Iron Deficiency Research Articles

Does oral iron and folate supplementation during pregnancy protect against adverse birth outcomes and reduced neonatal and infant mortality in Africa: A protocol for a systematic review and meta-analysis?

Globally, one-third of pregnant women are at risk of iron deficiency, particularly in the African region. While recent findings show that iron and folate supplementation can lower the risk of adverse birth outcomes and childhood mortality, our understanding of its impact in Africa remains incomplete due to insufficient evidence. This protocol outlines the systematic review steps to investigate the impact of oral iron and folate supplementation during pregnancy on adverse birth outcomes, neonatal mortality and infant mortality in Africa. MEDLINE, PsycINFO, Embase, Scopus, CINAHL, Web of Science, and Cochrane databases were searched for published articles. Google Scholar and Advanced Google Search were used for gray literature and nonindexed articles. Oral iron and/or folate supplementation during pregnancy is the primary exposure. The review will focus on adverse birth outcomes, neonatal mortality and infant mortality. Both Cochrane Effective Practice and Organization of Care and Newcastle-Ottawa Scale risk of bias assessment tools will be used. Meta-analysis will be conducted if design and data analysis methodologies permit. This systematic review and meta-analysis will provide up-to-date evidence about iron and folate supplementation's role in adverse birth outcomes, neonatal mortality and infant mortality in the African region. This review will provide insights that help policymakers, program planners, researchers, and public health practitioners interested in working in the region. CRD42023452588.

#3019 Hepcidin and erythropoietin along with iron indices to asses anemia in lupus nephritis population

Abstract Background and Aims There is a broad spectrum of hematologic manifestations in SLE including lymphopenia, anemia, thrombocytopenia, or pancytopenia. lymphadenopathy and splenomegaly are also identified especially with high disease activity. Anemia of chronic disease, representing approximately one third of the cases in patients with SLE. Santacruz et al, also reported that iron deficiency anemia is also a common cause, usually caused by blood loss. serum hepcidin levels are high in patients with CKD, and are associated with erythropoiesis stimulating agent resistant anemia due to the inability of stored iron to be accessed for erythropoiesis, they are also high in autoimmune diseases as SLE. we evaluated anaemia in lupus nephrites population by assessing the level of hepcidin, erythropoietin along with iron study Method in this observational study We identified 100 patients with SLE and diagnosed as lupus nephritis by means of renal biopsy ISN/RPS classification 2004 with some missed data about biopsy details, the patients assessed for anaemia by haemoglobin level, iron study (TSAT, ferritin), hepcidin (10-120 μg/L) and erythropoietin level (3-36 IU/L). Demographics, disease characteristics and comorbidities were ascertained and adjusted for. Results 52 % of patients with SLE, LN (mean age 37.85 (9.40) years, 94 % female,) had Hgb<12 g/dl. The two groups of patient were comparable in disease duration but anemia had higher disease activity than patients with normal Hgb (p. value 0.9, 0.001 ). Furthermore, incidence of DM and HTN wasn't have statical significant, laboratory investigation showed anemia is microcytic hypochromic with low TSAT, hepcidin is almost high in 72% of all patients but wasn't significantly different between the two groups but erythropoietin level was normal in 100% of patients in both groups. Conclusion Patients with SLE and LN have an increased prevalence of anemia due to different factors. Our data suggest that iron deficiency anaemia was prevalent in the study group which may be due to high hepcidin level in those group of patient or blood loses especially the majority were females, erythropoietin level as marker of anaemia in lupus nephritis patient had been found to be not an indicator, its receptor resistance or antibodies found in SLE patients.

#2275 Beyond glucose control: SGLT2 inhibitors' impact on hematological parameters in lupus nephritis patients

Abstract Background and Aims There is a broad spectrum of hematologic manifestations in SLE including lymphopenia, anemia, thrombocytopenia, or pancytopenia. Anemia worsens the prognosis of many chronic diseases including lupus nephritis. A recent systematic review and metanalysis showed that hemoglobin and hematocrit levels were significantly increased with SGLT2i therapy when compared to placebo. This study aimed to investigate the effect of SGLT2 inhibitors on hematological parameters including iron profile, hepcidin and erythropoietin levels in lupus nephritis patients. Method Double blind randomized controlled trial. The material of the current study included 79 Lupus nephritis patients who were recruited from Nephrology clinic- Urology and Nephrology Center- Mansoura University. Patients with an estimated glomerular filtration rate (eGFR) >30 ml/min/1.73 m2 had been randomly assigned to 2 groups Study group: included 38 lupus nephritis patients who were randomly assigned to receive dapagliflozin (10 mg once daily) Placebo group: included 41 lupus nephritis who were assigned to receive placebo. The two groups were randomly assigned using computer-generated random tables in a 1:1 ratio and followed up for 12 months. The findings were recorded, tabulated, and analyzed using SPSS22 for windows. Results Both groups had similar ages and gender distribution. BMI, diabetes mellitus, and hypertension rates were comparable between groups. The duration of lupus nephritis and management approaches did not differ. Biopsy results indicated no differences in the class of lupus nephritis. Serum chemistry, including serum creatinine, was similar between groups. The mean hemoglobin levels, MCV and MCH are similar between the control and study groups, with no statistically significant difference (p = 0.5, 0.9 and 0.9 respectively). Regarding iron indices, the median ferritin, TSAT levels show a numerical difference, but it does not reach statistical significance (p = 0.09, 0.05), The mean erythropoietin and hepcidin levels are not significantly different between the groups (p value= 0.1 and 0.9 respectively) also, platelet counts are similar between the groups (p = 0.7). compares hematological investigations before and after the intervention in the study group. There is a statistically significant increase in mean hemoglobin levels post-intervention compared to baseline (p = 0.02) and the mean MCH levels show a numerical increase post-intervention, but the difference is not statistically significant (p = 0.1), but the mean MCV levels do not show a statistically significant change post-intervention (p = 0.7). The median ferritin levels and TSAT values show a numerical increase post-intervention, but the difference is not statistically significant (p = 0.8 and 0.9 respectively). There is a statistically significant decrease in mean hepcidin levels post-intervention (116 ± 15 from baseline 181 ± 76) and (p = 0.001). erythropoietin levels show a numerical increase post-intervention, but the difference is not statistically significant (p = 0.1). there is a slight decrease in platelets counts after intervention but make statistically significant (p = 0.01), but The hematological data after 12 months suggest overall similarity between the control and study groups in terms of hemoglobin, MCV, MCH, ferritin, TSAT, and platelet count, also hepcidin and erythropoietin levels were comparable between both groups (P = 0.7). percentage of participant with anemia (Hgb< 12 g/dl) decreased in study group after intervention from 61% to 42% but with no significant difference with control group (p = 0.3) Conclusion Anemia in lupus nephritis patients is primarily due to iron deficiency, associated with elevated hepcidin levels. Further research is needed to explore these patients' underlying causes of anemia. SGLT2 inhibitors are important add on drugs that has positive effect on varies hematological parameters in lupus nephritis patients in addition to their renal benefits.

#2770 Evaluation of the effect of IV iron therapy on eGFR and Pro-BNP in patients with chronic kidney disease and heart failure with preserved EF

Abstract Background and Aims Iron replacement in treating heart failure (HF) is an issue whose importance has been better understood in recent years. Although controversies exist, randomized controlled studies have shown that IV iron treatment reduces mortality and improves symptomatology in heart failure with low EF (HFrEF). IV iron has not dramatically affected survival in heart failure with preserved EF (HFpEF). However, there is data that it might reduce symptoms and hospitalizations. For patients with chronic kidney disease (CKD) and HF, around 60% of them have HFpEF. Major heart failure and iron studies have often been performed on patients with low EF. Furthermore, in some of these studies, GFR values were not reported, and in the others, GFR was often > 60 ml/minute. We planned this study to evaluate the effects of IV iron therapy on eGFR and Pro-BNP levels in non-dialysis CKD patients with HFpEF. Method This study was conducted between January 2022 and December 2023. Patients with iron deficiency anemia, stage 2-5ND chronic kidney disease, and those with Pro-BNP values of 1000 and above were selected. Two independent cardiologists evaluated them, and the diagnosis of heart failure was confirmed. Patients were given one dose of 500 or 1000 mg of FCM. Control values were obtained at the 1-month follow-up. Hospitalized or transfused patients, cases with primary hematological disease, and cases with conditions affecting ferritin levels were excluded. Patients whose RAAS blockade, SGLT-2 inhibitor, and diuretic doses were changed, were excluded from the analysis. No patients received ESA or HIF stabilizers. Demographic and clinical data of the patients were recorded. The patients' creatinine, eGFR, hemoglobin, ferritin, and pro-BNP levels were evaluated before and after iron treatment Results Seventy-four patients were recruited. Forty-seven patients were women. The average age was 68 ± 11 years. Forty-eight of the patients had diabetes (64.9%) and 47 (63.5%) had coronary artery disease. The etiology of HFpEF was diastolic heart failure in 45 patients (60%). Other patients had valve disease, HFmEF, HFimpEF, isolated right-sided HF, and mixed types of HFpEF. After IV iron treatment, an increase of 3 ± 1 ml/min in GFR and 1.1 ± 0.1 g/dL in hemoglobin was detected. ProBNP levels decreased by 46%. All findings were statistically significant. The findings are summarized in Table 1. Conclusion The decrease in ProBNP levels was similar to the HFrEF literature. No positive or negative effects of iron on GFR were observed in the REVOKE and FIND-CKD studies, which compared oral and IV iron in CKD patients. The small but significant increase in GFR in our study could be attributed to the improvement of cardiac function. However, the small number of patients and the short follow-up period make it difficult to reach a definitive conclusion on this issue. We have shown that IV iron treatment significantly reduces Pro-BNP levels in CKD patients with HFpEF. IV iron has no adverse effects on renal function in the short term, and there is little signal of potential positive effects. Longer-term studies, preferably randomized with oral iron, with appropriate sample size, are needed to evaluate how IV iron affects end-points such as HF symptom score, hospitalization, eGFR slope, need for renal replacement, and mortality in this patient group. Strengths Well-selected patient group, a high Pro-BNP cut-off point, re-evaluation of each patient by the cardiologists Limitations Relatively small cohort, short follow-up period

Causal relationship between iron deficiency anemia and asthma: a Mendelian randomization study

BackgroundObservational studies have suggested an association between iron deficiency anemia (IDA) and asthma, which may affect the occurrence of asthma. However, whether IDA is a new management goal for asthma remains to be determined.ObjectiveWe conducted a two-sample Mendelian randomization(MR)analysis to assess the association between IDA and asthma.MethodsWe performed a two-sample MR study to assess a causal relationship between IDA (ncase = 12,434, ncontrol = 59,827) and asthma (ncase = 20,629, ncontrol = 135,449). Inverse variance weighted (IVW) was used as the primary method for the analyses. Furthermore, we used weighted medians and MR-Egger to enhance robustness. Data linking genetic variation to IDA and asthma were combined to assess the impact of IDA on asthma risk.ResultsThere are five single nucleotide polymorphisms (SNPs) were used as genetic tool variables for exposure factors. Genetically determined IDA was significantly associated with an increased risk of asthma (OR = 1.37, 95% CI: 1.09–1.72, p = 0.007). There was little heterogeneity in the MR studies and no evidence of level pleiotropy was found.ConclusionsIn our MR study, our findings emphasize that IDA may be associated with a high risk of asthma, indicating a potential role for IDA in the development of asthma. Future research needs to elucidate its potential mechanisms to pave the way for the prevention and treatment of asthma.

#1174 Prevalence and factors contributing to erythropoietin hyporesponsiveness in CKD patients on hemodialysis: a single center, cross sectional study

Abstract Background and Aims Anemia, one of the most frequent early complications of CKD is associated with a reduced QOL, cardiovascular morbidity, accelerated CKD progression, and it is an independent predictor of mortality. The successful management of anemia is a vital part of patient care, that improves clinical outcomes. According to the literature, 90% of renal anemia patients responded in a dose-dependent manner to rHu EPO, whereas the remaining 5–10% of patients had either a blunted or absent response to this agent, despite high-dose therapy. Erythropoietin hyporesponsiveness is a strong, independent predictor of mortality risk. Various factors have been associated with ESA hypo responsiveness in different studies. Both the inability to achieve a target hemoglobin and administration of high dose epoetin -alpha are associated with increased risk of CVD complications. AIMS AND OBJECTIVES Method STUDY PERIOD: December 2021 to DECEMBER 2022 STUDY DESIGN: Observational cross sectional study. SAMPLE SIZE: N = 144: Patients older than 18 years old undergoing hemodialysis for at least 3 months before the study were enrolled. History of inpatient treatment, infection, bleeding or transfusion within the last month, hematologic disorders sickle cell disease, MDS and active malignancies were excluded. Required parameters were recorded on every month follow up;Demographic data, Cause of ESRD, Dialysis vintage, ESAs dose (Unit/week), type, Medications history; Dose (mg/week) of iron preparation & use of medication like ACEi, ARBs, dialysis adequacy(Kt/V), haemogram, Liver function test, Kidney function test Iron profile, Serum parathyroid hormone, Serum calcium & phosphorus, CRP, Anti EPO antibodies(if required). We used the European Best Practice Guideline (EBPG) II definition to define ESA hyporesponsiveness for our study purpose(Increase in erythropoietin dose ≥25% to maintain the same Hgb level or < 1 mg/dL gain in Hgb after 4 weeks. EHRI was calculated by dividing weekly ESA dose per kilogram of body weight (IU/Kg/W) by hemoglobin level (g/dL). Based on EHRI, patients were assigned or divided into 2 groups. Group I (EHRI<16) and Group II (EHRI ≥ 16). Patients in the Group II were labeled as erythropoietin hyporesponsive patients and they were compared with others in order to identify the impact of different factors on ESA. Results Among 144 patients, 80 were male and 64 females and 28.4% were diabetic. Mean EHRI were calculated for all patients and based on EHRI pts were divided into two study groups, Gr-I (EHRI<16) & Gr-II(EHRI ≥16). EHRI ≥16 group was considered as ESA hyporesponsive groups. The study parameters were compared between the groups and its statistical significance measured. The overall prevalence of ESA hyporesponsive in our study was 26.3%. Conclusion The overall prevalence of ESA hyporesponsive in our study was 26.3%. Iron deficiency anemia, inadequate dialysis, chronic inflammation, malnutrition, secondary hyperparathyroidism and increased dialysis vintage were the factors associated with ESA hyporesponsiveness.

Endoscopically diagnosed hookworm infestation in an adult with chronic iron deficiency anaemia

Despite advances in hookworm control and prevention campaigns, the prevalence remains high in sub-Saharan Africa. Iron deficiency anaemia is a major complication in those with prolonged infection, a high hookworm burden, and undernutrition, though most infected people are asymptomatic. While infected patients are commonly diagnosed by the presence of ova or cysts in the stool, gastrointestinal (GI) endoscopy is required for those with negative stool tests and chronic iron deficiency anaemia. A 48-year-old female with symptoms of anaemia for nearly two years presented to Mbarara Regional Referral Hospital with worsening palpitations, easy fatigability, and dizziness over a period of one month. She was given blood transfusions on two occasions. She lives near the lake where she also gets water for drinking and domestic use. We advise GI endoscopy for all patients with chronic iron deficiency anaemia of unexplained aetiology on standard non-invasive testing. Hookworm’s mass empirical treatment policy in endemic areas should be further emphasised.

Iron deficiency in children with a focus on inflammatory conditions.

Iron deficiency (ID) tends to be overlooked compared with anemia. However, its prevalence is estimated to be twice as high as that of ID anemia, and ID without anemia can be accompanied by clinical and functional impairments. The symptoms of ID are nonspecific, such as fatigue and lethargy, but can lead to neurodevelopmental disorders in children, restless legs syndrome, and recurrent infections due to immune system dysregulation. In particular, the risk of ID is high in the context of chronic inflammatory diseases (CIDs) due to the reaction of various cytokines and the resulting increase in hepcidin levels; ID further exacerbates these diseases and increases mortality. Therefore, the diagnosis of ID should not be overlooked through ID screening especially in high-risk groups. Ferritin and transferrin saturation levels are the primary laboratory parameters used to diagnose ID. However, as ferritin levels respond to inflammation, the diagnostic criteria differ among guidelines. Therefore, new tools and criteria for accurately diagnosing ID should be developed. Treatment can be initiated only with an accurate diagnosis. Oral iron is typically the first-line treatment for ID; however, the efficacy and safety of intravenous iron have recently been recognized. Symptoms improve quickly after treatment, and the prognosis of accompanying diseases can also be improved. This review highlights the need to improve global awareness of ID diagnosis and treatment, even in the absence of anemia, to improve the quality of life of affected children, especially those with CIDs.

The quality of life and work productivity are affected by the presence of nausea/vomiting in patients taking iron preparations for heavy menstrual bleeding or anemia: a population-based cross-sectional survey in Japan

BackgroundPatients with iron deficiency anemia are treated with iron preparations, but gastrointestinal symptoms such as nausea and vomiting occur frequently. These symptoms may negatively affect the quality of life and work productivity in patients with iron deficiency anemia. This study assessed the impact of nausea and vomiting on the quality of life and work productivity of patients taking iron preparations for heavy menstrual bleeding or anemia.MethodsAn online survey was conducted among patients taking iron preparations for heavy menstrual bleeding or anemia. Demographic data and information about medication use and the health condition were collected. The patients were asked to answer the 5-level EQ-5D version, and work productivity and activity impairment questionnaires. The outcomes were reported by patients in the presences of nausea, vomiting, and nausea or vomiting. The association with the 5-level EQ-5D version utility score for the severity and frequency of the symptoms were also assessed.ResultsA total of 385 patients were enrolled, and 96 were patients with nausea or vomiting, of which 94 were with nausea and 27 were with vomiting. The 5-level EQ-5D version utility scores for the patients with nausea, vomiting, and nausea or vomiting were significantly lower than those of the patients without these symptoms (p < 0.001 for each). The 5-level EQ-5D version utility score was correlated with the severity of nausea and the frequency of vomiting per day (p < 0.001 for each). As for the work productivity and activity impairment, the presenteeism, the overall work impairment, and the activity impairment of the patients with nausea, vomiting, and nausea or vomiting were significantly higher than those without these symptoms (p < 0.001 for each). The absenteeism was slightly higher trend was observed, but not significant.ConclusionPatients taking iron preparations who have nausea or vomiting experience a significant burden in terms of poorer quality of life and higher work productivity impairment.Trial registrationUMIN000045700 (http://www.umin.ac.jp/ctr/). Registered on October 11, 2021.

Role of Intravenous Iron in Current Era

Iron is an essential trace mineral necessary for life, and iron deficiency anaemia (IDA) is one of the most common haematological problems worldwide. Oral iron replacement therapy is a simple, inexpensive treatment option for the treatment of iron deficiency in stable patients, but there are many populations for whom IV iron is more effective. Therefore, IV iron should be considered when there are no contraindications, when poor response to oral iron is anticipated, when rapid hematologic responses are desired. Third generation intravenous (IV) iron therapies allow rapid and complete replacement dosing without the toxicity issues inherent with older iron preparations. This review provides an updated overview on diagnosis and management of IDA in patients with chronic conditions, preoperative and considers the properties of the different IV irons, and how differences might impact current and future clinical practice. We will discuss the benefits and limitations of oral versus intravenous iron replacement. Keywords: Anaemia; Intravenous Iron; Iron Deficiency; Oral Iron

Fluorescence lifetime of plant leaves with sub-nanosecond resolution

The study aimed to develop a measurement apparatus for in vivo chlorophyll-a (Chl-a) fluorescence decay measurements of plants by means of time correlated single photon counting. In this approach, sub-nanosecond laser pulses with a repetition rate of 10 MHz are applied to excite the sample, followed by the analysis of arrival times of the emitted fluorescence photons. Photon statistics are generated by iteratively fitting the sum of two exponential functions. The tool was tested on both plastid and in vivo leaf samples of Savoy cabbage (Brassica oleracea var. sabauda) with 3–4 subsequent leaves giving a complete sample coverage starting from the outermost. The Chl-a fluorescence lifetime exhibited a gradual increase in both the isolated plastid suspensions and the in vivo leaf samples towards the innermost leaf layers explained by an increase of natural absence of light (etiolation syndrome). Furthermore, cadmium stress and iron deficiency were investigated on treated sugar beet (Beta vulgaris) samples in vivo using TCSPS measurements. The reduced fluorescence quenching resulted in an increased fluorescence lifetime. Finally, a long-term (10 week) testing of the setup was carried out on Chl-retaining resurrection Haberlea rhodopensis plants protecting themselves by an elevated non-photochemical quenching yielding a decrease of fluorescence lifetime during their desiccation.

Leading with dysphagia… An unusual view of a common symptom.

Plummer-Vinson syndrome (PVS) is characterized by the classic triad of post-cricoid dysphagia, iron-deficiency anemia and esophageal webs. PVS is commonly found in women of middle age especially in the fourth and fifth decade of life. The prevalence of PVS has decreased due to early detection of iron deficiency and repletion of iron stores. We report a case of a 81-year-old female patient who had a classic presentation of PVS, treated successfully with endoscopic procedure. To our knowledge, the current case is the fourth case of dysphagia related to Plummer-Vinson syndrome reported in an octogenarian in the literature so far. Iron supplementation can resolve dysphagia in many patients, but dilation of esophageal webs may sometimes be required. PVS should be part of the differential diagnosis of sideropenic dysphagia, especially due the risk of pharyngeal and esophageal epidermoid neoplasia.

Iron deficiency, anemia and atrial fibrillation

Iron deficiency, anemia and atrial fibrillation

Role of BACH1 in multiple myeloma

ABSTRACT Objective Examine Bach1 protein expression in bone marrow biopsy specimens obtained from newly diagnosed multiple myeloma (NDMM) and iron deficiency anemia (IDA) patients. Conduct a thorough analysis to explore the potential connection between Bach1 and the onset as well as treatment response of NDMM. Methods This study investigated Bach1 expression in bone marrow biopsy tissues from NDMM and IDA patients. Immunohistochemical staining and Image-pro Plus software were utilized for quantitatively obtaining the expression level of Bach1 protein. Arrange Bach1 expression levels from high to low, and use its median expression level as the threshold. Samples with Bach1 expression level above the median are categorized as the high-expression group, while those below the median are categorized as the low-expression group. Under this grouping, a detailed discussion was conducted to explore relationship of the Bach1 expression level with the patients’ gender, ISS stage, and survival rate based on the Bortezomib (Btz) therapy. Results Our experiment indicates that the expression level of Bach1 in NDMM patients is significantly higher than in IDA patients. Furthermore, we discovered that patients in the high-expression group exhibit better prognosis compared to those in the low-expression group after Btz-treatment. Bioinformatics analysis further confirms this conclusion. Conclusion By categorizing Bach1 expression level as high and low, our study offers a unique perspective on understanding the relationship between Bach1 and NDMM.

The relationship of hypothyroidism to iron deficiency in the body: Review Article

The lack of iron storage has a significant impact on the thyroid gland's efficiency, and its synthesis of hormones, which are required for biological activities in the body, has been compromised. Furthermore, thyroid issues have a negative impact on iron levels in the body and the amount of iron stored. Inactivity of the gland leads to poor iron absorption, and it is frequently misdiagnosed with hypothyroidism due to similar symptoms. Although hypothyroidism and iron insufficiency are distinct illnesses, they are sometimes linked. Hypothyroidism can impair the body's ability to absorb iron, resulting in iron deficiency anemia. Furthermore, because both illnesses can induce symptoms like weariness, weakness, and pale skin, it's critical to receive a good diagnosis to discover the underlying source of these symptoms. Iron deficiency is commonly connected with hypothyroidism. Current research has demonstrated that adding iron to hormonal therapy for the treatment of pathological hypothyroidism situations improved the pathological condition as compared to using hormonal therapy for the thyroid gland alone.

Use of Different Iron Preparations for Prophylaxis and Effects on Iron Status in Infancy.

Aim: To evaluate using different iron preparations for iron deficiency and/or iron deficiency anemia prophylaxis in infants and their iron status. Methods: In this study, we retrospectively evaluated the electronic patient records of 651 healthy children aged 9 to 13 months who met the inclusion criteria and who were followed up in pediatric follow-up outpatient clinics between January 2023 and June 2023. Results: A total of 651 children with a mean age of 11.2 ± 1.4 months, 54.7% of whom were boys, who met the inclusion criteria were included in the study; 56.5% of the children were using Fe + 3 salt and the others were using Fe + 2 salt, microencapsulated iron, or sucrosomial iron drops. After the fifth month of prophylaxis, when the effects of the iron preparations used on the mean laboratory values were evaluated, it was found that hemoglobin, serum iron, and ferritin levels were lower in sucrosomial iron and microencapsulated iron users compared to other preparations (p = 0.001). When statistically pairwise comparisons were made between the groups, hemoglobin and serum iron values were found to be lower in the group using sucrosomial iron compared to the groups using Fe + 2 and Fe + 3 salts (p < 0.0001). Hemoglobin and ferritin levels were higher in the group using Fe + 2 salt compared to both sucrosomial iron and microencapsulated iron groups (p < 0.0001). When the infants were evaluated according to iron status, it was found that 208 (31.9%) had iron deficiency. Iron deficiency was found to be less in infants of families who defined their economic status as rich and in infants who used iron regularly (p-values 0.044 and 0.001, respectively). Iron deficiency/iron deficiency anemia was observed at a higher rate in the group using sucrosomial iron and microencapsulated iron prophylaxis (p = 0.001). Conclusions: To prevent iron deficiency, it is very important to use appropriate iron preparations for prophylaxis and to feed foods with high iron content. Although we found that families were willing to use different iron preparations other than iron salts for their infants, the results presented herein indicate that the rate of iron deficiency was lower in patients using iron salts. However, randomized controlled studies are needed to determine whether these preparations are effective in iron prophylaxis in infants.

Iron parameters analysis in dogs with myxomatous mitral valve disease.

Myxomatous mitral valve disease (MMVD) is the most common acquired cardiovascular disease in small breed dogs. In contrast to human patients with heart failure (HF), iron deficiency (ID) prevalence in dogs with MMVD is weakly known. The study aimed to assess the usability of ID markers in serum and reticulocyte parameters from whole blood of dogs with MMVD to evaluate early ID symptoms. Sixty-eight dogs (43 male and 25 female) were included in the study. MMVD dogs were assigned according to the 2019 ACVIM guidelines for groups B1 (n = 9), B2 (n = 10), C (n = 27) and D (n = 10). Groups were also combined into B1 and B2 as non-symptomatic HF and C with D as symptomatic HF. Healthy controls were 12 dogs. Serum iron concentration below the reference range in dogs with MMVD was 12.5%. Other ID indices, such as %SAT, UIBC, and TIBC were similar in the MMVD groups and healthy controls (p > 0.05 for all parameters). Statistical comparison between control group and 4 groups of different stages of MMVD showed that significant differences occur only in serum transferrin. The assessment of ferritin and soluble transferrin receptors using Western Blotting did not show differences between control (n = 7) and MMVD (n = 33) dogs. Study has shown positive correlation between ID parameters and echocardiographic indices such as LA/Ao and LVIDdN, and some biochemical parameters. A significant increase in reticulocytes percentage, assessed manually, was observed in the HF group of animals (p = 0.027) compared to the control group. Studies have shown that ID parameters in serum are not significantly different in dogs with MMVD compared to healthy dogs. However, there is a clear correlation between atrial size and normalised left ventricular size to body size and some biochemical parameters, including ID parameters and therefore the severity of MMVD.

Long-term Effects of Iron Deficiency in Early Infancy on Neurodevelopment

Introduction and Purpose: Iron deficiency alongside anaemia is one of the most significant global health concerns with potentially long-lasting implications on child development and health outcomes. The period of infancy represents a crucial phase of central nervous system maturation, rendering infants particularly susceptible to the adverse effects of iron deficiency. It is therefore crucial to pay close attention to this issue. The aim of this review is to elucidate the neurological implications of iron deficiency in infancy and emphasize the necessity of implementing preventive strategies to safeguard child development. State of Knowledge: Iron deficiency in infancy can result in impairments of brain development. Extensive research highlights the influence of this micronutrient on various physiological processes, including the synthesis of neurotransmitters, neuronal metabolism, myelination, synaptogenesis and gene expression. Furthermore, iron deficiency during infancy is associated with adverse developmental outcomes, including cognitive, motor, and socioemotional deficits. Long-term follow-up studies have elucidated the enduring neurological consequences of iron deficiency in infancy, with effects extending into childhood and beyond. Summary: Given that the changes that occur during the infantile period are often irreversible and have long-lasting implications for future development, it is of the utmost importance to prioritize prevention strategies.

Association of dietary iron intake with diabetic kidney disease among individuals with diabetes.

The current study investigated the correlation between dietary iron intake and diabetic kidney disease among diabetic adults. This cross-sectional study enrolled 8118 participants who suffered from diabetes from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Dietary iron intake was obtained from 24 h recall interviews, and diabetic kidney disease was defined as eGFR < 60 mL/min per 1.73 m2 or albumin creatinine ratio (ACR) ≥ 30 mg/g. Three weighted logistic regression models were utilized to investigate odd ratio (OR) and 95% CIs for diabetic kidney disease. Stratified analyses were performed by gender, age, BMI, HbA1c, hypertension status, and smoking status, and diabetes types. Among 8118 participants (51.6% male, mean age 61.3 years), 40.7% of participants suffered from diabetic kidney disease. With the adjustment of potential covariates, we found that ≥ 12.59 mg of dietary iron was related to a lower risk of diabetic kidney disease (OR = 0.78, 95% CI: 0.63 to 0.96; OR = 0.79, 95% CI: 0.63 to 0.98). In stratified analyses, higher iron intake was negatively related to diabetic kidney disease, especially among those who were male, < 60 years, those with hypertension, those with HbA1c < 7.0%, and those who were ex-smokers. The result remained robust in sensitivity analyses. We found that ≥ 12.59 mg of dietary iron is associated with a lower risk of diabetic kidney disease, especially in those who were male, younger, heavier weight, have better blood sugar control, and those who were ex-smokers.

Gastroscopy Yield in the Young: Comprehensive Assessment of Endoscopic and Histologic Findings—A Comparative Study

Background. The escalating utilization of gastroscopy in young individuals necessitates an in-depth examination of its diagnostic yield and outcomes in this population. This study aims to investigate and compare various aspects of gastroscopy between young and older adults, shedding light on age-related differences in indications, endoscopic findings, histologic outcomes, and clinically significant findings (CSFs). Methods. A retrospective, large cohort study spanning five years, focused on consecutive patients undergoing gastroscopy. We analyzed age subgroups, specifically categorizing patients into those aged 30 and below, 30–39, 40–49, and a control group aged 50 and above. The investigation aimed to compare various aspects of gastroscopy outcomes among these distinct age categories. Indication-based analyses were conducted to assess the yield and outcomes in these subgroups, focusing on CSFs and the number needed to investigate (NNTI). Results. A total of 1313 young patients aged 16–49 and 3396 controls aged 50 and above were included. Among the young patients, unspecified epigastric pain and dyspepsia emerged as a prevalent indication, accounting for 41.5% of cases. Endoscopic findings revealed a significantly higher diagnosis rate of gastritis than controls (48.2% vs. 35.7%; p&lt;0.001). Histologic analysis demonstrated a substantially elevated rate of H. pylori-associated gastritis in the young (41.1% vs. 29%; p&lt;0.001). Notably, although significantly lower than older controls, precancerous lesions were detected in 7.5% of young patients. CSFs’ diagnosis rate displayed a clear age-dependent increase. Particularly, gastroscopy for upper gastrointestinal bleeding and iron deficiency anemia were associated with higher CSF rates across all young-age subgroups. In multivariate analysis, age and indications of upper gastrointestinal bleeding and iron deficiency anemia were predictors of CSFs’ detection in young patients. Conclusion. This study comprehensively delineates various facets of gastroscopy in the young population, elucidating age and indication-specific patterns in endoscopic and histologic findings, and clinically significant outcomes.