human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: One hundred and three antenatal patients with initial haemoglobin levels of 10.7 g./100 ml . or less at their first antenatal visit were treated with either ferrous gluconate , Ferrogradumet or intravenous Astrafer . A significant rise in haemoglobin level occurred in the first month in those groups receiving iron therapy compared with the control group . From the end of the first month until 36 weeks gestation , there was no significant difference between the treatment groups Objective : To evaluate the effectiveness of a stepwise use of recombinant human erythropoietin ( rhEPO ) in pregnant patients with severe anemia or nonresponsive to intravenously administered iron only . Methods : All subjects had iron deficiency anemia , i.e. , a hemoglobin ( Hb ) level < 10.0 g/dl and ferritin ≤15 μg/l . Patients with an Hb level ≥9.0 g/dl and < 10.0 g/dl received 200 mg iron sucrose intravenously twice weekly . If response to therapy was poor , patients additionally received 10,000 U rhEPO twice weekly . Patients with an Hb level < 9.0 g/dl primarily received iron sucrose and rhEPO likewise . Results : Of the 84 patients , 59 had a  baseline Hb level between 9.0 and 9.9 g/dl , of whom 32 responded poorly , thus receiving additional rhEPO . Twenty-five patients had a baseline Hb level < 9.0 g/dl . The overall Hb level after therapy was 11.0 g/dl ( ±0.5 , range 10.0–12.6 g/dl ) . Mean duration of therapy was 3.5 weeks ( 7 infusions ) . Conclusion : This study shows an effective treatment regimen for patients with various degrees of anemia in pregnancy . Iron sucrose is a safe and effective treatment option . In cases of severe iron deficiency anemia or poor response to parenteral iron therapy additional administration of rhEPO might be considered . However , the mechanism for not responding to  intravenous iron therapy despite iron deficiency anemia still remains unclear to a large extent OBJECTIVE : The aim of this study was to compare the efficacy of intravenous iron to oral iron in the treatment of anemia in pregnancy . METHODS : In this r and omized open-label study , 90 women with hemoglobin levels between 8 and 10.5 g/dL and ferritin values less than 13 & mgr;g/L received either oral iron polymaltose complex ( 300 mg elemental iron per day ) or intravenous iron sucrose . The iron sucrose dose was calculated from the following formula : weight before pregnancy ( kg ) × ( 110 g/L – actual hemoglobin [ g/L ] ) × 0.24 + 500 mg . Treatment efficacy was assessed by measuring hemoglobin and ferritin on the 14th and 28th days and at delivery , and the hemoglobin on the first postpartum day . Adverse drug reactions , fetal weight , hospitalization time , and blood transfusions were also recorded . RESULTS : Hemoglobin values varied significantly with time between groups ( interaction effect , P < .001 ) . The change in hemoglobin from baseline was significantly higher in the intravenous group than the oral group at each measurement ; the changes with respect to subsequent hemoglobin were significantly higher on the 14th ( P = .004 ) and 28th ( P = .031 ) days . Ferritin values were higher in patients receiving intravenous iron throughout pregnancy . No serious adverse drug reactions were observed . Fetal weight and hospitalization time were similar in the 2 groups . Blood transfusion was required for only one patient in the oral group . CONCLUSION : Intravenous iron treated iron-deficiency anemia of pregnancy and restored iron stores faster and more effectively than oral iron , with no serious adverse reactions . LEVEL OF EVIDENCE : OBJECTIVE ( 1 ) To determine an alternative iron supplementation with better efficacy , compliance & safety in treatment of iron deficiency anemia during pregnancy , ( 2 ) to reduce blood transfusion during pregnancy , labor and puerperium . MATERIAL AND METHOD A prospect i ve comparative study . A total number of 60 pregnant women with the gestational age of 12 - 34 weeks were included in the study who were suffering from iron deficiency anemia . They were divided in 3 groups ( A , B and C ) . Group A ( n = 15 ) received intravenous iron sucrose according to recommended dose containing 500 mg of iron sucrose for storage , in group B ( n = 20 ) iron sucrose was administered according to deficit calculated as per formula but 200 mg of iron was given for storage instead of 500 mg , to reduce cost . While group C received intra muscular iron Sorbitol in the dose used as practice . RESULTS Mean hemoglobin in group A and B was 8.0 + /- 1.1 g/dl and 8.9 + /- 0.7 respectively , in group C , it was 8.8 + /- 0.9 g/dl . In group A & B initial hemoglobin was assessed 3 weeks post therapy which showed an average rise of 2.8 g/dl ( group A ) and 1.9 g/dl ( group B ) and second assessment of Hemoglobin was done prior to delivery ( ave : 6.6 weeks ) showed a total rise of 3.8 g/dl ( group A ) and 2.4 g/dl ( group B ) . Pre delivery mean Hemoglobin in group A and B was 11.8 g/dl and 11.3 g/dl respectively . In group C , the Hemoglobin was assessed only prior to delivery ( average : 8.4 weeks from the start of therapy ) , and a rise of 1.4 g/dl was observed with pre delivery mean Hemoglobin of 10.2 g/dl . Target hemoglobin levels i.e. 11 g/dl was achieved by 80 % in Group A , 70 % in Group B and 28 % in Group C by the time of delivery . Blood transfusion was not required in any group . In group A and B one patient had moderate abdominal pain , 2 had weakness and shivering and 3 had phlebitis at the site where intravenous canula was retained . None of patient discontinued the therapy due to any adverse effect . In group C majority complained of pain at injection site while 5 patients dropped out from the study due to intolerance . CONCLUSION Intravenous iron therapy is safe , convenient and more effective then intramuscular iron therapy in treatment of iron deficiency anemia during pregnancy . The intravenous iron therapy can replace blood transfusion in antenatal period BACKGROUND Daily oral iron supplementation during pregnancy fails to reduce the prevalence of anemia . However , 2 or 3 intramuscular doses of iron given at monthly intervals were recently found to be effective . OBJECTIVE We compared the safety and efficacy in treating pregnancy anemia of 3 intramuscular doses of iron given at monthly intervals with those of daily oral iron supplementation . DESIGN In a prospect i ve , partially r and omized study , 148 pregnant women received daily oral doses of 100 mg elemental Fe and 500 micro g folic acid , and 106 pregnant women received 3 intramuscular doses of 250 mg elemental Fe as iron dextran at 1-mo intervals and oral doses of 5 mg folic acid twice weekly .  One hundred women in each group completed the study .  Changes in hemoglobin , iron indicators , pregnancy outcomes , and birth weight were compared between the 2 groups . RESULTS Hemoglobin and iron indicators improved significantly with both treatments . The increase in serum ferritin concentration after parenteral iron treatment was significantly higher than that after oral iron treatment . No significant differences between the 2 groups in pregnancy outcomes and birth weight were observed . Systemic side effects were more common in the parenteral iron group , whereas gastrointestinal side effects were more common in the oral iron group . CONCLUSIONS The intramuscular administration of 3 doses of 250 mg Fe at monthly intervals appears to have good compliance and efficacy and may be used in women who can not tolerate oral administration of iron . However , intramuscular administration of iron is appropriate only in hospital setting s well equipped to treat anaphylactic crises The effect of daily rather than weekly iron supplementation was compared in women who were 8 - 24 wk pregnant . One group ( n = 68 ) received 60 mg Fe/d , the second group ( n = 71 ) received 120 mg Fe/wk , given at once . Supplementation lasted 11.3 wk on average , depending on gestational date at entry , and was not supervised . Hemoglobin increased in both groups ( P < 0.001 ) ; serum ferritin did not change significantly . There was no significant difference between groups for changes in hemoglobin and serum ferritin . In a subgroup of women with a hemoglobin concentration < 110 g/L at baseline ( n = 45 daily ; n = 54 weekly ) no significant within-group changes occurred in serum ferritin , but the change in the daily group was 4.1 micrograms/L higher than in the weekly group ( P = 0.049 ) . Compliance , as indicated by two positive stool tests , was approximately equal to 54.3 % in the daily group and 62.2 % in the weekly group . We conclude that for the complete sample of subjects , the treatment effect of daily compared with weekly supplementation was similar under conditions resembling a normal antenatal care program In rural China , many pregnant women in their third trimester suffer from anemia ( 48 % ) and iron deficiency ( ID ; 42 % ) , often with coexisting deficiencies of retinol and riboflavin . We investigated the effect of retinol and riboflavin supplementation in addition to iron plus folic acid on anemia and subjective well-being in pregnant women . The study was a 2-mo , double-blind , r and omized trial . Subjects ( n = 366 ) with anemia [ hemoglobin ( Hb ) < /= 105 g/L ] were r and omly assigned to 4 groups , all receiving 60 mg/d iron and 400 mug/d folic acid . The iron+folic acid ( IF ) group ( n = 93 ) served as reference , the iron+folic acid+retinol group ( IFA ) ( n = 91 ) was treated with 2000 mug retinol , the iron+folic acid+riboflavin group ( IFB ) ( n = 91 ) with 1.0 mg riboflavin , and the iron+folic acid+retinol+riboflavin group ( IFAB ) ( n = 91 ) with retinol and riboflavin . After the 2-mo intervention , the Hb concentration increased in all 4 groups ( P < 0.001 ) . The increase in the IFAB group was 5.4 + /- 1.1 g/L greater than in the IF group ( P < 0.001 ) . The reduced prevalence of anemia ( Hb < 110g/L ) and ID anemia were significantly greater in the groups supplemented with retinol and /or riboflavin than in the IF group . Moreover , gastrointestinal symptoms were less prevalent in the IFA group than in the IF group ( P < 0.05 ) and improved well-being was more prevalent in the groups receiving additional retinol and /or riboflavin than in the IF group ( P < 0.05 ) . Thus , a combination of iron , folic acid , retinol , and riboflavin was more effective than iron plus folic acid alone . Multimicronutrient supplementation may be worthwhile for pregnant women in rural China In the context of limited effectiveness of iron supplementation programs , intermittent iron supplementation is currently under debate as a possible alternative strategy that may enhance the effectiveness of operational programs . This field-based trial assessed the outcome of twice weekly iron supplementation compared to daily in Pakistan . A double-blind , r and omized , clinical trial was conducted in Northern Pakistan . Anemic pregnant women ( n = 191 ) were assigned to receive daily ( 200 mg ferrous sulfate ) or twice weekly ( 2 x 200 mg ferrous sulfate ) iron supplementation .  Hemoglobin was measured at baseline and at 4-wk intervals for up to 12 wk . Serum ferritin was measured at baseline and 8 or 12 wk . Analysis was by intention to treat . The two groups did not differ in age , parity , sociodemographic characteristics , hemoglobin or serum ferritin concentrations at baseline . Women who received iron daily had a greater rise in hemoglobin compared with women who received iron twice weekly ( 17.8 + /- 1.8 vs. 3.8 + /- 1.2 g/L , P < 0.001 ) . The serum ferritin concentrations increased by 17.7 + /- 3.9 microgram/L ( P < 0.001 ) in the daily supplemented group and did not change in the twice weekly group . Daily iron supplementation remained superior to twice weekly supplementation after controlling initial hemoglobin Z-scores and duration of treatment . The body mass index ( BMI ) modified the effect of daily versus twice weekly iron supplementation . For every unit increase in BMI , the difference between the two treatment groups was reduced by 0.0014 ( final hemoglobin Z-score ; P = 0.027 ) . We recommend continuation of daily iron supplementation as opposed to intermittent iron supplementation in pregnant women in developing countries BACKGROUND 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: One hundred and three antenatal patients with initial haemoglobin levels of 10.7 g./100 ml . or less at their first antenatal visit were treated with either ferrous gluconate , Ferrogradumet or intravenous Astrafer . A significant rise in haemoglobin level occurred in the first month in those groups receiving iron therapy compared with the control group . From the end of the first month until 36 weeks gestation , there was no significant difference between the treatment groups Objective : To evaluate the effectiveness of a stepwise use of recombinant human erythropoietin ( rhEPO ) in pregnant patients with severe anemia or nonresponsive to intravenously administered iron only . Methods : All subjects had iron deficiency anemia , i.e. , a hemoglobin ( Hb ) level < 10.0 g/dl and ferritin ≤15 μg/l . Patients with an Hb level ≥9.0 g/dl and < 10.0 g/dl received 200 mg iron sucrose intravenously twice weekly . If response to therapy was poor , patients additionally received 10,000 U rhEPO twice weekly . Patients with an Hb level < 9.0 g/dl primarily received iron sucrose and rhEPO likewise . Results : Of the 84 patients , 59 had a  baseline Hb level between 9.0 and 9.9 g/dl , of whom 32 responded poorly , thus receiving additional rhEPO . Twenty-five patients had a baseline Hb level < 9.0 g/dl . The overall Hb level after therapy was 11.0 g/dl ( ±0.5 , range 10.0–12.6 g/dl ) . Mean duration of therapy was 3.5 weeks ( 7 infusions ) . Conclusion : This study shows an effective treatment regimen for patients with various degrees of anemia in pregnancy . Iron sucrose is a safe and effective treatment option . In cases of severe iron deficiency anemia or poor response to parenteral iron therapy additional administration of rhEPO might be considered . However , the mechanism for not responding to  intravenous iron therapy despite iron deficiency anemia still remains unclear to a large extent OBJECTIVE : The aim of this study was to compare the efficacy of intravenous iron to oral iron in the treatment of anemia in pregnancy . METHODS : In this r and omized open-label study , 90 women with hemoglobin levels between 8 and 10.5 g/dL and ferritin values less than 13 & mgr;g/L received either oral iron polymaltose complex ( 300 mg elemental iron per day ) or intravenous iron sucrose . The iron sucrose dose was calculated from the following formula : weight before pregnancy ( kg ) × ( 110 g/L – actual hemoglobin [ g/L ] ) × 0.24 + 500 mg . Treatment efficacy was assessed by measuring hemoglobin and ferritin on the 14th and 28th days and at delivery , and the hemoglobin on the first postpartum day . Adverse drug reactions , fetal weight , hospitalization time , and blood transfusions were also recorded . RESULTS : Hemoglobin values varied significantly with time between groups ( interaction effect , P < .001 ) . The change in hemoglobin from baseline was significantly higher in the intravenous group than the oral group at each measurement ; the changes with respect to subsequent hemoglobin were significantly higher on the 14th ( P = .004 ) and 28th ( P = .031 ) days . Ferritin values were higher in patients receiving intravenous iron throughout pregnancy . No serious adverse drug reactions were observed . Fetal weight and hospitalization time were similar in the 2 groups . Blood transfusion was required for only one patient in the oral group . CONCLUSION : Intravenous iron treated iron-deficiency anemia of pregnancy and restored iron stores faster and more effectively than oral iron , with no serious adverse reactions . LEVEL OF EVIDENCE : OBJECTIVE ( 1 ) To determine an alternative iron supplementation with better efficacy , compliance & safety in treatment of iron deficiency anemia during pregnancy , ( 2 ) to reduce blood transfusion during pregnancy , labor and puerperium . MATERIAL AND METHOD A prospect i ve comparative study . A total number of 60 pregnant women with the gestational age of 12 - 34 weeks were included in the study who were suffering from iron deficiency anemia . They were divided in 3 groups ( A , B and C ) . Group A ( n = 15 ) received intravenous iron sucrose according to recommended dose containing 500 mg of iron sucrose for storage , in group B ( n = 20 ) iron sucrose was administered according to deficit calculated as per formula but 200 mg of iron was given for storage instead of 500 mg , to reduce cost . While group C received intra muscular iron Sorbitol in the dose used as practice . RESULTS Mean hemoglobin in group A and B was 8.0 + /- 1.1 g/dl and 8.9 + /- 0.7 respectively , in group C , it was 8.8 + /- 0.9 g/dl . In group A & B initial hemoglobin was assessed 3 weeks post therapy which showed an average rise of 2.8 g/dl ( group A ) and 1.9 g/dl ( group B ) and second assessment of Hemoglobin was done prior to delivery ( ave : 6.6 weeks ) showed a total rise of 3.8 g/dl ( group A ) and 2.4 g/dl ( group B ) . Pre delivery mean Hemoglobin in group A and B was 11.8 g/dl and 11.3 g/dl respectively . In group C , the Hemoglobin was assessed only prior to delivery ( average : 8.4 weeks from the start of therapy ) , and a rise of 1.4 g/dl was observed with pre delivery mean Hemoglobin of 10.2 g/dl . Target hemoglobin levels i.e. 11 g/dl was achieved by 80 % in Group A , 70 % in Group B and 28 % in Group C by the time of delivery . Blood transfusion was not required in any group . In group A and B one patient had moderate abdominal pain , 2 had weakness and shivering and 3 had phlebitis at the site where intravenous canula was retained . None of patient discontinued the therapy due to any adverse effect . In group C majority complained of pain at injection site while 5 patients dropped out from the study due to intolerance . CONCLUSION Intravenous iron therapy is safe , convenient and more effective then intramuscular iron therapy in treatment of iron deficiency anemia during pregnancy . The intravenous iron therapy can replace blood transfusion in antenatal period BACKGROUND Daily oral iron supplementation during pregnancy fails to reduce the prevalence of anemia . However , 2 or 3 intramuscular doses of iron given at monthly intervals were recently found to be effective . OBJECTIVE We compared the safety and efficacy in treating pregnancy anemia of 3 intramuscular doses of iron given at monthly intervals with those of daily oral iron supplementation . DESIGN In a prospect i ve , partially r and omized study , 148 pregnant women received daily oral doses of 100 mg elemental Fe and 500 micro g folic acid , and 106 pregnant women received 3 intramuscular doses of 250 mg elemental Fe as iron dextran at 1-mo intervals and oral doses of 5 mg folic acid twice weekly .  One hundred women in each group completed the study .  Changes in hemoglobin , iron indicators , pregnancy outcomes , and birth weight were compared between the 2 groups . RESULTS Hemoglobin and iron indicators improved significantly with both treatments . The increase in serum ferritin concentration after parenteral iron treatment was significantly higher than that after oral iron treatment . No significant differences between the 2 groups in pregnancy outcomes and birth weight were observed . Systemic side effects were more common in the parenteral iron group , whereas gastrointestinal side effects were more common in the oral iron group . CONCLUSIONS The intramuscular administration of 3 doses of 250 mg Fe at monthly intervals appears to have good compliance and efficacy and may be used in women who can not tolerate oral administration of iron . However , intramuscular administration of iron is appropriate only in hospital setting s well equipped to treat anaphylactic crises The effect of daily rather than weekly iron supplementation was compared in women who were 8 - 24 wk pregnant . One group ( n = 68 ) received 60 mg Fe/d , the second group ( n = 71 ) received 120 mg Fe/wk , given at once . Supplementation lasted 11.3 wk on average , depending on gestational date at entry , and was not supervised . Hemoglobin increased in both groups ( P < 0.001 ) ; serum ferritin did not change significantly . There was no significant difference between groups for changes in hemoglobin and serum ferritin . In a subgroup of women with a hemoglobin concentration < 110 g/L at baseline ( n = 45 daily ; n = 54 weekly ) no significant within-group changes occurred in serum ferritin , but the change in the daily group was 4.1 micrograms/L higher than in the weekly group ( P = 0.049 ) . Compliance , as indicated by two positive stool tests , was approximately equal to 54.3 % in the daily group and 62.2 % in the weekly group . We conclude that for the complete sample of subjects , the treatment effect of daily compared with weekly supplementation was similar under conditions resembling a normal antenatal care program In rural China , many pregnant women in their third trimester suffer from anemia ( 48 % ) and iron deficiency ( ID ; 42 % ) , often with coexisting deficiencies of retinol and riboflavin . We investigated the effect of retinol and riboflavin supplementation in addition to iron plus folic acid on anemia and subjective well-being in pregnant women . The study was a 2-mo , double-blind , r and omized trial . Subjects ( n = 366 ) with anemia [ hemoglobin ( Hb ) < /= 105 g/L ] were r and omly assigned to 4 groups , all receiving 60 mg/d iron and 400 mug/d folic acid . The iron+folic acid ( IF ) group ( n = 93 ) served as reference , the iron+folic acid+retinol group ( IFA ) ( n = 91 ) was treated with 2000 mug retinol , the iron+folic acid+riboflavin group ( IFB ) ( n = 91 ) with 1.0 mg riboflavin , and the iron+folic acid+retinol+riboflavin group ( IFAB ) ( n = 91 ) with retinol and riboflavin . After the 2-mo intervention , the Hb concentration increased in all 4 groups ( P < 0.001 ) . The increase in the IFAB group was 5.4 + /- 1.1 g/L greater than in the IF group ( P < 0.001 ) . The reduced prevalence of anemia ( Hb < 110g/L ) and ID anemia were significantly greater in the groups supplemented with retinol and /or riboflavin than in the IF group . Moreover , gastrointestinal symptoms were less prevalent in the IFA group than in the IF group ( P < 0.05 ) and improved well-being was more prevalent in the groups receiving additional retinol and /or riboflavin than in the IF group ( P < 0.05 ) . Thus , a combination of iron , folic acid , retinol , and riboflavin was more effective than iron plus folic acid alone . Multimicronutrient supplementation may be worthwhile for pregnant women in rural China In the context of limited effectiveness of iron supplementation programs , intermittent iron supplementation is currently under debate as a possible alternative strategy that may enhance the effectiveness of operational programs . This field-based trial assessed the outcome of twice weekly iron supplementation compared to daily in Pakistan . A double-blind , r and omized , clinical trial was conducted in Northern Pakistan . Anemic pregnant women ( n = 191 ) were assigned to receive daily ( 200 mg ferrous sulfate ) or twice weekly ( 2 x 200 mg ferrous sulfate ) iron supplementation .  Hemoglobin was measured at baseline and at 4-wk intervals for up to 12 wk . Serum ferritin was measured at baseline and 8 or 12 wk . Analysis was by intention to treat . The two groups did not differ in age , parity , sociodemographic characteristics , hemoglobin or serum ferritin concentrations at baseline . Women who received iron daily had a greater rise in hemoglobin compared with women who received iron twice weekly ( 17.8 + /- 1.8 vs. 3.8 + /- 1.2 g/L , P < 0.001 ) . The serum ferritin concentrations increased by 17.7 + /- 3.9 microgram/L ( P < 0.001 ) in the daily supplemented group and did not change in the twice weekly group . Daily iron supplementation remained superior to twice weekly supplementation after controlling initial hemoglobin Z-scores and duration of treatment . The body mass index ( BMI ) modified the effect of daily versus twice weekly iron supplementation . For every unit increase in BMI , the difference between the two treatment groups was reduced by 0.0014 ( final hemoglobin Z-score ; P = 0.027 ) . We recommend continuation of daily iron supplementation as opposed to intermittent iron supplementation in pregnant women in developing countries BACKGROUND 
    Output:
    