Postoperative intravenously administered iron sucrose versus postoperative orally administered iron to treat post-bariatric abdominoplasty anaemia (ISAPA): the study protocol for a randomised controlled trial

BACKGROUND: Anaemia and iron deficiency are common complications following post-bariatric abdominoplasty. Given the low oral absorbability of iron resulting from bariatric surgery, it has been hypothesised that postoperative intravenously administered iron supplementation could be used to treat anaemia and to prevent the development of iron deficiency in these patients. METHODS/DESIGN: In this multicentre open-label randomised clinical trial, 56 adult women undergoing post-bariatric anchor-line abdominoplasty will be allocated at a ratio of 1:1 for postoperative supplementation with two intravenously administered applications of 200 mg of iron saccharate or postoperative supplementation with 100 mg of iron polymaltose complex administered orally, twice a day for 8 weeks. The primary outcome is the difference in mean haemoglobin levels between the two groups at eight postoperative weeks. Secondary outcomes evaluated at one, four and eight postoperative weeks include iron profile, reticulocyte count, overall quality of life measured using the Short-Form 36 Health Survey (SF-36) questionnaire, fatigue measured using the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F), adverse effects and postoperative complications. DISCUSSION: This randomised clinical trial aims to evaluate the haematopoietic effectiveness of intravenously administered iron supplementation in patients undergoing post-bariatric abdominoplasty. A more effective recovery of haemoglobin levels could help improve the patients’ quality of life and could provide an improved haematological status in preparation for the subsequent and frequent plastic surgeries these patients undergo. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01857011 (8 May 2013), Universal Trial Number U111-1169-6223, Brazilian Clinical Trials Registry (REBEC): RBR-2JGRKQ

Ultrasound detection of abnormal cerebrovascular morphology in a mouse model of sickle cell disease based on wave reflection

Sickle cell disease (SCD) is associated with a high risk of stroke, and affected individuals often have focal brain lesions termed silent cerebral infarcts. The mechanisms leading to these types of injuries are at present poorly understood. Our group has recently demonstrated a non-invasive measurement of cerebrovascular impedance and wave reflection in mice using high-frequency ultrasound in the common carotid artery. To better understand the pathophysiology in SCD, we used this approach in combination with micro-computed tomography to investigate changes in cerebrovascular morphology in the Townes mouse model of SCD. Relative to controls, the SCD mice demonstrated the following: (i) increased carotid artery diameter, blood flow and vessel wall thickness; (ii) elevated pulse wave velocity; (iii) increased reflection coefficient; and (iv) an increase in the total number of vessel segments in the brain. This study highlights the potential for wave reflection to aid the non-invasive clinical assessment of vascular pathology in SCD

Hemoglobin Area and Time Index Above 90\ua0g/L are Associated with Improved 6-Month Functional Outcomes in Patients with Severe Traumatic Brain Injury

Purpose: There is conflicting data on the relationship between anemia and outcomes in patients with traumatic brain injuries (TBI). The objective of this study was to determine if the proportion of time and area under the hemoglobin-time curve of\ua0 6590\ua0g/L are independently associated with 6-month functional outcomes. Methods: Retrospective cohort study of 116 patients with a severe TBI who underwent invasive neuromonitoring between June 2006 and December 2013. Hemoglobin area (HAI) and time (HTI) indices were calculated by dividing the total area, or time, under the hemoglobin-time curve at 90\ua0g/L or above by the total duration of monitoring. Multivariable log-binomial regression was used to model the association between HAI or HTI and 6\ua0month favorable neurologic outcome (Glasgow Outcome Score 4 or 5). Results: Patients had a mean age of 38\ua0years (SD 16) with a median admission Glasgow Coma Scale of 6 (IQR 4\u20137). There were 1523 hemoglobin measurements and 523 monitoring days. Patients had a hemoglobin\ua0 6590\ua0g/L for a median of 70\ua0% (IQR 37\u2013100) of the time. Each 10\ua0g/L increase in HAI (RR 1.23, 95\ua0%CI 1.04\u20131.44, P\ua0=\ua00.011), and 10\ua0% increase in HTI (1.10, 95\ua0%CI 1.04\u20131.16, P\ua0<\ua00.001) were associated with improved neurologic outcome. Thirty-one patients (27\ua0%) received a transfusion with the median pre-transfusion hemoglobin being 81\ua0g/L (IQR 76\u201387). Conclusions: In patients with severe TBI, increased area under the curve and percentage of time that the hemoglobin concentration was\ua0 6590\ua0g/L, were associated with improved neurologic outcomes