Search Results (441)

Background: Anaemia in adolescents can be influenced by parasitic infections, systemic inflammation, and nutritional status. Objective: To determine whether C-reactive protein (CRP), nutritional status, and infection with Ascaris lumbricoides, Giardia lamblia, or Trichuris trichiura are associated with anaemia in adolescent athletes from Tacna compared to non-athletes. Methods: A cross-sectional study was conducted involving 250 male football players aged 13–18 years and 150 age-matched non-athletes. Haemoglobin, haematocrit, ferritin, serum iron, CRP, and parasitic status were measured; mean comparisons and logistic regression were applied. Results: Anaemia was more prevalent among athletes than non-athletes (30% vs. 18%; p < 0.001). Infected athletes showed lower haemoglobin (11.9 ± 1.1 g/dL) and higher CRP (5.0 ± 1.9 mg/L) levels compared to non-infected athletes (13.8 ± 1.0 g/dL and 2.2 ± 1.1 mg/L; p < 0.001). Logistic regression identified CRP as an independent predictor of anaemia (adjusted OR = 1.20; 95% CI: 1.08–1.38; p < 0.001), while parasitic infections showed no direct association after adjustment. Underweight status was associated with a higher prevalence of anaemia (36%). Conclusions: Systemic inflammation emerged as the main factor associated with anaemia in this population, with parasitic infections contributing indirectly by increasing inflammation. Periodic deworming, iron supplementation, and CRP monitoring are recommended to reduce the burden of anaemia in adolescent athletes from endemic regions. Full article

Background/Objectives: Iron deficiency without anaemia (IDNA) is common in non-dialysis-dependent chronic kidney disease (CKD) and contributes to fatigue, reduced exercise tolerance, and impaired quality of life (QoL). While intravenous (IV) iron replacement is known to benefit anaemic patients, its role in IDNA remains uncertain. This study aimed to evaluate the impact of ferric derisomaltose (FDI) on patient-reported QoL outcomes in CKD patients with IDNA. Methods: This was a post hoc analysis of the double-blind, multicentre Iron and the Heart randomised controlled trial. Fifty-four participants with IDNA (ferritin < 100 µg/L or transferrin saturation < 20% and haemoglobin 110–150 g/L) and CKD stages G3b–G5 were randomised 1:1 to receive either 1000 mg FDI (n = 26) or placebo (n = 28). An additional 10 iron-replete CKD patients served as controls. SF-36v2 QoL surveys were collected at baseline, 1 month, and 3 months. Results: SF-36v2 scores declined across all domains, but deterioration was consistently milder in the FDI group. Role physical declined by 3% in the FDI group versus 12% with placebo and 4% in controls. Bodily pain improved by 2.8% with FDI but worsened by 1.5% in the placebo group. Mental health improved by 3.4 points with FDI and declined by 2.7 points in the placebo group, creating a 6.1-point separation. While differences did not reach statistical significance, likely due to small sample size, the consistent trends favour FDI. Conclusions: IV iron may attenuate QoL decline in non-dialysis-dependent CKD patients with IDNA. These findings support the need for larger, adequately powered trials to assess patient-centred outcomes in this population. Full article

Background/Objectives: Undernutrition and intestinal parasitic infections are critical public health problems in low-income countries, with adverse effects on child growth and increasing anaemia. Madagascar, with a high prevalence of these factors, lacks comprehensive studies analysing their interaction. This study aimed to assess the nutritional status, the prevalence of anaemia, and the occurrence of intestinal parasitic infections among children and adolescents in three southern regions of Madagascar. Methods: A cross-sectional, prospective study of 289 children and adolescents (10–18 years) from three schools located in Antsoamadiro, Fianarantsoa, and Toliara was conducted. Sociodemographic, anthropometric, and haemoglobin concentration data, as well as faecal samples, were collected. Nutritional status was assessed by Nutrimetry, combining Height-for-Age and BMI-for-Age indicators. Stool samples were analysed by optical microscopy and molecular methods. Results: Nutricode 1 (short stature/stunting + thinness/wasting) was significantly more frequent in Toliara. Nutricode 1 was also significantly more prevalent in males than females. Anaemia affected 57.8% of participants and was significantly associated with Nutricode 1. The overall parasitism rate was also associated with Nutricode 1. Trichuris trichiura and Ascaris lumbricoides significantly increased the risk of stunting, wasting, and Nutricode 1. Co-infection with Trichuris trichiura + Giardia duodenalis was significantly associated with wasting and Nutricode 1. This co-infection was also related to the presence of anaemia, as was moderate-intensity infection with T. trichiura. Conclusions: There is a high co-burden of undernutrition, anaemia, and parasitic infections in southern Madagascar. These findings highlight the urgency of implementing comprehensive health programmes combining parasite control, nutritional support, and iron supplementation adapted to regional realities. Full article

Background: Iron deficiency (ID) is a prevalent comorbidity of heart failure (HF), affecting up to 59% of patients, regardless of the presence of anaemia. Although its negative impact on left ventricular (LV) function is well documented, its effect on right ventricular (RV) function remains unclear. This study assessed the effects of ID on RV global longitudinal strain (RV-GLS) in patients diagnosed with acute decompensated HF (ADHF). Methods: This study included data from 100 patients hospitalised with ADHF irrespective of LV ejection fraction (LVEF) value. ID was defined according to the European Society of Cardiology HF guidelines as serum ferritin <100 ng/mL or ferritin 100–299 ng/mL, with transferrin saturation <20%. Anaemia was defined according to World Health Organization criteria as haemoglobin level <12 g/dL in women and <13 g/dL in men. RV systolic function was assessed using parameters including RV ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), peak systolic tissue Doppler velocity of the RV annulus (RV TDI S′), acceleration time of the RV outflow tract, and RV free wall GLS. Results: The mean (±SD) age of the study population (64% male) was 70 ± 10 years. The median LVEF was 35%, with 66% of patients classified with HF with reduced ejection fraction, 6% with HF with mid-range ejection fraction, and 28% with HF with preserved ejection fraction. Fifty-eight percent of patients had ID. There were no significant differences between patients with and without ID regarding demographics, LVEF, RV FAC, RV TDI S′, or systolic pulmonary artery pressure. However, TAPSE (15.6 versus [vs.] 17.2 mm; p = 0.05) and RV free wall GLS (−14.7% vs. −18.2%; p = 0.005) were significantly lower in patients with ID, indicating subclinical RV systolic dysfunction. Conclusions: ID was associated with subclinical impairment of RV systolic function in patients diagnosed with ADHF, as evidenced by reductions in TAPSE and RV-GLS, despite the preservation of conventional RV systolic function parameters. Further research validating these findings and exploring the underlying mechanisms is warranted. Full article

Background: Micronutrient deficiencies, particularly among pregnant women and children under five years old, remain a significant public health challenge in Nigeria. Despite existing policies and programmes, national data on prevalence and risk factors are fragmented. Objective: To synthesise the current evidence on the prevalence of key micronutrient deficiencies and associated risk factors among pregnant women and children under five years old in Nigeria. Methods: A systematic review and meta-analysis were conducted using peer-reviewed studies that were published between 2008 and 2024. The databases searched included PubMed, Scopus, and African Journals Online. After screening 1207 studies, 37 studies were included: 27 were conducted among pregnant women and 10 were among children. A meta-analysis was conducted to estimate the anaemia prevalence using a random-effects model. A narrative synthesis was conducted to synthesise evidence on other micronutrients (i.e., magnesium, copper, and vitamins C and E) due to the limited data and risk factors. Results: The pooled prevalence of anaemia was 56% among children and 54% among pregnant women. The prevalence of other micronutrient deficiencies varied widely, with a high prevalence of zinc (86.4%), magnesium (94%), and vitamin D (73.3%) deficiencies in certain regions. The identified risk factors included poor dietary diversity, lower socioeconomic status, low maternal education, infection burden, and early or high parity. Most studies were facility-based and sub-national, limiting the generalisability. Conclusions: This review highlights a high prevalence of anaemia and micronutrient deficiencies among pregnant women and children in Nigeria. Key risk factors included a poor diet, low maternal education, infections, and reproductive health challenges. Targeted, multisectoral policies are urgently needed to address these gaps and improve health outcomes. Full article

Backgrounds and Objectives: Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare but potentially severe complication of SARS-CoV-2 infection, with increasingly reported renal manifestations. Materials and Methods: The aim of this retrospective study was to compare clinical and laboratory characteristics across age categories, with special emphasis on renal function. We analysed data from 64 patients with MIS-C treated between July 2020 and December 2023. Results: In children under 3 years of age, there was a higher prevalence of leucocytosis, elevated platelet counts, and anaemia, along with a lower frequency of complications. The 3–6-year age group was characterized by the presence of rash, hypoalbuminemia, and elevated transaminases. The 7–12-year age group showed the highest rate of organ dysfunction. In adolescents (13–18 years), neurological symptoms, the highest BMI values, the greatest prevalence of comorbidities, leukopenia, lymphopenia, and elevated GGT levels were observed. The incidence of acute kidney injury (AKI) was 6.3% (n = 4/64). Following treatment, the majority of patients achieved full recovery (n = 61/64; 95.2%). Conclusions: There are pronounced age-related differences in the clinical presentation of MIS-C, with distinct immune and clinical patterns suggesting developmental influences on disease expression and outcomes. Older children showed a higher prevalence of comorbidities and organ dysfunction compared to younger patients. Notably, this study found a markedly lower incidence of acute kidney injury (6.3%) compared to previously reported rates (20–30%), indicating potential regional or age-related protective factors. These findings highlight the importance of age-specific evaluation in MIS-C and underscore the need for further multicentre research to refine therapeutic protocols. Full article

Background: Anaemia and undernutrition remain a significant public health problem in low and middle-income countries (LMICs), particularly affecting under-five children. In Tanzania, the prevalence of anaemia and undernutrition in under-five children is still high; however, less is known about the prevalence and predictors of these conditions in rural areas. Therefore, the current cross-sectional study presents the prevalence and determinants of anaemia and undernutrition among 457 children aged 6–24 months in the Babati and Hanang districts of Tanzania. Method: Haemoglobin concentration was assessed through capillary blood samples. Anaemia was classified according to WHO 2011 guidelines using a cut-off of <11.0 g/dL for children under five, while the WHO 2006 growth indicators were used to classify the nutritional status (i.e., stunting, wasting and underweight). Results: The results from this study show that 32%, 32%, 20% and 4% of children aged 6–24 months were anaemic, stunted, underweight and wasted, respectively, while only 33% had an adequate minimum dietary diversity (MDD). In addition, the child’s age (13–24 months) was significantly associated with anaemia (AOR: 2.1 95% CI 1.4, 3.1), stunting (AOR:17.4 95% CI 10.3, 29.4) and underweight (AOR: 15.9 95% CI 7.9, 32.0). Moreover, male children were three times more likely to be wasted (AOR: 3.5 95% CI 1.1, 10.9) than their female counterparts. Anaemia and stunting were the most prevalent nutritional disorders among 6–24-month-old children in the Hanang and Babati districts. Moreover, age (13–24 months) was found to be the common predictor for anaemia, stunting and underweight. Conclusion: The observed association between age and anaemia, as well as undernutrition, suggest that age may be an essential factor when designing nutrition-related programs in similar rural settings. Full article

Background: Colon capsule endoscopy (CCE) or panenteric capsule endoscopy (PCE) offers a promising, non-invasive diagnostic approach for patients with iron deficiency anaemia (IDA). However, high rates of conversion to conventional colonoscopy (CCC) following capsule procedures reduce cost-effectiveness and patient satisfaction. Optimising the faecal immunochemical test (FIT) threshold may improve patient stratification and reduce unnecessary conversions in future applications within the IDA diagnostic pathway. Methods: The CLEAR IDA study was a multicentre, retrospective observational study conducted across four UK hospitals. Data were collected over a six-month study period and included patients referred via the two-week-wait (2WW) cancer pathway for iron deficiency, with or without anaemia, over a 12-month timeframe. Colonoscopy findings were analysed and extrapolated using NHS England’s CCE-to-colonoscopy referral criteria to assess the predictive value of FIT for colorectal cancer (CRC), polyp burden, and CCC using ROC curve analysis. The optimal FIT threshold was identified through three complementary approaches: threshold-based analysis, decision curve analysis, and cost–benefit modelling. Results: A total of 1531 patients were analysed; only 1.6% underwent small bowel capsule endoscopy. The diagnostic accuracy (AUC) of FIT for predicting CRC, polypoidal lesions, and CCC was 0.78, 0.58, and 0.69, respectively. Threshold-based analysis identified FIT = 15 µg/g as the lowest level at which CCC rates significantly increased (p = 0.02; OR = 1.87; 95% CI: 1.07–3.14). Decision curve analysis showed a maximum net benefit at FIT = 17.6 µg/g, while cost–benefit modelling identified 9 µg/g as the most cost-effective. Raising the threshold to 10 µg/g resulted in a net loss of GBP –294.4 per patient. An optimal cost-effective FIT threshold range was identified between 10 and 17.6 µg/g. The threshold selection should be tailored to local service capacity and resource availability. Conclusions: While FIT alone is an imperfect triage tool, optimising thresholds between 10 and 17 µg/g may enhance cost-effectiveness and guide appropriate PCE use in IDA. Full article

Soil-transmitted helminths (STHs) are parasitic nematodes that infect humans, particularly in tropical and subtropical regions, where they contribute substantially to neglected tropical diseases (NTDs). Among them, hookworms (Ancylostoma duodenale, Necator americanus and Ancylostoma ceylanicum) cause substantial morbidity, leading to anaemia, malnutrition, and developmental impairment. Despite the global impact of hookworm disease, genomic research on A. duodenale has lagged behind that of other hookworms, limiting comparative and molecular biological investigations. Here, we report the first chromosome-level reference genome of A. duodenale, assembled from a single adult specimen archived in ethanol at −20 °C for more than 27 years. Using third-generation sequencing (PacBio Revio, Menlo Park, CA, USA, Oxford Nanopore, Oxford, UK), Hi-C scaffolding, and advanced computational tools, we produced a high-quality 319 Mb genome, filling a critical gap in hookworm genomics. Comparative analyses with N. americanus and the related, free-living nematode Caenorhabditis elegans provided new insights into genome organisation, synteny, and specific adaptations. While A. duodenale exhibited strong chromosomal synteny with N. americanus, its limited synteny with C. elegans highlights its distinct parasitic adaptations. We identified 20,015 protein-coding genes, including conserved single-copy orthologues (SCOs) linked to host–pathogen interactions, immune evasion and essential biological processes. The first comprehensive secretome analysis of A. duodenale revealed a diverse repertoire of excretory/secretory (ES) proteins, including immunomodulatory candidates predicted to interact with host structural and immune-related proteins. This study advances hookworm genomics, establishes a basis for the sequencing of archival specimens, and provides fundamental insights into the molecular biology of A. duodenale. The genomic resource for this hookworm species creates new opportunities for diagnostic, therapeutic, and vaccine development within a One Health framework. It complements recent epidemiological work and aligns with the WHO NTD roadmap (2021–2030) and Sustainable Development Goal 3.3. Full article

The evaporation of a blood sessile droplet on a solid substrate generates distinctive desiccation patterns. These patterns have been identified as a potential tool for interpreting the pathological information of donors, since their morphological features encode pathological indicators linked to blood-related disorders. We collected two representative sets of blood samples from anonymous patients: healthy donors (normal haematocrit) and anaemia patients (low haematocrit). Our real-time observations of the morphological evolution during desiccation reveal distinct differences in pattern development. The macroscopic analysis indicates that blood sessile droplets from anaemia patients with abnormally low haematocrit levels experience divergent morphological trajectories, forming cracking patterns distinguishable from those of healthy donors. Our microscopic comparisons show that the blood desiccation patterns of healthy donors exhibit a longer coronal region and greater deposit coverage in the central region than those of anaemia patients. Our further analysis correlates these morphological variations to the effects of the haematocrit level of blood samples on material redistribution. This work proposes a facile strategy for health diagnostics through blood desiccation pattern analysis, highlighting its potential as a foundation for diagnostic platforms. Full article

Background/Objectives: Iron deficiency anaemia (IDA) is a common complication in patients with colorectal cancer presenting for surgery. Perioperative IDA is associated with increased post-operative mortality and morbidity. The impact on clinical outcomes for the active management of anaemia before surgery, with treatments such as intravenous (IV) iron, is uncertain. Methods: We performed a single-centre nested cohort study, analysing prospectively collected data from patients with colorectal cancer who were treated with IV iron prior to elective major abdominal surgery. Cox proportional hazard models were used to quantify the effect of anaemia treatment on length of stay. Other outcomes, including transfusion rates, were estimated using logistic regression analyses. Models were adjusted for age, sex, comorbidities and surgical details. Results: The length of stay was longer for patients with untreated anaemia compared to patients without anaemia (adjusted hazard ratio, HR 0.66 [95% confidence interval, CI 0.45, 0.95]). For patients with anaemia, the length of stay was shorter in those treated when compared to those not treated (adjusted HR 0.59 [95% CI 0.45, 0.78]). Patients with untreated anaemia had higher transfusion rates than patients with treated anaemia (adjusted odds ratio, OR 0.35 [95% CI 0.18, 0.66]) and non-anaemic patients (adjusted odds ratio, OR 0.20 [95% CI 0.07, 0.55]). Conclusions: This study suggests that treating iron deficiency anaemia with IV iron pre-operatively reduces length of stay and transfusion rates in colorectal cancer patients. Full article

Background: Idiopathic intracranial hypertension (IIH) is, by definition, of unknown cause. Davson’s equation indicates that the increased intracranial pressure (ICP) found in IIH could be due to an increase in the CSF formation rate (CSF_fr), the CSF outflow resistance (R_out) or the venous sinus pressure. Studies simultaneously measuring the ICP and sagittal sinus pressures in IIH suggest that there is either a reduction in the R_out and/or the CSF_fr. The latter suggests that the increased venous pressure can be the only variable causing this disease process. A study maintaining the ICP at zero showed a significantly elevated CSF_fr in this disease. The purpose of the current study is to define the most feasible explanation for these findings and to suggest a viable pathophysiology for IIH. Methods: A lumped parameter vascular model, originally developed to study normal pressure hydrocephalus, was extended to investigate IIH. The model used the simultaneously obtained ICP and sagittal sinus pressure measurements from five experiments published in the literature to estimate the CSF_fr and the capillary transmural pressure (TMP). The assumptions made during this study were those of a normal mean arterial pressure, a normal total R_out and a normal blood flow rate. Results: When the CSF formation rates were plotted against the estimated capillary transmural pressures, a straight line was returned, suggesting that the CSF_fr and capillary TMP are related. Conclusions: The novel findings of this study suggest that the CSF_fr in IIH varies with the capillary TMP. A reduced capillary TMP in IIH can moderate the ICP if there is net CSF absorption across the capillaries. This would require the blood–brain barrier (BBB) to be disrupted. The model suggests that drugs which stabilise the BBB may trigger IIH by blocking CSF absorption across the capillaries, increasing the apparent CSF formation rate back toward normal and increasing the ICP. Anaemia will promote IIH by increasing the cerebral blood flow, the capillary TMP and the CSF_fr. Full article

Background: Iron supplementation during pregnancy is associated with several health benefits, including a reduced risk of maternal anaemia and improved neonatal outcomes such as lower rates of low birth weight, infection, and anaemia in infancy. However, its impact on neonatal and post-neonatal mortality remains unclear in resource-limited settings, where adherence to maternal iron supplementation is low. This study examined the association between maternal iron supplementation and neonatal and post-neonatal mortality and explored whether low birth weight (LBW) modifies those associations. Methods: This cross-sectional study utilised Demographic and Health Survey data collected between 2015 and 2023 from 26 sub-Saharan countries, including 287,642 neonates and 279,819 post-neonates. The primary outcomes were neonatal deaths (within 28 days) and post-neonatal deaths (between 29 days and 12 months). These outcomes and the exposure variables of iron supplementation and its duration were based on maternal recall. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated using generalised linear mixed models, with stratification by LBW. Results: There was no significant association between maternal iron supplementation and neonatal mortality (aOR = 1.07; 95% CI: 0.86, 1.34). However, the interaction between LBW and iron supplementation was statistically significant (p = 0.04). Among the LBW infants, the absence of iron supplementation increased the odds of neonatal mortality by 68% (aOR = 1.68; 95% CI: 1.14, 2.47), while supplementation for ≥90 days reduced the odds by 45% (aOR = 0.55; 95% CI: 0.35, 0.84). For post-neonatal mortality, lack of iron supplementation increased the odds by 25% (aOR = 1.25; 95% CI: 1.01, 1.56), whereas supplementation for ≥90 days reduced the odds by 27% (aOR = 0.73; 95% CI: 0.57, 0.93). Conclusions: Maternal iron supplementation was associated with lower post-neonatal mortality and improved neonatal survival among LBW infants. These findings suggest that iron intake may support infant survival, particularly in vulnerable populations. Full article

Multimorbidity poses significant challenges for resource-constrained healthcare systems, particularly in low and middle income countries where specific combinations of chronic conditions may differentially impact function. This cross-sectional study examined multimorbidity patterns and associations with functioning among 165 adults attending semi-rural primary healthcare facilities in South Africa. Participants completed performance-based measures (handgrip strength, five-times sit-to-stand test, step test and exercise prescription tool [STEP] maximum oxygen consumption) and self-reported function (12-item WHODAS 2.0). Exploratory factor analysis identified three multimorbidity patterns: HIV-hypercholesterolaemia-obesity (Pattern 1), hypertension-anaemia-lung disease (Pattern 2), and stroke-heart disease-hypercholesterolaemia (Pattern 3). Pattern 1 was associated with reduced aerobic capacity (β = −6.41, 95% CI: −9.45, −3.36) and grip strength (β = −0.11, 95% CI: −0.14, −0.07). Pattern 2 showed associations with mild (β = 1.12, 95% CI: 0.28, 1.97) and moderate (β = 1.48, 95% CI: 0.53, 2.43) self-reported functional problems and reduced grip strength (β = −0.05, 95% CI: −0.09, −0.003). Pattern 3 was associated with all self-reported impairment levels, with the strongest association for severe impairment (β = 2.16, 95% CI: 0.32, 4.01). These findings highlight the convergence of infectious and non-communicable diseases in this setting. Simple clinical measures like grip strength and self-reported function may hold potential as screening or monitoring tools in the presence of disease patterns, warranting further research. Full article

Background/Objectives: Iron deficiency anemia in pregnancy poses risks to mothers and infants. This study aimed to correlate maternal iron indices in the second trimester with cord blood indices and pregnancy outcomes. Methods: This prospective cohort study was nested within the RAPIDIRON Trial (Reducing Anaemia in Pregnancy in India) at Jawaharlal Nehru Medical College, Karnataka, India. A total of 292 pregnant women with moderate anemia who received oral iron supplementation were enrolled from April 2021 to May 2023. Maternal iron indices were measured at multiple time points and correlated with cord blood indices and pregnancy outcomes. Results: Increased hemoglobin levels were observed in mothers of preterm and term neonates from 8.92 ± 0.81 vs. 9.02 ± 0.77 g/dL at 12–16 weeks to 11.14 ± 1.31 vs. 10.73 ± 1.24 g/dL at 26–30 weeks. A similar trend was observed in mothers across birth weight groups. Ferritin and TSAT levels significantly increased in all outcome groups (p < 0.001), peaking at 20–24 weeks and then slightly declining at 26–30 weeks. Additionally, maternal sTfR levels significantly improved from the early (7.72 ± 1.33 vs. 7.51 ± 1.61) to late second trimester (5.87 ± 0.81 vs. 5.76 ± 1.11) in mothers of both anemic and non-anemic neonates (p < 0.001). Maternal sTfR in other outcome groups also showed a similar pattern. A negligible correlation was found between maternal and cord blood iron indices. Conclusions: Maternal iron indices increased from the early to mid-second trimester, followed by a slight fall in the late second trimester. Notably, higher iron indices were observed in mothers of preterm and low-birth-weight neonates. Full article