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Types of oral contraceptives, their mode of action, choice of dosage, side effects, and contraindications are summarized for the general clinician. A 50 mcg dosage of estrogen in a combination formula appears to be the minimum dose necessary for consistent protection from pregnancy although some compounds with less estrogen but a more powerful progestin appear to provide good protection. These lower dose estrogen formulations may be advised if estrogen-related symptoms such as nausea or breast soreness are encountered. In amenorrheao r symptoms of estrogen deprivation 80-100 mcgs of estrogen may be required. Although there is a risk of thromboembolic disease, hypertension, carbohydrate and lipid metabolic effects, gallbladder disease, hepatoma, and possible post-pill amenorrhea, these problems can be minimized by careful screening of patients. Benefits include decreased incidence of ovarian cysts, benign breast neoplasia, menstrual disorders, premenstrual syndrome, iron deficiency anemia, sebaceous cysts, and acne (due to decreased sebum production with estrogen adminsitration). Patients need to be reminded that the morbidity and mortality associated with pregnancy exceed that attributed to oral contraceptives.
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PMID:Oral contraception. 83 94

A 39-year-old woman presented with a 2-month history of repeated severe headache, nausea and diplopia. On admission she was obese with bilateral papilledma and abducens weakness. Mass lesion and sinus thrombosis were ruled out by brain CT and angiography. CSF pressure was normal initially. CSF pressure fluctuated with menstrual cycle, sometimes showing over 600 mmH2O with worsening of the symptoms. She was diagnosed as benign intracranial hypertension (BIH). Diuretics did not improve the symptoms, and visual disturbances ensued and deteriorated. A spinal subarachnoid space-peritoneal shunt was inserted to control CSF pressure, showing rapid improvement of headache and diplopia but visual disturbances remained almost unchanged. Optic nerve sheath fenestration was performed without improvement of visual deterioration. We postulated multiple factors such as obesity, menstrual abnormality, iron deficiency anemia and analgesic drugs played important roles to produce BIH in this case. Careful quantitative perimetry should be done to decide a suitable time for surgical treatment in BIH.
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PMID:[A case of benign intracranial hypertension with fluctuated symptoms and CSF pressure synchronized with menstrual cycle]. 149 Mar 15

The clinical efficacy and tolerability of gastroprotected ferritin were assessed in children affected by iron deficiency and/or sideropenic anemia. Forty-seven children with iron-deficiency and/or sideropenic anemia were included in the study and were treated with gastroprotected ferritin at a dose of 4-5 mg/kg/day per os for 4 months. Only 33 children correctly completed the entire treatment cycle, achieving a marked improvement of blood parameters (increased Hb, accompanied by higher levels of sideremia and in particular ferritin, with a contemporary decrease in erythrocytic protoporphyrin and transferrinemia) and clinical symptoms, especially pallor, anorexia, debility, somnolence, hyperactivity, disturbed sleep and excessive sweating. Of the remaining 14 children, 9 failed to present for the planned control after the 4 months of therapy, 3 abandoned therapy due to difficulties of assumption and 2 because of intolerance phenomena, such as nausea and diarrhoea. In conclusion, gastroprotected proteoferrin is efficacious and well tolerated in the treatment of iron deficiency in children.
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PMID:[Evaluation of the effectiveness of gastro-protected proteoferrin in the therapy of sideropenic anemia in childhood]. 228 21

The purpose of this study was to investigate the prevalence and type of lesions in the upper gastrointestinal tract and to identify characteristics associated with ulcer disease among geriatric inpatients with positive faecal occult blood test and/or iron deficiency anaemia. Two thousand five hundred and four patients aged 60-98 (mean, 82) years admitted to a geriatric clinic for rehabilitation were screened by faecal occult blood test, for B-haemoglobin, and, in a case of anaemia, analyses of serum levels of mean corpuscular volume, mean corpuscular haemoglobin concentration, iron, and total iron-binding capacity. One hundred and seventy patients were included in the study. A high prevalence of ulcer disease (22%) was found. Significantly higher proportions of non-steroidal anti-inflammatory drugs and steroid users and of patients with rheumatoid arthritis and osteoarthrosis were found among ulcer patients than among patients without ulcerative upper gastrointestinal lesions. The clinical picture of ulcer disease differed from the classic presentation: abdominal pain occurred in only 7 of 38 patients (18%), whereas appetite and weight loss and nausea/vomiting were common. It is important to be aware of the high prevalence and the clinical picture of ulcer disease among geriatric inpatients with iron deficiency anaemia and/or occult gastrointestinal bleeding.
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PMID:Ulcer disease among geriatric inpatients with positive faecal occult blood test and/or iron deficiency anaemia. A prospective study. 235 77

Iron deficiency anemia affects over 2 billion people. Particularly at risk are pregnant women and young children. Although distribution of iron supplements is practised in many antenatal care programs in developing countries, it has often been alleged that pregnant women do not take them. Poor compliance arises not only because of patient behavior but also from factors out of the patient's control. This paper presents the results of a review of the literature on medical compliance to determine whether iron supplementation is different from other medications, to assess the known levels of compliance, and to synthesize recommendations for improving compliance relevant to iron supplementation. The review showed that compliance with iron therapy is a specific case of medical compliance. Reasons for non-compliance with iron deficiency treatment include: inadequate program support (lack of political commitment and financial support); insufficient service delivery (poor provider-user dynamics; lack of supplies, access, training, and motivation of health care professionals); and patient factors (misunderstanding instructions, side effects, frustration about the frequency and number of pills taken, migration, fear of having big babies, personal problems, nausea that accompanies pregnancy, and the subtlety of anemia which makes demand for treatment low). Much has been made about the side effects (nausea, constipation, etc.) that women might experience during iron therapy as the cause of poor compliance with iron supplementation without justification according to this review. Instead, unavailability of iron supplements was the most common reason why women did not take iron supplements. Women bear a disproportionate burden from iron deficiency anemia even though the technology exists to address the problem at low cost. Governments and health care professionals must renew their commitment to iron therapy by monitoring and improving compliance. We can significantly improve compliance by: making sure that iron supplements are available at all times; providing advanced warning about the possibility of side effects; involving the patient in the therapeutic strategy; and providing reminders, such as posters and calendars, about taking supplements.
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PMID:Determinants of compliance with iron supplementation: supplies, side effects, or psychology? 793 55

We reported a case of Addison's disease, caused by adrenal tuberculosis. The patient was female, seventy four years old. She complained cough and body weight loss. She complained cough from June, 1989, but her home doctor didn't take care of her symptoms. September 1989, she felt appetite loss, and easy fatigue, so her home doctor suspected her disease as pulmonary tuberculosis, so he introduced our hospital, and she admitted. When she admitted, her chest roentogenogram revealed bIII2. Sputum smear examinations were negative. Laboratory data on admission, we observed slightly eosinophilia, severe iron deficiency anemia, and accenturation of blood sedimentation rate. Immediately after admission, she complained nausea, vomiting, coldness, and powerless. On 25 days after admission, she lost her senses suddenly, and her blood pressure fell 5 days after, she fell in shock state, too. We found out her blood sugar data was 29. After blood examinations, we found out that ACTH was high, cortisole, 17-KS, 17-OHCS were low. So we thought she got acute hypoadrenocorticism. We found her abdominal CT revealed calcification in her right adrenal gland. We diagnosed her disease as Addison's disease caused by adrenal tuberculosis so we began to give prednisolone, 7.5 mg per day. After giving, her state made better. We thought her disease as Addison's disease caused by adrenal tuberculosis, revealed acute hypoadrenocorticism.
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PMID:[A case of Addison's disease caused by adrenal tuberculosis, and revealed acute hypoadrenocorticism]. 826 25

Iron deficiency anemia is a significant health problem for women. An intervention utilizing home visits by a nurse and the intake of alternate iron supplements was examined. Outcome measures of hematocrit levels and side effects are reported in this manuscript. Ten African-American inner city homeless women in transitional housing agreed to participate in this longitudinal study. Each participant was encouraged to take the alternate iron supplements for a three month period. Hematocrit values increased from recruitment through the third month. A paired t-test was significant (t value -5.39; df, 9; p < .0001). In addition, the side effect of fatigue decreased from recruitment through the third month. A paired t-test was significant (t value 3.18: df, 7: p = .015). During the weekly and monthly visits, when the subjects were asked if the supplements had any effect on their feelings of well-being, two women stated they had "little effects." In terms of side effects there were no complaints of nausea, stomach ache, or black tarry stools. Of the approximately 12 visits to each subject, constipation was reported only two times by two subjects. While the women did not report black stools they did offer that the vitamins seemed to color their stools green (three reported it one time and two subjects reported it three times). The benefits and the lack of side effects may have far-reaching implications for client populations such as the elderly and pregnant women who typically have difficulty with anemia and constipation alike. The weekly visits by the nurse may have added to the compliance and success of this program.
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PMID:Side effects of alternative iron supplementation: a pilot study. 1061 42

An estimated 50% of pregnant women in Africa are anemic-- a condition that has been linked to intrauterine growth retardation, increased perinatal mortality, low birthweight, compromised immunity, and possible psychomotor and cognitive impairments. In tropical Africa, iron and folate deficiencies and malaria are the major causes of anemia in pregnancy. Iron deficiency anemia results from a combination of dietary insufficiency, excessive requirements associated with multiparity, and chronic blood loss from hookworm infestation. An essential component of maternal-child health services in Africa is prevention of anemia and therapeutic management once severe anemia is documented. Since 35% of nonpregnant African women are anemic, many women will enter pregnancy with inadequate iron stores. Thus, the prophylactic dose of iron should be at least 120 mg/day rather than the usual 60 mg dose. Unfortunately, increased dosages of iron increase the side effects of constipation and nausea, so careful counseling is necessary to ensure compliance. Folic acid, which has no side effects, should be administered in doses of 1.5 mg/day. To reduce the risk of malaria, a therapeutic dose of chloroquine should be administered at the 1st prenatal visit (600 mg for 2 days and 300 mg on the 3rd day) followed by proguanil (100 mg/day) until delivery. In cases where anemia persists or emerges, the iron dose should be increased to 200 mg of ferrous sulfate 3 time/day (180 m,g of elemental iron) and 5 mg of folic acid should be provided. Blood transfusion should be used sparingly and only in severe cases, given the risk of transmission of human immunodeficiency virus.
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PMID:Towards a more effective management of pregnancy related anaemias in Africa. 1231 81

Anemia is a common disease in elderly people. However, since hemoglobin concentration often decreases subclinically with aging because of nutritional impairment, its pathological significance is unclear. To investigate the pathological significance of low hemoglobin concentration, we studied the relation between hemoglobin levels and arrhythmia, as well as circulatory parameters. Arrhythmia was detected by Holter type ambulatory electrocardiography in 42 elderly people (aged 60 or over) living in a nursing home. Plasma concentrations of human atrial natriuretic peptide (hANP) after iron therapy were determined by immunoradiometric assay. Changes in circulatory parameters in elderly people with iron deficiency anemia were examined. Supraventricular and ventricular premature contractions significantly increased in elderly people with low hemoglobin concentrations or hematocrit. hANP increased significantly as the hemoglobin concentration decreased in 22 elderly people. Of these 22 subjects, 11 showed a low serum concentration of iron, and were administered ferrous salts. No side effects, such as nausea, occurred. After iron supplementation, the average hemoglobin level increased from 9.0 to 10.5 g/dl, and the average hANP level was reduced from 58.3+/-23.5 to 41.2+/-27.9 pg/ml, which was statistically significant by Wilcoxon's signed rank sum test. The increase in the hemoglobin level inversely correlated with the hANP level. Heart rate, blood pressure and body weight of subjects decreased significantly after iron supplementation therapy. Although hemoglobin levels were increased by iron supplementation therapy after a long period of anemia, the duration of the period with low hemoglobin levels showed no significant relation to initial hANP concentration. In conclusion, low hemoglobin levels induced secretion of hANP, and treatment of iron deficiency might exert favorable effects on the circulatory system.
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PMID:Atrial natriuretic peptide in aged patients with iron deficiency anemia. 1537 90

The etiology of pica, the purposive consumption of non-food substances, is not understood, despite its ubiquity among gravidae. We examined correlates of pica in a representative obstetric population (n = 2,368) on Pemba Island, Zanzibar, Tanzania to examine proposed etiologies. Cross-sectional data were collected on socioeconomic characteristics, food intake, geophagy (earth consumption), amylophagy (raw starch consumption), anthropometry, iron status, parasitic burden, and gastrointestinal morbidities. Amylophagy was reported by 36.3%, geophagy by 5.2%, and any pica by 40.1%. There was a strong additive relationship of geophagy and amylophagy with lower hemoglobin (Hb) concentration and iron deficiency anemia. By multivariate logistic regression, any pica was associated with Hb level (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.72-0.81), nausea (OR = 1.45, 95% CI = 1.20-1.73), and abdominal pain (OR = 1.22, 95% CI = 1.01-1.48). These striking results indicate that the nature of the relationship between pica, pregnancy, gastrointestinal distress, and iron deficiency anemia merits further investigation.
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PMID:Association of pica with anemia and gastrointestinal distress among pregnant women in Zanzibar, Tanzania. 2059 93


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