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El-Banna MH, Abdelgawad MH, Eltahawy N, Algeda FR, Elsayed TM. Hematological and neurological impact studies on the exposure to naturally occurring radioactive materials. Appl Radiat Isot 2024; 211:111424. [PMID: 38970986 DOI: 10.1016/j.apradiso.2024.111424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/13/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
Naturally Occurring Radioactive Materials (NORM) contribute to everyone's natural background radiation dose. The technologically advanced activities of the gas and oil sectors produce considerable amounts of radioactive materials as industrial by-products or waste products. The goal of the current study is to estimate the danger of long-term liability to Technologically Enhanced Naturally Occurring Radioactive Materials (TE-NORM) on blood indices, neurotransmitters, oxidative stress markers, and β-amyloid in the cerebral cortex of rats' brains. Twenty adult male albino rats were divided into two equal groups (n = 10): control and irradiated. Irradiated rats were exposed to a total dose of 0.016 Gy of TE-NORM as a whole-body chronic exposure over a period of two months. It should be ''The results showed no significant changes in RBC count, Hb concentration, hematocrit percentage (HCT%), and Mean Corpuscular Hemoglobin Concentration (MCHC). However, there was a significant increase in the Mean Corpuscular Volume of RBCs (MCV) and a significant decrease in cell distribution width (RDW%) compared to the control. Alteration in neurotransmitters is noticeable by a significant increase in glutamic acid and significant decreases in serotonin and dopamine. Increased lipid peroxidation, decreased glutathione content, superoxide dismutase, catalase, and glutathione peroxidase activities indicating oxidative stress were accompanied by increased β-amyloid in the cerebral cortex of rats' brains. The findings of the present study showed that chronic radiation liability has some harmful effects, that may predict the risks of future health problems in occupational radiation exposure in the oil industries. Therefore, the control of exposure and application of sample dosimetry is recommended for health and safety.
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Affiliation(s)
- Mohamed H El-Banna
- Biophysics Branch, Physics Department, Faculty of Science, Al-Azhar University, Cairo, Egypt
| | - Mahmoud H Abdelgawad
- Biophysics Branch, Physics Department, Faculty of Science, Al-Azhar University, Cairo, Egypt.
| | - Noaman Eltahawy
- Radiation Biology Department, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority, Cairo, Egypt
| | - Fatma R Algeda
- Radiation Biology Department, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority, Cairo, Egypt
| | - Tamer M Elsayed
- Biophysics Branch, Physics Department, Faculty of Science, Al-Azhar University, Cairo, Egypt
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Machingauta A, Mukanganyama S. Antibacterial Activity and Proposed Mode of Action of Extracts from Selected Zimbabwean Medicinal Plants against Acinetobacter baumannii. Adv Pharmacol Pharm Sci 2024; 2024:8858665. [PMID: 39220823 PMCID: PMC11364482 DOI: 10.1155/2024/8858665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 06/27/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
Acinetobacter baumannii was identified by the WHO as a priority pathogen in which the research and development of new antibiotics is urgently needed. Plant phytochemicals have potential as sources of new antimicrobials. The objective of the study was to determine the antibacterial activity of extracts of selected Zimbabwean medicinal plants against A. baumannii and determine their possible mode of action. Extracts were prepared from the leaves of the eight plants including the bark of Erythrina abyssinica using solvents of different polarities. Antibacterial activity was evaluated using the microbroth dilution method coupled with the in vitro iodonitrotetrazolium colorimetric assay. The effect of the extracts on membrane integrity was determined by quantifying the amount of protein and nucleic acid leaked from the cells after exposure to the extracts. The effects of the extracts on biofilms were investigated. Toxicity studies were carried out using sheep erythrocytes and murine peritoneal cells. Seven out of eight evaluated plant extracts were found to have antibacterial activity. The Combretum apiculatum acetonie (CAA) extract showed the highest inhibitory activity against A. baumannii with a minimal inhibitory concentration of 125 µg/mL. The minimum inhibitory concentration (MIC) of the CAA extract caused a protein leakage of 32 µg/mL from A. baumannii. The Combretum apiculatum acetonie (CAA), C. apiculatum methanolic (CAM), Combretum zeyheri methanolic (CZM), and Erythrina abyssinica methanolic (EAM) extracts inhibited A. baumannii biofilm formation. The EAM extract was shown to disrupt mature biofilms. The potent extracts were nontoxic to sheep erythrocytes and mouse peritoneal cells. The activities shown by the extracts indicate that the plants have potential as sources of effective antibacterial and antibiofilm formation agents against A. baumannii.
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Affiliation(s)
- Auxillia Machingauta
- Bio-Molecular Interactions Analyses GroupDepartment of Biotechnology and BiochemistryUniversity of Zimbabwe, Mt Pleasant, P.O. Box 167, Harare, Zimbabwe
| | - Stanley Mukanganyama
- Department of TherapeuticsNatural Products Research UnitAfrican Institute of Biomedical Science and TechnologyWilkins Hospital, Block C, Corner J. Tongogara and R. Tangwena, Harare, Zimbabwe
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Finkelstein JL, Cuthbert A, Weeks J, Venkatramanan S, Larvie DY, De-Regil LM, Garcia-Casal MN. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2024; 8:CD004736. [PMID: 39145520 PMCID: PMC11325660 DOI: 10.1002/14651858.cd004736.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
BACKGROUND Iron and folic acid supplementation have been recommended in pregnancy for anaemia prevention, and may improve other maternal, pregnancy, and infant outcomes. OBJECTIVES To examine the effects of daily oral iron supplementation during pregnancy, either alone or in combination with folic acid or with other vitamins and minerals, as an intervention in antenatal care. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Trials Registry on 18 January 2024 (including CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO's International Clinical Trials Registry Platform, conference proceedings), and searched reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised trials that evaluated the effects of oral supplementation with daily iron, iron + folic acid, or iron + other vitamins and minerals during pregnancy were included. DATA COLLECTION AND ANALYSIS Review authors independently assessed trial eligibility, ascertained trustworthiness based on pre-defined criteria, assessed risk of bias, extracted data, and conducted checks for accuracy. We used the GRADE approach to assess the certainty of the evidence for primary outcomes. We anticipated high heterogeneity amongst trials; we pooled trial results using a random-effects model (average treatment effect). MAIN RESULTS We included 57 trials involving 48,971 women. A total of 40 trials compared the effects of daily oral supplements with iron to placebo or no iron; eight trials evaluated the effects of iron + folic acid compared to placebo or no iron + folic acid. Iron supplementation compared to placebo or no iron Maternal outcomes: Iron supplementation during pregnancy may reduce maternal anaemia (4.0% versus 7.4%; risk ratio (RR) 0.30, 95% confidence interval (CI) 0.20 to 0.47; 14 trials, 13,543 women; low-certainty evidence) and iron deficiency at term (44.0% versus 66.0%; RR 0.51, 95% CI 0.38 to 0.68; 8 trials, 2873 women; low-certainty evidence), and probably reduces maternal iron-deficiency anaemia at term (5.0% versus 18.4%; RR 0.41, 95% CI 0.26 to 0.63; 7 trials, 2704 women; moderate-certainty evidence), compared to placebo or no iron supplementation. There is probably little to no difference in maternal death (2 versus 4 events, RR 0.57, 95% CI 0.12 to 2.69; 3 trials, 14,060 women; moderate-certainty evidence). The evidence is very uncertain for adverse effects (21.6% versus 18.0%; RR 1.29, 95% CI 0.83 to 2.02; 12 trials, 2423 women; very low-certainty evidence) and severe anaemia (Hb < 70 g/L) in the second/third trimester (< 1% versus 3.6%; RR 0.22, 95% CI 0.01 to 3.20; 8 trials, 1398 women; very low-certainty evidence). No trials reported clinical malaria or infection during pregnancy. Infant outcomes: Women taking iron supplements are probably less likely to have infants with low birthweight (5.2% versus 6.1%; RR 0.84, 95% CI 0.72 to 0.99; 12 trials, 18,290 infants; moderate-certainty evidence), compared to placebo or no iron supplementation. However, the evidence is very uncertain for infant birthweight (MD 24.9 g, 95% CI -125.81 to 175.60; 16 trials, 18,554 infants; very low-certainty evidence). There is probably little to no difference in preterm birth (7.6% versus 8.2%; RR 0.93, 95% CI 0.84 to 1.02; 11 trials, 18,827 infants; moderate-certainty evidence) and there may be little to no difference in neonatal death (1.4% versus 1.5%, RR 0.98, 95% CI 0.77 to 1.24; 4 trials, 17,243 infants; low-certainty evidence) or congenital anomalies, including neural tube defects (41 versus 48 events; RR 0.88, 95% CI 0.58 to 1.33; 4 trials, 14,377 infants; low-certainty evidence). Iron + folic supplementation compared to placebo or no iron + folic acid Maternal outcomes: Daily oral supplementation with iron + folic acid probably reduces maternal anaemia at term (12.1% versus 25.5%; RR 0.44, 95% CI 0.30 to 0.64; 4 trials, 1962 women; moderate-certainty evidence), and may reduce maternal iron deficiency at term (3.6% versus 15%; RR 0.24, 95% CI 0.06 to 0.99; 1 trial, 131 women; low-certainty evidence), compared to placebo or no iron + folic acid. The evidence is very uncertain about the effects of iron + folic acid on maternal iron-deficiency anaemia (10.8% versus 25%; RR 0.43, 95% CI 0.17 to 1.09; 1 trial, 131 women; very low-certainty evidence), or maternal deaths (no events; 1 trial; very low-certainty evidence). The evidence is uncertain for adverse effects (21.0% versus 0.0%; RR 44.32, 95% CI 2.77 to 709.09; 1 trial, 456 women; low-certainty evidence), and the evidence is very uncertain for severe anaemia in the second or third trimester (< 1% versus 5.6%; RR 0.12, 95% CI 0.02 to 0.63; 4 trials, 506 women; very low-certainty evidence), compared to placebo or no iron + folic acid. Infant outcomes: There may be little to no difference in infant low birthweight (33.4% versus 40.2%; RR 1.07, 95% CI 0.31 to 3.74; 2 trials, 1311 infants; low-certainty evidence), comparing iron + folic acid supplementation to placebo or no iron + folic acid. Infants born to women who received iron + folic acid during pregnancy probably had higher birthweight (MD 57.73 g, 95% CI 7.66 to 107.79; 2 trials, 1365 infants; moderate-certainty evidence), compared to placebo or no iron + folic acid. There may be little to no difference in other infant outcomes, including preterm birth (19.4% versus 19.2%; RR 1.55, 95% CI 0.40 to 6.00; 3 trials, 1497 infants; low-certainty evidence), neonatal death (3.4% versus 4.2%; RR 0.81, 95% CI 0.51 to 1.30; 1 trial, 1793 infants; low-certainty evidence), or congenital anomalies (1.7% versus 2.4; RR 0.70, 95% CI 0.35 to 1.40; 1 trial, 1652 infants; low-certainty evidence), comparing iron + folic acid supplementation to placebo or no iron + folic acid. A total of 19 trials were conducted in malaria-endemic countries, or in settings with some malaria risk. No studies reported maternal clinical malaria; one study reported data on placental malaria. AUTHORS' CONCLUSIONS Daily oral iron supplementation during pregnancy may reduce maternal anaemia and iron deficiency at term. For other maternal and infant outcomes, there was little to no difference between groups or the evidence was uncertain. Future research is needed to examine the effects of iron supplementation on other maternal and infant health outcomes, including infant iron status, growth, and development.
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Affiliation(s)
| | - Anna Cuthbert
- Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Jo Weeks
- Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | | | - Doreen Y Larvie
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Luz Maria De-Regil
- Multisectoral Action in Food Systems Unit, World Health Organization, Geneva, Switzerland
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Karakochuk CD, Dary O, Flores-Urrutia MC, Garcia-Casal MN, Hayashi C, Jefferds MED, Johnston R, Larson LM, Mapango C, Mazariegos Cordero DI, Moorthy D, Namaste S, Rogers LM, Saha K, Wuehler S. Emerging Evidence and Critical Issues with the Use of Single-Drop Capillary Blood for the Measurement of Hemoglobin Concentration in Population-Level Anemia Surveys. Adv Nutr 2024:100290. [PMID: 39151753 DOI: 10.1016/j.advnut.2024.100290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 08/01/2024] [Accepted: 08/07/2024] [Indexed: 08/19/2024] Open
Abstract
Accurate and precise measurement of hemoglobin concentration is critical for reliable estimations of anemia prevalence at the population level. When systematic and/or random error are introduced in hemoglobin measurement, estimates of anemia prevalence might be significantly erroneous and, hence, limit their usefulness. For decades, single-drop capillary blood has been the most common blood source used for the measurement of hemoglobin concentration in surveys, especially in low-income and middle-income countries. In this study, we highlight historical and emerging evidence that single-drop capillary blood introduces a high degree of random error (variability) to hemoglobin estimates, leading to less reliable estimates of anemia prevalence at the population level. At present, the best practice is to collect and use venous blood for measurement of hemoglobin with an automated hematology analyzer, following standard operating procedures and quality assurance measures. Where use of an automated analyzer is not possible, the analysis of venous blood in a point-of-care hemoglobinometer by trained phlebotomists or specimen collectors should be considered. A forthcoming systematic review will provide additional evidence on the accuracy and precision of single-drop capillary blood for hemoglobin assessment. In the meantime, we raise caution when using single-drop capillary blood for hemoglobin measurement as it can result in inaccurate hemoglobin estimates and less reliable anemia prevalence estimates.
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Affiliation(s)
- Crystal D Karakochuk
- Food, Nutrition and Health, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, Canada
| | - Omar Dary
- Bureau for Global Health, Maternal and Chid Health and Nutrition Office, USAID, Washington, D.C., United States
| | | | | | - Chika Hayashi
- Data & Analytics Section, Division of Data, Analytics, Planning and Monitoring, United Nations Children's Fund, New York, United States
| | - Maria Elena D Jefferds
- Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Robert Johnston
- Data & Analytics Section, Division of Data, Analytics, Planning and Monitoring, United Nations Children's Fund, New York, United States
| | - Leila M Larson
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Carine Mapango
- Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dora I Mazariegos Cordero
- Nutrition and Micronutrient Department, Institute of Nutrition of Central America and Panamá, Guatemala City, Guatemala
| | - Denish Moorthy
- NuMERAL, RTI International, Washington, D.C., United States
| | - Sorrel Namaste
- NuMERAL, RTI International, Washington, D.C., United States
| | - Lisa M Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Kuntal Saha
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Sara Wuehler
- Program Operations Unit, Nutrition International, Ottawa, Ontario, Canada.
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Hackl LS, Karakochuk CD, Mazariegos DI, Jeremiah K, Obeid O, Ravi N, Ayana DA, Varela V, Alayón S, Dary O, Moorthy D. Assessing Accuracy and Precision of Hemoglobin Determination in Venous, Capillary Pool, and Single-Drop Capillary Blood Specimens Using three Different HemoCue® Hb Models: The Multicountry Hemoglobin Measurement (HEME) Study. J Nutr 2024; 154:2326-2334. [PMID: 38580209 DOI: 10.1016/j.tjnut.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Anemia prevalence estimates reported in population surveys can vary based on the blood specimen source (capillary or venous) and analytic device (hematology autoanalyzers or portable hemoglobinometers) used for hemoglobin (Hb) determination. OBJECTIVES This study aimed to compare accuracy and precision of Hb measurement in three blood specimen types on three models of hemoglobinometers against the results from venous blood from the same individuals measured on automated analyzers (AAs). METHODS This multisite (Cambodia, Ethiopia, Guatemala, Lebanon, Nigeria, and Tanzania) study assessed Hb measurements in paired venous and capillary blood specimens from apparently healthy women (aged 15-49 y) and children (aged 12-59 mo) using three HemoCue® Hb models (201+, 301, and 801). Measurements were compared against reference values: venous blood in hematology AA and adjusted via regression calibration or mean difference in HemoCue® Hb. Venous, capillary pool, and single-drop capillary blood specimens were assessed for accuracy and precision. RESULTS Venous blood measured using HemoCue® Hb 301 exhibited a positive mean error, whereas responses in HemoCue® Hb 201+ and 801 were nondirectional compared with the reference. Adjustment with the reference harmonized mean errors for all devices across study sites to <1.0 g/L using venous blood. Precision was highest for venous blood (±5-16 g/L) in all sites, lowest for single-drop capillary (±9-37 g/L), and intermediate (±9-28 g/L) for capillary pool blood specimen. Imprecision differed across sites, especially with both capillary blood specimens, suggesting different levels of personnel skills. CONCLUSIONS Findings suggest that venous blood is needed for accurate and precise Hb determination. Single-drop capillary blood use should be discouraged owing to high measurement variability. Further research should evaluate the viability and reliability of capillary pool blood for this purpose. Accuracy of HemoCue® Hb devices can be improved via standardization against results from venous blood assessed using AA.
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Affiliation(s)
- Laura S Hackl
- USAID Advancing Nutrition, John Snow Inc., Arlington, VA, USA
| | - Crystal D Karakochuk
- Food, Nutrition and Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Dora Inés Mazariegos
- Department of Nutrition and Micronutrients, Institute of Nutrition of Central America and Panama, Calzada Roosevelt, Guatemala
| | - Kidola Jeremiah
- National Institute of Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Omar Obeid
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | | | - Desalegn A Ayana
- School of Medical Laboratory Science, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Veronica Varela
- USAID Advancing Nutrition, John Snow Inc., Arlington, VA, USA
| | - Silvia Alayón
- USAID Advancing Nutrition, Save the Children US, Arlington, VA, United States
| | - Omar Dary
- Bureau for Global Health, United States Agency for International Development, Washington, DC, United States
| | - Denish Moorthy
- USAID Advancing Nutrition, John Snow Inc., Arlington, VA, USA.
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Locks LM, Bhaise S, Dhurde V, Gugel A, Lauer J, Shah M, Goghari A, Hibberd PL, Patel A. The prevalence of anemia during pregnancy and its correlates vary by trimester and hemoglobin assessment method in Eastern Maharashtra, India. MATERNAL & CHILD NUTRITION 2024:e13684. [PMID: 38943254 DOI: 10.1111/mcn.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/10/2024] [Accepted: 05/29/2024] [Indexed: 07/01/2024]
Abstract
Approximately half of pregnant women in India are anemic, representing over 7.5 million women. Few studies have assessed the relationship between multiple micronutrient deficiencies and anemia during pregnancy or the trajectory of hemoglobin (Hb) during pregnancy in low-resource settings. We enrolled 200 pregnant women from the Maternal and Newborn Health (MNH) registry, a population-based pregnancy and birth registry in Eastern Maharashtra, India to address these gaps. The women provided capillary (finger-prick) and venous blood specimens at enrollment (<15 weeks), and a second capillary specimen in the 3rd trimester (>27 weeks). Capillary specimens were analyzed at the time of collection with a HemoCue Hb 201+; venous specimens were shipped on dry ice to a laboratory for cyanmethemoglobin assessment. In the 1st trimester, mean Hb concentration and anemia (Hb<11.0 g/dL) prevalence using capillary specimens were 10.9 ± 1.5 g/dL and 51.1%; mean Hb concentration using venous blood specimens was estimated to be 11.3 ± 1.3 g/dL and anemia prevalence was 37.5%. The prevalence of iron, vitamin B12 and folate deficiencies were 40%, 30% and 0%, respectively. Among women with anemia in the 1st trimester (venous blood), 56% had concurrent iron deficiency (inflammation-adjusted serum ferritin <15 µg/L) indicating that their anemia may be amenable to iron supplementation. In total, 21% of women had ID and anemia, 19% ID in the absence of anemia, 16.5% anemia in the absence of ID and 43.5% had neither. By the 3rd trimester, mean Hb from capillary specimens had declined to 10.1 ± 1.35 g/dL and anemia prevalence increased to 70.7%, despite 99.4% mothers reporting receipt of iron-folic acid (IFA) supplements during her current pregnancy, and 83.9% reporting IFA consumption the previous day. Significant predictors of anemia in the 1st trimester (both venous and capillary) included the number of weeks gestation at the time of Hb assessment and inflammation-adjusted serum ferritin. For 3rd trimester anemia, significant predictors included 1st trimester height, BMI and IFA consumption during the 3rd trimester (but not 1st trimester micronutrient biomarkers), indicating that IFA supplementation over the course of pregnancy may have influenced micronutrient status and anemia risk. Our findings highlight the severity of the burden of anemia and micronutrient deficiencies in Eastern Maharashtra, but also highlight that in many cases, ID and anemia affect different individuals. Preventing and managing anemia in pregnancy in India will require strengthening both clinical and community-based strategies targeting iron deficiency, as well as other causes of anemia.
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Affiliation(s)
- Lindsey M Locks
- Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | | | | | - Abigail Gugel
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Jacqueline Lauer
- Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
| | - Miloni Shah
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Aboli Goghari
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Patricia L Hibberd
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Higher Education and Research, Wardha, India
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Jenkins M, Amoaful EF, Abdulai M, Quartey V, Situma R, Ofosu-Apea P, Aballo J, Demuyakor ME, Gosdin L, Mapango C, Jefferds MED, Addo OY. Comparison of venous and pooled capillary hemoglobin levels for the detection of anemia among adolescent girls. Front Nutr 2024; 11:1360306. [PMID: 38912302 PMCID: PMC11191668 DOI: 10.3389/fnut.2024.1360306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/17/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Blood source is a known preanalytical factor affecting hemoglobin (Hb) concentrations, and there is evidence that capillary and venous blood may yield disparate Hb levels and anemia prevalence. However, data from adolescents are scarce. Objective To compare Hb and anemia prevalence measured by venous and individual pooled capillary blood among a sample of girls aged 10-19 years from 232 schools in four regions of Ghana in 2022. Methods Among girls who had venous blood draws, a random subsample was selected for capillary blood. Hb was measured using HemoCue® Hb-301. We used Lin's concordance correlation coefficient (CCC) to quantify the strength of the bivariate relationship between venous and capillary Hb and a paired t-test for difference in means. We used McNemar's test for discordance in anemia cases by blood source and weighted Kappa to quantify agreement by anemia severity. A multivariate generalized estimating equation was used to quantify adjusted population anemia prevalence and assess the association between blood source and predicted anemia risk. Results We found strong concordance between Hb measures (CCC = 0.86). The difference between mean venous Hb (12.8 g/dL, ± 1.1) and capillary Hb (12.9 g/dL, ± 1.2) was not significant (p = 0.26). Crude anemia prevalence by venous and capillary blood was 20.6% and 19.5%, respectively. Adjusted population anemia prevalence was 23.5% for venous blood and 22.5% for capillary (p = 0.45). Blood source was not associated with predicted anemia risk (risk ratio: 0.99, 95% CI: 0.96, 1.02). Discordance in anemia cases by blood source was not significant (McNemar p = 0.46). Weighted Kappa demonstrated moderate agreement by severity (ĸ = 0.67). Among those with anemia by either blood source (n = 111), 59% were identified by both sources. Conclusion In Ghanaian adolescent girls, there was no difference in mean Hb, anemia prevalence, or predicted anemia risk by blood source. However, only 59% of girls with anemia by either blood source were identified as having anemia by both sources. These findings suggest that pooled capillary blood may be useful for estimating Hb and anemia at the population level, but that caution is needed when interpreting individual-level data.
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Affiliation(s)
- Mica Jenkins
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Esi Foriwa Amoaful
- Nutrition Department, Family Health Division, Ghana Health Service, Ministry of Health, Accra, Ghana
| | - Mutala Abdulai
- Nutrition Department, Family Health Division, Ghana Health Service, Ministry of Health, Accra, Ghana
| | - Veronica Quartey
- Nutrition Department, Family Health Division, Ghana Health Service, Ministry of Health, Accra, Ghana
| | | | | | | | - Maku E. Demuyakor
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Lucas Gosdin
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Carine Mapango
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Maria Elena D. Jefferds
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - O. Yaw Addo
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, United States
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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8
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Pickering PA, Harris I, Smith D, McCallum F, Kaminiel P, Auliff A, Cheng Q. Burden of Submicroscopic Plasmodium Infections and Detection of kelch13 Mutant Parasites in Military and Civilian Populations in Papua New Guinea. Am J Trop Med Hyg 2024; 110:639-647. [PMID: 38377613 PMCID: PMC10993850 DOI: 10.4269/ajtmh.23-0508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/22/2023] [Indexed: 02/22/2024] Open
Abstract
Malaria remains a major public health problem in Papua New Guinea (PNG) and an important force health protection issue for both PNG and Australian Defence Forces. To investigate the malaria burden in the military and civilians residing on military bases, a cross-sectional survey was conducted in April 2019 at three military bases in Wewak, Manus Island, and Vanimo, PNG. A total of 1,041 participants were enrolled; 235 military personnel from three bases and 806 civilians from Wewak and Vanimo. Polymerase chain reaction (PCR) revealed an overall high prevalence of Plasmodium infection in both the military and civilians. Among the military, the infection prevalence was significantly higher in Wewak (35.5%) and Vanimo (33.3%) bases than on Manus Island (11.8%). Among civilians, children (<16 years old) had significantly higher odds of being PCR positive than adults (≥16 years old). At Wewak and Vanimo, Plasmodium vivax accounted for 85.4%, 78.2%, and 66.2% of infections in military, children, and adult populations. Overall, 87.3%, 41.3%, and 61.3% of Plasmodium infections in the military, children, and adults, respectively, were detected only by PCR, not by microscopy (submicroscopic [SM] infections). Children had a significantly lower proportion of SM infections than adults and Papua New Guinea Defence Force personnel. Infection status was not associated with hemoglobin levels in these populations at the time of the survey. Mutant kelch13 (C580Y) parasites were identified in 5/68 Plasmodium falciparum-infected individuals. The survey results indicate extensive malaria transmission on these bases, especially in Wewak and Vanimo. More intensified interventions are required to reduce malaria transmission on PNG military bases.
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Affiliation(s)
- Paul A. Pickering
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - Ivor Harris
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - David Smith
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - Fiona McCallum
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - Peter Kaminiel
- Papua New Guinea Defence Force Health Service, Port Moresby, Papua New Guinea
| | - Alyson Auliff
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
| | - Qin Cheng
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia
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9
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Namaste SM, Baingana R, Brindle E. Hemoglobin measurement in venous blood compared with pooled and single-drop capillary blood: a method-comparison study in a controlled and survey setting in Uganda among children and women. Am J Clin Nutr 2024; 119:949-959. [PMID: 38176682 DOI: 10.1016/j.ajcnut.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 12/03/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Standard practice for estimating anemia in population-based surveys is to use a point-of-care device to measure hemoglobin (Hb) in a single drop of capillary blood. Emerging evidence points to larger than expected differences in Hb concentration depending on the blood source. OBJECTIVE We evaluated use of different blood sources to measure Hb with a HemoCue 201+ analyzer compared with the reference method of venous blood tested with a Sysmex XN-450 hematology analyzer. METHODS Hb concentration in venous, pooled capillary, and single-drop capillary blood were collected in controlled (laboratory) and survey (Demographic Health Survey-8 pilot) settings in Uganda among children 6-59 mo and nonpregnant women 15-49 y. Venous and capillary blood collected from the same individual was tested using a HemoCue 201+ analyzer and the venous blood was also measured with a Sysmex XN-450 hematology analyzer. Agreement between measures was estimated using Lin's concordance correlation coefficient, Bland-Altman plots, and Deming regression. Means and prevalences were compared using paired t-tests and McNemar's tests, respectively. RESULTS The limits of agreement between Hb measured using a HemoCue 201+ analyzer and the reference method were lowest for venous (1.1-1.96 g/dL), followed by pooled capillary (1.45-2.27 g/dL), and single-drop capillary blood (2.23-3.41 g/dL). Mean differences were <0.5 g/dL across comparators. There were statistically significant differences in Hb concentration from both types of capillary blood. Anemia prevalence was lower in pooled capillary blood compared with the reference method. CONCLUSIONS The variability of Hb measured by capillary blood using the HemoCue 201+ analyzer is higher than venous blood but the extent to which this impacts the validity of Hb and anemia estimates requires further exploration. Future research is also needed to evaluate the implications of using venous compared with capillary blood in population-based surveys. This trial was registered at clinicaltrials.gov (NCT05059457).
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Affiliation(s)
| | - Rhona Baingana
- Makerere University College of Natural Sciences, Kampala, Uganda, Africa
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10
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De la Cruz-Góngora V, Villalpando S, Shamah-Levy T. Overview of Trends in Anemia and Iron Deficiency in the Mexican Population From 1999 to 2018-19. Food Nutr Bull 2024; 45:57-64. [PMID: 38661355 DOI: 10.1177/03795721241240014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Despite the emergence of diverse programs in Mexico to address anemia and micronutrient deficiencies in disadvantaged groups, progress on reducing their prevalence has stagnated. In Mexico, anemia surveillance at the population level is conducted through the National Health and Nutrition Survey ENSANUT (for its acronym in Spanish). OBJECTIVE To overview the trends in anemia and iron deficiency (ID) from 1999 to 2018-19 in the Mexican population before COVID-19 pandemic. METHODS Data from five nationwide surveys in Mexico were used. Where available, data on anemia, ID, and ID anemia (IDA) were extracted from ENSANUTs 1999, 2006, 2012, 2016, and 2018-19 in participants from 1 to 99 years old. Blood sample collection methods were similar across surveys (1999-2018) where capillary drop blood was used to estimate Hb using a HemoCue and serum blood samples to measure ferritin and C-reactive protein concentration. RESULTS The trend in anemia prevalence shows a U-shape from 1999 to 2018-19 in <60 years old. In older adults (≥60 years), an increasing trend was observed. Anemia declined progressively from 1999 to 2012 but increased from 2016 to 2018-19 in comparison with 2012. In contrast, ID declined from 2006 to 2018-19, mainly in children, while IDA did not change over this period. In older adults, ID prevalence remained constant over time. CONCLUSIONS The shifting trend in anemia prevalence across ENSANUTs 1999 through 2018-19 did not mimic the decreasing trend of ID over the same period of time. Other noncausal factors seem to play an important role in the variability of hemoglobin measurements.
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Affiliation(s)
- Vanessa De la Cruz-Góngora
- Centre for Evaluation and Survey Research, National Institute of Public Health, Cuernavaca, Mexico
- Global Brain Health Institute (GBHI), Trinity College Dublin (TCD), Dublin, Ireland
| | - Salvador Villalpando
- Centre for Evaluation and Survey Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Teresa Shamah-Levy
- Centre for Evaluation and Survey Research, National Institute of Public Health, Cuernavaca, Mexico
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11
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Azupogo F, Abizari AR, Feskens EJM, Verhoef H, Brouwer ID. Ten2Twenty-Ghana: a randomised controlled trial on the efficacy of multiple micronutrient-fortified biscuits on the micronutrient status of adolescent girls. Br J Nutr 2024; 131:707-719. [PMID: 37795629 PMCID: PMC10803820 DOI: 10.1017/s0007114523002234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/23/2023] [Accepted: 10/02/2023] [Indexed: 10/06/2023]
Abstract
Adolescent girls are an important target group for micronutrient interventions particularly in Sub-Saharan Africa where adolescent pregnancy and micronutrient deficiencies are common. When consumed in sufficient amounts and at levels appropriate for the population, fortified foods may be a useful strategy for this group, but little is known about their effectiveness and timing (regarding menarche), particularly in resource-poor environments. We evaluated the effect of consuming multiple micronutrient-fortified biscuits (MMB), sold in the Ghanaian market, 5 d/week for 26 weeks compared with unfortified biscuits (UB) on the micronutrient status of female adolescents. We also explored to what extent the intervention effect varied before or after menarche. Ten2Twenty-Ghana was a 26-week double-blind, randomised controlled trial among adolescent girls aged 10-17 years (n 621) in the Mion District, Ghana. Biomarkers of micronutrient status included concentrations of Hb, plasma ferritin (PF), soluble transferrin receptor (TfR) and retinol-binding protein (RBP), including body-iron stores. Intention-to-treat analysis was supplemented by protocol-specific analysis. We found no effect of the intervention on PF, TfR and RBP. MMB consumption did not affect anaemia and micronutrient deficiencies at the population level. MMB consumption increased the prevalence of vitamin A deficiency by 6·2 % (95 % CI (0·7, 11·6)) among pre-menarche girls when adjusted for baseline micronutrient status, age and height-for-age Z-score, but it decreased the prevalence of deficient/low vitamin A status by -9·6 % (95 % CI (-18·9, -0·3)) among post-menarche girls. Consuming MMB available in the market did not increase iron status in our study, but reduced the prevalence of deficient/low vitamin A status in post-menarcheal girls.
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Affiliation(s)
- Fusta Azupogo
- Department of Family and Consumer Sciences, Faculty of Agriculture, Food and Consumer Sciences, University for Development Studies, Tamale, 1882, Ghana
- Institute for Global Nutrition, University of California, Davis, USA
| | - Abdul-Razak Abizari
- Formerly of the Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Hans Verhoef
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Inge D. Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
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12
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Lavoie A, Lemire M, Lévesque B, Ayotte P. Determinants of iron deficiency and anemia among Nunavimmiut: results from the Qanuilirpitaa? 2017 Nunavik Health Survey. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:152-167. [PMID: 37165141 PMCID: PMC10831004 DOI: 10.17269/s41997-023-00775-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 04/11/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To estimate the prevalence of iron deficiency (ID) and anemia and study their main distal and proximal protective and risk factors among Nunavimmiut 16 years and older in 2017. METHODS In a cross-sectional participatory survey of 831 women and 436 men from the Qanuilirpitaa? 2017 Nunavik Inuit Health Survey, venous blood samples were collected to measure various indicators of iron status and anemia as well as biomarkers of nutritional and inflammatory status and contaminant exposures. Sociodemographic, food security status, anthropometric, lifestyle, dietary, and health data were collected using questionnaires, clinical sessions, and a medical chart review. ID and anemia diagnoses were based on serum ferritin (SF) and hemoglobin (Hb), respectively. Multiple regressions were used to assess correlates of anemia and iron status. RESULTS Prevalence of ID was highest among women of childbearing age (16-49 years old, 33%) and anemia among adults aged 50 years and older (31%). These estimates are prone to biases due to the relatively low participation rate (37%). Serum vitamin D, omega-3 polyunsaturated fatty acid content of erythrocyte membranes, blood selenium, inflammation, higher socioeconomic status (SES), obesity, and alcohol consumption were all positively associated with SF, while Helicobacter pylori infection and a recent pregnancy were negatively associated with Hb among women of childbearing age. Among older adults, food insecurity was associated with lower SF. CONCLUSION While data reported here provide some indication of an improvement since the previous survey conducted in 2004, additional efforts should be devoted to further increasing the SES and access to country foods and nutritious market foods in this population, the two main protective factors against ID and anemia identified in the present study.
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Affiliation(s)
- Audrey Lavoie
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada
| | - Mélanie Lemire
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada
- Institut de biologie intégrative et des systèmes, Université Laval, Quebec City, QC, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Benoit Lévesque
- Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Pierre Ayotte
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada.
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada.
- Institut national de santé publique du Québec, Quebec City, QC, Canada.
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13
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Yassen K, Omer N, Alsahaf F, Al Amer F, Alhamad F, Alherz I, Bushehab A, Alniniya F, Alwabari M. Comparing Non-Invasive Spectrophotometry to Hematology Analysis for Hemoglobin Measurements in Sickle Cell Disease Patients. J Clin Med 2023; 12:7517. [PMID: 38137588 PMCID: PMC10744205 DOI: 10.3390/jcm12247517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Patients with sickle cell disease (SCD) require repeated blood sampling for hemoglobin (Hb) concentration measurements. The primary aim of this study was to compare non-invasive spectrophotometric hemoglobin (SpHb, g/dL) measurements to those taken via an automated hematology analyzer (Hb, g/dL) in patients with SCD visiting outpatient clinics and to investigate the correlations and agreements between both measurement techniques. Secondarily, we aimed to identify the SpHb cut-off concentration for the diagnosis of anemia and to monitor the effects of the pleth variability index (PVI, %) and perfusion index (PI) on SpHb measurements. The results gained from the examination of one hundred and fifty-eight patients indicated that the SpHb measurements overestimated the lab Hb concentrations, with a mean (SpHb-Hb) bias of 0.82 g/dL (SD 1.29). The SpHb measurements were positively correlated with the Hb measurements (Kendall's tau correlation (τ), n = 158, τ = 0.68, p < 0.001), with an intra-class correlation (ICC) of 0.67 and a 95% CI from 0.57 to 0.74 (p = 0.000). The SpHb cut-off concentration to diagnose anemia was 11.4 and 11.7 g/dL for males and females, respectively. SpHb sensitivity was low for males and females at 64.4% and 57.1%; however, the specificity was higher at 90.9% and 75%, with positive predictive values (PPVs) of 95.6 and 85.7, respectively. No correlation existed between SpHb measurements and the PVI (%) in contrast with a moderate correlation with the PI (r = 0.049, p = 0.54, and r = 0.36, p < 0.001, respectively). The mean PI was low at 2.52 ± 1.7. In conclusion, the SpHb measurements were consistently higher than the lab Hb concentrations, with a positive correlation. The sensitivity and precision of the SpHb measurements were lower than expected. However, the SpHb specificity and its positive predictive values (PPVs) indicated that it is less likely for a patient with a positive SpHb test result for anemia to be non-anemic. These results will allow SpHb measurement to play a role in excluding the presence of anemia. In light of the low PI values determined, the SpHb measurements were challenging to take and, thus, require further technological improvements.
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Affiliation(s)
- Khaled Yassen
- Anesthesia Unit, Surgery Department, College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia
| | - Nawal Omer
- Hereditary Blood Disease Center, Hofuf 36422, Al Ahsa, Saudi Arabia;
| | - Fatimah Alsahaf
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.A.); (F.A.); (M.A.)
| | - Fatima Al Amer
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.A.); (F.A.); (M.A.)
| | - Fatimah Alhamad
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.A.); (F.A.); (M.A.)
| | - Imran Alherz
- Anesthesia Department, King Fahad Hospital, Ministry of Health, Hofuf 36441, Al Ahsa, Saudi Arabia; (I.A.); (F.A.)
| | - Abdulaziz Bushehab
- Nursing Services, Hereditary Blood Disease Center, Hofuf 36422, Al Ahsa, Saudi Arabia;
| | - Fatma Alniniya
- Anesthesia Department, King Fahad Hospital, Ministry of Health, Hofuf 36441, Al Ahsa, Saudi Arabia; (I.A.); (F.A.)
| | - Maryam Alwabari
- College of Medicine, King Faisal University, Hofuf 31983, Al Ahsa, Saudi Arabia; (F.A.); (F.A.A.); (F.A.); (M.A.)
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14
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Delabaere A, Guerard M, Cahierc R, Bouvier D, Pereira B, Gallot D. Accuracy of a portable hemoglobinometer (HemoCue) to measure fetal hemoglobin values during in utero transfusion. J Matern Fetal Neonatal Med 2023; 36:2266092. [PMID: 37840223 DOI: 10.1080/14767058.2023.2266092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/27/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES The current recommended treatment for severe fetal anemia is in utero transfusion (IUT). During this procedure, the evaluation of the necessary volume of transfused blood is based on regular measurement of fetal hemoglobin (FHb) concentration. The gold standard measurement is performed in the biology laboratory. A rapid medical test such as HemoCue® is an effective way to predict FHb concentration. It would reduce the time to obtain results and therefore the procedure duration. To evaluate the accuracy of HemoCue® to measure FHb during IUT, we compared Hb levels obtained by HemoCue® and by our biology laboratory. METHODS This retrospective study involved all pregnant women who had undergone an IUT in the university hospital of Clermont-Ferrand, France, during the period from 1 January 2010 to 6 June 2021. The FHb level was evaluated by two methods, a rapid medical test, HemoCue®, and a standard method in the biology laboratory. RESULTS We obtained 244 pairs of results from HemoCue® and our laboratory, of 90 IUT procedures. The correlation between the two sets of results was excellent, with Lin's concordance correlation coefficient of 0.979. However, we established that the measurements were not significantly modified by IUT number, puncture time, cause of fetal anemia, estimated fetal weight, gestational age, and delay between two IUT or middle cerebral artery peak systolic velocity values. CONCLUSION Our results allowed to extend the relevance of FHb measurements by HemoCue® during IUT.
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Affiliation(s)
- Amélie Delabaere
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Maeva Guerard
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Equipe "Translational approach to epithelial injury and repair", Université Clermont Auvergne, CNRS, Inserm, GReD, Clermont-Ferrand, France
| | - Romain Cahierc
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Damien Bouvier
- Equipe "Translational approach to epithelial injury and repair", Université Clermont Auvergne, CNRS, Inserm, GReD, Clermont-Ferrand, France
- Biochemistry and Molecular Biology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- University Hospital of Clermont-Ferrand, Biostatistics Unit, the Clinical Research and Innovation Direction, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Denis Gallot
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Equipe "Translational approach to epithelial injury and repair", Université Clermont Auvergne, CNRS, Inserm, GReD, Clermont-Ferrand, France
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15
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Williams AM, Brown KH, Allen LH, Dary O, Moorthy D, Suchdev PS. Improving Anemia Assessment in Clinical and Public Health Settings. J Nutr 2023; 153 Suppl 1:S29-S41. [PMID: 37778891 PMCID: PMC11002965 DOI: 10.1016/j.tjnut.2023.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/28/2023] [Accepted: 05/10/2023] [Indexed: 10/03/2023] Open
Abstract
We aim to provide a practical approach to assess anemia and its primary causes, both in clinical settings and in the context of public health programs. Anemia remains a global challenge; thus, to achieve goals for anemia reduction and assess progress, standardized approaches are required for the assessment of anemia and its causes. We first provide a brief review of how to assess anemia, based on hemoglobin concentrations and cutoffs that correspond to age, sex, and physiologic status. Next, we discuss how to assess the likely causes of anemia in different settings. The causes of anemia are classified as non-nutritional (for example, because of infection, inflammation, blood loss, or genetic disorders) or nutrition-specific (for example, because of deficiencies of iron, vitamin A, riboflavin, vitamin B12, or folate). There is an important overlap between these 2 categories, such as the increased likelihood of iron deficiency in the context of inflammation. Given the multifaceted nature of anemia etiology, we introduce a framework for anemia assessment based on the "ecology of anemia," which recognizes its many overlapping causes. This conceptual framework is meant to inform what data on anemia causes may need to be collected in population surveys. The framework has a supporting table with information on the diagnostic tests, biomarkers and proposed cutoffs, characteristics, and feasibility of collecting the myriad information that can help elucidate the anemia etiology. We also provide examples of how this framework can be applied to interpret the anemia risk factor data from population-based surveys that can inform decisions about context-specific interventions. Finally, we present research gaps and priorities related to anemia assessment.
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Affiliation(s)
- Anne M Williams
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand; Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States; Emory University, Atlanta, GA, United States.
| | - Kenneth H Brown
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA, United States
| | - Lindsay H Allen
- United States Department of Agriculture, Agricultural Research Service Western Human Nutrition Research Center, Davis, CA, United States
| | - Omar Dary
- Division of Nutrition and Environmental Health, Office of Maternal and Child Health and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, DC, United States
| | | | - Parminder S Suchdev
- Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States; Emory University, Atlanta, GA, United States
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16
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Bilukha O, Kianian B, Samson KLI. Characteristics of hemoglobin distributions in preschool children and non-pregnant women of reproductive age and their implications for establishing quality control criteria for hemoglobin data in field surveys: evidence from 483 surveys conducted in refugee settings worldwide. Popul Health Metr 2023; 21:20. [PMID: 37940990 PMCID: PMC10633933 DOI: 10.1186/s12963-023-00315-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Currently, there is a lack of clear guidance on hemoglobin (Hb) data quality parameters and plausible flagging ranges for population-representative surveys. There is a need to determine which properties of Hb data indicate lower data quality and increased measurement error and which represent intrinsic statistical properties of Hb distributions rather than quality problems. METHODS We explored statistical characteristics of Hb distributions and plausible exclusion ranges in population-representative surveys of non-pregnant women of reproductive age (WRA) (15-49 years, n = 401 surveys) and children (6-59 months, n = 461 surveys) conducted in refugee settings by the United Nations High Commissioner for Refugees (UNHCR). Hb distribution characteristics [standard deviation (SD), skewness and kurtosis] were compared to those from Demographic and Health Surveys (DHS). RESULTS Overall, 0.08% of child and 0.14% of WRA Hb values were outside of the previously proposed 4.0-18.0 g/dL plausible range. Surveys conducted in Uganda tended to have unusually high SD compared with surveys from other settings, possibly an indication of problematic measurement quality. We therefore used summary results on SD, skewness and kurtosis excluding surveys from Uganda when comparing with DHS results or proposing plausible ranges. Both WRA and child Hb distributions tended to be left-skewed and had excess positive kurtosis. Mean survey-level SD was greater, mean skewness more negative, and mean kurtosis more positive in WRA surveys compared to child surveys. All these findings were broadly similar to those from DHS surveys. Mean SD in DHS surveys was higher than that in our data for both children (1.48 vs. 1.34) and WRA (1.58 vs. 1.43). CONCLUSIONS We observed several statistical characteristics of Hb distributions that may not necessarily be indicative of data quality problems and bear strong similarities with the characteristics found in DHS surveys. Hb distributions tended to be negatively skewed and positively kurtotic, and SD in many surveys exceeded 1.5 (previously proposed upper plausible range). Based on our empirical evidence, surveys with skewness above + 0.2 and kurtosis below -0.5 or Hb SD outside the range of 1.1-1.55 g/dL for children (6-59 mo) or 1.1-1.65 g/dL for non-pregnant WRA (15-49 y) may require further quality investigation.
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Affiliation(s)
- Oleg Bilukha
- Emergency Response and Recovery Branch, Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30333, USA.
| | - Behzad Kianian
- Emergency Response and Recovery Branch, Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30333, USA
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Dziorny A, Jones C, Salant J, Kubis S, Zand MS, Wolfe H, Srinivasan V. Clinical and Analytic Accuracy of Simultaneously Acquired Hemoglobin Measurements: A Multi-Institution Cohort Study to Minimize Redundant Laboratory Usage. Pediatr Crit Care Med 2023; 24:e520-e530. [PMID: 37219964 PMCID: PMC10665541 DOI: 10.1097/pcc.0000000000003287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Frequent diagnostic blood sampling contributes to anemia among critically ill children. Reducing duplicative hemoglobin testing while maintaining clinical accuracy can improve patient care efficacy. The objective of this study was to determine the analytical and clinical accuracy of simultaneously acquired hemoglobin measurements with different methods. DESIGN Retrospective cohort study. SETTING Two U.S. children's hospitals. PATIENTS Children (< 18 yr old) admitted to the PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We identified hemoglobin results from complete blood count (CBC) panels paired with blood gas (BG) panels and point-of-care (POC) devices. We estimated analytic accuracy by comparing hemoglobin distributions, correlation coefficients, and Bland-Altman bias. We measured clinical accuracy with error grid analysis and defined mismatch zones as low, medium, or high risk-based on deviance from unity and risk of therapeutic error. We calculated pairwise agreement to a binary decision to transfuse based on a hemoglobin value. Our cohort includes 49,004 ICU admissions from 29,926 patients, resulting in 85,757 CBC-BG hemoglobin pairs. BG hemoglobin was significantly higher (mean bias, 0.43-0.58 g/dL) than CBC hemoglobin with similar Pearson correlation ( R2 ) (0.90-0.91). POC hemoglobin was also significantly higher, but of lower magnitude (mean bias, 0.14 g/dL). Error grid analysis revealed only 78 (< 0.1%) CBC-BG hemoglobin pairs in the high-risk zone. For CBC-BG hemoglobin pairs, at a BG hemoglobin cutoff of greater than 8.0 g/dL, the "number needed to miss" a CBC hemoglobin less than 7 g/dL was 275 and 474 at each institution, respectively. CONCLUSIONS In this pragmatic two-institution cohort of greater than 29,000 patients, we show similar clinical and analytic accuracy of CBC and BG hemoglobin. Although BG hemoglobin values are higher than CBC hemoglobin values, the small magnitude is unlikely to be clinically significant. Application of these findings may reduce duplicative testing and decrease anemia among critically ill children.
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Affiliation(s)
- Adam Dziorny
- Department of Pediatrics, University of Rochester School of
Medicine, Rochester, NY
- Department of Biomedical Engineering, University of
Rochester, Rochester, NY
| | - Chloe Jones
- Department of Biomedical Engineering, University of
Rochester, Rochester, NY
| | - Jennifer Salant
- Department of Pediatrics, Weill Cornell Medicine, New York,
NY
| | - Sherri Kubis
- Department of Anesthesiology & Critical Care Medicine,
Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Martin S. Zand
- Department of Internal Medicine, University of Rochester
School of Medicine, Rochester NY
| | - Heather Wolfe
- Department of Anesthesiology & Critical Care Medicine,
Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Anesthesiology, Critical Care and Pediatrics,
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Vijay Srinivasan
- Department of Anesthesiology & Critical Care Medicine,
Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Anesthesiology, Critical Care and Pediatrics,
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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18
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Webb KL, Gorman EK, Morkeberg OH, Klassen SA, Regimbal RJ, Wiggins CC, Joyner MJ, Hammer SM, Senefeld JW. The relationship between hemoglobin and [Formula: see text]: A systematic review and meta-analysis. PLoS One 2023; 18:e0292835. [PMID: 37824583 PMCID: PMC10569622 DOI: 10.1371/journal.pone.0292835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE There is widespread agreement about the key role of hemoglobin for oxygen transport. Both observational and interventional studies have examined the relationship between hemoglobin levels and maximal oxygen uptake ([Formula: see text]) in humans. However, there exists considerable variability in the scientific literature regarding the potential relationship between hemoglobin and [Formula: see text]. Thus, we aimed to provide a comprehensive analysis of the diverse literature and examine the relationship between hemoglobin levels (hemoglobin concentration and mass) and [Formula: see text] (absolute and relative [Formula: see text]) among both observational and interventional studies. METHODS A systematic search was performed on December 6th, 2021. The study procedures and reporting of findings followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Article selection and data abstraction were performed in duplicate by two independent reviewers. Primary outcomes were hemoglobin levels and [Formula: see text] values (absolute and relative). For observational studies, meta-regression models were performed to examine the relationship between hemoglobin levels and [Formula: see text] values. For interventional studies, meta-analysis models were performed to determine the change in [Formula: see text] values (standard paired difference) associated with interventions designed to modify hemoglobin levels or [Formula: see text]. Meta-regression models were then performed to determine the relationship between a change in hemoglobin levels and the change in [Formula: see text] values. RESULTS Data from 384 studies (226 observational studies and 158 interventional studies) were examined. For observational data, there was a positive association between absolute [Formula: see text] and hemoglobin levels (hemoglobin concentration, hemoglobin mass, and hematocrit (P<0.001 for all)). Prespecified subgroup analyses demonstrated no apparent sex-related differences among these relationships. For interventional data, there was a positive association between the change of absolute [Formula: see text] (standard paired difference) and the change in hemoglobin levels (hemoglobin concentration (P<0.0001) and hemoglobin mass (P = 0.006)). CONCLUSION These findings suggest that [Formula: see text] values are closely associated with hemoglobin levels among both observational and interventional studies. Although our findings suggest a lack of sex differences in these relationships, there were limited studies incorporating females or stratifying results by biological sex.
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Affiliation(s)
- Kevin L. Webb
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ellen K. Gorman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Olaf H. Morkeberg
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Stephen A. Klassen
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | - Riley J. Regimbal
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Shane M. Hammer
- Department of Kinesiology, Applied Health, and Recreation, Oklahoma State University, Stillwater, Oklahoma, United States of America
| | - Jonathon W. Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
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19
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Vishal V, Sachdeva A, Bhalla K, Dureja A, Tarte S. Exploring the Involvement of Cytokines in Pediatric Patients Afflicted by Simple Febrile Seizures: A Case-Control Study. Cureus 2023; 15:e48083. [PMID: 38046507 PMCID: PMC10689979 DOI: 10.7759/cureus.48083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
AIM Most children under six with seizures experience febrile seizures (FS), which occur with a temperature of 38°C or higher and no apparent infectious or metabolic causes. FS has a multifaceted etiology, involving genetic and environmental factors. This study aimed to explore the connection between the cytokine system (part of the immune system related to inflammation) and FS to uncover potential relationships. METHOD This research was carried out on 50 patients experiencing FS and 25 patients experiencing only fever served as cases and controls, respectively. The patient's blood was obtained under sterile circumstances from the antecubital/femoral vein as soon as feasible following the commencement of seizures. The complete hemogram analysis was done using the Mindray BC-5800 auto hematology analyzer (Mindray Medical International Limited, Shenzhen, China). RESULT The cases group had significantly higher interleukin-4 (IL-4) concentrations (292.85 pg/mL) than controls (81.04 pg/mL), indicating a statistically significant difference (p<0.05), respectively. In the current research, case participants had a significantly lower mean level of interleukin-6 (IL-6) than control participants. The average IL-6 concentration in cases was 28.00 pg/mL, whereas in controls was 93.09pg/mL. Patients with FS have an important function for the cytokine network to perform. CONCLUSION The findings showed a significant difference in cytokine concentrations between patients with FS and control subjects, highlighting a potential link between the cytokine system and FS. Additionally, lower levels of IL-6 in case participants suggest a complex role of cytokines in FS, emphasizing the importance of the cytokine network in this condition.
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Affiliation(s)
- Vaibhav Vishal
- Biochemistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Ashuma Sachdeva
- Biochemistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Kapil Bhalla
- Biochemistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Ankanksha Dureja
- Pediatrics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Sagar Tarte
- Biochemistry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
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20
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Ohuma EO, Jabin N, Young MF, Epie T, Martorell R, Peña-Rosas JP, Garcia-Casal MN, Papageorghiou AT, Kennedy SH, Villar J. Association between maternal haemoglobin concentrations and maternal and neonatal outcomes: the prospective, observational, multinational, INTERBIO-21st fetal study. Lancet Haematol 2023; 10:e756-e766. [PMID: 37482061 DOI: 10.1016/s2352-3026(23)00170-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Anaemia in pregnancy is a global health problem with associated maternal and neonatal morbidity and mortality. We aimed to investigate the association between maternal haemoglobin concentrations during pregnancy and the risk of adverse maternal and neonatal outcomes. METHODS In this prospective, observational, multinational, INTERBIO-21st fetal study conducted at maternity units in Brazil, Kenya, Pakistan, South Africa, and the UK, we enrolled pregnant women (aged ≥18 years, BMI <35 kg/m2, natural conception, and singleton pregnancy) who initiated antenatal care before 14 weeks' gestation. At each 5±1 weekly visit until delivery, information was collected about the pregnancy, as well as the results of blood tests taken as part of routine antenatal care, including haemoglobin values. The outcome measures were maternal (gestational diabetes, pregnancy-induced hypertension, and preterm premature rupture of membranes) and neonatal outcomes (small for gestational age, preterm birth, and acute respiratory distress syndrome). FINDINGS Between Feb 8, 2012, and Nov 30, 2019, 2069 women (mean age 30·7 years [SD 5·0]) had at least one routinely haemoglobin concentration measured at 14-40 weeks' gestation, contributing 4690 haemoglobin measurements for the analysis. Compared with a haemoglobin cutoff of 110 g/L, the risk was increased more than two-fold for pregnancy-induced hypertension at haemoglobin concentrations of 170 g/L (risk ratio [RR] 2·29 [95% CI 1·19-4·39]) and higher, for preterm birth at haemoglobin concentrations of 70 g/L (RR 2·04 [95% CI 1·20-3·48]) and 165 g/L (RR 2·06 [95% CI 1·41-3·02]), and for acute respiratory distress syndrome at haemoglobin concentrations of 165 g/L (RR 2·84 [95% CI 1·51-5·35]). Trimester-specific results are also presented. INTERPRETATION Our data suggests that the current WHO haemoglobin cutoffs are associated with reduced risk of adverse maternal and neonatal outcomes. The current haemoglobin concentration cutoffs during pregnancy should not only consider thresholds for low haemoglobin concentrations that are associated with adverse outcomes but also define a threshold for high haemoglobin concentrations given the U-shaped relationship between haemoglobin concentration and adverse neonatal and maternal outcomes. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Eric O Ohuma
- Maternal, Adolescent, Reproductive, and Child Health (MARCH) Centre, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Nusrat Jabin
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Melissa F Young
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Terrence Epie
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Juan Pablo Peña-Rosas
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | | | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Jose Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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21
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Pacheco MO, Lutz HM, Armada J, Davies N, Gerzenshtein IK, Cakley AS, Spiess BD, Stoppel WL. Silk Fibroin Particles as Carriers in the Development of Hemoglobin-Based Oxygen Carriers. ADVANCED NANOBIOMED RESEARCH 2023; 3:2300019. [PMID: 38708087 PMCID: PMC11068031 DOI: 10.1002/anbr.202300019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Oxygen therapeutics have a range of applications in transfusion medicine and disease treatment. Synthetic molecules and all-natural or semi-synthetic hemoglobin-based oxygen carriers (HBOCs) have seen success as potential circulating oxygen carriers. However, many early HBOC products stalled in development due to side effects from excess hemoglobin in the blood stream and hemoglobin entering the tissue. To overcome these issues, research has focused on increasing the molecular diameter of hemoglobin by polymerizing hemoglobin molecules or encapsulating hemoglobin in liposomal carriers. This work leverages the properties of silk fibroin, a cytocompatible and non-thrombogenic biopolymer, known to entrap protein-based cargo, to engineer a fully protein-based oxygen carrier. Herein, an all-aqueous solvent evaporation technique was used to form silk particles via phase separation from a bulk polyvinyl alcohol phase (PVA). Particles size was tuned, and particles were formed with and without hemoglobin. The encapsulation efficiency and ferrous state of hemoglobin were analyzed, resulting in 60% encapsulation efficiency and a maximum of 20% ferric hemoglobin, yielding 100 µg/mL active hemoglobin in certain sfHBOC formulations. The system did not elicit a strong inflammation response in vitro, demonstrating the potential for this particle system to serve as an injectable HBOC.
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Affiliation(s)
- Marisa O Pacheco
- Department of Chemical Engineering, University of Florida, Gainesville FL
| | - Henry M Lutz
- Department of Chemical Engineering, University of Florida, Gainesville FL
| | - Jostin Armada
- Department of Chemical Engineering, University of Florida, Gainesville FL
| | - Nickolas Davies
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville FL
| | | | - Alaura S Cakley
- Department of Chemical Engineering, University of Florida, Gainesville FL
| | - Bruce D Spiess
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville FL
| | - Whitney L Stoppel
- Department of Chemical Engineering, University of Florida, Gainesville FL
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville FL
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22
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Morocho-Alburqueque N, Quincho-Lopez A, Nesemann JM, Cañari-Casaño JL, Elorreaga OA, Muñoz M, Talero S, Harding-Esch EM, Saboyá-Díaz MI, Honorio-Morales HA, Durand S, Carey-Angeles CA, Klausner JD, Keenan JD, Lescano AG. Prevalence of and factors associated with childhood anaemia in remote villages of the Peruvian Amazon: a cross-sectional study and geospatial analysis. Trans R Soc Trop Med Hyg 2023; 117:598-605. [PMID: 37039044 PMCID: PMC10398418 DOI: 10.1093/trstmh/trad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/28/2023] [Accepted: 03/23/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Anaemia is a public health problem in Peru. In the Loreto region of the Amazon, ≥50% of children may be anaemic, although insufficient information exists for rural villages. METHODS To generate more data about childhood anaemia in the Peruvian Amazon, haemoglobin was measured as part of a trachoma survey in 21 randomly selected villages. All children 1-9 y of age from 30 randomly selected households per village were recruited. Anaemia was classified according to the World Health Organization guidelines and a socio-economic status (SES) index was created for each household using principal component analysis. Spatial autocorrelation was determined using Moran's I and Ripley's K function. RESULTS Of 678 children with complete haemoglobin data, 25.4% (95% confidence interval [CI] 21.2 to 30.1) had mild-or-worse anaemia and 22.1% (95% CI 15.6 to 30.3) had moderate-or-worse anaemia. Mild-or-worse anaemia was more common among children whose primary source of drinking water was surface water (prevalence ratio [PR] 1.26 [95% CI 1.14 to 1.40], p<0.001) and who were in the lowest SES tercile (PR 1.16 [95% CI 1.02 to 1.32], p=0.021). Moderate-or-worse anaemia was more common among boys (PR 1.32 [95% CI 1.09 to 1.60], p=0.005). No evidence of geospatial clustering was found. CONCLUSIONS Remote villages of the Amazon would benefit from interventions for childhood anaemia and the poorest households would have the most to gain. Integrating anaemia screening into neglected tropical diseases surveys is an opportunity to use public health resources more efficiently.
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Affiliation(s)
| | - Alvaro Quincho-Lopez
- Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Peru
| | - John M Nesemann
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, USA
| | - Jorge L Cañari-Casaño
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Oliver A Elorreaga
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- GMINIS Research Group, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Marleny Muñoz
- Área de Epidemiología, Red de Salud Alto Amazonas, Yurimaguas, Peru
| | - Sandra Talero
- Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Martha Idalí Saboyá-Díaz
- Pan American Health Organization, Department of Communicable Diseases and Environmental Determinants of Health, Washington, DC, USA
| | | | - Salomón Durand
- Área de Epidemiología, Dirección Regional de Salud Loreto, Iquitos, Peru
| | | | - Jeffrey D Klausner
- Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jeremy D Keenan
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, USA
| | - Andres G Lescano
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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23
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Garcia-Casal MN, Dary O, Jefferds ME, Pasricha SR. Diagnosing anemia: Challenges selecting methods, addressing underlying causes, and implementing actions at the public health level. Ann N Y Acad Sci 2023; 1524:37-50. [PMID: 37061792 PMCID: PMC10880862 DOI: 10.1111/nyas.14996] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
Accurate and affordable tools for diagnosing anemia and its main determinants are essential for understanding the magnitude and distribution of the problem and the appropriate interventions needed for its timely prevention and treatment. The objective of this review is to address methods, equipment, and sample-related and quality control aspects of hemoglobin measurement for anemia diagnosis. Also, other iron-, infectious-, and genetic-related causes of anemia are addressed in individuals and populations. The best practice for hemoglobin determination is the use of venous blood, analyzed on automated hematology analyzers, with high-quality control measures in place. The importance of a correct anemia diagnosis is highlighted by the cost of a misdiagnosis. A false-negative diagnosis may result in missing out and not treating anemia, its causes, and its adverse effects. On the other hand, a false-positive diagnosis may result in the provision of unneeded treatment or referral for expensive laboratory tests to determine a cause of anemia, wasting valuable resources and risking causing harm. At the individual level, clinicians must understand the causes of absolute and functional anemia to diagnose and treat anemia at the clinical level. Actions toward anemia diagnosis and control at public health levels require global, regional, and country actions that should cover general and context-specific characteristics.
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Affiliation(s)
| | - Omar Dary
- Bureau for Global Health, US Agency for International Development, Washington, DC, USA
| | - Maria Elena Jefferds
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
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24
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Abaane DN, Adokiya MN, Abiiro GA. Factors associated with anaemia in pregnancy: A retrospective cross-sectional study in the Bolgatanga Municipality, northern Ghana. PLoS One 2023; 18:e0286186. [PMID: 37228063 DOI: 10.1371/journal.pone.0286186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Anaemia in pregnancy (AIP) remains a severe public health problem associated with adverse outcomes. This study assessed haemoglobin levels and the prevalence of anaemia during antenatal care (ANC) registration, at 28 weeks and 36 weeks of gestation as well as the factors associated with AIP at the different stages of pregnancy. METHODS A retrospective cross-sectional design was implemented. Using ANC registers as the sampling frame, 372 pregnant women, within 36 and 40 weeks of gestation were randomly sampled from 28 health facilities for the study. The participants were all receiving ANC in the Bolgatanga Municipality. Data were collected via clinical records review and a questionnaire-based survey between October and November, 2020. Using the Statistical Package for the Social Sciences (SPSS), descriptive analysis of haemoglobin levels and the prevalence of anaemia were performed. In addition, binary logistic regression was used to identify the factors associated with anaemia in pregnancy. AIP was determined using the national practice of 11.0g/dl haemoglobin cut-off point and the World Health Organisation's recommended adjustment for the 2nd trimester of pregnancy was made using the cut-off of 10.5g/dl to account for the effect of haemodilution. RESULTS At booking, AIP prevalence was 35.8% (95%CI:30.9, 40.9) using a cut-off of 11.0g/dl and 25.3% (95%CI:20.9, 30.0) using a cut-off of 10.5g/dl for those in the 2nd trimester. At 28 weeks, AIP prevalence was 53.1% (95%CI:45.8, 60.3) and 37.5 (95%CI:30.6, 44.8) using a cut-off of 11.0g/dl and 10.5g/dl for those in the 2nd trimester, respectively. At 36 weeks, AIP prevalence was 44.8% (95%CI:39.2, 50.4) using a cut-off of 11.0g/dl. At p<0.05, registering after the first trimester (AOR = 1.87, 95%CI: 1.17, 2.98, P = 0.009) and at a regional hospital (AOR = 2.25, 95%CI: 1.02, 4.98, P = 0.044) were associated with increased odds of AIP but registering at a private hospital (AOR = 0.32, 95%CI: 0.11, 0.92, P = 0.035) was associated with decreased odds of AIP at booking. At 28 weeks, age group 26-35 years (AOR = 0.46, 95%CI: 0.21, 0.98, P = 0.044), Christianity (AOR = 0.32, 95%CI: 0.31, 0.89, P = 0.028.), high wealth (AOR = 0.27, 95%CI: 0.09, 0.83, P = 0.022) and tertiary education (AOR = 0.09, 95%CI:0.02, 0.54, P = 0.009) were associated with decreased odds of AIP. At 36 weeks, booking after first trimester of pregnancy was associated with increased odds (AOR = 1.72, 95%CI: 1.05, 2.84, P = 0.033) whilst high wealth (AOR = 0.44, 95%CI: 0.20, 0.99, P = 0.049), higher age groups-26-35 (AOR = 0.38, 95%CI: 0.21, 0.68, P = 0.001) and 36-49 years (AOR = 0.35, 95%CI: 0.13, 0.90, P = 0.024) and secondary education of spouse were associated with reduced odds (AOR = 0.35, 95%CI: 0.14, 0.88, P = 0.026) of AIP. CONCLUSION AIP consistently increased from registration to 36 weeks of gestation. Given the observed correlates of AIP, we recommend that interventions geared towards early ANC registration, improved household wealth, and improved maternal education are required to reduce AIP.
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Affiliation(s)
- Donatus Nbonibe Abaane
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
- District Nutrition Unit, District Health Directorate, Ghana Health Service, Garu, Ghana
| | - Martin Nyaaba Adokiya
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Gilbert Abotisem Abiiro
- Department of Health Services, Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana
- Department of Population and Reproductive Health, School of Public Health, University for Development Studies, Tamale, Ghana
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25
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ocks LM, Paudyal N, Lundsgaard S, Thapa LB, Joshi N, Mei LZ, Whitehead RD, Jefferds MED. The Prevalence of Anemia in Children Aged 6-23 Months and its Correlates Differ by District in Kapilvastu and Achham Districts in Nepal. Curr Dev Nutr 2023; 7:100063. [PMID: 37180849 PMCID: PMC10164769 DOI: 10.1016/j.cdnut.2023.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
Background Analyses of predictors of anemia or malnutrition often pool national or regional data, which may hide variability at subnational levels. Objectives We sought to identify the risk factors for anemia in young Nepali children aged 6-23 mo in 2 districts: Kapilvastu and Achham. Methods This is an analysis of two cross-sectional surveys that were conducted as part of a program evaluation of an infant and young child feeding and micronutrient powder intervention that included anemia as a primary outcome. Baseline and endline surveys in each district (in 2013 and 2016) included hemoglobin assessments in n = 4709 children who were representative of children 6-23 mo in each district. Log-binomial regression models accounting for the survey design were used to estimate univariable and multivariable prevalence ratios for risk factors at multiple levels-underlying, direct, and biological causes. Average attributable fractions (AFs) for the population were calculated for significant predictor biomarkers of anemia in multivariable models. Results In Accham, the prevalence of anemia was 31.4%; significant predictors included child's age, household asset ownership, length-for-age z-score, inflammation (CRP concentration > 0.5 mg/L; α-1 acid glycoprotein concentration > 1 mg/mL), and iron deficiency (serum ferritin concentration < 12 μg/L with BRINDA-inflammation adjustment). In Kapilvastu, the prevalence of anemia was 48.1%; significant predictors included child's sex and ethnicity, wasting and weight-for-length z-score, any morbidity in the previous 2 wk, consumption of fortified foods, receipt of multiple micronutrient powder distributions, iron deficiency, zinc deficiency (nonfasting serum zinc concentration of <65 μg/dL in the morning and that of <57 μg/dL in the afternoon), and inflammation. In Achham, average AFs were 28.2% and 19.8% for iron deficiency and inflammation, respectively. Average AFs for anemia in Kapilvastu were 32.1%, 4.2%, and 4.9% for iron deficiency, zinc deficiency, and inflammation, respectively. Conclusions The prevalence of anemia and its risk factors varied between districts, with inflammation contributing to a greater share of anemia in Achham than in Kapilvastu. The estimated AF for iron deficiency was around 30% in both districts; iron-delivering interventions and multisectoral approaches to anemia are warranted.
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Affiliation(s)
- Lindsey M. ocks
- Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
- Department of Global Health, School of Public Health, Boston University, Boston, MA, United States
| | - Naveen Paudyal
- Nutrition Section, United Nations Children’s Fund, Kathmandu, Nepal
| | - Sabrina Lundsgaard
- Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Lila Bikram Thapa
- Nutrition Section, Family Welfare Division, Ministry of Health and Population, Kathmandu, Nepal
| | | | - LZuguo Mei
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, Centers of Disease Control and Prevention, Atlanta, GA, United States
| | - Ralph D. Whitehead
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, Centers of Disease Control and Prevention, Atlanta, GA, United States
| | - Maria Elena D. Jefferds
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, Centers of Disease Control and Prevention, Atlanta, GA, United States
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Hess SY, Owais A, Jefferds MED, Young MF, Cahill A, Rogers LM. Accelerating action to reduce anemia: Review of causes and risk factors and related data needs. Ann N Y Acad Sci 2023; 1523:11-23. [PMID: 36987993 PMCID: PMC10918744 DOI: 10.1111/nyas.14985] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Anemia is a major public health concern. Young children, menstruating adolescent girls and women, and pregnant women are among the most vulnerable. Anemia is the consequence of a wide range of causes, including biological, socioeconomic, and ecological risk factors. Primary causes include: iron deficiency; inherited red blood cell disorders; infections, such as soil-transmitted helminthiasis, schistosomiasis, and malaria; gynecological and obstetric conditions; and other chronic diseases that lead to blood loss, decreased erythropoiesis, or destruction of erythrocytes. The most vulnerable population groups in low- and middle-income countries are often at the greatest risk to suffer from several of these causes simultaneously as low socioeconomic status is linked with an increased risk of anemia through multiple pathways. Targeted and effective action is needed to prevent anemia. Understanding the causes and risk factors of anemia for different population subgroups within a country guides the design and implementation of effective strategies to prevent and treat anemia. A coordinated approach across various expert groups and programs could make the best use of existing data or could help to determine when newer and more relevant data may need to be collected, especially in countries with a high anemia burden and limited information on the etiology of anemia.
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Affiliation(s)
- Sonja Y. Hess
- Institute for Global Nutrition and Department of Nutrition, University of California Davis, Davis, California, USA
- Micronutrient Forum, Washington, DC, USA
| | - Aatekah Owais
- Centre for Global Child Health, Hospital for Sick Children on behalf of Exemplars in Global Health, Toronto, Ontario, Canada
| | | | - Melissa F. Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Andrew Cahill
- Gates Ventures on behalf of Exemplars in Global Health, Seattle, Washington, USA
| | - Lisa M. Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
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Azinge IE, Ogunyemi A, Ogamba CF, Jimoh RO. Prevalence of anemia and associated factors among adults in a select population in Lagos, Southwest Nigeria. J Public Health Afr 2023; 14:2224. [PMID: 37347070 PMCID: PMC10280247 DOI: 10.4081/jphia.2023.2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/08/2022] [Indexed: 06/23/2023] Open
Abstract
Background Anemia is a public health problem affecting people in both the developed and developing world and has serious consequences on health. Objective This study determines the prevalence of anemia amongst people of different socioeconomic levels, associated factors, and the prevalence of anemia in populations other than children or pregnant women. Methods This is a descriptive cross-sectional study using a pretested interviewer-administered questionnaire to collect data from 387 residents. A multi-stage random sampling technique was used. Analysis of blood samples using the HemoCue301 system and data analysis using SPSS 20. Chi-square test and binary logistic regression were used to test association and determine predictors of anemia respectively, with P<0.05 considered statistically significant. Results The mean age of respondents was 35±11.8 years, with 28.9% of respondents being anemic. Female respondents (52.7%) were more than male respondents (47.3%). Female respondents (39.2%) had a higher prevalence of anemia than male respondents (17.5%). There was a significant association between sex, level of education, and anemia status. Being female, having no formal education, or only having a primary school level of education were significant predictors of anemia [odds ratio (OR)=2.55; 95% confidence interval (CI)=1.54, 4.23; P=0.00; OR=12.57; 95%CI=2.39, 66.27; P=0.00; and OR=2.54; 95%CI=1.16, 5.58; P=0.02 respectively]. Conclusion There was a higher prevalence of anemia among women, younger people, and those with no or only primary levels of formal education. Awareness programs targeted at women and people with lower levels of education are necessary to reduce the overall prevalence of anemia in this region.
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Affiliation(s)
- Ifeoma Elaine Azinge
- Department of Community Health and Primary Care, College of Medicine, University of Lagos
| | - Adedoyin Ogunyemi
- Department of Community Health and Primary Care, College of Medicine, University of Lagos
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Kanu FA, Jefferds MED, Williams AM, Addo OY, Suchdev PS, Sharma AJ. Association between hemoglobin and elevation among school-aged children: a verification of proposed adjustments. Am J Clin Nutr 2023:S0002-9165(23)46843-8. [PMID: 37059418 DOI: 10.1016/j.ajcnut.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Anemia is defined by a hemoglobin (Hb) concentration lower than normal based on cutoffs specific to age, sex, and pregnancy status. Hemoglobin increases with elevation as an adaptive response to lower blood oxygen saturation, thus, adjusting Hb concentration for elevation is necessary before applying cutoffs. OBJECTIVE Recent evidence among preschool-aged children (PSC) and non-pregnant reproductive-aged women (WRA) suggests that current World Health Organization (WHO) recommended Hb adjustments for elevation need updating. To confirm these findings, we examined the cross-sectional association between Hb and elevation among non-pregnant school-age children (SAC). METHODS Using data from 9 population-based surveys, we examined 26,518 SAC 5-14 years (54.5% female) with data on Hb and elevation (-6 to 3,834 meters, m). We used generalized linear models to assess the association between Hb and elevation under varying conditions, including controlling for inflammation-corrected iron and vitamin A deficiency. Hemoglobin adjustments for each 500 m increase in elevation were estimated for SAC and compared to existing adjustments and those estimated for PSC and WRA. We evaluated the impact of adjustments on anemia prevalence. RESULTS Hemoglobin concentration (g/L) was positively associated with elevation (m). The SAC elevation adjustments were consistent with those reported among PSC and WRA and suggest current recommendations may under-adjust Hb for those residing at lower elevations (<3000 m) and over-adjust Hb for those residing at higher elevations (>3000 m). Among the surveys included, proposed elevation adjustments increased anemia prevalence among SAC by 0 (Ghana, United Kingdom) to 15 (Malawi) percentage points relative to current elevation adjustments. CONCLUSION Results confirm that current recommended Hb adjustments for elevation may need updating, and anemia prevalence in SAC may be higher than currently estimated. Findings will inform the WHO reexamination of global guidelines on the use of Hb adjustments for anemia assessment and may result in improved identification and treatment of anemia.
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Affiliation(s)
- Florence A Kanu
- Nutrition Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA; The U.S. Public Health Service Commissioned Corps, Atlanta, Georgia
| | | | - Anne M Williams
- Nutrition Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA; McKing, Atlanta, GA
| | - O Yaw Addo
- Nutrition Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA
| | - Parminder S Suchdev
- Nutrition Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Pediatrics, Emory University, Atlanta, GA
| | - Andrea J Sharma
- Nutrition Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA; The U.S. Public Health Service Commissioned Corps, Atlanta, Georgia
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Anwar MC, Budiono I, Putriningtyas ND, Nisa AA, Santjaka A, Suswandany DL. The efficacy of Bloso fish (Glossogobius giuris sp.) in improving hemoglobin, hematocrit, platelet, and albumin levels of Wistar rats with hypoalbuminemia. POTRAVINARSTVO 2023. [DOI: 10.5219/1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Tuberculosis (TB) is an infectious disease worldwide that causes death. Common clinical manifestations of patients with TB include anemia, hypoalbuminemia, and malnutrition. Most patients with TB are infected with coccus bacteria, such as Staphylococcus aureus, that commonly attack the respiratory tract. However, the consumption of heme protein sources could improve the nutritional status of patients with TB. Fish comprise one of the most widely consumed sources of heme. The bloso fish (Glossogobius giuris sp.), considered a fish without economic value is a new alternative source of heme protein. This study aimed to develop supplements using bloso fish (Glossogobius giuris sp.). This study used an experimental pretest-post-test control group design. Seven male Wistar rats were used as the negative control group. Twenty- eight male Wistar rats were administered S. aureus, fed a protein-deficient diet, and divided into the positive control group, the K1 group, which received up to 675 mg/200 g of bloso fish flour, the K2 group, which received up to 67.5 mg/200 g of bloso fish oil, and the K3 group, which received up to 675 mg/200 g of bloso fish fluor from oil extraction dregs. Treatment was administered for 28 days. The hemoglobin (Hb), hematocrit (Ht), platelet, and albumin levels in blood serum from the retroorbital vein were measured. Data were processed using a paired t-test and one-way analysis of variance. The results showed differences in Hb, Ht, platelet, and albumin levels were observed before and after treatment. Additionally, differences in Hb, Ht, platelet, and albumin levels were observed in the groups that received bloso fish flour and bloso fish oil. Bloso fish flour and bloso fish oil increased the Hb, Ht, platelet, and albumin levels of rats with hypoalbuminemia.
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Haggenmüller V, Bogler L, Weber AC, Kumar A, Bärnighausen T, Danquah I, Vollmer S. Smartphone-based point-of-care anemia screening in rural Bihar in India. COMMUNICATIONS MEDICINE 2023; 3:38. [PMID: 36949164 PMCID: PMC10033918 DOI: 10.1038/s43856-023-00267-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 03/02/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND The high prevalence of anemia in resource-constrained settings calls for easy-to-use, inexpensive screening tools. The Sanguina Smartphone App, an innovative tool for non-invasive hemoglobin estimation via color-sensitive, algorithm-based analysis of fingernail bed images, was validated in the United States. This study evaluates the performance of the App in a population with different socio-economic, ethnic, demographic and cultural composition in rural Bihar, India. METHODS For 272 mainly adult patients of a private health centre, hemoglobin measurement with the App is compared with the gold standard laboratory blood analysis. For a second sample of 179 children attending pre-schools, hemoglobin measurement with the App is compared to the results of the HemoCue Hb 301, a point-of-care device using a small blood sample, serving as the reference standard for field-based settings. RESULTS The App reaches ±4.43 g/dl accuracy and 0.38 g/dl bias of comparator values in the clinic-based sample, and ±3.54 g/dl and 1.30 g/dl, respectively in the pre-school sample. After retraining the algorithm with the collected data, the validity of the upgraded version is retested showing an improved performance (accuracy of ±2.25 g/dl, bias of 0.25 g/dl), corresponding to the results of the original validation study from the United States. CONCLUSIONS The initial version of the App does not achieve the accuracy needed for diagnosis or screening. After retraining the algorithm, it achieves an accuracy sufficient for screening. The improved version with the potential for further adaptions is a promising easy-to-use, inexpensive screening tool for anemia in resource-constrained point-of-care settings.
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Affiliation(s)
- Verena Haggenmüller
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Lisa Bogler
- Centre for Modern Indian Studies (CeMIS), University of Goettingen, Waldweg 26, 37073, Göttingen, Germany.
| | - Ann-Charline Weber
- Centre for Modern Indian Studies (CeMIS), University of Goettingen, Waldweg 26, 37073, Göttingen, Germany
| | - Abhijeet Kumar
- Centre for Modern Indian Studies (CeMIS), University of Goettingen, Waldweg 26, 37073, Göttingen, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Ina Danquah
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Sebastian Vollmer
- Centre for Modern Indian Studies (CeMIS), University of Goettingen, Waldweg 26, 37073, Göttingen, Germany
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Pacheco MO, Lutz HM, Armada J, Davies N, Gerzenshtein IK, Cakley AS, Spiess BD, Stoppel WL. Silk Fibroin Particles as Carriers in the Development of All-Natural Hemoglobin-Based Oxygen Carriers (HBOCs). BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.01.530637. [PMID: 36909572 PMCID: PMC10002772 DOI: 10.1101/2023.03.01.530637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Oxygen therapeutics have a range of applications in transfusion medicine and disease treatment. Synthetic molecules and all-natural or semi-synthetic hemoglobin-based oxygen carriers (HBOCs) have seen success as potential circulating oxygen carriers. However, many early HBOC products were removed from the market due to side effects from excess hemoglobin in the blood stream and hemoglobin entering the tissue. To overcome these issues, research has focused on increasing the molecular diameter of hemoglobin by polymerizing hemoglobin molecules or encapsulating hemoglobin in liposomal carriers, where immune responses and circulation times remain a challenge. This work looks to leverage the properties of silk fibroin, a cytocompatible and non-thrombogenic biopolymer, known to entrap protein-based cargo, to engineer a silk fibroin-hemoglobin-based oxygen carrier (sfHBOC). Herein, an all-aqueous solvent evaporation technique was used to form silk fibroin particles with and without hemoglobin to tailor the formulation for specific particle sizes. The encapsulation efficiency and ferrous state of hemoglobin were analyzed, resulting in 60% encapsulation efficiency and a maximum of 20% ferric hemoglobin, yielding 100 µg/mL active hemoglobin in certain sfHBOC formulations. The system did not elicit a strong inflammation response in vitro, demonstrating the potential for this particle system to serve as an injectable HBOC.
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Affiliation(s)
- Marisa O Pacheco
- Department of Chemical Engineering, University of Florida, Gainesville FL
| | - Henry M Lutz
- Department of Chemical Engineering, University of Florida, Gainesville FL
| | - Jostin Armada
- Department of Chemical Engineering, University of Florida, Gainesville FL
| | - Nickolas Davies
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville FL
| | | | - Alaura S Cakley
- Department of Chemical Engineering, University of Florida, Gainesville FL
| | - Bruce D Spiess
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville FL
| | - Whitney L Stoppel
- Department of Chemical Engineering, University of Florida, Gainesville FL
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville FL
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Demuyakor ME, Jalal C, Williams AM, Bouckaert KP, Whitehead RD, Bhuiyan MM, Siraj S, Ara R, Pike V, Jefferds MED. Design, Methods, and Select Baseline Results from a School Nutrition Project for Adolescents in Bangladesh. Curr Dev Nutr 2023. [DOI: 10.1016/j.cdnut.2023.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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O’Mahony D, Mabunda SA, Mntonintshi M, Iruedo J, Kaswa R, Blanco-Blanco E, Ogunsanwo B, Namugenyi KAF, Vasaikar S, Yogeswaran P. Causes of Moderate and Severe Anaemia in a High-HIV and TB-Prevalent Adult Population in the Eastern Cape Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3584. [PMID: 36834279 PMCID: PMC9966846 DOI: 10.3390/ijerph20043584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Anaemia affects one in four adults in South Africa, with a higher prevalence in persons with HIV and tuberculosis. The aim of this study is to characterise the causes of anaemia in primary care and a district hospital setting. METHODS A cross-sectional study design investigated a purposive sample of adult males and non-pregnant females at two community health centres and a hospital casualty and outpatients. Fingerpick blood haemoglobin was measured with HemoCueHb201+. Those with moderate and severe anaemia underwent clinical examination and laboratory tests. RESULTS Of 1327 patients screened, median age was 48 years, and 63.5% were female. Of 471 (35.5%) with moderate and severe anaemia on HemoCue, 55.2% had HIV, 16.6% tuberculosis, 5.9% chronic kidney disease, 2.6% cancer, and 1.3% heart failure. Laboratory testing confirmed 227 (48.2%) with moderate and 111 (23.6%) with severe anaemia, of whom 72.3% had anaemia of inflammation, 26.5% iron-deficiency anaemia, 6.1% folate deficiency, and 2.5% vitamin B12 deficiency. Overall, 57.5% had two or more causes of anaemia. Multivariate modelling showed that patients with severe anaemia were three times more likely to have tuberculosis (OR = 3.1, 95% CI = 1.5-6.5; p-value = 0.002). Microcytosis was present in 40.5% with iron deficiency, macrocytosis in 22.2% with folate deficiency, and 33.3% with vitamin B12 deficiency. The sensitivities of the reticulocyte haemoglobin content and % hypochromic red blood cells in diagnosing iron deficiency were 34.7% and 29.7%, respectively. CONCLUSIONS HIV, iron deficiency, and tuberculosis were the most prevalent causes of moderate and severe anaemia. The majority had multiple causes. Iron, folate, and vitamin B12 deficiencies should be identified by biochemical testing rather than by red cell volume.
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Affiliation(s)
- Don O’Mahony
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Sikhumbuzo A. Mabunda
- School of Population Health, University of New South Wales, Sydney 2052, Australia
- George Institute for Global Health, University of New South Wales, Sydney 2042, Australia
- Department of Public Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Mbulelo Mntonintshi
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Joshua Iruedo
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Ramprakash Kaswa
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
| | - Ernesto Blanco-Blanco
- Department of Laboratory Medicine and Pathology, Walter Sisulu University, Mthatha 5100, South Africa
| | - Basil Ogunsanwo
- Department of Surgery, Walter Sisulu University, Mthatha 5117, South Africa
| | | | - Sandeep Vasaikar
- Department of Microbiology, Walter Sisulu University, Mthatha 5117, South Africa
| | - Parimalaranie Yogeswaran
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha 5117, South Africa
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Optimization of the Hemolysis Assay for the Assessment of Cytotoxicity. Int J Mol Sci 2023; 24:ijms24032914. [PMID: 36769243 PMCID: PMC9917735 DOI: 10.3390/ijms24032914] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
In vitro determination of hemolytic properties is a common and important method for preliminary evaluation of cytotoxicity of chemicals, drugs, or any blood-contacting medical device or material. The method itself is relatively straightforward, however, protocols used in the literature vary substantially. This leads to significant difficulties both in interpreting and in comparing the obtained values. Here, we examine how the different variables used under different experimental setups may affect the outcome of this assay. We find that certain key parameters affect the hemolysis measurements in a critical manner. The hemolytic effect of compounds tested here varied up to fourfold depending on the species of the blood source. The use of different types of detergents used for generating positive control samples (i.e., 100% hemolysis) produced up to 2.7-fold differences in the calculated hemolysis ratios. Furthermore, we find an expected, but substantial, increase in the number of hemolyzed erythrocytes with increasing erythrocyte concentration and with prolonged incubation time, which in turn affects the calculated hemolysis ratios. Based on our findings we propose an optimized protocol in an attempt to standardize future hemolysis studies.
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Fothergill A, Crider KS, Johnson CB, Raj MP, Guetterman HM, Bose B, Rose CE, Qi YP, Williams JL, Kuriyan R, Bonam W, Finkelstein JL. Comparison of Anemia Screening Methods Using Paired Venous Samples in Women of Reproductive Age in Southern India. J Nutr 2023; 152:2978-2992. [PMID: 36130238 PMCID: PMC9840000 DOI: 10.1093/jn/nxac218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/28/2022] [Accepted: 09/16/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Anemia is an important public health problem, and accurate estimates may inform policy and programs. Although hemoglobin (Hb) assessment of venous blood via automated hematology analyzers (AHAs) is recommended, most population-based surveys estimate anemia prevalence based on analysis of capillary blood via portable hemoglobinometers. OBJECTIVES We aimed to evaluate screening methods for hemoglobin and anemia assessment using paired venous samples. METHODS Participants were women 15-40 y who were not pregnant or lactating. Paired venous whole blood samples (n = 896) were analyzed for hemoglobin (Hb) via portable hemoglobinometer (HemoCue 301) and Coulter Counter AHA. Anemia and severe anemia were defined as Hb <12.0g/dL and <8.0 g/dL, respectively. Bland-Altman methods were used to assess the level of agreement for Hb results (mean difference, SD of differences, limits of agreement). Diagnostic accuracy parameters (sensitivity, specificity, positive predictive value, negative predictive value, accuracy) were calculated to evaluate HemoCue performance compared to the AHA reference, overall and by sociodemographic, nutritional, and metabolic characteristics. RESULTS The estimated anemia prevalence was significantly lower via HemoCue vs. AHA (36.3% compared with 41.6%; P value < 0.0001). The HemoCue had 84.4% accuracy for anemia screening and 98.8% for severe anemia, compared to the AHA reference. The HemoCue had 74.8% sensitivity and 91.2% specificity, compared to AHA. HemoCue sensitivity was higher in women with iron deficiency [serum ferritin (SF) <15.0 μg/L: 81.6% compared with SF ≥15.0 μg/L: 41.3%], and lower in women with metabolic risk factors, including overweight [BMI ≥25.0 kg/m2: 63.9% vs. BMI <25.0 kg/m2: 78.8%], or elevated CRP (>1.0 mg/L: 67.2% vs. ≤1.0 mg/L: 82.9%), trunk fat (>35%: 62.7% vs. ≤35%: 80.1%), or whole-body fat (>35%: 63.9% vs. ≤35%: 80.3%). CONCLUSIONS Findings suggest that women with anemia may be incorrectly identified as not anemic via portable hemoglobinometer, and anemia prevalence may be underestimated at the population level.This study was registered at clinicaltrials.gov as NCT04048330.
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Affiliation(s)
- Amy Fothergill
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Krista S Crider
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | | | - Mical P Raj
- Arogyavaram Medical Centre, Andhra Pradesh, India
| | | | - Beena Bose
- Division of Nutrition, St. John's Research Institute, Bangalore, India
| | - Charles E Rose
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Yan P Qi
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Jennifer L Williams
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Rebecca Kuriyan
- Division of Nutrition, St. John's Research Institute, Bangalore, India
| | - Wesley Bonam
- Arogyavaram Medical Centre, Andhra Pradesh, India
| | - Julia L Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
- Division of Nutrition, St. John's Research Institute, Bangalore, India
- Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
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Frater JL, Hirsch-Ginsberg C, d'Onofrio G, George TI. Arterial blood as an alternative specimen source for complete blood cell count: More human studies are needed. Int J Lab Hematol 2023; 45:e90-e92. [PMID: 36627166 DOI: 10.1111/ijlh.14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023]
Affiliation(s)
- John L Frater
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Cheryl Hirsch-Ginsberg
- Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Giuseppe d'Onofrio
- Department of Hematology, Catholic University of the Sacred Heart, Rome, Italy
| | - Tracy I George
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Meng Z, Tayyab M, Lin Z, Raji H, Javanmard M. A Smartphone-Based Disposable Hemoglobin Sensor Based on Colorimetric Analysis. SENSORS (BASEL, SWITZERLAND) 2022; 23:394. [PMID: 36616992 PMCID: PMC9823837 DOI: 10.3390/s23010394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Hemoglobin is a biomarker of interest for the diagnosis and prognosis of various diseases such as anemia, sickle cell disease, and thalassemia. In this paper, we present a disposable device that has the potential of being used in a setting for accurately quantifying hemoglobin levels in whole blood based on colorimetric analysis using a smartphone camera. Our biosensor employs a disposable microfluidic chip which is made using medical-grade tapes and filter paper on a glass slide in conjunction with a custom-made PolyDimethylSiloaxane (PDMS) micropump for enhancing capillary flow. Once the blood flows through the device, the glass slide is imaged using a smartphone equipped with a custom 3D printed attachment. The attachment has a Light Emitting Diode (LED) that functions as an independent light source to reduce the noise caused by background illumination and external light sources. We then use the RGB values obtained from the image to quantify the hemoglobin levels. We demonstrated the capability of our device for quantifying hemoglobin in Bovine Hemoglobin Powder, Frozen Beef Blood, and human blood. We present a logarithmic model that specifies the relationship between the Red channel of the RGB values and Hemoglobin concentration.
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Law SM, Hardy R, Anderson D, Small L, Hurley J, Beggs L, Campbell Y, Olsen M, Mancini‐Flegel T, Valentine A, Borowitz MJ, Francischetti IMB. Supply chain disruptions due to the SARS-CoV-2 pandemic lead to an unusual preanalytical error in measuring hemoglobin concentration in a large medical center. EJHAEM 2022; 4:JHA2626. [PMID: 36718355 PMCID: PMC9877861 DOI: 10.1002/jha2.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Samuel M. Law
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Rochelle Hardy
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Danna Anderson
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Lona Small
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Jennifer Hurley
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Leon Beggs
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Yanka Campbell
- Johns Hopkins Medical InstitutionsSidney Kimmel Comprehensive Cancer Center at Johns HopkinsBaltimoreMaryland
| | - MiKaela Olsen
- Johns Hopkins Medical InstitutionsSidney Kimmel Comprehensive Cancer Center at Johns HopkinsBaltimoreMaryland
| | - Tina Mancini‐Flegel
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Al Valentine
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Michael J. Borowitz
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMaryland
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De la Cruz-Góngora V, Méndez-Gómez-Humarán I, Gaona-Pineda EB, Shamah-Levy T, Dary O. Drops of Capillary Blood Are Not Appropriate for Hemoglobin Measurement with Point-of-Care Devices: A Comparative Study Using Drop Capillary, Pooled Capillary, and Venous Blood Samples. Nutrients 2022; 14:nu14245346. [PMID: 36558505 PMCID: PMC9786209 DOI: 10.3390/nu14245346] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Population-based surveys matched by time but using different methodologies for determining hemoglobin (Hb) concentration have shown inconsistencies in estimating anemia prevalence. This study aimed to estimate measurement errors in Hb quantification in HemoCue 201+ using venous blood (VB) and capillary blood both drops (DCB) and pools (PCB), and compare the results against those of a reference method (VB analyzed in hematology analyzers based on the cyanmethemoglobin method). Children (n = 49), adult females (n = 50), and older adults (n = 50) were randomly allocated to donate VB (4 mL) and either DCB (three drops) or PCB (350 µL). Results in HemoCue were analyzed through Bland Altman and Lyn's concordance against Hb concentration by the reference method. A positive average bias (systematic error) was found for the HemoCue (0.31 g/dL) using the same VB samples. This value was then subtracted from all readings carried out in the device. After this adjustment, DCB still produced a positive bias (0.42 ± 0.81 g/dL), and the variation of single results was ±1.6 g/dL (95% CI). PCB and VB performed similarly; the average bias was negligible (-0.02 ± 0.36 and 0.00 ± 0.33 g/dL, respectively) and the variation of the results (95% CI) was ±0.7 g/dL or lower. Lyn's concordance values were 0.86, 0.96, and 0.98 for DCB, PCB, and VB, respectively. Random variation using DCB is too large to approximate the true Hb values, and therefore DCB should be discontinued for diagnosing anemia both in individuals and in populations.
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Affiliation(s)
- Vanessa De la Cruz-Góngora
- Centre for Evaluation and Survey Research, National Institute of Public Health, Cuernavaca 62100, Mexico
| | | | - Elsa Berenice Gaona-Pineda
- Centre for Evaluation and Survey Research, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Teresa Shamah-Levy
- Centre for Evaluation and Survey Research, National Institute of Public Health, Cuernavaca 62100, Mexico
- Correspondence: ; Tel.: +52-777-329300 (ext. 7223)
| | - Omar Dary
- Bureau for Global Health, USAID, Washington, DC 20523, USA
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Stawschenko E, Schaller T, Kern B, Bode B, Dörries F, Kusche-Vihrog K, Gehring H, Wegerich P. Current Status of Measurement Accuracy for Total Hemoglobin Concentration in the Clinical Context. BIOSENSORS 2022; 12:1147. [PMID: 36551114 PMCID: PMC9775510 DOI: 10.3390/bios12121147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The main objective of this investigation is to provide data about the accuracy of total hemoglobin concentration measurements with respect to clinical settings, and to devices within the categories of point-of-care and reference systems. In particular, tolerance of hemoglobin concentrations below 9 g/dL that have become common in clinical practice today determines the need to demonstrate the limits of measurement accuracy in patient care. METHODS Samples extracted from six units of heparinized human blood with total hemoglobin concentrations ranging from 3 to 18 g/dL were assigned to the test devices in a random order. The pool of test devices comprised blood gas analyzers, an automatic hematology analyzer, a laboratory reference method, and the point-of-care system HemoCue. To reduce the pre-analytic error, each sample was measured three times. Due to the characteristics of the tested devices and methods, we selected the mean values of the data from all these devices, measured at the corresponding total hemoglobin concentrations, as the reference. MAIN RESULTS The measurement results of the test devices overlap within strict limits (R2 = 0.999). Only the detailed analysis provides information about minor but systematic deviations. In the group of clinically relevant devices, which are involved in patient blood management decisions, the relative differences were within the limit of +/- 5 % for values down to 3 g/dL. CONCLUSIONS A clinically relevant change of +/- 0.5 g/dL of total hemoglobin concentration can be detected with all selected devices and methods. Compliance with more stringent definitions-these are the relative differences of 5 % in relation to the corresponding reference values and the clinically adapted thresholds in the format of a tolerance level analysis-was achieved by the clinical devices assessed here.
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Affiliation(s)
- Elena Stawschenko
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, 23538 Luebeck, Germany
| | - Tim Schaller
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, 23538 Luebeck, Germany
- Institute of Biomedical Engineering, University of Luebeck, 23562 Luebeck, Germany
| | - Benjamin Kern
- Medical Sensors and Devices Laboratory, Lübeck University of Applied Sciences, 23562 Luebeck, Germany
| | - Berit Bode
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, 23538 Luebeck, Germany
| | - Frank Dörries
- Northern Scientific Tec & Integration GmbH, Kollaustr. 11-13, 22525 Hamburg, Germany
| | | | - Hartmut Gehring
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, 23538 Luebeck, Germany
| | - Philipp Wegerich
- Institute of Biomedical Engineering, University of Luebeck, 23562 Luebeck, Germany
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Killilea DW, Kuypers FA, Larkin SK, Schultz K. Blood draw site and analytic device influence hemoglobin measurements. PLoS One 2022; 17:e0278350. [PMID: 36449486 PMCID: PMC9710840 DOI: 10.1371/journal.pone.0278350] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Anemia is a continuing global public health concern and a priority for international action. The prevalence of anemia is estimated from the hemoglobin (Hb) levels within target populations, yet the procedures for measuring Hb are not standardized and different approaches may result in discrepancies. Several analytical variables have been proposed to influence Hb measurements, but it is difficult to understand the impact on specific variables from large population or field studies. Therefore, we designed a highly controlled protocol that minimized most technical parameters to specifically investigate the impact of blood draw site and analytic device on Hb measurements. A diverse cohort of sixty healthy adults each provided a sequential capillary and venous blood sample that were measured for Hb using an automated hematology analyzer (ADVIA-2120) and two point-of-care devices (HemoCue 201+ and HemoCue 301). Comparing blood draw sites, the mean Hb content was 0.32-0.47 g/dL (2-4%) higher in capillary compared to venous blood from the same donors. Comparing different Hb measuring instruments, the mean Hb content was 0.19-0.46 g/dL (1-4%) higher measured with HemoCue devices compared to ADVIA-2120 in both capillary and venous blood from the same donors. The maximum variance in measurement was also higher with HemoCue devices using blood from venous (5-6% CV) and capillary (21-25% CV) sites compared to ADVIA-2120 (0.6-2% CV). Other variables including blood collection tube manufacturer did not affect mean Hb content. These results demonstrate that even when most technical variables are minimized, the blood draw site and the analytical device can have a small but statistically significant effect on the mean and dispersion of Hb measurements. Even in this study, the few participants identified as mildly anemic using venous blood measured by ADVIA-2120 would not have been classified as anemic using their capillary blood samples or point-of-care analyzers. Thus, caution is warranted when comparing Hb values between studies having differences in blood draw site and Hb measuring device. Future anemia testing should maintain consistency in these analytical variables.
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Affiliation(s)
- David W. Killilea
- Office of Research, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Frans A. Kuypers
- Division of Hematology, Department of Pediatrics, University of California San Francisco, San Francisco, California, United States of America
| | - Sandra K. Larkin
- Division of Hematology, Department of Pediatrics, University of California San Francisco, San Francisco, California, United States of America
| | - Kathleen Schultz
- Office of Research, University of California San Francisco, San Francisco, California, United States of America
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Stevens GA, Flores-Urrutia MC, Rogers LM, Paciorek CJ, Rohner F, Namaste S, Wirth JP. Associations between type of blood collection, analytical approach, mean haemoglobin and anaemia prevalence in population-based surveys: A systematic review and meta-analysis. J Glob Health 2022; 12:04088. [PMID: 36412108 PMCID: PMC9682214 DOI: 10.7189/jogh.12.04088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Previous studies have observed that haemoglobin concentrations can be affected by type of blood collection, analysis methods and device, and that near-in-time population-based surveys report substantially different anaemia prevalence. We investigated whether differences in mean haemoglobin or prevalence of anaemia between near-in-time surveys of the same population were associated with differences in type of blood collection or analytic approach to haemoglobin measurement. Methods We systematically identified pairs of population-based surveys that measured haemoglobin in the same population of women of reproductive age (WRA) or preschool-aged children (PSC). Surveys were matched on geographic coverage, urban/rural place of residence, inclusion of pregnant women, time of data collection (within 18 months), and, to the extent feasible, age range. Differences in anaemia prevalence were presented graphically. Random-effects meta-analysis and meta-regression of difference in mean haemoglobin were carried out, with subgroups defined by comparison of type of blood collection and analytic approach within each survey pair. Results We included 23 survey pairs from 17 countries for PSC and 17 survey pairs from 11 countries for WRA. Meta-regression indicates that surveys measuring haemoglobin with HemoCue® Hb 301 found higher haemoglobin concentrations than near-in-time surveys using HemoCue® Hb 201+ in non-pregnant women ((NPW); 5.8 g/L (95% confidence interval (CI) = 3.2-8.3) mean difference, n = 5 pairs) and PSC (4.3 g/L (1.4-7.2), n = 6). Surveys collecting venous blood found higher haemoglobin concentrations than near-in-time surveys collecting capillary blood in PSC (3.8 g/L (0.8-6.7), n = 8), but not NPW (0.4 g/L (-1.9-2.8), n = 9). Conclusions Because this study is observational, differences in haemoglobin concentrations in near-in-time surveys may be caused by other factors associated with choice of analytic approach or type of blood collected. The source or sources of differences should be clarified to improve use of surveys to prioritize and evaluate public health programs. Registration PROSPERO CRD42022296553.
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Affiliation(s)
- Gretchen A Stevens
- Independent Researcher, Los Angeles, California, USA
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | | | - Lisa M Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | | | | | - Sorrel Namaste
- The DHS Program, ICF International, Rockville, Maryland, USA
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Liu R, Pitruzzello G, Rosa M, Battisti A, Cerri C, Tortora G. Towards an Innovative Sensor in Smart Capsule for Aerial Drones for Blood and Blood Component Delivery. MICROMACHINES 2022; 13:1664. [PMID: 36296017 PMCID: PMC9611978 DOI: 10.3390/mi13101664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Aerial drone technology is currently being investigated worldwide for the delivery of blood components. Although it has been demonstrated to be safe, the delivered medical substances still need to be analyzed at the end of the flight mission to assess the level of haemolysis and pH prior to the use in a patient. This process can last up to 30 min and prevent the time saved using drone delivery. Our study aims to integrating an innovative sensor for the haemolysis and pH detection into the Smart Capsule, an already demonstrated technology capable of managing transfusion transport through drones. In the proposed scenario, the haemolysis is evaluated optically by a minilysis device using LED-photodetector combination. The preliminary validation has been demonstrated for both the thermal stability of the Smart Capsule and the haemolysis detection of the minilysis device prototype. Firstly, the onboard temperature test has shown that the delivery system is capable of maintaining proper temperature, even though the samples have been manipulated to reach a higher temperature before inserting into the Smart Capsule. Then, in the laboratory haemolysis test, the trend of linear regression between the outputs from the spectrophotometer and the minilysis prototype confirmed the concept design of the minilysis device.
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Affiliation(s)
- Rongrong Liu
- BioRobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Giorgio Pitruzzello
- BioRobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Smart Medical Theatre Laboratory, ABzero, 56124 Pisa, Italy
| | - Mafalda Rosa
- BioRobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Antonella Battisti
- Istituto Nanoscienze—CNR and Scuola Normale Superiore, 56127 Pisa, Italy
| | - Chiara Cerri
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy
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Scott S, Lahiri A, Sethi V, de Wagt A, Menon P, Yadav K, Varghese M, Joe W, Vir SC, Nguyen PH. Anaemia in Indians aged 10–19 years: Prevalence, burden and associated factors at national and regional levels. MATERNAL & CHILD NUTRITION 2022; 18:e13391. [PMID: 35719126 PMCID: PMC9480897 DOI: 10.1111/mcn.13391] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Samuel Scott
- International Food Policy Research Institute New Delhi India
| | - Anwesha Lahiri
- MRC Epidemiology Unit, Institute of Metabolic Science University of Cambridge School of Clinical Medicine Cambridge UK
- Population Research Centre, Institute of Economic Growth New Delhi India
| | - Vani Sethi
- Nutrition Division, UNICEF New Delhi India
| | | | - Purnima Menon
- International Food Policy Research Institute New Delhi India
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences New Delhi India
| | | | - William Joe
- Population Research Centre, Institute of Economic Growth New Delhi India
| | - Sheila C. Vir
- Public Health Nutrition and Development Centre New Delhi India
| | - Phuong Hong Nguyen
- International Food Policy Research Institute Washington District of Columbia USA
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Abu-Sulb A, Al-Najjar R, Maghnam R, Ashhab A. Acid-suppressive therapy among infants and risk of anemia at 12 months of age. SAGE Open Med 2022; 10:20503121221123117. [PMID: 36105547 PMCID: PMC9465608 DOI: 10.1177/20503121221123117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Numerous studies have shown that links exist between exposure to acid
suppression among adults and nutritional deficiencies, especially vitamin
B12 and iron. While the use of acid suppression among children and infants
is common, nutritional deficiency remains a concern but does not have
numerous studies to support it. We conducted a cohort study to examine this
concern; the hypothesis we proposed is that acid-suppressive therapy (AST)
during infancy is linked to anemia in the first year of life. Methods: This retrospective cohort study included infants born between 2017 and 2018
who visited Legacy Community Health. The inclusion criteria were exposure to
acid suppression for a minimum of 1 month and a hemoglobin reading at
12–15 months. Infants who had hemoglobinopathies, failure to thrive, or
malabsorption syndromes were excluded. Mean hemoglobin was calculated, and
student’s t-test was applied to find statistical
differences between the two groups. Change in weight before and after
treatment was recorded. Occurrence of respiratory and gastroenterological
adverse events was recorded in the exposed group. Results: Overall, 135 exposed infants were identified 135 controls were selected. The
majority of the sample included Hispanic girls. Ranitidine was the most
commonly prescribed medicine. The duration of treatment was 3 months. Weight
improved significantly at termination of the treatment. There was no
significant difference between the hemoglobin level of cases and controls,
and both were not considered anemic. Conclusion: AST was not linked to anemia, despite the slightly lower hemoglobin in some
cases. There were few weaknesses in our study; therefore, further studies
can examine this link by focusing further on medication type and close
follow-up. We found that although proton pump inhibitors are considered the
first line of treatment, histamine-2 receptor antagonists were more
frequently prescribed. Strategies to familiarize general pediatricians with
the NSAPGHAN guidelines might be needed.
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Affiliation(s)
- Ahmad Abu-Sulb
- Division of Pediatrics, Legacy Community Health, Houston, TX, USA
| | - Rawan Al-Najjar
- Division of Neonatology, Baylor College of Medicine, Houston, TX, USA
| | - Rama Maghnam
- Department of Pediatrics, Monmouth Medical Center, Long Branch, NJ, USA
| | - Ashraf Ashhab
- Division of Digestive & Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Oğuz O, Serin H, Hocaoğlu FS. Evaluation of Hemoglobin and Hematocrit Values by the COOximetry and Cyanide-Free Sodium Lauryl Sulphate Methods: A Retrospective Study. ISTANBUL MEDICAL JOURNAL 2022. [DOI: 10.4274/imj.galenos.2022.92845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Finkelstein JL, Fothergill A, Guetterman HM, Johnson CB, Bose B, Qi YP, Rose CE, Williams JL, Mehta S, Kuriyan R, Bonam W, Crider KS. Iron status and inflammation in women of reproductive age: A population-based biomarker survey and clinical study. Clin Nutr ESPEN 2022; 49:483-494. [PMID: 35623855 PMCID: PMC10878764 DOI: 10.1016/j.clnesp.2022.02.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/18/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Women of reproductive age (WRA) are at increased risk for anemia and iron deficiency. However, there is limited population-level data in India, which could help inform evidence-based recommendations and policy. AIMS To conduct a population-based biomarker survey of anemia, iron deficiency, and inflammation in WRA in Southern India. METHODS Participants were WRA (15-40 y) who were not pregnant or lactating. Blood samples (n = 979) were collected and analyzed for hemoglobin (Hb), serum ferritin (SF), soluble transferrin receptor (sTfR), C-reactive protein (CRP), and alpha-1 acid glycoprotein (AGP). Anemia and severe anemia were defined as Hb < 12.0 and < 8.0 g/dL. Serum ferritin was adjusted for inflammation using BRINDA methods. Iron deficiency was defined as SF <15.0 μg/L, iron insufficiency was defined as SF < 20.0 and < 25.0 μg/L, and iron deficiency anemia was defined as Hb < 12.0 g/dL and SF < 15.0 μg/L. Inflammation was defined as CRP > 5.0 mg/L or AGP > 1.0 g/L. Restricted cubic spline regression models were also used to determine if alternative SF thresholds should be used t to classify iron deficiency. RESULTS A total of 41.5% of WRA had anemia, and 3.0% had severe anemia. Findings from spline analyses suggested a SF cut-off of < 15.0 μg/L, consistent with conventional cut-offs for iron deficiency. 46.3% of WRA had SF < 15.0 μg/L (BRINDA-adjusted: 61.5%), 55.0% had SF < 20.0 μg/L (72.7%), 61.8% had SF < 25.0 μg/L (81.0%), and 30.0% had IDA (34.5%). 17.3% of WRA had CRP > 5.0 mg/L and 22.2% had AGP > 1.0 g/L. The prevalence of ID (rural vs. urban: 49.1% vs. 34.9%; p = 0.0004), iron insufficiency (57.8% vs. 43.8%; p = 0.0005), and IDA (31.8% vs. 22.4%; p = 0.01) were significantly higher in rural areas, although CRP levels were lower and there were no differences in elevated CRP or AGP. CONCLUSIONS The burden of anemia and iron deficiency in this population was substantial, and increased after adjusting for inflammation, suggesting potential to benefit from screening and interventions. REGISTRATION NUMBER NCT04048330.
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Affiliation(s)
- Julia L Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca NY, USA; Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA; Institute for Nutritional Sciences, Global Health, and Technology, Cornell University, Ithaca, NY, USA; St. John's Research Institute, Bangalore, Karnataka, India.
| | - Amy Fothergill
- Division of Nutritional Sciences, Cornell University, Ithaca NY, USA
| | | | | | - Beena Bose
- St. John's Research Institute, Bangalore, Karnataka, India
| | - Yan Ping Qi
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Charles E Rose
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer L Williams
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca NY, USA; Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA; Institute for Nutritional Sciences, Global Health, and Technology, Cornell University, Ithaca, NY, USA
| | | | - Wesley Bonam
- Arogyavaram Medical Centre, Andhra Pradesh, India
| | - Krista S Crider
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Vitali L, Raffi M, Piras A. Acute Cardiovascular and Metabolic Effects of Different Warm-Up Protocols on Dynamic Apnea. J Sports Sci Med 2022; 21:298-307. [PMID: 35719233 PMCID: PMC9157517 DOI: 10.52082/jssm.2022.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/22/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to evaluate the acute physiological response to different warm-up protocols on the dynamic apnea performance. The traditional approach, including a series of short-mid dives in water (WET warm-up), was compared to a more recent strategy, consisting in exercises performed outside the water (DRY warm-up). Nine athletes were tested in two different sessions, in which the only difference was the warm-up executed before 75m of dynamic apnea. Heart rate variability, baroreflex sensitivity, hemoglobin, blood lactate and the rate of perceived exertion were recorded and analyzed. With respect to WET condition, DRY showed lower lactate level before the dive (1.93 vs. 2.60 mmol/L, p = 0.006), higher autonomic indices and lower heart rate during the subsequent dynamic apnea. A significant correlation between lactate produced during WET with the duration of the subsequent dynamic apnea, suggests that higher lactate levels could affect the dive performance (72 vs. 70 sec, p = 0.028). The hemoglobin concentration and the rate of perceived exertion did not show significant differences between conditions. The present findings partially support the claims of freediving athletes who adopt the DRY warm-up, since it induces a more pronounced diving response, avoiding higher lactate levels and reducing the dive time of a dynamic apnea.
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Affiliation(s)
- Luca Vitali
- Department for Life Quality Studies, University of Bologna, Italy
| | - Milena Raffi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Alessandro Piras
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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Leidman E, Doocy S, Heymsfield G, Sebushishe A, Mbong EN, Majer J, Bollemeijer I. Risk factors for hospitalisation and death from COVID-19: a prospective cohort study in South Sudan and Eastern Democratic Republic of the Congo. BMJ Open 2022; 12:e060639. [PMID: 35584876 PMCID: PMC9118359 DOI: 10.1136/bmjopen-2021-060639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/11/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Our study described demographic characteristics, exposures and symptoms, and comorbidities to evaluate risk factors of hospitalisation and mortality among cases in Juba, South Sudan (SSD) and North and South Kivu in eastern Democratic Republic of the Congo (DRC). DESIGN Prospective observational cohort of COVID-19 cases. METHODS Individuals presenting for care at one of five study facilities in SSD (n=1) or DRC (n=4) or referred from home-based care by mobile medical teams between December 2020 and June 2021 were eligible for enrolment. Demographic characteristics, COVID-19 exposures, symptoms at presentation, as well as acute and chronic comorbidities, were evaluated using a standard questionnaire at enrolment. Disease progression was characterised by location of care using mixed-effects regression models. RESULTS 751 individuals were eligible for enrolment. Among cases followed to discharge or death (n=519), 375 were enrolled outpatients (75.7%). A similar number of cases were enrolled in DRC (n=262) and SSD (n=257). Overall mortality was 4.8% (95% CI: 3.2% to 6.9%); there were no outpatient deaths. Patients presenting with any symptoms had higher odds of hospitalisation (adjusted OR (AOR) 2.78, 95% CI 1.47 to 5.27) and all deaths occurred among symptomatic individuals. Odds of both hospitalisation and mortality were greatest among cases with respiratory symptoms; presence of low oxygen levels on enrolment was strongly associated with both hospitalisation (AOR 7.77, 95% CI 4.22 to 14.29) and mortality (AOR 25.29, 95% CI 6.42 to 99.54). Presence of more than one chronic comorbidity was associated with 4.96 (95% CI 1.51 to 16.31) times greater odds of death; neither infectious comorbidities evaluated, nor malnutrition, were significantly associated with increased mortality. CONCLUSIONS Consistent with prior literature, older age, low oxygen level, other respiratory symptoms and chronic comorbidities were all risk factors for mortality. Patients presenting with these characteristics were more likely to be hospitalised, providing evidence of effective triage and referral. TRIAL REGISTRATION NUMBER NCT04568499.
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Affiliation(s)
- Eva Leidman
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shannon Doocy
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Grace Heymsfield
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Eta Ngole Mbong
- International Medical Corps, Kinshasa, The Democratic Republic of the Congo
| | - Jennifer Majer
- International Medical Corps, Santa Monica, California, USA
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Oumer A, Abebe T, Hassan K, Hamza A. Validity and Predictive Performance of Mini Nutritional Assessment Tool for Institutionalized Elders in Ethiopia. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6764657. [PMID: 35445139 PMCID: PMC9015874 DOI: 10.1155/2022/6764657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/21/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022]
Abstract
Background Despite the high burden of malnutrition in the country, there is a lack of a simple and valid tool to screen elders in Ethiopia. The Mini Nutritional Assessment (MNA) tool has been validated for comprehensive geriatric assessment to identify malnutrition in other countries. However, there is a lack of evidence on the potential validity and reliability of the tool for institutionalized elders in Ethiopia. This study was aimed at determining the validity and predictive performance of MNA tool for malnutrition among Ethiopian institutionalized elderly. Methods A facility-based survey was conducted on randomly selected 164 elders in geriatric centers to evaluate the validity, reliability, and predictive performance of full MNA against hemoglobin (Hgb) and ideal body weight (IBW) measured under standard procedures. The data was presented in ROC graphs, and reliability was evaluated with Cronbach alpha. The receiver-operating characteristic curve (ROC) analysis was used to assess the predictive performance of the tool. The area under the curve (AUC) with its 95% CI was reported. The Youden index, at maximum sensitivity and specificity, was used to obtain optimal cutoff points. Results The internal consistency of the tool was good (α = 0.80). The full MNA score can better predict Hgb (AUC = 0.845; 0.783-0.899) and percentage of IBW (AUC = 0.90; 0.842-0.941) at specified cutoff points. A full MNA can predict malnutrition or risk of malnutrition based on percentage IBW at a sensitivity and specificity of 97.3% and 72.2%, respectively. Conclusions The full MNA has the potential to be a reliable and valid nutritional assessment tool for institutional elders.
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Affiliation(s)
- Abdu Oumer
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Tariku Abebe
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Kalkidan Hassan
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Jimma University, Jimma, Ethiopia
| | - Aragaw Hamza
- Department of Anesthesia, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
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