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Lang R, Coburn SB, Gill MJ, Justice AC, Grossman J, Gebo KA, Horberg MA, Mayor AM, Silverberg MJ, McGinnis KA, Hogan B, Moore RD, Althoff KN. Evaluation of mean corpuscular volume among anemic people with HIV in North America following ART initiation. AIDS Res Ther 2024; 21:52. [PMID: 39113038 PMCID: PMC11304803 DOI: 10.1186/s12981-024-00641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 07/25/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Anemia is common and associated with increased morbidity among people with HIV (PWH). Classification of anemia using the mean corpuscular volume (MCV) can help investigate the underlying causative factors of anemia. We characterize anemia using MCV among PWH receiving antiretroviral therapy (ART), and identify the risk factors for normocytic, macrocytic, and microcytic anemias. METHODS Including PWH with anemia (hemoglobin measure < 12.9 g/dL among men and < 11.9 g/dL among women) in the NA-ACCORD from 01/01/2007 to 12/31/2017, we estimated the annual distribution of normocytic (80-100 femtolitre (fL)), macrocytic (> 100 fL) or microcytic (< 80 fL) anemia based on the lowest hemoglobin within each year. Poisson regression models with robust variance and general estimating equations were used to estimate crude and adjusted prevalence ratios and 95% confidence intervals for risk factors for macrocytic (vs. normocytic) and microcytic (vs. normocytic) anemia stratified by sex. RESULTS Among 37,984 hemoglobin measurements that identified anemia in 14,590 PWH, 27,909 (74%) were normocytic, 4257 (11%) were microcytic, and 5818 (15%) were macrocytic. Of the anemic PWH included over the study period, 1910 (13%) experienced at least one measure of microcytic anemia and 3208 (22%) at least one measure of macrocytic anemia. Normocytic anemia was most common among both males and females, followed by microcytic among females and macrocytic among males. Over time, the proportion of anemic PWH who have macrocytosis decreased while microcytosis increased. Macrocytic (vs. normocytic) anemia is associated with increasing age and comorbidities. With increasing age, microcytic anemia decreased among females but not males. A greater proportion of PWH with normocytic anemia had CD4 counts ≤ 200 cells/mm3 and had recently initiated ART. CONCLUSION In anemic PWH, normocytic anemia was most common. Over time macrocytic anemia decreased, and microcytic anemia increased irrespective of sex. Normocytic anemia is often due to chronic disease and may explain the greater risk for normocytic anemia among those with lower CD4 counts or recent ART initiation. Identified risk factors for type-specific anemias including sex, age, comorbidities, and HIV factors, can help inform targeted investigation into the underlying causes.
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Affiliation(s)
- Raynell Lang
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Sally B Coburn
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amy C Justice
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | | | - Kelly A Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Angel M Mayor
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, Bayamon, Puerto Rico
| | | | | | - Brenna Hogan
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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Association of anemia with functional outcomes in patients with mechanical thrombectomy. Clin Neurol Neurosurg 2021; 211:107028. [PMID: 34826754 DOI: 10.1016/j.clineuro.2021.107028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Anemia at presentation is associated with worse outcomes in patients with acute ischemic stroke (AIS). We aim to investigate the association of anemia parameters with functional dependence and mortality in patients who undergo mechanical thrombectomy (MT). METHODS We performed a retrospective chart review of patients who underwent MT for an anterior circulation large vessel occlusion at a comprehensive stroke center from 1/2015-6/2020. Anemia was considered as a dichotomous categorical variable with a cutoff point of hemoglobin (Hb) < 12.0 g/dL in women and < 13.0 g/dL in men, as per the definition of the World Health Organization. Mean values of Hb and hematocrit (HCT) were obtained over the first five days of admission. Hemoglobin and HCT variability were measured using standard deviation (SD), and coefficient variability (CV) over the first five days of admission. Values of variance and difference (the difference between peak and trough of Hemoglobin or HCT) were also recorded. Multivariate logistic regression analyses were performed, including the predictor variables which were contributing significantly to the model (P < 0.05) in the univariate analysis, with 30-day functional dependence (mRS 3-6) (primary outcome) and 30-day mortality (secondary outcome) as the dependent variables. RESULTS 188 patients met our inclusion criteria. Anemia on presentation, lower mean and minimum values of five-day Hb and HCT, and higher variability in five-day Hb and HCT parameters were associated with higher 3-month mortality. Men with lower mean and minimum values of five-day Hb and HCT had a significantly higher likelihood of functional dependence at 3-months. This finding was not replicated amongst women in our cohort. CONCLUSION Our study demonstrated higher 3-mortality in patients with anemia and Hb variability. Our study also demonstrated a higher likelihood of functional dependence in patients amongst men with anemia.
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Moutongo Mouandza R, M'bondoukwe NP, Obiang Ndong GP, Nzaou Nziengui A, Batchy Ognagosso FB, Nziengui Tirogo C, Moutombi Ditombi B, Mawili-Mboumba DP, Bouyou-Akotet MK. Anaemia in asymptomatic parasite carriers living in urban, rural and peri-urban settings of Gabon. Trans R Soc Trop Med Hyg 2020; 114:618-626. [DOI: 10.1093/trstmh/traa047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/19/2019] [Accepted: 06/05/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
This cross-sectional study was carried out in different settlements of Gabon to determine the influence of single or multiple parasite carriage on haemoglobin (Hb) levels.
Methods
Between April 2015 and June 2016, healthy volunteers from urban, peri-urban and rural areas were screened for malaria, blood filariasis and intestinal parasitic infections using microscopic methods. Hb concentration was measured with a Hemocue analyser. The association between parasite carriage and anaemia was assessed.
Results
Among the 775 volunteers examined, 319 (41.2%) were from rural villages and 76.0% were adults. Filariasis, intestinal parasitic infections, Plasmodium falciparum and polyparasitism were detected in 15.6, 14.6, 9.5 and 6.8% of participants, respectively. Anaemia prevalence was 72.6%, with rates of mild, moderate and severe anaemia being 30.9, 61.1 and 8.0%, respectively. The median Hb level was lowest in the presence of hookworms (7.1 g/dl [interquartile range {IQR} 6.8–7.5]), Schistosoma intercalatum (6.9 g/dl), Trichuris trichiura (10.1 g/dl [IQR 8.9–11.5]) and Plasmodium falciparum (10.0 g/dl [IQR 9.1–11.2]) compared with filariaemia (12.1 g/dl [IQR 10.5–13.2]) (p=0.03). Moderate to severe anaemia predominated among those single-infected with P. falciparum (69.5%) or co-infected with intestinal parasitic infections and P. falciparum (76.2%), while it was found in only 23.2% of individuals with filariasis. All participants with soil-transmitted helminths and more than half with a Blastocystis sp. (68.8%) infection had moderate anaemia.
Conclusions
The prevalence of anaemia is high. Asymptomatic parasite carriage is associated with anaemia in this surveyed population in Gabon.
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Affiliation(s)
- R Moutongo Mouandza
- Département de Parasitologie-Mycologie-Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, BP 4009, Libreville, Gabon
| | - N P M'bondoukwe
- Département de Parasitologie-Mycologie-Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, BP 4009, Libreville, Gabon
| | | | - A Nzaou Nziengui
- Département de Parasitologie-Mycologie-Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, BP 4009, Libreville, Gabon
| | - F B Batchy Ognagosso
- Département de Parasitologie-Mycologie-Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, BP 4009, Libreville, Gabon
| | - C Nziengui Tirogo
- Département de Parasitologie-Mycologie-Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, BP 4009, Libreville, Gabon
| | - B Moutombi Ditombi
- Département de Parasitologie-Mycologie-Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, BP 4009, Libreville, Gabon
| | - D P Mawili-Mboumba
- Département de Parasitologie-Mycologie-Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, BP 4009, Libreville, Gabon
| | - M K Bouyou-Akotet
- Département de Parasitologie-Mycologie-Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, BP 4009, Libreville, Gabon
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Zeiher J, Ombrellaro KJ, Perumal N, Keil T, Mensink GBM, Finger JD. Correlates and Determinants of Cardiorespiratory Fitness in Adults: a Systematic Review. SPORTS MEDICINE-OPEN 2019; 5:39. [PMID: 31482208 PMCID: PMC6722171 DOI: 10.1186/s40798-019-0211-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/05/2019] [Indexed: 01/17/2023]
Abstract
Background Enhanced cardiorespiratory fitness (CRF) is now a well-established predictor of numerous adverse health outcomes. Knowledge about the pathways leading to enhanced CRF is essential for developing appropriate interventions. Hence, the aim of this review was to provide a detailed overview of the current state of research regarding individual factors associated with or influencing CRF among the general adult population. Methods We searched the PubMed, EMBASE, and Cochrane Library databases and also conducted a search for grey literature (Google Scholar). Eligible indicators of CRF were objectively assessed measures of CRF by submaximal or maximal exercise testing measured using treadmill or cycle ergometer tests. We included quantitative observational studies of the general adult population. Using a semi-quantitative approach, we compiled summary tables aggregating the study results for each potential correlate or determinant of CRF. Results We identified 3005 studies, 78 of which met the inclusion criteria. Almost all of these studies were conducted in high-income countries. Study quality scores assessing the risk of bias in the individual studies ranged from 40 to 100%. Male sex, age (inverse), education, socioeconomic status, ethnicity, body mass index (inverse), body weight (inverse), waist circumference, body fat (inverse), resting heart rate (inverse), C-reactive protein (inverse), smoking (inverse), alcohol consumption, and multiple measures of leisure-time physical activity were independently and consistently associated with CRF. Conclusions In synthesizing the current research on the correlates and determinants of CRF among adults, this systematic review identified gaps in the current understanding of factors influencing CRF. Beyond the scope of this review, environmental and interpersonal determinants should be further investigated. Systematic Review Registration PROSPERO, CRD42017055456. Electronic supplementary material The online version of this article (10.1186/s40798-019-0211-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johannes Zeiher
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany.
| | - Katherine J Ombrellaro
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Nita Perumal
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Thomas Keil
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Institute for Health Resort Medicine and Health Promotion, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany.,Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gert B M Mensink
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Jonas D Finger
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
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Satish V, Rao RM, Manjunath NK, Amritanshu R, Vivek U, Shreeganesh HR, Deepashree S. Yoga versus physical exercise for cardio-respiratory fitness in adolescent school children: a randomized controlled trial. Int J Adolesc Med Health 2018; 32:ijamh-2017-0154. [PMID: 29369813 DOI: 10.1515/ijamh-2017-0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/24/2017] [Indexed: 11/15/2022]
Abstract
Background Yoga is very effective in improving health especially cardio-respiratory fitness and also overall performance in adolescents. There are no large numbers of randomized controlled studies conducted on comparing yoga with physical activity for cardio-respiratory fitness in adolescent school children with large sample size. Objective Aerobic training is known to improve physical and cardio-respiratory fitness in children. Cardio-respiratory fitness is an important indicator of health in children. In this study we evaluate the effects of yoga versus physical exercise training on cardio-respiratory fitness in adolescent school children. Subjects Eight hundred two school students from 10 schools across four districts were recruited for this study. Methods In this prospective two arm RCT around 802 students were randomized to receive daily one hour yoga training (n = 411) or physical exercise (n = 391) over a period of two months. VO2 max was estimated using 20 m shuttle run test. However, yoga (n = 377) and physical exercise (n = 371) students contributed data to the analyses. Data was analysed using students t test. Results There was a significant improvement in VO2 max using 20 m Shuttle run test in both yoga (p < 0.001) and exercise (p < 0.001) group following intervention. There was no significant change in VO2 max between yoga and physical exercise group following intervention. However, in the subgroup with an above median cut-off of VO2 max; there was a significant improvement in yoga group compared to control group following intervention (p = 0.03). Conclusion The results suggest yoga can improve cardio-respiratory fitness and aerobic capacity as physical exercise intervention in adolescent school children.
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Affiliation(s)
- Vhavle Satish
- Swami Vivekananda Yoga Anusandhana Samsthana, Department of Life Sciences, Bengaluru, India
| | - Raghavendra Mohan Rao
- Centre for Academic Research, HCG Foundation, Healthcare Global Enterprises Ltd., #8, P Kalinga Rao Rd, Sampangiramanagara, Bengaluru-560027, India
| | | | - Ram Amritanshu
- Healthcare Global Enterprises ltd., Department of CAM, Sampangiramanagara, Bengaluru, India
| | - Udupa Vivek
- Divine Park, Department of Research and Development, Saligrama, Udupi, India
| | | | - Shashidhara Deepashree
- Healthcare Global Enterprises ltd., Department of CAM, Sampangiramanagara, Bengaluru, India
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