Normal Zinc Levels Research Articles

Plasma Zinc Levels in Patients with Diabetic Nephropathy: Is there a Relationship with NLRP3 Inflammasome Activation and Renal Prognosis?

Zinc is an essential trace element, and impaired zinc homeostasis may be associated with inflammation in patients with diabetic nephropathy (DN). We investigated the influence of zinc level on nod-like receptor nucleotide-binding domain and leucine-rich repeat pyrin-3 domain (NLRP3) inflammasome expression and renal prognosis in patients with DN. We recruited 90 patients definitively diagnosed with DN by renal biopsy and 40 healthy controls. Zinc, NLRP3, interleukin (IL)-1β, and IL-18 levels were detected in blood samples, and the correlations between these parameters were assessed. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) evaluated the predictive value of zinc and the NLRP3 inflammasome for DN. Furthermore, patients with DN were divided into low- and normal-zinc groups to observe differences in clinical indicators and identify expression of inflammatory-related factors in renal tissue. Kaplan-Meier survival curves predicted the impact of zinc levels on renal prognosis. We found thatthe plasma zinc concentration in patients with DN was lower, while NLRP3, IL-1β, and IL-18 levels were higher than were those in patients without DN (P < 0.05). Zinc level was negatively correlated with NLRP3, IL-1β, and IL-18 levels (P < 0.01). Zinc and the NLRP3 inflammasome were predictive of DN, but their combination improved the diagnostic value. The DCA curve demonstrated a good positive net benefit in the combined model. Compared to patients with low zinc levels, patients with normal zinc levels had lower expression of NLRP3 inflammasome and a better prognosis. Zinc has a protective effect on DN and may affect NLRP3 inflammasome activation.

Zinc Deficiency in Critically Ill Patients: Impact on Clinical Outcome.

Background Zinc is a trace element essential for the normal functioning of many vital enzymes and organ systems. Studies examining the rates and degrees of zinc deficiency and its consequences in patients with critical illnesses remain scarce. Materials and methods This is a prospective observational study assessing zinc deficiency in critically ill adult patients admitted to a tertiary care intensive care unit (ICU) and its impact on clinical outcomes. Patients were divided into those with normal (≥ 71 µg/dl) and low (≤ 70 µg/dl) zinc levels. Zinc-deficient patients were further divided into mild, moderate, and severe zinc deficiency groups based on zinc levels of 61-70 µg/dl, 51-60 µg/dl, and below 51 µg/dl, respectively. The primary outcome assessed was ICU mortality, and the secondary outcomes were ICU length of stay (LOS), duration of invasive mechanical ventilation (IMV), acute kidney injury (AKI) at admission, need for non-invasive ventilation (NIV), renal replacement therapy (RRT), or vasopressors during the course of the ICU. Other parameters compared included APACHE (Acute Physiology and Chronic Health Evaluation) II, SOFA (Sequential Organ Failure Assessment) score on day 1, and levels of lactate, procalcitonin, calcium, magnesium, phosphate, and serum albumin. The study also compared the mean zinc levels in patients with low and high SOFA scores (scores up to 7 vs. 8 and above) and low and high APACHE II values (scores up to 15 vs. 16 and above). Results A total of 50 patients were included, of whom 43 (86%) were zinc deficient. Mortality in zinc-deficient and normal zinc-level patients was 33% and 43%, respectively (p = 0.602). Patients with zinc deficiency were also older (mean age 69 vs. 49 years, p = 0.02). There was no difference in secondary outcome parameters, except for more zinc-deficient patients needing RRT. Twenty-six of the zinc-deficient patients had severe zinc deficiency, ten moderate, and seven mild (p = 0.663). ICU mortality was approximately 42%, 10%, and 29% in the severe, moderate, and mild deficiency groups, respectively (p = 0.092). Zinc levels were similar between those with low and high APACHE II scores (mean 47.9 vs. 45.5 µg/dl, p = 0.606) as well as between low and high SOFA scores (mean 47.8 vs. 45.7 µg/dl, p = 0.054). Conclusion The present study suggests that zinc deficiency is very common in critically ill patients but does not correlate with their severity of illness, nor does it lead to a poorer outcome in these patients. However, further studies with a larger cohort of patients would be required to make definitive conclusions.

Efficacy of Normalising Serum Zinc Level for Patients with Olfactory Dysfunction and Zinc Deficiency

Plain Language SummaryThis study examined how zinc levels relate to problems with smelling, which is called olfactory dysfunction. We studied 42 participants who had trouble smelling due to infections, injuries, or unknown reasons and who also had low zinc levels in their blood. After the participants consumed a zinc supplement to treat their low zinc levels, we placed the participants either in the group for those who had their zinc levels go back to normal or in the group for those who remained zinc deficient. We tested the participants’ sense of smell in different ways, including using an olfactometer, a card with different scents, and questionnaires. The group with normal zinc levels did much better in all the smell tests; the zinc-deficient group only improved in 1 test, which was the questionnaire. These results suggest that if someone has trouble smelling and they also lack the appropriate level of zinc, it might be difficult for them to get better. However, if they can improve their zinc level and bring it to a normal level, their sense of smell could improve. In summary, this study demonstrated a connection between zinc levels and smelling ability, indicating that repairing zinc deficiency may aid in treating olfactory dysfunction.

Взаимосвязь уровня цинка в сыворотке крови с тяжестью и характером течения COVID-19

Zinc is a trace element with potent immunoregulatory and antiviral properties, and it is used for the prevention and treatment of coronavirus disease 2019 (COVID-19) at the beginning of epidemic. However, we do not know the clinical significance of serum zinc levels in COVID-19 patients. This study was conducted to evaluate the relationship between serum zinc levels and COVID-19 infection. Patients and methods. A prospective study was carried out in Al-Basrah city, Iraq, from November 2021 to March 2022. Initially, serum zinc levels were compared between COVID-19 patients and healthy controls. Then COVID-19 patients with zinc deficiency were compared to those with normal zinc levels. Results. COVID-19 patients showed significantly lower zinc levels after exclusion of zinc intake compared to healthy controls (p = 0.027). Among COVID-19 patients, 60 (40%) were found to be zinc deficient. These patients had a longer recovery period and a higher need for hospitalization. Conclusion. Zinc is an important trace element that plays a crucial role in immunity function, and the results of the present study demonstrate significantly lower zinc levels in COVID-19 patients compared to healthy controls. Key words: COVID-19, zinc, immune system

Micronutrients and nutritional status among children living with HIV with and without severe acute malnutrition: IMPAACT P1092

BackgroundMicronutrient deficiencies from malabsorption, gut infections, and altered gut barrier function are common in children living with the human immunodeficiency virus (CLHIV) and may worsen with severe acute malnutrition (SAM). Exploratory data of baseline zinc and selenium levels and changes over 48 weeks in children living with HIV by nutritional status are presented.MethodsZinc, selenium, serum protein and albumin levels measured at study entry and over 48 weeks were compared between children aged 6 to < 36 months who were living with HIV and had SAM or mild malnutrition-normal nutrition. Children with SAM were enrolled after 10–18 days of nutritional rehabilitation. Two-sided t-tests were used to compare levels and changes in levels of micronutrients and proteins by nutritional status.ResultsFifty-two participants, 25 with and 27 without SAM, of median (Q1,Q3) age 19 (13,25) and 18 (12,25) months respectively, were enrolled. Zinc deficiency was present at entry in 2/25 (8%) of those who had SAM. Mean (SD) baseline zinc levels were [52.2(15.3) and 54.7(12.0) µg/dL] for the SAM and non-SAM cohorts respectively while selenium levels were similar [92.9(25.0), 84.3(29.2) µg/L]. Mean changes of zinc and selenium from study entry to week 48 were similar between the children with and without SAM. There was no significant difference between baseline protein levels [75.2(13.2), 77.3(9.4) g/L] and the mean change from study entry to 48 weeks was also similar between the two groups; with a mean difference of 4.6 g/L [95% CI, (-2.4,11.6)].Children with SAM compared to those without had significantly lower serum albumin levels at study entry with similar levels at 48 weeks.ConclusionsChildren with severe malnutrition who were initiated/switched to zidovudine/lamivudine/boosted lopinavir following 10 to 18 days of nutritional rehabilitation showed normal baseline levels of selenium and zinc, and had comparable selenium levels after 48 weeks. There was a strong positive correlation in entry and week 48 selenium levels within each cohort and for zinc in the non-SAM cohort. These data support the current WHO recommended approach to management of severe malnutrition in CLHIV who are initiated on combination antiretroviral treatment.Trial registrationRegistered with ClinicalTrials.gov Identifier NCT01818258 26/03/2013.

Association between serum zinc levels and multiple cutaneous warts: A cross-sectional study

Abstract Background: Warts are cutaneous manifestations of human papillomavirus (HPV). Trauma and maceration facilitate initial epidermal inoculation. The spread may then occur by autoinoculation. Local and systemic immune factors appear to influence the spread. Zinc is an essential micronutrient having a wide spectrum of actions. Deficiency of the same adversely affects the immune function, especially, T cell functions. The role of zinc as an immunological modulator activates lymphocytes and cytokines against the penetration and replication of viruses, which has increasingly been recognized. Numerous skin disorders have been linked to zinc deficiency. A high dose of oral zinc sulfate has shown outstanding therapeutic efficacy and prevents relapse in patients with recalcitrant and multiple warts. Owing to the therapeutic efficacy of oral zinc in the treatment of warts, the current study was undertaken to find out the association between serum zinc level and multiple cutaneous warts among the study population. Materials and methods: One hundred and ten patients with cutaneous warts met the inclusion criteria and an equal number of age and sex-matched controls were enrolled. A consecutive sampling technique was used for the enrolment. Details regarding the duration, number, clinical type, size, and distribution of the warts were recorded. Serum zinc levels were estimated in both cases and controls. Data were tabulated and analyzed using the SPSS software version 20. Results: The reference range for normal serum zinc levels was taken as 60–180 µg/dL. Normal serum zinc levels were found in 91 (100%) of the cases and 100 (110%) of the controls; high levels were found only in 9 (10%) of the cases. Cases were found to have significantly higher mean serum zinc levels compared with the controls. (121.1 ± 35.78 µg/dL vs. 101.8 ± 20.48µg/dL, P = 0.0001). Conclusion: Patients with multiple cutaneous warts were found to have higher mean serum zinc levels compared with age and sex-matched controls. There was no significant association of serum zinc levels with the duration or the number of warts.

Cross-sectional observational study: Investigation of zinc concentration in white patients with cancer

ObjectivesNumerous studies describe the role of zinc in the immune system and metabolism. Zinc may influence the pathogenesis and prognosis of cancer. The aim of this study to determine the prevalence of zinc deficiency in patients with cancer. The study's primary objective was to evaluate the frequency of zinc deficiency in White patients with cancer and characterize the clinical factors predisposing individuals to decreased zinc concentration. The study also aimed to estimate the dose of zinc supplementation that would prevent deficiency. MethodsRetrospective data for this cross-sectional study were analyzed from 300 consecutive white patients diagnosed with neoplastic disease and admitted to a major oncology hospital for treatment. Zinc plasma concentration, nutritional status, body composition, and medical history of ailments and dysphagia were recorded. Supplementation was introduced in patients with zinc deficiency according to the local protocol. Zinc plasma levels were collected at follow-up visits. ResultsZinc deficiency was diagnosed in 68% of the patients. Poor nutritional status was significantly associated with zinc deficiency (low body mass index, weight loss, low albumin level). Low lean body mass (P = 0.003) and adipose tissue (P = 0.045) correlated with zinc deficiency. Patients with zinc deficiency reported dysphagia more frequently than those with normal zinc levels (18 versus 8%; P = 0.03). Squamous cell carcinoma was significantly associated with zinc deficiency (P = 0.043). Oral zinc supplementation resulted in reaching laboratory norms for plasma concentration in only 27% of patients with zinc deficiency and was not dependent on lower (10–15 mg) or higher (25–30 mg) dosing (P > 0.05). ConclusionsZinc deficiency is common in cachectic, malnourished patients with cancer. Nutritional guidelines for these patients should include screening for micronutrient deficiencies. Further studies are needed to determine the role, dosage, duration, and form of nutritional supplementation recommended for specific cancer diagnoses.

P10 Think zinc: nutritional deficiency in a breastfed infant associated with antenatal proton-pump inhibitor exposure

Abstract A 5-month-old infant presented with a 3-month history of a dramatic periorofacial and acral dermatitis associated with recurrent infections, increasing lethargy and poor feeding. He was born at full term, breastfed exclusively, and had no family history of skin disease. Serum alkaline phosphatase was 41 (range 82–383) and zinc levels were undetectably low (&amp;lt; 3 mg mol–1; normal 10–25). Maternal breastmilk zinc levels were low (3.15, control mean 12.7), and maternal serum zinc was normal. A rapid improvement was noted within days of zinc sulfate supplementation. Zinc supplementation was stopped after 3 months, with normal follow-up zinc levels. The mother had taken omeprazole from 30 weeks’ gestation to birth. In her previous pregnancy there was no proton-pump inhibitor (PPI) ingestion, and no manifestation of zinc deficiency in the older sibling, who had also been breastfed exclusively. Maternal genetic testing for defects in SLC30A2, a zinc transporter in mammary tissue, was negative. Acrodermatitis enteropathica involves recessive mutations in the SLC39A4 gene, and secondary transient infantile zinc deficiency can be due to prematurity, low zinc intake, or malabsorptive processes such as cystic fibrosis. It is rare in breastfed infants due to enhanced bioavailability of zinc. PPIs can decrease serum zinc due to intestinal chelation, although little is known regarding their effect on transplacental or transmammary zinc transmission. To our knowledge this is the first report of zinc deficiency in a breastfed infant associated with maternal PPI use, potentially due to diminished transmammary and/or transplacental zinc transmission.

Trace Elements Status (Zinc &amp; Copper) in Pediatric Patients on Regular Hemodialysis

Background Hemodialysis patients are at risk for deficiency of essential trace elements and excess of toxic trace elements, both of which can affect health. Objectives Up to our knowledge, there is no previous data about the normal values of trace elements in pediatric hemodialysis patient, so our aim was to evaluate the status of both serum zinc &amp; copper in our pediatric hemodialysis patients in order to evaluate the need for supplementation. Methodology This is a case control study which involved 2 groups: Patients’ group included 60 children with end stage kidney disease on regular hemodialysis following up at Pediatric Dialysis Unit, Ain Shams University Hospitals and 60 healthy children served as a control group. Measurements of serum copper and zinc were performed by atomic absorption spectrophotometry, complete blood count (CBC), iron and lipid profiles were done and correlated to serum copper and zinc level. Results Patients’ group were 32 males (53.3%) and 28 females (46.6%) with an average age of 13.06 ± 2.08, 8-17 years, BMI of (15.07 ± 3.30, 8.38-21.14 Kg/m2) and duration of hemodialysis was (3.28 ± 2.33, 1-10 years). The control group were 39 males (65%) and 21 females (35%) with age of (8 ± 2.14, 5-12 years) and BMI was (16.36 ± 1.30, 14.6-18.5 Kg/m2). Six patients (10%) had low serum zinc level with values between 58 to 59 mcg% (normal:60-120 mcg%), while only two patients (3.3%) had low serum copper level with values of 66 mcg% (normal:70140 mcg%). All control group had normal serum zinc and copper levels with a significant difference between patients and control groups as regards serum copper level (Patients’ group 78.06 ± 7.5 mcg%, control group 82.46 ± 8.13 mcg%, P = 0.03). We found a negative correlation between blood copper and ferritin level (r = 0.334, P value = 0.009). We also found a positive correlation between blood copper and cholesterol level (r = 0.276, P value = 0.033). Conclusion Hemodialysis could lead to depletion of biologically essential trace elements, thus routine monitoring of trace element blood levels is important for proper nutritional support of patients on hemodialysis.

Age-Related Variations in Serum Zinc Levels Among Female Patients in Sulaymaniyah, Iraq: Implications for Addressing Zinc Deficiency.

Background Zinc plays a crucial role in human nutrition and various biochemical processes, making it indispensable for all life forms. Therefore, it is important to address low zinc levels, particularly among women, to prevent potential health issues. Objective This study aimed to evaluate the serum zinc levels of female patients in Sulaymaniyah, Iraq. Methods This retrospective cross-sectional studyincluded atotal of 299 patients,ranging in age from 16 to 48 years, who sought medical care at Baxshin Hospital in Sulaymaniyah Governorate, Iraq, between October 2022 and April 2023. The biochemical test was conducted to screen the patient's blood samples for serum zinc levels. Results Among 299 patients, 99 individuals had low zinc levels, 11 had high zinc levels, and 189 exhibited normal zinc levels. The analysis revealed a significant difference between low, normal, and high serum zinc levels, as evidenced by a p-value of <0.05. In terms of age-related variations, individuals under 20 years old had an average serum zinc level of 121.4 µg/dL. However, those between 21 and 30 years old demonstrated the highest average serum zinc level of 153.6 µg/dL, followed by 135 µg/dL for individuals aged 31-40, and 119 µg/dL for those above 40 years old. Conclusion These findings indicate that serum zinc levels may vary based on the age group of individuals. Consequently, further research is needed to explore the implications of these variations and establish appropriate strategies to address zinc deficiency among women in Sulaymaniyah.

A study of plasma levels of zinc in children with pica in a public hospital setup

Background: Pica is the craving and purposeful consumption of non-food substances. In children with pica, there is a greater possibility of zinc deficiency. Objectives: To study the plasma levels of zinc in children having pica and to study the efficacy of pica as a clinical marker of zinc deficiency. Method: This is a case control study of children attending the outpatient department of a tertiary health centre. A total of 92 children were enrolled in the study, of which 46 children who had the habit of pica were taken as cases and the remaining 46 children without the habit of pica were enrolled as controls. Serum zinc levels of the 92 children were estimated. Results: Of the 92 children included in the study, 56% of cases and 47% of controls belonged to the age group of 2 to 2.5 years. It was observed that 96% of cases had zinc deficiency whereas 100% of controls had normal zinc levels. The mean zinc level of the cases was 46.73±21.32mcg/dL compared to 148.5±15.4mcg/dL in the controls. Accuracy of pica as a clinical marker of zinc deficiency was 97%. Conclusions: The mean zinc level of the cases who had pica was significantly lower than the mean zinc level of the controls indicating that pica is a useful clinical marker for zinc deficiency. Sri Lanka Journal of Child Health, 2023: 52(2): 182-187

Ixekizumab-associated transverse myelopathy in a patient with psoriatic arthritis (P14-3.017)

<h3>Objective:</h3> We present the case of a woman with acute-onset myelopathy who presented with sensory symptoms and ataxia. We discuss her diagnosis of monoclonal antibody-induced short-segment transverse myelopathy and the potential mechanisms mediating this adverse reaction. <h3>Background:</h3> Monoclonal antibodies have provided novel therapeutic avenues for several disorders in oncology, rheumatology, and neurology. These treatments, however, have been noted to carry a rapidly growing host of adverse reactions, many of which involve the nervous system. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> A 57-year-old right-handed woman with psoriatic arthritis on monthly ixekizumab injections (a humanized monoclonal antibody directed against interleukin 17A) was admitted for a two-day history of progressive dysesthesias, which ascended from her feet to the lower abdomen. Her neurologic examination showed patellar and ankle hyperreflexia with large-fiber modality length-dependent sensory loss and preserved small-fiber modalities. The workup was notable for normal B12, homocysteine, copper, and zinc levels. No abnormal protein bands were identified on serum protein electrophoresis. A lumbar puncture yielded a bland CSF with two white cells, glucose of 65, protein of 43.5, and 0 oligoclonal bands. Serum ANA was positive with homogeneous with a 1:320 titer, reflecting to positive dsDNA and Scl70. A broad infectious workup was negative for HSV, VZV, CMV West Nile virus, Lyme, syphilis, HIV, and HTLV-2. MRI of the neuraxis was remarkable for a short-segment T2 hyperintense lesion of the dorsal column spanning T7–9. In the context of unrevealing etiological work-up, she was diagnosed with ixekizumab-induced transverse myelopathy and the biologic drug was stopped. She continued to improve during the following year without recurring CNS symptoms. <h3>Conclusions:</h3> We report the first case of ixekizumab-induced thoracic transverse myelopathy which we stipulate may result from dysregulation of the T-helper pathways given the antagonism of IL-17A. As shown by this clinical presentation, neurologists need to be aware of the adverse reactions of monoclonal antibodies. <b>Disclosure:</b> Dr. Rosso has nothing to disclose. Dr. Milano has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Jackson kelly. Dr. Gleichgerrcht has nothing to disclose.

Copper Deficiency in Wilson's Disease with a Normal Zinc Value.

Copper deficiency (CD) is a rare complication of long-term treatment of Wilson's disease (WD) and is usually accompanied by high serum zinc levels. A 57-year-old woman with WD presented with limb weakness and sensory disturbance due to myeloneuropathy and macrocytic anemia after 36 years of treatment. Markedly reduced serum free copper values confirmed CD, which was considered to be caused by progressive dysphagia and severe diarrhea rather than zinc overdose because of the normal serum zinc levels. Discontinuing copper-reducing therapy and increasing copper intake improved her symptoms. Physicians should be alert for the risk of CD in WD patients, especially those with dysphagia.

Association of zinc deficiency with infectious complications in pediatric hematopoietic stem cell transplantation patients.

Zinc plays essential roles in immune function and epithelial integrity. Patients undergoing hematopoietic stem cell transplantation (HSCT) often have low plasma zinc levels because of poor intake and diarrhea. We hypothesized that patients with zinc deficiency before HSCT had worse infectious complications after HSCT compared with patients with normal zinc levels. Citrulline, a marker of intestinal integrity, was also hypothesized to be lower in patients with zinc deficiency. Thirty patients undergoing HSCT at Ramathibodi Hospital during March 2020-September 2021 were enrolled. Blood samples for plasma zinc and citrulline were collected during the HSCT period. The 14- and 90-day outcomes after HSCT were prospectively recorded. Twelve of 30 (40%) patients had zinc deficiency before HSCT. Zinc-deficient patients were younger (median (interquartile range): 6 (8.8) vs 13 (5.8) years old; p = 0.017). Zinc levels tended to increase after admission in both groups. Patients with zinc deficiency had lower citrulline levels than those with normal zinc levels. Citrulline levels decreased in both groups after stem cell infusion, and the level was not significantly different between the two groups. Zinc-deficient patients had a higher rate of bacterial infection within 90 days after HSCT than those with normal zinc levels (6 in 12 patients (50.0%) vs 1 in 18 patients (5.6%); odds ratio [OR]: 17.0; 95% confidence interval [CI]: 1.68-171.70; p = 0.016). This remained significant after adjustments for age (adjusted OR: 12.31; 95% CI: 1.084-139.92; p = 0.043). The prevalence of zinc deficiency in pediatric patients undergoing HSCT was high. Zinc-deficient patients had lower citrulline levels and higher incidence of bacterial infection after HSCT. However, citrulline level was not different between patients with and without bacterial infections. It is worth to investigate whether zinc supplementation before HSCT can reduce bacterial infection after HSCT.

Post-diagnostic Zinc Supplement Use and Prostate Cancer Survival Among Men With Nonmetastatic Prostate Cancer.

Biological and experimental evidence support restoration of normal zinc levels in malignant prostate cells as a promising prostate cancer treatment, yet the influence of zinc supplementation after diagnosis on prostate cancer survival in a human population is unknown. We prospectively assessed post-diagnostic zinc supplementation in relation to prostate cancer survival among 5,788 men with nonmetastatic prostate cancer in the Health Professionals Follow-up Study (1986-2019). We used Cox regression models to estimate the multivariable hazard ratios and 95% confidence intervals of lethal prostate cancer (distant metastases or prostate cancer-specific death) and all-cause mortality according to post-diagnostic zinc supplement use and dosage. During a median follow-up of 11 years, we documented 527 lethal prostate cancer events and 3,198 all-cause deaths. Fifteen percent of men reported zinc supplement use post-diagnosis. Compared to nonusers, post-diagnostic zinc supplement use was associated suggestively with a lower risk of lethal prostate cancer (HR [95% CI], 0.82 [0.60-1.13]) and significantly with all-cause mortality (0.84 [0.74-0.96]). The inverse association was mostly observed among men who used post-diagnostic zinc supplements of 1-24 mg/d (lethal prostate cancer: 0.55 [0.32-0.96]; all-cause mortality: 0.77 [0.64-0.93]), while higher dosage did not show a lower risk. Post-diagnostic low-dose zinc supplement use among nonmetastatic prostate cancer patients was associated with lower risk of lethal prostate cancer and all-cause mortality. A potential benefit of low-dose post-diagnostic zinc supplement for prostate cancer survival merits further study.

Significance of Zinc Replacement Therapy After Pancreaticoduodenectomy.

Recently, a decrease in serum zinc levels and the need for zinc preparations have been reported in the perioperative period of gastrointestinal surgery. In this study, we examined treatment outcomes among patients supplemented with zinc after pancreaticoduodenectomy (PD) and evaluated the significance of zinc replacement therapy. From June 2020 to April 2021, 56 patients who received zinc acetate hydrate (50 mg/day) from postoperative day 3 after PD in our department were retrospectively reviewed. Patients' characteristics and preoperative as well as postoperative data, including serum zinc levels and surgical results at 1 month were reviewed. Preoperative zinc deficiency was present in 86.1% (46/56) of the patients. Moreover, despite zinc supplementation, 17.8% (10/56) of patients had postoperative zinc deficiency. A comparison between the low zinc level group (Zn <80 μg/dl) and the normal zinc level group (Zn ≥80 μg/dl) after surgery showed siginificant differences among patients with malignant diseases (vs. benign diseases, p=0.044), those undergoing open surgery (vs. minimally invasive surgery, p=0.036), and those with intraoperative blood loss ≥346 ml (vs. <346 ml: p=0.041) in the univariate analysis. Multivariate analysis revealed that zinc deficiency was significantly associated with open surgery [odds ratio (OR)=15.885, 95% confidence interval (CI)=1.77-142.01, p=0.013] and intraoperative blood loss (OR=9.329, 95% CI=1.50-57.74, p=0.016). In patients undergoing open PD for pancreatic cancer, zinc preparations of 50 mg may not be sufficient and further supplementation may be necessary.

Zinc Deficiency: The Association with Vitamin B12 in People of Different Ages

Background: Zinc and vitamin B12 are the foremost important micronutrients. About a quarter of Iranian households have a zinc deficiency. Objectives: Considering the importance of these micronutrients, this study aimed to investigate the association between zinc deficiency and vitamin B12 in people of different ages who had their blood tested in the Pasteur laboratory in Ahvaz. Methods: In this cross-sectional study, serum levels of zinc and vitamin B12 were measured using atomic absorption spectrophotometry and electro-chemiluminescence, respectively. Then, samples were divided into normal and zinc-deficient groups based on serum zinc levels. Serum vitamin B12 levels were also compared between two defined groups. The correlation between age and both zinc and vitamin B12 were determined through statistical tests. Results: In 60.5% of samples, serum zinc was lower than in the normal group. However, the two groups had no statistically significant difference in zinc levels (P = 0.085). Findings showed that with increasing one year of age, serum zinc level decreases by 0.13 units, and serum level of vitamin B12 increases by 0.19 units. Although the serum level of vitamin B12 in the group with normal zinc levels was higher than in the zinc-deficient group, this difference was not statistically significant (P = 0.743). Conclusions: Zinc and Vitamin B12 serum levels can have a clinically positive correlation, and zinc deficiency might be effective in manipulating vitamin B12 status in the body.

Correlation of Whole Blood Zinc Levels, CD4 Cell Count, Disease Stage, and Dermatologic Manifestations Among HIV Patients: A Single Center Experience in Philippines

Objective: Zinc deficiency is the most common micronutrient abnormality seen in human immunodeficiency virus (HIV) infection. Depletion of CD4 cells is a hallmark of HIV infection. The study aims to determine the association between whole blood zinc levels and CD4 cell count and stage of HIV infection among patients in a tertiary hospital in the Philippines. Methods: Sixty-five newly diagnosed HIV-positive patients of the institution were recruited. Demographic profile, whole blood zinc levels, CD4 cell count level, HIV disease stage, and presence of any dermatologic manifestations were noted. Prevalence of zinc deficiency and correlation between whole blood zinc levels and CD4 cell count were determined. The data were analyzed by chi-square and pearson correlation analysis. Results: Among the 65 patients, overall zinc deficiency was noted at 33.8%. Low CD4 count and HIV disease stage IV participants had the highest percentage of zinc deficiency at 54.6% and 50%, respectively. A correlation coefficient at r = 0.3364 was noted between whole blood zinc levels and CD4 cell count (P = 0.006). Twenty-nine patients presented with dermatologic manifestations, with 10 patients being zinc deficient. Conclusion: A weak positive correlation was seen between zinc levels and CD4 count. There is an increasing frequency of zinc level deficiency with a higher HIV disease stage. Dermatologic manifestations of HIV may be present in both patients with normal and deficient zinc levels.

Influence of zinc levels and Nrf2 expression in the clinical and pathological changes in patients with diabetic nephropathy

ObjectiveWe investigated the correlation between zinc levels and Nrf2 expression and potential effects on the clinicopathology of patients with diabetic nephropathy (DN).MethodsWe selected 30 patients with DN, diagnosed via renal biopsy at our hospital from March 2018 to November 2019, and enrolled 30 healthy individuals from a medical examination center as the control group. Patients with DN were divided into normal-zinc and low-zinc groups. We detected the levels of zinc, copper, and Nrf2 mRNA in their serum, and collected the clinical and pathological data of DN patients.ResultsSerum zinc level and Nrf2 mRNA expression were significantly decreased in patients with DN compared to those of healthy people (P < 0.05). Of the 30 patients, 16 had low zinc (53.3%) and 14 had normal zinc levels (46.7%). There was no significant difference in the blood Nrf2 mRNA expression between the two groups (P > 0.05). However, the expression of Nrf2 in the kidney tissue of the low-zinc group was significantly lower compared to the normal-zinc group (P < 0.05). Diastolic blood pressure and copper levels were significantly higher in the low-zinc group (P < 0.05). In contrast, body mass index, red blood cell count, Hb level, and the ratio of zinc to copper were significantly lower in the low-zinc group (P < 0.05). The pathological classifications of the low-zinc group were more severe (P < 0.05).ConclusionPatients with DN were more likely to have zinc deficiency and lower expression of Nrf2. Additionally, DN patients with zinc deficiency were prone to have more severe clinical and pathological manifestations.

Effect of nutrition education on nutritional status and serum zinc level of HIV and AIDS clients: implication for care in resource-limited settings

Background: People living with HIV or AIDS in resource-limited settings are faced with challenges in their nutrition and micronutrient levels. This study aimed to determine the effect of nutrition education on the nutrition status and serum zinc level of HIV and AIDS clients, and its implication for HIV care in resource-limited settings. Methods: This intervention study was conducted among HIV clients at the University of Nigeria Teaching Hospital and Enugu State University Teaching Hospital, which served as the intervention and control groups respectively. A nutrition education programme was delivered to the intervention group. In both groups, before and after the intervention, the body mass index of participants was calculated using their height (m2) and weight (kg) while their serum zinc levels were analysed using spectrophotometry. Chi-square and McNemar chi-square tests were used in the analysis. Results: A total of 185 respondents was studied in each group, with the majority in the 30–39 and 40–49 age groups, respectively (65.4% of the study group and 64.4% of the control group). Larger proportions of respondents in both groups were females (72.4% vs 75.1% respectively). Three months after the intervention, the proportion of respondents with normal serum zinc levels improved significantly from 20.5% to 51.9% in the intervention group (χ 2 McNemar, p < 0.001), whereas the control group had no appreciable improvement (16.8% vs 22.7%) (χ 2 McNemar, p < 0.117). Furthermore, the post-intervention serum zinc level difference between the intervention and control groups was statistically significant (χ 2 = 33.699; p < 0.001). No statistically significant difference existed in the nutritional status between the groups (χ 2 = 3.469; p = 0.325). Conclusion: Nutrition education had a positive effect on the serum zinc levels of HIV clients. Integrating nutrition education programmes as a key component of HIV care in resource-limited settings will help improve the serum zinc level of people living with HIV, which ultimately improves their immune status and life expectancy.