Moderate Severe Anemia Research Articles

Relationship between anemia and occupational fall injuries in female part-time employees: an observational study of large supermarket stores in Japan.

Occupational fall injuries have recently increased markedly in Japan, together with an increase in later-middle-aged females in the labor market. However, the association between anemia, which is prevalent among Japanese females, and falls is unclear. Here, we investigated the association between anemia and occupational fall injuries. Participants were 6,780 part-time female employees aged 35-64 working in Japanese supermarket stores of a retail company who had at least one health checkup each year between 2017 and 2022. Anemia was defined as hemoglobin (Hb) <12.0 g/dL (Mild: 11.0-11.9 g/dL, Moderate-severe: Hb<11.0g/dL). Fall injuries were defined as slips, trips and falls on the same level, requiring medical attention based on the occupational injury data by the company. Incidence rate ratios (IRRs) for falls were estimated using multilevel Poisson regression, adjusting age and body mass index (BMI). The annual rate of occupational fall injuries was 0.7%. The adjusted IRR and 95% confidence intervals (CI) for occupational fall injuries among participants with anemia was 1.71 (1.12-2.60). When dividing anemia into two groups, IRR (95%CI) was 1.46 (0.84-2.53) for Mild anemia and 2.13 (1.18-3.84) for Moderate-severe anemia (p for trend=0.007). In this observational study of employees of large Japanese supermarket stores, anemia was significantly associated with a higher incidence of occupational falls. Our findings suggest the importance of anemia in the prevention of occupational falls.

Hypoxia-inducible factor prolyl hydroxylase inhibitors for anaemia in chronic kidney disease: a clinical practice document by the European Renal Best Practice board of the European Renal Association.

Anaemia is a common complication of chronic kidney disease (CKD) and is associated with poor long-term outcomes and quality of life. The use of supplemental iron, erythropoiesis-stimulating agents (ESAs) and blood transfusions has been the mainstay for treatment of anaemia in CKD for more than 3decades. Despite available treatments, CKD patients with anaemia are undertreated and moderate-severe anaemia remains prevalent in the CKD population. Anaemia has consistently been associated with greater mortality, hospitalization, cardiovascular events and CKD progression in CKD patients, and the risk increases with anaemia severity. Hypoxia-inducible factor (HIF) prolyl hydroxylase (PH) inhibitors have a novel mechanism of action by mimicking the body's response to hypoxia and have emerged as an alternative to ESAs for treatment of anaemia in CKD. Their efficacy in correcting and maintaining haemoglobin has been demonstrated in >30 phase 3 clinical trials. Additionally, HIF activation results in various pleiotropic effects beyond erythropoiesis, with cholesterol reduction and improved iron homeostasis and potential anti-inflammatory effects. The long-term safety of these agents, particularly with respect to cardiovascular and thromboembolic events, and their possible effect on tumour growth needs to be fully elucidated. This article presents in detail the effects of HIF-PH inhibitors, describes their mechanisms of action and pharmacologic properties and discusses their place in the treatment of anaemia in CKD according to the available evidence.

Inflammatory immune profiles associated with disease severity in pulmonary tuberculosis patients with moderate to severe clinical TB or anemia.

Immune control of Mycobacterium tuberculosis (Mtb) infection is largely influenced by the extensive disease heterogeneity that is typical for tuberculosis (TB). In this study, the peripheral inflammatory immune profile of different sub-groups of pulmonary TB patients was explored based on clinical disease severity, anemia of chronic disease, or the radiological extent of lung disease. Plasma samples were obtained from n=107 patients with active pulmonary TB at the time of diagnosis and after start of standard chemotherapy. A composite clinical TB symptoms score, blood hemoglobin status and chest X-ray imaging were used to sub-group TB patients into 1.) mild and moderate-severe clinical TB, 2.) anemic and non-anemic TB, or 3.) limited and extensive lung involvement. Plasma levels of biomarkers associated with inflammation pathways were assessed using a Bio-Plex Magpix 37-multiplex assay. In parallel, Th1/Th2 cytokines were quantified with a 27-multiplex in matched plasma and cell culture supernatants from whole blood stimulated with M. tuberculosis-antigens using the QuantiFERON-TB Gold assay. Clinical TB disease severity correlated with low blood hemoglobin levels and anemia but not with radiological findings in this study cohort. Multiplex protein analyses revealed that distinct clusters of inflammation markers and cytokines separated the different TB disease sub-groups with variable efficacy. Several top-ranked markers overlapped, while other markers were unique with regards to their importance to differentiate the TB disease severity groups. A distinct immune response profile defined by elevated levels of BAFF, LIGHT, sTNF-R1 and 2, IP-10, osteopontin, chitinase-3-like protein 1, and IFNα2 and IL-8, were most effective in separating TB patients with different clinical disease severity and were also promising candidates for treatment monitoring. TB patients with mild disease displayed immune polarization towards mixed Th1/Th2 responses, while pro-inflammatory and B cell stimulating cytokines as well as immunomodulatory mediators predominated in moderate-severe TB disease and anemia of TB. Our data demonstrated that clinical disease severity in TB is associated with anemia and distinct inflammatory immune profiles. These results contribute to the understanding of immunopathology in pulmonary TB and define top-ranked inflammatory mediators as biomarkers of disease severity and treatment prognosis.

Anemia and atrial fibrillation ablation recurrence: insights from a large-scale multicentre registry

Abstract Background Both atrial fibrillation (AF) and anemia are associated with an increased mortality, and they often coexist. Whether anemia is associated with arrhythmia recurrence after catheter ablation (CA) of AF remains unknown. Methods We conducted a large-scale, prospective, multicentre, observational study (Kansai Plus Atrial Fibrillation Registry). Out of 5010 consecutive patients who underwent an initial radiofrequency CA (RFCA) of AF at 26 centres, we enrolled 4966 patients whose hemoglobin data were available (age 64.4 years, 27.3% female, and 35.6% non-paroxysmal AF). The entire cohort was divided into three subgroups according to the WHO classification of anemia: normal (hemoglobin ≥ 13.0 g/dL in men and ≥ 12.0 g/dL in women, n=4300, 86.6%), mild anemia (11.0 ≤ hemoglobin &amp;lt; 13.0 g/dL in men and 11.0 ≤ hemoglobin &amp;lt; 12.0 g/dL in women, n = 519, 10.5%), and moderate-severe anemia (&amp;lt;11.0 g/dL in both men and women, n = 147, 3.0%). The median follow-up duration was 2.9 years. Results The mean age increased significantly as the anemia progressed (normal vs. mild anemia vs. moderate-severe anemia; 63.5 vs. 69.8 vs. 72.1, p&amp;lt;0.0001). While the normal group and mild anemia group consisted of predominantly males (74.0% and 70.5%, respectively), the moderate-severe anemia group consisted predominantly of females (57.8%, p&amp;lt;0.0001). The proportion of paroxysmal atrial fibrillation was 62.4% in the normal, 78.4% in the mild anemia, and 76.2% in the moderate-severe anemia group, respectively (p&amp;lt;0.0001). The 3-year cumulative incidence of AF recurrence after a single procedure was the highest in the moderate-severe anemia group (normal vs. mild anemia vs. moderate-severe anemia, 39.6% vs. 43.5% vs. 49.7%, log-rank p=0.0004). Conclusion Anemia patients experienced more frequent AF recurrences after RFCA of AF.KM curve according to anemia group

Severe form of COVID-19 in a neonate with resuscitated cardio-respiratory arrest - Case presentation

SARS-CoV-2 infection is usually a self-limiting viral infection in healthy children. Still, it’s effects on the neonatal population remain largely unknown. There has been evidence of adverse events on neonates, mostly consisting in case reports of patients with severe forms of COVID-19 and also recent cohort studied of the pediatric population including the neonatal subgroup. The clinical presentation appears different in the neonatal patients in contrast with older children, and may manifest also as a life-threatening respiratory infection with systemic complications. In this paper we present a clinical case of a premature boy with a corrected age of 40 weeks at admission to the Pediatric Infectious Diseases Clinical Department IX of the National Institute of Infectious Diseases “Prof. Dr. Matei Bals” with the diagnosis of SARS-CoV-2 infection. The positive diagnosis was established on suggestive clinical picture (fever, dry couch, rhinorrhea, loose stools and inappetence) and confirmed by SARS-CoV-2 rapid antigen test. Laboratory investigations at admission showed only moderate to severe anemia, mild inflammatory syndrome and a mild neonatal hyperbilirubinemia, with normal leukocyte count, normal glycaemia, ionograme and blood gases. Chest x-ray showed moderate interstitial pneumonia. In the second day of admission, after 24h of favorable evolution, with no fever and present appetite, he suddenly presented during defecation a presumptive vasovagal syndrome, with general hypotonia and a short period of desaturation. Laboratory investigations made during the episode showed normal glycaemia, normal ionograme, normal blood gases, moderate-severe anemia and important metabolic acidosis. A new chest x-ray showed evolution of the interstitial pneumonia. We did a blood transfusion and continued antiviral treatment, antibiotic treatment and perfusions. He maintained normal pulmonary and cardiac function for another 6 hours, after which he presented a tonic-clonic seizure and after administration of intrarectal benzodiazepines he presented cardio-pulmonary arrest. He was resuscitated, intubated and sedated and transfer to a children ICU. 2 weeks later after admission in the ICU he was discharged with favorable outcome. The case presented shows that although SARS-CoV-2 infection is often a mild condition in children, COVID-19 in neonates can have an unpredicted course. Rapid evolution to sever forms can be a possible disease outcome. Preterm birth with associated complications like bronchodysplasia or anemia, can predispose to sever evolution of the disease, and this child must be kept safe. There is also a neurotropic potential of the SARS-CoV-2 virus that has to be followed.

ARTERYAL HIPERTENSION AND VERY ELDERLY PATIENTS. THE EXPERIENCE OF AN INTERNAL MEDICINE DEPARTMENT

Objective: The purpose of this study is to highlight the clinical and paraclinical characteristics of fragile hypertensive patients, over 85 years old, admitted to a mixed internal medicine department (Covid and non-Covid) between January 2022 and October 2022. Design and method: Between January 2022 and October 2022, 80 patients with a primary or secondary diagnosis of arterial hypertension were admitted, of which only 23 (28.75%) were over 85 years old. Of the 23 patients, 13 (56.52%) were hospitalized with a diagnosis of Sars Cov 2 infection. Regarding the gender distribution, 12 are women (52.17%) and 11 are men (47.82%). Patients comorbidities: 14 patients (60.86%) with different degrees of heart failure, atrial fibrillation (39.13%) - 8 patients and one patient was diagnosed with atrial fibrillation during hospitalization, cognitive disorders and dementia in a proportion of 47.82 % (11 patients) and a significant number of patients were admitted with moderate-severe anemia (13 patients, 56.52%). Of the 9 patients with atrial fibrillation, 5 are male (55%) and 4 (45%) female, cardiac enzymes (troponin and CK MB) are within normal limits in 8 patients. During the medical tests, 3 patients (13.04%) were diagnosed withdifferent of neoplasia. Only 2 patients (8.69%) presented slight dyselectrolytemia (hyponatremia and hypokalemia). Results: Pathologies are treated with: angiotensin converting enzyme inhibitors (17.39% - 4 patients), calcium channel blockers (39.13% - 9), anticoagulants (39.13% - 9 patients), diuretics (26.08 %-6 patients) and beta blockers (11 pac-47.82%). 13 patients (56.52%) died and 43.47% were discharged with an improved condition. 9 patients died as a result of Covid multiple organ system failure, 1 death was of cardiovascular cause and 3 non-Covid pulmonary failure deaths. Conclusions: Frail patients, older than 85 years, with multiple comorbidities, require detailed investigations and adjustments of medication doses according to their status in order to maintain the discreet balance in which they are.

The severity of preoperative anemia escalates risk of poor short-term outcomes after lumbar spine fusion.

To evaluate how preoperative anemia severity affects 90-day outcomes of spinal fusion surgery. A retrospective cohort study was conducted on adult lumbar fusion patients at a tertiary medical center. Patients were classified by World Health Organization anemia severity definitions for comparisons. Multivariate regression models were created to control for confounding variables, for all primary outcomes of transfusion requirements, non-home discharge, readmissions, complications, and length of stay. A total of 2582 patients were included: 2.7% with moderate-severe anemia, 11.0% with mild anemia, and 86.3% without anemia. Moderate-severe patients had the longest hospital stay (5.03days vs 4.14 and 3.59days, p < 0.001) and highest risk of transfusion (52.2% vs 13.0% vs 2.69%, p < 0.001), non-home discharge (39.1% vs 27.8% vs 15.4%, p < 0.001), readmission (7.25% vs 5.99% vs 3.36%, p = 0.023), and complications (13.0% vs 9.51% vs 6.20%, p = 0.012). On multivariable logistic regression, both patients with mild and moderate-severe anemia had an increased risk of transfusion (OR: 37.3, p < 0.001; OR: 5.25, p < 0.001, respectively) and non-home discharge (OR: 2.00, p = 0.021; OR: 1.71, p = 0.001, respectively) compared to patients without anemia. Anemia severity was not independently associated with complications or 90-day readmission. On multivariable linear regression, mild anemia (β: 0.37, p = 0.001) and moderate-severe anemia (β: 1.07, p < 0.001) were independently associated with length of hospital stay. Patients with moderate-severe preoperative anemia are at increased risk for longer length of stay, transfusions, and non-home discharge. Improved optimization of preoperative anemia may significantly reduce healthcare utilization, and surgeons should consider these risks in preoperative planning. III.

The utility of inpatient anemia workup in hemoglobin < 10g/dL diagnosed randomly in the third trimester: a retrospective study.

About 40% of pregnant women are anemic and at an increased risk for complications. We examined the efficacy of inpatient anemia workup and treatment in pregnant women diagnosed with moderate-severe anemia (hemoglobin < 10mg/dL), during hospitalization in the late second-trimester and third-trimester. This retrospective study, conducted between March 2020 and November 2022, included women at ≥ 24 gestational weeks who were hospitalized due to various indications and diagnosed with anemia (hemoglobin < 10mg/dL). The study group comprised women who underwent an inpatient anemia workup and initiation of anemia treatment. The comparison group comprised women who did not undergo an inpatient anemia investigation. The primary outcome was the rate of pre-delivery hemoglobin > 11g/dL. The most frequent etiology of anemia in the study group (n = 188) was iron-deficiency anemia (30.2%), followed by mixed anemia of iron, folate and vitamin-B12 deficiencies (20.7%). In the study vs. the comparison group (n = 179), the rate of pre-delivery hemoglobin > 11g/dL was higher, and the increase in hemoglobin from intervention to delivery was greater. The ideal timing for anemia intervention for maximizing the increase in pre-delivery hemoglobin was 6-weeks or more prior to delivery. The rates of postpartum hemorrhage and blood transfusions were similar. The rate of postpartum hemoglobin < 10g/dL was lower in the study than the comparison group. Inpatient anemia investigation and treatment resulted in higher peri-delivery hemoglobin. In women randomly diagnosed with anemia at hospitalization, the rate of pre-delivery hemoglobin > 11g/dL was increased among those who underwent a simple anemia investigation and treatment initiation.

Presence and impact of anemia in patients supported with left ventricular assist devices

Data on anemia and its effects on patients supported with continuous-flow left ventricular assist devices (LVADs) are lacking. This study sought to describe the presence of anemia over time and investigate its association with mortality, quality of life, exercise capacity, and adverse events in LVAD patients. Adults receiving durable LVADs between 2008 and 2017 were identified from the INTERMACS database. The full cohort was stratified according to anemia severity (no anemia, mild, and moderate-severe). The analysis of 19,509 patients (females: 21.2%, age: 56.9±12.9 years) showed that moderate-severe anemia affected 45.2% of patients at baseline, 33.5% of them at 6 months, and 32.3% in the fourth year after implantation. The presence of normal hemoglobin was 24.4% before surgery, 32.5% at 6 months, and 36.6% at 4 years after implantation. Multivariable linear mixed-effect regression revealed that the average hemoglobin over time was significantly lower (β, -0.233, 95% confidence interval (CI): -0.282 to -0.185), and the reduction of hemoglobin over time was bigger (β, -0.032 95% CI: -0.035 to -0.028) for LVAD nonsurvivors compared with LVAD survivors. Adjusted Cox regression showed that the severity of preimplant anemia was associated with higher mortality (HR, mild: 1.19; 95%CI: 1.05-1.35 and moderate-severe: 1.44; 95% CI: 1.28-1.62), with similar results in competing risk regression. Anemia progression during follow-up was associated with decreased Kansas City Cardiomyopathy Questionnaire scores and shorter 6-minute walk distances. In patients supported with LVADs, anemia is a frequent comorbidity, and deterioration over time is associated with poor prognosis.

Perinatal Outcome of Pregnant Women with RhD Sensitization: A Five-Year Cross-Sectional Study at a Tertiary Care Hospital in Ethiopia.

Isoimmunization is a process of immunizing an antigen-negative pregnant individual with a paternally derived fetal antigen. Although the Rh systems contain many antigen subtypes (D, C, c, E, e), the RhD antigen is highly immunogenic. This research aimed to investigate the perinatal Outcome of pregnant women with RhD sensitization at St. Paul's Hospital Millennium Medical College (SPHMMC), Ethiopia. A facility-based retrospective cross-sectional study was conducted on 98 pregnant women with RhD alloimmunization at SPHMMC from September 11, 2016, to September 10, 2021. SPSS 26 was used for data analysis. Descriptive statistics were utilized to assess the perinatal outcome of pregnant women with RhD alloimmunization. Fisher's exact test was used to determine which association, and a P value <0.05 was considered statistically significant. From the 98 pregnancies (06 - hydropic, 92 - non-hydropic) at high risk for fetal anemia, 45.9% of cases had MCA-PSV above 1.5MoM. Among these, 21.42% of all fetuses received an intrauterine transfusion. Forty-three IUTs were performed in 21 fetuses. The median number of transfusions per fetus was two. About 52.4% of the transfused fetuses had severe anemia, and 28.6% had moderate anemia. Prediction of MCA PSV ≥1.5MOM in diagnosing moderate-severe anemia in pregnant women with RhD sensitization 81%. General neonatal survival of alloimmunizations was 93.8%, 90.5% with IUT, 50% with hydrops fetalis, and 96.7% without hydrops. This research provides evidence that MCA PSV ≥1.5MoM is modest predictor of moderate-severe anemia in untransfused fetuses. This study was a step toward the development of more extensive and multicenter studies on the Perinatal Outcome of pregnant women with RhD sensitization in Ethiopia. Extra studies are needed to evaluate strategies for estimates of fetal anemia after blood transfusion as a result of the absence of information on the IUT database.

Anaemia and adverse outcomes in European patients with atrial fibrillation: a report from the ESC-EHRA EORP atrial fibrillation general long-term registry

Abstract Background Anaemia is an independent predictor of atrial fibrillation (AF) and a common comorbidity. Real world data on the impact of anaemia on clinical outcomes, and on the benefits and risks of oral anticoagulation (OAC) are limited. Purpose To investigate the association of different degrees of anaemia with adverse outcomes in a cohort of European patients with AF. Methods We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry with baseline hemoglobin (Hb) values. Patients were stratified according to World Health Organization (WHO) definition of anaemia: (i) No anaemia (Hb≥12.0g/dl for women and Hb≥13.0g/dl for men), Mild anaemia (Hb 11.0–11.9g/dl for women and Hb 11.0–12.9g/dl for men), and moderate-severe anaemia (Hb ≤10.9 g/dl for both sexes). Primary outcomes were all-cause death, major adverse cardiac events (MACE, as the composite of any thromboembolism (TE)/acute coronary syndrome/cardiovascular death) and major bleeding. Results From the original 11,096 AF patients enrolled in the Registry, 7767 (69.9%) were included in the present analysis (median age 70 years, interquartile range [IQR] 62–77, males 58.3%, CHA2DS2VASc score median 3 [2–4], HAS-BLED median 2 [1–2]). A total of 5973 (76.9%) patients did not have anaemia, 1156 (14.9%) had mild anaemia, and 638 (8.2%) had moderate/severe anaemia. Patients with anaemia were more likely to have more comorbidities, frailty, permanent AF and polypharmacy (≥5 drugs). Overall, 318 (18.4%) patients with anaemia and an indication for anticoagulation [i.e. CHA2DS2-VASc≥1 (males), or ≥2 (females)] did not receive any OAC. After a median (IQR) follow-up of 730 (692–749) days, all-cause death was 10.5% and there were 841 (11.6%) MACE and 186 (2.5%) major bleeds. Kaplan–Meier analysis showed a higher cumulative risk for patients with moderate-severe anaemia for all the outcomes considered (Figure) (Log Rank tests, all p&amp;lt;0.001). Adjusted Cox regression analyses revealed that patients with mild and moderate-severe anaemia had a higher risk for all-cause death (adjusted hazard ratio [aHR] 2.02, 95% confidence interval [CI] 1.71–2.40 and aHR 2.39, 95% CI 1.97–2.91, respectively), MACE (aHR 1.44, 95% CI 1.17–1.76 and aHR 1.64, 95% CI 1.30–2.07 respectively), and major bleeding (aHR 1.52, 05% CI 1.02–2.25 and aHR 3.73, 95% CI 2.59–5.37, respectively). Among patients with moderate-severe anaemia, use of OAC was associated with lower risk of all-cause mortality (HR 0.64, 95% CI 0.46–0.89) and MACE (HR 0.55, 95% CI 0.36–0.84), without a significant increased risk of major bleeding (HR 0.81, 95% CI 0.43–1.52). Conclusions In a large contemporary cohort of European AF patients, almost 25% have concomitant anaemia which is associated with an increased risk for all-cause mortality, MACE and major bleeding. Use of OAC was associated with a lower risk of all-cause mortality in patients with moderate-severe anaemia, without significant increased risk of major bleeding. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2016), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2011–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2017), Menarini Int. Op. (2009–2012), MSD-Merck &amp; Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2010–2021), and Vifor (2019–2022)

Association of Anemia with Dementia and Cognitive Decline among Community-Dwelling Elderly

Introduction: The association of anemia with dementia in elders is controversial. We examined the potential association of anemia with dementia in a large population of elders. Methods: Historical-prospective registry-based study. Included 36,951 community-dwelling elders (65–113 years) that were followed during 2002–2012. Anemia of all kinds was defined according to Clalit Health Services (CHS) definitions: hemoglobin (HGB) <14 g/dL men, <12 g/dL women; and World Health Organization (WHO): HGB <13 g/dL men, <12 g/dL women. Anemia was categorized as mild (HGB 11–13 g/dL men, 11–12 g/dL women) or moderate-severe (HGB <8–10.9 g/dL men and women). Background data, laboratory values, and diagnosis of dementia and cognitive decline (DCD) were reviewed. Results: During the 10-year follow-up period, DCD was newly diagnosed in 7,180 subjects (19.4%). Subjects with DCD had a higher rate of anemia than those without DCD. Time to development of DCD was 1.5 years shorter in those with than without anemia. On multivariate Cox regression analysis adjusted for age and sex, the hazard ratio (HR) for DCD was 1.45 (95% CI: 1.37–1.54) by CHS and 1.51 (95% CI: 1.41–1.61) WHO anemia criteria. The more severe the anemia, the greater the risk of DCD development (HGB 13–14 g/dL [men only], HR = 1.20 [95% CI: 1.09–1.32]; mild anemia, HR = 1.38 [95% CI: 1.28–1.49]; moderate-severe anemia, HR = 1.64 [CI: 1.41–1.90]). Every decrease in 1 standard deviation of HGB (1.4 g/dL) increased the DCD risk by 15%. A competing risk model has weakened the association of anemia with DCD risk. Conclusions and implications: Anemia in community-dwelling elders appears to be associated with an increased DCD risk in a dose-response manner. Application of the WHO anemia criteria in men may miss patients with mild anemia that places them at DCD risk. Further research should look at anemia as a cause of reversible dementia.

Impact of anemia on the clinical outcomes in elderly patients with atrial fibrillation receiving apixaban: J-ELD AF registry subanalysis.

BackgroundThe impact of anemia on the safety and efficacy of anticoagulants in elderly patients with atrial fibrillation (AF) has not been elucidated.Method and ResultsThe J-ELD AF Registry is a large-scale, multicenter prospective observational study, of the one-year outcomes after administration of on-label doses of apixaban in Japanese patients with non-valvular AF aged ≥ 75 years. The entire cohort (3,015 patients from 110 institutions) was divided into three subgroups according to the WHO classification of anemia: normal (hemoglobin ≥ 13.0 g/dL in men and ≥ 12.0 g/dL in women, n = 1733, 57.5%), mild anemia (11.0 ≤ hemoglobin < 13.0 g/dL in men and 11.0 ≤ hemoglobin < 12.0 g/dL in women, n = 839, 27.8%), and moderate-severe anemia (<11.0 g/dL in both men and women, n = 443, 14.7%). The event rates (/100 person-years) for the normal, mild anemia, and moderate-severe anemia groups were 1.36, 1.81, and 1.99 for strokes or systemic embolisms (log-rank p = 0.556), 1.74, 1.16, and 4.02 for bleeding requiring hospitalization (log-rank p = 0.007), 2.03, 3.72, and 6.44 for total death (log-rank p < 0.001), and 0.86, 1.03, and 1.24 for cardiovascular death (log-rank p = 0.770), respectively. After adjusting for the confounders, moderate-severe anemia was an independent risk of total death (hazard ratio [95% confidence interval]; 2.21 [1.28–3.81], P = 0.004), but not for strokes or systemic embolisms and bleeding.ConclusionsIn AF patients aged ≥ 75 years taking an on-label dose of apixaban, moderate-severe anemia was not an independent risk of a stroke or systemic embolism and bleeding requiring hospitalization.

The rate of decline in fetal hemoglobin following intrauterine blood transfusion in the management of red cell alloimmunization

ObjectiveHemolytic disease of the fetus and newborn is characterized by fetal anemia, secondary to maternal alloantibody-mediated fetal erythrocyte destruction. Despite our reliance on intrauterine blood transfusion (IUT) to maintain severely affected pregnancies, it remains difficult to predict the fetal response to an infusion of donor blood. Our objective was to determine the daily rate of decline in fetal hemoglobin following one, two, and three transfusions. We also evaluated the relationship between the fetal hemoglobin level and the corresponding doppler measurement of the fetal middle cerebral artery peak systolic velocity (MCA-PSV). Study DesignA prospective observational study of all singleton pregnancies treated with intrauterine transfusion for fetal anemia secondary to maternal alloimmunization at the National Maternity Hospital, a tertiary referral centre, was conducted over a 10-year period (2011–2020). Demographic and clinical data was obtained from the electronic patient records. Ethical approval was granted by the Ethics and Research Committee of the National Maternity Hospital. ResultsA total of 90 intrauterine blood transfusions were performed in 41 fetuses affected by maternal alloimmunization, of which 70% (n = 29), 34% (n = 14) and 15% (n = 6) required a 2nd, 3rd, and 4th transfusion, respectively. The mean rate of decline in fetal hemoglobin following the first transfusion was 0.4 g/dl/day (range, 0.12–0.64 g/dl/day). The mean rate of decline was lower after repeat transfusions at 0.27 g/dl/day (range, 0.16–0.45 g/dl/day). The sensitivity of MCA-PSV threshold of 1.5 Multiples of the Median (MoM) to detect moderate-severe anaemia declined with rank of IUT, from 82% after one previous transfusion, to 75% after two or more previous transfusions. No fetal mortality was seen in our series. ConclusionKnowledge of the expected rate of decline in fetal hemoglobin following an IUT aids in the determination of appropriate timing of subsequent transfusions in a fetus affected by red cell alloimmunization. We observed a reducing rate of daily decline in hemoglobin in fetuses requiring successive transfusions. Our findings suggest a reduced accuracy of the MCA-PSV threshold of 1.5 MoM in determining the optimal timing of 2nd, 3rd, and 4th transfusions.

Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas.

Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas.

Levels and correlates of physical activity and capacity among HIV-infected compared to HIV-uninfected individuals.

IntroductionIn the HIV-infected individuals, physical activity improves physical strength, quality of life and reduces the risk of developing non-communicable diseases. In Sub-Saharan Africa, HIV-infected patients report being less active compared to HIV-uninfected individuals. We assessed the levels and correlates of objectively measured physical activity and capacity among HIV-infected antiretroviral therapy (ART)-naive individuals compared to HIV-uninfected individuals in Mwanza, Tanzania.MethodWe conducted a cross-sectional study among newly diagnosed HIV-infected ART-naive individuals and HIV-uninfected individuals frequency-matched for age and sex. Socio-demographic data, anthropometrics, CD4 counts, haemoglobin level, and C-reactive protein (CRP) were collected. Physical activity energy expenditure (PAEE) was assessed as measure of physical activity whereas sleeping heart rate (SHR) and grip strength were assessed as measures of physical capacity. Multivariable linear regression was used to assess the correlates associated with physical activity and capacity.ResultsA total of 272 HIV-infected and 119 HIV-uninfected individuals, mean age 39 years and 60% women participated in the study. Compared to HIV-uninfected individuals, HIV-infected had poorer physical activity and capacity: lower PAEE (-7.3 kj/kg/day, 95% CI: -11.2, -3.3), elevated SHR (7.7 beats/min, 95%CI: 10.1, 5.3) and reduced grip strength (-4.7 kg, 95%CI: -6.8, -2.8). In HIV-infected individuals, low body mass index, moderate-severe anaemia, low CD4 counts and high CRP were associated with lower physical activity and capacity. In HIV-uninfected individuals, abdominal obesity and moderate anaemia were associated with lower physical activity and capacity.ConclusionHIV-infected participants had lower levels of physical activity and capacity than HIV-uninfected participants. Correlates of physical activity and capacity differed by HIV status. Management of HIV and related conditions needs to be provided effectively in health care facilities. Interventions promoting physical activity in these populations will be of importance to improve their health and reduce the risk of non-communicable diseases.

Study of characteristics of intracavitary uterine pathologies among perimenopausal and postmenopausal women presenting with abnormal uterine bleeding

Objets: Study of clinical and para-clinical characteristics of intracavitary pathologies in peri-menopausal and post-menopausal women with abnormal uterine bleeding (AUB). Materials and methods: This was a prospective observational study and included 150 women above 40 years-old with AUB and had histopathological results to compare. Results: A mean age of total study was 51.51 &plusmn; 7.65. The most common symptom of AUB in perimenopause women was menorrhagia, making up to 62.2% of cases. There were 54.7% of cases had at least one functional symptom associated besides AUB, frequent symptoms were pale skin (35.9%) and hypogastric pain (31.3%). Prevalence of intracavitary pathologies differentiated from age, the most common abnormalities in peri-menopausal bleeding women are endometrial hyperplasia (66.7%), in post-menopausal bleeding women were endometrial hyperplasia (51,7%) and endometrial cancer (EC) (38,3%). Women with peri-menopausal bleeding had moderate-severe anemia (58.1%) was greater than women with post-menopausal bleeding (10.0%). The most common anormality resulting in severe anemia was endometrial hyperplasia (70.8%), EC occupied only 4.2%. Our study revealed age, diabetes in relationship to malignant disease. Others factors were less associated With malignancy. Size of uterus was different between the benign and malignant group in post-menopausal women with AUB. Dimension of lesion mass was also different among intracavity pathologies. Conclusion: Menorrhagia was the most common type of uterine bleeding caused severe anemia in perimenopausal women. Endometrial hyperplasia was the most popular cause lead to menorrhagia in intracavitary abnormalities. Age, diabetes increased the risk for EC. Size of uterus and intrauterine mass had association with malignant lesion in postmenopause with AUB.

OPTIMIZATION OF OPERATIVE DELIVERY OF WOMEN IN LABOR WITH PLACENTA PREVIA

The aim – to evaluate the effectiveness of preventive ligation of uterine vessels during caesarean section in women with placenta previa.&#x0D; Material and Methods. The study was conducted on the basis of the Regional Perinatal Center and Maternity Hospital № 5 (Odessa) for 2000–2020 and performing the main stage of cesarean section after reducing perfusion in the placenta. Uterine ligation was performed after fetal removal. The volume of blood loss, the condition of the mother and fetus were monitored, and perinatal results were analyzed.&#x0D; Statistical processing was performed by methods of variance and frequency analysis using Statistica 13.0 software (TIBCO, USA).&#x0D; Results. The mean age of pregnant women was 33.4±1.2 years. The clinic of placenta previa during pregnancy was extremely scanty. As a rule, the diagnosis was made during ultrasound monitoring. In 16 (17.7 %) there was repeated bleeding from the genital tract without pain and increased uterine tone, with the development of anemia of moderate severity. Single bleeding was observed in 53 (58.9 %) women.&#x0D; Blood loss was 1380±112 ml in group I, 466±34 ml in group II (p&lt;0.05). The frequency of anemia in the postoperative period was 38.0 % and 17.5 %, respectively (p&lt;0.05). All newborns were discharged on the 5-7th day of the postpartum period in satisfactory condition. There were no cases of distress syndrome.&#x0D; Conclusions: 1. The method of control of blood loss during placenta previa by ligation of the uterine arteries is effective – blood loss was in group I 1380±112 ml, in group II – 466±34 ml (p&lt;0,05). 2. The frequency of anemia in the postoperative period was 38.0 in group I and 17.5 % in group II (p&lt;0.05).

Factors Related To Incidence of Anemia in HIV Infected Children With Zidovudin in H Adam Malik Hospital

Background: Anemia is one of the most common haematological complications in people with HIV infection. Anemia is associated with increased disease progression as well as worsening clinical conditions. Zidovudin is the first-line anti-retoviral treatment of HIV which has anemia side effects. The prevalence of anemia due to zidovudine varies from 3.7% to 41.6%, 21.3% was moderate-severe anemia. Besides zidovudin, there was a relationship between age, CD4 cell count, and opportunistic infections with the incidence of anemia. Objective: To study factors related to incidence of anemia in HIV infected children with zidovudin in H Adam Malik general hospital. Methods: A retrospective cross-sectional study, 80 subjects who received zidovudin therapy were taken through medical records, then analyzed bivariate and multivariate analysis of risk factors for anemia. Results: The incidence of anemia was 41.4% consisting of mild anemia 28.6%, moderate anemia 5.7%, severe anemia 7.1%. There is a correlation between anemia and immunodiciency status (P <0.001, PR 12.833, CI 1.863 - 88.395), nutritional status (P <0.001, PR: 10.731, CI 2.763 - 41.671), and length of therapy (P = 0.001, PR 2.779, CI 1.428 - 5,409). Multivariate analysis found that nutritional status was the most influential risk factor in influencing the onset of anemia in children with HIV who were given zidovudine therapy. Conclusion: there is a relationship between nutritional status, immonodeficiency status and length of therapy to the incidence of anemia in HIV-infected children who are given zidovudine therapy.

Cost-Effectiveness of Ferrous Fumarate-Folic Acid and Ferrous Gluconate-Multivitamins in a High Prevalence Area of Iron Deficiency Anemia in Indonesia.

BackgroundUp to now, the combinations of ferrous fumarate–folic acid (FF-FA) and ferrous gluconate–multivitamins (FG-MV) have been implemented by the local government in the province of Papua. Nevertheless, there is no a specific economic evaluation that has been applied to investigate the cost-effectiveness of FF-FA and FG-MV.ObjectiveThis study aimed to investigate the cost-effectiveness of FF-FA and FG-MV to be implemented in Teluk Bintuni, as one of the districts with the highest prevalence of iron deficiency anemia in Papua by taking the healthcare perspective into account.MethodsA prospective observational study was applied by considering two groups of women (15–49 years old) with iron deficiency anemia who received FF-FA and FG-MV from September to November 2018. Applying a purposive sampling method, respondents were selected from 875 targeted women in six sub-districts, who met inclusion criteria. To estimate the total cost, we applied a healthcare perspective that considered direct medical cost only (eg, the procurement cost of iron tablets, cost of Hb test, and cost of healthcare visit). To estimate the effectiveness of intervention, we applied two major parameters, such as Hb level and utility score in quality-adjusted life year (QALY). The cost-effectiveness values were evaluated by using the criteria on the cost-effectiveness of healthcare intervention according to the threshold of gross domestic product (GDP) per capita (cost per QALY gained).ResultsFrom 875 targeted women in six sub-districts who met inclusion criteria, we found approximately 222 women with moderate–severe iron deficiency anemia and 110 women with complete data in the group of FF-FA (n=69) and FG-MV (n-41). The results showed that there were significant differences (p-value <0.05) on the number of respondents, age, oral iron cost, total healthcare cost and utility score in both intervention groups. Comparing the use of FG-MV with FF-FA, we estimated the incremental cost-effectiveness ratios (ICERs) would be $255.77 per controlled patient, $142.09 per patient with Hb increment >2.00 g/dL, $79.93 per patient with Hb increment >1.00 g/dL, and $11.59 per QALY gained.ConclusionThe ICER was estimated to be $11.59 per QALY gained, which was highly cost-effective, according to GDP-based cost-effectiveness threshold. In addition, the utility score of women with iron deficiency anemia was considered to be the most influential factor impacting the cost-effectiveness value.