limited education, first-time donors, and utilizing a fixed strategy for blood collection were identified as potential risk factors independently associated with TTIs.

LEP rs7799039 and LEPR rs1137101 gene variants are not associated with clinical features in patients with metabolic syndrome in the Turkish population.

Genetic predisposition plays a role in the etiology of metabolic syndrome (MetS), an important health problem worldwide. Leptin (LEP), produced by adipose tissue, plays a crucial role in the development of MetS. In this study, we evaluated the effects of LEP and LEP receptor (LEPR) variants on clinical findings and risk of developing MetS in the Turkish population. A total of 320 patients were included in the study, of whom 150 were patients with MetS and 170 were healthy controls. DNA was extracted from blood samples. LEP rs7799039 and LEPR rs1137101 variants were genotyped using the polymerase chain reaction-based restriction fragment length polymorphism method. The genotype distributions of these variants and clinical and laboratory findings were compared. The LEP rs7799039 GA and AA genotypes and A allele frequencies were higher in participants with MetS than in the control group. For LEP rs7799039, the genotype AA-GA was higher in males, and the GG genotype was higher in females. On analyzing the clinical outcomes associated with these variants, it was observed that individuals possessing LEP rs7799039 GA and AA genotypes displayed elevated levels of triglycerides. In addition, those with the AG-GG genotype of LEPR rs1137101 had lower mean hemoglobin levels. Our results showed that the LEP rs7799039 and LEPR rs1137101 variants may be associated with both the risk of MetS development and clinical findings. Among the various contributors to MetS, a genetic predisposition is commonly recognized as the primary cause.

On-admission serum 25(OH)D level and mortality within one year in older patients

BackgroundMounting evidence suggests that vitamin D deficiency is associated with a higher risk of many chronic non-skeletal, age-associated diseases as well as mortality.AimTo determine, in older patients aged ≥ 80, the prevalence of vitamin D deficiency and its association with comorbidity, laboratory tests, length of stay and mortality within one year from blood withdrawal on admission to acute geriatrics ward.MethodsWe retrospectively surveyed electronic hospital health records of 830 older patients. The recorded data included patient demographics (e.g., age, sex, stay duration, readmissions number, death within one year from blood withdrawal on admission), medical diagnoses, laboratory results, including 25-hydroxyvitamin D [25(OH)D], and medications. We compared the characteristics of the patients who survived to those who died within one year.ResultsOn admission, in 53.6% patients, vitamin D levels were lower than 50 nmol/L, and in 32%, the levels were ≤ 35 nmol/L. Persons who died were likely to be older, of male sex, were likely to be admitted for pneumonia or CHF, were likely to have lower level of albumin or hemoglobin, lower level of vitamin D or higher vitamin B12 and higher level of creatinine, were also likely to have had a lengthier hospitalization stay, a greater number of hospitalizations in the last year, a higher number of comorbidities, to have consumption of ≥5 drugs or likely to being treated with insulin, diuretics, antipsychotics, anticoagulants or benzodiazepines. Higher age, male sex, on-admission CHF, higher number of drugs, lower albumin, higher vitamin B12, vitamin D < 50 nmol/L, and consumption of antipsychotics and anticoagulants – were predictors of mortality.ConclusionHypovitaminosis D is predictive of mortality in older patients within one year from hospitalization in the acute geriatric ward, but a causal relationship cannot be deduced. Nevertheless, older patients in acute care settings, because of their health vulnerability, should be considered for vitamin D testing. In the acutely ill patients, early intervention with vitamin D might improve outcomes. Accurate evaluation of mortality predictors in this age group patients may be more challenging and require variables that were not included in our study.

Risk factors for postoperative delirium in frail elderly patients undergoing on-pump cardiac surgery and development of a prediction model-a prospective observational study.

To identify the risk factors for postoperative delirium (POD) after cardiac surgery in frail elderly patients and develop a receiver operating characteristic (ROC) prediction model to confirm the effectiveness. This was a prospective observational study, patients were assessed preoperatively according to the frailty index (FI) scale. Cerebral (SctO2) was assessed at different time points using near-infrared spectroscopy (NIRS). On the basis of the occurrence of POD within 7 days after surgery, patients were divided into POD and non-POD groups. Risk factors were analyzed using logistic regression analysis, while their predictive values were evaluated using the receiver operating characteristic curve analysis. POD was significantly associated with frailty, lower preoperative MMSE scores, hyperlipidemia, diabetes, cerebrovascular disease, lower hemoglobin level, lower albumin level, longer operation time, longer CPB time, lower SctO2 at T5, and lower SctO2baseline (P < 0.05). SrtO2 and SmtO2 did not differ significantly between groups. FI, preoperative MMSE score, and operation time as independent risk factors (P < 0.05). Significant predictive value was demonstrated in all 3 variables (P < 0.001; respectively). Among them, high sensitivity and specificity were observed with the FI (cut-off value 0.27, sensitivity 75%, specificity 73.5%) and operation time (cut-off value 237.5, sensitivity 62.5%, specificity 78.6%). The FI, preoperative MMSE score, and operation time were independent risk factors for POD in elderly patients after cardiac surgery, with high predictive value observed with the FI and operation time. Cerebral oxygen saturation was associated with POD but was not an independent risk factor. Chinese Clinical Trail Registry, No: chictr2200056038.

Cord blood transfusions in extremely low gestational age neonates to reduce severe retinopathy of prematurity: results of a prespecified interim analysis of the randomized BORN trial

BackgroundPreterm infants are at high risk for retinopathy of prematurity (ROP), with potential life-long visual impairment. Low fetal hemoglobin (HbF) levels predict ROP. It is unknown if preventing the HbF decrease also reduces ROP.MethodsBORN is an ongoing multicenter double-blinded randomized controlled trial investigating whether transfusing HbF-enriched cord blood-red blood cells (CB-RBCs) instead of adult donor-RBC units (A-RBCs) reduces the incidence of severe ROP (NCT05100212). Neonates born between 24 and 27 + 6 weeks of gestation are enrolled and randomized 1:1 to receive adult donor-RBCs (A-RBCs, arm A) or allogeneic CB-RBCs (arm B) from birth to the postmenstrual age (PMA) of 31 + 6 weeks. Primary outcome is the rate of severe ROP at 40 weeks of PMA or discharge, with a sample size of 146 patients. A prespecified interim analysis was scheduled after the first 58 patients were enrolled, with the main purpose to evaluate the safety of CB-RBC transfusions.ResultsResults in the intention-to-treat and per-protocol analysis are reported. Twenty-eight patients were in arm A and 30 in arm B. Overall, 104 A-RBC units and 49 CB-RBC units were transfused, with a high rate of protocol deviations. A total of 336 adverse events were recorded, with similar incidence and severity in the two arms. By per-protocol analysis, patients receiving A-RBCs or both RBC types experienced more adverse events than non-transfused patients or those transfused exclusively with CB-RBCs, and suffered from more severe forms of bradycardia, pulmonary hypertension, and hemodynamically significant patent ductus arteriosus. Serum potassium, lactate, and pH were similar after CB-RBCs or A-RBCs. Fourteen patients died and 44 were evaluated for ROP. Ten of them developed severe ROP, with no differences between arms. At per-protocol analysis each A-RBC transfusion carried a relative risk for severe ROP of 1.66 (95% CI 1.06–2.20) in comparison with CB-RBCs. The area under the curve of HbF suggested that HbF decrement before 30 weeks PMA is critical for severe ROP development. Subsequent CB-RBC transfusions do not lessen the ROP risk.ConclusionsThe interim analysis shows that CB-RBC transfusion strategy in preterm neonates is safe and, if early adopted, might protect them from severe ROP.Trial registrationProspectively registered at ClinicalTrials.gov on October 29, 2021. Identifier number NCT05100212.

Comparative Quantification of Fungiform Papillae Density and Taste Perception in Anemic and Healthy Controls: A Case-Control Study.

Background Taste perception is crucial for dietary choices, nutrition, and overall health. The human tongue, particularly the fungiform papillae, plays a significant role in taste sensation, especially for sweet and umami flavors. Anemia, a common condition characterized by low hemoglobin levels, can affect sensory perception, including taste. Recent research has begun to explore the relationship between fungiform papillae density and taste perception in individuals with anemia. Objective This study aimed to investigate the comparative quantification of fungiform papillae density and its correlation with taste perception in anemic and healthy individuals, with the goal of understanding the underlying mechanisms linking anemia to taste disturbances. Methods A total of 100 adults (50 anemic and 50 healthy controls) aged 18-65 participated in the study. Demographic data, dietary habits, and medical history were collected. Taste perception was assessed using a taste strip test and psychophysical scaling methods, including magnitude estimation and the method of constant stimuli. Fungiform papillae density was quantified using high-resolution images of the tongue. Statistical analyses, including t-tests and correlation analyses, were conducted to compare the groups and explore relationships between hemoglobin levels, papillae density, and taste perception. Results The study found that anemic individuals had a slightly lower mean fungiform papillae density (49 papillae per square centimeter) compared to healthy controls (57 papillae per square centimeter). In the taste strip test, anemic participants showed reduced accuracy in taste perception, particularly for bitter flavors. However, psychophysical scaling results, as measured by magnitude estimation, revealed no statistically significant difference in subjective taste intensity between the anemic and healthy control groups (p=0.8666). Conclusion The study suggests that while anemic individuals may exhibit reduced fungiform papillae density and altered taste perception, particularly for bitter flavors, the overall subjective perception of taste intensity does not significantly differ from that of healthy controls. These findings contribute to the understanding of taste disturbances in anemia and may inform future diagnostic and therapeutic approaches for managing taste disorders in affected individuals.

Recombinant erythropoietin for the treatment of iron deficiency anemia in pregnancy: A systematic review.

Treatment options for severe, refractory iron deficiency anemia are limited in pregnancy. To review the available literature on the use of recombinant erythropoietin in the treatment of iron deficiency anemia in pregnancy. An electronic search of seven databases from inception to March 2022 was performed using a combination of keywords. We included all randomized controlled or observational studies of pregnant patients with iron deficiency anemia who received recombinant erythropoietin or control. The primary outcome was a change in hematologic parameters (hemoglobin or hematocrit) after treatment. Studies were appraised using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. Data were summarized using narrative synthesis and descriptive statistics as appropriate. This study was registered with PROSPERO, CRD42022313328. Of 234 studies screened, five studies met the inclusion criteria and had sufficient data for analysis (n = 103 recombinant erythropoietin and n = 104 controls). All patients in the intervention group received iron supplementation (intravenous or oral) in addition to recombinant erythropoietin. All patients in the control group received iron supplementation (intravenous or oral) alone. As the result of variance between studies in inclusion criteria, the timing of repeat blood draws, and data reporting, a meta-analysis could not be performed. Three studies found that serial recombinant erythropoietin combined with iron supplementation was more effective at raising hematologic laboratory parameters (hemoglobin or hematocrit) than iron alone. One study reported no difference in hemoglobin or hematocrit levels between groups at day 28. However, patients in this study only received one dose of recombinant erythropoietin, whereas those in the other studies received serial doses. Another study also found no difference in hemoglobin levels by day 28, but patients in the recombinant erythropoietin group had lower hemoglobin levels at baseline and a more rapid rise in hemoglobin than iron alone. This is demonstrated by a more significant rise in hemoglobin at day 11 in the recombinant erythropoietin group than in the control group. Serial recombinant erythropoietin administration and iron supplementation may be more effective at treating refractory iron deficiency anemia in pregnancy than iron supplementation alone.

Analysis of Blood Donor Deferral Pattern at a Tertiary Care Hospital in Chennai: A Cross-Sectional Retrospective Study.

Background Blood is essential for saving lives, particularly in emergencies. However, many patients, especially in developing countries face delays in accessing safe blood due to inadequate infrastructure, insufficient blood banks, poorly equipped laboratories, unreliable transportation systems, low donation rates driven by cultural beliefs, fear, and misconceptions, poor blood donor recruitment and retention, economic constraints, and a general lack of awareness and education about blood donation. Ensuring safe transfusions requires advanced technology and promoting healthy, voluntary donations. Donor selection is crucial for safety, preventing adverse reactions through proper criteria and infection screenings. Donor deferrals can discourage donors and hinder recruitment, so identifying and addressing deferral causes is vital. Blood centers must balance quality and quantity by using thorough donor assessments. Efforts should focus on both recruiting new donors and retaining deferred ones to ensure a stable blood supply. Aim The aim of the study is to evaluate and analyze the patterns and causes of blood donor deferrals in a tertiary care hospital. The objectives are to determine the incidence and reasons for blood donor deferrals. Materials and methods A cross-sectional retrospective study was conducted for 36 months fromMay 2021 to May 2024.A simple random sampling method was used to select the blood donors who reported for donation. Data was obtained from records maintained by the blood center. Descriptive statistics were utilized to summarize the demographics of the blood donors, including deferral rates among males and females, and the frequency of temporary and permanent deferrals. A Chi-square test was done to find the association between gender and deferral rates in blood donation. This analysis aimed to explore gender variations and underlying health status differences between male and female donors, as these can influence deferral rates. Results From May 2021 to May 2024, 17,082 people registered to donate blood at the Blood Centre, Department of Transfusion Medicine. Out of these, 1,000 donors, or 5.85%, were deferred. The majority of donors were males 16,638, with only 444 females. Most deferrals (76.4%) were temporary, often due to low hemoglobin levels or recent alcohol intake. Permanent deferrals (23.6%) were usually due to uncontrolled hypertension and diabetes. A significant association was found between gender and type of deferral among participants (p < 0.05). Conclusion This cross-sectional retrospective study on blood donor deferral patterns in a tertiary care hospital highlights key reasons such as low hemoglobin, recent alcohol intake, hypertension, and diabetes. To improve donor eligibility and retention, targeted strategies including enhanced education and community engagement are essential. These efforts will strengthen blood transfusion services and support critical healthcare needs effectively.

The Correlation Between Family Support with The Quality of Life of School-Age Children with Thalassemia

Introduction: Thalassemia is a severe disease affecting many school-aged children, characterized by symptoms such as weakness and paleness due to low hemoglobin levels. These children often require routine blood transfusions, which can lead to several side effects impacting their quality of life. Generally, the quality of life for school-aged children with thalassemia is lower than that of their healthy peers. Family support is one factor that can influence the quality of life of children with thalassemia. This study investigated the relationship between family support and quality of life in school-aged children with thalassemia at Immanuel Way Halim Hospital, Bandar Lampung.Methods: The research design was descriptive-analytic with a cross-sectional approach. The sample included all school-aged thalassemia patients in the Edelweiss Hospital room at Immanuel Way Halim, totaling 28 respondents. The sampling technique used was purposive sampling, with inclusion criteria being school-aged thalassemia patients (ages 7 to 18 years) who could communicate well. Data analysis was conducted using the Chi-square test.Results: The results indicated that 19 respondents (67.9%) had positive family support, and 14 (50%) had a high quality of life. Statistical analysis showed a p-value of 0.027 (&lt;0.05).Conclusion: There is a significant relationship between family support and the quality of life of children with thalassemia in the Edelweiss Hospital room at Immanuel Way Halim, Bandar Lampung.

Evaluation of the risk prediction model of pressure injuries in hospitalized patient: A systematic review and meta-analysis.

The main aim of this study is to synthesize the prevalent predictive models for pressure injuries in hospitalized patients, with the goal of identifying common predictive factors linked to pressure injuries in hospitalized patients. This endeavour holds the potential to provide clinical nurses with a valuable reference for providing targeted care to high-risk patients. Pressure injuries (PIs) are a frequently occurring health problem throughout the world. There are mounting studies about risk prediction model of PIs reported and published. However, the prediction performance of the models is still unclear. Systematic review and meta-analysis: The Cochrane Library, PubMed, Embase, CINAHL, Web of Science and Chinese databases including CNKI (China National Knowledge Infrastructure), Wanfang Database, Weipu Database and CBM (China Biology Medicine). This systematic review was conducted following PRISMA recommendations. The databases of Cochrane Library, PubMed, Embase, CINAHL, Web of Science, and CNKI, Weipu Database, Wanfang Database and CBM were searched for all studies published before September 2023. We included studies with cohort, case-control designs, reporting the development of risk model and have been validated externally and internally among the hospitalized patients. Two researchers selected the retrieved studies according to the inclusion and exclusion criteria, and critically evaluated the quality of studies based on the CHARMS checklist. The PRISMA guideline was used to report the systematic review and meta-analysis. Sixty-two studies were included, which contained 99 pressure injuries risk prediction models. The AUC (area under ROC curve) of modelling in 32 prediction models were reported ranged from .70 to .99, while the AUC of verification in 38 models were reported ranged from .70 to .98. Gender (OR = 1.41, CI: .99 ~ 1.31), age (WMD = 8.81, CI: 8.11 ~ 9.57), diabetes mellitus (OR = 1.64, CI: 1.36 ~ 1.99), mechanical ventilation (OR = 2.71, CI: 2.05 ~ 3.57), length of hospital stay (WMD = 7.65, CI: 7.24 ~ 8.05) were the most common predictors of pressure injuries. Studies of PIs risk prediction model in hospitalized patients had high research quality, and the risk prediction models also had good predictive performance. However, some of the included studies lacked of internal or external validation in modelling, which affected the stability and extendibility. The aged, male patient in ICU, albumin, haematocrit, low haemoglobin level, diabetes, mechanical ventilation and length of stay in hospital were high-risk factors for pressure injuries in hospitalized patients. In the future, it is recommended that clinical nurses, in practice, select predictive models with better performance to identify high-risk patients based on the actual situation and provide care targeting the high-risk factors to prevent the occurrence of diseases. The risk prediction model is an effective tool for identifying patients at the risk of developing PIs. With the help of risk prediction tool, nurses can identify the high-risk patients and common predictive factors, predict the probability of developing PIs, then provide specific preventive measures to improve the outcomes of these patients. CRD42023445258.

The lived experiences of fatigue among patients receiving haemodialysis in Oman: a qualitative exploration

BackgroundFatigue among patients with end-stage kidney disease (ESKD) receiving haemodialysis imposes a substantial burden on patients’ quality of life and expected treatment outcomes. This study explores the perspective on ESKD-related fatigue and contributing factors among Omani patients receiving haemodialysis.MethodsAn exploratory qualitative design was used. Participants (N = 25) were recruited from two Omani haemodialysis centres, and data were collected through semi-structured interviews, which were transcribed and analysed using a thematic analysis approach. NVivo 11 is used to manage qualitative data and create memos, nodes, and codes.ResultsFindings highlighted three themes: (i)“Inevitability of fatigue,” (ii)“Contributors to physical fatigue,” and (iii)“Contributors to mental fatigue.” Theme one alluded to the inevitability of fatigue and the unique experience encountered by patients. Theme two addressed the physical fatigue associated with ESKD-related factors, such as chronically low haemoglobin levels, and the exhausting impact caused by the frequency and travelling distance for treatment sessions. Theme three, mental fatigue, was notably driven by heightened emotional disturbance, encompassing frustration, guilt, anxiety, and distress, that in turn impacted family interactions, frequently triggering anger and remorse. Moreover, mental fatigue is a result of disturbances in expressing physical sexuality in marriage, as physical fatigue was found to be a significant contributor to unsatisfactory sexual experiences and, thus, straining the relationships between couples.ConclusionsThis study offers an explanation of fatigue among Omani patients with ESKD who are receiving haemodialysis. The study emphasises close links between physiological change, the haemodialysis process, and mental tiredness, together with their contribution to supporting the need for a holistic approach and care strategies in managing these patients and promoting patient and family well-being.

Effects of thalassemia minor on umbilical artery blood flow and perinatal outcomes in pregnancy: A retrospective cohort study.

The aim of the present study was to compare the fetal umbilical artery blood flow parameters in the third trimester and perinatal outcomes between pregnant women with and without thalassemia minorin South China. This was a retrospective cohort study. Doppler ultrasound was used to detect fetal umbilical artery hemodynamics in pregnant women with or without thalassemia minor during the third trimester. The main parameters assessed were umbilical artery peak systolic flow velocity/end-diastolic flow velocity (S/D), resistance index (RI), pulsation index (PI), and relevant perinatal outcomes. This study included 540 pregnant women, 180 with thalassemia minor and 360 being healthy controls. In the third trimester, the thalassemia minor group had higher umbilical artery S/D (P = 0.002), RI (P = 0.002), and PI (P = 0.012) than healthy pregnant women, as well as lower levels of hemoglobin (Hb) (P < 0.001) and higher ferritin levels (P < 0.001). Compared to the non-thalassemia group, neonatal body weight in the thalassemia minor group was significantly lower (P = 0.001). Additionally, the incidence of maternal anemia (odds ratio [OR] 3.92; 95% confidence interval [CI]: 2.57-5.99, P < 0.001), low birth weight (OR 15.35; 95% CI: 1.71-137.93, P = 0.015), fetal distress (OR 2.18; 95% CI: 1.12-4.26, P = 0.023), neonatal asphyxia (OR 12.81; 95% CI: 1.40-117.33, P = 0.024), oligohydramnios (OR 18.25; 95% CI: 2.21-150.36, P = 0.007) and Apgar score <7 at 1 min after birth (OR 7.97; 95% CI: 1.53-41.54, P = 0.014) was significantly higher in the thalassemia minor group. Pregnant women with thalassemia minor have higher umbilical artery S/D, RI and PI during the third trimester and a higher risk of adverse perinatal outcomes.