Anaemia, iron deficiency and susceptibility to infections

M, Gowda MAS. A Cross-Sectional Study on Post-COVID-19 Menstrual Abnormalities in Women of Reproductive Age Group at a Tertiary Care Hospital

Purpose: This study aimed to evaluate the effect of COVID-19 infection and vaccination on all the menstrual cycle parameters in the women of reproductive age group, 18-45 years, at a tertiary care hospital. Methods: A single-center, descriptive cross-sectional study was done from January 2, 2023, to June 24, 2023. Sampling was nonprobabilistic and purposeful. Participants were recruited via calls, in-person interviews, and online surveys. A total of 931 participants were recruited, of which 141 participants were eligible for the study. Descriptive statistics were performed for all variables. Pearson's chi-square test was done to compare categorical variables among different groups, and the Wilcoxon matched pair signed-rank test was done to compare the menstrual cycle patterns before and after COVID-19 infection and vaccination. Simple linear regression and multiple linear regression analysis were done wherever necessary. p < 0.05 was considered statistically significant. Results: A total of 931 participants were recruited, of which 141 participants were eligible for the study. The median age was 29 years. Those who reported menstrual abnormalities were mainly of the age group 18-27 (n = 62, 44.0%), resided in an urban locality (n = 123, 87.2%), and were employed (full-time/part-time) (n = 57, 40.4%). Of the 42 participants with menstrual changes, 27 (64.3%) participants experienced changes post-COVID-19 infection before their first vaccination dose and 15 (35.7%) after the first vaccination dose. In this group, 15 (35.7%) continue to experience abnormalities in their cycles. Analysis showed that participants having severe COVID-19 symptoms were more likely to have an earlier onset of menstrual abnormalities (beta = -2.072, p=0.040). Participants with an above-normal BMI were more likely to have increased pain/cramps during menses (beta = 0.236, p=0.0.013). Participants who were students/employed (beta = -0.365, p=0.001) with an above-normal BMI (beta = 0.182, p=0.024) were more likely to experience increased mood swings/tension/irritability. On comparing the onset and duration of menstrual abnormalities in the post-COVID-19 infection and postvaccination groups, it was found that the latter group had a late-onset and short-term effect, while the former group had an early-onset and long-term effect on menses. Conclusion: Our study shows that there is evidence of the onset of menstrual irregularities following COVID-19 infection and vaccination. The study revealed COVID-19 infection and vaccination influence menstrual cycles, the former posing a higher risk, but their effects on menstruation independent of one another are to be studied further.

High-resolution spatial prediction of anemia risk among children aged 6 to 59 months in low- and middle-income countries

BACKGROUND

Anemia, a severe condition among children associated with adverse health effects such as impaired growth, limited physical and cognitive development, and increased mortality risk, remains widespread, particularly in low- and middle-income countries. This study combines Demographic and Health Surveys data with remotely sensed climate, demographic, environmental, and geo-spatial information, creating a data set comprising about 750,000 observations on childhood anemia from 37 countries. It is used to provide high-resolution spatio-temporal estimates of all forms of childhood anemia between 2005 and 2020.

METHODS

Employing full probabilistic Bayesian distributional regression models, the research accurately predicts age-specific and spatially varying anemia risks. These models enable the assessment of the complete distribution of hemoglobin levels. Additionally, this analysis also provides predictions at a high resolution, allowing precise monitoring of this indicator, aligned with Sustainable Development Goal (SDG) 2.

RESULTS

This analysis provides high-resolution estimates for all forms of anemia and reveals and identifies striking disparities within and between countries. Based on these estimates, the prevalence of anemia decreased from 65.0% [62.6%-67.4%] in sub-Saharan Africa and 63.1% [60.6%-65.5%] in South Asia in 2010 to 63.4% [60.7%-66.0%] in sub-Saharan Africa and 58.8% [56.4%-61.3%] in South Asia in 2020. This translates into approximately 98.7 [94.5-102.8] million and 95.1 [91.1-99.0] million affected children aged 6 to 59 months in 2020, respectively, making it a major public health concern.

CONCLUSIONS

Our approach facilitates the monitoring of age-specific spatio-temporal dynamics and the identification of hotspots related to this important global public health issue. To our knowledge, this represents the first high-resolution mapping of anemia risk in children. In addition, these results reveal striking disparities between and within countries and highlight the influence of socio-economic and environmental factors on this condition. The findings can guide efforts to improve health systems, promote education, and implement interventions that break the cycle of poverty and anemia.

Nutritional Status of Adult People Living with HIV: A Narrative Review

BACKGROUND

The interaction between HIV infection, nutrition and immune system functioning is intricate, leading, in many cases, to a cycle of poor health outcomes. Despite the widespread use of highly active antiretroviral therapy (HAART) since the late 1990s and the concomitant increase in the life expectancy of people living with HIV (PLHIV), malnutrition and HIV-associated wasting continue to pose significant challenges, particularly in developing countries. Additionally, metabolic adverse effects associated with HAART, such as alterations in bone and lipid metabolism, as well as the impact on cardiovascular health, add further complexity to patient care.

METHODS

We conducted a comprehensive literature review of relevant studies involving adults diagnosed with HIV. The studies, published between 2000 and 2023, were identified using the Medline/PubMed, Scopus and Google Scholar databases.

RESULTS

Accumulating evidence in the literature indicates that careful monitoring and appropriate nutritional interventions can significantly enhance clinical outcomes in malnourished HIV-positive persons. The importance of addressing the prevalent deficiencies in certain micronutrients discussed in many of the studies is clearly underlined. However, challenges remain, particularly in low-income settings, where limited resources and infrastructure can impede effective implementation.

CONCLUSIONS

There are critical research gaps with regard to the interaction between ART and nutrition, as well as the development of tailored nutritional approaches that aim to improve patient outcomes. Future research directions and policy strategies should focus on the development of sustainable programmes aimed at enhancing the quality of life for PLHIV.

Iron deficiency and infection risk in Danish blood donors

BACKGROUND

We aimed to investigate if iron deficiency was associated with infection susceptibility in a large cohort of healthy individuals.

STUDY DESIGN AND METHODS

The Danish Blood Donor Study is a national ongoing prospective study of blood donors. We included 94,628 donors with 338,290 ferritin measurements from March 2010 to October 2022. We performed sex-stratified multivariable Cox regression to estimate the risk of infection for iron-deficient donors compared with iron-replete donors. Infection was defined as either a filled prescription of antibiotics registered in the Danish National Prescription Registry (NPR), or a hospital contact with infection registered in the Danish National Patient Registry (DNPR).

RESULTS

Iron deficiency was associated with an overall increased risk of infection (defined as prescriptions of antibiotics) for women (hazard ratio [HR] 1.08, 95% confidence interval [CI] 1.02-1.15). Subgroup analyses showed an increased risk of respiratory tract infections (HR 1.16, 95% CI 1.05-1.28) and urinary tract infections (HR 1.16, 95% CI 1.04-1.29). Iron deficiency was not associated with overall risk of infection for men (HR 1.02, 95% CI 0.82-1.28). For both men and women, no association was found between iron deficiency and hospital contacts for infections.

CONCLUSION

Iron deficiency was associated with an increased risk of infection in female blood donors. However, effect sizes were small, and there was no association between iron deficiency and hospital contacts for infection. Consequently, risk of infection should not be considered an apprehension regarding blood donation. These findings support the role of iron in immune function and monitorization of iron stores in female blood donors.

Reference intervals and percentiles for soluble transferrin receptor and sTfR/log ferritin index in healthy children and adolescents

OBJECTIVES

Soluble transferrin receptor (sTfR) is a marker of both erythropoiesis and iron status and is considered useful for detecting iron deficiency, especially in inflammatory conditions, but reference intervals covering the entire pediatric age spectrum are lacking.

METHODS

We studied 1,064 (48.5 % female) healthy children of the entire pediatric age spectrum to determine reference values and percentiles for sTfR and the ratio of sTfR to log-ferritin (sTfR-F index) using a standard immunoturbidimetric assay.

RESULTS

Soluble TfR levels were highly age-specific, with a peak in infancy and a decline in adulthood, whereas the sTfR-F index was a rather constant parameter. There were positive linear relationships for sTfR with hemoglobin (Hb) (p=0.008) and transferrin (females p<0.001; males p=0.003). A negative association was observed between sTfR and ferritin in females (p<0.0001) and for transferrin saturation and mean corpuscular volume (MCV) in both sexes (both p<0.0001). We found a positive relationship between sTfR and body height, body mass index (BMI) and inflammatory markers (CrP p<0.0001; WBC p=0.0172), while sTfR-F index was not affected by inflammation.

CONCLUSIONS

Soluble TfR values appear to reflect the activity of infant erythropoiesis and to be modulated by inflammation and iron deficiency even in a healthy cohort.

Dietary Modulation of the Immune System

Recent insights into the influence of nutrition on immune system components have driven the development of dietary strategies targeting the prevention and management of major metabolic-inflammatory diseases. This review summarizes the bidirectional relationship between nutrition and immunocompetence, beginning with an overview of immune system components and their functions. It examines the effects of nutritional status, dietary patterns, and food bioactives on systemic inflammation, immune cell populations, and lymphoid tissues, as well as their associations with infectious and chronic disease pathogenesis. The mechanisms by which key nutrients influence immune constituents are delineated, focusing on vitamins A, D, E, C, and B, as well as minerals including zinc, iron, and selenium. Also highlighted are the immunomodulatory effects of polyunsaturated fatty acids as well as bioactive phenolic compounds and probiotics, given their expanding relevance. Each section addresses the implications of nutritional and nutraceutical interventions involving these nutrients within the broader context of major infectious, metabolic, and inflammatory diseases. This review further underscores that, while targeted nutrient supplementation can effectively restore immune function to optimal levels, caution is necessary in certain cases, as it may increase morbidity in specific diseases. In other instances, dietary counseling should be integrated to ensure that therapeutic goals are achieved safely and effectively.

Can the lung ultrasound score predict pulmonary complications after non-thoracic surgery in patients with blunt thoracic trauma: A single-center observational study

STUDY OBJECTIVE

Patients with blunt thoracic trauma have a high risk of developing postoperative pulmonary complications (PPCs). In this study, we aimed to identify the risk factors for PPCs after non-thoracic surgery in patients with blunt thoracic trauma and investigate the efficacy of perioperative lung ultrasound scores in predicting PPC occurrence.

DESIGN

Prospective observational study.

SETTING

A Chinese tertiary orthopedic hospital.

PARTICIPANTS

This observational study included 369 patients with blunt thoracic trauma who underwent surgery for pelvic and upper or lower extremity fractures.

INTERVENTIONS

Lung ultrasonography was performed pre- and postoperatively.

MEASUREMENTS

Patients were followed up for 1 week to assess PPCs and assigned to the PPC or non-PPC groups. We identified risk factors for PPCs using univariate and multivariate logistic regression analyses. The predictive value of these risk factors was evaluated using receiver operating characteristic (ROC) curves.

MAIN RESULTS

PPCs incidence was 36.58 %. The two groups differed significantly in Injury Severity Scores, American Society of Anesthesiologists (ASA) classification, chronic obstructive pulmonary disease, hydrothorax, preoperative hypoxemia, lung ultrasound score, preoperative hemoglobin level, intraoperative infusion volume, and Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) scores (P < 0.05). Independent risk factors for PPCs included ASA classification III, higher postoperative lung ultrasound scores, preoperative anemia, higher intraoperative infusion volume, and higher ARISCAT scores. ROC curve analysis revealed that postoperative lung ultrasound score (area under the curve [AUC]: 0.810, cutoff: 10), preoperative hemoglobin level (AUC: 0.627, cutoff: 97), intraoperative infusion volume (AUC: 0.701, cutoff: 886.51 mL/h) and ARISCAT score (AUC: 0.718, cutoff: 33) predicted postoperative outcomes effectively.

CONCLUSIONS

Postoperative lung ultrasound scores reliably predicted pulmonary complications after non-thoracic surgery in patients with blunt thoracic trauma. ASA classification III, preoperative anemia, excessive intraoperative fluid infusion, higher ARISCAT, and postoperative lung ultrasound scores were significant risk factors associated with PPCs.

TRIAL REGISTRATION

Clinical Trial Number: 1900023408. Registered on May 26, 2019.

Phytochemical Profiling and Therapeutic Potential of Thyme (Thymus spp.): A Medicinal Herb

Thymol is a phenol monoterpene that is naturally derived from cymene and is an isomer of carvacrol. It constitutes a significant portion (10%-64%) of the essential oils found in thyme (Thymus vulgaris L., Lamiaceae), a medicinal plant renowned for its therapeutic properties. Wild thyme is native to the Mediterranean region and has been used in cooking and medicine for a long time. In contemporary contexts, both thymol and thyme offer diverse functional applications in the pharmaceutical, food, and cosmetic industries. Thymol has attracted scientific interest for its potential therapeutic applications in pharmaceuticals and nutraceuticals. Studies have explored its efficacy in treating respiratory, nervous, and cardiovascular disorders, highlighting its promising role in diverse therapeutic interventions. Additionally, this compound demonstrates antimicrobial, antioxidant, anticarcinogenic, anti-inflammatory, and antispasmodic properties. It also shows potential as a growth enhancer and has immunomodulatory properties as well. Other discussed aspects include thymol toxicity, bioavailability, metabolism, and distribution in animals and humans. This review summarizes the most significant data regarding the beneficial effects of thyme bioactive compounds and their applications as a food preservative while taking into account the thyme plant extract and its essential oil.

Neuromuscular dysfunction and pathogenesis in triosephosphate isomerase deficiency

Triosephosphate isomerase deficiency (TPI Df) is a rare multisystem disorder with severe neuromuscular symptoms which arises exclusively from mutations within the TPI1 gene. Studies of TPI Df have been limited due to the absence of mammalian disease models and difficulties obtaining patient samples. Recently, we developed a novel murine model of TPI Df which models the most common disease-causing mutation in humans, TPI1E105D. Using our model in the present study, the underlying pathogenesis of neuromuscular symptoms has been elucidated. This is the first report detailing studies of neuromuscular pathology within a murine model of TPI Df. We identified several contributors to neuromuscular symptoms, including neurodegeneration in the brain, alterations in neurotransmission at the neuromuscular junction, and reduced muscle fiber size. TPI Df mice also exhibited signs of cardiac pathology and displayed a deficit in vascular smooth muscle functionality. Together, these findings provide insight into pathogenesis of the neuromuscular symptoms in TPI Df and can guide the future development of therapeutics.

Determinants of normal haemoglobin concentration among under-five children in Sub-Saharan Africa: a Positive deviance inquiry using cross-sectional study design

BACKGROUND

Low haemoglobin level in children is linked with short-term and long-term consequences including developmental delay. Globally, over half of the children under the age of five years had low haemoglobin concentration. However, there is limited research on the prevalence and determinants of normal haemoglobin concentration among under-five children in sub-Saharan Africa.

OBJECTIVE

To assess determinants of normal haemoglobin concentration among under-five children in SSA.

DESIGN

Cross-sectional study design using a positive deviance approach SETTING: 33 SSA countries.

PARTICIPANTS

129 408 children aged 6-59 months PRIMARY AND SECONDARY OUTCOME MEASURES: A multilevel Poisson regression model with robust variance was fitted to identify determinants of normal haemoglobin concentration. An adjusted prevalence ratio with a 95% CI was reported to declare the statistical significance.

RESULT

The pooled prevalence of normal haemoglobin concentration among under-five children in SSA was 34.9% (95% CI: 34.6% to 35.1%). High maternal education, middle and rich household wealth, female child, frequent antenatal care visits, non-anaemic mothers, taking anthelmintic drugs and normal nutritional status were associated with increased odds of normal haemoglobin concentration. On the other hand, higher birth order, having fever and diarrhoea, rural residence were associated with lower odds of normal haemoglobin levels.

CONCLUSION

According to our finding, only four out of 10 under-five children in SSA had a normal haemoglobin level. This finding proved that anaemia among children in SSA remains a serious public health concern. Therefore, improving maternal education, provision of drugs for an intestinal parasite and early detection and treatment of maternal anaemia, febrile illness and diarrhoeal disease is important.

A case report of chronic intermedullary inflammation of bone in a child

Osteolytic lesions refer to the destruction of any part of bone due to a disease process (pertaining to dissolution of bone, especially loss of calcium). Osteomyelitis is the inflammation of the bone caused by an infecting organism. Although bone is normally resilient to bacterial colonization, events such as trauma, surgery, infections, the presence of foreign bodies, and anemia may disrupt bony integrity and lead to the onset of bone infections. Sometimes, osteomyelitis causes no signs and symptoms or the signs and symptoms are hard to distinguish from other problems. This may be true for children, older adults, and people whose immune systems are compromised. Here, we report a case of chronic intermedullary inflammation of bone in a child.

Biology of Anemia: A Public Health Perspective

Our goal is to present recent progress in understanding the biological mechanisms underlying anemia from a public health perspective. We describe important advances in understanding common causes of anemia and their interactions, including iron deficiency (ID), lack of other micronutrients, infection, inflammation, and genetic conditions. ID develops if the iron circulating in the blood cannot provide the amounts required for red blood cell production and tissue needs. ID anemia develops as iron-limited red blood cell production fails to maintain the hemoglobin concentration above the threshold used to define anemia. Globally, absolute ID (absent or reduced body iron stores that do not meet the need for iron of an individual but may respond to iron supplementation) contributes to only a limited proportion of anemia. Functional ID (adequate or increased iron stores that cannot meet the need for iron because of the effects of infection or inflammation and does not respond to iron supplementation) is frequently responsible for anemia in low- and middle-income countries. Absolute and functional ID may coexist. We highlight continued improvement in understanding the roles of infections and inflammation in causing a large proportion of anemia. Deficiencies of nutrients other than iron are less common but important in some settings. The importance of genetic conditions as causes of anemia depends upon the specific inherited red blood cell abnormalities and their prevalence in the settings examined. From a public health perspective, each setting has a distinctive composition of components underlying the common causes of anemia. We emphasize the coincidence between regions with a high prevalence of anemia attributed to ID (both absolute and functional), those with endemic infections, and those with widespread genetic conditions affecting red blood cells, especially in sub-Saharan Africa and regions in Asia and Oceania.

The IRONy in Athletic Performance

Iron is an essential micronutrient for athletes, intricately linked to their performance, by regulating cellular respiration and metabolism. Impaired iron levels in the body can significantly hinder athletic performance. The increased demand for iron due to exercise, coupled with potential dietary iron insufficiencies, particularly among endurance athletes, amplifies the risk of iron deficiency. Moreover, prolonged exercise can impact iron absorption, utilization, storage, and overall iron concentrations in an athlete. On the contrary, iron overload may initially lead to enhanced performance; however, chronic excess iron intake or underlying genetic conditions can lead to detrimental health consequences and may negatively impact athletic performance. Excess iron induces oxidative damage, not only compromising muscle function and recovery, but also affecting various tissues and organs in the body. This narrative review delineates the complex relationship between exercise and iron metabolism, and its profound effects on athletic performance. The article also provides guidance on managing iron intake through dietary adjustments, oral iron supplementation for performance enhancement in cases of deficiency, and strategies for addressing iron overload in athletes. Current research is focused on augmenting iron absorption by standardizing the route of administration while minimizing side effects. Additionally, there is ongoing work to identify inhibitors and activators that affect iron absorption, aiming to optimize the body's iron levels from dietary sources, supplements, and chelators. In summary, by refining the athletic diet, considering the timing and dosage of iron supplements for deficiency, and implementing chelation therapies for iron overload, we can effectively enhance athletic performance and overall well-being.

Factors associated with anemia among school-going adolescents aged 10-17 years in Zanzibar, Tanzania: a cross sectional study

BACKGROUND

Anemia among adolescents (ages 10-19 years) is a leading cause of morbidity and mortality in low- and middle-income countries and carries long-term health and economic consequences. To address the issue, policymakers and programmers require evidence of the burden of anemia among adolescents in specific contexts, as well as an understanding of the factors associated with anemia in this population.

METHODS

We conducted a cross-sectional survey as a baseline assessment to determine the prevalence and factors associated with anemia in secondary school students, as part of a cluster-randomized effectiveness trial testing different micronutrient supplementation strategies in addressing anemia among adolescents in Zanzibar. Between March 7th to 25th, 2022 the survey was conducted on 2,479 school-going adolescents aged 10-17 years from 42 schools on the island of Zanzibar, Tanzania. Hemoglobin concentration was measured along with the collection of socio-demographics, health, food frequency, and water, sanitation and hygiene data.

RESULTS

Based on the World Health Organization cutoffs for anemia, 53.3% of the sample had anemia (mild, moderate, or severe). Using chi-square tests and logistic regressions, we determined that females had higher odds of anemia than males (Adjusted OR = 1.47; 95% CI: 1.24, 1.74), those in the highest wealth quintile had lower odds of anemia than those in the lowest wealth quintile (Adjusted OR = 0.7; CI: 0.54, 0.91), stunted adolescents had higher odds of anemia than non-stunted students (Adjusted OR = 1.38; 95% CI: 1.06,1.81), and those who used shared toilets had higher odds of moderate or severe anemia than those with private toilet access (Adjusted OR = 1.68; CI: 1.07, 2.64).

CONCLUSIONS

The high prevalence of anemia in this sample indicates an urgent need to address anemia among adolescents in Zanzibar, and the factors associated with anemia point to the importance of water, sanitation, and hygiene interventions in addition to dietary and nutritional support.

TRIAL REGISTRATION

NCT05104554, registered 03/11/2021.

Infectious Risk and Variability of Hemoglobin Level in Patients Undergoing Hemodialysis

Introduction

In the management of anemia in chronic kidney disease, hemoglobin levels often fall below or exceed target ranges. Past retrospective cohort studies of patients undergoing hemodialysis with conventional erythropoiesis stimulating agents (ESAs) found that hemoglobin level fluctuations predicted mortality and cardiovascular adverse events; long-acting agents were thereafter widely available. An updated validation by a prospective cohort study was needed.

Methods

Using Cox regression models, we evaluated associations between hemoglobin variability and all-cause death, hospitalization, and cardiovascular, thrombotic, or infectious adverse event outcomes in 3063 hemodialysis patients' data from the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS) from 2012 to 2018.

Results

During a median follow-up time of 2.5 years, all-cause mortality was lowest in the first quartile and tended to be higher in groups with greater hemoglobin variability (hazard ratio [HR]: 95% confidence interval for the fourth quartile of an absolute value of hemoglobin variability: 1.44 [0.99-2.08], P for trend = 0.056). Infectious event incidence in these patients was also lower in the first quartile than for the other quartiles (P for trend < 0.01). The association was more pronounced in patients with lower serum ferritin levels or iron supplementation. Cardiovascular and thrombotic event incidence was not associated with hemoglobin variability.

Conclusions

Maintenance hemodialysis patients on ESA treatment with higher hemoglobin variability are at higher risk for all-cause mortality and particularly infectious events.

Role of iron in host-microbiota interaction and its effects on intestinal mucosal growth and immune plasticity in a piglet model

Iron is an essential trace element for both the host and resident microbes in the gut. In this study, iron was administered orally and parenterally to anemic piglets to investigate the role of iron in host-microbiota interaction and its effects on intestinal mucosal growth and immune plasticity. We found that oral iron administration easily increased the abundance of Proteobacteria and Escherichia-Shigella, and decreased the abundance of Lactobacillus in the ileum. Furthermore, similar bacterial changes, namely an increase in Proteobacteria, Escherichia-Shigella, and Fusobacterium and a reduction in the Christensenellaceae_R-7_group, were observed in the colon of both iron-supplemented groups. Spearman's correlation analysis indicated that the changed Fusobacterium, Fusobacteria and Proteobacteria in the colon were positively correlated with hemoglobin, colon and spleen iron levels. Nevertheless, it was found that activated mTOR1 signaling, improved villous height and crypt depth in the ileum, enhanced immune communication, and increased protein expression of IL-22 and IL-10 in the colon of both iron-supplemented groups. In conclusion, the benefits of improved host iron outweigh the risks of altered gut microbiota for intestinal mucosal growth and immune regulation in treating iron deficiency anemia.

Hydrothermal Synthesis of Molybdenum Disulfide Quantum Dots for Highly Sensitive Detection of Iron Ions in Protein Succinate Oral Solution

In this paper, a molybdenum disulfide fluorescent probe with an Fe³⁺ fluorescent system was first synthesized by the hydrothermal method for the detection of iron ion concentration in oral solution of protein succinate. It was characterized by infrared, fluorescence, X-ray photoelectron spectroscopy, scanning electron microscopy, and transmission electron microscopy. The probes were found to have good stability, photobleaching, and storage stability. The effects of dilution, pH, reaction time, and iron ion concentration on the fluorescent system were also investigated. The relative fluorescence intensity [(I₀ - I)/I₀] showed a good linear relationship with the iron ion concentration in the range of 0-50 μM, with the linear equation [(I₀ - I)/I₀] = 0.0148[Fe³⁺] + 0.0833 (r² = 0.9943, n = 11) and the detection limit of 2.43 μM. The reaction mechanism was also explored, as well as its ion selectivity, reversibility, accuracy, precision, and concentration of Fe ions in the actual sample. It was found that the probe can selectively detect Fe ions with a certain degree of reversibility, accuracy, precision, and ideal recovery, and it can be used for the determination of Fe³⁺ in proteosuccinic acid oral solution.

Cooperation between physiological defenses and immune resistance produces asymptomatic carriage of a lethal bacterial pathogen

Animals evolved two defense strategies to survive infections. Antagonistic strategies include immune resistance mechanisms that operate to kill invading pathogens. Cooperative or physiological defenses mediate host adaptation to the infected state, limiting physiological damage and disease, without killing the pathogen, and have been shown to cause asymptomatic carriage and transmission of lethal pathogens. Here, we demonstrate that physiological defenses cooperate with the adaptive immune response to generate long-term asymptomatic carriage of the lethal enteric murine pathogen, Citrobacter rodentium. Asymptomatic carriage of genetically virulent C. rodentium provided immune resistance against subsequent infections. Immune protection was dependent on systemic antibody responses and pathogen virulence behavior rather than the recognition of specific virulent antigens. Last, we demonstrate that an avirulent strain of C. rodentium in the field has background mutations in genes that are important for LPS structure. Our work reveals insight into how asymptomatic infections can arise mechanistically with immune resistance, mediating exclusion of phenotypically virulent enteric pathogen to promote asymptomatic carriage.

Iron Status and Supplementation during Tuberculosis

Tuberculosis (TB) is characterised by chronic non-resolving inflammation. The effects of the host immune and inflammatory response to reduce iron acquisition by the bacteria, together with other contributing factors, predispose TB patients to anaemia of infection and iron deficiency anaemia (IDA). The presence of anaemia in TB patients has been linked to poor clinical outcomes. However, due to the reliance of the bacteria on iron, the management of anaemia in TB is complicated, and anaemia of infection is likely to resolve with correct TB drug treatment. On the other hand, IDA may require iron supplementation. This review aims to describe iron metabolism in TB and how this contributes to the development of iron deficiency and anaemia. Additionally, we summarise the evidence on the association between iron status and clinical outcomes as well as the available preclinical and clinical trials on iron supplementation in TB.

Cooperation between physiological defenses and immune resistance produces asymptomatic carriage of a lethal bacterial pathogen

Animals have evolved two defense strategies to survive infections. Antagonistic strategies include mechanisms of immune resistance that operate to sense and kill invading pathogens. Cooperative or physiological defenses mediate host adaptation to the infected state, limiting physiological damage and disease, without killing the pathogen, and have been shown to cause asymptomatic carriage and transmission of lethal pathogens. Here we demonstrate that physiological defenses cooperate with the adaptive immune response to generate long-term asymptomatic carriage of the lethal enteric murine pathogen, Citrobacter rodentium. Asymptomatic carriage of genetically virulent C. rodentium provided immune resistance against subsequent infections. Host immune protection was dependent on systemic antibody responses and pathogen virulence behavior, rather than the recognition of specific virulent factor antigens. Finally, we demonstrate that an avirulent strain of C. rodentium in the field has background mutations in two genes that are important for LPS structure. Our work reveals novel insight into how asymptomatic infections can arise mechanistically with immune resistance, mediating exclusion of phenotypically virulent enteric pathogen to promote asymptomatic carriage.

Prevalence and Associated Risk Factors of Anemia Among Hospitalized Children in a Tertiary Level Hospital in Botswana

Anemia is a global health concern and has been associated with long term cognitive and behavioral adverse effects. A cross sectional study was conducted to determine the prevalence of and risk factors for anemia in infants and children between 6 months to 5 years of age admitted to a tertiary hospital in Botswana. Baseline full blood count of every patient admitted during the study period was assessed to determine if anemia was present. Data were collected from patient's medical inpatient chart, electronic medical record (Integrated Patient Management System (IPMS)), and through interviewing parents and caregivers. Multivariate logistic regression model was used to identify risk factors of anemia. A total of 250 patients were included in the study. Prevalence of anemia in this cohort was 42.8%. There were 145 (58%) males. Of the patients with anemia, 56.1%, 39.2%, and 4.7% had mild, moderate, and severe anemia, respectively. Microcytic anemia consistent with iron deficiency was identified in 61 (57%) patients. Age was the only independent predictor of anemia. Children aged 24 months and more had a 50% lower risk of having anemia than their younger counterparts (odds ratio (OR) 0.52; 95% Confidence Interval (95% CI) 0.30 to 0.89). The findings of this study demonstrate anemia as a serious health concern in the pediatric population in Botswana.

Iron in infectious diseases friend or foe?: The role of gut microbiota

Iron is a trace element involved in metabolic functions for all organisms, from microorganisms to mammalians. Iron deficiency is a prevalent health problem that affects billions of people worldwide, and iron overload could have some hazardous effect. The complex microbial community in the human body, also called microbiota, influences the host immune defence against infections. An imbalance in gut microbiota, dysbiosis, changes the host's susceptibility to infections by regulating the immune system. In recent years, the number of studies on the relationship between infectious diseases and microbiota has increased. Gut microbiota is affected by different parameters, including mode of delivery, hygiene habits, diet, drugs, and plasma iron levels during the lifetime. Gut microbiota may influence iron levels in the body, and iron overload and deficiency can also affect gut microbiota composition. Novel researches on microbiota shed light on the fact that the bidirectional interactions between gut microbiota and iron play a role in the pathogenesis of many diseases, especially infections. A better understanding of these interactions may help us to comprehend the pathogenesis of many infectious and metabolic diseases affecting people worldwide and following the development of more effective preventive and/or therapeutic strategies. In this review, we aimed to present the iron-mediated host-gut microbiota interactions, susceptibility to bacterial infections, and iron-targeted therapy approaches for infections.

Preoperative Anemia and Risk of In-hospital Postoperative Complications in Patients with Hip Fracture

Purpose

To evaluate the impact of preoperative anemia on postoperative complications after hip fracture surgery.

Patients and Methods

We conducted a retrospective study including hip fracture patients at a teaching hospital between 2005 and 2022. We defined preoperative anemia as the last hemoglobin measurement level before surgery < 130 g/L for men and < 120 g/L for women. The primary outcome was a composite of in-hospital major complications, including pneumonia, respiratory failure, gastrointestinal bleeding, urinary tract infection, incision infection, deep venous thrombosis, pulmonary embolism, angina pectoris, arrhythmia, myocardial infarction, heart failure, stroke, and death. Secondary outcomes were cardiovascular events, infection, pneumonia, and death. We used multivariate negative binomial or logistic regression to evaluate the impact of anemia and its severity, categorized as mild (90-130 g/L for men, 90-120 g/L for women) or moderate-to-severe (< 90 g/L for both) anemia on outcomes.

Results

Of the 3540 included patients, 1960 had preoperative anemia. 188 anemic patients experienced 324 major complications, while 63 non-anemic patients had 94 major complications. The risk of major complications was 165.3 (95% CI, 149.5-182.4) and 59.5 (95% CI, 48.9-72.3) per 1000 persons in anemic and non-anemic patients, respectively. Anemic patients were more likely to have major complications than non-anemic patients (adjusted incidence rate ratio (aIRR), 1.87; 95% CI, 1.30-2.72), which was consistent in mild (aIRR, 1.77; 95% CI, 1.22-2.59) and moderate-to-severe (aIRR, 2.97; 95% CI, 1.65-5.38) anemia. Preoperative anemia also increased the risk of cardiovascular events (aIRR, 1.96; 95% CI, 1.29-3.01), infection (aIRR, 1.68; 95% CI, 1.01-2.86), pneumonia (adjusted odds ratio (aOR), 1.91; 95% CI, 1.06-3.57), and death (aOR, 3.17; 95% CI, 1.06-11.89).

Conclusion

Our findings suggest that even mild preoperative anemia is associated with major postoperative complications in hip fracture patients. This finding highlights considering preoperative anemia as a risk factor in surgical decision-making for high-risk patients.

Prevalence and determinants of anemia among children aged from 6 to 59 months in Liberia: a multilevel analysis of the 2019/20 Liberia demographic and health survey data

Background

Anemia is a serious worldwide public health issue that happens at any stage of life but primarily affects young kids and pregnant mothers. Although anemia has a significant impact on child health, its magnitude and associated factors in children aged 6-59 months have not been yet studied in Liberia. Therefore, the aim of this study was to identify the prevalence and determinants of anemia in children aged 6-59 months in Liberia.

Methods

The data was extracted from Liberia Demographic and Health Survey, conducted from October 2019 to February 2020. The sample was obtained using a stratified two-stage cluster sampling technique. An overall weighted sample of 2,524 kids aged 6-59 months was involved in the final analysis. We used Stata version 14 software for data extraction and analysis. A multilevel logistic regression model was employed to identify factors associated with anemia. Variables with a P-value of <0.2 in the bivariable logistic regression analysis were selected as candidates for multivariable analysis. In multivariable analysis, the adjusted odds ratios (AOR) with the 95% confidence interval (CI) were declared as the determinants of anemia.

Results

The prevalence of anemia in children aged 6-59 months in Liberia was 70.8% [95% CI: 68.9%, 72.5%]. Of these, 3.4% were severe anemia, 38.3% were moderate anemia and 29.1% were mild anemia. Children aged 6-23 and 24-42 months, being stunted, children from households with unimproved toilet facilities, children from households with unimproved water sources, and lack of media (television) exposure were significantly associated with higher odds of anemia. However, using mosquito bed nets, living in the Northwestern and Northcentral region were significantly associated with lower odds of anemia among children 6-59 months.

Conclusion

In this study, anemia in kids aged 6-59 months in Liberia was a main public health issue. Age of the child, stunting, toilet facility, water source, exposure to television, mosquito bed net use, and region were significant determinants of anemia. Therefore, it is better to provide intervention for the early detection and management of stunted children. Similarly, interventions should be strengthened to address unimproved water sources, unimproved toilet facilities, and lack of media exposure.

Prevalence of, and factors associated with anaemia in children aged 1-3 years in Aceh, Indonesia: A cross-sectional study

Background: Child anaemia continues to represent a major public health challenge in lower-and-middle income countries. It has serious long-term consequences for child growth and development. In Indonesia, there was a 10% increase in the national prevalence of child anaemia between 2013 and 2018. Aim: This study aims to assess the prevalence of, and factors associated with anaemia among children aged one to three years in eight districts in Aceh Province, Indonesia. Methods: A cross-sectional study was conducted on a sample of 1148 mother-child dyads aged one to three years between November and December 2018. The sampling process involved a three-stage cluster sampling design using the probability proportionate to size methodology. Anaemia status was determined using haemoglobin level (Hb < 11.0 g/dL). Data were analysed using multivariable logistic regression to estimate adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI) for associated factors. Results: The overall prevalence of anaemia was 76.1% (869/1142). 44.7% (510/1142) and 28.6% (327/1142) had moderate and mild anaemia, respectively. Child aged 12-24 months (aOR: 2.00, 95% CI: 1.26-3.17), not receiving routine immunisation (aOR: 2.62, 95% CI: 1.34-5.10), and maternal anaemia (aOR: 2.15, 95% CI: 1.59-2.90) were significantly associated with anaemia. Conclusion: The prevalence of anaemia among the children in this study was high, and was associated with child age, immunisation status, and maternal anaemia. These findings provide further insight into anaemia as a public health issue at a sub-national level in Indonesia and for development of targeted programmes to address associated risk factors of child anaemia.

A Nomogram With Six Variables Is Useful to Predict the Risk of Acquiring Carbapenem-Resistant Microorganism Infection in ICU Patients

Background

Carbapenem-resistant microorganism (CRO) transmission in the medical setting confers a global threat to public health. However, there is no established risk prediction model for infection due to CRO in ICU patients. This study aimed to develop a nomogram to predict the risk of acquiring CRO infection in patients with the first ICU admission and to determine the length of ICU stay (ICU-LOS) and 28-day survival.

Methods

Patient data were retrieved from the Medical Information Mart for Intensive Care (MIMIC-IV) database based on predetermined inclusion and exclusion criteria. A CRO was defined as a bacterium isolated from any humoral microbial culture that showed insensitivity or resistance to carbapenems. The characteristics of CRO and non-CRO patients in the first ICU admission were compared. Propensity score matching was applied to balance the differences between the CRO and non-CRO cohorts. Kaplan–Meier curves were constructed to determine the 28-day survival rate and ICU-LOS. Furthermore, after randomization of the CRO cohort into the training and validation sets, a predictive nomogram was constructed based on LASSO regression and Logistic regression analysis, and its performance was verified by internal validation.

Results

Overall, 4531 patients who had first ICU admission as recorded in MIMIC-IV were enrolled, 183 (4.04%) of whom were diagnosed with CRO infection. Moreover, CRO infection was independently associated with 28-day survival and ICU-LOS in ICU patients. Parameters eligible for inclusion in this nomogram were male sex, hemoglobin-min, temperature-max, use of a peripherally inserted central catheter line, dialysis treatment, and use of carbapenems. This nomogram showed a better performance as indicated by the area under the receiver operating characteristic curve values of 0.776 (95% confidence interval [CI] 0.667-0.750) and 0.723 (95% CI 0.556-0.855) in the training and validation sets, respectively, in terms of predicting the risk of acquiring CRO infection.

Conclusions

CRO infection was independently associated with ICU-LOS and 28-day survival in patients with first ICU admission. The nomogram showed the best prediction of the risk of acquiring CRO infection in ICU patients. Based on the nomogram-based scoring, we can management the risk factors and guide individualized prevention and control of CRO.

Iron deficiency and biomarkers of inflammation: a 3-year prospective analysis of the DO-HEALTH trial

Background

The longitudinal association between iron deficiency and inflammatory biomarkers levels has not been fully explored among relatively healthy older adults.

Aims

To assess whether iron deficiency at baseline and at any yearly follow-up time point, with or without anemia, was associated with changes from baseline in high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) levels over 3 years.

Methods

This is a post-hoc observational analysis of DO-HEALTH, a double-blind, randomized controlled trial including 2157 European community-dwelling adults age 70+. The outcomes were changes from baseline in hs-CRP and IL-6 levels, measured at 12, 24, and 36 months of follow-up. Iron deficiency was defined by soluble transferrin receptor levels > 28.1 nmol/L and baseline anemia by hemoglobin levels < 130 g/L for men and < 120 g/L for women.

Results

In total, 2141 participants were included in the analyses (mean age: 74.9 years, 61.5% of women, 26.8% with iron deficiency). Baseline iron deficiency was associated with greater increase in IL-6 levels (mean difference in change: 0.52 ng/L, 95%CI 0.03–1.00, P = .04) over 3 years. Iron deficiency at any yearly time point was associated with higher increases in hs-CRP (mean difference in change: 1.62 mg/L, 95%CI 0.98–2.26, P < .001) and IL-6 levels (mean difference in change: 1.33 ng/L, 95%CI 0.87–1.79, P < .001) over 3 years. No significant interaction between iron deficiency and anemia was found, suggesting that the results are independent of the anemic status.

Conclusions

These findings suggest that iron deficiency may play a role in low-grade chronic inflammation among relatively healthy older adults.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-01955-3.

History of anemia and long-term mortality due to infection: a cohort study with 12 years follow-up in South Korea

BACKGROUND

Anemia, which is a condition with reduced healthy red blood cells, is reported to be closely related to the development of infectious diseases. We aimed to investigate the association between history of anemia and 12-year mortality rate due to infections, and compare it with that among non-anemic individuals.

METHODS

Data from the National Health Insurance Service Health Screening Cohort were used in this population-based cohort study. Adults who underwent standardized medical examination between and 2002-2003 were included, and the mortality rate due to infection between 2004 and 2015 was analyzed. Individuals were considered to have a history of anemia if the serum hemoglobin level in 2002-2003 was < 12 g/dL for women and < 13 g/dL for men. The severity of anemia at that time was categorized as mild (12 g/dL > hemoglobin ≥11 g/dL in women and 13 g/dL > hemoglobin ≥11 g/dL in men), moderate (hemoglobin 8-10.9 g/dL), or severe (hemoglobin < 8 g/dL). Propensity score (PS) matching and Cox regression analysis were used as statistical methods.

RESULTS

Overall, 512,905 individuals were included in this study. The mean age of the participants was 54.5 years old (range: 40-98), and 49,042 (9.6%) individuals were classified in the anemic group, which comprised of 36,383 (7.1%), 11,787 (2.3%), and 872 (0.2%) participants in the mild, moderate, and severe sub-groups, respectively. After PS matching, 49,039 individuals in each group were included in the analysis. The risk of mortality due to infection in the anemic group was 1.77-fold higher (hazard ratio [HR]: 1.77, 95% confidence interval [CI]: 1.52-2.60; P < 0.001) than that in the non-anemic group. In the subgroup analysis, the mild and moderate anemia groups had 1.38-fold (HR: 1.38, 95% CI: 1.23 to 1.55; P < 0.001) and 2.02-fold (HR: 2.02, 95% CI: 1.62 to 2.50; P < 0.001) risk of mortality due to infection compared to that of the non-anemic group, respectively. The severe anemia group did not have a significantly different risk of mortality due to infection (P = 0.448).

CONCLUSIONS

History of anemia was associated with increased mortality rate due to infection at 12-year follow-up.

Ironing out mechanisms of iron homeostasis and disorders of iron deficiency

Iron plays an important role in mammalian physiological processes. It is a critical component for the function of many proteins, including enzymes that require heme and iron-sulfur clusters. However, excess iron is also detrimental because of its ability to catalyze the formation of reactive oxygen species. As a result, cellular and systemic iron levels are tightly regulated to prevent oxidative damage. Iron deficiency can lead to a number of pathological conditions, the most prominent being anemia. Iron deficiency should be corrected to improve adult patients' symptoms and to facilitate normal growth during fetal development and childhood. However, inappropriate use of intravenous iron in chronic conditions, such as cancer and heart failure, in the absence of clear iron deficiency can lead to unwanted side effects. Thus, this form of therapy should be reserved for certain patients who cannot tolerate oral iron and need rapid iron replenishment. Here, we will review cellular and systemic iron homeostasis and will discuss complications of iron deficiency.

Nutritional status, diet and viral respiratory infections: perspectives for severe acute respiratory syndrome coronavirus 2

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was recognised by the WHO as a pandemic in 2020. Host preparation to combat the virus is an important strategy to avoid COVID-19 severity. Thus, the relationship between eating habits, nutritional status and their effects on the immune response and further implications in viral respiratory infections is an important topic discussed in this review. Malnutrition causes the most diverse alterations in the immune system, suppressing of the immune response and increasing the susceptibility to infections such as SARS-CoV-2. On the other hand, obesity induces low-grade chronic inflammation caused by excess adiposity, which increases angiotensin-converting enzyme 2. It decreases the immune response favouring SARS-CoV-2 virulence and promoting respiratory distress syndrome. The present review highlights the importance of food choices considering their inflammatory effects, consequently increasing the viral susceptibility observed in malnutrition and obesity. Healthy eating habits, micronutrients, bioactive compounds and probiotics are strategies for COVID-19 prevention. Therefore, a diversified and balanced diet can contribute to the improvement of the immune response to viral infections such as COVID-19.

Prevalence and determinants of severity levels of anemia among children aged 6-59 months in sub-Saharan Africa: A multilevel ordinal logistic regression analysis

BACKGROUND

Anemia is a major public health problem affecting more than half of children under the age of five globally. It has serious short- and long-term consequences including growth retardation, impaired motor and cognitive development, and increased morbidity and mortality. Despite anemia is the leading cause of child mortality in sub-Saharan Africa, there is limited evidence on the prevalence and determinants of anemia among under-five children in sub-Saharan Africa. Therefore, this study aimed to investigate the prevalence and determinants of severity levels of anemia among children aged 6-59 months in sub-Saharan Africa.

METHODS

This study was based on the most recent Demographic and Health Survey (DHS) data of 32 sub-Saharan African countries. A total weighted sample of 135,619 children aged 6-59 months was included in the study. Considering the hierarchical nature of DHS data and the ordinal nature of anemia, a multilevel ordinal logistic regression model was applied. Proportional odds assumption was tested by Brant test and it was satisfied (p-value = 0.091). Besides, deviance was used for model comparison. Variables with a p-value ≤0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel proportional odds model, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported for potential determinant factors of severity levels of anemia.

RESULTS

The overall prevalence of anemia among children aged 6-59 months in sub-Saharan Africa was 64.1% [95% CI: 63.9%, 64.4%]. Of which, 26.2% were mildly anemic, 34.9% moderately anemic and 3% severely anemic. Poor maternal education, lower household wealth status, large family size, being male child, multiple births, having fever in the last two weeks, having diarrhea in the last two weeks, higher-order birth, maternal anemia, underweight, wasted, and stunted were significantly associated with increased odds of higher levels of anemia. Whereas, being 24-59 months age, taking drugs for an intestinal parasite, and born from mothers aged ≥ 20 years were significantly associated with lower odds of higher levels of anemia.

CONCLUSION

Severity levels of anemia among children aged 6-59 months in sub-Saharan Africa was a major public health problem. Enhancing maternal education, providing drugs for an intestinal parasite, designing interventions that address maternal anemia, febrile illness, and diarrheal disease, and strengthening the economic status of the family are recommended to reduce childhood anemia. Furthermore, it is better to strengthen the strategies of early detection and management of stunted, wasted, and underweight children to decrease childhood anemia.

Iron Deficiency and Recovery in Yeast: A Quantitative Proteomics Approach

Iron is an essential element for life, as it is critical for oxygen transport, cellular respiration, DNA synthesis, and metabolism. Disruptions in iron metabolism have been associated with several complex diseases like diabetes, cancer, infection susceptibility, neurodegeneration, and others; however, the molecular mechanisms linking iron metabolism with these diseases are not fully understood. A commonly used model to study iron deficiency (ID) is yeast, Saccharomyces cerevisiae. Here, we used quantitative (phospho)proteomics to explore the early (4 and 6 h) and late (12 h) response to ID. We showed that metabolic pathways like the Krebs cycle, amino acid, and ergosterol biosynthesis were affected by ID. In addition, during the late response, several proteins related to the ubiquitin-proteasome system and autophagy were upregulated. We also explored the proteomic changes during a recovery period after 12 h of ID. Several proteins recovered their steady-state levels, but some others, such as cytochromes, did not recover during the time tested. Additionally, we showed that autophagy is active during ID, and some of the degraded proteins during ID can be rescued using KO strains for several key autophagy genes. Our results highlight the complex proteome changes occurring during ID and recovery. This study constitutes a valuable data set for researchers interested in iron biology, offering a temporal proteomic data set for ID, as well as a compendium the proteomic changes associated with episodes of iron recovery.

Improving the safety of intravenous iron treatments for patients with chronic kidney disease

Introduction: Iron-deficiency anemia in chronic kidney disease (CKD) is common and has prognostic, financial, and quality of life implications. Intravenous (IV) iron is a key intervention for optimal management, however, ongoing safety concerns exist. Area covered: The potential side effects associated with IV iron use are addressed as we review the most recent studies. Hypersensitivity reactions and true anaphylaxis are indeed rare with a greater understanding of the nature of labile iron and 'Fishbane' reactions. Hypophosphatemia appears commoner with certain IV iron preparations, however its significance in CKD requires exploration. The long-standing questions regarding oxidative stress and the potential susceptibility to infections and worsening cardiovascular morbidity are discussed. Iron overload secondary to repeat IV iron infusions is plausible, however, a number of guidelines limit and strictly guide prescription. Expert opinion: The past decade has improved our understanding of IV iron administration safety in patients with CKD. Third generation IV iron compounds have minimized hypersensitivity reactions while allowing high doses to be administered safely and rapidly in non-dialysis-dependent CKD patients. However, differences in safety profiles such as hypophosphatemia require further study and therapy should be tailored to the individual. Clinicians should feel confident in using IV iron therapy.

The pathogenesis of CKD complications; Attack of dysregulated iron and phosphate metabolism

Chronic kidney disease (CKD) patients have a tremendously higher risk of developing cardiovascular disease (CVD) and infection than the non-CKD population, which could be caused by intertwining actions of hyperphosphatemia and CKD associated misdistribution of iron. CVD is often associated with vascular calcification, which has been attributed to hyperphosphatemia, and could be initiated in mitochondria, inducing apoptosis, and accelerated by reactive oxygen species (ROS). The production of ROS is principally linked to intracellular ferrous iron. For infection, the virulence and pathogenicity of a pathogen is directly related to its capacity to acquire iron for proliferation and to escape or subvert the host's immune response. Iron administration for renal anemia can sometimes be overdosed, which could decrease host immune mechanisms through its direct effect on neutrophils, macrophages and T cell function. Hyperphosphatemia has been demonstrated to be associated with an increased incidence of infection. We hypothesized two possible mechanisms: 1) fibroblast growth factor-23 levels are increased in parallel with serum phosphate levels and directly impair leukocyte recruitment and host defense mechanisms, and 2) circulating non-transferrin-bound iron (NTBI) is increased due to decreased iron binding capacity of the carrier protein transferrin in high-phosphate conditions. From these observations, maintaining an adequate serum range of phosphate levels and minimizing intracellular iron accumulation could attenuate the development of CKD complications.

Comparison of pathological clotting using haematological, functional and morphological investigations in HIV-positive and HIV-negative patients with deep vein thrombosis

BACKGROUND

Patients infected with the human immunodeficiency virus (HIV) are more prone to systemic inflammation and pathological clotting, and many may develop deep vein thrombosis (DVT) as a result of this dysregulated inflammatory profile. Coagulation tests are not routinely performed unless there is a specific reason.

METHODS

We recruited ten healthy control subjects, 35 HIV negative patients with deep vein thrombosis (HIV negative-DVT), and 13 HIV patients with DVT (HIV positive-DVT) on the primary antiretroviral therapy (ARV) regimen-emtricitabine, tenofovir and efavirenz. Serum inflammatory markers, haematological results, viscoelastic properties using thromboelastography (TEG) and scanning electron microscopy (SEM) of whole blood (WB) were used to compare the groups.

RESULTS

The DVT patients (HIV positive and HIV negative) had raised inflammatory markers. The HIV positive-DVT group had anaemia in keeping with anaemia of chronic disorders. DVT patients had a hypercoagulable profile on the TEG but no significant difference between HIV negative-DVT and HIV positive-DVT groups. The TEG analysis compared well and supported our ultrastructural results. Scanning electron microscopy of DVT patient's red blood cells (RBCs) and platelets demonstrated inflammatory changes including abnormal cell shapes, irregular membranes and microparticle formation. All the ultrastructural changes were more prominent in the HIV positive-DVT patients.

CONCLUSIONS

Although there were trends that HIV-positive patients were more hypercoagulable on functional tests (viscoelastic profile) compared to HIV-negative patients, there were no significant differences between the 2 groups. The sample size was, however, small in number. Morphologically there were inflammatory changes in patients with DVT. These ultrastructural changes, specifically with regard to platelets, appear more pronounced in HIV-positive patients which may contribute to increased risk for hypercoagulability and deep vein thrombosis.

The Effect of Abnormal Iron Metabolism on Osteoporosis

Iron is one of the important trace elements in life activities. Abnormal iron metabolism increases the incidence of many skeletal diseases, especially for osteoporosis. Iron metabolism plays a key role in the bone homeostasis. Disturbance of iron metabolism not only promotes osteoclast differentiation and apoptosis of osteoblasts but also inhibits proliferation and differentiation of osteoblasts, which eventually destroys the balance of bone remodeling. The strength and density of bone can be weakened by the disordered iron metabolism, which increases the incidence of osteoporosis. Clinically, compounds or drugs that regulate iron metabolism are used for the treatment of osteoporosis. The goal of this review summarizes the new progress on the effect of iron overload or deficiency on osteoporosis and the mechanism of disordered iron metabolism on osteoporosis. Explaining the relationship of iron metabolism with osteoporosis may provide ideas for clinical treatment and development of new drugs.

Prevalence of surgical site infection and its associated factors after cesarean section in Ethiopia: systematic review and meta-analysis

BACKGROUND

Surgical site infection (SSI) affects nearly one third of patients who have undergone a surgical procedure. It is a significant and substantial cause of surgical patient morbidity and mortality later with human and financial costs threat. There are fragmented and pocket studies which reported the prevalence of SSI among mothers who experienced for cesarean section and its risk factors. However, there is no any solid evidence established at the national level; which was also the interest of the authors to fill this gap. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of SSI after cesarean section and its associated factors at national level.

METHODS

Original articles were searched in PubMed, MEDLINE, EMBASE, CINAHL, Google Scholar, HINARI portal, and Cochrane Library. All observational studies defined outcome of variable "SSI as infection related to an operation procedure that occur at or near surgical incision within 30 days of operation or after one year if an implant is placed" were considered. Data were extracted using standard data extraction excel spread sheet checklists developed according to 2014 Joanna Briggs Institute Reviewers' Manual after the quality was assessed through Newcastle-Ottawa quality assessment scale. The I² statistic was used to quantify heterogeneity across studies. Funnel plot asymmetry and Egger's tests were used to check for publication bias. A fixed effect model was used to estimate the pooled prevalence of SSI. Odds Ratio (OR) with 95% Confidence Interval (CI) was also considered to determine the association of identified variables with SSI. Statistical analysis was conducted using STATA version 14 software.

RESULT

From initial 179 identified articles, 11 were eligible for inclusion in the final systematic review and meta-analysis. Studies with a score of 6 and above were included for final analysis. All included studies were institutional based cross sectional. The pooled estimate of SSI after cesarean section in Ethiopia was 9.72% (95%CI: 8.38, 11.05). Premature rapture of membrane (PROM) > 12 h (OR = 5.32, 95%CI: 3.61, 7.83), duration of labor> 24 h (OR = 3.67, 95%CI: 2.45, 5.48), chorioamnionitis (OR = 9.11, 95%CI: 5.21, 15.93), anemia (OR = 4.56, 95%CI: 2.88, 7.22) and having vertical skin incision (OR = 4.17, 95%CI: 2.90, 6.02) had increased odds of developing SSI after cesarean section.

CONCLUSION

The prevalence of SSI after cesarean section in Ethiopia was high compared with the sphere standards of communicable disease control (CDC) guidelines for SSI after cesarean section. Therefore, Ministry of Health with its stake holders should give special emphasis on community and institution based programs in manner to prevent prolonged labor, PROM, chorioamnionitis and anemia which will also have synergistic impact on SSI after cesarean section. Moreover, there is also a call to health professionals not to use vertical incision as primary option of cesarean section to reduce the risk of developing surgical site infection among mothers.

Comparison of Oral and Parenteral Iron Administration on Iron Homeostasis, Oxidative and Immune Status in Anemic Neonatal Pigs

The present study was to evaluate the consequences of iron status across oral and parenteral iron administrations in prevention of iron deficiency anemia. A total of 24 one-day-old male neonatal piglets were allocated into three groups given non-iron supplementation (NON), intramuscular iron dextran injection (FeDex), and oral administration of ferrous glycine chelate (FeGly), respectively. At day 8, no significant differences in final body weight, average weight gain, and tissue coefficients were observed among three groups (P > 0.05). Both oral FeGly and FeDex injection significantly increased serum iron, ferritin, hemoglobin, and tissue iron deposition (P < 0.05). However, FeDex-injected supplementation resulted in rapidly rising hepcidin levels and hepatic iron deposition (P < 0.05). In addition, compared to parenteral iron supplementation, greater serum IgA level, SOD, and GSH-Px activities, lower expressions of IL-1β and TNF-α in the liver, and lower expressions of IL-6 and TNF-α in the spleen were found in oral iron piglets (P < 0.05). According to our results, oral administration of ferrous glycine chelate improved iron homeostasis, and oxidative and immune status in anemic neonatal pigs.

Influence of Dietary Advice Including Green Vegetables, Beef, and Whole Dairy Products on Recurrent Upper Respiratory Tract Infections in Children: A Randomized Controlled Trial

Background: Since no treatment exists for children suffering from upper respiratory tract infections (URTIs) without immunological disorders, we searched for a possible tool to improve the health of these children. Aim: We evaluated whether dietary advice (based on food matrix and food synergy), including standard supportive care, can decrease the number and duration of URTIs in children with recurrent URTIs. Design and Setting: This study was a multicenter randomized controlled trial in two pediatric outpatient clinics in the Netherlands, with 118 children aged one to four years with recurrent URTIs. The dietary advice group received dietary advice plus standard supportive care, while the control group received standard supportive care alone for six months. The dietary advice consisted of green vegetables five times per week, beef three times per week, 300 mL whole milk per day, and whole dairy butter on bread every day. Portion sizes were age-appropriate. Results and Conclusion: Children in the dietary advice group had 4.8 (1.6–9.5) days per month with symptoms of an URTI in the last three months of the study, compared to 7.7 (4.0–12.3) in the control group (p = 0.028). The total number of URTIs during the six-month study period was 5.7 (±0.55) versus 6.8 (±0.49), respectively (p = 0.068). The use of antibiotics was significantly reduced in the dietary advice group, as well as visits to a general practitioner, thereby possibly reducing healthcare costs. The results show a reduced number of days with symptoms of a URTI following dietary advice. The number of infections was not significantly reduced.

Microbial Metabolite Signaling Is Required for Systemic Iron Homeostasis

Iron is a central micronutrient needed by all living organisms. Competition for iron in the intestinal tract is essential for the maintenance of indigenous microbial populations and for host health. How symbiotic relationships between hosts and native microbes persist during times of iron limitation is unclear. Here, we demonstrate that indigenous bacteria possess an iron-dependent mechanism that inhibits host iron transport and storage. Using a high-throughput screen of microbial metabolites, we found that gut microbiota produce metabolites that suppress hypoxia-inducible factor 2α (HIF-2α) a master transcription factor of intestinal iron absorption and increase the iron-storage protein ferritin, resulting in decreased intestinal iron absorption by the host. We identified 1,3-diaminopropane (DAP) and reuterin as inhibitors of HIF-2α via inhibition of heterodimerization. DAP and reuterin effectively ameliorated systemic iron overload. This work provides evidence of intestine-microbiota metabolic crosstalk that is essential for systemic iron homeostasis.

Study of release kinetics and degradation thermodynamics of ferric citrate liposomes

Ferric citrate liposome (FAC-Lip) with good sustained-released property was prepared by the rotary-evaporated film-ultrasonic method, and characterized by TEM, DLS, zeta potential and encapsulation efficiency (EE%). The effects of membrane material ratios (m_PC: m_chol = 8:1, 10:1 and 12:1) and drug lipid ratios (m_FAC: m_PC = 1:4, 1:6.5 and 1:8) on the release of FAC-Lip were examined. The in vitro release kinetic models and mechanisms of FAC-Lip in artificial gastric juice (SGF) and artificial intestinal juice (SIF) compared with free-FAC were determined. The thermal degradation in PBS was also determined. The results showed that FAC-Lip with membrane material ratio (10:1) and drug lipid ratio (1:6.5) had the optimal sustained-released property, unilamellar vesicles with uniform size (178 ± 2.12 nm), negative charge (-56 ± 3.51 mV) and high encapsulation efficiency (72.77 ± 0.42%). The in vitro release kinetic models of FAC-Lip were two-phase kinetics model and the release mechanisms were non-Fick diffusion both in SGF and SIF. The thermal degradation of FAC-Lip was an endothermic and spontaneous reaction. The results may be helpful in optimizing drug-liposome design, application in food and medicine industries, and furthermore, predicting and guiding medication in vivo.

Cruz PC, Borromeo TH, Lalusin A, Hernandez JE, Acuin C, Reinke R, Swamy BPM. Zinc and Iron Nutrition Status in the Philippines Population and Local Soils

The Philippines is one of the major rice-producing and rice-consuming countries of Asia. A large portion of its population depends on rice for their daily caloric intake and nutritional needs. The lack of dietary diversity among poor communities has led to nutritional consequences, particularly micronutrient deficiencies. Iron-deficiency anemia (IDA) and zinc deficiency (ZnD) are two serious nutritional problems that affect the health and economic sector of the country. Since rice dominates the Filipino diet by default, biofortification of rice will help improve the micronutrient status. The Philippine government has proactively initiated various programs and policies to address micronutrient deficiencies, particularly through fortification of basic food commodities. Biofortification, the fortification of rice with micronutrients through breeding, is considered the most sustainable and cost-effective strategy that can benefit large vulnerable populations. However, developing promising genotypes with micronutrient-enriched grains should be coupled with improving micronutrient bioavailability in the soil in order to optimize biofortification. This review documents the prevailing soil Zn-deficiency problems in the major rice production areas in the Philippines that may influence the Zn nutritional status of the population. The article also reports on the biofortification efforts that have resulted in the development of two biofortified varieties approved for commercial release in the Philippines. As nutritional security is increasingly recognized as a priority area, greater efforts are required to develop biofortified rice varieties that suit both farmers' and consumers' preferences, and that can address these critical needs for human health in a sustainable and cost-effective manner.

Effects of delayed cord clamping on infants after neonatal period: A systematic review and meta-analysis

BACKGROUND

The majority of current evidences simply showed the short-term benefits of delayed cord clamping, mainly focusing on the first week after birth. Without follow-up data, we can hardly come to the conclusion that delayed cord clamping may do more harm than good.

OBJECTIVE

To evaluate the long-term effects of delayed cord clamping compared with early cord clamping on infants after neonatal period.

DESIGN

Systematic review and meta-analysis of randomized controlled trials (RCTs).

DATA SOURCES

PubMed, EMBASE, and the Cochrane Library were systematically searched from inception date to June 22, 2018 for randomized clinical trials comparing early cord clamping with delayed cord clamping in infants beyond 1 month of age.

REVIEW METHODS

Two reviewers independently assessed trial eligibility and quality and extracted all infants' follow-up data after one month of age, which were divided into two groups for analysis, with follow-up periods of less than 6 months (<6 months) and beyond 6 months (≥6 months) respectively.

RESULTS

A total of twenty RCTs were identified and included in this study. All data of the twenty studies were pooled for final meta-analysis (3733 infants). Among preterm deliveries, delayed cord clamping slightly increased hematocrit (6-10 weeks) and serum ferritin (6-10 weeks). For term infants, delayed cord clamping reduced the incidence of anemia after six months of age (≥6 months), iron deficiency (< 6 months, ≥6 months) and iron deficiency anemia (4-12 months), while increased mean corpuscular volume before six months of age (< 6 months), hemoglobin after six months of age (≥6 months), serum iron (2-4 months), total body iron (4-6 months), serum ferritin (< 6 months, ≥6 months) and transferrin saturation (2-12 months). There were no significant differences between early versus late cord clamping groups for other variables.

CONCLUSION

Delayed cord clamping modestly improved hematological and iron status of both preterm and term infants after neonatal period. This affords cogent evidence on the practice of delayed cord clamping for medical staff, especially for countries and regions suffering from relatively higher prevalence rate of iron deficiency during infancy and childhood.

Malaria causes long-term effects on markers of iron status in children: a critical assessment of existing clinical and epidemiological tools

Background

Most epidemiological studies on the interplay between iron deficiency and malaria risk classify individuals as iron-deficient or iron-replete based on inflammation-dependent iron markers and adjustment for inflammation by using C-reactive protein (CRP) or α-1-acid glycoprotein (AGP). The validity of this approach and the usefulness of fibroblast growth factor 23 (FGF23) as a proposed inflammation-independent iron marker were tested.

Methods

Conventional iron markers and FGF23 were measured in children with acute falciparum malaria and after 1, 2, 4, and 6 weeks. Children, who were transfused or received iron supplementation in the follow-up period, were excluded, and iron stores were considered to be stable throughout. Ferritin levels 6 weeks after admission were used as a reference for admission iron status and compared with iron markers at different time points.

Results

There were long-term perturbations in iron markers during convalescence from acute malaria. None of the tested iron parameters, including FGF23, were independent of inflammation. CRP and AGP normalized faster than ferritin after malaria episodes.

Conclusion

Malaria may bias epidemiological studies based on inflammation-dependent iron markers. Better markers of iron status during and after inflammation are needed in order to test strategies for iron supplementation in populations at risk of malaria.

Hepcidin mediated iron homoeostasis as immune regulator in visceral leishmaniasis patients

AIM

Iron is key ingredient for immunosurveillance and host-pathogen interaction. Intracellular pathogen steals the iron from the host, but how parasite orchestrates iron acquisition and affects immune responses remains controversial. We aimed to study the iron homoeostasis in visceral leishmaniasis (VL) and its influence on immune machinery.

METHODS AND RESULTS

This study was performed on purified monocytes and T cells, peripheral blood mononuclear cells and splenic aspirates for transcriptional analyses of iron homoeostasis (hepcidin, DMT1, transferrin receptor, ferroportin) and immune modulations (IFN-γ, HLA-DR, IL-10, iNOS, IL-6). Serum/plasma was used for determination of iron, total/transferrin iron-binding capacity and anti-leishmania antibody titres in cases. We report that VL-induced perturbation in iron homoeostasis may cause immune dysfunctions. VL cases had decreased iron uptake by transferrin-dependent and transferrin-independent routes while elevated hepcidin, degraded sole iron exporter ferroportin. Therefore, it appears that perturbation in iron homoeostasis has essential role in HLA-DR mediated antigen presentation and innate armoury by downregulating iNOS as well as altering IFN-γ, IL-6 and IL-10 profiles.

CONCLUSION

The iron homoeostasis by hepcidin can serve as one of the crucial determinants for regulating immune cell signalling; therefore, targeting iron metabolism, specifically hepcidin alone or in combination with agonists, can serve to clear infection.

Factors associated with anemia in young children in Brazil

BACKGROUND

Anemia is recognized as a major public health problem in childhood, especially in children under 24 months of age. Despite improvements in public health strategies to prevent and control anemia in Brazilian young children in the last decade, few studies have assessed the predictors for this condition in primary health care. Thus, this study aimed to assess the associated factors of anemia in young children who visited primary public health care facilities in Brazil.

METHODS

A cross-sectional study was conducted with 520 children aged 11 to 15 months who visited the primary health care in four Brazilian cities. Anemia was defined as hemoglobin concentration < 110 g/L in venous blood samples. Multilevel Poisson regression models were used to describe the associations between anemia and independent variables.

RESULTS

The frequency of anemia was 23.1%. A higher frequency was observed in children who live with more than one other child younger than 5 years in the house (Prevalence Ratio [PR] 1.47; 95% Confidence Interval [CI] 1.01-2.14), who started to receive fruits and vegetables after 8 months of age (PR 1.92; 95% CI 1.19-3.10), who were stunted (PR 2.44; 95% CI 1.32-4.50), who were hospitalized at least once in their life (PR 1.55; 95% CI 1.03-2.33) and who were in the lower tertile of serum folate concentration (PR 2.24; 95% CI 1.30-3.85).

CONCLUSIONS

Inadequate complementary feeding practices and morbidity were the main predictors for anemia in early childhood in this population. Improvements in current strategies to promote healthy complementary feeding along with better control of morbidities are recommended to reduce anemia in Brazilian young children.

Modulation of Iron Metabolism in Response to Infection: Twists for All Tastes

Iron is an essential nutrient for almost all living organisms, but is not easily made available. Hosts and pathogens engage in a fight for the metal during an infection, leading to major alterations in the host’s iron metabolism. Important pathological consequences can emerge from the mentioned interaction, including anemia. Several recent reports have highlighted the alterations in iron metabolism caused by different types of infection, and several possible therapeutic strategies emerge, based on the targeting of the host’s iron metabolism. Here, we review the most recent literature on iron metabolism alterations that are induced by infection, the consequent development of anemia, and the potential therapeutic approaches to modulate iron metabolism in order to correct iron-related pathologies and control the ongoing infection.

Association of iron status with the risk of bloodstream infections: results from the prospective population-based HUNT Study in Norway

PURPOSE

As iron is essential for both immune function and microbial growth, alterations in iron status could influence the risk of infections. We assessed the associations of iron status with risk of bloodstream infections (BSIs) and BSI mortality.

METHODS

We measured serum iron, transferrin saturation (Tsat) and total iron-binding capacity (TIBC) in 61,852 participants in the population-based HUNT2 study (1995-97). Incident BSIs (1995-2011) were identified through linkage with the Mid-Norway Sepsis Register, which includes prospectively registered information on BSI from local and regional hospitals. We assessed the risk of a first-time BSI and BSI mortality with the iron indices using Cox proportional hazards regression analysis.

RESULTS

During a median follow-up of 14.8 years, 1738 individuals experienced at least one episode of BSI, and 370 died within 30 days after a BSI. In age- and sex-adjusted analyses, BSI risk was increased among participants with indices of iron deficiency, serum iron ≤ 2.5th percentile (HR 1.72, 95% CI 1.34-2.21), Tsat ≤ 2.5th percentile (HR 1.48, 95% CI 1.12-1.96) or TIBC ≥ 97.5th percentile (HR 1.46, 95% CI 1.06-2.01). The associations remained similar after adjusting for comorbidities and exclusion of BSI related to cancer, rheumatic illnesses and inflammatory bowel disease. BSI mortality showed similar associations.

CONCLUSION

Indices of severe iron deficiency are associated with an increased risk of a future BSI.

Iron status and anaemia in Sri Lankan secondary school children: A cross-sectional survey

BACKGROUND

Iron deficiency, the most common micronutrient disorder and cause of anaemia globally, impairs growth, cognition, behaviour and resistance to infection.

METHODS/RESULTS

As part of a national survey of inherited haemoglobin variants in 7526 students from 72 secondary schools purposefully selected from the 25 districts of Sri Lanka, we studied 5912 students with a normal haemoglobin genotype. Median age was 16.0 (IQR 15.0-17.0) years and 3189 (53.9%) students were males. Most students were Sinhalese (65.7%), with fewer Tamils (23.1%) and Muslims (11.2%). Anaemia occurred in 470 students and was more common in females (11.1%) than males (5.6%). Haemoglobin, serum ferritin, transferrin receptor and iron were determined in 1196 students with low red cell indices and a structured sample of those with normal red cell indices (n = 513). The findings were weighted to estimate the frequencies of iron deficiency and iron deficiency anaemia classified according to WHO criteria. Iron depletion (serum ferritin <15ug/ml) occurred in 19.2% and cellular iron deficiency (low serum ferritin and transferrin receptor >28.1 nmol/l) in 11.6% students. Iron deficiency anaemia (cellular iron deficiency with low haemoglobin) occurred in only 130/2794 (4.6%) females and 28/2789 (1.0%) males. Iron biomarkers were normal in 83/470 (14.6%) students with anaemia. In multiple regression analysis, the odds for iron depletion and cellular iron deficiency were about one-third in males compared with females, and the odds for iron deficiency anaemia were about one fifth in males compared to females. Tamil ethnicity and age <16 years increased the risk of all three stages of iron deficiency and living at high altitude significantly reduced the risk of iron depletion.

CONCLUSIONS

Low iron status and anaemia remain common problems in Sri Lankan secondary school students especially females, younger students and the socioeconomically disadvantaged Tamil population. More research is needed to identify factors other than low iron status that contribute to anaemia in adolescents.