RESUMO
INTRODUCTION: Functional dyspepsia (FD) is a complex symptom. Currently there are multiple therapeutic options that are used for the management of these patients; however, FD therapies are based on symptomatic control and do not address the pathophysiological pathways involved in its development. The duodenum has been proposed as a key site to understand the complex pathophysiology involved in FD. OBJECTIVE: The aim of the study is to determine duodenal eosinophilia in patients with FD and establish the clinical-pathological correlation with the cardinal symptoms of dyspepsia. MATERIAL AND METHODS: Case-control study. Patients older than 18 years with dyspepsia according to the Rome IV criteria, and upper gastrointestinal endoscopy normal (FD group).Patients with iron deficiency anemia and chronic diarrhea (control group). Biopsies were taken in the stomach, duodenal bulb and second portion of duodenum. A sample size of 140 patients (70 patients in the FD group and 70 patients in the control group) was calculated. The collected information was described and analyzed by conventional statistical techniques. RESULTS: 243 patients were recruited. 84 patients were included in the FD group and 84 patients in the control group. 135 patients were women (80.3%). The mean age was 53.6 years (SD 14.9). Duodenal eosinophilia was found with significant difference in patients with early satiety (p=0.01). There was no difference in patients with postprandial fullness (p=0.63), epigastric pain or burning (p=0.26), gastroesophageal reflux symptoms (p=0.13), allergy and food intolerance (p=0.42) and smoking (p=0.28). There was no relationship between duodenal mastocytosis and early satiety (p=0.98), postprandial fullness (p=0.78), and epigastric pain or burning (p=0.82). CONCLUSIONS: Duodenal eosinophilia was similar in FD and controls. In subgroup analysis, duodenal eosinophilia occurs in patients with early satiety.
Assuntos
Duodenopatias/epidemiologia , Dispepsia/epidemiologia , Eosinofilia/epidemiologia , Dor Abdominal/epidemiologia , Adulto , Anemia Ferropriva/patologia , Estudos de Casos e Controles , Doença Crônica , Comorbidade , Diarreia/patologia , Duodenopatias/patologia , Dispepsia/patologia , Eosinofilia/patologia , Feminino , Intolerância Alimentar/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Humanos , Masculino , Mastocitose/epidemiologia , Saciação , Fumar/epidemiologia , Avaliação de SintomasRESUMO
Introducción: La dispepsia funcional (DPF) es una entidad compleja cuya fisiopatología no está claramente definida. Existen alteraciones motoras gastroduodenales y recientemente se ha dado importancia a la eosinofilia duodenal. Objetivo: El objetivo de este estudio fuedeterminar si existe asociación entre eosinofilia duodenal y DPF. Materiales y métodos: Estudio de casos y controles. Pacientes mayores de 18 años con dispepsia según ROMA IV, a quienes se descartó DP orgánica con endoscopia alta (EVDA). Los controles fueron pacientes con anemia ferropénica y diarrea crónica a quienes de rutina se toman biopsias tanto del estómago como del duodeno. Se calcularon 70 pacientes en cada grupo. La información se recolectó en un formulario específico. Resultados: Hubo 243 pacientes elegibles. Se incluyeron 84 pacientes en grupo. El 80% eran mujeres. Edad promedio 53,6 años. Se encontró eosinofilia duodenal con diferencia significativa en los pacientes con saciedad precoz (p=0,01). No hubo diferencia significativa en los pacientes con llenura posprandial (p=0,63), dolor o ardor epigástrico (p=0,26), síntomas de reflujo gastroesofágico (p=0,13), alergia e intolerancia a alimentos (p=0,42) y tabaquismo (p=0,28). Asimismo, no se encontró relación entre mastocitosis duodenal y saciedad precoz (p=0,98), llenura posprandial (p=0,78) y dolor o ardor epigástrico (p=0,82). Conclusiones: La eosinofilia duodenal fue más frecuente en pacientes con DPF que tenían saciedad precoz.
Introduction: Functional dyspepsia (FD) is a complex symptom. Currently there are multiple therapeutic options that are used for the management of these patients; however, FD therapies are based on symptomatic control and do not address the pathophysiological pathways involved in its development. The duodenum has been proposed as a key site to understand the complex pathophysiology involved in FD. Objective: The aim of the study is to determine duodenal eosinophilia in patients with FD and establish the clinical-pathological correlation with the cardinal symptoms of dyspepsia. Material and methods: Case-control study. Patients older than 18 years with dyspepsia according to the Rome IV criteria, and upper gastrointestinal endoscopy normal (FD group).Patients with iron deficiency anemia and chronic diarrhea (control group). Biopsies were taken in the stomach, duodenal bulb and second portion of duodenum. A sample size of 140 patients (70 patients in the FD group and 70 patients in the control group) was calculated. The collected information was described and analyzed by conventional statistical techniques. Results: 243 patients were recruited. 84 patients were included in the FD group and 84 patients in the control group. 135 patients were women (80.3%). The mean age was 53.6 years (SD 14.9). Duodenal eosinophilia was found with significant difference in patients with early satiety (p=0.01). There was no difference in patients with postprandial fullness (p=0.63), epigastric pain or burning (p=0.26), gastroesophageal reflux symptoms (p=0.13), allergy and food intolerance (p=0.42) and smoking (p=0.28). There was no relationship between duodenal mastocytosis and early satiety (p=0.98), postprandial fullness (p=0.78), and epigastric pain or burning (p=0.82). Conclusions: Duodenal eosinophilia was similar in FD and controls. In subgroup analysis, duodenal eosinophilia occurs in patients with early satiety.
Assuntos
Adulto , Feminino , Humanos , Masculino , Duodenopatias/epidemiologia , Dispepsia/epidemiologia , Eosinofilia/epidemiologia , Saciação , Mastocitose/epidemiologia , Fumar/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Dor Abdominal/epidemiologia , Estudos de Casos e Controles , Comorbidade , Doença Crônica , Anemia Ferropriva/patologia , Diarreia/patologia , Duodenopatias/patologia , Dispepsia/patologia , Eosinofilia/patologia , Avaliação de Sintomas , Intolerância Alimentar/epidemiologiaRESUMO
BACKGROUND: Around 47-74% of patients with hereditary hemorrhagic telangiectasia (HHT) have hepatic vascular malformations (HVMs); magnetic resonance images (MRI) of the central nervous system (CNS) might show in T1 sequences a hyper-intensity signal in different areas, mainly in the basal ganglia (BG) as consequence of manganese (Mn) deposits as observed in cirrhotic patients. These patients might suffer from different neuropsychiatric disorders (hepatic encephalopathy). In HHT patients, even in the presence of hepatic shunts, hepatocellular function is usually preserved. Additionally, Mn shares iron absorption mechanisms, transferrin and CNS transferrin receptors. In iron deficiency conditions, the Mn may harbor transferrin and access BG. The objectives were to describe frequency of BG Mn deposit-induced lesions (BGMnIL) in HHT patients, its relationship with iron deficiency anemia (IDA) and HVMs. Finally, explore the association between neuropsychological and motor consequences. We performed a cross-sectional study. We determined HHT patients with or without BG-MnIL by the MRI screening of the CNS. We included all patients with lesions and a random sample of those without lesions. All patients underwent standardized and validated neuropsychological assessment to evaluate BG actions. Results were analyzed with multiple logistic regression, adjusting for potential confounders. RESULTS: Among 307 participants from a cohort included in the Institutional HHT Registry, 179 patients had MRI performed and Curaçao Criteria ≥3. The prevalence of BG-MnIL was 34.6% (95%CI 27.69-42.09). While neuropsychological symptoms were present in all patients, BG-MnIL patients performed poorly in three of the neuropsychological tests (serial dotting, line tracing time, number connection test A). HVMs frequency in BG-MnIL was 95.1%, versus 71.4% in those without lesions (p < 0.001). IDA frequency was 90.3% versus 54% (p < 0.001). When IDA is present, estimated risk for BG-MnIL is remarkably high (OR 7.73, 95%CI 2.23-26.73). After adjustment for possible confounders (gender, age, presence of HVMs), IDA was still associated with increased risk of BG-MnIL (adjusted OR 6.32, 95% CI 2.32-17.20; p < 0.001). CONCLUSIONS: Physicians should assess BG-MnIL in HHT patients in CNS-MRI. IDA and HVMs present increased risk of lesions. Patients with BG-MnIL have neuropsychological impairment, and they might benefit from sparing IDA, or undergoing future therapeutic options. TRIAL REGISTRATION: NCT01761981 . Registered January 3rd 2013.
Assuntos
Ferro/metabolismo , Telangiectasia Hemorrágica Hereditária/metabolismo , Telangiectasia Hemorrágica Hereditária/patologia , Adulto , Idoso , Anemia Ferropriva/metabolismo , Anemia Ferropriva/patologia , Gânglios da Base/metabolismo , Gânglios da Base/patologia , Sistema Nervoso Central/metabolismo , Sistema Nervoso Central/patologia , Estudos Transversais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Manganês/metabolismo , Pessoa de Meia-Idade , Telangiectasia Hemorrágica Hereditária/genéticaRESUMO
Studies have reported a positive effect of prebiotics on the bioavailability of iron. This study evaluated the effect of partially hydrolyzed guar gum (PHGG) on iron absorption mechanisms in anemic rats. Male Wistar rats were fed 75g American Institute of Nutrition Rodent Diets for growth, pregnancy and lactation (AIN93-G) without iron for three weeks in order to induce iron deficiency anemia. Then they were fed a control diet (n = 12; without fiber) or a diet with 7.5% of PHGG (n = 12), both without iron. Food intake, body growth and the feed efficiency coefficient (FEC) were measured. The animals were euthanized after two weeks of treatment. The weight of the organs, the pH of the cecal content, and the hepatic iron and ferroportin expression in the cecum, duodenum, and liver were assessed. The intake of PHGG reduced food intake without affecting body growth, and there was a difference between the groups regarding the FEC (p = 0.026), with the highest value found in the PHGG group. The weight of the cecal content increased (p ≤ 0.001) and the pH of the cecal content was significantly lower in the PHGG group. The intake of PHGG significantly increased ferroportin expression in the cecum; however, the difference was not significant in the duodenum and the liver. PHGG seems to have a positive influence on iron absorption through transporter expression, and structural and physiological changes in the colon of anemic growing animals.
Assuntos
Anemia Ferropriva/dietoterapia , Proteínas de Transporte de Cátions/biossíntese , Ceco/metabolismo , Modelos Animais de Doenças , Galactanos/uso terapêutico , Mucosa Intestinal/metabolismo , Mananas/uso terapêutico , Gomas Vegetais/uso terapêutico , Prebióticos , Anemia Ferropriva/sangue , Anemia Ferropriva/metabolismo , Anemia Ferropriva/patologia , Animais , Biomarcadores/sangue , Proteínas de Transporte de Cátions/metabolismo , Ceco/patologia , Colo/metabolismo , Colo/patologia , Ingestão de Energia , Galactanos/efeitos adversos , Galactanos/metabolismo , Hidrólise , Absorção Intestinal , Mucosa Intestinal/patologia , Ferro/metabolismo , Ferro da Dieta/metabolismo , Fígado/metabolismo , Fígado/patologia , Masculino , Mananas/efeitos adversos , Mananas/metabolismo , Tamanho do Órgão , Especificidade de Órgãos , Gomas Vegetais/efeitos adversos , Gomas Vegetais/metabolismo , Prebióticos/efeitos adversos , Ratos Wistar , Aumento de PesoAssuntos
Humanos , Masculino , Feminino , Criança , Pediatria , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/patologia , Epidemiologia Descritiva , UruguaiRESUMO
Prebiotics may increase intestinal Fe absorption in anaemic growing rats. The present study evaluated the effects of high-performance (HP) inulin and oligofructose on factors that regulate Fe absorption in anaemic rats during the growth phase. Male Wistar rats aged 21 d of age were fed AIN-93G ration without Fe for 2 weeks to induce Fe-deficiency anaemia. The rats were fed on day 35 a control diet, or a diet with 10 % HP inulin, or a diet with 10 % oligofructose, without Fe supplementation. The animals were euthanised after 2 weeks, and segments of the duodenum, caecum, colon and liver were removed. The expression levels of proteins in the intestinal segments were assessed using Western blotting. The levels of serum, urine and liver hepcidin and the concentrations of IL-10, IL-6 and TNF-α in the caecum, colon and liver were measured using the ELISA test. HP inulin increased the expression of the divalent metal transporter 1 protein in the caecum by 162 % (P= 0·04), and the expression of duodenal cytochrome b reductase in the colon by 136 % (P= 0·02). Oligofructose decreased the expression of the protein ferroportin in the duodenum (P= 0·02), the concentrations of IL-10 (P= 0·044), IL-6 (P= 0·036) and TNF-α (P= 0·004) in the caecum, as well as the level of urinary hepcidin (P< 0·001). These results indicate that prebiotics may interfere with the expression of various intestinal proteins and systemic factors involved in the regulation of intestinal Fe absorption in anaemic rats during the growth phase.
Assuntos
Anemia Ferropriva/dietoterapia , Proteínas de Transporte de Cátions/metabolismo , Grupo dos Citocromos b/metabolismo , Mucosa Intestinal/metabolismo , Prebióticos , Regulação para Cima , Anemia Ferropriva/imunologia , Anemia Ferropriva/metabolismo , Anemia Ferropriva/patologia , Animais , Proteínas de Transporte de Cátions/agonistas , Ceco/imunologia , Ceco/metabolismo , Ceco/patologia , Colo/enzimologia , Colo/imunologia , Colo/metabolismo , Grupo dos Citocromos b/química , Grupo dos Citocromos b/genética , Duodeno/imunologia , Duodeno/metabolismo , Duodeno/patologia , Hepcidinas/sangue , Hepcidinas/metabolismo , Hepcidinas/urina , Mediadores da Inflamação/metabolismo , Mucosa Intestinal/imunologia , Mucosa Intestinal/patologia , Inulina/efeitos adversos , Inulina/uso terapêutico , Fígado/imunologia , Fígado/metabolismo , Fígado/patologia , Masculino , Oligossacarídeos/efeitos adversos , Oligossacarídeos/uso terapêutico , Tamanho do Órgão , Prebióticos/efeitos adversos , Ratos Wistar , Aumento de PesoRESUMO
The present study investigated the effects of fructo-oligosaccharides (FOS) on the bioavailability of Fe from ferric pyrophosphate (FP), a water-insoluble compound, in Fe-deficient anaemic rats that were subjected to a Hb repletion assay. Male Wistar rats (n 64) were fed adequate or low (8 mg/kg) Fe diets for 15 d followed by 1 or 2 weeks of Fe repletion with diets providing 35 mg Fe/kg as ferrous sulphate (FS), FP or FP that was mixed with 7·5% FOS in the form of yacon flour or Raftilose P95 (RAF), a purified source of FOS. The effects of FOS were observed within the 1st week of the repletion period. Fe bioavailability was improved by FOS supplementation, as measured by Hb regeneration efficiency and hepatic Fe stores, which were more pronounced in the RAF group. Moreover, RAF supplementation resulted in a higher biological value relative to that of the FP group. FOS supplementation resulted in caecal enlargement, in addition to acidification and Fe species redistribution in the caecal contents relative to the control rats. These effects occurred concomitantly with decreased ferroportin (FPN)-1 expression in the caecal mucosa, which was similar in magnitude to that observed in the FS group. Caecum mucosal morphometry was influenced by FOS supplementation, whereas crypt fission and cell proliferation were highest in the caecum of the RAF group. These results reinforce the effects of FOS as Fe bioavailability enhancers in anaemic rats that are sustained by early changes in their caecal environment (decreased mucosal FPN-1 expression and increased Fe absorbability, crypt fission and cellularity).
Assuntos
Anemia Ferropriva/dietoterapia , Proteínas de Transporte de Cátions/metabolismo , Ceco/patologia , Mucosa Intestinal/patologia , Ferro da Dieta/administração & dosagem , Ferro/análise , Oligossacarídeos/uso terapêutico , Anemia Ferropriva/sangue , Anemia Ferropriva/metabolismo , Anemia Ferropriva/patologia , Animais , Brasil , Proteínas de Transporte de Cátions/genética , Ceco/metabolismo , Proliferação de Células , Difosfatos/administração & dosagem , Compostos Ferrosos/administração & dosagem , Alimentos Fortificados , Frutose/análise , Conteúdo Gastrointestinal/química , Hemoglobinas/análise , Ferro/administração & dosagem , Ferro/sangue , Ferro/química , Ferro/metabolismo , Ferro da Dieta/metabolismo , Ferro da Dieta/uso terapêutico , Masculino , Valor Nutritivo , Oligossacarídeos/química , Raízes de Plantas/química , Prebióticos , Ratos Wistar , Traqueófitas/químicaRESUMO
OBJECTIVE: Iron deficiency (ID) and iron deficiency anaemia (IDA) are global major public health problems, particularly in developing countries. Whilst an association between H. pylori infection and ID/IDA has been proposed in the literature, currently there is no consensus. We studied the effects of H. pylori infection on ID/IDA in a cohort of children undergoing upper gastrointestinal endoscopy for upper abdominal pain in two developing and one developed country. METHODS: In total 311 children (mean age 10.7±3.2 years) from Latin America--Belo Horizonte/Brazil (nâ=â125), Santiago/Chile (nâ=â105)--and London/UK (nâ=â81), were studied. Gastric and duodenal biopsies were obtained for evaluation of histology and H. pylori status and blood samples for parameters of ID/IDA. RESULTS: The prevalence of H. pylori infection was 27.7% being significantly higher (p<0.001) in Latin America (35%) than in UK (7%). Multiple linear regression models revealed H. pylori infection as a significant predictor of low ferritin and haemoglobin concentrations in children from Latin-America. A negative correlation was observed between MCV (râ=â-0.26; pâ=â0.01) and MCH (râ=â-0.27; pâ=â0.01) values and the degree of antral chronic inflammation, and between MCH and the degree of corpus chronic (râ=â-0.29, pâ=â0.008) and active (râ=â-0.27, pâ=â0.002) inflammation. CONCLUSIONS: This study demonstrates that H. pylori infection in children influences the serum ferritin and haemoglobin concentrations, markers of early depletion of iron stores and anaemia respectively.
Assuntos
Dor Abdominal/sangue , Anemia Ferropriva/sangue , Ferritinas/metabolismo , Infecções por Helicobacter/sangue , Hemoglobinas/metabolismo , Ferro/sangue , Dor Abdominal/complicações , Dor Abdominal/microbiologia , Dor Abdominal/patologia , Adolescente , Anemia Ferropriva/complicações , Anemia Ferropriva/microbiologia , Anemia Ferropriva/patologia , Biópsia , Brasil/epidemiologia , Criança , Chile/epidemiologia , Duodenoscopia , Duodeno/metabolismo , Duodeno/microbiologia , Duodeno/patologia , Feminino , Mucosa Gástrica/metabolismo , Gastroscopia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Helicobacter pylori/metabolismo , Humanos , Londres/epidemiologia , Masculino , Prevalência , Estômago/microbiologia , Estômago/patologiaRESUMO
BACKGROUND: Anemia is a prevalent condition in heart failure with multiple potential causes. The complex interaction between iron stores, hepcidin, inflammation and anemia is poorly comprehended. We tested the hypothesis that, in stable heart failure patients with anemia, hepcidin is associated with iron deficiency status irrespective of inflammation. METHODS AND RESULTS: Stable systolic heart failure outpatients with and without anemia underwent a complete iron panel, erythropoietin, hepcidin and tumor necrosis factor (TNF)-α assessment. Sixty outpatients were studied. Anemic patients (n = 38, mean hemoglobin 11.4 ± 1 g/dl) were older (69.6 ± 9.6 vs. 58 ± 10.8 years old, p < 0.01) compared with nonanemic patients (n = 22, mean hemoglobin 13.8 ± 1.1 g/dl). Iron deficiency was present in 42% of patients with anemia. TNF-α and hepcidin were 29 and 21% higher in patients with anemia, respectively, compared to nonanemic patients; however, no correlations were found between hepcidin and TNF-α levels. Hepcidin levels in the lower tertile (<31.7 ng/ml) were strongly associated with iron deficiency (OR 16.5, 95% CI 2.2-121.2; p < 0.01). CONCLUSION: In stable heart failure patients with anemia, hepcidin levels may be more importantly regulated by patients' iron stores than by inflammation.
Assuntos
Anemia Ferropriva/metabolismo , Peptídeos Catiônicos Antimicrobianos/sangue , Insuficiência Cardíaca/metabolismo , Idoso , Idoso de 80 Anos ou mais , Anemia Ferropriva/complicações , Anemia Ferropriva/patologia , Estudos Transversais , Eritropoetina/sangue , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/patologia , Hemoglobinas/análise , Hepcidinas , Humanos , Ferro/metabolismo , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pacientes Ambulatoriais , Receptores da Transferrina/sangue , Fator de Necrose Tumoral alfa/sangueRESUMO
Iron deficiency impairs the formation of hemoglobin, red blood cells, as well the transport of oxygen. The wound healing process involves numerous functions, many of which are dependent on the presence of oxygen. Laser has been shown to improve angiogenesis, increases blood supply, cell proliferation and function. We aimed to study the effect of λ660 nm laser and λ700 nm light-emitting diode (LED) on fibroblastic proliferation on cutaneous wounds on iron-deficient rodents. Induction of iron anemia was carried out by feeding 105 newborn rats with a special iron-free diet. A 1 × 1 cm wound was created on the dorsum of each animal that were randomly distributed into seven groups: I, control anemic; II, anemic no treatment; III, anemic+L; IV, anemic+LED; V, healthy no treatment; VI, healthy+laser; VII, healthy+LED (n=15 each). Phototherapy was carried out using either a diode laser (λ660 nm, 40 mW, 10 J/cm(2)) or a prototype LED device (λ700 ± 20 nm, 15 mW, 10 J/cm(2)). Treatment started immediately after surgery and was repeated at 48-h interval during 7, 14, and 21 days. After animal death, specimens were taken, routinely processed, cut, stained with hematoxylin-eosin, and underwent histological analysis and fibroblast counting. Significant difference between healthy and anemic subjects on regards the number of fibroblast between treatments was seen (p<0.008, p<0.001). On healthy animals, significant higher count was seen when laser was used (p<0.008). Anemic subjects irradiated with LED showed significantly higher count (p<0.001). It is concluded that the use of LED light caused a significant positive biomodulation of fibroblastic proliferation on anemic animals and laser was more effective on increasing proliferation on non-anemics.
Assuntos
Terapia com Luz de Baixa Intensidade , Fototerapia , Pele/lesões , Pele/efeitos da radiação , Cicatrização/efeitos da radiação , Anemia Ferropriva/patologia , Anemia Ferropriva/radioterapia , Animais , Animais Recém-Nascidos , Proliferação de Células/efeitos da radiação , Modelos Animais de Doenças , Fibroblastos/patologia , Fibroblastos/efeitos da radiação , Luz , Masculino , Ratos , Ratos Wistar , Pele/patologiaRESUMO
INTRODUCTION: Iron-deficient erythropoiesis attributable to nutritional deficiency is the most common cause of anemia in early childhood. Beckman Coulter has proposed new parameters: red blood cell size factor (RSf) and low hemoglobin density (LHD%). [Formula: see text] The aims of the present communication were to establish reference ranges (RR) for RSf and LHD% in a healthy pediatric population; to evaluate clinical utility of these parameters in the diagnosis of iron-deficiency anemia (IDA); and to compare RSf and LHD% with RET-He. METHODS: Two hundred healthy infants and 51 with IDA were analyzed on Coulter LH750 and Sysmex XT2000i analyzers. RESULTS: RR for RSf in children aged 0.5-6 years, 82.2-102.0 and 83.7-103.1 fl in the group aged 6-18 years. RR for LHD% was 1.1-9.0%. ROC analysis for RSf and LHD% in the diagnosis of IDA showed an AUC 0.8460 and 0.8654, respectively. The best RSf value to detect a restricted erythropoiesis was 89fl, sensitivity 92%, specificity 81%. LHD% optimal cutoff point was 6.0%, sensitivity 80%, and specificity 88%. Good correlation was observed between these parameters with Ret-He, r = 0.888 and r = -0.790, respectively. CONCLUSION: RSf and LHD% could be useful tools in the screening of IDA. These parameters can be obtained in the course of routine blood counts, with no additional cost or need for more blood sampling.
Assuntos
Anemia Ferropriva/diagnóstico , Índices de Eritrócitos , Eritrócitos/patologia , Deficiências de Ferro , Reticulócitos/patologia , Adolescente , Anemia Ferropriva/patologia , Área Sob a Curva , Criança , Pré-Escolar , Eritropoese , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Triagem Neonatal , Curva ROC , Valores de ReferênciaRESUMO
Iron requirements are significantly increased during pregnancy, which makes the daily dietary reference intake difficult to achieve through diet. Because iron deficiency may cause iron-deficiency anemia, which increases perinatal mortality, iron supplementation has been broadly adopted as a standard procedure during pregnancy. However, caution should be exercised as recent evidence suggests that iron excess may hamper fetus development and increase the risk for gestational diabetes mellitus (GDM). Literature is still scarce and it is inconclusive on this matter as the risks and benefits of prophylactic iron supplementation during pregnancy are still a source of controversy. However, it is imperative that a greater attention be given to the iron circulating levels individually. This practice would provide a better evaluation of the necessity and dosage determination of iron supplementation during pregnancy, being, therefore, potentially less likely to trigger the excess of iron-induced deleterious effects.
La demanda nutricional de hierro aumenta significativamente durante el embarazo siendo difícil alcanzar las dosis diarias recomendadas solamente a través de la alimentación. Dado que la deficiencia de hierro puede causar anemia y aumento de la mortalidad perinatal, la suplementación con hierro ha sido ampliamente utilizada como procedimiento estándar en las mujeres embarazadas. Sin embargo esta práctica debe usarse con cautela porque evidencias recientes sugieren efectos adversos de los niveles altos de hierro, que pueden perjudicar el desarrollo fetal y aumentar el riesgo de la diabetes mellitus gestacional (DMG). Aún no existe acuerdo, en la literatura, sobre la mejor manera de abordar el problema. Los riesgos y beneficios de la suplementación con hierro todavía son materia de debate. Sin embargo, es necesario que se preste más atención, de forma individual, a los niveles de hierro circulante Esta práctica permitiría una mejor evaluación de la necesidad de suplementación con hierro y de la determinación de la dosis a ser administrada, siendo de esta manera menos factible que se desencadenen los efectos deletéreos causados por el exceso de hierro.
A demanda nutricional de ferro aumenta significativamente durante a gestação, sendo difícil alcançar a ingestão diária recomendada apenas via alimentação. Como a deficiência de ferro pode ocasionar anemia ferropriva, aumentando a mortalidade perinatal, sua suplementação tem sido amplamente utilizada como procedimento padrão em gestantes. No entanto, tal prática deve ser vista com cautela, pois novas evidências sugerem efeitos adversos dos altos níveis férricos, que podem comprometer o desenvolvimento fetal e aumentar o risco para o diabetes mellitus gestacional (DMG). A literatura não é conclusiva sobre a melhor abordagem ao problema. Os riscos e benefícios da suplementação profilática de ferro ainda são motivo de controvérsia. Entretanto, é imperativo que maior atenção seja dada aos níveis circulantes de ferro de forma individualizada. Essa prática permitiria melhor avaliação da necessidade e da determinação da dosagem da suplementação de ferro durante a gestação, sendo então potencialmente menos passível de desencadear os efeitos deletérios induzidos pelo excesso de ferro.
Assuntos
Diabetes Gestacional/patologia , Anemia Ferropriva/patologia , Nutrição da GestanteRESUMO
Iron sucrose originator (IS(ORIG)) has been used to treat iron deficiency and iron deficiency anemia for decades. Iron sucrose similars (ISSs) have recently entered the market. In this non-clinical study of non-anemic rats, five doses (40 mg iron/kg body weight) of six ISSs marketed in Asian countries, IS(ORIG) or saline solution (control) were administered intravenously over four weeks to compare their toxicologic effects. Vasodilatory effects, impaired renal function and hepatic damage were only observed in the ISS groups. Significantly elevated serum iron and transferrin saturation levels were observed in the ISS groups suggesting a higher release of iron resulting in higher amounts of non-transferrin bound (free) iron compared to IS(ORIG). This might explain the elevated oxidative stress and increased levels of inflammatory markers and antioxidant enzymes in the liver, heart and kidneys of ISS-treated animals. Physico-chemical analyses showed that the molecular structure of most of the ISSs differed greatly from that of the IS(ORIG). These differences may be responsible for the organ damage and oxidative stress observed in the ISS groups. Significant differences were also found between different lots of a single ISS product. In contrast, polarographic analyses of three different IS(ORIG) lots were identical, indicating that the molecular structure and thus the manufacturing process for IS(ORIG) is highly consistent. Data from this study suggest that ISSs and IS(ORIG) differ significantly. Therefore, before widespread use of these products it would be prudent to evaluate additional non-clinical and/or clinical data proving the safety, therapeutic equivalence and interchangeability of ISSs with IS(ORIG).
Assuntos
Modelos Animais de Doenças , Compostos Férricos/administração & dosagem , Compostos Férricos/toxicidade , Ácido Glucárico/administração & dosagem , Ácido Glucárico/toxicidade , Estresse Oxidativo/fisiologia , Anemia Ferropriva/sangue , Anemia Ferropriva/induzido quimicamente , Anemia Ferropriva/patologia , Animais , Feminino , Compostos Férricos/sangue , Óxido de Ferro Sacarado , Ácido Glucárico/sangue , Inflamação/sangue , Inflamação/induzido quimicamente , Inflamação/patologia , Masculino , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Sprague-DawleyRESUMO
OBJETIVO: Avaliar a deficiência ou sobrecarga de ferro em lactentes com doença falciforme, a fim de embasar a decisão de recomendar (ou não) a suplementação profilática de ferro nessa população. MÉTODOS: Estudo retrospectivo transversal envolvendo 135 lactentes menores de 2 anos (66 meninos e 69 meninas), com genótipos SS e SC (77/58), nascidos entre 2005 e 2006 em Minas Gerais. Os indicadores de uma possível deficiência de ferro foram: volume corpuscular médio (VCM), hemoglobina corpuscular média (HCM), saturação da transferrina (ST) e ferritina. Dezessete lactentes [12,6 por cento, intervalo de confiança de 95 por cento (IC95 por cento) 7,0-18,2 por cento] haviam recebido hemotransfusão antes da coleta dos exames. RESULTADOS: ST e ferritina estavam significativamente mais baixas nos lactentes com hemoglobina SC (p < 0,001). Quando dois indicadores foram utilizados para definir a deficiência de ferro (VCM ou HCM baixos mais ST ou ferritina baixas), 17,8 por cento das crianças (IC95 por cento 11,3-24,3 por cento) tinham deficiência de ferro, predominando naquelas com perfil SC (p = 0,003). Análise das crianças que não haviam sido transfundidas (n = 118) mostrou prevalência de ferropenia em 19,5 por cento. Constatou-se aumento de ferritina em 15 lactentes (11,3 por cento; IC95 por cento 5,9-16,7 por cento); a maioria havia sido transfundida. CONCLUSÕES: A maior parte dos lactentes com doença falciforme não desenvolve deficiência de ferro, mas alguns têm déficit significativo. Este estudo indica que lactentes com doença falciforme, principalmente aqueles com hemoglobinopatia SC, talvez possam receber ferro profilático; no entanto, a suplementação deve ser suspensa após a primeira hemotransfusão.
OBJECTIVE: To assess iron deficiency or overload in infants with sickle cell disease in order to support the decision to recommend (or not) iron prophylactic supplementation in this population. METHODS: Cross-sectional and retrospective study with 135 infants below 2 years old (66 boys and 69 girls), 77 with SS and 58 with SC hemoglobin, born between 2005 and 2006 in Minas Gerais, Brazil. Indicators of possible iron deficiency were: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), transferrin saturation (TS), and ferritin. Blood transfusions had been given to 17 infants (12.6 percent, 95 percent confidence interval [95 percentCI] 7.0-18.2 percent) before laboratory tests were done. RESULTS: Ferritin and TS were significantly lower in SC infants (p < 0.001). When two indices were considered for the definition of iron deficiency (low MCV or MCH plus low ferritin or TS), 17.8 percent of children (95 percentCI 11.3-24.3 percent) presented iron deficiency, mainly those with SC hemoglobin (p = 0.003). An analysis of infants who were not given transfusions (n = 118) showed that 19.5 percent presented iron deficiency. Fifteen infants (11.3 percent, 95 percentCI 5.9-16.7 percent) presented increased ferritin; the majority had been transfused. CONCLUSIONS: Most infants with sickle cell disease do not develop iron deficiency, though some have a significant deficit. This study indicates that infants with sickle cell disease, mainly those with SC hemoglobin, may receive prophylactic iron; however, supplementation should be withdrawn after the first blood transfusion.
Assuntos
Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Anemia Ferropriva/epidemiologia , Anemia Falciforme/epidemiologia , Anemia Ferropriva/patologia , Anemia Ferropriva/prevenção & controle , Anemia Falciforme/sangue , Anemia Falciforme/classificação , Biomarcadores/sangue , Transfusão de Sangue/estatística & dados numéricos , Brasil/epidemiologia , Métodos Epidemiológicos , Ferritinas/sangue , Transferrina/análiseRESUMO
OBJECTIVE: To assess iron deficiency or overload in infants with sickle cell disease in order to support the decision to recommend (or not) iron prophylactic supplementation in this population. METHODS: Cross-sectional and retrospective study with 135 infants below 2 years old (66 boys and 69 girls), 77 with SS and 58 with SC hemoglobin, born between 2005 and 2006 in Minas Gerais, Brazil. Indicators of possible iron deficiency were: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), transferrin saturation (TS), and ferritin. Blood transfusions had been given to 17 infants (12.6%, 95% confidence interval [95%CI] 7.0-18.2%) before laboratory tests were done. RESULTS: Ferritin and TS were significantly lower in SC infants (p < 0.001). When two indices were considered for the definition of iron deficiency (low MCV or MCH plus low ferritin or TS), 17.8% of children (95%CI 11.3-24.3%) presented iron deficiency, mainly those with SC hemoglobin (p = 0.003). An analysis of infants who were not given transfusions (n = 118) showed that 19.5% presented iron deficiency. Fifteen infants (11.3%, 95%CI 5.9-16.7%) presented increased ferritin; the majority had been transfused. CONCLUSIONS: Most infants with sickle cell disease do not develop iron deficiency, though some have a significant deficit. This study indicates that infants with sickle cell disease, mainly those with SC hemoglobin, may receive prophylactic iron; however, supplementation should be withdrawn after the first blood transfusion.
Assuntos
Anemia Ferropriva/epidemiologia , Anemia Falciforme/epidemiologia , Anemia Ferropriva/patologia , Anemia Ferropriva/prevenção & controle , Anemia Falciforme/sangue , Anemia Falciforme/classificação , Biomarcadores/sangue , Transfusão de Sangue/estatística & dados numéricos , Brasil/epidemiologia , Pré-Escolar , Métodos Epidemiológicos , Feminino , Ferritinas/sangue , Humanos , Lactente , Masculino , Transferrina/análiseRESUMO
PURPOSE: To compare the process of myelination in the developing optic nerve (ON) of anaemic rats with the subsequent recovery after being fed an iron-recovery diet. METHODS: In this study, the morphometrical parameters in the ON were assessed by electron microscopy in Wistar rats that were on an iron-deficient diet for 32 days or for 21 days followed by 10 days on an iron-recovery diet. Qualitative and quantitative analyses were performed using representative electron ultramicrographs. Data were analysed by one-way analysis of variance (ANOVA). When differences were detected, comparisons were made using Tukey's post hoc test (P<0.05 was considered to be significant). RESULTS: Qualitative analysis of the ONs in anaemic and recovered animals showed a higher rate of deformed axons and increased lamellar separation in the myelin sheath when compared with the respective control group. The ON of the anaemic group showed a reduced mean density of myelinated fibres when compared with the control group. The fibre area ratio, axon area ratio, and myelin area ratio of large axons/small axons in the ONs of the control group showed the highest values for the myelin areas, axon areas, and total fibre areas. The control group showed a significantly higher myelin sheath thickness when compared with the anaemic and recovered groups. CONCLUSIONS: Our data indicate that iron is necessary for maintenance of the ON cell structure, and that morphological damage from iron deficiency is not easily reverted by iron repletion.
Assuntos
Anemia Ferropriva/tratamento farmacológico , Ferro/administração & dosagem , Bainha de Mielina/efeitos dos fármacos , Fármacos Neuroprotetores/administração & dosagem , Análise de Variância , Anemia Ferropriva/patologia , Animais , Suplementos Nutricionais , Modelos Animais de Doenças , Deficiências de Ferro , Microscopia Eletrônica , Bainha de Mielina/patologia , Bainha de Mielina/fisiologia , Nervo Óptico/patologia , Nervo Óptico/fisiologia , Ratos , Ratos WistarRESUMO
In this study, morphological changes in the optic nerve were determined by light microscopy in Wistar rats on an iron-deficient diet for 32 days or for 21 days followed by 10 days on an iron-recovery diet. The morphometric findings showed significantly fewer blood vessels and oligodendrocytes in the iron-deficient rats and iron-recovery rats than in the control group, as well as more astrocytes in the iron-recovery rats. Serum iron levels of the iron-deficient rats were significantly lower than those of the controls. On the other hand, iron-recovery rats had normal serum iron levels, but no change in the abnormal morphology of the myelinated axons and morphometric parameters. Our data indicate that iron is necessary for maintenance of the optic nerve cell structure, and morphological damage from iron-deficiency is not easily reverted by iron reposition.
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Anemia Ferropriva/patologia , Animais Recém-Nascidos , Nervo Óptico/patologia , Anemia Ferropriva/tratamento farmacológico , Animais , Astrócitos/patologia , Feminino , Ferro/administração & dosagem , Ferro/sangue , Deficiências de Ferro , Ferro da Dieta/administração & dosagem , Lactação , Masculino , Fibras Nervosas Mielinizadas/patologia , Oligodendroglia/patologia , Nervo Óptico/irrigação sanguínea , Ratos , Ratos WistarRESUMO
We have used a model of iron deficiency in the rat to analyze the effects of a disruption in iron availability on oligodendroglial cell (OLGc) maturation and myelinogenesis and to explore the possible beneficial influence of an intracranial injection (ICI) of apotransferrin (aTf) at 3 days of age on this process. Studies carried out on postnatal days 17 and 24 showed that iron deficiency produced a decrease in myelin proteins and lipids at 24 days of age. Immunohistochemistry showed that in untreated iron-deficient (ID) rats, the immunoreactivity of anti-adenomatous polyposis coli (APC) and anti-MBP antibodies decreased markedly with reference to normal controls, whereas in ID rats treated with an ICI of aTf, the immunoreactivity of these markers increased. A similar situation occurred with the immunoreactivity of H-ferritin. In primary OLGc cultures from ID rats, there was a high number of cells positive to the antibody against the polysialylated form of the cell surface glycoprotein NCAM (PSA-NCAM) compared with in OLGc cultures prepared from normal controls or from ID animals treated with aTf. The number of MBP+ cells in cultures from ID rats increased after treatment with aTf. The presence of lipid rafts evaluated with a specific anti-protein prion cellular (PrPc) antibody showed a smaller number of PrPc-positive structures in ID rat cultures. Treatment of the ID animals with a single ICI of aTf stimulated myelination, producing a significant correction in the different biochemical parameters affected by ID.
Assuntos
Anemia Ferropriva/tratamento farmacológico , Anemia Ferropriva/patologia , Apoproteínas/uso terapêutico , Doenças Desmielinizantes/tratamento farmacológico , Doenças Desmielinizantes/patologia , Fibras Nervosas Mielinizadas/patologia , Transferrina/uso terapêutico , Anemia Ferropriva/sangue , Animais , Animais Recém-Nascidos , Apoproteínas/farmacologia , Células Cultivadas , Doenças Desmielinizantes/sangue , Modelos Animais de Doenças , Feminino , Bainha de Mielina/efeitos dos fármacos , Bainha de Mielina/patologia , Fibras Nervosas Mielinizadas/efeitos dos fármacos , Gravidez , Ratos , Ratos Wistar , Transferrina/farmacologiaRESUMO
La anemia ferropénica es un problema de salud pública a nivel mundial. Los niños pequeños son más vulnerables a esta deficiencia. Determinar los factores de riesgo y protección para la anemia ferropénica en niños menores de 6 años. Estudio descriptivo, transversal. Se evaluaron 100 niños. Edad, género, estratificación social, tipo de lactancia, edad de ablactación, diagnóstico nutricional, características de la dieta (calorías, proteínas y hierro). Hemoglobina (Hb), Hematocrito (HTO), Volumen Corpuscular Medio (VCM), Hemoglobulina Corpuscular Media (HCM), hierro sérico. A las variables se les aplicó un análisis de regresión logística simple. 46 por ciento de los pacientes tenían anemia. Siendo la media para la edad de 19,2 meses, tiempo de lactancia materna exclusiva 5,2 meses, inicio de ablactación de 5,7 meses, hemoglobina de 9,9 g/dl. Se observa que en los niños de menor edad existe un mayor riesgo de presentar anemia. No se demostró una diferencia estadísticamente significativa entre los pacientes anémicos y no anémicos en relación al Gaffar Méndez Castellano y diagnóstico nutricional. Los factores de riesgo para la anemia con valores de Odds Ratio (OR) >1 fueron la edad menor de 24 meses, ausencia de lactancia materna exclusiva en menores de 6 meses, ablactación antes de los 5 meses, dietas hipocalóricas y el hierro sérico < 41 ug/dL. La dieta normoproteica resultó ser factor de protección (OR<1). Se evidenció la importancia de la lactancia materna y de una adecuada alimentación complementaria a partir del 5° mes de la vida como factores de protección para la anemia ferropénica en niños menores de 6 años.
Iron deficiency anemia is considered as a worlwide public health problem. Small children are more vulnerable to this deficiency. To determine the risk and protection factors for iron deficiency anemia in children under 6 years of age. This is a descriptive and cross-sectional study. 100 children were evaluated. Age, gender, social stratification, nursing type, complementary feedings, nutritional diagnosis, characteristic of the diet (calories, proteins and iron). Hemoglobin (Hb), hematocrit (HTO), mean corpuscular volume (VCM), mean corpuscular hemoglobin (HCM), total and fractional proteins, serum iron. 46% of patients wer anemic. Average values were: age 19,2 months, duration of exclusive breastfeeding 5.2 months, beginning of complementary feeding 5,7 months, hemoglobin 9.9 g/dl. Younger children had an increased risk of developin ganemia. There was not a statistically significant difference between anemic and non anemic patients in regard to Graffar and nutritional diagnosis. Risk factors for anemia (Odds Ratio-OR-values >1) were age under 24 months, lack of exclusive breastfeeding in children under 6 months, complementary feedings before 5 months of age, hypocaloric diet and serum iron <41 ug/dL. Normoproteic diets proved to be a protection factor (OR<1). Breastfeeding and appropriate complementary feedings after 5 months of age are protection factors for iron deficiency anemia in children under 6 years of age.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Anemia Ferropriva/imunologia , Anemia Ferropriva/patologia , Anemias Nutricionais/diagnóstico , Deficiências de Ferro/diagnóstico , Heme/análise , Índices de Eritrócitos/fisiologia , Cuidado da Criança , Ingestão de Energia , Composição de AlimentosRESUMO
New parameters correlated with the hemoglobin content in reticulocytes (RET-Y) and in red blood cells (RBC-Y) have been suggested as helpful in diagnosing iron deficiency anemia. We have studied RET-Y and RBC-Y indices in two groups of patients with microcytosis to verify if these parameters could be used to differentiate iron deficiency anemia from beta-thalassemia minor. Blood samples from 33 iron-deficient patients, 25 beta-thalassemic minor patients and 50 normal individuals were analyzed on a Sysmex XE-2100 instrument. A significant difference was observed in reticulocyte counting and immature reticulocyte fraction between iron deficiency anemia and beta-thalassemia minor groups, but not in RBC-X and RET-Y parameters. Reticulocyte counting was higher in beta-thalassemia minor and the immature reticulocyte fraction was higher in severe iron deficiency anemia. The ratio RET-Y/mean cell volume was tested and was significantly different when beta-thalassemia minor was compared with mild and severe iron deficiency anemia, and showed better performance than the Mentzer ratio and the Green and King function. A great overlap of RET-Y and RBC-Y individual values was observed in both groups of microcytic anemias; we conclude that these new indices may be used with caution as indicative of iron deficiency, mainly in populations where beta-thalassemia minor is frequent.