Increased Serum Ferritin Levels Research Articles

Impact of serum IL-10 level on the clinical outcome of COVID-19 patients and the development of post-COVID pulmonary fibrosis

A characteristic feature of the cytokine storm in coronavirus disease 2019 (COVID-19) is the dramatic elevation of serum interleukin 10 (IL-10). This may be a negative feedback mechanism to suppress inflammation. However, this IL-10 elevation may contribute to COVID-19 severity. In our study, we aimed to evaluate the effect of serum IL-10 level on patients' clinical outcome and the incidence of post-COVID19 pulmonary fibrosis. This was a prospective observational study, included 100 patients, confirmed to have COVID-19, Of these, 50 patients had COVID-19 without evidence of pneumonia in computed tomography (CT) scans (group I) and the other 50 patients had COVID-19 pneumonia (group II). Our results showed a significant increase in serum ferritin level in patients with COVID pneumonia. However, no difference was found in serum C-reactive protein (CRP) nor D-Dimer between both groups. There was a statistically significant increase in serum IL-10 in patients with COVID pneumonia compared with COVID patients without pneumonia (p<0.001). Fibrosis was developed in 35 patients (70%) with COVID pneumonia after 3 months and 4 of them died, however, all patients without pneumonia survived. Among age, serum IL-10, aspartate aminotransferase (AST), alanine transaminase (ALT), elevated serum IL-10 was found to be an independent predictor of pneumonia (p=0.32). However, there was no significant effect for IL-10 on patients’ clinical outcome. There was a statistically significant correlation between serum IL-10 levels and oxygen (O2) demand, CRP and D-Dimer (p= 0.015, p=0.034 and p=0.042, respectively). The higher the level of IL-10 the less fibrosis detected in follow up CT scans (p=0.038). In conclusion, even though IL-10 was significantly associated with disease severity (higher in pneumonia), elevated serum Il-10 has an independent role in decreasing the incidence of post-COVID-19 pulmonary fibrosis.

Neurodevelopmental Outcomes in Children Vertically Exposed to Chikungunya Virus: A Two Years Follow-up Study.

To monitor by the first 24 months of life, children born to mothers with laboratory evidence of chikungunya virus (CHIKV) infection during pregnancy or up to 8 weeks before it, and to describe abnormalities in head circumference (HC), auditory and ophthalmological assessments and neuroimaging tests during the follow-up period. This is a observational, descriptive, longitudinal and prospective study of children born to mothers who had a rash and a positive test for CHIKV during pregnancy or up to 8 weeks before it. They were admitted between November 2015 and May 2019 in the outpatient multidisciplinary clinic to investigate acute exanthematous disease. The exposed children were followed up by a multidisciplinary team and underwent periodic measurements of the HC. The Denver II test was applied, in addition to transfontanellar ultrasound (TU) to evaluate neurodevelopmental outcomes during the study period. Ophthalmological and auditory examinations, echocardiography and laboratory tests were also included. We included in the study 27 children vertically exposed to CHIKV. All children had a negative polymerase chain reaction test for the virus collected at the first outpatient visit (mean age of 16.8 days and standard deviation of 8 days). No clinical condition compatible with congenital infection at birth was reported. A change in HC characterized by macrocephaly and mild global delay development was observed in a 1-year-old child whose mother was infected in the peripartum, but with normal TU. Changes in the TU were observed in 2 other children with nonspecific subependymal cystic malformation that was not evident by the cranial computed tomography. The other children monitored showed normal results in the Denver II test, in the HC and TU. No changes were identified on ocular ophthalmoscopy or auditory brainstem response test. Two children had an increase in serum ferritin levels during the first year of life, with the others' inflammatory disease markers normal. Our study added knowledge about the neurodevelopment of children exposed to CHIKV during pregnancy by a longitudinal and prospective follow-up, throughout their first 24 months of life. We did not observe a negative impact of exposure to the virus on the neurological examination, global developmental test or measurements of the HC of these children.

Iron overload and liver function in patients with beta thalassemia major: A cross sectional study.

In thalassemia major, repeated blood transfusions result in iron overload causing organ damage. The objective of this study was assessment of liver enzymes in patients with Thalassemia major and to observe their association with ferritin. A cross-sectional study was performed, at Islamabad Medical and Dental College and its affiliated Akbar Niazi Teaching Hospital from November 2021 till August 2022. Serum ferritin, AST, ALT, and total bilirubin levels were determined, in 135 patients of beta thalassemia major receiving transfusions. Data analysis was performed using SPSS Version 20. For categorical variables, calculation of frequencies and percentages was performed. Mean (± standard deviation) was determined for quantitative variables. ANOVA with post hoc Tukey's test was used for determining association between liver enzymes and serum ferritin. A p-value of <0.05 was considered significant. The correlation between ferritin and LFTs was determined by Pearson's correlation coefficient. Patients had an age range of 7-30 years, and males constituted 51% of sample. Mean level of ferritin was 6062.61 + 3641.79 ng/ml, with an insignificant difference between the genders (p =0.366). The levels of AST, ALT and bilirubin were perceived to show a significant increase in patients with ferritin levels >5000ng/ml, when compared with patients having ferritin levels < 2,500 ng/ml. A significant positive correlation of increasing serum ferritin levels was observed with ALT (r= 0.682), to a lesser extent with AST (r = 0.532), and only a weak correlation with serum bilirubin (r = 0.350). Liver damage was caused by increased iron deposition. LFTs should be performed regularly to detect and reduce liver damage by increasing chelation therapy, thereby reducing morbidity and mortality due to thalassemia.

Possible alteration in serum ferritin level in malaria infected HIV seropositive individuals in Nauth, Nnewi, Nigeria

The role of Ferritin in monitoring disease progression in immune compromised HIV individuals with an underlying active infection like malaria is a subject of growing research. Ferritin being an acute phase protein, plays important role in assessing the range of damage due to inflammation in immunosuppressed patients leaving in highly endemic malaria regions. The levels of serum ferritin in malaria infected HIV positive individuals in Nnamdi Azikiwe University teaching hospital (NAUTH), Nnewi, Anambra State, Nigeria, was assessed. Questionnaire was used to obtain the demographic details of the participants, and to rule out other inflammatory infections. 88 participants of the age group 18 - 65 years, comprising 24 with HIV infection, 22 with HIV and Malaria co-infection, 22 with Malaria infection, and a control group of 22 individuals with neither HIV nor malaria infection were randomly recruited. Ferritin level was determined using enzyme linked immunosorbent assay technique and a cross sectional prospective study design was used. A significantly high mean serum ferritin level was observed in HIV infected individuals with and/ or without malaria co-infection than in malaria positive and control group (p&lt;0.05 respectively). Serum ferritin level was significantly higher in female participants than in male counterparts (p &lt; 0.05). Serum ferritin level was significantly higher in individuals with CD4 count &gt;500 than in CD4 count ≤ 500 (p &lt; 0.05). Blood pressure was significantly higher in HIV infected and malaria positive individuals when compared with controls. The increased serum ferritin level and higher blood pressure in HIV infected participants suggests active inflammatory process, reduced immunity and hypertension which may have worsened by malaria co-infection. This may subsequently lead to vascular and endothelia damage causing disease severity.

Increased serum ferritin is associated with severity of orbital disease in COVID-19-associated rhino-orbito-cerebral mucormycosis: A quantitative analysis.

Effect of serum ferritin on severity of coronavirus disease 2019 (COVID-19)-associated rhino-orbito-cerebral mucormycosis. To study the association between increased serum ferritin and severity of orbital disease in COVID-19-associated rhino-orbito-cerebral mucormycosis. A cross-sectional study. Hundred (n) out of 155 treatment-naive patients of COVID-19 infection presenting with the signs and symptoms of rhino-orbito-cerebral mucormycosis were enrolled in study. Based on the classification proposed by Honavar, the study patients were classified into four stages: Stage 1: involvement of the nasal mucosa (n = 11), Stage 2: involvement of paranasal sinuses (n = 14), Stage 3: involvement of the orbit (n = 37), Stage 4: involvement of the central nervous system (n = 38). Stage 3 was further divided into four substages: 3a: nasolacrimal duct, medial orbit, vision unaffected (n = 4); 3b: diffuse orbital involvement (>1 quadrant or >2 structures), vision unaffected (n = 15); 3c: central retinal artery occlusion or ophthalmic artery occlusion, superior ophthalmic vein thrombosis, involvement of superior orbital fissure, inferior orbital fissure, orbital apex, diminution or loss of vision (n = 13); 3d: bilateral orbital involvement (n = 5). Fasting blood sugar (FBS), postprandial blood sugar (PPBS), and inflammatory markers (serum ferritin, interleukin-6, C-reactive protein, and D-dimer) were assessed. Serum level of ferritin was analyzed by using chemiluminescence immunoassay method. Mean FBS (mg/dl) was 165.03 ± 70.43 for stage 1, 185.67 ± 64.82 for stage 2, 159.05 ± 68.60 for stage 3, and 158.20 ± 62.05 for stage 4. Mean PPBS (mg/dl) was 238.70 ± 141.29 for stage 1, 252 ± 103.69 for stage 2, 257.09 ± 103.48 for stage 3, and 229.53 ± 76.81 for stage 4. Mean serum ferritin (µg/l) was 302.67 ± 266.95 in stage 1, 444.19 ± 116.36 in stage 2, 504.85 ± 205.99 in stage 3, and 825.95 ± 777.30 in stage 4. A statistically significant increase in serum ferritin levels with severity of disease (P = 0.005) was noted. Similar trend was observed in substages of stage 3. Pearson correlation analysis showed a positive correlation between serum ferritin and severity of disease (P = 0.0007). Increased serum ferritin was significantly independently associated with severity of orbital disease in COVID-19-associated rhino-orbito-cerebral mucormycosis.

Weekly iron-folic acid supplementation and its impact on children and adolescents iron status, mental health and school performance: a systematic review and meta-analysis in sub-Saharan Africa

ObjectiveThis systematic review and meta-analysis aimed to comprehensively assess the impact of weekly iron-folic acid supplementation (WIFAS) on the nutrition, health and educational outcomes of children and adolescents in sub-Saharan...

Ferritin Levels on Hospital Admission Predict Hypoxic-Ischemic Encephalopathy in Patients After Out-of-Hospital Cardiac Arrest: A Prospective Observational Single-Center Study.

Out-of-hospital cardiac arrest (OHCA) is a major health concern in Western societies. Poor outcome after OHCA is determined by the extent of hypoxic-ischemic encephalopathy (HIE). Dysregulation of iron metabolism has prognostic relevance in patients with ischemic stroke and sepsis. The aim of this study was to determine whether serum iron parameters help to estimate outcomes after OHCA. In this prospective single-center study, 70 adult OHCA patients were analyzed. Serum ferritin, iron, transferrin (TRF), and TRF saturation (TRFS) were measured in blood samples drawn on day 0 (admission), day 2, day 4, and 6 months after the return of spontaneous circulation (ROSC). The association of 4 iron parameters with in-hospital mortality, neurological outcome (cerebral performance category [CPC]), and HIE was investigated by receiver operating characteristics and multivariate regression analyses. OHCA subjects displayed significantly increased serum ferritin levels on day 0 and lowered iron, TRF, and TRFS on days 2 and 4 after ROSC, as compared to concentrations measured at a 6-month follow-up. Iron parameters were not associated with in-hospital mortality or neurological outcomes according to the CPC. Ferritin on admission was an independent predictor of features of HIE on cranial computed tomography and death due to HIE. OHCA is associated with alterations in iron metabolism that persist for several days after ROSC. Ferritin on admission can help to predict HIE.

Potential mediation effect of insulin resistance on the association between iron metabolism indicators and non-alcoholic fatty liver disease.

Iron metabolism and insulin resistance (IR) are closely related to non-alcoholic fatty liver disease (NAFLD). However, the interplay between them on the occurrence and progression of NAFLD is not fully understood. We aimed to disentangle the crosstalk between iron metabolism and IR and explore its impact on NAFLD. We analyzed data from the National Health and Nutritional Examination Survey (NHANES) 2017-2018 to evaluate the association between serum iron metabolism indicators (ferritin, serum iron, unsaturated iron-binding capacity [UIBC], total iron-binding capacity [TIBC], transferrin saturation, and transferrin receptor) and NAFLD/non-alcoholic steatohepatitis (NASH). Mediation analysis was conducted to explore the role of IR played in these relationship. A total of 4812 participants were included, among whom 43.7% were diagnosed with NAFLD and 13.2% were further diagnosed with NASH. After adjusting the covariates, the risk of NAFLD increases with increasing serum ferritin (adjusted odds ratio [aOR] 1.71, 95% confidence interval [CI] 1.37-2.14), UIBC (aOR 1.45, 95% CI 1.17-1.79), and TIBC (aOR 1.36, 95% CI 1.11-1.68). Higher levels of serum ferritin (aOR 3.70, 95% CI 2.25-6.19) and TIBC (aOR 1.69, 95% CI 1.13-2.56) were also positively associated with NASH. Participants with IR were more likely to have NAFLD/NASH. Moreover, IR-mediated efficacy accounted for 85.85% and 64.51% between ferritin and NAFLD and NASH, respectively. Higher levels ofserum ferritin and TIBC are closely associated with the occurrence of NAFLD and NASH. IR may be considered a possible link between NAFLD or NASH and increased serum ferritin levels.

Serum Ferritin Level Linked to Male Type-2 Diabetes Mellitus Patients Amongst Residents of Hyderabad, Sindh

Introduction: Diabetes mellitus is a metabolic disorder which is caused by either deficiency of insulin or its disturbed action on peripheral receptors. Globally it is estimated that 451 million peoples were suffering from Diabetes mellitus type 2 in 2017 and this burden will rise to 693million in 2045.The relationship between diabetes mellitus and serum ferritin levels is intricately linked, sharing a common intersection in the liver where both glucose metabolism and iron metabolism converge. Aims and Objectives: To measure the serum ferritin levels among residents of Hyderabad with type 2 Diabetes Mellitus. Place and Duration of study: The study was conducted in the Outpatient Department (OPD) of Liaquat university Hospital from June 2022 to August 2022 (3 months). Material and Methods: The study consists of 100 subjects divided into two groups, a control group consists of 50 normal healthy people with normal fasting glucose below 100mg/dl and a Case group consists of 50 patients with fasting glucose level more than 125 mg/dl according to World Health Organization criteria. Their Serum ferritin levels were evaluated using the ELFA method, employing a commercially available kit supplied by Roche Cobas Integra. The results were analyzed on the software Graph Pad Prism 9, p-value ? 0.05was taken as significant. Results: The frequency of Type 2 Diabetes mellitus was significantly higher in patients with increased serum ferritin levels (P=0.001) with an odds ratio of 1.838 , a sensitivity/specifity value of (0.50/0.56) and a robust likelihood ratio of 2.25. Conclusion: The study underscores a potential link between elevated serum ferritin and Diabetes Mellitus Type-2.

CORRELATIONS BETWEEN FERRITIN LEVELS AND CREATININE IN PEDIATRIC THALASSEMIA PATIENTS PRODIA CILEGON

Thalassemia is a blood disorder that is passed down genetically from parents to their children. The body cannot form normal red blood cells resulting in them being damaged easily and having a short life of less than 120 days and anemia, requiring continuous blood transfusions to maintain hemoglobin levels in the body. A history of repeated blood transfusions can cause excess iron in the body which is characterized by an increase in serum ferritin levels which can cause damage to kidney function by looking at creatinine levels. The purpose of this study was to determine whether there is a relationship between ferritin and creatinine levels in children with thalassemia. This study used a quantitative method with a cross sectional approach. The sampling technique used in this study was the total sampling technique. The sample used was 12 samples. Data processing in this study used the Shapiro-Wilk Normality test and the Pearson Correlation test in bivariate analysis. The results of the analysis of this study indicate that there is no significant relationship between the ferritin and creatinine levels in children with thalassemia where the value of Sig. 0.212 &gt; 0.05 (p&gt; 0.05), and shows a significant negative correlation of -0.389. This study in thalassemia children had high ferrtin levels but creatinine levels were still within normal limits.

Efficacy of Vitamin C with Iron Supplementation in Iron Deficiency Anemia Patients: A Systematic Review and Meta-Analysis

Background Oral iron supplementation is one of the mainstays of treatment for iron deficiency anemia (IDA) but can be complicated by poor absorption. Vitamin C is hypothesized to increase the acidity of the GI tract and enhance the conversion of non-absorbable ferric iron (Fe 3+) to its absorbable ferrous (Fe 2+) state for improved absorption and is often prescribed with iron. However, whether vitamin C supplementation translates to clinically relevant differences, such as sufficient improvements in hemoglobin, remains unclear and a synthesis of available evidence is lacking. Therefore, the present systematic review and meta-analysis aims to compare oral iron with or without vitamin C supplementation in patients with IDA. Methods MEDLINE, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials were searched from database inception to July 2023 for randomized controlled trials (RCTs) and non-randomized studies (NRSs) that investigated the use of oral iron supplements with vitamin C compared to oral iron supplements only in patients with IDA. Title &amp; abstract, full text review and data extraction were conducted independently and in duplicate. The primary outcome was the change in serum hemoglobin levels in g/dL. Secondary outcomes include change in serum ferritin, change in transferrin saturation, change in reticulocyte percentage, and incidence of adverse events including constipation, nausea/vomiting, GI upset and poor taste. The Mantel-Haenszel fixed effects model was utilized for the meta-analysis. The calculated effect sizes were represented by odds ratios (OR) and mean differences (MD) for binary endpoints and continuous endpoints, respectively, with 95% confidence intervals (CI). Results 2231 studies were retrieved from electronic databases. 12 RCTs and one prospective cohort study comprising 2240 patients were included. There was a small but statistically significant increase in serum hemoglobin level (MD 0.14 g/dL [95%CI 0.08, 0.20]) and serum ferritin levels (MD 3.23 µg/L [95%CI 1.63, 4.84]) in the iron + vitamin C group compared to the iron only group. There was a greater reduction in serum transferrin saturation associated with vitamin C supplementation (MD -2.01% [95%CI -3.31, -0.71%]) but the pool of evidence consists of only two studies. Reticulocyte percentage (MD 0.22% [95%CI 0.08, 0.36]) was higher in the iron + vitamin C group than in the iron only group. There were no significant differences between the iron + vitamin C group and the iron only group in overall incidence of adverse effects (OR 0.71 [95%CI 0.50, 1.00]), constipation (odds ratio (OR) 0.83 [95%CI 0.35, 1.96]), or nausea/vomiting (OR 0.80 [95%CI 0.52, 1.24]). The risk of GI upset is lower in the iron + vitamin C group (OR 0.40 [95%CI 0.18, 0.92]). Nevertheless, only three primary studies reported on incidence of adverse events. Conclusion The addition of vitamin C to iron supplementation in the management of IDA was associated with a statistically significant, but likely clinically unimportant, increase in serum hemoglobin of 0.14 g/dL. Similarly, a statistically significant increase in serum ferritin levels by 3.23 µg/L was observed, but its clinical relevance remains uncertain. A strength of the present analysis is the number of RCTs included; however, its conclusions are limited by the heterogeneity of interventions (e.g. different formulations/dosage) across studies. Our results do not provide strong evidence for adding vitamin C to iron supplementation.

Improvement of Underlying Disease Pathophysiology of Ineffective Erythropoiesis in Non-Transfusion-Dependent (NTD) Patients with β-Thalassemia Receiving Luspatercept: Biomarker Analysis from the BEYOND Trial

Background: Ineffective erythropoiesis and chronic hemolytic anemia are hallmarks of β-thalassemia which ultimately lead to extramedullary hematopoiesis (EMH), iron overload and other complications. Patients with hemoglobin levels chronically &amp;lt; 10 g/dL are at higher risk for clinical complications and mortality. A significant proportion of patients treated with luspatercept on the BEYOND study (NCT03342404) achieved ≥ 1.0 g/dL hemoglobin increases from baseline, with a manageable safety profile. This increase of hemoglobin is associated with improvement in health-related quality of life. (Taher et al, Lancet Haematol. 2022; 9(10):e733-e744). Aim: To report biomarker-correlated data demonstrating the benefit of luspatercept on underlying ineffective erythropoiesis, iron homeostasis, and hemolysis. Methods: Serum samples and MRI data were collected from 145 patients (luspatercept [n = 96] and placebo [n = 49]) enrolled in the multi-center, randomized, double-blind, placebo-controlled phase 2 BEYOND trial for this study. Samples were analyzed for levels of hepcidin, erythroferrone (ERFE), erythropoietin (EPO), soluble transferrin receptor (sTFR), fetal hemoglobin (HbF), serum ferritin, growth differentiation factor (GDF) 11, GDF15 and LDH by ELISA at Intertek (San Diego, CA). Liver iron content (LIC) was assessed by R2 MRI. MRI/ultrasound was used to determine spleen volumes. Results: Luspatercept responders, (patients who achieved hemoglobin increase ≥ 1.0 g/dL from baseline) had significantly lower baseline levels of ERFE ( P = 0.0065), EPO ( P = 0.00019), sTFR1 ( P = 0.00043), GDF15 ( P = 4.4e -5), and HbF ( P = 0.00016), and higher hepcidin levels ( P = 0.022), compared with non-responders. Baseline bilirubin, serum ferritin, LIC, and spleen volume were not significantly different between responders and non-responders. Levels of GDF11, a member of the TGFβ superfamily of ligands targeted by luspatercept, were significantly reduced at week 48 in the treatment group compared to baseline ( P = 0.001), though not different between responders and non-responders; no such reduction was observed in the placebo group. In the luspatercept arm, bilirubin and LDH did not significantly change from baseline to week 48 in either responders ( P = 0.289) or non-responders ( P = 1.000). However, reticulocytes increased significantly in responders ( P = 0.028) without any increase in HbF ( P = 0.82), suggesting increased effective erythropoiesis and stabilization of hemolysis. Luspatercept responders had significant reductions in spleen volume at week 48 compared with baseline ( P &amp;lt; 0.001), suggesting reduced EMH. Spleen volumes at week 48 of NR in both arms were not significantly different. Placebo patients had a significant increase in serum ferritin levels at week 48 ( P = 0.030), likely from ongoing ineffective erythropoiesis and dysregulated iron homeostasis. At week 48, serum ferritin levels were significantly decreased in luspatercept responders ( P = 0.003), but not in non-responders ( P = 0.480). No significant changes in LIC were observed in either the placebo or luspatercept groups at week 48 compared to baseline. Conclusions: Analysis of biomarkers suggests that patients with NTD β-thalassemia receiving luspatercept had an improvement in ineffective erythropoiesis, the primary underlying pathophysiologic mechanism. In responders to luspatercept, increase in reticulocytes, without an increase in HbF, suggests more efficient maturation and differentiation in the bone marrow. Furthermore, the reduction in spleen volume suggests that this efficient improvement in marrow erythropoiesis leads to reduction in EMH. At the time of analysis, LIC remained unchanged, which in combination with reduction in serum ferritin, suggests that the improvement in ineffective erythropoiesis may also have improved dysregulated iron homeostasis, with reduction in iron absorption and no further iron loading. Therefore, this analysis shows that luspatercept treatment results in improved ineffective erythropoiesis, reduced EMH and improved iron homeostasis.

Iron: The silent culprit in your adipose tissue.

Iron plays a vital role in essential biological processes and requires precise regulation within the body. Dysregulation of iron homeostasis, characterized by increased serum ferritin levels and excessive accumulation of iron in the liver, adipose tissue, and skeletal muscle, is associated with obesity and insulin resistance. Notably, iron excess in adipose tissue promotes adipose tissue dysfunction. As optimal adipose tissue function is crucial for maintaining a healthy phenotype in obesity, a comprehensive understanding of iron homeostasis in adipose tissue is imperative for designing new therapeutic approaches to improve and prevent adipose tissue dysfunction. Here, we conducted a review of relevant studies, focusing on and providing valuable insights into the intricate interplay between iron and adipose tissue. It sheds light on the impact of iron on adipogenesis and the physiology of both white and brown adipose tissue. Furthermore, we highlight the critical role of key modulators, such as cytosolic aconitase, mitochondria, and macrophages, in maintaining iron homeostasis within adipose tissue.

Study of Serum Ferritin and Glycemic Status in Type II Diabetic Patients

Introduction: Diabetes mellitus has often found to be associated with iron dysregulation, manifested by increased serum ferritin level. Iron is essential for beta- cell insulin secretion, although, increasing concentration of iron and ferritin induce oxidative damage and dysfunction of pancreatic beta cells, leading to resistance to insulin, thus, consequent in hyperglycemia. Objective: To observe the association between serum ferritin and HbA1c concentration among type 2 DM patients. Methods: With an observational study design, the present study has been done among 63 purposively selected type 2 diabetic patients who attended the selected pathology institute during the period of January to June, 2021. Following availing the ethical approval from concerning ethical review committee and informed written consent of the patients, data regarding age, sex, height, weight, body mass index (BMI), diabetic duration, HbA1c concentration and serum ferritin level has been collected and recorded in a semi-structured questionnaire. Data were analyzed using Statistical Package for Social Science (SPSS) 20. Results: The study recorded that, the mean serum ferritin level was significantly higher among the poor glycemic control group than the good glycemic control group of respondents (p&lt;0.05) though no statistically significant difference was observed in terms of age, sex, BMI or diabetic duration among the groups (p&gt;0.05). Conclusion: Higher serum ferritin level among diabetic patients with poor glycemic control may indicate that there is a pathological role of serum ferritin to induce changes in glycemic status, which requires further in depth studies to apprehend about the mechanism. JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 07-10

Inflammatory Biomarkers Affecting Survival Prognosis in Patients Receiving Veno-Venous ECMO for Severe COVID-19 Pneumonia.

Severe COVID-19 pneumonia in which mechanical ventilation is unable to achieve adequate gas exchange can be treated with veno-venous ECMO, eliminating the need for aggressive mechanical ventilation which might promote ventilator-induced lung injury and increase mortality. In this retrospective observational study, 18 critically ill COVID-19 patients who were treated using V-V ECMO during an 11-month period in a tertiary COVID-19 hospital were analyzed. Biomarkers of inflammation and clinical features were compared between survivors and non-survivors. Survival rates were compared between patients receiving ECMO and propensity matched mechanically ventilated controls. There were 7 survivors and 11 non-survivors. The survivors were significantly younger, with a higher proportion of females, higher serum procalcitonin at ICU admission, and before initiation of ECMO they had significantly lower Murray scores, PaCO2, WBC counts, serum ferritin levels, and higher glomerular filtration rates. No significant difference in mortality was found between patients treated with ECMO compared to patients treated using conventional lung protective ventilation. Hypercapnia, leukocytosis, reduced glomerular filtration rate, and increased serum ferritin levels prior to initiation of V-V ECMO in patients with severe COVID-19 pneumonia may be early warning signs of reduced chance of survival. Further multicentric studies are needed to confirm these findings.

Persistent Increase in Serum Ferritin Levels despite Converting to Permanent Vascular Access in Pediatric Hemodialysis Patients: Pediatric Nephrology Research Consortium Study.

Our objective was to examine serum ferritin trends after conversion to permanent vascular access (PVA) among children who started hemodialysis (HD) using tunneled cuffed catheters (TCC). Retrospective chart reviews were completed on 98 subjects from 20 pediatric HD centers. Serum ferritin levels were collected at the creation of PVA and for two years thereafter. There were 11 (11%) arteriovenous grafts (AVG) and 87 (89%) arteriovenous fistulae (AVF). Their mean TCC use was 10.4 ± 17.3 months. Serum ferritin at PVA creation was elevated at 562.64 ± 492.34 ng/mL, increased to 753.84 ± 561.54 ng/mL (p = < 0.001) in the first year and remained at 759.60 ± 528.11 ng/mL in the second year (p = 0.004). The serum ferritin levels did not show a statistically significant linear association with respective serum hematocrit values. In a multiple linear regression model, there were three predictors of serum ferritin during the first year of follow-up: steroid-resistant nephrotic syndrome as primary etiology (p = 0.035), being from a center that enrolled >10 cases (p = 0.049) and baseline serum ferritin level (p = 0.017). Increasing serum ferritin after conversion to PVA is concerning. This increase is not associated with serum hematocrit trends. Future studies should investigate the correlation of serum transferrin saturation and ferritin levels in pediatric HD patients.

Increase in Serum Ferritin Level as a Marker of Disease Activity in Pediatric Sys-temic Lupus Erythematosus (pSLE) Patients

Ferritin is an acute-phase reactant that is elevated in autoimmune disorders, including systemic lupus erythematosus (SLE). However, their correlation with disease activity scores has not been confirmed. Pandemic Covid-19 makes children visitation to hospital to get the treatment of SLE were delayed. This study aimed to evaluate correlation between serum ferritin and disease activity and its role in screening for flare in pediatric SLE (pSLE) patients during pandemic Covid-19. This is a cross-sectional study conducted in Saiful Anwar General Hospital Malang. Sampling was carried out sequentially on pediatric patients who met the criteria for Systemic Lupus International Collaborating Clinics (SLICC) and were recorded between July 2021-May 2022. All patients were interviewed and assessed for disease activity using SLE Disease Activity Index 2000 (SLEDAI-2k). A score &lt;4 was categorized as inactive disease. Biochemical, serological tests including markers of disease activity and ferritin level were measured by standard laboratory procedure. Comparison, correlation and ROC curve analyses were performed with SPSS software. There were 38 females pSLE participated in this study. The mean age of the patients were 12.6 ± 3.02 years. Serum ferritin significantly higher in active disease compared to inactive disease 84.50 ng/mL (68.00-151.75 ng/mL) ng/mL and 815.00 ng/mL (451.25-1570.00 ng/mL), a value of p&lt;0.05 was determined to be statistically significant. A significant correlation was found between serum ferritin with SLEDAI 2K (r = 0.890, p = 0.000). Correlation was also found between serum ferritin and IgM anti-double stranded-DNA (r = 0.325, p = 0.046), but not with other laboratory and serological parameters. In ROC curve analysis, we found that Area Under The Curve (AUC) 0.989, 95%CI 0.964-1.014, p value 0,000, with cut off value 297.50 with sensitivity 85% and specificity 94.4%. Ferritin was increased in active disease as compared to inactive disease and correlated with SLEDAI score and IgM-dsDNA. Thus, ferritin may be potential as an affordable and available marker of disease activity in pSLE during pandemic Covid-19.

The efficacy and safety of intravenous sucrose iron therapy for recurrent iron deficiency anemia

Objective: To evaluate the efficacy and safety of intravenous iron supplementation in patients with recurrent iron deficiency anemia (IDA) . Methods: This retrospective analysis of 90 patients with recurrent IDA from May 2012 to December 2021 was conducted, comparing the efficacy and safety of the intravenous iron therapy group and the oral iron therapy group. Results: Among the 90 patients with recurrent IDA, 20 were males and 70 were females, with a median age of 40 (range: 14-85) years. A total of 60 patients received intravenous iron supplementation and 30 received oral iron supplementation. The hematologic response rates in the intravenous iron group were significantly higher than those in the oral iron group at 4 and 8 weeks after treatment [80.0% (48/60) vs 3.3% (1/30) and 96.7% (58/60) vs 46.7% (14/30), all P<0.001, respectively]. The median increase in hemoglobin levels was also significantly higher in the intravenous iron group than in the oral iron group [38 (4, 66) g/L vs 7 (1, 22) g/L at week 4 and 44.5 (18, 80) g/L vs 19 (3, 53) g/L at week 8, all P<0.001]. The intravenous iron group had a significantly higher proportion of patients who achieved normal hemoglobin levels than the oral iron group (55.0% vs 0 and 90% vs 43.3%, all P<0.001, respectively). Iron metabolism indicators were tested before and after 8 weeks of treatment in 26 and 7 patients in the intravenous and oral iron groups, respectively. The median increase in serum ferritin (SF) levels in the intravenous iron group 8 weeks after treatment was 113.7 (49.7, 413.5) μg/L, and 54% (14/26) of these patients had SF levels of ≥100 μg/L, which was significantly higher than the median increase in SF levels in the oral iron group [14.0 (5.8, 84.2) μg/L, t=4.760, P<0.001] and the proportion of patients with SF levels of ≥100 μg/L (P=0.013). The incidence of adverse reactions was 3.3% (2/60) in the intravenous iron group, which was significantly lower than that in the oral iron group [20.0% (6/30), P=0.015]. Conclusion: Intravenous iron supplementation is more effective for hematologic response, faster hemoglobin increase, and higher iron storage replenishment rates compared with oral iron supplementation in patients with recurrent IDA, and it is well tolerated by patients.

TO STUDY EFFECTIVENESS OF DEFERASIROX, AN ORAL IRON CHELATOR IN BLOOD TRANSFUSION DEPENDENT PEDIATRIC THALASSEMIA PATIENTS

Background: Inblood transfusion related thalassemia patients, high iron state is observed because of regular blood transfusion. Our body has limited mechanism to excrete iron, excess of iron gets deposited in various organs causing their dysfunction. To prevent the complication associated with this iron overload use of iron chelators becomes important in management of such patients. Aims /Objectives: 1.To determine effectiveness of deferasirox, an oral iron chelator to decrease iron overload in reference to serum ferritin level in blood transfusion dependent pediatric thalassemia patients. 2.To determine effectiveness of deferasirox in reducing iron deposition induced organ damage. Methods: This is a hospital based retrospective observationalstudy conducted on 80 blood transfusion dependent thalassemia patients admitted in tertiary care hospital. Data was collected in pre-designed case record sheets after taking consent from parents. Results:in the present study the mean age was 7.12 years for females and 10.93 years for males. The mean of pre and post blood transfusion hemoglobin was significantly higher (7.07 and 10.76 respectively). The mean blood transfusion days are 26.33. Mean annual blood requirement is 198.99. Mean drop rate is 1.02. On comparing mean ferritin levels, there was a significant difference between baseline (711.81), start of deferasirox treatment (1271.71) and the end of 2nd dose increment of deferasirox (2076.11). The mean ferritin decreased significantly after starting deferasirox (from 1360.03 to 1271.71) by the end of1stdose increment (from 1832.41 to 1696.75) by the end of 2nd dose increment (from 2097.32 to 2076.11) , but when we compare mean ferritin after end of 2nddose increment of deferasirox (2076.11) with6 month back mean ferritin (2506) or current mean ferritin (2514.90) there is increase in ferritin.Mean blood transfusions at start of deferasirox is (11.025), at 1st dose increment is (26.13), at 2nd dose increment is (42.12).There were no organ complications seen with the present population at the end of the study Conclusion: from the results of our study, we state that using deferasirox as oral iron chelator in blood transfusion dependent pediatric thalassemia patients helps in reducing iron overload till we reach maximum dose of oral deferasirox but beyond that there is significant increase in serum ferritin level,thereby necessitating use of another iron chelator along with oral deferasirox(either deferoxamine, deferiprone or some new iron chelator),. Also in this study it is observed that there is no iron deposition related significant organ damage.

Is Serum Ferritin an Early Marker for COVID-19-Associated Mucormycosis?

Background Coronavirus disease 2019 (COVID-19)is a hyperinflammatory disease caused by severe acute respiratory syndrome coronavirus 2, which makes critically ill patients susceptible to invasive fungal infections. Invasive fungal infections such as mucormycosis are associated with high morbidity and mortality. This study aimed to determine theserum ferritin levels in COVID-19-associated mucormycosis (CAM) patients and isolate and identify the fungi causing secondary fungal infections in patients with suspected CAM. Methodology This cross-sectional study was conducted from June to September 2021 among CAM patients admitted to Bowring and Lady Curzon Hospital. After obtaining approval from the institutional ethics committee and valid consent, data regarding demographic details, past medical history, and serum ferritin levels, along with other blood investigations, were carefully collected from patients presenting with clinical features of mucormycosis and a history of COVID-19. Samples were examined under a bright field microscope using wet mounts of samples in KOH, cultured on Sabouraud's dextrose agar, and examined under a microscope after staining with lactophenol cotton blue for the isolation and correct identification of fungi. Statistical analysis was done using Microsoft Excel (Microsoft Corp., Seattle, WA, USA) and SPSS version 26.0 (IBM Corp., Armonk, NY, USA). A p-value less than <0.05 was considered statistically significant. Results A total of 95 patients with CAM were included in this study, comprising 70 males and 25 females. The mean age of presentation was 49.83 ± 12.41 years, with 73% males and 26% females. Type 2 diabetes mellitus was noted in 69% of patients, hypertension in 29%, and steroid use in 42%. The mean serum ferritin level was 537.38 ± 468.88 ng/mL. We found a significant association between increased serum ferritin and a history of diabetes. Serum ferritin levels had a statistically significant correlation with samples of patients who were positive for Mucorales under KOH microscopy. The fungal culture showed the growth of Aspergillus, Mucor, Rhizopus, and Candida. The mean value of serum ferritin in patients who showed mucor growth was 842.09 ng/mL. Conclusions We found a significant increase in serum ferritin levels in CAM patients. Ferritin can be used as an early marker for screening mucormycosis in COVID-19 patients. Monitoring patients with elevated serum ferritin levels in severe COVID-19, glycemic control, judicious use of corticosteroids, early diagnosis, and appropriate treatment can aid in better management of the disease.