Low Serum Ferritin Levels Research Articles

Assessment of diagnostic accuracy of Gazelle: A point-of-care testing device for screening β-thalassemia trait

Background & objectives Timely detection of population with β-thalassemia trait (BTT) followed by genetic counselling is an advocated method of preventing the birth of a child with β-thalassemia major. In this study we aim to assess the diagnostic accuracy of Gazelle, a point-of-care (POC) testing device, in screening for BTT in hospital laboratory setting. Methods Standards for Reporting Diagnostic Accuracy (STARD) guidelines were followed in developing study design, recruiting study participants and sample size calculation for the current research. A consecutive sample of 446 participants was recruited for this study and was tested for the reference test Gazelle as well as the gold standard cation exchange high performance liquid chromatography (CE-HPLC). Low serum ferritin levels are known to interfere with the production of HbA2 and in turn lead to false negative results. Hence, the study population was divided into two categories with respect to a cut off value of 15ng/dl of serum ferritin and the results were analyzed. Results Overall diagnostic accuracy of Gazelle for detecting BTT was found to be 95.3 per cent with a confidence interval (CI) of (92.9 - 97.1) and the sensitivity was 94.5 per cent with a 95% CI of (84.8 - 98.8). When analyzed by the serum ferritin level the diagnostic accuracy was found to be 94.7 per cent (91.1% - 97.1%) and 95.7 per cent (91.8% - 98.1%) for participants with serum ferritin level as > 15 ng/ml and < 15 ng/ml, respectively. Interpretation & conclusions This study found Gazelle to be a good screening tool for β-thalassemia trait with high sensitivity, specificity and accuracy. However, it is recommended that the final confirmation of the diagnosis done by a diagnostic test like HPLC or Capillary Zone Electrophoresis (CZE).

The Impact of Iron Deficiency on Prognosis in Stroke and Non-Stroke Populations: A Retrospective Cohort Study

Background and AimsIron deficiency (ID) leads to a significant global health burden, but research on the impact of ID on the prognosis of stroke patients is rare. We aim to investigate the impact of ID on the all-cause mortality of both the stroke and non-stroke individuals. Methods and ResultsThis retrospective cohort study used data from the National Health and Nutrition Examination Survey (NHANES) conducted from 1999 to 2002. The follow-up period for the participants extended until December 31, 2019. Overall, 7239 participants were enrolled, out of which 200 had a history of stroke. There was no difference in the prevalence of ID (ferritin <100 ng/mL or serum ferritin concentration 100-299 ng/mL with transferrin saturation (TSAT) <20%) between stroke and non-stroke individuals (68% vs 65%, P =0.5) even after propensity score matching (68% vs 63%, P =0.5). In stroke survivors, ID was found to be associated with a higher risk of all-cause mortality over a 5-year period (HR: 4.16, 95% CI: 1.54-11.3, P = 0.005). Additionally, there was no link between ID and all-cause mortality in individuals without stroke. Moreover, we did not observe a significant association between dietary iron, total folate, and ID in stroke patients. ConclusionStroke survivors with low serum ferritin levels have an increased risk of 5-year all-cause mortality. Health care providers should consider screening for ID among individuals with a history of stroke. Future clinical trials examining the effects of iron therapy on patients with stroke and coexisting ID are warranted.

Evaluation of Iron Deficiency Anemia in Pregnancy

Anemia in pregnancy was the common nutritional deficiency and a frequent medical concern that leads to numerous known complications, impacting both maternal and fetal health. Objective: To evaluate the biochemical parameters such as serum Iron, Ferritin TIBS and TfS in anemic and non-anemic pregnant women. Methods: In this cross-sectional study, pregnant women age 18-45 years attending the gynecological department of Niazi welfare foundation teaching hospital, Sargodha from April 2023 to January 2024 were included. Serum iron, ferritin, total iron-binding capacity, and transferrin saturation were assessed from blood samples. Independent sample t-test in SPSS version 26.0 was applied to see significant difference in biochemical parameters at value of &lt;0.05. Results: Findings revealed mean hemoglobin level of 10.26 ± 1.52 g/dl in all participants. Anemic results were found in majority, accounting for 268 (70.9%) cases. Among these anemic patients, 149 (55.5%) had mild anemia, 107 (40%) had moderate anemia, and 12 (4.5%) had severe anemia. Anemic patients had significantly lower serum ferritin level (p = 0.02), serum iron (p &lt; 0.001), and transferrin saturation (p &lt; 0.002) than non-anemic patients. Additionally, total iron-binding capacity, (p &lt; 0.001) indicated the anemic status of the pregnant women. Conclusions: Biochemical parameters of pregnant women with anemia were reduced compared to those without anemia. Healthcare providers should closely monitor pregnant women with reduced biochemical levels to prevent complications for both the mother and the fetus.

Serum Alpha-synuclein in Restless Legs Syndrome.

To determine any correlation between serum alpha-synuclein (α-syn) concentrations and restless legs syndrome (RLS), and to explore the impact of intravenous iron supplementation on serum α-syn levels. We collected clinical data on 113 RLS patients in whom serum α-syn levels were quantified using an ELISA kit and compared to a group of 45 age matched controls. A subset of 9 RLS patients who received intravenous (IV) iron underwent pre- and post-treatment blood sampling to assess α-syn and ferritin response. Family history of RLS was reported by 62.8% of patients, and current dopaminergic augmentation was observed in 31.0%. Low serum ferritin levels below 75 μg/L were seen in 39.8%. Serum α-syn levels were found to be significantly decreased in RLS patients (mean: 7.7ng/ml) compared to controls (mean: 10.7ng/ml,), p<0.05. Stratification based on sex, age and age of onset, did not reveal significant differences in α-syn levels. In 9 RLS patients who received IV iron treatment, a linear correlation between fold change in α-syn and ferritin was observed (R: 0.7, p <0.05). The temporal relation between serum α-syn and IV iron treatment showed a gradual decline of α-syn and ferritin by time correlation (p = 0.023, R: -0.739). In our study of 113 RLS subjects, serum α-syn levels were decreased in RLS patients compared to healthy controls and increased in the 9 patients who received IV iron treatment in correlation with ferritin. This correlation could suggest a mechanism for reduced dopamine transmission in RLS.

Preoperative serum ferritin as a biomarker for predicting delirium among elderly patients receiving non-cardiac surgery: a retrospective cohort study

Iron metabolism disorder has been identified as a contributor to the pathogenesis and progression of multiple cognitive dysfunction-related diseases, including postoperative delirium. However, the association between preoperative iron reserves and postoperative delirium risk remains elusive. This retrospective cohort study aimed to explore the impact of preoperative serum ferritin levels on the risk of postoperative delirium in elderly patients undergoing non-neurosurgical and non-cardiac procedures. Conducted at the Chinese PLA General Hospital between January 2014 and December 2021, the study finally included 12,841 patients aged 65 years and above. Preoperative serum ferritin levels were assessed within 30 days before surgery, and postoperative delirium occurrence within the first seven days after surgery was determined through medical chart review. The analyses revealed that both low and high levels of serum ferritin were associated with an increased risk of postoperative delirium. Patients in the lowest quintile of serum ferritin exhibited an 81% increased risk, while those in the highest quintile faced a 91% increased risk compared to those in the second quintile. Furthermore, mediation analyses indicated that the direct effect of preoperative serum ferritin on postoperative delirium contradicted its indirect effect mediated by hemoglobin levels. These findings suggest that maintaining serum ferritin within moderate range preoperatively could be beneficial for managing postoperative delirium risk among elderly patients.

Analysis of erythrocyte and iron study data among plateletpheresis donors in Hangzhou, China

BackgroundThe purpose of this study is to obtain the iron parameters level of blood donors and the population who need to pay attention to iron parameters level in this area. MethodsA total of 993 plateletpheresis donors were included in this study, including 798 males and 195 females. The results of erythrocyte and iron parameters of blood donors were compared and analyzed in different groups according to the gender, age and number of blood donations. ResultThe proportion of men and women with low serum ferritin (SF) levels was 10.8 % and 27.7 %, respectively. The mean levels of serum iron (SI), SF, transferrin saturation (Tfs), hemoglobin (Hb) and hematocrit (HCT) of male blood donors decreased with the increase of age groups, but there was no significant statistical difference between the results of female blood donors. The level of SI, SF, Tfs, Hb and HCT of male donors decreased with the increase of blood donations in the past year, while TRF and TIBC increased. The level of Hb, HCT and SF of female donors showed no significant downward trend, while the levels of TRF increased with increasing donations in the past year, excluding first-time donors. The SI of female donors trended down, and TIBC trended up with increasing donations. ConclusionBlood collection institutions need to focus on iron parameters levels in older and frequent male donors, and young fertile female donors.

Impact of TNFRSF1B (rs3397, rs1061624 and rs1061622) and IL6 (rs1800796, rs1800797 and rs1554606) Gene Polymorphisms on Inflammatory Response in Patients with End-Stage Kidney Disease Undergoing Dialysis.

We aimed to study the impact of polymorphisms in the genes encoding interleukin-6 (IL6) and tumor necrosis factor receptor-2 (TNFR2), reported to be mortality risk predictors, in patients with end-stage kidney disease (ESKD) undergoing dialysis. TNFRSF1B (rs3397, rs1061624, and rs1061622) and IL6 (rs1800796, rs1800797, and rs1554606) polymorphisms were studied in patients with ESKD and controls; the genotype and allele frequencies and the associations with inflammatory and erythropoiesis markers were determined; deaths were recorded throughout the following two years. The genotype and allele frequencies for the TNFRSF1B rs3397 polymorphism were different in these patients compared to those in the controls and the global and European populations, and patients with the C allele were less common. Patients with the CC genotype for TNFRSF1B rs3397 presented higher hemoglobin and erythrocyte counts and lower TNF-α levels, suggesting a more favorable inflammatory response that seems to be associated with erythropoiesis improvement. Patients with the GG genotype for TNFRSF1B rs1061622 showed lower serum ferritin levels. None of the TNFRSF1B (rs3397, rs1061624, and rs1061622) or IL6 (rs1800796, rs1800797, and rs1554606) polymorphisms had a significant impact on the all-cause mortality rate of Portuguese patients with ESKD.

Serum ferritin levels in children of simple febrile seizures in tertiary institute

Background: Seizure onset is impacted by a number of variables, including genetics, diet, geography, concurrent illnesses, metabolic state, history of head trauma, and blood levels of particular minerals. Due to the fact that iron is required for the proper functioning of a number of enzymes and neurotransmitters in the central nervous system, low blood ferritin levels may lower the seizure threshold. The aim of the study was to determine the association between serum ferritin levels and simple febrile seizures. Methods: The present observational study was conducted in department of pediatrics of a tertiary institute and included a total of 200 study subjects who visited to pediatric OPD/emergency room with febrile illness. The data was collected with the help of a structured clinical proforma. The collected data was recorded in Microsoft Excel sheet and statistical analysis was done with the help of SPSS version 21.0. Results: In our study, the maximum number of the study subjects were between 13 and 24 months (35%) with male to female ratio 1.2:1. In patients with simple febrile seizure the mean Hb level was 9.1±1.4 gm/dl, the mean MCV was 72.6±7.4 f1, mean MCH was 23.73±3.2 pg and mean serum ferritin was 13.4±9.5 ng/ml as compared to those patients with febrile illness without seizure the mean Hb level was 11.5±1.2 gm/dl, mean MCV was 82.1±5.5 f1, mean MCH was 29.6±2.9 pg and mean serum ferritin was 33.6±20.2 ng/ml. Conclusions: It is concluded that the low serum ferritin level is a risk factor of simple febrile seizure.

Association of Risk Factors with Female Pattern Hair Loss

Introduction: Female Pattern Hair Loss (FPHL) is one of the main causes of hair loss in adult women and has a major impact on individual’s quality of life. It evolves from the progressive miniaturization of follicles that lead to a subsequent decrease of the hair density, leading to a non-scarring diffuse alopecia. In spite of the high frequency of the disease and the relevance of its psychological impact, its pathogenesis is not yet fully understood, being influenced by genetic, hormonal, and environmental factors. Objective: To evaluate etiological factors associated with female pattern hair loss. Materials &amp; Methods: This was a hospital-based case control study, conducted in the Department of Dermatology &amp; Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from March, 2021 to August, 2022. In this study, total 100 females aged 18 to 45 years were enrolled. Among them, 30 females had history of hair loss &gt;6 months, presented to outpatient department, BSMMU were included as case &amp; 70 healthy females who had no history of hair loss included as control according to inclusion &amp; exclusion criteria. Diagnosis of FPHL was made clinically &amp; Ludwig classifications were used to assess the degree of hair loss. Information on possible risk factors for FPHL was collected using a questionnaire interview. Result: The mean age of the patients with FPHL was 41.0±7.77 years with majority belongs to &gt;40 years of age group &amp; their mean duration of hair loss was 26.3±12.0 months. Among the patients of FPHL, 36.7% had history of inadequate intake of iron containing food, 66.7% had family history of alopecia, 36.7% had history of increased bleeding during their menstruation, 20.0% had multiple (&gt;3) childbirth &amp; 23.3% had hypertension. About 86.7% patients with FPHL had low serum ferritin (&lt;30ng/ml) with mean serum ferritin level was 20.25±16.07ng/ml and 66.7% patients of FPHL had low Hb (&lt;12 µg/l) with mean Hb was 11.47±1.52 µg/l. In the multivariate logistic regression analysis significant association found with FPHL were age (OR 2.013, 95% CI 0.672-3.714), family history of alopecia (OR1.231, 95% CI 0.162-1.991) and lower serum ferritin level (OR1.090, 95% CI 1.043-1.139). Conclusion: Age, family history of alopecia, lower serum ferritin may be implicated as risk factors for female pattern hair loss. Medicine Today 2023 Vol.36 (1): 7-11

Association of Low Serum Ferritin Levels in Patients Having Alopecia Areata: A Case Control Study

Introduction: Alopecia areata is a medical condition characterized by non-scarring hair loss occurring in patches. Etiopatho-genesis of the disease involves genetic, immunological and various other factors. Reduced ferritin stores lead to impaired DNA synthesis disrupting hair follicle production hence playing a role in the patho-physiology of alopecia areata. Aims &amp; Objectives: To establish the association of low serum ferritin levels and alopecia areata. Place and Duration of Study: The study was conducted for duration of six months from February to August 2022 at Dermatology Department Shalamar Hospital, Lahore. Material &amp; Method: A total of 104 participants were recruited for this study, into a group of 52 patients having alopecia areata and 52 age and gender matched healthy controls. All these participants were advised to get their serum ferritin levels done from the same laboratory to control bias. Values of serum ferritin levels were recorded in ng/ml on a predesigned proforma. The data was analyzed using SPSS version 23.0. Frequencies and percentages were calculated for qualitative variables, p ? 0.05 was considered statistically significant. Results: Mean age was 30.63±4.15 years in case group and 29.94±3.65 years in control group. Within each group (n=52), 16 were males whereas 36 were females (p=1.000). Serum ferritin levels were 18.82±4.47ng/ml in case group and 20.92±4.31ng/ml in control group (p=0.017). Frequency of low serum ferritin level was 63%(29) in case group and 37 %(17) in control group (p=0.029) with significant Odds Ratio of 2.596. Conclusion: We concluded that there is significant association of alopecia areata and low serum ferritin levels and early detection and restoration of iron stores may potentially enhance the management of alopecia areata.

Serum ferritin and neutrophil-to-lymphocyte ratio predict all-cause mortality in patients receiving maintenance hemodialysis: a prospective study.

Introduction: Maintenance hemodialysis is an effective treatment for end-stage renal disease patients. A critical factor contributing to the deterioration and death of maintenance hemodialysis patients is inflammation. Therefore, we focused on two inflammatory markers, serum ferritin and neutrophil-to-lymphocyte ratio, to speculate whether they could predict the prognosis of maintenance hemodialysis patients. Patients and methods: We followed 168 patients with maintenance hemodialysis from July 2019 to July 2022 with the endpoint of all-cause death or follow-up completion. Receiver operating characteristic curves were plotted to assess the values of serum ferritin, neutrophil-to-lymphocyte ratio and serum ferritin combined with neutrophil-to-lymphocyte ratio to predict the outcomes of maintenance hemodialysis patients. Kaplan-Meier survival curves were constructed to compare survival rates over time. Results: Receiver operating characteristic curves demonstrated that the best cut-off value of serum ferritin for predicting the prognosis of maintenance hemodialysis patients was 346.05μg/L, and that of neutrophil-to-lymphocyte ratio was 3.225. Furthermore, a combination of both had a more excellent predicting value than either index (p < 0.05). Kaplan-Meier survival curve analyses revealed that low serum ferritin levels and low neutrophil-to-lymphocyte ratio had a higher probability of survival than high ferritin levels and high neutrophil-to-lymphocyte ratio, separately. Conclusion: Elevated serum ferritin and neutrophil-to-lymphocyte ratio are closely related to all-cause mortality among maintenance hemodialysis patients, for which they may be predictors of all-cause mortality. Additionally, the combination of the two has a much higher predictor value for the prognosis of maintenance hemodialysis patients.

Lower serum ferritin levels are associated with worse cognitive performance in aging

ObjectivesIron is important for neurogenesis, synaptic development, and neurotransmitter synthesis. Serum ferritin (SF) is a reliable marker for assessing iron stores. Therefore, we evaluated the cognitive function associated with SF levels. We also assessed brain iron content using R2* Magnetic Resonance Imaging (MRI) and its association with SF levels. DesignData from three cross-sectional observational studies were used. Aging Imageomics (n = 1030) was conducted on aged subjects. Health Imageomics (n = 971) and IR0NMET (n = 175) were conducted in middle-aged subjects. Setting and participantsParticipants were enrolled at Dr. Josep Trueta University Hospital facilities. The three cohorts included a total of 2176 subjects (mean age, 52 years; 48% men). MeasurementsSF levels were measured by standard laboratory methods. Total Digits Span (TDS), and Phonemic Verbal Fluency (PVF) were used to assess executive function. Language function was assessed by semantic verbal fluency (SVF), attention by the Symbol Digit Modalities Test, and memory by the Memory Binding Tests - Total Free Recall and Total Delayed Free Recall. MRI was used to assess the iron content of the brain by R2*. ResultsIn subjects aged 65 years or older, SF levels were associated with increased TDS (β = 0.003, p = 0.02), PVF (β = 0.004, p = 0.01), and SVF (β = 0.004, p = 0.002) scores. After stratification by sex, these findings were significant only in men, where SF was associated with increased TDS (β = 0.003, p = 0.01), PVF (β = 0.004, p = 0.03), and SVF (β = 0.004, p = 0.009) scores. In middle-aged subjects, SF was also associated with increased SVF scores (β = 0.005, p = 0.011). Lastly, in men, SF levels were negatively associated with R2*, a surrogate marker of brain iron content, in both the left frontal inferior opercular area (r = −0.41, p = 0.005) and the right frontal inferior opercular area (r = −0.44, p = 0.002). ConclusionsSF is significantly and positively associated with cognition. In older people with low SF levels, iron supplementation may be a promising therapy to improve cognition.

Can serum ferritin serve as a biomarker for the prognosis of gynecological malignant tumors? A retrospective cohort study.

It is widely accepted that there is a strong relationship between iron levels and cancer. This study aimed to investigate the relationship between serum ferritin levels and the severity and prognosis of gynecological malignant tumors. This retrospective study included patients with gynecological malignant tumors at Sir Run Run Shaw Hospital in the Department of Obstetrics and Gynecology from January 2013 to June 2019. Patients were grouped according to their serum ferritin level: low (< 13μg/L), normal (13-150μg/L), and high (> 150μg/L). Correlation analyses were performed between serum ferritin level and other factors. Cox univariable and multivariable analysis and Kaplan-Meier survival curves were used to assess the impact of ferritin on survival in patients with gynecologic tumors. The 402 total patients were divided into a low (n= 37), normal (n= 182), and high (n= 183) ferritin level group. Correlation analyses were performed that WBC, MCV, CRP, CA125, and CA153 were significantly positively correlated with serum ferritin level. The Kaplan-Meier survival curves revealed that of the three groups analyzed, the high serum ferritin level group had a significantly shorter survival time versus the normal and low serum ferritin level groups (log-rank P= 0.003). Univariable Cox regression analysis identified that patients with high serum ferritin levels had a significant correlation with risk of death compared to the patients with lower and normal serum ferritin levels. Serum ferritin was not found to be significant (HR = 0.792, 95% CI: 0.351-1.787, P= 0.574) in the multivariable Cox analysis. Although this study did not find serum ferritin to be a significant independent prognosis indicator in gynecological malignant tumors, this study did identify that gynecological malignant tumor patients with high serum ferritin levels have significantly less survival time than patients with low or normal serum ferritin levels.

Assessing Nutritional Anemia Among University Students in Jazan, Saudi Arabia: A Public Health Perspective.

Nutritional anemia is a significant public health concern worldwide, particularly affecting young adults and children in Saudi Arabia, where inadequate nutrition is considered a primary contributing factor. This study aims to (i) examine the levels of serum iron, folate, and vitamin B12 in young adult students, with a focus on identifying any deficiencies and their association with anemia; (ii) explore the prevalence of mixed-deficiency anemia resulting from deficiencies in serum iron, folate, and vitamin B12 (iii) explore how sociodemographic characteristics and dietary habits influence serum iron, folate, and vitamin B12 levels. This cross-sectional study encompassed 158 young adult students at Jazan University, Saudi Arabia. Blood samples were collected following a comprehensive questionnaire addressing sociodemographic and health characteristics. These samples were analyzed for complete blood count, serum iron, folate, and vitamin B12 levels. The findings of this study revealed a significant decrease in serum iron levels, with 70.6% of males and 88% in females exhibiting reduced level. Additionally, low levels of folate were observed in 4% of the study population, while deficiency in vitamin B12 was found in 2.2% of the study population. However, the simultaneous presence of low serum iron levels along with deficiencies in folate or vitamin B12 was not observed in the study participants. The study indicates that there is a high incidence of low serum iron and ferritin levels among university students in Saudi Arabia, which poses a considerable public health concern. Conversely, the prevalence of folate and vitamin B12 deficiencies among the students was comparatively low, and notably, there were no cases where these deficiencies were observed alongside iron deficiency.

Serum ferritin level in children with normal hemoglobin and low MCV and MCH in a hospital in Iraq

Background: Iron deficiency is common around the world, particularly in young people because of their elevated need for iron to grow and develop. Iron deficiency is demonstrated by low levels of serum ferritin. This research will investigate the level of serum ferritin in children with normal hemoglobin but low MCV and MCH, the purpose of this is to determine the degree to which subclinical iron deficiency is present and distinguish it from other causes of microcytosis. Method: 150 children with typical hemoglobin but low MCV and MCH were recruited recognizing subordinate iron deficiency. Blood samples and demographic information regarding sociological aspects were collected and assessed. A computerized hematology analyzer and an ELISA were both used to assess the level of haemoglobin in the blood and the serum level of ferritin. Results: Children with normal hemoglobin but low MCV and MCH had a mean hemoglobin level of 12.7±0.6 mg/ dl and a serum ferritin level of 86.5±7 ng/ ml, according to the study. The levels of serum ferritin and hemoglobin changed significantly, depending on the sociodemographic variables. Among the pediatric population, the levels of serum ferritin and hemoglobin were significantly higher (P-value 0.002). Conclusion: In children with typical hemoglobin, but low MCV and MCH, the sociodemographic factors are strongly associated with the hemoglobin and serum ferritin levels. Gender, birth order, and family size—children under the age of 10 years— had an effect on the serum level of ferritin. The age, birthdate, and the time of supplemental food consumption also had an effect on hemoglobin levels. These findings demonstrate the necessity of recognizing and treating iron deficiency early on in life.

Diagnosis and treatment of iron deficiency anemia

The causes of iron deficiency anemia include blood loss, increased demand, insufficient dietary intake, and disorders affecting iron absorption. In certain circumstances, atrophic gastritis, either autoimmune or due to Helicobacter pylori infection, may contribute. On very rare occasions, iron-refractory iron deficiency anemia can develop as a consequence of TMPRSS6 mutations. Iron deficiency anemia is diagnosed by identification of microcytic hypochromic anemia with low serum ferritin levels. In cases of chronic disorders such as chronic kidney disease, chronic heart failure, and chronic inflammatory disorders, the diagnosis may also incorporate transferrin saturation. Treatment of underlying diseases is recommended along with iron supplementation. While oral iron supplements are the first choice, intravenous iron may be considered when oral administration is impractical, iron absorption is impaired, or rapid iron replenishment is necessary. Recently, high-dose intravenous iron formulations became available in Japan, but their use requires caution due to potential risks of allergic reactions, hypophosphatemia/osteomalacia, iron overload, and vascular leakage. Notably, the benefits of high-dose intravenous iron for patients with heart failure and iron deficiency are recognized in the field of cardiology. This article provides an overview, incorporating recent developments in the field of iron deficiency anemia.

Association between Body Iron Status and Cognitive Task Performance in a Nationally Representative Sample of Older Adults.

Iron is an essential micronutrient that is necessary for proper cognitive function. However, the dose-response relationship between body iron status and cognitive function remains unclear. The objective of this study was to investigate the association between serum ferritin concentrations, an indicator of body iron status, and cognitive function in older adults. Based on the National Health and Nutrition Examination Survey (NHANES) 1999 -2002 in the United States, nationally representative data was collected from 2,567 adults aged 60 years and older who had objectively measured serum ferritin levels and cognitive performance. High ferritin levels were defined as a serum ferritin level >200 ng/mL in women and >300 ng/mL in men. Low ferritin levels were defined as a serum ferritin level <30 ng/mL. The digit symbol substitution test (DSST) was employed to assess cognitive function. Multivariable logistic regression analyses with survey weights were performed after the DSST was dichotomized at the median score. The weighted prevalence of adults with normal, low, and high serum ferritin levels were 73.98%, 9.12%, and 16.91%, respectively. A U-shaped association between serum ferritin concentrations and cognitive task performance was observed. After adjusting for demographic, socioeconomic, lifestyle, and C-reactive protein factors, the odds ratio (95% confidence intervals) for lower cognitive performance was 1.39 (1.11, 1.74) in adults with high ferritin levels and 1.38 (0.86, 2.22) in adults with low ferritin levels, compared with those with normal ferritin levels. The association between serum ferritin levels and lower cognitive performance was stronger in adults aged 60 to 69 years old than those aged 70 years and older. In conclusion, in a nationally representative sample of older adults in the United States, a high serum ferritin level was significantly associated with worse cognitive task performance. Thus, the relationship between low serum ferritin concentrations and cognitive task performance warrants further investigation.

Association of serum iron and serum calcium levels in children with febrile seizures

Objectives: The current case–control study was conducted to investigate the relationship of iron deficiency anemia and calcium levels with febrile seizures (FSs) in children. Materials and Methods: The study included 200 children ranging in age from 6 to 60 months. One hundred cases had FSs, including simple FSs and rest; 100 controls had a short history of febrile illness (&lt;3 days) without seizures. A statistical analysis of the data was carried out using Statistical Package for the Social Sciences version 23. Results: The mean weight, height, and head circumference of cases and controls are 9.73 ± 2.51 kg and 10.63 ± 3.34 kg, 79.66 ± 11.08 cm and 85.43 ± 15.55 cm, and 46.37 ± 2.79 cm and 46.83 ± 3.72 cm, respectively. As per the Indian Academy of Pediatrics, 27% of cases and 37% of controls had protein energy malnutrition (PEM). In cases and controls, the mean hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, and red cell distribution width values were 9.23 ± 1.30 and 10.78 ± 1.60 gm/dL, 68.83 ± 8.86 and 78.59 ± 9.82 fl, 25.40 ± 3.47 and 28.50 ± 3.60 pg, and 18.73 ± 1.77 and 16.44 ± 1.76, respectively, and are statistically significant. Patients had lower serum ferritin levels than controls. The mean blood calcium levels in cases and controls were 9.13 ± 0.64 and 9.05 ± 0.93 mg/dL, respectively (P = 0.507). Iron deficiency anemia was found in 26% of cases and 7% of controls (P value &lt;0.001). Hypocalcemia was reported in only 18% of patients and 23% of controls (P = 0.38). Conclusion: There is a clear correlation between FSs and iron deficiency. The majority of data suggests that hypocalcemia is unlikely to be the cause of FSs. Early detection and intervention of iron deficiency in children could help in the prevention and recurrence of FSs.

Relationship between Iron Deficiency and Thyroid Function: A Systematic Review and Meta-Analysis.

Objective: Iron deficiency (ID) is the most prevalent nutritional deficiency worldwide. Low levels of serum ferritin (SF) could affect the thyroid gland and its functioning. The purpose of this systematic review and meta-analysis is to summarize the main currently available evidence and analyze data on the relationship between ID and thyroid function. Methods: This study included all articles evaluating the relationship between ID and thyroid function. Quality assessment was performed using Cambridge Quality Checklists. The search strategy included the following combination of Medical Subjects Headings terms and keywords: "iron deficiency", "thyroid function", "thyroid disease", "thyroid dysfunction", and "hypothyroidism". A meta-analysis was performed to evaluate whether thyroid stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels differed between patients with ID and healthy controls without ID. For statistical comparison between cases and controls, the mean difference (MD) was calculated, and a subgroup analysis of pregnant and non-pregnant women was performed. Cochran's Q testing and heterogeneity indices (I2) were used to assess statistical heterogeneity. Sensitivity analysis and publication bias analyses were also performed, both qualitatively and quantitatively. Finally, a meta-regression analysis was performed to evaluate the correlation between serum TSH or FT4 levels and SF in the study population. Results: Ten cross-sectional studies were identified and reviewed. Patients with ID showed TSH (MD: -0.24 mIU/L; 95% CI -0.41, -0.07; I2 = 100%, p = 0.005), FT4 (MD: -1.18 pmol/L; 95% CI -1.43, -0.94; I2 = 99%, p < 0.000001), and FT3 (MD: -0.22 pmol/L; 95% CI -0.32, -0.12; I2 = 99%, p < 0.00001) levels that were significantly lower. Subgroup analysis confirmed significantly lower TSH, FT4, and FT3 levels in pregnant women. Non-pregnant women showed significantly lower serum FT4 and FT3 levels but no difference in TSH values. Meta-regression analysis showed that serum TSH and FT4 levels were positively correlated with SF levels. Our systematic review of the literature found that ID significantly increases the prevalence of thyroid autoantibody (anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies) positivity both individually and collectively. Conclusion: Studies currently published in the literature indicate a possible relationship between ID, thyroid function, and autoimmunity, especially in some patient groups. Data analysis shows that thyroid hormone levels are lower in patients with ID and, in particular, in pregnant women. Further studies are needed to understand the role played by iron in thyroid metabolism.

The clinical characteristics of subcutaneous and mediastinal emphysema in anti-melanoma differentiation-associated 5 positive dermatomyositis associated with interstitial lung disease.

To investigate the clinical characteristics of subcutaneous emphysema (SE) and mediastinal emphysema (ME) occurring in patients with anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis associated with interstitial lung disease (anti-MDA5-positive DM-ILD). In this retrospective study, a total of 117 anti-MDA5-positive DM-ILD patients were admitted to our hospital. All patients underwent an assessment of autoantibodies, serum ferritin levels, and lung high-resolution CT scans. In patients with anti-MDA5-positive DM-ILD, the incidence of SE/ME was found to be 11.1%, which was significantly higher compared to patients with anti-synthetase syndrome (p<0.01). The mortality rate among anti-MDA5-positive DM-ILD patients with SE/ME was significantly higher than those without SE/ME (p=0.0022). There was no statistically significant difference in the occurrence of SE/ME between patients with positive anti-Ro-52 antibodies and those with negative anti-Ro-52 antibodies (p=0.18). Patients with higher serum ferritin levels (1000 ng/ml ≤serum ferritin ≤1500 ng/ml) had a higher likelihood of developing SE/ME compared to patients with lower serum ferritin levels (serum ferritin <500 ng/ml) (p<0.01). Among 13 anti-MDA5-positive DM-ILD patients with SE/ME, six (46.2%) developed SE/ME within 1 month of being diagnosed and 53.8% of patients underwent positive pressure ventilation prior to the onset of SE/ME. We found that SE/ME is not uncommon in anti-MDA5-positive DM-ILD and is an important factor associated with poor patient prognosis. The occurrence of SE/ME is correlated with high levels of serum ferritin and is not related to anti-Ro-52 antibodies. Rheumatologists should pay close attention to SE/ME caused by positive pressure ventilation in anti-MDA5-positive DM-ILD patients.