La anemia, enfermedad ocasionada por la ingesta inadecuada de hierro. Según la OPS más del 40% de todos los casos presentan en Asía y África. La prevalencia en menores de 5 años es de 50-60% en los países en desarrollo. Más frecuente en R. N. de bajo peso y menores de 2 años. Según el ENDES (2,005) pese a la reducción, de 49.6% a 46.2% en menores de 5 años la prevalencia se mantiene alta, frecuente en niños de la Sierra 54.9% y Selva 51.3%. / Tesis

Determina el efecto de las visitas domiciliarias en el consumo adecuado de los multimicronutrientes y nivel de hemoglobina de los niños de 6 a 36 meses del Sector B y C de Pachacútec-Ventanilla, en el periodo febrero-julio 2014. Es una investigación cuantitativa, descriptiva, longitudinal y prospectiva. Participan 14 niños y niñas de 6 a 36 meses de edad, quienes han sido suplementados con los multimicronutrientes sin necesidad de padecer anemia. Para la realización de visitas domiciliarias se utiliza el formato normado por la Directiva Sanitaria del MINSA, en donde se encuentran preguntas dirigidas a las madres para conocer el consumo diario de los multimicronutrientes, y en dos momentos (al inicio y al final de la investigación), una ficha de registro de los sobres consumidos y motivos de interrupción del consumo. Emplea un fotómetro marca Hemocure para determinar el nivel de hemoglobina que presentaron los niños. Encuentra que el 100% de participantes consumió adecuadamente el multimicronutrientes y que al finalizar las visitas el grupo de niños y niñas que sí tenían anemia disminuyó. Concluye que las visitas domiciliarias producen un efecto positivo sobre el consumo adecuado de los multimicronutrientes y la disminución de la anemia en los niños y niñas de 6 a 36 meses de edad de Pachacútec. / Tesis

OBJETIVOS: Determinar los factores obstétricos asociados a la anemia posparto inmediato en primíparas en el Instituto Nacional Materno Perinatal septiembre - noviembre 2015 METODOLOGÍA: Estudio descriptivo, de corte transversal, retrospectivo. La muestra estudiada fue conformada por 110 primíparas con anemia posparto inmediato atendidas en el Instituto Nacional Materno Perinatal durante el periodo de septiembre a noviembre de 2015. Se estimaron las frecuencias absolutas y relativas para variables cualitativas y medidas de tendencia central y dispersión para variables cuantitativas. Se utilizó la prueba Chi-cuadrado para hallar la relación de las variables cualitativas con un nivel de confianza (IC) del 95%. RESULTADOS: La edad promedio de las usuarias fue de 22 años. El grado de anemia en las pacientes, fue de un 68% anemia leve, 28% anemia moderada y 3% anemia severa. Los factores que se asocian significativamente a la anemia posparto inmediato fueron el uso de analgesia durante el trabajo de parto (p=0.009) presentándose en un 34% de puérperas (OR 2,10, IC 95% 1,58, 3.56), la práctica de episiotomía (p=0.033) con 83% de puérperas (OR 1,75, IC 95% 1,06, 1.89) y los desgarros en partes blandas (p=0.003) en donde el 31% de puérperas presento este factor. CONCLUSIONES: La analgesia durante el trabajo de parto, la práctica de episiotomía y los desgarros en las partes blandas son factores estadísticamente significativos para la presencia de anemia posparto inmediato en primíparas. PALABRAS CLAVES: PUERPERIO INMEDIATO, PRIMIPARA, ANEMIA POSPARTO, FACTORES OBSTETRICOS. / --- OBJECTIVES: Determine obstetric factors associated with immediate postpartum anemia in gilts at the Maternal Perinatal Institute National September-November 2015. METHODS: Descriptive, retrospective, cross-sectional study. The sample was composed of 110 primiparous with immediate postpartum anemia treated at the National Institute Maternal Perinatal during the period April to June 2015 the absolute and relative frequencies for qualitative variables and measures of central tendency and dispersion for quantitative variables were estimated. Chi-square test was used to find the relation of qualitative variables with a confidence level (CI) of 95%. RESULTS: The average age of users was 22 years. The degree of anemia among patients was 68% mild anemia, moderate anemia 28% and 3% severe anemia. The factors significantly associated with immediate postpartum anemia were the use of analgesia during labor (p = 0.009) appearing in 34% of postpartum women (OR 2.10, 95% CI 1.58, 3.56), the practice of episiotomy (p = 0.033) with 83% of postpartum women (OR 1.75, 95% CI 1.06, 1.89) and soft tissue tears (p = 0.003) where 31% of women presented this factor. CONCLUSIONS: Analgesia during labor, the practice of episiotomy and tears in the soft parts are statistically significant for the presence of immediate postpartum anemia in primiparous factors. KEYWORDS: PUERPERIUM IMMEDIATE, PRIMÍPARA, ANEMIA POSTPARTUM, OBSTETRIC FACTORS. / Tesis

No description available.

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The variability of clinical severity in sickle cell anemia patients has been attributed in part to fetal hemoglobin (HbF) expression. Hereditary persistence of fetal hemoglobin (HPFH) describes benign disorders that are characterized by increased y-globin chain expression often with a reduction or absence of B-globin chain expression. HPFH can be due to naturally occurring deletions at the 3' end of the B-globin locus. Variable size deletions that remove alpha(HBO) and B(HBB) globin genes result in HPFH and alphaB-thalassemia. We examined clinical and hematology data in 28 patients with sickle hemoglobin (HbS)/HPFH. We found HbS/HPFH patients did not have anemia, and had slightly reduced mean corpuscular volume (MCV). Their age, hemoglobin and MCV were found to be correlated with HbF levels. These individuals were asymptomatic when compared to homozygous HbSS patients even with unusually high levels of HbF. Three major quantitative trait loci (QTL) significantly associated with HbF levels in individuals from different populations have been identified and include polymorphisms in the Gy-globin gene (HBG2) promoter, BCL 11A, and the HBS1 L-MYB intergenic region. We investigated polymorphisms in these QTL in a unique cohort of 20 African American patients with sickle cell anemia expressing HbF levels equal to or greater than 11%. We also found significant associations of HbF in 2 of the 3 major loci, BCL11A (rs766432) (P=0.05), and HBS1L-MYB intergenic region (rs9399137) (P= 0.02). A 3 basepair (bp) (TAG) deletion in high linkage disequilibrium with rs9399137 in the HBS1 L-MYB intergenic region might also account for high HbF expression. Two QTL influence HbF levels in African Americans with sickle cell anemia but together account for 20% of HbF variance [1]. Therefore to further explore possible causes of high HbF, we sequenced a 14.1 kilobases (kb) DNA fragment between Ay-globin gene (HBG1) and HBD in 15 high HbF and 15 low HbF patients. The DNA fragment houses the 7.2kb Corfu deletion that is associated with elevated HbF levels in the homozygous state and also contains binding sites for BCL11A. Thirty-eight single nucleotide polymorph isms (SNPs) were present in both groups of patients. Four SNPs had significantly higher major allele frequencies in the high HbF group (P<0.05) suggesting that polymorphisms in this area might contribute to elevated HbF levels in African American sickle cell anemia patients. / 2999-01-01

Introducción: La anemia por deficiencia de hierro es el tipo de anemia más común en las gestantes. Por ende se establece la atención prenatal en suplementación de hierro, que informa la cobertura de gestantes que reciben el suplemento, más no se tiene información del comportamiento (adherencia) ni de los factores asociados al consumo de la suplementación. Actualmente la prevalencia de anemia está en aumento pese a haber aumentado la cobertura de la suplementación con hierro. Casi todos los casos de anemia ferropénica responden rápidamente al tratamiento, aunque no siempre es así debido a la falta de adhesión a la terapia y cumplimiento como principal problema. Objetivos: Determinar adherencia y factores asociados a la suplementación de hierro en gestantes anémicas. Diseño: Descriptivo, observacional de corte transversal.Institución: Servicio de Gineco-Obstetricia, Hospital Santa Rosa, Pueblo Libre. Participantes:42 gestantes anémicas: 17 del grupo baja adherencia y 25 del grupo moderada-óptima adherencia.Intervenciones: Se realizó la identificación de la gestante anémica según lectura de su última hemoglobina en la historia clínica. Para la entrevista sobre la adherencia y factores asociados a la suplementación de hierro, se utilizaron formatos elaborados y validados para dicho fin. El procesamiento de la información y análisis estadístico se realizó utilizando el programa SPSS v20.Principales medidas de resultados: Determinación del nivel de adherencia y factores asociados a la adherencia a la suplementación de hierro en gestantes anémicas. Resultados: De las gestantes anémicas el 50%, 40,5% y el 9,5% presentaron una adherencia moderada, baja y óptima respectivamente. Respecto a los factores asociados a la suplementación se encontró respecto al factor tratamiento: Las náuseas (31%) y el estreñimiento(28%) fueron las molestias más frecuentes en las gestantes, el 38,1% presentó un solo síntoma, el tiempo de suplementación promedio fue de 15 semanas, el 76,2%realizó una toma por día, el acompañamiento más frecuente con que tomaban el suplemento fue la limonada (44%),referente al factor paciente : solo el 35,7% conocía los beneficios de la suplementación, al 83,3% no le cayó bien el consumo del suplemento, sobre el factor equipo o el sistema de asistencia sanitaria : Se encontró que el 100% de las gestantes recibió los suplementos pero solo el 31% recibió consejería sobre la suplementación , según factor enfermedad : el 71,4% presentó anemia leve seguidamente el 21,4% con anemia moderada. No se encontraron diferencias significativas en el estudio. Conclusiones: El nivel de adherencia más frecuente fue el moderado. Ninguno de los factores tuvo relación con los niveles de la adherencia.

In a study of the natural history of homozygous sickle cell (SS) disease 154 of 160 Jamaican children in whom SS genotype had been diagnosed by cord blood haemoglobin electrophoresis were followed to age 1 to 5 years. Seventeen girls and five boys died. Severe bacterial infections and acute splenic sequestration (ASS) were the principal causes of death. The incidence of each of these complications of SS disease was studied in relation to the natural history of splenomegaly and of splenic reticuloendothelial function. Splenomegaly was assessed by physical examination at each clinic visit. 37&percnt; SS children had had palpable spleens by age 6 months, 66&percnt; by age 12 months, 79&percnt; by age 24 months and 85&percnt; by age 36 months. Splenic reticuloendothelial function was assessed by estimating the percentage of pitted blood cells (pit count) using differential interference contrast microscopy. Pit counts in 139 control children with normal haeomoglobin genotype AA were always below 9&percnt;. Pit counts performed serially in 130 of the SS children (in 46 from birth) rose with age, and were greater than 9&percnt; in 23 SS children at age 1 year, 42&percnt; at age 2 years and 52&percnt; at age 3 years. Radioactive colloid spleen scans showed no splenic uptake of colloid in 11 SS children with palpable spleens and pit counts greater than 9&percnt;, confirming impairment of their splenic reticuloendothelial activity.

The burden of sickle cell disease lies in Africa where resources are limited . Hydroxyurea may be an affordable treatmentoption for these patients. Purpose To asses whether hydroxyurea has any effect in reducing vaso-occlusive crises, hospitalization and transfusion requirements in children with homozygous sickle cell a n a e m i a . To e v a l u a t e t h e t o x i c i t y o f h y d r o x y u r e a . M e t h o d s T h i s i s a r e t r o s p e c t i v e , d e s c r i p t i v e s t u d y o f c l i n i c a l and h a e m a t o l o g i c a l o u t c o m e s i n c h i l d r e n w i t h s i c k l e c e l l a n a e m i a t r e a t e d w i t h h y d r o x y u r e a . R e s u 1t s Ten p a t i e n t s w e r e e v a l u a t e d . H y d r o x y u r e a d e c r e a s e d t h e r a t e o f v a s o - o c c 1 u s i o n and d e c r e a s e d t h e t r a n s f u s i o n r e q u i r e m e n t s . The c l i n i c a l and h a e m a t o l o g i c a l b e n e f i t s w e r e g r e a t e s t when f o e t a l h a e m o b l o b i n was m a x i m a l . T h e r e was no s h o r t - t e r m t o x i c i t y . C o n c l u s i o n H y d r o x y u r e a a m e l i o r a t e s symptoms in sickle cell disease. On going studies are n e e d e d t o a s s e s s l o n g - t e r m e f f e c t s .

Foram estudadas 363 gestantes de primeira consulta, que não faziam uso de medicamentos que continham ferro, ácido fólico, vitamina B12 ou associação destes, na ocasião da coleta do material, em Centros de Saúde do Estado, no Subdistrito de Paz do Butantã, município de São Paulo. A prevalência de anemia (concentração de hemoglobina inferior a 11,6 g/dl) foi de 12,4%. As médias das concentrações de hemoglobina e as prevalências de anemia, segundo o trimestre de gestação, foram respectivamente: 13,47 g/dl e 3,57% no primeiro, 12,47 g/dl e 20,86% no segundo e 12,25 g/dl e 32,14% no terceiro trimestre. Não encontramos diferença. estatisticamente significativa entre as médias das concentrações de hemoglobina e entre as prevalências de anemia nas gestantes primigestas e multigestas. O mesmo aconteceu com as médias e as prevalências das gestantes multigestas com intervalo do último parto até dois anos e maior que dois anos. Na amostra estudada, encontramos maior prevalência de anemia naquelas gestantes que pertenciam às famílias que tinham renda per capita até 0,5 SMPC (salário mínimo per capita). As prevalências de verminose e de ancilostomídeos nas 300 gestantes foram respectivamente: 64,7% e 14,0%. Nas gestantes anêmicas foram respectivamente: 73,7% e 7,9%. Nas gestantes anêmicas, a prevalência de deficiência de ferro foi de 42,2% (concentração de ferro sérico <50 &#181;g/dl) ou 46,7% (saturação da transferrina <15% ou 40,0% (concentração de ferro sérico <50 &#181;g/dl e saturação de transferrina <15%). A prevalência de deficiência de ácido fólico foi 44,4%. A prevalência de deficiência de ferro e ácido fólico foi de 17,8%. Não encontramos deficiência de vitamina B<SUB<12 nas gestantes anêmicas. / Abstract not available

Por ser um parasita hematófago, Haemonchus contortus é modelo para estudo da anemia verminótica em ovinos. A presente pesquisa objetivou analisar as diferenças hematológicas e bioquímicas entre ovinos resistentes, resilientes e sensíveis, e propor a utilização das variações do hematócrito e do teor de hemoglobina durante o período de infecção com H. contortus para agrupar os animais nessas categorias. Para tal, 32 ovinos adultos da raça White Dorper foram infectados com 10.000 larvas L3 de H. contortus em bolus. Nos dias 0, 1, 4, 7, 14, 21, 28 e 34 após a infecção foram realizados: exames clínicos, hemograma, leucograma, perfil bioquímico e contagem de ovos por grama de fezes (OPG). O abate dos animais ocorreu no dia 35 para contagem de parasitas no abomaso. Utilizou-se a variação entre o hematócrito inicial e o final associada à contagem total de parasitas adultos no abomaso para classificar 21 animais em resistentes, resilientes e sensíveis. Verificou-se que as variações do hematócrito e do teor de hemoglobina ao longo do período de parasitismo são mais eficazes em descrever as respostas dos ovinos do que os valores do hematócrito e hemoglobina em si. Durante os primeiros 30 dias de hemoncose os ovinos resilientes mantém o equilíbrio entre produção e perda de hemácias, não ocorrendo envio de células imaturas para a corrente sanguínea. Em oposição, os sensíveis desenvolvem anemia sem sinais de regeneração e sem diminuição do ferro sérico o que denota uma possível falta ou insuficiência de resposta da medula óssea. Nesse período, o leucograma não apresenta especificidades que possam ser atribuídas a características de resistência, resiliência ou sensibilidade. Ocorreu diminuição de proteína total, albumina, beta-hidroxibutirato, triglicérides e movimentos ruminais, portanto menor produtividade, em todos os animais, incluído os resistentes, o que permite recomendar que os ovinos sejam mantidos em ausência de verminose / Haemonchus contortus is a hematophagous parasite, it is a model for the study of verminous anemia in sheep. The present study aimed to analyze the hematological and biochemical differences between resistant, resilient and sensitive sheep and to propose the use variations of hematocrit and hemoglobin content during the infection period with H. contortus to group the animals in these categories. For this, 32 adult White Dorper sheep were infected with 10,000 L3 larvae of H. contortus on bolus. On days 0, 1, 4, 7, 14, 21, 28 and 34 post-infection were performed: clinical exams, hemogram, leukogram, biochemical profile and fecal egg count (FEC). The slaughter of the animals occurred on day 35 for counting parasites in the abomasum. The variation between the initial and final hematocrit associated to the total adult parasite count in the abomasum was used to classify 21 animals as resistant, resilient and sensitive. Variations in hematocrit and hemoglobin content over the period of parasitism have been found to be more effective in describing ovine responses than hematocrit and hemoglobin values per se. During the first 30 days of hemonchosis, the resilient sheep maintains the balance between production and loss of red blood cells, and there is no release of immature cells into the bloodstream. In contrast, the susceptible individuals develop anemia with no signs of regeneration and no decrease in serum iron, which indicates a possible lack or insufficiency of bone marrow response. In this period, the leukogram does not present specificities that can be attributed to characteristics of resistance, resilience or sensitivity. There was decrease in total protein, albumin, beta-hydroxybutyrate, triglycerides and ruminal movements, thus lower productivity, in all animals, including the resistant ones, which allows to recommend keep sheep in the absence of verminose