Antecedentes: Aproximadamente 01 de cada 03 niños peruanos de 6 a 59 meses de edad tiene anemia. Por otro lado, la depresión materna, que puede ser incapacitante y afectar el cuidado adecuado de los niños, está asociada con la desnutrición crónica de los mismos. De igual manera, la desnutrición crónica está asociada a anemia en los niños. Por esto, el objetivo de este estudio es evaluar si existe asociación entre los síntomas depresivos de las madres y la presencia de anemia en sus hijos. Métodos: Estudio transversal analítico de la Encuesta Demográfica y de Salud Familiar 2015, que es representativa a nivel nacional. Los síntomas depresivos se midieron con el Patient Health Questionnaire -9 (PHQ-9) utilizando una puntuación de 10 como punto de corte. La presencia de anemia se midió con HemoCue® y se consideró positiva cuando la hemoglobina era inferior a 11 g / dL. La razón de prevalencia cruda y ajustada (RP y RPa) se calcularon con intervalos de confianza del 95%, utilizando modelos lineales generalizados de la familia Poisson Resultados: Se analizaron 6683 binomios madre-hijo. La prevalencia de anemia en los niños fue del 28,7% [IC 95%: 27,3-30,2]. y la de los síntomas depresivos en la madre de 6.9% [IC 95%: 6,1-7,9]. No se encontró asociación estadísticamente significativa entre las dos variables principales en el análisis bivariado ni en los diferentes modelos multivariados (RPa: 1.05, IC 95%: 0.85-1.30). Nuestros resultados no muestran asociación entre los síntomas depresivos maternos y la anemia en el niño. Conclusiones: No se encontró asociación entre síntomas depresivos maternos y anemia en sus hijos mayores de 6 a 59 meses en el análisis bivariado, multivariado, gráfico de dispersión o con análisis por estratos. La prevalencia de síntomas depresivos maternos y de anemia en el niño se mantienen elevados en la muestra. Se sugiere continuar el estudio de esta posible asociación y el modelo multifactorial de anemia en el niño con estudios prospectivos. / Background: Approximately, one in three Peruvian children aged 6 to 59 months have anemia. Maternal depression, which may be disabling and affect the proper care of children, is associated with chronic malnutrition of their children. In the same way, chronic malnutrition in children is associated with children anemia Therefore, the aim of this study is to evaluate if there is an association between depressive symptoms of mothers with the presence of anemia in their children. Methods: Analytical cross-sectional study of the Peruvian Demographic Health Survey 2015, which is nationally representative. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) using a score of 10 as cut-off. The presence of anemia was measured using HemoCue® and was considered positive when hemoglobin was less than 11 g/dL. Crude and adjusted prevalence ratios (PR and aPR) were calculated with 95% confidence intervals, using generalized linear models of the Poisson family. Results: We analyzed 6683 mother-child binomials. The prevalence of anemia in the children was 28.7% [95% CI: 27.3-30.2]. and that of depressive symptoms in the mother of 6.9% [95% CI:6,1-7,9]. We did not find statistically significant association between the two main variables in the bivariate analysis nor in the different multivariate models (RPa: 1.05, 95% CI: 0.85-1.30). Our results show no association between maternal depressive symptoms and anemia in the child. Conclusions: We found no association between maternal depressive symptoms and anemia in their children aged 6 to 59 months in the bivariate, multivariate, scatter plot or stratum analysis. The prevalence of maternal depressive symptoms and anemia in their child remain high in the sample. We suggest to continue the study of this possible association and the multifactorial anemia model with prospective studies. / Tesis

Orientador: Claudia Regina Bonini-Domingos / Banca: Nicola Amanda Conran Zorzetto / Banca: Maria Stella Figueiredo / Resumo: A anemia falciforme (AF) apresenta processos fisiopatológicos complexos que dificultam o tratamento e culminam no desenvolvimento de manifestações clínicas diversificadas, as quais são moduladas por marcadores genéticos, como os haplótipos da globina beta S (β S ), e bioquímicos como glicoproteínas plasmáticas detoxificadoras: haptoglobina (Hp) e a hemopexina (Hpx) que formam complexos com a Hb e grupo heme livres, respectivamente, garantindo efeitos antioxidantes e anti-inflamatórios, e a eritropoetina (Epo) que repõe os eritrócitos em resposta à hemólise, por exemplo. Desta forma, o objetivo do trabalho foi verificar, em portadores da AF, a influência do haplótipo Bantu sobre o tratamento com hidroxiuréia (HU) por meio da análise de marcadores de estresse oxidativo e eritrogênico, correlacionando-os com parâmetros hematimétricos e níveis de hemoglobina fetal (Hb F). Para isso, o grupo amostral (67 portadores da AF), foi dividido em três subgrupos: 25 (37,3%) homozigotos para o haplótipo Bantu (Bantu/Bantu), 26 (38,8%) heterozigotos para o haplótipo Bantu (Bantu/_) e 16 (23,0%) sem o haplótipo Bantu (_/_). Todos sob uso de HU há pelo menos 300 dias, sem transfusão sanguínea há 120 dias e adultos independentes do gênero. A confirmação da homozigose para Hb S e dos haplótipos β S , foi realizada por PCR-RFLP; os níveis de peroxidação lipídica (TBARS) foram avaliados por método espectrofotométrico e as glicoproteínas plasmáticas (Epo, Hp e Hpx) por ensaio imunoenzimático. Os parâmetros hematológicos foram fornecidos pelo HEMORIO. A média de Hb F no grupo amostral foi de 12,1% e não diferiu entre os subgrupos (p=0,55), porém o Bantu/_ apresentou acréscimo na média sendo o Benin o segundo haplótipo mais frequente. Os valores médios de... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Sickle cell anemia (SCA) presents complex pathophysiological processes that complicate the treatment and culminate in development of diverse clinical manifestations, which are modulated by genetic markers, such as beta-S globin haplotype (β S ), and biochemical, such as plasmatic glycoproteins with action to detoxify: haptoglobin (Hp) and hemopexin (Hpx), which form complexes with free Hb and heme, respectively, providing antioxidant and anti-inflammatory effects, and erythropoietin (Epo), that restores the erythrocytes in response to hemolysis, for example. Thus, the aim of this study was to determine, in patients with SCA, the influence of Bantu haplotype in treatment with hydroxyurea (HU), by analysis of oxidative stress and erythrogenic markers, correlating them with hematological parameters and levels of fetal hemoglobin (Hb F). For this, the sample group (67 SCA patients), was divided into three subgroups: 25 (37.3%) were homozygous for the Bantu haplotypes (Bantu/Bantu), 26 (38.8%) heterozygous for the Bantu haplotype (Bantu/_) and 16 (23.0%) without the Bantu haplotype (_/_). The sample group was under use of HU for at least 300 days, without blood transfusion for 120 days and were all adults independent of the genus. The confirmation of homozygous Hb S and β S haplotypes was performed by PCR-RFLP; levels of lipid peroxidation (TBARS) were measured by the spectrophotometric method and plasmatic glycoproteins (Epo, Hp and Hpx) by enzyme immunoassay. Hematological parameters were provided by HEMORIO. The average of Hb F in the sample group was 12.1% and did not differ between the groups (p = 0.55), but the Bantu/_ showed an increase in the average, being Benin the second most frequent haplotype. The average values of Epo, Hp and Hpx did not differ between the subgroups, indicating... (Complete abstract click electronic access below) / Mestre

Objetivo General: Determinar la correlación clínica y de exámenes de laboratorio del Síndrome Hellp con los resultados materno - neonatales. Material y Métodos: Se realizó un estudio observacional longitudinal, retrospectivo correlacional, en pacientes como diagnostico Síndrome de Hellp, encontrándose en un lapso de tres años, un total de 153 casos; se correlacionó los resultados maternos y resultados neonatales con los parámetros de laboratorio que hacen el diagnóstico de Sd de Hellp. Para el análisis se usaron las pruebas t de student, para las variables paramétricas; y para las variables no paramétricas, se utilizó la prueba de Kruskal – Wallis, considerándose la significación estadística con un valor de p <0.05. Resultados: La incidencia del S. de Hellp fue de 0.76%, siendo la clase III la mas frecuente (60%), el 48% no tuvo CPN, la mayor parte de las gestaciones culminaron por cesárea (62.7%), siendo la clase I la que tuvo mas cesáreas; se observó que el edema pulmonar se encontró en la clase I, los vómitos están relacionados significativamente con malos resultados materno y neonatales, La epigastralgia se relaciona mejor con la clase I en el 50%, la eclampsia no guarda relación de causalidad con los niveles plaquetarios, los parámetros de laboratorio no guardan relación con resultados neonatales, la diferencia de resultados neonatales con el tipo de Hellp no fue observada, los preterminos se presentaron en el 44.3%, la ictericia se asocio mas a clases I y II con 50 y 41%, la mortalidad neonatal se observo mas con la clase 1 con 16.7%; en los RN se observo la relación directa de nauseas con muerte neonatal 25%, también de nauseas con sepsis neonatal (66.6%), finalmente se aprecia un mayor uso de hemoderivados en la Clase I, >66%. Conclusiones: La Clase de Hellp de mayor severidad se correlaciona con malos resultados maternos, mayor tasa de cesáreas, uso de hemoderivados, complicaciones oculares, pulmonares, uso de UCI, mayor tiempo de hospitalización, así como de malos resultados neonatales, sepsis y muerte neonatal; siendo el parámetro clínico de mayor importancia las nauseas y los vómitos, que se relacionan con malos resultados maternos; en cuanto a los niveles de plaquetas, los valores bajos se asocian a muerte y sepsis neonatal. / Tesis de segunda especialidad

Thesis (Licenciado en Nutriciʹon y Dietʹtica)--Universidad Tʹecnica del Norte. Facultad Ciencias de la Salud Escuela de Nutriciʹon y Dietʹeica. / Abstract in Spanish and English.

Equine infectious anemia virus (EIAV) causes rapid development of acute disease followed by recurring episodes of fever, thrombocytopenia and viremia, termed chronic EIA. Most infected horses control the virus by immune mechanisms and become inapparent carriers. To further our understanding of the equine immune response to EIAV, a multi-probe ribonuclease protection assay (RPA) was developed to quantitate equine-specific cytokine mRNAs. Eleven template plasmids specific to ten equine cytokine genes and the ?-actin gene were generated, from which radiolabeled anti-sense RNA probes were produced. The RPA simultaneously quantitated mRNA levels of interleukin (IL)-1, IL-1, IL-6, IL-8, IL-10, IL-12 p35, IL-12 p40, interferon (IFN)-, transforming growth factor (TGF)-1 and tumor necrosis factor (TNF)- in equine peripheral blood mononuclear cells and equine monocyte-derived macrophages (EMDM). The assay detected as few as 5105 RNA molecules and displayed coefficients of variation of 0.03-0.08 when normalized to -actin expression. Using this RPA, cytokine expression in EMDM infected with 2 molecularly cloned viruses (EIAV17 and EIAV19) was determined. EIAV17 varies from EIAV19 only in env, rev and LTR and causes fatal disease in Shetland ponies. When added to EMDM cultures, virulent EIAV17 stimulated expression of IL-1, IL-1, IL-6, IL-10 and TNF-. These cytokine mRNAs were significantly elevated by 0.5 to 1 hr post infection (hpi) and returned to basal levels by 12 to 24 hpi, indicating modulation by early event(s), such as receptor binding. In contrast to EIAV17, EIAV19 is avirulent in vivo and failed to induce any of the tested cytokines in EMDM. These data show a direct correlation between the virulence of the EIAV clone and the induction of cytokines. The cytokines stimulated by EIAV17 may contribute to EIA-associated symptoms, enhance viral replication in the host, and regulate the host immune response. To determine whether cytokine induction requires EIAV17 replication, EMDM cultures were exposed to UV-inactivated EIAV17 and cytokine induction was monitored. UV-inactivation did not block cytokine induction by EIAV17, suggesting dispensability of viral replication. Given that EIAV17 induces cytokines in a rapid and replication-independent manner, the activation of cytokine expression is likely mediated by binding of EIAV17 to equine macrophage receptor(s).

Purpose: Anemia in children is a major Public Health problem in developing countries such as Ivory Coast. The fortification of wheat flour with iron and folic acid has been mandated in this country in 2007. To date, there are no studies conducted to assess the effectiveness of these fortification efforts. Therefore, the purpose of this study was to determine if mandated iron and folic acid fortification of wheat flour has reduced the prevalence of anemia in Ivory Coast children. Methods: The study was conducted at the pediatric unit of the university hospital of Treichville, one of the 3 main hospitals of Abidjan, the largest city of Ivory Coast. The medical records of 467 children from 5 to 14 years old were analyzed. The period from January 1st 2004 to December 31st 2006 was considered as pre-fortification period and the period from January 1st 2008 to December 31st 2010 was regarded as the post-fortification period. Data for anemia, hemoglobin, hematocrit, red blood cell count, and MCV were compared between pre- and post-fortification periods. Results: The results showed that there were no statistically significant difference in prevalence of anemia and mean hemoglobin, hematocrit, red blood cells, and MCV between pre and post-fortification periods. Conclusion: The double fortification of wheat flour with folic acid and iron had no significant impact on anemia in Ivorian children. This is perhaps due to the fact that wheat flour is not widely consumed as rice and rice products are more popular in Ivory Coast population. The Ivorian government perhaps should focus efforts on the fortification of these products.

Maternal and child undernutrition are a significant problem in the developing world, with serious consequences for human health and socio-economic development. In Cambodia, 55% of children, 43% of women of reproductive age, and 50% of pregnant women are anemic. Current prevention and control practices rely on supplementation with iron pills or large-scale food fortification, neither of which are affordable or feasible in rural Cambodia. In the study areas, 97% of women did not meet their daily iron requirements. The current research focuses on the design and evaluation of an innovative iron supplementation technique. A culturally acceptable, inexpensive and lightweight iron ingot was designed to resemble a fish species considered lucky in Khmer culture. The ingot, referred to as ‘try sabay’ or ‘happy fish’, was designed to supply iron at a slow, steady rate. Iron leaching was observed in water and soup samples prepared with the iron fish when used concurrently with an acidifier. More than 75% of daily iron requirements can be met with regular use. Its use in the common pot of soup or boiled water provides supplementation to the entire family. The effectiveness of the iron fish was investigated in a randomized community trial involving 310 women in rural Cambodia. Blood samples were taken at baseline and every three months thereafter, over a 12-month trial period. Significant increases in hemoglobin concentrations were observed in women allocated an iron fish when compared to controls throughout the study, with an endline difference of 11.6 g/L. Significant improvements in serum ferritin concentration were observed at 9 months (6.9 ng/mL) and endline (30.8 ng/mL) in women who used an iron fish regularly when compared to the control group. Overall, use of the iron fish led to a two-fold reduction in the prevalence of anemia. The supplement was used daily by 94% of the households at the end of the trial. The study highlights the acceptability and effectiveness of a fish-shaped iron ingot as a means of improving dietary iron content. It offers a promising, simple solution to iron deficiency anemia if the project can be scaled-up for use throughout the country. / Canadian Institutes of Health Research, University of Guelph, International Development Research Centre (Canada)

Diamond Blackfan Anemia is a rare congenital disease that is primarily characterized by reduced erythroid progenitors. DBA pathogenesis has been associated with genes encoding ribosomal proteins (RPs) which are important in translation. However, this fails to explain why erythropoiesis is specifically disrupted. Our lab previously found that aberrant splicing of the human transcript encoding heme exporter, FLVCR1, is involved in DBA pathogenesis; and that RPS19 implicated in 25% of DBA patients, regulates FLVCR1 transcript splicing. This thesis investigated the role of another DBA associated gene encoding RPS17, in the regulation of FLVCR1 splicing and disrupted erythropoiesis in DBA. My findings further support the role of FLVCR1 aberrant splicing in DBA and provide evidence suggesting that RPS17 may not be a candidate DBA gene. Furthermore, my study implicates a potential role for RPS19 transcript levels in defective erythroid differentiation observed in DBA.

Diamond Blackfan Anemia is a rare congenital disease that is primarily characterized by reduced erythroid progenitors. DBA pathogenesis has been associated with genes encoding ribosomal proteins (RPs) which are important in translation. However, this fails to explain why erythropoiesis is specifically disrupted. Our lab previously found that aberrant splicing of the human transcript encoding heme exporter, FLVCR1, is involved in DBA pathogenesis; and that RPS19 implicated in 25% of DBA patients, regulates FLVCR1 transcript splicing. This thesis investigated the role of another DBA associated gene encoding RPS17, in the regulation of FLVCR1 splicing and disrupted erythropoiesis in DBA. My findings further support the role of FLVCR1 aberrant splicing in DBA and provide evidence suggesting that RPS17 may not be a candidate DBA gene. Furthermore, my study implicates a potential role for RPS19 transcript levels in defective erythroid differentiation observed in DBA.

Objetivo: Desarrollar un alimento funcional a partir de hierro hémico (relleno para galletas) y evaluar su biodisponibilidad en cerdos en etapa de crecimiento, a fin de que sea usado en humanos para el control y prevención de la deficiencia de hierro, con más ventajas que los productos actuales.Material y métodos: La fase experimental del proyecto se realizó en dos etapas:1.- Desarrollo del relleno para galletas enriquecido con hierro hémico. Incluida la elaboración de la documentación correspondiente a los procesos.2.- Evaluación de la biodisponibilidad del metal en cerdas en crecimiento, para lo cual se formaron 3 grupos a los que se les administró: 1) Pienso bajo en hierro, más galletas adicionadas con hierro hémico en forma de relleno. 2) Pienso bajo en hierro, más caramelos de goma adicionados con lactato ferroso y 3) Pienso normal (con sulfato ferroso), considerado este como el grupo control. Se realizó un seguimiento diario y quincenalmente se tomó el peso y se hicieron determinaciones del perfil férrico en muestras de sangre de las cerdas. Se realizó análisis pareado: valores iniciales contra finales y análisis de variancia entre los resultados de los tres grupos.Resultados: Se desarrolló un producto de apariencia cremosa de color marrón oscuro, olor y sabor a chocolate, apropiada untabilidad, contenido de hierro hémico de 2,6 mg por gramo, 14,8% de proteína de buena calidad biológica y vida útil de un mes. Se fabricó mediante un proceso sencillo, sin necesidad de usar calor y aceptable cantidad de grasa (10.9%) en su composición.En la evaluación de biodisponibilidad, las cerdas suplementadas con hierro hémico presentaron mayor ganancia de peso: 14,6% más que las suplementadas con lactato ferroso y un 27,8% mayor que las del grupo control. La mortalidad fue menor en el grupo de hierro hémico (10%), que los grupos que recibieron lactato ferroso (20%) y el grupo control (50%). En los tres grupos de estudio, fue notorio un incremento de los parámetros sanguíneos que informan del hierro funcionante y un decremento en el hierro circulante, este último, más manifiesto en el grupo de hémico.Hubo una tendencia en los promedios de la cantidad total de hierro detectada en los grupos de estudio; de mayor a menor fue en el siguiente orden: Grupo de hémico, lactato y control. Inversa a los promedios de la cantidad total de hierro consumida, que de menor a mayor fue: hémico, lactato y control.Conclusiones: Es posible formular un producto aceptable, con alto contenido de hierro hémico y factible de ser usado como relleno para galletas.La suplementación con hierro hémico demostró ser mejor en el incremento de peso y en la disminución de la mortalidad de cerdas en crecimiento. / Objective: To develop a functional food based on hemic iron (a biscuit filling) and which has more advantages than present-day products and to assess its bioavailability in growing female pigs, with the aim of using it in humans for the control and prevention of iron deficiency.Material and methods: The experimental phase of the project was carried out in two stages 1) Development of a biscuit filling enriched with hemic iron. At the same time, the documents relating to the process were prepared.2) Assessment of the bioavailability of metal in growing female pigs, for the purpose of which three groups were formed, to which the following were administered: 1) feed low in iron content , as well as biscuits containing hemic iron in the form of a filling. 2) Feed low in iron, as well as gums containing ferrous lactate and 3) normal feed (with ferrous sulphate), this being the control group.A daily follow-up was carried out and, on a fortnightly basis, the female pigs were weighed and the ferric profile was measured from blood samples that were taken. Parallel tests were carried out: initial levels contrasted with final ones and an ANOVA of the results of the three tests was carried out.Results: A dark brown product with a creamy appearance smelling and tasting of chocolate and with an appropriate spreadability was developed, containing 2,6mg of hemic iron per gram 14,8% protein of good biological quality, and a shelf-life of one month.It was elaborated by means of a simple process, without the need to use heat and with an acceptable amount of fat (10,9%) as part of its composition.When an assessment was made of bioavailability, the female pigs supplemented with hemic iron presented a greater weight increase: 14,6% more than those supplemented with ferrous lactate and 27,8% more than those of the control group.The mortality rate was less in the hemic iron group (10%) than in the groups which received ferrous lactate (20%) and than in the control group (50%). In the three study groups, there was a clear increase in the blood parameters which provide information on the functioning iron and a clear decrease in the circulating iron, the latter being more evident in the hemic group.A tendency was observed in the averages of the total amount of iron detected in the study groups: from higher to lower in the following order: The hemic group, the lactate group and the control group.Conclusions: It is possible to elaborate an acceptable product with a high hemic iron content, and which can be used in a viable manner as a biscuit filling.Supplementation with hemic iron was proven to give better results with regard to weight increase and with regard to a decrease in the mortality rate among growing female pigs.