Risk Of Anemia Research Articles

Association between anaemia and aflatoxin B1 and fumonisin B1 exposure in HIV-infected and HIV-uninfected pregnant women from Harare, Zimbabwe.

Aflatoxin B1 (AFB1) and fumonisin B1 (FB1) are poisons that contaminate poorly stored staple foods in resource-limited settings. Antenatal AFB1 and FB1 exposure may cause anaemia. We aimed to determine the associations of urinary aflatoxin M1 (AFM1) and FB1, biomarkers of AFB1 and FB1 exposure, respectively, with erythrocyte parameters and anaemia. A retrospective cross-sectional study was conducted in 68 HIV-infected and 61 HIV-uninfected pregnant women ≥ 20 weeks gestational age in Harare, Zimbabwe. AFM1 and FB1 were measured in urine via competitive ELISA, and levels were grouped into tertiles. The erythrocyte parameters assessed were haemoglobin (Hb), mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red blood cell (RBC), haematocrit (HCT), and red blood cell distribution width. Associations of urinary AFM1 and FB1 with erythrocyte parameters, and anaemia were assessed in a multiple regression controlled for potential confounders. The presence of FB1 in urine decreased Hb levels in all women (β= -0.98, 95% CI: -1.94, 0.02) and HIV-uninfected (β= -1.99, 95% CI: -3.71, -0.26). FB1 tertile 3 decreased Hb levels (β= -0.88, 95% CI: -1.74, 0.01) and HCT levels (β= -2.65, 95% CI: -5.26, 0.03) in HIV-infected. AFM1 tertile 2 decreased RBC levels in HIV-infected (β= -0.34, 95% CI: -0.71, -0.03). The presence of FB1 in urine increased anaemia risk in HIV-uninfected (OR: 10.68 95% CI: 1.02, 112.34). AFM1 tertile 2 increased macrocytic anaemia risk in HIV-infected (OR: 13.72, 95% CI: 0.92, 203.55). There is need to ensure food safety through monitoring and nutritional interventions to improve maternal-infant health outcomes.

Effect of Nutrition Education During Pregnancy on Iron-Folic Acid Supplementation Compliance and Anemia in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.

Stakeholders implement nutrition education to prevent and control anemia during pregnancy. Nutrition education during pregnancy can increase the consumption of iron-folic acid (IFA) supplements and encourage behavioral changes. However, there is no comprehensive meta-analysis to determine the effectiveness of this intervention. This review aimed to determine the effect of nutrition education on IFA supplementation (IFAS) compliance, hemoglobin level change, and prevalence of anemia in low- and middle-income countries. The systematic searches on Ovid Medline, Scopus, Embase (Elsevier), Web of Science, Health and Medical Collection (ProQuest), and Google Scholar were conducted until September 11, 2023. The updated searches were performed on November 16, 2023. In total, 12 436 records were imported to Covidence. Of these, 9109 records were screened by title and abstract. A total of 112 records were evaluated in full, and 53 articles were ultimately included based on eligibility. Fifty-three peer-reviewed research articles met the inclusion criteria, involving 13 475 pregnant women. Those who received nutrition education during pregnancy were 2.80 times more likely to comply with IFAS (odds ratio = 2.80; 95% CI: 2.04, 3.83; I2 = 66.20%). There was an average increase of 0.88 g/dL (Cohen's d = 0.88; 95% CI: 0.63, 1.13; I2 = 96.17%) in hemoglobin levels among women who received nutrition education. A meta-regression analysis revealed that 61.85% (adjusted R2 = 61.85%) of heterogeneity between standardized mean differences was explained by anemia status, intervention duration, and geographic region. Also, pregnant women in the nutrition education group had a 34% (relative risk = 0.66; 95% CI: 0.54, 0.80, I2 = 86.85%) lower risk of anemia compared with the control group. Nutrition education during pregnancy improves compliance with IFAS, increases hemoglobin levels, and reduces the risk of anemia. Therefore, it is crucial to enhance the existing nutrition education program to prevent and control anemia during pregnancy. PROSPERO registration no. CRD42023454241.

Anaemia during pregnancy: could riboflavin deficiency be implicated?

Anaemia affects more than 36% of all pregnancies globally and is associated with significant maternal and neonatal morbidity and mortality. Iron deficiency is widely recognised as the most common nutritional cause of anaemia but other nutrient deficiencies are also implicated, including the B vitamin riboflavin, albeit its role is largely under-investigated and thus typically overlooked. Riboflavin, in its cofactor forms flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN), is required for numerous oxidation-reduction reactions, antioxidant function, and in the metabolism of other B vitamins and iron. While clinical deficiency of riboflavin is largely confined to low-income countries, sub-clinical (functional) deficiency is much more widespread, including in high-income countries, and is particularly common among women of reproductive age and during pregnancy. Limited observational evidence from high-income populations suggests that suboptimal riboflavin status contributes to an increased risk of anaemia. Furthermore, randomised controlled trials in pregnant women from low- and middle-income countries have demonstrated beneficial effects of riboflavin on haematological status and anaemia. Various mechanisms have been proposed to explain the contribution of riboflavin deficiency to anaemia, with the strongest evidence pointing to an adverse effect on iron metabolism, given that riboflavin co-factors are required for the release of iron from storage ferritin in the production of red blood cells. Overall, this review investigates riboflavin intakes and status during pregnancy in different populations and evaluates the available evidence for the under-recognised role of riboflavin in the maintenance of haemoglobin concentrations together with its potential to protect against the development of anaemia during pregnancy.

Abstract 4134655: Clinical Outcomes of Patients with Alcoholic Cirrhosis and Acute STEMI Undergoing PCI

Original research: Background: The objective is to evaluate the outcomes of percutaneous coronary intervention (PCI) in patients with alcoholic cirrhosis presenting with ST-segment elevation myocardial infarction (STEMI). Methods: We analyzed data from the National Inpatient Sample (NIS) for the years 2016-2020. Our cohort included patients admitted with STEMI and a secondary diagnosis of alcoholic cirrhosis, excluding those under 18 or those not receiving PCI. Propensity score matching using a kernel method was applied to adjust for 22 variables, including patient demographics, hospital characteristics, and comorbid conditions. Results: Among 119,799 patients, 98 had alcoholic cirrhosis. These patients exhibited higher mortality (18% vs. 5%) and longer hospital stays (5.4 days vs. 3.6 days). They also had increased risks of acute blood loss anemia (13% vs. 3.5%) and gastrointestinal bleeding (18% vs. 2%). Additionally, acute kidney injury was more prevalent in the cirrhosis group (25.5% vs. 14%). Although heart failure exacerbation and cardiac arrhythmias were more common, these were not statistically significant (Table 1). Conclusion: Our study indicates a significantly higher mortality rate among patients with alcoholic cirrhosis undergoing PCI for STEMI. These patients are also at increased risk of postoperative bleeding due to compromised liver function and hemostatic abnormalities, as reflected by higher incidences of acute blood loss anemia and gastrointestinal bleeding. Additionally, there is an elevated risk of acute kidney injury post-PCI, highlighting the need for renal-protective strategies. These findings stress the necessity for specialized care, vigilant monitoring, and tailored protocols to address the unique challenges faced by this population, aiming to reduce morbidity and mortality.

Abstract 4131460: Restrictive or Liberal Blood Transfusion in Patients with Myocardial Infarction and Renal Insufficiency

Background: Chronic kidney disease (CKD) is associated with risk of myocardial infarction (MI) and anemia. Among patients with CKD and anemia who experience MI, it remains uncertain if a liberal transfusion threshold (LTT) strategy (hemoglobin cutoff [Hgb] < 10 g/dL) is superior to a restrictive transfusion threshold (RTT, Hgb 7-8 g/dL) strategy. Objectives: To evaluate outcomes of those with CKD randomized to RTT vs. LTT in the Myocardial Ischemia and Transfusion (MINT) trial (NCT02981407). Methods: Among 3,495 MINT participants with non-missing creatinine (99.7%), we compared the baseline characteristics and outcomes at 30 days post-randomization of those individuals without CKD (N = 1279), CKD with eGFR 30-60 mL/min/1.73 m 2 (N = 999), CKD with eGFR < 30 mL/min/1.73 m 2 (N = 802), and CKD requiring dialysis (N = 415), both overall and by randomized transfusion strategy. Interaction terms for eGFR category by treatment assignment on each outcome were assessed. Results: Individuals with CKD compared to those without CKD more frequently presented with NSTEMI (all p < 0.001) and had a greater risk of all-cause death, recurrent MI, rehospitalization, and heart failure (all p < 0.05). Compared to a liberal transfusion strategy, a restrictive strategy among non-dialysis dependent individuals with an eGFR < 30 mL/min/1.73 m 2 was associated with an increased risk of death/recurrent MI ( Figure 1 ) and unplanned rehospitalization ( Figure 2 ). Among individuals with an eGFR 30-60 mL/min/1.73 m 2 , a restrictive strategy was associated with an increased risk of cardiac death ( Figure 1 ). No eGFR category by treatment assignment interaction terms were significant. Conclusions: In this prespecified analysis, individuals with CKD were at greater risk of death, recurrent MI, heart failure, and unplanned rehospitalization at 30 days post-randomization than those without CKD. In individuals with CKD, a restrictive transfusion strategy was associated with increased risk of adverse outcomes.

Delayed Umbilical Cord Clamping: and Improved Neonatal Outcomes

Delayed cord clamping (DCC) has emerged as a critical practice in modern obstetrics, offering significant benefits to both term and preterm infants. Immediate cord clamping was widely practised to facilitate neonatal care and manage maternal health concerns. However, growing evidence underscores the advantages of delaying cord clamping for 1-3 minutes post-birth. This practice enhances neonatal outcomes by increasing blood volume, improving iron stores, and ensuring a smoother transition to independent physiological function. The physiological benefits of DCC, including better oxygenation and higher haemoglobin levels, contribute to a reduced risk of neonatal anaemia and support long-term health. Additionally, DCC has been associated with improved breastfeeding success and is particularly valuable in low-resource settings where access to comprehensive healthcare may be limited. The practice is endorsed by major health organizations such as the World Health Organization and the American College of Obstetricians and Gynaecologists, reflecting its importance in promoting neonatal health.This article explores the historical context, physiological mechanisms, and global guidelines that inform DCC, highlighting its role as a low-cost, easily implementable intervention with substantial benefits. While there are instances where immediate clamping may still be necessary, particularly in cases of neonatal distress, DCC is increasingly recognized and accepted globally as the standard of care that optimizes neonatal outcomes.

Neoadjuvant immune checkpoint inhibitor reduced recurrence in operable NSCLC patients with pathological complete response: a retrospective analysis

BackgroundThis study aimed to evaluate if neoadjuvant immune checkpoint inhibitor (ICI) plus chemotherapy (CT) reduced tumor recurrence after surgery than neoadjuvant CT alone in non–small cell lung cancer (NSCLC) patients with pathologic complete response (pCR).MethodsFrom January 1st 2019 to April 30th 2022, 16 NSCLC patients with pCR who received both neoadjuvant ICI and CT were designated as ICI/CT group. Another 8 patients, who received neoadjuvant CT alone, were designated as CT group. The tumor recurrence and patients’ survival status were analyzed.ResultsSquamous cell carcinoma was the predominant histology type in both groups. The CT group had higher percentage of patients who received adjuvant CT than the ICI/CT group (100% vs. 75%, p = 0.046). All patients had been followed up for at least 20 months. At 20 months after surgery, the ICI/CT group had a tumor recurrence rate of 6.25%, which was significantly lower than 37.5% recurrence rate of the CT group. One patient of the CT group died of gastrointestinal hemorrhage and severe anemia at 11 months after surgery, and no patient in the ICI/CT group died. During adjuvant therapy, the ICI/CT group had significantly lower risk of anemia (12.5% vs. 50%) than the CT group (p = 0.046).ConclusionThe study found that in NSCLC patients with pCR, neoadjuvant ICI reduced tumor recurrence rate. This indicated that like in advanced stage NSCLC, the ICI might bring similar long-term anti-tumor effect in operable NSCLC patients.

Trends and inequalities in anaemia prevalence among children aged 6–59 months in Ghana, 2003–2022

BackgroundAnaemia, characterised by a deficiency in red blood cells or haemoglobin, is a public health issue in Ghana, particularly among children. The prevalence of anaemia in this age group has been a longstanding concern due to its adverse effects on cognitive development, physical growth, and well-being. This study examined the trends and inequalities in anaemia prevalence among children aged 6–59 months in Ghana between 2003 and 2022.MethodsData from the Ghana Demographic Health Survey conducted between 2003 and 2022 was used to analyse the prevalence of anaemia in children aged 6–59 months. The World Health Organization’s Health Equity Assessment Toolkit software calculated several inequality measures, including difference, ratio, population-attributable risk, and population-attributable percentage. An inequality assessment was performed for six stratifiers: child’s age, mother’s economic status, maternal educational level, place of residence, child’s sex, and sub-national region.ResultsAnaemia prevalence among children aged 6–59 months in Ghana declined from 76.1% in 2003 to 48.9% by 2022. The results revealed an age-related inequality in anaemia prevalence among children in Ghana, with younger age group ( 6–11 months) consistently showing higher rates. The age-related inequality Difference was 24.6 percentage points in 2022, indicating that age is crucial to understanding anaemia risk. Economic-related inequality between children of mothers in Quintile 5 (richest) and Quintile 1 (poorest) increased from a Difference of 21.1 percentage points in 2003 to 32.7 percentage points in 2022 highlighting the stark inequalities across wealth quintiles. Education inequality between children of mothers with higher education and no education decreased from a Difference of 29.4 percentage points in 2003 to 25.3 percentage points in 2022, suggesting that children from less educated households are still at higher risk. Place of residence inequality between children of mothers living in urban areas and rural areas increased from a Difference of 12.3 percentage points in 2003 to 14.8 percentage points in 2022 reflecting urban-rural disparities. Sex-related inequality between male and female children decreased from a Difference of -0.3 percentage points in 2003 to -5.5 percentage points in 2022 indicating the absence of inequality based on sex of the child. Lastly, regional inequalities are pronounced, as indicated by an increase in the Difference from 21.2 percentage points in 2003 to 34.0 percentage points in 2022, highlighting that children in certain regions like the Northern and Upper East are more affected by anaemia.ConclusionThe decline in anaemia prevalence among children aged 6–59 months in Ghana, reflects substantial progress; however, notable inequalities persist across age, economic status, education, place of residence, and region. To address these disparities, strategies such as enhancing access to healthcare services in underserved regions, implementing community education programs to raise awareness about nutrition and health, and promoting economic empowerment initiatives can be effective. Additionally, community education can play a crucial role in offsetting the effects of low household education levels, fostering a more informed population that can advocate for better health practices and policies. By addressing these key areas, we can work towards reducing anaemia prevalence and improving child health outcomes across all populations in Ghana.

Adverse maternal and fetal outcomes among tribal pregnant women suffering from sickle cell disease: A retrospective cohort study in a community-based hospital situated in a tribal block of Gujarat, India.

The study presents the risk of the maternal-fetal morbidity and mortality among one of the largest cohort of sickle cell disease (SCD) pregnancies in India and reports the epidemiology of the maternal morbidity. This was a retrospective cohort study conducted at Kasturba Maternity Hospital, SEWA Rural, in the tribal area of Gujarat, India. All pregnant women admitted to the Hospital between 2016 and 2021 were screened for SCD, and their maternal-fetal morbidities were recorded throughout the pregnancy. We quantified risk of maternal-fetal morbidity and mortality among SCD, trait and normal pregnancies after adjusting for potential confounders using Poisson and logistic regression. A total of 24 256 delivered during the study period, with 354 (1.5%) and 4216 (17.4%) suffering from SCD and trait, respectively. After adjusting for potential confounders, the women with SCD pregnancy had higher risk of maternal death (adjusted-odds-ratio [AOR] 13.7, 95% CI: 4.5-42.7), anemia (AOR 6.8, 95% CI: 4.5-10.2), severe anemia (AOR 4.3, 95% CI: 3.3-5.6), preterm delivery (AOR 4.5, 95% CI: 3.6-5.7), cesarean section (AOR 5.5, 95% CI: 4.7-7.0), stillbirth (AOR 3.4, 95% CI: 2.3-5.3), and low birth weight (AOR 3.1, 95% CI: 2.4-39) compared to normal pregnancies. Maternal morbidities occurred throughout the pregnancy; however, the risk was highest during the last month of pregnancy. Pregnant women who had severe manifestation of SCD before the pregnancy were at higher risk of developing maternal morbidities. We concluded that SCD might be an independent risk-factor for developing maternal-fetal morbidities. The SCD pregnancies with prior severe manifestations must be carefully managed during the last month of pregnancy when the risk is highest.

Olaparib-associated toxicity in cancer patients: a systematic review and meta-analysis.

To investigate the characteristics of olaparib-associated adverse events (AEs) in cancer patients. Databases were searched for phase II and III randomized controlled trials (RCTs) involving olaparib treatment up to March 2024. A systematic assessment was performed. Twenty-seven RCTs involving 9542 patients were included. This meta-analysis indicates that olaparib could significantly increase the risk of developing any all-grade (RR, 1.08; 95% CI, 1.03-1.13; p = 0.001) and high-grade (RR, 1.45; 95% CI, 1.19-1.77; p = 0.0003) AEs in cancer patients. Olaparib could increase the risk of dose reduction (RR, 3.00; 95% CI, 1.59-5.70; p = 0.0007) and treatment discontinuation (RR, 2.00; 95% CI, 1.28-3.14; p = 0.002). Hematologic toxicities and gastrointestinal toxicities commonly occur in patients receiving olaparib. Anemia, nausea, and fatigue were the most frequent AEs, with olaparib increasing the risk of both all-grade and high-grade occurrences of these events. Patients with longer treatment durations tend to have a higher risk of anemia. Patients with urinary system tumors tend to have a higher risk of nausea, while those with breast cancer tend to have a higher risk of fatigue. Olaparib maintenance therapy may be associated with a higher risk of fatigue. Olaparib could increase other AEs such as diarrhea, vomiting, decreased appetite, dyspepsia, dysgeusia, dizziness, headache, back pain, urinary tract infection, dyspnea, and cough. Olaparib-containing therapy could increase the occurrence of specific AEs in patients with cancer. Clinicians should be aware of these risks and conduct regular monitoring.

The Relationship Between Chronic Energy Deficiency and Anemia in Pregnant Women at The Madandan Community Health Center Rantetayo District Tana Toraja Regency

Chronic Energy Deficiency in pregnant women negatively impacts maternal health and fetal development, leading to weight loss, fatigue, weakness, and reduced immunity. CED also increases the risk of anemia, which can decrease oxygen supply and disrupt vital organ function. Anemia in pregnant women can cause fatigue, reduced productivity, and a higher risk of pregnancy and childbirth complications. This quantitative cross-sectional study aimed to analyze the relationship between CED and anemia in 40 pregnant women out of a total population of 64 at the Madandan Community Health Center, Tana Toraja. Data collection was carried out using a questionnaire, and the analysis employed a chi-square test. The results of Fisher's Exact Test indicated a significant association (p 0.000 < 0.05) between Chronic Energy Deficiency and anemia among pregnant women seeking treatment at the Madandan Community Health Center. The study recommends that community health centers enhance education on balanced nutrition for pregnant women through prenatal clinics, including up-to-date nutritional information, regular health monitoring, and provision of appropriate supplements to reduce the risk of anemia.

Compliance with weekly iron folic acid supplementation and associated factors among secondary school adolescent girls, in Jimma Arjo District, West Ethiopia, 2022: A mixed method cross-sectional Study

Background: Iron deficiency anemia is a prevalent and major public health problem in low- and middle-income countries among adolescent girls. The risk of Iron deficiency anemia and its consequences are prevented by taking and complying with a weekly iron-folic acid supplement. However, there was no information regarding compliance and its associated factors in Ethiopia. The study aimed to determine the magnitude of compliance with weekly Iron-folic acid supplementation and associated factors among Jimma Arjo secondary school adolescent girls. Methods: Institutional-based cross-sectional study was conducted on 417 adolescent girls in three secondary schools of Jimma Arjo, West Ethiopia from March 1st to 31st, 2022 using interviewer-administered structured and semi-structured questionnaires. Bivariable and multivariable logistic regression analyses were used to determine the association of variables. Results: Compliance with iron-folic acid supplementation was 29.3% with 95% CI (24.9, 33.3). Mother`s secondary level of education (AOR=4.94 (95% CI:2.45,9.94)), awareness of anemia (AOR=4.23 (95% CI:2.35,7.61)), good knowledge about iron-folic acid supplementation (AOR=3.96 (95% CI:2.17,7.22)), lack of iron-folic acid supplementation (AOR=0.42 (95% CI:0.23,0.75)), and iron-folic acid supplementation side effects (AOR=0.17 (95% CI:0.08,0.37)) were factors significantly associated with iron-folic acid supplementation compliance. Misconceptions about iron-folic acid supplementation, forgetfulness of tablet, lack of access to drinking water, and irregularity of school weekly iron-folic acid supplementation days were identified as the main barriers to adolescent girls' compliance with iron-folic acid supplementation in a qualitative study. Conclusions: Weekly iron-folic acid supplementation compliance was low at 29.3%. Scheduled health education, parental participation in the program, access to drinking water, refresher training for school focal persons, and fixed weekly iron-folic acid supplementation days can improve compliance with iron-folic acid supplementation and are recommended.

Intervention on Anemia prevention among adolescent girls: A quasi-experimental study on providing meatballs chips modified to increase hemoglobin levels

Adolescent girls are at higher risk of anemia due to menstrual cycle, with iron deficiency from daily food intake being the most common cause. Therefore, this study aimed to determine the effect of fried meatballs modified with a combination of local ingredients, such as chicken liver flour, moringa oleifera leaves, soybean tempeh flour, and mackerel fish, abbreviated as Tioek chips, on changes in haemoglobin levels on adolescent girls in Kupang City and Kupang Regency. The results show that foods modified with nutritious local ingredients such as Tioek chips can be classified as an affordable and delicious alternative to healthy snacks to prevent anemia.

Prevalent and incident anemia in PARAGON-HF

Abstract Background Anemia is a common comorbidity in patients with heart failure (HF) and is associated with adverse prognosis. Renin-angiotensin system inhibitors (RASi) have been shown to lower hemoglobin levels, potentially related to direct reductions in erythropoetin levels and hematopoiesis. We examined whether sacubitril/valsartan might attenuate this effect of RASi alone on incident anemia in patients with HF with mildly reduced or preserved ejection fraction. Methods PARAGON-HF was a global, multicenter randomized clinical trial of sacubitril/valsartan versus the RASi valsartan in patients with HF and left ventricular ejection fraction≥45%. Anemia was defined as hemoglobin <120 g/L in women and <130 g/L in men. We evaluated changes in hemoglobin, risks of incident anemia and new oral iron initiation during follow-up. We also assessed treatment effects on the primary composite endpoint of total HF hospitalizations (HFH) and cardiovascular (CV) death according to anemia status. Results Among 4,795 participants with a hemoglobin measurement available, 1,111 (23.2%) had anemia at randomization of which 3.5%, 77.7%, and 18.8% were characterized as micro-, normo-, and macrocytic anemia. 5.6% were treated with oral iron at baseline. Over a 2.7-year median follow-up period, patients with anemia were at nearly twice the risk of the primary outcome (21.6 vs. 11.5 per 100py; rate ratio 1.90; 95% CI: 1.62-2.21; P<0.001). Compared with valsartan, sacubitril/valsartan significantly slowed the decline in hemoglobin levels by 1.4 g/L (95% CI: 0.4-2.4 g/L; P = 0.005; Figure 1 Panel A). Participants treated with sacubitril/valsartan were at significantly lower risk of developing anemia (30.3% vs. 37.6%; HR 0.76; 95% CI: 0.68-0.85; P<0.001; Figure 1 Panel B) and starting oral iron therapy (8.1% vs. 10.0%; HR 0.81; 95% CI: 0.67-0.97; P = 0.026; Figure 2). Treatment effects of sacubitril/valsartan vs. valsartan on the primary endpoint were consistent among patients with and without anemia (Pinteraction=1.00). Conclusions Among patients with HF with mildly reduced or preserved ejection fraction, treatment with sacubitril/valsartan resulted in slower declines in hemoglobin, lower rates of incident anemia, and fewer new initiations of iron therapy compared with RASi.

Linezolid Pharmacokinetic-Anemia Modeling in Children with Rifampicin-Resistant Tuberculosis.

Linezolid, an important component of rifampicin- and multidrug-resistant tuberculosis (RR/MDR-TB) treatment, is associated with treatment-limiting toxicities, including anemia. Patient-level and linezolid pharmacokinetic risk factors for anemia have not been well described in children treated for RR/MDR-TB. We evaluated the pharmacokinetics of linezolid and longitudinal hemoglobin data to validate an existing population linezolid pharmacokinetic model. We assessed the impact of linezolid pharmacokinetics and the risk of developing anemia in a prospectively enrolled cohort of children. The validation of a previously published population pharmacokinetic linezolid model used nonlinear mixed effects modeling. A multivariable ordinal logistic regression model was built to predict the incidence of anemia. A total of 112 children, median age 7.2 (IQR: 2.2-16.3) years, were included from South Africa (n=87) and India (n=25). Of these, 24 children contributed new linezolid pharmacokinetic data. The population pharmacokinetic model which informs the currently recommended linezolid dosing in children (10-15 mg/kg) was validated with these additional new data. For every 1 g/dL lower baseline hemoglobin, the odds of developing grade 3 or 4 anemia increased by 2.64 (95% CI 1.98-3.62). For every 1 mg/L*h higher linezolid area under the concentration-time curve (AUC), the odds of developing a grade 3 or 4 anemia increased by 1.012 (95% CI 1.007-1.017). These data taken together, confirm currently recommended linezolid doses in children. The risk of anemia in children should be carefully considered and monitored throughout. Initiating linezolid in children with low baseline hemoglobin increases the probability of experiencing grade 3 or 4 anemia.

Real-world safety profile of zanubrutinib: a disproportionality analysis based on the FAERS database

ObjectiveZanubrutinib is a second-generation Bruton’s tyrosine kinase inhibitor that has been approved for the treatment of several B cell malignancies. The aim of this study was to evaluate adverse events...

Nonlinearity association of blood cobalt with the risk of anemia among middle-aged and older adults: National Health and Nutrition Examination Survey

ABSTRACT Objective The use of cobalt alloys in medical implants poses a high risk of cobalt exposure, yet there is a lack of evidence regarding the association between blood cobalt levels and anemia. This study aimed to explore the link between blood cobalt levels and the onset of anemia and to identify potential threshold levels of blood cobalt that could affect anemia. Methods The US National Health and Nutrition Examination Survey data from 2017 to 2020 were analyzed for this cross-sectional study. This study primarily employed multivariate logistic regression, stratified interaction analysis, restricted cubic splines (RCS), and threshold effect analysis to explore the relationship between blood cobalt concentration and anemia. Results The study included 5510 participants and among them 12.2% were diagnosed with anemia. Logistic regression model indicates a positive correlation between blood cobalt levels and the risk of anemia. RCS shows that the relationship between ln cobalt concentration and anemia was non-linear (J-shaped). The ln cobalt inflection point was approximately 0.81. The odds ratio of anemia with ln cobalt ≥ 0.81 was 4.00 (95% CI: 2.95–5.43, p < 0.001), the odds ratio of anemia with ln cobalt < 0.81 was 0.73 (95% CI: 0.45–1.18, p = 0.201). Conclusions The analysis unveiled a non-linear relationship, indicating that elevated blood cobalt levels were linked to a heightened likelihood of developing anemia in middle-aged and older adults; the cut-off value of ln cobalt was approximately 0.81. The findings of this study warrant further investigation.

Association between changes in depressive symptoms and risk of anemia: from the China Health and Retirement longitudinal study

BackgroundPrevious studies have reported that anemia was associated with depression, but the association between changes in depressive symptoms and the risk of anemia was unclear. This study aimed to explore whether changes in depressive symptoms were associated with anemia among the middle-aged and elderly adults.MethodsA total of 6112 patients aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) were included in this analysis. Elevated Depression Symptoms (EDS) was defined as the Center for Epidemiological Studies Depression Scale-10 score ≥ 10. Depression status was defined as no depressive symptom [no EDS at Wave 1 (2011–2012) and Wave 2 (2013–2014)], decreasing depressive symptoms (EDS at Wave 1, no EDS at Wave 2), increasing depressive symptoms (no EDS at Wave 1, EDS at Wave 2), persistent depressive symptoms (EDS at Wave 1 and Wave 2). Multivariable logistic regression analyses were conducted to estimate the relationships between depressive symptoms and the changes and risk of anemia.ResultsDuring the follow-up of Wave 1 and Wave 3 (2015–2016), 906 participants (14.82%) developed anemia, the multivariable-adjusted odds ratio for the depressive symptom compared with the no depressive symptom was 1.24 (95% CI, 1.12–1.58) for anemia. From Wave 2 to Wave 3, there were 828 participants (14.62%) diagnosed with anemia. Compared to participants with no depressive symptom, those with persistent depressive symptoms during Wave 1 and Wave 2 had the significantly elevated risk of anemia (odds ratio 1.44, 95% CI 1.21–1.84).ConclusionsThe present study demonstrated that baseline depressive symptoms and changes in depressive symptoms were associated with increased risks of anemia.

Trends and predictors of severe and moderate anaemia among children aged 6–59 months in India: an analysis of three rounds of National Family Health Survey (NFHS) data

BackgroundChildhood anaemia remains a significant public health problem in India, as it adversely affects child development and overall health outcomes. This study aimed to analyse the prevalence of severe and moderate anaemia among children aged 6–59 months and identify consistent predictors of this condition over the past 15 years.MethodsData from the three most recent rounds of the NFHS were used for this analysis. The final weighted sample included 40,331 children from the NFHS-3 (2005–2006), 200,093 from the NFHS-4 (2015–2016), and 178,909 from the NFHS-5 (2019–2021). Descriptive and bivariate analyses were conducted, followed by binary logistic regression to identify factors associated with severe and moderate anaemia in children aged 6–59 months. All statistical analyses were performed using Stata version 14.ResultsOver the past 15 years, the prevalence of severe and moderate anaemia among children in India has shown a slight decline. However, the influence of various predictors has changed over time. Young children (aged 6–23 months), those from Scheduled Caste (SC) and Scheduled Tribe (ST) communities, and children born to mothers with high parity and low educational attainment remain particularly vulnerable to anaemia. Additionally, short-term illness significantly increases the risk of anaemia. Furthermore, women’s autonomy, indicated by higher education and lower fertility rates, along with maternal nutrition education, have emerged as key factors in reducing anaemia burden in the future. Notably, children whose mothers had no education were 1.4 times more likely to suffer from severe or moderate anaemia. Similarly, children born to mothers with four to five children (OR 1.1, p < 0.05) and those with six or more children (OR 1.2, p < 0.05) had an elevated risk of anaemia.ConclusionThe findings highlight three key areas for programmatic focus to accelerate anaemia reduction in India: [1] targeting young children (aged 6–23 months); [2] ensuring the inclusion of SC and ST communities in all relevant interventions; and [3] promoting women’s autonomy. These strategies are essential for reducing the burden of anaemia across the country.

Low-Dose Aspirin and Risk of Anaemia in Older Adults: Insights from a Danish Register-based Cohort Study.

To assess the risk of anaemia among low-dose aspirin (LDA) exposure in Danish older individuals in a real-world setting. Population based-cohort study conducted using Danish registers. The study population included older individuals (≥65 years) exposed to LDA between 2008 and 2013 for primary or secondary prevention of cardiovascular events. Over a five-year follow-up, outcomes included anaemia incidence based on haemoglobin values and hematinic deficiency incidence based on antianemic prescriptions. Among the 313 508 individuals included in the study population, those exposed to LDA (n = 59 869, 19.1%) had an incidence of hematinic deficiency determined by the use of antianemic treatment of 9.6%, with an incidence rate ratio of 9.11 (95% Confidence Interval, CI: 8.81-9.41) when compared to non-users of LDA (n = 253 639, 80.9%), who had an incidence of 3.7%. Anaemia determined by haemoglobin value measurements was observed in 5.9% of those exposed to LDA, with an incidence rate ratio of 7.89 (95% CI: 7.58-8.21) when compared to non-users of LDA. Approximately one in five individuals (n = 2 422, 21.5%) who experienced anaemia also experienced bleeding. Severe anaemia was observed in 1.3% of those exposed to LDA compared to 0.6% of those not exposed. Among the exposed, the reduction in haemoglobin and ferritin levels was associated with the severity of anaemia. These findings indicate that in a real-world setting, anaemia with LDA can occur in 6 to 10 older individuals out of every 100 LDA users during the first 5 years of treatment.