Mean Hb Values Research Articles

“Comparative evaluation of cytotoxicity of three herbal endodontic irrigants at three intervals of time” – An in vitro study

Aim: The aim of the study was to evaluate and compare the cytotoxicity of 25% of neem leaf extract (Azadirachta indica), 20% of guava leaf extracts (Psidium guajava), and 20% of cinnamon extract (Cinnamomum zeylanicum) irrigants at three intervals of time. Methodology: Four groups were formed (n = 15), Group 1 (control group) – normal saline solution, Group 2 – 25% of neem extract, Group 3 – 20% of guava extract, and Group 4 – 20% of cinnamon extract. Each group was further divided into three subgroups based on intervals (n = 5). Subgroup A – at 10 min, Subgroup B – at 20 min, and Subgroup C – at 30 min. One hundred microliters of each irrigant was added to 2 mL of the diluted red blood cells suspension obtained from a human volunteer. Hemoglobin (Hb) estimation was done with an automated hematology analyzer after incubating the test samples at 10, 20, and 30 min intervals. Results: The reduction in the mean Hb values was not statistically significant in the normal saline, guava, and cinnamon groups. However, in the neem extract group, the mean Hb values reduced significantly at P < 0.001. Among the subgroups, Subgroup A (10 min) showed the least cytotoxicity. Conclusion: In the present study, 20% guava extract had the lowest cytotoxicity and cytotoxicity increased with time. Hence, 20% guava extract can be used as an alternative to conventional irrigants as it has been shown to have the least cytotoxicity.

Haemoglobin values, transfusion practices, and long-term outcomes in critically ill patients with traumatic brain injury: a secondary analysis of CENTER-TBI

Haemoglobin (Hb) thresholds and red blood cells (RBC) transfusion strategies in traumatic brain injury (TBI) are controversial. Our objective was to assess the association of Hb values with long-term outcomes in critically ill TBI patients. We conducted a secondary analysis of CENTER-TBI, a large multicentre, prospective, observational study of European TBI patients. All patients admitted to the Intensive Care Unit (ICU) with available haemoglobin data on admission and during the first week were included. During the first seven days, daily lowest haemoglobin values were considered either a continous variable or categorised as < 7.5 g/dL, between 7.5–9.5 and > 9.5 g/dL. Anaemia was defined as haemoglobin value < 9.5 g/dL. Transfusion practices were described as “restrictive” or “liberal” based on haemoglobin values before transfusion (e.g. < 7.5 g/dL or 7.5–9.5 g/dL). Our primary outcome was the Glasgow outcome scale extended (GOSE) at six months, defined as being unfavourable when < 5. Of 1590 included, 1231 had haemoglobin values available on admission. A mean Injury Severity Score (ISS) of 33 (SD 16), isolated TBI in 502 (40.7%) and a mean Hb value at ICU admission of 12.6 (SD 2.2) g/dL was observed. 121 (9.8%) patients had Hb < 9.5 g/dL, of whom 15 (1.2%) had Hb < 7.5 g/dL. 292 (18.4%) received at least one RBC transfusion with a median haemoglobin value before transfusion of 8.4 (IQR 7.7–8.5) g/dL. Considerable heterogeneity regarding threshold transfusion was observed among centres. In the multivariable logistic regression analysis, the increase of haemoglobin value was independently associated with the decrease in the occurrence of unfavourable neurological outcomes (OR 0.78; 95% CI 0.70–0.87). Congruous results were observed in patients with the lowest haemoglobin values within the first 7 days < 7.5 g/dL (OR 2.09; 95% CI 1.15–3.81) and those between 7.5 and 9.5 g/dL (OR 1.61; 95% CI 1.07–2.42) compared to haemoglobin values > 9.5 g/dL. Results were consistent when considering mortality at 6 months as an outcome. The increase of hemoglobin value was associated with the decrease of mortality (OR 0.88; 95% CI 0.76–1.00); haemoglobin values less than 7.5 g/dL was associated with an increase of mortality (OR 3.21; 95% CI 1.59–6.49). Anaemia was independently associated with long-term unfavourable neurological outcomes and mortality in critically ill TBI patients.Trial registration: CENTER-TBI is registered at ClinicalTrials.gov, NCT02210221, last update 2022–11–07.

Comparison of indirect cyanmethaemoglobin method and TrueHb haemometer point of care test with direct cyanmethaemoglobin (gold standard) method for strengthening anaemia detection at primary health care level

ABSTRACT Introduction: The most reliable indicator for anaemia diagnosis at the population level is haemoglobin (Hb) estimation. The direct cyanmethaemoglobin method is considered the gold standard method for haemoglobin estimation. However, for resource constraint areas like primary health care (PHC) level, either blood samples are transported on filter paper for Hb testing (indirect cyanmethaemoglobin method) in laboratory or point of care testing is commonly used. Therefore, a comparative analysis of haemoglobin estimation of direct with indirect cyanmethaemoglobin method and also with TrueHb (Wrig Nanosystems Pvt. Ltd.) haemometer was done to strengthen anaemia diagnosis at the PHC level. Materials and Methods: This was a cross-sectional study. A total of 90 participants above 9 years of age, who visited the outpatient department (OPD) of health centre, Kheri and gave consent were included. Comparative analysis was done between Hb concentration assessed by indirect cyanmethaemoglobin method and TrueHb haemometer device against the gold standard method. Results: The mean Hb value estimated by direct method, TrueHb haemometer and indirect methods (filter paper A, B and C) was 11.42 ± 1.59 g/dl, 11.52 ± 1.54 g/dl, 10.66 ± 1.52 g/dl, 9.84 ± 1.50 g/dl and 10.19 ± 1.62 g/dl, respectively. There was no significant difference found between the mean Hb concentration estimated by the direct method and the TrueHb haemometer device. However, there was a significant difference in mean Hb values between the direct method and the indirect method. Therefore, regression analysis was done to estimate the correction factor for the indirect method. Conclusion: TrueHb metre device gave promising results in comparison to the gold standard method and can be used if resource permits in PHC centres. Indirect methods of haemoglobin estimation can be an alternative in resource-constraint settings, specifically for surveys. However, further studies are required for the validation of the indirect method.

Evaluation of Iron Status in Children Presenting with Febrile Seizure in a Tertiary Health-care Facility

Abstract Introduction: The aim of this study was to investigate the relationship between iron deficiency anemia (IDA) and febrile seizures (FS) in children. Materials and Methods: The study included 100 cases of FS in children between the ages of 6 and 60 months, including both simple and complex FS. Children in the same age range who had a fever but no seizures made up the control group. The various hematological parameters reflecting the iron status, including hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red-cell distribution width (RDW), serum ferritin, and total iron-binding capacity (TIBC), were evaluated in both groups to ascertain the relationship between the iron status and the FS. Results: Male-female ratio in children with and without FS were 1.2:1 and 1.3:1, with a mean age of 25.16 ± 11.75 and 24.37 ± 11.75 months, respectively. Age and gender distribution were comparable between the two groups (P = 0.719 and P = 0.851, respectively). The mean values for Hb, MCV, MCHC, RDW, ferritin, and TIBC among children who had FS were 11.030.98 g/dL, 66.1810.97 fl, 32.421.38 pg/L, 14.881.13, 46.5432.64 ng/mL, and 419.7672.49 g/dL, respectively. In contrast, the readings for the control group’s children were 11.91 0.78, 67.94 11.06 fl, 32.80 0.60 pg/L, 14.16 1.01, 59.20 27.52 ng/mL, and 378.65 60.87 g/dL, respectively. Except for the mean MCV, each of these variances was statistically significant. Conclusions: Our results suggest that IDA is a major risk factor for FS since it was more common in the case group than in the control group.

Performance analysis of point-of-care testing haemoglobin concentration methods with automated haematology analyser amongst blood donors

Abstract Background: In terms of rapidness, testing methodology and sensitivity, point-of-care (POC) testing devices provide quality in haemoglobin (Hb) check for safe donation of blood. Methods: This was a prospective observational study in a tertiary care centre. Capillary finger-prick samples obtained from 100 blood donors were analysed prior to donation using reagent-free cuvettes (DiaSpect Tm), digital haemoglobinometer (True Hb) and Hb photometer (HemoCue 301). Venous samples were drawn for analysis on haematology analyser. Donors were accepted based on copper sulphate method acceptance criteria. The performance of the devices was evaluated considering automated haematology analyser (Sysmex XN 1000) as the gold standard. Results: The mean Hb value using Sysmex XN 1000, HemoCue 301, DiaSpect Tm and True Hb were 14.8 ± 1.1 g/dL, 15.4 ± 1.8 g/dL, 15.3 ± 1.8 g/dL and 18.6 ± 2.8 g/dL, respectively. The sensitivity of True Hb, DiaSpect Tm, HemoCue 301 and copper sulphate method were 96.8%, 96.8%, 3.7% and 98.9%, respectively. DiaSpect Tm had a specificity of 60% whereas specificity of True Hb and copper sulphate method were 20% each. True Hb, HemoCue 301, DiaSpect Tm and copper sulphate had a positive predictive value of 95.8%, 94.7%, 97.9% and 95.9% and accuracy of 93%, 89%, 95% and 95%, respectively. The mean turnaround time was 1 sec for DiaSpect Tm whereas 35.3 sec and 2.6 sec for True Hb and HemoCue 301, respectively. The copper sulphate test provided the highest rate of donor’s acceptance, despite unacceptable Hb levels. Conclusions: DiaSpect Tm has the advantage of rapid turnaround time, high specificity and accuracy when compared to gold standard method.

Evaluation of Haemato-biochemical Effects of Tiletamine-zolazepam Alone and in Combination with Xylazine or Xylazine-ketamine in Atropinized Dogs

Background: Tiletamine-zolazepam is a good injectable anaesthetic widely used in veterinary patients and thus the present study was planned to evaluate the effect of tiletamine-zolazepam alone and in combination with xylazine and xylazine-ketamine in dogs. Methods: Eighteen dogs irrespective of age, breed, sex and body weight (requiring various surgical corrections) were randomly divided into three groups namely A, B and C. Atropine sulphate was administered in all the groups followed by tiletamine-zolazepam in group A, xylazine and tiletamine-zolazepam in group B and xylazine, ketamine and tiletamine-zolazepam in group C. The efficacy of the anaesthesia was evaluated at different time intervals upto recovery by observing clinical, physiological and haemato-biochemical parameters. Result: Induction dose of tiletamine-zolazepam observed in group A, B and C was 6.5, 5.5 and 4.0 mg/kg body weight, respectively. Induction time values were decreased and duration of anaesthesia was increased from group A to group C. All physiological parameters differs significantly (p less than 0.05) between the groups. Mean values of Hb, TEC, PCV, TLC, lymphocytes, monocytes, eosinophils, basophils and total proteins showed transient decrease whereas neutrophils, ALT, AST, total bilirubin, plasma glucose, BUN and serum creatinine showed transient increase in all the groups at 30 and 60 minutes. Haemato-biochemical parameters approached to baseline values upto 24 hours. Thus, it can be concluded that the various combinations of tiletamine-zolazepam with pre-medicants like xylazine and xylazine-ketamine was found to be safe with regard to their effects on haemato-biochemical parameters.

Evaluation of biochemical parameters in operating room staff exposed to radiation and anesthetic gases.

Exposure to ionizing radiations and other hazardous agents such as anesthetic gases pose serious risks to the health of healthcare workers. This study aimed to evaluate the changes in blood and biochemical parameters of the operating room staff exposed to ionizing radiations and remnants of anesthetic gas. This cross-sectional study was performed at (Ayatollah Taleghani Hospital). The control group was selected from different parts of the hospital that were not exposed to ionizing radiations and anesthetics, including the office, services, and treatment. The case group included all operating room personnel. Hematopoietic parameters such as complete blood count and WBC differential, and parameters of liver function such as serum activity of liver enzymes (ALT, AST, ALP, LDH) and serum bilirubin levels, fasting blood sugar, serum lipid profile, level of vitamin D and magnesium were measured for the exposed and referent subjects. Additionally, a checklist was used to gather data regarding the occupational variables and medical histories of the studied subjects. The mean values of Hb, Hct, Vitamin D, and MCHC, as well as the RBC count, were significantly lower in the exposed individuals than in the referent subjects. In contrast, the proportion of smokers was significantly higher in the exposed group than in the referent group. No significant differences were noted between exposed and unexposed groups as far as other parameters were concerned. However, no significant differences were noted between the case and control groups as far as other measured parameters were concerned. Likewise, no significant differences were noted between exposed and referent groups as far as blood types, history of underlying diseases, work history, working hours per month, number of morning and evening shift hours, type of diet, consumption of a high-fat diet a day before blood sampling, X-ray in the recent year, history of radiotherapy, and therapeutic agents use was concerned. Exposure of operating room staff to ionizing radiations and waste anesthetics gases is associated with subtle, subclinical prepathologic decreases in some hematopoietic parameters such as hemoglobin, hematocrit and MCHC levels, RBC count as well as vitamin D levels.

Efficacy of aquatic exercises on balance in children with sickle cell anemia: A randomized controlled trial

The aim of this study was to investigate the efficacy of aquatic exercises on balance in children with sickle cell anemia. A randomized controlled trial was conducted. Sixty children with mild sickle cell anemia and poor balance from both sexes (35 boys and 25 girls) participated in this study. Their ages ranged from 5-10 years with a mean value of 7.30± 1.66 years in the study group (A) and 7.26 ±1.70 in the control group (B). They were divided into two equal groups: the study group (A) and the control group (B). The study group (A) consisted of 30 children (17 boys and 13 girls), who received medical treatment (prescribed by physician), balance exercises, and aquatic exercises sessions. The control group (B) consisted of 30 children (18 boys and 12 girls) who received medical treatment (prescribed by physician) and balance exercises only. The program continued for eight weeks with two sessions per week with a total of sixteen sessions. Each session lasted forty minutes for aquatic exercises sessions and thirty minutes for the balance exercises sessions. Balance was measured before and after treatment using the Pediatric Balance Scale (PBS). A complete blood analysis was performed before and after treatment. The balance functions showed a statistically significant improvement in the study group (A) (p &lt; 0.05) with an improvement of 28.09% after treatment, while in the control group (B) the improvement was not statistically significant (p &gt; 0.05) with a percentage of 10.93% after treatment. The mean Hb value also improved by 29.2% in the study group (A) with a statistically significant increase (p &lt; 0.05), while in the control group (B) there was no statistically significant improvement (p &gt; 0.05) with a percentage of 8.44% after treatment. The aquatic exercise program has a positive effect on improving balance functions in children with sickle cell anemia.

A Cross Sectional Analysis of Etiology of Anemia Among Elderly Patients

The aim of this study is to evaluate the etiology and features of anemia in elderly patients from the perspective of hematology and to determine the rate of unexplained anemia. The medical records of elderly patients over the age of 65 who applied to the Hematology Department of Ankara Baskent University Hospital between January 2015 and January 2020 were retrospectively analyzed. According to WHO criteria, the threshold value accepted for anemia was Hb &amp;lt;12 g/dL for women and &amp;lt;13 g/dL for men. The prevalence of anemia was 18% among 3330 elderly patients. The ratio of women to men diagnosed with anemia was 1.5:1, and the mean age was 77.34±8.32. The mean Hb value was 9.79±1.75 g/dl and decreased significantly with advancing age (p&amp;lt;0.001). Polypharmacy was present in 68.3% of the patients. The etiological distribution of anemia was nutritional anemia in 339 (56.5%), hematologic malignancy in 127 (21.1%), anemia of chronic disease in 125 (20.8%), and unexplained anemia in 58 (9.7%) patients. 72% of the patients with indications for bone marrow biopsy had the procedure. Anemia in the elderly is a challenging issue due to comorbidity, polypharmacy, and problems in further examination. Hematological evaluation of anemia in elderly patients will reduce the rate of unexplained anemia. Patient selection for invasive procedures should be based on a risk-benefit ratio in frail elderly patients.

Pengaruh Pemberian Vitamin C Kombinasi Fe terhadap Peningkatan Kadar Haemoglobin pada Ibu Hamil di Puskesmas Lubuk Sanai

Anemia is common worldwide, especially in developing countries. Anemia is common in pregnant and lactating women. This is due to her high FE deficiency in pregnant and lactating women. This study, in the work area of the Lubuk Sanai Health Center, aimed to determine the effect of FE with vitamin C on increasing hemoglobin levels in pregnant women. A quasi-experimental study using a non-randomized Twi group pre-test and post-test design. The sampling technique in this study was to use a targeted sampling technique and 32 samples were obtained and divided into 16 control and 16 case respondents. Data collection was based on primary data by confirming Hb and secondary data by examining pregnancy register documents. The Shapiro-Wilk test was used for data analysis. Results showed that the average Hb level of mothers given vitamin C in combination with iron was her 10.362 before treatment and 11.375 after treatment, increasing by 1.013. Mean HB values in the control group were 10.288 before and 10.731 after, an increase of 0.443. At the Lubuk Sanai Health Center, giving a combination of Fe and vitamin C increases H levels in pregnant women. Puskesmas hopes to improve wellness programs to prevent anemia during pregnancy by administering a combination of vitamin C and iron tablets.

In vivo Anti-anaemic Effect of an Aqueous Root Extract of Phyllanthus muellerianus (Kuntze) Exell in Model Rats

Background: Anaemia is a very serious condition in Zambia. One of the plants that has been used traditionally is Phyllanthus muellerianus where different parts of shrub are used to treat a number of diseases in Zambian folklore medicine. Earlier studies have investigated medicinal properties of its aqueous root extracts. This study evaluated the effect of P. muellerianus roots on the haematological indices of albino rats and determined its phytochemical profile. In order to prove this, we carried out phytochemical screening of the root extract and assessed the anti-anaemic effect of the aqueous extract on laboratory rats with tail-bled induced anaemia. Materials and Methods: Thirty-six male albino rats placed in six groups were used for the study. The groups comprised the 100, 200, and 400 mg/kg plant extract, Ranferon (200 mg/kg positive control), anaemic (non-treated control) and a normal (non-anaemic control) groups. Anaemia, induced through bleeding of the rats, was defined as haemoglobin (Hb) levels less than 12 g/dL. The anti-anaemic potential of the plant was determined by comparing its effect on the haematological parameters of rats on treatment to that of the control group. Results: Phytochemical screening revealed positive results for alkaloids, flavonoids, saponins, glycosides, steroids, triterpenoids and tannins with varying amounts. After treatment, rats on the 400 mg/kg plant extract dose showed the greatest increase in the mean values for Hb, Packed cell volume (PCV) and RBC count were 43.31.2%, 15.40.3 g/dL and 6.30.3 x106 /L respectively, when compared to the negative control group (P &lt; 0.05). Conclusions: The aqueous root extract of P. muellerianus was efficacious against anaemia in a dose-dependent manner. The phytochemical compositions seem to be responsible for its haematopoietic properties. Thus, the root decoction of P. muellerianus is useful in alleviating anaemia and the results lend credence to its use in traditional medicine in the management of anaemia.

Types of Inherited Hemoglobin Disorders Among the Patients Attending Hematology Outdoor of a Tertiary Care Hospital in Bangladesh

Background: Inherited Haemoglobin (Hb) disorders are the most frequent genetic hereditary disorders with an increasing global health burden, especially in low- and middle-income countries. This disorder is mostly caused by a point mutation on a globin gene resulting mostly in single amino acid substitutions and consequently defective globin chain production or reduced production of normal haemoglobin. Despite the limited study of this country regarding this issue, the number of individuals suffering from inherited Hb disorders is not negligible. Thus, the study was designed to evaluate the types of inherited haemoglobin disorders among the patients attending the haematology outdoor of Dhaka Medical College Hospital (DMCH). Methods: This hospital-based cross-sectional study was conducted at the Department of Haematology in DMCH, for a period of 6 months (June 2022 to November 2022. People attending the Haematology outpatient department and diagnosed with a case of inherited Hb disorder were approached for inclusion. Written informed consent was taken from each subject. Ethical issues were ensured properly. For the study, a total of 100 patients were interviewed for less than 30 minutes of duration in each case. Relevant investigations such as, Hemoglobin (Hb), Red Cell Count (RCC), MCV, MCH, MCHC, RDW, Reticulocyte, Serum ferritin were done in the Haematology lab of DMCH, and data were collected in a semi-structured questionnaire. Collected Data were analyzed by SPSS 21. Results: Out of 100 inherited Hb disorder subjects, the majority (60 or 60%) were from the age group of 14 to 24 years. The mean age of patients was 38.78 ± 6.09 with range 15-51 years. The male-female ratio was 1:1. The majority (58%) came from rural areas and 42% came from urban areas. Mean value of Hb was 10.54; subsequently, MCV (63.25), MCH (22.18), S ferritin (140.43). The majority of patients had their onset of clinical presentation of illness for 5 years. Among total subjects, two-thirds of the patients (66 or 66%) had Hb E Disease followed by 14% Beta thalassaemia trait, 14% Hb E trait, and 6% b thalassaemia major. No association was noted between the type of thalassaemia with age &amp; sex of the subjects. Conclusion: Irrespective of age and sex variations, Hb E disease is the most frequent inherited haemoglobin disorder among the patient attending the haematology outdoor of a tertiary care hospital. J MEDICINE 2023; 24(2): 96-105

Assessment of the Clinic-pathological Profile of Patients with Pancytopenia

Introduction: Pancytopenia is an important clinico-hematological condition encountered in day-to-day clinical practice. Pancytopenia is often very difficult to diagnose and treat often owing to its varied aetiologies, causes might ranging from infections, nutritional deficiencies to malignancies. Materials and Methods: This was a cross-sectional study conducted in Department of General Medicine, Rohilkhand Medical College and Hospital, Bareilly. Patients’ information was filled in pro forma, and contains patient’s age, gender, clinical features, clinical findings, CBC findings, bone marrow findings, and diagnosis from all patients collected. Detailed clinical history and clinical examination along with blood investigation were carried out. Results: In the present study, the mean level of platelets was 54,000 ± 31,549/µL, with a minimum level of 2000/µL and a maximum level of 130,000/µL, indicating that majority of patients suffered from thrombocytopenia. The mean level of white blood cells (WBCs) was 2873.4 ± 780.4/µL, with a minimum level of 1000/µL and a maximum level of 3860/µL, indicating that all the patients suffered from leukopenia. 30% of patients had normocytic normochromic RBC, 24% had macrocytic normochromic RBC, 22% had macrocytic hyperchromic, 6% had microcytic normochromic, 8% had microcytic hypochromic, and 10% had both macrocytic and microcytic RBCs. Conclusion: Mean values of Hb, WBC &amp; Platelet count was non-significantly higher among female patients comparing to males, though mean value of MCV was non-significantly higher in male patients comparing to females.

Incidence and haematobiochemical study of amphistomosis in buffaloes (Bubalus bubalis) in Mhow, Madhya Pradesh

In the present study, samples from 100 buffaloes of either sex were collected from slaughterhouse located at Cantonment Board Mhow for the detection of ruminal amphistomosis. Blood samples with or without anticoagulant were collected to study the haematobiochemical changes in buffaloes suffered from amphistomosis. Amphistomes were also collected for morphological identification of amphistome species in slaughtered animals. The prevalence of ruminal amphistomes was found to be 8%. The infected buffaloes in this study showed a reduction in the mean values of Hb, TEC and PCV. There was an increase in TLC and neutrophil count. Lymphocytes showed a slight decrease in their mean values and no significant changes were seen in values of basophil and eosinophil count. The infected buffaloes in this study showed a reduction in the mean values of total protein. The mean values of SGOT, SGPT and alkaline phosphatase showed an increment in the infected buffalo.

#2768 DIFFERENT EFFECTS OF HYPOXIA-INDUCIBLE FACTOR PROLYL HYDROXYLASE INHIBITORS ON SERUM LIPIDS LEVELS IN HEMODIALYSIS PATIENTS

Abstract Background The activity of hypoxia-inducible factor (HIF), an oxygen-sensitive transcription factor involved in erythropoiesis, is regulated by HIF-prolyl hydroxylases. With reduced oxygen tension, the activity of these enzymes is suppressed, resulting in increased erythropoiesis. Chen et al. reported that the decrease in that total cholesterol (TC) was greater with roxadustat than with epoetin alfa, as was the decrease in low density lipoprotein-cholesterol (LDL-C) in patients undergoing dialysis [1]. Csiky et al. reported roxadustat was superior to erythropoiesis-stimulating agent (ESA) in decreasing LDL-C levels from baseline in patients on dialysis [2]. Roxadustat is an oral HIF-prolyl hydroxylase inhibitor (HIF-PHI) developed for dialysis-dependent chronic kidney disease (CKD) anemia. While the impact of HIF-PHI on mean hemoglobin (Hb) change in patients on hemodialysis (HD) has been investigated [1], its effects on serum lipid levels have yet to be explored. Clarifying such effects is particularly important because HD patients usually have lower plasma high-density lipoprotein-cholesterol (HDL-C) levels than healthy individuals. Low HDL-C levels are associated with an increased risk of death in HD patients. The effects of HIF-PHIs on dyslipidemia in patients on HD are unclear. This study aimed to investigate the effects of HIF-PHIs on serum lipid levels in HD patients. Methods We investigated the effect of HIF-PHIs in three groups by measuring the levels Hb, serum TC, LDL-C, HDL-C, triglycerides (TG), iron, total iron-binding capacity (TIBC), transferrin saturation (TSAT), ferritin. Study 1: We evaluated the efficacy of roxadustat in 13 patients (1 female and 12 males) with HD-dependent CKD anemia and dyslipidemia over 24 weeks. Study 2: We evaluated the efficacy of daprodustat in 9 patients (2 females and 7 males) with HD-dependent CKD anemia and dyslipidemia over 24 weeks. Study 3: We evaluated the efficacy of enarodustat in 15 patients (3 females and 12 males) with HD-dependent CKD anemia and dyslipidemia over 12 weeks. Results Study 1: The mean age and mean HD vintage were 77.7 and 6.6 years, respectively. After roxadustat treatment, the mean Hb values (from 10.4 to 10.7 g/dL) did not significantly change. There were no significant changes in mean serum iron, TG, ferritin. However, the following parameters showed a significant decrease: mean TC (from 138.4 to 106.6 mg/dL, p = 0.0002), LDL-C (77.7 to 53.8 mg/dL, p = 0.0002), HDL-C (from 43.3 to 35.9 mg/dL, p = 0.0005), and TSAT (from 32.6 to 31.2%, p = 0.0479). There was a significant increases in the mean TIBC (from 220.5 to 265.1 μg/dL, p = 0.0002). Study 2: The mean age and mean HD vintage were 74.6 and 3.2 years, respectively. After daprodustat treatment, the mean Hb values did not significantly change. There were no significant changes in the mean TC, LDL-C, TG, TSAT, ferritin. However, the mean HDL-C levels showed a statistically significant decrease (from 50.4 to 45.3 mg/dL, p = 0.0117). Furthermore, there were significant increases in the serum iron level (from 72.5 to 89.1 μg/dL, p = 0.0078) and the mean TIBC level (from 229.7 to 272.8 μg/dL, p = 0.0039). Study 3: The mean age and mean HD vintage were 69.3 and 8.9 years, respectively. After enarodustat treatment, the mean Hb values did not significantly change. There were no significant changes in the mean TC, LDL-C, HDL-C, TG, TSAT, ferritin, iron. There was a significant increase in the mean TIBC (from 230.0 to 259.4 μg/dL, p = 0.0151). Conclusions We found that HIF-PHIs had different effects on serum lipids levels in HD patients. Roxadustat treatment improved iron metabolism stabilized Hb levels, and significantly decreased LDL-C levels. Daprodustat and enarodustat treatment improved iron metabolism, maintained stable Hb levels.

Protective Effect of Olive Oil and Nigella Seed Oil on some Physiological Parameters in Rabbits Administered D-galactosamine

This study was to evaluate some physiological parameters for the protective effect of olive oil and nigella seed oil in rabbits administered D-galactosamine (D-GaIN) (600 mg/kg) a single dose with concentrations of body weight of rabbits on some parameters of blood (84) of the male rabbits weighted (400-550g) and (10) weeks of age were randomly divided into six groups, six rabbits in each group, given all the animals normal food during the experimental period of 1,2 and 3 weeks, explained to the animals at the end of each period of experience and took blood samples to measure (Hb,RBC.s, WBC.s,WBC.d,N, WBC.d,L, WBC.d,M, WBC.d,E) was reached the following conclusions: D-GaIN injection caused gradually increase in Hemoglobin level (Hb) and WBC.s and reached the peak level in three weeks post treatment compared to control group. The joint administration of olive oil with D-GaIN to experimental animals improving of effect D-GaIN on oxidative stress with varying degree, there was gradually decreased in mean value of Hb and WBC.s at three-week compared to D-GaIN group. However, the elevation in the mean value of WBC.d.L, WBC.d.N and WBC.d.E in two weeks compared to control. The treatment with Nigella oil after injecting D-GaIN to experimental animals influencing on hematological parameters with varying degree, treatment with Nigella oil after injecting D-GaIN to experimental animals influencing on hematological parameters with varying degree, there was gradually increase in mean value of Hb and WBC.d.L in two weeks compared to control group. Similarly, the mean value of WBC.d.N, WBC.s (9.30±2.03×103 cell/cu.mm. blood) counts were recorded in one week compared to control and D-GaIN groups.

The role of mean corpuscular volume and red cell distribution width in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors: the MARECAP retrospective study.

Tyrosine-kinase inhibitors (TKIs) and immunotherapy represent the backbone treatment for metastatic renal cell carcinoma (mRCC) patients. The aim of the present study was to describe mean corpuscular volume (MCV) and red cell distribution width (RDW) in mRCC patients treated with pazopanib or cabozantinib, and to explore their potential impact on oncological outcomes. We conducted a multicenter retrospective observational study in mRCC patients treated with pazopanib or cabozantinib between January 2012 and December 2020 in nine Italian centers. Descriptive statistics, univariate, and multivariate analyses were performed. The primary endpoints were the incidence and trend over time of anemia, macrocytosis (elevated MCV), and anisocytosis (elevated RDW). The secondary endpoints were the correlations of MCV and RDW with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). A total of 301 patients were enrolled; mean Hb value was 12.5 g/dl, a mean increase of 1 g/dl was observed at day 15 and maintained at 3 months. Most patients had baseline macrocytosis (MCV levels > 87 fl), with a significant mean increase after 3 months of treatment. At univariate analysis patients with macrocytosis had better ORR, longer PFS, and OS. About one third of patients had baseline anisocytosis (RDW > 16%), with a significant mean increase after 3 months of treatment. At univariate analysis, patients with RDW values ⩽ 16% had higher ORR, longer PFS, and OS. At multivariate analysis, baseline macrocytosis was significantly associated with better PFS in patients treated with pazopanib and baseline anisocytosis with shorter OS in all patients. mRCC patients treated with pazopanib or cabozantinib may have baseline macrocytosis and anisocytosis. A significant increase of Hb, MCV, and RDW after TKIs start was observed. Baseline macrocytosis is positively correlated with PFS in patients treated with pazopanib and baseline anisocytosis affects survival of patients treated with TKIs.

Comparative study on intravenous iron sucrose versus intravenous ferric carboxymaltose in the management of iron deficiency anaemia in pregnancy in a tertiary care hospital, Bengaluru

Background: Iron deficiency is the most common nutritional deficiency worldwide; it affects 1.6 billion people Iron deficiency (ID) and iron deficiency anemia (IDA) are often encountered in the general population, particularly among children and women with abnormal uterine bleeding (AUB) and during pregnancy as well as postpartum period Intravenous (IV) iron replacement can deliver the total amount of required iron over a short period. Currently, the most commonly used IV iron formulations are iron sucrose (IS) and ferric carboxymaltose (FCM) [4-6]. Iron sucrose does not require test dose and is safe. Ferric carboxymaltose (FCM) is the latest I.V. iron formulation which can be used at high doses and allows rapid administration (up to 1000 mg in a single dose infused in 15 minutes) The present study was a comparative study of parenteral iron therapy (intravenous iron sucrose versus intravenous ferric carboxymaltose in the management of iron deficiency anaemia in pregnancy.Methods: In the present study, 50 pregnant women with IDA were randomly distributed into two groups of 25 each. Group - A: 25 receiving intravenous iron sucrose therapy; Group - B: 25 receiving intravenous ferric carboxymaltose therapy.Results: Majority of the study participants in Group A had gestational age between 20–25 weeks (48%). The mean age of the study participants in Group A was found to be 22.86+4.42 weeks. Majority of the study participants in Group B had gestational age between 20-25 weeks (36%). The mean age of the study participants was found to be 23.01+3.01 weeks. Majority of the study participants in Group A had nil parity (40%). 36% of the study participants in Group B had nil parity. 60% of the study participants in group A had Mild degree of anaemia with 52% in group B having mild degree of anaemia. 40% and 44% of the study participants in group A and group B had Moderate degree of anaemia respectively. The association was found to be statistically significant between the mean Hb and Ferritin values pre-treatment, 3rd and 6th week follow-up post treatment and the 2 groups of study participants. The adverse effects were comparatively lower among Group B (IV ferric carboxymaltose) than Group A (IV iron sucrose) of the study participants.Conclusions: IV ferric carboxymaltose administration increases the hemoglobin level more rapidly as compared to iron sucrose in women with iron deficiency anemia in the pregnancy. It also stores iron more rapidly. No serious adverse effects were recorded. Ferric carboxymaltose is well tolerated, safe and effective alternative to iron sucrose in iron deficiency anemia of pregnancy. FCM has the advantage of a large dose administration per sitting and early rise in hemoglobin level.

Spatial distribution and identifying biochemical factors affecting haemoglobin levels among women of reproductive age for each province in Indonesia: A geospatial analysis.

Anaemia is still a public health problem in Indonesia. The iron supplement program, known as Tablet Tambah Darah (Blood Add Tablet) has not yet produced optimal results. This study aimed to identify the cause of anaemia and the factors that influence it. Biochemical indicator data are haemoglobin (Hb), C-reactive protein (CRP), ferritin and serum transferrin receptor (sTfR) from 9,463 women of reproduction age. Data from the Basic Health Research (Riskesdas) project of 2013 were used for the study. ANOVA as well as global and local regression approaches (classical regression and geo-weighted regression) were used to compare the mean Hb and CRP values between provinces and to determine the factors that influence Hb concentrations. The results showed that the distribution of anaemia in Indonesia is uneven and not always caused by iron deficiency. The lowest Hb mean coupled with the highest iron deficiency was found in Papua, where there are high rates of parasitic infections. In contrast, the highest mean Hb coupled with low iron deficiency, and also low infection rates, was found in North Sulawesi. The Hb concentrations were significantly associated by ferritin, CRP and sTfR and there were varying magnitudes between provinces. Although anaemia is mainly influenced by the iron concentration, CRP, ferritin and sTfR can also affect it through their association with inflammatory reactions. Identification of all causes of anaemia in each province needs to be done in the future, while blanket iron supplementation should be reviewed.

Individualized anemia management enhanced by ferric pyrophosphate citrate protocol

The optimal use of erythropoiesis-stimulating agents (ESAs) and parenteral iron in managing anemia in end-stage renal disease (ESRD) remains controversial. One-size-fits-all rule-based algorithms dominate dosing protocols for ESA and parenteral iron. However, the Food & Drug Administration (FDA) guidelines for using ESAs in chronic kidney disease recommend individualized therapy for the patient. This prospective quality assurance project was at a single hemodialysis (HD) center comprising three 6-month phases (A, B, C) separated by 3-month washout periods. Standard bi-weekly ESA dose titration and intravenous (IV) iron sucrose protocols were used in baseline Phase A, and ferric pyrophosphate citrate (FPC) augmented iron in Phase B. In Phase C, an FPC protocol and weekly, individualized ESA management were used. We examined clinic-level mean differences in hemoglobin (Hb) and ESRD-related outcomes by phase with repeated ANOVA. To examine the Hb at the patient level, we used multi-level mixed-effect regression adjusting for phase, month, and other relevant confounders at each month over time to derive the mean marginal effects of phase. There were 54, 78, and 66 patients in phases A, B, and C, respectively, with raw mean Hb values of 9.9, 10.2, and 10.3 g/dL. The percentage of Hb values < 9 g/dL declined from 14.3% in Phase A to 7.6% in Phase C (p = 0.007). The multivariable mixed-effect regression results showed mean marginal Hb was higher by 0.3 mg/dL and 0.4 mg/dL in Phases B and C, respectively, compared to Phase A. We also observed reduced ferritin (p = 0.003) and transferrin saturation (TSAT) (p = 0.008) levels from Phase A to Phase C with the repeated ANOVA analysis. Ferric pyrophosphate citrate (FPC) appears to support more efficient ESA-stimulated erythropoiesis. Moreover, individualized ESA management combined with FPC (Phase C) was associated with further improvement in efficiency as we observed the fewest patients with Hb values < 9 g/dL concurrent with greater decreases in ferritin levels and reduced ESA doses. However, future prospective studies to confirm these findings on a larger, more diverse cohort of ESRD patients are warranted.