Search Results (15)

Background/Objectives: Atrial fibrillation and coronary artery disease frequently coexist in patients undergoing percutaneous left atrial appendage occlusion (LAAO), creating a complex therapeutic setting in which prevention of device-related thrombosis, cardioembolic events, and coronary ischemic complications must be balanced against a high or prohibitive bleeding risk. The optimal post-procedural antithrombotic regimen remains uncertain, particularly in patients with previous or recent percutaneous coronary intervention or acute coronary syndrome. Methods: This narrative review examines the rationale and current evidence supporting antithrombotic therapy after LAAO and integrates these data with contemporary strategies for abbreviated or de-escalated antiplatelet therapy after coronary intervention. Results: Device-related thrombosis occurs predominantly within the first 45–90 days after implantation, corresponding to the period of incomplete device endothelialisation, whereas thrombotic risk after coronary stenting or acute coronary syndrome is similarly greatest during the early phase and progressively declines thereafter. This temporal overlap supports an initially protective regimen followed by early treatment simplification whenever appropriate. We propose a pragmatic framework in which treatment intensity is determined by a global bleeding–thrombotic risk profile incorporating bleeding history, anaemia, comorbidities, frailty, coronary presentation, procedural complexity, and follow-up imaging. The approach includes predefined triggers for rapid de-escalation in the presence of relevant bleeding or haemoglobin decline and escalation when device-related thrombosis is detected. Conclusions: Current evidence remains heterogeneous and largely observational, the proposed algorithm should be considered a decision-support framework rather than a prescriptive pathway. Prospective randomised studies are needed to define the safest individualised regimen for patients with concomitant LAAO and coronary artery disease. Full article

Severe anaemia remains a major public health challenge, disproportionately affecting children and women of reproductive age in sub-Saharan Africa. In high-burden settings, the aetiology of severe anaemia is multifactorial, encompassing nutritional deficiencies, infections, and host genetic factors. Beyond its direct clinical consequences, severe anaemia is also associated with increased susceptibility to invasive bacterial infections, particularly those caused by enteric pathogens such as non-typhoidal Salmonella and Escherichia coli. In this review, we present an integrated framework linking severe anaemia and invasive bacterial infection through three interconnected biological pathways, collectively termed the gut–iron–immune axis: gut microbial dysbiosis and impaired intestinal barrier integrity; disrupted iron homeostasis; and impaired immune function. We examine context-specific modifiers in endemic settings, including iron deficiency, malnutrition, malaria, sickle cell disease, and environmental enteric dysfunction. We also discuss how management of severe anaemia, including blood transfusion and iron supplementation, reshapes the gut microbiome, with direct implications for microbial translocation, invasive bacterial infection, and clinical outcomes. Finally, we identify key knowledge gaps and research priorities to guide safer and more effective prevention and management of severe anaemia in high-burden settings. Full article

Background and Objectives: Preoperative anaemia represents a key modifiable risk factor in obstetrics. Within the framework of Patient Blood Management (PBM), establishing precise hemoglobin (Hb) thresholds is essential for optimal clinical decision-making. This study aimed to assess the predictive value of preoperative hemoglobin levels and to determine the optimal cutoff associated with transfusion risk. Materials and Methods: A retrospective analysis was performed on 932 pregnant women. The association between preoperative hemoglobin, anticoagulant therapy, mode of delivery and maternal age with the need for red blood cell transfusion was evaluated using binary logistic regression and Receiver Operating Characteristic (ROC) curve analysis with the Youden index. Results: Red blood cell transfusion was required in 5.2% (n = 48) of the study population. Logistic regression identified preoperative hemoglobin as the strongest independent predictor (p < 0.001, OR = 0.216, 95% CI: 0.153–0.306), indicating that each 1 g/dL increase in Hb reduced the likelihood of transfusion by 78.4%. Anticoagulant therapy and age were not significant independent predictors (p > 0.05). ROC analysis demonstrated excellent predictive performance, with an Area Under the Curve (AUC) of 0.875 (95% CI: 0.823–0.927, p < 0.001). The optimal threshold for predicting transfusion risk was 10.9 g/dL (sensitivity: 89.6%, specificity: 60.5%). Conclusions: Preoperative hemoglobin concentration is the primary determinant of transfusion risk, outweighing the influence of clinical comorbidities. The integration of PBM protocols designed to sustain hemoglobin levels above 10.9 g/dL is essential to reduce perioperative transfusion requirements and to promote improved maternal safety and clinical outcomes. Full article

Childhood stunting remains a major public health challenge in India and is influenced by multiple socioeconomic and environmental factors. This ecological study examined district-level correlates of childhood stunting, including Crimes Against Women (CAW), the Multidimensional Poverty Index (MPI), and drought severity, using data from NFHS-5, the National Crime Records Bureau, NITI Aayog’s MPI reports, and the Drought Atlas of India. Spatial autocorrelation and Spatial regression models were applied alongside machine learning approaches and SHAP-based Explainable AI (XAI) interpretation. Childhood stunting exhibited significant spatial clustering (Moran’s I = 0.520, p < 0.001), with hotspots in northern, central, and eastern India. Higher stunting was associated with higher birth order, low maternal BMI, child anaemia, and MPI, and negative associations with iodised salt usage, electricity access, and timely postnatal care. A significant spatial lag parameter (ρ = 0.348) indicated substantial spillover effects. Machine learning models consistently identified MPI, drought severity, and CAW as key predictors. The integrated spatial and machine learning framework identifies key correlates and spatial dependencies of childhood stunting, highlighting the need for region-specific, multisectoral interventions. Full article

Congenital dyserythropoietic anaemia type-I (CDA-I) is a rare autosomal recessive disease characterised by ineffective erythropoiesis, haemolysis and non-haematological developmental abnormalities. Its treatment is multifactorial, including the management of anaemia, iron overload and prevention of osteoporosis. The only treatment specific to CDA-I is subcutaneous interferon alpha (IFNα) 2A. This study presents the first summary of all published cases of CDA-I patients (n = 33) treated with IFNα and categorises their outcome. We also present new unpublished cases (n = 7). Overall, we find that IFNα administration causes a statistically significant mean increase in haemoglobin of 30.7 g/L (p < 0.001). However, we note that previous studies do not assess the impact of IFNα therapy on providing symptomatic benefit to patients with CDA-I, or the weight of side effects on their quality of life. We collaborate directly with patients through the organisation Congenital Anaemia Network to establish patient preferences regarding IFNα treatment. We propose a classification framework for the use of IFNα in CDA-I that includes patient-reported outcome measures in addition to grading response according to changes in Hb levels. We believe that the use of this framework will aid standardisation in measuring response to therapy, improve clinical practice and assist in future research. Full article

Maternal undernutrition remains a major modifiable risk factor for adverse pregnancy outcomes. Dietary supplements are widely used to bridge nutritional gaps, but their efficacy, safety, and quality control remain controversial. This review critically evaluates the mechanisms, clinical evidence, and quality assurance of key supplements (folic acid, iron, vitamin D, calcium, iodine, omega-3 PUFA, choline, and multiple micronutrients) specifically in pregnant and postpartum women. We highlight that while folic acid (400–800 µg/d) and iron supplementation reduce neural tube defects by >70% and maternal anaemia by 30–50%, respectively, high-dose antioxidant cocktails (vitamins C + E) have shown no benefit and potential harm in large RCTs. Up to 18–40% of commercially available prenatal supplements contain undeclared pharmaceuticals, heavy metals, or incorrect dosages, underscoring the urgent need for advanced analytical methods (LC-MS/MS, HRMS, NMR). We propose the GAPSS (Genotype–Analytics–Physiology–Safety–Sustainability) framework for future personalised maternal nutrition. Rigorous, pregnancy-specific quality control combined with biomarker-guided supplementation is essential to maximise benefits and minimise risks. Full article

Background/Objectives: In Pakistan, 41.7% of women of reproductive age and 53.7% of children aged 6–59 months are anaemic. This study aimed to evaluate the effectiveness of a nutritional supplementation programme, underpinned with behaviour change communication and implemented through Lady Health Workers (LHWs), in reducing anaemia among pregnant and lactating women as well as 6–59-month-old children. Methods: This study used a quasi-experimental design with an intervention and a control group. A total of 2821 and 2410 pregnant and lactating women and 3397 and 3277 children aged 6–59 months participated in the baseline and endline surveys, respectively. The study areas were matched for demographic and economic characteristics, and both had routine public-sector health and nutrition programmes, including iron–folic acid supplementation during pregnancy. The participants in the intervention group received additional nutritional support. Throughout the pregnancy and in the first six months of exclusive breast feeding, women were provided 5 kg (165 g/day) of wheat soya blend (WSB) per month. Children aged 6–23 months received lipid-based nutrient supplements (LNS), and those aged 24–59 months received micronutrient powder. We applied a difference-in-difference (DID) analysis with kernel propensity score matching to assess the impact on anaemia, a secondary outcome of a stunting prevention programme. Results: Maternal anaemia (both pregnant and breastfeeding women) declined substantially in the intervention areas from 80.4% to 62.6% compared with a smaller reduction in the control areas (80.0% to 72.9%). The DID estimate showed a 10.7-percentage-point (pp) greater decline in maternal anaemia (p ≤ 0.001). Both pregnant and lactating women benefited, with DID reductions of 16.7 pp (p ≤ 0.001) and 9.4 pp (p = 0.005), respectively. The largest gains occurred among women in higher-wealth quintiles, with reductions up to 22.6 pp (p ≤ 0.001). In contrast, childhood anaemia showed no overall significant difference between intervention and control areas (DID = −0.7 pp, p = 0.73). However, significant improvements were observed among male children (DID = −10.3 pp, p = 0.001) and those in higher-wealth quintiles (DID = −15.0 pp, p = 0.002). Conclusions: Overall, the findings suggest that LHWs can effectively reduce maternal anaemia when iron–folic acid supplementation is complemented with WSB and targeted behaviour change communication. Full article

Background: Although the micronutrients (vitamins and trace minerals) essential for growth and normal physiological function are obtained from the diet, a substantial fraction of the human population is deficient in one or more micronutrients due to inadequate nutrition and/or malabsorption. Methods: This narrative review examines evidence that airborne micronutrients (‘aeronutrients’) are readily absorbed by the lungs, and preclinical and clinical evidence that inhaled iodine and vitamins A, B12 and D can enter the bloodstream. Results: Inhaled vitamin B12 resolves the symptoms and haematological features of pernicious anaemia with a bioavailability comparable to intramuscular injections and superior to oral formulations. Inhaled nebulised vitamin A restores serum levels in children with retinol deficiency. Randomised controlled trials have reported that inhalation of nebulised preparations of vitamins A, B12, magnesium and zinc are well tolerated and not associated with adverse health effects. Aeronutrient formulations have untapped potential for the therapeutic treatment of nutritional deficits, particularly in individuals with malabsorption or a low tolerance of injections. Aeronutrient therapy should be regarded as a medical intervention and be regulated accordingly, with efficacy and safety supported by scientific evidence, unlike the ‘vitamin vapes’ marketed by the wellness industry. Conclusions: Before this potential can be realised, a regulatory framework will need to be developed for aeronutrients. The high effectiveness of the pulmonary route introduces concerns regarding overdosing and toxicity which can best be addressed by categorising these formulations as prescription drugs that require regular monitoring of nutritional and health status. Full article

Background: Uraemic cardiomyopathy (UCM), the cardiac manifestation of chronic kidney disease, represents a significant clinical challenge that is often underdiagnosed despite being one of the strongest predictors of mortality in the chronic kidney disease (CKD) population. It develops through pathophysiological mechanisms unique to the uraemic state—left ventricular hypertrophy, myocardial fibrosis, and diastolic dysfunction—that often progress silently, sometimes even without traditional cardiovascular risk factors. Purpose: This review synthesises nephrology-centric mechanisms with clinical phenotypes and contemporary imaging (including CMR T1/T2 mapping and ECV), and proposes a CKD-stage–tailored diagnostic–therapeutic framework. It offers a distinct perspective by integrating the complex pathophysiology of UCM with practical diagnostic approaches and evolving management strategies, differentiating it from prior cardiology-focused overviews. Methods: A comprehensive literature search was conducted across Ovid MEDLINE, Embase, PubMed, Google Scholar, BMJ Best Practice, and UpToDate for studies published up to March 2025. Key findings were extracted from the final evidence set and manually verified for relevance. This review introduces a patho-mechanical cascade model of uraemic cardiomyopathy, integrating toxin-driven, metabolic, and haemodynamic axes. Nephrology-led screening protocols are proposed, leveraging proteomics and strain echo, and advocate mineralocorticoid receptor antagonists with sodium–glucose co-transporter-2 (SGLT2) inhibitor initiation at CKD Stage 3a. Cardiorenal clinics are essential for improved outcomes. Key Insights: UCM develops from a multifactorial process. This involves neurohormonal activation, oxidative stress, chronic inflammation, and exposure to toxins such as indoxyl sulfate and p-cresyl sulfate, arising from uraemia. Diagnosis is challenging, masked by overlapping features of fluid overload and anaemia. SGLT2 inhibitors, non-steroidal mineralocorticoid antagonists, and renin–angiotensin–aldosterone system modulation offer promising interventions. The effect of the dialysis modality, its timing, and renal transplantation on cardiac remodelling also emerging from recent studies. Conclusions: UCM sits at the intersection of two failing organ systems. Managing it effectively requires a paradigm shift to incorporate pharmacological and early diagnostic interventions and the integration of cardiology and nephrology care, and the timely implementation of interventions. 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

Malaria poses a significant threat to pregnant women in sub-Saharan Africa, necessitating effective interventions like the intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). However, challenges persist in the uptake and effectiveness of this intervention. This scoping review aims to explore IPTp-SP uptake in African countries, identify influencing factors, and assess its effectiveness in preventing malaria and adverse outcomes in pregnancy. This scoping review follows Arksey and O’Malley’s framework, employing the PRISMA-ScR guidelines for reporting. Searches were conducted in PubMed, Embase, Scopus, JSTOR, Web of Science, Google Scholar, and ProQuest, focusing on studies post-2000 published in the English language. The search produced 15,153 records, of which 104 full-text records were eligible and 101 papers were included in this review. The findings suggest varying IPTp-SP uptake rates, spanning from 5.3% to 98.9%, with their effectiveness supported by longitudinal studies, randomised controlled-trials (RCTs), cross-sectional surveys, and mixed-method studies. IPTp-SP demonstrates efficacy in reducing malaria during pregnancy, placental parasitaemia, and anaemia episodes, alongside improved birth outcomes. Common adverse effects of IPTp-SP include prematurity and low birth weight. Facilitators of IPTp-SP uptake include education and ANC attendance, while commonly reported barriers included inadequate knowledge and healthcare system challenges. The findings also suggest adverse effects such as prematurity, low birth weight, and maternal and perinatal mortality associated with IPTp-SP uptake. It is vital to strengthen antenatal care services by integrating comprehensive counselling on IPTp-SP and address healthcare system challenges. Community engagement, women’s empowerment, and context-specific interventions are necessary for promoting IPTp-SP uptake and improving maternal and neonatal health outcomes in Africa. Full article

Background: A collaborative prescribing (CP) practice model, established by the endocrinologists, pharmacists, and advanced practice nurses, aims to provide for the postoperative monitoring and medical and nutritional management of stable patients after bariatric surgery. Method: Under the CP agreement, endocrinologists refer patients who have undergone bariatric surgery with stable medical conditions to CP practitioners, comprising senior pharmacists and advanced practice nurses. CP practitioners review the patient’s weight loss progress, blood test results and vitals, the sufficiency of micronutrient repletion, adherence to supplements and medications, and chronic disease control. CP practitioners can prescribe and adjust the medications and supplements, in accordance with a clinical evaluation and standard guidance. Patients who require immediate attention due to complications or red flags are referred to the primary endocrinologist for further management. Results: From 5 May 2020 to 30 September 2023, CP practitioners provided 672 consultations. At least 68% and 80% of patients achieved appropriate weight loss post-surgery during the acute and maintenance phases, respectively. Less than 10% of the patients presented with anaemia and iron deficiency, and vitamin B12, folate and vitamin D deficiency. More than 80% of patients achieved a HbA1c of less than 7%. Conclusions: The CP practice framework provides a sustainable and viable model to facilitate optimal outcomes after bariatric surgery. Full article

Background: Over the last two decades, many sub-Saharan African (SSA) countries have undergone dietary and nutrition transitions fuelled by rapid urbanisation, economic development, and globalisation. The aim of the current study was to examine outcomes of the nutrition transition and the epidemiologic transition in SSA countries in terms of food intake, health, and socioeconomic and development factors. Methods: Food balance sheet data—specifically, per capita energy intake per day and per capita gram intake per day—from the CountrySTAT framework of the Food and Agricultural Organization (FAO) were analysed for major food commodities. Additionally, selected health and development indicators supplied by UNICEF, the WHO and the World Bank were analysed. Results: Four dietary patterns emerged. The diet of the southern African/island cluster (South Africa, Mauritius, Eswatini, Namibia, Cabo Verde, and the outlier Seychelles) resembles a Westernised diet, with median values high on sugar/sweeteners, alcohol, meat, animal fats, eggs, and dairy. On the other hand, the diet of countries in the other three clusters appears to be more traditional, with countries in the desert/semi-arid cluster consuming more cereals and pulses/tree nuts, countries in the tropical coastal cluster consuming more fish and vegetable oils, and countries in the equatorial cluster consuming more starchy roots and fruit and vegetables. The resulting median values of health indicators also indicate a higher prevalence of non-communicable diseases in the southern African/island cluster, whereas stunting and anaemia are higher in the other three clusters. Conclusions: SSA countries are in different stages of the nutrition transition. By superimposing clusters generated using macronutrient intake values on a map of the climatic regions in Africa, one can clearly see the importance of climate on the availability of food and food intake patterns. Climate change presents a great challenge to healthy eating, as the link between climate regions and diets is illustrated. Full article

Small island developing states (SIDS) have a high burden of nutrition-related disease associated with nutrient-poor, energy-dense diets. In response to these issues, we assessed the effectiveness of nutrition-based interventions on nutritional status (under-nutrition) and metabolic health (over-nutrition) among persons in SIDS. We included SIDS-based nutrition studies with change in nutrition status (e.g., markers of anaemia) or metabolic status (e.g., markers of glycaemia) as outcomes. The PRISMA framework was applied and MEDLINE, Embase, CINAHL, OARE library, Web of Science, Scopus, ASSIA, EconLit, AGORA, AGRICOLA, AGRIS, WHO-EMRO, and LILACS were searched (2000–2020). Cochrane risk of bias (ROB) and Cochrane ROBINS-I tools assessed ROB for randomised and non-randomised studies, respectively. PROSPERO registration (CRD42021236396) was undertaken. We included 50 eligible interventions, involving 37,591 participants: 14 trials reported on nutritional status, 36 on metabolic health. Effective interventions, evaluated at the individual level, took a multifaceted approach for metabolic outcomes; while nutrition outcomes utilised supplements. Most intervention types were suitable for issues related to ‘over’ nutrition versus ‘under’ nutrition. Twenty-six studies (nutrition status (six); metabolic health (twenty)) were effective (p < 0.05). With the current rise of nutrition-related public health challenges, there is a need for further development and evaluation of these and related interventions at the population level. Full article

The Community added value of Centres of Expertise (CoE) and European Reference Networks (ERN) is particularly high for rare diseases (RD) due to the rarity of these conditions, which implies both a small number of patients and scarcity of expertise within a single country. Gathering expertise at the European level is therefore, paramount in order to ensure equal access to accurate information, appropriate and timely diagnosis and high quality clinical care and follow up for patients with rare diseases. This applies particularly to rare anaemias due to the high number of different rare diseases that constitute this group. In this context, the European Network for Rare and Congenital Anaemias (ENERCA), co-financed by the European Commission, was created in 2002 with the aim of prevention and management of rare anaemias (RA) and the development and promotion of policies to improve the well-being of European Union citizens. The ENERCA White Book is a position paper, developed as a deliverable of the ENERCA (phase 3) project that intends to contribute to the creation of a ERN in RA (ERN-RA) by preparation of the recommendations and, in particular, the definition of the criteria that CoE, local centres (LC) and their interrelations have to fulfil as healthcare providers. It has been nourished by all the activities that have been performed over the past ten years within the ENERCA framework. The White Book is addressed to authorities in charge of the identifying CoE, as an essential requirement for the official recognition of the ERN, to European and national health authorities, Healthcare centres and health professionals, as well as to all other stakeholders interested in RA. It is also addressed to the patients, as a way to empower their community in this process. One particular characteristic of the White Book is the integration of the three main aspects of a CoE: (a) ethical and legal frameworks to ensure the non-discrimination and non-stigmatisation of rare disease patients across Europe, within their sphere of competencies; (b) clinical and laboratory frameworks for defining technical and quality criteria including scope, general and disease specific elements currently defined as technical and professional standards for the diagnosis, treatment and follow-up of patients with RA; and (c) the expectations patients have of CoE. Conceived as a working tool directed to a broad range of stakeholders, the White book has been designed and structured to be comprehensible even to non-technical and /or non-professional audiences. The reader will find an up-to-date description and epidemiological information on RA as well as the European Union background policies for defining CoE and ERN-RA. A working group was created with experts of different profiles, known as the European Working Group on Rare Anaemias (EGRA). In order to achieve its objectives, the methodology used by EGRA, was characterised by three main principles: Interdisciplinary, European coverage, and evidence-based principles. Work has been developed into four sequential steps: 1. Analysis of the current situation of RA in Europe by healthcare professionals in order to identify the most relevant issues that have to be addressed by a centre in order for it to be recommended as CoE. 2. Preparation of questionnaires to perform surveys on how the relevant issues identified in step 1 can be translated into practical recommendations. 3. Analysis of the questionnaire results by face to face meetings, feedback and consensus evaluation, and 4. Preparation of a report on ENERCA policy recommendations for CoE. This report is presented in a user-friendly format, easy to understand and available through the ENERCA website (www.enerca.org). Several important conclusions can be drawn from the ENERCA White Book, including the importance of laboratories involved in the diagnosis of RA, patient oriented and multidisciplinary care at the CoE, the need for coordination and cooperation within and outside the centre, the provision of information to patients and health professionals and the involvement of public authorities at the national and European levels. Official recognition of this structure and assurance of its long term sustainability will only be achieved if public authorities work hand by hand with both professionals experts in different disciplines and patients. Finally, the ENERCA White book aims to be a practical tool for health authorities of Member States (MS) that are preparing their national directory of formally designated CoE. For this, it is important that MS authorities recognise RA as an important health component to be included within the National Plans or Actions for Rare Diseases. Full article