Francisco Plácido Nogueira Arcanjo

Use of Iron-Fortified Rice Reduces Anemia in Infants

Food fortification is advocated to tackle iron deficiency in anemic populations. Our objective was to evaluate the impact of iron-fortified rice (Ultrarice(®)) weekly on hemoglobin and anemia levels compared with standard rice (control). This cluster-randomized study deals with infants (10-23 months) from two public child day care centers in Brazil, n = 216, in an 18 week intervention. The intervention group received individual portions of fortified rice (50 g) provided 56.4 mg elemental/Fe. For intervention center: baseline mean hemoglobin was 11.44 ± 1.07 g/dl, and after intervention 11.67 ± 0.96 g/dl, p < 0.029; for control: baseline mean hemoglobin value was 11.35 ± 4.01 g/dl, and after intervention 11.36 ± 2.10 g/dl, p = 0.986. Anemia prevalence for intervention center was 31.25% at baseline, and 18.75% at end of study, p = 0.045; for control 43.50% were anemic at baseline, and 37.1% at the end of study, p = 0.22. Number Needed to Treat was 7. Iron-fortified rice was effective in increasing hemoglobin levels and reducing anemia in infants.

Randomized controlled trial of iron-fortified drinking water in preschool children.

Objectives: To evaluate the effects of fortified drinking water, with different concentrations of iron added, on hemoglobin and hematocrit values in preschoolers. Methods: Double-blind, randomized cluster clinical trial, with children aged 2 to 5 years of age, from 4 state-run schools, forming 1 group for each school. For fortification, ferrous sulphate in concentrations of 5 mg of elemental iron per liter of water (group A), 7.5 mg (group B), and 10 mg (group C), was used during a period of 4 months. In group D, the control, a placebo (Bixa orellana) was added. Hemoglobin and hematocrit values were checked before and after intervention. Results: Before fortification, hemoglobin and hematocrit averages were below the reference values adopted in all groups. After fortification, the prevalence of anemia showed a reduction in the 4 groups, which was more pronounced in group B, at 48.3%. The hemoglobin values in groups B (11.5) and C (11.4) were statistically similar. However, the average consumption of water/day/student was lower in group C. Comparison of hemoglobin values between groups A (11.2) and D (11.0) did not show a significant difference, suggesting insignificant efficacy with 5 mg Fe/L fortification. Conclusions: The consumption of drinking water fortified with 7.5 mg of elemental iron/L water resulted in greater adhesion and an increase in hemoglobin values, with a reduction in the prevalence of anemia.

How Safe Is Your Motorcycle Helmet

PURPOSE Motorcycle crash helmets do not totally prevent head and facial trauma. The aim of this study was to investigate if protection offered by helmets differs according to helmet type. MATERIALS AND METHODS In this retrospective cohort study, outpatient records of motorcyclists were analyzed for the Facial Injury Severity Scale (FISS), traumatic brain injury (TBI), facial fractures, and helmet use. Statistical analysis was conducted using the Fisher and Bonferroni tests, bivariate regression analysis, and 1-way analysis of variance. RESULTS There were 253 motorcyclists who sustained craniomaxillofacial injuries and were referred for outpatient treatment (men, 88.9%; mean age, 29.64 ± 11.6 yr); 60.1% had up to 9 years of formal education; 156 patients reported not using crash helmets, 51 were using open-face helmets, and 46 were using full-face helmets. The mean FISS score was significantly higher for unhelmeted riders compared with full-face helmet riders (P = .047), with no difference between unhelmeted riders and open-face helmet users (P = 1.00). Results for TBI were statistically greater for those wearing open-face helmets compared with full-face helmets (P = .035). CONCLUSION In this study, a large percentage of motorcyclists had facial fractures and TBI, and crash helmets did not always offer adequate protection against craniomaxillofacial injury, especially open-face helmets. Thus, further investigation into helmet types and quality of protection offered is recommended.

Effect of a beverage fortified with evaporated sugarcane juice on hemoglobin levels in preschool children

The study objective was to measure the effect of consumption of a beverage mixed with a high-iron sweetener (evaporated sugarcane juice known as rapadura) on hemoglobin levels in preschool children, and to compare it with the effect of consuming the same beverage sweetened with refined sugar. Research consisted of a 12-week randomized, controlled double-blind trial conducted in 2007 at a state-run school in Sobral, Brazil, among children aged 2-3 years. The study sample was divided into two groups-one consuming cashew juice mixed with 25 g of rapadura and 40 mg of ascorbic acid (per 200-mL serving), and another consuming the same quantity of juice and ascorbic acid sweetened with 25 g of standard refined sugar. A significant statistical increase in hemoglobin was observed in the group consuming the rapadura-fortified beverage. It was therefore concluded that consumption of rapadura increased hemoglobin and thus reduced iron deficiency anemia in preschool children.

Social adaptability and substance abuse: Predictors of depression among hemodialysis patients?

BackgroundSeveral aspects linked to social are involved in the onset of depressive feelings. We aimed to find out if social adaptability and substance abuse predict depression among end-stage renal disease (ESRD) patients undergoing hemodialysis (HD).MethodsWe included 145 ESRD patients undergoing HD. Social adaptability was estimated by the Social Adaptability Index (SAI). Substance abuse was defined according to SAI. We screened for depression by applying the 20-item version of the Center for Epidemiologic Studies Depression Scale. A score ≥ 24 classified the patients as depressed. Comparisons between depressed and non-depressed patients were carried out and logistic regression was performed to test gender, age, total SAI, SAI without the substance abuse item, only the substance abuse score and substance abuse as a categorical variable (yes/no) as predictors of depression.ResultsThere were 36 (24.8%) depressed patients. There were no differences regarding demographic and laboratory data between the depressed and non-depressed patients. Mean SAI among depressed and non-depressed patients was, respectively, 6.1 ± 1.6 vs. 6.2 ± 1.9 (p=0.901). The percentage of patients with or without substance abuse among depressed patients was, respectively, 13.8% vs. 13.9% (p=1.000). Gender, age, total SAI, SAI without the substance abuse item, only the substance abuse score and substance abuse as a categorical variable did not predict depression.ConclusionsSocial adaptability and substance abuse did not predict depression in HD patients. We propose that aspects related to socioeconomic status not comprised in SAI items should be ruled out as predictors of depression.

Weekly Iron Supplementation for the Prevention of Anemia in Pre-school Children: A Randomized, Double-blind, Placebo-controlled Trial

OBJECTIVE This study analyses the impact of weekly iron supplementation with ferrous sulphate heptahydrate (FeSO4) in 5-year-olds compared with placebo, on hemoglobin (Hb) and hematocrit (Ht) values and anemia. DESIGN The study concerns a cluster-randomized, placebo-controlled double-blind trial. Intervention participants received 50 mg elemental iron for 14 weeks. SETTING The study population comprised pre-school children (n = 135) from one randomly chosen public school in the northeast of Brazil. SUBJECTS Participants were 5-year-old students from a public school. RESULTS Mean Hb and Ht values increased after iron supplementation, with p < 0.0001. There was no statistically significant increase in the placebo group. After intervention, anemia prevalence reduced only in the intervention group, from 48.0% to 26.0%. CONCLUSIONS Weekly iron supplementation was effective in reducing anemia in 5-year-olds.

Contrast-induced nephropathy after primary angioplasty for acute myocardial infarction

INTRODUCTION The prevention of contrast-induced nephropathy (CIN) is difficult in emergency situations, making it essential to study CIN in patients submitted to urgent angioplasty. OBJECTIVE To determine the incidence and associated factors to CIN in patients with myocardial infarction (MI) submitted to primary angioplasty in the first 12 hours after onset of symptoms. METHODS We studied 201 consecutive cases of MI with ST-segment elevation with less than 12 hours of evolution. All patients were submitted to the same angioplasty protocol. CIN was defined as an absolute increase of creatinine of at least 0.5 mg/dL and/or a relative increase of creatinine of 25% in relation to baseline in a period between 48 and 72 hours after contrast administration. The variables that differed between patients with and without CIN in univariate analysis were analyzed by logistic regression. RESULTS The sample was formed by 135 (67.2%) men and 66 (32.8%) women, with mean age of 66.6 ± 11.7 years. The incidence of CIN was 23.8%. In univariate analysis the patients with CIN were older and had higher frequency of left ventricular ejection fraction ≤ 40% and Killip classification ≥ 2. In multivariate analysis, we did not find independent predictors of CIN. CONCLUSION CIN occurred in ¼ of the patients with MI submitted to angioplasty without predictor variables. This finding highlights the need for CIN preventive measures after contrast use in emergency angioplasty.

Daily and Weekly Iron Supplementations are Effective in Increasing Hemoglobin and Reducing Anemia in Infants.

OBJECTIVE The objective of this study was to evaluate the effect of daily and weekly iron supplementation compared with control on hemoglobin values and anemia prevalence in infants. METHODS In this cluster-randomized study, we evaluated infants aged 12-24 months (n = 210) from three public daycare centers, during 4 months. Intervention-group A was allocated 25 mg elemental iron once weekly; intervention-group B received 12.5 mg elemental iron once daily; control-group C received 0.5 ml of a natural color additive. Hemoglobin was assessed before and after intervention. RESULTS Baseline mean hemoglobin was 8.81 ± 0.89 g/dl (group A), 9.70 ± 1.56 g/dl (group B) and 10.96 ± 0.92 g/dl (group C); after intervention, mean hemoglobin was 10.03 ± 0.78 g/dl (p < 0.0001), 10.65 ± 0.97 g/dl (p < 0.0001) and 11.30 ± 0.80 g/dl (p = 0.0034) for groups A, B and C, respectively. Anemia prevalence was as follows: group A, 100% at baseline and 83.3% at end of study, p = 0.0001; group, B 75.0% and 41.7%, p = 0.0002; group C, 50.0% and 37.5%, p = 0.182. CONCLUSIONS Weekly and daily iron supplementation were effective in increasing hemoglobin levels and reducing anemia in infants.

Rice fortified with iron given weekly increases hemoglobin levels and reduces anemia in infants: a community intervention trial.

More than two billion people suffer from anemia worldwide, and it is estimated that more than 50 % of cases are caused by iron deficiency. In this community intervention trial, we evaluated infants aged 10 to 23 months of age (n = 171) from two public child day-care centers. Intervention lasted 18 weeks. The 50-g individual portion (uncooked) of fortified rice provided 56.4 mg of elemental iron as ferric pyrophosphate. Capillary blood samples to test for anemia were taken at baseline and at endpoint. The objective of this study was to evaluate the impact of rice fortified with iron (Ultrarice®) on hemoglobin and anemia prevalence compared with standard household rice. For the fortified rice center, baseline mean hemoglobin was 113.7 ± 9.2 g/L, and at endpoint 119.5 ± 7.7 g/L, p < 0.0001; for the standard rice center, baseline mean hemoglobin value was 113.5 ± 40.7 g/L, and at endpoint 113.6 ± 21.0, p = 0.99. Anemia prevalence for the fortified rice center was 27.8 % (20/72) at baseline, and 11.1 % (8/72) at endpoint, p = 0.012; for the control center, 47.1 % (33/70) were anemic at baseline, and 37.1 % (26/70) at the end of the study, p = 0.23. The Number Needed to Treat (NNT) was 4. In this intervention, rice fortified with iron given weekly was effective in increasing hemoglobin levels and reducing anemia in infants.

Distance between residence and the dialysis unit does not impact self-perceived outcomes in hemodialysis patients

BackgroundPatients have to travel long distances to undergo hemodialysis (HD) in some regions. We aimed to search for an association of the distance between patients’ residence and the dialysis unit with quality of life, depression and coping among end-stage renal disease (ESRD) patients undergoing maintenance HD.MethodsWe studied 161 ESRD patients undergoing HD during April 2009. Quality of life, depression and coping were assessed by the SF-36, the 10-item CES-D and the Jalowiec Coping Scale, respectively. The sample was stratified in three groups: I-patients residing in Sobral (where the dialysis unit is located); II-patients residing in towns up to 100 km from Sobral; and III-patients residing in towns distant greater than 100 km from Sobral. Analysis of variance was used to detect differences in quality of life and coping scores between the groups. Logistic regression was used to test distance as a predictor of depression.ResultsThere were 47 (29.2%) patients residing in Sobral, 46 (28.6%) up to 100 km away and 68 (42.2%) greater than 100 km from Sobral. There were no differences related to quality of life and coping scores between the groups. Distance was not a predictor of depression.ConclusionsSocial and cultural factors may explain the lack of differences. Studies from other regions are needed to clarify the distance effects on self-perceived outcomes among HD patients.