Enormity of iron deficiency anaemia and haematological indices in Primary and secondary school going children in central rural Gujarat, India

Anemia is one of the associated and underlying health conditions observed in large number of school going children of rural India. National Family Health Survey (NHFS) data published by Government of Indiaindicates increased prevalence ofanaemia in children of rural India. In the present study, children of government school of the Waghodia tehsil, Vadodara district Gujarat were surveyed. A cross sectional study was conducted to survey 500 children of either genderaccording to WHO gradation as normal range (12.6 ± 0.54 gm/dl); mild anemia (11.01 ± 0.58gm/dl) and moderate anemia(9.11 ± 0.3gm/dl).Observations indicated that, 20.6%, 74.8% and 4.6%children were in normal or above normal range, mild anemia and moderate anemia respectively. Overall79.4% of children have anemia. It reveals the escalating magnitude of prevalence of IDA in rural Gujarat. Prevalence is more in 9-11 age group (56%). Gender wise distribution shows mild and moderate anemia in 305 (80.9%) and 14 (3.7%) respectively amongst 377 male children; whereas mild anemia and moderate anemia in 305 (80.9%) and 14 (3.7%) respectively amongst 123 female children. In nutshell, prevalence of anemia is prominent in children of age group in different rural parts of Gujarat.

Gestational Anaemia and its Associated Factors in Normal Pregnant Women

Objectives: To determine the hemoglobin levels in normal pregnant women and investigate the association of anemia with gestational age, number of antenatal visits, obstetrical complications and mode of delivery. Methodology: This is a cross-sectional study conducted at the Lady Willingdon Hospital, Khairpur Mirs, Pakistan from May 2021 to August 2021. A total of 139 normal pregnant women were recruited during antenatal visits. Patients were grouped into normal and anemic groups based on serum hemoglobin levels. Gestational age, obstetrical complications, mode of delivery and fetal outcome were recorded to find its association with anemia. Data was analyzed on SPSS 20.0 and p-value < 0.05 was considered as statistically significant. Results: Out of n=139 normal pregnant women, n=26 women had normal hemoglobin levels, n=49 were mild anemic, n=46 had moderate anemia whereas n=18 had severe anemia. Overall, the prevalence of gestational anemia was 81%. There was significant association between hemoglobin status and number of antenatal visits and complications in previous pregnancies. Hemoglobin status was not significantly associated with gestational age and mode of delivery. Conclusion: In conclusion, we found that gestational anemia is highly prevalent in Pakistan. Early detection of anemia and its correction via supplementations are recommended.

Frequency of Low Birth Weight in Pregnant Women with Anemia

Objective: To determine the frequency of low birth weight in pregnant women with anemia. Methodology: This descriptive cross-sectional survey, was conducted at OMC Hospital, Jail Road, Lahore and Medicine Deptt. of Lahore General Hospital during March 2020 to November 2020. We included 320pregnant females with gestational ages between 30 to 36 weeks with hemoglobin level of <10g/dl and further classified as moderate anemia with (Hb levels 8-9.9g/dl) and in severe anemia for those having Hb 8g/dl. All cases with known systemic diseases/abnormalities like hemoglobinopathies (sickle cell anemia/thalassemia), diabetes, hypertension, smoking, renal problems, oligo/polyhydramnios were excluded from the study. The neonates were examined after the delivery is done with the help of pediatrician and all protocols for neonates assessment were followed. All findings were recorded, low birth weight was considered if the neonatal weight was <2500g. These neonates were followed until they are discharged from the hospital or mortality (if any). Routine informed consent was also obtained from the patients attendants to use their data in the study. Results: In our study, 32.5% of the cases were low birth weight whereas 67.5%(n=216) cases had normal birth weight. Conclusion: Frequency of low birth weight is higher in mothers presenting with anemia. Keywords: Maternal anemia, low birth weight, association

Influence of Anemia on Postoperative Cognitive Function in Patients Undergo Hysteromyoma Surgery

Cognitive dysfunction is a common disease in aging population. This study aims to compare the influence of different degrees of anemia on the cognitive function of patients undergo hysteromyoma surgery. Sixty-one patients aged 18–60 years who underwent uterine fibroid surgery in the Second Affiliated Hospital of Shantou University Medical College from March 2019 to December 2020 were selected for this study. Patients were divided into three groups: group normal (Group N, patients have no anemia), group of mild anemia (Group Mi, patients have mild anemia) and group of moderate anemia (Group Mo, patients had moderate anemia). Combined spinal and epidural anesthesia were administered. Cognitive function tests were performed 1 day before the surgery and repeated at the 5th and 30th days after surgery. Peripheral venous blood samples from patients were collected before the surgery, right after surgery and at the 24th and 72nd hours after surgery. The contents of S-100β, IL-6, TNF-α and IL-1β in serum samples were determined by ELISA. It was found that there were no significant differences in general characteristics of patients among Group N, Group Mi and Group Mo (p &gt; 0.05). Nine patients developed postoperative cognitive dysfunction after surgery, and the incidence was 14.75% (9/61). The incidence of postoperative cognitive dysfunction (POCD) was 40% in Group Mo, which was higher than that in Group N and Group Mi. The difference was statistically significant (p &lt; 0.05). Inflammatory factors in patients with POCD were higher in post-surgery than before-surgery (p &lt; 0.05), while there was no statistical significance in the difference of inflammatory factors of patients without POCD before and after surgery (p &gt; 0.05). Taken together, this study suggested that moderate anemia could be a risk factor of POCD in patients undergoing hysteromyoma surgeries. This study will help surgeons developing measures for preventing the occurrence of POCD.

Hemoglobin Changes during Long-Lasting Frontline Treatment with Tyrosine-Kinase Inhibitors in Patients with Chronic Myeloid Leukemia

Introduction Chronic Myeloid Leukemia (CML) has become highly curable after introduction of Tyrosine-Kinase Inhibitors (TKIs). However, several side-effects have been reported with the prolonged use of TKIs: in particular, severe cardiovascular and pulmonary toxicities were observed with 2 nd generation TKIs (2G-TKIs), nilotinib and dasatinib. Imatinib is generally considered safer, even if some concerns were recently raised on its renal toxicity and occurrence of late anemia. Aims To evaluate the impact of imatinib compared to 2G-TKIs on the hemoglobin (Hb) levels in the long-lasting frontline treatment of CML patients. Methods From 1/2002 to 12/2015, 365 CML patients were diagnosed and treated frontline with TKIs in 2 different Centres in Italy: of them, 123 permanently discontinued the treatment before the 5 th year from the start due to intolerance (31 cases, 25.2%), primary resistance (41, 33.3%), secondary resistance (16, 13.0%), blastic evolution (4, 3.2%), unrelated death (12, 9.8%) or were lost to follow-up (19, 15.5%). At 5 years, the remaining 242 patients were still receiving frontline TKI treatment and were considered for the present analysis. Hb levels were recorded at baseline and thereafter every 12 months up to the 5 th year of treatment. Results As to frontline treatment, 186 patients (76.8%) received imatinib and 56 (23.2%) 2G-TKIs (nilotinib in 44 cases and dasatinib in 12, respectively). The main clinical features at diagnosis of the entire cohort and according to frontline treatment are reported in the table: median Hb value at baseline was significantly lower in patients treated with 2G-TKIs. Median Hb values at different time-points according to frontline treatment are reported in the Figure. In patients treated with imatinib, median Hb levels at 12 th (12.5 g/dl, IQR 11.6-13.5) and 60 th month (12.4 g/dl, IQR 11.4-13.3) were stable compared to baseline (12.8 g/dl, IQR 11.3-13.8) (p=0.248 and p=0.075, respectively). On the contrary, median Hb levels at 12 th (13.4 g/dl, IQR 12.2-14.3) and 60 th month (13.6 g/dl, IQR 12.0-14.6) showed a significant increase compared to baseline (11.8 g/dl, IQR 10.6-13.7) in patients treated with 2G-TKIs (p&lt;0.001 in both cases). As a consequence, during the treatment median Hb values became significantly higher at any different time-point in patients treated with 2G-TKIs compared to patients treated with imatinib (p=0.005 at the 12 th month, p=0.010 at the 60 th month). At baseline, the rate of patients with mild to moderate anemia (Hb &lt; 11 g/dl) was significantly lower in those treated with imatinib [34/186 (18.2%) vs 20/56 (35.7%) treated with 2G-TKIs, p=0.006]: at the 12 th month, no difference was observed [15/186 (8.0%) in patients treated with imatinib vs 3/56 (5.3%) in patients treated with 2G-TKIs, p=0.498], while at the 60 th months the rate of patients with mild to moderate anemia became significantly higher in those treated with imatinib [29/186 (15.6%) vs 2/56 (3.6%) treated with 2G-TKI, p=0.018]. Conclusions Present data highlight that long-lasting treatment with imatinib can have a negative late effect on erythropoiesis, with incomplete recovery of hemoglobin levels and occurrence of late anemia in about 15% of patients at the 60 th month of therapy.This possible adverse event, which is still unrecognized and seems very rare with 2G-TKIs, could affect quality of life and should be recognized in the long-term management of CML patients. Figure 1 Figure 1. Disclosures Latagliata: BMS Cellgene: Honoraria; Pfizer: Honoraria; Novartis: Honoraria. Martelli: Novartis: Other: advisory board; Gilead: Other: advisory board. Breccia: Pfizer: Honoraria; Novartis: Honoraria; Incyte: Honoraria; Bristol Myers Squibb/Celgene: Honoraria; Abbvie: Honoraria.

Description of The Event of Anemia in Women of Real Age of Coral Cadets in Ciseeng, Bogor City 2021

Nutrition is one of the determining factors to achieve excellent and optimal health. Anemia is still a nutritional problem in the world, especially in developing countries, including Indonesia. Anemia is a condition in which a person's hemoglobin (Hb) level in the blood is lower than normal. Infertile women are one of the groups at risk for anemia. Several research results in several regions in Indonesia show that the prevalence of anemia infertile women is still high. We aim to describe the incidence of anemia in women of childbearing age in Ciseeng, Bogor, 2021. Using a qualitative study design, employing FGD, in-depth interviews, and active observation. All informants suffer from moderate anemia with Hb levels between 8.7 g/dl to 10.8 g/dl and have several symptoms or signs of anemia, namely 5L, dizziness, fatigue, pale nails, lips, and eyelids. The lack of iron-containing foods and the presence of tea in the breakfast menu of the informants is one of the factors that make the informants suffer from anemia, due to the disruption of iron absorption by the tannins contained in tea. Most of the informants have abnormal menstrual patterns and this is one of the determinants of the incidence of anemia experienced by the informants. An overview of matters relating to the incidence of anemia in women of childbearing age at youth organizations in Ciseeng Bogor, including a description of nutrient intake, breakfast behavior, tea/coffee drinking behavior, menstruation, nutritional knowledge. All key informants had Hb levels below 12 g/dl, ie 8.7 – 10.8 g/dl. Three informants had Hb levels below 10 g/dl, 12 others had Hb levels 10-11 g/dl. The results of this Hb examination indicate that all informants suffer from anemia which is classified as moderate anemia according to the classification of anemia according to WHO.

Nutritional Status of Adolescent Girls in Corporation Schools in India: Still the Goal is Far Ahead

Adolescence is a vulnerable period for the incidence of malnutrition, as rapid growth takes place in this phase of life. Malnutrition, especially among adolescent girls, adversely affects future generations and indirectly impedes national productivity. Maternal malnutrition also contributes significantly to maternal mortality. It is required to be reduced to 70 per lac live births in 2030 from 167 per lac live births in 2013 to achieve sustainable development goals. The other crucial sustainable development goal is improvement in nutritional status in all phases of life. In the present study, we assessed the healthy situation by Body mass index and Haemoglobin estimation of adolescent girls incorporation school located at Pimpri, Pune, India. Most of the girls belonged to lower-middle to middle socioeconomic status. 67.9% of AGs under study were malnourished, while 8.6% were overweight. Only 3.5% of them had Haemoglobin in the normal range, 1% had severe, 65% of adolescent girls understudy had moderate anemia, and the rest had mild anemia. Results of the study show that India is still far away from attaining Sustainable development goals regarding the nutrition of adolescent girls and will have to take great efforts by existing program evaluation, modification, and strict implementation.

Growth differentiation factor 15 predicts poor prognosis in patients with heart failure and reduced ejection fraction and anemia: results from RED-HF

Aims We aimed to assess the value of GDF-15, a stress-responsive cytokine, in predicting clinical outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and anemia Methods and results Serum GDF-15 was assessed in 1582 HFrEF and mild-to-moderate anemia patients who where followed for 28 months in the Reduction of Events by Darbepoetin alfa in Heart Failure (RED-HF) trial, an overall neutral RCT evaluating the effect darbepoetin alfa on clinical outcomes in patients with systolic heart failure and mild-to-moderate anemia. Association between baseline and change in GDF-15 during 6 months follow-up and the primary composite outcome of all-cause death or HF hospitalization were evaluated in multivariable Cox-models adjusted for conventional clinical and biochemical risk factors. The adjusted risk for the primary outcome increased with (i) successive tertiles of baseline GDF-15 (tertile 3 HR 1.56 [1.23–1.98] p < 0.001) as well as with (ii) a 15% increase in GDF-15 levels over 6 months of follow-up (HR 1.68 [1.38–2.06] p < 0.001). Addition of change in GDF-15 to the fully adjusted model improved the C-statistics (p < 0.001). No interaction between treatment and baseline or change in GDF-15 on outcome was observed. GDF-15 was inversely associated with several indices of anemia and correlated positively with ferritin. Conclusions In patients with HF and anemia, both higher baseline serum GDF-15 levels and an increase in GDF-15 during follow-up, were associated with worse clinical outcomes. GDF-15 did not identify subgroups of patients who might benefit from correction of anemia but was associated with several indices of anemia and iron status in the HF patients. Graphic abstract

Anemia prevalence and factors associated among pregnant women in India

The objective of this review is to evaluate the prevalence of anemia and factors associated with Anemia among pregnant women in India. A search was conducted through electronic databases PubMed, google scholar and l Medline, non-electronic databases were also search for articles published between 2017 to 2021. PRISMA guided the reporting of items. All articles were included in qualitative analysis. A total of nine (9) studies (N=7,29,485) conducted among pregnant women in India were included in this review. The overall prevalence of anemia ranged from 23.16% to 81.8%, mild anemia reported in three studies ranged from 35.0% to 60.6%, moderate anemia from 8.0% to 49.5% and severe anemia ranged from 1.4% to 6.9% only. Education status of both wife and husband, maternal age, occupation, income, residence, dietary habits, parity, child spacing, attendance of ANC services and interventions nutrition programs were the main factors associated with the hemoglobin status of the pregnant women. The prevalence of anemia was high among the study participants. Sociodemographic factors were associated with Hb levels of the women. Efforts should be made to encourage women to attend antenatal services (ANC) and nutritional programs should also cover pregnant women.

COVID-19 second wave deadlier than first in pregnant women: a comparative observational study and the COVID saga continues

Background: A two wave pattern has been seen in many countries in reported cases of corona virus disease-19 during the 2020 pandemic. Observed data show that the effects of the virus do vary between the two periods. Differences in severity of the disease have been reported, although the comparative characteristics of the two waves still remain largely unknown.Methods: This was a prospective cross sectional study continuation of our first paper comparing 133 pregnant COVID-19 positive patients delivered at District Hospital, Bellary, in the first wave and 251 patients admitted during second wave.Results: In the present study 87.9% patients were in the age of 20-30 years, 90% patients belong to lower socio-economic status, mild anemia about 27.4% in second wave, moderate anemia seen in 16.7% in second wave, and 10.35% had severe anemia. Non-severe pre-eclampsia was present in 18.72% of the patients, severe pre-eclampsia was seen in 9.94% of the cases and 01.59% had gestational hypertension. Mode of delivery was 17.9% FTND, 3.77% FTVD emergency LSCS was 74.5% in second wave, and preterm delivery was seen in 3.77% in second wave. Elevated levels of D-dimer were found 34.6% in second wave. 14 deaths being reported in second wave.Conclusions: This study compared the obstetric and clinical outcome in COVID-19 positive patients who are in labor in first and second wave of COVID-19 infection. Although our conclusions are limited, the finding so obtained are important for understanding the clinical parameters, obstetric parameters and perinatal outcome in both waves with considerable increase in maternal mortality in second wave.