Iron Deficiency Anemia Research Articles

ORAL IRON-HYDROXIDE POLYMALTOSE COMPLEX VERSUS SUCROSOMIAL IRON FOR CHILDREN WITH IRON DEFICIENCY WITH OR WITHOUT ANEMIA: A CLINICAL TRIAL WITH EMPHASIS ON INTESTINAL INFLAMMATION

Background: Iron deficiency anemia (IDA) is a major public health problem among children worldwide. Iron deficiency without anemia (IDWA) is at least twice as common as IDA. Some studies propose that oral iron fortification can modify the infant’s gut microbiome leading to intestinal inflammation. Objectives: To determine whether oral iron therapy can lead to intestinal inflammation in children with IDA or IDWA. Patients and methods: Fifty-six patients aged 6 months to 16 years (median age 7.6 years) with IDA or IDWA were randomly assigned to receive either iron (III)-hydroxide polymaltose complex (IPC) 5mg/kg once daily (maximum dose 100 mg) or sucrosomial iron (SI) 1.4 mg/kg once daily (maximum dose 29.4 mg). Safety and efficacy were studied after 30 and 90 days of treatment. In addition, fecal calprotectin as a marker of intestinal inflammation was measured simultaneously and compared to results obtained before therapy. Results: A significant increase in serum ferritin was noted in both groups as the median ferritin level at baseline was 6.7 μg/L in the IPC group and 6.6 μg/L in the SI group, increasing to 15.9 μg/L and 12.1μg/L respectively, after 90 days of treatment. However, there was no significant change in fecal calprotectin in either group. In addition, no differences in the trend over time were observed between the two groups regarding fecal calprotectin, serum ferritin, and hemoglobin. Conclusions: IPC and SI were equally effective in treating IDA and IDWA. At the recommended doses, oral iron therapy does not seem to induce intestinal inflammation.

Iron Deficiency Anemia Among Women in Skardu, Gilgit-Baltistan

ABSTRACT Objective: To determine the frequency of iron deficiency anemia among women in Skardu, Gligit-Baltistan. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Skardu, Pakistan, from Dec 2021 to May 2022. Methodology: A total of 202 women were selected through consecutive sampling from General Medical OPD of Combined Military Hospital, Skardu, Pakistan. Hemoglobin globin levels (Hb gram/deciliter), mean corpuscular volume (MCV fL) and red cell distribution width (RDW%) were determined for all enrolled patients. Results: Mean age of participants in this study was 34.46±10.93 years. Reduced Hb was observed in 62(30.69%) women with a mean hemoglobin level of 9.48±1.59 gl/deciliter and mean corpuscular volume of 79.97±10.7d fL. Among these women, 5(2.47%) were severely anemic (6.56±0.39 gl/deciliter), 28(13.86%) moderately anemic (8.51±0.83 gl/deciliter) while 29(14.35%) were mildly anemic (10.92±0.48 gl/deciliter). Women of younger age group, between18-35 years, were found to suffer more from iron deficiency anemia (39.14%) with mean hemoglobin levels of 11.31±1.80 and mean corpuscular volume of 79.34±10.86 fL. Conclusion: Iron Deficiency Anemia is present in female population of Gilgit-Baltistan in general and woman of childbearing age in particular. Emergency measures for awareness and fortification of basic food items with iron should be undertaken at large scale.

Littoral cell angioma of a huge spleen with peripheral blood pancytopenia in a 14-year-old boy: a case report and review of the literature

BackgroundSplenic littoral cell angioma (LCA) is an exceptionally uncommon malignant potential vascular tumor with infrequent occurrences in pediatric patients. Due to its reliance on histopathological analysis for diagnosis, LCA may be mistakenly identified as other splenic tumors. Patients with LCA may experience anemia or thrombocytopenia, but peripheral blood pancytopenia is infrequent.Case reportA 14-year-old boy presented with peripheral blood pancytopenia, necessitating hospitalization after splenomegaly was identified during a physical examination. Following the exclusion of hematological disorders, a splenectomy was conducted; histopathological examination confirmed the diagnoses of LCA. No metastases or recurrences were observed during the 8-month follow-up. To the best of our knowledge, this case represents the first instance of LCA associated with pancytopenia in a pediatric patient.ConclusionLCA can lead to iron-deficiency anemia or thrombocytopenia, with rare occurrences of pancytopenia, potentially resulting in misdiagnosis as a hematological disorder. Surgical intervention remains an effective treatment for LCA.

Gastrointestinal Angiodysplasia Resolution After Transcatheter Aortic Valve Implantation

Heyde syndrome is the cooccurrence of aortic stenosis and gastrointestinal bleeding secondary to vascular lesions, including angiodysplasias. Several studies have demonstrated cessation of gastrointestinal bleeding after transcatheter aortic valve implantation (TAVI), but the etiology and effects on vascular lesions are largely unknown. To examine the associations of TAVI with gastrointestinal vascular lesions and identify factors associated with recovery among patients with iron deficiency anemia and severe aortic stenosis. In this prospective, single-center cohort study, patients with iron deficiency anemia on the TAVI waiting list from September 2020 to February 2022 were assessed by capsule endoscopy. Those with vascular lesions were reassessed 6 months after TAVI. Endoscopic images were anonymized and evaluated by 2 independent researchers. Data were analyzed from September 2022 to August 2024. TAVI. The primary outcome was the mean difference in the number of vascular lesions before vs after TAVI. A total of 24 patients (mean [SD] age, 77.4 [7.1] years; 18 [75.0%] male) underwent capsule endoscopy, and vascular lesions were present in 18 patients (75.0%). TAVI was performed in 15 of 18 patients with vascular lesions, of whom 11 agreed to a second capsule endoscopy. The mean (SD) number of vascular lesions across the gastrointestinal tract decreased from 6.4 (5.6) lesions before TAVI to 2.0 (2.1) lesions 6 months after TAVI (P = .04). The number of vascular lesions decreased in 9 of 11 patients (81.8%), including 6 patients (54.5%) who no longer had typical angiodysplasias. Resolution of angiodysplasias was less frequent in patients who had multiple valvular heart disease before TAVI (0 of 3 patients) vs those without multiple valvular heart disease (6 of 8 patients [75.0%]) and in patients with significant paravalvular leakage after TAVI (2 of 5 patients [40.0%]) vs those without significant leakage (4 of 6 patients [66.7%]). In this cohort study of 24 patients with iron deficiency anemia and severe aortic stenosis, angiodysplasias were present in 75.0% of patients. TAVI was associated with reduced size and number of angiodysplasias in these patients. These findings suggest that TAVI not only improves aortic stenosis but may also reduce gastrointestinal bleeding by resolving vascular lesions, offering a dual benefit for patients with Heyde syndrome.

Blood cell HbA1c measured by enzymatic assay show higher than whole blood HbA1c in patients with iron deficiency anemia

Blood cell HbA1c measured by enzymatic assay show higher than whole blood HbA1c in patients with iron deficiency anemia

Compliance with weekly iron folic acid supplementation and associated factors among secondary school adolescent girls, in Jimma Arjo District, West Ethiopia, 2022: A mixed method cross-sectional Study

Background: Iron deficiency anemia is a prevalent and major public health problem in low- and middle-income countries among adolescent girls. The risk of Iron deficiency anemia and its consequences are prevented by taking and complying with a weekly iron-folic acid supplement. However, there was no information regarding compliance and its associated factors in Ethiopia. The study aimed to determine the magnitude of compliance with weekly Iron-folic acid supplementation and associated factors among Jimma Arjo secondary school adolescent girls. Methods: Institutional-based cross-sectional study was conducted on 417 adolescent girls in three secondary schools of Jimma Arjo, West Ethiopia from March 1st to 31st, 2022 using interviewer-administered structured and semi-structured questionnaires. Bivariable and multivariable logistic regression analyses were used to determine the association of variables. Results: Compliance with iron-folic acid supplementation was 29.3% with 95% CI (24.9, 33.3). Mother`s secondary level of education (AOR=4.94 (95% CI:2.45,9.94)), awareness of anemia (AOR=4.23 (95% CI:2.35,7.61)), good knowledge about iron-folic acid supplementation (AOR=3.96 (95% CI:2.17,7.22)), lack of iron-folic acid supplementation (AOR=0.42 (95% CI:0.23,0.75)), and iron-folic acid supplementation side effects (AOR=0.17 (95% CI:0.08,0.37)) were factors significantly associated with iron-folic acid supplementation compliance. Misconceptions about iron-folic acid supplementation, forgetfulness of tablet, lack of access to drinking water, and irregularity of school weekly iron-folic acid supplementation days were identified as the main barriers to adolescent girls' compliance with iron-folic acid supplementation in a qualitative study. Conclusions: Weekly iron-folic acid supplementation compliance was low at 29.3%. Scheduled health education, parental participation in the program, access to drinking water, refresher training for school focal persons, and fixed weekly iron-folic acid supplementation days can improve compliance with iron-folic acid supplementation and are recommended.

Inflammatory biomarkers and hepcidin levels in Iron deficiency anemia among women of reproductive age

Inflammatory biomarkers and hepcidin levels in Iron deficiency anemia among women of reproductive age

Comparative estimation of ascorbic acid (Vitamin C) in Sweet-melon, Watermelon and Cucumber

This research is carried out to provide valuable information for individuals that would want to properly modify their nutrient intake. It would enable individuals to know the quantity of these fruits (Sweet melon, Watermelon and Cucumber) needed to be consumed per day to meet the Recommended Daily Allowance (RDA) of Vitamin C for healthy living. Understanding the relative content of Ascorbic acid in these fruits will help individuals plan their diets and know how to properly incorporate them in foods daily to avoid Vitamin C deficiency health problems. This study determined and compared the vitamin C content in Sweet melon, Watermelon and Cucumber. The extracted juices were analysed for ascorbic acid (Vitamin C) using Iodometric Titration method. Results obtained showed that Sweet melon contain (58.4mg/100cm³), Water melon (22.75mg/100cm³) and Cucumber (16.25mg/100cm³) concentrations of ascorbic acid. The ascorbic acid concentrations being highest in Sweet melon and lowest in Cucumber. Therefore sweet melon is the best source of Vitamin C among the three fruits analyzed. Sweet melon can be recommended for individuals suffering from vitamin C deficiency. It is recommended that nutrition and health education is needed to promote increased consumption of fruits rich in Vitamin C content to avoid diseases caused by its deficiency such as scurvy, Iron deficiency anemia, bone disease in children.

Iron status in children with acute COVID-19 and paediatric inflammatory multisystem syndrome during infection and after recovery

BackgroundCOVID-19 has significant effects on organ function, particularly on lung function and iron metabolism. Studies have shown increased levels of ferritin, an iron storage protein, in COVID-19 patients, indicating potential changes in iron utilization. Research has focused primarily on adults, with limited studies on paediatric patients and a lack of comparisons with MIS-C patients. This study aimed to assess iron status in paediatric COVID-19 patients using traditional and new biomarkers, soluble transferrin receptors (sTfR) and Reticulocyte hemoglobin equivalent (RET-He), to improve diagnosis and prognosis. Additionally, we sought to compare iron status between acute COVID-19 patients and MIS-C patients and evaluate the relationships among iron dysmetabolism, disease severity, and prognosis in paediatric patients. The study also involved monitoring iron status during and after infection to understand its impact on patient severity and prognosis.MethodsA cohort study involving 49 patients aged 1 month to 18 years was conducted at the isolation department of Mansoura University Children's Hospital. The study included 36 patients with acute COVID-19 and 13 with multisystem inflammatory syndrome of childhood (MIS-C). Diagnosis was based on PCR from a deep nasopharyngeal swab or a positive antibody test. Follow-up of survivors was conducted 3 months after recovery. Blood samples were obtained during infection and at follow-up for CBC, Ret-He, iron kinetics, and sTfR analyses.ResultsSignificant iron deficiency anaemia was observed in all patients during infection, with improvement after 3 months of recovery in survivors. The improvement was more obvious in MIS-C patients, with Hb and iron kinetics not significantly affected by disease severity. The STfR was significantly lower in nonsurvivors than in survivors. The ROC curve showed that a baseline sTfR ≤ 18 nmol/L was a statistically significant difference between nonsurvivors and survivors (area under the curve (AUC) = 0.810, p < .001), with 66.7% sensitivity and 82.5% specificity. Regression analysis revealed that patients with baseline sTfRs ≤ 18 nmol/L were 5.9 times more susceptible to death.ConclusionThis study revealed that COVID-19 in children caused iron deficiency anaemia, which improved within 3 months after recovery. Haemoglobin and sTfRs were identified as reliable indicators of IDA in these patients, unlike iron kinetics and RET-He.

The contribution of iron metabolism to heart failure: a haematological and biochemical perspective

Abstract Introduction Heart failure (HF) can be influenced by diverse modulators, such as genes involved in iron metabolism - HFE, SLC40A1 and TMPRSS6, and haematological and biochemical parameters - serum iron, ferritin, transferrin saturation, mean corpuscular volume (MCV) and Red Cell Distribution Width (RDW). Objectives To investigate the association of genetic variants in the HFE gene [C282Y (rs1800562) and H63D (rs1799945)], SLC40A1 (rs1439816 and rs2304704) and TMPRSS6 (rs855791) with haematological parameters and biochemical biomarkers of iron metabolism in HF and in its various forms of presentation [preserved Ejection Fraction-HFpEF and non-preserved Ejection Fraction-HFnpEF (middly reduced + reduced)], in each sex. Methods 301 individuals with HF were studied (141 men and 160 women), with a median age of 80 years (min=31 and max=99) and a median body mass index (BMI) of 25.90 kg/m2 (min=16.50 and max=47.30). Multiplex PCR-ARMS technique was used to analyze the HFE gene variants (C282Y and H63D) and Endpoint Genotyping was used for the remaining variants. Statistical analysis was carried out using SPSS software, version 28.0, with a statistical significance level of p&amp;lt;0.05. Results The presence of indicators of iron deficiency anaemia was verified in the haematological and biochemical parameters in our population of HF. Significant differences were found in serum iron values in the presence of the mutant allele for the three genes studied: 1)in the H63D (p=0.006) for females, and more particularly in females with HFnpEF (p=0.020); 2) in the rs1439816 for males (p=0.035) and more particularly in males with HFpEF (p=0.036); and 3) in the rs855791 for males (p=0.018). As for ferritin, significant differences were found in the presence of the mutant allele for the rs2304704 (p=0.001) in females. For transferrin saturation, significant differences were found in the presence of the mutant allele for the three genes studied: 1) in the H63D (p=0.013) for females, more specifically in females with HFpEF (p=0.043); 2) in the rs1439816 in males (p=0.037); and 3) in the rs855791 in females (p=0.034), particularly in females with HFpEF (p=0.023), and in males (p=0.032), particularly in males with HFpEF (p=0.037). Analyzing the MCV, there were statistically significant differences in the presence of the mutant allele for the rs2304704 (p=0.012) in females, particularly in those with HFpEF (p&amp;lt;0.001). Regarding RDW, significant differences were found in the presence of the mutant allele of the C282Y polymorphism in females with HFpEF (p=0.048). Conclusion Ferropenic anaemia highly prevalent in this population with HF. All the genes analyzed contribute to the modulation of the analyzed parameters/biomarkers, however, the SLC40A1 gene showed greater modulating capacity. Genetic modulation was more relevant in HFpEF women, suggesting that this sex is the most susceptible to genetic modulation.

Criteria for identifying a risk group for iron deficiency anemia from among healthy women of reproductive age

The article presents the results of a survey of healthy women of reproductive age with the definition of criteria for identifying a risk group for anemia from among them. The criteria were the indicators of peripheral blood: a decrease in the concentration of Hb (below 120.0 g/l) of blood and hematocrit, an expansion of RDW, a decrease in the volume of red blood cells (MCV), as well as a decrease in the amount of serum iron, ferritin, total protein that do not reach the lower limit of normal and the presence of a history of diagnosis of somatoform dysfunction of the autonomic nervous system. The application of the identified criteria for the early diagnosis of iron deficiency will allow effective timely preventive measures to prevent the development of iron deficiency anemia in women of reproductive age.

The Relationship Between Ghrelin and Iron Metabolism In Beta Thalassemia Major Patients

IntroductionStudies in beta thalassemia major (β-TM) patients have shown that the responses of HIF2α, hepcidin and ferroportin molecules to high iron levels are impaired. In recent years, studies conducted in patients with iron deficiency anemia have investigated the relationship between ghrelin hormone and iron metabolism. In this study, we aimed to contribute to the etiopathogenesis of this disease by examining the changes in ghrelin hormone levels in patients with β-TM.Material and methodsFifty-two β-TM and 23 controls were included in our study. Blood counts, routine biochemical parameters, HIF2α, hepcidin and ghrelin levels were studied in blood samples taken from the volunteers.ResultsErythrocyte indexes, serum bilirubin, iron, unsaturated iron binding capacity, total iron binding capacity and ferritin levels showed significant differences between two groups (p&lt;0.05) . There was no significant difference between two groups for serum HIF2α and hepcidin levels. When two groups were compared, ghrelin levels were found to be significantly higher in patients (p&lt;0.05). When the correlation between parameters was examined in all subjects, a weak positive correlation was found between ghrelin and HIF2α (r=0.263) (p&lt;0.05) and a significant positive correlation was found between ghrelin and ferritin (r=0.417) (p&lt;0.05).ConclusionsOur study showed that there is a positive correlation between ghrelin and ferritin levels. Elevated ghrelin levels in patients with β-TM may have an important role in regulating impaired iron metabolism. Molecular level studies are needed to determine synthesis pathways.

Hepcidin, GDF-15 and their Impact on Iron Metabolism in CKD

Background Anemia is an important complication in chronic kidney disease (CKD). We studied the diagnostic accuracy of hepcidin and growth differentiation factor-15 (GDF-15) as early markers of iron deficiency anemia (IDA) in non-dialysis (ND-CKD) patients. Materials and Methods This was a cross-sectional, case-control study comprising 100 cases of CKD (newly diagnosed and non-dialyzed) and 40 healthy controls. Serum levels of hepcidin and GDF-15 were estimated using ELISA-based assays. Receiver operator characteristics were used to evaluate the diagnostic validity of hepcidin and GDF-15 for absolute and functional iron deficiency anemia. Results About 33% of the cases were females with a mean age of 47.64 (± 13.68) years. The predictive value of hepcidin for diagnosing functional IDA in CKD was found to be 69.1% (95% CI: 52.5% to 82.7%), and that of GDF-15 was found to be 68.8% (95% CI: 52.6% to 82.1%). Hepcidin significantly correlated with hemoglobin (r = 0.278, p = 0.005) and serum iron (r = 0.222; p = 0.025). GDF-15 positively correlated with ferritin (r = 0.346, p &lt; 0.0001) and hsCRP (r = 0.223, p = 0.0088) and negatively correlated with eGFR (r = -0.462, p &lt; 000001), Hb (r = -0.481, p &lt; 0.00001) and TIBC (r = -0.353, p &lt; 0.0001). Conclusion Hepcidin and GDF-15 could predict functional IDA in our patients but not absolute IDA.

Diagnosis and Treatment of Iron Deficiency and Iron Deficiency Anemia in Children and Adolescents: Recommendations of the Polish Pediatric Society, the Polish Society of Pediatric Oncology and Hematology, the Polish Society of Neonatology, and the Polish Society of Family Medicine

Background/Objectives. Iron deficiency is one of the most common nutritional deficiencies worldwide and is the leading cause of anemia in the pediatric population (microcytic, hypochromic anemia due to iron deficiency). Moreover, untreated iron deficiency can lead to various systemic consequences and can disrupt the child’s development. Methods/Results. Therefore, a team of experts from the Polish Pediatric Society, the Polish Society of Pediatric Oncology and Hematology, the Polish Neonatology Society, and the Polish Society of Family Medicine, based on a review of the current literature, their own clinical experience, and critical discussion, has developed updated guidelines for the diagnosis, prevention, and treatment of iron deficiency in children from birth to 18 years of age. These recommendations apply to the general population and do not take into account the specifics of individual conditions and diseases.

Ambulatory care sensitive diseases/conditions in adult patients. A systematic review

Aim. To summarize the published data on the nomenclature of ambu­latory care sensitive diseases/conditions (ACSCs) in adult patients as one of the tools for a comprehensive assessment of the effectiveness of primary health care (PHC) measures implemented.Material and methods. The study was implemented in 4 following stages: 1 — search for articles by keywords in electronic bibliographic databases; 2 — duplicate elimination; 3 — review of abstracts with an as­sessment for compliance with the inclusion/exclusion criteria, fol­lowed by a search for full-text versions and final selection of pub­lications; 4 — systematization and analysis of data on the ACSCs. Articles published in the period from January 1, 2012 to December 31, 2022 and containing information on ACSC nomenclature were searched in 4 domestic and foreign electronic bibliographic databases (Elibrary, NLM (PubMed), MEDLINE, PreMEDLINE). The PRISMA (Preferred Re­porting Items for Systematic reviews and Meta-Analyses) system was used in the preparation of the systematic review. Systematization of information on the obtained results was carried out in Microsoft Office Excel 2016 spreadsheets.Results. In total, out of 10898 initially found publications, 11 full-text pa­pers describing studies that fully met the inclusion/exclusion criteria we­re admitted to stage 4 and were included in the final analysis. In none of the 11 publications was ACSC nomenclature identical to any other pub­lication included in stage 4 of the analysis. Variability in the total num­ber of ACSCs was noted in each of the assessed papers. In 100% of the analyzed publications, the NCAs included chronic obstructive pul­monary disease/chronic bronchitis, heart failure, diabetes, and hypertension. In 91% (10 publications), the ACSCs included angina pectoris, asthma, iron deficiency anemia, dental and oral diseases, urinary tract infections, acute skin infections, and gastroenteritis.Conclusion. The nomenclature of the ACSCs in different countries is characterized by variability due to demographic, epidemiological, organizational, and other features. The conducted systematic review showed that the nomenclature of the ACSCs has not been defined in the Russian Federation. The data obtained in this work can serve as a basis for initiating a project aimed at developing a domestic nomenclature of ACSCs as one of the tools for a comprehensive assessment of the effectiveness of PHC measures implemented.

Unusual partners: a rare cause of small bowel bulges and a common cause of anemia.

A 67-year-old female, without prior medical history, presented to the emergency department due to dizziness and asthenia, where iron deficiency anemia, without visible blood loss, was identified. A previous abdominal computed tomography revealed intestinal pneumatosis of the proximal jejunum and right colon. The upper endoscopy showed non-atrophic gastritis associated with H.pylori infection, which was treated, and the colonoscopy revealed right colic pneumatosis, without other alterations. A small bowel capsule endoscopy was performed, revealing bulging areas of the intestinal wall, lymphangiectasias and angioectasias, in the proximal small bowel. A single balloon assisted anterograde enteroscopy reached the proximal jejunum, showing several areas of bulging with endoscopically normal mucosa, compatible with intestinal pneumatosis. In 3 bulging areas, there were multiple lymphangiectasias and friable punctate angioectasias, which were treated with argon-plasma coagulation and through-the-scope clip with haemostatic success. The procedure was uneventful. After 6 months of follow-up, the patient was asymptomatic, without anemia or iron deficiency.

46 Micronutrient deficiencies in children and youth with autism spectrum disorder: Findings from a national surveillance study

Abstract Background Children and youth with autism spectrum disorder (ASD) may be at risk of micronutrient deficiencies secondary to feeding problems such as limited dietary repertoire and high-frequency single food intake. The epidemiology of micronutrient deficiencies in the paediatric ASD population has not been studied. Objectives To determine minimum incidence, clinical characteristics, and health care utilization for four micronutrient deficiencies in children and youth with ASD in Canada: (1) vitamin A deficiency/xerophthalmia, (2) scurvy, (3) severe, symptomatic vitamin D deficiency, and (4) severe iron-deficiency anemia. Design/Methods We conducted a study via the Canadian Paediatric Surveillance Program, an active, population-based surveillance platform, between January 2020 and December 2022. More than 2,500 paediatricians and paediatric subspecialists were asked, monthly, to report cases of children and youth &amp;lt;18 years of age with ASD and one or more of the micronutrient deficiencies under surveillance. Case information was obtained via a detailed clinical questionnaire. Descriptive statistics were used to summarize the data. For average yearly minimum incidence estimates, we used case counts over the 3 year surveillance period, 2021 census data and recent ASD prevalence estimates (2% of children/youth aged 1 to 17 years living in private dwellings in Canada). Results Twenty-seven children and youth met the case definition (most male; median age 7.7 years, range 1.8–14.9 years). Multiple deficiencies were diagnosed concurrently in 9/27 (33%). Minimum incidence, per 100,000 children and youth with ASD per year, was 5.1 for scurvy (17 diagnoses); 3.0 for severe iron deficiency anemia (10 diagnoses); 2.1 for severe, symptomatic vitamin D deficiency (7 diagnoses); and &amp;lt;1 for vitamin A deficiency/xerophthalmia (&amp;lt;5 diagnoses). Restricted diet/limited food repertoire, attributed to the patient, was universal (27/27). Number of different foods in the patient’s diet was &amp;lt;10 in nearly all (20/23, 87%). Most patients were non-verbal (19/27, 70%) and of normal weight (18/26, 69%). Two-thirds (18/27, 67%) were admitted to hospital (median duration 8 days, range 3–32 days). One-third (9/27, 33%) underwent an invasive procedure as part of their diagnostic workup. Conclusion This surveillance study represents the first population-level examination of the epidemiology of micronutrient deficiencies in children and youth with ASD. Results suggest that micronutrient deficiencies in ASD are rare but clinically important, leading not infrequently to hospital admission and invasive investigations. Clinical characteristics of cases should inform anticipatory guidance and prevention efforts tailored to the paediatric ASD population.

Outcomes of COVID-19 in Pregnant Women: A Retrospective Analysis of 300 Cases in Jordan

Background: The impact of COVID-19 on pregnancy remains a critical area of research, with growing evidence suggesting that maternal infection, particularly in the third trimester, may lead to significant complications Aims: The primary aim was to investigate the maternal and neonatal outcome of pregnant Jordanian women with COVID-19. The secondary aim included exploring demographics, obstetrics characteristics, and comorbidities among these women. Methods: A retrospective comprehensive review of the records of 300 cases of pregnant women with COVID-19, who were treated between November 2020 and April 2021 at Queen Alia Military Hospital (a main referral center for patients with COVID-19) in Jordan. All cases were confirmed by the rapid antigen test (RAT) + long polymerase chain reaction (PCR) test used to detect SARS-CoV-2 by amplifying viral RNA from patient samples. Women infected with COVID-19 were categorized into four groups according to the RCOG guidelines for COVID-19 infection in pregnancy: asymptomatic, mild, moderate, and severe cases. All cases were managed following the Royal College of Obstetricians and Gynecologists protocol for COVID-19 in pregnancy. Data extracted from patient’s records included demographic information, COVID-19 clinical manifestations, obstetric history, diagnostic findings, treatment plans, comorbidities, gestational age at diagnosis, treatment protocols, and maternal and neonatal outcomes. Results: The mean age was 29.7 years; 98.3% were nonsmokers; 8% had previous miscarriages, and 67.3% had the infection in the third trimester. Iron deficiency anemia affected 30.3%, while 18.3% had comorbidities, mainly hypothyroidism. Most women were asymptomatic 61.7%, but 33% had respiratory symptoms, 4.7% needed intensive care unit (ICU) admission, and 2.7% resulted in maternal deaths. First-trimester and second-trimester miscarriages were recorded in 2.67% and 3.67% of cases, respectively, while preterm labor occurred in 3.0% of pregnancies. Additionally, age and hospitalization duration had a positive correlation with the neonatal outcomes (r = 0.349, p &lt; 0.01), (r = 0.376, p &lt; 0.01), respectively. Furthermore, COVID-19 presentation and treatment options demonstrated a strong positive correlation (p-value &lt;0.01). On the other hand, maternal death had a strong negative correlation with poor neonatal outcomes (r = −0.776, p &lt; 0.01). Conclusion: The study showed that COVID-19 in pregnant women, particularly in the third trimester, is associated with significant neonatal complications, with age, hospitalization duration, and COVID-19 severity strongly impacting outcomes.

Diagnostic Performance of Red Blood Cell Indices in the Differential Diagnosis of Iron Deficiency Anemia and the Thalassemia Trait in Chile: A Retrospective Study

Background: Iron deficiency anemia (IDA) and the β-thalassemia trait (BTT) are two main causes of hypochromic–microcytic anemia worldwide. Researchers have described many red blood cell (RBC) indices as screening tests for presumptive differentiation, based on differences observed in complete blood count (CBC) data for each condition. There are few BTT reports in Chile, and neither laboratories nor clinical staff have widely used these indices. Objective: The objective of this study was to evaluate the diagnostic performance of 29 RBC indices in 182 patients (51 BTT and 131 IDA) and compare CBC results in both groups. Methods: A retrospective search was carried out in the Laboratory Information System between January 2021 and February 2024 to collect results from CBC, and 29 RBC indices were calculated for each patient. Then, sensitivity, specificity, positive predictive value, negative predictive value, Youden’s index, positive likelihood ratio, negative likelihood ratio, and diagnostic accuracy were calculated using MedCalc©. Results: The Green and King, Wongprachum, and Keikhaei indices showed the best discriminatory power with Youden index values of 0.923, 0.908, and 0.896, respectively, and significant differences were observed in all CBC parameters between BTT and IDA patients (p &lt; 0.001). Conclusions: The Green and King, Wongprachum, and Keikhaei indices showed the best performance; therefore, they can be used as screening for the differential diagnosis between BTT and IDA in order to improve diagnosis given the important therapeutic and epidemiological implications. In this way, clinical laboratories could have a main role in the investigation of these patients.

Endoscopic resection of a juvenile jejunum polyp which caused recurrent intestinal bleeding in a 12-month-old child

Introduction To verify a source of obscure gastrointestinal bleeding (GIB) leading to iron deficiency anemia is a challenging diagnostic problem. Intestinal polyps can be one of such sources. Sporadic juvenile intestinal polyps are extremely rare at the first year of life. The authors present a clinical case which demonstrates endoscopic diagnostics and resection of a jejunum polyp in a 12-month-old child weighing 6,3 kg. We did not find similar publications in literature. Clinical observation A 12-month-old boy was admitted to our clinic with long-lasting complaints of dark stool and iron deficiency anemia. For the first time, GIB symptoms appeared at the age of one month. The child was repeatedly examined (ultrasound, computed tomography, esophagogastroduodenoscopy (EGD), colonoscopy), but GIB source was not found. The child was prescribed symptomatic therapy for iron deficiency anemia including red blood cell transfusion. At current hospitalization in our clinic an intestinal polyp and transient small intestinal intussusception were suspected at ultrasound examination. The child underwent EGD, video capsule endoscopy, colonoscopy, laparoscopy. But the source of the bleeding was not found. During the repeated enteroscopy a sporadic juvenile jejunum polyp 17x15 mm was found at 40 cm distally to the pylorus. Endoscopic mucosal resection with the polyp was performed. The postoperative period was uneventful. One month later there were no complaints, no signs of anemia, stool was normal. Conclusion A sporadic juvenile jejunal polyp may be a cause of obscure recurrent intestinal bleeding in children. Modern intraluminal endoscopy allows not only to put diagnosis, but also to perform a minimally invasive surgical intervention.