The influence of a low-dose combined oral contraceptive on menstrual blood loss and iron status.

The influence of a low-dose combined oral contraceptive (ethinyl estradiol 30 micrograms + desogestrel 0.15 mg) on menstrual blood loss (MBL) was evaluated in 20 healthy, young women. MBL prior to commencing oral contraception was 60.2 +/- 5.6 ml (range 22-116 ml), and decreased (p < 0.001) to 36.5 +/- 5.2 ml (range 7-80 ml) and 33.7 +/- 4.1 ml (range 5-70 ml) after 3 and 6 months' oral contraceptive medication, respectively. The reduction in MBL during oral contraception was most apparent during the first two days of menstruation. Five women had an MBL > 80 ml prior to commencing oral contraceptive medication. In all of these women, MBL during the 6th menstrual period after commencing oral contraception was < 80 ml. All the women included in this study had a normal blood hemoglobin concentration, hematocrit and erythrocyte indices and there were no significant changes in these variables during the course of the study. Serum ferritin concentration prior to commencing oral contraception was 44.2 +/- 9.0 micrograms/l and was largely unchanged after 6 months' oral contraception (39.7 +/- 6.3 micrograms/l). On admission to the study, two women had a serum ferritin < 10 micrograms/l, indicative of low iron stores. Both these women had an MBL > 80 ml at the baseline assessment. Serum ferritin concentration increased during oral contraceptive medication in both women (from 8.5 micrograms/l to 12.0 micrograms/l and from 5.4 micrograms/l to 6.8 micrograms/l, respectively). The duration of menstruation (p < 0.01) and the number of women suffering from dysmenorrhea (p < 0.05) was reduced during oral contraception.     

Menstrual blood loss and body iron stores in Brazilian women

Menstrual blood loss (MBL) studies are relevant for developing world women as this could be an important cause of anemia. Whenever a contraceptive method is to be used by such women, consideration should be given to the method which least affects the volume of MBL. In 309 women considered as clinically healthy, MBL, serum ferritin, serum iron and hemoglobin levels were measured: a mean MBL of 23 ml was found. Age, weight, height and previous oral contraceptive use did not affect MBL. Higher parity women may have higher MBL levels but their hematologic indices are not altered. While body iron stores (as judged by serum ferritin levels) are depleted in women who bleed more than 60 ml per cycle, clinical anemia may not be present until their blood loss exceeds 80 ml per menstruation. Brazilian women who lose more than 60 ml of menstrual blood associated with multiple pregnancies without adequate iron supplementation may have a depletion of their body iron stores.     

The influence of copper surface area on menstrual blood loss and iron status in women fitted with an IUD

The influence of copper surface area on menstrual blood loss (MBL) was evaluated in 34 healthy women (mean age 36.4 +/- 1.4 yr, range 27-46 yr), who were fitted with a Multiload intrauterine device (IUD) with either 250 mm2 (MLCu-250) or 375 mm2 (MLCu-375) copper wire. MBL prior to IUD insertion was 54.4 +/- 10.3 ml for women subsequently fitted with a MLCu-250 and 56.9 +/- 6.9 ml for women fitted with a MLCu-375. An increase (p less than 0.01) in MBL was recorded 3 months after IUD insertion for both the women fitted with a MLCu-250 (86.4 +/- 10.3 ml) and a MLCu-375 (81.1 +/- 8.3 ml). This increase in MBL remained unchanged throughout the study period of one year. At no point were there any significant differences in MBL or increase in MBL between women fitted with a MLCu-250 or MLCu-375. There were no significant differences in serum ferritin, blood hemoglobin, hematocrit or erythrocyte indices before IUD insertion in the women grouped according to type of IUD, nor were any significant changes recorded in any of these parameters after IUD insertion. Thus, our findings that the increase in copper surface area from 250 mm2 to 375 mm2 had no effect on MBL were also substantiated by the hematological findings.     

Modifications of hemato-biological parameters in pregnant women in a migrating population in northern Cameroon: prevalence of anemia, iron and folates deficiencies

The wholesale displacement of a population can have nutritional consequences for the migrants. With this in mind, the prevalences of anemia and of iron and folic acid deficiencies were studied in a group of 90 pregnant women living in northeast Benoue, an area situated in northern Cameroon where a development project was initiated in 1973. This project aimed at moving a population from the extreme northern highlands to the fertile valley of the Benoue. The following hemato-biological parameters were measured: hemoglobin, hematocrit, mean cell hemoglobin concentration, plasma iron, transferrin saturation, serum concentrations of folates, prealbumin, transferrin, protides and their fractions. The investigation showed that anemia, as well as iron and folic acid deficiencies, were rare when using World Health Organization criteria. The anemia prevalence, judged on a hemoglobin level of less than 11 g per 100 ml, is 8%, iron deficiency prevalence is 10% (plasma iron level below 50 micrograms per 100 ml), and folic acid deficiency prevalence is 3% (serum folic acid level below 3 ng per ml). However, 40% of the pregnant women had a level of transferrin saturation below 15%. In non deficient subjects, we observed a decrease between the first and second trimesters of pregnancy in hemato-biological parameters linked to anemia or to nutritional status (hemoglobin, hematocrit, plasma iron, transferrin saturation, prealbumin). The nutritional conditions in the area appeared sufficient to prevent deficiencies which are frequently observed in pregnant women in Africa.     

Iron and ferritin in Italian subjects

We studied the iron status of 400 Italian subjects, 200 men and 200 women, equally distributed in four 10-year age groups between 20 and 60 years. The frequency of iron deficiency was elevated in women of childbearing age. On average 13% of the women in the three younger age groups showed low serum ferritin levels and 16–18% a low transferrin saturation index. Only 6% of the women over 50 were iron deficient. Signs of iron deficiency were never observed in more than 2% of the men in the age groups under 50, with the percentage rising slightly in the men over 50.In the women an inverse correlation was found between serum ferritin levels and number of births [log ferritin (ng/ml) vs number of births, b ± SE (b): –0.252 ± 0.088] and between serum ferritin and duration of menstruation [log ferritin (ng/ml) vs duration of menstruation (days), b ±SE (b): –0.160 ± 0.065]. Furthermore, hemoglobin levels were 0.700 (± 0.248, SE) g/dl lower in the women with abundant menstrual flow, and hemoglobin levels correlated inversely with number of births [hemoglobin (g/dl) vs number of births, b ± SE (b): -0.354 + 0.115].Our study showed an elevated frequency of iron deficiency in women of reproductive age. The number of births and abundance of menstrual flow were both important factors in predisposing younger women to developing iron deficiency.     

三种长效避孕皮下埋植剂对妇女月经血量的影响

为探讨国产Ⅰ、Ⅱ型和Norplant皮下埋植剂对妇女月经血量的影响,对89例健康妇女按随机分配原则,埋植国产Ⅰ型、Ⅱ型和Norplant三种长效避孕皮下埋植剂,测定埋植前及埋植后3,6,12月月经失血量及血红蛋白。埋植前3组平均月经血量(MBL)分别为43.3±6.9ml,48.9±4.3ml,43.7±5.5ml,埋植后MBL在第3周期分别为32.8±13.2ml,24.8±5.5ml,19.7±9.3ml,在第12周期分别为23.9±5.9ml,40.8±10.4ml,25.9±6.0ml,明显低于埋前水平(P<0.05～P<0.001)血红蛋白在埋植后有上升趋势。本研究提示使用长效皮下埋植剂减少妇女月经血量,增加血红蛋白,可以作为妇女选用的高效节育避孕措施。     

Hemoglobin Concentration during Early Pregnancy as an Accurate Predictor of Anemia during Late Pregnancy

It is undetermined which blood variables related to iron storage during the first trimester of pregnancy could efficiently predict anemia occurring during the third trimester. Red blood cell count (RBC), hemoglobin concentration, hematocrit, ferritin, iron, and total iron binding capacity (TIBC) were assessed longitudinally during the first, second, and third trimesters of 231 healthy Japanese women. None of the patients had anemia in the first trimester and none used iron supplementation before the second trimester blood test. Anemia was defined as hemoglobin (Hb) < 11 g/dL for the first trimester and Hb < 10.0 g/dL for the third trimester. Forty-seven (20%) women developed anemia in the third trimester. The first trimester RBC, Hb, hematocrit, and ferritin levels were significantly lower in women with third-trimester anemia than those without anemia. The first trimester hemoglobin level exhibited a greater area under the curve of the receiver operating characteristic curve for prediction of the third trimester anemia than other blood variables; the optimal cut-off (12.6 g/dL) of hemoglobin yielded a sensitivity of 83% (39/47). First trimester hemoglobin levels were significantly better predictors of anemia during the third trimester than the indices of iron storage, including serum iron, ferritin, and TIBC levels.     

Pregnancy interruption with RU 486 in combination with dl-15-methyl-prostaglandin-F2α-methyl ester: The Chinese experience

In a multicenter study taking place in four centers in Beijing (People's Republic of China), pregnancies up to 49 days of amenorrhea (DA) were interrupted with RU 486 (RU 38486, mifepristone, 600 mg orally once), followed 36–60 hours later by administration of dl-15-methyl-PGF_2α -methyl ester (PG05, 1 mg vaginal suppository). One-hundred-and-sixty women were included in the study, three of whom being excluded from efficacy assessment because of non-compliance to the protocol. Complete pregnancy interruption without additional surgical procedure (success) was obtained in 136 women (86.6%, 95% confidence interval: 81.3–91.9%). The success rate was significantly (P = 0.013) higher for pregnancies below (91.3%), than for pregnancies above 42 days of amenorrhea (DA) (76.6%). The time elapsed between RU 486 intake and complete expulsion was 2.8 ± 1.5 (sd) days (range: 1–12 days). Expulsion took place at the latest 4 days after RU 486 in 125 women (94.7%), and in 107 of these women, it occurred 3.1 ± 1.7 (sd) hours after PG05 administration.Uterine bleeding occurred in all women after RU 486 intake whatever the outcome of treatment and lasted 11.5 ± 4.8 (sd) days (range: 3–36 days). It was judged more or much more abundant than usual periods in 6.15 % of the women. It led to a slight but significant decrease in hemoglobin as measured eight and 14 days after RU 486 intake. In five women, hemoglobin decreased by 4 g/dl or more, but no patient required a blood transfusion. The clinical and biological tolerance of the treatment was otherwise very satisfactory: mild to moderate pain were reported in ~ 80% of the women after PG05, and in ~ 20% of the patients, nausea, vomiting and diarrhea were observed. These were usually moderate, although in one case severe vomiting occurred after RU 486 intake and necessitated vacuum aspiration before PG05 administration. A moderate and transient increase in SGPT (to less than 1.5 times the upper normal limit) was noted in three women after RU 486 and before PG05, and in five women after both RU 486 and PG05.     

Impact of Mannose-Binding Lectin 2 Polymorphism on the Risk of Hepatocellular Carcinoma: A Case-Control Study in Chinese Han Population

Background

Mannose-binding lectin2 (MBL2) is implicated in the host immune response, but there are limited data about MBL2 polymorphisms and hepatocellular carcinoma (HCC) risk. This study aimed to investigate the relationship between the MBL2 rs7096206 polymorphism and HCC risk in a Chinese Han population.

Methods

A population-based case-control study of 220 HCC patients and 220 age- and gender-matched healthy control subjects from a Chinese Han population was conducted. Genomic DNA was extracted from blood samples, and the presence of the MBL2 polymorphism rs7096206 was assessed using matrix-assisted laser desorption-ionization time-of-flight mass spectrometry. Conditional logistic regression was performed to assess the risk of HCC by determining odds ratios and 95% confidence intervals (CIs).

Results

The odds of HCC among carriers of CG and GG genotypes were 7.33 (95% CI, 2.53–21.29) and 12.48 (95% CI, 2.08–74.90), respectively. In the dominant genetic model, GG+CG carriers had an approximately 8-fold increased risk (95% CI, 2.83–22.62) compared with those with the CC genotype. The G allele was significantly associated with elevated HCC risk, with an odds ratio of 6.83 (95% CI, 2.90–16.10).

Conclusions

Our findings suggest that the MBL2 polymorphism rs7096206 is associated with HCC susceptibility and has the potential to serve as a biomarker to detect populations at increased HCC risk.Key words: mannose-binding lectin 2, polymorphism, case-control study, hepatocellular carcinoma     

Quantitative menstrual and intermenstrual blood loss in women using Lippes Loop and Copper T intrauterine devices

One-hundred-twenty-seven women were studied during three consecutive menstrual cycles preceding and six non-consecutive menstrual cycles during the first year following insertion of either a Lippes Loop C or Copper T intrauterine device (IUD). Both menstrual blood loss (MBL) and intermenstrual blood loss (IMBL) were quantified during these cycles. When postinsertion MBL was averaged and compared to mean preinsertion MBL, the Lippes Loop and Copper T devices increased the volume of menstrual bleeding by 99 and 42 percent, respectively. In spite of this, mean hemoglobin levels did not change significantly during the period of study.Quantifiable IMBL was experienced primarily during the first cycle postinsertion. The incidence was 90 percent in women inserted with the Lippes Loop C and 48 percent in women inserted with the Copper T during this cycle. The volume of IMBL was extremely variable among the women studied (0.7 – 398 ml). In several cases the volume nearly equalled or even exceeded the MBL of the first cycle. Incidence of IMBL fell to 6.5 percent and 5.0 percent in the second postinsertion cycle for women with loops and copper devices, respectively. Thereafter the incidence was negligible. This marked decrease in incidence apparently was not due to closures for bleeding. Average IMBL contributed less than ten percent of total blood loss experienced by the IUD users during the first year after insertion. Following the first postinsertion cycle, mean IMBL contributed less than two percent of the total blood loss.     

Association of Hemoglobin and Hematocrit Levels during Pregnancy and Maternal Dietary Iron Intake with Allergic Diseases in Children: The Japan Environment and Children’s Study (JECS)

Few epidemiologic studies have examined the role of maternal iron status in allergic diseases in offspring and findings have been inconsistent. We used a large birth cohort in Japan to explore the association of the markers for maternal iron status (maternal hemoglobin, hematocrit and dietary iron intake during pregnancy) with allergy development in offspring during early childhood. We analyzed information on children age 0–3 years from the Japan Environment and Children’s Study (JECS). We used logistic models and generalized estimating equation models to evaluate the effect of maternal hemoglobin and hematocrit levels and dietary iron intake on allergies in children. Models were also fitted with propensity score-matched datasets. Data were collected for a total of 91,247 mother–child pairs. The prevalence (95% confidence interval) of low hemoglobin and hematocrit was 14.0% (13.7–14.2%) and 12.5% (12.3–12.8%), respectively. After adjusting confounders, low hemoglobin and hematocrit during pregnancy were not associated with childhood allergic outcomes. Findings from models with propensity score-matched datasets also indicated that children born to mothers with low hemoglobin or hematocrit levels during pregnancy did not have a higher risk of developing allergic conditions at 3 years old. We found no meaningful associations between low energy adjusted maternal dietary iron intake and allergies in children. In conclusion, using birth cohort data, we found no evidence supporting an association of low maternal hemoglobin, hematocrit and low dietary iron intake with allergy symptoms during early childhood. Further studies with more suitable proxy markers for blood iron status are needed.     

Development and psychometric tests of the Chinese-version Low Vision Quality of Life Questionnaire

Background/Aims:To develop and assess the psychometric validity of a Chinese language Vision Health related quality-of-life (VRQoL) measurement instrument for the Chinese visually impaired.Methods: The Low Vision Quality of Life Questionnaire (LVQOL) was translated and adapted into the Chinese-version Low Vision Quality of Life Questionnaire (CLVQOL). The CLVQOL was completed by 100 randomly selected people with low vision (primary group) and 100 people with normal vision (control group). Ninety-four participants from the primary group completed the CLVQOL a second time 2 weeks later (test–retest group). The internal consistency reliability, test–retest reliability, item-internal consistency, item-discrimination validity, construct validity and discriminatory power of the CLVQOL were calculated.Results: The review committee agreed that the CLVQOL replicated the meaning of the LVQOL and was sensitive to cultural differences. The Cronbach’s α coefficient and the split-half coefficient for the four scales and total CLVQOL scales were 0.75–0.97. The test–retest reliability as estimated by the intraclass correlations coefficient was 0.69–0.95. Item-internal consistency was >0.4 and item-discrimination validity was generally <0.40. The Varimax rotation factor analysis of the CLVQOL identified four principal factors. the quality-of-life rating of four subscales and the total score of the CLVQOL of the primary group were lower than those of the Control group, both in hospital-based subjects and community-based subjects.Conclusion: The CLVQOL Chinese is a culturally specific vision-related quality-of-life measure instrument. It satisfies conventional psychometric criteria, discriminates visually healthy populations from low vision patients and may be valuable in screening the local community as well as for use in clinical practice or research.     

Epidemiology of paragonimiasis in Cross River basin, Nigeria: prevalence and intensity of infection due to Paragonimus uterobilateralis in Yakurr local government area

Prevalence and intensity of paragonimiasis among inhabitants of the Yakurr Local Government Area in the Cross River basin of Nigeria is reported. Diagnosis was based on a single sample detection of eggs of Paragonimus in 5 ml of sputum. 12.27% out of 880 subjects were infected. The infections were due to Paragonimus uterobilateralis. Prevalence of the infection increased with age, up to a peak prevalence of 23.75% (19 out of 108) among subjects between the ages of 17–22 y old. Thereafter, it declined progressively with increase in age to much lower values such that by the age of 53–58 y old, infection had fallen by more than 75%. Prevalence of the infection was significantly higher among females, 13.80% (58 out of 108), than males 11.36% (50 out of 108) (P < 0.009). Intensity of infection (eggs/5 ml sputum) ranged from 12–123 eggs/5 ml sputum, with subjects between the ages of 17–22 y old being the most heavily infected group. Prevalence and intensity of the infection were positively correlated (P < 0.497). The need for control measures to reduce human suffering due to infections in the area, particularly among women and children is emphasized.     

Age- and sex-related blood cell values in healthy black Americans

Hemoglobin, mean corpuscular volume, erythrocyte count, and leukocyte count were measured, and hematocrit, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration were computed electronically for 7,739 healthy black persons. The study population comprised 3,393 males and 4,346 females 1-84 years of age, all from the Washington, DC, metropolitan area. Persons with sickle cell disease and elevated hemoglobin F were excluded from analysis, but those with traits for hemoglobin S, C, and thalassemia were not. Mean and percentile values are presented in tabular form. Hemoglobin, hematocrit, and mean corpuscular volumes were lower than those reported in surveys of white populations. Beginning with the 11-15-year age groups, black males had higher red cell values than black females. After age 30, mean hemoglobin levels for men gradually declined, while those in women rose, so that the sex difference diminished after 60 years of age. Leukocyte counts were higher in young children and in women, compared with men ages 21-50 years. After 60 years of age, the sex difference disappeared. Further large surveys that exclude data on persons with iron deficiency are needed in black populations.     

Increase in the amount of erythrocyte δ-aminolevulinic acid dehydratase in workers with moderate lead exposure

Summary The amount of ALA-D in human erythrocytes was determined directly by radioimmunoassay or calculated from the restored activity assayed in the presence of zinc and dithiothreitol, and a good correlation was observed between the RIA-based and the restored activity-based amounts.The RIA-based amount of ALA-D in the blood of 10 normal individuals (blood lead levels of 5.6 ± 2.3 g/100 ml: mean ± SD) and 19 lead-exposed workers (blood lead levels of 41.2 ± 10.2 g/100 ml) was 54.1 ± 11.8 g/ml blood and 92.3 ± 20.6 g/ml blood, respectively, indicating an apparent increase of the enzyme amount in lead-exposed workers.A significant increase in the amount of erythrocyte ALA-D calculated from the restored activity in lead-exposed workers was observed even in the low blood lead level of 10–20 g/100 ml, resulting in the range of blood lead level 20–40 g/100 ml. No significant difference was observed in hematocrit and hemoglobin content between lead-exposed and non-exposed groups. These observations suggested that the increase of erythrocyte ALA-D in lead exposure was not due to anemia, which might result in the increase of young erythrocytes in peripheral blood.This increase in the amount of ALA-D in human erythrocytes might be a result of the function to overcome the inhibition of the enzyme in bone marrow cells during lead exposure, and these findings may throw light on the danger to human health of low-level lead toxicity.Abbreviations ALA-D -Aminolevulinic acid dehydratase or 5-Amnoevulinic acid hydro-lyase, EC 4.2.1.24 - ALA -Aminolevulinic acid - Rc Reticulocyte - RIA Radioimmunoassay - DTT Dithiothreitol Supported in parts by Science Research Fund of the Ministry of Education, Science and Culture of Japan and by Research Grant of Fujiwara Foundation of Kyoto University     

Assessment of long-term efficacy of hepatitis B vaccine

In a healthy cohort of 462 subjects in which hepatitis B vaccine was administered between 1990 and 1992 a follow-up study was carried out to determine the duration of protection. Individuals with antibody against the hepatitis B virus surface antigen (anti-HBs) titer lower than 100 mIU/ml were administered a booster dose and antibodies determined 30 days later. The proportion of protection 6.5 years after vaccination was 85% (95% CI: 82–88). Only nine vaccinees seroconverted to anti-HBc positivity without becoming carrier or ill. In 125 subjects in which a booster dose was administered a significant increase in geometric mean of anti-HBs titer was observed (609 mIU/ml) as compared to late (13 mIU/ml) and early post-vaccination antibody levels (256 mIU/ml, Wilcoxon's test, p < 0.001) suggesting the existence of an anamnestic response. We conclude that in immunocompetent population it is not necessary to administer a booster dose 6.5 years after hepatitis B vaccination.     

Menstrual blood loss estimates in women using copper 7 and multiload-250 intrauterine devices

An estimate of the menstrual blood loss (MBL) in 29 women using the Cu-7 and in 33 women using the ML-250 IUDs was carried out. None of the women who took part in the study used hormonal contraceptives or IUDs for six months previous to the study. Before the insertion of the IUD, the MBL of each woman was measured for one or two cycles.Once the IUD was inserted, the MBL was measured at intervals of 1, 3, 6, 9 and 12 months after insertion. After this, the IUD was removed and the MBL measured each month thereafter for 3 months. In the pre-insertion period, the MBL was similar in both groups: 39.3 ± 5.9 for the group with the Cu-7, and 41.6 ± 5.5 ml for the one with the ML-250. After the insertion of the Cu-7, either a slight increase or no increase at all of MBL was observed during the 12 months of IUD use. When the IUD was removed, the menstrual blood loss level returned to normal, i.e. to the pre-insertion level.     

Blood lead levels in Malaysian urban and rural pregnant women

A cross-sectional study was carried out in Malaysia to determine blood lead levels in a group of 60 pregnant women living in an urban area and another group of 63 pregnant women from a rural district. The mean blood lead level of the urban women (17·3 μg/100 ml) was significantly higher than that of the rural women (15·5 μg/100 ml). The higher urban levels probably reflect greater environmental exposure to lead. The study did not demonstrate any statistical relationship of blood lead levels with age or duration of pregnancy.     

Effects of alpha-methyldopa on male sexual function

To determine the frequency and possible mechanism whereby alpha-methyldopa causes disturbances in male sexuality, 105 hypertensive men using this drug were interviewed; serum testosterone was measured in those with diminished sexual functioning (N=36) and a subgroup of subjects with no such alterations (N=30). The occurrence of impotence (N=28) was dose-dependent, with frequencies of 14.3%, 23.4%, and 52.2% in men taking <1.0 g/day, 1.0–1.5 g/day, and 2.0 g/day of alpha-methyldopa, respectively. Serum testosterone concentrations in men using alpha-methyldopa who had impotence (606±23 ng/100 ml, mean±S.E.M.), depressed libido (601±21 ng/100 ml), and normal potency (591±18 ng/100 ml) were similar to healthy adult non-hypertensive males of the same age (624±26 ng/100 ml). Health-care professionals should query all hypertensive patients about sexual symptoms before and during drug therapy, since these are a common potential cause of non-compliance.     

Effect of prior pregnancy and combined oral contraceptives on baseline menstrual blood loss and bleeding response to intrauterine devices.

No effect of pregnancy was found on baseline menstrual blood loss (MBL) in women within one year of parturition or abortion. The increased bleeding response of women to intrauterine devices (IUDs) was found to be independent of pregnancy status during the year preceding IUD sertion. Women pregnant within a year of insertion had no different MBL than those pregnant more than a year prior to insertion. MBL quantified in subjects within three months of discontinuing combined oral contraceptives (OCs) was significantly lower than in prior non-OC users. Furthermore, MBL was significantly reduced in the former group during the first three menses following IUD insertion. At the sixth and twelfth menses post-insertion, MBL was still lower in prior OC users, but the difference between users and non-users was less and no longer statistically significant.