Transferrin Levels Research Articles

Serum transferrin as a biomarker of hepatocyte nuclear factor 4 alpha activity and hepatocyte function in liver diseases

BackgroundSerum transferrin levels represent an independent predictor of mortality in patients with liver failure. Hepatocyte nuclear factor 4 alpha (HNF4α) is a master regulator of hepatocyte functions. The aim of this study was to explore whether serum transferrin reflects HNF4α activity.MethodsFactors regulating transferrin expression in alcoholic hepatitis (AH) were assessed via transcriptomic/methylomic analysis as well as chromatin immunoprecipitation coupled to DNA sequencing. The findings were corroborated in primary hepatocytes. Serum and liver samples from 40 patients with advanced liver disease of multiple etiologies were also studied.ResultsIn patients with advanced liver disease, serum transferrin levels correlated with hepatic transferrin expression (r = 0.51, p = 0.01). Immunohistochemical and biochemical tests confirmed reduced HNF4α and transferrin protein levels in individuals with cirrhosis. In AH, hepatic gene-gene correlation analysis in liver transcriptome revealed an enrichment of HNF4α signature in transferrin-correlated transcriptome while transforming growth factor beta 1 (TGFβ1), tumor necrosis factor α (TNFα), interleukin 1 beta (IL-1β), and interleukin 6 (IL-6) negatively associated with transferrin signature. A key regulatory region in transferrin promoter was hypermethylated in patients with AH. In primary hepatocytes, treatment with TGFβ1 or the HNF4α inhibitor BI6015 suppressed transferrin production, while exposure to TNFα, IL-1β, and IL-6 had no effect. The correlation between hepatic HNF4A and transferrin mRNA levels was also seen in advanced liver disease.ConclusionsSerum transferrin levels constitute a prognostic and mechanistic biomarker. Consequently, they may serve as a surrogate of impaired hepatic HNF4α signaling and liver failure.

Serum Level of Transferrin Unique Peptide Is Decreased in Patients With Acute Ischemic Stroke.

Objectives: Free irons are transported into brain tissues by transferrin and play an important role in neuronal/glial cell damage. Lower serum levels of transferrin have been found in patients with ischemic stroke, compared with healthy subjects. In present study, we investigated whether transferrin unique peptide (TF-UP) could be employed as a serum biomarker for brain tissue damage in acute ischemic stroke.Methods: The venous blood samples of 94 ischemic stroke patients and 35 brain tumor-stroke mimics (BT-SM) patients were collected within the first 72 h (Median time 23.25, Interquartile range 60.75) of acute onset in the emergency room. Total TF-UP and total albumin unique peptide (Alb-UP) were identified with liquid chromatography/mass spectrometry (LC–MS/MS) and quantified by multiple reaction monitoring (MRM) method using labeled reference peptide (LRP) for further analysis.Results: Median ratio of total TF-UP/LRP was 0.85 (Interquartile range, 0.21) in the brain tumor-stroke mimics (BT-SM) group, and 0.45 (0.14) in the ischemic stroke group; median Alb-UP/LRP ratio was 0.66 (0.16) in the BT-SM group, and 0.55 (0.20) in the ischemic stroke group. The overall trend from low to high levels was statistically significant for TF-UP/LRP (P < 0.0001), but not for Alb-UP/LRP (P = 0.1667). According to the receiver operating characteristic (ROC) curve, the area under the curve (AUC) was 0.9565 and the optimal cutoff value of serum TF-UP was 0.6317, which yielded a sensitivity of 91.49% and a specificity of 88.57%. The odds ratio (95% confidence intervals) of serum TF-UP/LRP was 83.31 (23.43, 296.22, P < 0.0001).Conclusions: Serum TF-UP/LRP level is decreased in patients with acute ischemic stroke in comparison with brain tumor, and it may serve as a serum biomarker for the neuronal/glial cell damage in cerebral infarction.

Retrospective Evaluation of Effects of Preoperative Anaemia Treatment in Gynaecological and Obstetric Surgical Patients.

ObjectiveIn anemic patients undergoing surgery, there is an increase in the requirement of blood transfusion, longer hospital stay and higher intensive care unit adimission. In this study we aimed to evaluate the efficacy of iv iron treatment before elective obstetric or gynecological operations retrospectively.MethodsAfter obtaining approval of ethics committee, records of 5688 patients underwent either obstetric or gynecological surgery between January 1st of 2016 to December 31st of 2018 were documented retrospectively and 241 anemic cases were identified. Eighty-one anemic patients who did not receive any iv iron treatment preoperatively were excluded and 160 cases treated with either iv iron (either sucrose or ferric carboxy maltose) were included. The laboratory results including haemoglobin (Hb), MCV,MCH and serum iron binding capacities, ferritin, iron and transferrin levels were documented before (preoperative) and after iv iron treatment (postoperative 10th day) were collected from files. Difference between preoperative and postoperative Hb, MCV, MCH, TIBC, serum ferritin, iron and transferrin levels of these cases were determined.ResultsIn 97 obstetric cases, the differences of Hb, MCV, MCH, serum iron, ferritin, iron binding capacity values before surgery and postoperative 10th day were respectively found as 1.3 g dL−1 (p=0.000); 1.9 fL (p=0.000); 0.3 pg (p=0.01); 44.4 μg dL−1 (p=0.008); 85.9 μg L−1 (p=0.009); 211.7 μg dL−1 (p=0.001). In 63 gynecologic cases, same measurements were evaluated and similar differences in Hb, MCV, MCH, serum ferritin and transferrin saturation values were 1.25 g dL−1 (p=0.000); 2.2 fL (p=0.000); 0.8 pg (p=0.000); 215.6 μg L−1 (p=0.002); 41.5% (p=0.044). Two obstetric patients and 7 gynaecologic patients were transfused erytrocyte suspensions after surgery.ConclusionEfficacy of preoperative iv iron therapy in gynaecologic-obstetric patients with IDA has been demonstrated and its importance has been revisited once again.

Preoperative transferrin level is a novel prognostic marker for colorectal cancer.

AimThis study investigated whether preoperative serum transferrin, a rapid‐turnover protein, was associated with prognosis after colorectal cancer (CRC) resection.MethodsWe evaluated preoperative transferrin, which was calculated as iron and unsaturated iron‐binding capacity, in 501 patients who underwent surgery for Stage I–III CRC. Transferrin level was directly proportional to total iron‐binding capacity (TIBC), and TIBC < 250 μg/dl was defined as low transferrin. The associations between transferrin and prognosis were evaluated in univariate and multivariate Cox proportional hazards analyses.ResultsFifty‐eight of 501 patients (11.5%) had low transferrin. In these patients, low transferrin was significantly associated with high age, female gender, low body mass index (<18.5), high white blood cell count, low total protein, low albumin, high C‐reactive protein, low hemoglobin, and low neutrophil/lymphocyte ratio. In the univariate analysis, low transferrin was associated with shorter relapse‐free survival (RFS) (hazard ratio [HR] 2.180, 95% confidence interval [CI] 1.417‐3.354, P < .001), overall survival (OS) (HR 2.930, 95% CI 1.784‐4.811, P < .001), and cancer‐specific survival (CSS) (HR 2.122, 95% CI 1.053‐4.275, P = .035). In multivariate analysis, high age (P < .001), Glasgow Prognostic Score (P = .009), and low transferrin (HR 2.336, 95% CI 1.173‐4.654, P = .011) were independently associated with shorter OS, and depth of invasion pT4 (P = .015), presence of lymph node metastasis (P = .001), low hemoglobin (P = .034), and low transferrin (HR 2.638, 95% CI 1.113‐5.043, P = .025) were independently associated with shorter CSS.ConclusionsPreoperative serum transferrin in Stage I–III CRC patients was identified as a novel prognostic marker by univariate and multivariate analyses.

Role of Regulatory Proteins Involved in Iron Homeostasis in Pulmonary Tuberculosis Patients and Their Household Contacts.

Early identification and treatment of active tuberculosis disease among high risk household contacts could limit new transmission and better clinical outcome, thus decreasing TB burden. Host iron homeostasis is an important yet underevaluated factor in pathophysiology of tuberculosis (TB). One such protein is hepcidin which internalizes ferroportin (membrane iron transporter), thus inhibiting iron export from macrophages which is utilised by bacteria leading to disease severity. Iron homeostasis markers were evaluated in 50 pulmonary tuberculosis patients (PTB) and their household contacts to assess their utility as biomarkers for TB development. Altered iron homeostasis with significantly lower haemoglobin levels despite optimum serum iron levels was observed in PTB compared to household contacts and healthy controls pointing towards anaemia of inflammation. Higher serum hepcidin with lower ferroportin expression and hence higher ferritin levels was seen in PTB compared to both household contacts and healthy controls due to IL-6 induced hepcidin production in TB. Transferrin levels were found to be significantly lower in PTB and household contacts as compared to healthy controls owing to higher ferritin levels in PTB group. Upon infection, regulation of iron absorption is disturbed via increased hepcidin levels leading to ferroportin internalization and thus inhibition of iron export from macrophages which may lead to favourable M.tb. survival and multiplication leading to tuberculosis. Some of these markers could be assessed for early identification and treatment of active tuberculosis among high risk household contacts limiting new transmission and better clinical outcome, thus decreasing TB burden.

Serum Copper, Ceruloplasmin, Iron, Transferrin level in patients with Psoriasis and their relationship with severity of the disease

Psoriasis is a common, chronic, immune mediated inflammatory disease that involves the innate immunological system (keratinocyte, dendritic cell, histiocytes, mast cells and endothelial cells) and acquired immunological system (T lymphocytes). Essential trace elements like iron (Fe), copper (Cu) undergo redox cycling and have physiological significance in inflammatory process. This study is aimed at measuring the level of copper, ceruloplasmin, iron and transferrin in psoriasis patient and to assess its relationship with the severity of the disease. This is an observational cross sectional study. It was conducted at the department of Dermatology and Venereology, BSMMU, Dhaka. Age range of the patient was 18 to 65 years. The mean age of the patients was 39.1±13.54 years, 57.9% patients were male and 42.1% were female. Male: female ratio was 1.4:1. Male patients were predominant. Mean duration of disease 5.36±4.05 years with range from 1.0 to 14 years. Most of the (76.3%) patients had mild disease followed by 23.7% had moderate to severe disease. Serum level of trace elements was compared between mild and moderate to severe group of psoriasis patients but difference were not statistically significant (p&gt;0.05). Weak negative correlation was found between PASI score and serum levels of copper (r = “0.134, P = 0.423), iron (r = –0.080, p = 0.632), transferrin (r = –0.079, p = 0.638) and weak positive correlation was found with ceruloplasmin (r = 0.228, p = 0.168). The results of the present research provide valuable information and correlation between the measured biomarkers and severity of psoriasis. Serum Ceruloplasmin, copper, iron and serum transferrin could serve as a biomarker of psoriasis but not as a marker of psoriasis severity.&#x0D; J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 59-68

Effects of pancreatectomy on nutritional state, pancreatic function, and quality of life over 5years of follow up.

To analyze serial changes in nutritional status, pancreatic function, and quality of life (QoL) over 5years of follow-up after pancreatectomy. Patients undergoing pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) between 2007 and 2013 were included. Data on relative body weight (RBW); triceps skinfold thickness (TSFT); body mass index (BMI); serum protein, albumin, transferrin, fasting blood glucose, postprandial 2-h glucose, and stool elastase levels; and QoL questionnaire scores were collected serially for 5years. Two hundred and seventeen patients were enrolled, but 79 patients completed the 5-year follow-up. RBW, BMI, and TSFT continued to decrease postoperatively but increased after 6months. Transferrin, albumin, and protein levels recovered to the preoperative level after 3months. Multivariate analysis revealed that a BMI >25 kg/m2 , DP, and adjuvant therapy had a significant impact on endocrine pancreatic insufficiency. Although steatorrhea and diarrhea were mainly resolved by 12months, the stool elastase level decreased after PD and was not restored. The mean scores for all QoL questionnaires improved above the preoperative value at 12months. Patients undergoing pancreatectomy can return to their daily lives after 12months. However, those with risk factors associated with pancreatic function and QoL need more careful follow-up and supportive management.

Effect of enteral nutritional support on nutritional status of patients with gastric cancer receiving chemoradiotherapy after gastrectomy

Aim: To evaluate the effects of enteral nutritional support in gastric cancer patients who received chemoradiotherapy (CRT) after gastrectomy. Materials and Methods: Patients who underwent total/subtotal gastrectomy due to gastric cancer and received postoperative CRT between January 1, 2010 and December 31, 2015 at Zonguldak Bulent Ecevit University Faculty of Medicine General Surgery Clinic were included in the study. The nutritional risk of patients was recorded using NRS-2002. The values of patients at the scheduled routine clinical follow-up at the end of the first year were compared with baseline values. Results: While 64.7% (n=22) of the patients continued to receive enteral nutritional support regularly (CNS group), 35.3% of the patients (n=12) discontinued nutritional support (DNS group). Patients in the DNS group had significantly lower baseline NRS-2002 scores (p=0.049). The NRS-2002 score of the CNS group decreased significantly at follow-up compared to the pre-CRT values. At the end of the first year, statistically significant increases were found in body weight, body mass index, transferrin level and vitamin D level of both patient groups. While the mean RBC count decreased significantly in the CNS group (p=0.002), there was no significant difference in the DNS group (p=0.382). When the amount of temporal change in RBC was evaluated, there was a significant difference between the DNS and CNS groups. Although vitamin B12 level and urea level increased in both groups, this increase was significant only in the DNS group (p = 0.049). Conclusions: In this study, it was determined that gastric cancer patients who continued enteral nutrition in the first year after CRT had significantly higher nutritional risk before CRT. Enteral nutrition reduces nutritional risk and shows positive results on nutritional parameters such as body weight, ferritin, transferrin, vitamin D, vitamin B12.

Correlation of serum acute-phase proteins with bone repair in rabbits (Oryctolagus cuniculus) submitted to partial radio ostectomy

ABSTRACT: Bone trauma triggers an acute inflammatory response, which can alter the serum concentration of acute-phase proteins (PFA). We aimed to evaluate the effectiveness of PFA measurement as a laboratory biomarker for inflammation related to bone regeneration. A partial ostectomy of the right radius was performed on 22 young male rabbits. The complete blood count, albumin, ceruloplasmin, haptoglobin, C-reactive protein, and transferrin levels were recorded and correlated with the radiographic evolution of bone healing. Statistically the best correlations with the inflammatory process and radiological findings were reported with haptoglobin and transferrin compared to the other measured PFAs. Haptoglobin and transferrin showed a maximum peak 24 and 36 hours after surgery, respectively. Transferrin displayed signs of decrease in the first 6 hours after surgery, in advance of the leukocyte response. The measurement of acute-phase proteins proved to be viable, considering the conditions in which the present study was carried out. Among all variables studied, haptoglobin and transferrin showed best correlation with the inflammatory process of bone healing. Additional studies are needed to determine the sensitivity of acute-phase proteins as predictors of complications in the treatment of fractures.

Effects of beclomethasone and aminophylline combined with enteral nutrition in chronic obstructive pulmonary disease on nutritional status and immune function in elders.

To investigate the efficacy of beclomethasone and aminophylline combined with enteral nutrition in the treatment of elderly patients with chronic obstructive pulmonary disease (COPD) and the associated effects of these drugs on patient nutritional status and immune function. In total, 115 elderly patients with COPD were included and were randomized into an enteral nutrition (EN) group and a control (CON) group. Aminophylline, in combination with beclomethasone, was administered to the CON group, whereas aminophylline and beclomethasone in combination with EN was administered to the EN group. Patients in the EN group showed significant improvement in partial pressure of carbon dioxide, forced expiratory volume in 1 sec/ expiratory forced vital capacity, and partial pressure of oxygen than those in the CON group. The levels of IgM, IgG, and IgA as well as the number of CD4+/CD8+ and CD4+/CD3+ T cells were higher in the EN group than those in the CON group (p<0.05); the EN group also exhibited higher levels of inflammatory cytokines, such as tumor necrosis factor-α and interleukin (IL)-1β (p<0.05), and lower levels of IL-6 than the CON group. In addition, patients in the EN group showed a significant increase in serum total protein, albumin, and transferrin levels than those in the CON group (p<0.05). Elderly patients with COPD showed a marked response to a regimen of beclomethasone, aminophylline, and EN, which significantly improved their immune function and nutritional status.

A study on assessment of different levels of iron, TIBC, transferrin and ferritin during pregnancy trimesters and lactation

Background: Iron deficiency is the most common nutritional disorder in the pregnant women. This study was conducted to investigate the possible contribution and impact of iron status on pregnancy in a costal population. One hundred seventy pregnant women aged between 18-38 years are taken in the current study. The women were followed up weekly till delivery after which neonatal anthropometrics and other birth out comes were recorded. Mean serum Hemoglobin, ferritin and iron were found to be lower in 3rd trimester as compared to 1st trimester, which become lower at postpartum then reach nearly to normal value during lactation. While serum ferritin was found to be lower in 2nd trimester as compared to 1st trimester, it was significantly higher in 3rd as compared to second trimesters and also decreased at postpartum and lactation. Serum TIBC, transferrin and Fe/TIBC levels increased during 1st, 2nd and 3rd trimesters, Serum TIBC also elevated at postpartum, then decreased during lactation. This result provides that, it is important to detect which form of iron become abnormal during trimesters of pregnancy, postpartum and lactation which may lead to cause of nutritional deficiency in pregnant women, so as to reduce public problem.

Changes in postoperative long-term nutritional status and quality of life after total pancreatectomy

PurposeQuality of life (QoL) is widely known to be poor after total pancreatectomy (TP) due to the loss of pancreatic function and poor nutritional status, but prospective studies on changes in QoL over time are lacking. The aim of this study was to prospectively evaluate the short- and long-term consequences of pancreatic exocrine insufficiency, changes in nutritional status, and their associated effects on QoL after TP.MethodsProspective data were collected from patients who underwent TP between 2008 and 2018. Validated questionnaires (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ] Core 30, EORTC QLQ-pancreatic cancer module, and the Mini Nutritional Assessment), measured frequency of bowel movement, relative body weight (RBW), triceps skinfold thickness (TSFT), and serum levels of protein, albumin, transferrin, and hemoglobin A1c were collected serially for 1 year.ResultsThirty patients who underwent TP were eligible for the study. Bowel movement frequency increased over time, and the RBW and TSFT were lowest by 1 year. The global health status score showed no significant difference over time. At 3 months, physical and role function scores as well as symptoms of fatigue, constipation, and digestive difficulties worsened significantly. Most indices recovered after 1 year, but poorer physical function scores, digestive difficulties, and altered bowel habits persisted.ConclusionBecause some symptoms do not recover over time, careful follow-up and supportive postoperative management are needed for TP patients, including nutritional support with pancreatic enzyme replacement and education about medication adherence and diet.

Iron Deficiency and Pruritus: A Cross-Sectional Analysis to Assess Its Association and Relationship.

Background:As generalized pruritus can be a symptom of a systemic disease, iron deficiency may be the underlying internal cause of its symptoms. Because data on the relationship between iron deficiency and generalized chronic pruritus are limited, more research is needed to ensure proper diagnosis and management.Aims:To evaluate the prevalence of iron deficiency in patients with generalized chronic pruritus in the southeast region of Rajasthan and to assess the correlation of serum ferritin with iron deficiency variables.Materials and Methods:An observational, analytical study was conducted among a total of 200 patients complaining of itching all across the body without any skin lesions for more than 6 weeks and enrolled in the outdoor and indoor Dermatology, Venereology, and Leprology departments of the Government Medical College, Kota. The duration of the study experiment was 1 year from June 2018 to May 2019.Results:Females (108; 54%) were more than males (92; 46%) with a ratio of 1.17:1. The mean age of the patients was 37.35 ± 13.56. S. ferritin was found to be below 15 g/L in 58 (29%) patients. Significant correlation was found between S. ferritin and hemoglobin, MCV, MCH, and MCHC, and the P value was <0.05. Maximum number of patients (70; 35%) achieved visual analog scale (VAS) scores between 4 and 9, followed by 50 (25%) patients obtaining scores >9. Similarly, a correlation was found between the VAS score and hemoglobin, MCV, MCH, and MCHC and a statistically significant P value was obtained.Limitations:The sample size was small in the study. The overall levels of iron and serum transferrin were not checked, keeping patients' compliance in mind.Conclusion:Although statistically significant results were found, limitations were also present in our study; so, further studies for proper diagnosis and management should be conducted in greater depth.

Real-world study in oncological outpatients of an oral supplement enriched with ω-3 fatty acids - effect on quality of life and nutritional parameters

Background: cancer patients are a group at high nutritional risk. Oral nutritional supplementation (ONS) can improve nutritional status. Objective: the objective of our study was to evaluate the effectiveness on nutritional parameters and quality of life of a ω3-enriched ONS in oncology outpatients in a real-world study. Material and methods: a total of 35 outpatient cancer patients who received 2 ONS per day were recruited. Chemistry, anthropometric, impedance measurement, nutritional survey, malnutrition universal screening tool (MUST) test, and EQ5D quality of life test were all used before and after 3 months of intervention. Results: mean age was 65.4 ± 10.7 years (18 females/17 males). Mean completion of the group was 81.7 ± 7.2 %. During the intervention, total protein (1.5 ± 0.2 g/dL; p = 0.01), albumin (0.9 ± 0.1 mg/dL; p = 0.04), and transferrin (53.9 ± 21.1 mg/dL; p = 0.02) levels increased. At the beginning of the study, 100 % of the patients were in the high nutritional risk category according to MUST. After the intervention, 34.3 % (n = 12) were in the low nutritional risk category, 51.4 % (n = 18) in the moderate nutritional risk category, and only 14.3 % (n = 5) in the category of high nutritional risk; previously, 100 % of patients had high nutritional risk (p = 0.02). The total score in the quality of life test increased significantly (0.51 ± 0.06 vs 0.84 ± 0.03 points; p = 0.01), with improvement in 5 dimensions. Conclusions: the use of a ω3-enriched ONS in a real-world study with cancer outpatients showed a beneficial effect on nutritional parameters and quality of life.

Endoscopic gastrostomy for nutritional support in post-stroke dysphagia.

Introduction: persistent dysphagia affects 15 % of stroke patients and contributes to malnutrition, aspiration, and death. This study aimed to characterize patients with post-stroke dysphagia who underwent percutaneous endoscopic gastrostomy (PEG), and to assess the impact of PEG feeding on nutritional status and outcome. Methods: an observational and retrospective study using records from patients with post-stroke dysphagia who underwent PEG. Body mass index (BMI), serum albumin, transferrin, and cholesterol were recorded at the time of PEG insertion (T0) and 3 months later (T3). The evolution of these parameters was analyzed and compared to survival. Results: we obtained data from 158 patients (53.2 % males) with a median age of 75 years. Most strokes were ischemic (n = 135, 85.4 %). Median time between stroke and PEG was 2 months. Median survival after gastrostomy was 16 months. At admission, 41.6 % of patients had low BMI, 62.3 % low albumin, 68.6 % low transferrin, and 59.6 % low cholesterol levels. The prevalence of low albumin and low transferrin was higher in the patients who underwent PEG more than 2 months after stroke. A significant increase in albumin and transferrin, and a normalization of cholesterol levels was observed after 3 months of PEG feeding. Mortality was 12.9 %, 27.7 %, and 40 % at 1, 3, and 12 months, respectively. Survival was lower in patients with low albumin, transferrin or total cholesterol at admission. Conclusions: the prevalence of malnutrition is high among patients with post-stroke dysphagia. PEG feeding improves albumin, transferrin, and cholesterol levels. Early post-PEG mortality is high and must be considered on an individual basis.

The overbearing physiological changes marring iron indices interpretation in response to iron therapy during pregnancy

Background: Iron deficiency anemia (IDA) is most common cause of anemia in pregnancy. In order to prevent this iron supplementation is routinely practiced as a prophylactic measure in pregnant women all over. The biochemical parameters assessed in IDA comprise an iron profile evaluation which consists of estimation of serum ferritin, serum iron, total iron binding capacity(TIBC), serum transferrin levels and calculation of transferrin saturation. These biochemical parameters are subjected to variations due to maternal adaption phenomenon. Aim: In the current study we have chosen three iron indices, serum iron, serum TIBC and transferrin saturation percent to note their performance in diagnosing and monitoring the response to iron therapy in pregnant women. Methodology: The study population are thirty- six pregnant women in their early second trimester, who are diagnosed with mild iron deficiency anemia (Hemoglobin between 9 and 11 g %). Iron parameters, serum iron, serum TIBC and transferrin saturation levels were analyzed in these women. They are then given oral iron preparation in the form of Ferrous sulphate for a period of twelve weeks. After this the Hemoglobin level, serum iron, TIBC and transferrin saturation levels are re-analyzed in these women. Results: The hemoglobin levels increased (p= 0.002). as expected after oral iron intake. Serum iron levels improved from 58.19±39.07 to 64.78±34.96 μg/dl. Serum TIBC value before supplementation 234.22±134.49 increased to 437.33±94.95 after, which contradicts the expected pattern seen in response to therapy in general population. Similarly absurdity prevails in transferrin saturation index levels which dropped from 36.8 ± 31.8 to 16.3 ± 10.6. Conclusion: The iron status during pregnancy is highly influenced by the maternal changes. And a blind interpretation of the report can lead to erroneous diagnosis. The interpretation of values should be based on the trimester specific reference ranges during pregnancy.

Nutritional response and clinical complications in patients with post-pyloric and gastric enteral tubes

ABSTRACT Objective The present study assessed the differences in nutritional markers (albumin, transferrin, total body fat, and body mass index) and clinical complications (diarrhea, vomiting, and diet interruptions) associated with enteral nutrition. Methods This is an open-label, randomized, two-arm parallel-group controlled clinical trial. Out of 105 patients assessed for eligibility, 35 adult patients were randomly divided into two groups and followed for 28 days. The sample comprised a heterogeneous group of severely ill individuals initially treated in the intensive care units. Neurological conditions (i.e., strokes and brain tumours) were the most common reasons for hospitalization. Patients had one singularity: the clinical need for exclusive enteral nutrition therapy. One group received the diet via gastric tube and the other via a post-pyloric tube. Results The groups presented increases in the calories prescribed and administered, as well as reduced diet discontinuation. Although similar values were observed up to day 21, the post-pyloric group showed increased albumin levels compared to the gastric group on Day 28. Transferrin levels increased over time in both groups. Conclusion There were no differences in the complications recorded between groups, albeit serum albumin significantly increased in the post-pyloric group.

Assessment of Some Heavy Metals and Iron Parameters amongst Dumpsite Scavengers in Port Harcourt, Nigeria

Aim: The aim of the study was to determine the levels of some heavy metals, namely Cadmium (Cd), Lead (Pd), and Iron (Fe) in waste scavengers in port-Harcourt, Nigeria&#x0D; Study Design: This study is a cross-sectional observational study.&#x0D; Place and Duration of Study: This study was conducted in Port Harcourt, Rivers State, Nigeria, between March, 2019 and October, 2019.&#x0D; Methodology: A total of 170 subjects of ages between 16 to 43 years. Of this, 100 were dumpsite scavengers while 70 were apparently healthy control subjects. The subjects involved in this study gave their informed consent and had no history of diabetes mellitus, hypertension, and renal and hepatic disorders, and have been in scavenging activity for at least one year. Three milliliters (3ml) of blood was taken from each subject and put in plain bottles. The serum obtained was put in plain bottles and stored at -200C prior to analysis. The heavy metals were assayed using the Atomic Absorption Spectrophotometry (AAS) while the hepatic parameters were assayed using Mindray Biochemistry auto analyzer (Model BS120, Shenzhen, China). Serum ferritin was assayed using enzyme immunoassay while serum transferrin was done using colorimetric method. Data obtained were analyzed using Student’s t test and Pearson’s correlation.&#x0D; Results: The body mass index (BMI) of the scavengers were significantly lower than that of the control subjects (p=.0001). The activities of the liver enzymes AST, ALT and ALP were significantly higher in the scavengers compared to the control subjects (p=.0001). The levels of total proteins, albumin and globulin of the scavengers were significantly lower than those of the control subjects (p=.0001). The levels of serum iron, transferrin and ferritin were similarly lower in the scavengers compared to the control subjects (p=.0001). However, the levels of cadmium and lead were significantly higher in the scavengers compared to the control subjects (p=.0001).&#x0D; Conclusion: These findings indicate possible biochemical derangements in the scavengers due to their exposure to the hazards associated with the scavenging activity.

A panel of urinary proteins predicts active lupus nephritis and response to rituximab treatment.

∼30% of patients with SLE develop LN. Presence and/or severity of LN are currently assessed by renal biopsy, but biomarkers in serum or urine samples may provide an avenue for non-invasive routine testing. We aimed to validate a urinary protein panel for its ability to predict active renal involvement in SLE. A total of 197 SLE patients and 48 healthy controls were recruited, and urine samples collected. Seventy-five of the SLE patients had active LN and 104 had no or inactive renal disease. Concentrations of lipocalin-like prostaglandin D synthase (LPGDS), transferrin, alpha-1-acid glycoprotein (AGP-1), ceruloplasmin, monocyte chemoattractant protein 1 (MCP-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were quantified by MILLIPLEX® Assays using the MAGPIX Luminex platform. Binary logistic regression was conducted to examine whether proteins levels associate with active renal involvement and/or response to rituximab treatment. Urine levels of transferrin (P<0.005), AGP-1 (P<0.0001), MCP-1 (P<0.001) and sVCAM-1 (P<0.005) were significantly higher in SLE patients when compared with healthy controls. Furthermore, levels of transferrin, AGP-1, ceruloplasmin, MCP-1 and sVCAM-1 (all P<0.0001) were higher in SLE patients with active LN when compared with patients without active LN. A combination of five urine proteins, namely LPGDS, transferrin, ceruloplasmin, MCP-1 and sVCAM-1 was a good predictor of active LN (AUC 0.898). A combined model of LPGDS, transferrin, AGP-1, ceruloplasmin, MCP-1 and sVCAM-1 predicted response to rituximab treatment at 12 months (AUC 0.818). Findings support the use of a urinary protein panel to identify active LN and potentially predict response to treatment with rituximab in adult SLE patients. Prospective studies are required to confirm findings.

Potential Role and Excretion Level of Urinary Transferrin, KIM-1, RBP, MCP-1 and NGAL Markers in Diabetic Nephropathy.

BackgroundAnalyzing urinary biomarkers may provide better insight into pathophysiological mechanisms of diabetic kidney diseases. The study aimed to analyze the pattern of selected excreted urinary biomarkers and its correlation with albuminuria and estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes.MethodsA total of 185 patients with type 2 diabetes were categorized according to KDIGO guideline based on albuminuria and eGFR. The urinary markers (transferrin, KIM-1, RBP, MCP-1 and NGAL) were measured by ELISA.ResultsThe urinary markers were associated with eGFR (total protein/Cr, p=0.001; RBP/Cr, p=0.007; MCP-1/Cr, p=0.023; NGAL/Cr, p=0.011) and albuminuria (total protein/Cr, p<0.001; transferrin, p<0.001; RBP/Cr, p<0.001; MCP-1/Cr, p<0.001; NGAL/Cr, p=0.002).ConclusionThe urinary marker levels (total protein, RBP, MCP-1, and NGAL) are elevated with severity of kidney damage and expressed more in progressive renal impairment.