Anemia Of Inflammation Research Articles

Association between inflammatory markers and anemia in patients with diabetic foot ulcer.

Aim: Anemia of inflammation (AI) is common among patients with diabetic foot ulcers (DFU). This study aimed to investigate the specific relationship between inflammation indicators and anemia in patients with DFU.Materials & methods: This cross-sectional study was carried out among patients with DFU between 2018 and 2023. Clinical data were gathered before treatment. Restricted cubic spline regression was employed to investigate the non-linear associations between inflammation and anemia.Results: A total of 395 patients with Wagner grades 2-4 were enrolled in the study. About 63.54% of the patients with DFU had anemia which was primarily presented with normocytic hypopigmentation anemia. Elevated IL-6 levels (39.10-369pg/ml) were significantly associated with an increased likelihood of anemia (OR=4.84; 95% CI: 1.97-11.90). Similarly, high CRP levels (48.56-385mg/l) were linked to a higher prevalence of anemia (OR=5.01; 95% CI: 2.35-10.68). Furthermore, a nonlinear relationship was observed between CRP levels and anemia, suggesting that CRP values exceeding 53.889mg/l may trigger anemia in patients with diabetic foot ulcers.Conclusion: Inflammation is identified as an independent risk factor for AI in patients with DFU. The inflammation indicators (CRP and IL-6) and anemia exhibit an L-shaped nonlinear correlation in patients with DFU.

Using RET-He and Delta-He in the Sysmex XN-1000V Analyzer to Differentiate Between Chronic Hemorrhagic and Chronic Inflammatory Anemia in Small Animals

Chronic hemorrhagic anemia (CHA) and anemia of chronic inflammation (ACI) are difficult to differentiate in small animals using hematology. Advanced hematological parameters (RET-He, Delta-He and %Hypo-He) are used in humans to discriminate between types of non-regenerative anemia. Whether they could be useful in the diagnosis of CHA and ACI in small animals is unknown. We evaluated these parameters in the Sysmex XN-1000V analyzer in a population of non-anemic and anemic dogs and cats. Delta-He was significantly different between dogs with CHA and ACI. Moreover, Delta-He and RET-He were different between healthy and non-anemic dogs with inflammation. Neither of these two statements was true for cats. We also report the reference ranges for these parameters using the Sysmex XN-1000V. Although additional clinical and laboratory information should always be considered, the measurement of these parameters using this analyzer can help clinicians to classify type of anemia.

Systematic Review of Associations between Anxiety, Depression, and Functional/Biological aging among Cancer Survivors.

Evidence suggests a mind-body component to aging, through which psychological distress from anxiety and depression drives molecular changes that promote early decline (ie, accelerated aging). Cancer survivors experience particularly high rates of anxiety and depression. Some survivors also have accelerated aging, though the relationships between anxiety/depression and aging are not clear. A synthesis of evidence is needed to understand the state of the science and impending priorities. PubMed, Embase, CINAHL, Web of Science, and PsycNet databases were searched for studies that measured associations between depression, anxiety, and non-chronological aging in cancer survivors (2012 to 2022). Data were methodologically evaluated. Survivorship studies were included if they were peer-reviewed, published in English from 2012-2022, and measured associations between anxiety/depression and aging. 51 studies were included. Just over half were cross-sectional (53%). Foci included functional (n = 35, 69%) and biological (n = 16, 31%). Functional aging measures included frailty, sarcopenia, geriatric assessment, and cognition. Biological aging measures included telomere length, telomerase, age-related inflammatory blood-based biomarkers, renal insufficiency, anemia, and DNA methylation. 223 associations were tested. Associations between anxiety, depression and aging were generally positive, though with varying strengths. Most compelling were associations between functional aging-depression. There were concerns for selection and measurement biases. Findings suggest positive associations between anxiety, depression and aging among cancer survivors. Future work is needed to clarify temporality, develop a consensus on the operationalization of aging, and diversify cohorts.

Special considerations for hidradenitis suppurativa in skin of colour: A review of literature

AbstractHidradenitis suppurativa, a chronic inflammatory skin condition, disproportionately affects individuals with skin of colour (SOC), particularly African Americans. Despite the increased prevalence in SOC, racial minorities are underrepresented in HS clinical trials, limiting our understanding of treatment efficacy. The purpose of this narrative review is to discuss the current literature regarding the clinical presentation, comorbidities, and management of HS in SOC individuals. A PubMed search was conducted using the terms Hidradenitis suppurativa, comorbidities, skin of colour, African–American, Hispanic, and quality of life with relevant studies written in English and pertaining to the demographics and clinical trials were included. African American patients with HS tend to experience more severe disease manifestations, higher rates of comorbidities like inflammatory bowel disease and anaemia, increased healthcare utilisation, and a greater likelihood of surgical interventions. While the current literature provides extensive information about African Americans regarding comorbidities and disease prevalence, there is a lack of research on Hispanic and other ethnic groups. For future research, it is important to broaden our focus to include various ethnic groups. Addressing these disparities requires focused interventions, inclusive clinical research initiatives, and healthcare policies tailored to the specific needs of patients with skin of colour.

Diet induced mitochondrial DNA replication instability in Rad51c mutant mice drives sex-bias in anemia of inflammation.

Anemia of inflammation (AI) is a common comorbidity associated with obesity, diabetes, cardiac disease, aging, and during anti-cancer therapies. Mounting evidence illustrates that males are disproportionally affected by AI, but not why. Here we demonstrate a molecular cause for a sex-bias in inflammation. The data shows that mitochondrial DNA (mtDNA) instability induced by dietary stress causes anemia associated with inflamed macrophages and improper iron recycling in mice. These phenotypes are enhanced in mice with mutations in Fanco/Rad51c , which predisposes to the progeroid disease Fanconi Anemia. The data reveals a striking sex-bias whereby females are protected. We find that estrogen acts as a mitochondrial antioxidant that reduces diet-induced oxidative stress, mtDNA replication instability and the distinctively mtDNA-dependent unphosphorylated STAT1 response. Consequently, treatment of male Rad51c mutant mice with estrogen or mitochondrial antioxidants suppresses the inflammation-induced anemia. Collectively, this study uncovers estrogen-responsive mtDNA replication instability as a cause for sex-specific inflammatory responses and molecular driver for AI.

Anakinra in the management of adult-onset still's disease: a single-center experience.

Adult-onset Still's disease (AOSD) is a rare systemic autoinflammatory disorder of unknown etiology characterized by systemic inflammation, high fever, salmon-colored skin rash, arthralgia, and arthritis. Patients with AOSD may also present with elevated inflammatory markers, hyperferritinemia, anemia, leukocytosis, hepatosplenomegaly, and lymphadenopathy. Glucocorticoids and biological disease-modifying anti-rheumatic drugs, including the anti-interleukin-1 agent anakinra, are used in the management of AOSD. This retrospective single-center study included patients with AOSD who were registered at our tertiary center, and received anakinra treatment. The primary outcome of our study was the proportion of patients who achieved complete remission of disease-related clinical and laboratory complications. The glucocorticoid treatment profiles of the included patients before and after anakinra treatment were also analyzed. The occurrence of serious and non-serious adverse events was recorded to analyze the safety profile of anakinra. Thirty-four patients with AOSD, including 25 females (73.5%), were enrolled in the study. Twelve patients (35.3%) achieved complete remission and 14 patients (41.2%) achieved partial remission after anakinra treatment. Eight patients (23.5%) did not response to anakinra. Anakinra significantly decreased the number of patients receiving glucocorticoid treatment [33 (97%) vs. 22 (64.7%), p < 0.001] and the mean daily glucocorticoid dose [19 ± 13.5mg vs. 4.6 ± 5.8mg, p < 0.001]. Mild adverse events occurred in 11 patients (32.3%) with injection site reactions being the most common. One patient (2.9%) was diagnosed with tuberculosis within the treatment period. Anakinra is an effective and generally safe option for biological treatment initiation in the management of AOSD.

Inflammatory indexes and anemia in chronic kidney disease: correlation and survival analysis of the National Health and Nutrition Examination Survey 2005–2018

Background There is currently no research on the correlation between novel inflammatory indexes systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the risk of anemia in chronic kidney disease (CKD) population, as well as survival analysis in CKD with anemia. Methods This investigation encompassed 4444 adult subjects out of the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. The study utilized multi-variable logistic regression to assess the relationship between SII, NLR, PLR, and anemia risk occurrence in CKD population. Survival differences in CKD patients with anemia, based on varying levels of SII, NLR, and PLR were evaluated employing Kaplan–Meier and Cox proportional hazards models. Results The adjusted logistic regression model demonstrates that SII, NLR, and PLR are associated with the risk of anemia occurrence in CKD population. Kaplan–Meier’s analysis reveals significant differences in survival rates among CKD patients with anemia stratified by NLR levels. The adjusted Cox proportional hazards model shows that the higher NLR group has a 30% elevated risk of all-cause mortality contrasted with lower group (hazard ratio, HR: 1.30, confidence interval (CI) [1.01, 1.66], p value <.04). Restricted cubic spline (RCS) demonstrates no nonlinear relationship between NLR and all-cause mortality. Lastly, sub-cohort analysis indicates that in populations with diabetes, hypertension, and hyperuricemia, NLR levels have a greater impact on all-cause mortality. Conclusions Controlling inflammation may reduce the occurrence of anemia in CKD populations, with NLR serving to be a potential prognostic indicator for survival results within CKD patients suffering from co-morbid anemia.

COEXISTENCE OF GOLDENHAR SYNDROME WITH JUVENILE IDIOPATHIC ARTHRITIS: A CAUSAL LINK OR MERE COINCIDENCE?

Goldenhar syndrome, a rare congenital anomaly primarily affecting the face, external ear and vertebrae, and juvenile idiopathic arthritis (JIA), a chronic inflammatory disease in children under 16, represent distinct and uncommon clinical entities. We report the case of a five-and-a-half-year-old girl, with a history of treated congenital hip dislocation, admitted for persistent joint pain for over 6 months, affecting both knees, wrists and ankles with inflammatory signs without associated visceral manifestations. Clinical examination revealed a dysmorphic facies characteristic of Goldenhar syndrome, including facial asymmetry with mandibular hypoplasia, auricular anomalies such as a bilateral pre-tracheal appendix, an acrochordon on the right cheek, a pre-auricular sinus, microtia, and a closed right external auditory canal. A lumbar scoliosis was also identified on dorsolumbar spine imaging, with a CT scan of the rock that objectified an imperforation of the right external auditory canal and lack of visualization of the tympanic membrane, consolidating the diagnosis of Goldenhar syndrome.Biologically, the patient presented with inflammatory anemia with a moderate inflammatory syndrome, as well as hypergammaglobulinemia detected by protein electrophoresis. Tests for antinuclear antibodies and rheumatoid factor were negative (15 IU/mL). X-rays of the affected joints were taken, and the diagnosis of Idiopathic Juvenile Arthritis was retained after eliminating all differential diagnoses. This unusual coexistence raises complex diagnostic and therapeutic challenges, requiring a multidisciplinary approach and ongoing surveillance for comprehensive management.

Impact of vitamin D deficiency on iron status in children with type I diabetes

Vitamin D deficiency (VDD) and anemia are both public health nutrition concerns. An association between VDD and anemia has been suggested in various healthy and diseased populations. The current study aimed to elucidate the effect of VDD on iron status in children with type I diabetes mellitus (T1DM). The study recruited two groups of children with T1DM: control group comprised of 38 T1DM children with sufficient vitamin D (> 30 ng/ml) and a case group, consisted of 52 T1DM children with VDD (< 20 ng/ml). Both groups had comparable gender, age, BMI, and disease duration. The laboratory measurements included analysis of blood indices, markers of iron metabolism, hepcidin and inflammatory markers included interleukin 6 (IL-6) and C-reactive protein (CRP). Compared to control group, T1DM children with VDD differs specifically in terms of some markers of blood indices, such as decreased hemoglobin and increased red blood cell distribution width. Moreover, decreased serum iron, ferritin, total iron-binding capacity and transferrin along with elevated inflammatory markers were observed in case group. Results of the study indicated that VDD had increased the risk of iron deficiency anemia in children with T1DM as well as inflammatory related anemia. Furthermore, in T1DM children, VDD had raised the incidence of both absolute and functional iron deficiency, with greater incidence of the former. This study may indicate that VDD may be a risk factor that may worsen iron deficiency anemia in T1DM.

Teratoma of the pericardium revealed by seronegative polyarthritis: A case report

Introduction: Rheumatoid arthritis (RA) is an inflammatory, autoimmune disease with preferential involvement of the synovium in the proximal joints of the hands and feet. Formerly known as chronic progressive polyarthritis or chronic rheumatoid arthritis, its course is characterised by joint erosion and destruction. Coronary heart disease and strokes, the consequences of atheromatous disease, are part of rheumatoid arthritis and are responsible for the increased morbidity and mortality observed in this disease. Cardiac tumours in children are rare. The frequent use of echocardiography has helped to detect them earlier and with greater sensitivity. Most cardiac tumours in children are congenital, primary and benign. Most are discovered in children under one year of age. The aim of this study is to report the discovery of this type of tumour in a 10-year-old child being treated for seronegative polyarthritis. Observation: We report the observation of a 10-year-old girl, from a non-consanguineous marriage, with a history of systemic arthritis on difal 25mg *2/d + MTX 0.8mg/kg/week. Present since the age of 3 with recurrent arthralgias, admitted for polyarthralgias, fever with chest pain and whose examination found swelling, pain and limitation of passive and active movement of the left knee joint and elbow joint. Biological work-up revealed inflammatory microcytic hypochromic anaemia, normal ferritin, elevated CRP and ESR, ECBU, stool culture, ASLO serology, sputum BK, sputum TB PCR, Gene Xpert in sputum, Quantiiferon, SAM work-up and rheumatoid factors (RF) were negative, antinuclear antibodies (ANA) positive. EX. Ophthalmology and abdominal ultrasound normal, chest X-ray reveals cardiomegaly (ICT 0.6), X-ray of the spine + knee + elbow showed a discreet increase in the transparency of the bone structure. ETT found an oval mass measuring 20/25mm at the level of the junction between OD and VD not managing the reflux of the tricuspid valve and THORACIC CT in favour of a mass adherent to the pericardium evoking in the first instance a teratoma. Conclusion: Cardiac tumours in children are rare, and pericardial teratomas are often benign. In this study, we emphasise the importance of looking for underlying cardiac disease in the presence of recurrent episodes of arthralgia in children. Early positive diagnosis of the disease and the therapeutic implications are vital.

Rocaglamide regulates iron homeostasis by suppressing hepcidin expression

The anemia of inflammation (AI) is characterized by the presence of inflammation and abnormal elevation of hepcidin. Accumulating evidence has proved that Rocaglamide (RocA) was involved in inflammation regulation. Nevertheless, the role of RocA in AI, especially in iron metabolism, has not been investigated, and its underlying mechanism remains elusive. Here, we demonstrated that RocA dramatically suppressed the elevation of hepcidin and ferritin in LPS-treated mice cell line RAW264.7 and peritoneal macrophages. In vivo study showed that RocA can restrain the depletion of serum iron (SI) and transferrin (Tf) saturation caused by LPS. Further investigation showed that RocA suppressed the upregulation of hepcidin mRNA and downregulation of Fpn1 protein expression in the spleen and liver of LPS-treated mice. Mechanistically, this effect was attributed to RocA's ability to inhibit the IL-6/STAT3 pathway, resulting in the suppression of hepcidin mRNA and subsequent increase in Fpn1 and TfR1 expression in LPS-treated macrophages. Moreover, RocA inhibited the elevation of the cellular labile iron pool (LIP) and reactive oxygen species (ROS) induced by LPS in RAW264.7 cells. These findings reveal a pivotal mechanism underlying the roles of RocA in modulating iron homeostasis and also provide a candidate natural product on alleviating AI.

Clinical and histological features of histiocytoid Sweet syndrome associated with VEXAS syndrome.

VEXAS (Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is caused by acquired somatic mutations in UBA1. Sweet-syndrome-like skin disorders [and especially histiocytoid Sweet syndrome (HSS)] may be associated with VEXAS syndrome. To characterize the clinical and histopathological features of HSS in patients with VEXAS syndrome. Skin biopsies with a histological diagnosis of HSS at Rennes University Medical Center (Rennes, France) between October 2011 and January 2022 were reviewed in this study. Sanger sequencing and digital polymerase chain reaction were used to screen skin, blood and bone marrow samples for UBA1 variants, and thus classify patients as having VEXAS syndrome or not. We evaluated the clinical, histological and molecular (UBA1) characteristics of patients with or without VEXAS syndrome. We compared 15 skin biopsies from 7 patients found to have VEXAS syndrome and 19 skin biopsies from 15 patients without VEXAS syndrome. Persistent C-reactive protein elevation, macrocytosis, anaemia and haematological malignancies were more prevalent in patients with VEXAS syndrome [6/7 (86%), 6/7 (86%), 7/7 (100%) and 6/7 (86%), respectively] than in patients without [5/14 (36%), 6/15 (40%), 8/15 (53%) and 8/15 (53%), respectively]. These features sometimes appeared after the first skin manifestations, and a UBA1 mutation was found in the skin of five patients with VEXAS syndrome. Dermal infiltration by reniform histiocytoid cells (myeloperoxidase-positive and/or CD163-positive) and a periadnexal distribution were more frequently observed in VEXAS syndrome biopsies [15/15 (100%) and 3/15 (20%), respectively, vs. 11/19 (58%) and 0/19 (0%) in non-VEXAS syndrome biopsies, respectively]. Our findings might help pathologists to consider a diagnosis of VEXAS syndrome and to initiate early genetic testing.

Iron Deficiency in Anemic Children Surviving Critical Illness: Post Hoc Analysis of a Single-Center Prospective Cohort in Canada, 2019-2022.

Many children leave the PICU with anemia. The mechanisms of post-PICU anemia are poorly investigated, and treatment of anemia, other than blood, is rarely started during PICU. We aimed to characterize the contributions of iron depletion (ID) and/or inflammation in the development of post-PICU anemia and to explore the utility of hepcidin (a novel iron marker) at detecting ID during inflammation. Post hoc analysis of a single-center prospective study (November 2019 to September 2022). PICU, quaternary center, Canada. Children admitted to PICU with greater than or equal to 48 hours of invasive or greater than or equal to 96 hours of noninvasive ventilation. We excluded patients with preexisting conditions causing anemia or those admitted after cardiac surgery. None. Hematological and iron profiles were performed at PICU discharge on 56 participants of which 37 (37/56) were diagnosed with anemia. Thirty-three children (33/56; 59%) were younger than 2 years. Median Pediatric Logistic Organ Dysfunction score was 11 (interquartile range, 6-16). Twenty-four of the 37 anemic patients had repeat bloodwork 2 months post-PICU. Of those, four (4/24; 16%) remained anemic. Hematologic profiles were categorized as: anemia of inflammation (AI), iron deficiency anemia (IDA), IDA with inflammation, and ID (low iron stores without anemia). Seven (7/47; 15%) had AI at discharge, and one had persistent AI post-PICU. Three patients (3/47; 6%) had IDA at discharge; of which one was lost to follow-up and the other two were no longer anemic but had ID post-PICU. Eleven additional patients developed ID post-PICU. In the exploratory analysis, we identified a diagnostic cutoff value for ID during inflammation from the receiver operating characteristic curve for hepcidin of 31.9 pg/mL. This cutoff would increase the detection of ID at discharge from 6% to 34%. The burden of ID in children post-PICU is high and better management strategies are required. Hepcidin may increase the diagnostic yield of ID in patients with inflammation.

Diagnosis and treatment of Ehrlichiosis in a Pug dog

In addition to damaging the skin and causing inflammatory reactions and anemia, dog tick infestations are vectors for blood parasites such as Ehrlichia spp., known as Ehrlichiosis. This article reports the case of a five-year-old female Pug dog whose body was covered with ticks. The clinical examination found tick infestation on the face, ears, back, abdomen, legs, and interdigital areas. Supporting examinations included a complete blood count (CBC), buffy coat smear, and a test kit. CBC examination showed that the dog had leukocytosis, neutrophilia, hypochromic microcytic anemia, and thrombocytopenia. A buffy coat smear examination showed the presence of Ehrlichia morulae in the cytoplasm of the dog's monocytes, and the test kit results were positive for Ehrlichia antibodies; therefore, the dog was diagnosed with Ehrlichiosis. Treatment is done by administering Doxycycline, Intervetta Dr. Choice Ferro-B, and Fu Fang Ejiao Jiang orally for 21 days. After treatment, hematological parameters in leukocytes, neutrophils, erythrocytes, and platelets returned to normal ranges.

Pattern of Bone Marrow Hypometabolism on 18 F-FDG PET CT in Systemic Lupus Erythematous-Associated Aplastic Anemia.

We present the case of a 23-year-old woman with juvenile onset systemic lupus erythematous on a background of thrombotic thrombocytopenic purpura, who was referred for 18 F-FDG PET CT scan due to pyrexia of unknown origin with raised inflammatory markers, severe thrombocytopenia, and anemia. An interesting pattern of predominantly photopenic hypometabolic bone marrow activity was demonstrated on 18 F-FDG PET CT.

P1181 Prevalence and trend of anemia in a large cohort of children with inflammatory bowel disease

Abstract Background Anemia is a common extraintestinal manifestation in inflammatory bowel disease (IBD) with an impact on patients’ quality of life. Our aim was to determine the prevalence of anemia and its characteristics at the diagnosis in children with inflammatory bowel disease (IBD) and to investigate its trend during follow-up. Methods We conducted an observational, multicenter cohort study including data of IBD children with anemia at the diagnosis enrolled in the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) IBD registry. Demographic, clinical, laboratory and endoscopic data were collected at the diagnosis and anemia trend was evaluated at 1-year follow-up. Anemia was diagnosed based on the WHO criteria and classified as mild, moderate, and severe accordingly. Results Five hundred eighty-nine [295 CD (50%) and 294 UC/IBDU (50%)] out of 1634 with IBD presented with anemia, resulting in a prevalence of 36%. Anemia rate was higher in CD than in UC (39% vs 33%, p = 0.009). Most patients presented at the diagnosis with moderate anemia (55%). The most common forms of anemia were iron deficiency anemia (IDA) and combined inflammatory and IDA anemia (InflIDA), both present in 42% of children. Only 15% of children had anemia of inflammation. Children with CD had higher rates of mild anemia than UC (38% vs 33%, p&amp;lt;0.0001), while severe anemia was more common in UC (13% vs 6%, p= 0.001) as well as IDA (53% vs 31%, p&amp;lt;0.0001). Younger age and lower albumin levels significantly correlated with the severity of the anemia in CD. In UC, females were more likely to experience severe anemia (69% vs 47%, p=0.02) and an extensive disease was more prevalent in children with moderate and severe anemia then in those with mild anemia (p=0.01 and p=0.03, respectively). At 1 year, 99 children (17%) were still anemic. At multivariable logistic regression analysis, baseline wPCDAI and SES-CD significantly correlated with the persistence of anemia at 1 year in CD. No variables correlated with the persistence of anemia in UC. Conclusion More than one-third of pediatric patients present with anemia at the diagnosis of IBD, most commonly moderate. A severe anemia is most common in UC compared to CD. Iron deficiency anemia (alone or in its form of InflIDA) is the most common cause of anemia in children with IBD. One out of five is still anemic after 1 year from the diagnosis.

Association between dietary inflammatory index and anemia in US adults.

Anemia is a widespread global health concern, and recent research has unveiled a link between anemia and inflammation. The Dietary Inflammation Index (DII) is a novel tool used to assess the overall inflammatory potential of an individual's diet. However, until now, there have been no studies demonstrating a connection between DII and anemia. This study aimed to explore the relationship between DII and the risk of anemia among Americans, as well as to examine the influence of other risk factors on this association. Data from 32,244 patients were collected from the National Health and Nutrition Examination Survey (NHANES) database spanning from 1999 to 2018. Using multivariable logistic regression, we examined the correlation between DII and anemia. Subgroup analyses and smoothed curve analyses were conducted to further investigate the association between DII and anemia. The analysis revealed a significant positive association between higher DII scores and increased anemia risk in the American population (Odds Ratio [OR] = 1.06, 95% Confidence Interval [CI] = 1.03 to 1.09, p < 0.0001). This association remained consistent in subgroup analyses, encompassing various age groups, distinct Body Mass Index (BMI) categories, varying diabetes mellitus statuses, histories of hypertension, females, individuals with a RIP <3.5, and Non-Hispanic Black individuals. Notably, the association was particularly significant among non-smokers. Smoothed curve fitting analysis demonstrated a linear relationship between DII and the prevalence of anemia. Our findings underscore a positive correlation between the inflammatory potential of one's diet and the risk of anemia, especially when coupled with other risk factors. Consequently, reducing the consumption of pro-inflammatory foods may serve as one of the effective measures against the development of anemia. Given the variations in gender, age, BMI, and chronic diseases observed in our study, tailored policies could better cater to the specific needs of diverse populations.

Patient Blood Management in Microsurgical Procedures for Reconstructive Surgery.

Introduction: The main purpose of reconstructive surgery (RS) is to restore the integrity of soft tissues damaged by trauma, surgery, congenital deformity, burns, or infection. Microsurgical techniques consist of harvesting tissues that are separated from the vascular sources of the donor site and anastomosed to the vessels of the recipient site. In these procedures, there are some preoperative modifiable factors that have the potential to influence the outcome of the flap transfer and its anastomosis. The management of anemia, which is always present in the postoperative period and plays a decisive role in the implantation of the flap, covers significant importance, and is associated with clinical and laboratory settings of chronic inflammation. Methods: Chronic inflammatory anemia (ACD) is a constant condition in patients who have undergone RS and correlates with the perfusion of the free flap. The aim of this treatment protocol is to reduce the transfusion rate by maintaining both a good organ perfusion and correction of the patient's anemic state. From January 2017 to September 2019, we studied 16 patients (16 males, mean age 38 years) who underwent microsurgical procedures for RS. Their hemoglobin (Hb) levels, corpuscular indexes, transferrin saturation (TSAT) ferritin concentrations and creatinine clearance were measured the first day after surgery (T0), after the first week (T1), and after five weeks (T2). At T0, all the patients showed low hemoglobin levels (average 7.4 g/dL, STD 0.71 range 6.2-7.4 g dL-1), with an MCV of 72, MCH of 28, MCHC of 33, RDW of 16, serum iron of 35, ferritin of 28, Ret% of 1.36, TRF of 277, creatinine clearance of 119 and high ferritin levels (range 320-560 ng mL-1) with TSAT less than 20%. All the patients were assessed for their clinical status, medical history and comorbidities before the beginning of the therapy. Results: A collaboration between the two departments (Department of Transfusion Medicine and Department of Reconstructive Surgery) resulted in the application of a therapeutic protocol with erythropoietic stimulating agents (ESAs) (Binocrit 6000 UI/week) and intravenous iron every other day, starting the second day after surgery. Thirteen patients received ESAs and FCM (ferric carboxymaltose, 500-1000 mg per session), three patients received ESAs and iron gluconate (one vial every other day). No patients received blood transfusions. No side effects were observed, and most importantly, no limb or flap rejection occurred. Conclusions: Preliminary data from our protocol show an optimal therapeutic response, notwithstanding the very limited scientific literature and data available in this specific surgical field. The enrollment of further patients will allow us to validate this therapeutic protocol with statistically sound data.

Haemodialysis Patients with Type 2 Diabetes Mellitus and COVID-19: An Observational Study

Background and Objectives: Chronic Kidney Disease (CKD) affects 6,7% of the adult population in Romania and is associated with high morbidity. About one out of three adults with diabetes has kidney disease. According to current literature data, the prevalence of diabetes is very high, up to 11,6%, of whom 2,4% had undiagnosed diabetes, and is the leading cause of kidney damage and the need for renal replacement therapy (RRT). COVID-19 has brought with it a lot of unanswered questions, regarding the risk factors, the disease evolution, and the treatment possibilities. It became clear that diabetic kidney disease (DKD) is among the independent risk factors that predict unfavorable outcomes upon SARS-CoV-2 infection, so we aimed to evaluate the characteristics of diabetic and non-diabetic dialyzed patients, COVID-19 positive. Materials and Methods: It is an observational, single-center study that analyzed type 2 diabetes mellitus and non–diabetic patients in maintenance hemodialysis hospitalized for SARS CoV-2 infection. Results: A total of 101 adult dialyzed patients were admitted with a SARS-CoV-2 RT-PCR positive test, out of which 42 had a long history of diabetes mellitus type 2 and 59 of them have been known with other etiologies of CKD. Hypertension and heart disease were the most commonly associated comorbidities. Inflammatory markers and anemia were significantly increased in diabetic patients compared to non-diabetic. Conclusions: We found that anemia was more severe in patients COVID-19-positive MHD T2DM patients.

Anaemia, iron deficiency and inflammation prevalence in children in the Mount Cameroon area and the contribution of inflammatory cytokines on haemoglobin and ferritin concentrations: a cross sectional study

BackgroundIron deficiency (ID) and anaemia of inflammation (AI) coexist where infections and nutritional deficiencies are common. The aim of this study was to determine burden of ID, anaemia, inflammation and AI in children in malaria endemic Limbe, Mount Cameroon as well as decipher the contribution of some inflammatory cytokines on the concentration of haemoglobin and ferritin.MethodsA total of 520 children aged ≤ 15 years old from the Limbe Health District (LHD) were randomly selected and examined in a cross-sectional study for iron deficiency, anaemia, inflammation and inflammation anaemia. Collected blood samples were used for full blood count and inflammatory marker analyses with the aid of a haemoanalyzer and ELISA machine, respectively. Spearman’s rank correlation analysis was used to determine the correlation between cytokines and haemoglobin while multiple linear regression analysis was used to evaluate the effects of inflammatory cytokines on haemoglobin and ferritin concentrations.ResultsThe overall prevalence of anaemia, ID, IDA, inflammation and AI were respectively, 67.5%, 34.6%, 12.9%, 63.1% and 30.2%. Children aged 12‒15 years (P = 0.001), enrolled from the community (P < 0.001), whose parents are civil servants (P < 0.001), living in a home with 6‒10 occupants (P = 0.016), afebrile (P < 0.001) and malaria negative (P = 0.007) had the highest prevalence of ID while, children ≤ 5 years old (P = 0.001), with a family size of 1‒5 occupants (P = 0.033) had the highest prevalence of AI. Haemoglobin concentration positively correlated with concentrations of IFN-γ (P < 0.001), TNF-α (0.045) and ferritin (P < 0.001) while a negative correlation was observed with IL-10 (P = 0.003). In the multiple linear regression analysis only IL-6 significantly (P = 0.030) influenced haemoglobin concentration.ConclusionsWhile IL-6 is of significance in the pathology of anaemia, iron deficiency and anaemia of inflammation are of moderate public health concerns in the Mount Cameroon area. Hence, appropriate intervention against anaemia, ID and AI should be directed at children ≤ 5 years and counterparts > 10 years old that bear the highest burden.