Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy

OBJECTIVE

To evaluate the safety and efficacy of intravenous iron sucrose complex (ISC) as compared with oral ferrous sulfate in the treatment of iron deficiency anemia during pregnancy.

STUDY DESIGN

prospective, open, controlled study in which pregnant women with iron deficiency anemia were sequentially selected from the antenatal clinic and assigned either to ISC (study group) or to ferrous sulfate (control group).

METHODS

Each study patient was given the total calculated amount of ICS (Hb deficit (g/l) x body weight (kg) x 0.3) in divided doses (200 mg (elemental iron) in 100 ml normal saline intravenously over 1 h daily) followed by 10 mg/kg to replenish iron stores. Each patient of the control group was given ferrous sulfate 300 mg (60 mg elemental iron) orally three times a day. All patients were monitored for adverse effects, clinical and laboratory response.

RESULTS

There were 52 patients and 59 controls. ISC group achieved a significantly higher Hb level (128.5 +/- 6.6 g/l vs. 111.4 +/- 12.4 g/l in the control group P < or = 0.001) in a shorter period (6.9 +/- 1.8 weeks vs. 14.9 +/- 3.1 weeks in the control group, P < or = 0.001). ISC complex group showed no major side effects while 4 (6%) of the control group could not tolerate ferrous sulfate, 18 (30%) complained of disturbing gastrointestinal symptoms and 18 (30%) had poor compliance.

CONCLUSION

We conclude that ISC is safe and effective in the treatment of iron deficiency anemia during pregnancy.

The oral health status of Omani 12-year-olds--a national survey

This study reports the first ever national oral health survey of Omani 12-year-olds. Conducted in October 1993, of the 3,435 children examined, 1,438 (41.9%) were caries-free, although regional variations ranged from 24.8% to 61.9%. Overall, the national DMFT averaged 1.53, the majority of caries experienced being in the form of untreated decay, with occlusal surfaces of first permanent molars being the most commonly involved site. Oral hygiene was poor, only 11% of those examined being scored as plaque-free.

Malakoplakia of bone presenting as a pathological fracture

A male aged 54 years presented with a pathological fracture of the right femur at the subtrochanteric level. The fracture site showed a lytic lesion with expansion of the bone, considered to be a metastasis. On histology, however, the area turned out to be malakoplakia of bone. The patient responded well to antibiotics and sulphonamides along with skeletal traction. This appears to be the fourth reported case of malakoplakia of bone.

Melatonin rhythms in seasonal affective disorder

We examined 24-hour melatonin rhythms from 20 patients with seasonal affective disorder (SAD) and 20 healthy volunteers. Patients and controls were individually matched for age, sex, and month of study. Plasma samples were taken at hourly intervals, and were assayed for melatonin by radio-immunoassay. The 24-hourly melatonin estimations for each individual were fitted to a cosine curve, and the significance of the curve fits was calculated. Two analyses were performed. In analysis 1 the following were calculated: (a) cosine fit, (b) significance of fits, (c) mean amplitude and acrophase (peak) and (d) mean melatonin levels. The curve fits were highly significant for all but three subjects (two patients, one control), but there were no significant differences in any measure between the two groups. In analysis 2 the comparisons were repeated and restricted to the 18 patients and 19 controls in whom there was a significantly significant melatonin rhythm. Again there were no significant differences between groups. These results suggest that the circadian rhythm of melatonin is not abnormal in SAD, and that the therapeutic effect of light in SAD is not mediated by phase shifts in melatonin secretion.

Seasonal affective disorder: response to light as measured by electroencephalogram, melatonin suppression, and cerebral blood flow

This study was designed to test the hypothesis that patients with SAD have significantly different physiological responses to light than healthy age- and sex-matched controls. We studied retinal contrast sensitivity, visual evoked EEG responses, and melatonin suppression by, and cerebral blood flow response to, full-spectrum artificial daylight. There was no significant difference between 10 patients and 11 controls in retinal contrast sensitivity, or amplitude or latency of N2, P2, P100 or P300 on EEG. We compared melatonin suppression in 12 SAD patients and 12 controls. During exposure to 500 lux and 1500 lux artificial daylight both the SAD patients and controls had a significant melatonin percentage suppression; however, the percentage suppression did not differ significantly between the SAD patients and the controls. In addition, we carried out a small pilot study into the effect of light on cerebral blood flow in four SAD patients and four controls. Before exposure to 1500 lux artificial daylight there was no significant difference between patients and controls in global, regional or cerebral hemispheric blood flow. After light exposure the SAD patients and controls had a significantly different percentage change in cerebral blood flow. We suggest that patients with SAD do not have significantly physiological responses to light than controls, except perhaps in cerebral blood flow. Furthermore, mechanisms other than supersensitivity of melatonin suppression must explain both the pathophysiology of the disorder and its response to treatment with light.

Hysterical paralysis as a complication of snake bite

Until recently, hysteria was believed to be uncommon amongst the indigenous inhabitants of tropical Africa. Though snake bites are common, there has not been any previous report of hysterical manifestations following snake bite. We report a case of hysterical paralysis in a nulliparous Nigerian female, with comments on its diagnostic and prognostic implications in an ethnic community.

[Hydatid cyst fluid (Echinococcus granulosus) biochemistry. Influence of site on cyst permeability]

Eleven metabolites were determined in 19 hydatid cyst fluids of variable size and localization, and in patients plasma before surgery. Specific indirect immunofluorescent antibody titration was carried out. Sodium (132 +/- 5.2 mmol/l), chloride (92.9 +/- 6.5 mmol/l) and bicarbonate (22.1 +/- 1.5 mmol/l) were found at the same concentration than in plasma. Potassium (5.4 +/- 0.3 mmol/l) and calcium levels (4.7 +/- 0.9 mmol/l) were higher than in plasma, and phosphate (0.1 +/- 0.03 mmol/l) decreased tenfold. Glucose (3.4 +/- 0.8 mmol/l), creatinine (39.3 +/- 7.2 mumol/l) and urea nitrogen (4.6 +/- 0.8 mmol/l) showed great variations. Cholesterol levels 0.06 +/- 0.03 mmol/l) were a hundredfold lower than in plasma. Total protein levels (0.34 +/- 0.09 g/l) were found at very low concentrations. Extra-pulmonary cysts showed significantly higher antibody titers than pulmonary cysts. No correlation was observed between the size of the cysts and the level of the immune response. Significant difference about the relative cholesterol concentration (cystic concentration/plasmatic concentration) was observed between pulmonary and extra-pulmonary cysts (respectively 0.0048 +/- 0.0032 and 0.018 +/- 0.01--p less than 0.05). No correlation was observed between the size of the cyst, or the corresponding levels of the immune response, and the cholesterol levels. The hypothesis of a greater membrane permeability in extra-pulmonary cyst is discussed.

[Diffuse hepato-pulmonary hydatidosis. Apropos of a case]

The authors report a case of diffuse hydatid disease of the lung and liver. This association accounts for about 20 per cent of cases. Diffuse lesions are, on the other hand, exceptional. In this case the lung and liver functions were both impaired. Surgical management involved resection of the top of the cyst protruding from the liver and pulmonary cystectomy. The relative simplicity of the postoperative course, restoration of liver function and improvement in lung function prompt the authors to recommend surgical management of these cases, which cannot be treated medically.

Effect of fatty acid modification of cultured hepatoma cells on susceptibility to natural killer cells

Rat hepatoma (Morris 7777) cells modified with either oleic or linoleic acid exhibited greater susceptibility to normal spleen cell-mediated lysis in a 16-hr 51Cr release assay. At effector:target cell ratios of 300:1, the specific lysis of fatty acid-enriched target cells (cultured for 2 days in fatty acid-supplemented medium) by the normal rat spleen cells was 60% higher than the untreated target cells (P less than 0.01). Prolonging the culture in fatty acid-supplemented medium up to 6 days produced similar effects. Analysis of the fatty acid composition of cellular lipids revealed that an elevation of oleic or linoleic acid was the only significant alteration in the hepatoma cells grown in the oleic or linoleic acid-supplemented medium, respectively. The percentage of the acids was increased in the total cellular phospholipids, the choline, ethanolamine, serine, and inositol phosphoglyceride fractions, and the neutral lipids. In conclusion, we suggest that the elevation of oleic acid and linoleic acid contents in the membranes of the fatty acid-modified hepatoma cells may contribute to the increased susceptibility of these cells to natural killer cell-mediated cytotoxicity.

In vitro activation and behavior of the ameboid sperm of Ascaris suum (Nematoda)

A system is described for the study of activation and motility of Ascaris spermatozoa in vitro. Activation was accomplished by addition of the sperm-activating substances (SAS), extracted from the male accessory gland, to cells incubated in phosphate-buffered saline (pH 7.4) at 37-39 degrees C under anaerobic conditions (95% N2, 5% CO2). Activation is characterized by a change from spherical to ameboid shape with coalescence of the refringent granules. The normal ameboid spermatozoa bear several stubby and needle-like filopodia at the lamellipodial margin. Within the lamellipodium are bundles of microfilament-like structures extending toward the pseudopodial membrane and concentrating within the needle-like filopodia. These filopodia exhibit a pendulous, sweeping motion with subsequent retraction and disappearence within the main lamellipodium. Membranes of the ameboid cells interact at the pseudopodial regions with partial fusion, as suggested by apparent membrane breakdown between interdigitating portions of the pseudopodia. Activation is complete in 5-15 min, is totally inhibited at 4 degrees C and/or by an atmospheric environment, but can be reinitiated by transfer to anaerobic conditions at 22-39 degrees C. Activation also requires favorable pH (6.8-8.7) and continual exposure to sufficiently high sodium concentrations (134-154 mM), i.e., lowering of sodium concentration to 10 mM causes irreversible inactivation. Sodium may be replaced by potassium or lithium but not by Tris or sucrose. Proteinases (10 microgram/ml) can act as activators even though SAS lack detectable proteolytic activity against azoalbumin, azocasein, TAME and BTEE and SAS activation was not inhibited by TLCK or soybean trypsin inhibitor.