The objective of this study was to evaluate copper sulphate densitometry as a screening method for anaemia in children. The accuracy of copper sulphate densitometry was also compared to clinical assessment for the presence of pallor and haemoglobin measurement with a BMS-haemoglobinometer. Different observers performed these three screening tests independently. For the purposes of this study, anaemia was defined as a laboratory haemoglobin (Hb) concentration below 10 g/dl. A cross-sectional screening study was undertaken, where the results of the different screening tests were compared to laboratory haemoglobin determination (gold standard). The study sample consisted of one hundred consecutive children, aged between 6 months and 6 years, whose parents had given informed written consent for participation. The study was conducted in the Paediatric Outpatient Department of Pretoria Academic Hospital (73 children) and a local creche (27 children). In this study sample, the prevalence of anaemia (Hb < 10 g/dl) was 17% (95% Confidence Interval (95%CI) 10.2; 25.8). Clinical assessment by students for the presence of pallor had a sensitivity of 41.2% (95%CI 19.4; 66.5), specificity of 81.9% (95%CI 71.6; 89.2), positive predictive value of 31.8% (95% CI14.7; 54.9) and negative predictive value of 87.2%(95%CI 77.2; 93.3). The likelihood ratio for detection of anaemia by clinical assessment was 2.3. Copper sulphate densitometry had a sensitivity of 88.2% (95%CI 62.3; 97.9), specificity of 89.2% (95%CI 79.9; 94.6), positive predictive value of 62.5% (95% CI 40.8; 80.5) and negative predictive value of 97.4% (95%CI 90.0; 99.5) to screen for anaemia. The Likelihood Ratio of a positive copper sulphate-screening test was 8.17. On average, haemoglobin concentration was underestimated by 0.29 g/dl with the BMS-haemoglobinometer, with the 95% limits of agreement ranging from underestimation by 1.3 g/dl to over-estimation by 1.9 g/dl. Logistic regression analysis revealed that both the copper sulphate test and measurements with the BMS-haemoglobinometer predicted anaemia accurately. The area under the Receiver Operating Characteristic (ROC) curve for the haemoglobinometer was 0.94 (95%CI 0.87; 1), while the area under the curve for copper sulphate densitometry was 0.89 (95% CI 0.73; 1). Used together, the area under the ROC curve was 0.95 (95% CI 0.89; 1). In resource-poor settings, copper sulphate densitometry could be an accurate, inexpensive and simple screening method for anaemia in children. / Dissertation (MSc (Clinical Epidemiology))--University of Pretoria, 2005. / Clinical Epidemiology / unrestricted

INTRODUCTION: Anemia is a frequent complication in patients with inflammatory bowel disease (IBD). The inflammation observed in IBD negatively impact absorption of iron. This could lead to increased hospitalizations, affect growth and development, and decrease overall quality of life. This is especially pronounced in the pediatric population. The screening and treatment of iron deficiency anemia (IDA) varies between centers, and as a result, roughly 40-60% of pediatric IBD patients are iron deficient. OBJECTIVES: The objective of this study is to assess the efficacy and safety profile of intravenous and enteral iron therapy in a population of iron deficient patients with IBD. The secondary aim of this study is to determine if oral or intravenous iron therapy can improve hematologic and iron parameters. We will also examine the longitudinal changes in gastrointestinal (GI) symptoms and quality of life in patients receiving oral and intravenous iron supplementation. METHODS: We conducted a prospective cohort study in pediatric patients with IBD admitted to the inpatient GI service at Boston Children’s Hospital from 09/05/2017 to 03/05/2018. Forty-six IBD patients were screened, and twenty-nine (63%) were identified as iron deficient and were consented for data collection through chart review and administration of the IMPACT-III quality of life questionnaire. RESULTS: Out of the twenty-nine IBD patients, eighteen (62%) received intravenous iron, seven (24%) received oral iron, and four (14%) were untreated and served as controls. The mean change in hemoglobin in patients receiving parenteral, oral, or no iron therapy was 1.6g/dl±0.5, 1.1g/dl±0.4, and 0.2g/dl±0.5, respectively. The change in hemoglobin was significant between the parenteral and oral iron group (P<0.05). The mean change in health-related quality of life scores in patients receiving parenteral or oral iron therapy was 11.6±11.4 and 3.8l±7.5, respectively. CONCLUSION: Our study demonstrates that intravenous iron therapy was more efficacious than oral iron in improving hematologic and iron parameters in IBD patients. This improvement was concomitant with higher scores on the IMPACT-III quality of life questionnaire, suggesting that iron supplementation improves health-related quality of life in IBD patients with iron deficiency anemia.

A normal pregnancy consumes 500–800 mg of iron from the mother. Premenopausal women have a high incidence of marginal iron stores or iron deficiency (ID), with or without anemia, particularly in the less developed world. Although pregnancy is associated with a “physiologic” anemia largely related to maternal volume expansion; it is paradoxically associated with an increase in erythrocyte production and erythrocyte mass/kg. ID is a limiting factor for this erythrocyte mass expansion and can contribute to adverse pregnancy outcomes. This review summarizes erythrocyte and iron balance observed in pregnancy; its implications and impact on mother and child; and provides an overview of approaches to the recognition of ID in pregnancy and its management, including clinically relevant questions for further investigation.

Iron depletion (ID) is the most common nutrient deficiency worldwide and is the leading cause of anemia. Chronic arsenic (As) exposure is a major public health problem in Bangladesh and triggers inflammatory responses that render iron status assessment challenging. We assessed the prevalence of ID and iron deficiency anemia (IDA) in 147 arsenic-exposed Bangladeshi women (75 skin lesion cases; 72 controls), ages 18-33 years, who were part of a skin lesion study. Hemoglobin (Hb) was measured in whole blood; ferritin and hs-c-reactive protein (CRP) were measured in serum. The prevalence of anemia (Hb<120g/L) was 18%. Although the prevalence of ID (ferritin≤12mcg/L) did not differ between cases and controls, anemia was more common among cases (25% vs. 10%; p=0.02). Of anemic women, 27% (N=7) also had ID (Hb<120g/L and ferritin≤12mcg/L), indicating IDA. Women with normal iron status had higher toenail arsenic compared to iron-depleted women (2.9 vs 1.4 µg As/g toenail; p=0.00), and their water arsenic concentration was higher than that of iron-depleted women (18.8 vs 6.2 µg As/L; p=0.03); every 1µg increase in toenail As was associated with a 45% lowered risk of ID (OR=0.55, 95%CI=0.33,0.94). Much of the anemia in this cohort appears unrelated to ID, but could be linked to other nutrients, such as folate and vitamin B12, which are involved in both hematopoiesis and arsenic metabolism. It is possible that arsenic exposure in this cohort compromised folate and vitamin B12 status.

Oral iron replacement therapy is often used as a first-line modality for the treatment of iron deficiency anemia (IDA). Oral iron replacement options include tablets, capsules, and liquid formulations. Esophagitis due to iron tablet administration is a well-documented phenomenon, yet peptic ulcer disease secondary to iron tablet administration is less well-known. An 83-year-old female with a past medical history of chronic kidney disease stage V, anemia of inflammatory disease, heart failure with preserved ejection fraction, and gastroesophageal reflux disease presented to the hospital with diffuse abdominal pain and dark red emesis. She was started on ferrous sulfate supplementation two weeks ago and described progressive abdominal pain and nausea since beginning the medication. She was not taking nonsteroidal anti-inflammatories (NSAIDs), antiplatelets, or anticoagulants. Six months ago, she had an unremarkable upper endoscopy performed for new-onset gastroesophageal reflux disease. Laboratory studies revealed a hemoglobin of 7.3 mg/dL and due to a concern for rapid blood loss, she was given one unit of packed red blood cells. A non-contrast computed tomography was performed showing wall thickening of the stomach and the first two portions of the duodenum. A possible ulcer was seen in the distal posterior stomach. The patient was made NPO, and twice daily intravenous pantoprazole was started. An upper endoscopy was performed which revealed a 2.5 cm clean-based ulcer in the duodenal bulb. Biopsies showed acute inflammation and positivity for iron debris but were negative for Helicobacter pylori. Once daily pantoprazole was continued, and her ferrous sulfate tablets were discontinued. Her symptoms did not return. Ferrous sulfate may erode and ulcerate the gastric and duodenal mucosa like that of a chemical burn. Iron deposits may be seen on biopsies performed with Prussian blue staining. Brown crystalline deposits may be seen on hematoxylin and eosin staining. Iron injury may be seen in pill or capsule formulations due to a concentration effect, but this is typically not seen with solution forms. Treatment includes discontinuation of tablet or capsule formulations and substitution with liquid forms.

No description available.

No description available.

Actualmente la anemia ferropénica, es un problema de salud a nivel mundial, con mayor prevalencia en la niñez, por lo tanto, la madre opta por conductas basadas en conocimientos, actitudes y prácticas. El objetivo general fue: Determinar la relación que existe entre conocimientos, actitudes y prácticas de alimentación y anemia ferropénica en niños de 6 a 24 meses, en el Centro de Salud San Ignacio- 2019. Fue de tipo cuantitativo, diseño no experimental, descriptivo correlacional. Se realizo en el centro de salud San Ignacio, con una población de 80 madres, la muestra fue censal, el muestreo por conveniencia. El instrumento fue un cuestionario validado por juicio de expertos según prueba V de Aiken=1, la confiabilidad se probó mediante alfa de Conbrach con puntaje de 0.794. se tuvieron en cuenta las consideraciones éticas de Belmont: En cuanto a la dimensión conocimientos 70% tiene nivel adecuado y 30% inadecuado; asimismo la dimensión actitudes 52.5% es inadecuado y 47,5% adecuado y la dimensión práctica predomina el nivel inadecuado con 57,5% 42,5% están en niveles adecuados. En lo que respecta al tipo de anemia ferropénica de los niños de 6 a 24 meses prevalece la anemia leve con 87,5%, 12,5% anemia moderada y 0% anemia severa. En conclusión, existe relación significativa entre la dimensión actitudes de alimentación de las madres de niños de 6 a 24 meses en cuanto a los niveles de anemia ferropénica con una significancia bilateral de 0,025; esto indica asociación inversa entre ambas variables. / Currently, iron deficiency anemia is a worldwide health problem, with a higher prevalence in children, therefore, the mother chooses behaviors based on knowledge, attitudes and practices. The general objective was: To determinate the relationship between knowledge, attitudes and feeding practices and iron deficiency anemia in children aged 6 to 24 months, at the San Ignacio Health Center – 2019. The study was quantitative, descriptive, non-experimental design, cross-sectional descriptive-correlational type. It was conducted in the San Ignacio Health Center, with a population of 80 mothers, the sample was census, convenience sampling. The instrument was a questionnaire validated by expert judgment according to Aiken’s V test = 1 and pilot test with Cronbach’s alpha, which yielded a score of 0.794. Belmont Ethical considerations. The results: Regarding the knowledge dimension, 70% have an adequate level and 30% inadequate; likewise, the attitudes dimension 52.5% is inadequate and 47.5% adequate and the practical dimension is dominated by the inadequate level with 57.5% and 42.5% represents adequate levels. Concerning the type of iron deficiency anemia in children aged 6 to 24 months, mild anemia prevails with 87.5%, 12.5% moderate anemia and 0% severe anemia. It is concluding mother have basic knowledge about nutrition and iron deficiency anemia, however, they have weaknesses in terms of attitudes and practices. In conclusion, there is a significant relationship between the feeding attitudes dimension of mothers of children from 6 to 24 months in terms of the levels of iron deficiency anemia with a bilateral significance of 0.025; This indicates an inverse association between both variables.

Cribra orbitalia represents one of the most frequent bone pathologies in skeletal remains of past populations. This lesion is characterised by porous, furrowed even trabecular disruption on the outer table of the compact bone on the orbital roof. Although the origin of cribra orbitalia is linked to marrow hyperplasia as a consequence of iron deficiency anemia, even other causes are not ruled out. Both occurences cribra orbitalia alone and coincidence with other signs of diseases have been recorded. Research of this study applies to cribra orbitalia as a long- term stress indicator on the skeleton and a symptom of specific diseases or anemic syndroms. Skeletal remains from Czech medieval sites with presence of cribra orbitalia as well as whole graveyard from Oškobrh were analysed. Macroscopical investigation did not demonstrate periodic coincidence of cribra orbitalia and specific bone signs of the diseases. However, the following bone changes have been observed: hyperostosis porotica, increased vascularization, supranasal porosity, inflammatory- hemorrhagic reaction on the endocranium which can in terms of differential diagnosis help to clarify the nature and/or cause of the origin of cribra orbitalia. Comparison of the population from Oškobrh with other medieval graveyards showed that frequency of...

A anemia ferropriva no Brasil é o problema carencial de maior magnitude tendo como principal fator a insuficiência de alimentos fontes de ferro na dieta. O objetivo deste estudo foi analisar, por meio de um exercício teórico, a capacidade da alimentação atender à recomendação e necessidade de ferro levando em consideração a legislação para fortificação das farinhas de trigo e de milho com o mineral vigente no Brasil desde junho de 2004. Para esse exercício foram utilizados os dados secundários referidos em relação à aquisição alimentar domiciliar pela população brasileira na Pesquisa de Orçamentos Familiares 2002/2003, destacando as macrorregiões e, entre as classes de rendimento, exclusivamente os dados referentes às famílias com rendimento mensal inferior a dois salários mínimos. Os valores encontrados foram organizados para estimar a disponibilidade e biodisponibilidade do ferro na alimentação adquirida e realizar o cálculo da densidade de ferro e densidade de ferro biodisponível. A partir da aquisição alimentar domiciliar verificou-se um valor calórico diário insuficiente para atender à necessidade energética. Verificou-se que o baixo teor de ferro proveniente dos alimentos naturalmente fontes do mineral feijão e carnes foi acrescido em 45% com o ferro dos alimentos derivados das farinhas de trigo e de milho fortificadas. Entre as famílias com renda mensal inferior a dois salários mínimos o aumento foi de 40%. Mesmo com a fortificação, a quantidade de ferro veiculada pela alimentação nacional está longe de atingir a recomendação de 14mg Fe/dia. O valor encontrado atende a recomendação marcial para o homem, mas representa apenas 55% do recomendado para a mulher. A densidade do ferro biodisponível de 0,360mg/1000 Kcal também não atendeu à necessidade diária do homem (1,0 mg/dia) e muito menos da mulher (2,2 mg/dia). A elevada prevalência com que essa deficiência ocorre, justificada pelo baixo consumo do mineral, acarreta à Saúde Pública elevados custos diretos e indiretos. A fortificação das farinhas com ferro é uma medida destinada a grandes segmentos populacionais e visa principalmente à prevenção e controle da deficiência marcial. / The iron deficiency anemia in Brazil is a fundamental problem of greater magnitude, and its main factor is that in the Brazilian diet there is insufficient use of foods that provide sources of iron. The objective of this piece of work is, by means of a theoretical work, to analyze if the diet is able to meet the recommendation / need of iron taking into account the legislation of fortification of wheat flour and corn with the current mineral in Brazil since June, 2004. For this matter, secondary data referring the domestic food acquisition by the Brazilian population in the \"Pesquisa de Orçamentos Familiares\" household budget survey 2002 / 2003 were used, focusing on the biggest regions and the income classes, especially the ones with monthly income inferior to two minimal salaries. The values found were organized to estimate the availability and the bioavailability of iron in the diet and to calculate the density of iron and of bioavailable iron. Based on the domestic food acquisition, a caloric value, which was insufficient to meet the needs of energy consumption, was observed. It was also noticed that the low amount of iron coming from foods naturally found in beans and meat was increased by 45% with the iron derived from fortified wheat flour and corn. Among families whose income was inferior to two minimal salaries, the increase was 40%. Even with the fortification, the quantity of iron available in the usual diet of the country is far behind the recommended 14mg per day. The amount meets the recommended for male, but it only adds up to 55% of what is recommended for the females. The density of boiavailable iron, which was 0.360 mg / 1000kcal, was also unable to meet the daily need of a male (1.0mg per day) and most notably of a female (2.2mg per day). The high prevalence that this deficiency happens, justify by the low consumption of this mineral, brings very high direct and indirect expenses to the Brazilian Department of Public Health Public. The fortification of flour with iron is a measure destined to great population segments and is aimed specifically at the prevention and control of martial deficiency.