Basic Approach to Prevalence of Iron-Deficiency Anemia among Pregnant Women and Children in South Florida before 2003

Obviously iron deficiency is determined as the most prevalent nutritional problem in the world today. It is provoked by a lack of iron in the diet. In South Florida, since pregnant women tend to neglect prenatal care, the prevalence of anemia primarily occurs during the first and second trimesters of their pregnancy. Accordingly, medical studies show that premature deliveries, low birth weight, birth defects, infant mortality, etc. result from iron deficiency anemia. In this, birth defects are, however, considered as quite associated with folic acid deficiency anemia. That explains why, this paper also deals with the study published by the March of Dimes on folic acid and pregnancy. In addition, the paper approaches qualitatively the socioeconomic and sociocultural aspects of the disease according to eight (8) interviews conducted in Broward and Miami Date counties to highlight the existing preventive programs for vulnerable population such as women, infants and children in South Florida, USA.

Fatores Maternos associados à ocorrência de Mielomeningocele: Uma Revisão Bibliográfica / Maternal Factors Associated with the Occurrence of Myelomeningocele: A Literature Review

Resumo- A mielomeningocele configura um defeito primário do tubo neural mais comum, tal defeito constitui uma das malformações congênitas mais graves do recém-nascido, uma vez que o sistema nervoso central tem início em um tubo que se desenvolve nas estruturas mais complexas do corpo humano. O defeito pode ocorrer na sua porção cranial, resultando em malformações como anencefalia e encefalocele ou na porção caudal resultando em malformações que em grupo são conhecidas como espinha bífida. A mielomeningocele é classificada como espinha bífida aberta e ocorre nas primeiras quatro semanas de gestação. O objetivo deste estudo foi identificar na literatura fatores maternos associados ao aparecimento da mielomeningocele. A coleta de dados foi realizada em outubro a novembro de 2021, nas bases de dados SciELO, Google acadêmico e BVS – Brasil utilizando as palavras chaves: “mielomeningocele”, “malformação tubo neural” e “fatores maternos”, sendo necessária também a pesquisa em livros específicos, constituindo uma amostra de 13 publicações. A deficiência de ácido fólico destacou-se como principal fator materno associado à ocorrência da mielomeningocele; além da ingestão materna de anticonvulsivantes, ingestão de fármacos antagonistas do ácido fólico, doenças como o diabetes e a obesidade, deficiência de zinco, baixas condições socioeconômicas e influências perturbadoras como a irradiação e a hipertermia materna. Conclui-se que medidas públicas no combate aos fatores maternos preveníveis são necessárias, uma vez que a mielomeningocele é uma patologia limitante, complexa, com impacto na qualidade de vida dos pacientes e de seus familiares além de requerer equipe especializada e multidisciplinar.Palavras-Chave: Mielomeningocele; Malformações; Espinha bífida. Abstract- Myelomeningocele is a primary defect of the most common neural tube, this defect is one of the most serious congenital malformations in newborns, since the central nervous system starts in a tube that develops in the most complex structures of the human body. The defect can occur in its cranial portion, resulting in malformations such as anencephaly and encephalocele, or in the caudal portion, resulting in malformations that, in group, are known as spina bifida. Myelomeningocele is classified as open spina bifida and occurs within the first four weeks of pregnancy. The aim of this study was to identify maternal factors associated with the onset of myelomeningocele in the literature. Data collection was carried out from October to November 2021, in the SciELO, Google Academic and BVS – Brazil databases using the keywords: “myelomeningocele”, “neural tube malformation” and “maternal factors”, also requiring the research in specific books, constituting a sample of 13 publications. Folic acid deficiency stood out as the main maternal factor associated with the occurrence of myelomeningocele; in addition to maternal intake of anticonvulsants, intake of drugs that are antagonists to folic acid, diseases such as diabetes and obesity, zinc deficiency, low socioeconomic conditions and disturbing influences such as radiation and maternal hyperthermia. It is concluded that public measures to combat preventable maternal factors are necessary, since myelomeningocele is a limiting and complex pathology, with an impact on the quality of life of patients and their families, in addition to requiring a specialized and multidisciplinary team.Keywords: Myelomeningocele. Malformations. Spina bifida.

Basic Approach to Prevalence of Iron-Deficiency Anemia among Pregnant Women and Children in South Florida before 2003

Obviously iron deficiency is determined as the most prevalent nutritional problem in the world today. It is provoked by a lack of iron in the diet. In South Florida, since pregnant women tend to neglect prenatal care, the prevalence of anemia primarily occurs during the first and second trimesters of their pregnancy. Accordingly, medical studies show that premature deliveries, low birth weight, birth defects, infant mortality, etc. result from iron deficiency anemia. In this, birth defects are, however, considered as quite associated with folic acid deficiency anemia. That explains why, this paper also deals with the study published by the March of Dimes on folic acid and pregnancy. In addition, the paper approaches qualitatively the socioeconomic and sociocultural aspects of the disease according to eight (8) interviews conducted in Broward and Miami Date counties to highlight the existing preventive programs for vulnerable population such as women, infants and children in South Florida, USA.

Formulation and Evaluation of Liposomal Drug Delivery System for Sulfasalazine

Aim: Aim of the current study is to prepare and characterize sulfasalazine-loaded liposomes to improve the bioavailability of the drug and to lessen the adverse effects of the drug. Background: Diseases like inflammatory bowel disease can be treated by anti-inflammatory agents like “Sulfasalazine,” It can also be used to treat ulcerative colitis and Crohn’s disease. The biological half-life of sulfasalazine is 5-10hr; as in the case of conventional therapy, there is a chance of missing the dose. Therefore, frequent administration of drugs is essential to maintain the desired steady-state level. The side effects are thrombocytopenia, megaloblastic anemia, bone marrow depression, folic acid deficiency, impairment of male fertility (Oligospermia), intestinal nephritis due to 5-ASA, diarrhoea, headache, and skin rashes. The bioavailability of sulfasalazine is 15%. This work was undertaken to enhance bioavailability and decrease the side effects. Objective: The main objective of the study is to improve the solubility of sulfasalazine by formulating a liposomal drug delivery system. The major objective is to develop a liposomal formulation with good stability and the highest entrapment efficiency. Methods: Liposomes were produced by the thin-film hydration method. Nine formulations of liposomes were prepared by varying the concentrations of soya lecithin and cholesterol and changing the drug ratio. The obtained liposomes were characterized for surface morphology, FTIR, particle size, zeta potential, drug content, entrapment efficiency, and in-vitro diffusion studies. Results: Among the nine formulations of liposomes, F3 was found to be the best formulation with an entrapment efficiency of 97.8% and a zeta potential value of -37.2mV. Liposomes followed first-order kinetics with a non-fickian diffusion pathway. Conclusions: Sulfasalazine loaded liposomes were prepared with good stability and the highest entrapment efficiency.

Role of Surgical Intervention in Hereditary Spherocytosis with Haemolytic Anaemia, Splenomegaly and Jaundice

haemolytic anaemia, splenomegaly and jaundice, admitted in Chettinad hospital and research institute during one year period from January 2019 to January 2020. Surgical intervention is indicated for selected patients with hereditary spherocytosis with haemolytic anaemia and jaundice to abate the hemolytic process after correction of anaemia with blood transfusion. Pigmented gallstones are seen in more than 50% cases for which incidence increases with severity of hemolysis and with age. Complications include aplastic anemia (most common after parvovirus B19 infection), haemolytic crisis during inter-current infection, megaloblastic crisis – during folic acid deficiency, cardiomyopathy, hematological malignancies.

A case of anencephaly in an Unbooked Primipara diagnosed at 35 weeks gestation

Background: Anencephaly is a rare but lethal congenital anomaly of the neural tube. Ideally, the diagnosis is made early in pregnancy and the pregnancy is usually terminated. This is to prevent avoidable complications during pregnancy and childbirth as well as the accompanying psychological trauma from late intrauterine foetal death or death during the neonatal period. Objective: To report a case of anencephaly in an unbooked primipara at 35 weeks gestation. Methods: The case note of the patient and how she was managed were reviewed. A relevant review of the literature on the subject was also done. Case report: Mrs A.N was a 22year old unbooked G3P1+1 who was referred to the Rivers State University Teaching Hospital (RSUTH) on the 4th of September, 2021 with a three-day history of bleeding per vaginam and an ultrasound scan report of an absent cranium and club foot at 35weeks gestation. She resided in a rural area and was on herbal medication in the index pregnancy. She did not receive routine antenatal medications and had no family history of congenital malformations. She had an induction of labour at presentation and delivered a severely asphyxiated male anencephalic baby weighing 2.0kg. The baby died 9minutes after delivery. Conclusion: Anencephaly is a lethal anomaly that is associated with folic acid deficiency. Despite available diagnostic tools, most women in rural areas lack access to antenatal care and will have a late diagnosis and increased morbidity. Thus, there is a need to improve access to antenatal care for women in rural communities, as well as supplement food with folic acid for women in the reproductive age group.

A Review on Metformin: Clinical Significance and Side Effects

Metformin is a biguanide that has been used extensively worldwide for the treatment of type II diabetes mellitus. It improves glycaemic control by enhancing insulin sensitivity in liver and muscle. An advantage of metformin treatment is the tendency of weight reduction and the absence of significant hypoglycaemia; blood glucose levels are reduced only to normal as it does not stimulate insulin secretion. Metformin also has a beneficial effect on several cardiovascular risk factors including dyslipidemia, elevated plasminogen activator inhibitor 1 levels, other fibrinolytic abnormalities, hyperinsulinemia, and insulin resistance. Metformin enhances muscle and adipocyte insulin receptor number and/or affinity, increases insulin receptor tyrosine kinase activity, stimulates glucose transport and glycogen synthesis, and reduces both hepatic gluconeogenesis and glycogenolysis. The disadvantages are confined to the gastro-intestinal side effects and the potential risk of vitamin B 12 and folic acid deficiency during long-term use. These side effects can be minimized by slow titration and consumption with meals. The under lying mechanism for gastrointestinal intolerance are proposed to be stimulation of intestinal secretion of serotonin, alteration in incretin and metabolism of glucose, and malabsorption of bile salts. Lactic acidosis is rare contraindication associated with metformin. Most reported cases of lactic acidosis occur in patients with contraindications, particularly impaired renal function. Metformin has a good safety profile, efficacy and comparatively reduced cost. Its ability to improve insulin sensitivity and the cardiovascular risk profile of type II diabetic patients has enhanced its clinical use as first-line therapy.

Does Folic Acid Protect Patients with Inflammatory Bowel Disease from Complications?

Folic acid, referred to as vitamin B9, is a water-soluble substance, which participates in the synthesis of nucleic acids, amino acids, and proteins. Similarly to B12 and B6, vitamin B9 is involved in the metabolism of homocysteine, which is associated with the MTHFR gene. The human body is not able to synthesize folic acid; thus, it must be supplemented with diet. The most common consequence of folic acid deficiency is anemia; however, some studies have also demonstrated the correlation between low bone mineral density, hyperhomocysteinemia, and folic acid deficiency. Patients with inflammatory bowel disease (IBD) frequently suffer from malabsorption and avoid certain products, such as fresh fruits and vegetables, which constitute the main sources of vitamin B9. Additionally, the use of sulfasalazine by patients may result in folic acid deficiency. Therefore, IBD patients present a higher risk of folic acid deficiency and require particular supervision with regard to anemia and osteoporosis prevention, which are common consequences of IBD.

Demography and management outcome of neural tube defects in a Nigerian tertiary health institution

Background: Neural tube defects (NTD) are a group of congenital anomalies of the central nervous system (CNS). Its management is very challenging. A recognised leading cause is a folic acid deficiency, therefore prevented by taking a preconception folic acid. This study looked at the demographic features and management outcome of neural tube defect, a fairly common preventable condition with the need to raise awareness on its preventive measures. Methods: The study was conducted on 82 patients with NTD that were managed in federal medical centre Yola, in North-Eastern Nigeria. It was a retrospective study over a 4-year period, from January 2016 to December 2019.Results: Ages at presentations ranged from 1 to 93 days with a mode of 3 days. There were 29 males and 53 females with a male to female ratio of 1:1.8. Spina bifida constituted 74.4%, encephalocele (20%), Anencephaly (5%). Types of spina bifida managed were myelomeningocele (63.5%), meningocele (33.3%), and lipo-myelomeningocele (3.2%). Two had a 2-level meningocele. Syndromic associations of myelomeningocele were with hydrocephalus (78.1%), foot deformity (22.2%), cardiac (2.5%), and anorectal malformation (2.5%). Ninety-five-point one had various surgeries with 30.8% developing postoperative complications. commonest was post excision of myelomeningocele and encephalocele hydrocephalus (29.1%) in 7 patients. Post-operative Mortality was reported in 2 patients (8.3%).Conclusions: Myelomeningocele was the commonest NTD, and its syndromic association with hydrocephalus was common. A large number of patients had surgical interventions with a good outcome. Post-op mortality was minimal.

Literature Review Pengaruh Asam Folat Pada Kadar Hemoglobin Untuk Wanita Prakonsepsi Dengan Anemia

Folic acid is important in the process of formation and maturation of erythrocytes, so that folic acid deficiency can manifest in anemia. Anemia is defined by hemoglobin levels in preconception women <12.0 g/dl, one of which is due to the lack of erythrocyte. Globally, the prevalence of anemia in women not pregnant (childbearing age) is 1.1%, and affects 19 million women not pregnant. Prevention of anemia in women of childbearing age can improve the degree of health of pregnant women, which ultimately contributes to a decrease in maternal and perinatal death. So that in preconception care is recommended anemia prevention measures in the form of nutritional interventions, one of which is recommended to prevent folic acid deficiency. The purpose of the study was to find out the influence of folic acid on hemoglobin levels of preconception women with anemia. literature review study, study 5 articles that meet inclusion and exclusion criteria. Search through Google Scholar, Garuda, and Pubmed, keywords that iron folic acid, folic acid, and anemia in preconception. from 5 articles examined there was an influence of folic acid on hemoglobin levels in preconception women. hemoglobin levels in preconception women are influenced by the adequacy of folic acid. So folic acid deficiency has an effect on the incidence of anemia in preconception women ABSTRAK Asam folat penting dalam proses pembentukan dan pematangan eritrosit, sehingga defisiensi asam folat bisa bermanifestasi pada anemia. Anemia didefinisikan dengan kadar hemoglobin pada wanita prakonsepsi <12,0 g/dl yang salah satunya dikarenakan kurangnya jumlah eritrosit. Secara global, prevalensi anemia pada wanita tidak hamil (usia subur) yaitu 1,1%, dan mempengaruhi 19 juta wanita tidak hamil. Pencegahan anemia pada wanita usia subur dapat meningkatkan derajat kesehatan wanita hamil, yang pada akhirnya berkontribusi pada penurunan kematian ibu dan perinatal. Sehingga dalam pelayanan kesehatan prakonsepsi (preconception care) dianjurkan tindakan pencegahan anemia berupa intervensi gizi yang salah satunya dianjurkan untuk mencegah defisiensi asam folat. Tujuan penelitian untuk mengetahui pengaruh asam folat pada kadar hemoglobin wanita prakonsepsi dengan anemia. Studi literature review, menelaah 5 artikel yang memenuhi kriteria inklusi dan eksklusi. Pencarian melalui Google Scholar, Garuda, dan Pubmed, kata kunci yang iron folic acid, asam folat, dan anemia in preconception. Dari 5 artikel yang ditelaah didapatkan adanya pengaruh asam folat terhadap kadar hemoglobin pada wanita prakonsepsi. Kadar hemoglobin pada wanita prakonsepsi salah satunya dipengaruhi oleh tingkat kecukupan asam folat. Sehingga defisiensi asam folat berpengaruh pada kejadian anemia pada wanita prakonsepsi.