Search Results for: Anemia sideropenica e carenza marziale senza anemia: senza ferro si sta male

Aiom, ‘se possibile usare farmaci alternativi in nuovi pazienti’

La battaglia sul fine vita si sposta ancora una volta sul piano nazionale e potrebbe vedere nei prossimi mesi un braccio di ferro tra Governo e diverse Regioni. Ad innescare…

Introduction
Anaemia in the elderly is often difficult to treat with iron supplementation alone as prevalence of anaemia of chronic disease (ACD) alone or mixed with iron-deficiency anaemia (IDA) is high in this age group. Hepcidin remains high in ACD, preventing utilisation of iron for heme synthesis. Vitamin D3 has shown hepcidin suppression activity in both in vitro and in vivo studies. As there is no study assessing the effect of iron–folic acid (IFA) with vitamin D3 on haemoglobin levels in the elderly in India, we want to conduct this study to estimate the impact of supplementation of a therapeutic package of IFA and vitamin D3 on haemoglobin levels in the elderly with mild-to-moderate anaemia in comparison with IFA only. The study will also assess the impact of the proposed intervention on ferritin, hepcidin, 25-hydroxyvitamin D, C reactive protein (CRP) and parathyroid hormone (PTH) levels.

Methods and analysis
This study is a community-based, double-blind, placebo-controlled, randomised trial. The study will be done in the Kalyani municipality area. Individuals aged ≥60 years with mild-to-moderate anaemia and normal vitamin D3 levels will be randomised into the intervention (IFA and vitamin D3 supplementation) group or the control group (IFA and olive oil as placebo). All medications will be self-administered. Follow-up will be done on a weekly basis for 12 weeks. The calculated sample size is 150 in each arm. Block randomisation will be done. The primary outcome is change in haemoglobin levels from baseline to 12 weeks. Secondary outcome is change in serum ferritin, 25-hydroxyvitamin D, hepcidin, CRP and PTH levels from baseline to 12 weeks.

Ethics and dissemination
Ethical approval from the Institutional Ethics Committee of All India Institute of Medical Sciences Kalyani has been obtained (IEC/AIIMS/Kalyani/Meeting/2022/03). Written informed consent will be obtained from each study participant. The trial results will be reported through publication in a reputable journal and disseminated through health talks within the communities.

Trial registration number
CTRI/2022/05/042775.

Protocol version
Version 1.0.

“Mancano 20-30 mila medici, ‘in pancia’ 45mila”

New England Journal of Medicine, Volume 390, Issue 10, Page 960-962, March 2024.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Oggi c’è carenza di medici per la cattiva programmazione e il picco dei pensionamentiDal 2034 in poi crollano le uscite e la maxi offerta di nuovi dottori può trasformarsi in una pletora

Locatelli: ‘Può trasformare la vita dei pazienti’

Stroke, Volume 55, Issue Suppl_1, Page ATMP10-ATMP10, February 1, 2024. Introduction:Sickle Cell Anemia (SCA) causes lower hemoglobin, leading to increased cerebral blood flow (CBF) to maintain cerebral oxygen metabolism (CMRO2). Although CBF rises in childhood to meet higher CMRO2demands, further compensatory increases in CBF in children with SCA may tap into a limited hemodynamic reserve, increasing risk for infarct. Cerebrovascular reactivity (CVR) reflects hemodynamic reserve by measuring the vasculature’s response to vasoactive stimuli, particularly in the gray matter (GM). We hypothesized that children with SCA have lower GM CVR, regardless of CMRO2.Methods:We used magnetic resonance imaging of children with and without SCA to collect pseudocontinuous arterial spin labeling (pCASL) for CBF, asymmetric spin echo for oxygen extraction fraction (OEF) and blood oxygen level dependent (BOLD) data correlated with hypercapnic challenges for CVR. Lab draws confirmed Hemoglobin (Hb) values. CMRO2was calculated as CBF x OEF x Arterial Oxygen Content (1.36 x Hb x SpO2). Continuous variable differences between groups were analyzed using the Mann-WhitneyUtest, and categorical variables using the Fisher’s exact test. Linear regression assessed the relationship between CVR and Hb. Reported significant relationships survived multiple comparisons correction.Results:A total of 35 participants, ages 8–22 years had quality CVR data [9 SCA subjects (5 male) and 26 controls (9 male)]. Of these, 8 SCA and 20 controls had adequate quality metabolic data. The groups are matched by age (p=0.56) and sex (p=0.43). Children with SCA had higher GM CBF (62.0 v 49.3 mL/100g/min; p=0.03), but similar GM CMRO2(1.81 v 1.42 mL/100g/min; p=0.07) than controls. GM CVR was significantly lower in SCA than controls (0.17 v 0.27 %/mmHg; p=0.0003). Lower CVR was associated with lower Hb (Figure) after adjusting for age and sex (p

Stroke, Volume 55, Issue Suppl_1, Page AWP225-AWP225, February 1, 2024. Background:Anemia is a well-established risk factor for stroke in many populations. Recent data suggest that in patients with moyamoya arteriopathy (MMA), decrease in hemoglobin is associated with perioperative stroke. Evaluating the role of anemia in stroke pathogenesis outside of the perioperative period in MMA could aid in risk stratification and stroke prevention.Hypothesis:We hypothesized that patients with MMA have lower hemoglobin levels in the setting of vascular events compared to their pre-event baseline.Methods:In this retrospective self-controlled case series, we abstracted demographic and clinical data from patients < 40 years old with MMA cared for in our institution’s pediatric or young adult stroke clinics between 2003 and 2023. Laboratory data for each vascular event (stroke or TIA) were collected. The most recent laboratory data preceding events were also collected (baseline). Perioperative events (those occurring ≤7 days after revascularization) were excluded. Pre- and post-revascularization events were analyzed together and separately. Paired T-tests were used to compare baseline and vascular event hemoglobin values.Results:Eighty-nine (89) participants met inclusion criteria. There were 32 vascular events with corresponding baseline data available. There was no significant difference in hemoglobin between event and baseline values (11.2 v 11.3 g/dL, p = 0.87). However, among only pre-surgical events (n=20), hemoglobin was lower during events compared to baseline (10.4 v 11.5 g/dL, p=0.03). For events that occurred >7 days post-revascularization (n=12), hemoglobin was higher during events compared with baseline (12.6 v 10.9 g/dL, p=0.008).Conclusions:In our cohort of children and young adults with MMA, hemoglobin was lower than baseline during presurgical vascular events and higher than baseline during post-revascularization vascular events. Though further exploration with multivariate models is necessary, these preliminary data suggest that while anemia and dehydration may both increase the risk of stroke in MMA, the relative contributions of these stroke risk factors differ based on surgical status.

Stroke, Volume 55, Issue Suppl_1, Page ATP306-ATP306, February 1, 2024. Anemic intracerebral hemorrhage (ICH) patients are observed to have poor clinical outcomes with increased risk of hematoma expansion (HE) and impaired cerebral oxygenation. To assess whether anemia causes these observations, we assessed neuroimaging evidence of HE and neuropathological changes of hypoxia and blood brain barrier (BBB) dysfunction in anemic vs non-anemic mice with ICH. Anemia was generated in 3 month old female C57/BL6 mice using iron-deficient chow. Age and sex-matched controls were fed iron-replete control diet. Anemia was verified using modified Drabkin assays. Collagenase was used to induce ICH. ICH volume and HE were quantified using serial T2-weighed MRI at 1, 4, and 24 hours after ICH. Early 24 hour mortality was recorded. After the last MRI, surviving mice were euthanized by intracardiac perfusion and the brain was processed for histological analysis of vascular permeability (IgG), microglia number and activation (Iba1 and CD68), and response to hypoxia (HIF1α). Statistical analyses were performed using two-tailed ANOVA. Compared to controls, anemic mice displayed larger final ICH lesion volumes (anemia: 7.7 mm3vs control: 6.1 mm3), greater HE at 24 hours (anemia: 111.4% vs control: 23.6%) and increased early mortality (anemia: 30% vs control: 0%). Histological analyses revealed that, while microglial activation and BBB permeability to serum IgGs in control mice were restricted to the ipsilateral hemisphere and mostly localized perilesionally, anemic mice had increased immune infiltration and increased BBB permeability in both hemispheres. Similarly, non-ICH anemic mice showed increased and widespread immune cell infiltration and increased BBB permeability compared to non-ICH control mice, suggesting that consistently low hemoglobin concentrations may increase cerebrovascular susceptibility to injury.Future studies will be needed to further clarify cellular and molecular mechanisms driving our findings and whether anemia can be a treatable target to improve ICH outcomes.

Stroke, Volume 55, Issue Suppl_1, Page AWP176-AWP176, February 1, 2024. Background:We have previously identified that hemoglobin decrements and new-onset anemia during an intracerebral hemorrhage (ICH) hospitalization is frequent, rapid, and associates with poor outcome. Though this association may be related to impaired cerebral oxygen delivery, it is unclear whether these changes relate to cerebral ischemia. We investigated the relationship of hemoglobin decrements over time and ischemic lesions on brain MRI during an ICH hospitalization.Methods:Consecutive patients with acute spontaneous ICH enrolled into a single-center, prospective cohort study between 2009 and 2019 were assessed. Patients who had a brain MRI and serial hemoglobin measurements were included. Change in hemoglobin from admission to date of brain MRI (delta Hgb) was defined as the exposure. The outcome was the presence of remote ischemic lesions, defined as foci of diffusion restriction >10 mm away from the hematoma on brain MRI. A regression model assessed relationships between delta Hgb and DWI brain lesions, adjusting for baseline demographics, ICH severity, and time to MRI. Separate sensitivity models were adjusted for admission systolic blood pressure and hemoglobin.Results:We identified 189 ICH patients with brain MRI and serial hemoglobin measurements during their hospitalization. The mean age was 66.5 (SD 14.8) and 49.2% were female. Mean admission hemoglobin was 13.5 g/dL (SD 2.0), mean change in hemoglobin from admission to day of MRI was -1.6 (SD 1.6), median time from ICH onset to MRI was 2 (IQR 1-4) days, and 31.7% of patients had ischemic lesions on MRI. We identified an association of greater decrements in hemoglobin with ischemic lesions in our primary model (adjusted OR 0.79, 95%CI 0.64-0.99, p=0.04). Sensitivity analyses adjusting for admission systolic blood pressure and hemoglobin did not change this association.Conclusions:Greater hemoglobin decrements associate with remote ischemic lesions on brain MRI of patients with acute ICH. Further work is needed to assess drivers of anemia after ICH and possible causal mechanisms for ischemic brain injury to assess whether anemia is a modifiable treatment target to improve ICH outcomes.