Displaying publications 301 - 320 of 485 in total

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  1. Iron status of pregnant Indian women from an area of active iron supplementation
    Menon KC, Ferguson EL, Thomson CD, Gray AR, Zodpey S, Saraf A, et al.
    Nutrition, 2014 Mar;30(3):291-6.
    PMID: 24484679 DOI: 10.1016/j.nut.2013.08.015
    The aim of this study was to investigate the iron status of pregnant tribal women from Ramtek, Nagpur, Maharashtra, India using a combination of indices.
    Matched MeSH terms: Anemia, Iron-Deficiency/blood; Anemia, Iron-Deficiency/epidemiology*
  2. Carbamoylphosphate synthetase 1 (CPS1) deficiency: clinical, biochemical, and molecular characterization in Malaysian patients
    Ali EZ, Khalid MK, Yunus ZM, Yakob Y, Chin CB, Abd Latif K, et al.
    Eur J Pediatr, 2016 Mar;175(3):339-46.
    PMID: 26440671 DOI: 10.1007/s00431-015-2644-z
    Carbamoyl phosphate synthetase 1 (CPS1) deficiency is a rare autosomal recessive disorder of ureagenesis presenting as life-threatening hyperammonemia. In this study, we present the main clinical features and biochemical and molecular data of six Malaysian patients with CPS1 deficiency. All the patients have neonatal-onset symptoms, initially diagnosed as infections before hyperammonemia was recognized. They have typical biochemical findings of hyperglutaminemia, hypocitrullinemia, and low to normal urinary excretion of orotate. One neonate succumbed to the first hyperammonemic decompensation. Five neonatal survivors received long-term treatment consisting of dietary protein restriction and ammonia-scavenging drugs. They have delayed neurocognitive development of varying severity. Genetic analysis revealed eight mutations in CPS1 gene, five of which were not previously reported. Five mutations were missense changes while another three were predicted to create premature stop codons. In silico analyses showed that these new mutations affected different CPS1 enzyme domains and were predicted to interrupt interactions at enzyme active sites, disturb local enzyme conformation, and destabilize assembly of intact enzyme complex.

    CONCLUSION: All mutations are private except one mutation; p.Ile1254Phe was found in three unrelated families. Identification of a recurrent p.Ile1254Phe mutation suggests the presence of a common and unique mutation in our population. Our study also expands the mutational spectrum of the CPS1 gene.

    Matched MeSH terms: Carbamoyl-Phosphate Synthase I Deficiency Disease/diagnosis*; Carbamoyl-Phosphate Synthase I Deficiency Disease/genetics
  3. Fulltext Recurrent Intestinal Obstruction in a Patient with Selective IgA Deficiency
    Hui CK
    Malays J Med Sci, 2016 Nov;23(6):123-127.
    PMID: 28090187 DOI: 10.21315/mjms2016.23.6.14
    A 32 year old woman presented with acute onset of abdominal pain and fever. An urgent computerised tomography (CT) of the whole abdomen showed dilated loop at the terminal ileum in the right lower abdomen with thickening of the wall and oedema. The CT was suggestive of distal small bowel obstruction at the ileum with surrounding wall oedema. Multiple biopsies taken from the terminal ileum and colon on colonoscopy were all unremarkable. She represented one-year later with a recurrence of intestinal obstruction. CT enteroclysis showed collapse at the distal 3 cm segment of the terminal ileum. There was no associated wall thickening, active inflammatory changes or ileitis. This was suspicious of post-inflammatory change or fibrosis. She was subsequently found to have selective IgA deficiency with recurrent infection in the terminal ileum resulting in intestinal obstruction. In conclusion, selective IgA deficiency should be considered in patients with recurrent intestinal obstruction without anatomical obstructions.
    Matched MeSH terms: IgA Deficiency
  4. Some observations on vitamin A starvation among immigrant Indians in Malaysia
    Field JW
    Malayan Medical Journal, 1931;6:46-53.
    Matched MeSH terms: Vitamin A Deficiency
  5. Improvement in the diagnostics of iron deficiency anemia using multiple marker combinations
    Yang ES, Kim YS, Park CY, Kim JD, Song HJ
    Sains Malaysiana, 2015;44:1653-1659.
    Anemia of chronic disease (ACD) frequently occurred in patients with chronic inflammatory diseases and can be treated
    by treating the underlying disease. On the other hand, iron-deficiency anemia (IDA), the most common type of anemia,
    occurred with iron loss or when the iron requirement of the body was increased. Since the treatment methods for ACD
    and IDA differ, it is important to clinically distinguish between the two types of anemia. In this study, we investigated and
    evaluated the performance of a number of biomarkers, including ferritin, soluble transferrin receptor (sTfR), hepcidin,
    C-reactive protein (CRP) and combination markers containing ferritin for the diagnosis of IDA using serum samples from
    Korean patients (80 ACD and 48 IDA Korean patients). Among the single markers, ferritin exhibited the best performance
    with 98.58% AUC and 97.50% sensitivity. In this study, a combination of two biomarkers was used to differentially
    diagnose IDA and ACD. Among the combination markers, ferritin + sTfR showed the best performance with 99.51% AUC
    and 98.75% sensitivity. We found that the ferritin + sTfR combination showed the best diagnostic performance with
    1.25% higher SN than ferritin alone. Moreover, it also showed 10% better diagnostic performance than the single ferritin
    marker within the data range where the distinction between ACD and IDA is unclear. We propose that using combination
    markers containing ferritin may diagnose IDA more accurately and facilitate the determination of the appropriate anemia
    treatment to expedite patient recovery.
    Matched MeSH terms: Anemia, Iron-Deficiency
  6. Fulltext Correlation between Soil-Transmitted Helminths Infection and Serum Iron Level among Primary School Children in Medan
    Arrasyid NK, Sinambela MN, Tala ZZ, Darlan DM, Warli SM
    Open Access Maced J Med Sci, 2017 Apr 15;5(2):117-120.
    PMID: 28507613 DOI: 10.3889/oamjms.2017.016
    BACKGROUND: The latest estimates indicate that more than 2 billion people worldwide are infected by Soil-Transmitted Helminths (STH). The burden of STH infection is mainly attributed to the chronic effect on health and quality of life of those infected. It is also contributed to micronutrient deficiencies such as iron-deficiency anaemia. The prevalence of worm infection in Public Primary School students in Medan was quite high (40.3%), and 33.3% was anaemic in the latest study.

    AIM: To determine the correlation between STH infection with serum iron (SI) level on primary school children, as well as to determine the prevalence of SI level and worm infection, and the type of worm that infects the most of them.

    METHODS: This study was conducted in the cross-sectional method. Consecutive sampling technique was used and a total of 132 students age 8-12 years old were included. The study took places in Public Primary School 060925 Amplas, Medan and 101747 Hamparan Perak, Deli Serdang throughout May-October 2016. Fisher Exact test was used to analyse the correlation between STH infection and SI level.

    RESULTS: The prevalence of STH infection was 7.6%, and low SI was 11.4%.

    CONCLUSION: There was no significant correlation between STH infection and SI level (P = 0.317). The prevalence of low SI level was not significantly dependent on STH infection (RP = 1.877, 95% CI = 0.481-7.181).

    Matched MeSH terms: Anemia, Iron-Deficiency
  7. Fulltext Prevalence of Vitamin B12 Deficiency and its Associated Factors among Patients with Type 2 Diabetes Mellitus on Metformin from a District in Malaysia
    Krishnan GD, Zakaria MH, Yahaya N
    J ASEAN Fed Endocr Soc, 2020;35(2):163-168.
    PMID: 33442187 DOI: 10.15605/jafes.035.02.03
    Introduction: Vitamin B12 deficiency is more common among metformin-treated subjects although the prevalence is variable. Many factors have been associated with this. The aim of this study is to determine the prevalence of vitamin B12 deficiency and its associated factors among patients with type 2 diabetes mellitus (DM) who are on metformin.

    Methodology: A total of 205 patients who fit eligibility criteria were included in the study. A questionnaire was completed, and blood was drawn to study vitamin B12 levels. Vitamin B12 deficiency was defined as serum B12 level of ≤300 pg/mL (221 pmol/L).

    Results: The prevalence of vitamin B12 deficiency among metformin-treated patients with type 2 DM patients was 28.3% (n=58). The median vitamin B12 level was 419 (±257) pg/mL. The non-Malay population was at a higher risk for metformin-associated vitamin B12 deficiency [adjusted odds ratio (OR) 3.86, 95% CI: 1.836 to 8.104, p<0.001]. Duration of metformin use of more than five years showed increased risk for metformin-associated vitamin B12 deficiency (adjusted OR 2.06, 95% CI: 1.003 to 4.227, p=0.049).

    Conclusion: Our study suggests that the prevalence of vitamin B12 deficiency among patients with type 2 diabetes mellitus on metformin in our population is substantial. This is more frequent among the non-Malay population and those who have been on metformin for more than five years.

    Matched MeSH terms: Vitamin B 12 Deficiency
  8. Fulltext The Perilous PPI: Proton Pump Inhibitor as a Cause of Clinically Significant Hypomagnesaemia
    Tai YT, Tong CV
    J ASEAN Fed Endocr Soc, 2020;35(1):109-113.
    PMID: 33442177 DOI: 10.15605/jafes.035.01.18
    Proton pump inhibitors (PPIs) are the mainstay of therapy for all gastric acid related diseases and are commonly used in current clinical practice. Although widely regarded as safe, PPIs have been associated with a variety of adverse effects, including hypomagnesaemia. The postulated mechanism of PPI-related hypomagnesaemia involves inhibition of intestinal magnesium absorption via transient receptor potential melastin (TRPM) 6 and 7 cation channels. PPIinduced hypomagnesaemia (PPIH) has become a well recognized phenomenon since it was first reported in 2006. Clinical concerns arise from growing number of case reports presenting PPIH as a consequence of long-term PPI use, with more than 30 cases published to date. In this article, we report 2 cases of PPIH associated with the use of pantoprazole. Both patients presented with severe hypomagnesaemia and hypocalcaemia. One of them had associated hypokalemia and cardiac arrhythmia. A casual relation with PPIs postulated and supported by resolution of electrolyte abnormalities after discontinuation of PPIs.
    Matched MeSH terms: Magnesium Deficiency
  9. Fulltext Debilitating Pain and Fractures: a Rare Case of Hypophosphatemic Osteomalacia with Concomitant Vitamin D Deficiency in Neurofibromatosis Type 1
    Nagaratnam S, Karupiah M, Mustafa N
    J ASEAN Fed Endocr Soc, 2020;35(1):105-108.
    PMID: 33442176 DOI: 10.15605/jafes.035.01.17
    Hypophosphatemic osteomalacia is a rare form of metabolic bone disorder in neurofibromatosis type 1 (NF1). The exact disease mechanism of this disorder in NF1 is yet to be established. We present a 44-year-old female known to have NF1, who presents with debilitating bone pain, weakness and multiple fractures. Laboratory investigations showed persistent hypophosphatemia with renal phosphate wasting suggestive of hypophosphatemic osteomalacia. She also had concomitant vitamin D deficiency which contributed to the disease severity. Medical therapy with oral phosphate and vitamin D improved her symptoms without significant changes in fracture healing or phosphate levels.
    Matched MeSH terms: Vitamin D Deficiency
  10. Factor V inhibitor in neonatal intracranial hemorrhage secondary to severe congenital factor V deficiency
    Lee WS, Chong LA, Begum S, Abdullah WA, Koh MT, Lim EJ
    J Pediatr Hematol Oncol, 2001 May;23(4):244-6.
    PMID: 11846304
    We report a newborn infant girl, born to consanguineous parents, with recurrent intracranial hemorrhage secondary to congenital factor V deficiency with factor V inhibitor. Repeated transfusions of fresh-frozen plasma (FFP) and platelet concentrates, administrations of immunosuppressive therapy (prednisolone and cyclophosphamide), and intravenous immunoglobulin failed to normalize the coagulation profiles. Exchange transfusion followed-up by administrations of activated prothrombin complex and transfusions of FFP and platelet concentrates caused a temporary normalization of coagulation profile, enabling an insertion of ventriculoperitoneal (VP) shunt for progressive hydrocephalus. The treatment was complicated by thrombosis of left brachial artery and ischemia of left middle finger. The child finally died from another episode of intracranial hemorrhage 10 days after insertion of the VP shunt.
    Matched MeSH terms: Factor V Deficiency/complications*; Factor V Deficiency/immunology; Factor V Deficiency/therapy
  11. Fulltext Interaction between vitamin E and glutathione in rat brain: Effect of chronic ethanol administration
    Marcus SR, Chandrakala MV, Nadiger HA
    Asia Pac J Clin Nutr, 1998 Dec;7(3/4):201-5.
    PMID: 24393672
    The protection against ethanol-induced lipid peroxidation is rendered by antioxidants such as vitamin E and glutathione (GSH) interacting with each other and also functioning independently. A study of the levels of GSH and activities of glutathione peroxidase (GP), glutathione reductase (GR) and glutathione transferase (GST) in the cerebral cortex (CC), cerebellum (CB) and brain stem (BS) of vitamin E-supplemented and -deficient rats subjected to ethanol administration for 30 days was carried out. Chronic ethanol administration to vitamin E-supplemented rats elevated GP, GR and GST activities in the three regions and GSH levels in the CB. Chronic ethanol administration to vitamin E-deficient rats elevated GR activity in the three regions and GP activity in the CC and CB, decreased GST activity in the CC and CB, but did not alter GSH levels compared with normal rats subjected to chronic ethanol administration. The results indicate that vitamin E helps to maintain GSH levels to combat increased peroxidation while its absence has a deleterious effect.
    Matched MeSH terms: Vitamin E Deficiency
  12. Fulltext Risk factors for antenatal hypovitaminosis D in an urban district in Malaysia
    Bukhary NBI, Isa ZM, Shamsuddin K, Lin KG, Mahdy ZA, Hassan H, et al.
    BMC Pregnancy Childbirth, 2016 07 13;16(1):156.
    PMID: 27411716 DOI: 10.1186/s12884-016-0939-3
    BACKGROUND: Pregnant women form one of the high risk groups facing hypovitaminosis D. Low level of vitamin D will affect directly or indirectly both mother and fetus. Screening vitamin D in the first trimester of pregnancy is important to determine the necessary preventive action. Therefore, this study was aimed to determine the prevalence of hypovitaminosis D and its risk factors among pregnant women in the first trimester.

    METHODS: A cross sectional study was carried out among first trimester pregnant women during their first antenatal visit. Samples were taken from different ethnicities in an urban district in Malaysia. A total of 396 respondents (99 % response rate) aged 18-40 years completed self-administered and guided questionnaire (characteristics and risk factors), validated semi-quantitative food frequency questionnaire for vitamin D in Malaysia (FFQ vitamin D/My), anthropometric measures (weight and height), blood test for serum 25(OH)D, skin measurement using Mexameter (MX 18) and Fitzpatrick Skin Type Chart Measurement (FSTCM). Data were analyzed to determine the association between risk factors and hypovitaminosis D.

    RESULTS: The prevalence of hypovitaminosis D (serum 25(OH)D 

    Matched MeSH terms: Vitamin D Deficiency/ethnology; Vitamin D Deficiency/etiology*; Vitamin D Deficiency/epidemiology
  13. Fulltext Iron intake and iron deficiency anaemia among young women in Kuala Lumpur
    Loh, S. P., Khor, G. L.
    Malaysian Journal of Medicine and Health Sciences, 2010;6(1):63-70.
    MyJurnal
    Objective: To assess the prevalence of iron deficiency, anaemia and iron deficiency anaemia (IDA) in women aged 20-40 years and its association with iron intake. Methods: A total of 388 women were recruited from universities and work sites in Kuala Lumpur and its suburbs. The subjects comprised 135 Malays, 130 Chinese and 123 Indians. Dietary intake was estimated using a single 24-hour food recall and a semi-quantitative food frequency questionnaire. Haemoglobin (Hb), haematocrit (hct), mean corpuscular volume (MCV) and serum ferritin were determined. Results: The prevalence of anaemia (Hb
    Matched MeSH terms: Anemia, Iron-Deficiency
  14. Nutritional status of children in Malaysia : persistence of old problems
    Khor, Geok Lin
    Malaysian Journal of Child Health, 1997;9(2):133-150.
    MyJurnal
    Serious protein-energy malnutrition and severe nutrient deficiencies affected children in poor rural communities and estates during the first half of the century until the 1960s or so. Since then, the nutritional status of children in Malaysia in general has imporved amidst active socioeconomic development and various intervention programmes that have been implemented. Nevertheless, results from studies undertaken in the 1990s indicate that certain old nutrition problems in children still persist. These include protein-energy malnutrition in the forms of underweight, stunting and wasting, as well as iron deficiency anaemia, worm infestation and iodine deficiency disorders. Meanwhile, there is an increase in the prevalence of overweight among urban children. This review discusses the prevalence of these issues in rural communities, estates, Orang Asli, and communities in Sarawak and Sabah.
    Matched MeSH terms: Anemia, Iron-Deficiency
  15. Severe iron deficiency anaemia in prolonged exclusively breast and cow's milk-fed infants
    Haifa Abdul Latiff, Mohd Nasir Hassan, Mohd Sham Kasim
    Malaysian Journal of Child Health, 1994;6(1):49-51.
    MyJurnal
    We report here a case of severe iron deficiency anaemia resulting from prolonged exclusive milk diet without any iron supplementation. The patient was a 1112 year old boy, the only child of a factory worker, who was breasffed until 4 months of age followed by exclusive feeding by non-fortifiedformula. He presented with severe iron deficiency anaemia with haemoglobin of4 .0g% and required blood trans-fusion. Iron and.vitamin supplements were given and cereals were slowly introduced. He responded very well to the treatment with satis-factory weight gain and improvement of anaemia. (Copied from article).
    Matched MeSH terms: Anemia, Iron-Deficiency
  16. Genetic variation in the glucose-6-phosphate dehydrogenase gene in Kelantan Malays with neonatal jaundice
    Mohd Yusoff, N., Choo, K.E., Ghazali, S., Ibrahim, I., Mohd Hussin, Z.A., Mohd Yunus, et al.
    Malaysian Journal of Paediatrics and Child Health, 2000;12(1):11-15.
    MyJurnal
    Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked red blood cell enzymopathy common in malaria endemic areas. Individuals affected by this disease show a wide variety of clinical signs including neonatal jaundice. In this preliminary report we describe the heterogeneity of G6PD deficient gene in neonatal jaundice in the Malay population in Kelantan. Thirteen G6PD deficient Malay neonates with hyperbilirubinemia were subjected to mutation analysis of the G6PD gene for known candidate mutations. Molecular defects were identified in the 13 patients studied. Though all of these were mis-sense mutations, identified nucleotide changes were heterogeneous. Six patients were found to have a C to T nucleotide change at nucleotide 563 of the G6PD gene (C563T), corresponding to G6PD Mediterranean; three cases had a single nucleotide change at T383C (G6PD Vanua Lava), two cases had G487A (G6PD Mahidol) and two cases had G1376T (G6PD Canton). These findings suggest that there are heterogeneous mutations of the G6PD gene associated with neonatal jaundice in the Malay population in Kelantan.
    Matched MeSH terms: Glucosephosphate Dehydrogenase Deficiency
  17. Fulltext Detection of partial G6PD deficiency using OSMMR2000-D Kit with Hb normalization
    Azma, R.Z., Siti Zubaidah, M., Azlin, I., Hafiza, A., Nurasyikin, Y., Nor Hidayati, S., et al.
    Medicine & Health, 2014;9(1):11-21.
    MyJurnal
    Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme deficiency worldwide including Malaysia. Screening of cord blood for partial G6PD deficiency is important as they are also prone to develop acute haemolysis. In this study, we determined the prevalence of partial G6PD deficient in paediatric population aged 1 month-12 years and normal term female neonates using OSMMR-D kit with haemoglobin (Hb) normalization and compare it with florescence spot test (FST). A total of 236 children, aged between between 1 month-12 years and 614 normal term female neonates were recruited for this study. Determination of normal means for G6PD activity and; cut-off points for partial and severe deficiency were determined according to WHO Working Group (1989). Determination of prevalence for partial deficiency for both groups (female patient) was done using this enzyme assay kit and findings were compared with FST. In this study, 15.7% (18/115) female children were classified as partial G6PD deficient by quantitative enzyme method (G6PD activity: 4.23-5.26U/gHb). However, FST only detected 0.9% (1/115) with minimal G6PD activity. The prevalence of partial G6PD deficiency in female neonate group was 3.42% (21/614) by enzyme assay versus 0.49% (3/614) by FST. This study concluded that our routine screening method using FST was unable to diagnose female heterozygotes. We recommend using this quantitative enzyme assay method by OSMMR-D kit since it was more sensitive in detecting G6PD deficiency in female neonates compared to FST.
    Matched MeSH terms: Glucosephosphate Dehydrogenase Deficiency
  18. Fulltext Primary hyperparathyroidism with vitamin D deficiency in third trimester of pregnancy
    Tong, Chin Voon, Mohamad Rafie Md Kaslan
    International e-Journal of Science, Medicine & Education, 2015;9(3):47-51.
    MyJurnal
    In pregnancy, the diagnosis of primary hyperparathyroidism (PHP) may be delayed due to physiological changes that occur during this period. The maternal related complications of PHP during pregnancy has been reported to be as high as 67%, whilst fetal complications up to 80% of cases.1 The therapeutic gold standard and definitive treatment for PHP in pregnancy is minimally invasive parathyroidectomy in the second trimester. We report a case of a 22-year old primidgravida who underwent parathyroidectomy in the third trimester of her pregnancy for PHP with persistent hypercalcemia. She was also found to have Vitamin D deficiency which probably led to secondary hyperparathyroidism and made her hypercalcemia more apparent during pregnancy
    Matched MeSH terms: Vitamin D Deficiency
  19. Fulltext Congenital renal anomalies - a dissection observational study
    Bilodi, Arun Kumar .S, Gangadhar, M R
    Malaysian Journal of Medical Research, 2017;1(1):14-18.
    MyJurnal
    Anomaly is a congenital disorder. It is a medical condition that is present since birth. But the word congenital neither applies nor excludes genetic disorder. Congenital anomalies due to environmental factors are called as Teratogens. Infections, deficiency in the diet and toxins are environmental causes. Maternal folic acid deficiency may cause spina bifida. Intake of alcohol, and certain prescribed drugs like phenytoin may cause congenital anomalies or defects. Apart from physical anomalies, other types of congenital disorders are inborn errors of metabolism (Kumar, Abbas and Fausto, 2005). About 15% to 25% of anomalies are due to chromosomal factors or single gene factors, 8% to 12% anomalies are said to be due to environmental factors, 25% are said to be due to multifactorial inheritance 40% to 60% of anomalies are of unknown origin (Stevenson, 1993 ; Nelson and Holmes, 1984). Congenital anomalies are present since birth with structural deformity found immediately after birth or their presence may be detected by signs and symptoms later on (Holland and Brew, 1991). Congenital Anomalies are seen in 2% of population as major abnormality. There are two types of abnormalities, namely malformations where growth disturbances occur during embryogenesis and the other is deformation. It is late change that appears in a structure which was normal earlier (Roizen and Patterson, 2003).
    Matched MeSH terms: Folic Acid Deficiency
  20. Fulltext Effectiveness of iron polymaltose complex in treatment and prevention of iron deficiency anemia in children: a systematic review and meta-analysis
    Mohd Rosli RR, Norhayati MN, Ismail SB
    PeerJ, 2021;9:e10527.
    PMID: 33520436 DOI: 10.7717/peerj.10527
    Background: Iron deficiency anemia (IDA) is commonly treated with iron formulations. Despite the expanding acceptance of iron polymaltose complex (IPC) among clinicians, there is sparse and contradictory evidence regarding its efficacy in the management of IDA in children. This systematic review and meta-analysis aimed to assess the effectiveness of IPC in the treatment and prevention of IDA in children.

    Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE and Epistemonikos for all randomized control trials (RCTs) comparing oral IPC with standard oral iron supplementation for the treatment or prevention of IDA in children. We independently screened the titles and abstracts of identified trials before the full text of relevant trials was evaluated for eligibility. We then independently extracted data on the methods, interventions, outcomes, and risk of bias from the included trials. A random-effects model was used to estimate the risk ratios and mean differences with 95% confidence intervals.

    Results: Eight trials comprising 493 randomized patients were included and analyzed using three comparison groups. The comparison group of which was used to evaluate IPC and ferrous sulphate (FS) for treatment of IDA showed that IPC is less effective in increasing Hb (MD -0.81, 95% CI -1.08 to -0.53; I2 = 48%, P 

    Matched MeSH terms: Anemia, Iron-Deficiency
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