Feb. 16, 2010( Medscape)
Summary : The QT interval response during sinus tachycardia induced by standing can serve as a useful bedside test in diagnosing long QT syndrome.
Basis for Study : The goal of this study was "to determine whether the short-lived sinus tachycardia that occurs during standing will expose changes in the QT interval that are of diagnostic value."
Detailed Summary of Study : 68 patients with long QT syndrome and 82 control subjects underwent ECGs while resting supine and then after getting up quickly. Changes in the QT interval in response to standing were then analyzed to see if they could distinguish between the groups.
Results/Body : Although the subjects' heart rate accelerated by the same amount in both groups upon standing, the average QT interval shortened in the controls but increased in the long QT patients. During maximal tachycardia the corrected QT interval increased significantly less in the control subjects than in the patients. "Receiver-operating characteristic curves showed that the test adds diagnostic value."
Sources & Other Links ; Viskin S, Postema PG, Bhuiyan ZA, Rosso R, Kalman JM, Vohra JK, Guevara-Valdivia ME, Marquez MF, Kogan E, Belhassen B, Glikson M, Strasberg B, Antzelevitch C, Wilde AA.. The response of the QT interval to the brief tachycardia provoked by standing: a bedside test for diagnosing long QT syndrome. J Am Coll Cardiol. 2010 Jan 22.
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Friday, February 26, 2010
Thursday, February 25, 2010
Aromatase Inhibitors vs other endocrine therapies for treatment of advanced breast. cancer
Feb. 16, 2010(Medscape)
Authors : Gibson Lorna, Lawrence David, Dawson Claire, Bliss Judith
Review Group : Cochrane Breast Cancer Group
Abstract : Endocrine therapy removes the influence of. oestrogen on breast cancer cells and so hormonal treatments such as. tamoxifen, megestrol acetate and. medroxyprogesterone acetate have been in use for many years for advanced breast cancer. Aromatase inhibitors (AIs) inhibit oestrogen synthesis in the peripheral tissues and have a similar tumour-regressing effect to other endocrine treatments.. Aminoglutethimide was the first AI in clinical use and now the third generation AIs, anastrozole, exemestane and letrozole, are in current use. Randomised trial evidence on response rates and side effects of these drugs is still limited.
Objectives:
To compare AIs to other endocrine therapy in the treatment of advanced breast cancer in postmenopausal women.
Search strategy:
For this update, the Cochrane Breast Cancer Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) and relevant conference proceedings were searched (to 30 June 2008).
Selection criteria:
Randomised controlled trials in. postmenopausal women comparing the effects of any AI versus other endocrine therapy, no endocrine therapy, or a different AI in the treatment of advanced (metastatic) breast cancer. Non-English language publications, comparisons of the same AI at different doses, AIs used as neoadjuvant treatment, or outcomes not related to tumour response were excluded.
Data collection and analysis:
Data from published trials were extracted independently by two review authors and cross-checked by a third. Hazard ratios (HR) were derived for analysis of time-to-event outcomes (overall and progression-free survival). Odds ratios (OR) were derived for objective response, clinical benefit, and toxicity.
Main results:
Thirty-seven trials were identified, 31 of which were included in the main analysis of any AI versus any other treatment (11,403 women). No trials were excluded due to inadequate allocation concealment.The pooled estimate showed a significant survival benefit for treatment with an AI over other endocrine therapies (HR 0.90, 95% CI 0.84 to 0.97). A subgroup analysis of the three commonly prescribed AIs (anastrozole, exemestane, letrozole) also showed a similar survival benefit (HR 0.88, 95% CI 0.80 to 0.96). There were very limited data to compare one AI with a different AI, but these suggested an advantage for letrozole over anastrozole.AIs have a different toxicity profile to other endocrine therapies. For those currently prescribed, and for all AIs combined, they had similar levels of hot flushes and arthralgia; increased risks of rash, nausea, diarrhoea and vomiting; but a 71% decreased risk of vaginal bleeding and 47% decrease in thromboembolic events compared with other endocrine therapies.
Authors' conclusions:
In women with advanced (metastatic) breast cancer, aromatase inhibitors including those in current clinical use show a survival benefit when compared to other endocrine therapy.
Implications : Historically, the treatment for advanced (metastatic) breast cancer has been with hormonal treatments such as tamoxifen or the progestins MA or MPA. This review confirms a survival benefit of treating advanced (metastatic) breast cancer with the third generation aromatase inhibitors (anastrozole, exemestane, and letrozole) that are being used clinically today.
Citation: Gibson L, Lawrence D, Dawson C, Bliss J. Aromatase inhibitors for treatment of advanced breast cancer in postmenopausal women. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD003370. DOI: 10.1002/14651858.CD003370.pub3.
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Authors : Gibson Lorna, Lawrence David, Dawson Claire, Bliss Judith
Review Group : Cochrane Breast Cancer Group
Abstract : Endocrine therapy removes the influence of. oestrogen on breast cancer cells and so hormonal treatments such as. tamoxifen, megestrol acetate and. medroxyprogesterone acetate have been in use for many years for advanced breast cancer. Aromatase inhibitors (AIs) inhibit oestrogen synthesis in the peripheral tissues and have a similar tumour-regressing effect to other endocrine treatments.. Aminoglutethimide was the first AI in clinical use and now the third generation AIs, anastrozole, exemestane and letrozole, are in current use. Randomised trial evidence on response rates and side effects of these drugs is still limited.
Objectives:
To compare AIs to other endocrine therapy in the treatment of advanced breast cancer in postmenopausal women.
Search strategy:
For this update, the Cochrane Breast Cancer Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) and relevant conference proceedings were searched (to 30 June 2008).
Selection criteria:
Randomised controlled trials in. postmenopausal women comparing the effects of any AI versus other endocrine therapy, no endocrine therapy, or a different AI in the treatment of advanced (metastatic) breast cancer. Non-English language publications, comparisons of the same AI at different doses, AIs used as neoadjuvant treatment, or outcomes not related to tumour response were excluded.
Data collection and analysis:
Data from published trials were extracted independently by two review authors and cross-checked by a third. Hazard ratios (HR) were derived for analysis of time-to-event outcomes (overall and progression-free survival). Odds ratios (OR) were derived for objective response, clinical benefit, and toxicity.
Main results:
Thirty-seven trials were identified, 31 of which were included in the main analysis of any AI versus any other treatment (11,403 women). No trials were excluded due to inadequate allocation concealment.The pooled estimate showed a significant survival benefit for treatment with an AI over other endocrine therapies (HR 0.90, 95% CI 0.84 to 0.97). A subgroup analysis of the three commonly prescribed AIs (anastrozole, exemestane, letrozole) also showed a similar survival benefit (HR 0.88, 95% CI 0.80 to 0.96). There were very limited data to compare one AI with a different AI, but these suggested an advantage for letrozole over anastrozole.AIs have a different toxicity profile to other endocrine therapies. For those currently prescribed, and for all AIs combined, they had similar levels of hot flushes and arthralgia; increased risks of rash, nausea, diarrhoea and vomiting; but a 71% decreased risk of vaginal bleeding and 47% decrease in thromboembolic events compared with other endocrine therapies.
Authors' conclusions:
In women with advanced (metastatic) breast cancer, aromatase inhibitors including those in current clinical use show a survival benefit when compared to other endocrine therapy.
Implications : Historically, the treatment for advanced (metastatic) breast cancer has been with hormonal treatments such as tamoxifen or the progestins MA or MPA. This review confirms a survival benefit of treating advanced (metastatic) breast cancer with the third generation aromatase inhibitors (anastrozole, exemestane, and letrozole) that are being used clinically today.
Citation: Gibson L, Lawrence D, Dawson C, Bliss J. Aromatase inhibitors for treatment of advanced breast cancer in postmenopausal women. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD003370. DOI: 10.1002/14651858.CD003370.pub3.
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FDA Announces Possible Safety Concern for HIV Drug Combination
FDA NEWS RELEASE
For Immediate Release: Feb. 23, 2010
Media Inquiries: Erica Jefferson, 301-796-4988; erica.jefferson@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA( from medscape for iphone)
Review of data indicating life-threatening heart abnormality underway
The U.S. Food and Drug Administration today announced preliminary data suggesting that Invirase (saquinavir) in combination with Norvir (ritonavir) may have potentially important adverse effects on the heart.
When used together, the drugs may cause prolongation of the QT and PR intervals on an electrocardiogram. Prolongation of the QT interval may lead to a condition known as torsades de pointes, an abnormal heart rhythm. Prolongation of the PR interval may also lead to an abnormal heart rhythm known as heart block. With torsades de pointes or with heart block, patients may experience lightheadedness, fainting, or abnormal heart beats. In some cases, torsades de pointes may progress to a life-threatening irregular heart beat known as ventricular fibrillation.
Review of the data is ongoing. Preliminary findings suggest that some patients using Invirase and Norvir may be at an increased risk for heart abnormalities leading to irregular heart rhythms. For example, the risk for torsades de pointes may be increased in patients who are also using medications known to cause a heart disturbance called QT interval prolongation. The risk may also be increased in patients who have a history of QT interval prolongation.
Patients using Invirase should talk to their health care professional about any questions or concerns they have about Invirase. Patients and health care professionals should report any side effects from the use of Invirase to the FDA’s MedWatch program:
http://www.fda.gov/safety/MedWatch/default.htm
Invirase is an antiretroviral medication that was first approved in 1995. Invirase is used in combination with Norvir and other antiretroviral medicines to treat HIV in adults. Invirase does not cure HIV infection, may not prevent you from developing HIV-related illnesses, and may not prevent you from spreading HIV to other people.
This early communication is in keeping with FDA’s commitment to inform the public about ongoing safety reviews of drugs. FDA will communicate its findings to the public as soon as the review is complete.
Invirase is marketed by San Francisco-based Genentech, a subsidiary of the Roche Group. Norvir is marketed by Abbott Park, Ill.-based Abbott Laboratories.
For more information:
FDA Drug Safety Communication: Ongoing safety review of Invirase (saquinavir) and possible association with abnormal heart rhythms
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For Immediate Release: Feb. 23, 2010
Media Inquiries: Erica Jefferson, 301-796-4988; erica.jefferson@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA( from medscape for iphone)
Review of data indicating life-threatening heart abnormality underway
The U.S. Food and Drug Administration today announced preliminary data suggesting that Invirase (saquinavir) in combination with Norvir (ritonavir) may have potentially important adverse effects on the heart.
When used together, the drugs may cause prolongation of the QT and PR intervals on an electrocardiogram. Prolongation of the QT interval may lead to a condition known as torsades de pointes, an abnormal heart rhythm. Prolongation of the PR interval may also lead to an abnormal heart rhythm known as heart block. With torsades de pointes or with heart block, patients may experience lightheadedness, fainting, or abnormal heart beats. In some cases, torsades de pointes may progress to a life-threatening irregular heart beat known as ventricular fibrillation.
Review of the data is ongoing. Preliminary findings suggest that some patients using Invirase and Norvir may be at an increased risk for heart abnormalities leading to irregular heart rhythms. For example, the risk for torsades de pointes may be increased in patients who are also using medications known to cause a heart disturbance called QT interval prolongation. The risk may also be increased in patients who have a history of QT interval prolongation.
Patients using Invirase should talk to their health care professional about any questions or concerns they have about Invirase. Patients and health care professionals should report any side effects from the use of Invirase to the FDA’s MedWatch program:
http://www.fda.gov/safety/MedWatch/default.htm
Invirase is an antiretroviral medication that was first approved in 1995. Invirase is used in combination with Norvir and other antiretroviral medicines to treat HIV in adults. Invirase does not cure HIV infection, may not prevent you from developing HIV-related illnesses, and may not prevent you from spreading HIV to other people.
This early communication is in keeping with FDA’s commitment to inform the public about ongoing safety reviews of drugs. FDA will communicate its findings to the public as soon as the review is complete.
Invirase is marketed by San Francisco-based Genentech, a subsidiary of the Roche Group. Norvir is marketed by Abbott Park, Ill.-based Abbott Laboratories.
For more information:
FDA Drug Safety Communication: Ongoing safety review of Invirase (saquinavir) and possible association with abnormal heart rhythms
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Decreasing the fat content of milk served in schools can increase consumption while reducing calorie and fat intake
Feb. 16, 2010( Medscape)
Summary : Replacing whole milk with low-fat or fat-free milk and serving only fat-free chocolate milk in New York City school cafeterias "decreased the amount of fat and calories apparently consumed by students without decreasing overall school milk purchases, thereby maintaining student consumption of calcium and important vitamins."
Basis for Study : New York City’s Department of Education changed its school milk policies in an attempt to combat childhood obesity. This article summarizes the impact of these changes on students’ intake of milk, calories and fat.
Detailed Summary of Study : Starting in 2004, whole milk was replaced by low-fat or fat-free milk in school cafeterias, and chocolate milk was changed from low-fat to fat-free. The changes were instituted city-wide in 2006.
Results/Body : "By removing whole milk and switching from low-fat to fat-free chocolate milk, NYC public school milk-drinking students were served an estimated 5,960 fewer calories and 619 fewer grams of fat in 2009 than they were in 2004. Other school systems can use these results to guide changes to their own school food policies." Contrary to concerns that removing whole milk would reduce children's milk intake, "school milk purchases per student per year increased 1.3% in fiscal year 2009 compared with 2004 purchases"-from 112 half-pints per student in 2004 to 114 in 2009.
Sources & Other Links : Alberti PM, Perlman SE, Nonas C,et al. Effects of switching from whole to low-fat/fat-free milk in public schools—New York City, 2004-2009. MMWR 2010;Jan 10/59:70-73
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Summary : Replacing whole milk with low-fat or fat-free milk and serving only fat-free chocolate milk in New York City school cafeterias "decreased the amount of fat and calories apparently consumed by students without decreasing overall school milk purchases, thereby maintaining student consumption of calcium and important vitamins."
Basis for Study : New York City’s Department of Education changed its school milk policies in an attempt to combat childhood obesity. This article summarizes the impact of these changes on students’ intake of milk, calories and fat.
Detailed Summary of Study : Starting in 2004, whole milk was replaced by low-fat or fat-free milk in school cafeterias, and chocolate milk was changed from low-fat to fat-free. The changes were instituted city-wide in 2006.
Results/Body : "By removing whole milk and switching from low-fat to fat-free chocolate milk, NYC public school milk-drinking students were served an estimated 5,960 fewer calories and 619 fewer grams of fat in 2009 than they were in 2004. Other school systems can use these results to guide changes to their own school food policies." Contrary to concerns that removing whole milk would reduce children's milk intake, "school milk purchases per student per year increased 1.3% in fiscal year 2009 compared with 2004 purchases"-from 112 half-pints per student in 2004 to 114 in 2009.
Sources & Other Links : Alberti PM, Perlman SE, Nonas C,et al. Effects of switching from whole to low-fat/fat-free milk in public schools—New York City, 2004-2009. MMWR 2010;Jan 10/59:70-73
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Low and high mean HbA(1c) values were associated with increased all-cause mortality and cardiac events
Feb. 16, 2010(Medscape)
Summary :Patients with type 2 diabetes who had both the lowest and the highest mean HbA(1c) levels had a higher all-cause mortality rate. “If confirmed, diabetes guidelines might need revision to include a minimum HbA(1c) value.”
Basis for Study : “Results of intervention studies in patients with type 2 diabetes have led to concerns about the safety of aiming for normal blood glucose concentrations.” This British study investigated whether survival is affected by the HbA(1c) level.
Detailed Summary of Study : All-cause mortality was determined in two groups of patients age 50 with type 2 diabetes: "27,965 patients whose treatment had been intensified from oral monotherapy to combination therapy with oral blood-glucose lowering agents, and 20,005 who had changed to regimens that included insulin." Mortality was compared based on HbA(1c) level (stratified into 10 groups). Findings were adjusted for age, sex, smoking, cholesterol, cardiovascular risk and general morbidity.
Results/Body :Patients with the lowest all-cause mortality were those with HbA(1c) of 7.5%. Compared with that group, patients in the lowest and highest groups (HbA(1c) of 6.4% and 10.5% respectively) had a significantly higher risk of dying.
Sources & Other Links :Currie CJ, Peters JR, Tynan A, Evans M, Heine RJ, Bracco OL, Zagar T, Poole CD. Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study.Lancet. 2010 Jan 26.
Summary :Patients with type 2 diabetes who had both the lowest and the highest mean HbA(1c) levels had a higher all-cause mortality rate. “If confirmed, diabetes guidelines might need revision to include a minimum HbA(1c) value.”
Basis for Study : “Results of intervention studies in patients with type 2 diabetes have led to concerns about the safety of aiming for normal blood glucose concentrations.” This British study investigated whether survival is affected by the HbA(1c) level.
Detailed Summary of Study : All-cause mortality was determined in two groups of patients age 50 with type 2 diabetes: "27,965 patients whose treatment had been intensified from oral monotherapy to combination therapy with oral blood-glucose lowering agents, and 20,005 who had changed to regimens that included insulin." Mortality was compared based on HbA(1c) level (stratified into 10 groups). Findings were adjusted for age, sex, smoking, cholesterol, cardiovascular risk and general morbidity.
Results/Body :Patients with the lowest all-cause mortality were those with HbA(1c) of 7.5%. Compared with that group, patients in the lowest and highest groups (HbA(1c) of 6.4% and 10.5% respectively) had a significantly higher risk of dying.
Sources & Other Links :Currie CJ, Peters JR, Tynan A, Evans M, Heine RJ, Bracco OL, Zagar T, Poole CD. Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study.Lancet. 2010 Jan 26.
Prenatal supplementation with iron or iron+folic acid is effective for preventing. anemia and iron deficiency at term
Feb. 16, 2010(Medscape)
Authors:Peña-Rosas Juan Pablo, Viteri Fernando E
Review Group;Cochrane Pregnancy and Childbirth Group
Abstract : Intake of supplements containing iron or a combination of iron and folic acid by pregnant women may improve maternal health and. pregnancy outcomes. Recently, intermittent supplementation regimens have been proposed as alternatives to daily regimens.
Objectives:
To assess the effectiveness and safety of daily and intermittent use of iron or iron+folic acid supplements by pregnant women.
Search strategy:
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2009) and contacted relevant organisations for the identification of ongoing and unpublished studies.
Selection criteria:
All randomised or quasi-randomised trials evaluating the effect of supplementation with iron or iron+folic acid during pregnancy.
Data collection and analysis:
We assessed the methodological quality of trials using the standard Cochrane criteria. Two authors independently assessed which trials to include in the review and one author extracted data.
Main results:
We included 49 trials, involving 23,200 pregnant women. Overall, the results showed significant heterogeneity across most prespecified outcomes and were analysed assuming random-effects. The trials provided limited information related to clinical maternal and infant outcomes.Overall, daily iron supplementation was associated with increased haemoglobin levels in maternal blood both before and after birth and reduced risk of anaemia at term. These effects did not differ significantly between women receiving intermittent or daily iron or iron+folic acid supplementation. Women who received daily prenatal iron supplementation with or without folic acid were less likely to have iron deficiency at term as defined by current cut-off values than those who received no treatment or placebo. Side effects and haemoconcentration (a haemoglobin level greater than 130 g/L) were more common among women who received daily iron or iron+folic acid supplementation than among those who received no treatment or placebo. The risk of haemoconcentration during the second and third trimester was higher among those on a daily regimen of iron supplementation. The clinical significance of haemoconcentration remains uncertain.
Authors' conclusions:
Universal prenatal supplementation with iron or iron+folic acid provided either daily or weekly is effective to prevent anaemia and iron deficiency at term. We found no evidence, however, of the significant reductionin substantive maternal and neonatal adverse clinical outcomes (low birthweight, delayed development, preterm birth, infection,postpartum. haemorrhage). Associated side effects and particularly haemoconcentration during pregnancy may suggest the need for revising iron doses and schemes of supplementation during pregnancy and adjust preventive iron supplementation recommendations.
Implications:Daily or intermittent supplementation with iron or with iron+folic acid by pregnant women clearly results in a substantial reduction in the prevalence of maternal anaemia at term and increased maternal Hb concentrations at term. However, the current sparse data fail to demonstrate that supplementation with iron alone or in combination with folic acid among women without anaemia or with mild or moderate anaemia by current cut-off criteria is significantly associated with any other substantial beneficial or adverse effects on maternal health, fetal health, or pregnancy outcomes. Available data also indicate that weekly supplementation is as effective as daily supplementation in preventing low haemoglobin levels associated with negative outcome consequences and that the use of either daily or weekly iron supplements (with or without folic acid) may be beneficial where iron deficiency and anaemia are prevalent pre-gestationally or in early pregnancy. Starting supplementation early in pregnancy must be stressed, together with interventions to improve pregnancy iron and folate status prior to conception. The evidence suggests that iron supplementation schemes providing more iron than women need may not be desirable, and doses and formulations that can reduce side effects should be encouraged. However, current preventive antenatal iron supplementation doses recommended for populations in developing countries, based on therapeutic doses, appear to be excessive even where moderate/mild anaemia is found. Consequently, current recommended iron and folic acid supplementation schemes during pregnancy should be reviewed to adjust iron doses to levels that are effective and safe for the mothers and newborns and that can assure compliance. Current preventive antenatal iron supplementation doses recommended for populations in developing countries appear to be excessive. Starting supplementation early in pregnancy must be stressed, together with interventions to improve pregnancy iron and folate status prior to conception. The evidence suggests that iron supplementation schemes providing more iron than women need may not be desirable, and doses and formulations that can reduce side effects should be encouraged. Intermittent supplementation with iron could be considered in anaemia prevention strategies not only prior to but also during pregnancy.
Citation : Peña-Rosas JP, Viteri FE. Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD004736. DOI: 10.1002/14651858.CD004736.pub3.
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Authors:Peña-Rosas Juan Pablo, Viteri Fernando E
Review Group;Cochrane Pregnancy and Childbirth Group
Abstract : Intake of supplements containing iron or a combination of iron and folic acid by pregnant women may improve maternal health and. pregnancy outcomes. Recently, intermittent supplementation regimens have been proposed as alternatives to daily regimens.
Objectives:
To assess the effectiveness and safety of daily and intermittent use of iron or iron+folic acid supplements by pregnant women.
Search strategy:
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2009) and contacted relevant organisations for the identification of ongoing and unpublished studies.
Selection criteria:
All randomised or quasi-randomised trials evaluating the effect of supplementation with iron or iron+folic acid during pregnancy.
Data collection and analysis:
We assessed the methodological quality of trials using the standard Cochrane criteria. Two authors independently assessed which trials to include in the review and one author extracted data.
Main results:
We included 49 trials, involving 23,200 pregnant women. Overall, the results showed significant heterogeneity across most prespecified outcomes and were analysed assuming random-effects. The trials provided limited information related to clinical maternal and infant outcomes.Overall, daily iron supplementation was associated with increased haemoglobin levels in maternal blood both before and after birth and reduced risk of anaemia at term. These effects did not differ significantly between women receiving intermittent or daily iron or iron+folic acid supplementation. Women who received daily prenatal iron supplementation with or without folic acid were less likely to have iron deficiency at term as defined by current cut-off values than those who received no treatment or placebo. Side effects and haemoconcentration (a haemoglobin level greater than 130 g/L) were more common among women who received daily iron or iron+folic acid supplementation than among those who received no treatment or placebo. The risk of haemoconcentration during the second and third trimester was higher among those on a daily regimen of iron supplementation. The clinical significance of haemoconcentration remains uncertain.
Authors' conclusions:
Universal prenatal supplementation with iron or iron+folic acid provided either daily or weekly is effective to prevent anaemia and iron deficiency at term. We found no evidence, however, of the significant reductionin substantive maternal and neonatal adverse clinical outcomes (low birthweight, delayed development, preterm birth, infection,postpartum. haemorrhage). Associated side effects and particularly haemoconcentration during pregnancy may suggest the need for revising iron doses and schemes of supplementation during pregnancy and adjust preventive iron supplementation recommendations.
Implications:Daily or intermittent supplementation with iron or with iron+folic acid by pregnant women clearly results in a substantial reduction in the prevalence of maternal anaemia at term and increased maternal Hb concentrations at term. However, the current sparse data fail to demonstrate that supplementation with iron alone or in combination with folic acid among women without anaemia or with mild or moderate anaemia by current cut-off criteria is significantly associated with any other substantial beneficial or adverse effects on maternal health, fetal health, or pregnancy outcomes. Available data also indicate that weekly supplementation is as effective as daily supplementation in preventing low haemoglobin levels associated with negative outcome consequences and that the use of either daily or weekly iron supplements (with or without folic acid) may be beneficial where iron deficiency and anaemia are prevalent pre-gestationally or in early pregnancy. Starting supplementation early in pregnancy must be stressed, together with interventions to improve pregnancy iron and folate status prior to conception. The evidence suggests that iron supplementation schemes providing more iron than women need may not be desirable, and doses and formulations that can reduce side effects should be encouraged. However, current preventive antenatal iron supplementation doses recommended for populations in developing countries, based on therapeutic doses, appear to be excessive even where moderate/mild anaemia is found. Consequently, current recommended iron and folic acid supplementation schemes during pregnancy should be reviewed to adjust iron doses to levels that are effective and safe for the mothers and newborns and that can assure compliance. Current preventive antenatal iron supplementation doses recommended for populations in developing countries appear to be excessive. Starting supplementation early in pregnancy must be stressed, together with interventions to improve pregnancy iron and folate status prior to conception. The evidence suggests that iron supplementation schemes providing more iron than women need may not be desirable, and doses and formulations that can reduce side effects should be encouraged. Intermittent supplementation with iron could be considered in anaemia prevention strategies not only prior to but also during pregnancy.
Citation : Peña-Rosas JP, Viteri FE. Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD004736. DOI: 10.1002/14651858.CD004736.pub3.
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Patuhlah.....
Abu Hurayra reported that the Messenger of Allah, may Allah bless him and grant him peace, said, "All of my community will enter the Garden except those who refuse." He was asked, "Who are those who refuse, Messenger of Allah?" He said, "Those who obey me will enter the Garden and those who disobey me refuse." [al-Bukhari]
Tuesday, February 23, 2010
hari ni panas...
today is a very damned hot day... but is a blessing from the creator of the world to test our own body thermometer.. are we an obedient and thankful slave or not? The answer only we ourselves and the creator know... nothing much more to say... just look at these pictures & ponder...
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kopok lekor...
aku suka makan kopok lekor.. jadi aku buat sendiri... muahahaha... resepi dari internet!
ni version pertama....3 hari lepas
ni 2nd round...2 hari lepas
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ni version pertama....3 hari lepas
ni 2nd round...2 hari lepas
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