Lower Hb Research Articles

Abstract 29: Effects of a Novel Structural Variant in Hemoglobin on Racial Differences in Hemoglobin A1c

Background: Studies have found higher hemoglobin A1c (HbA1c) at similar levels of glucose for adults who self-identify as Black vs. White, but the mechanism for this difference is poorly understood. Genetic variants that are more common in persons of African descent that affect hemoglobin (Hb) or red cell turnover may explain some of this difference. A recently discovered deletion in a non-coding region of the HBA2 gene is common in persons of African descent and may contribute to differences in Hb and HbA1c. Methods: We evaluated 5178 participants (mean age 56 years, 18% Black, 55% female) who attended Visit 2 (1990-1992) of the Atherosclerosis Risk in Communities Study without diagnosed diabetes and BMI <30 kg/m 2 . We compared the distributions of Hb and HbA1c in Black and White participants by the number of deletions in the HBA2 region (zero, one, or two). We used linear regression to evaluate the extent to which this genetic variant explained glucose-independent Black-White differences in HbA1c and Hb. Results: Deletions in the HBA2 region were common in Black participants (30% one, 4% two) but rare in White participants (1%: one, 0%: two). Mean Hb was lower in Black participants with one (-0.38 g/dL, p<0.001) and two deletions (-0.76 g/dL, p=0.002) and HbA1c was higher (one: +0.11%, p<0.001; two deletions: +0.13%, p=0.11) ( Figure ). Results were similar in White participants with one deletion (N=38), but non-significant. In a regression model adjusted for age, sex, fasting glucose, and BMI, the differences in HbA1c and Hb comparing Blacks vs White adults were +0.2% and -0.6 g/dL, respectively. Additional adjustment for HBA2 deletions explained 16% of the difference in HbA1c and 19% of the difference in Hb. Conclusions: A variation in the non-coding region of the HBA2 gene common in those with African ancestry results in significantly lower Hb and significantly higher HbA1c, partially explaining the small observed racial differences in HbA1c. Other undiscovered variants could more fully explain observed racial differences in HbA1c.

Which Laboratory and Clinical Feature are different in Pregnant and Non-pregnant Women with COVID-19? A Cross-sectional Study in the West of Iran

Background: This study aimed to determine the differences in laboratory and clinical characteristics of pregnant and non-pregnant women with COVID-19 in Hamadan, the west of Iran. Material & Methods: This cross-sectional study compared 135 pregnant with 135 non-pregnant women without underlying diseases and matched by age with COVID-19 from March 2020 to June 2021 in Hamadan, a western city in Iran. Their demographic characteristics, clinical symptoms, vital signs, and laboratory findings were evaluated using a preset checklist and contrasted between the two groups. The adjusted odds ratios (ORs) for the outcomes of illness were presented. A considerable amount of analysis was performed on all data using the SPSS version 26 software. Results: In general, there was a significant association between most clinical symptoms and status of pregnancy. Although the Peripheral oxygen saturation with a pulse oximeter (SPO2) mean was significantly lower among non-pregnant compared to the pregnant women (89.19±4.52 versus 94.91±3.12; p < 0.001), the mean of heart rate was significantly lower among pregnant women compared to non-pregnant women (90.59±11.80 versus 96.50±15.02; p = 0.001). The percentage of low hemoglobin (Hb), abnormal Blood Urea Nitrogen, high Creatinine (CR), high Erythrocyte Sedimentation Rate and high Lactate Dehydrogenase was significantly higher in non-pregnant women compared to the pregnant women. Women with pregnancy compared to non-pregnant women and women with low Hb compared to normal Hb had a considerably increased chance of intensive care unit /death. Each unit increase in SPO2 and pulse rate resulted in a considerable reduction in this risk. In addition, women with high CR, shortness of breath and per unit rise in temperature had a considerably higher chance of staying in the hospital for a longer period of time. Conclusion: The clinical and para-clinical manifestations of pregnant women with COVID-19 are different from non-pregnant women. Although there was a significant difference between the two groups due to mortality, the percentage of admission to the intensive care unit in pregnant women with COVID-19 is higher than in non-pregnant women. To avoid these adverse outcomes, pregnant women should take precautions to avoid COVID-19 infection.

Correlation of Hemoglobin Level With New Inflammatory Markers in the Emergency Department: A Retrospective Study Exploring Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte, Platelet-to-Lymphocyte, and Mean Platelet Volume-to-Platelet Count Ratios.

Background Anemia of chronic disease is known to be associated with inflammation. However, the relationship between hemoglobin (Hb) levels and potential inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume-to-platelet count ratio (MPV/PC) has not been extensively studied. The primary objective of this retrospective analytical study conducted at Al Zahraa Hospital University Medical Center (ZHUMC), Beirut, was to investigate the correlation between Hb levels andpotential inflammatory markers (NLR, MLR, PLR, MPV/PC) in patients visiting the emergency department (ED), across different genders and age groups. The secondary objectives were to compare Hb levels and inflammatory markers values between the referred medical ward group (thehospitalized patients who were admitted to the medical ward), and the non-referred to medical ward group (the patients who were discharged home from the ED), and to evaluate the predictability of inflammatory markers and Hb levels for referral to the medical ward, including the determination of optimal cutoffvalues for hospital admission to the medical ward. Methods We analyzed the blood parameters of 379 adult patients who presented to the ED with various medical complaints between September 1, 2022, and November 30, 2022 (three months). These patients were included in the study after we checked their eligibility regarding the verification of all our inclusion and exclusion criteria. Results Our findings revealed a significant negative correlation between Hb levels and PLR (r = -0.24) in both genders and across different age groups. The group referred to the medical ward exhibited lower Hb levels and higher NLR, MLR, and PLR values (P < 0.001). NLR/Hb ratio emerged as a predictive factor for admission in genitourinary (R² = 0.158; OR = 5.62) and respiratory groups (R² = 0.206; OR = 5.89), with specific cutoff values of 0.533 (Sensitivity = 57.1% & Specificity = 84.2%) and 0.276 (Sensitivity = 85% & Specificity = 51.1%), respectively. Conclusions Our study demonstrates that hemoglobin level negatively correlates with PLR. NLR, MLR, and PLR stand as important inflammatory markers. Moreover, we present the first study in the literature to show that NLR/Hb ratio can serve as a predictor for referral to the medical ward, particularly in the genitourinary and respiratory patient groups, underscoring its value in risk assessment as a prognostic marker reflecting the need for admission when the case is more serious.

Evaluation of Impact of Low Hb, MCV, MCHC and MCH on Cognitive Ability of Undergraduated Medical Students

Introduction: Low concentrations of hemoglobin or anemia can contribute chronic brain hypoxia and reduced aerobic capacity, thus increasing the risk of dementia or cognitive decline. From the clinical point of view, brain ischemia is a known risk factor of cognitive dysfunction and dementia. We investigated correlation and impact of low Hb, MCV, MCHC and MCH on cognitive abilities from 386 participants on 59 top 10 undergraduate medical students. Objective: This study aimed to determine and evaluate the correlation and impact of low Hb, MCV, MCHC and MCH on cognitive abilities of 59 top 10 undergraduated medical students in Ahmad Shah Abdali Higher Education Institute of Khost province of Afghanistan. Method and Materials: It is prospective descriptive cross sectional study, on 59 top 10 undergraduated medical students in Ahmad Shah Abdali Higher Education Institute of Khost province from 2023/ Oct / 12 to 2023/ Nov / 02. The including parameters were Hb, MCV, MCHC and MCH of all 386 participants under study that recorded in computer special format. Hb, MCV, MCHC and MCH are done by special regents and micro lab. Recorded findings processing, comparison and evaluation results have been identified by IBM SPSS-23 version. Results: The study was conducted during (20) days on 386 undergraduated medical students in Ahmad shah Abdali Higher Education Institute of Khost province. Initially we described all male participants according to age. At the current study all male participants were with (mean age: 23.14 ± 3.68; range: 20-45 years). All participants of this study were from all (1st, 2nd, 3rd, 4th, 5th and 6th) classes. Statistic description of all participants, according to Hb, MCV, MCHC and MCH shows that normal range of Hb level for male (14-16.6g/dl) was more prevalent 301(77.97). Low level of Hb for male (Low ˂ 13.5g/dl) was 19(4.92) and high level of Hb for male (High &gt; 16.6g/dl) was 66(17.09).The normal range of MCV (80-95%) was 327(84.71), low range (Low ˂80) was 54(13.98) and high range (High&gt;95%) was 5(1.29).The normal range of MCHC (32-36%) was 370(95.85), low range (Low ˂ 32) was 15(3.88) and high range (High&gt;36%) was 1(0.25).The normal range of MCH (23-31%) was 322(83.41), low range (Low ˂ 23) was 19(4.92) and high range (High&gt;31%) was 5(11.65). In the second part of this study we described all above parameters in the group of all 59 top 10 participants students for comparative outcomes. Statistic description of 59 top 10 participants, according to Age, Hb, MCV, MCHC and MCH shows that at the current study top 10 participants were with (mean age 23.40± 2.78; range: 18-32 years). Normal range of Hb level for male (14-16.6g/dl) was 43(72.88). Low level of Hb for male (Low ˂ 13.5g/dl) was 2(3.38) and high level of Hb for male (High &gt; 16.6g/dl) was 14(23.72). The normal range of MCV (80-95%) was 51(86.44), low range (Low ˂80) was 8(13.55) and high range (High&gt;95%) was 0(0). The normal range of MCHC (32-36%) was 57(96.61), low range (Low ˂ 32) was 2(3.38) and high range (High&gt;36%) was 0(0).The normal range of MCH (23-31%) was 50(84.74), low range (Low ˂ 23) was 2(3.38) and high range (High&gt;31%) was 7(11.86).Pearson correlation between Hb and MCV is at the 0.01 level significant, (P&lt;0.00). Conclusion: Overall, findings of our study indicated that, low Hb, MCV, MCHC and MCH have significant correlation with cognitive ability of undergraduated students. However, this issue needs to further investigations to confirm these findings.

Direct anterior approach with conventional instruments versus robotic posterolateral approach in elective total hip replacement for primary osteoarthritis: a case-control study.

The purpose of this study is to compare peri-operative and short-term outcomes in patients who underwent elective total hip replacement (THA) for primary osteoarthritis (OA) with direct anterior approach (DAA) versus a pair-matched cohort of patients who underwent robotic-assisted THA with posterolateral approach. Data from consecutive patients who underwent elective hip replacement from 2021 to 2023 for primary OA were retrospectively retrieved and divided into two groups: the DAA group, who underwent THA with the DAA approach using conventional instruments, and the robotic posterolateral (R-PL group), who underwent robot arm-assisted THA with the posterolateral approach. Comparative assessed outcomes were: operative time, radiographical implant positioning, intake of rescue analgesics, blood loss, transfusion rate, leg length discrepancy and functional outcomes (Harris hip score and forgotten joint score). A total of 100 pair-matched patients were retrieved with a mean age of 66.7 ± 10.7 (range: 32-85) years and a mean follow-up of 12.8 ± 3.6 (range: 7-24) months. No differences in patients' characteristics were detected. Patients in the R-PL group required less rescue tramadol (p > 0.001), ketorolac (p = 0.028) and acetaminophen (p < 0.001). There was no significant difference in the operative time between (MD = 5.0min; p = 0.071). Patients in the DAA group had significantly lower Hb levels at day 1 (p = 0.002) without significant differences in transfusion rate (p = 0.283). Patients in the R-PL group had shorter length of stay (LOS) with a mean difference of 1.8days [p < 0.001; 95% confidence interval (CI) 1.4-2.3]. No difference in clinical outcomes was found [leg length discrepancy (LLD), p = 0.572; HHS, p = 0.558; forgotten joint score (FJS), p = 0.629]. No radiographical differences were measured in cup inclination (MD = 2.0°, p = 0.069), malpositioning [odd ratio (OR) = 0.2; p = 0.141], stem alignment (OR = 0.3; p = 0.485) and stem sizing (OR = 1.5; p = 1.000). There was no difference in complication rate except for lateral femoral cutaneous nerve damage, which was higher in DAA group (p < 0.001). R-PL and DAA THA had comparable short-term clinical and radiological outcomes along with similar complication rates. The R-PL group showed significantly lower Hb drop, rescue analgesic consumption and shorter LOS. This is a preliminary study and no strong recommendation can be provided. Further prospective randomized trials are requested to further investigate the cost-effectiveness of robotic surgery in THA. Level IV, case-control study.

A retrospective cohort study of clinical characteristics and outcomes of type 2 diabetic patients with kidney disease.

Type 2 diabetes mellitus (T2DM) with chronic kidney disease (CKD) poses a serious health threat and becomes a new challenge. T2DM patients with CKD fall into three categories, diabetic nephropathy (DN), non-diabetic kidney disease (NDKD), and diabetic nephropathy plus non-diabetic kidney disease (DN + NDKD), according to kidney biopsy. The purpose of our study was to compare the clinical characteristics and kidney outcomes of DN, NDKD, and DN + NDKD patients. Data on clinical characteristics, pathological findings, and prognosis were collected from June 2016 to July 2022 in patients with previously diagnosed T2DM and confirmed DN and or NDKD by kidney biopsy at Tongji Hospital in Wuhan, China. The endpoint was defined as kidney transplantation, dialysis, or a twofold increase in serum creatinine. In our 6-year retrospective cohort research, a total of 268 diabetic patients were admitted and categorized into three groups by kidney biopsy. The 268 patients were assigned to DN (n=74), NDKD (n=109), and DN + NDKD (n=85) groups. The most frequent NDKD was membranous nephropathy (MN) (n=45,41.28%). Hypertensive nephropathy was the most common subtype in the DN+NDKD group (n=34,40%). A total of 34 patients (12.7%) reached the endpoint. The difference between the Kaplan-Meier survival curves of the DN, NDKD, and DN + NDKD groups was significant (p<0.05). Multifactorial analysis showed that increased SBP [HR (95% CI): 1.018(1.002-1.035), p=0.025], lower Hb [HR(95% CI): 0.979(0.961-0.997), p=0.023], higher glycosylated hemoglobin [HR(95% CI): 1.338(1.080-1.658), p=0.008] and reduced serum ALB [HR(95% CI): 0.952(0.910-0.996), p=0.032] were risk factors for outcomes in the T2DM patients with CKD. This research based on a Chinese cohort demonstrated that the risk of endpoint events differed among DN, NDKD, and DN+NDKD patients. In T2DM patients with CKD, DN patients displayed worse kidney prognosis than those with NDKD or DN + NDKD. Increased SBP, higher glycosylated hemoglobin, lower Hb, and decreased serum ALB may be correlated with adverse kidney outcomes in T2DM patients.

The medium-term impact of a micronutrient powder intervention on anemia among young children in Rural China

BackgroundPoor development of young children is a common issue in developing countries and it is well established that iron deficiency anemia is one of the risk factors. Research has shown that iron deficiency is a common micronutrient deficiency among children in rural China and can result in anemia. A previous paper using data from the same trial as those used in the current study, but conducted when sample children were younger, found that after 6 months of providing caregivers of children 6–11 months of age free access to iron-rich micronutrient powder (MNP) increased the hemoglobin concentrations (Hb) of their children. However, no effects were found 12 and 18 months after the intervention. The current study followed up the children four years after the start of the original intervention (when the children were 4–5 years old) and aims to assess the medium-term impacts of the MNP program on the nutritional status of the sample pre-school-aged children, including their levels of Hb, the prevalence of anemia, and the dietary diversity of the diets of the children.MethodsAt baseline, this study sampled 1,802 children aged 6–11 months in rural Western China. The intervention lasted 18 months. In this medium-term follow-up study that successfully followed 81% (n = 1,464) of children (aged 49–65 months) from the original study population 4 years after the start of the intervention, we used both intention-to-treat (ITT) effect and average treatment on the treated effect (ATT) analyses to assess the medium-term impacts of the MNP distribution program on the nutritional status of sample children.ResultsThe ITT analysis shows that the MNP intervention decreased the prevalence of anemia of young children in the medium run by 8% (4 percentage points, p < 0.1). The ATT analysis shows that consuming 100 (out of 540) MNP sachets during the initial intervention led to a decrease in anemia of 4% (2 percentage points, p < 0.1). Among children with moderate anemia at baseline (Hb < 100 g/L), the intervention reduced the probability of anemia by 45% (9 percentage points, p < 0.1), and, for those families that complied by consuming 100 (out of 540) sachets, a 25% (5 percentage points, p < 0.05) reduction in the anemia rate was found. The MNP intervention also led to a persistent increase in dietary diversity among children that were moderately anemic at baseline. The results from the quantile treatment effect analysis demonstrated that children with lower Hb levels at baseline benefited relatively more from the MNP intervention.ConclusionsThe findings of the current study reveal that the MNP intervention has medium-term effects on the nutritional status of children in rural China. The impacts of the MNP program were relatively higher for children that initially had more severe anemia levels. Hence, the implications of this study are that programs that aim to increase caregiver knowledge of nutrition and improve their feeding practices should be encouraged across rural China. Families, policymakers, and China’s society overall need to continue to pay more attention to problems of childhood anemia in rural areas. This is particularly crucial for families with moderately anemic children at an early age as it can significantly contribute to improving the anemia status of children across rural areas of China.Trial registrationISRCTN44149146 (15/04/2013).

IMPACT OF GESTATIONAL DIABETES MELLITUS ON HEMATOLOGICAL PARAMETERS, LIVER FUNCTION, RENAL FUNCTION, AND LIPID PROFILE IN ANTENATAL WOMEN AT A TERTIARY CARE HOSPITAL

Objective: Gestational diabetes mellitus (GDM) is a condition in which glucose intolerance is first recognized during pregnancy. It affects a substantial percentage of pregnancies globally, with a significant prevalence in India. Iron supplementation is often recommended to prevent anemia, but caution is advised in GDM due to the potential inflammatory effects. Elevated hemoglobin (Hb) levels, associated with excess iron, may increase the risk of GDM. This study aims to investigate the differences in Hb and various other blood parameters between controlled and uncontrolled GDM mothers attending antenatal OPD for a regular check-up. Methods: This cross-sectional study was conducted among 100 women diagnosed with GDM at a tertiary care hospital in Western Tamil Nadu after obtaining ethical clearance and informed consent from the participants. Routine blood investigations, like a complete hemogram, HbA1C, renal and liver function tests, and lipid profiles, were recorded. Participants were categorized based on HbA1C values (&lt;6.5 as normal, &gt;6.5 as abnormal). Differences in blood parameters between the two groups were statistically analyzed. Results: The study found no significant differences in age, weight, height, or BMI between the controlled and uncontrolled GDM groups. Mean HbA1c levels were 5.58±0.41 and 6.98±1.23 in controlled and uncontrolled GDM groups, respectively. Comparing hematological parameters, the controlled GDM group exhibited higher mean red blood cell (RBC) levels (4.6±0.69 vs. 4.12±0.92) but lower Hb levels (12.25±2.26 vs. 11.01±3.59) than the uncontrolled GDM group. There were no significant differences in platelet, lymphocyte, and MCH levels. Urea, triglycerides, and globulin levels were higher in the uncontrolled GDM group, but all values remained within normal limits. Conclusion: Elevated Hb levels were associated with uncontrolled GDM, indicating a potential risk factor. The study underscores the importance of monitoring iron levels in GDM patients. In addition, heightened white blood cell counts and altered hematological parameters suggest an inflammatory component in uncontrolled GDM. Further research is warranted to explore these associations and their clinical implications for managing GDM effectively.

Abstract TMP10: Children With Sickle Cell Anemia Have Impaired Cerebrovascular Reactivity

Introduction: Sickle Cell Anemia (SCA) causes lower hemoglobin, leading to increased cerebral blood flow (CBF) to maintain cerebral oxygen metabolism (CMRO 2 ). Although CBF rises in childhood to meet higher CMRO 2 demands, further compensatory increases in CBF in children with SCA may tap into a limited hemodynamic reserve, increasing risk for infarct. Cerebrovascular reactivity (CVR) reflects hemodynamic reserve by measuring the vasculature’s response to vasoactive stimuli, particularly in the gray matter (GM). We hypothesized that children with SCA have lower GM CVR, regardless of CMRO 2 . Methods: We used magnetic resonance imaging of children with and without SCA to collect pseudocontinuous arterial spin labeling (pCASL) for CBF, asymmetric spin echo for oxygen extraction fraction (OEF) and blood oxygen level dependent (BOLD) data correlated with hypercapnic challenges for CVR. Lab draws confirmed Hemoglobin (Hb) values. CMRO 2 was calculated as CBF x OEF x Arterial Oxygen Content (1.36 x Hb x SpO 2 ). Continuous variable differences between groups were analyzed using the Mann-Whitney U test, and categorical variables using the Fisher’s exact test. Linear regression assessed the relationship between CVR and Hb. Reported significant relationships survived multiple comparisons correction. Results: A total of 35 participants, ages 8–22 years had quality CVR data [9 SCA subjects (5 male) and 26 controls (9 male)]. Of these, 8 SCA and 20 controls had adequate quality metabolic data. The groups are matched by age (p=0.56) and sex (p=0.43). Children with SCA had higher GM CBF (62.0 v 49.3 mL/100g/min; p=0.03), but similar GM CMRO 2 (1.81 v 1.42 mL/100g/min; p=0.07) than controls. GM CVR was significantly lower in SCA than controls (0.17 v 0.27 %/mmHg; p=0.0003). Lower CVR was associated with lower Hb (Figure) after adjusting for age and sex (p &lt;0.0001). Conclusion: Lower GM CVR in children with SCA indicates a lower hemodynamic reserve, likely related to the degree of anemia.

Identification of patients with metastatic urothelial cancer not able to receive maintenance avelumab.

702 Background: Maintenance avelumab following frontline platinum-based chemotherapy for metastatic urothelial cancer (mUC) is associated with survival benefit. Eligibility to receive avelumab maintenance requires receiving 4-6 cycles chemotherapy without disease progression. Not all patients complete 6 cycles of chemotherapy or meet eligibility to receive avelumab and these patients may need to have alternative therapies. Here we present real world data to assess whether baseline characteristics can be used to identify patients unable to complete 6 cycles of chemotherapy and whom may not be eligible for maintenance avelumab. Methods: This retrospective audit was performed at Barts Cancer Centre for consecutive patients from January 2010 until August 2023. Patients who received frontline gemcitabine and cisplatin/carboplatin chemotherapy for advanced mUC were included. Eligibility for avelumab is defined as completing 4-6 cycles of chemotherapy without disease progression (PD). Characteristics of patients completing 6 cycles of chemotherapy, versus those who do not were described. Chi-squared tests were conducted to compare characteristic between the two groups, using SPSS v28. Results: 265 patients receiving frontline systemic therapy were identified over a 13-year period. 242 (91%) received Gem/Cis or Gem/Carbo chemotherapy. 151 (63%) patients were eligible to receive maintenance avelumab. 91 (38%) patients were not eligible due to receiving less than 4 cycles chemotherapy (68%) or due to PD (75%), or both. 91 (38%) patients completed 6 cycles of chemotherapy. Having a low baseline Hb &lt;100g/dl was the only baseline characteristic associated with receiving less than 6 cycles chemotherapy (p=0.002). 33% of patients who completed less than 6 cycles chemotherapy had a Hb &lt;100g/dl, compared to 10% of the patients who completed chemotherapy (p=0.002). Any dose delays was associated with a lower likelihood of being eligible to receive avelumab (32% and 18% dose delays in avelumab eligible vs ineligible cohorts, respectively (p&lt;0.001). Patients with any dose delays had more frequently received carboplatin (65% vs 39%, p=0.012) and had visceral metastases including liver metastases (63% vs 39%, p=0.014), compared to those without dose delays. Conclusions: Specific baseline factors predispose to an inability to deliver 6 cycles of chemotherapy without complications or progression. These patients are less likely to receive maintenance avelumab. These data help the optimise number of cycles offered to patients in mUC.

A Comparison of Clinical, Demographic and Treatment Characteristics of Pediatric-Onset and Adult-Onset Patients Diagnosed With Localized Scleroderma.

Morphea localized scleroderma (LS) is a rare skin disease with unknown pathogenesis, which causes sclerosis of the dermis and subcutaneous tissue. It was aimed to compare the characteristics of patients with pediatric and adult-onset morphea. A retrospective analysis was performed on the records of 183 adult morphea patients. The demographics, clinical and laboratory characteristics, and treatment options of the patients were recorded. Adult patients with morphea over the age of 18 were divided into two groups according to the age of onset and compared. Twenty-two percent (N = 41) of the patients had pediatric-onset morphea (POLS) and 77.6% (n=142) had adult-onset morphea (AOLS). While POLS had a higher head-neck involvement, AOLS had a higher breast involvement (P < 0.001 and P = 0.043). Patients with linear morphea were younger, and more frequently had at least one laboratory anomaly (P = 0.016 versus 0.024). Anti-dsDNA positivity and low hemoglobin (Hb) were observed more frequently in patients with breast involvement. Patients with inguinal involvement, on the other hand, had lower Hb and a higher rate of diabetes, and those patients were older (P = 0.042, 0.040, and 0.012, respectively). Clinical characteristics and accompanying laboratory anomalies of the patients with morphea depend on the age of onset, involvement areas and the types of morphea, having such data readily available should guide the holistic approach for, and the monitoring process of, the disease.

The effectiveness of oral bovine lactoferrin compared to iron supplementation in patients with a low hemoglobin profile: A systematic review and meta-analysis of randomized clinical trials

BackgroundPatients with a low serum blood hemoglobin concentration suffer from a pathologic state that contributes significantly to morbidity and mortality figures worldwide. Oral iron supplementation, the most common method of treatment, is reported to have poor patient adherence, due to its unwanted side effects. Lactoferrin is a globular glycoprotein of the transferrin family that has shown promising results in patients with a low hemoglobin profile. This systematic review and meta-analysis of randomized clinical trials explore its effect on blood hemoglobin compared to conventional iron preparations.MethodsWe followed the PRISMA Guidelines for reporting systematic reviews and meta-analyses. A systematic search was conducted in electronic databases (PubMed, CINAHL, Scopus, and Cochrane) from inception to June 2022. Meta-analysis was performed on studies where the primary outcome was the mean Hb concentration, comparing lactoferrin to ferrous sulfate subgroups. We assessed the methodological quality of the trials using the Jadad scoring scale.ResultsNineteen trials published between 2006 and 2022 met the eligibility criteria. It has been found that the levels of Hb concentration in different populations with varying health conditions undergo a moderate to significant change after treatment with all types of trialed interventions, including both iron and lactoferrin treatment, in both the intervention group and the comparison group. Most of the studies report that LF showed a statistically significant increase in Hb concentration levels, compared to those in the iron group. The meta-analysis included seven trials comparing the effectiveness of lactoferrin to ferrous sulfate for patients with low Hb concentration. The analysis showed a statistically significant increase in Hb levels in the oral bovine lactoferrin group compared to ferrous sulfate (SMD -0.81, 95% CI: -1.21, -0.42, p < 0.0001, I2 = 95.8%, P heterogeneity < 0.001).ConclusionsLactoferrin is an effective intervention at doses of 100–250 ng/day, for patients with a low Hb concentration. As a safer option and with high compliance evidence, lactoferrin can serve as an iron replacement treatment for patients who may be experiencing adverse side effects due to iron intake.

The risk factors and predictive modeling of mortality in patients with mental disorders combined with severe pneumonia.

We explored clinical characteristics and risk factors for mortality in patients with mental disorders combined with severe pneumonia and developed predictive models. We retrospectively analyzed the data of 161 patients with mental disorders combined with severe pneumonia in the intensive care unit (ICU) of a psychiatric hospital from May 2020 to February 2023, and divided them into two groups according to whether they died or not, and analyzed their basic characteristics, laboratory results and treatments, etc. We analyzed the risk factors of patients' deaths using logistics regression, established a prediction model, and drew a dynamic nomogram based on the results of the regression analysis. Based on the results of regression analysis, a prediction model was established and a dynamic nomogram was drawn. The non-survivor group and the survivor group of patients with mental disorders combined with severe pneumonia were statistically different in terms of age, type of primary mental illness, whether or not they were intubated, whether or not they had been bedridden for a long period in the past, and the Montreal Cognitive Assessment (MoCA) scale, procalcitonin (PCT), albumin (ALB), hemoglobin (Hb), etc. Logistics regression analysis revealed the following: MoCA scale (OR = 0.932, 95% CI:0.872-0.997), age (OR = 1.077, 95%CI:1.029-1.128), PCT (OR = 1.078, 95% CI:10.006-10.155), ALB (OR = 0.971, 95%CI:0.893-1.056), Hb (OR = 0.971, 95% CI: 0.942-0.986) were statistically significant. The ROC curve showed that the model predicted patient death with an area under the curve (AUC) of 0.827 with a sensitivity of 73.4% and a specificity of 80.4%. Low MoCA score, age, PCT, and low Hb are independent risk factors for death in patients with mental disorders with severe pneumonia, and the prediction model constructed using these factors showed good predictive efficacy.

Association between low selenoprotein P concentrations and anaemia in hospitalized heart failure patients.

Heart failure (HF) patients with anaemia tend to have a worse outcome, with increased hospitalization rates, decreased exercise tolerance, and higher mortality compared to those without anaemia. Limited research exists on the association between selenium deficiency and anaemia specifically in HF patients, despite previous findings of a correlation in different populations. The BIOSTAT-CHF study demonstrated that higher selenium levels in HF patients were associated to a lower risk of anaemia and iron deficiency. This study investigates the relationship between selenoprotein P (SELENOP) concentrations, a major contributor and functional biomarker of selenium transport, and anaemia, Hb levels, and iron status in hospitalized HF patients. SELENOP was analysed in 320 hospitalized HF subjects, with complete data available for 310 subjects. The relationships between continuous SELENOP concentrations and 1) Hb concentrations, 2) anaemia (Hb<115g/L (women), <130g/L (men)), and 3) iron status (as measured by transferrin receptor 1 (TfR1) which increases in iron deficiency) were evaluated using multivariable logistic and linear regression models. Additionally, SELENOP concentrations in the lowest quartile were related to anaemia, haemoglobin, and iron state in multivariable logistic and linear models. The mean age of the study population was 75.0±11.6years, and 30% were women. Anaemia was present in 133 subjects (42.9%). SELENOP concentrations were positively correlated with haemoglobin concentrations (0.238; P<0.001) and negatively with TfR1 concentrations (-0.238, P<0.001). In multivariable regression models, higher SELENOP concentrations were associated with higher Hb concentrations (B=3.23; P=0.002) and lower TfR1 concentrations (B=-0.20; P<0.001). Furthermore, SELENOP deficiency was associated with lower Hb concentrations (B=-7.64: P=0.001), higher TfR1 concentrations (B=0.31; P=0.003), and higher odds of anaemia in HF patients (odds ratio 2.17; 95% confidence interval 1.23-3.82; P=0.008). In hospitalized heart failure patients, lower concentrations of SELENOP were associated with higher prevalence of anaemia.

Hepatobiliary complications in children with sickle cell disease; retrospective single-center study

Objective: This study aimed to determine how common hepatobiliary complications were in children with sickle cell disease (SCD). Methods: This was a retrospective descriptive study conducted at a single tertiary health care center, King Saud Medical City (KSMC), Pediatric Hospital, Riyadh from April 2023 to April 2024. Patient recruitment was done by reviewing the medical records. All pediatric patient cases under 14 years, with SCD in both genders were included without specifying any race or ethnic characteristic. Results: A total of 143 patient cases with SCD were included from the hospital database. More than half of them were males. Hepatobiliary complications were observed in 19.5% of patients with SCD, cholelithiasis occurred in 26 (18.2%), cholangiopathy (bile duct stenosis) occurred in 3 (2.1%) and only one patient had acute hepatic sequestration (AHS). Biliary complication (cholelithiasis) was significantly associated with age and raised alanine aminotransferase (ALT) (p-value 0.042). Raised ALT was associated significantly with age, hemoglobin (Hb) level, and AHS. Total bilirubin &amp;gt; 2 mg/dl (&amp;gt; 34 micro mol/L) and direct bilirubin &amp;gt; 1 mg/dl (&amp;gt; 17 micro mol/L) were observed in 26.9% and 61.5% of patients who had cholelithiasis respectively, low Hb in 46.2% and low platelet in 30.8%. Conclusion: Hepatobiliary complications were observed in less than one-fifth of patients with SCD. The most common complication observed was cholelithiasis, rare complications were cholangiopathy and AHS.

Causes and management of Pica disorder among central Iraqi peoples.

Aim: To find the causes and factors behind the Pica disorder, which helps in early diagnosis and appropriate treatments.. Materials and Methods: A retrospective cross-section study was carried out between July 1, 2022, and April 20, 2023, enrolling 300 patients from different provinces of central and south Iraq with Pica disease whose diagnosis depended on specialized physicians according to WHO guidelines. The participants were following up for three to six months in private clinics. Results: 92.4% of the patients were female, and 41% of patients were under 20 years old, with low ferritin, HB, and vitamin D levels (80% of cases), and these markers showed a negative correlation with the number of Pica. Chowing of ice and clay were the common types of Pica, which represent about 30% each, while 34% of cases had multiple types, which had signs and symptoms of fever, palpitation, vomiting, abdominal pain, paleness, headaches, and hair loss. Six-month flows were better than three months. Conclusions: Pica was a disorder that could lead to behavior and emotional abnormalities that caused the patients to eat some things that were eaten by healthy people. This may be, as concluded from our results, due to reduced levels of ferritin, hemoglobin (Hb), and vitamin D that caused these psychological problems.

Malaria parasitaemia and its impact on biological parameters among children

Malaria remains a major public health problem in children in endemic areas. This study aimed to determine its prevalence, intensity, and assess how biological parameters like RBC count, haemoglobin, haematocrit, glycaemia, platelet count and WBC count vary with respect to parasitaemia in children <16 years attending the Nkwen District Hospital, northwest Cameroon. The study was a hospital-based cross-sectional study conducted between March-May 2023. Structured, closed-ended questionnaires were administered to obtain information. Patients' temperature was measured using an infrared forehead digital thermometer. Malaria was diagnosed by RDT and positive samples Giemsa-stained for parasitaemia. Full blood count was performed using a haemolyser and glycaemia measured using a glucometer. In total, 321 children were examined. Overall prevalence of malaria (all P. falciparum) was 22.7% (73/321), with 24.7% (18/73), 34.2% (25/73) and 41.1% (30/73) having low, moderate and high parasitaemias, respectively. Overall GMPD was 2.670.8±179.9/μL; children aged 6-10 years were hit hardest (5.377.7 ± 3.2/μL). Malaria-positive children had significantly lower RBC count, Hb concentration, Hct, blood sugar, WBC and platelet counts (p<0.05) compared to those that were negative. Among positive children, RBC count, Hct, Hb, lymphocyte and platelet count each showed a significant (p<0.05) decrease while total WBC and granulocyte count each showed a significant (p<0.05) increase with increasing levels of parasitaemia. Changes in biological parameters during malaria are sensitive but poor specific indicators of malaria because they may overlap with symptoms of other infections. More attention should be given to children aged 6-10 years during strategic planning and design of malaria control programmes.

Management of Delayed Hemolytic Transfusion Reaction in a Patient with Sickle Cell Disease: A Case Report

Background: Sickle cell disease (SCD) is a group of inherited blood disorders characterized by abnormalities in hemoglobin (Hb), leading to distortion in shape of red blood cells (RBCs) and their breakdown, potentially blocking blood flow and resulting in pain and anemia. This can significantly impact the patient’s quality of life. Patients often require multiple blood transfusions to prevent complications associated with SCD by reducing the concentration of damaged hemoglobin. However, one of the significant complications of blood transfusions is Delayed Hemolytic Transfusion Reaction (DHTR), which occurs due to RBC alloimmunization (i.e., formation of antibodies against donor RBC antigens). DHTR can manifest as a sudden decrease in hemoglobin levels, which may progress to rapid multiorgan failure and death. Thus, prompt diagnosis is crucial for timely management. This case report highlights the diagnosis and management of a 56-year-old African American female with SCD who presented with bilateral severe knee pain and low Hb levels. Case Presentation: The patient’s symptoms, past medical history, and investigation findings led to a diagnosis of DHTR. Management was conducted within the framework of Bloodless Medicine, incorporating strategies to minimize blood loss and optimize erythropoiesis. Treatment included the use of erythropoietin (EPO) to manage hemoglobin levels and the administration of opioids and supplemental oxygen for symptom relief. Conclusion: Our case report highlights the challenges and various management strategies employed in treating DHTR in SCD patients. It emphasizes the importance of early recognition of the complication and compares the risks and benefits of additional blood transfusions in such patients. By presenting this case, we aim to contribute to the growing literature on DHTR in SCD patients and highlight the need for further research and optimized management strategies in this population.

Compliance and Lifestyle of Children with Celiac Disease in the Iranian Children.

Celiac disease is popular and needs a proper and constant gluten-free diet. However, data on the experience of the disease by children are insufficient. A few children have difficulty adjusting their lifestyles, and gluten-free foods are difficult for them. The present study aimed to find influential factors in the growth disorders and nonresponse to the treatment diet in celiac patients. We gave a list of all children with celiac disease to the project manager and according to the criteria extracted additional information from their files. Duodenal biopsies on 382 patients with suspected celiac disease and 93 patients with positive pathology were included in the study, regardless of antibody and genetic titer, then analyzed their information using appropriate statistical tests. The mean age of individuals was 9.48 ± 3.88, and 35 were male and 58 female. At the age of <5, there was more growth disorder than other age groups. The recovery percentage in short stature was significantly better in children with higher marches, and they responded better to the treatment regimen. Individuals with comorbidities had higher anti-tTG and lower Hb levels, higher incidence of growth disorder, did not respond to the treatment regimen. Those with a first-degree relative with celiac disease had a lower growth disorder than others. Identifying and correcting nutritional disorders in patients with celiac disease need to evaluate persistent symptoms and identify their causes to plan appropriate treatment and follow-up of patients with celiac disease step by step and continuously.

Linking D-Dimer and haematological parameters among Indian COVID 19 patients.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak continues to place a significant strain on healthcare systems, economies, and patient management. Therefore, it is of interest to evaluate the role of D-Dimer and haematological parameters to identify severity and outcome of COVID 19 patients. Total 100 cases diagnosed with COVID 19 were recruited in the study and followed up for 6 months. The subjects were grouped into 2, Group 1: Newly Diagnosed COVID 19 Patients and Group 2: After 6 months of follow up COVID 19 Patients. We analyzed Hb, RBCs, WBCs, PT, APTT and D-Dimer and also, we taken CT values of the study subjects. A statistical analysis was done by using SPSS version 20.0. The WBCs and haemoglobin mean values are shown significant values between the study subjects, respectively with p-values < 0.001**. The PT and APTT significantly increased in newly diagnosed COVID 19 patients when compared to after 6 months of follow up at p-value < 0.001**. There was a positive correlation of WBCs, PT, APTT (r= 0.458, 526, 509) with D-Dimer and negatively correlated RBCS, Hb, CT (-0.056, 321, 526, 353), respectively at p < 0.001**. Thus, low platelet, high d-dimer, and fibrinogen may serve as risk markers for the progression of COVID-19 severity. Hence, COVID-19 patients may experience anaemia-related consequences as hypoxia, coronary and pulmonary failure due to low Hb concentration. Further, patients with COVID-19 also experience bleeding issues due to thrombocytopenia.