iron deficiency anaemia is the commonest nutritional anaemia in India as well as other developing countries. till an effective supplementation is implemented right from the age of 4 months the problem can not be solved. there is an urgent need to develop effective strategy to reach every infant in the country and give iron supplementation to every infant irrespective of class, creed, caste and society.
Hereditary spherocytosis is an inherited condition related to RBC destruction. its diagnosis is require to differentiate immune hemolytic anemia and G-6-P-D deficiency anemia
Iron deficiency anemia is one of the nutritional deficiency anemia, and the most common microcytic hypochromic anemia. it is also one of the common anemia in Pakistan. Pregnant and lactating are most commonly affected.
This presentation is about Malnutrition in Pediatrics; Epidemiology, Risk factors, etiology, Clinical Evaluation, plotting on Growth charts and Management are Covered.
Hereditary spherocytosis is an inherited condition related to RBC destruction. its diagnosis is require to differentiate immune hemolytic anemia and G-6-P-D deficiency anemia
Iron deficiency anemia is one of the nutritional deficiency anemia, and the most common microcytic hypochromic anemia. it is also one of the common anemia in Pakistan. Pregnant and lactating are most commonly affected.
This presentation is about Malnutrition in Pediatrics; Epidemiology, Risk factors, etiology, Clinical Evaluation, plotting on Growth charts and Management are Covered.
Small Linear/ Cyclic Bioactive/Synthetic peptides for the treatment of Iron Deficiency Anaemia. Softwares used were licenced versions. Method is specific for laboratory scale only, for fine crystals, Glycine / Alanine are better starting materials.
Anemia is a condition in which the number of red blood cells and/OR their oxy...Niranjan Chavan
Anemia is a condition in which the number of red blood cells and/OR their
oxygen-carrying capacity is insufficient to meet the body’s physiological needs.
This white paper will discuss iron therapy in general, why it is sometimes problematic,mainly due to tolerance and practical issues for those suffering from iron deficiency.
Important groups that are discussed in this aspect are children, young girls, fertile females, seniors and people with chronic diseases such as IBD, CHF, CKD that affect the iron metabolism and how Heme‐Iron supplementation change this situation.
The target is to inform the medicinal and pharmaceutical communities of this relatively
new form of therapy and why it has great benefits compared to the traditional methods.
Can the health system sustain population explosion in indiaHarivansh Chopra
The present pandemic has taught us many lessons as far as health care delivery system is concerned in india. population growth is a neglected issue for many decades in india and it is well known that till we are able to control the growth ,all remedial action to improve health care go in vain.this presentation is highlighting the existing gaps in the provision of primary health care in india. we definitely need to increase the percentage of GDP on health as well as control the population.
Lesson learned and not learned in COVID -19 PANDEMICHarivansh Chopra
in march 2019 WHO declared covid -19 as pandemic and since than we have come long way to understand the epidemiology of covid -19. we also have learned quite a number of unpleasant/pleasant lessons in the control and management of covod -19. vaccines have been developed by a quite rapid pace across the globe and similarly vaccine hesitancy and utilisation has also been seen across the globe . this is a very simple presentation highlighting the the importance of correct knowledge and strategies to control this pandemic
Bio psycho social and spiritual dimension and chdHarivansh Chopra
This presentation is a part of webinar on prevention and reversal of chd and type 2 diabetes mellitus . in this presentation prof rahul bansal has emphasised the role of mind body connection and role of stress in causation as well its removal in prevention and reversal of chd.he has given ample evidence of use of meditation, yoga, as well as of prayers and diet in the reversal of chd
CORONARY ARTERY DISEASE is a modern epidemic in india. due to changes in living conditions and habits its prevalence is increasing day by day . in this presentation i have explained the various risk factors and innovations in diagnosis of CAD. IT is very useful for primary health care physicians and community medicine specialist
Promotion of child survival -Experiences, innovations and opportunitiesHarivansh Chopra
In this presentation, i have discussed the normal growth in children. the focus of attention must be an infant as it is the time of maximum growth and chances of growth faltering are also high. if one has to reduce underfive mortality and promote child survival than aBIGWIN APPROACH is to be followed. i have also shared few success stories of low birth weight babies attaining the target at one year of age.causes of malnutrition are also discussed and what type of opportunities are there for public health professional in the community settings.focus from under six has to be shifted to ist year of life
crying in infant is a normal phenomenon but can be troublesome when an infant cry excessively. colic is an acronym and it is important to rule out every physiological and pathological cause before making a diagnosis of colic.this presentation will help you in doing so . happy viewing.
Success stories & innovative approach for prevention of childhood malnutr...Harivansh Chopra
in this presentation i have shown few success stories of low birth weight children attaining normal weight by the end of first year by implementing an innovative BIGWIN APPROACH. Bigwin is an acronym for the best practices described aptly in this presentation.if we can shift the strategy to prevent malnutrition in children from under six to under one than we can overcome malnutrition in five years time provided if we are able to reach every pregnant women and newborn child.
This is a most basic presentation on balanced diet and RDA. Unfortunately the basic requirements are easily forgotten and right kind of nutrition education is thus not provided to population. Remembering the right requirement in vulnerable periods is of utmost important to prevent the occurrence of deficiency and its deleterious effects
Vitamin C is a water soluble vitamin and thus is not stored in the body . It is potent antioxidant and in this covid-19 arena ,there is lot of emphasis of its role in enhancing immunity. it is required daily in 40-80 mgm. This requirement can be easily fulfilled by eating food which are the rich sources of this vitamin.Hope this presentation will clear lots of myths which are prevalent like taking tablet 500-1000mgm daily
CORONARY HEART DISEASE is the modern epidemic facing the developing world. Among all the modifiable risk factors ,diet plays an important role in all of them. adequate knowledge is the first step towards behaviour change . in this presentation I have tried to impress upon food items which are beneficial as well as harmful for individuals having risk factors or disease . hope it will stimulate the viewer to understand and change the eating habits in the society.
Nutrition assessment in children- dr harivansh chopraHarivansh Chopra
Assessment of nutritional status especially in vulnerable population is important for taking prompt action. young children are the most affected proportion of the population in the world.In community settings, rapid methods of assessment are important tools to identify children suffering from both macro and micro deficiencies .This is pictorial presentation showing various methods as well as pictures of deficiencies
Nutritional deficiencies are very common in india as well as in other developing countries.both macro and micro nutrients are not eaten in adequate quantities in india due to poverty and ignorance. A number of national program are there to combat these deficiencies.But unfortunately effective implementation is lacking due to which nutritional deficiency is not being overcome in our country. Now due to covid -19 these are bound to increase
Stress is the gift of modern society which has got a lot of bearing on the mental and physical health of the people . the stress can't be eliminated in totality but can be minimised by using this simple presentation and applying it in day to day life .the answer of stress is in the word stress only.kindly view and use and share it further.
Medicine is considered as one of the best profession in the world and Doctors are still considered next to GOD because they save human life. now a days doctors in developing countries are under tremendous stress. lot of changes are happening in medical education and recently national medical commission has started a new initiative to to change the teaching learning practices medical colleges. Now the upcoming doctors are to be trained keeping in mind the necessary attributes and skills which are required to fulfil their responsibility in fitting manner in future.
This presentation is based upon my more than 3 decades of experience in medical college.
Immunization is one of the best public health intervention to reduce mortality and morbidity caused by vaccine preventable diseases. in this part i am going to describe regarding cold chain ,frequently ask questions regarding vaccines and how to manage acute and life threatening adverse reactions at most peripheral level
Immunization is one of the best public health intervention to prevent morbidity as well as mortality. it also help in prevention of malnutrition in young children.still developing countries are trying hard to make it universal. in india lot of changes have taken place in the immunization schedule and number of newer vaccines have been incorporated. still the awareness as well as acceptability is not universal . this presentation is very basic and will help students as well as teachers. we all have to join hands to make it universal
japenese encephalitis is an important vector borne disease which carries a high mortality as well as high disability. it is a preventable disease and an effective vaccine is available for it.the vaccine is an important part of universal immunization program in india. Environmental modification and control of vector will go long way in the control of this disease.
Enhancing child survival means keeping the normal child as normal as well as bringing low birth weight child to normal.this presentation describe four real stories of low birth weight children attaining normal weight by the end of first year. for this intensive child caring practices are to be implemented. in fact a BIGWIN APPROACH is applied. if this strategy is scaled up then we can make india and other developing countries free of malnutrition in five years thereby giving a big boost to child survival.videotalk can be seen at https://youtu.be/7Ey07cV2clw
Tuberculosis infection is very common in the world and the disease manifest when ever either the virulence of the organism increases or the resistance of the host goes down.it can affect any part of the body.the best method of control of tuberculosis is early diagnosis and treatment.despite international cooperation the problem of resistance in tuberculosis is increasing and great efforts are being made to tackle this problem both in diagnostic tools as well as in treatment modalities. the social factors also play a big role in the causation as well as emergence of resistance is concerned . a participatory approach is required to combat the problem.
meningococcal meningitis is a very serious and fatal disease if not treated in time. the case fatality rate can go upto 50% in untreated cases .there are many strains which are responsible for its occurrence .it tend to occur both in endemic as well as in epidemic form. a qudrivalent vaccine is available for protection. recipient of this vaccine are to be given chemo prophylaxis .recently a vaccine against type b strain has been made avialable in canada for use in routine immunization
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Anaemia is the most common public
health problem in India as well as in
other developing countries.
INTRODUCTION
3. Although there are a number of causes of anaemia in young
children but commonly anaemia is classified as :
Microcytic Hypochromic Anaemia
Normocytic Normochromic Anaemia
Megaloblastic Anaemia
INTRODUCTION
7. By far the commonest anaemia is iron
deficiency anaemia and despite of
having a national program for the
control of anaemia it is not been able
to make a dent on the prevalence in
India
INTRODUCTION
8. The main reason for failure of this program is
lack of life cycle approach in the prevention of
iron deficiency anaemia. As per various National
Family Health Surveys, the prevalence of anemia
has been staggering around 70% among the
children below 3 years of age.
INTRODUCTION
9. The main cause of this high prevalence of
anaemia in young children is failure to provide
supplementary iron right from the age of 4
months of life and this results in child becoming
anaemic by the end of first year and then this
anemia remain persistent in pre school, school
going and adolescent age group.
INTRODUCTION
10. INTRODUCTION
Especially it becomes more profound in
adolescent females again due to lack of
therapeutic approach in this particular
age group. the failure to treat anaemia
in adolescent results in propagation of
anaemia in pregnancy.
11. DR.HARIVANSH CHOPRA
What is Iron
Functions
Rich sources
Daily requirement
Public health importance
OBJECTIVES
13. DR.HARIVANSH CHOPRA
HIDDEN HUNGER
The term was coined by WHO in 1986 & refers to the problems
associated with the deficiency of 3 essential micronutrients:
IRON
IODINE
VITAMIN A
14. DR.HARIVANSH CHOPRA
IRON IN NATURE
Iron is among the abundant minerals on
earth.
Of the 87 elements in the earth’s crust,
Iron constitutes 5.6% and ranks fourth
behind Oxygen (46.4%), Silicon (28.4%) and
Aluminum (8.3%).
15. DR.HARIVANSH CHOPRA
What is Iron?
•Iron is vital to the health of
the human body, and is
found in every human cell.
17. DR.HARIVANSH CHOPRA
What is Iron?
•Iron is an integral part of
many proteins and enzymes
that maintain good health.
18. DR.HARIVANSH CHOPRA
What is Iron?
•In humans, iron is an essential
component of proteins involved
in oxygen transport.
19. DR.HARIVANSH CHOPRA
What is Iron?
• It is also essential for the regulation of cell
growth and differentiation
• It helps cells to "breathe."
• Iron works with protein to make the
hemoglobin in red blood cells.
21. DR.HARIVANSH CHOPRA
What is Iron?
• Heme iron is found only in animal flesh,
as it is derived from the hemoglobin and
myoglobin in animal tissues.
• Non-heme iron is found in plant foods
and dairy products.
23. DR.HARIVANSH CHOPRA
•Red blood cells pick up oxygen
from lungs and distribute the
oxygen to tissues throughout
the body
How it Functions?
24. DR.HARIVANSH CHOPRA
•The ability of red blood cells
to carry oxygen is attributed
to the presence of iron in
hemoglobin molecule.
How it Functions?
25. DR.HARIVANSH CHOPRA
•If we lack iron, we will
produce less hemoglobin,
and therefore supply less
oxygen to our tissues.
How it Functions?
26. DR.HARIVANSH CHOPRA
•Iron is also an important
constituent of another
protein called myoglobin.
How it Functions?
27. DR.HARIVANSH CHOPRA
•Myoglobin, like hemoglobin, is an
oxygen-carrying molecule, which
distributes oxygen to muscles cells,
especially to skeletal muscles and to
the heart.
How it Functions?
28. DR.HARIVANSH CHOPRA
• Energy Production
• Iron also plays a vital role in the
production of energy as a constituent of
several enzymes, including iron catalase,
iron peroxidase, and the cytochrome
enzymes
How it Functions?
29. DR.HARIVANSH CHOPRA
How it Functions?
• It is also involved in the production of
carnitine, a nonessential amino acid
important for the proper utilization of fat.
• The function of the immune system is also
dependent on sufficient iron.
30. DR.HARIVANSH CHOPRA
MAGNITUDE OF PROBLEM
Iron deficiency is the most common micronutrient deficiency in the world
affecting 1.3 billion people i.e. 24% of the world population.
32. DR.HARIVANSH CHOPRA
MAGNITUDE OF PROBLEM
The highest overall rates of anemia are reported in
southern Asia and certain regions of Africa
33. DR.HARIVANSH CHOPRA
PREVALENCE IN WORLD
REGION 6 – 59 MONTHS PREGNANT
WOMEN
NON PREGNANT
WOMEN
AFRICA 60.2 % 44.6 % 37.6 %
LATIN AMERICA AND CARIBBEAN 29.1 % 28.6 % 19.1 %
NORTH AMERICA 07.0 % 17.1 % 12.4 %
ASIA 42.0 % 39.3 % 31.9 %
EUROPE 19.3 % 24.5 % 20.1 %
OCENIA 26.2 % 29.0 % 20.0 %
GLOBAL 42.6 % 38.2 % 29.4 %
34. DR.HARIVANSH CHOPRA
PREVALENCE IN INDIA
ACCORDING TO NFHS 4: PREVALENCE OF ANEMIA
AGE GROUP PREVALENCE
6 – 59 MONTHS 58.4 %
PREGNANT WOMEN (15 – 49 YEARS) 53.1 %
NON PREGNANT WOMEN (15 – 49 YEARS) 50.3 %
ALL WOMEN 15 – 49 YEARS 53.0 %
MEN 22.7 %
35. DR.HARIVANSH CHOPRA
PREVALENCE IN UTTAR PRADESH
ACCORDING TO NFHS 4: PREVALENCE OF ANEMIA
AGE GROUP PREVALENCE
6 – 59 MONTHS 63.2 %
PREGNANT WOMEN (15 – 49 YEARS) 52.5 %
NON PREGNANT WOMEN (15 – 49 YEARS) 51.0 %
ALL WOMEN 15 – 49 YEARS 52.4 %
MEN 23.7 %
36. DR.HARIVANSH CHOPRA
ANEMIA IN CHILDREN < 5 YEARS
NORMAL
31%
MILD ANAEMIA
26%
MODERATE
ANAEMIA
40%SEVERE ANAEMIA
3%
ANAEMIA IN CHILDREN 6 - 59 MONTHS (NFHS 3)
38. DR.HARIVANSH CHOPRA
According to the epidemiological data
collected from multiple countries by the
WHO, Some 35 % of women and 43 % of
young children in the world are affected
by anemia.
MAGNITUDE OF PROBLEM
41. DR.HARIVANSH CHOPRA
•The amount of iron needed depends on age, gender, &
activity level.
•Iron needs increase during periods of rapid growth, such as
during pregnancy, childhood, & adolescence when new
tissue is being built.
DAILY REQUIREMENT
42. DR.HARIVANSH CHOPRA
• Women and teenage girls need more iron than
men because of menstrual losses.
• Competitive athletes may also experience an
increased need for iron.
DAILY REQUIREMENT
44. DR.HARIVANSH CHOPRA
IMPACT OF COOKING, STORAGE AND PROCESSING
• Much of the iron in whole
grains is found in the bran
and germ.
45. DR.HARIVANSH CHOPRA
As a result, the milling of grain, which
removes the bran and germ,
eliminates about 75% of the naturally
occurring iron in whole grains.
IMPACT OF COOKING, STORAGE AND PROCESSING
46. DR.HARIVANSH CHOPRA
Impact of Cooking,
Storage and Processing
• Refined grains are often fortified
with iron, but the added iron is
less absorbable than the iron that
naturally occurs in the grain.
IMPACT OF COOKING, STORAGE AND PROCESSING
47. DR.HARIVANSH CHOPRA
•Cooking with iron cookware
will add iron to food, a
practice that can eventually
lead to iron toxicity.
IMPACT OF COOKING, STORAGE AND PROCESSING
48. DR.HARIVANSH CHOPRA
• Iron absorption is increased when there is
an increased physiological need for iron,
as occurs in children during rapid growth
periods and during pregnancy and
lactation.
Predisposing factors for Deficiency
49. DR.HARIVANSH CHOPRA
•Iron absorption is decreased in people with low
stomach acid (hypochlorhydria),
•Iron absorption is decreased by caffeine and
tannic acid found in coffee and tea and by
phosphates found in carbonated soft drinks.
Predisposing factors for Deficiency
50. DR.HARIVANSH CHOPRA
Phytates, found in whole grains, and
oxalates, found in spinach and chocolate,
may also decrease iron absorption by forming
complexes with the mineral that cannot be
absorbed through the digestive tract.
Predisposing factors for Deficiency
54. DR.HARIVANSH CHOPRA
• Use of the following medications may increase the
amount of iron needed :
1) Aspirin and NSAIDS (for eg, ibuprofen)
2) Histamine blockers
3) Neomycin
4) Stanozolol,
5) Warfarin (Coumadin)
DRUG -NUTRIENT INTERACTIONS
55. DR.HARIVANSH CHOPRA
• Dietary iron may impact the absorption of the following medications:
1) Iron binds with sulfasalazine, decreasing sulfasalazine absorption.
2) Iron decreases the absorption of tetracycline.
3) Iron supplements may decrease absorption of thyroid hormone
medications.
DRUG -NUTRIENT INTERACTIONS
56. DR.HARIVANSH CHOPRA
•Iron supplements may interfere with the action of
carbidopa, a drug used in the treatment of Parkinson's
disease.
•Iron supplements decrease the absorption of methyldopa, a
drug used to lower blood pressure in people with high blood
pressure.
DRUG -NUTRIENT INTERACTIONS
57. DR.HARIVANSH CHOPRA
How do other nutrients interact with iron?
Several nutrients increase iron absorption
including ascorbic acid (vitamin C), copper,
cobalt, and manganese.
NUTRIENT INTERACTIONS
58. DR.HARIVANSH CHOPRA
Amino acids also improve iron absorption by
stimulating the secretion of hydrochloric acid in
the stomach.
High dietary intake of calcium may decrease
absorption of dietary iron.
NUTRIENT INTERACTIONS
59. DR.HARIVANSH CHOPRA
What health conditions require special
emphasis on iron?
HEALTH CONDITIONS
Alcoholism
Attention deficit disorder
63. DR.HARIVANSH CHOPRA
• Many people with iron deficiency don't have
any signs and symptoms because the body's
iron stores are depleted slowly. As anemia
progresses, following symptoms maybe
recognized:
1) Fatigue and weakness
2) Pale skin and mucous membranes
CLINICAL FEATURES
66. DR.HARIVANSH CHOPRA
• Also known as Paterson Kelly syndrome.
Characterized by :
1) Iron-deficiency anaemia,
2) Atrophic changes in buccal,
glossopharyngeal, and esophageal
mucous membranes,
Plummer-Vinson Syndrome
68. DR.HARIVANSH CHOPRA
CUT OFF POINTS FOR DIAGNOSIS
OF ANAEMIA (WHO)
Adult male 13g/dl (venous)
Adult female (non pregnant) 12g/dl
Adult female (pregnant) 11g/dl
Children (6month-6yr) 11g/dl
Children (6-14yr) 12g/dl
70. DR.HARIVANSH CHOPRA
•A complete blood count (CBC) may
reveal low Hb levels and low
hematocrit.
•The CBC gives information about the
size of the red blood cells (RBCs).
DIAGNOSIS
72. DR.HARIVANSH CHOPRA
The reticulocyte count measures the
number of immature red blood cells
being produced. This is a useful test
because it can indicate a problem before
anemia develops.
DIAGNOSIS
73. DR.HARIVANSH CHOPRA
•Serum iron directly measures the
amount of iron in the blood, but
may not accurately reflect how
much iron is concentrated in the
body's cells.
DIAGNOSIS
74. DR.HARIVANSH CHOPRA
Serum ferritin reflects total body iron stores. It's one of the earliest
indicators of depleted iron levels, especially when used in
conjunction with other tests, such as a CBC.
Stool test to detect occult blood loss and to detect presence of eggs
of any worms.
DIAGNOSIS
79. DR.HARIVANSH CHOPRA
Normal bone marrow is shown here.
Note the erythroid islands where erythropoiesis is occurring.
DIAGNOSIS
80. DR.HARIVANSH CHOPRA
• The diagnosis of iron deficiency anemia requires further
investigation as to its cause. It can be a sign of other
disease, such as
DIAGNOSIS
Colon cancer
Malabsorption
Chronic blood loss
81. DR.HARIVANSH CHOPRA
Diversion of iron to fetal erythropoiesis
during pregnancy,
Intravascular hemolysis &
Hemoglobinuria or other forms of chronic
blood loss should all be considered.
DIAGNOSIS
82. DR.HARIVANSH CHOPRA
Treatment for underlying problem-
• Deworming of patients
• Change in dietary habits
• Wearing of shoes
TREATMENT
83. DR.HARIVANSH CHOPRA
•Iron-rich foods are encouraged.
•Causes of persistent blood loss if any
(polyps, chronic dysentery, ulcerative
colitis etc.) need to be treated.
TREATMENT
84. DR.HARIVANSH CHOPRA
ORAL IRON THERAPY :
The optimal dose of iron is 3-6mg/kg body
weight given orally in 3 doses.
With this, hemoglobin level should rise by
0.4g/dl / day.
TREATMENT
85. DR.HARIVANSH CHOPRA
Oral therapy should be continued
for at-least 8 – 12 weeks.
Vitamin C should be included in
diet and phytate avoided.
TREATMENT
87. DR.HARIVANSH CHOPRA
•Iron requirement is determined from the following
equation :
IRON (mg) =Wt (kg) X Hb deficit (g/dl) X 80
100 X 3.4 X 1.5
Or, Wt (kg) X Hb deficit (g/dl) X 4
TREATMENT
88. DR.HARIVANSH CHOPRA
Follow up evaluation with CBC is
essential to demonstrate whether
the treatment has been effective.
TREATMENT
89. Children 6 – 60 months
SUPPLEMENTATION
•20 mg of elemental iron and
100 mcg of folic acid in
biweekly regimen
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
90. Children 6 – 60 months
• MILD ANEMIA (Hb 10 – 10.9 gm/dl)
3mg of iron/Kg/day for 2 months
In case the child has not responded to treatment of anemia for 2
months, refer the child to the FRU/DH with F-IMNCI trained
MO/Pediatrician/Physician for further investigation
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
91. Children 6 – 60 months
• MODERATE ANEMIA (Hb 7 – 9.9 gm/dl)
3mg of iron/Kg/day for 2 months
In case the child has not responded to treatment of anemia for 2
months, refer the child to the FRU/DH with F-IMNCI trained
MO/Pediatrician/Physician for further investigation
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
92. Children 6 – 60 months
• SEVERE ANEMIA (Hb < 7 )
Refer urgently to DH/FRU
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
93. MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN CHILDREN 6 MONTHS – 5 YEARS
HISTORY TO BE TAKEN FOR
Duration of symptoms
Usual diet (before current illness)
Family circumstances
Prolonged fever
Worm infestation
Bleeding from any site
Any lumps in the body 93
94. EXAMINATION FOR
Severe palmar pallor
Skin bleeds
Lymphadenopathy
Hepato splenomegaly
Signs of heart failure
DR.HARIVANSH CHOPRA
MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN CHILDREN 6 MONTHS – 5 YEARS
95. Investigations Indication for blood
transfusion
Blood transfusion
• Full blood count and
examination of a thin film
for cell morphology
• Blood films for malaria
parasites
• Stool Examination for ova,
cyst, and occult blood
All children with Hb ≤4gm/dl
Children with Hb 4-6 gm/dl
with any of the following :
Dehydration
Shock
Impaired Consciousness
Heart Failure
Deep and labored Breathing
Very high parasitemia
If packed cells are available,
give 10ml/kg over 3-4 hours
preferably. If not, give whole
blood 20ml/kg over 3-4 hours
95
96. DOSE OF IFA SYRUP FOR ANEMIC CHILDREN
6 MONTHS – 5 YEARS
AGE OF CHILD DOSE FREQUENCY
6 months – 12 months
(6-10 kg)
1 ml of IFA syrup Once a day
1 year – 3 years
(10 – 14 kg)
1.5 ml of IFA syrup Once a day
3 years – 5 years
(14 – 19 kg)
2 ml of IFA syrup Once a day
96
97. SUPPLEMENTATION
Tablets of 45mg elemental iron
and 400mcg of folic acid
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
CHILDREN 5 – 10 YEARS
98. • MILD ANEMIA (Hb 11 – 11.9 gm/dl)
3mg of iron/Kg/day for 2 months
In case the child has not responded to treatment of anemia for 2
months, refer the child to the FRU/DH with F-IMNCI trained
MO/Pediatrician/Physician for further investigation
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
CHILDREN 5 – 10 YEARS
99. • MODERATE ANEMIA (Hb 8 – 10.9 gm/dl)
3mg of iron/Kg/day for 2 months
In case the child has not responded to treatment of anemia for 2
months, refer the child to the FRU/DH with F-IMNCI trained
MO/Pediatrician/Physician for further investigation
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
CHILDREN 5 – 10 YEARS
100. • SEVERE ANEMIA (Hb < 8 gm/dl )
Refer urgently to DH/FRU
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
CHILDREN 5 – 10 YEARS
101. MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN CHILDREN 5 – 10 YEARS
HISTORY TO BE TAKEN FOR
Duration of symptoms
Usual diet (before current illness)
Family circumstances
Prolonged fever
Worm infestation
Bleeding from any site
Any lumps in the body 101
102. EXAMINATION FOR
Severe palmar pallor
Skin bleeds
Lymphadenopathy
Hepato splenomegaly
Signs of heart failure
DR.HARIVANSH CHOPRA
MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN CHILDREN 5 – 10 YEARS
103. Investigations Indication for blood
transfusion
Blood transfusion
• Full blood count and
examination of a thin film
for cell morphology
• Blood films for malaria
parasites
• Stool Examination for ova,
cyst, and occult blood
All children with Hb ≤4gm/dl
Children with Hb 4-6 gm/dl
with any of the following :
Dehydration
Shock
Impaired Consciousness
Heart Failure
Deep and labored Breathing
Very high parasitemia
If packed cells are available,
give 10ml/kg over 3-4 hours
preferably. If not, give whole
blood 20ml/kg over 3-4 hours
103
105. SUPPLEMENTATION
100mg elemental Iron and
500mcg folic acid
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
ADOLESCENTS 10 – 19 YEARS
106. • MILD ANEMIA (Hb 11 – 11.9 gm/dl)
60mg of iron/day for 3months
In case the child has not responded to treatment of anemia for 3
months, refer the child to the FRU/DH with F-IMNCI trained
MO/Pediatrician/Physician for further investigation
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
ADOLESCENTS 10 – 19 YEARS
107. • MODERATE ANEMIA (Hb 8 – 10.9 gm/dl)
60 mg of iron/day for 3 months
In case the child has not responded to treatment of anemia for 3
months, refer the child to the FRU/DH with F-IMNCI trained
MO/Pediatrician/Physician for further investigation
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
ADOLESCENTS 10 – 19 YEARS
108. • SEVERE ANEMIA (Hb < 8 gm/dl )
Refer urgently to DH/FRU
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
ADOLESCENTS 10 – 19 YEARS
109. MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN ADOLESCENT
HISTORY TO BE TAKEN FOR
Duration of symptoms
Usual diet (before current illness)
Family circumstances
Prolonged fever
Worm infestation
Bleeding from any site
Any lumps in the body 109
110. EXAMINATION FOR
Severe palmar pallor
Skin bleeds
Lymphadenopathy
Hepato splenomegaly
Signs of heart failure
DR.HARIVANSH CHOPRA
MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN ADOLESCENT
111. Investigations Indication for blood
transfusion
Blood transfusion
• Full blood count and
examination of a thin film
for cell morphology
• Blood films for malaria
parasites
• Stool Examination for ova,
cyst, and occult blood
All children with Hb ≤4gm/dl
Children with Hb 4-6 gm/dl
with any of the following :
Dehydration
Shock
Impaired Consciousness
Heart Failure
Deep and labored Breathing
Very high parasitemia
If packed cells are available,
give 10ml/kg over 3-4 hours
preferably. If not, give whole
blood 20ml/kg over 3-4 hours
111
113. • Hb level 9 – 11gm/dl
• IFA tablets 100mg iron and 500
mcg folic acid
• 2 IFA tablets per day for at least
100 days
2 IFA tablets
Hb estimation
monthly
If stores do not
improve: Referral
DR.HARIVANSH CHOPRA
PREGNANT AND LACTATING WOMEN
114. • Hb 8 – 9 mg/dl
Cause of IDA must be investigated
• 2 tablet IFA to be given daily
DR.HARIVANSH CHOPRA
PREGNANT AND LACTATING WOMEN
2 IFA tablets
Hb estimation
monthly
If stores do not
improve: Referral
115. • Hb 7 – 8 mg / dl
• Before starting the treatment, the
women should be investigated to
detect the cause of anemia
• Injectable IM preparations
DR.HARIVANSH CHOPRA
PREGNANT AND LACTATING WOMEN
116. • Hb 5 – 7 mg / dl
• Continue Parenteral iron therapy
as for Hb level between 7-8mg/dl.
• Hb testing to be done after 8
weeks
Parenteral iron
Hb estimation at 8
weeks
Hb 9-11
2 tablets / day
DR.HARIVANSH CHOPRA
PREGNANT AND LACTATING WOMEN
117. • Hb < 5 gm /dl
• injectable IV sucrose preparations
• Immediate Hospitalization irrespective
of period of gestation in hospitals for
blood transfusion
DR.HARIVANSH CHOPRA
PREGNANT AND LACTATING WOMEN
118. 118
LEVEL OF Hb TREATMENT FOLLOW UP REFERRAL
MILD ANEMIA
(11 -11.9 gm/dl)
60mg of elemental
iron daily for 3 months
Follow up every month
Hb estimation after completing 3
months of treatment to assess if
Hb estimates are >12 gm/dl
In case the child has no
improvement in Hb levels after
3 months of treatment,
adolescent will be referred to
DH/FRU for further
investigation
MODERATE
ANEMIA
(8 – 10.9 gm/dl)
60mg of elemental
iron daily for 3 months
Investigation
Follow up every month
Hb estimation after completing 3
months of treatment to assess if
Hb estimates are >12 gm/dl
In case the child has no
improvement in Hb levels after
3 months of treatment,
adolescent will be referred to
DH/FRU for further
investigation
SEVERE ANEMIA
(<7gm/dl)
Refer urgently to
DH/FRU
Severely Anaemic adolescents
would be line listed by ANM
119. DR.HARIVANSH CHOPRA
Prevention of iron deficiency can be achieved
by following measures :
Dietary changes
Fortification of foods
Supplementation
PREVENTION
122. DR.HARIVANSH CHOPRA
•Launched in 1970 to prevent nutritional
anaemia in mother & children.
•This program is now a part of RCH II
program.
NATIONAL NUTRITIONAL ANAEMIA
PROPHYLAXIS PROGRAM
123. DR.HARIVANSH CHOPRA
NATIONAL NUTRITIONAL ANAEMIA
PROPHYLAXIS PROGRAM
• Under this program, prophylactic treatment
for expected and nursing mothers are given
one tablet containing 100 mg elementary iron
and 0.5 mg folic acid.
124. DR.HARIVANSH CHOPRA
NATIONAL NUTRITIONAL ANAEMIA
PROPHYLAXIS PROGRAM
• Children are given one tablet containing 20mg
elemental iron and 0.1 mg folic acid for a
period of 100 days.
• For therapeutic purpose, number of tablets is
increased to 2 daily.
125. NATIONAL IRON + INITIATIVE
Launched to bring existing
Programmes together and
establish new age groups
125
126. Bi weekly iron supplementation for pre school
children 6 months to 5 years
DR.HARIVANSH CHOPRA
Weekly Supplementation for children from
1st to 5th grade in Govt. and Govt. aided
school
NATIONAL IRON + INITIATIVE
127. Weekly supplementation for out of school
children (5 – 10 years) at Anganwadi Centers.
DR.HARIVANSH CHOPRA
Weekly Supplementation for adolescents (10
– 19 years)
NATIONAL IRON + INITIATIVE
128. Pregnant and lactating women
DR.HARIVANSH CHOPRA
Weekly Supplementation for women in
reproductive age
NATIONAL IRON + INITIATIVE
129. LACK OF AWARENESS IN MASSES AND PERIPHERAL HEALTH WORKERS
REGARDING ANAEMIA
LACK OF STRATEGY TO REACH EVERY CHILD
LACK OF STRATEGY TO SUPPLEMENT IRON FROM AGE OF 4 MONTHS
LACK OF ADEQUATE SUPPLY OF IRON SYRUPS AND DROPS
FAILURE TO ADDRESS SOCIAL FACTORS RELATED TO HIGH FERTILITY AND MORE
STRESS ON POPULATION CONTROL
130. DR.HARIVANSH CHOPRA
CONCLUSION
Iron deficiency is the commonest deficiency disorder.
If not treated in time, it results in mortality in the vulnerable
period of life.
Despite having a technically good programme for its prevention,
cost effective supplementation is still not implemented..!!
131. DR.HARIVANSH CHOPRA
• Normal requirement of iron in children is-
1. 0.1mg/kg/day
2. 0.5mg/kg/day
3. 1mg/kg/day
4. 5mg/kg/day ANS. 3
132. DR.HARIVANSH CHOPRA
• The prevalence of anaemia in pregnancy in India is –
1. 10-20%
2. 20-30%
3. 30-40%
4. 40-50% ANS. 4
133. DR.HARIVANSH CHOPRA
• WHO Cut off point for diagnosis of anaemia for children (6month-
6year) is :
1) 11g/dl
2) 12g/dl
3) 13g/dl
4) 10g/dl
ANS. 1
134. DR.HARIVANSH CHOPRA
• Normal serum iron level is :
1. 30-80 µg/dl
2. 80-180 µg/dl
3. 150-250 µg/dl
4. 250-450 µg/dl ANS. 2
135. DR.HARIVANSH CHOPRA
• The content of a tablet used for prevention of Nutritional Anaemia in
Pregnant female is :
1. 50mg iron, 0.1mg folic acid
2. 50mg iron, 0.5mg folic acid
3. 100mg iron, 0.1mg folic acid
4. 100mg iron, 0.5mg folic acid
ANS. 4