Anaemia and cigarette smoking

Association of ambient air pollution with hemoglobin levels and anemia in the general population of Korean adults

BACKGROUND

Emerging evidence has suggested significant associations between ambient air pollution and changes in hemoglobin levels or anemia in specific vulnerable groups, but few studies have assessed this relationship in the general population. This study aimed to evaluate the association between long-term exposure to air pollution and hemoglobin concentrations or anemia in general adults in South Korea.

METHODS

A total of 69,830 Korean adults from a large-scale nationwide survey were selected for our final analysis. Air pollutants included particulate matter with an aerodynamic diameter less than or equal to 10 micrometers (PM10), particulate matter with an aerodynamic diameter less than or equal to 2.5 micrometers, nitrogen dioxide, sulfur dioxide (SO2), and carbon monoxide (CO). We measured the serum hemoglobin concentration to assess anemia for each participant.

RESULTS

In the fully adjusted model, exposure levels to PM10, SO2, and CO for one and two years were significantly associated with decreased hemoglobin concentrations (all p < 0.05), with effects ranging from 0.15 to 0.62% per increase in interquartile range (IQR) for each air pollutant. We also showed a significant association of annual exposure to PM10 with anemia (p = 0.0426); the odds ratio (OR) [95% confidence interval (CI)] for anemia per each increase in IQR in PM10 was estimated to be 1.039 (1.001-1.079). This association was also found in the 2-year duration of exposure (OR = 1.046; 95% CI = 1.009-1.083; adjusted Model 2). In addition, CO exposure during two years was closely related to anemia (OR = 1.046; 95% CI = 1.004-1.091; adjusted Model 2).

CONCLUSIONS

This study provides the first evidence that long-term exposure to air pollution, especially PM10, is significantly associated with reduced hemoglobin levels and anemia in the general adult population.

Anaemia among women of reproductive age in selected sub-Saharan African countries: multivariate decomposition analyses of the demographic and health surveys data 2008-2018

Objectives

The burden and highest regional prevalence of anaemia is reported in sub-Saharan Africa (SSA). The study evaluated changes in anaemia prevalence across the Demographic Health Surveys (DHS) periods in SSA and reported factors influencing observed changes in the trend.

Method

The study was implemented by a two-stage cross-sectional stratified sampling approach. The study involved women of reproductive age (15-49 years) in sub-Saharan Africa countries (Ghana, Sierra Leone, Mali, and Benin) using two different periods of their demographic health surveys (DHS) data. The study adopted both descriptive and inferential statistical methods. The chi-square test was used to determine the existence of a statistically significant relationship between the outcome and predictor variables and test the observed changes in anaemia. Multivariable logistic regression analyses were conducted on each survey year and the pooled dataset for eligible study countries. Multivariate decomposition analysis was performed to explain how compositional changes and behavioural effects of women characteristics affected the changes in anaemia prevalence. The study reported frequencies, percentages and odds ratios along with their 95% confidence intervals (CI).

Results

Ghana and Sierra Leone experienced 17.07% [95% CI: 14.76-19.37, p < 0.001] and 1% [95% CI: 1.0-2.9, p > 0.05] of anaemia decrease from period 1 to period 2, respectively, while Mali and Benin experienced 11% [95% CI: 9.14-12.90, p < 0.001] and 16.7% [95% CI: 14.99-18.5, p < 0.001] of increase in anaemia prevalence from period 1 to period 2, respectively. Behavioural effects explained the decrease in Ghana and the increase in Benin and Mali while endowments or compositional changes explained the decrease in Sierra Leone.

Conclusion

Anaemia continues to pose a significant challenge in sub-Saharan Africa. Therefore, there is an imperative need to scale up the implementation of nutrition-related programmes and advocacies to ensure optimum changes in women nutrition-related behaviours.

Prevalence of Iron Deficiency and Iron Deficiency Anemia Among Nursing Students Working in the Internal Medicine Clinic

Objective  The objective of this study is to evaluate the frequency of iron deficiency (ID) and iron deficiency anemia (IDA) among nursing students working in the internal medicine clinic of our hospital. Methods The study was designed as a prospective cohort study. The study population comprised nursing students working in the internal medicine clinic of our hospital from January 1, 2016, through June 1, 2016. Data concerning the participants' anamnesis, physical examination findings, and sociodemographic characteristics were recorded. Blood samples were taken. The participants' blood parameters were evaluated for anemia. Results A total of 99 nursing students, 43 (43.4%) male and 56 (56.6%) female, were included in the study. The mean age was 17.4 ± 0.58 years for the male student group and 17.64 ± 0.73 years for the female student group. We detected ID in 22.2% of the nursing students, anemia in 8%, and IDA in 4%. ID was present in 22 (39.3%) of the female students. There was a significant difference between the male and female student groups in terms of the prevalence of ID (p < 0.001). The mean hemoglobin levels of the male and female student groups were 15.85 ± 1.10 g/dL and 12.90 ± 1.05 g/dL, respectively. Conclusion We determined that the number of students with ID was higher than the number of students with IDA. Once ID is diagnosed, it may be necessary to take precautions and treat it according to the severity of the deficiency. It is extremely important to educate nursing students and raise their awareness about ID and IDA.

Factors for the development of anemia in patients with newly introduced olaparib: A retrospective case-control study

Anemia is the most common dose-limiting toxicity of olaparib. However, few studies have analyzed the clinical features of olaparib-induced anemia. This study investigated the clinical features of olaparib-induced anemia. Additionally, the role of folate or vitamin B12 in olaparib-induced anemia was examined. This retrospective case-control study included patients who received olaparib at Mie University Hospital between January 2018 and December 2020. Data were collected between initiation of olaparib and discontinuation of olaparib or till December 2021. We investigated the development of grade ≥ 3 anemia during olaparib administration for at least 1 year. We examined patients with grade ≥ 3 anemia considering the mean corpuscular volume (MCV), its association with gastrointestinal events and cumulative dose of carboplatin. For the sub-study analysis, data on patients treated with olaparib for ovarian or endometrial cancer were collected to evaluate the Common Terminology Criteria for Adverse Events (CTCAE) or monthly changes in folate or vitamin B12 levels from baseline to 3 months after olaparib initiation. These data were collected between initiation of olaparib and discontinuation of olaparib or till November 2022. Patients with no data on folic acid or vitamin B12 levels were excluded from the sub-study. In the main study, 40 patients were included. Eighteen patients (45%) developed grade ≥ 3 anemia, and all patients discontinued treatment (94%) or reduced olaparib dose (67%) after developing anemia. Among the patients with grade ≥ 3 anemia, 9 (50%) exhibited macrocytic anemia and 15 (83%) had previously received carboplatin. The incidence of grade ≥ 2 dysgeusia was significantly higher in patients with grade ≥ 3 anemia (P = .034). Moreover, the cumulative dose of previously administered carboplatin was higher in patients who had 3 episodes of anemia (P = .102). In sub-study, 12 had data on folic acid and vitamin B12 levels. Sub-study analysis showed that none fulfilled the criteria for deficiency of folate or vitamin B12, while 3 developed grade 3 anemia. This study revealed that olaparib-induced anemia frequently occurs as macrocytic and normocytic erythroblastic anemia without folate or vitamin B12 deficiencies. A high cumulative dose of previously administered carboplatin and dysgeusia may be associated with olaparib-induced anemia.

Impacts of cigarette smoking on blood circulation: do we need a new approach to blood donor selection?

Smoking is a major public health problem and is considered the leading cause of preventable death worldwide. Gas-phase smoke carries bioactive substances and toxic compounds, affecting human health and reducing life spans. The negative effects of smoking on red blood cell (RBC) quality include destroying RBCs and increasing carboxy hemoglobin (COHb). Smoking increases the concentrations of heavy metals such as cadmium (Cd) and lead (Pb) in the blood. Moreover, tobacco smoking has been found to be associated with heightened platelet (PLT)-dependent thrombin level which will induce a prothrombotic state. Smoking may affect the blood circulation of donors, and subsequently the blood components, and ultimately the recipients of transfusion. Nevertheless, there are no restrictions on smoking for volunteer blood donor screenings currently. We reviewed the articles about the influence of smoking on smokers' blood circulation as well as the impact of donated blood products on transfusion when these smokers act as blood donors. We aim to attract blood collection centers' attention to strengthen the management of blood donors who smoke, avoiding their use in massive transfusion protocol and susceptible recipients, especially pediatric ones.

Advanced Materials Design for Adsorption of Toxic Substances in Cigarette Smoke

Cigarettes, despite being economically important legal consumer products, are highly addictive and harmful, particularly to the respiratory system. Tobacco smoke is a complex mixture containing over 7000 chemical compounds, 86 of which are identified to have "sufficient evidence of carcinogenicity" in either animal or human tests. Thus, tobacco smoke poses a significant health risk to humans. This article focuses on materials that help reduce the levels of major carcinogens in cigarette smoke; these include nicotine, polycyclic aromatic hydrocarbons, tobacco-specific nitrosamines, hydrogen cyanide, carbon monoxide, and formaldehyde. Specifically, the research progress on adsorption effects and mechanisms of advanced materials such as cellulose, zeolite, activated carbon, graphene, and molecularly imprinted polymers are highlighted. The future trends and prospects in this field are also discussed. Notably, with advancements in supramolecular chemistry and materials engineering, the design of functionally oriented materials has become increasingly multidisciplinary. Certainly, several advanced materials can play a critical role in reducing the harmful effects of cigarette smoke. This review aims to serve as an insightful reference for the design of hybrid and functionally oriented advanced materials.

Genetically influenced tobacco and alcohol use behaviors impact erythroid trait variation

Genome wide association studies (GWAS) have associated thousands of loci with quantitative human blood trait variation. Blood trait associated loci and related genes may regulate blood cell-intrinsic biological processes, or alternatively impact blood cell development and function via systemic factors and disease processes. Clinical observations linking behaviors like tobacco or alcohol use with altered blood traits can be subject to bias, and these trait relationships have not been systematically explored at the genetic level. Using a Mendelian randomization (MR) framework, we confirmed causal effects of smoking and drinking that were largely confined to the erythroid lineage. Using multivariable MR and causal mediation analyses, we confirmed that an increased genetic predisposition to smoke tobacco was associated with increased alcohol intake, indirectly decreasing red blood cell count and related erythroid traits. These findings demonstrate a novel role for genetically influenced behaviors in determining human blood traits, revealing opportunities to dissect related pathways and mechanisms that influence hematopoiesis.

Tobacco smoking-related risk for iron deficiency anemia: A case-control study

BACKGROUND

Globally, iron deficiency anemia (IDA) is a significant public health problem. Tobacco smoking as a risk factor for anemia is often ignored.

AIMS

To study the tobacco smoking-associated risk for IDA.

This study was conducted in a tertiary care hospital in Dehradun, India from January 2019 to December 2020. One hundred ten patients having IDA (serum ferritin < 15 mcg/l) and an equal number of controls were randomly selected and assessed regarding their tobacco smoking status and type, quantity, and duration of tobacco used.

RESULTS

Seventy-six (69.1%) patients with IDA were tobacco smokers and were predominantly males (51cases, 67.1%) and beedi smokers (52 cases, 68.4%). The odds ratios (ORs) for the association of smoking tobacco (cigarette and beedi collectively), cigarette, and beedi with IDA were 7.60 (p < 0.0001), 2.79 (p = 0.01), and 5.68 (p < 0.0001), respectively. OR for developing IDA was more among light smokers (OR = 7.72, p < 0.0001) and increased with duration of smoking (p < 0.0001). IDA was not significantly associated with confounding risk factors like malnutrition (OR = 1.00, p = 1.00), low socioeconomic status (OR = 0.64, p = 0.21), dietary habits (OR = 1.43, p = 0.45), and place of residence (OR = 0.93, p = 0.88).

CONCLUSIONS

Tobacco smoking has a strong association with IDA. Both beedi smoking and cigarette smoking have a significant association with IDA. The risk of IDA is more among light smokers and is duration-dependent.

Cigarette Smoking, and Blood Monocyte Count Correlate with Chronic Lung Injuries and Mortality

Background

Cigarette smoking (CS)-related monocytosis contributes to the development of chronic lung injuries via complex mechanisms. We aim to determine correlations between measures of CS and monocytes, their capacities to predict chronic lung diseases, and their associations with mortality.

Methods

A single-center retrospective study of patients undergoing surgical resection for suspected lung nodules/masses was performed. CS was quantified as cigarettes smoked per day (CPD), duration of smoking, composite pack years (CPY), current smoking status, and smoking cessation years. A multivariate logistic regression analysis was performed.

Results

Of 382 eligible patients, 88% were ever smokers. In this group, 45% were current smokers with mean CPD of 27.2±40.0. CPY and duration of smoking showed positive linear correlations with percentage monocyte count. Physiologically, CPY was associated with progressive obstruction, hyperinflation, and reduced diffusion capacity (DL_CO). Across the quartiles of smoking, there was an accumulation of radiologic and histologic abnormalities. Anthracosis and emphysema were associated with CPD, while lung cancer, respiratory bronchiolitis (RB), emphysema, and honeycombing were statistically related to duration of smoking. Analysis using consecutive CPY showed associations with lung cancer (≥10 and <30), fibrosis (≥20 and <40), RB (≥50), anthracosis and emphysema (≥10 and onwards). Percentage monocytes correlated with organizing pneumonia (OP), fibrosis, and emphysema. The greater CPY increased mortality across the groups. Significant predictors of mortality included percentage monocyte, anemia, GERD, and reduced DL_CO.

Conclusion

Indices of CS and greater monocyte numbers were associated with endpoints of chronic lung disease suggesting a participation in pathogenesis. Application of these easily available metrics may support a chronology of CS-induced chronic lung injuries. While a relative lesser amount of smoking can be associated with lung cancer and fibrosis, greater CPY increases the risk for emphysema. Monocytosis predicted lung fibrosis and mortality. Duration of smoking may serve as a better marker of monocytosis and associated chronic lung diseases.

Genes, exposures, and interactions on preterm birth risk: an exploratory study in an Argentine population

Preterm birth (PTB) is the main condition related to perinatal morbimortality worldwide. The aim of this study was to identify associations of spontaneous PTB with genetic variants, exposures, and interactions between and within them. We carried out a retrospective case-control study including parental sociodemographic and obstetric data, and fetal genetic variants. We sequenced the coding and flanking regions of five candidate genes from the placental blood cord of 69 preterm newborns and 61 at term newborns. We identify the characteristics with the greatest predictive power of PTB using penalized regressions, in which we include exposures (E), genetic variants (G), and two-way interactions. Few prenatal visits (< 5) was the main predictor of PTB from 26 G, 35 E, 299 G × G, 564 E × E, and 875 G × E evaluated terms. Within the fetal genetic characteristics, we observed associations of rs4845397 (KCNN3, allele T) variant; G × G interaction between rs12621551 (COL4A3, allele T) and rs73993878 (COL4A3, allele A), which showed sensitivity to anemia; and G × G interaction between rs11680670 (COL4A3, allele T) and rs2074351 (PON1, allele A), which showed sensitivity to vaginal discharge. The results of this exploratory study suggest that social disparities and metabolic pathways linked to uterine relaxation, inflammation/infections, and collagen metabolism would be involved in PTB etiology. Future studies with a larger sample size are necessary to confirm these findings and to analyze a greater number of exposures.

Anemia and Associated Factors Among Lactating Women in Sierra Leone: An Analysis of the Sierra Leone Demographic and Health Survey 2019

Background

Anemia is a condition in which hemoglobin (Hb) concentration and/or red blood cell (RBC) numbers are lower than normal and insufficient to meet an individual's physiological needs. The prevalence of anemia among women of reproductive age is high in Sub-Saharan Africa (SSA), including Sierra Leone. However, data on anemia among lactating women in Sierra Leone are scarce. Therefore, this study was conducted to estimate the prevalence of anemia and determine its associated factors among lactating women in Sierra Leone.

Methods

The 2019 Sierra Leone Demographic and Health Survey (SLDH) data were used of which 1543 lactating women aged 15 to 49 years old had hemoglobin measurements. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. Multivariate binary logistic regression was used to determine factors associated with anemia among lactating women in Sierra Leone.

Results

The general prevalence of anemia among lactating women in Sierra Leone was 52.9% (95% CI = 50.9-55.8). Almost a quarter, 23.8% (95% CI = 22.1-26.3) of the lactating women had mild anemia, 27.4% (95% CI = 25.3-29.7) had moderate anemia and 1.7% (95% CI = 1.1-2.5) had severe anemia. The use of modern contraceptives (aOR = 1.64, 95% CI = 1.09-2.47), not being visited by a field worker in the past year (aOR = 1.51, 95% CI = 1.12-2.03) and being Muslim (aOR = 1.46, 95% CI = 1.11-1.91), were associated with higher odds of being anemic. Being given and having bought iron supplements during pregnancy (aOR = 0.46, 95% CI = 0.25-0.87) was associated with less odds of being anemic.

Conclusion

More than half of the lactating mothers in our study were anemic. The risk factors for anemia in our study included: use of modern contraceptives, not being visited by a field worker in the past year and being Muslim. Receiving iron supplements during pregnancy was protective against anemia. According to the results from this study, the recommendation for lactating women was to maintain routine interface with the healthcare system which includes being visited by a field worker who should prescribe and issue iron supplements to them. Lactating women especially Muslims should receive routine nutrition education by the health workers at the health facilities during antenatal care visits or postnatal care in regard to anemia and means of prevention and treatment. Community stakeholders should also work in collaboration to establish scalable methods to correctly identify pregnant women with risk factors, inform them about anemia with caution, and apply appropriate measures as trained or instructed.

Smoking is associated with altered serum and hair essential metal and metalloid levels in women

The objective of the study was to evaluate the association between smoking and essential metal (Co, Cr, Cu, Fe, Mn, V, Zn) and metalloid (Se) levels in hair and serum of adult women using inductively coupled plasma-mass spectrometry (ICP-MS). In this cross-sectional study, a total of 344 women 20-70 years old including 199 smokers and 145 non-smoking women were enrolled. Serum Cu, Fe, and Zn levels in smoking women were found to be 6%, 8%, and 3% lower of levels in non-smokers, respectively. In contrast, circulating Mn, V, and especially Cr concentrations in smoking women exceeded the respective values in non-smoking women by 5%, 14%, and 54%. Hair Fe and Se levels in smoking women were 17% and 23% lower as compared to non-smoking controls, respectively. In multiple regression models, smoking severity was inversely associated with serum and hair Se concentrations, whereas the relationship to serum and hair Cr was positive. In addition, serum Zn and hair Fe levels were found to be inversely associated with the number of cigarettes per day. These findings hypothesize that health hazards of smoking may be at least in part be mediated by alteration in essential metal and metalloid metabolism.

Preterm birth etiological pathways: a Bayesian networks and mediation analysis approach

BACKGROUND

The aim of this study was to determine the mediating effect of spontaneous preterm birth (PTB) main predictors that would allow to suggest etiological pathways.

METHODS

We carried out a case-control study, including sociodemographic characteristics, habits, health care, and obstetric data of multiparous women who gave birth at a maternity hospital from Tucumán, Argentina, between 2005 and 2010: 998 women without previous PTB who delivered at term and 562 who delivered preterm. We selected factors with the greatest predictive power using a penalized logistic regression model. A data-driven Bayesian network including the selected factors was created where we identified pathways and performed mediation analyses.

RESULTS

We identified three PTB pathways whose natural indirect effect was greater than zero with a 95% confidence interval: maternal age less than 20 years mediated by few prenatal visits, vaginal bleeding in the first trimester mediated by vaginal bleeding in the second trimester, and urinary tract infection mediated by vaginal bleeding in the second trimester. The effect mediated in these pathways showed greater sensitivity to confounders affecting the variables mediator-outcome and exposure-mediator in the same direction.

CONCLUSION

The identified pathways suggest PTB etiological lines related to social disparities and exposure to genitourinary tract infections.

IMPACT

Few prenatal visits (<5) and vaginal bleeding are two of the main predictors for spontaneous preterm birth in the studied population. Few prenatal visits mediates part of the risk associated with maternal age less than 20 years and vaginal bleeding in the second trimester mediates part of the risk associated with vaginal bleeding in the first trimester and with urinary tract infection. Social disparities and exposure to genitourinary tract infections would be etiological lines of spontaneous preterm birth.

Prevalence and determinants of anemia among Iranian population aged ≥35 years: A PERSIAN cohort-based cross-sectional study

Background

So far, no comprehensive studies have been performed to assess burden and determinants of anemia in Iran. In the present study, we aimed to answer this query using the data obtained from the Prospective Epidemiological Research Studies in IrAN (PERSIAN).

Methods

In this cross-sectional study, we included 161,686 adult participants (aged 35 years and older) from 16 provinces of Iran. Anemia was defined as a hemoglobin concentration of <13 g/dL in males and <12 g/dL in females. To evaluate the association between anemia and different factors, we used the multivariable Poisson regression analysis with robust variance by applying adjusted prevalence ratio (PR) with 95% confidence interval (CI).

Results

Of the total number of subjects, 72,387 (44.77%) were male and others were female. Mean age was 49.39±9.15 years old. The overall age- and sex-standardized prevalence of anemia was 8.83% (95% CI: 8.70–8.96%) in the included population. The highest and the lowest age- and sex-standardized prevalence of anemia pertained to Hormozgan (37.41%, 95% CI: 35.97–38.85%) and Kurdistan (4.57%, 95% CI: 3.87–5.27%) provinces, respectively. Being female (PR = 2.97), rural residence (PR = 1.24), being retired (PR = 1.53) and housewife (PR = 1.11), third and fourth wealth status quartiles (PR = 1.09 and PR = 1.11, respectively), being underweight (PR = 1.49), drug user (PR = 1.35), inadequate sleep (PR = 1.16), poor physical activity (PR = 1.15), diabetes (PR = 1.09), renal failure (PR = 2.24), and cancer (PR = 1.35) were associated with increased risk of anemia. On the other hand, illiteracy (PR = 0.79) and abdominal obesity (PR = 0.77) decreased the risk of anemia.

Conclusions

According to the results, a variable prevalence of anemia was observed across the included provinces. We tried to provide an informative report on anemia prevalence for health professionals and authorities to take measures for identification and management of the cases of anemia in high-prevalence areas.

Cigarette Smoke Particle-Induced Lung Injury and Iron Homeostasis

It is proposed that the mechanistic basis for non-neoplastic lung injury with cigarette smoking is a disruption of iron homeostasis in cells after exposure to cigarette smoke particle (CSP). Following the complexation and sequestration of intracellular iron by CSP, the host response (eg, inflammation, mucus production, and fibrosis) attempts to reverse a functional metal deficiency. Clinical manifestations of this response can present as respiratory bronchiolitis, desquamative interstitial pneumonitis, pulmonary Langerhans’ cell histiocytosis, asthma, pulmonary hypertension, chronic bronchitis, and pulmonary fibrosis. If the response is unsuccessful, the functional deficiency of iron progresses to irreversible cell death evident in emphysema and bronchiectasis. The subsequent clinical and pathological presentation is a continuum of lung injuries, which overlap and coexist with one another. Designating these non-neoplastic lung injuries after smoking as distinct disease processes fails to recognize shared relationships to each other and ultimately to CSP, as well as the common mechanistic pathway (ie, disruption of iron homeostasis).

Ameliorating effect of melatonin against nicotine induced lung and heart toxicity in rats

The present study was carried out to investigate the ameliorative effects of melatonin against nicotine-induced heart and lung toxicity. For this purpose, 75 mature male Sprague Dawley (SD) rats weighing 150-170 g were randomly divided into five groups (15 rats each): control group (rats were I/P injected with 1% ethanol in saline), nicotine group (rats were I/P injected with 0.6 mg/kg body weight), and combined nicotine and melatonin groups (rats received nicotine as in the previous group and melatonin at a dose of 1, 5, or 10 mg/kg body weight, respectively); all treatments were continued for 21 days. Fasting blood samples were collected from each rat at the 11th day and one day after the end of the last injection (22nd day) for complete blood count (CBC) determination, while sera were collected for the determination of lipid profiles. Malondialdehyde (MDA) concentration, superoxide dismutase (SOD) activity, and reduced glutathione (GSH) as well as DNA fragmentation percentage were assessed in cardiac tissue. Heart and lung samples were collected for estimation of caspase-3 expression and histopathological examination. The results revealed that nicotine increased the number of RBCs, Hb concentration, total cholesterol, and low density lipoprotein (LDL) and decreased high density lipoprotein (HDL). In addition, it decreased SOD activity and GSH concentration with increased MDA concentration, and DNA fragmentation in the heart, as well as caspase-3 expression in both heart and lungs. It also induced histopathological changes in the heart and lung tissues. Melatonin could ameliorate the deleterious effect of nicotine on the previous parameters either partially or completely, where melatonin restored complete blood count, improved lipid profile, mended lipid peroxidation and antioxidant parameters in the cardiac tissue, rectified caspase-3 expression in the heart and lungs, ameliorated DNA fragmentation percentage in the heart, and protected both heart and lung tissue against the harmful effect of nicotine. It is concluded that melatonin has a protective effect on the heart and lungs against the harmful effect of nicotine.

Tobacco use in the Myeloproliferative neoplasms: symptom burden, patient opinions, and care

BACKGROUND

Patients with Philadelphia-negative Myeloproliferative Neoplasms (MPN) suffer from numerous symptoms and decreased quality of life. Smoking is associated with an increased symptom burden in several malignancies. The aim of this study was to analyze the association between smoking and MPN-related symptom burden and explore MPN patients' opinions on smoking.

METHODS

A total of 435 patients with MPN participated in a cross-sectional internet-based survey developed by the Mayo Clinic and the Myeloproliferative Neoplasm Quality of Life Group. Patients reported their demographics, disease characteristics, tobacco use, and opinions on tobacco use. In addition, MPN-related symptoms were reported via the validated 10-item version of the Myeloproliferative Neoplasms Symptom Assessment Form.

RESULTS

Current/former smokers reported worse fatigue (mean severity 5.6 vs. 5.0, p = 0.02) and inactivity (mean severity 4.0 vs. 3.4, p = 0.03) than never smokers. Moreover, current/former smokers more frequently experienced early satiety (68.5% vs. 58.3%, p = 0.03), inactivity (79.9% vs. 71.1%, p = 0.04), and concentration difficulties (82.1% vs. 73.1%, p = 0.04). Although not significant, a higher total symptom burden was observed for current/former smokers (mean 30.4 vs. 27.0, p = 0.07). Accordingly, overall quality of life was significantly better among never smokers than current/former smokers (mean 3.5 vs. 3.9, p = 0.03). Only 43.2% of the current/former smokers reported having discussed tobacco use with their physician, and 17.5% did not believe smoking increased the risk of thrombosis.

CONCLUSION

The current study suggests that smoking may be associated with increased prevalence and severity of MPN symptoms and underscores the need to enhance patient education and address tobacco use in the care of MPN patients.

Association between anemia, physical performance and cognitive function in Iranian elderly people: evidence from Bushehr Elderly Health (BEH) program

Background and objectives

The present study aimed to investigate the relation between anemia and hemoglobin (Hgb) concentration, physical performance, and cognitive function in a large sample of Iranian elderly population.

Methods

Data were collected from Bushehr elderly health (BEH) program. A total of 3000 persons aged ≥60 years were selected through multistage random sampling. Hemoglobin values lower than 12 and 13 g/dL were considered as anemia for women and men, respectively. The cognitive function was measured using the Mini-cog test and Category fluency test (CFT), and the physical function was measured using handgrip strength (muscle strength), Relative handgrip strength (RHGS), and 4.57-m usual gait speed. Univariate and adjusted multivariate logistic regression and linear regression with Stata MP (version 15) were run, and a p-value of < 0.05 was used as statistically significant for all analyses.

Results

Among participants, 7.43% were anemic, and 115 (51.57%) simultaneously had anemia and cognitive disorder. There were significant associations between red blood cell count (RBC), hemoglobin (Hgb), platelet count (PLT), and hematocrit percentage (HCT) with cognitive impairment. Additionally, Hgb concentration was significantly associated with all physical measures (Mean handgrip, Relative handgrip, and usual gait speed) and late recall (mini-cog) among the whole participants. This association remained statistically significant after considering multi-cofounders. In contrast, after stratifying the participants by gender, the association between Hgb concentration and usual gait speed was decreased in both men and women; moreover, Hgb association with cognitive measures (category fluency test and late recall) was no longer significant (all p-values > 0.05).

Conclusion

There was a cross-sectional and significant association between anemia and functional variables (e.g., Relative and mean handgrip) in Iranian elderly population, whereas Semantic memory, Late recall, and walking were more affected by gender.

Multiple Micronutrients, Including Zinc, Selenium and Iron, Are Positively Associated with Anemia in New Zealand Aged Care Residents

Anemia is a significant comorbidity for older adults not fully attributable to iron deficiency. Low-grade inflammation and other micronutrient deficiencies also contribute. This cross-sectional study examined the relationships between nutrient and non-nutrient factors with hemoglobin and anemia in 285 residents (>65 years) of 16 New Zealand aged-care facilities. Blood samples were analyzed for hemoglobin, ferritin, sTfR, hepcidin, zinc, selenium, and interleukin-6 (IL-6), (with ferritin, sTfR, zinc and selenium adjusted for inflammation). Linear regression models examined the relationships between micronutrient biomarkers (iron, zinc, selenium, vitamin B-12 and D), age, sex, and health factors with hemoglobin. Thirty-two percent of participants exhibited anemia, although <2% had either depleted iron stores or iron deficiency. Plasma zinc and selenium deficiencies were present in 72% and 38% of participants, respectively. Plasma zinc and total body iron (TBI) were positively associated (p < 0.05) with hemoglobin, while gastric acid suppressing medications, hepcidin, and interleukin-6 were inversely associated. These relationships were maintained after the application of anemia cut-offs. These findings emphasize the importance of considering multiple micronutrient deficiencies as risk factors for anemia.

Prevalence and associated factors of baseline anemia among cervical cancer patients in Tikur Anbesa Specialized Hospital, Ethiopia

Background

Almost one patient with cancer in two is anemic. About 40 to 64% of cervical cancer patients are anemic at time of presentation. The rate of anemia increases with the use of chemotherapy, radiotherapy, hormonal therapy and associated with poorer treatment outcome and quality of life. Therefore, the aim of this study was to assess prevalence and associated factors of baseline anemia among cervical cancer patients in Tikur Anbesa Specialized Hospital (TASH), Ethiopia.

Methods

Institutional based cross-sectional study was done from March to April 2019 at TASH cancer center. Data were collected from patient’s chart using structured checklist and analyzed using Stata14.2. Binary logistic regression model was used to identify covariates which affected the outcome variable.

Result

This is a 3-years retrospective study from 2014 to 2016. The prevalence of baseline anemia among cervical cancer patients was 50.95%. Being stage IV [AOR = 2.38, 95% CI (1.21–4.67)], having comorbidity [AOR = 3.32, 95% CI (2.25–4.90)] and using substances (patients who used one, two or all of the three substances (cigarate, chat and alcohol)) [AOR = 2.03, 95% CI (1.21–3.41)] significantly increased the occurrence of anemia while being divorced [AOR = 0.6, 95% CI (0.36–0.98)] decreased the occurrence of anemia in the current study.

Conclusion

The prevalence of baseline anemia was high in the current study compared to other literatures. Significant factors of baseline anemia of cervical cancer in the current study were advanced stage (stage IV), presence of comorbidity, substance usage and being divorced (protective). The authors recommend that it is better to give special attention to those patients with the stated factors that could interfere treatment outcome.

Resistance training prevents right ventricle hypertrophy in rats exposed to secondhand cigarette smoke

Exposure to secondhand cigarette smoke is associated with the development of diverse diseases. Resistance training has been considered one of the most useful tools for patients with pulmonary disease, improving their quality of life. This study aimed to evaluate the effect of resistance training (RT) on the prevention of thickening of the right ventricle wall of rats exposed to secondhand cigarette smoke. Thirty-two Wistar rats were divided into four groups: Control (C), Smoker (S), Exercised (E) and Exercised Smoker (ES). The smoker groups were exposed to the smoke of four cigarettes for 30 min, twice daily, five days a week, for 16 weeks. The exercised groups climbed on a vertical ladder with progressive load, once a day, five days a week, for 16 weeks. The heart, trachea, lung, liver and gastrocnemius muscle were removed for histopathological analysis. Pulmonary emphysema (S and ES vs C and E, P < 0.0001) and pulmonary artery thickness enlargement (S vs C and E, P = 0.003, ES vs C, P = 0.003) were detected in the smoking groups. There was an increase in the right ventricle thickness in the S group compared with all other groups (P < 0.0001). An increase in resident macrophages in the liver was detected in both smoking groups compared with the C group (P = 0.002). Additionally, a relevant reduction of the diameter of the muscle fibers was detected only in ES compared with the C, S and E groups (P = 0.0002), impairing, at least in part, the muscle mass in exercised smoking rats. Therefore, it was concluded that resistance training prevented the increase of thickness of the right ventricle in rats exposed to secondhand cigarette smoke, but it may be not so beneficial for the skeletal muscle of smoking rats.

Modification of the effects of prenatal manganese exposure on child neurodevelopment by maternal anemia and iron deficiency

BACKGROUND

We evaluated: (1) associations of prenatal manganese (Mn) levels with child neurodevelopment at 4-6 years; (2) effect modification by maternal anemia and iron deficiency; and (3) sex-specific effects.

METHODS

We measured blood Mn, hemoglobin, and serum ferritin in mothers at the second trimester, third trimester, and at birth, and in cord blood from a prospective birth cohort in Mexico City (n = 571). McCarthy Scales of Children's Abilities were measured at 4-6 years. Using linear regression, we estimated associations between prenatal Mn and neurodevelopment, examined anemia and iron deficiency as effect modifiers, and analyzed associations by child sex.

RESULTS

No direct associations were observed between Mn, anemia, or iron deficiency and McCarthy Scales. Second trimester iron deficiency and third trimester anemia modified the effect of Mn on child neurodevelopment. For instance, second trimester Mn was positively associated child memory scores in mother's with normal ferritin (1.85 (0.02, 3.45)), but negatively associated in mother's with low ferritin (-2.41 (-5.28, 0.47), interaction P value = 0.01), a pattern observed across scales. No effect modification at birth or in cord blood was observed.

CONCLUSIONS

Anemia/iron deficiency during pregnancy may modify Mn impacts on child neurodevelopment, particularly in boys.

Definitive chemoradiotherapy in patients with squamous cell cancers of the head and neck - results from an unselected cohort of the clinical cooperation group "Personalized Radiotherapy in Head and Neck Cancer"

BACKGROUND

Definitive chemoradiotherapy (dCRT) is a standard treatment for patients with locally advanced head and neck cancer. There is a clinical need for a stratification of this prognostically heterogeneous group of tumors in order to optimize treatment of individual patients. We retrospectively reviewed all patients with head and neck squamous cell carcinoma (HNSCC) of the oral cavity, oropharynx, hypopharynx, or larynx, treated with dCRT from 09/2008 until 03/2016 at the Department of Radiation Oncology, LMU Munich. Here we report the clinical results of the cohort which represent the basis for biomarker discovery and molecular genetic research within the framework of a clinical cooperation group.

METHODS

Patient data were collected and analyzed for outcome and treatment failures with regard to previously described and established risk factors.

RESULTS

We identified 184 patients with a median follow-up of 65 months and a median age of 64 years. Patients received dCRT with a median dose of 70 Gy and simultaneous chemotherapy in 90.2% of cases, mostly mitomycin C / 5-FU in concordance with the ARO 95-06 trial. The actuarial 3-year overall survival (OS), local, locoregional and distant failure rates were 42.7, 29.8, 34.0 and 23.4%, respectively. Human papillomavirus-associated oropharynx cancer (HPVOPC) and smaller gross tumor volume were associated with significantly improved locoregional tumor control rate, disease-free survival (DFS) and OS in multivariate analysis. Additionally, lower hemoglobin levels were significantly associated with impaired DFS und OS in univariate analysis. The extent of lymph node involvement was associated with distant failure, DFS and OS. Moreover, 92 patients (50%) of our cohort have been treated in concordance with the ARO 95-06 study, corroborating the results of this study.

CONCLUSION

Our cohort is a large unselected monocentric cohort of HNSCC patients treated with dCRT. Tumor control rates and survival rates compare favorably with the results of previously published reports. The clinical data, together with the available tumor samples from biopsies, will allow translational research based on molecular genetic analyses.

Prevalence of and factors related to anemia among Japanese adult women: Secondary data analysis using health check-up database

The issue of anemia is important in terms of a woman’s preconception health. This study aimed to conduct an exploratory investigation of the prevalence of and factors related to anemia in non-pregnant Japanese women. Secondary data analysis was conducted using a database of women aged 20–49 years old who had attended an annual health check-up at a hospital in Tokyo (n = 10,598). A multiple logistic regression analysis was performed to identify factors related to anemia in two age groups: women aged 34 and under and those aged 35 and over. Anemia was defined as hemoglobin concentration levels <12.0 g/dL. The overall proportion of women with Hb <12.0 g/dL was 17.1%. Women aged 35 and over with a current medical history of uterine myoma were found to be at a higher risk of anemia. Women aged 35 and over who were overweight had a lower risk of anemia than women with normal weights. Current and past smoking habits affected hemoglobin levels among women aged 35 and over. In both age groups, those who drank alcohol habitually were at a lower risk than those who did not. Related factors of anemia should take into consideration a woman’s age and lifestyle.

Reexamination of hemoglobin adjustments to define anemia: altitude and smoking

The correct interpretation of hemoglobin (Hb) to identify anemia requires adjusting for altitude and smoking. Current adjustments were derived using data collected before 1985, from low-income preschool-aged children (PSC) in the United States and indigenous men in Peru for altitude, and from White women of reproductive age (WRA) in the United States for smoking. Given the oldness and limited representativeness of these data, we reexamined associations between Hb and altitude and/or smoking using 13 population-based surveys and 1 cohort study each conducted after 2000. All WHO regions except South-East Asia were represented. The dataset included 68,193 observations among PSC (6-59 months) and nonpregnant WRA (15-49 years) with data on Hb and altitude (-28 to 4000 m), and 19,826 observations among WRA with data on Hb and smoking (status or daily cigarette quantity). Generalized linear models were used to assess the robustness of associations under varying conditions, including controlling for inflammation-corrected iron and vitamin A deficiency. Our study confirms that Hb should be adjusted for altitude and/or smoking; these adjustments are additive. However, recommendations for Hb adjustment likely need updating. Notably, current recommendations may underadjust Hb for light smokers and for those residing at lower altitudes and overadjust Hb for those residing at higher altitudes.

The Sting of Rejection: Deferring Blood Donors due to Low Hemoglobin Values Reduces Future Returns

Background

Roughly one quarter of short-term temporary deferrals (STTD) of blood donors are low-hemoglobin deferrals (LHD), i.e. STTD due to a hemoglobin (Hb) value falling below a cutoff of 125 g/L for female and 135 g/L for male donors. Since voluntarily donating blood is a prosocial activity, donors may perceive deferral as social exclusion, which can cause social pain, decrease self-esteem, and lead to antisocial behavior. However, little is known about the causal impacts of LHD on donor return.

Study Design and Methods

We conducted a quasi-experiment with 80,060 donors invited to blood drives in the canton of Zurich, Switzerland, between 2009 and 2014. Within a narrow window of Hb values around the predetermined cutoff, the rate of LHD jumps discontinuously. This discontinuous jump allows us to quantify the causal effects of LHD on donor return, as it is uncorrelated with other unobserved factors that may also affect donor return.

Results

We found different behavioral reactions to LHD for female and male donors. Female donors do not react to the first LHD. However, after any repeated LHD, they are 13.53 percentage points (p <0.001) less likely to make at least 1 donation attempt within the next 18 months and make 0.389 fewer donation attempts (p <0.001). Male donors react to the first LHD. They are 5.32 percentage points (p = 0.139) less likely to make at least 1 donation attempt over the next 18 months and make 0.227 (p = 0.018) fewer donation attempts. After any repeated LHD, male donors are 13.30 percentage points (p = 0.004) less likely to make at least 1 donation attempt and make 0.152 (p = 0.308) fewer donation attempts.

Conclusion

LHD have detrimental impacts on donor return, especially if they occur repeatedly - suggesting that avoiding false LHD and helping donors to better cope with them helps to maintain the pool of prospective donors.

Preoperative anemia and perioperative blood transfusion in head and neck squamous cell carcinoma

OBJECTIVES

To evaluate the impact of preoperative anemia and perioperative blood transfusion (PBT) on disease free (DFS) and overall survival (OS) of patients with head and neck squamous cell carcinoma (HNSCC).

METHODS

Retrospective study of 354 patients primarily treated with surgery between 2006 and 2016. Cases were selected according to completeness and accuracy of available clinical data. Thus, a selection bias cannot be excluded. Patients who received PBT were identified by our controlling department and verified by our blood bank data base.

RESULTS

Both, preoperative anemia and PBT significantly decreased OS in univariate analysis. Although PBT was needed more frequently by older patients in worse physical conditions with more advanced HNSCC, subgroup analysis also demonstrate a profoundly negative effect of PBT on OS in younger patients and early stage HNSCC. According to a restrictive transfusion policy at our hospital the transfusion rate was comparably low. We could not verify increasing effects of PBT on cancer recurrence rates as it was previously shown.

DISCUSSION

Preoperative anemia is the most common paraneoplastic syndrome in HNSCC. Despite its devastating prognostic effect we suggest a restrictive transfusion policy whenever possible. Our data also show that anemia as an independent prognostic factor in head and neck surgical oncology is defined not only by low hemoglobin concentrations but low red blood cell counts as well.

Low vitamin B12 increases risk of gastric cancer: A prospective study of one-carbon metabolism nutrients and risk of upper gastrointestinal tract cancer

Previous studies have found associations between one-carbon metabolism nutrients and risk of several cancers, but little is known regarding upper gastrointestinal tract (UGI) cancer. We analyzed prediagnostic serum concentrations of several one-carbon metabolism nutrients (vitamin B12, folate, vitamin B6, riboflavin and homocysteine) in a nested case-control study within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study of male smokers, which was undertaken in Finland between 1985 and 1988. We conducted a nested case-control study including 127 noncardia gastric adenocarcinoma (NCGA), 41 esophagogastric junctional adenocarcinoma and 60 esophageal squamous cell carcinoma incident cases identified within ATBC. Controls were matched to cases on age, date of serum collection and follow-up time. One-carbon nutrient concentrations were measured in fasting serum samples collected at baseline (up to 17 years prior to cancer diagnosis). Odds ratios and 95% confidence intervals (CI) were calculated using conditional logistic regression. Lower prediagnostic vitamin B12 concentrations at baseline were associated with a 5.8-fold increased risk of NCGA (95% CI = 2.7-12.6 for lowest compared to highest quartile, p-trend <0.001). This association remained in participants who developed cancer more than 10 years after blood collection, and after restricting the analysis to participants with clinically normal serum vitamin B12 (>300 pmol/L). In contrast, pepsinogen I, a known serologic marker of gastric atrophy, was not associated with NCGA in this population. As vitamin B12 absorption requires intact gastric mucosa to produce acid and intrinsic factor, our findings suggest vitamin B12 as a possible serologic marker for the atrophic gastritis that precedes NCGA, one more strongly associated with subsequent NCGA than pepsinogen.

Arsenic exposures alter clinical indicators of anemia in a male population of smokers and non-smokers in Bangladesh

Drinking water arsenic (WAs) exposure has been linked to a number of detrimental health outcomes including anemia, primarily among pregnant women. Little is known about the effects of arsenic (As) on hematological disorders among men. We have examined the role of As exposure on hematological indicators of anemia in a group of men exposed to a wide range of As in their drinking water. We conducted a cross-sectional investigation among 119 healthy men in the Health Effects of As Longitudinal Study (HEALS) cohort, in rural Bangladesh. The participants are part of an ongoing study focused on evaluating the influence of As and smoking on immune function. Samples were collected at recruitment and analyzed for water As, urinary As (UAs) and UAs metabolites to assess As exposure. Blood samples were also collected at recruitment and assayed immediately for hematological parameters. We found that increased WAs levels were associated with decreased red blood cell counts [β=-0.13, p<0.0001] as well as hematocrit packed cell volumes [β=-0.68, p=0.008] following adjustment for age, smoking, body mass index and polycyclic aromatic hydrocarbon-DNA adducts. Other measures of As exposure (UAs and its metabolites) demonstrated similar associations. Slightly stronger effects were observed among smokers. We also observed an effect of As on hemoglobin among smokers in relation to UAs [β=-0.54, p<0.05]. Our analysis revealed effects of As exposure on hematological indicators of anemia in a group of healthy male smokers and non-smokers.

Anemia at the time of diagnosis of inflammatory bowel disease: Prevalence and associated factors in adolescent and adult patients

BACKGROUND

The prevalence, characteristic and determinants of anemia, at the time of inflammatory bowel disease (IBD) diagnosis have yet to be fully elucidated.

METHODS

Retrospective cross-sectional study. Analytical data and disease characteristics obtained upon diagnosis of 1278 IBD patients [Crohn's disease/ulcerative colitis (CD/UC): 718/560] were collected.

RESULTS

Anemia was present in 41.2% of patients at diagnosis (47% and 33.8% of CD and UC patients, respectively; p<0.001), being severe in 5.5%. Iron deficiency anemia represented 69.6% of cases, with no differences between CD and UC. Female sex was the strongest risk factor for anemia in both CD and UC (OR 7.11; 95%CI 4.18-12.10 and 6.55; 95%CI 3.39-12.63, respectively), followed by elevated (≥2mg/dL) C-reactive protein (OR 4.08; 95%CI 2.39-6.97 and 4.58; 95%CI 2.26-9.27, respectively). Current smoking was a risk factor for anemia in CD (OR 2.23; 95%CI 1.24-4.02), but a protective one in UC (OR 0.36; 95%CI 0.14-0.92). A penetrating CD behavior increased the risk of anemia (OR 3.34; 95%CI 1.36-8.21); in UC, anemia increased with disease extension (E2+E3) (OR 1.80; 95%CI 1.13-2.86).

CONCLUSIONS

Female sex and disease activity are major determinants of anemia at IBD diagnosis. Anemia is associated with disease behavior in CD and with disease extension in UC.

Household food insecurity in Mexico is associated with the co-occurrence of overweight and anemia among women of reproductive age, but not female adolescents

We aimed to determine the association between household food insecurity (HFI) and the co-occurrence of overweight and anemia among women of reproductive age in the Mexican population. We analyzed data on 4,039 nonpregnant female adolescents (15-19 years) and 10,760 nonpregnant adult women of reproductive age (20-49 years) from the 2012 National Health and Nutrition Survey of Mexico. The survey uses a two-stage sampling design, stratified by rural and urban regions. The Latin American and Caribbean Food Security Scale was used to assess HFI. We assessed overweight and obesity in women based on World Health Organization classifications for body mass index, and BMI-for-age Z-scores for female adolescents, and defined anemia as an altitude-adjusted hemoglobin (Hb) concentration < 120 g/L based on measurement of capillary Hb concentrations. In multiple logistic regression models adjusting for potential confounding covariates, HFI was not associated with the co-occurrence of anemia and overweight among female adolescents. The adjusted odds of women of reproductive age from mildly and moderately food-insecure households, respectively, experiencing concurrent anemia and overweight were 48% (OR: 1.48; 95% CI: 1.15, 1.91) and 49% (OR: 1.49; 95% CI: 1.08, 2.06) higher than among women from food-secure households. Severe HFI was not associated with concurrent overweight and anemia among female adolescents or women. HFI may be a shared mechanism for dual forms of malnutrition within the same individual, simultaneously contributing to overconsumption and dietary inadequacy.

Change in pulmonary diffusion capacity in a general population sample over 9 years

Rationale

Data on the change in diffusion capacity of the lung for carbon monoxide (DL_CO) over time are limited. We aimed to examine change in DL_CO (ΔDL_CO) over a 9-year period and its predictors.

Methods

A Norwegian community sample comprising 1,152 subjects aged 18–73 years was examined in 1987 and 1988. Of the 1,109 subjects still alive, 830 (75%) were re-examined in 1996/97. DL_CO was measured with the single breath-holding technique. Covariables recorded at baseline included sex, age, height, weight, smoking status, pack years, occupational exposure, educational level, and spirometry. Generalized estimating equations analyses were performed to examine relations between ΔDL_CO and the covariables.

Results

At baseline, mean [standard deviation (SD)] DL_CO was 10.8 (2.4) and 7.8 (1.6) mmol·min⁻¹·kPa⁻¹ in men and women, respectively. Mean (SD) ΔDL_CO was −0.24 (1.31) mmol·min⁻¹·kPa⁻¹. ΔDL_CO was negatively related to baseline age, DL_CO, current smoking, and pack years, and positively related to forced expiratory volume in 1 second (FEV₁) and weight. Sex, occupational exposure, and educational level were not related to ΔDL_CO.

Conclusions

In a community sample, more rapid decline in DL_CO during 9 years of observation time was related to higher age, baseline current smoking, more pack years, larger weight, and lower FEV₁.

Influence of tobacco smoking on transferrin sialylation during pregnancy in smoking and non-smoking women with iron deficiency

OBJECTIVES

Tobacco smoking influence on proteins is leading to despaired foetal nourishment. Transferrin, is an essential metal-binding protein responsible for iron transport and proper foetal development. This study examines influence of tobacco smoking on transferrin sialic acid residues and its connection to foetal nourishment at women with iron deficiency.

METHODS

The study involved 190 samples from pregnant women in 1st, 2nd and 3rd trimester. Women were divided in terms of tobacco smoking and iron deficiency.

RESULTS

During pregnancy, the levels of 2-, 5- and 6-sialo transferrin were increasing while 3- and 4-sialo transferrin were decreasing in all groups. Transferrin isoforms showed positive correlation with lowered iron stores in the blood of non-smoking women.

CONCLUSION

Tobacco smoking has an influence on number of sialic acids residues in the transferrin and seems to change conversion of Tf isoforms, and this may disturb iron transport and in consequence influence on foetal development and nourishment.

Blood donors' physical characteristics are associated with pre- and post-donation symptoms - Donor InSight

BACKGROUND

Observational data suggest that some donors might benefit from donating while others may be harmed. The aim of this study was to investigate the prevalence and potential, routinely measured, determinants of pre- and post-donation symptoms.

MATERIALS AND METHODS

In Donor InSight, questionnaire data from 23,064 whole blood donors (53% female) were linked to routinely measured data on donors' physical characteristics (haemoglobin, blood pressure, body mass index and estimated blood volume) from the Dutch donor database. Absolute and relative associations between donors' physical donor and the presence of pre- and post-donation symptoms were studied using multivariable logistic regression.

RESULTS

Pre-donation symptoms (lack of energy, headaches) were reported by 3% of men and 3% of women. Five percent of men and 4% of women reported positive post-donation symptoms (feeling fit, fewer headaches). Negative symptoms (fatigue, dizziness) were more common, occurring in 8% of men and 19% of women. All the studied donors' physical characteristics were positively associated with pre- and positive post-donation symptoms and negatively associated with negative symptoms. Body mass index was most consistently and independently associated with symptoms.

DISCUSSION

Donors' physical characteristics, in particular body mass index, were consistently associated with pre- and post-donation symptoms. This indicates that subgroups of donors more and less tolerant to donation might be identifiable using routinely measured data. Further research is warranted to study underlying mechanisms and potential strategies to predict and prevent donor reactions.

Impact of comorbidity and anemia in patients with oropharyngeal cancer primarily treated with surgery in the human papillomavirus era

BACKGROUND

Comorbidity and anemia strongly influence treatment and outcome of oropharyngeal squamous cell carcinomas (SCCs), but respective data are frequently lacking in clinical studies. We evaluated 149 cases of oropharyngeal SCC primarily treated with surgery regarding the impact of these factors on disease-free survival (DFS) and overall survival (OS).

METHODS

Data were recorded during treatment and follow-up visits. Human papillomavirus (HPV) association of oropharyngeal SCC was detected by p16 immunohistochemistry.

RESULTS

Patients with p16-positive disease were significantly less comorbid and anemic, and treated more aggressively. Comorbidity and anemia, but not p16 status, significantly influenced DFS and had more impact on OS than p16 status.

CONCLUSION

In our study, p16-positive seems a good surrogate marker for healthier patients. Patients with p16-positive disease showed improved survival, but this was limited to none/mild comorbid and/or nonanemic individuals in this group. On the basis of our results, we strongly suggest the inclusion of these factors in risk stratification for clinical studies. © 2016 Wiley Periodicals, Inc. Head Neck 39: 7-16, 2017.

PULMONARY AND BIOCHEMICAL CHARACTERISTICS OF SMOKER AND NON-SMOKER MODERN DANCERS

ABSTRACT Introduction: Although the harmful effects of smoking on the cardiovascular and respiratory systems have been established for a long time, the effect on physiological and physical parameters in modern female dancers is not well documented. Objective: To determine differences in selected pulmonary functions, biochemical parameters, and body composition in female smoker and non-smoker modern dancers who are university or graduate students. Methods: A total of twenty-two female modern dancers (mean age of 24.6 ± 4.3 years), who were non-smokers (n = 11) and smokers (n = 11), voluntarily participated in the study. The smokers had been smoking 1 to 20 cigarettes per day for an average period of seven years. The pulmonary function test Mir Spirobank Spirometer, (Italy) was applied; selected biochemical parameters were tested, and various anthropometric measurements (height, weight and seven skinfold thickness) were performed. The results of body composition were evaluated using Jackson-Pollock equations. Intergroup comparisons were performed using the Mann-Whitney U test. Result: No significant differences were found between smoker and non-smoker dancers in terms of body composition (body fat, % body fat, lean body fat) and selected biochemical parameters (p > 0.05). However, non-smokers had prediction values of forced expiratory volume during the first second (FEV1) and peak expiratory flow (PEF) significantly better (p < 0.05). The effect of smoking on the performance of female modern dancers should be examined in a longitudinal study, with a higher number of participants. Conclusion: It was observed that smoking reduces lung pulmonary capacity at a certain rate, although the biochemical parameters and body composition of the female smoker and non-smoker dancers were similar.

Generalized, severe, chronic periodontitis is associated with anemia of chronic disease: a pilot study in urban, Indian males

AIM

Anemia of chronic disease, a cytokine-mediated anemia, is a frequent complication of many chronic inflammatory conditions. The present case-control study was aimed to evaluate levels of systemic hematological markers indicative of anemia in patients with generalized, severe, chronic periodontitis.

METHODS

A convenience quota sample of 30 systemically-healthy, urban, male patients comprised two groups, based on full mouth periodontal examination: group A patients (n=15) were diagnosed with generalized, severe, chronic periodontitis, and group B patients comprised the control group (n=15), which included patients with a clinically-healthy periodontium. Laboratory blood investigations included hemoglobin (g%), total number of erythrocytes (red blood cells), hematocrit/packed cell volume, erythrocyte sedimentation rate, mean corpuscular volume of erythrocytes, and mean corpuscular hemoglobin concentration. An analysis of covariance using age as a covariate was done to compare the mean values of hematological parameters within groups.

RESULTS

The mean values of hemoglobin, red blood cells, packed cell volume, and mean corpuscular hemoglobin concentration were significantly lower, while the mean corpuscular volume of erythrocytes and erythrocyte sedimentation rate were significantly higher in group A patients compared to those in group B, indicating mild anemia.

CONCLUSIONS

Severe periodontal disease can be linked with anemic status.

Anemia in inflammatory bowel disease outpatients: prevalence, risk factors, and etiology

Anemia is common in inflammatory bowel disease (IBD). However, epidemiological studies of nonwestern IBD populations are limited and may be confounded by demographic, socioeconomic, and disease-related influences. This study evaluated the prevalence, risk factors, and etiology of anemia in Brazilian outpatients with IBD. Methods. In this cross-sectional study, 100 Crohn's disease (CD) patients and 100 ulcerative colitis (UC) subjects were assessed. Anemia workup included complete blood count, ferritin, transferrin saturation, serum levels of folic acid and vitamin B₁₂, and C-reactive protein (CRP) concentration. Results. The overall prevalence of anemia in IBD was 21%. There was no significant difference in the prevalence of anemia between CD subjects (24%) and UC (18%). Moderate disease activity (OR: 3.48, 95% CI, 1.95–9.64, P = 0.002) and elevated CRP levels (OR: 1.8, 95% CI, 1.04–3.11, P = 0.02) were independently associated with anemia. The most common etiologies of anemia found in both groups were iron deficiency anemia (IDA; 10% on CD and 6% on UC) followed by the anemia of chronic disease (ACD; 6% for both groups). Conclusions. In Brazilian IBD outpatients, anemia is highly concurrent condition. Disease moderate activity as well as increased CRP was strongly associated with comorbid anemia. IDA and/or ACD were the most common etiologies.

The relationship between obesity and prescription of smoking cessation medications

The objective of this study was to examine the differences in prescription of smoking cessation medications among smokers with different body mass index (BMI) classifications. A retrospective cross-sectional study was conducted using National Ambulatory Medical Care Survey data (2006-2010). Self-reported current smokers aged 18 years and older were included in the study. The outcome of interest was receiving a prescription for a Food and Drug Administration-approved smoking cessation medication. Multivariate logistic regression was performed to assess the association between the outcome variable and the main independent variable (BMI classification), controlling for other covariates. The results showed that overweight, obese, and severely obese smokers were less likely to be prescribed a smoking cessation medication as compared to normal weight smokers. Although 5.11% of normal weight smokers were prescribed a smoking cessation medication, only 3.70% of overweight smokers, 3.41% of obese smokers, and 2.50% of severely obese smokers were prescribed a smoking cessation medication. In addition, older smokers, whites, smokers visiting primary care providers, smokers receiving tobacco counseling, and nondiabetic smokers were more likely to be prescribed a smoking cessation medication. Lower prescription of smoking cessation medications among overweight, obese, and severely obese smokers might be driven by patients' health concerns and behavioral factors or providers' treatment preferences or biases. The disparity in smoking cessation medication prescription among smokers with different BMI classifications raises quality of care and health care concerns for overweight, obese, and severely obese smokers.

Anaemia in inflammatory bowel disease: a population-based 10-year follow-up

BACKGROUND

The point prevalence estimates of anaemia in patients with inflammatory bowel disease (IBD) range between 6% and 74%. The variation is probably due to differences in the definition of anaemia and the study populations.

AIM

To retrospectively determine the prevalence of anaemia at diagnosis and at the 1-, 5- and 10-year follow-ups in patients with IBD from a prospectively followed, population-based inception cohort (the IBSEN Study). To compare the prevalence of anaemia after a 10-year disease course with the prevalence of anaemia in the background population, and to assess clinical factors associated with anaemia at diagnosis and during follow-up.

METHODS

Newly diagnosed IBD patients were included in a population-based, prospective cohort. Follow-up was performed at 1, 5 and 10 years. All visits included clinical examinations and blood samples. Anaemia was defined according to the WHO.

RESULTS

A total of 756 patients (UC, n = 519 and CD, n = 237) were included; 48.8% of CD and 20.2% of UC patients were anaemic at diagnosis (P < 0.001). The proportion of patients with anaemia decreased during the disease course in all patients, except in women with CD. After 10 years of disease, the relative risk for anaemia was increased in all groups, except for women with UC. The variables associated with anaemia were generally unchanged during the disease course, and elevated CRP was the strongest predictor of risk.

CONCLUSIONS

Anaemia was more common in CD than in UC. The prevalence of anaemia decreased during the disease course. Women with CD were at high risk for anaemia. Elevated CRP was independently associated with anaemia.

Determinants of moderate-to-severe anaemia among women of reproductive age in Tanzania: analysis of data from the 2010 Tanzania Demographic and Health Survey

OBJECTIVE

To identify determinants of moderate-to-severe anaemia among women of reproductive age in Tanzania.

METHODS

We included participants from the 2010 Tanzania Demographic and Health Survey, which collected data on socio-demographic and maternal health and determined haemoglobin levels from blood samples. We performed logistic regression to calculate adjusted odds ratios for associations between socio-demographic, contextual, reproductive and lifestyle factors, and moderate-to-severe anaemia and investigated interactions between certain risk factors.

RESULTS

Of 9477 women, 20.1% were anaemic. Pregnancy was significantly associated with anaemia (adjusted OR 1.75, 95% CI 1.43-2.15), but the effect varied significantly by urban/rural residence, wealth and education. The effect of pregnancy was stronger in women without education and those who were in lower wealth groups, with significant interactions observed for each of these factors. Education was associated with a lower anaemia risk, particularly in the poorest group (OR 0.58, 95% CI 0.43-0.80), and in pregnant women. The risk of anaemia fell with rising iron supplementation coverage. Lack of toilet facilities increased anaemia risk (OR 1.26, 95% CI 1.00-1.60), whereas using hormonal contraception reduced it. There was no association with age, urban/rural residence, wealth or type of cooking fuel in adjusted analysis.

CONCLUSION

Pregnant women in Tanzania are particularly at risk of moderate-to-severe anaemia, with the effect modified by urban/rural residence, education and wealth. Prevention interventions should target women with lower education or without proper sanitation facilities, and women who are pregnant, particularly if they are uneducated or in lower wealth groups.

Assessment and interpretation of micronutrient status during pregnancy

Accurate assessment of maternal micronutrient status is critical to the prevention of suboptimal micronutrient status and anaemia during pregnancy. Measurement of Fe, folate and vitamin B12 status is complicated by adaptive changes to maternal and placental physiology that markedly affect concentrations of circulating micronutrients and their functional biomarkers. Validation of new assessment methods by comparison with gold standards is often prevented by ethical considerations. Antenatal screening in the UK is predominantly concerned with the detection of anaemia, although estimation of maternal Fe stores by serum ferritin at the start of antenatal care may be a more effective preventive strategy. Functional assessment of maternal anaemia is highly problematic, so instead reference data are used for its definition. The effect of mild-to-moderate anaemia on pregnancy outcome is unclear because of the crude nature of its assessment and the influence of confounding factors. Fe-deficient erythropoiesis may be detected by assessment of erythrocyte Zn protoporphyrin and reticulocyte Hb, although such measures may be unavailable in many clinical laboratories. Serum soluble transferrin receptor is highly responsive to tissue Fe deficiency and is less affected by inflammation than most other indicators. Direct inter-assay comparison of serum and erythrocyte folate values is inadvisable since recovery rates differ greatly between methods. Serum total homocysteine is a useful functional biomarker of both folate and vitamin B12 status but during pregnancy is influenced by other factors that reduce its sensitivity. Isotope-dilution liquid chromatography-tandem MS and serum holo-transcobalamin provide new opportunities to gain detailed data of folate species and vitamin B12 fractions in large samples.